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lecture notes chap 6,7,8,10.docx

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Konstantine Zakzanis

Lecture 6- Eating Disorders -much more common since 1980 with the rise of commercialization -aneroxia nervosa- loss of appetite -begins teenage years, after some stress event or dieting -more in women -diagnosis on 4 criteria: refusal to maintain body weight= less than 85% of considered normal for age and height. Intense fear of gaining weight and not reduced by weight loss. Distorted sense of body shape. Loss of menstrual cycle in women (least important criteria) -2 types of AN= 1)Restricted type: patient achieves by starving, restricting coloric intake 2)binge eating-purging: achieve by binging-purging. Vomit, lexatives and exercise. More psychopathology, resisant to treatment -AN takes 6-7 yrs to recover and 70% recover otherwise outcome is death from starvation Bulimia -binge and purge but not less than 85% of normal weight -recurrent episodes of binge eating -binge eating is enormous amounts of food consumed in less than 2 hours. Occurs secretely and triggered by stress -patients describe it as dissociative experiences -after binge feel disgust and fear of weight gain then plurge to undo -2 types: purging- vomit and non purging types- excessive exercise, lexatives or limit caloric intake Binge Eating disorders -recurrent binges 2 times a week for 6 months -lack of control, stress, alone eating -no purging behavior Medical complications Biological and socio-cultural factors -Family systems theory- Munichin- IMPORTANT -symptoms of eating disorder are best understood by understanding about the patient and how the symptoms are embedded in the dysfunctional family structure. Plays important role in helping the family avoid conflicts reinforcing non eating behavior -patients are incredibly stubborn to treat -90% are not in treatment and when they do they are at death door step -first step is to making them gain weight -antidepressants- helps people with bulimia not anorexia Somatoform Disorders & Dissociative disorders -Somatoform are very common, dissociative are very rare b/c psychological factors are important in development and maintainance of both -Somatoform disorders 1) Pain disorders -psych factors onset and maintaining pain -diagnose with psych factors or medical or both -pain is biopsychosocial concept- no objective way to diagnose -result in stress and disability to be diagnosed -occupational social dysfunction -comorbid diagnos mostly- results in disability or creates additional problem. Ex: substance abuse and pain disorder comorbidity -has temporal relation to some stressful event -iotergenic disability develops – over the course of disorder. Individual avoids unpleasant activities to secure attention and sympathy. Differentiate from malingering -patients describe generalized pain -acute=less than 6 months, chronic= more than 6 months -cant be diagnosed with solely psych or medical conditions Body dysmorphic disorder: imagined or exaggerated defects in physical appearance -gender difference -result in stress and disability -comorbid with social phobia- agarophobia, depression, eating disorders, thought of suicides, substance abuse, personality disorder mainly borderline personality disorders. Cannot have narcisst personality disorder. Case of elephant man Hypochondriasis -preoccupation of fear of having illness -5% population suffer from any hypochondriases state -age of onset early adulthood Somatization disorder -long history of recurrent multiple somatic complaints without any physical cause -individual seeks multiple medical -4 criteria- -result in impairment and disability -comodbidity in anxiety and mood disorders, substance abuse -lifetime prevalence 0.5, more common in women -onset is adulthood -different from conversion b/c symptoms of conversion are limited to neurological Conversion -sudden loss of vision, paralysis, tingling ssensations, insensitivity to pain -neurological complain -phonia: loss of voice, anosmia:loss of smell -psychologically caused Malingering: different from facticious disorder -difference: in malingering the complaints are consciously produced, under voluntary control. Fabricated for external incentive. In factitious the person reports the same symptoms, under unconscious control , lack of incentives -take on the role of sick person resulting in attention and sympathy -factitous disorders sometimes called munchausen syndrome or by proxy, or la belle indifference Dissociative disorder -incredibly rare based on case studies not a lot of experimental studies Dissociative amnesia: unable to recall important personal information, occurs after a stressful episode and the episode thereafter where they cant remember. Time walked Interrogate- cant remember after the event (dissociative amnesia) and retrograde amnesia( not dissociative amnesia)- cant remember before the event -difficult to distinguish from true memory loss which is not sudden but slowly progressive -psych factors cause and maintain dissociative amnesia. Case of the Sailor. Dissosiative fugue -more rare -person suddenly leaves home and creates a new identity -memory loss is expansive, retrograde loss ass well -recovery is usually complete -no recollection of what they’ve done while in fugue -stressor in life -case of Burt Tale Dissociative identity disorder -atleast 2 separate ego states or alters that exist independent of each other -atleast 1 alter has control (aware of all personalities) one main alter state -cause disability, distress -typically long lasting sometim
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