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Chapter 9 Practice Exam Questions

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Konstantine Zakzanis

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Chapter 9-Eating Disorders [LEARNING GOALS] 1. Be able to distinguish the symptoms associated with anorexia, bulimia, and binge eating disorder and to be able to distinguish among the different eating disorders. 2. Be able to describe the neurobiological, sociocultural, and psychological factors implicated in the etiology of eating disorders. 3. Be able to discuss the issues surrounding the growing epidemic of obesity in the United States. 4. Be able to describe the methods of treatment for eating disorders and the evidence supporting their effectiveness. Summary Clinical Descriptions • The two main eating disorders are anorexia nervosa and bulimia nervosa. Binge eating disorder is being studied for possible inclusion in the DSM-IV. The symptoms of anorexia nervosa include refusal to maintain normal body weight, an intense fear of being fat, a distorted sense of body shape, and, in women, amenorrhea. Anorexia typically begins in the mid-teens, is ten times more frequent in women than in men, and is comorbid with several other disorders, notably depression. Its course is not favorable, and it can be life threatening. The symptoms of bulimia nervosa include episodes of binge eating followed by purging, fear of being fat, and a distorted body image. Like anorexia, bulimia begins in adolescence, is much more frequent in women than in men, and is comorbid with other diagnoses, such as depression. Prognosis is somewhat more favorable than for anorexia. Etiology • Research on the eating disorders has examined genetics and brain mechanisms. Evidence is consistent with a possible genetic diathesis. Endogenous opioids and serotonin, both of which play a role in mediating hunger and satiety, have been examined in eating disorders. Low levels of both these brain chemicals have been found in such patients, but evidence that these cause eating disorders is limited. Dopamine is also involved with eating, but its role in eating disorders has been studied less. • As sociocultural standards changed to favor a thinner shape as the ideal for women, the frequency of eating disorders increased. The objectification of women’s bodies also exerts pressure for women to see themselves through a sociocultural lens. The prevalence of eating disorders is higher in industrialized countries, where the cultural pressure to be thin is strongest. White women tend to have greater body dissatisfaction and general eating disturbances than African American women, though the prevalence rates for actual eating disorders are not markedly different between these two ethnic groups. • On a psychological level, several factors play important roles. Psychodynamic theories of eating disorders emphasize parent–child relationships and personality characteristics. Research on characteristics of families with an eating-disordered child have yielded different data depending on how the data was collected. Reports of patients show high levels of conflict, but actual observations of the families do not find them especially deviant. Studies of personality have found that patients with eating disorders are high in neuroticism and perfectionism and low in self-esteem. Many women with eating disorders report being abused as children, but early abuse does not appear to be a specific risk factor for eating disorders. • Cognitive behavioral theories of eating disorders propose that fear of being fat and body-image distortion make weight loss a powerful reinforcer. Among patients with bulimia nervosa, negative affect and stress precipitate binges that create anxiety, which is then relieved by purging. Treatment • The main neurobiological treatment of eating disorders is the use of antidepressants. Although somewhat effective, drop-out rates from drug-treatment programs are high, and relapse is common when patients stop taking the medication. Treatment of anorexia often requires hospitalization to reduce the medical complications of the disorder. Providing reinforcers for weight gain, such as visits from friends, has been somewhat successful, but no treatment has yet been shown to produce long-term maintenance of weight gain. • Cognitive behavioral treatment for bulimia focuses on questioning society’s standards for physical attractiveness, challenging beliefs that encourage severe food restriction, and developing normal eating patterns. Outcomes are promising, both in the short and long term. 1. In the DSM-IV, eating disorders are listed as a. disorders beginning in childhood or adolescence. b. somatization disorders. c. psychological factors affecting medical condition. d. a separate diagnostic category. Answer: D Type: Factual Page: 271 2. Individuals with anorexia nervosa a. stop eating because of an abnormal increase in blood sugar, which alters their perceptions of hunger. b. fear gaining weight so much that they stop eating. c. have lost their appetite, leading them to stop eating. d. stop eating but do not lose weight. Answer: B Type: Factual Page: 271 3. A physiological effect of anorexia nervosa is a. growing heavier, darker hair. b. amenorrhea (loss or irregularity of menstrual period). c. high blood pressure. d. All of the above are correct. Answer: B Type: Factual Page: 271 4. Cathy stopped eating meals over two months ago. Now, she eats very little, and only when under some family pressure. She has lost over 22 pounds, and is now about 15% below normal body weight for her height. She probably a. has anorexia, restricting type. b. has anorexia, binge-eating-purging type. c. has bulimia nervosa. d. is also abusing illicit drugs. Answer: A Type: Applied Page: 271 5. As compared to those with the restricting type, people with anorexia nervosa binge- eating-purging type typically have a. more severe overall psychopathology. b. less severe overall psychopathology. c. equally severe overall psychopathology. d. None of the above; no data currently exists regarding differences between the two types of anorexia nervosa. Answer: A Type: Factual Page: 271 6. A result of distorted body image on anorexics can be observed by a. excessive preoccupation with makeup. b. critical evaluation of body areas such as stomach and buttocks. c. frequent questioning of others regarding their appearance. d. checking behaviors designed to ensure that their stomach and buttocks appear smaller than in reality. Answer: B Type: Factual Page: 271 7. Anorexia nervosa in men a. is nonexistent. b. is related to less family conflict than in women. c. is less likely to be fatal than in women. d. although less common, is quite similar to that in women. Answer: D Type: Factual Page: 271 8. There is a close tie between anorexia nervosa and a. depression. b. stealing. c. suicide. d. hypertension. Answer: A Type: Factual Page: 272 9. Regina visits her general practitioner medical doctor. Her weight is 90 pounds although she believes she is overweight. She ‘snacks’ on laxatives, and restricts her eating to one small meal a day, after which she exercises for two hours. Her physical exam is likely to reveal that she has a. lowered heart rate and blood pressure. b. calcium deposits. c. improved muscle tone. d. fibroid tumors. Answer: A Type: Applied Page: 273 10. What is the most likely prognosis for a woman with anorexia nervosa? a. She will regain normal weight as she enters puberty. b. She will develop bulimia nervosa. c. She will enter treatment and maintain normal weight following treatment. d. She will eventually recover, but continue to struggle with the disorder for many years. Answer: D Type: Factual Page: 273 11. The DSM-IV categorizes bulimia nervosa as a. an organic mental disorder. b. psychological factors affecting a medical condition. c. a subtype of anorexia nervosa. d. an eating disorder separate from anorexia nervosa. Answer: D Type: Factual Page: 273 12. The easiest way to distinguish between bulimia and anorexia nervosa is a. bingeing. b. a higher rate of psychological distress. c. pronounced weight loss. d. depression. Answer: C Type: Factual Page: 274 13. Betsy is excessively concerned that she is becoming fat and restricts her eating to avoid such a consequence. She weighs approximately 20% less than normal body weight given her height. At times, she will sit down with her family and eat a full meal, but immediately afterwards takes several laxatives. Betsy most likely a. has anorexia, restricting type. b. has anorexia, binge-eating-purging type. c. has bulimia nervosa. d. has binge-eating disorder. Answer: B Type: Applied Page: 271 14. During binge episodes, many bulimics a. feel a great sense of control. b. experience a feeling of being out of control. c. feel very satisfied. d. None of the above choices are correct. Answer: B Type: Factual Page: 274 15. In bulimia nervosa, binge eating typically a. involves sweets. b. occurs while alone. c. occurs after a negative social interaction. d. All of the above are correct. Answer: D Type: Factual Page: 274 16. Compared to the binge, purging is felt by many bulimics to be a. a source of relief. b. more anxiety- producing. c. more disgusting. d. a source of pride. Answer: A Type: Factual Page: 274 17. The feature common to both anorexia nervosa and bulimia nervosa is a. refusal to maintain normal body weight. b. fear of gaining weight. c. purging to prevent weight gain. d. None of the above is correct. Answer: B Type: Factual Page: 271, 274-275 18. Prior to the onset of bulimia, sufferers often a. have anorexia nervosa. b. are overweight and dieting. c. have attempted suicide. d. have higher than normal levels of serotonin. Answer: B Type: Factual Page: 275 19. Which of the following lists the disorders in order of descending rate of suicide attempts? a. anorexia, bulimia, major depression. b. major depression, bulimia, anorexia. c. anorexia, major depression, bulimia. d. None of the above; all three disorders have comparable rates of suicide attempts. Answer: D Type: Factual Page: 275 20. As compared to anorexia nervosa, the diagnosis of bulimia nervosa has a. higher mortality rates. b. lower mortality rates. c. equal mortality rates. d. None of the above; data on mortality caused by eating disorders does not exist. Answer: B Type: Factual Page: 275 21. Gina has bulimia nervosa. Which of the following factors would worsen her prognosis? a. Having active cocaine abuse. b. Having a history of Major Depressive Disorder. c. Binging and purging twelve times per week. d. All of the above would worsen her prognosis. Answer: D Type: Applied Page: 275 22. A new diagnosis among eating disorders in the DSM-IV-TR, requiring additional study, is a. bulimarexia. b. binge eating disorder. c. dysmorphia disorder. d. None of the above choices are correct. Answer: B Type: Factual Page: 275 23. Binge eating disorder is characterized by binging a. between periods of starvation. b. despite guilt over weight gain. c. with weight under 85% of normal. d. without compensatory behaviors. Answer: D Type: Factual Page: 275 24. Beatrice has lost control of her eating. She gorges on huge amounts of high fat fast foods, eating as much as 2000 calories in 30 minutes. She is gaining weight rapidly, and weighs over 170 pounds. Which disorder fits Beatrice’s symptoms best? a. binge eating disorder b. anorexia nervosa c. obesity d. bulimia nervosa Answer: A Type: Applied Page: 275 25. Individuals with binge eating disorder are a. relatively confident with their body image. b. more likely to be white than black. c. often obese. d. less likely to have a history of dieting than people with anorexia nervosa. Answer: C Type: Factual Page: 276 26. Which of the following is defined, in part, by the absence of purging? a. anorexia nervosa b. bulimia nervosa c. binge eating disorder d. Purging always occurs in each of these conditions. Answer: C Type: Factual Page: 275-276 27. Which of the following is a distinction between bulimia nervosa and binge eating disorder? a. loss of control during binges b. distress about binging c. rapid eating during binges d. compensatory behaviors after binges Answer: D Type: Factual Page: 275-276 28. Eating disorders are usually caused by a. genetic disposition. b. neurochemical imbalance. c. sociocultural pressures. d. a combination of factors. Answer: D Type: Factual Page: 278 29. If your sister has anorexia nervosa and you are female, a. you are over ten times more likely than average to have the disorder yourself. b. your mother is likely alcoholic. c. you are three times more likely than average to have anorexia nervosa. d. there is no greater risk to you for developing an eating disorder. Answer: A Type: Factual Page: 278 30. Twin studies of eating disorders have shown a. environmental factors to be of greater influence than genetic factors. b. higher concordance amongst monozygotic (MZ) twins compared to dizygotic (DZ) twins. c. that genes do not affect personality characteristics associated with eating disorders. d. All of the above are correct. Answer: B Type: Factual Page: 278 31. Genetic influences on eating disorders are a. a substantial factor. b. a minor factor. c. more important for anorexia nervosa. d. more important for bulimia nervosa. Answer: A Type: Factual Page: 278 32. Research regarding the role of the hypothalamus in anorexia nervosa indicates that a. the hypothalamus is damaged in most individuals with anorexia. b. hypothalamus dysfunction is the most likely explanation for the fact that people with anorexia do not experience hunger. c. the hypothalamus appears to be overactive in people with anorexia, leading to binge eating. d. dysfunction in the hypothalamus does not seem to be an important factor in anorexia. Answer: D Type: Factual Page: 279 33. Although the hypothalamus has been considered a part of the biological etiology of anorexia, a limitation of this account is a. it fails to account for purging episodes. b. there is no accounting for the obsession with food. c. it lacks an adaptive feature. d. the lack of attention paid to neurotransmitter systems known to be dysfunctional in anorexia. Answer: B Type: Factual Page: 279 34. In eating disorders, endogenous opioids a. are at low levels, leading to a euphoric state. b. are likely reinforcing. c. are released by purging, leading to euphoria. d. are decreased by bingeing, leading to euphoria. Answer: B Type: Factual Page: 279 35. Which of the following brain mechanisms have been implicated in anorexia? a. Starvation releases natural pain-reducing opioids producing a high which reinforces not eating. b. With puberty, female hormones increase dramatically and damage centers which control eating in the thalamus and pituitary. c. Excessive exercise depletes the brain of neurotransmitters utilized by areas that regulate hunger or satiation. d. Stress-released hormones reduce the sensitivity of receptors that detect blood-sugar levels and release hormones that induce hunger. Answer: A Type: Factual Page: 279 36. The neurotransmitter most closely associated with eating disorders is a. epinephrine. b. norepinephrine. c. opioid. d. serotonin. Answer: D Type: Factual Page: 279 37. The role of serotonin a. is well understood in anorexia. b. is well understood in bulimia. c. is well understood in both anorexia and bulimia. d. is better understood in bulimia than anorexia. Answer: D Type: Factual Page: 279 38. Which of the following biological factors have been largely ruled out as part of the etiology of eating disorders? a. serotonin b. endogenous opioids c. hypothalamus d. genetic factors Answer: C Type: Factual Page: 279 39. Recent research has begun to focus on the role of ________ in eating behavior. a. norepinephrine b. the hypothalamus c. dopamine d. serotonin Answer: C Type: Factual Page: 280 40. Paula scored higher on a measure of dietary restraint than did Roberta. Based on this information, recent research suggests that a. Roberta would be more likely to have bulimia nervosa. b. Paula probably has anorexia nervosa. c. Roberta will probably exhibit greater dopamine activity in her brain when presented with food. d. Paula will probably exhibit greater dopamine activity in her brain when presented with food. Answer: D Type: Applied Page: 280 41. According to the text, the Body Mass Index (BMI) of Playboy and Playgirl centerfolds has a. both decreased over time. b. both increased over time. c. decreased and increased, respectively over time. d. increased and decreased, respectively over time. Answer: C Type: Factual Page: 280 42. Lydia is a white, upper-class woman with anorexia. Which of the following is most likely to also be true of Lydia? a. She has dieted before. b. She also has bulimia. c. She also has b
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