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PSY 35000 Midterm: psy 350 exam 2 study guide

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Purdue University
PSY 35000
Daniel Foti

• Eating disorder (8) o Two different perspectives on disordered eating: the categorical model (i.e., DSM categories) and the dimensional model (i.e., symptom dimensions) o Epidemiology and phenomenology of eating disorders ▪ Three major disorders: • Anorexia nervosa o Life time prevalence (.06%) o Chronic if left untreated o Onset 18-21 o 3x more in girls o Criteria ▪ Weight below normal ▪ Fear of gaining weight ▪ Binge/purge vs. restricting o Comorbidity ▪ OCD ▪ Mood, anxiety, substance abuse o Highest mortality rate • Bulimia nervosa o Life time prevalence (1.0%) o Chronic if left untreated o Onset 18-21 o 3x more in girls o Criteria ▪ Binge • Eating a “large amount” of food in a discrete period of time • Can be 5,000+ calories • Subjective sense of lack of control o Dissociation? ▪ Purge • Compensatory behavior to prevent weight gain • Vomiting, laxatives, diuretics, fasting, exercise, etc. • Ineffective ▪ Normal weight ▪ Pre occupation with body shape/weight o Comorbidity ▪ Anxiety disorders: 80% ▪ Mood disorders: 50-70% • Consequence, not a cause ▪ Substance use disorders: 37% • Binge eating disorder* o Life time prevalence (2.8%) o Subthreshold binge eating more common in males o Criteria ▪ Binge o Eating a “large amount” of food in a discrete period of time o Can be 5,000+ calories o Subjective sense of lack of control ▪ Dissociation? ▪ NO purge o New diagnosis (less known) ▪ More common in ales than other EDs ▪ Similar preoccupation with body shape/weight ▪ Strong link with mood ▪ ▪ Symptom dimensions • Binging behavior • Purging behavior • Weight o Role of social/cultural risk factors ▪ EDs strongly associated with Western culture ▪ BMI has declined for the Miss America pageant since 1920, and now it is under 18 BMI which is considered healthy ▪ Waist to hip ratio is used to analyze attractiveness, fertility, and health (.07 women and .09 males ) ▪ Wpmen tend to desire to be smaller than their actual average and also lower than what men consider attractiveis too, men on the other hand are opposite and tend to wish to be bigger than even what women consider attractive ▪ ED start with normal dieting ▪ Worldwide prevalence rising ▪ Most common in Caucasian, middle/upper class ▪ Risk fator • Stress • Negative affect • Perfectionism • Heredity (4-5x) ▪ Emotion • BN/BED  guilt/shame • AN  pride, perfectionism • Regulation of mood/anxiety through eating o Effective treatments for each disorder ▪ Drug Treatments • AN = not effective • BN = antidepressants o Prozac approved in 1996 o Short-term reduction in binge/purge symptoms ▪ Weight restoration • Malnourishment needs to be addressed separately • May require inpatient hospitalization • Tube feeding ▪ CBT (cognitive behavioral therepy)  Target thoughts/behaviors related to eating and body shape ▪ “Enhanced” CBT • Target key components of eating disorders • Trans-diagnostic approach ▪ C (cognitive): • Distorted thoughts about body shape/weight ▪ B (behavioral): • Scheduled meals and other activities • Coping strategies to resist binge/purge urges • Exposure-like exercises ▪ IPT (interpersonal psychotherapy)  Target interpersonal functioning broadly, not body image per se or eating habits ▪ CBT is known to be effective for BN. How does IPT compare? • IPT has lower rates of remittance than CBT • Post-treatment: CBT > IPT • Follow-up: o CBT = IPT o Patients with IPT continued to improve slowly over time o Patients with CBT maintained their gains • Sleep disorders o Epidemiology and phenomenology of sleep disorders o Treatment of sleep disorders, including “sleep hygiene” • Substance use disorders o Nicotine, glass, crack, crystal meth, valium o Substances ▪ Depressants ▪ Stimulants • Ex) Adderall, Meth • Effects- elation, alertness and then crash (psychotic symptoms) • Neurotransmitters dopamine, norepinephrine • Tolerance builds quick • Withdrawl  depression and apathy ▪ Opiates • Ex) narcotics: heroin • Effects euphoria, pain relief, drowsiness • Neurotransmitters endorphin, opoid receptors • Withdrawl: stomach problems, insomnia, chills, muscle aches ▪ Hallucinogens • Ex) LSD • Alters perception • Tolerencance develops fast • Withdrawl? ▪ Cannabis • Single most common illegal substance • Effects are subjective • Psychotic symptoms • tolerance withdrawl? o Diagnoses ▪ Substance-related ▪ Substance-induced o Levels of involvement, from casual usage to physiological dependence ▪ Use ▪ Intoxication ▪ Abuse ▪ Dependence ▪ o Symptoms of substance use disorder, including the dimensional assessment of severity ▪ Using more than intended (D) ▪ Difficulty reducing usage (D) ▪ Time-consuming (D) ▪ Craving*** ▪ Failure to fulfill role obligations (A) ▪ Social/interpersonal problems (A) ▪ Important activities are given up (D) ▪ Usage in which it may be dangerous (A) ▪ Tolerance (D) ▪ Withdrawal (D) ▪ DIMENSION: 2-3, 4-5, 6+ ▪ o Genetic vs. environmental causes ▪ Substance use is strongly influenced by environment ▪ Substance problems are strongly influenced by genetic vulnerability o Challenges to treatment, and the role of motivational interviewing ▪ Treatments • Agonist substitution o Replace drug with a safer substance o e.g., methadone, nicotine gum/patch • Antagonists o Block the positive effect of the drug o Does not block the withdrawal symptoms o …potential problems? • Aversive treatment o Make the drug unpleasant o e.g., Antabuse o …potential problems? • These approaches are all generally ineffective when used on their own • AA (NA, CA, etc) o “12 step programs” o Abstinence o Faith in a higher power o Hugely influential o Limited research base o Very little research o Likely mechanisms: ▪ Social support ▪ Structure • CBT for substance use o Highly effective o Cues/triggers o Coping skills o Relapse prevention o Identify high-risk situations ▪ Environmental cues ▪ Affective triggers ▪ Distorted thoughts o Emphasis on coping skills (to resist urges) and relapse prevention • THEME: Biological and psychosocial treatments require high motivation ▪ Motivational interviewing • Background: Substance use treatment has focused primarily on adults, and MI is known to be effective. In adolescents, the focus has been mostly on prevention • Methods o 94 adolescents (ages 18-19) o All admitted to ER following an alcohol-related incident ▪ Car accident, assault, fall, or other injury o Random assignment to MI or “standard care” ▪ MI: 40-minute session led by BA/MA-level clinicians ▪ Focus on empathy, exploring ambivalence, setting goals ▪ Standard care: “A handout on avoiding drinking and driving and a list of local treatment agencies” o Follow-up interviews 3 and 6 months later • Results o Drinking was reduced in both groups at follow-up, with no difference in tx o Risky behaviors were lower in MI group ▪ Drinking and driving ▪ Alcohol-related injuries ▪ Moving violations (per DMV report) o Reduced alcohol-related problems with family, friends, partners, and at school o Conclusion: MI represents a brief, low-cost intervention that may directly reduce functional impairment in drinking among adolescents o Psychological ▪ Positive reinforcement • Subjective pleasure • “Hijacking” of the brain’s reward network ▪ Negative reinforcement • Escape from pain, stress, anxiety, depression • Escape form withdrawal symptoms o • Personality disorder o Advantage to dimensions ▪ Eliminates heterogeneity and co-occurrence ▪ Covers all forms of PD ▪ Applicable to every client ▪ Limited or no gender/cultural bias o Big Five” ▪ Neuroticism ▪ Extraversion ▪ Openness ▪ Agreeableness ▪ Conscientiousness o Normal versus abnormal personality traits ▪ Personality Disorders are malad
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