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Psych 270 Exam 3
a
76
Psychology
Undergraduate 3
04/05/2013

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Term
Bulimia Nervose DSM-IV Criteria
Definition

- Recurrent episodes of binge eating


- Recurrent compensatory behavior to prevent weight gain


- Behaviors occur at least twice a week for three months


- Self-evaluation is largely influenced by body shape and weight

Term

Bulimia Nervosa

 

Subtypes 

 
Definition

1. Purging type: self-induced vomiting, misuse of laxative, diuretics or enemas 

       - Takes place to get rid of what was             consumed 

2. Non-purging type: fasting, excessive dieting and/or exercise 

Term

Bulimia Nervosa

 

Clinical Features

Definition

- Negative view of self

- Binges (100-60k calories)

- Sense of lack of control

- Negative feeling following binge

- Purge

- Medical Complications

Term

Bulimia Nervosa

 

Medical Complications

 
Definition

- Anemia (low iron)

- Rupture of heart

- Electrolyte imbalance

- Fertility difficulties

- Chronic sore throat and vomiting blood

- Irrregular periods

- Stomach cramps

- Constipation

- Cavities

- Acne 

Term

Bulimia Nervosa

 

Prevalence 

Definition

- 1-3% of women

- 10x less in men

      - under diagnosed in men

- 18-30% in college female population

- Less prevalent in non-Western countries 

Term
Bulimia Nervosa

Onset
Definition
- Mostly late adolescence or early adult (18 years)
- Frequently triggered by stressful event
- Starting a new phase in life ( college, breakup, etc)
Term
Bulimia Nervosa

Course
Definition
- Persists for several years and is often untreated
- Can go unnoticed; people may be of normal weight
- Intermittent periods of remission
Term
Bulimia Nervosa

Comorbidity
Definition
- Mood disorder (up to 89%)
- Specifically depression or bipolar
- Anxiety disorder (OCD and GAD)
- Personality disorders
- Substance abuse
- Kleptomania
Term
Anorexia Nervosa

DSM-IV Criteria
Definition
- Refusal to maintain body weight at or above the minimally normal weight for age and height (less than 85% of what is expected)
- Intense fear of gaining weight or becoming fat, even though underweight
Term
Anorexia Nervosa

Subtypes
Definition
1. Restrictive type: During the current episode, the person has not regularly engaged in binge-eating/purging behavior
- Type most people think of
- Person consumes very small amounts of food per day
2. Binge-eating/Purging type: During the current episode, person has regularly binged and/or purged
Term
Anorexia Nervosa

Clinical Features
Definition
- Depressive symptoms
- Obsessive compulsive features (related or unrelated to food) - may be due to effects of starvation
- Fear of eating in public
- Negative evaluation of self
- Strong need to control
- Medical Complications
Term
Anorexia Nervosa

Clinical Features: Restricting type compared to binge/purge
Definition
Bing-eating/purging type have:
- Other impulse control problems
- Mood lability
- Sexually active
Term
Anorexia Nervosa

Clinical Features: Medical Complications
Definition
- SAME medical problems associated with Bulimia Nervosa, for binge-eating/purging type
- Semi-starvation also affects most major organ systems
- Hospitalization may be required - 10% of these will die from consequences of starvation or suicide
Term
Anorexia Nervosa

Prevalence
Definition
- 0.5-1% in women
- Less frequent in men
- Sub-clinical level of anorexia nervosa are more common
- Does not fit clinical definition but still a problem
- More prevalent in industrialized societies
- More prevalent in families of higher socio economic status
Term
Anorexia Nervosa

Onset
Definition
- Mean age of onset = 17
- Rarely begins before puberty, but when it does, it is associated with more problems
- Rarely begins after 40 years old
- When it begins in early adolescence > better prognosis
- Frequently triggered by stressful event
Term
Anorexia Nervosa

Course
Definition
- Course is extremely variable
- Some recover after 1 episode, others struggle for years
Term
Anorexia Nervosa

Comorbidity
Definition
- Mood disorders
- Anxiety Disorders
- Personality Disorders
- Substance abuse, for binge-purge type
- Kleptomania
Term
Bulimia Nervosa & Anorexia Nervosa

Etiology: Socio cultural pressures
Definition
- Pressures for women to look thin
- Increase in amount of people dealing with obesity
Term
Bulimia Nervosa & Anorexia Nervosa

Etiology: Family Environment
Definition
- Emphasis from family on caring what you look like
- Some evidence that people develop Anorexia Nervosa as a result of family problems
Term
Bulimia Nervosa & Anorexia Nervosa

Etiology: Ego Deficit and Cognitive Disturbances
Definition
- Numb depression, make themselves happy
- Person has cognitive disturbance about the importance of food
Term
Bulimia Nervosa & Anorexia Nervosa

Etiology: Biological Models
Definition
- People who grow up eating a lot of fat in their diet; they will always be over weight; will always eat a lot of fats
- Mood Disorder - eating disorder is a manifestation of mood disorder
Term
Bulimia Nervosa & Anorexia Nervosa

Cognitive Behavioral Model
Definition
- Distorted attitudes about body weight and shape
- Dietary restrain based on rigid rules
- Break in dietary restrain
- Anxiety because of fear of fatness
- Purging to relieve anxiety and undo effects of binge - negative reinforcement
- Elimination of nutrients increases probability of binge. Electrolyte imbalance and lower metabolic rate increases probability or weight gain
- Cycle becomes habitual and uncontrollable
Term
Bulimia Nervosa

Cognitive Therapy
Definition
- Change distorted attitudes (weight/body shape)
- Establish a regular, healthy eating pattern
- Food log
- 3 meals and 2 snacks a day = immensely helpful
- Provide coping skills (deal with stressful events)
- Without these, "numb" themselves with a binge
- Binge = negative reinforcement
- Change errors of thinking (all or nothing thinking)
- Replace purging with other anxiety/depressive reducing measures
- Relapse prevention
Term
Substance Related Disorders

Three classes of drugs
Definition
Depressants

Stimulants

Hallucinogens
Term
Substance Related Disorders

Two types of substance disorders
Definition
- Dependence

- Abuse
Term
Substance Related Disorders

Substance Dependence
Definition
- Maladaptive pattern of substance abuse, significant impairment in at least THREE of the following:
1) Tolerance (biological, not psychological)
2) Withdrawal (biological, not psychological)
3) Person consumes drug to reduce withdrawal symptoms
4) Taken in large amounts or over a longer period of time than intended (person can't control abuse)
5) Persistent desire or unsuccessful efforts to cut down
6) Great deal of time spent in activities to get or use substance or recover from its effect
7) Social, occupational, or recreational activities given up or reduced
8) Use continued despite knowledge of problems
Term
Substance Related Disorders

Substance Abuse
Definition
- Maladaptive pattern of substance use leading to clinically significant impairment (at least ONE of the follorwing):
1) Recurrent substance use resulting in failure to meet major obligations
2) Recurrent use in situations which is is physically hazardous
3) Recurrent substance related problems (ex: arrests)
- Symptoms have NEVER met criteria for dependence
- You keep the dependence label unless you completely stop using the substance
Term
Alcohol (depressant)

Prevalence
Definition
- 2/3 of americans drink
- 5% are heavy drinkers
- 3:1 male to female ratio for heavy drinking
- 7.4-9.7% meet criteria for abuse or dependence of ONE YEAR
- Lifetime: 13-23%, 5:1 male to female ratio
Term
Alcohol (depressant)

Three patterns of abuse
Definition
1. Steady
2. Weekend/evenings
3. Binges: men - 5 drinks @ one time; women - 4 drinks at one time
Term
Alcohol (depressant)

Costs
Definition
- 1 person every 23 minutes dies alcohol related death
- Family = higher levels of disharmony, physical/sexual abuse
Term
Alcohol (depressant)

Health Costs
Definition
- Liver damage (cirrhosis) 7th highest cause of death in U.S.
- Heart problems
- Impairment of immune system
- Nutritional problems
- Mental disorders caused by vitamin and mineral deficiencies
- Fetal Alcohol Syndrome
Term
Cocaine (Stimulant)

Prevalence
Definition
- 23 million in U.S. have tried
- 2 million currently using (once a month)
- 1 out of 5 users meet criteria for abuse and dependence
-Crack cocaine is cheaper
Term
Cocaine (Stimulant)

Health costs
Definition
- 25% increase of cocaine related ER visits. 1982- 1991
- Linked to 20% of all intentional suicides (under 61) not overdose
- Overdose
- Heart problems
- Brain seizures
- Fetal Cocaine Syndrome
- Signs less evident than Fetal Alcohol but more sever consequences (ex: mental retardation)
Term
Cannabis (Hallucinogen)

Prevalence
Definition
- Increase of abuse and dependence, compared to 1970's
- Drug has become stronger and more addictive which leads to more use
Term
Cannabis (Hallucinogen)

Costs
Definition
- Deficits in sensory and motor skills
- Deficits in cognitive functioning (memory loss)
- Medical problems - lung disease
- Decrease of human reproduction
- Impact on immune system
Term
Substance Abuse

Etiology: Biological
Definition
- Twin studies- one twin has substance abuse, other twin:
1) Not identical 28% chance of substance abuse
2) Identical 54% chance of substance abuse problem
Term
Substance Abuse

Etiology: Psychodynamic
Definition
- Dependency/oral fixation
ex: Family with 19 children: children do not receive much attention; many of children develop substance abuse problem
Term
Substance Abuse

Etiology: Behavioral
Definition
- Operant conditioning - rat in cage receive shock vs rat that did not; Rate the received shock drank more alcohol to deal with pain
- Classical conditioning
- Modeling - way to get pleasure, decrease stress; children see this from parents and media
Term
Substance Abuse

Etiology: Socio Cultural
Definition
- Values reinforcing or tolerating use

Ex: friends, college
Term
Substance Abuse

Treatment: Biological
Definition
- Detox used in severe cases, frequent but not sufficient alone
- Drug antagonists - weakens impact of drug when taken or produces negative symptoms
- Drug substitutes (methadone instead of heroin
Term
Substance Abuse

Treatment: Psychodynamic
Definition
- Insight
Term
Substance Abuse

Treatment: CBT
Definition
- Aversive conditioning
- Alternative coping skills
- Behavioral self-control and relapse prevention
Term
Substance Abuse

Treatment: Self-help
Definition
- support and spiritual involvement
Term
Sexual Disorder & Gender Identity Disorder

Sexual Response Cycle
Definition
- Desire - urge to have sex, day dream, sexual fantasies, etc
- Arousal/Excitement - general physical arousal
- Orgasm
- Resolution
Term
Sexual Dysfunction Disorders
Definition
- Psychological disorders which make it impossible to have or enjoy intercourse
- 31% men, 43% women
Term
Sexual Disorders

4 major DSM-IV Categories
Definition
- Desire
- Excitement
- Orgasm
- Sexual pain
Term
Sexual Disorders

3 Specifiers
Definition
1. Lifelong vs. acquired
2. Generalized vs. Specific
3. Psychological factors vs. Combined (with a medical condition)
Term
Desire Disorders

Hypoactive Sexual Desire Disorder
Definition
- Persistent or recurrently deficient (or absent) sexual desire and sexual fantasies
- Can be less than 1 time every 2 weeks
- Varies depending on: age, culture, life events
- Lack of desire may cause stress
- 15% men, 20-35% women
Term
Desire Disorders

Sexual Aversion Disorder
Definition
- Person actively avoids sexual activities and experiences sex as unpleasant or anxiety provoking
- Rates are unknown, but supposed to be rare
- Sexual Phobia
Term
Sexual Arousal Disorders

Male Erectile Disorder
Definition
- Inability to attain or maintain an adequate erection until the completion of sexual activity
- 10% of men in last year
- Increases with age
- #1 sexual disorder men seek treatment for
- Interaction of psychological and biological factors
Term
Sexual Arousal Disorders

Female Sexual Arousal Disorder
Definition
: Inability to attain or maintain an adequate lubrication-swelling response of sexual excitement until completion of sexual activity
-11-48% of women
: prevalence greater in post-menopausal women
- Rarely diagnosed alone; usually with sexual arousal disorder
Term
Orgasmic Disorders

Male orgasmic disorder
Definition
: Inability to ejaculate following normal sexual excitement phase
- 1-3% of men during lifetime
- caused by performance issues
Term
Orgasmic Disorders

Premature Ejaculation
Definition
: Ejaculation occurs with minimal sexual stimulation
- 25-40% experience during lifetime
- Seen more often in younger men
- Maybe associated with hurried masturbation techniques
Term
Orgasmic Disorder

Female Orgasmic Disorder
Definition
: Persisten delay in/absence of orgasm
- 20-30% of female pop.
- 10-15% of women report never having had an orgasm
- 10-15% rarely experience orgasm
Term
Sexual Pain Disorders

Vaginismus
Definition
: involuntary muscle spasms at the entrance to the vagina that prevents penetration and intercourse
- 1% of general pop.
- Conditioned fear response- set off by thought that penetration may be painful or damaging
Term
Sexual Pain Disorders

Dyspareunia
Definition
: extreme pain in genitals during sexual activity
- 1-5% of men; 10-15% of women
- Usually has a physical cause:
a) pelvic inflammatory disease
b) allergic reaction to contraceptive
c) tumor
d) sexual assault
Term
Sexual Dysfunctions

Causes: Biological
Definition
- chronic illness
- medical conditions
- hormonal or vascular abnormalities: high levels of prolactin, low testosterone, too high or too low estrogen
- Drug use
Term
Sexual Dysfunction Disorders

Causes: Psychosocial
Definition
- relationship difficulties
- stress/anxiety
- depression
- trauma
- maladaptive attitudes and cognitions
- performance anxiety
Term
Sexual Dysfunction Disorders

Treatment History
Definition
- 1st half of 20th century: long term psychodynamic
- 1950's-60's: behavioral therapy (dysfunction caused by fears)
- 1970's: William Master's and Virginia Johnson "SexTherapy"
Term
Sexual Dysfunction Disorder

Treatment: Biological
Definition
- Treatment of medical condition
- Adjustment of drug use
- Hormone replacement therapy
- "Technical interventions"
Term
Sexual Dysfunction Disorder

Treatment: Sex Therapy
Definition
- Short term, directive therapy using cognitive, behavioral, and communication building techniques
- Sensate focus: partners alternate between giving and receiving stimulation in a relaxed, openly communicating atmosphere
Term
Gender Identity Disorder

DSM Criteria
Definition
A. Strong and persistent and cross-gender identification
B. Persistent discomfort with his or her sex or sense of inappropriateness in the gender role of the sex
C. Disturbance is NOT concurrent with a physical intersex condition
D. Disturbance causes clinically significant distress or impairment
Term
Gener Identity Disorder

Prevalence
Definition
- 1:100,000 females
- 1: 24,000 males
- 4x more likely in men than women
- Occurs in homosexuals and heterosexuals
Term
Gender Identity Disorder

Comorbidity
Definition
- Substance use
- Depression
- Suicidal Behavior
Term
Gender Identity Disorder

Causes/Contributors
Definition
- Parent/Family Factors
- Biological Factors (insufficient testosterone)
Term
Gender Identity Disorder

Treatment
Definition
Biological

Psychotherapy
Term
Sexual Dysfunction Disorders

Paraphilias
Definition
: Repeated intense sexual urges, fantasies, or behaviors, in response to objects or situations that society deems inappropriate (non-human, non-consenting, suffering/humiliation, children)
- Last 6 months at least
- Exclusive or preferred means of arousal
- Cause distress
Term
Sexual Dysfunction Disorders

Paraphilia: 8 types
Definition
Fetishism
Transvestic fetishism
Exhibitionism
Voyeurism
Frotteurism
Pedophilia
Sexual masochism
Sexual sadism
Term
Paraphilias

Fetishism
Definition
- use of inanimate objects to achieve sexual arousal
Term
Paraphilias

Transvestic Fetishism
Definition
- need to dress in clothes of the opposite sex to achieve sexual arousal
- cross dressing
- typically person is heterosexual, married male
- hard to determine in women
Term
Paraphilias

Pedophilia
Definition
- person experiences recurrent and intense sexual urges, sexually arousing fantasies or behaviors with young children
- common in people that were abused as a child
4% 3 years and younger, 18% 4-7, 40% 8-11
Term
Paraphilias

Pedophilia: Two Types
Definition
Exclusive: children are their primary and only means of sexual pleasure

Non-exclusive: Children are not their only means of sexual pleasure
Term
Lanugo
Definition
Fine, downy hair on face/trunk of body

Associated with anorexia
Term
Amenorrhea
Definition
Absence of at least 3 consecutive menstruations
Term
Rumination
Definition
Regurgitation and re-chewing of food
Term
Abstinence Violation Effect
Definition
Guilt and perceived loss of control a person feels when they slip up and do their drug
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