Clinical psychology
Chapter 11
Eating disorders
Anorexia nervousa
DSM-5 criteria for anorexia nervousa
Amenorrhea: loss of menstrual period
Two types of anorexia nervosa:
Typically begins in the early to middle teenage years, often after an episode of dieting and the occurrence of life stress.
Lifetime prevalence: less than one percent
10 time more frequent in women than in men.
Suicide rates are quite high for people with anorexia
Physical consequences of anorexia nervosa
Self-starvation and use of laxatives produce numerous undesirable biological consequences in people with anorexia nervosa.
Prognosis
Between 50 and 70 percent of people with anorexia eventually recover.
Recovery often takes 6 to 7 years, and relapses are common before a stable pattern of eating and weight maintenance is achieved.
Anorexia nervosa is a life-threatening illness.
Bulimia nervosa
DSM-5 criteria for bulimia nervosa
Involves episodes of rapid consumption of a large amount of food, followed by compensatory behavior, such as vomiting, fasting, or excessive exercise, to prevent weight gain.
Binge has two characteristics:
Bulimia nervosa is not diagnosed if the bingeing and purging occur only in the context of anorexia nervosa and its extreme weight loss.
The diagnoses in such a case is anorexia nervosa, binge-eating/purgning type.
The key difference between anorexia and bulimia is weight loss.
People with bulimia do not lose a tremendous amount of weight.
In bulimia, binges typically occur in secret. They may be triggered by stress and negative emotions they arouse, and they continue until the person is uncomfortably full.
There is wide variation in the caloric content consumed by people with bulimia nervosa during binges.
People report that they lose control during a binge, even to the point of experiencing something akin to a strancelike state. They are usually ashamed of their binges and try to conceal them.
After the binge is over, feelings of discomfort, disgust, and fear of weight gain lead to the second step of bulimia nervosa, the inappropriate compensatory behavior (purging) to attempt to undo the caloric effects of the binge.
Episodes of bingeing and compensatory behavior occur at least once a weak for 3 months.
People with bulimia nervosa are afraid of gaining weight, and their self-esteem depends heavily on maintaining normal weight.
Typically begins in late adolecence or early adulthood.
90% of the cases are women
1 to 2 percent of the population
Many people with bulimia nervosa were somewhat overweight before the onset of the disorder, and the binge eating often started during an episode of dieting.
Comorbid with numerous other episodes.
Suicide rates are higher among people with bulimia nervosa than in the general population, but substantially lower than among people with anorexia.
Physical consequences of bulimia nervosa
Bulimia is associated with several physical side effects.
Prognosis
75 percent recover, although about 10 to 20 percent remain fully symptomatic.
Intervening soon after diagnosis is made is linked with an even better prognosis.
People with bulimia nervosa who binge and vomit more and who have comorbid substance use or a history of depression have a poorer prognosis than people without these factors.
Binge eating disorder
DSM-5 criteria for Binge eating disorder:
Lack of control during the binges.
Absence of weight loss and compensatory behaviors.
Most often, people with binge eating disorder are obese.
Not all obese people meet criteria for binge eating disorder.
Associated with obesity and a history of dieting.
Linked to impaired work and social functioning, depression, low self-esteem, substance use disorders, and dissatisfaction with body shape.
Risk factors for developing binge eating disorder are:
More prevalent than either anorexia nervosa or bulimia nervosa.
3,5 percent for women and 2, percent for men.
Comorbid with depression and anxiety disorders
Physical consequences of binge eating disorder
Many of the physical consequences are likely a function of associated obesity.
Problems not associated with the obesity:
Prognosis
Between 25 and 82 percent of people recover.
People have binge eating much longer than anorexia or bulimia.
Genetic factors
Both anorexia and bulimia run in families.
It has a genetic influence.
Nonshared environmental factors also contribute to the development of eating disorders.
Key features of the eating disorders, such as dissatisfaction with one’s body, a strong desire to be thin, binge eating, and preoccupation with weight, are heritable.
Common genetic factors may account for the relationship between certain personality characteristics.
Neurobiological factors
The hypothalamus is a key brain center for regulating hunger and eating.
The level of hormones regulated by the hypothalamus is abnormal in people with anorexia.
These hormonal abnormalities occur as a result of self-starvation, and levels return normal after weight gain.
A dysfunctional hypothalamus does not seem highly likely as a factor in anorexia nervosa.
Endogenous opioids are substances produced by the body that reduce pain sensations, enhance mood, and suppress appetite.
Starvation among people with anorexia may increase the levels of endogenous opioids, resulting in a positively reinforcing euphoric state.
Excessive exercise seen among some people with eating disorders would increase opioids and thus be reinforcing.
We don’t know if the low levels of opioids seen in people with bulimia are a cause or an effect of changes in food intake or purging.
Serotonin promotes satiety.
Binges of people with bulimia could result from a serotonin deficit that causes them to not feel satiated as they eat.
Food restriction interferes with serotonin synthesis in the brain. Among people with anorexia, the severe food intake restrictions could interfere with the serotonin system.
There are low levels of serotonin metaoblies among people with anorexia and bulimia.
Serotonin could also be linked to the comorbid depression often found in anorexia and bulimia.
Dopamine is linked to the motivation to obtain food and other pleasurable or rewarding things.
Restrained eaters may be more sensitive to food cues, since one of the functions of dopamine is to signal the salience of a particular stimuli.
Women with anorexia showed greater activation in the ventral stiratum, an area of the brain linked to dopamine and reward, than women without anorexia when viewing pictures of underweight women.
Women with either anorexia or bulimia had greater expression of the dopamine transporter gene DAT. DAT influences the release of a protein that regulates the reuptake of dopamine back into the synapse.
Brain activity or gene expression of certain dopamine genes is correlated with eating disorders.
Cognitive behavioral factors
People with eating disorders may have maladaptive schemata that narrow their attention toward thoughts and images related to weight, body shape, and food.
Anorexia nervosa
Cognitive behavioral theories of anorexia nervosa emphasize fear of fatness and body-image disturbance as the motivating factors that powerfully reinforce weight loss.
Many who develop anorexia nervosa symptoms report that the onset followed a period of weight loss and dieting.
Perfectionism and a sense of personal inadequacy may lead a person to become especially concerned with his or her appearance, making dieting a potent reinforcer.
Seeing portrayals in the media of thinness as an ideal, being overweight, and tending to compare oneself with especially attractive others all contribute to dissatisfaction with one’s body.
Criticism of peers and parents about being overweight is also important in producing a drive to thinness.
Bulimia nervosa and binge eating disorder
People with bulimia are also thought to be over-concerned with weight gain and body appearance.
They judge self-worth mainly by their weight and shape.
They try to follow a pattern of restrictive eating that is very rigid, with strict rules regarding how much to eat, what kinds of food to eat, what kinds of food to eat, and when to eat.
These strict rules are inevitably broken, and the lapse escalates into a binge.
After the binge, feelings of disgust and fear of becoming fat build up, leading to compensatory actions such as vomiting.
Although purging temporarily reduces the anxiety from having eaten too much, this cycle lowers the person’s self-esteem, which triggers still more bingeing and purging, a vicious circle that maintains desired body weight but has serious medical consequences.
Conditions that further increase the eating of restrained eaters after a preload,
The binge may function as a means of regulating negative affect. But this is not successful.
Stress and negative affect are relieved by purging.
Concerns about body shape and weight predicted restrained eating, which in turn predicted an increase in binge eating.
There is a bias toward food and body image.
Sociocultural factors
Throughout history, the standards societies have set for the ideal body have varied greatly.
As society become more health and fat conscious, dieting to lose weight has become more common.
Social standards stressing the importance of thinness play a rile in the development of eating disorders.
Exposure to media portrayals of unrealistically thin models can influence reports of body dissatisfaction.
The sociocultural ideal of thinness is a likely vehicle through which people learn to fear being or even feeling fat.
Reducing the stigma associated with being overweight will be beneficial to those with eating disorders as well as those who are obese.
Gender influences
Western cultures reinforce the desirability of being thin for women more than men.
Women are defined more by their bodies, whereas men are esteemed more for their accomplishments. This led women to self-objectify.
Cross-cultural studies
Evidence for eating disorders across cultures depends on the disorder.
Cases of anorexia have been found in cultures with very little western influence. But, the anorexia observed in these diverse cultures does not always include the intense fear of gaining weight or being fat.
Bulimia nervosa appears to be more common in industrialized societies.
Other factors contributing to the etiology of eating disorders
Personality influences
An eating disorder itself can affect personality.
Personality traits
additional for bulimia:
Characteristics of families
Family characteristics may contribute to the risk for developing an eating disorder, but, eating disorders also likely have an impact on family functioning.
Child abuse and eating disorders
Some studies have indicated that self-reports of childhood sexual abuse are higher among people with eating disorders than among people without eating disorders, especially those with bulimia nervosa.
Not especially for eating disorders.
Higher rates of childhood physical abuse among people with eating disorders.
Hospitalization is frequently required to treat people with anorexia so that their ingestion of food can be gradually increased and carefully monitored.
Medications
Because bulimia nervosa is often comorbid with depression, it has been treated with various antidepressants.
Reduce purging and binge eating.
Big dropout.
Medications for anorexia have not shown to be successful.
Medication for binge eating disorder has not been well studied.
Psychological treatment of anorexia nervosa
Therapy for anorexia is generally believed to be a two-tiered process
Psychological treatment for anorexia can also involve cognitive behavior therapy (CBT)
Family therapy is the principle form of psychological treatment for anorexia.
Three major goals
Psychological treatment of bulimia nervosa
Cognitive behavior therapy is the best-validated and most current standard for the treatment of bulimia.
In CBT, people with bulimia are encouraged to question society’s standards for physical attractiveness. People with bulimia must also uncover and then change beliefs that encourage them to starve themselves to avoid becoming overweight.
They must be helped to see that normal body weight can be maintained without severe dieting and that unrealistic restriction of food intake can often trigger a binge.
Altering all-or-nothing thinking can help people begin to eat more moderately.
They also learn assertiveness skills, which help them cope with unreasonable demands placed on them by others, as well as more satisfying ways of relating to people.
The overall goal of treatment in bulimia is to develop normal eating patterns.
ERP can help in the short-term.
People with bulimia who are successful in overcoming their urge to binge and purge also improve in associated problem areas.
CBT alone is more effective than any available drug treatment.
Self-help CBT is effective for people on the wait-list.
Family therapy is also affective for bulimia.
Psychological treatment for binge eating disorder
Cognitive behavior therapy has been shown to be effective for binge eating disorder.
CBT targets binges as well as restrained eating by emphasizing self-monitoring, self-control, and problem solving as regards eating.
IPT is also effective.
Preventive interventions for eating disorders
Three different types of preventive interventions have been developed and implemented:
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Introduction and historical overview - summary of chapter 1 of Abnormal Psychology by Kring, Davison, Neale & Johnson (12th edition)
Clinical psychology
Chapter 1
Introduction and historical overview
Introduction
Psychopathology: the field concerned with the nature, development, and treatment of mental disorders.
Continually developing and adding new findings.
Sigma: the destructive beliefs and attitudes held by a society that are ascribed to groups considered different in some manner, such as people with mental illness.
Stigma has four characteristics:
The treatment of individuals with mental disorders throughout recorded history has not generally been good, and this has contributed to their stigmatization.
Mental illness remains one of the most stigmatized of conditions in the twenty-first century.
Mental disorder is one disorder that contains several characteristics.
Four key characteristics that any comprehensive mental disorder definition ought to have:
No single characteristic can fully define the concept.
Mental disorder is usually determined based on the presence of several characteristics at one time.
Personal distress
A person’s behavior may be classified as disordered if it causes him or her great distress.
But not all mental disorders cause distress.
And not all behavior that causes distress is disordered.
Disability
Impairment in some important area of life.
Disability alone cannot be used to define mental disorder. Not all disorders involve disability.
Other characteristics that might, in some circumstances, be considered disabilities, do not fall within the domain of psychopathology.
Violation of social norms
In the realm of behaviors, social norms are widely held standards that people use consciously or intuitively to make judgments about where behaviors are situated on such scales as good-bad, right-wrong, justified-unjustified, and acceptable-unacceptable.
Behavior that violates social norms might be classified as disordered.
This is not enough for defining mental disorder. It is too broad and too narrow.
And social norms vary across cultures and ethnic groups.
Dysfunction
Harmful dysfunction. Has a value judgment and a objective component (dysfunction).
A judgment
Current paradigms in psychopathology - summary of chapter 2 of Abnormal Psychology by Kring, Davison, Neale & Johnson (12th edition)Clinical psychology
Chapter 2
Current paradigms in psychopathology
Introduction
Science is a human enterprise that is bound by scientists’ human limitations.
Paradigm: a conceptual framework or approach within a scientist works.
A paradigm as profound implications for how scientist operate at any given time.
Three paradigms that guide the study and treatment of psychopathology
Factors that cut across all the paradigms:
Almost all behavior is heritable to some degree.
Despite this, genes do not operate in isolation from the environment. Through the life span, the environment shapes how our genes are expressed, and our genes also shape the environment.
Nature via nurture.
Without the environment, genes could not express themselves and thus contribute to behavior.
Genes: the carriers of genetic information.
The number of genes is not important. The sequencing, or ordering, of these genes as well as their expression is what makes us unique.
What genes do matters more than the number of genes we have. Genes make proteins that in turn make the body and the brain work.
Gene expression: some proteins switch, or turn, on and off other genes.
Polygenic: several genes turning themselves on and off as they interact with a person’s environment is the essence of genetic vulnerability.
We do not inherit mental illness from our genes. We develop mental illness trough the interaction of our genes with our environment.
Heritability: the extent to which variability in a particular behavior in a population can be accounted for by genetic factors.
Shared environment factors: those things that members of a family have in common, such as parents’ marital status.
Nonshared environment (or unique environment) factors: those things believed to be important in understanding why two siblings from the same family can be so different.
Nonshared environmental experiences have much more to do with the development of mental illness than the shared experiences.
Behavior genetics
Behavior genetics: the study of the degree to which genes and environmental factors influence behavior.
Genotype: the total genetic makeup of an individual, consisting of inherited genes. The genotype cannot be observed outwardly.
Phenotype: the totality of observable behavioral characteristics.
The genotype should not be viewed as a static entity. Genetic programs are quite flexible.
The phenotype changes
Diagnosis and assessment - summary of chapter 3 of Abnormal Psychology by Kring, Davison, Neale & Johnson (12th edition)Clinical psychology
Chapter 3
Diagnosis and assessment
Introduction
Diagnosis can be the first major step in good clinical care.
Having a correct diagnosis will allow the clinician to describe base rates, causes, and treatment.
Hearing a diagnosis can help a person understand why certain symptoms are occurring.
Two concepts that play a key role in diagnosis and assessment:
Reliability
Reliability: consistency of measurement.
Validity
Validity: whether a measure measures what it is supposed to measure.
Unreliable measures will not have good validity.
Reliability does not guarantee validity.
The diagnostic system of the American psychiatric association: DSM-5
Diagnostic and Statistical Manual of Mental Disorders (DSM).
Multiaxial classification system forces the diagnostician to consider a broad range of information.
Axis:
Removal oaf the multiaxial system
The multiaxinal system developed for DSM-IV-TR is removed in DSM-5.
In place of the first three axes clinicians are simply to note psychiatric and medical diagnoses.
Organizing diagnoses by causes
DSM-5 defines diagnoses entirely on the basis of symptoms.
In the DSM-5, the chapters are reorganized to reflect patterns of comorbidity and shared etiology.
Enhanced sensitivity to the developmental nature of psychopathology
Childhood diagnoses
.....read more Research methods in psychopathology - summary of chapter 4 of Abnormal Psychology by Kring, Davison, Neale & Johnson (12th edition)Clinical psychology
Chapter 4
Research methods in psychopathology
Introduction
Theory: a set of propositions meant to explain a class observations.
Hypotheses: expectations about what should occur if a theory is true.
The case study
Case study: recording detailed information about one person at a time.
The case study can be used:
The correlational method
Variables are measured as they exist in nature.
Psycho-pathologist will rely on correlational methods when there are ethical reasons not to manipulate a variable.
Comparison of people with and without diagnoses can be correlational as well.
Measuring correlation
Statistical and clinical significance
A statistical correlation is unlikely to have occurred by chance.
A non-significant correlation may have occurred by chance, so it does not provide evidence for an important relationship.
A statistical finding is usually considered significant if the probability that it is a chance finding is 5 less in 100. p<0.05.
In general, as the absolute size of the correlation coefficient increases, the result is more likely to be statistically significant.
The significance is also influenced by the number of participants in the study.
Clinical significance: whether a relationship between variables is large enough to matter.
Problems of causality
Correlational method does not allow determination of cause-effect relationship.
Epidemiology: the study of the distribution of disorders in a population.
Focuses on three features of a disorder
Epidemiological studies are designed to be representative of
.....read more Mood disorders - summary of chapter 5 of Abnormal Psychology by Kring, Davison, Neale & Johnson (12th edition)Clinical psychology
Chapter 5
Mood disorders
Mood disorders involve disabling disturbances in emotion.
The DSM-5 recognizes two broad types of mood disorders:
Depressive disorders
The cardinal symptoms of depression include profound sadness and/or an inability to experience pleasure.
Physical symptoms of depression are also common
Social withdrawal is common.
Major depressive disorder
Major depressive disorder (MDD)
DSM-5 criteria
Persistent depressive disorder (Dysthymia)
People wit dysthymia are chronically depressed, more then half of the time for at least 2 years. They feel blue or derive little pleasures from usual activities and pastimes.
DSM-5 criteria for persistent depressive disorder (dysthymia)
Anxiety disorders - summary of chapter 6 of Abnormal Psychology by Kring, Davison, Neale & Johnson (12th edition)Clinical psychology
Chapter 6
Anxiety disorders
Introduction
Anxiety: apprehension over an anticipated problem (future)
Fear: a reaction to immediate danger
Both anxiety and fear can involve arousal, or sympathetic nervous system activity.
Anxiety and fear are both adaptive.
In some anxiety disorders, the fear system seems to misfire. A person experiences fear at a time when there is no danger in the environment.
Anxiety creates a U-shape curve with performance.
Anxiety disorders as a group are the most common type of psychiatric diagnosis.
Phobias are particularly common
For each anxiety disorder, several criteria must be met for a DSM-5 diagnoses to be made:
Each disorder, though, is defined by a different set of symptoms related to anxiety or fear.
Anxiety disorders:
Specific phobias
A specific phobia: a disproportionate fear caused by a specific object or situation.
The person recognizes that the fear is excessive, but still goes to great lengths to avoid the feared object or situation.
Specific phobias tend to cluster around a small number of feared objects and situations.
The DSM categorizes specific phobias according to these sources of fear.
A person with one type of specific phobia is very likely to have another type of specific phobia as well. There is high comorbidity of specific phobias.
DSM-5 criteria:
Social anxiety disorder
Social anxiety disorder: a persistent, unrealistically intense fear of social situations that might involve being scrutinized by, or even just exposed to, unfamiliar people.
The problems caused by it tend to be much more pervasive and to interfere much more with normal activities than the problems caused by other phobias.
Social anxiety disorder generally begins during adolescence. For some, though, the symptoms first emerge during childhood.
Without
Obsessive-compulsive-related and trauma-related disorders - summary of chapter 7 of Abnormal Psychology by Kring, Davison, Neale & Johnson (12th edition)Clinical psychology
Chapter 7
Obsessive-compulsive-related and trauma-related disorders
OCD is defined by repetitive thoughts and urges (obsessions) as well as an irresistible need to engage in repetitive behaviors or mental acts (compulsions)
Body dysmorphic disorder and hoarding disorder have symptoms or repetitive thoughts and behaviors.
For all three conditions, the repetitive thoughts and behaviors are distressing, feel uncontrollable, and require a considerable amount of time.
For the person with these conditions, the thoughts and behaviors feel unstoppable.
These syndromes often co-occur.
Clinical descriptions and epidemiology of the obsessive-compulsive and related disorders
Obsessive-compulsive disorder
Obsessive-compulsive disorder (OCD) is characterized by obsessions or compulsions.
Obsessions: intrusive and recurring thoughts, images, or impulses that are persistent and uncontrollable and often appear irrational to the person experiencing them.
For people with OCD, obsessions have such force and frequency that they interfere with normal activities.
People with obsessions may also be prone to extreme doubts, procrastination, and indecision.
Compulsions: repetitive, clearly excessive behaviors or mental acts that the person feels driven to perform to reduce the anxiety caused by obsessive thoughts or to prevent some calamity from occurring.
Even though rationally understanding that there is no need for this behavior, the person feels as something dire will happen if the act is not performed.
The sheer frequency with which compulsions are repeated may be staggering.
Commonly reported compulsions:
OCD tends to begin either before age 10 or else in late adolescence/early adulthood.
Slightly more common among women than men.
The pattern of symptoms appears to be similar across cultures.
High comorbidity.
DSM-5 criteria for Obsessive-compulsive disorder
Dissociative disorders and somatic symptom- related disorders - summary of chapter 8 of Abnormal Psychology by Kring, Davison, Neale & Johnson (12th edition)Clinical psychology
Chapter 8
Dissociative disorders and somatic symptom- related disorders
Introduction
Both types of disorders are hypothesized to be associated with stressful experiences, yet symptoms do not involve direct expressions of anxiety.
Dissociative and somatic symptom-related disorders tend to be comorbid.
The DSM-5 includes three major dissociative disorders:
The dissociative disorders are all presumed to be caused by a common mechanism, dissociation. Which results in some aspect of cognition or experience being inaccessible consciously.
Dissociation and memory
Psychodynamic theory suggests that in dissociative disorder traumatic events are repressed.
In this model, memories are forgotten because they are so aversive.
Memory for emotional relevant stimuli is enhanced by stress, while memory for neutral stimuli is impaired.
Dissociative disorders involve unusual ways of responding to stress.
Extremely high levels of stress hormones could interfere with memory formation.
In the face of severe trauma, memories may be stored in such a way that they are not accessible to awareness later when the person has returned to a more normal state.
Dissociative disorders are considered an extreme outcome of this process.
Dissociative amnesia
The person with dissociative amnesia is unable to recall important personal information, usually information about some traumatic experience.
The holes in memory are too extensive to be explained by ordinary forgetfulness.
The information is not permanently lost, but it cannot be retrieved during the episode of amnesia, which may last for as short a period as several hours, or as long as several years.
The amnesia usually disappears as suddenly as it began, with complete recovery and only a small change of recurrence.
Most of the memory loss involves information about some part of a traumatic experience.
More rarely the amnesia is for entire events during a circumscribed period of distress.
During the period of amnesia, the person’s behavior is otherwise unremarkable, except that the memory loss may cause some disorientation.
In a more severe sub-type of amnesia, fugue, the memory loss is more extensive.
The person not only becomes totally amnesic but suddenly leaves home and work.
Recovery is usually complete, although it takes various amounts of time.
After recovery, people are fully able to remember the details of their life and experiences,
Schizophrenia - summary of chapter 9 of Abnormal Psychology by Kring, Davison, Neale & Johnson (12th edition)Clinical psychology
Chapter 9
Schizophrenia
Schizophrenia: a disorder characterized by disturbances in thought, emotion and behavior.
>1% prevalence
Slightly more men than women.
Sometimes develops in childhood, but usually appears in late adolescence or early adulthood
people with schizophrenia typically have a number of episodes of their symptoms and less severe but still debilitating symptoms between episodes.
The range of symptoms in the diagnosis of schizophrenia is extensive, although people with schizophrenia typically have only some of these problems at any given time.
No single essential symptom must be present for a diagnosis of schizophrenia.
Researchers divided symptoms in three
DSM-5 criteria of schizophrenia
Positive symptoms
Positive symptoms comprise excesses and distortions, such as hallucinations and delusions.
For the most part, acute episodes of schizophrenia are characterized by positive symptoms.
Delusions
Delusions: beliefs contrary to reality and firmly held in spite of disconfirming evidence.
Common symptoms in schizophrenia.
Delusions take several forms including:
Delusions are also found in other diagnoses,
Hallucinations and other disturbances of perception
Hallucinations: sensory experiences in the absence of any relevant information for the environment.
More often auditory than visual.
Negative symptoms
The negative symptoms of schizophrenia consists of behavioral deficits.
Include:
Negative symptoms tend to endure beyond an acute episode and have profound
.....read more Substance use disorders - summary of chapter 10 of Abnormal Psychology by Kring, Davison, Neale & Johnson (12th edition)Clinical psychology
Chapter 10
Substance use disorders
Prevalence adolescents: 9,3 to 10 percent.
Addiction: a more severe substance use disorder that is characterized by having more symptoms, tolerance, and withdrawal, by using more of the substance than intended, by trying unsuccessfully to stop, by having physical or psychological problems made worse by the drug, and by experiencing problems at work or with friends.
Tolerance: indicated by either:
Withdrawal: the negative physical and psychological effects that develop when a person stops taking the substance or reduces the amount.
DSM-5 criteria for substance use disorder
Alcohol use disorder
Delirium tremens (DTs): when the level of alcohol in the blood drops suddenly.
Liver enzymes that metabolize alcohol can account to a small extent for tolerance. The central nervous system is responsible as well.
Tolerance results from changes in the number or sensitivity of GABA or glutamate receptors. Withdrawal may result because some neural pathways increase their activation to compensate for alcohol’s inhibitory effects in the brain.
Alcohol use disorder is often part of polydurg abuse.
Polydrug abuse: abusing ore than one drug at a time.
Alcohol and nicotine are cross-tolerant; nicotine can induce tolerance for the rewarding effects of alcohol and vice versa.
Consumption of both drugs may be increased to maintain their rewarding effects.
Prevalence and cost of alcohol abuse and dependence
No yet prevalence estimates.
Especially frequent among college-age adults.
Binge drinking: having five drinks in a short period of time
Heavy-use drinking: having five drinks on the same occasion five or mire times in a 30-day period.
Among college students, binge drinking and heavy-use prevalence rates are 43,5 and 16 percent.
Binge drinking can have serious consequences
More men than women have problems with alcohol, though
.....read more Eating disorders - summary of chapter 11 of Abnormal Psychology by Kring, Davison, Neale & Johnson (12th edition)Clinical psychology
Chapter 11
Eating disorders
Anorexia nervousa
DSM-5 criteria for anorexia nervousa
Amenorrhea: loss of menstrual period
Two types of anorexia nervosa:
Typically begins in the early to middle teenage years, often after an episode of dieting and the occurrence of life stress.
Lifetime prevalence: less than one percent
10 time more frequent in women than in men.
Suicide rates are quite high for people with anorexia
Physical consequences of anorexia nervosa
Self-starvation and use of laxatives produce numerous undesirable biological consequences in people with anorexia nervosa.
Prognosis
Between 50 and 70 percent of people with anorexia eventually recover.
Recovery often takes 6 to 7 years, and relapses are common before a stable pattern of eating and weight maintenance is achieved.
Anorexia nervosa is a life-threatening illness.
Bulimia nervosa
DSM-5 criteria for bulimia nervosa
Involves episodes of rapid consumption of a large amount of food, followed by compensatory behavior, such as vomiting, fasting, or excessive exercise, to prevent weight gain.
Binge has two characteristics:
Bulimia nervosa is not diagnosed if the bingeing and purging occur only in the context of anorexia nervosa and its extreme weight loss.
The diagnoses in such a case is anorexia nervosa, binge-eating/purgning type.
The key difference between anorexia and bulimia is weight loss.
People with bulimia do not lose a
Sexual disorders - summary of chapter 12 of Abnormal Psychology by Kring, Davison, Neale & Johnson (12th edition)Clinical psychology
Chapter 12
Sexual disorders
Sexual dysfunctions are defined by persistent disruptions in the ability to experience sexual arousal, desire, orgasm, or by pain associated with intercourse.
Paraphilias are defined by persistent and troubling attractions to unusual sexual activities or objects.
Definitions of what is normal or desirable in human sexual behavior vary with time and place.
Culture influences attitudes and beliefs about sexuality.
Gender and sexuality
Women tend to be more ashamed of any flaws in their appearance than do men, and this shame can interfere with sexual satisfaction.
For women, sexuality appears to be more closely tied to relationship, status, and social norms than for men.
Among women with sexual symptoms, more than half believe their symptoms are caused by relationship problems. Men are more likely to think about their sexuality in terms of power than are women.
There are many parallels in men’s and women’s sexuality.
The sexual response cycle
Four phases in the human sexual response cycle
Sexual dysfunctions
Sexuality usually occurs in the context of an intimate personal relationship.
Our sexuality shapes at least part of our self-concept.
When sexual problems emerge, they can wreak havoc on our self-esteem and relationships.
Clinical descriptions of sexual dysfunctions
The DSM-5 divides sexual dysfunctions into three categories:
Separate diagnoses are provided for men and women.
The diagnostic criteria for all sexual dysfunction specify that dysfunction should be persistent and recurrent and should cause clinically significant distress or problems with functioning.
A diagnoses of sexual dysfunction is not made it the problem is believed to be due entirely to a medical illness or another psychological disorder.
Many people with problems in one phase of the sexual cycle will often report problems in another phase. Some of this may just be a vicious circle.
Sexual problems in one person may lead to sexual problems in the partner.
Disorders involving sexual interest, desire, and arousal
DSM-5 criteria for Male hypoactive sexual desire disorder
DSM-5 criteria for Erectile disorder
DSM-5 criteria for Female sexual interest/arousal disorder
Disorders of childhood - summary of chapter 13 of Abnormal Psychology by Kring, Davison, Neale & Johnson (12th edition)Clinical psychology
Chapter 13
Disorders of childhood
Most theories of childhood disorder, consider childhood experience and development critically important to adult mental health.
Before making a diagnosis of a particular disorder in children, clinicians must first consider what is typical for a particular age.
Some childhood disorders are unique to children.
The more prevalent childhood disorders are often divided into two broad domains,
Children and adolescents may exhibit symptoms form both domains.
Across cultures, externalizing behaviors are consistently found more often among boys and internalizing behaviors more often among girls, at least in adolescence.
Childhood disorders involve an interaction of genetic, neurobiological, and psychological factors.
Clinical descriptions, prevalence, and prognosis of ADHD
DSM-5 criteria for attention-deficit/hyperactivity disorder
Although children with ADHD are usually friendly and talkative, they often miss subtle social cues.
Children with ADHD can know what the socially correct action is in hypothetical situations but be unable to translate this knowledge into appropriate behavior in real-life social interactions.
DSM-5 includes three specifiers to indicate which symptoms predominate
The combined specifier comprises the majority of children with ADHD.
A difficult differential diagnosis is between ADHD and conduct
.....read more Late life and neurocognitive disorders - summary of chapter 14 of Abnormal Psychology by Kring, Davison, Neale & Johnson (12th edition)Clinical psychology
Chapter 14
Late life and neurocognitive disorders
As we age, physiological changes are inevitable, and there may be emotional and mental changes as well.
Many of these influence social interactions.
The problems experienced in late life
Mental health is tied to the physical and social problems in a person’s life.
No other have more of these problems than the elderly.
As people age, the quality of depth of sleep declines.
Sleep apnea: a disorder in which a person stops breathing for seconds to minutes during the night. Increase with old age.
Several problems are evident in the medical treatment available during late life.
Research methods in the study of aging
Three kinds of effects:
Two major research designs
The DSM criteria are the same for older and younger adults.
The process of diagnoses must be considered with care. DSM criteria specify that a psychological disorder should not be diagnosed if the symptoms can be accounted for by a medical condition or medication side effects.
Clinicians must be extremely careful to consider the interactions between physical and psychological health.
Estimating the prevalence of psychological disorders in late life
Persons over age 65 have the lowest overall prevalence of mental disorders of all age groups.
Mot people with psychological disorders in late life are experiencing a continuation of symptoms that began earlier.
Why so low?
Methodological issues in estimating the prevalence of psychopathology
Personality disorders summary of chapter 15 of Abnormal Psychology by Kring, Davison, Neale & Johnson (12th edition)Clinical psychology
Chapter 15
Personality disorders
The personality disorders are a heterogeneous group of disorders defined by problems in forming a stably positive sense of self and with sustaining close and constructive relationships.
People with personality disorders experience difficulties with their identity and their relationship in multiple domains of life, and these problems are sustained for years.
Their personality problems are evident in cognition, emotion, relationships, and impulsive control. The symptoms of personality disorders are pervasive and persistent.
The DSM-5 approach to classification
In the DSM-5, the 10 different personality disorders are classified in three clusters, reflecting the idea that these disorders are characterized by:
Many people with psychological disorder will also experience a personality disorder.
Comorbid personality disorder are associated with more severe symptoms, poorer social functioning, and worse treatment outcomes for may conditions.
Diagnostic reliability
Using structured interviews and multiple informants can improve reliability.
Comorbidity
Personality disorders tend to be comorbid with each other.
Alternative DSM-5 model for personality disorders
Reducing the number of personality disorders, incorporating personality trait dimensions, and diagnosing personality disorders on the basis of extreme scores on personality trait dimensions.
Two types of dimensional scores
Key strengths:
Alternative DSM-5 criteria for Personality disorder
Odd/eccentric cluster includes:
Paranoid personality disorder
DSM-5 criteria for Paranoid personality disorder
Introduction to clinical psychology In this magazine, you can find the information you need for the first year course introduction to clinical psychology in the study psychology at the uva.
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