Exam 2

Cultural:
•  Emphasis on thinness for women
•  Emphasis on diet to accomplish low weight
Biological:
•  Set-point theory- our bodies have an internal regulating mechanism such that your body has a set weight it will acclimate too in order for you to be healthy

• 12% men
• 88% women
• men try to get muscular whereas women want to lose weight overall
  

personality in accordance with your ego
-how you see yourself, personality disorders, eating disorders

personality is not in accordance with your ego
-depression

during the current episode of anorexia, the person has not regularly engaged in binge-eating or purgine behavior (self induced vomiting or the misuse of laxatives, diuretics, or enemas)

during the current episode of anorexia, person has regularly engaged in binge eating or purging behavior

over involved mothers result in restrictive anorexia, while underinvolved mothers result in bulimia

-59% of men and 49% of women are overweight (BMI over 25)
-Economic cost of obesity are estimated 5.5% of all health care costs (39 billion)
-Prevalence of dieting: in 1960 &% men, 14% women; in 1992 24% men and 40% women. 37% men think they are overweight, while 25% of women feel they are overweight

-a clash of philosophies in two fields
-eating disorders field: dieting can and does cause eating disorders
-obesity field: dieting represents a potential solution to a serious medical problem
-Sensible resolution of debate: discourage dieting in normal weight people; encourage dieting in those who are obese

we are whom we surround ourselves with
-study done by Fowler
-tracked health of 5000 people from 1971-2003
first made map of how subjects were connected
then tracked patterns of how and when the subjects became obese
Found that people weren't getting fat randomly, but that groups of people would get fat together while other groupings remained slender
when a Framingham resident became obese his or her friends were 57% more likely to become fat too

smoking
drinking
study habits
happiness

Proposed by Favaza and Rosenthal 1993, not in DSM but will be in the DSM-V
-preoccupation with physically harming oneself
-repeated failure to resist impulses to destroy or alter ones body
-increasing tension before and relief after the act
--to help... CARESS

CA= communicate alternatively (art, writing, words, ect). this will provide a different outlet for the expressive part that is normally done through harm
RE= release endorphins (running, exercising, laughing) ways of releasing endorphins and calming oneself
SS=self soothing. treat yourself gently in ways where you would hurt yourself, and now learn to caress yourself

studies the connection between how a person lives and illness

high fat, sugar, carb diets
stress
lack of exercise
type A personality
family history (genetics)
low socioeconomic status
sedentary lifestyle
excessive consumption of alcohol
hypertension
smoking
serum cholesterol
age
high straining job

time is urgent
competitive
hard driving
quick to anger
undercurrent of annoyance

Measuring a cities pace
-walking speed- on side walk, recorded how long it took people to walk
-working speed- teller getting change in bank. different banks
-talking speed-number of symbols in a minute of talking
-the watch factor
--type a personalities are at higher risk of heart disease because of reponses with adrenaline and other hormones that are released when stressed

study of the relationship between psychological factors and the immune system

-kill disease (bacteria, vruses, cancer cells)
-to remember an antigen, so that defense is quicker next time around
-to help in repair of tissue after injury

white blood cell (leuokocytes)
-they cirrculate throughout the body within the bloodstream

how well the immune system identifies and destroys anitgens
-it is decreased by stress, death of a spouse, a spouse with alzheimers, taking care of spouse with alzheimers, and medical students at the time of exams, especially those who reported lonliness
-what should you do about your immune system? -stay happy

the way we perceive or interpret events effects how we feel 

-distortions about self, world and future
-attributions can be (for most depressed people)
  -internal vs external (im a worthless person)
    -global vs specific in all areas of life
    -stable vs unstable

you see things in black and white
-either perfect or absolutely terrible
if your performance falls short of perfect, you see yourself as a complete failure

you see a single negative event as a never ending pattern of defeat

you pick out a single negative detail and dwell on it excluseively so that your vision of all reality becomes darkened

you have a precise fixed idea of how you or others should behave and overestimate how bad it is if these expectations aren't met

you think that others are behaving negatively because of you, without considering more plausible explanations

you reject positive experiences by insisting they 'don't count' for some reason

you make negative interpretation even though there are no definite facts that convincingly support your conclusion
-mind reading: assuming you know what one is thinking
-fortune telling- predicting how things will turn out

making decisions or arguments based on how you feel about the actual evidence

-women have more internal (anxiety, depression)
-men hav emore external disorders (alcoholism, violence)
•    Intriguing fact about depression: people born after 1945 are 10 times more likely to suffer a major depression than people born 50 years earlier

Exansive, elevated or irritable mood for at least a week and include 3 of the following
-inflated self esteem or grandiosity
-decreased need for sleep
-pressure to keep talking
-flight of ideas
-distractibility
-increase in goal directed avtivity
-excessive involvement in pleasurable activities with high risk for bad outcomes

-prescense or history of one or more major depressive disorders
-prescense of history of one or more hypomanic episode
-there has never been a manic or mixed episode

-Emotional
--feelings of sadness, diminished pleasure (anhedonia)
-Movitvational
--passivity, lack of responsive initiation
-Cognitive
--pessimism, hopelessness, low self esteem

-Hypomania in Bipolar II

both mania and depression
-not bipolar because they arent severe enough or meeting full criteria

a depressed mood for over 2 years, with two symptoms of depression

only in bipolar II
-less severe mania

-shakable depression that can be temporarily taken away by doing enjoyable things

at least 1 major depressive episode, at least 2 weeks of depression, plus 5 symptoms of depression including anhedonia and depressed mood

depressed mood
anhedonia (lack of pleasure)
feelings of worthlessness
poor concentration
inability to think
suicidal
appetite change
weight loss or gain
insomnia or hypersomnia
fatigue or low energy

-almost all depressed persons are anxious
but...
-not all anxious persons are depressed

prozac, zoloft, paxil celexa
action- selectively block reuptake of serotonin, other neurotransmitters not much affected
side effects- much less than other anti depressants...
1 agitation
2 insomnia
3 sexual slow down

selective serotonin reuptake inhibitors

13671 patients, most adults try two or more meds before finding one that workds
-best to take med for at least 8 wks before trying another one
-if 1st med fails, switching or augmenting are equally effective
***if 1st med fails, switching to cognitive therapy or to another med are equally effective
with first drug (celexa) 33% remitted
after 4th try at switching or augmenting, 67% remitted

-disrupted personal relationships
-problems are longstanding
-often associated with other negative outcomes (addiction, illegal behavior)
-disorder colors each new situations and results in a repetition of maladaptive patterns of behaviors
disorder usually marked worse by impact on others than personal pain

To make a diagnosis of a personality disorder, these criteria must be satisfied in addition to the specific criteria listed under the individually named personality disorders
-experiences and behaviors that deviates markedly from the expectations of the individuals culture. This pattern is manifested in 2 (or more) of the following areas:
-cognition- in perception and interpretation of the self, others and events
-affect- the range, intensity, labiality and appropriateness of emotional response

thoughts and behaviors that are in conflict, with needs and goals of ego, or further, in conflict with a personals idea self image

behaviors, values, feelings, which are in harmony with or acceptable to the needs and goals of th eego, or consistent with ones idea self image

•  A- odd essentric
      •    Paranoid, schizoid, schizotypal
•  B- dramatic, erratic
      •    Antisocial, borderline, histrionic, narcissistic
•  C- fearful, anxious
•          Avoidant, dependent, obsessive-compulsive

pervasive pattern of unwarranted suspiciousness of others.
for example- is preoccupied with doubts about loyalty of friends, reads hidden meanings into benign remarks or events, suspects that others are expliting or deceving him, suspects that partner is cheating
- defining characteristic- suspiciousness
-3 hallmark behaviors: mistrust of ppl including friends, bearing grudges, and feeling victimized
-cognitive dysfunction: constantly scanning the enviornment for 'evidence' supporting suspicions

pervasive pattern of detachment from social relationships and a restircted range of emotions in interpersonal settings. Doesn't desire or enjoy close relationships, little or no interest in sex with another person, shows emotional coldness/detachment
-Defining characteristics- severely restricted range of emotions and social detachment. little to no interest in social relationships, rarely marry and don't have close friends. they experience anhedonia, have an inability to show warmth and emotiona

acute discomfort with relationships, eccentricities of behaviors or appearance
- magical thinking, odd speech (vague, metaphorical, circumstantial)
-social anxiety with paranoid flavor
-characterized by odd speech, behvaior, thinking and or perception, but the oddity is not enough for a diagnosis of schizophrenia
-may report illusions (feeling like dea parent is in the room) or magical thinking(predict future)
-often have childhood histories of having been teased&excluded due to strangeness

-individual has grandiose sense of self-importance, sometimes with feelings of inferiority
-bragging of talent and achievements often accompanied by fragile self-esteem
-individuals are poorly equipped for friendship or love: demand great deal from others sucha s affection, favors. Tpically have a long history of erratic interpersonal relationships
*resembles histrionic pd in that narcissitic type want admiration, while histrionnic type desires concern

-characteristics- social withdrawal, hypersensitivity to rejection, reluctance to enter into reltationships, desire for acceptance and affection, low self esteem
-marked by social withdrawl*
  -has hypersensitivity to possibility of rejection, humiliation, or shame
  -tends to aviod relationships unless sure of other's uncritical affection
-low self esteem
-difficlut to differentiate from social phobia
  -social phobia is restricted to specific situations
  -avoidant pd affects almost evday life

-dependence on other characterizes dependent pd
-fear of abandonment underlies dependency
-may grow tolerant of unacceptable behaviors of others leading to a vicious cycle leading to more helpless feelings
-overlap with borderline personalities, borderline personality is more diabling

-excessive preoccupation with orderliness, perfectionism and ontrol describe obessive compulsive personality disorder
-overly concerned with mechanics of efficiency
-obsessive compulsive personality disorder differs from obsessive compulsive disorder
  -personality disorder is milder and more pervasive
  -personality disorder is more commong
-while seen as 'workaholics', preoccupation with perfection makes them often late for deadlines

resistance to demands for adequate performance in both occupational and social functionality
-resistance expressed indirectly
--procrasination
--dawdling
--stubbornness
--intentional ineffieciency
--forgetfulness'
----because of these reasons, longstanding social and occupation ineffectiveness

•  Histrionic Personality Disorder
o  Self dramatization
•  Act very emotional and dramatic in a way that draw attention to them
•  Overly flirtatious and dress provocatively
•  Crying automatically/immediately to get you to do something for them
•  More in women
  Example, kim kardashian, paris Hilton

•  Difficulties in establishing a secure self identity- heavily dependent on relationships with others to achieve a sense of selfhood
•  Distrust- expect to be abandoned or victimized by the people they depend on
•  Impulsive and self-destructive behavior- e.g., drug abuse, reckless driving, fighting, promiscuity, suicide, cutting
•  Difficulty in controlling anger and other emotions- primary emotions are grief and anger
one of the most diagnosed PDs
reports of childhood abuse phy&sexual

•  Predatory attitude toward other people- chronic indifference to and violation of the rights of fellow human beings
•  1% females; 4-6% in males; heavily weighted in men TEST
•  Sycopothy- extreme version of antisocial
o  3 Core Behaviors
•  intolerance – example- KKK (judgmental, prejudiced, doesn’t respect beliefs and practices of others)
•  Manipulativeness

•  Hare (person)- DSM’s APD criteria fail to include the interpersonal and emotional characteristics traditionally associated with psychopathy
•  These include
  Lack of empathy
  Inflated sense of ones self importance
  Glib, superficial interpersonal style (joking, light heartedness,
•  70% of prison inmates met criteria for ATP

many psychopaths are superficially charming, and can be excellent mimics of normal human emotion

Predictors of psychopathy: bed wetting, fire setting, torturing of animals (doing these things to get a rise for themselves, they don’t get discomfort from doing it and want to get a rise for themselves)

•  Intense fear of obesity or gaining weight
•  Restricting type or eating-purging type
•  15% below expected body weight
•  self evaluation is unduly influenced by body shape and weight
•  denial of seriousness

borderline and histrionic

social contagion theory

•  BP1- full mania, depressive symptoms/episodes
•  BP2- hypomania, major depressive episode (has to have depressive episode)

•  Sense of control (regaining a sense of control over eating)

schizotypal

•  Time urgent, quick to anger, competitive, hard driving

OCD
  Compulsion to control weight, and they constantly think about it and don’t follow own rules they will punish themselves for it, obsessions are intense fear of gaining weight and then they will purge

adhd

divorced men, artists, people over 60

repression

over involved mother will develop restrictive type anorexia
underinvolved mom will develop bulimia

•  Eating large amounts of food in a discrete amount of time (2 hour period) that is larger than most people would eat under the same circumstances
•  A sense of lack of control over eating during the episode

o  Identify negative automatic thoughts and faulty cognitions (cognitive distortions), then gather evidence to challenge these cognitions and develop rational responses as well as new skills as needed

  According to Hare, many psychopaths are superficially charming, and can be excellent mimics of normal human emotion