Halgin6e ppt ch14
- 1. Richard P. Halgin Susan Krauss Whitbourne University of Massachusetts at Amherst slides by Travis Langley Henderson State University Abnormal Psychology Clinical Perspectives on Psychological Disorders 5e Clinical Perspectives on Psychological Disorders 6e Richard P. Halgin Susan Krauss Whitbourne slides by Travis Langley Henderson State University Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display.
- 2. Eating Disorders & Impulse- Control Disorders Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display. Chapter 14
- 3. Eating Disorders Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display.
- 4. Anorexia and Bulimia Anorexia nervosa: Eating disorder characterized by an inability to maintain normal weight, an intense fear of gaining weight, and distorted body perception. Bulimia nervosa: Eating disorder involving alternation between eating large amounts of food in a short time, then compensating by vomiting or other extreme actions to avoid weight gain. Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display.
- 5. Anorexia and Bulimia Anorexia nervosa: Eating disorder characterized by an inability to maintain normal weight, an intense fear of gaining weight, and distorted body perception. Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display.
- 6. Anorexia Nervosa Refuse/unable to maintain 85% of expected weight for frame, height. Intense fear of gaining weight, though underweight. Distorted perception of weight or body shape. Amenhorrhea. Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display. Anorexia Nervosa
- 7. Anorexia Nervosa As self-starvation continues, bodily signs of physical disturbance become more evident. For example: Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display. Anorexia Nervosa Effects of Yellowing of the skin. Impaired organ functioning. Death (1 in 10).
- 8. Bulimia Nervosa Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display. Bulimia Nervosa People with bulimia nervosa alternate between eating large amounts of food in a short time, then compensating for the added calories by vomiting or other extreme actions.
- 9. Bulimia Nervosa BINGES: Episodes of eating large amounts of food, characterized by: in a 2-hour period, eating an amount much greater than others would eat; feeling a lack of control over what or how much is being eaten. Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display. Bulimia Nervosa
- 10. Bulimia Nervosa COMPENSATING BEHAVIORS PURGING TYPE – try to force out of their bodies what they’ve just eaten by NONPURGING TYPE – try to compensate by fasting or overexercising. Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display. Bulimia Nervosa vomiting administering enemas taking laxatives or diuretics
- 11. Effects of Bulimia Nervosa IPECAC SYRUP, if used regularly to induce vomiting, has toxic effects Dental decay Enlarged salivary glands Menstrual irregularity is common. LAXATIVES, DIURETICS, and DIET PILLS also have toxic effects over time Gastrointestinal damage may be permanent Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display. Bulimia Nervosa Effects of
- 12. THEORIES OF EATING DISORDERS BIOLOGICAL - Altered dopamine and serotonin neurotransmitter systems. PSYCHOLOGICAL - Turn to food to escape inner turmoil and pain; from cognitive standpoint, over time get trapped in eating patterns. SOCIOCULTURAL - Dysfunctional family functioning and societal obsession with food. Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display.
- 13. TREATMENT OF EATING DISORDERS COMBINATION OF APPROACHES MEDICATION PSYCHOTHERAPY Cognitive/Behavioral Interpersonal Therapy Family Therapy Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display.
- 14. TREATMENT OF EATING DISORDERS Therapists have found multifamily therapy to be particularly effective. Several families participate in group sessions together. Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display.
- 15. Impulse- Control Disorders Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display.
- 16. IMPULSE-CONTROL DISORDERS These disorders involve disturbances in the ability to regulate specific impulses not attributable to other DSM-IV-TR diagnoses. Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display.
- 17. Kleptomania An impulse-control disorder that involves the persistent urge to steal. Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display. Kleptomania The act of stealing excites sufferers. The object stolen is not particularly desired. Stealing releases tension, although the urge feels unpleasant, senseless.
- 18. Kleptomania Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display. Kleptomania The lack of interest in the stolen item is the main feature that differentiates a kleptomaniac from a typical shoplifter or burglar.
- 19. Pathological Gambling An impulse-control disorder involving the persistent urge to gamble. Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display. Pathological Gambling
- 20. Pathological Gambling Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display. Pathological Gambling
- 21. Pyromania An impulse-control disorder involving the persistent and compelling urge to start fires. Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display. Urge to prepare, set, and watch fires for fun (unlike arsonists motivated by greed or revenge).
- 22. Sexual Impulsivity Although this is not an official DSM-IV - TR diagnosis, symptoms of sexually impulsive people are similar to those of impulse-control disorders. Clinicians have seen growing numbers of clients looking for help to contain uncontrollable sexuality. Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display. Sexual Impulsivity
- 23. SEXUAL IMPULSIVITY Driven to engage in frequent, indiscriminate sex. Often feel bad after they engage in sex. May extend into violent deviance, like rape, rape/murders, serial killing. Usually also have substance abuse disorder and depression; some may have dissociative symptoms. Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display. Sexual Impulsivity
- 24. Trichotillomania The compulsion to pull out one’s hair. Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display. Trichotillomania
- 25. Trichotillomania The compulsion to pull out one’s hair. Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display. Trichotillomania Co-occurring disorders - depression, anxiety disorder, substance abuse, eating disorder Biological base - Related to OCD (abnormalities in basal ganglia, motor control area) Behavioral base - Rooted in environmental cues, done to relieve tension Sociocultural – The result of feeling abandoned, neglected, emotionally overburdened
- 26. INTERMITTENT EXPLOSIVE DISORDER Over 90% have co-occurring mood disorder. Other co-occurring disorders include substance problems and anxiety. Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display. Intermittent Explosive Disorder An impulse-control disorder involving an inability to hold back urges to express strong angry feelings and associated violent behaviors.
- 27. Internet Addiction An impulse control condition in which an individual feels irresistible need for Internet-based activities. Although not included in the DSM-IV-TR , Internet addiction shares characteristics of impulse-control disorders. Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display.
- 28. “Cyber-disorders” An informal diagnostic term for clients whose primary clinical problem involves the Internet. Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display.
- 29. “Cyber-disorders” An informal diagnostic term for clients whose primary clinical problem involves the Internet. Subtypes: cyber-sexual addiction cyber-relation addiction net compulsions (e.g., online gambling, shopping, trading) information overload compulsive online game playing Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display.
- 30. Eating Disorders and Impulse-Control Disorders: The Biopsychosocial Perspective These disorders involve people’s struggles to control strong urges to act in ways that are destructive or detrimental to their existence. Experts have proposed they fall on an “affective spectrum” that includes other disorders with obsessive or compulsive qualities. Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display.
- 31. For more information on material covered in this chapter, visit our Web site: Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display. http:/ www.mhhe.com/halgin6e
Editor's Notes
- #5: People with eating disorders struggle to control their disturbed attitudes and behaviors regarding food, and many put their lives at risk. Differences: Anorexics have distorted body image, bulimics have accurate body image; anorexics significantly below normal weight, bulimic’s weight is average or above-average.
- #6: Numbers of males with anorexia nervosa have increased.
- #7: Four symptoms characterize anorexia nervosa. Amenhorrhea: (for postpubescent females) the absence of at least three consecutive menstrual cycles.
- #8: 1 in 10 die as a result of starvation, medical complications, or suicide.
- #11: Some people with anorexia nervosa also engage in compensating behaviors, but their primary symptom is that they starve themselves.
- #12: Also possible: fluid retention in hands and feet; destruction of the heart muscle; collapse of the heart valve. Effects occur throughout the gastrointestinal, cardiovascular, and nervous systems. For girls, the highest risk for development of binge behavior is age 16; purging, 18. 42% of bulimic men identify themselves as homosexual or bisexual; 58% anorexic men, asexual.
- #13: Norepinephrine and serotonin deficiencies are also implicated in mood and compulsive disorders, so it is interesting to note high co-morbidity between those disorders and the eating disorders. Victims of childhood abuse have higher rates of eating disorders. Individuals with eating disorders tend to avoid problems rather than resolve them; resort to wishful thinking rather than realistic appraisal; and don’t seek social support even when in serious trouble. The pursuit of emotional comfort through eating may also be seen as a desperate expression of unresolved feelings of dependency.
- #14: Given the multiple perspectives on the causes of eating disorders and the evidence to support each, it follows that effective treatment usually requires a combination of approaches. Medication: Fluoxetine (Prozac) can help control relapse, maintain weight gains, and reduce other symptoms. Regardless of the potential usefulness of medications, though, psychotherapy is clearly needed. Cognitive/behavioral: Establish good eating patterns; self-monitoring techniques; learn self-control, problem-solving, cognitive-restructuring. Interpersonal therapy: Therapy focuses on helping the client cope with stress in interpersonal situations and with feelings of low self-esteem. Family therapy: A review of research indicates that involvement of the parents and the teen is sufficient to bring about positive change.
- #17: Impulse-control disorders: Psychological disorders in which people repeatedly engage in behaviors that are potentially harmful, feeling unable to stop themselves and experiencing a sense of desperation if their attempts to carry out the behaviors are thwarted.
- #18: Most people with kleptomania are unsure what to do with the stolen items.
- #19: People with kleptomania are driven by a persistent urge to steal, although their theft is not motivated by a wish to own the object or by its monetary value. A serotonin deficiency might underlie kleptomania. Clinicians use techniques like covert sensitization to control the urge to steal. However, few cases come to clinical attention.
- #20: Often gamblers have experienced a big win , a gain of large amounts of money in one bet, propelling them into a pattern of addiction that inevitably becomes almost impossible to break. The big win was so reinforcing, they become obsessed with the need to re-experience it. From a biological perspective, the perpetual pursuit of the big win is similar to effects of substance addiction. Personality influences: High impulsivity and psychopathy are thought to predispose individuals to seek excitement like that provided by gambling.
- #21: Internet addiction is becoming the newest context for pathological gambling. Although more common among young people, it is also becoming prevalent among the adult population.
- #22: Achieve intense pleasure, gratification, relief when fire starts. Rooted in childhood problems . Adults often have substance abuse and interpersonal problems. Difficult to treat, but behavioral, cognitive, and psychodynamic therapy may help.
- #23: Some experts believe the easy availability of sexuality on the Internet has pulled some people into desperately seeking sexual gratification, addictedly viewing sexual images, participating in sexually oriented chat rooms, or contacting other people seeking sexual encounters.
- #24: Like other conditions in the obsessive-compulsive spectrum, this responds to SSRIs. Insight-oriented therapy focuses on analyzing underlying conflicts. Behavioral techniques include covert conditioning, imaginal desensitization, and behavioral contracting.
- #25: They tend to engage in hair-pulling only when alone. Some may eat the hair they pull out.
- #26: Trichobezoar (“Rapunzel syndrome”): Condition in which swallowed hair solidifies in the stomach or intestines.
- #27: Features of this disorder suggest a complex interaction of biological and environmental factors leading up to it. Learning theorists feel operant conditioning explains the behavior of people who explode occasionally, that it leads to powerful reinforcement for them. Based on findings of serotonergic abnormalities, clinicians advocates medications.
- #29: Information overload involves compulsive Web surfing or database searches.
- #31: In attempting to explain impulse-control disorders, experts have proposed that they fall on an “affective spectrum” that includes mood disorders, substance abuse disorders, anxiety disorders, and eating disorders. All these conditions share certain symptoms, hypothesized biological mechanisms, and treatments.