Exam 3 Flashcards by Anthony Kemmer

Eating Disorders: Part 1

Yuh

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Body Image (1m10s)

*Percentage of normal weight women
think they are overweight? _____

Percentage of college women diet? ____
Percentage of college men diet? ____

38%

66%
42%

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Body Image in the U.S. (6m)

*Americans spend >$30 billion per year on
weight loss products

*The American govt. spends ~$30 billion per
year on all education, employment, and
social services programs combined

*Most diets [fail/are successful]

fail

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Eating disorders (9m55s)

Characterized by a severe disturbance in eating behavior
Overvaluation of ______ and ______
Primary types:
________ ________ (AN)
________ ________ (BN)
_____ _______ _______ (BED)

weight, shape

Anorexia Nervosa
Bulimia Nervosa
Binge Eating Disorder

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Anorexia Nervosa (11m10s)
-Characterized by intense fear of gaining \_\_\_\_\_\_\_ and excessive \_\_\_\_\_\_ loss.

weight

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Anorexia Nervosa (20s) LISTEN AGAIN

*Criterion A: Restriction of ______ intake relative to requirements, leading to a significantly LOW body ______ in the context of age, sex, developmental trajectory, and physical weight.

*Criterion B: Intense fear of gaining weight or becoming
___, or persistent behavior that interferes with weight
gain, even though _________

*Criterion C: Distorted ________ of body shape and size,
or persistent lack of recognition of the seriousness of the
current low body weight.

energy
weight

fat
underweight

perception

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Anorexia Nervosa Subtypes (4m55s)

Restricting subtype
Persistent efforts to _____ food intake
Binge‐eating/purging type
Binge
-‘Out of control’ _________ of an amount of food far GREATER than what most people would eat in the same amount of time, under same circumstances
Purge
-________ of the food eaten
–Self‐induced vomiting; misusing laxatives, diuretics, and enemas
Other compensatory behaviors
-Excessive exercise or fasting

limit

consumption

Removal

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Anorexia Nervosa (7m10s)

*Distorted thinking:
“I have a rule when I weigh myself.If I’ve gained
then I starve the rest of the day. But if I’ve lost,
then I starve too.”

“Anorexia is not a self‐inflicted disease, it’s a self‐
controlled lifestyle.”

“It’s not deprivation, it’s liberation”

Yup

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_______ _______ (9m30s)
-Characterized by ‘uncontrollable binge eating’ and
recurrent inappropriate behaviors to prevent weight
gain.

Bulimia Nervosa

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Bulimia Nervosa Diagnostic Criteria (10m00s)

*Criterion A: Recurrent episodes of ______ eating

*Criterion B: Recurrent and inappropriate
efforts to _________ for the effects of binge
eating

*A and B Most Important

*Criterion C: Must take place at least once a week for 3 months

*Criterion D: Self‐evaluation is unduly influenced by body
shape or weight

*Criterion E: Not due to _______

binge

compensate

anorexia

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True or false:

-AN always trumps BN

Truth

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Binge Eating Triggers (13m10s)

Stress
Eating
Being alone
Craving specific foods
Thinking of food
Going home
Going to a party
Feeling bored and lonely
Feeling hungry
Drinking alcohol
Going out with romantic partner
Eating out
RESTRAINED EATING
Pretty much ANYTHING that

Yuh

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Bulimia vs. Anorexia (15m15s)

Bulimia Nervosa
Tend to be of _______ weight, or even ________.

*Binge‐eating/purging subtype of AN should be considered another form of BN?

*If both diagnoses are met, _________ ________ is
diagnosed (i.e.,Criterion E for BN)

*___ trumps ___!

normal, overweight

anorexia nervosa

AN > BN

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BINGE EATING DISORDER (16m45s)
-Characterized by __________ eating during a discrete
period of time and a feeling of lack of control over
eating.

excessive

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Binge Eating Disorder (BED) (17m10s)

*Criterion A: Recurrent episodes of ______ eating

Criterion B: __+ of the following:
Eating much more rapidly than normal
Eating to the point of feeling uncomfortably full
Eating large amounts of food when not hungry
Eating alone due to embarrassment about how much one is eating
Feelings of disgust, guilt, or depression after overeating
Criterion C: Marked distress regarding binge eating
Criterion D: Binge eating 1/week for 3 months
Criterion E: No __________ behaviors

binge

compensatory

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Prevalence (18m10s)

_______ _______ disorder is the most common eating disorder
Lifetime prevalence of 3.5% in women, 2% in men
Prevalence is 6‐8% in obese individuals
Bulimia Nervosa
1‐2% for women, 0.5% for men
Anorexia Nervosa (______ common)
0.9% in women, 0.3% in men

Binge eating disorder –> most common

LEAST

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*Age of Onset and Sex Differences (20m30s)

Peak Age of Onset
AN: 19‐20 yrs
BN: 16‐20 yrs
BED: 18‐20 yrs
Gender Ratio
__:__females to male
Current research is suggesting__:__ female to male

10: 1
3: 1

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Note about MEN + EDs (22m15s)

10% of people with eating disorders are men
Males exhibit similar symptoms to females
History of being overweight
Mixed evidence about sexual orientation as a risk factor
Cultural confounds to identifying compensatory behaviors
-E.g., physical activity

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Other Risk Factors for men? (25m10s)

Sports
-Wrestling (cutting weight quickly)
Gymnastics

Yuh

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A new ED that’s more common in men? (28m10s)

_______ ________
-Focused on your body not being muscular enough

Muscle Dysmorphia

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Other Concerns Masking EDs? (37m35s)

Orthorexia
Obsession with _____ eating and _______
___________ (42m45s)
Modulating your intake before/after an eating episode to compensate for calories
Drive for leanness (44m55s)
Potentially a lesser form of muscle dysmorphia…

clean, exercise

Drunkorexia

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Medical Complications and Physical Consequences (46m40s)

*Anorexia can lead to:
 Death from heart arrhythmias
 Kidney damage
 Renal failure
 amenorrhea/ low testosterone
 Dry skin, brittle hair and nails
 Yellow skin
 Lanugo: downy hair on body and face
 Susceptibility to cold
 Low blood pressure
 Thiamin (vitamin B1) deficiency
 Osteoperosis later in life

Yuh

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Medical Complications and Physical Consequences (47m30s)

*Bulimia can lead to:
-_________ imbalances
-Hypokalemia (low ________)
-Damage to hands, throat, and teeth from induced
vomiting

Electrolyte

potassium

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Course and Outcomes (49m00s) Listen again

*AN variable

Löwe and colleagues
(2001) – AN

*21 years after first seeking treatment

Yuh

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Course and Outcome (51m30s) * Anorexia and Suicide - Suicide is the _______ highest cause of death - 4‐5% - Completed suicide are __x higher * Better prognosis for BN and BED than AN - 70% with BN tend to recover, 60‐70% with BED *However, residual symptoms often ______, and high rates of diagnostic crossover

second 50x remain

Comorbidity (54m00s) *__________ (as many as 50%) *Obsessive‐compulsive disorder *Substance abuse disorders (particularly in BN and the binge‐eating/purging subtype of AN) * Personality disorders * Self‐harm behaviors * Anxiety Disorders (for BED)

Depression

Cultural Considerations (54m30s) * Eating disorders are not limited to _______ culture * Culture plays a role in clinical presentation * AN, BED not “culture bound” but BN may be Historically… * Being ________ = risk factor * Being African American = _______ factor

Western Caucasian protective

Lecture 2 - EATING DISORDERS: PART II

YUH

Biological Causal Factors (1m30s) * Genetics - __x greater lifetime risk for relatives of those with eating disorder - AN : 11.3x - BN: 4.4‐9.6x - BED: 1.9‐2.2x * Twin Studies (3m40s) - Genetics account for up to __% of AN risk - 59‐83% BN risk - 41‐57% BED risk *Just because you have the predisposition, doesn't mean you will develop the disorder

10 88

*Biological Causal Factors (5m30s) * Gene x Environment - ________ (mood regulation, appetite, impulsivity, sleep) -Dopamine (individuals w/ AN in particular) --People w/ AN doesn't have the same biological reward when they eat chocolate, for example. - Puberty - -Males and females are at the same risk of developing an ED before puberty, but when puberty hits, _______ are more likely to develop the ED than men. * Temperament (8m30s) - Harm avoidance ‐‐> AN - -They don't want to do things that are risky or anxiety provoking. - Perfectionism --> AN, BN - -"Has to be a certain way," strong desire to have things just right. Rigid. - Novelty seeking --> BN - -More impulsivity than other ED (b/c of binge-purge patterns they engage in, and those binge/purge cycles are not planned out...

Serotonin females

Sociocultural Factors (10m15s) * Media Influences - Magazine models - Diet advertisements *Barbie?

Yuh

Sociocultural Factors (18m40s) *Women’s ____-______ plummets right after reading a fashion magazine *Men’s body satisfaction _________ after watchingTV commercials with muscular men

self‐esteem decreases

Sociocultural Factors (20m15s) *The "____" ideal does not characterize all of U.S. history, nor all cultures

thin

Sociocultural Factors (23m20s) * Becker and colleagues (2002) ‐ - Fiji Study - Early 1990s - -High rates of ________ women - -Associated with being strong, able to work, kind and generous (all valued traits in the culture) - -Being thin viewed ________ (sickly, incompetent) -Emergence ofTV andAmerican shows such as Beverly Hills 90210 and Melrose Place --Young Women began to express concerns about weight and dislike for their bodies --Dieting increased

overweight negatively

Sociocultural Factors (25m20s) * Peers are highly influential - Appearance culture - Puberty - Teasing - Eating and weight norms - Fat talk * Selection or socialization? - [Selection/Socialization]: Choosing friends who are similar - [Selection/Socialization]: Becoming more like your friends *We see that people become more like their friends over time.

Selection | Socialization

Sociocultural Factors (39m30s) *Family interactions -Misperception of healthy weight child as overweight -Critical weight‐related comments -Fewer family meals

Yuh

Contemporary Issues (40m50s) *“Pro‐ana” websites provide tips to those who feel compelled to keep ______ themselves *Facebook and social media

starving

Individual Risk Factors (42m00s) * Internalizing the ____ ideal - Buying into the notion that being thin is highly desirable - Drive for muscularity? - Drive for leanness? * _____ _________ (43m30s) - **Most potent predictor** * Dieting - Most EDs start with “normal” dieting - But is all dieting bad?

thin Body Dissatisfaction

Individual Risk Factors (45m45s) *Loss of control eating * Negative affect - Depressive symptoms - Negative urgency - -Tendency to act impulsively when distressed * Childhood abuse? (46m50s) - Questionable risk factor...

Yuh

Transdiagnostic Model of Eating Disorders (50m50s) -Over-evaluation of shape and weight and their control at the core...

Yuh

Treatment of AN (52m10s) * Reluctance to seek ________ --> high drop out rates - Especially binge/purge subtype *Immediate goal is to **restore weight** to a level that is no longer ____-_________ -IV feeding, feeding tubes -Monitoring of caloric intake *Medications -Antidepressants and some antipsychotics – help with distorted thinking – evidence not that strong

treatment life‐threatening **AN is one of the toughest ED to treat

Treatment for AN (54m45s) * BEST TREATMENT: ______‐Based Therapy (intense) - Treatment of choice for adolescents - 10‐20 sessions over 6‐12 months (long) - Important aspects include: - -Use _____ to help build healthier eating habits - -Teach family how to provide appropriate ______ - -Deal with other family issues * Only ~___% achieve remission - Intense treatment, family can burn out...

Family family support 50%

Treatment for AN (58m30s) * Cognitive‐Behavioral Therapy (CBT) - Change maladaptive behaviors and thoughts - Treatment length recommended for 1‐2 years *Primary focus is on challenging and changing maladaptive cognitions *Not as successful as family therapy, and perhaps higher relapse rates.

Yuh

Treatment of Bulimia (59m45s) *____________ or other medications * Cognitive‐behavioral therapy - Main focus is on normalizing eating patterns a restructuring maladaptive patterns of thinking * Dialectical Behavior Therapy - Helpful for those with comorbid self‐injury or substance use *Better outcomes than for AN, and generally leads to symptom improvement

Antidepressants

Treatment for BED (1h, 5m00s) * Cognitive Behavioral Therapy (1h, 1m50s) - [More/less] effective than antidepressants - Primary focus is on changing maladaptive thoughts and behaviors (getting them on regular eating schedule) *Interpersonal Therapy -Address poor social functioning and consequent negative mood (comes out of the psychodynamic historical perspective) * Goal of treatment is NOT _____ _____ - The goal is to address those binge eating behaviors

More weight loss

Treatment Prognosis (1h, 7m15s) * AN - Early treatment - Early weight gain - Good therapeutic alliance * BN - Less severe baseline _________ - Early symptom reduction

depression

Obesity (1h, 8m30s) - __3 are obese in US - A major public health problem - Can be regarded as a state of excessive, chronic fat storage - Defined on the basis of the body mass index - -> (weight)/(height^2) x 703 = BMI * BMI is a flawed number because... - Muscle weighs more than weight - Water weight fluctuates throughout the day - Doesn't take into account bone density - -BMI is a rough number, rough estimate...

1/3

LECTURE 3 - Obesity (1m55s) *“Food addiction”? *Found in all racial and ethnic groups, but most prevalent in [black/white] [men/women] *Other risk factors include being: -Older -Female -Of low SES -Children of parents with obesity

black women

Risk and Causal Factors (4m15s) * Genetic inheritance - Gene x environment *Hormones involved in appetite and weight regulation -Increased body fat --> increased _____ --> decreased food intake *Leptin is the hormone that is supposed to regulate how hungry you are * _____ – causes hunger at certain times of day - -The hormone that regulates when you 'start' to feel hungry * Role of sleep - When we're tired, we tend to eat more.

Leptin Grehlin

Overlapping Models: ED and Obesity (9m25s) *Eating ________ is associated with less weight-gain over time.

breakfast

Overlapping Models (12m15s) * Girls - Concern with weight - Dieting - Parental weight‐related teasing (binge eating) - Same‐sex media image (purging, overweight) - Family meal frequency * Boys - Concern with weight (binge eating, overweight) *For girls, more __________ factors For girls, more of a ___________ factor

For girls, more sociocultural factors For girls, more of a psychological factor

Pathways to Obesity (13m40s) *Binge eating is a predictor of later _____ * Pathways to binge eating may include - Social pressure to conform to the thin ideal - Depression and low self‐esteem

obesity

Treatment of Obesity (15m10s) * Methods used to treat obesity include - Lifestyle modifications - -May consist of decreasing _______ intake, increasing ________ _______ - Medications - -Work by blocking the body's absorption of fat - Bariatric surgery - -An increasing popular option - -Require at least a year of psychological prep, minimum age of 16 *Once people become obese, it is [easy/difficult] for them to lose weight and maintain their new low weight *Therefore, prevention is important

caloric physical activity difficult

Substance Use Disorders - (27m10s)

Yuh

% reporting use of specific substances at any time during their lives (age 12 and up) *(28m04s)

Yuh

Substance Use: DSM‐5 Terms (30m20s) • Disordered Use: The ingestion of psychoactive drugs or substances that cause significant ________ or distress • _______: desire to consume or use a particular substance • Intoxication: Reversible substance specific syndrome due to intake of a substance which interferes with functioning (fighting, impaired judgment, slowed reflexes, etc.)

impairment Craving

Factors Influencing Intoxication (32m05s) • The substance used • Dose • Duration of the dose • Person’s tolerance for the substance • Time since last dose • Age, weight, gender, food in system, sleep, medications • _________ about the substance’s effects -What you 'expect' impacts the effectiveness of the drug... • Setting

Expectations

Substance Use: DSM‐5 Terms (34m00s) • __________: -Need for markedly increased amounts of the substance in order to achieve desired effect -Markedly diminished effect with continued use of the same amount of the substance • __________: -Characteristic withdrawal syndrome of the substance -The same or similar substance is taken to avoid or relieve withdrawal symptoms

Tolerance Withdrawal

Categorical vs. Continuous (35m40s) * DSM IV - Categorical and sucked * DSM-5 - Continuous approach to understand substance use

Yuh

Alcohol Use Disorder (36m20s) *Criterion A: Problematic pattern of alcohol use leading to clinically significant impairment or distress, as manifested by ≥ __ within a __‐ month period: • Taking larger amounts or over a longer period than planned • Persistent desire or failure to cut down • Great deal of time spent • Craving (strong desire for or urge to use) • Recurrent use resulting in failure to fulfill major obligations • Continued use despite social or interpersonal problems • Important activities are given up or reduced due to alcohol • Recurrent use in hazardous situations • Continued use despite a persistent physical problems • Tolerance • Withdrawal

2, 12

Alcohol Use Disorder (37m15s) Mild (2-3 symptoms) Moderate (4-5 symptoms) Severe (6+ symptoms)

Yuh

Binge Drinking (39m20s) • Consuming large amounts of alcohol in _____ period of time * Common in ______ settings * NIAAA definition - Males: __+ in 2 hours - Females: __+ in 2 hours

short college 5 4

Alcohol Use Disorder Statistics (42m20s) • Prevalence - 50.3% of Americans aged 12+ currently use alcohol - ____% engage in binge drinking - Lifetime – 29.1%, 12 month – 13.9% • More common among ____ than ____ * Course * 19.8% with lifetime AUD ever treated

22.8 men, women

Comorbidity (44m20s) • ____ of individuals with alcohol use disorders have another psychiatric disorder • Poly‐substance abuse common -People tend to use more than one substance that they're using

Alcohol and the Brain (46m20s) • At lower levels, alcohol stimulates certain brain cells and activates the brain’s “________ areas” • At higher levels, alcohol __________ brain functioning * BAC of .08 = intoxicated * BAC of .30 to .50 = unconsciousness

pleasure depresses

Alcohol Use Disorder (47m40s) ``` *Physical effects of alcohol on the body • Cirrhosis of the liver • Malnutrition • Cardiovascular disease • Fetal alcohol syndrome ```

Yuh

Alcohol Use Disorder (48m20s) * Physical effects of alcohol on the body - ________ of the liver

Cirrhosis

Alcohol Use Disorder (48m20s) * Physical effects of alcohol on the body - ________ of the liver

Cirrhosis

Alcohol Use Disorder (50m30s) *Psychosocial effects of AUD • Chronic ______, oversensitivity, depression -When you drink and then sleep, it's not considered rested sleep, you don't get rested sleep. * Loss of responsibility, pride in appearance * Personality disorganization/deterioration * Family problems, loss of work, homelessness * More vulnerable to self‐harm/suicide

fatigue

Impact of Alcohol (51m30s) ``` *Societal Costs • Lost Work • Homelessness • Health care costs --~$26 ______ annually • Suicide rates (24% involve alcohol) • DUI costs including deaths • Crime -- ~ 1/3 of arrests in the US are related to alcohol abuse ```

billion

Causal factors (54m10s) * Biological * Psychosocial * Sociocultural

Yuhhh

Causal Factors ‐ Terminology (54m20s) • ______ factor - Indirect and potentially more latent influence - -Devient peers, genetic predisposition, impulsive personality - -> these things will increase risk over the LONG TERM • ________ factor -Things that will increase your risk in the CURRENT MOMENT (peer pressure, anxiety) • Direct and immediate influence

Distal Proximal

Biological Causal Factors (55m20s) * _____________ dopamine pathway - -Where we see the substances light up the brain - Center of psychoactive drug activation in the brain - Reward deficiency syndrome - -Abnormality in D2 receptors

Mesocorticolimbic

Biological Causal Factors (56m40s) ``` *Genetic Vulnerability • Heritability estimates of 40‐60% • Family AUD --> 3‐4x increased risk • Metabolism of alcohol • Response to alcohol • Craving for alcohol ``` • Gene x environment

Yuh

Psychosocial Causal Factors (59m00s) *Parenting • Lack of ______ family relationships and ________ guidance • Lack of monitoring • Chaotic environments •Family _________ and parental modeling can serve as a protective factor even when other risk factors are present.

stable, parental involvement

Psychosocial Causal Factors (1h, 00m) * Cognitive factors - Selective attention - Positive __________ - -Associated w/ increased risk of alcohol abuse - -If you think good things are going to happen when you take substances, we have good data to suggest that better things happen. *Personality factors -Impulsivity --People who tend to be more impulsive -Also, sensation seeking, anxiety‐sensitivity, introversion/hopelessness

expectancies

Psychosocial Causal Factors (1h, 1m50s) LISTEN AGAIN *Learning Theories •Classical conditioning -Pairing things with that physiological response to the substance, and then that becomes a learned response --Ex: heroin --> Pairing the physiological response to the setting or the specific needles, then when you move to a new setting, the conditioned stimulus isn't there, so your body doesn't start responding, which increases the risk for overdose. • Operant conditioning (true for all substances) - Positive reinforcement - -When you have positive outcomes, you're more likely to engage in that behavior again - Negative reinforcement - Distant punishers - -The punishments (w/ SUD) tend to be more long down the road - -The immediate punishment is not usually common w/ substance abuse...Cirrhosis of the liver comes way down the line. • Modeling -"If they're enjoying theirselves then I can enjoy myself." • Especially relevant to adolescent use

Yuh

Sociocultural Causal Factors (1h,4m30s) *Sociocultural causal factors • Alcohol as a “social ________” in Western cultures • Differences across religions, countries

lubricant

Treatment of AUD (1h, 5m15s) * Biological approaches include - Medications to block the desire to drink: - -________ (makes you noxious if you drink alcohol, positive punishment) - -Naltrexone (decrease cravings) * Medications to lower the side effects of acute withdrawal: - Valium - Diazepam *Alcohol withdrawal can be incredibly dangerous.

Antabuse

LECTURE 4 - Substance Use Disorders Part I Cont. Treatment of AUD • Psychological treatment approaches include • Inpatient and residential treatment • Group therapy • Individual therapy ************************************************* • Behavioral/Cognitive Behavioral therapy • ____ Reduction -Trying to decrease the amount the individual is drinking, an increase their self-care, not complete abstinence -Teaching to do things in the safest way possible if you're going to do it • _________ Prevention -Form of CBT, prepping individuals that It's going to be really hard when you have cravings that are so strong. -Future focused, problem solving approach. • Motivational Interviewing -Aimed at enhancing that intrinsic motivation to stop drinking • Alcoholics Anonymous/12‐Step programs -Spiritually based programs, acceptance based

Harm Relapse

Treatment for AUD • Project MATCH • Matching Alcohol Treatment to Client Heterogenity • Manualized AA, MI, and CBT approaches to treating alcohol use disorders • Results showed all worked equally well, and treatment matching isn’t necessary for AUD * *Which is most effective for treating alcohol disorder? - _____________

They all work well equally

Substance Use Disorders Part II

Yuh

DSM Overview: Other Substances (55s) *Same diagnostic criteria as for AUD *BUT, _________ syndromes vary across substance categories

withdrawal

Prevalence fun! (Any use) (1m25s)

Yuh

SUD Prevalence (3m00s) * May be ___________ - Underreported, people not be honest about how much they use, etc. * 12 month prevalence ~6.7% SUD - Of those, ~12% also had AUD * Prevalence higher among young adults - 5% of adolescents - 16.3% young adults

underestimated

Categories of Substances (5m15s) - Stimulants - Opiates - Hallucinogens - Marijuana - Other drugs - Gambling

Yuh

Stimulants (5m45s) * E.g., Caffeine, nicotine, cocaine, amphetamine * “_______” * Used to treat ADHD, narcolepsy (sleep disorder, have a hard time staying awake, falling asleep randomly)

Uppers

Stimulants (6m30s) * Stimulate CNS - Increased heart rate and blood pressure * Cocaine and amphetamines increase _______ levels - Long-term use produces ________ brain changes * Caffeine increases ________ * Nicotine functions both as a ________ and _________

dopamine permanent serotonin stimulant and depressant

Stimulants (8m30s) *Cocaine, amphetamine, methamphetamine, dexedrine, methylphenidate, nicotine, caffeine -Produces euphoria, alertness, excitement -Prevalence of use --Cocaine – 1.5% of young adults (current use) --Methamphetamine – 2.3% of the population (ever-use) --Nicotine – 28.4% of population (current use) --Caffeine – 85% of population (daily use)

Yuh

Stimulants (9m30s) ``` *Secondary health effects  Damage to ______ passage (due to snorting)  Risky sexual behavior  Skin and oral deterioration  Psychosis and psychotic behavior  Headaches and cognitive impairment  Insomnia, restlessness  Cancer and emphysema ```

nasal

Opiates/Narcotics (11m30s) *Opium, heroin, morphine, codeine, Oxycontin *Traditionally used as a _______ and ________ (used to decrease/treat anxiety) *Secondary health problems (HIV/AIDS)

painkiller, anxiolytic

Opiates (13m00s) *Highly _______ -Depress the CNS -Attach to dopamine receptors --> Feelings of ________ -Withdrawal starts 8 hours after consuming substance and can last for up to __ days. * Brain receptors that are sensitive to opiates - Endorphins

addictive euphoria 8

Opiates/Narcotics (17m30s) * Social effects - Life focused on _______ drug, more involvement with legal system, personality degeneration * Causal factors - Pleasure, _______, peer pressure, _______ seeking - Gene x Environment interactions * Sociocultural factors - "Narcotics sub-culture” - Undereducated, unemployed

obtaining curiosity, sensation

Classical Conditioning in Substance Use (21m40s) Listen again

Yuh

Hallucinogens (24m20s) * LSD, MDMA, psilocybin, PCP, ketamine, mescaline, peyote ``` *Produces ________ distortion; alters ________ experiences -Depersonalization -“Trips” -“Out-of-____ experience” ``` *Do not produce dependence or withdrawal

sensory, perceptual body

Hallucinogens (25m50s) *Can generate mood swings, “bad trips,” ________, and organic brain dysfunction *Associated with “_____” sub-culture *Used for _________ purposes in older cultures

flashbacks hippie ceremonial

Hallucinogens (28m20s) * Do not… - Directly impact ________ transmission - Produce _____ effects on organs *They do binds to 5-HT _______ receptor

dopamine toxic serotonin

Hallucinogens (29m30s) * Ecstasy (MDMA) - Has both __________ and ________ properties - -Ecstasy makes you really ________. - --Dehydration - Tablets vary widely in strength, and often contain other drugs - Rush, feeling of calm energy/well-being, intensified feelings, colors, sounds - Empathy, sensation of understanding and accepting others - But also nausea, sweating, clenching of teeth, muscle cramps, blurred vision - ________ impairment and more severe organic brain problems seem possible, yet long-term effects unknown

hallucinogenic, stimulant thirsty Memory

Marijuana/Cannabis (39m40s) *Cannabis sativa, hashish, synthetic/”spice” *Mild ____________ effects, euphoria, relaxation -May be used to decrease anxiety *Most frequently used illicit drug

hallucinogenic

Cannabis (40m30s) * Some secondary negative effects - May intensify _____ mood, anxiety - _______ and functional impairment - Short-term _______ deficits

poor Lethargy memory

Cannabis (42m50s) * Legalization of marijuana - Pro - -_________ marijuana - -Prohibition does not stop consumers from consuming drugs - -No risk of _______ or extremely impaired judgment - -Collapse in the illegal drug industry, and a reduction in crimes * Con - -_______ while intoxicated - -Third party effects - -Correlates such as low _________ - -“Gateway drug

Medicinal overdose Driving achievement

Other Drugs (46m50s) * Sedatives - Phenobarbitol * Antianxiety drugs/Benzodiazepines - Xanax, Valium, Klonopin *Both are effective at promoting _____ and reducing ______, but both have abuse/dependence liabilities.

sleep, tension

Gambling (48m55s) *New to DSM-5 *“Substance _________” -Needs to bet more to achieve the same level of excitement

tolerance

Gambling (50m00s) *Cognitive-emotional processes 1. __________ conditioning - We are sensitive to rewards - Winning feels good 2. Experience of ____ - People will see things that make them think of gambling which will want to make them gamble 3. Impulsivity - When people gamble, they can do so very impulsively and just keep going 4. Impaired executive functioning

Behavioral cues

SUD Causal Factors (53m00s) * Similar to AUD factors - Biological Factors - -Genetics - Psychological Factors - -Personality, SES, availability, peer pressure, etc. - Drug Properties! - -Latency to take effect, half-life, route of administration, etc

Yuh

Substance Use Disorders (53m50s) *Treatment methods 1. __________ = starting point 2. _______ building (often involves feedback) -Cognitive-behavioral therapy -Relapse prevention -Group therapy, support groups (e.g., NA) -Medications, replacement therapies (e.g., methadone, nicotine patch) *Treatment drop-out, relapse rates generally ____

Detoxification Motivation high

Personality Disorders: Clinical Features (20s) * DSM Definition - Enduring pattern of behavior that is ________ (happens across context and time) and ________ (doing the same behavior over and over again), as well as stable and of long duration that causes significant distress or impairment in functioning. * Behaviors manifested in 2 of the following areas: - Cognition - Affectivity (referring to emotions, too much or too little) - Interpersonal Functioning - Impulse Control

pervasive, inflexible

Personality Disorders: Clinical Features (4m00s) *Not resulting from inability to deal with acute stress *Evaluation of the ____-term patterns of functioning which is evident by early _________ *KEY FEATURE - ___________ difficulties * This category of disorders encompass both a - Broad range of behavioral problems - Wide range of severity

LONG adulthood Interpersonal

Personality Disorders: Clinical Features (4m00s) *Not resulting from inability to deal with acute stress *Evaluation of the ____-term patterns of functioning which is evident by early _________ *KEY FEATURE - ___________ difficulties * This category of disorders encompass both a - ______ range of behavioral problems - Wide range of severity

LONG adulthood Interpersonal Broad

Personality Disorders: Research Issues (7m00s) * Personality disorders are [easy/difficult] to diagnose - Diagnostic criteria not as well defined as other disorders - Reliability and validity of the diagnoses * Difficulty studying causal factors - Unclear etiological view - High levels of __________ - -60-85% with one PD have at least one more - -25% have two or more PDs - -More likely to meet criteria for another disorder, but not vice versa -Most studies are retrospective

DIFFICULT comorbidity

Personality Disorders: Dimensional Approach (15m00s) * Dimensional Approach - Emphasizes impairments in functioning - Four key functioning elements (identity, self-direction, empathy, intimacy) - Five personality traits - Diagnosis = impairment in __________ + 1 ≥ pathological __________ trait

functioning personality

Personality Disorders: Dimensional Approach (17m20s) * Five factor structure of PD characteristics - Detachment (extraversion) - Negative affectivity (neuroticism) - Antagonism (agreeableness) - Disinhibition (conscientiousness) - Psychoticism (openness) *Personality styles can be ________ or __________

adaptive maladaptive

Mnemonic for the personality disorders: Wild, weird, worried

Yuh

Cluster A Personality Disorders (20m30s) **WEIRD** * Paranoid Personality Disorder - ____________ and mistrust of others and a tendency to see themselves as blameless (tend to be on guard for perceived attacks) * Schizoid Personality Disorder - _______ social relationships and the inability and lack of desire to form ___________ to others * Schizotypal Personality Disorder - Peculiar thought patterns, oddities of _________ and speech that interferes with communication and social interaction

Suspiciousness Impaired, attachments perception

Cluster A: Paranoid Personality Disorder (24m00s) ~WEIRD~ * Criterion A: Pervasive _______ and *suspiciousness* of others (≥__): - Suspects without basis that others are exploiting, harming, or deceiving - Preoccupation with unjustified doubts about loyalty or trustworthiness of friends or associated - Reluctance to confide in others because of unwarranted fear that information will be used maliciously - Reads hidden demeaning or threatening meanings into benign remarks or events - Persistently bears grudges - Perceives character attacks or reputation that are not apparent to others and is quick to react angrily - Has recurrent, unjustified, suspicions regarding fidelity of spouse/partner -Does not occur exclusively during the course of a psychotic disorder or mood disorder with psychotic features

4 distrust

Cluster A: Schizoid Personality Disorder (26m10s) ~WEIRD~ * Criterion A: Detachment from ______ relationships and a restricted range of expression of emotions in interpersonal settings (≥__): - Neither desires nor enjoys _____ relationships - Almost always chooses ______ activities - Has little if any interest in sexual experiences - Takes pleasure in few if any activities - Lacks close friends or confidants - Appears indifferent to praise or criticism - Shows emotional coldness, detachment, flat affect -Does not occur exclusively during the course of a psychotic disorder, mood disorder with psychotic features, or pervasive developmental disorder (e.g., autism).

social 4 close solitary

Cluster A: Schizotypal Personality Disorder (28m15s) ~WEIRD~ * Criterion A: Social and interpersonal '_______' marked by acute discomfort with and reduced capacity for relationships and cognitive or perceptual distortions/eccentricities (≥__): - Ideas of reference - ____ beliefs and magical thinking - _______ perceptual experiences - Odd thinking and speech - Suspiciousness or paranoid ideation - Inappropriate or constricted affect - Behavior or appearance that is odd, eccentric, or peculiar - Lack of close friends of confidants - Excessive social anxiety that does not diminish with familiarity - Does not occur exclusively during the course of psychotic disorders and pervasive developmental disorder

deficits 5 Odd Unusual

Cluster A Personality Disorders (33m00s) * Lifetime Prevalence - Paranoid: 2.3-4.4% - Schizoid: 3.1-4.9% - Schizotypal: 3.3% * Gender Ratio - ______ > _______

Males > Females

Cluster A Personality Disorders (34m35s) *Causal Factors - Paranoid - -Partial genetic transmission? - --Heritability of high levels of __________ (low agreeableness) and __________ (angry-hostility)? - -Parental neglect or abuse, exposure to violent adults? - Schizoid - -Personality traits have only modest heritability - --High ________, low openness to feelings - -Maladaptive underlying schemas - --“I’m basically alone” (view others as intrusive) - --“Relationships are messy and undesirable” - Schizotypal - -Moderate heritability - -Biological association with ___________ - --Share similar cognitive deficits - --Family studies

antagonism neuroticism introversion schizophrenia

Cluster B Personality Disorders (40m40s) ~WILD~ * Histrionic Personality Disorder - Emotional and _________ (theatrical) over concern with attractiveness, and tendency to irritability and temper outburst if attention seeking is frustrated * Narcissistic Personality Disorder - Grandiosity, preoccupation with receiving ________, self-promoting, and lack of empathy * Antisocial Personality Disorder - Lack of ______ or ______ development, inability to follow approved models of behavior, deceitfulness, shameless manipulation of others, and history of conduct problems as a child * Borderline Personality Disorder - __________, inappropriate anger, drastic mood shifts, chronic feelings of boredom and fears of abandonment, and self-injurious behaviors or suicide

dramatic attention moral, ethical Impulsiveness

Cluster B: Histrionic Personality Disorder (41m41s) "The emotional drama queen" ~WILD~ *Excessive 'emotionality' and _________ seeking (≥___): -Discomfort in situation in which s/he is not the ______ of attention -Inappropriate sexually seductive or provocative behavior -Displays rapidly shifting and shallow expression of emotions -Consistently uses physical appearance to draw attention to self -Has an excessively impressionist style of speech -Shows self-dramatization and exaggerated expressions of emotion -Is overly suggestible -Considers relationships to be more intimate then they actually are

attention 5 center

Cluster B: Narcissistic Personality Disorder (43m55s) "I am so awesome and you need to tell me I am awesome" ~WILD~ *Grandiosity, need for admiration, lack of empathy (≥__) -Grandiose sense of _____-importance -Preoccupation with fantasies of unlimited success, power, brilliance, beauty -Belief that s/he is special or unique -Excessive need for admiration -Sense of _________ -Tendency to be interpersonally exploitative -Lacks ________ for the feelings of others -Often envious of others or believes that others are envious of him -Shows arrogant, haughty behaviors or attitudes

5 self entitlement empathy

Cluster B: Histrionic and Narcissistic (46m10s) * Lifetime Prevalence - Histrionic: 1.8% - Narcissistic: 6% * Gender Ratio - Histrionic: _______ > _______ - Narcissistic: _______ > _______

- Histrionic: Females > Males - -(Women are more emotional and dramatic) -Narcissistic: Males > Females

Histrionic PD wants ANY attention, good and bad Narcissistic PD wants only POSITIVE attention - tell them they're awesome

Yuh

Cluster B: Histrionic and Narcissistic (49m40s) *Causal Factors - Histrionic - -May be a common underlying predisposition with _________ PD - -Extreme expression of both ___________ and ___________ - -Maladaptive schemas - ---“Unless I entertain people, no one will like me” - ---“People will leave me if I don’t captivate them” - Narcissistic - -Low on facets of __________, High on facets of Openness and Neuroticism - -Psychodynamic - --Parents who don’t help child develop normal levels of self-confidence and sense of self-worth - -_______ ______ theory - --Unrealistic parental overvaluation (parents that pamper and indulge their children)

antisocial Neuroticism and Extraversion Agreeableness Social learning

Cluster B: Antisocial Personality Disorder (53m10s) ~WILD~ * Criterion A: Disregard for and violation of rights of others (≥___): - Failure to _______ to social norms - Deceitfulness - Impulsivity or failure to plan ahead - Irritability and aggressiveness - Reckless disregard for ______ of self or others - Consistent irresponsibility - Lack of remorse * ≥ 18 years old * Conduct disorder with onset before age ___ * Not exclusively during schizophrenia or bipolar

3 conform safety 15

Cluster B: Antisocial Personality Disorder (58m10s) *Psychopathy (or sociopath) --> The Iceman -Two Dimensions: 1) Affective and interpersonal factor (~fearlessness) -Lack of _______ and guilt, callousness/lack of empathy, glib and superficial charm, inflated and arrogant self-appraisal 2) Behavioral factor (~externalizing vulnerability) -_______, impulsive, and socially deviant lifestyle (poor behavioral control and parasitic lifestyle) -About ____ of those with ASPD also meet criteria for psychopathy, while about 80% with psychopathy meet ASPD - Psychopathy is the best predictor of violence and recidivism - Where may It be adaptive? - -You would want a cop, navy seal, surgeon, CEO --> lack of empathy/lack of emotional response is helpful in these professions.

remorse Antisocial half

Lecture 6 - Personality Disorders Continued

Yuh

Cluster B: Antisocial Personality Disorder (4m15s) **Listen again** * Causal Factors - Genetic Influences - -Findings from twin studies & adoption studies - ---Moderate heritability, but environmental influences also important - -ASPD may share common genetic predispositions with substance use disorders - Family & Socialization: - -Poor parental supervision & involvement (including parental loss) - -Abuse and neglect (parental rejection) - -Dysfunctional family structure - -Do not learn to pay attention to social stimuli - Low Fear Hypothesis and Conditioning - -Less susceptible to ____ and _______ - -Slow at learning to stop responding in order to avoid __________ - --People with ASPD don't get upset - General emotional deficits - -Difficulty processing affective stimuli - -Abnormality in the prefrontal cortex?

fear and anxiety punishment

Cluster B: Borderline Personality Disorder (18m55s) *Instability of interpersonal relationships, self-image, and affects marked by impulsivity (≥ 5) -Frantic efforts to avoid real or imagined ____________ -A pattern of unstable and intense interpersonal relationships  Identity disturbance characterized by a persistently unstable selfimage or sense of self  Impulsivity in at least 2 potentially self-damaging areas (e.g., spending, sex, substance use, reckless driving)  Recurrent suicidal behavior, gestures, or self-injurious behaviors (e.g., cutting)  Affective instability due to marked reactivity of mood  Chronic feelings of emptiness  Inappropriate, intense anger  Transient, stress-related paranoid ideation or severe dissociative symptoms

abandonment

Cluster B: Antisocial Personality Disorder (17m30s) * Prevalence - 3% lifetime (psychopathy 1%?) * Gender Ratio - 3:1 _____ to ______ * Comorbidity - Substance use disorders * Sociocultural Influence: - ASPD and Psychopathy occurs in a wide range of cultures -Exact manifestations and prevalence are influenced by sociocultural context - -Less prevalent in cultures with strong discouragement of aggression - -Cultures characterized by individualism have higher rates than those characterized by collectivism

3:1 male to female

Cluster B: Borderline Personality Disorder (18m55s) *Instability of interpersonal relationships, self-image, and affects marked by impulsivity (≥ 5) -Frantic efforts to avoid real or imagined ____________ -A pattern of unstable and intense interpersonal relationships --People with BDP are hot/cold -________ disturbance characterized by a persistently unstable self image or sense of self -Impulsivity in at least 2 potentially self-damaging areas (e.g., spending, sex, substance use, reckless driving) -Recurrent ________ behavior, gestures, or self-injurious behaviors (e.g., cutting) -Affective instability due to marked reactivity of mood -Chronic feelings of ________ -Inappropriate, intense ______ -Transient, stress-related paranoid ideation or severe dissociative symptoms - This is how they behave because this is how they've learned to get their interpersonal needs met... - People with BPD experience very intense emotions and they don't necessarily have the skills to cope with these negative emotions.

abandonment Identity suicidal emptiness anger

Cluster B: Borderline Personality Disorder (27m30s) *Most _________ diagnosed PD * Prevalence - 1.6% * Gender Ratio - 3:1 _______ to _____ * Comorbidity - Mood disorders, substance use disorders, eating disorders, and other personality disorders

commonly 3:1 female to male

Cluster B: Borderline Personality Disorder (28m05s) *Causal Factors -_________ appear to play a very significant role --Heritability of personality traits of affective instability and impulsivity -Lowered functioning of ________ and structural and functional differences in a variety of brain regions - High rates of ________ events in childhood (e.g., abuse, neglect) -Diathesis (personality)-stress(trauma) models

Genetics serotonin stressful

Genetics serotonin stressful Diathesis stress models

The model (32m20s)

Yuh

Cluster C: Obsessive-Compulsive PD (39m15s) * Preoccupation with orderliness, __________, mental and interpersonal control at expense of flexibility, openness and efficiency (≥4): - Preoccupation with details, rules, order, or schedules to the extent that the major point of an activity is lost - Extreme perfectionism that interferes with task completion -Excessive devotion to work to the exclusion of leisure and friendships - Overly inflexible and overconscientious about matters of morality, ethics, or values - Inability to discard worn out or worthless objects - Reluctance to delegate tasks or work with others unless others do exactly the same thing - Miserliness in spending style toward both self and others - Shows rigidity and stubbornness *Not OCD --> No obsessions or compulsions

perfectionism

Personality Disorders: Outcomes and Treatment (45m55s) LISTEN AGAIN * Difficult to treat. Why? - Relatively ________, *pervasive* and *inflexible* patterns of behaviors - Most with PD enter treatment at _________'s request (remember interpersonal difficulties) - Cluster A (paranoid ideations) and B (maladaptive interpersonal relationships when dealing w/ people) – extreme difficulty forming ________ with a therapist * Comorbidity – worse outcomes, particularly the treatment of other non-PD disorders (i.e., depression) * Cognitive therapies have been adapted to focus on specific schemas associated with the personality disorder * Medications – antidepressants (SSRIs), antipsychotic, mood stabilizers - -Medications don't *treat* the disorder,

enduring someone’s relationship

Personality Disorders: Outcomes and Treatment (51m10s) * Borderline Personality Disorder - Dialectical Behavior Therapy (form of CBT) – Marsha Linehan - -Focuses on one’s inability to tolerate strong states of ________ affect - ---Accept the negative affect – instead of engaging in self-destructive behaviors -Hierarchy of Goals for therapy: 1) Decrease _______/self-harming 2) Decrease behaviors that interfere with therapy • (e.g., missed sessions, lying) 3) Decrease behaviors that interfere with a ______ lifestyle • (e.g., substance abuse) 4) Increase behavioral _____ to regulate emotions, increase interpersonal skills, and increase _________ for distress 5) Additional goals chosen by the patient (specific needs) * *This is the best treatment for Borderline Personality Disorder** - -Works well - -Downside, takes a very long time (1-2 years on average)

negative suicidal stable skills tolerance

Personality Disorders: Outcomes and Treatment (59m00s) * Antisocial Personality Disorder - Lack of _________ for treatment (don’t think they need it) - __________ (i.e., punishment) – does not treat the disorder - Treatment often occurs for legal reasons (court mandated) - Psychopathy – can it be treated? - -Some people think it can be, evidence doesn't seem to support that it can *Antisocial behaviors tend to decrease after age of 40 * Biological - Meds - Mood stabilizers may help with aggression - Electroconvulsive therapy – mixed results * Cognitive Behavioral Therapy - Increase self-control, self-critical thinking, and social perspective taking - Increase victim awareness - Teach anger management - Modify antisocial attitudes and cognitions - Other comorbid problems (substance use)

motivation Incarceration

Personality Disorders: Outcomes and Treatment (59m00s) * Antisocial Personality Disorder - Lack of _________ for treatment (don’t think they need it) - __________ (i.e., punishment) – does not treat the disorder - Treatment often occurs for legal reasons (court mandated) - Psychopathy – can it be treated? - -Some people think it can be, evidence doesn't seem to support that it can - Antisocial behaviors tend to decrease after age of ___ - Biological - -Meds - _____ stabilizers may help with aggression - -Electroconvulsive therapy – mixed results - Cognitive Behavioral Therapy - Increase self-control, self-critical thinking, and social perspective taking - Increase victim awareness - Teach anger management - Modify antisocial attitudes and cognitions - Other comorbid problems (substance use)

motivation Incarceration 40 Mood

Exam 3 Flashcards

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