lecture 4 - mental health disorders 2 Flashcards

Question

biological - Brian dysfunction and neural plasticity

Answer 1

Speciﬁc brain lesions with observable defects in brain tis- sue are rarely a primary cause of psychiatric disorders. However, advances in understanding how more subtle deﬁciencies of brain structure or function are implicated in many mental disorders have been increasing at a rapid pace in the past few decades. Some of these advances come from the greater availability of sophisticated new neuroim- aging techniques to study the function and structure of the brain (see Chapter 4 for more details). Research has revealed that genetic factors guide brain development—so these diﬀerent pieces of the biological puzzle are all related (Hibar et al., 2015). However, we also know that genetic programs for brain development are not so rigid and deter- ministic as was once believed (Gottesman & Hanson, 2005; Thompson & Nelson, 2001). Instead, there is considerable neural plasticity—ﬂexibility of the brain in making changes in organization and function in response to pre- and post- natal experiences, stress, diet, disease, drugs, maturation, and so forth. Existing neural circuits can be modiﬁed, or new neural circuits can be generated (Wamsley & Fishell, 2017). The eﬀects can be either beneﬁcial or detrimental to the individual, depending on the circumstances. Research on neural and behavioral plasticity, in combi- nation with the work described earlier on genotype– environment correlations, makes it clear why developmen- tal psychopathologists have been devoting increasing attention to a developmental systems approach (Masten, 2006; Spencer et al., 2009), which acknowledges that genet- ics influences neural activity, which in turn influences behavior, which in turn inﬂuences the environment, but also that these inﬂuences are bidirectional.

Answer 2

Imbalances in neurotransmitters in the brain can result in abnormal behavior. Psychological stress can bring on neurotransmitter imbalances. Excessive production and release of neurotransmitters into the synapses can cause a functional excess in levels of that neurotransmitter. Dysfunctions in the normal processes by which neurotransmitters are deactivated can result in imbalances. Problems with the receptors in the postsynaptic neuron can also cause imbalances. Different disorders are thought to stem from different patterns of neurotransmitter imbalances in various brain areas. Medications used to treat various disorders are often believed to operate by correcting these imbalances. The widely prescribed antidepressants Prozac and Zoloft are designed to slow the reuptake of the neurotransmitter serotonin. Five different kinds of neurotransmitters have been most extensively studied in relationship to psychopathology. The first three neurotransmitters belong to a class called monoamines. Norepinephrine has been implicated as playing an important role in emergency reactions and basic motives. Norepinephrine also plays a role in attention and orientation. Glutamate and GABA are also neurotransmitters studied in relationship to psychopathology. Over a hundred neurotransmitters have been discovered to date. Neurons that are sensitive to a particular neurotransmitter tend to cluster together, forming neural paths between different parts of the brain known as chemical circuits.- Dopamine is involved in pleasure, cognitive processing, schizophrenia, and addictive disorders. Serotonin is another neurotransmitter. Nerve impulses travel from the cell body or dendrites of one neuron down the axon. Neurotransmitter substances are released into the synapse, which is a tiny fluid-filled space between the axon endings of one neuron and the dendrites or cell body of another neuron. Neurotransmitters are chemical substances that are released into the synapse by the presynaptic neuron when a nerve impulse occurs. The neurotransmitter substances act on the postsynaptic membrane of the dendrite (or cell body) of the receiving neuron, which has specialized receptor sites where the neurotransmitter substances pass on their message. Neurotransmitters can stimulate the postsynaptic neuron to either initiate an impulse or inhibit impulse transmission. Neurotransmitter substance does not stay around indefinitely and is quickly destroyed by an enzyme or returned to storage vesicles in the axon endings by a reuptake mechanism. Monoamine oxidase is an enzyme that can destroy excess neurotransmitters in the presynaptic terminal. There are many different kinds of neurotransmitters that can increase or inhibit the likelihood of the postsynaptic neuron firing. The concentration of certain neurotransmitters within the synapse affects whether the neural message is successfully transmitted to the postsynaptic neuron. Synapse, axon, neurotransmitter, enzyme, receptor, dendrite, and mitochondria are all terms related to interneuronal transmission. Neurotransmitters can stimulate the postsynaptic neuron to either initiate an impulse or inhibit impulse transmission. Reuptake is a process of reabsorption by which the neurotransmitters are reabsorbed Epinephrine (adrenaline) and cortisol are stress hormones produced by the adrenal gland. Cortisol provides negative feedback to the hypothalamus and pituitary to decrease the release of CRH and ACTH. Malfunctioning of the negative feedback system has been implicated in various forms of psychopathology such as depression and posttraumatic stress disorder. Imbalance in sex hormones, such as male hormones, can contribute to maladaptive behavior. Gonadal hormonal influences on the developing nervous system also contribute to some differences between behavior in men and women. Neurotransmitter serotonin plays an important role in emotional disorders such as anxiety and depression. Excitatory neurotransmitter glutamate has been implicated in schizophrenia. Neurotransmitter GABA is strongly implicated in reducing anxiety and other emotional states characterized by high levels of arousal. Many forms of psychopathology have been associated with various abnormalities in neurotransmitter functioning and altered sensitivities of receptor sites. Medications used to treat various disorders act at the synapse as their site of action. Certain medications act to increase or decrease the concentrations of pertinent neurotransmitters in the synaptic gap. Medications may block the reuptake process, alter the sensitivity of receptor sites, or affect the actions of enzymes that break down neurotransmitter substances. The synapse is an important site of action for many medications used to treat psychopathology. Each neurotransmitter will be discussed at greater length when relevant disorders are discussed in later chapters.- Medications that enhance the effects of a neurotransmitter on the post-synaptic neuron are called agonists, while those that inhibit the effects of a neurotransmitter on a post-synaptic neuron are called antagonists. Hormones are chemical messengers produced and released by endocrine glands that affect target cells in various parts of the brain and body. The hypothalamus regulates the pituitary gland, which is the master gland of the body that produces hormones that regulate other endocrine glands. The hypothalamic-pituitary-adrenal (HPA) axis is an important set of interactions that involves messages in the form of corticotropin-releasing hormone (CRH) traveling from the hypothalamus to the pituitary, which then releases adrenocorticotropic hormone (ACTH) that stimulates the cortical part of the adrenal gland. The HPA axis is involved in regulating the body's stress response by releasing epinephrine and cortisol. Hormonal imbalances have been linked to some forms of psychopathology. Hormones influence diverse events such as fight-or-flight reactions, sexual responses, physical growth, and many other physical expressions of mental states. The neuroendocrine system links the central nervous system to the endocrine system. The pituitary gland produces a variety of hormones that regulate or control other endocrine glands in the body. The hypothalamus periodically sends hormone signals to the pituitary gland. The adrenal gland is located on top of the kidneys and produces epinephrine and cortisol. The HPA axis involves the hypothalamus, pituitary gland, and adrenal gland. Corticotropin-releasing hormone (CR

Answer 3

Positive affect and activity level are related to the adult dimension of extraversion. Attentional persistence and effortful control are related to the adult dimension of constraint or control. Boys show slightly higher levels of activity and intense pleasure than girls, whereas girls have greater control of their impulses and greater ability to regulate their attention. Temperament shows a moderate degree of stability from late in the first year of life through at least middle childhood, although it can change. The temperament of an infant or young child has profound effects on a variety of important developmental processes. Children with a fearful temperament have many opportunities for the classical conditioning of fear to situations in which fear is provoked. Children with high levels of positive affect and activity are more likely to show high levels of mastery motivation. Children with high levels of fear and sadness are less likely to show mastery motivation. Children with high levels of negative emotionality are more difficult for parents to be supportive of, and different parents have different styles of parenting such children. Families with lower socioeconomic status are, on average, less supportive of difficult children than families of mid to high socioeconomic status. Temperament may set the stage for the development of various forms of psychopathology later in life. Children who are fearful and hypervigilant in many novel or unfamiliar situations have been labeled behaviorally inhibited by Kagan, Fox, and their colleagues. Behaviorally inhibited trait has a significant heritable component, and it is a risk factor for the development of anxiety disorders later in childhood and probably in adulthood.- Temperament refers to a child's reactivity and characteristic ways of self-regulation, which is believed to be biologically programmed. Babies show differences in their characteristic emotional and arousal responses to various stimuli and in their tendency to approach, withdraw, or attend to various situations. Some babies are naturally sensitive to slight sounds or sunlight, while others seem insensitive to such stimulation. Genetic factors strongly influence the temperament of babies, but prenatal and postnatal environmental factors also play a role in their development. Early temperament is thought to be the basis from which our personality develops. Approximately five dimensions of temperament can be identified in babies starting at about 2 to 3 months of age: fearfulness, irritability/frustration, positive affect, activity level, and attentional persistence/effortful control. These dimensions of temperament seem to be related to the three important dimensions of adult personality: neuroticism or negative emotionality, extraversion or positive emotionality, and constraint. The infant dimensions of fearfulness and irritability correspond to the adult dimension of neuroticism. Temperament is consistent over time, causing us to have similar reactions in similar contexts. Highly uninhibited 2-year-old children may have difficulty learning moral standards for their behavior from parents or society, and they have been shown at age 13 to exhibit more aggressive and delinquent behavior. Temperament is strongly influenced by genetic factors, but prenatal and postnatal environmental factors also play a role in their development. Rothbart, Derryberry, and Hershey (2000) conducted research on temperament and identified five dimensions of temperament in babies. The five dimensions of temperament identified by Rothbart, Derryberry, and Hers

Answer 4

Sigmund Freud founded the psychoanalytic school, which emphasized the role of uncon- scious motives and thoughts and their dynamic interrela- tionships in the determination of both normal and abnormal behavior. A key concept here is the unconscious. According to Freud, the conscious part of the mind repre- sents a relatively small area, whereas the unconscious part, like the submerged part of an iceberg, is the much larger portion. In the depths of the unconscious are the hurtful memories, forbidden desires, and other experiences that have been repressed—that is, pushed out of consciousness. However, Freud believed that unconscious material con- tinues to seek expression and emerges in fantasies, dreams, slips of the tongue, and so forth. Until such unconscious material is brought to awareness and integrated into the conscious part of the mind—for example, through psycho- analysis (a form of psychotherapy Freud developed; see Chapter 16)—it may lead to irrational and maladaptive behavior. For our purposes, a general overview of the prin- ciples of classical psychoanalytic theory will suﬃce. We then discuss several of the newer psychodynamic perspec- tives, which were the second generation of theories that stemmed in some important ways out of Freud’s original psychoanalytic theory and yet also departed from it in sig- niﬁcant ways. FUNDAMENTALS OF FREUD’S PSYCHOANALYTIC THEORY In an eﬀort to explain human behavior, Freud theorized that a person’s behavior results from the interac- tion of three key components of the personality that he called the id, ego, and superego. The superego is the outgrowth of internalizing the taboos and moral values of society concerning what is right and wrong, essentially what we refer to as the conscience. The superego becomes an inner control system that deals with the uninhibited desires of the id. The interplay of id, ego, and superego is of crucial significance in determining behavior. Anxiety plays a key causal role in most forms of psychopathology, according to Freud's psychoanalytic viewpoint. Anxiety is the body’s natural warning system that signals impending danger and the need to take corrective action. Anxiety is sometimes overtly experienced and at other times it is repressed and then transformed into and manifested in other overt symptoms such as conversion blindness or paralysis. When material is brought to awareness and integrated into the conscious part of the mind, it may lead to irrational and maladaptive behavior. Classical psychoanalytic theory suggests that a person’s behavior results from the interaction of three key components of the personality: the id, ego, and superego. The id is the source of instinctual drives and is the first structure to appear in infancy. Inner mental conflicts arise because the three subsystems (id, ego, and superego) are striving for different goals. Unresolved intrapsychic conflicts lead to mental disorder. Freud developed psychoanalysis, a form of psychotherapy that brings material to awareness and integrates it into the conscious part of the mind. Several newer psychodynamic perspectives stem from Freud's original psychoanalytic theory but also depart from it in significant ways. The principles of classical psychoanalytic theory provide a general overview of Freud's explanation of human behavior.- Freud believed that drives could be divided into two opposing types: life instincts and death instincts. Life instincts are constructive drives primarily of a sexual nature and constitute the libido. Death instincts are destructive drives that tend towards aggression, destruction, and eventual death. The id operates on the pleasure principle and is concerned only with the immediate gratification of instinctual needs. The ego mediates between the demands of the id and the realities of the external world and assumes the role of mediating between the physical needs of the body/id and the need to find an appropriate place and time. One of the basic functions of the ego is to meet id demands but in such a way as to ensure the well-being and survival of the individual. The ego's adaptive measures are referred to as secondary process thinking, and the ego operates on the reality principle. According to Freud, id demands, especially sexual and aggressive strivings, are inherently in conflict with the rules and prohibitions imposed by society. The ego requires the use of reason and other intellectual resources in dealing with the external world, as well as the exercise of control over id demands. The id can generate mental images and wish-fulfilling fantasies, referred to as primary process thinking, but it cannot undertake the realistic actions needed to meet instinctual demands. Freud used the term sexual in a broad sense to refer to almost anything pleasurable, from eating to painting. Anxiety is almost universally experienced at some point. The woman in the image shows her anxiety while awaiting news about the outcome of surgery on her sick child. Freud believed that the basic emotional and psychic energy of life was the libido. The pleasure principle is the id's tendency to seek There are five stages of psychosexual development that individuals pass through from infancy through puberty. The oral stage occurs during the first two years of life and is characterized by the mouth being the principal erogenous zone. The anal stage occurs from ages 2 to 3, and the anus provides the major source of pleasurable stimulation during toilet training. The phallic stage occurs from ages 3 to 5 or 6, and self-manipulation of the genitals provides the major source of pleasure. During the latency period, from ages 6 to 12, sexual motivations decrease in importance as a child becomes preoccupied with developing skills and other activities. The deepest feelings of pleasure come from sexual relations after puberty, which is known as the genital stage. Appropriate gratification during each stage is important if a person is to avoid being fixated at that level. Freud believed that an individual who does not receive adequate oral gratification may be prone to excessive eating or other forms of oral stimulation in adulthood. Anxiety is a normal response to danger or threat, but when it is excessive and persistent, it can be considered problematic or pathological. The ego can cope with elevated anxiety through rational measures, but when anxiety exists only in the unconscious, it cannot be dealt with through rational measures. Ego-defense mechanisms are irrational protective measures that help reduce anxiety by pushing painful ideas out of consciousness. Freud proposed that defense mechanisms reduce anxiety by not dealing directly with the problem. Forgetting a dental appointment is an example of a defense mechanism. There are several types of ego-defense mechanisms, which are described in Table 3.1. Ego-defense mechanisms help individuals cope with anxiety and protect their- Freud proposed that there are five psychosexual stages of development. The demands of the id are evident in early childhood. Babies pass through an oral stage, in which sucking is a dominant pleasure. Ego-defense mechanisms are used to prevent painful or dangerous thoughts from entering consciousness. Displacement is an ego-defense mechanism that involves discharging pent-up feelings on objects less dangerous than those arousing the feelings. Fixation is an ego-defense mechanism that involves attaching oneself in an unreasonable or exaggerated way to some person, or arresting emotional development on a childhood or adolescent level. Projection is an ego-defense mechanism that involves attributing one’s unacceptable motives or characteristics to others. Rationalization is an ego-defense mechanism that involves using contrived explanations to conceal or disguise unworthy motives for one’s behavior. Reaction formation is an ego-defense mechanism that involves preventing the awareness or expression of unacceptable desires by an exaggerated adoption of seemingly opposite behavior. Regression is an ego-defense mechanism that involves retreating to an earlier developmental level involving less mature behavior and responsibility. Repression is an ego-defense mechanism that involves preventing painful or dangerous thoughts from entering consciousness. Sublimation is an ego-defense mechanism that involves channeling frustrated sexual energy into substitutive activities. The DSM-IV-TR is a source used for this information. An example of displacement is a woman harassed by her boss at work initiating an argument with her husband. An example of fixation is an unmarried, middle-aged man still depending on his mother to provide his basic needs. An example of projection is an expansionist-minded dictator of a totalitarian state being convinced that neighboring countries are planning to invade.

Answer 5

The process of classical conditioning was discovered by Russian physiologist Ivan Pavlov. Dogs gradually began to salivate in response to a nonfood stimulus such as a bell after the stimulus had been regularly accompanied by food. Food is the unconditioned stimulus, and salivation is the unconditioned response. A stimulus that signals food delivery and eventually elicits salivation is called a conditioned stimulus (CS). Conditioning has occurred when the presentation of the conditioned stimulus alone elicits salivation—the conditioned response (CR). Classical conditioning is not as blind or automatic as was once thought, and animals actively acquire information about what CSs allow them to predict, expect, or prepare for an upcoming biologically significant event (the UCS). Behavioral psychologists believed that the study of subjective experience did not provide acceptable scientific data because such observations were not open to verification by other investigators. Only the study of directly observable behavior and of the stimuli and reinforcing conditions that control it could serve as a basis for understanding human behavior. The hallmark of classical conditioning is that a formerly neutral stimulus—the CS—acquires the capacity to elicit biologically adaptive responses through repeated pairings with the UCS. Conditioning also occurs when a neutral CS is paired with a painful or frightening stimulus such as a mild electric shock or loud noise, and fear rather than salivation is conditioned. The conditioned reflex was discovered by Ivan Pavlov. The behavioral perspective arose in the early twentieth century in part as a reaction against the unscientific methods of psychoanalysis. Behavioral psychologists believed that the study of directly observable behavior is the only basis for understanding human behavior. Classical conditioning is a process where a neutral stimulus becomes a conditioned stimulus that elicits a conditioned response- The behavioral approach views learning as the modification of behavior due to experiences. The behaviorists focus on the effects of environmental conditions or stimuli on the acquisition, modification, and elimination of different types of response patterns. Classical conditioning is a type of learning where a neutral stimulus is paired repeatedly with an unconditioned stimulus that naturally elicits an unconditioned behavior. The behavioral view of abnormal behavior and its treatment are tied to experimental work on classical conditioning. Watson was a behaviorist who believed that conditioning could train any healthy child to become any sort of adult one wished, and that abnormal behavior could be modified through reconditioning. Behaviorally oriented psychologists still accept many of the basic tenets of Watson’s doctrine today, although they are more cautious in their claims. Operant conditioning is a type of conditioning where the consequences of behavior influence behavior, and an individual learns how to achieve a desired goal. In operant conditioning, the concept of reinforcement is essential, which refers either to the delivery of a reward or pleasant stimulus, or to the removal of or escape from an aversive stimulus. New responses are learned and tend to recur if they are reinforced, and an instrumental response appears to be especially persistent when reinforcement is intermittent. Initially a high rate of reinforcement may be necessary to establish an instrumental response, but lesser rates are usually sufficient to maintain it. In instrumental conditioning, it is now believed that the animal or person learns a response–outcome expectancy, that is, learns that a response will lead to a reward outcome. Classical conditioning is the type of conditioning studied by Pavlov and Watson. In classical conditioning, a stimulus that is initially neutral (the conditioned stimulus or CS) becomes associated with a stimulus that elicits a reﬂexive response (the unconditioned stimulus or UCS). New responses are learned in operant conditioning, whereas classical conditioning involves the pairing of stimuli. Classically conditioned responses are well maintained over time and are not simply forgotten. Only CSs that provide reliable and nonredundant information about the occurrence of a UCS acquire the capacity to elicit CRs. Conditioning will not occur if UCSs- If a conditioned stimulus (CS) is presented repeatedly without the unconditioned stimulus (UCS), the conditioned response (CR) gradually extinguishes. However, extinction should not be confused with unlearning because the response may return at some future point in time, which is known as spontaneous recovery. A weaker CR may still be elicited in different environmental contexts than in the one where the extinction process took place. Any extinction of fear that has taken place in a therapist’s office may not necessarily generalize completely and automatically to other contexts outside the therapist’s office. Classical conditioning can condition many physiological and emotional responses, including fear, anxiety, sexual arousal, and drug addiction. Pavlov’s discoveries in classical conditioning excited John B. Watson, who changed the focus of psychology to the study of overt behavior rather than the study of theoretical mentalistic constructs, an approach he called behaviorism. Reinforcement is key in operant conditioning to achieve a desired goal with either the delivery of a reward or the removal of an aversive stimulus.

Answer 6

Since the 1950s many psychologists, including some learn- ing theorists, focused on cognitive processes and their impact on behavior. Cognitive psychology involves the study of basic information-processing mechanisms such as attention and memory, as well as higher mental processes such as thinking, planning, and decision making. The current emphasis within psychology as a whole on under- standing all of these facets of normal human cognition originally began as a reaction against the relatively mecha- nistic nature of the traditional, radical behavioral view- point (espoused by Watson and Skinner), including its failure to attend to the importance of mental processes— both in their own right and for their inﬂuence on emotions and behavior. bandura - stressed that human beings regulate behavior by internal symbolic processes. That is, we learn by internal reinforcement. According to Bandura, we prepare ourselves for diﬃcult tasks, for exam- ple, by visualizing what the consequences would be if we did not perform them. schemas and cognitive distortions - about ourselves, other people , the world around us, schemas about social roles Our self-schemas include our views on who we are, what we might become, and what is important to us. However, schemas are also sources of psychological vul- nerabilities because some of our schemas or certain aspects of our self-schemas may be distorted and inaccurate. addition, we often hold some schemas—even distorted ones—with conviction, making them resistant to change. ATTRIBUTIONS, ATTRIBUTIONAL STYLE, AND PSYCHOPATHOLOGY Attribution theory has also con- tributed signiﬁcantly to the cognitive-behavioral approach (Gotlib & Abramson, 1999). Attribution is simply the pro- cess of assigning causes to things that happen. We may attribute behavior to external events such as rewards or punishments (“He did it for the money”), or we may assume that the causes are internal and derive from traits within ourselves or others (“He did it because he is so gen- erous”). Causal attributions help us explain our own or other people’s behaviors and make it possible to predict what we or others are likely to do in the future. A student who fails a test may attribute the failure to a lack of intelli- gence (a personal trait) or to ambiguous test questions or unclear directions (environmental causes). COGNITIVE THERAPY Beck, who is generally consid- ered thefounder of cognitive therapy, has been enormously influential in the development of cognitive-behavioral treatment approaches to various forms of psychopathol- ogy.

Answer 7

Children who do not have the resources that are typically supplied by parents or parental surrogates may be left with deep and sometimes irreversible psychological scars. These needed resources range from food and shelter to love and attention. Deprivation of such resources can occur in several forms. The most severe manifestations of depri- vation are usually seen among abandoned or orphaned children, who may be either institutionalized or placed in a succession of unwholesome and inadequate foster homes. However, it can also occur in intact families where, for one reason or another, parents are unable (for instance, because of mental disorder) or unwilling to provide close and fre- quent human attention and nurturing. institutionalisation means children receive less warmth and physical contact, less intellectual, emotional, and social stimulation; and a lack of encouragement and help in posi- tive learning. Many children institutionalizedininfancy andearly childhood show severe emotional, behavioral, and learning problemsand are atrisk for disturbed attachment relationships and psychopathol- ogy (Bos et al., 2011; Ellis et al., 2004; Smyke et al., 2007). neglect and abuse in the home - Outright parental abuse (physical or sexual or both) of children has been associated with many negative eﬀects on children’s emotional, intellectual, and physical devel- opment, although some studies have suggested that, at least among infants, gross neglect may be worse than hav- ing an abusive relationship. Abused children often have a tendency to be overly aggressive (both verbally and physi- cally), even to the extent of bullying. Some even respond with anger and aggression to friendly overtures from peers (Cicchetti & Toth, 2005). separation - Bowlby (1960, 1973) ﬁrst summarized the traumatic eﬀects, for children from 2 to 5 years old, of being separated from their parents during prolonged periods of hospitalization.

Answer 8

Even in the absence of severe deprivation, neglect, or trauma, many kinds of deviations in parenting can have profound eﬀects on a child’s subsequent ability to cope with life’s challenges and thus can create a child’s vulner- ability to various forms of psychopathology. Therefore, although their explanations vary considerably, the psycho- logical viewpoints on causes of psychopathology all focus on the behavioral tendencies a child acquires in the course of early social interaction with others—chieﬂy parents or parental surrogates (Parke, 2004; Sroufe et al., 2000). parenting style diagram in photos

Answer 9

Disturbed parent–child patterns such as parental rejection are rarely found in severe form unless the total familial context is also abnormal. Thus, disturbed family structure is an overarching risk factor that increases an individual’s vulnerability to particular stressors. We will distinguish between intact families where there is signiﬁcant marital discord and families that have been disrupted by divorce or separation. MARITAL DISCORD All couples argue, but when taken to an extreme, marital discord can have damaging psycho- logicaleﬀectson both adultsand theirchildren (e.g.,Amato, 2006; Amato & Booth, 2001; Parke, 2004). More severe cases of marital discord may expose children to one or more of the stressors we have already discussed: child abuse or neglect, the eﬀects of living with a parent with a serious mental disorder, authoritarian or neglectful/uninvolved parenting, and spouse abuse. But even less severe cases of marital discord also have negative eﬀects on many chil- dren. divorced - Eﬀects of Divorce on Parents Unhappy marriages are dif- ﬁcult, but ending a marital relationship can also be enor- mously stressful for the adults, both mentally and physically. The negative eﬀects are often temporary, with most people being able to adapt constructively within 2 to 3 years, but some adults never fully recover (Amato, 2000; Hetherington, 2003a). Divorced and separated persons are overrepresented among psychiatric patients, although the direction of the causal relationship is not always clear. It should also be recognized, however, that divorce actually beneﬁts some individuals (Amato, 2000, 2010)—with some evidence that women are more likely to beneﬁt than men (Hetherington, 2003a). Eﬀects of Divorce on Children Divorce can have traumatic eﬀects on children, too. Feelings of insecurity and rejection may be aggravated by conﬂicting loyalties. Delinquency and a wide range of other psychological problems such as anxiety and depression are much more frequent among children and adolescents from divorced families than among those from intact families, although it is likely that a contributing factor here is prior or continuing parental strife (Strohschein, 2005). However, ﬁndings also show that, on average, such children had shown these problems to some degree even before their parents divorced (Amato, 2010; Strohschein, 2005).

Answer 10

In our society, the lower the socioeconomic class, the higher the incidence of mental disorders (World Health Organiza- tion, 2014). The strength of this inverse correlation varies with diﬀerent types of mental disorder, however. For exam- ple, antisocial personality disorder is strongly related to socioeconomic status (SES), occurring about 3 times as often in the lowest income category as in the highest income cate- gory, whereas depressive disorders occur only about 1.5 times as often in the lowestincomecategory as in the highest income category (Kessler & Zhao, 1999; Monroe et al., 2009).

Answer 11

bullying sources of popularity vs rejection In summary, children who fail to establish satisfactory relationships with peers during the developmental years are deprived of a crucial set of background experiences and are at higher-than-average risk for a variety of nega- tive outcomes in adolescence and adulthood including depression, school dropout, suicidal ideation, and delin- quency (Heilbron & Prinstein, 2010). However, one should also remember that peer social problems may also be early markers of disorders that have a heritable component but do not become full blown until later in adolescence or adulthood.

Answer 12

Experimental laboratory studies have tested how prej- udice and discrimination may “get under the skin” to increase the likelihood of negative health outcomes. Such studies have shown that the experience or perception of racial discrimination leads to increases in anger and car- diovascular reactivity (Mendes et al., 2008). In addition, discrimination increases risk-taking behavior, an eﬀect that is partially mediated (or explained) by increased cardio- vascular reactivity (Jamieson et al., 2013). Perceived dis- crimination also predicts lower levels of well-being for women (Ryﬀ et al., 2003).

Answer 13

The cultural perspective is concerned with the impact of culture on the deﬁnition and manifestation of mental disorders. Research supports the view that many psychological disturbances—in both adults and children—are universal, appearing in most cultures studied (Butcher, 2005; Kessler & Ustun, 2008). Although some universal symptoms and patterns of symptoms appear, sociocultural factors often inﬂuence which disorders develop, the forms they take, how preva- lent they are, and their courses. Beyond diﬀerences in how symptoms are expressed or reported by the individual, cultural diﬀerences in psycho- pathology may also result from diﬀerences in what cul- tures consider to bethe ideal kinds of behavior by members of that society.

Answer 14

According to the DSM-5 (APA, 2013), eating disorders are characterized by a persistent disturbance in eating behavior.

Answer 15

An important change from DSM-IV to DSM-5 is that in DSM-5 amenorrhea (cessation of men- struation) is no longer required for a person to be given the diagnosis. Studies have suggested thatwomen whocontinue to menstruate but meet all the other diagnostic criteria for anorexia nervosa are very similar psychologically to women who have amenorrhea and have ceased menstruating (Attia & Roberto, 2009). Amenorrhea is also not a cri- terion that can be used for males, nor can it be assessed in prepubescent girls or in women who use hormonal contraceptives. dsm 5 criteria A. Restriction ofenergy intake relative to requirements, leading to a signiﬁcantly low body weight in the context of age, sex, developmental trajectory, and physical health. Signiﬁcantly low weight is deﬁned as a weight that is less than minimally normal or, for children and adolescents, less than that min- imally expected. B. Intense fear of gaining weight or of becoming fat, or persis- tent behavior that interferes with weight gain, even though at a signiﬁcantly low weight. C. Disturbancein the wayin which one’s body weight or shape is experienced, undue inﬂuence of body weight or shape on self-evaluation, or persistent lack of recognition of the seri- ousness of the current low body weight. There are two types of anorexia nervosa: the restricting type and the binge-eating/purging type. The central diﬀer- ence between these two subtypes concerns the way in which patients maintain their very low weight. In the restricting type, every eﬀort is made to limit the quantity of food consumed. Patients with the binge-eating/purging type of anorexia nervosa differ from patients with restricting anorexia nervosa because in addition to restrictive eating, they also either binge eat, purge, or binge eat and purge.

Answer 16

Bulimia nervosa is characterized by uncontrollable binge eating and eﬀorts to prevent resulting weight gain by using inappropriate behaviors such as self-induced vomiting and excessive exercise. Bulimia nervosa was recognized as a psychiatric syndrome relatively recently. The British psy- chiatrist G. F. M. Russell (1997) proposed the term in 1979, and it was adopted into the DSM in 1987. The word bulimia comes from the Greek bous (which means “ox”), and limos (“hunger”). It is meant to denote a hunger of such propor- tions that the person “could eat an ox.” The DSM-5 criteria A. Recurrent episodes of binge eating. An episode of binge eat- ing is characterized by both of the following: 1. Eating, in adiscrete period of time (e.g., within any 2-hour period), an amount of food that is deﬁnitely larger than what most individuals would eat in a similar period of time under similar circumstances. 2. A sense of lack of control over eating during the episode (e.g., a feeling that one cannot stop eating or control what or how much one is eating). B. Recurrent inappropriate compensatory behaviors in order to prevent weight gain, such as self-induced vomiting; misuse of laxatives, diuretics, or other medications; fasting; or excessive exercise. C. The binge eating and inappropriate compensatory behaviors both occur, on average, at least once a week for 3 months. D. Self-evaluation is unduly influenced by body shape and weight. E. The disturbance does not occur exclusively during episodes of anorexia nervosa. People with anorexia nervosa and bulimia nervosa share a common preoccupation with their shape and their weight. However, unlike patients with anorexia nervosa, those with bulimia nervosa are typically of nor- mal weight or sometimes even slightly overweight.

Answer 17

A new addition to DSM-5 is the diagnosis of binge-eating disorder (BED). BED has some clinical features in com- mon with bulimia nervosa (see the DSM-5 criteria box). However, there is an important diﬀerence. After a binge, the person with BED does not engage in any form of inap- propriate “compensatory” behavior such as purging, using laxatives, or even exercising to limit weight gain. (Table 9.2 summarizes the similarities and diﬀerences between diﬀerent types of eating disorders.) There is also much less dietary restraint in BED than is typical of either bulimia nervosa or anorexia nervosa (Wilﬂey et al., 2000). A typical binge averages around 1,900 calories (Bartholme et al., 2006). Not surprisingly, binge eating disorder is associated with being overweight or even obese (Hudson et al., 2007; Pike et al., 2001), although, as with bulimia nervosa, weight is not a factor involved in making the diagnosis. DSM-5 Criteria for. . . Binge-Eating Disorder A. Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following: 1. Eating, in a discrete period of time (e.g., within any 2-hour period), an amount of food that is deﬁnitely larger than what most people would eat in a similar period of time under similar circumstances. 2. A sense of lack of control over eating during the epi- sode (e.g., a feeling that one cannot stop eating or control what or how much one is eating). B. The binge-eating episodes are associated with three (or more) of the following: 1. Eating much more rapidly than normal. 2. Eating until feeling uncomfortably full. 3. Eating large amounts of food when not feeling physi- cally hungry. 4. Eating alone because of feeling embarrassed by how much one is eating. 5. Feeling disgusted with oneself, depressed, or very guilty afterward. C. Marked distress regarding binge eating is present. D. The binge eating occurs, on average, at least once a week for 3 months. E. The binge eating is not associated with the recurrent use of inappropriate compensatory behavior as in bulimia nervosa and does not occur exclusively during the course of bulimia nervosa or anorexia nervosa.

Answer 18

anorexia most likely in ages 16 - 20 bulimia women 21 - 24 binge eating 30 - 50 3 females for every male with an eating disorder men are often under diagnosed risk factor for men is homosexuality as value attractiveness more

Answer 19

most common is binge eating - 3.5 % in women and 2 in men bulimia - worldwide 1% anorexia - in its severe form is as common as schizophrenia

Answer 20

3% with anorexia die - malnutrition - thin and brittle hair - dry skin - yellowish skin - difficulty in low temps - low blood pressure so tired, weak dizzy and faint - vitamin B1 deficiency - irregular heartbeat - dehydration - kidney disease - low potassium - anemia - loss of period

Answer 21

One way in which eating disorders diﬀer from other types of disorders is that there is a lot of diagnostic crossover. What this means is that it is quite common for someone who is diagnosed with one form of eating disorder to be later diagnosed with another eating disorder. This may reflect the fact that current diagnostic systems are not doing a good job categorizing these disorders and that dimensionally based approaches might be more appropri- ate.

Answer 22

Eating disorder diagnoses are commonly associated with other diagnosable psychiatric conditions. In fact, comorbid- ity is the rule rather than the exception (Hudson et al., 2007). For instance, approximately 68 percent of patients with anorexia nervosa, 63 percent of patients with bulimia ner- vosa, and almost 50 percent of people with binge-eating dis- order are also diagnosed with depression (Brewerton et al., 1995; Halmi, et al., 1991; Hudson et al., 2007; O’Brian & Vin- cent, 2003). Obsessive-compulsive disorder is often found in patients with anorexia nervosa and bulimia nervosa (Kaye et al., 2004; Milos et al., 2002; O’Brian & Vincent, 2003). also substance abuse in binge eating, bulimia and anorexia also personality disorders

Answer 23

Although the majority of research on eating disorders is conducted in the United States and Europe, eating disor- ders are not conﬁned to these areas. Widespread eating disorder diﬃculties have been reported among both Cau-casian and black South African college students (le Grange et al., 1998).Anorexia nervosa and bulimia nervosa are also clinical problems in Japan, Hong Kong, Taiwan, Singapore, and Korea (Lee & Katzman, 2002). Additionally, cases of eating disorders have been docu- mented in India and Africa. The prevalence of eating disor- ders in Iran is comparable to that in the United States (Nobakht & Dezhkam, 2000). And a few years ago, the ﬁrst published report of ﬁve men in centralChina who were diag- nosed with eating disorders appeared (Tong et al., 2005). Far from being conﬁned to industrialized Western countries, eat- ing disorders are becoming a problem worldwide. Being Caucasian, however, does appear to be associ- ated with subclinical problems that may place individuals at higher risk for developing eating disorders. Examples of such problems include body dissatisfaction, dietary restraint, and a drive for thinness. A meta-analysis involv- ing a total of 17,781 participants has shown that such atti- tudes and behaviors are signiﬁcantly more prevalent in whites than in nonwhites (Wildes et al., 2001). Although Asian women exhibit levels of pathological eating similar to those of white women (Wildes et al.,2001), it has long been held that African Americans are less sus- ceptible to subclinical types of eating problems and body image concerns than Caucasians are.

Answer 24

biological, sociocultural, family and individual variables all play a part.

Answer 25

- genetics - no evidence for link of candidate genes , the risk id higher if runs in family - Brain abnormalities - hypothalamus as plays and important role in eating eg tumours in hypothalamus associated with increase or loss of appetite - set point - There is a well-established tendency for our bodies to resist marked variation from some sort of biolog- ically determined set point or weight that our individual bodies try to “defend” - serotonin - it modulates appetite and feeding behaviour , many patients reposed well to treatment with antidepressants - reward sensitivity - A new direction in eating disor- ders research centers onthe brain pathways and neurotrans- mitters (such as dopamine) that are involved in reward processing. This makes a lot of sense because individuals who binge eat tend to consume high-fat and high-sugar foods that most of us tend to think of as rewarding. In con- trast, being less sensitive to food reward may make it easier for some people to restrict their food intake, thereby increas- ing risk for the development of anorexia nervosa (Stice & Shaw, 2017).

Answer 26

- thinness being deeply rooted as a cultural ideal - media creating pressure s to be thin eg after TV went to Fiji women more concerned about their weight

Answer 27

- family dysfunction is a risk factor - high parental expectations - other family members dieting - degree of critical comments from other family members about shape, weight, or eating.

Answer 28

gender - more frequent in women internalising the thin ideal - extent to which people do this is associated with a body dissatisfaction, dieting and negative affect. perfectionism - think thin body is the ideal 'perfect body' negative body image - consequence of sociocultural pressures dieting - a risk factor of development or worsening of eating disorders negative emotionality - negative affect as when we feel bad we become self-critical, it also predicts dietary restraint

Answer 29

medications eg antidepressants, antipsychotic - olonzapine family therapy - good for adolescents - better if il for under 3 years CBT - for 1 to 2 years - modify distorted beliefs about weight and food

Answer 30

medications - antidepressants CBT - focuses on normalising eating patterns with meal plans, nutritional education and ending binging and purging cycles by teaching person to eat small amounts regulary

Answer 31

antidepressants, appetite supplements and anticonvulsant medications interpersonal therapy or CBT

Answer 32

defined based on the statistic of the body mass index.

Answer 33

high cholesterol, hypertension, heart disease, arthritis, diabetes and cancer prevalence has doubled since 1980 - 600m adults are obese

Answer 34

people who are obese are often judged harshly by others. in the media are presented more negatively and are less likely to be shown having romantic relationships.

Answer 35

not included in DSM 5 and not an eating disorder from a diagnostic perspective

Answer 36

In all probability our genetic makeup plays an important role in determining how predisposed we are to becomingobese in the modern environment of increased food availability. Some of the genes that may, in our ances- tral past, have been advantageous and helped us survive in times of famine may predispose those who carry them to readily gain weight when food is plentiful. Interestingly, population groups that were most susceptible to starva- tion throughout history (e.g., Pima Indians, Paciﬁc Island- ers) are those that are most inclined to become obese when they have a sedentary lifestyle and a Western diet (see Friedman, 2003). evidence suggests BMI is polygenic and is influenced by a large number of common genes

Answer 37

leptin - Leptin (the name comesfrom the Greek word leptos, meaning “thin”) is produced by fat cells. It provides a key metabolic signal that informs the central nervous system about the state of the body’s fat reserves. When body fat levels decrease, leptin production decreases and food intake is stimulated (Ravussin et al., 2014). Rare genetic mutations that result in an inability to produce leptin cause people to have an insatiable appetite and result in morbid obesity. but has little effect as a treatment gherlin - Ghrelin (the name comes from a Hindu word meaning “growth”) is a hormone that is produced by the stomach. It is a powerful appetite stimulator. Under normal circumstances, ghrelin levels rise before a meal and fall after we have eaten. When ghrelin is injected into human volunteers, it makes them very hun- gry. This suggests that ghrelin is a key contributor to the appetite control system. People with a rare condition called Prader–Willi syn- drome have chromosomal abnormalities that create many problems, one of which is very high levels of ghrelin. Suf- ferers are extremely obese and often die before age 30 from obesity-related causes.

Answer 38

living in a culture that provides ready access to high-fat, high-sugar (junk) foods, encour- ages overconsumption, and makes it easy to avoid exercise. Consider also the issue of accessibility. Foods with low nutritional value (high fat, high sugar) are less expen- sive and also much easier to ﬁnd than foods with high nutritional value. Continued exposure to a culture that provides easy access to highly palatable foods, oﬀers large portions, and bombards people with endless food advertisements may explain why rates of obesity increase in immigrants after they have lived in the United States for a while.

Answer 39

Family behavior patterns may also play a role in the devel- opment of excessive eating and obesity. In some families, a high-fat, high-calorie diet (or an overemphasis on food) may lead to obesity in many or all family members, including the family pet. In other families, eating (or over- eating) becomes a habitual means of alleviating emotional distress or showing love (Musante et al., 1998). Family attitudes toward food are important because their consequences are likely to remain with us for a long time.

Answer 40

Foods that are high in fat or carbohydrates are the foods that console most of us when we are feeling troubled (Canetti et al., 2002). Workers who say that they are under a lot of stress report that they eat less healthy foods, and foods that are higher in fat, rela- tive to their less stressed counterparts (Ng & Jeﬀery, 2003). Might overeating function as a means of reducing feel- ings of distress or depression? Certainly many people with obesity experience psychological problems such as depres- sion.

Answer 41

Understanding the causes of obesity is complex because it results from a combination of genetic, environmental, and sociocultural inﬂuences. An important step along the path- way to obesity, however, may be binge eating. In a pro- spective study of 231 adolescent girls, Stice and colleagues (2002) established that binge eating is a predictor of later obesity. This suggests that we should pay close attention to the causes of binge eating. Relevant here is research suggesting that one pathway to binge eating may be through social pressure to conform to the thin ideal, as ironic as this may seem (Stice et al., 2002). Being heavy often leads to dieting, which may lead to binge eating when willpower wanes. Another pathway to binge eating may operate through depression and low self-esteem.

Answer 42

Reducing the prevalence of obesity is now a top priority. But if obesity is to be prevented, it must ﬁrst be recognized. Astonishingly, in a recent study conducted in Finland, 57 percent of parents who had a 7-year-old child who was overweight or obese failed to recognize that their child was overweight (Vanhala et al., 2009). In this Finnish study, childhood obesity was predicted by having a parent with obesity, skipping breakfast, habitual overeating, and not being physically active. Because we know that childhood obesity predicts adult obesity, parental education is clearly very important.

Answer 43

- lifestyle modifications - low calorie diet, exercise and some form of behavioural intervention -medications - orlistat works by reducing the amount of fat in the diet that can be absorbed onceit enters the gut. Other drugs such as lorcase- rin (Belviq) work in diﬀerent ways and target serotonin or other neurotransmitters. The newest medication to receive FDA approval is Contrave. This is a combination of naltrex- one (used to treat drug and alcohol addiction) and bupro- pion (used to treat depression and to help smokers quit). - bariatric surgery or gastric bypass surgery - most effective long term treatment - reduce storage and capacity of stomach and sometimes shorten length of intensitine so less food can be absorbed

lecture 4 - mental health disorders 2 Flashcards

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