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Abnormal Psych Exam 4

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Definitions of Anorexia
Restricting type - Every effort made to avoid food intake. Super slow, cut food in small pieces, depose of secretly

Binge-eating/purging type - overeating and then purge - self induced vomiting, laxative, diuretics, enemas

Approximately 30-50% transition from #1 to #2
Outcome of Treatment for Anorexia and what are common morbidity
OUTCOMES:
-16% of patients died
-51% had recovered, after a series of treatment failures, eventually get better
-Mortality less for bulimia
-Still many deal with food issues and body image issues.

CO-MORBIDITY:
- Often those with anorexia nervosa meet criteria for depression and OCD
- Prevalence - actually low for strict diagnosis-however many young females have disordered eating patterns
What causes anorexia, several theories
- Gender - females
- Perfectionism
- Childhood sexual abuse
- Negative affect - feel bad about self-become critical of self
- Negative body image - don't like how they look and feel bad about themselves.
Difference between Anorexia and Bulimia
- People with bulimia are either normal weight or slight overweight.
- Anorexics have a fear of being fat and refuse to maintain normal body weight.
Common behaviors and treatments of Anorexia Nervosa
BEHAVIORS:
- Dramatic weight loss in a relatively short period of time.
- Vague or secretive eating patterns
- Complaints of often feeling cold
- Flushing uneaten food down the toilet
- Dizziness and headaches
- Self-defeating statements after food consumption

TREATMENTS:
- In-Patient Program
- CBT is big
- Tube feeding is only a temp solution
- Medications have no proven track record
- Family therapy
Specific Diagnosis for Anorexia Nervosa
1. Lack of appetite due to nervousness
2. Really a fear of being fat, and a refusal to maintain normal body weight - usually about 85% normal
3. Distorted perception of body shape and size
4. Absence of 3 consecutive menstrual cycles
5. Denial of any weight problems
What is DID, what are the trends (from powerpoint in DID? What are some controversy with DID?
DID: Dissociative Identity Disorder. Another name for it is Multiple Personality Disorder.

Trends:
-More and more alters - average of 3 to 15 up to 100
-More and more bizarre behaviors for the alters -backgrounds not possible?
- Prevalence large increase from 200 to 30,000
- Higher in females - connected to a child sexual abuse.

CONTROVERSY:
- Not accepted by academics - therapists often support the idea.
- Recovered memory controversy - may be false.
They types of Amnesia
1. Localized - person doesn't remember a specific time period a few hours or first few days after a highly traumatic event.

2. Selective - some but not all of a time period.

3. Generalized - forgets entire life history

4. Continuous - remembers nothing past a certain point.
What is BDD and how do you treat it? Why is it more popular now?
BDD: Body Dysmorphic Disorder. It is an obsession with some perceived flaw or flaws in one's appearance.

You treat it with SSRI's and Exposure with Response Prevention.

It's popular now because of the media and how there is a "perfect" body
Munchausen's Syndrome by Proxy
Either parent or caretake will harm children just so that they can get attention from doctor's and seem as if they were the heroes in the process.
Dr. McCulloch's vs the books treatment for conversion disorder
Book: There is not much, maybe behavioral reinforcement/hypnosis

Dr. McCulloch: Psycho-dynamic approaches?
Symptoms of Conversion Disorder
Sensory - Problems in vision, hearing, and sensory loss (glove anasthesia) - but doesn't fit correct neuro pattern for loss.

Motor Symptoms - Can't write, walk, talk (often can whistle)

Seizures - Don't follow EEG, excessive thrashing about.
Difference between Conversion Disorder, Factitious Disorders, and Malingering
CONVERSION: Person is NOT intentionally faking. It is also called Hysteria. Felt to be an emotional component.

FACTITIOUS: Fake to maintain "sick" role, "professional patients" - now a DSM Dx.

Malingering - Faking for a reason/primary or secondary gain.
Treatment for Hypochondriasis, Somatization disorder, and Pain disorder
HYPOCHONDRIASIS: Only mentions CBT

SOMATIZATION: Very little; Find one consistent physician aware of dynamics

PAIN: Many abuse pain meds; Treatment programs reduce meds and focus on behavioral activity and no-pain behavior, relaxation, cognitive restructuring, sometimes tricyclic anti-depressants.
Diagnosis for Pain Disorder
1. Experience of persistent and severe pain in one or more areas of the body - somehow psychological factors play a role - person does have pain and does hurt - but judged to be non-physical to some extent.

2. Two DSM Subtypes: (a) psychological, (b) medical condition and psychological

3. Acute, less than 6 months; Chronic more than 6
Diagnosis for Somatization Disorder
1. Whole host of physical symptoms/complaints.

2. Starts before age 30, no real medical findings

3. 4 other criteria must be met:
-Four pain symptoms
-Two gastrointestinal symptoms
-One sexual symptom
-One pseudoneurological symptom
Diagnosis for Hypochondriasis
1. Either fears of having a serious disease or the idea that they actually have such a disease

2. Misinterpretation of bodily signs and symptoms - that could only be interpreted with thorough medical exam

3. NOT reassured by negative results, disappointed.

4. Must last 6 months
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