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Abnormal Psychology

LECTURE 1- Introduction to Abnormal Psychology 1: Defining abnormal behaviour; the classification and diagnosis of psychological disorders
What is abnormal? Unusual/rare/deviant/unexpected? - E.g. fetishism (sexual dysfunction) - But: eccentricity, positively valued deviations Causes distress? - E.g. depression, anxiety - But: normal distress, bipolar disorder Socially and culturally unacceptable? - E.g. substance use disorders - But: homosexuality, ADHD Neither one on its own is necessary or sufficient Psychological abnormality (mental illness or disorder) is not as readily definable as physical illness Psychological abnormality exists on a continuum with normality The definition of psychological abnormality (mental illness) reflects cultural values and social norms Socio-Cultural Considerations Environment: -Urban/rural: More people, diversity/ relatively homogenous-> not as challenged ; healthier people> healthier mentally -Industralised/non-industralised -Religiosity Gender Minority Status Models of Mental Illness Supernatural: Cause- spirits, stars or moon; past lives Treatment: exorcism, prayer etc Medical/Biological: Cause- internal physical problems (=biological dysfunction) Treatment: bleeding, diet, celibacy, exercise, rest, medication ** dominant model Psychological: Cause- beliefs, perceptions, values, goals, motivation, etc (=psychological dysfunction) Treatment: talking therapy, psychotherapy Sociocultural: Cause- poverty, prejudice, cultural norms Treatment; fix social ills Medical Model Some mental illnesses found to have physical causes (e.g. germs) - Begun to be seen as legitimate field for medicine Today: dominant model in psychiatry > assumes that psychological disorders can be:

-diagnosed similarity to physical illness -explained in terms of biological disease process> structural brain abnormalities (schizophrenia) neurochemical imbalance (depression) -best treated with medication, surgery, ECT Limits to Medical Model Reductionistic: reduces illnesses to low level processes looking only at the cellular level Single-factor model of illness: only looks at biological malfunctions Assumes a mind-body dualism (disconnect): -Clear boundary b/w physical health and illness, But: continuity b/w mental health and disorder -Clear boundaries b/w different physical illness, But: psychological disorders commonly co-occur Misassumptions of causation from treatment Biopsychosocial Model Assumes that health and illness are consequences of the interplay of biological, psychological, and social factors.

Advantages of the Biopsychosocial Model Macrolevel and microlevel processes interact- Environmental and cellular processes interact Health and illness are caused by multiple factors and produce multiple effects Mind and body cannot be distinguished Emphasises both health and illness Incorporates a SYSTEM THEORY approach Classification Systems Diagnostic and Statistical Manual of Mental Disorders (DSM) American Psychiatric Association Currently in 4th edn (DSM-IV-TR) Reflects the biological/medical model of mental illness International Classification of Disease and Health Related Problems (ICD) World Health Organisation Mental disorders added for the first time in 1948 Development of the DSM Strongly influenced by the psychoanalytic theory

DSM-IV Major depression Major Depressive Disorder: A single or recurrent depressive episode Major Depressive Episode: Depressed mood most of the day, nearly every day Markedly diminished pleasure/interest in activities Significant weight loss or gain Insomnia or hypersomnia nearly every day Psychomotor agitation or retardation nearly every day Fatigue/loss of energy nearly every day Feelings of worthlessness, excessive guilt nearly every day Diminished ability to concentrate nearly every day Recurrent thoughts of death, suicide, suicide attempts 5 or more is needed, (incl 1/ or 2/) in a 2-week period

Towards DSM-5 Allow assessment of severity, not only presence of disorder: tentative step towards dimensionality How do we assess psychopathology? Diagnosis of Psychological Disorders -Clinical interview *** - Axis I: Clinical symptoms -Questionnaires - Axis II: Personality Disorders or Mental Retardation -Observation - Axis III: General Medical Condition - Axis IV: Psychological and Environment Problems - Axis V: Global Assessment of Functioning (GAF) scale4 *DSM classification is a multi-axial system that is moving towards dimensionality -

LECTURE 2- Introduction to Abnormal Psychology II: Models of psychopathology and approaches to treatment
Why use psychological models? 1) 2) Models guide research and treatment decisions Research questions are specified based on components of the model Interventions are designed and implemented according to a model The major components of each model provide guidance regarding the etiology of disorders and what areas to target in treatment 3) It is important to be aware of other available paradigms- other possible explanations Psychological Models Psychoanalytic Model Most dominant model during the first half of the 20th C Id, ego, superego Stages of sexual development Majority of our thoughts and behaviours are unconscious Action is guided whether there is a balance btw Id (gratify urges immediately) , ego (holds urges in check with reality), superego (hold urges in check with morality)

Conflicts> makes us distressed Psychological Stages Psychoanalysis > insights orientated therapy that aims to resolve unconscious conflicts and defences Free associations Dream Analysis Interpretation: offering interpretations that are just within clients reach Processes of therapy: -Resistance -Transference Behavioural Classical conditioning (pavlov) Operant conditioning (Skinner)> these behaviours are reinforced, overtime your behaviour is shaped by this reinforcement E.g. positive reinforcement, negative reinforcement, punishment, extinction Maladjustment: Faulty learning Treatment Focus: New learning Banduras social cognitive theory> By engaging in feared behaviours you heighten selfefficacy Critiques: > cognitions are also important > Observational learning/ modelling Behavioural Treatment Approaches Social Skills Training: Modelling, behavioural experiments, Shaping Systematic Desensitisation Exposure (one of the most effective) -Creation of hierarchy (Fight vs Flight) -Gradual imaginal/ behavioural exposure response prevention -Little steps, sitting with it-> it will past, teach them to gradually face their fears move forward heighten self-efficacy ; realistic goals Humanistic Model/ Client-Centred Psychological health: Fully functioning, self-actualised persons Congruence vs incongruence (self-concept and actual experience> degree of overlap) Maladjustment results from: -environment imposes conditions of worth -own experience, emotions, needs, are blocked -self-actualisation thwarted Treatment Essential Components of Therapy: 1) Genuineness 2) Empathy 3) Unconditional positive regard: try to change that congruency > they feel no matter their behaviours they now accept themselves bc they are not accepted Major techniques: 1) Empathic listening/ unconditional positive regard 2) Reflection of content 3) Reflection of intent/ feeling

Cognitive Behavioural Model Currently the dominant model in psychology What we think influences what we feel and do

Maladaptive behaviour results from: Latent core negative beliefs Interpretation of experiences: consistent with core negative beliefs Cognitive biases (over generalisation, selective attention, catastrophising, personalising, magnification, mistaking feelings for facts, etc) - Negative automatic thoughts Integrative Approach - Psychopathology is multiply determined - One-dimensional accounts of psychopathology are incomplete - Consider reciprocal relations b/w biological, psychological, sociocultural factors; Nature + Nurture Summary Psychoanalytic Cause: repression if unresolved conflict Treatment: insight Behavioural Cause: learned responses to stimuli Treatment: new learning Humanistic Cause: thwarted self actualisation Treatment: empathy, unconditional positive regard Cognitive Cause: negative core beliefs, biased thinking Treatment: cognitive restructuring

LECTURE 3- Anxiety Disorders: Differentiating between normal anxiety and anxiety disorders; description of anxiety disorders in DSM
What is Anxiety? Activated in response to perceived threat The experience of anxiety is the same in normal and abnormal anxiety Three interrelated anxiety systems: Physical system Fight/flight response: sympathetic nervous system Mobilise resources to deal with threat Symptoms include: sweating, increased heat rate, trembling movements Cognitive system Perception of threat Attentional shift to threat Hypervigilance to threat Difficulty concentrating on other tasks Behavioural systems Escape/ avoidance tendencies (fighting/freezing) Aggression (fighting)

Normal Anxiety Necessary for survival> Expectancy of harm -> anxiety ->Attention, motivation; focus on reducing danger Individual differences: types of things people fear more, intensity of fear experienced

Abnormal Anxiety/ Anxiety Disorders Not qualitatively different from normal anxiety Same physical, cognitive, behavioural aspects Occurrence is excessive or inappropriate> anxiety occurs in absence of objective threat, anxiety is more intense than objective level of threat Characterised by overestimation of threat: Probability of negative outcome Cost of negative outcome Maintained by avoidance

DSM-IV Anxiety Disorders


Anxiety disorders are highly comorbid with each other and with depression

Panic Disorder: With/Without Agoraphobia Panic attack: Abrupt and intense fear or anxiety Peaks within 10 mins Classic symptoms of automatic arousals, other physical symptoms (hyperventilation) Situational/cued/triggered vs unexpected/uncued Fear of dying, losing control, going mad> situationally bound (cued) panic- occurs in presence or anticipation of feared stimulus Panic disorder: -unexpected/spontaneous panic attacks -Anxiety/worry about having another attack -Symptoms persist one month or more Agoraphobia Fear or avoidance of situations or events associated with panic: avoid physical activity, quit job, become house bound 30-50% with PD also has this

PANIC: Bodily sensations (shaking, breathing)> misinterpretation of bodily sensations> anxiety> increased bodily sensations -Sit with that panic> symptoms to subside Generalised Anxiety Disorder Excessive and uncontrollable worry About wide range of outcomes Physical symptoms are different from panic: Tension, irritability, restlessness, sleep problems Associated symptoms: Restlessness, feeling keyed up or on edge; easily fatigued, difficulty concentrating or mind going blank, muscle tension, sleep disturbance

Obsessive-Compulsive Disorder Obsessions: repeated, intrusive, irrational thoughts or impulses. Cause severe anxiety Compulsions: ritualised behaviours to relieve the anxiety caused by obsessions Associated with: Intolerance of uncertainty, inflated responsibility, thought-action fusion, magical ideation. Exposure reaction prevention

Posttraumatic Stress Disorder Occurs after a traumatic stressor: - experienced or witnessed an event that involved or threatens death of serious injury or threat to persons physical integrity -Individuals response included intense fear, helplessness, horror Symptoms includes: Re-experiencing of the event Avoidance and numbing Hypervigilence (increased arousal)> Sleep disturbance, anger, irritability, poor concentration, startle

DSM-IV Phobic Disorders Specific phobias: animal, natural environment, blood-injection-injury, situational Social phobia: fear and avoidance of social situations

Psychological Treatment of Anxiety Disorders Cognitive Behavioural Treatment Aim to reduce (biased) threat appraisal > thought monitoring; How likely/bad that the event will happen? Cognitive Techniques> thought diaries to identify automatic thoughts, thought challenging e.g. whats the evidence? Behavioural techniques> Relaxation training, Exposure to feared stimuli/ outcomes Exposure is essential in anxiety treatment

LECTURE 4- Mood Disorders: Defining major depression and other mood disorders; sociocultural, psychological and biological variables related to mood disorders
Mood Disorders Characterised by emotional disturbances that interfere with physical, perceptual, social and thought processes Unipolar Vs Bipolar Depression

DSM-IV Mood Disorders DSM-IV Depressive Disorders Unipolar: Depressive mood/episodes only -Major Depressive Disorder, Dysthymic Disorder, DD-NOS -Depressive episode : abnormally low mood DSM-IV Bipolar Disorders Bipolar: Manic and Depressive mood/episodes -Bipolar I Disorder, Bipolar II Disorder, Cyclothymic Disorder, NOS -Manic episode: abnormally elevated mood Extremes in normal mood

Unipolar vs Bipolar Depression - Unipolar: mood stable at one pt> major depression> stable - Bipolar: Manic episode- two very extreme moods; highly elevated mood; contrasted immediately after with very low moods

Criteria for a major depressive episode DSM-IV-TR Five (or more) of the following symptoms have been present during the same two-week period and represent a change from previous functioning
Depressed mood most of the day, nearly every day Lack of interest in pleasurable activities Weight loss or weight gain Insomnia or Hypersomnia Psychomotor agitation or retardation Fatigue or loss of energy Feelings of worthlessness or guilt Difficulty concentrating Recurrent thoughts of death or suicide Criteria for a hypomanic episode DSM-IV

A distinct period of persistently elevated, expansive, or irritable mood, lasting throughout at least 4 days, that is clearly different from the usual depressed mood. During the period of mood disturbance, three (or more) of the following symptoms have persisted (four if the mood is only irritable) and have been present to a significant degree: Inflated self-esteem or grandiosity Decreased need for sleep (e.g., feels rested after only 3 hours of sleep) Rapid or pressured speech Flight of ideas or racing thoughts Distractibility Increase in goal-directed or psychomotor agitation Excessive involvement in pleasurable activities that have a high potential for painful consequences

Is associated with an unequivocal change in functioning that is uncharacteristic, observable by others Episode not severe enough to cause marked impairment in social or occupational functioning, or to necessitate hospitalisation, and there are no psychotic features
Symptoms not due to direct effects of substance

Criteria for a manic episode DSM-IV

A distinct period of abnormally and persistently elevated, expansive, or irritable mood, lasting at least one week During the period of mood disturbance, three (or more) of the following symptoms have persisted (four if the mood is only irritable) and have been present to a significant degree:

Inflated self-esteem or grandiosity Decreased need for sleep (e.g., feels rested after only 3 hours of sleep) Rapid or pressured speech Flight of ideas or racing thoughts Distractibility Increase in goal-directed or psychomotor agitation Excessive involvement in pleasurable activities that have a high potential for painful consequences > The mood disturbance is sufficiently severe to cause marked impairment in occupational functioning or in usual social activities or relationships with others, or to necessitate hospitalization to prevent harm to self or others, or there are psychotic features. Major Depressive Disorder Major Depressive Episode 5 or more symptoms during 2 week period Affective symptoms: Depressed mood, anhedonia (loss of pleasure/interest) Cognitive symptoms: indecisiveness, lack of concentration Somatic symptoms: fatigue, sleep or appetite change Major Depressive Disorder Single or recurrent depressive episode, not accounted for by other disorders Recurrent episodes are common

Dsythymic Disorder Persistently depressed mood that continues for at least 2 years Symptoms of depressions are milder than major depression Symptoms can persist unchanged over long periods (eg. 20 yrs or more) Double depression Both MDD and Dysthymia

Bipolar I vs Bipolar II MOOD EPISODE Major Depressive Episode Manic Episode Hypomanic Episode BIPOLAR I -CAN, but not necessary PRESENT CAN, but not neccessary BIPOLAR II PRESENT NOT PRESENT PRESENT

What causes depression? On a clinical level, there is generally -A trigger (e.g. problem, negative experience) -A coping mechanism that started out being helpful but that has over time become unhelpful Mechanism is made up of elements of thinking, feeling and behaviour

Biological Theories Biological vulnerability + Stress Depression Genetic vulnerability: -Heritability: 35-60% -Heredity creates vulnerability to mood disorders Neuroendocrine system -Excess cortisol in response to stress> mood

Psychological Theories Cognitive vulnerability + Stress Depression Schema Theory (Beck, 1976) Pre-existing negative schemas -Activated by stress -Result in information processing biases -Negative thoughts become dominant in consciousness> distorted view of self, world, future

Diathesis Stress Model for Bipolar Depression Stressful Life Events causing disrupted routines and sleep deprivation Biological Vulnerability Early symptoms of mood disturbances

Manic, hypomanic or depressive episodes

Poor coping strategies

To turn it around.. What maintains depression? Thinking about the problem w/o finding a solution rumination -Thinking becomes more negative -Thoughts/beliefs become distorted Withdrawal and inaction -Life gets out of balance Biological Treatments of Depression Drug treatments: -Selective Serotonergic Reuptake Inhibitors (SSRIs) - Prozac, Zoloft, Paxil, etc -Specifically block reuptake of Serotonin -fewer side effects than older drugs -Effective in 70-80% Electroconvulsive Therapy (ECT) -Involves applying brief electrical current to the brain> uncertain how/why ECT works -Last resort effective for severe depression (80%) Psychological treatments of Depression Cognitive-Behavioural Therapy (CBT) Address cognitive errors in thinking Aims to develop more neutral realistic view NOT positive thinking Behavioural components: Behavioural Activation: increase reinforcing events Behavioural Experiments: test beliefs Outcomes comparable to drug therapy Lower relapse rates than biological txs Treatment of Bipolar Disorder There is no cure Is considered a lifelong illness Pharmacological treatments> Mood Stabilisers & Atypical Antipsychotics Psychological treatments> Reduce symptoms, prevent relapse & recurrence, restore healthy functioning, support Approaches: psychoeducation, CBT, interpersonal and social rhythm therapy, family interventions, relapse prevention Bring balance back to life -Regulate eating/sleeping/exercise/rest -Social contact -Pleasant activities -Involvement in tasks/projects that matter to the person

LECTURE 5- Schizophrenia: Symptoms of psychosis, Diagnosis and course of schizophrenia


Symptoms of Psychosis Positive Symptoms Excess or distortions of normal functions -Perception (hallucinations) -Distortions of though content (delusions) -Language & thought process (disorganised speech) -Self- monitoring of behaviour (grossly disorganised or catatonic behaviour)

Negative Symptoms Loss of normal function -Affective flattening -Fluency & productivity of though & speech (alogia) -Initiation of goal-directed behaviour (avolition)

Hallucinations A sensory percept that has a compelling sense of reality of a true perception but that occurs without external stimulation of the relevant sensory organ Considered the most distressing Sensory hallucinations: auditory, visual, olfactory, gustatory, tactile ~75% individuals with schizophrenia report hallucinations Auditory hallucinations are more common

Delusions False beliefs outside ones culture and do not change Individuals believe their beliefs are true even when proven untrue Classes of delusions: -Bizarre vs Non-bizarre: Tv is broadcasting only to them , they are a historical figure -Primary delusions vs secondary delusions -Primary: out of the blue -Secondary: changes due to abnormal mood, memory / hallucinations e.g. aud. Hallucinations follows delusions of being spied on

Types of Delusions Paranoid> delusions of persecution Delusions of reference> messages are delivered via a neutral source (e.g. tv & radio) of a personal nature Grandiose delusions> associated with manic episodes, religious belief they are religious diety/ have special powers Nihilistic delusions> belief one is dead or body parts not working

Thought disorder Disturbances in logical sequencing and coherence of thought Distortions in flow, structure or coherence Disturbances can be: -Positive: Circumstantiality, Tangentiality, Clang associations (speaking in a garbled way), Echolalia (repeating what others are saying), Neologisms (making up of non-words) - Negative: reduced stream of thought, poverty of speech

Disorganised (catatonic) behaviour Immobility, such as waxy flexibility Excessive but purposeless motor activity Extreme negativism/rigid posturing Peculiarities of voluntary movement- unusual postures, repeated movements, facial grimacing

Negative Symptoms of Psychosis Deficits in expression of speech, emotion and behaviour Types of negative symptoms -Alogiia (mid-speech; indvid. Suddenly stops) Flattened effect Avolition (lack of initiation of activities)

Diagnosis of schizophrenia Two or the following psychotic symptoms must be present for the significant portion of a 1 month period Delusions, hallucinations, disorganised speech, grossly disorganisied/catatonic behaviour, negative symptoms Continuous signs of the disturbance must be present for at least 6 months Schizophrenia Subtypes Paranoid Type Primarily symptoms- delusions &/or hallucination No neg. symptoms Later than other subtypes May have intimate r/s with other people but not marry /have children Disorganised Type Disorganised speech & behaviour Flat/ inappropriate affect- emotional reactions Anhedonia (lack of pleasure) Avolition (lack of motivation) Difficult to treat, poor prognosis Catatonic Type (3/5 needed) Motoric immobility wavy flexibility -bizarre postures Excessive motor activity - less responsive to treatment compared to other subtype

Course of Schizophrenia Only ~25% recovery rate Enduring psychosis= chronic schizophrenia Treatment focusing on enhancing lifestyle and living conditions Systemic management

Aetiology of Schizophrenia Stress Vulnerability Model Assumption that individuals with schiz. is biologically predispositioned to experiencing psychosis symptoms when faced with stress When they experience stressors they dont have adequate coping mechanisms> increases distress> psychotic episodes Focus on what are the triggers to stress, modify and plan these stressors; support, stress management skills etc

Genetics Degree of relatedness (proband) increases risk Confounded by role of upbringing in these families Twin studies reveal these factors may influence onset -lower birth weight, more physiological distress, impaired motor coordination

Role of Neurotransmitters Excessive numbers of or oversensitive dopamine receptors, rather than high levels of dopamine Also likely that several other neurotransmitters play a role Treatment of Schizophrenia Pharmacological Aims to reduce and maintain remission of symptoms Electroconvulsive Therapy Chlorpromazine Tranquilizing effects First-generation antipsychotic agents (FGAs) Second generation of Antipsychotic Agents / Atypical or Novel psychotic agents Cant normalise cognitive functioning or completely eliminate negative mood and sxs Issues with pharmacological treatment Compliance is a major concern Cant predict which will work best Dual-diagnosis/ substance abuse interactions Psychological Treatment Psychoeducation Provide patient and family info- disease course, triggers to episodes , medication Potential benefits- enhanced med compliance, mental functioning CBT Targets: thought and feelings in relation to symptoms Guided by stress vulnerability model

Family interventions - High expressed emotion (EE)- critical comments, hostility, rejection of patients - Aims of interventions: reduce extent of EE Limitations to current treatment Gaps in delivery of services, psychosocial and family interventions are rarely implemented Social stigma limits access to employment and educational support

Summary
Schizophrenia is a mental disorder characterized by two or more psychotic symptoms that are present for at least one month The stress vulnerability model is the prominent model for understanding and managing schizophrenia Treatment of schizophrenia focuses on identifying appropriate medication and enhancing social skills to encourage symptom control and autonomy

LECTURE 6- Eating disorders: Defining the various eating disorders; sociocultural, psychological and biological variables related to eating disorders
Anorexia Nervosa-DSM-IV Criteria

-Refusal to maintain body weight at or above a minimally normal weight for age and height: Weight
loss leading to maintenance of body weight <85% of that expected or failure to make expected weight gain during period of growth, leading to body weight less than 85% of that expected. - fear of weight gain even when underweight -Severe body image disturbance> denial of seriousness of illness Types of Anorexia Nervosa - Restricting type of anorexia nervosa: simply refusing to eat as a way of preventing weight gain. - Binge/Purge type: e.g. self induced vomiting or misuse of laxatives or diuretics. But is different from bulimia nervosa in 2 main ways: -they continue to be at least 15% below a healthy body weight -also develop amenorrhea, whereas those with bulimia do not Behaviours in Anorexia - Most individuals do not perceive they have an eating disorder Complications - Thinning of bones - Amenorrhea (90%) - Cardiac changes - Brittle hair and nails - Erosion of digestive tract and teeth - Dry and yellowish skin - Growth of fine hair over body - Refeeding syndrome> shortness of breath, physical collapse, seizures, coma, heart failure, death DSM-IV-TR Criteria for Bulimia Nervosa - Recurrent episodes of binge eating characterised by: -Eating in discrete period of time an amount of food that is definitely larger than most people would eat during a similar period of time

-a sense of lack of control over eating during the episode Recurrent inappropriate behaviours to prevent weight gain- self induced vomiting and misuse of laxatives The binge eating and inappropriate purging behaviours both occur, on average, at least twice a week for 3 mths. Self evaluation influenced by body shape and weight

2 types of bulimia nervosa - Purging type: self induced vomiting, laxatives etc - Non purging: compensatory behaviours such as fasting or excessive excercising Epidemiology - More common than anorexia - Slighter later onset than anorexia - Poorer outcomes with childhood obesity, low self esteem and personality disorder Associated Features - Normal or overweight - Bingeing usually precedes vomiting by one year - Frequent weight fluctuations Etiology eating disorders :Multifactorial - Genetics - Neurochemical/neurobiological - Psychosocial -sociocultural Proposed psychological causes AN and BN has in common: - Tendency to base self worth on weight/shape - Intense fear of gaining weight - Desire to attain unrealistic levels of thinness High degree of overlap in proposed causes: - Transdiagnostic model -core low self esteem -perfectionism -overvaluation of shape/size -distress intolerance Psychological factors Low self esteem Negative affect Body dissatisfaction Dysfunctional thinking regarding eating, shape and weigh - Perfectionism - Starvation can alter personality

Biological Factors in AN/BN Heritability Higher concordance rates with monozygotic twins Abnormally high levels of serotonin > reduced serotonin associated with increased appetite and decreased impulse control Lowered leptin levels (hormones) result with reduced body fat Evidence for brain abnormalities causing anorexia

Risk factors of anorexia


Accepting society's attitudes about thinness Perfectionist traits Being female Experiencing childhood anxiety Feeling increased concern or attention to weight and shape Having eating and gastrointestinal problems during early childhood Having a family history of addictions or eating disorders Having parents who are concerned about weight and weight loss Having a negative self-image

Sociocultural Factors
While cultural standards of the ideal woman has moved toward thinness, the reality is that both men and women are becoming more obese >Prevalence of obesity has doubled since 1900 >As social views of obesity become more negative, the incidence of eating disorders increases Peer pressure Overrepresentation in models, dancers, gymnasts, athletes Families that over-emphasize weight and appearance >Critical comments

Treatment for anorexia nervosa Primary aims: Restore physical health Normal eating patterns/attitudes to weigh and shape Psychiatric comorbidity Improve quality of life Initial priorities: depending on severity, treatment first focuses on stabilising health, then addresses psychological issues Hospitalise the patient and force them to ingest food to prevent death from starvation Make rewards contingent upon eating, teach relaxation techniques Emphasises the r/s of thoughts and feelings to behaviour Encourages parents to take responsibility for ensuring healthy eating at home Focuses on developing new patterns in family dynamics, fostering autonomy in patient Beneficial for younger patients

Hospitalisation and refeeding Behaviour therapy Cognitive behavioural therapy Family therapy

Effectiveness of Treatments Currently there is insufficient evidence Few controlled studies, small N CBT is preferable Individual therapy is better for weight gain, except among younger patients where family interventions may be more beneficial MET used as an adjunct to treatment is promising Psychotropic medications have demonstrated minimal benefit