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8331276988Eating disorder diag categoriesAnorexia nervosa Bulimia nervosa Binge eating disorder0
8331290094DSM-5 changeBinge eating disorder added Eating disorder part of "Feeding and Eating Disorders"1
8331313451Diag cri: anorexia nervosarestriction of food = very low body weight (BMI <18.5 for adults) Intense fear of weight gain or repeated behavior to interfere with weight gain Body image disturbance = feel fat even when emaciated2
8331331108Subtypes of anorexia nervosarestricting = weight loss by severely limiting food binge-eating / purging = regularly for last 3 months longitudinal research suggests questionable validity of subtypes3
8331356047Subscales from eating disorders inventorydrive for thinness bulimia body dissatisfaction ineffectiveness perfectionism interpersonal distrust interoceptive awareness maturity fears4
8331394210anorexia comorbiditydepression OCD phobias panic alcoholism PDs - men comorbid with substance dependence, mood disorders, or schizo5
8331971847Physical changes in anorexia-low blood pressure, heart rate decrease - kidney/gastrointestinal problems - loss of bone mass - lanugo (soft, downy body hair) - depletion potassium & sodium6
8331997510Prognosis for anorexia- 50~70% recover - relapse common - 10x death rates than general, 2x death rates than other PDs7
8332020309Diag crit: bulimia nervosa & DSM-5 crituncontrollable eating binges FOLLOWED by compensatory behavior DSM-5 - recurrent binge-eating (under 2 hours, loss of control) - recurrent compensatory behaviors to prevent weight gain8
8332055963Bulimia severity (per week)mild = 1-3 compensatory behaviors moderate = 4-7 severe = 8-13 extreme = 14<9
8332084424bulimia eating bingestriggered by stress or negative emotions or negative social interactions typically in secret shame & remorse often follow10
8332421088Bulimia vs. anorexia, binge-eating-purging typeextreme weight loss in anorexia at/above normal weight in bulimia (physically normal)11
8332437719bulimia comorbiditydepression, PD, anxiety, substance abuse, conduct disorder normal BMI12
8332445743physical changes in bulimiamenstrual irregularities (amenorrhea) laxative use depletes electrolytes loss of dental enamel from stomach acids13
8332472046prognosis bulimia~75% recover 10~20% remain fully symptomatic Poorer prognosis when DEPRESSION & SUBSTANCE ABUSE are comorbid or when more sever symptomatology14
8332505550Diag crit: binge eating disorderDSM-5 crit - recurrent binge eating - binge eating include 3 of following (eat rapid, uncomfortably full, large amount when not hungry, eat alone, feel disgusted) - NO COMPENSATORY BEHAVIOR15
8332890592Severity rating - binge eating disordermild = 1-3 moderate = 4-7 severe = 8-13 extreme = 14<16
8332958973binge eating disorder vs. anorexia & bulimiaAbsence of weight loss Absence of compensatory behaviors17
8333102794BED associated withobesity & history of dieting (BMI>30)18
8333127934Physical changes in BEDproblems associated with obesity - type 2 diabetes - others independent of obesity - sleep - anxiety - irritable bowel - early menstruation19
8333140998prognosis of BEDabout 60% recover most common & lasts the longest (avg 14.4 yrs)20
8333146291etiology of eating disorders: geneticsfamily and twin studies support genetic body dissatisfaction, desire for thinness environmental factors greater role21
8333161162etio of ED: neurobiologicalhypothalamus NOT directly involved low levels of endogenous opioids - that reduce pain, enhance mood, suppress appetite - release during starvation (may reinforce restricted eating) - excessive exercise increases opioids - low lvl in bulimia - serotonin = satiety (low lvl in anorexic and bulimic) = increase serotonin often effective - dopamin (anorexic viewing pics of underweight)22
8333208978etio of ED: cognitive behavioral anorexia- focus on dissatisfaction/fear of fatness - certain behavs negatively reinforcing - feeling of self-control by weight-loss = + reinforcing - criticism from family & peers23
8333349595etio of ED: cog behavioral bulimia- self worth = weight - rigid restrictive eating = lapses = binges (offlimit foods) - after binge, disgust and fear = compensatory behav - purging temporarily reduce anxiety about weight gain - restrained eating = central role (dieting & overeating)24
8333404225schematic of cog behav theory of bulimialow self-esteem and high - affect = dieting to feel better = food intake restricted too severely = diet is broken = binge = compensatory behaviors to reduce fears of weight gain25
8333429190etio of ED: genderobjectification of women's bodies - self-objectification aging & changes in life roles -> decreased ED symptoms26
8333457411etio of ED: ethnicbody dissatisfaction & symptoms of bulimia = strongly correlated w/ high acculturation stress27
8333919300etio of ED: othereating behav (semi-starvation) personality charateristics (perfectionism) family characteristics (self report high lvl of family conflict)28
8334331136etio of ED: child abuseself reports of childhood abuse (not specific to ED) too general of varliable29
8334344044Treatment of ED 1antidepressants (for bulimia but NOT anorexia) - limited research says antidepressant not effective in reducing binges or increasing weight loss in BED30
8334358502Treatment of ED 2anorexia - immediate goal to gain weight CBT - reductions in symptoms through 1 year family-based therapy effective - anorexia as interpersonal - family lunch sessions31
8334376179Treatment of ED bulimiachallenge! - ideal of thinness - belief of weight and dieting - all-or-nothing beliefs about food - self-assertiveness to improve interpersonal relatedness - CBT more effective than med -add exposure and ritual prevention (ERP) = short term effectiveness32
8334401275Treatment of ED: BEDCBT - interpersonal therapy (IPT) equally effective - weight-loss programs promote weight loss but not curb binge eating33
8334415623Prevention of EDpsychoeducation deemphasize sociocultural influences risk-factor approach34
8344976824DSM-5 sexual dysfunctionssexual desire, interest, arousal sexual pain orgasmic disorder35
8345013775gender & sexualitymen = think more about sex, more dysfunction as they age women = sex desire often linked to relationship status & social norms women more likely than men to report sexual dysfunction36
8345022738sexual response cycle1. desire phase 2. excitement phase 3. organsm phase 4. resolution phase37
8345027475DSM-5 3 categories of sexual dysfunction1. sexual desire, arousal, interest disorders - women : sexual interest/arousal disorder - men : hyposexual & erectile disorder 2. orgasmic disorder - women : female orgasmic disorder - men : premature / delayed ejaculation 3. sexual pain disorder - women : genito-pelvic pain/penetration disorder38
8345202101disorders involving sexual interest, desire, arousalwomen = persisten deficits in sexual interest (fantasies or urges), biological / subjective arousal men = hypoactive SDD (deficient or absent sexual fantasies/urges) erectile disorder39
8345214796DSM-5 crit for SI/AD in womendiminished/absent frequency of sexual interest/arousal/excitement causes marked distress/interpersonal problems not medical illness, or effect of drug40
8345230056DSM-5 crit for male disordershypoactive = similar to female (absent/diminshed desire, marked distress, not medical) erectile disorder (on at least 75% of sexual occasions) - inability to attain, maintain, marked decrease of erection, NOT medical41
8345246065other DSM-5 orgasmic disordersfemale organsmic disorder male delayed/premature ejaculation42
8345250980sexual pain disordersgenitopelvic pain/penetration disorder - pain during intercourse - men & women (rare in men) - medical, lack of vaginal lubrication, or menopausal problems - manual/oral stimulation okay - 10~30% prevalence DSM-4 = vaginismus and dyspareunia43
8345268267etio of sexual dysfunctionmasters & johnson two-tier model 1. immediate causes - performance fears - adoption of spectator role - observer vs. participant 2. distal (historical) causes - sociocultural - biological - sexual traumas - homosexual inclination44
8345281049examples of distal causes and immediate resultguilt from religious/cultural influences rape/sexual abuse homosexual lack of knowledge excessive alcohol physiological prob sociocultural = spectator role & performance fears45
8345293217predictors of sexual functioningpsychological factors physical factors social & sexual history factors46
8345301746etio of SD: biologicalDSM-5 separation for sexual dysfunctions caused by medical illnesses oi' (controversial) - diseases of vascular, nervous system - low level testosterone/estrogen - heavy alcohol - history of chronic alcoholism - heavy smoking - meds (antihypertensives, SSRI47
8345323353etio of SD: psychosocialrape childhood sexual abuse relationship probs (anger, hostility, poor communication / relationship security) Psycho disorders (depression, anxiety, PD) Low physiological arousal stress/exhaustion - cognitions48
8345454547treatment of SDanxiety reduction directed masturbation procedures to change thoughts/attitudes meds = PDE-5 inhibitors for erectile dysfunction (phosphodiesterase type 5 inhibitors = sildenafil (viagra), tadafil (cialis), vardenafil (levitra)) STV49
8345461440Paraphiliassexual attraction to unusual objects / sexual activities - 6 months - only diag when done with nonconsenting persons categories: inanimate objects or children50
8345467904paraphilias in DSM-5fetishistic transvestic pedohebephilic voyeuristic exhibitionistic frotteuristic sexual sadism/masochism51
8345472920fetishistic disorderdiag crit - for at least 6 months, arousal to nonliving objects or nongenital body parts - attraction irresistible & involuntary - often co-occur with other paraphilias52
8345482907pedohebephilic disordercontact with prepubertal / pubescen[t child - offender at least 16 yrs old & 5 yrs older than victim victims = neighbors, family, friends, clergy53
8345489988incestsubtype of pedohebephilic - most common = brother/sister - less common, more pathological = father/daughter54
8345493338voyeuristic disorderarousal while observing other who are unclothed/engaged in sexual activity - almost always men - excitement from unawareness (element of risk important) - seldom results in physical contact (orgasm = masturbation) - victims unaware55
8345499646diag crit = voyeuristicat least 6 months, arousal from observation of unsuspecting others who are naked, disrobing, engaged in sexual activity - acted on these urges with nonconsenting person56
8345503776exhibitionistic disorderintense desire to obtain sexual gratification through exposing of genitals to unwilling strangers - victim can be children, seldom physical contact - desire to shock/alarm victim often comorbid with voyeuristic / frotteuristic57
8345517399diag crit = exhibitionistic disorderat least 6 months, showing one's genital to unsuspecting person - nonconsenting person58
8345519783frotteuristic disordersexually touching of nonconsenting person - genital against women's body, fondle breast/genitals - often in crowded subway, public place59
8345528776sexual sadism/masochism disorderssadism - sexual gratification by inflicting pain/psychological suffering on another person masochism - sexual gratification by receiving pain/humiliation - asphyxiophilia (by oxygen deprivation) debate over inclusion in DSM-560
8345538297etio of paraphiliasmale hormones/androgens - no unusual lvls of testosterone classical = no support for orgasm conditioning hypothesis operant = poor social skills or reinforcement of unconventionality cog distortions = child doesn't run away, she must want me to fondle her61
8345547497treatment of paraphiliasincarceration & court-ordered treatment common difficult to interpret outcome from treatment studies - vary greatly - lack control groups - dropout rates high62
8345570993treatment of paraphiliasenhance motivation - denial & minimization of problem often present - some blame victim - lack of motivation & dropout cog behavioral treatment - aversion therapy - covert sensitization - counter distorted thinking - often combined with social skills & empathy training biological - castration in the past - meds (hormonal agents to reduce androgens = depo-provera & SSRI)63

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