chapter 14, 15 psych
Basic Concepts of Psychological Disorders
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Basic Concepts of Psychological Disorders (part 1)
Psychological disorders
Syndrome marked by a clinically significant disturbance in an individual’s cognition, emotion regulation, or behavior (APA, 2013)
Dysfunctional or maladaptive
Often accompanied by distress
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Basic Concepts of Psychological Disorders (part 2)
Understanding psychological disorders
Medical model
Hospitals replaced asylums in mental health movement.
Mental illnesses are diagnosed on the basis of symptoms, treated through therapy, and ideally cured.
Genetically influenced brain structure and biochemical abnormalities contribute to all major disorders.
Biopsychosocial approach
Psychology studies of how biological, psychological, and social-cultural factors interact to produce specific psychological disorders
Vulnerability-stress model; epigenetics
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Basic Concepts of Psychological Disorders (part 3)
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Basic Concepts of Psychological Disorders (part 4)
Classifying disorders and labeling people
Classification aims to predict a disorder’s future course, suggest appropriate treatment, and prompt research.
American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-5)
World Health Organization’s International Classification of Diseases (ICD)
U.S. National Institute of Mental Health’s Research Domain Criteria (RDoC)
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Basic Concepts of Psychological Disorders (part 5)
DSM-5 changes
Autism and Asperger’s syndrome = autism spectrum disorder (ASD)
Mental retardation = intellectual disability
Hoarding disorder and binge-eating disorder added
DSM-5 criticisms
Wider net pathologizes everyday life; too broad
Subjective diagnostic labels
Biasing power of labels
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Basic Concepts of Psychological Disorders (part 6)
Risk of harm to self and others: Understanding suicide
Suicide risk increases with anxiety and depression.
Risk increases with rebound of these disorders.
Social suggestions may trigger suicide.
Suicide is often unpredictable.
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Basic Concepts of Psychological Disorders (part 7)
Researchers report different group suicide rates.
National differences
Racial differences
Gender differences
Trait differences
Age differences and trends
Other group differences
Year-by-year differences
Gun ownership status
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Basic Concepts of Psychological Disorders (part 8)
Helping someone who is talking about suicide
Listen, empathize, and offer hope.
Connect the person with campus counseling resources or crisis text lines.
Protect someone at immediate risk by seeking help.
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Basic Concepts of Psychological Disorders (part 9)
People who engage in nonsuicidal self-injury (NSSI) may:
Find relief from intense negative thoughts through the distraction of pain.
Attract attention and possibly get help.
Relieve guilt by punishing themselves.
Get others to change their negative behavior (bullying, criticism).
Fit in with a peer group.
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Those who engage in NSSI often have experienced bullying, harassment, or stress (A. Miller et al., 2019; van Geel et al., 2015).
They are generally less able to tolerate and regulate emotional distress (Hamza et al., 2015).
And they are often both self-critical and impulsive (Beauchaine et al., 2019; Cha et al., 2016).
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Basic Concepts of Psychological Disorders (part 10)
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Self-injury rates peak higher for 15- to 19-year-old females than for same-age males (Mercado et al., 2017). Canada and England have simultaneously experienced the same gender difference and upward trend (CIHI, 2019; McManus et al., 2019).
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Basic Concepts of Psychological Disorders (part 12)
After the 2012 Newtown, Connecticut, slaughter of 26 schoolchildren and adults, and again following the 2018 Parkland, Florida, massacre of 17 youths and adults, people wondered if such tragedies couldn’t be prevented through mental health screenings.
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Could people with psychological disorders who are violence-prone be identified in advance by mental health workers and prevented from obtaining guns?
In 85 percent of U.S. mass killings between 1982 and 2017, the killer had no known prior contact with mental health professionals.
Most homicide “is committed by healthy people in the grip of everyday emotions using guns” (Friedman, 2017).
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Basic Concepts of Psychological Disorders (part 13)
Reported rates of psychological disorders: WHO study
Cultures vary in 28 country studies.
Lowest rate = Nigeria; highest rate = United States
Immigrant paradox
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From interviews in 28 countries. (Data from Kessler et al., 2009.)
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Basic Concepts of Psychological Disorders (part 14)
| Psychological Disorder | Percentage |
| Depressive disorders or bipolar disorder | 9.3 |
| Phobia of specific object or situation | 8.7 |
| Social anxiety disorder | 6.8 |
| Attention-deficit/hyperactivity disorder (ADHD) | 4.1 |
| Posttraumatic stress disorder (PTSD) | 3.5 |
| Generalized anxiety disorder | 3.1 |
| Schizophrenia | 1.1 |
| Obsessive-compulsive disorder | 1.0 |
Percentage of Americans Reporting Selected Psychological Disorders “in the Past Year”
Data from: National Institute of Mental Health (2018).
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Basic Concepts of Psychological Disorders (part 15)
What increases vulnerability to mental disorders?
Wide range of risk and protective factors exists for mental disorders.
Poverty, as a predictor of mental health, crosses ethnic and gender lines.
First symptoms are experienced by mid-teens to mid-twenties for majority of those studied.
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Table 14.3 provides additional information about risk and protective factors for mental disorders.
Among the earliest to appear are the symptoms of antisocial personality disorder (median age = 8) and of phobias (median age = 10). Alcohol use disorder, obsessive-compulsive disorder, bipolar disorder, and schizophrenia symptoms appear at a median age near 20. Major depressive disorder often hits somewhat later, at a median age of 25.
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Anxiety-Related Disorders
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Anxiety-Related Disorders (part 1)
Anxiety disorders
Are psychological disorders characterized by distressing, persistent anxiety, or maladaptive behaviors that reduce anxiety
Three anxiety disorders
Generalized anxiety disorder
Panic disorder
Specific phobias
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Anxiety-Related Disorders (part 2)
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Anxiety-Related Disorders (part 3)
Obsessive-compulsive disorders (OCD)
Characterized by unwanted repetitive thoughts (obsessions), actions (compulsions), or both that persistently interfere with everyday life.
Other OCD-related disorders
Hoarding • Body dysmorphic disorder
Trichotillomania • Excoriation disorder
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Anxiety-Related Disorders (part 4)
Posttraumatic stress disorder (PTSD)
Characterized by haunting memories, nightmares, hypervigilance, avoidance of trauma-related stimuli, social withdrawal, jumpy anxiety, numbness of feeling, and/or insomnia
Lingers for four weeks or more after a traumatic experience
Survivor resiliency; posttraumatic growth
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Anxiety-Related Disorders (part 5)
Why do some people develop PTSD, while others do not?
Amount of emotional distress
Individual differences in memory processing
Systemic racism, sexism, and inequality
Sexual assault
Food insecurity
Some psychologists believe PTSD has been overdiagnosed.
Normal stress-related events
Debriefing procedures
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Anxiety-Related Disorders (part 6)
Somatic symptom and related disorders
Somatic symptom disorder
Person interprets normal physical sensations as symptoms of a disease.
Illness anxiety disorder
Person interprets normal sensations as symptoms of dreaded disease.
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Anxiety-Related Disorders (part 7)
Understanding anxiety-related disorders
Conditioning
Classical conditioning
Stimulus generalization
Reinforcement
Cognition
Thoughts and memories
Interpretations and expectations
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Anxiety-Related Disorders (part 8)
Understanding anxiety-related disorders
Biology
Gene variations are associated with typical anxiety disorder symptoms or specific disorders (for example, OCD).
Gene influence is found in regulating brain level of neurotransmitters; serotonin, glutamate
Experience
Epigenetic marks from trauma or abuse increase genetic vulnerability to certain disorders (for example, PTSD).
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Anxiety-Related Disorders (part 9)
Understanding anxiety-related disorders
The brain is changed by experiences.
Traumatic, fear-learning experiences can leave tracks in the brain and create fear circuits.
Brain area for overarousal involves impulse control and habitual behaviors, especially in the anterior cingulate cortex.
Natural selection shapes some of behaviors that can interfere with daily life when taken to an extreme.
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Generalized anxiety disorder, panic attacks, phobias, OCD, and PTSD express themselves biologically as overarousal of brain areas involved in impulse control and habitual behaviors.
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Anxiety-Related Disorders (part 10)
When people were engaged in a challenging cognitive task, those with OCD showed the most activity in the anterior cingulate cortex in the brain’s frontal area (Maltby et al., 2005).
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Depressive Disorders and Bipolar Disorders
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Depressive Disorders and Bipolar Disorders (part 1)
Terms
Anxiety
Response to threat of future loss
Depression
Response to past and current stress
Major depressive disorder
Feelings of hopelessness and lethargy lasting several weeks or months
Bipolar disorder (formerly manic-depressive disorder)
Feelings that alternate between depression and overexcited hyperactivity
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Depressive Disorders and Bipolar Disorders (part 2)
Major depressive disorder
Depression is the leading cause of disability worldwide (WHO, 2017b).
Number-one reason why mental health services are sought
May have a seasonal pattern
DSM-5 classifies several major depressive disorders.
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In one survey conducted in 21 countries, 4.6 percent of people interviewed were experiencing moderate or severe depression, as have 1 in 10 U.S. adults at some point during the prior year (Hasin et al., 2018; Thornicroft et al., 2017).
U.S. depression levels rose dramatically during the COVID-19 pandemic. Younger adults, women, people of color, and those who were unemployed were hardest hit (Czeisler et al., 2020; Fitzpatrick et al., 2020; Twenge & Joiner, 2020).
At least 1 in 5 health care professionals—feeling socially isolated, overworked, and stressed from caring for people dying from the COVID-19 virus—reported symptoms of depression (Pappa et al., 2020; Rossi et al., 2020).
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Depressive Disorders and Bipolar Disorders (part 3)
| The DSM-5 classifies major depressive disorder as the presence of at least five of the following symptoms over a 2-week period of time (minimally including depressed mood or reduced interest) (American Psychiatric Association, 2013). |
| Depressed mood most of the time |
| Dramatically reduced interest or enjoyment in most activities most of the time |
| Significant challenges regulating appetite and weight |
| Significant challenges regulating sleep |
| Physical agitation or lethargy |
| Feeling listless or with much less energy |
| Feeling worthless, or feeling unwarranted guilt |
| Problems in thinking, concentrating, or making decisions |
| Thinking repetitively of death and suicide |
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Depressive Disorders and Bipolar Disorders (part 4)
Bipolar disorder
Person alternates between the hopelessness and lethargy of depression and the overexcited state of mania.
Less common, but often more dysfunctional, than major depressive disorder; potent predictor of suicide
No gender differences; increased diagnoses among adolescents
DSM-5 classification reduced child and adolescent diagnoses; disruptive mood dysregulation disorder
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Mania is a hyperactive, wildly optimistic state in which dangerously poor judgment is common.
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Depressive Disorders and Bipolar Disorders (part 5)
Creativity and risk for bipolar disorder
Clusters of genes associated with creativity increase the risk of developing bipolar disorder.
Risk factors for developing bipolar disorder predict greater creativity.
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One analysis of more than 1 million individuals showed that the only psychiatric condition linked to working in a creative profession was bipolar disorder.
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Depressive Disorders and Bipolar Disorders (part 6)
Any theory of depression must explain why:
Behaviors and thoughts change with depression.
Depression is widespread.
Women’s risk of major depressive disorder is roughly double men’s risk.
Most major depressive episodes end on their own.
Work, marriage, and relationship stress often precede depression.
Compared with past generations, depression strikes earlier and affects more people, with the highest rates among older teens and young adults.
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Depressive Disorders and Bipolar Disorders (part 7)
Biological perspective
Genes and depression
Heritability
Linkage analysis
The depressed brain
Brain activity slows
Functional connectivity analyses
Two neurotransmitter system
Nutritional effects
Heart-healthy diet
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Analyses of functional connectivity help scientists understand how different brain regions work together; this factor can underlie psychological disorders. People with major depressive disorder tend to show low connectivity between brain regions involved in experiencing (a) emotion and (b) emotion regulation; these two types of brain regions don’t “talk” to each other well.
Genes and depression
In major twin studies, one research team estimated the heritability of major depressive disorder at 40 percent.
Linkage analysis
The depressed brain
Brain activity slows during depression and becomes more active during mania.
Functional connectivity analyses show poor neural communication that explain why people with depression struggle with emotion regulation.
Two neurotransmitter system involved: norepinephrine; serotonin
Nutritional effects
A heart-healthy diet reduces risk of developing depression; alcohol misuse can lead to depression.
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Depressive Disorders and Bipolar Disorders (part 8)
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Using aggregated data from studies of identical and fraternal twins, researchers estimated the heritability of bipolar disorder, schizophrenia, anorexia nervosa, major depressive disorder, and generalized anxiety disorder (Bienvenu et al., 2011).
Heritability was calculated by a formula that compares the extent of similarity among identical versus fraternal twins.
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Depressive Disorders and Bipolar Disorders (part 9)
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Depressive Disorders and Bipolar Disorders (part 10)
Social-cognitive perspective
Diet, drugs, stress, and other environmental influences lay down epigenetic marks/molecular genetic tags that can turn certain genes on or off.
Life is seen through a lens of low self-esteem that feeds depression.
Self-defeating beliefs
Negative explanatory style
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Depressive Disorders and Bipolar Disorders (part 11)
Social-cognitive perspective
Negative thoughts, negative moods, and gender
Women are twice as vulnerable as men to depression.
Rumination; overthinking
Explanatory style
Self-defeating belief and learned helplessness
Pessimistic explanatory style
State-dependent memory
Cultural forces
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Major Depressive Disorder and Bipolar Disorder (part 12)
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After a negative experience, a depression-prone person may respond with a negative explanatory style.
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Major Depressive Disorder and Bipolar Disorder (part 13)
Therapists recognize this cycle and work to help depressed people break out of it.
Changing their negative thinking
Turning their attention outward
Engaging them in more pleasant and competent behavior
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Schizophrenia
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Schizophrenia (part 1)
Schizophrenia
Disorder characterized by delusions, hallucinations, disorganized speech, and/or diminished, inappropriate emotional expression
Psychotic disorders
Group of disorders marked by irrational ideas, distorted perceptions, and a loss of contact with reality
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Schizophrenia (part 2)
Signs of schizophrenia
Disturbed perceptions and beliefs
Hallucinations; delusions (false beliefs)
Disorganized speech
Diminished and inappropriate emotions
Flat affect; impaired theory of mind
Inappropriate motor behavior; catatonia
Onset and development
Chronic schizophrenia
Acute schizophrenia
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Schizophrenia (part 3)
Understanding schizophrenia: Brain abnormalities
Dopamine overactivity
Abnormally low brain activity in frontal lobe, thalamus, and amygdala
Abnormal brain anatomy in ventricles and cerebral tissue; smaller cortex, hippocampus, and corpus callosum; neural connection loss
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Schizophrenia (part 4)
Understanding schizophrenia: Prenatal environment and risk
Risk factors
Low birth weight; maternal diabetes; older paternal age; oxygen deprivation during delivery
Midpregnancy virus infection and fetal brain development
Country-specific flu epidemic
Birth in densely populated areas
Birth in winter and spring months
Mother’s flu infection during pregnancy and fetal-virus infections
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Schizophrenia (part 5)
Lifetime risk of developing schizophrenia varies with one’s genetic relatedness to someone having this disorder.
Across countries, barely more than 1 in 10 fraternal twins, but 5 in 10 identical twins, share a schizophrenia diagnosis. (Data from Gottesman, 2001; Hilker et al., 2018.)
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Schizophrenia is a group of disorders influenced by many genes, each with very small effects.
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Schizophrenia (part 6)
Understanding schizophrenia: Genetic influences
1 in 270 lifetime odds of being diagnosed with schizophrenia
Parent or sibling, identical twin with shared placenta, adopted children
Specific genes/combinations and predisposed schizophrenia-inducing brain abnormalities
Research findings: 176 genome locations; 413 associated genes
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Dissociative, Personality, and Eating Disorders
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Dissociative, Personality, and Eating Disorders (part 1)
Dissociative disorders
Are controversial, rare disorders in which conscious awareness becomes separated (dissociated) from previous memories, thoughts, and feelings; dissociative fugue state
Dissociative identity disorder (DID)
Two or more distinct identities, each with its own voice and mannerisms, seem to control the person’s behavior.
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Dissociative, Personality, and Eating Disorders (part 2)
Understanding dissociative identity disorder
First formal code for the disorder appeared in an earlier DSM edition; current criteria are in DSM-5.
Hoax, extreme version of normal, varied self, role-playing, or distinct body and brain state associated with differing identities?
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Dissociative, Personality, and Eating Disorders (part 3)
Personality disorders tend to form three clusters.
Anxiety
Example: Avoidant personality disorder
Eccentric or odd behaviors
Example: Schizotypal personality disorder
Dramatic or impulsive behaviors
Examples: Borderline personality disorder, narcissistic personality disorder, antisocial personality disorder
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Dissociative, Personality, and Eating Disorders (part 4)
Antisocial personality disorder
Sometimes called sociopathy or psychopathy
Usually male; can display symptoms by age 8
Lower emotional intelligence
Impulsive behavior; feel and fear little
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Dissociative, Personality, and Eating Disorders (part 5)
Understanding antisocial personality disorder
Biological factors
Genetic influences
Environmental factors
Brain structure
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Biological factors
Biological relative with antisocial and unemotional tendencies increases risk.
Genetic influences
No single gene; comorbidity from predisposing, overlapping genes
Environmental factors
Childhood abuse, family instability or poverty
Brain structure
Less activity in areas that typically respond to emotional stimuli, larger and hyperreactive dopamine reward system
Below normal in frontal lobe functions (planning, organization, inhibition) and smaller amygdala
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Dissociative, Personality, and Eating Disorders (part 6)
Eating disorders
Anorexia nervosa
Bulimia nervosa
Binge-eating disorder
What are the differences among these three disorders?
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At some point during their lifetime, about 2.6 million Americans (0.8 percent) meet DSM-5-defined criteria for anorexia, 2.6 million for bulimia, and 2.7 million for binge-eating disorder (Udo & Grilo, 2019). All three disorders can be deadly. They harm the body and mind, resulting in shorter life expectancy and greater risk of suicide and nonsuicidal self-injury (Cucchi et al., 2016; Fichter & Quadflieg, 2016; Mandelli et al., 2019).
Anorexia nervosa
An eating disorder in which a person (usually an adolescent female) maintains a starvation diet despite being significantly underweight and has an inaccurate self-perception; sometimes accompanied by excessive exercise
Bulimia nervosa
An eating disorder in which a person’s binge eating (usually of high-calorie foods) is followed by inappropriate weight-loss-promoting behavior, such as vomiting, laxative use, fasting, or excessive exercise
Binge-eating disorder
Significant binge-eating episodes, followed by distress, disgust, or guilt, but without the compensatory behavior that marks bulimia nervosa
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Dissociative, Personality, and Eating Disorders (part 7)
Understanding eating disorders
Family environment and characteristics
Heredity
Cultural and gender components
Peer effects
Media influence
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Those with eating disorders often have low body satisfaction, set perfectionist standards, and ruminate about falling short of expectations and how others perceive them (Farstad et al., 2016; M. Smith et al., 2018; S. Wang et al., 2019).
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Neurodevelopmental Disorders
EXPLORING PSYCHOLOGY
DAVID G. MYERS | C. NATHAN DEWALL | 12th edition
EXPLORING PSYCHOLOGY
DAVID G. MYERS | C. NATHAN DEWALL | 12th edition
Copyright © 2021 by Macmillan Learning. All rights reserved
IN
MODULES
56
Neurodevelopmental Disorders (part 1)
For people with neurodevelopmental disorders, typical changes are disrupted in childhood because of unusual features of the central nervous system.
Intellectual disability
Intelligence test score in lowest 3 percent of population (about 70 or below)
Difficulty adapting to normal demands of independent living: conceptual, social, practical
EXPLORING PSYCHOLOGY
DAVID G. MYERS | C. NATHAN DEWALL | 12th edition
Copyright © 2021 by Macmillan Learning. All rights reserved
IN
MODULES
In mild forms, intellectual disability, like normal intelligence, results from a combination of genetic and environmental factors (Reichenberg et al., 2016).
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Neurodevelopmental Disorders (part 2)
Autism spectrum disorder (ASD)
Cognitive and social-emotional disorder marked by social deficiencies and repetitive behaviors
Diagnoses across countries
Underlying source of symptoms; impaired theory of mind
Levels of severity
Biological factors: Prenatal environment, genes and genetic mutations; gender differences; brain functioning
Childhood vaccinations have no relationship to the disorder.
EXPLORING PSYCHOLOGY
DAVID G. MYERS | C. NATHAN DEWALL | 12th edition
Copyright © 2021 by Macmillan Learning. All rights reserved
IN
MODULES
58
Neurodevelopmental Disorders (part 3)
Attention-deficit/hyperactivity disorder (ADHD)
Psychological disorder marked by extreme inattention and/or hyperactivity and impulsivity
Diagnosis in United States; gender differences
Symptoms
Causes: Genetic, co-existing with learning disorder or with defiant and temper-prone behavior
Treatment: Stimulant drugs, psychological therapies
Skeptics and supporters debate.
EXPLORING PSYCHOLOGY
DAVID G. MYERS | C. NATHAN DEWALL | 12th edition
Copyright © 2021 by Macmillan Learning. All rights reserved
IN
MODULES
Extreme inattention, hyperactivity, and impulsivity can derail social, academic, and work achievements. These symptoms can be treated with medication and other therapies. But the debate continues over whether normal high energy is too often diagnosed as a psychiatric disorder and whether there is a cost to the long-term use of stimulant drugs in treating ADHD.
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