PSCY Essay

Feeding and Eating Disorders, Elimination Disorders, and Sleep-Wake Disorders

SSY 230: Lecture 9

Eating Disorders

People who have eating disorders experience persistent disturbances of eating or eating-related behavior that change the way they eat or retain their food. These disorders go beyond dieting or occasional overeating, significantly impairing the individual’s physical and psychosocial functioning.

Anorexia Nervosa

Clinicians diagnose an individual as having anorexia nervosa (AN) when he or she shows three basic types of symptoms:

-Severely restricted eating, which leads to an abnormally low body weight

-Intense and unrealistic fear of getting fat or gaining weight

-Disturbed self-perception of body shape or weight In other words, people with AN restrict their food intake, become preoccupied with gaining weight, and feel that they are already overweight even though they may be seriously underweight.

Anorexia Nervosa

In addition to the psychological consequences of AN, the depletion of nutrients in people who merit the diagnosis leads them to develop a series of serious health changes that can, in the extreme, become life threatening.

Constant undereating causes cardiac and respiratory problems, thinning bones, changes in gastrointestinal functioning, and loss of energy. Not only does their appearance change in terms of becoming abnormally thin and gaunt, but they can also suffer hair loss, and their nails become weak and brittle. Changes in their hormones caused by constant food deprivation can also lead them to become infertile. Their sexual functioning becomes disturbed.

Anorexia Nervosa

The higher risk of mortality in people with AN has been firmly established. The longer individuals have the disorder, the greater their risk. Although the majority of deaths from AN occur in young adults, a Norwegian study found that 43 percent of AN-related deaths occurred in women age 65 and older. Women with AN die not only from the complications of their disorder but from suicide, particularly if they have comorbid depression and the form of the disorder in which they alternate overeating with severe food restriction.

At the heart of the experience of AN is a core disturbance in the individual’s body image. People with AN believe their bodies are larger than they really are, which, in turn, they believe makes them unattractive. Women with the restrictive form of AN appear not to value thinness so much as to be repelled by the idea of being overweight.

The lifetime prevalence of AN is 0.9 percent for women and 0.3 percent for men. In addition, people with anorexia nervosa have higher rates of mood, anxiety, impulse-control, and substance use disorders.

Bulimia Nervosa

People with the eating disorder bulimia nervosa engage in binge eating, during which they rapidly eat an inordinately excessive amount of food, perhaps amounting to several thousand calories in a sitting. During these episodes, they experience a lack of control, which makes them feel they cannot stop eating or regulate how much they eat.

Following the binge, they then engage in purging, during

which they try to rid themselves of their excess caloric

consumption by engaging in self-induced vomiting, taking

laxatives or diuretics, and fasting or exercising

excessively. For a bulimia nervosa diagnosis, these

episodes must not occur exclusively during episodes of

anorexia nervosa.

The lifetime prevalence of bulimia nervosa is 1.5 percent

among women and 0.5 percent among men.

Bulimia Nervosa

Like those who have AN, people with bulimia nervosa develop a number of medical problems. The most serious occur with purging. For example, ipecac syrup, the medication that people use to induce vomiting, has severe toxic effects when taken regularly and in large doses. People who induce vomiting frequently also suffer from dental decay because the regurgitated material is highly acidic.

The laxatives, diuretics, and diet pills that people with bulimia use can also have toxic effects. Other health problems stem from behaviors they use to try to lose weight, such as giving themselves frequent enemas, regurgitating and then rechewing their food, and spending too much time in saunas. Related to being in a state of constant dehydration, the bulimic individual runs the risk of permanent gastrointestinal damage, fluid retention in the hands and feet, and heart muscle destruction or heart valve collapse.

Binge-Eating Disorder

Binge-eating disorder is a new diagnosis added to DSM-5 that covers individuals who lack control over their eating and engage in binges at least twice a week for 6 months. For binge-eating disorder to be diagnosed, the binges must occur with the intake of large amounts of food, go past the point of feeling full or hungry, occur while the person is alone, and be followed by self-disgust or guilt. Because the binge eating does not occur in association with compensatory behaviors, it is possible that individuals with this disorder gain a significant amount of weight.

Gender Differences in Eating Disorder Prevalence

Activity prompt: Consider the graphic on gender differences in eating disorder prevalence on the previous slide. Why do you think anorexia and bulimia are more prevalent among women, but binge-eating disorder is split evenly between men and women?

Biological Perspective of Eating Disorders

Eating disorders reflect a complex set of interactions among an individual’s experiences with eating, body image, and exposure to sociocultural influences. The attitudes people develop throughout life toward food, eating, and body size can all play a role in influencing the risk of developing an eating disorder.

Researchers working within the biological perspective are increasingly focusing on altered brain activity in individuals with eating disorders. In one innovative study, women with AN and women who had recovered from AN were compared on their fMRI responses to food-related cues with healthy controls after a night of fasting. Even those who were no longer symptomatic still showed lowered activation in the food reward centers and higher activation of inhibitory control areas of the brain, suggesting that the disorder creates lingering effects in the ways that individuals process food-related cues. Further research supports the effect of AN in altered brain activity in areas responsible for processing emotions, body-related stimuli, and self-perception

From the biological perspective, binge-eating disorder is understood as a form of addiction, in that individuals with this disorder engage in repetitive behaviors that persist despite the negative consequences. Because of its efficacy in treatment and the similarity of the disorder to other addictive disorders, researchers propose that lower levels of serotonin could be operating in this case. The fact that people with binge-eating disorder also experience mood and anxiety disorders further supports the role of serotonin. Researchers investigating altered serotonin activity in the brains of individuals with binge-eating disorder have indeed found evidence of its role. Compared to both healthy controls and people with gambling disorder, people with binge-eating disorder had effectively

lower serotonin in brain regions active in addictive behaviors.

Clinicians working from the biological perspective base their treatment of people with eating disorders on administering psychotropic medications, particularly SSRIs. However, despite their continued use, these are no longer considered advisable from an evidence-based perspective.

Cognitive Behavioral Approach to Eating Disorders

Psychological perspectives are now considered the treatment of choice for eating disorders. These approaches focus

on the core psychological components of disturbances in body image. The cognitive-affective component of body

image includes evaluation of one’s own appearance (satisfaction or dissatisfaction) and the importance of weight

and shape for an individual’s self-esteem. The perceptual component of body image includes the way individuals

mentally represent their bodies. Individuals with eating disorders typically overestimate their own body size. The

behavioral component includes body checking, such as frequent weighing or measuring body parts, and avoidance,

which is the wearing of baggy clothing or avoiding of social situations that expose the individual’s body to viewing

by others.

The primary aim of treatment is identifying and changing the individual’s maladaptive assumptions about his or her

body shape and weight. In addition, clinicians attempt to reduce the frequency of such maladaptive behaviors as

body checking and avoidance.

In cognitive-behavioral therapy, clinicians first attempt to change selective biases in people with eating disorders that lead them to focus on the parts of their bodies they dislike. Second, by using exposure therapy in which clients view their own bodies (“mirror confrontation”), clinicians attempt to reduce the negative emotions they ordinarily experience. Behavioral interventions focus on reducing the frequency of body checking. Third, clinicians can address size overestimation by helping clients view their bodies more holistically in front of a mirror, by teaching them mindfulness techniques to reduce their negative cognitions and affect about their bodies, and by giving them psychoeducation about the ways their beliefs reinforce their negative body image.

Avoidant/Restrictive Food Intake Disorder

In avoidant/restrictive food intake disorder, individuals show an apparent lack of interest in eating or food. They do so because they are concerned about the aversive consequences. In addition, they may avoid food based on its sensory characteristics (color, smell, texture, temperature, or taste). People may develop this disorder as the result of a conditioned negative response to having an aversive experience while eating, such as choking.

Previously included as a feeding disorder of infancy or early childhood in the DSM-IV-TR and regarded as an extreme version of “picky eating”, this diagnosis is now applicable to individuals of any age who do not have another eating disorder or concurrent medical condition, or who are following culturally prescribed eating restrictions. As a result of their disorder, they lose a significant amount of weight (or fail to achieve expected weight gain), show a significant nutritional deficiency, become dependent on feeding through a stomach tube or oral nutritional supplements, and show marked interference with their psychosocial functioning.

Eating Disorders Associated with Childhood

Pica

Children with pica eat inedible substances, such as paint, string, hair, animal droppings, and paper.

This is a serious disorder because even one incident can cause the child to experience significant medical consequences due to lead poisoning or injury to the gastrointestinal tract.

Pica is the most serious cause of self-injury to occur in people with intellectual developmental disabilities.

Clinicians treating pica must not only use a behavioral treatment strategy to reduce the individual’s injurious behaviors, but also institute prevention by ridding the home of potentially dangerous substances.

Eating Disorders Associated with Childhood

Rumination Disorder

In rumination disorder, the infant or child regurgitates and rechews food after swallowing it. Researchers have identified five common disturbances in these children:

(1) delayed or absent development of feeding and eating skills

(2) difficulty managing or tolerating food or drink (3) reluctance to eat food based on taste, texture, and other sensory factors

(4) lack of appetite or interest in food

(5) the use of feeding behaviors to comfort, self-soothe, or self-stimulate.

Of note: 25 to 45 percent of developmentally normal children have some type of problem with food and feeding, but 80 percent of those who are intellectually disabled do.

Elimination Disorders

Elimination disorders are characterized by age-inappropriate incontinence and are generally diagnosed in childhood.

Individuals with enuresis wet the bed or urinate in their clothing after they have reached the age of 5 years, at which point it is expected that they should be completely toilet trained. To receive this diagnosis, the child must show symptoms of enuresis for three consecutive months. In encopresis, a child who is at least 4 years old repeatedly has bowel movements either in his or her clothes or in another inappropriate place.

There are subtypes of enuresis based on the time of day the child inappropriately passes urine (daytime only, night only, or both). The subtypes of encopresis distinguish between children who have constipation and then become incontinent due to overflow of feces, and those who do not have constipation and overflow. Researchers believe these distinctions are important because they can differentiate which children do and do not have a medical condition that underlies their symptoms.

Of note: Boys are more likely than girls to experience these conditions.

Treatment for Elimination Disorders

Evidence-based treatment for childhood elimination disorders focuses on biobehavioral methods to establish continence. Enuresis can be treated through use of a “urine alarm,” a device attached to a child’s underwear or pajamas that emits an auditory and/or tactile sensation in response to moisture. The child then develops a conditioned avoidance response that can trigger muscular contractions in the external sphincter of the bladder prior to the leakage of urine. Encopresis treatments supported by empirical studies include enhanced toilet training and biofeedback. In enhanced toilet training, the child is rewarded for continence, given training about appropriate defecation dynamics, and taught breathing techniques and muscle training exercises to gain control over the anal sphincters.

If children have the retentive form of encopresis, they can benefit from behavioral training that rewards them for increasing their intake of fiber and fluid and ensures that they include time on the toilet as part of their daily schedules. Another more psychologically oriented approach focuses on unresolved anger that a child may be expressing in response to family issues. Such issues can include conflict between the parents, the arrival of a newborn sibling, or the behavior of an older sibling who torments the child. Treatment that addresses these family system issues can help to reduce the child’s symptoms.

Sleep-Wake Disorders

The science of sleep and treatment of sleep-wake disturbances is rapidly gaining attention, so much so that sleep medicine is now a field in its own right. Researchers and clinicians in sleep medicine typically take a biopsychosocial approach, examining genetic and neurophysiological contributions, psychological interactions, and social and cultural factors that impinge on the individual’s sleep quality and amount.

In the next slides, we will cover the major categories of sleep-wake disorders. They fall into the categories of insomnia disorder, narcolepsy, hypersomnolence disorder, breathing sleep-related disorders, circadian rhythm disorders, and parasomnias. To be diagnosable, symptoms must be present for a significant period of time, occur relatively frequently, and cause the individual to experience distress.

Insomnia Disorder

Difficulty initiating or maintaining sleep, along with early-morning awakening.

Narcolepsy Recurrent periods of an irrepressible need to sleep, lapsing into sleep, or

napping within the same day.

Diagnosis also requires either

episodes of jaw-opening or losing

facial muscle tone while laughing or

showing abnormal cerebral spinal

fluid (CSF) or sleep disturbances on

polysomnography.

Polysomography

The DSM-5 diagnostic criteria for sleep-wake disorders reflect progress in the availability of technology in assessment and differential diagnosis. Many of these diagnoses now use polysomnography, which is a sleep study that records brain waves, blood oxygen levels, heart rate, breathing, eye movements, and leg movements.

Hypersomnolence Disorder

Recurrent periods of sleep or lapses into sleep during the day, prolonged main sleep episodes, or difficulty being fully awake after abruptly awakening.

Breathing

Sleep-Related Disorders

Obstructive sleep apnea separate specific disorder: Frequent episodes of apnea and hypopnea while sleeping as indicated on polysomnography along with either snoring, snorting/gasping, or breathing pauses during sleep and daytime sleepiness, fatigue, or unrefreshing sleep.

Central sleep apnea: Frequent episodes of apnea while asleep.

Sleep-related hypoventilation: Episodes of decreased breathing (ventilation) while asleep.

Circadian Rhythm Sleep-Wake

Disorders

Persistent patterns of sleep disruption due primarily to altered circadian rhythm or misalignment between the individual’s internal circadian rhythm and the sleep-wake schedule required by the person’s

environment, or work or social schedule.

Includes delayed sleep phase type (delay in timing of major sleep period), advanced sleep phase type (sleep-wake cycles that are several hours earlier than conventional), irregular sleep-wake type, non-24-hour sleep-wake type, and shift work type.

Parasomnias

Non-rapid eye movement sleep arousal disorder: Recurrent episodes of incomplete awakening from sleep accompanied by either sleepwalking or sleepwalking not associated with rapid eye movements (REMs).

Nightmare disorder: Repeated occurrences of extended, dysphoric, and well-remembered dreams that typically involve threats to one’s life.

Rapid eye movement sleep behavior disorder: Frequent episodes of arousal during sleep associated with speaking and/or motor behaviors occurring during REM sleep.

Restless legs syndrome (RLS): An urge to move the legs along with uncomfortable and unpleasant sensations in the legs, urges that begin or worsen during periods of rest or inactivity that are partially or totally relieved by movement, and are worse or only occur in the evening or night.

Sleep-Wake Disorders

Sleeping disorders affect a large number of individuals, with perhaps as many as 30 percent of adults in the general population in the case of insomnia alone. If you are like many undergraduates, you most likely have already been affected by one or more of these disorders, given the typical environment of the college dormitory or student-populated apartment building in which noise in the night hours interferes with both sleep quality and quantity.

The availability of wearable technology that records length of time asleep, time awake, and even sleep stages is making it increasingly possible for individuals to gain an understanding of their own sleep patterns. As a result, more individuals may seek sleep therapy than was true in the past, when the only signal people received of a possible sleep disorder was feeling tired.

Treatments for sleep-wake disorders vary considerably depending on the nature of the disorder. Cognitive-behavioral therapy is regarded as highly efficacious for insomnia and, along with relaxation and sleep hygiene training, for improving sleep in college student populations.

New technologies are making it increasingly possible for individuals not only to detect but also to manage their own treatment in the home. Continuous positive airway pressure (CPAP) machines are mechanical devices used for treating sleep apnea. They are becoming increasingly practical and affordable .

Disruptive, Impulse-Control, and Conduct Disorders SSY 230: Lecture 9 Part II

Disruptive, Impulse-Control, and Conduct Disorders

People with one of the disruptive, impulse-control, or

conduct disorders show extreme lack of inhibition

(“disinhibition”). They are unable to restrain themselves

from expressing what are often high levels of negative

emotions. Although people with a variety of other disorders

also experience difficulties in self-regulating their behavior,

these particular disorders bring the individuals who have

them into significant conflict with social norms or authority

figures

Oppositional Defiant Disorder

Most children go through periods of negativism and mild defiance, particularly in adolescence, and most parents complain of occasional hostility or argumentativeness in their children. But what if such behaviors are present most of the time and are not just a phase?

Children and adolescents with oppositional defiant disorder display angry or irritable mood, argumentative or defiant behavior, and vindictiveness that results in significant family or school problems. Youths with this disorder repeatedly lose their temper, argue, refuse to do what they are told, and deliberately annoy other people. They are touchy, resentful, belligerent, spiteful, and self-righteous. Rather than seeing themselves as the cause of their problems, they blame other people or insist they are victims of circumstances.

To the extent that their behavior interferes with their school performance and friendships, they risk jeopardizing their relationships with teachers and peers. These losses can, in turn, lead them to feel inadequate and depressed and perhaps cause them to act out even more.

Oppositional Defiant Disorder

Oppositional defiant disorder makes its first appearance during the preteen years between ages 8 and 12, with rates higher in boys. Many children with the disorder, particularly boys, will develop antisocial personality disorder in adulthood; a small percentage will engage in serious criminal behavior. Girls with oppositional defiant disorder are at higher risk of developing depression, particularly if they show inability to regulate their emotions and a tendency toward defiance.

The goal of treatment for oppositional-defiant disorder is to help the child learn to exhibit appropriate behaviors, such as cooperation and self-control, and to unlearn problem behaviors, such as aggression, stealing, and lying. Therapy focuses on reinforcement, behavioral contracting, modeling, and relaxation training and may take place in the context of peer therapy groups and parent training. One such approach, individualized social competence therapy, uses cognitive-behavioral methods specifically tailored to the situations in which the child has experienced difficulties

Intermittent Explosive Disorder

People with intermittent explosive disorder are unable to hold back their urges to express strong angry feelings and associated violent behaviors. They can have angry outbursts that are either verbal (temper tantrums, tirades, arguments) or physical outbursts in which they become assaultive or destructive in ways that are out of proportion to any stress or provocation. These physical outbursts, on at least three occasions in a 12-month period, may cause damage to the individual, other people, or property. However, even if individuals showing verbal or physical aggression do not cause harm, they may still receive this diagnosis.

The rage shown by people with this disorder is out of proportion to any particular provocation or stress, and their actions are not premeditated. Afterward, they feel significantly distressed, suffer interpersonal or occupational consequences, or experience financial or legal consequences.

People with this disorder are more vulnerable to a number of threats to their physical health, including coronary heart disease, hypertension, stroke, diabetes, arthritis, back/neck pain, ulcer, headaches, and other chronic pain. They also are likely to have co-occurring disorders, including bipolar disorder, personality disorders such as antisocial or borderline, substance use disorder (particularly alcohol), and cognitive disorders.

Intermittent explosive disorder appears to have a strong familial component not accounted for by any comorbid conditions associated with it. Researchers believe the disorder may result from abnormalities in the serotonin system causing a loss of the ability to inhibit movement.

Intermittent Explosive Disorder

Faulty cognitions further contribute to the development of intermittent explosive disorder. People with this disorder have a set of negative beliefs that other people wish to harm them, beliefs they may have acquired through harsh punishments they received as children from their parents or caregivers. They feel, therefore, that their violence is justified. In addition, they may have learned through modeling that aggression is the way to cope with conflict or frustration. Adding to these psychological processes is the sanctioning of violence associated with the masculine gender role, a view that may in part explain the greater prevalence of this disorder in men.

Given the possible role of serotonergic abnormalities in this disorder, researchers have investigated the utility of SSRIs in treatment. However, though effective in reducing aggressive behaviors, SSRIs result in full or partial remission in fewer than 50 percent of cases. Mood stabilizers used in the treatment of bipolar disorder (lithium, oxcarbazepine, carbamazepine) also have some effects in reducing aggressive behavior, but there are few well-controlled studies.

Cognitive-behavioral therapy can also be beneficial for individuals with this disorder. In one approach, a variant of anger management therapy uses relaxation training, cognitive restructuring, hierarchical imaginal exposure, and relapse prevention for a 12-week period in individual or group modalities. Cognitive-behavioral therapy focuses on reducing anger and aggression as well as improving the individual’s social skills. Particularly important is reducing the individual’s misperceptions of social threat, which can, in turn, reduce overt expression of relational aggression.

Conduct Disorder

Individuals with conduct disorder violate the rights of others and society’s norms or laws.

Their delinquent behaviors include aggression directed toward people and animals such

as bullying and acts of animal cruelty, destruction of property, deceitfulness or theft, and

serious violations of rules such as being truant from school or running away from home.

The DSM-5 also specifies childhood or adolescent onset (before or after 10 years of age);

the presence or absence of remorse, guilt, and empathy; and the severity of the behavior,

ranging from lying and truancy to physical cruelty, use of a weapon, and stealing in the

presence of the victim.

Predisposing conditions to the development of conduct disorder include being raised

in harsh environments involving trauma, abuse, and neglect. Genetic vulnerability

may further exacerbate the risk of growing up in such households.

Unfortunately, whatever the causes, we know that aggressive and antisocial children are likely to have serious problems as adults. Results of longitudinal studies indicate that at least 50 percent of children with conduct disorder develop antisocial personality disorder.

Impulse Control Disorders

People with impulse-control disorders engage in repetitive, often harmful, behaviors that they feel are beyond their control.

Before they act on their impulses, these individuals experience tension and anxiety that they can relieve only by following through on their impulses.

After acting on their impulses, they experience a sense of pleasure or gratification, although later they may regret that they engaged in the behavior.

Pyromania

People with pyromania deliberately set fires, feeling tension and arousal before they commit the act. They are fascinated with and curious about fire and its situational contexts, and they derive pleasure, gratification, or relief when setting or witnessing fires or participating in their aftermath.

For an individual to be diagnosed with pyromania, the firesetting must not be done for monetary reasons, and the individual must not have other medical or psychiatric conditions. Arson, by contrast, is deliberate firesetting intended to produce financial gain, and an arsonist does not experience the relief shown by people with pyromania.

Pyromania

The majority of people with pyromania are male. Pyromania appears to be rare, however, even among arsonists. Pyromania appears to be a chronic condition if the individual does not receive treatment. Some individuals with pyromania may discontinue firesetting and instead switch to another addictive or impulsive behavior such as kleptomania or gambling disorder. An intensive study of 21 participants with a lifetime history of pyromania described the most likely triggers for their behavior as stress, boredom, feelings of inadequacy, and interpersonal conflict.

Like the other impulse-control disorders, pyromania may reflect abnormalities in dopamine functioning in areas of the brain involving behavioral addictions. Nevertheless, treatment for pyromania that follows the cognitive-behavioral model seems to show the most promise. The techniques include imaginal exposure and response prevention, cognitive restructuring of response to urges, and relaxation training.

Kleptomania

People with the impulse-control disorder kleptomania are driven by a persistent urge to steal. Unlike shoplifters or thieves, they are not motivated by monetary gain but instead seek excitement from the act of stealing. Like people with other impulse-control disorders, they would rather not be driven to this behavior, and they feel their urge is unpleasant, unwanted, intrusive, and senseless. They steal in response to an urge or state of craving,and they experience gratification afterwards. Because their focus is not on the items but on the act of stealing, individuals with kleptomania may give or throw away the stolen goods.

Kleptomania

To make a diagnosis of kleptomania, clinicians must be unable to better account for the individual’s stealing with another diagnosis of antisocial personality disorder, conduct disorder, or bipolar disorder (in a manic episode). There is overlap among the symptoms of kleptomania and mood, anxiety, and other impulse-control disorders, making it particularly important that clinicians engage in a thorough process of differential diagnosis.

Kleptomania has a number of significant effects on the individual’s life, not the least of which is the fear of or reality of arrest. Studies have shown that people with kleptomania are likely to have high lifetime prevalence rates of co-occurring depressive disorders, anxiety disorders, other impulse-control disorders, and drug abuse or dependence. Suicide attempts are common among people with kleptomania.

Studies of the neurobiology of kleptomania suggest that, like substance use disorders, this diagnosis is associated with altered dopamine, serotonin, and opioid receptor functions as well as changes in brain structures similar to those in people with cocaine dependence.

Individuals with kleptomania may struggle with their symptoms for years before seeking treatment, perhaps because they fear prosecution or because they are ashamed of their illegal yet uncontrollable actions. Naltrexone, a therapeutic medication used to treat individuals with substance dependence, is one approach that appears to have had some effectiveness. Cognitive-behavioral treatments also are effective, although they may need to be used beyond the typical 12-session structure.

Activity prompt: How do you imagine impulse control disorders can lead to conflict with the criminal justice system? Also consider

malingering-For example, what if an arsonist or thief were to feign mental illness to avoid criminal culpability?

Biopsychosocial Perspective

The disorders we have covered in this lecture represent a wide range of symptoms with a combination of biological causes, emotional difficulties, and sociocultural influences. A biopsychosocial approach therefore seems appropriate in understanding each. Moreover, these disorders have a developmental course. Eating and oppositional/conduct disorders appear to originate early in life. Over the course of adulthood, individuals may develop impulse-control disorders, and late in life, physiological changes may predispose older adults to sleep-wake disorders.

In the case of each category of disorder, clients can benefit from a multifaceted approach in which clinicians take into account these developmental and biopsychosocial influences. Some disorders, such as those in the sleep-wake category, may best be diagnosed through physiological tests such as polysomnography, even though treatment may focus on behavioral control of sleep. Individuals with symptoms of eating disorders should also be evaluated medically, but effective treatment requires a multipronged and team approach among mental health and medical professionals. The psychological and sociocultural components of impulse-control disorders tend to be more prominent in both diagnosis and treatment, although there may be biological contributions to each of these as well.

This wide range of disorders provides an excellent example of why a broad-ranging and integrative approach that takes a life-span view can be so important in understanding and treating psychological disorders. As research in these areas progresses, it is likely that clients in the future will benefit increasingly from interventions that take advantage of this multifaceted view.

Sources

Image 1: https://www.verywellmind.com/pregnancy-and-eating-disorders-4179037

Image 2: https://kidshelpline.com.au/teens/issues/eating-disorders

Image 3: https://www.quora.com/What-are-the-health-risks-of-eating-disorders

Image 4: https://www.verywellmind.com/signs-and-symptoms-of-bulimia-in-teens-2609258

Images 5 and 6: https://www.quora.com/What-are-the-health-risks-of-eating-disorders

Image 7: https://www.therecoveryvillage.com/mental-health/eating-disorders/related/eating-disorder-statistics/#gref

Image 8: Whitbourne, Susan Krauss. Abnormal Psychology: Clinical Perspectives on Psychological Disorders. McGraw-Hill Higher Education. Image 9: https://www.asrasleepcentre.com/2019/11/23/insomnia-symptoms-causes/

Image 10: https://www.verywellhealth.com/what-is-narcolepsy-3014795

Image 11: https://www.verywellhealth.com/what-to-expect-in-a-sleep-study-3015121

Image 12: https://www.verywellhealth.com/hypersomnia-overview-4582688

Image 13: https://www.bettersleepsimplified.com/sleep-disorders/

Image 14: https://www.facebook.com/illustratedpsych/photos/a.1436906373219284/1436906473219274/?type=3&theater

Image 15: https://www.liahonaacademy.com/oppositional-defiant-disorder-infographic-info.html

Image 16: https://socialecology.uci.edu/news/children-and-society-pay-high-price-failure-diagnose-treat-conduct-disorder

Images 17 and 18:

https://www.dk.com/uk/article/5-psychological-disorders-explained-in-eye-opening-infographics/?utm_source=Facebook&utm_medium=social&utm_campaign=250119_Psy chology_article_Facebook

Text: Whitbourne, Susan Krauss. Abnormal Psychology: Clinical Perspectives on Psychological Disorders. McGraw-Hill Higher Education. Kindle Edition.