Midterm Lessons in Abnormal Psychology RISK FACTORS

CHAPTER 1:  Body image dissatisfaction

 Perfectionism & Behavioral inflexibility
FEEDING AND EATING DISORDERS  Childhood feeding problems
 Anorexia Nervosa
 Family history of an eating disorder /
 Bulimia Nervosa
another mental disorder
 Binge – Eating Disorder
 History of an anxiety disorder
 PICA
 Rumination Disorder  History of dieting
 Avoidant/Restrictive Food Intake  Weight stigma (discrimination / stereotyping
Disorder based on a person’s weight)
 Teasing / bullying
 Limited social network or support system

ANOREXIA NERVOSA  Type 1 diabetes (a significant number of

women with type 1 diabetes have
disordered eating)
 20% dies as a result  Parenting style
 Highest mortality rate of any psychological  Household stress
disorder  Parental discord
 20 – 30% of deaths are suicide  Personality traits
 90% of patients with an eating disorder is  Overly high expectations in children
female
 Incidental diagnosed with eating disorder in
males are increasing
 Restrictive energy intake
 Intense fear of gain weight BINGE – EATING
 Persistent behaviors to prevent weight gain
 Body image disturbance DISORDER
Is a newly defined disorder and the criteria
OTHER SYMPTOMS is as follows:

Behavioral Symptoms:  Eating a massive amount of food in a short

 Talking about weight/gain all the time
 Refusing to eat in front of others
 Not wanting to go out with friends
Cognitive Symptoms:
 Confused / slow thinking
 Poor memory / judgement
period of time, like over a couple of hour,
and this would me more than average what
an average person would eat.
 While doing this you feel out of control, like
you can’t stop eating
 Occur at least once (1) a week for period of
3 months.
 Less emotionally aware of their feelings.

Emotional Symptoms:
 Anxiety
 Moodiness
 Depression & Suicidal thoughts
On a severity scale, binge eating disorder is
considered:
MILD: 1 to 2 times a week
MODERATE: 4 to 5 times a week
SEVERE: 8 to 13 times a week
EXTREME: 14 or more times a week
MUST HAVE AT LEAST 3 OF THESE 5
THINGS GOING ON
1. You eat faster than normal
2. You feel uncomfortably full
3. Eat but not hungry
4. Eat alone – you’re ashamed
5. Feel depressed, disgusted or guilty
Triggered by this emotions:
 Sadness
 Anger Strong Triggers
 Frustration
People binge on, are the  High sugar & fat foods.
TREATING BINGE EATING DISORDER
The main treatment for binge eating
disorder is therapy with or without medication.
Cognitive Behavior Therapy (CBT)
 Address binge eating that results from over
– restricting your diet, and over focusing on
your body images. Encourages better eating
behaviours and it works on your self-image.
Cognitive Behavior Therapy (Guided Self
Help)
 Is a way to do this kind of therapy on your
own without a therapist.
Interpersonal Behavioral Therapy (IBT)
 Helps identify the negative emotions that
you have stemming from a relationship.
Negative interactions that produce emotions
that you have trouble coping with and then
you use eating to cope.
Dialectal Behavioral Therapy (DBT)
 Address the emotions that trigger the
overeating and help you identify them,
tolerate them and find other ways to cope
with them.
MEDICATIONS:
- Antidepressants that falls into selective
serotonin reuptake inhibitor category.
- Vyvanse
BULIMIA NERVOSA
 Is an eating disorder characterized by
periods if binge eating and then purging.
Binge eating refers to the consumption of
large quantities of food in a single eating,
 Recurrent episodes of binge – eating
 Self – evaluation unduly influenced by body
and weight.
SPECIFIER:
MILD: 1 – 3 episodes / week
MODERATE: 4 – 7 episodes / week
SEVERE: 8 – 13 episodes / week
EXTREME: 14 or more episodes / week
 Worldwide prevalence of bulimia cases in
young females is around 1% to 3%.
 Expression of the core symptoms of
anorexia and bulimia to be present in up to
12% of women over the course of their
lifetimes.
 SYMPTOMS
%
Binge Eating  Unforced regurgitation (no retching)
Disorder  Belching prior to vomiting
Other Eating  Abdominal discomfort
Disorder  Chronic bad breath
Anorexia Nervosa
 Anxiety
 Skipping social events / social eating
Bulimia nervosa  Absence of gagging (choking) retching
(effort to vomit) acid reflux
 Weight loss
PICA 

Chapped lips
Tooth erosion / decay
 Depression
 Eating disorder marked by eating non –  Malnutrition
food items.
 Lack of sour or bile taste when food is
 It’s most commonly seen in childhood but
regurgitated. The timing of the regurgitation.
can occur in adulthood.
 Can cause stomach upset, teeth injury and CAUSES:
lead poisoning
 People with PICA often experience  Currently, no known cause for rumination
malnutrition disorder.
 Eating non – nutritive, non – food substance  For infants, and younger children: being
 Inappropriate to the developmental level over and under stimulated at home can
 Not part of a culturally supported / socially contribute to rumination disorder.
normative practice  May also be a way to deal with emotional
disorder, and can then become a habit that
PREVALENCE: is difficult to break.

 Children – 25% to 35% TREATMENT

 Pregnant – Up to 68%
A behavioral psychologist will often work
with a patient to unlearn habits, whether conscious

RUMINATION
or unconscious, that lead to the regurgitation.

 Deep breathing exercises, particularly after

DISORDER 
meals
Habit reversal training
 Relaxation techniques
 A disorder characterized by an individual’s
 Aversion therapy
uncontrollable and frequent regurgitation of
food that may be either re – chewed and
swallowed, or spit out.
 Most common to see in infants, young
children and individuals with intellectual
disabilities.
 Adolescents and adults are now more
frequently diagnosed.
 Not consider a commonly diagnosed
disorder.
ARFID: AVOIDANT /
REASONS FOR FOOD AVOIDANCE:

 Typically avoid food based on sensory

RESTRICTIVE FOOD 
qualities, such as smell, taste or texture.
May also avoid foods touching each other
INTAKE DISORDER  A previous bad experience with a certain
food (choking or food poisoning)

 Is an eating disorder marked by avoiding / EMOTIONAL RESPONSE

restricting food intake to the point of
significant weight loss, malnutrition or When a presented with a new food,
functional interference. likely experience fear and anxiety:

ARFID was added to the DSM in 2013,  Tensing of the shoulders or other muscles
replacing feeding disorder of infancy / early  Fidgeting
childhood and expanding the diagnostic criteria to  Sweating
include individuals across the lifespan.  Crying
 Shaking in the hands
Approximately, 1.5% of children and
 Inability to look at the food
adolescents develop ARFID and less than 1% of
individuals age 15 and older meet criteria for Can begin anytime from birth to the age 4, picky
ARFID. eating phases common in children between 16
months and 3 years of age.

EATING / FEEDING DISTURBANCE

RECOGNIZE RELATED DISORDERS
 Apparent lack of interest in food
 Avoidance based on the sensory  Obsessive – Compulsive Disorder
characteristics of food  Autism
 Concern about aversive consequences of  Food trauma
eating  Oral – motor delay
 Swallowing disorders
PERSISTENT FAILURE TO MEET
 Gastrointestinal disorders
APPROPRIATE NUTRITION:
Most picky eaters will succumb under the weight of
 Significant weight lost
hunger, individuals with ARFID, on the other hand
 Significant nutritional deficiency
will not.
 Dependence on enteral feeding or oral
nutritional supplements

Not better explained by lack of availability of food

due to culturally sanctioned practice.

Does not occur exclusively with anorexia or bulimia

No disturbance in body weight or shape

No other medical condition

OTHER SPECIFIED
SOMATIC SYMPTOMS DISORDERS

 Excessive or maladaptive response to

FEEDING OR EATING physical symptoms or to associated health
concerns.
DISORDER “SOMA” means body.

Medically unexplained physical symptoms. In some

ATYPICAL ANOREXIA NERVOSA cases, medical cause is known for physical
 All criteria meet significant weight loss, symptoms but the emotional distress and
(within or above normal range) impairment is excessive.

BULIMIA NERVOSA (OF LOW FREQUENCY

OR LIMITED DURATION)

 Binge eating and compensatory behaviors

less than once a week in less than 3
months.

BINGE – EATING DISORDER (LOW

FREQUENCY AND / OR LIMITED
DURATION)

 Binge eating less than once a week in less

than 3 months.

PURGING DISORDER

 Purging behavior in the absence of binge –

eating
NIGHT EATING SYNDROME
 Recurrent episodes of night eating, eating
after awakening from sleep or excessive
consumption after evening meal.
SOMATIC SYMPTOM AND RELATED
DISORDERS
 Somatic Symptom Disorder
 Illness Anxiety Disorder
 Functional Neurological Disorder
 Psychological Factors Affecting Other
Medical Condition
 Factitious Disorder

CHAPTER 2: SOMATIZATION DISORDER

SOMATIC SYMPTOM AND RELATED
DISORDERS
 Include a variety of conditions with
psychological conflicts which become
translated into physical problems or
complaints.
Briquet’s Syndrome (Pierre Briquet, French
Physician 1859)
 First described by Paul Briquet in 1859,
patients feel that they have been sickly most
of their lives and complain of a multitude of
symptoms referable to numerous different
organ systems.
SOMATIC SYMPTOM
DISORDER
 A person has a significant focus on physical
symptoms, such as pain, weakness or
shortness of breath, to a level that results in
major distress and / or problems
functioning.
A person with Somatic Symptom Disorder has true
physical symptoms but medical test can’t pinpoint a
cause for the physical symptoms.
DIAGNOSTIC CRITERIA:
 One or more somatic symptoms that are
distressing or result in significant disruption
of daily life.
 Excessive thoughts, feelings or behaviours
related to the somatic symptoms
 Disproportionate and persistent thought
about the seriousness of one’s symptoms
 Persistently high level of anxiety.
 Excessive time and energy devoted to these
symptoms or health concerns.
 Although any one somatic symptom may
not be continuously present, the state of
being symptomatic is persistent (typically
more than 6 months)
SPECIFY IT:
PERSISTENT – (More than 6 months)
Mild, Moderate, Severe
More common in women.
TREATMENT
 Regular visits, with a trusted health care
professional, offer support and reassurance.
 Psychotherapy (talk therapy) change
thinking and behavior, learn ways to cope
with pain or other symptoms, deal with
stress and improve functioning
 Antidepressant or anti – anxiety
medications useful if the person is also
experiencing significant depression or
anxiety.
ILLNESS ANXIETY
DISORDER
 The core feature is a preoccupation with
having or acquiring a serious, undiagnosed
medical illness.
SYMPTOMS:
 Avoiding people or places due to worry
about catching an illness.
 Constantly researching diseases and
symptoms.
 Exaggerating symptoms and their severity
(for instance, a cough become a sign of
lung cancer)
 Repeatedly checking for signs of illness,
such as taking your blood pressure or
temperature.
 Oversharing your symptoms and health
status with others.
 Seeking reassurance from loved ones about
your symptoms or health
ILLNESS ANXIETY DISORDER
(HYPOCHONDRIASIS)
 With or without symptoms or even with mild
symptoms
 Concern on the idea of being sick than the
symptoms
 Performs excessive health related
behaviors
 Doctor’s reassurance does not help
 FUNCTIONAL
NEUROLOGICAL
SYMPTOM DISORDER
(CONVERSION
DISORDER)
 Translation of unacceptable drives or
troubling conflicts into physical symptoms.
 Not intentionally producing the symptoms
(malingering) but converting

SOME OF THE SYMPTOMS:

 Weakness
 Paralysis of the arms or legs
 Loss of balance
 Difficulty walking
 Seizures, sometimes with limited
SPECIFIER: consciousness
 Episodes of unresponsiveness
 Care – seeking type  Difficulty swallowing
 Care – avoidant type  A feeling of a lump in the throat
 Slurred speech or loss of speaking ability
 Difficult hearing or loss of hearing
CAUSES
 Double vision, blurred vision or episodes of
 Faulty interpretation of physical signs and blindness
sensations  Numbness or loss of the touch sensation
 Genetic contributions
One or more symptoms of altered voluntary motor
 Stressful live events
or sensory functions.
 Memories of illnesses in the family
 Experience of “benefits” of being sick Incompatibility between symptoms and any
neurological or medical condition

TREATMENT: Causes distress and impairment of functioning.

 Cognitive – Behavioral Therapy

 Psychopharmacotherapy
 Factitious disorder is the intentional creation or
exaggeration of symptoms, but without intent for a
concrete benefit.

PSCYHOLOGICAL
CAUSES
FACTORS AFFECTING
OTHER MEDICAL
 Experience of traumatic event
 Unconscious processing of conflict

CONDITIONS
 Conversion of anxiety into symptoms
 Attention – getting

TREATMENT
(PFAOMC / PFAMC)
 Is a mental disorder that is diagnosed when
 Cognitive – Behavioral Therapy clinically significant psychological or
 Psychopharmacotherapy behavioural factors adversely affects an
individual’s medical condition and increases
their risk for suffering death, or disability.

FACTITIOUS A medical symptoms or condition (other than a

mental disorder) is present.

DISORDERS FACTORS:

 Have influenced the course of the medical

Factitious Disorder Imposed on Self condition
 Interfere with the treatment of the medical
Factitious Disorder Imposed on Another condition (e.g., poor adherence)
 Constitute additional well – established
(Factitious Disorder by Proxy or
health risks for the individual
Munchausen Syndrome by Proxy  Influence the underlying pathophysiology,
precipitating or exacerbating symptoms, or
 Falsification of physical or psychological
necessitating medical attention.
signs or symptoms, induction of injury or
disease associated with identified
deception.
 Presents himself / other as ill, impaired or
injuired. PSYCHOLOGICAL
FACTORS AFFECTING
 Single Episode
 Recurrent Episodes

Malingering is the intentional fabrication of medical

symptoms for the purpose of external gain.
MEDICAL CONDITION
 Psychological or Behavioral factors  Tender breasts
adversely affect the condition  Missed periods
 Morning sickness (nausea and vomiting)
 Development, delayed recovery
 Weight gain
 Interfere with treatment
 Additional health risks  Lactation
 Exacerbate symptoms  Increased appetite
 Inverted belly button
 Frequent urination
 Changes in hair and skin
SPECIFIER
 Enlarged uterus
MILD: Increases medical risk  False labor
 Softening of the cervix
MODERATE: Aggravates underlying medical
condition Some of the issues or conditions that may
cause pseudocyesis are:
SEVERE: Results in hospitalization
 Multiple miscarriages
EXTREME: Results in life threatening risk
 Loss of baby or child
 Infertility
 Mental breakdown
FACTORS INCLUDE:

 Psychological distress
 Patterns of interpersonal interaction
 Coping styles
 Maladaptive health behaviors

OTHER SPECIFIED
SOMATIC SYMPTOM CHAPTER 3:
AND RELATED
DISSOCIATIVE DISORDERS
DISORDER  Are characterized by an involuntary escape
from reality characterized by a
disconnection between thoughts, identity,
PSEUDOCYESIS (PHANTOM PREGNANCY)
consciousness and memory.
 A false belief of being pregnant that is
associated with objective signs and reported  Women are more likely than men to be
symptoms of pregnancy. diagnosed with dissociative disorder.
 A rare somatic symptoms disorder where a
non – pregnant and non – psychotic woman  The symptoms of a dissociative disorder
thinks she is pregnant usually first develop as a response to a
traumatic event, such as abuse or military
SYMPTOMS: combat, to keep those memories under
control.
 Up to 75% of people experience at least
one depersonalization / derealization episode in
their lives, with only 2% meeting the full criteria for
chronic episodes.
Dreaming and Dream – like experience,
Extremely Stressful Event, and Tired or Sleep
Deprived.
DISSOCIATIVE DISORDERS
 DISSOCIATIVE AMNESIA
 DISSOCIATIVE IDENTITY DISORDER
 DEPERSONALIZATION –
DEREALIZATION DISORDER
DEPERSONALIZATION
– DEREALIZATION
DISORDER
 Feeling of unreality are so severe and
frightening that they dominate an
individual’s life and prevent normal
functioning.
 Dancing away from herself “flipping – out”
DIAGNOSTIC CRITERIA
DEPERSONALIZATION
 Experiences of unreality or detachment from
one’s mind, self or body. People may feel as
if they are outside their bodies and watching
events happening to them.
 As if in a dream and watching yourself
Perception alters,
Temporarily lose sense of reality,
As if in a dream and watching yourself
DISSOCIATIVE
DEREALIZATION
 Experiences of unreality or detachment from
AMNESIA
one’s surrounding. People may feel as if
things and people in the world around them
are not real.
 You feel like you are living in a dream,
behind a glass wall or bubble. The world
around you seems “off”.
Sense of reality of the external world lost
Things may seem to change size or shape
People seem dead or mechanical
10 MOST COMMONLY EXPERIENCED
SYMPTOMS
 Surroundings seen unreal


Looking at the worlds through a fog
Body does not belong to one


Did not hear part of the conversation
Finding familiar face strange an unfamiliar


Staring off into space, unaware of time
Can’t remember if just did something or
thought it
 Do usually difficult things with
ease/spontaneity
 Act so differently / feel like two different
people
 Talk – out loud to oneself when alone
 Presence of persistent depersonalization or
derealization or both.
 During depersonalization or derealization
experience, reality testing remains intact.
 Caused significant distress and impairment
in functioning.
 Not attributable to substance use or another
medical condition.
 Not better explained by other mental
disorder such as schizophrenia or panic
disorder.
  Is when the mind blocks out important
information, causing “gaps” in memory.
 To protect from unpleasant, distressing or
traumatic experiences.
 Not the same as simply forgetting
something, still have the memories but can’t
access them.
SUPPRESSION – conscious, unmotivated
forgetting, consciously suppress impulses.
REPRESSION – unconscious, motivated forgetting,
unconsciously deny impulses.
2 TYPES OF AMNESIA
1. GENERALIZED AMNESIA – unable to
recall anything.
2. SELECTIVE AMNESIA (LOCALIZED
AMNESIA) – unable to recall specific
events.
DIAGNOSTIC CRITERIA
 Inability to recall anything autobiographic
information.
 Cause significant distress and impairment in
functioning
 Not caused by substance – use or another
medical condition
 Not better explained by other mental
disorder such as DID, PTSD,
Neurocognitive Disorders
SPECIFY IF: With Dissociative Fugue
Dissociative Fugue, “flight” (fugitive from the same
root) Take – off or travel to a new place
Create a new identity
DISSOCIATIVE
IDENTITY DISORDER
 DID is a serious disorder characterized by
switching or alternating between multiple
identities. These separate identities control
a person’s behavior at different times.
 Formerly called “Split Personality” or
“Multiple Personality”, usually have one
impulsive alter who handles sexuality and
generates income. Cross – gendered alters
not uncommon.
 May adopt as many as 100 new identities all
simultaneously co – existing
 Average close to 15
In some cases, identities are complete, in many
cases, only few characteristics are distinct.
Alters, the term used for other identities, may come
in response to life situation.
Host, the one which seeks for treatment, not
original personality, develops later but result to be
overwhelmed with the other personalities.
Switch, transition from one personality to another,
may be instantaneous.
Physical transformation may occur during
switches:
 Posture
 Facial Expression
 Physical disabilities
 Handedness (37%)
Children compartmentalize the traumatic memories,
or imagine as if they happened to someone else.
Multiple personalities may emerge as coping
mechanism. About 90% of people with diagnosed
DID report they had been victims of childhood
abuse and neglect.
DID is more commonly diagnosed in women than
men.
DIAGNOSTIC CRITERIA
Disruption of identity with 2 or more distinct

personality states
 Recurrent gaps in recall of everyday event,
personal information or traumatic event
 Cause significant distress and impairment in
functioning
  Not part of culture or any religious practice.
 Not attributable to substance – use and
other medical condition

PREVALENCE OF DISSOCIATIVE
DISORDERS

 0.8 – 2.8% Depersonalization –

Derealization

 1.8 – 7.3% Dissociative Amnesia

 3 – 6% Dissociative Identity Disorder

CAUSES OF DISSOCIATIVE DISORDERS

Usual onset is childhood.

Childhood Trauma and Abuse: a defenseless child
retreats to a fantasy world, other identities who can
protect them.

Putnam et al (1986)
 Experience Trauma – 97%
 Incest – 67%

A natural tendency to escape or dissociate

Suggestibility: Imaginary Playmate

TREATMENT OPTIONS FOR DID

 Psychotherapy / Cognitive therapy
 Hypnosis
 Psychopharmacological therapy
 Electroconvulsive therapy
 Adjunctive treatments