Abnormal Psychology 3rd Edition Beidel Test Bank Full Chapter PDF

Abnormal Psychology 3rd Edition
Beidel Test Bank

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Chapter 7
Feeding and Eating Disorders
Multiple Choice:
1) The example cited in the text of saints starving themselves out of devotion is
A) an illustration of the binge-purge cycle.
B) not considered a historical form of anorexia nervosa.
C) not a case of anorexia nervosa because it involves a religious context.
D) an example of the impact of context on symptom expression in an illness.
ANSWER: D
Diff: 1 Page Ref: 234-235
Topic: Chapter Opener
Skill: Factual
2) Among young women in today’s culture, anorexia nervosa is generally interpreted as

A) self-denial in order to attain a state of euphoria.
B) an attempt to achieve an ideal state of thinness.
C) a wish for parental attention.
D) a need to remain childlike in body build.
ANSWER: B
Diff: 1 Page Ref: 235
Topic: Chapter Opener
Skill: Factual
3) Select the statement that is FALSE regarding anorexia nervosa.

A) Victims weigh less than 85% of their ideal body weight.
B) It is rarely associated with mortality.
C) Younger patients do not have normal developmental weight gains.
D) Cases may be found throughout history.
ANSWER: B
Topic: Anorexia Nervosa
Skill: Conceptual
4) Margaret’s appetite has decreased markedly over the course of the semester, resulting in a
weight of 100 lbs. on her 5’9” frame. Her roommate has noticed that she tends to wear layers of
clothing even in warm weather and frequently complains about her weight. If Margaret were
referred for evaluation for an eating disorder, what percent of ideal body weight would be used
as a criterion for excessive weight loss?
A) 35%
B) 50%
C) 65%
D) 85%
ANSWER: D
Skill: Applied
5) Body mass index (BMI) is a way of expressing

A) the ratio of height and weight to percent body fat.
B) the threshold for abnormal weight loss.
C) percent of body fat.
D) both height and weight in one measure.
ANSWER: D
Skill: Factual
6) Clinicians use the ________ in determining the weight status of their clients.
A) caloric weight index (CWI)
B) body mass index (BMI)
C) weight to height ratio (WHR)
D) body weight ratio (BWR)
ANSWER: B
Skill: Conceptual
7) Alejandra has been diagnosed with anorexia nervosa. Her dinner last night consisted of 3
celery sticks, a spoonful of hummus, half of a slice of pita bread, and a cup of tea. Feeling full
and bloated after eating, Alejandra decided to work out on the treadmill for 40 minutes. Which of
the following anorexia nervosa subtypes accurately describes her condition?
A) Binging
B) Dieting
C) Purging
D) Restricting
ANSWER: D
Skill: Applied
8) Which of the following statements is TRUE of the binge eating/purging subtype of anorexia
nervosa?
A) Both binge eating and purging must be present for the diagnosis to be made.
B) Binge eating, purging, or both may be present for the disorder to be diagnosed.
C) Binge eating is often accompanied by excessive exercise.
D) Binge eating need only occur once to meet the diagnostic criterion.
ANSWER: B
Skill: Conceptual
9) A particularly perplexing clinical feature of anorexia nervosa is the

A) individual’s intense fear of gaining weight despite emaciation.
B) person’s concern over parental approval and acceptance.
C) person’s inability to articulate any food favorites..
D) patient’s willingness to binge after long periods of starvation.
ANSWER: A
Skill: Factual
10) Kaylyn suffers from anorexia nervosa. She induces vomiting. This is called
A) bingeing.
B) emaciation.
C) purging.
D) restricting.
ANSWER: C
Skill: Conceptual
11) Three consecutive months of ___________has been removed from the official diagnosis of
anorexia nervosa in the DSM 5 because it was determined that no meaningful differences
occurred between individuals with anorexia nervosa who do and do not menstruate.
A) weight loss
B) amenorrhea
C) purging
D) denial of emaciation
ANSWER: B
Skill: Factual
12) Select the statement below that is TRUE of amenorrhea and the diagnosis of anorexia
nervosa in the DSM-5.
A) Amenorrhea need not be present for anorexia nervosa to be diagnosed.
B) Research demonstrates meaningful differences in diagnosis between females who do and
do not menstruate.
C) Amenorrhea must be present for an anorexia nervosa diagnosis.
D) Menstruation must occur monthly but for briefer periods than usual for a diagnosis of
anorexia nervosa.
ANSWER: A
Skill: Conceptual
13) An associated medical feature of anorexia nervosa that might explain the tendency to layer
clothing even in mild temperatures is
A) lowered body temperature.
B) heightened blood pressure.
C) increased heart rate.
D) shallow breathing.
ANSWER: A
Skill: Factual
14) Epidemiological estimates of the prevalence of anorexia nervosa reveal that approximately 1
in _______ girls or women will suffer from it at some point in their lives.
A) 1,000
B) 100
C) 10,000
D) 100,000
ANSWER: A
Skill: Factual
15) Females are ____ more likely to develop anorexia nervosa than are males.
A) 3 times
B) 5 times
C) 6 times
D) 9 times
ANSWER: A
Skill: Factual
16) There is controversy in the research concerning the incidence of anorexia nervosa in our
country; some studies report stable rates, while others report an increase. This discrepancy may
be explained by the way in which studies were conducted or
A) attrition rates in studies.
B) the fact that many people never seek treatment.
C) improvements in screening tools for the disorder.
D) the underestimate of males having the disorder.
ANSWER: B
Skill: Factual
17) Certain segments of the population have higher rates of anorexia nervosa than others. Which
of the following segments would potentially have the highest rates of the disorder?
A) Females from suburban homes
B) Workers in service industries
C) Daughters of divorced parents
D) Workers in the entertainment industry
ANSWER: D
Skill: Factual
18) Psychological features often associated with anorexia nervosa include

A) anxiety and personality disorders.
B) anxiety and childhood disorders.
C) depression and somatoform disorders.
D) depression and anxiety.
ANSWER: D
Skill: Factual
19) Which of the following is TRUE of the course of anorexia nervosa as a disorder?
A) It usually develops during early adolescence and tends to be short-lived.
B) It may often include periods of relapse and remission.
C) It rarely includes a crossover into bulimia nervosa.
D) It does not have long-term health consequences for the patient.
ANSWER: B
Skill: Conceptual
20) Anorexia nervosa may be a lethal disorder resulting in death from the effects of starvation or
from
A) breathing difficulties.
B) stomach cancer.
C) amenorrehea.
D) suicide.
ANSWER: D
Skill: Conceptual
21) Karen Carpenter, a pop icon of the 1970’s whose case is presented in the text, died from
complications of anorexia nervosa. Which subtype of the disorder was evident in her story?
A) Bingeing/Purging
B) Restricting
C) Purging
D) Bingeing
ANSWER: C
Skill: Conceptual
22) The most important personality trait found in cases of anorexia nervosa is
A) perfectionism.
B) conscientiousness.
C) agreeableness.
D) responsibility.
ANSWER: A
Skill: Factual
23) Adolescence and young adulthood are typical periods of risk for eating disorders in that
individuals who are perfectionistic, prone to worry, and stressed by change may
A) resist unwanted interventions by parents or other authority figures.
B) find developmental milestones to be triggers for the disorder.
C) use regurgitation as a passive-aggressive tactic for control.
D) develop phobias centering on specific food groups.
ANSWER: B
Skill: Conceptual
24) At least 75% of all persons diagnosed with anorexia nervosa have a comorbid risk of
A) bipolar disorder.
B) substance abuse disorder.
C) major depressive disorder and posttraumatic stress disorder.
D) an anxiety disorder and major depressive disorder.
ANSWER: D
Skill: Factual
25) __________ disorders often precede the development of anorexia nervosa and consequently
may place a person at particular risk for the expression of the disorder.
A) Developmental
B) Personality
C) Anxiety
D) Substance abuse
ANSWER: C
Skill: Factual
26) Unlike anorexia nervosa, bulimia nervosa is

A) a visible eating disorder.
B) an invisible eating disorder.
C) life-threatening.
D) found in women only.
ANSWER: B
Topic: Bulimia Nervosa
Skill: Factual
27) Key symptoms of bulimia nervosa include recurrent episodes of binge eating, a feeling of
being “out of control” during binge eating episodes, and
A) inappropriate strategies for weight control.
B) amnesia for food consumption.
C) a fear of running out of food.
D) a desire to maintain a state of starvation.
ANSWER: A
Skill: Conceptual
28) For bulimia nervosa to be diagnosed, binge eating must have occurred
A) daily for a period of two months or more.
B) daily for a period of three months or more.
C) at least weekly for a period of two months or more.
D) at least weekly for a period of three months or more.
ANSWER: D
Skill: Factual
29) Biweekly for the last year, Beverly has experienced irresistible urges to eat two gallons of ice
cream and a bag of chocolate chip cookies. However, she manages to work off her calories using
an exercise regimen that includes two hours of treadmill activity followed by a four-mile jog.
Although she manages to avoid weight gain when she goes into her “binge modes,” she
complains of feeling out of control during these binges. Beverly exhibits symptoms of
A) obsessive-compulsive eating disorder.
B) bulimia nervosa.
C) anorexia nervosa.
D) a binge eating disorder.
ANSWER: B
Skill: Applied
30) Unlike overeating too much of a favorite food, people with bulimia nervosa
A) consume a large amount of food in a short period of time and use compensatory
behaviors.
B) consume a large quantity of food in a brief period of time but do not use laxatives.
C) do not have trouble stopping when they feel full.
D) feel more control over their eating because they have compensatory behaviors to regulate
weight gain.
ANSWER: A
Skill: Applied
31) Which of the following is TRUE of both anorexia nervosa and bulimia nervosa?
A) Both disorders involve periods of extreme overeating.
B) Patients with both disorders complain of fear starvation.
C) Both disorders involve a purging subtype.
D) Both disorders are not found among older persons.
ANSWER: C
Skill: Conceptual
32) In bulimia nervosa, binges are usually terminated because the person runs out of food, is
interrupted by someone, or
A) a strong gag reflex starts.
B) feels satiated.
C) experiences a strong urge to purge.
D) becomes violently ill.
ANSWER: C
Skill: Factual
33) Marina complains of feeling out-of-control after eating a slice of toast. In an eating disorders
paradigm, this behavior would be termed a(n)
A) objective binge.
B) subjective binge.
C) brief binge.
D) psychological binge.
ANSWER: B
Skill: Applied
34) Patterns of binge eating may vary among those diagnosed with bulimia nervosa. Bingeing
may occur from occasionally to
A) weekly.
B) daily.
C) hourly.
D) multiple times per day.
ANSWER: D
Skill: Factual
35) An inappropriate compensatory behavior may be defined as

A) any action taken to counteract a binge or avoid weight gain.
B) only those actions taken to avoid binge eating.
C) any ritualistic behavior used to avoid thinking about bingeing.
D) a healthy course of action taken to counteract negative consequences of bingeing.
ANSWER: A
Skill: Factual
36) Compared to those diagnosed with anorexia nervosa, patients with bulimia nervosa are more
likely to engage in
A) exhibitionistic behaviors.
B) high-risk sexual behavior.
C) alcohol and drug abuse.
D) self-mutilating behaviors such as “cutting.”
ANSWER: C
Skill: Factual
37) Which of the following most accurately describes the use of laxatives as a compensatory
strategy in bulimia nervosa?
A) It is an ineffective strategy for avoiding weight gain.
B) It is a safe and effective means of maintaining one’s desired weight.
C) Few persons diagnosed with the disorder actually use them.
D) Research indicates that it leads to retention of electrolytes in one’s system.
ANSWER: A
Skill: Conceptual
38) When subthreshold forms of bulimia nervosa are included, prevalence estimates of the
disorder range from ___ to ___ percent of the female population in westernized countries.
A) 5; 6
B) 7; 8
C) 10; 20
D) 12;15
ANSWER: A
Skill: Factual
39) Select the statement below that is TRUE of bulimia nervosa.

A) The incidence of the disorder has gradually declined over the last 10 years.
B) It is a more “modern” phenomenon than anorexia nervosa.
C) It is found more frequently in rural areas.
D) It does not appear to be a culture-bound phenomenon.
ANSWER: B
Skill: Factual
40) According to the text, because the criteria for both anorexia and bulimia nervosa were very
specific,
A) prevalence estimates may increase with the new DSM-5 criteria.
B) a diagnosis of either disorder captures accurate prevalence rates for anyone having an
eating disorder.
C) female prevalence rates for geriatric cases are overestimated in the U.S. population.
D) we can be fairly confident that we have identified those needing treatment for an eating
disorder.
ANSWER: A
Skill: Conceptual
41) Bulimia nervosa is more prevalent among females and tends to develop in
A) less industrialized countries.
B) families with more than 3 female children.
C) late childhood and early adolescence.
D) late adolescence or early adulthood.
ANSWER: D
Skill: Factual
42) In bulimia nervosa, erosion of dental enamel and callouses on the backs of the hands
A) is predictive of a suicide attempt among younger women.
B) are among some of the ways the disorder is hard on the body.
C) discriminates acute from chronic symptom expression of purging.
D) has been found to be an unreliable indicator of self-induced vomiting.
ANSWER: B
Skill: Factual
43) The use of laxatives in bulimia nervosa may lead to edema, dehydration, electrolyte
imbalances, and
A) chronic fluid retention.
B) severe intermittent bouts of gastritis.
C) irreversible bowel dysfunction.
D) permanent irregular heartbeats.
ANSWER: C
Skill: Factual
44) Compared with anorexia nervosa patients, persons diagnosed with bulimia nervosa have
A) a higher risk of mortality.
B) a lower risk of mortality.
C) no risk of mortality.
D) an equal risk of mortality.
ANSWER: B
Skill: Factual
45) Outcome research estimates tell us that ______ percent of patients diagnosed with bulimia
nervosa achieve full or partial remission.
A) 10
B) 20
C) 50
D) 80
ANSWER: C
Skill: Factual
46) A common personality trait in both anorexia and bulimia nervosa is

A) rule-boundedness.
B) introversion.
C) perfectionism.
D) conscientiousness.
ANSWER: C
Skill: Factual
47) As compared to individuals with anorexia nervosa, individuals with bulimia nervosa are
more
A) rigid.
B) perfectionistic.
C) obsessive.
D) impulsive.
ANSWER: D
Skill: Factual
48) Approximately _____ percent of those diagnosed with bulimia nervosa have another
psychiatric disorder at some point in their lives.
A) 20
B) 50
C) 70
D) 80
ANSWER: D
Skill: Factual
49) Elton John and Diana, Princess of Wales, whose cases are presented in the text, both suffered
from
A) anorexia nervosa.
B) alcohol abuse.
C) bulimia nervosa.
D) drug abuse.
ANSWER: C
Skill: Factual
50) Select the statement below that is FALSE regarding binge eating disorder.
A) It was only recently accepted as a formal psychiatric diagnosis.
B) It lacks the compensatory behaviors of bulimia nervosa.
C) Little is known about associated mortality or morbidity rates.
D) It may be a chronic condition.
ANSWER: A
Topic: Binge Eating Disorder
Skill: Conceptual
51) Willie enjoys eating in the university cafeteria because it features an all-you-can-eat buffet.
He prefers to wait until most people have dined before entering the facility because he feels
awkward about the amount he consumes. Willie usually eats until he feels uncomfortable,
although he does not purge. He is most likely to have which of the following disorders?
A) Bulimia nervosa
B) Binge-eating disorder
C) Eating disorder not otherwise specified
D) Anorexia nervosa—binge eating type
ANSWER: B
Skill: Applied
52) Obese people with binge eating disorder differ from obese persons without the disorder in
that the former
A) are more likely to have associated depression and anxiety disorders.
B) report more frequent purging episodes.
C) report a later onset of both obesity and dieting.
D) recall less fluctuation in weight throughout their lives.
ANSWER: A
Skill: Conceptual
53) The rates at which binge eating disorder occurs in the general population make it the
___________________________ of all eating disorders in DSM-5.
A) most frequently occurring
B) least frequently occurring
C) most dangerous
D) most socially acceptable form
ANSWER: A
Skill: Factual
54) Overeating behavior without regular inappropriate compensatory behaviors are characteristic
of which of the following?
A) Bulimia nervosa
B) Anorexia nervosa
C) Binge eating disorder
D) Purge eating disorder
ANSWER: C
Skill: Conceptual
55) Yolanda has been diagnosed as having an eating disorder involving “chewing and spitting.”
Given this information, what is the most likely formal diagnosis for her?
A) Anorexia nervosa
B) Bulimia nervosa
C) Rumination disorder
D) Restrictive eating disorder
ANSWER: C
Topic: Other Specified Feeding and Eating Disorders
Skill: Applied
56) Among men, the incidence of bulimia nervosa might be underestimated because
A) men are hesitant to admit having struggles with their weight.
B) little, if any, research has been conducted on men who have eating disorders.
C) the disorder is masked by alcohol and other substance abuse problems.
D) men prefer exercise to purging or other compensatory behaviors.
ANSWER: D
Topic: Sex, Race, Ethnicity, and Developmental Factors
Skill: Factual
57) Which of the following statements is FALSE regarding eating disorders among females?
A) They may result from increased pressure to attain the thin ideal.
B) They may result from the influence of hormones on appetite and weight regulation.
C) They may be diagnosed more frequently because of sex biases in the diagnostic criteria.
D) They are more likely than males to engage in binge eating disorders.
ANSWER: D
Skill: Factual
58) Epidemiologic data on eating disorders

A) suggest that eating disorders are more prevalent among black women than white women
in the U.S.
B) do not provide us with a clear picture of the racial and ethnic distribution of the disorders.
C) indicate that American Indian females have a disproportionately high rate of eating
disorders compared to Hispanic females.
D) suggest that anorexia nervosa among black women is underreported.
ANSWER: B
Skill: Factual
59) For binge eating disorder, epidemiologic data indicate
A) increased risk for the disorder among members of the lower socioeconomic classes.
B) the same findings as revealed in the study of anorexia and bulimia nervosa.
C) children of women with binge eating disorders are not at higher risk for the disorder.
D) more differences in prevalence exist across racial and ethnic groups.
ANSWER: A
Skill: Factual
60) Jenna is a young adolescent and has been diagnosed with anorexia nervosa. Most likely, her
recovery and treatment will address issues related to independence, trust, and
A) separation anxiety.
B) emotional freedom.
C) establishing romantic relationships.
D) assertiveness.
ANSWER: C
Skill: Applied
61) Christina is a middle school student going through puberty before her female classmates.
Consequently, she may be at
A) lower risk for developing dissatisfaction with her body.
B) greater risk for developing an eating disorder.
C) less risk for being underweight.
D) greater risk for being sexually abused.
ANSWER: B
Skill: Applied
62) Sexual abuse histories among patients with bulimia nervosa are
A) more common than typically seen in the family histories of anorexic patients.
B) less common than one would expect from the histories of anorexic patients.
C) no more common than among other psychological disorders.
D) not documented well enough to be able to assess a prevalence rate.
ANSWER: A
Skill: Factual
63) Animal studies have revealed that one part of the brain influential in appetite and weight
control is the
A) hypothalamus.
B) adrenal glands.
C) pituitary gland.
D) olfactory epithelium.
ANSWER: A
Topic: The Etiology of Eating Disorders
Skill: Conceptual
64) In persons with anorexia nervosa, abnormalities in serotonin levels may contribute to the
expression of
A) introversion.
B) perfectionism.
C) passive-aggressive behavior.
D) treatment resistance.
ANSWER: B
Skill: Factual
65) What structural brain abnormalities have researchers discovered in patients with anorexia
nervosa when they are ill?
A) Decreased hypothalamus size
B) Decreased ventricle size
C) Frontal lobe lesions
D) Loss of gray matter and reduced brain mass
ANSWER: D
Skill: Factual
66) Relatives of persons with anorexia nervosa or bulimia nervosa have an increased risk for
eating disorders _____ times that of persons with no familial history of these disorders.
A) 3
B) 5
C) 8
D) 10
ANSWER: D
Skill: Factual
67) The heritability of anorexia nervosa and bulimia nervosa indicates that there appears to be
A) a genetic component to both disorders.
B) no direct genetic link to the disorders.
C) genes that are solely responsible for the disorders.
D) genes that are dominant over environmental influences in producing the disorder.
ANSWER: A
Skill: Conceptual
68) Salvador Minuchin, who investigated patterns of family dysfunction among patients with
eating disorders, identified “enmeshment” as
A) a family’s willingness to maintain the sick status of the affected member.
B) familial attempts to cover up the family member’s illness.
C) the overidentification of family members with the therapist.
D) overinvolvement of all family members in the affairs of one member.
ANSWER: D
Skill: Conceptual
69) Overall, research indicates that the most effective approach in the treatment of anorexia
nervosa is
A) use of a multidisciplinary team.
B) nutritional counseling.
C) family systems counseling.
D) behavior modification.
ANSWER: A
Topic: The Treatment for Eating Disorders
Skill: Conceptual
70) In approaching the treatment of anorexia nervosa, a multidisciplinary team first

A) opens family channels of communication.
B) addresses weight restoration.
C) confronts the patient about his/her denial.
D) identifies conflict areas in childhood.
ANSWER: B
Skill: Factual
71) Inpatient treatment for anorexia nervosa may be required for persons at 75% of their
expected body weight. In addition, consideration is given to medical complications, failure to
improve with outpatient treatment, and
A) the person’s age.
B) the family’s willingness to engage with the multidisciplinary team.
C) suicide attempts or plans.
D) the chronicity of the disorder.
ANSWER: C
Skill: Factual
72) The only FDA-approved drug for an eating disorder is fluoxetine, and it is prescribed for
A) bulimia nervosa.
B) anorexia nervosa.
C) eating disorder not otherwise specified.
D) bingeing.
ANSWER: A
Skill: Factual
73) Select the cognitive-behavioral treatment element below that is most effective in promoting
behavioral change among persons with eating disorders.
A) training in diaphragmatic breathing
B) increasing self-esteem
C) altering thinking patterns
D) reducing family enmeshment.
ANSWER: C
Skill: Conceptual
74) With respect to the treatment of eating disorders, DBT is to CBT as _____ is to _____.
A) faulty thinking; emotional dysregulation
B) unconscious conflict; faulty thinking
C) emotional dysregulation; faulty thinking
D) emotional dysregulation; unconscious conflict
ANSWER: C
Skill: Conceptual
75) A treatment that focuses on emotional dysregulation and sees problem eating behaviors as
attempts to manage unpleasant emotional states is
A) family therapy
B) dialectical behavior therapy
C) interpersonal psychotherapy
D) supportive psychotherapy
ANSWER: B
Skill: Factual
True/False:
76) As early as the 19th century, Lasegue identified social and psychological factors associated
with anorexia nervosa.
ANSWER: TRUE
Skill: Factual
77) While anorexia nervosa is a disorder found before the 21st century binge eating disorder is a
disorder of fairly recent origin.
ANSWER: TRUE
Skill: Factual
78) Patients diagnosed as having the restricting subtype of anorexia nervosa control their weight
exclusively through dieting.
ANSWER: FALSE
Skill: Conceptual
79) Female anorexic patients may experience the loss of menstrual periods during the course of
the disorder.
ANSWER: TRUE
Skill: Factual
80) Subthreshold conditions of anorexia nervosa are not associated with problems in social or
occupational functioning.
ANSWER: FALSE
Skill: Factual
81) In recent times, more children and older persons are being diagnosed with the classic
symptoms of anorexia nervosa.
ANSWER: TRUE
Skill: Factual
82) Anorexia nervosa has the highest associated rate of mortality of any DSM-5 disorder.
ANSWER: TRUE
Skill: Factual
83) Research indicates that anxiety may predispose an individual for anorexia nervosa.
ANSWER: TRUE
Skill: Factual
84) A sense of loss of control over eating during binge episodes is not required for a diagnosis of
bulimia nervosa.
ANSWER: FALSE
Skill: Conceptual
85) A key diagnostic feature of bulimia nervosa is the consumption of a minimum of 20,000
calories during binge eating episodes.
ANSWER: FALSE
Skill: Factual
86) Few people die from complications of bulimia nervosa.
ANSWER: TRUE
Skill: Factual
87) Both shoplifting and impulsive spending are psychological features associated with bulimia
nervosa.
ANSWER: TRUE
Skill: Factual
88) Persons diagnosed as having bulimia nervosa are different from persons labeled as having
anorexia nervosa in that the former are less impulsive.
ANSWER: FALSE
Skill: Conceptual
89) Bulimia nervosa as a disorder is characterized by more erratic and impulsive traits when
compared to anorexia nervosa.
ANSWER: TRUE
Skill: Conceptual
90) In almost all cases, BED appears to be time-limited and part of a passing phase.
ANSWER: FALSE
Skill: Factual
91) According to the text, the DSM-IV system did not accurately capture eating disorders as they
exist in the real world.
ANSWER: TRUE
Skill: Conceptual
92) In those disorders included in the other specified feeding and eating disorders category,
patients may use chewing and spitting out food as a form of weight control.
ANSWER: TRUE
Skill: Conceptual
93) Anorexia nervosa is fairly prevalent in childhood but bulimia nervosa before puberty is
uncommon.
ANSWER: FALSE
Skill: Factual
94) Evidence from studies of eating disorders in humans reveals the presence of consistent
hypothalamic abnormalities.
ANSWER: FALSE
Skill: Factual
95) Research using animal models indicates that unlimited access to a physical activity and
scheduled feedings may lead to overactivity and emaciation.
ANSWER: TRUE
Skill: Conceptual
96) It is generally believed that abnormal serotonin levels contribute to the expression of some
personality features found in eating disorders.
ANSWER: TRUE
Skill: Factual
97) Structural brain abnormalities have been found in both anorexia and bulimia nervosa
patients; however, there is no research evidence that these differences were present before the
onset of the illness.
ANSWER: TRUE
Skill: Factual
98) The case of twins Michaela and Samantha Kendall presented in your text demonstrates that a
hostile environment may be a sole determinant of an eating disorder in some cases.
ANSWER: FALSE
Skill: Conceptual
99) Although initial promising research pointed to chromosome 10 as a “hot spot” in both
bulimia nervosa and obesity, subsequent research has failed to confirm this relationship.
ANSWER: FALSE
Skill: Factual
100) It is generally accepted that research has demonstrated that eating disorders are partially
influenced by genes.
ANSWER: TRUE
Skill: Factual
101) There is evidence to indicate a genetic predisposition makes an individual more vulnerable
to behaviors such as dieting, and that sociocultural exposure triggers the eating disordered
behavior.
ANSWER: TRUE
Skill: Factual
102) Although there are some differences among approaches to treatment of each of the
categories of eating disorders, normalization of eating behavior and weight is the primary goal of
treatment for all of the disorders.
ANSWER: TRUE
Skill: Conceptual
103) The most efficacious approach to the treatment of eating disorders involves the use of a
multidisciplinary team.
ANSWER: TRUE
Skill: Factual
104) Weight is the only real factor considered when someone with an eating disorder is
evaluated for inpatient treatment.
ANSWER: FALSE
Skill: Conceptual
105) Some medications have been identified as highly effective in the treatment of eating
disorders.
ANSWER: FALSE
Skill: Factual
106) Although essential, nutritional rehabilitation alone is not sufficient to help patients recover
from an eating disorder.
ANSWER: TRUE
Skill: Factual
107) Applying cognitive behavioral treatment to eating disorders means a focus on faulty
cognitions that reinforce eating and weight dysfunctions.
ANSWER: TRUE
Skill: Conceptual
108) During the acute stage of an eating disorder, a patient may not benefit from cognitive
behavioral treatment.
ANSWER: TRUE
Skill: Conceptual
109) Family-based treatments focus on changing the dysfunctional dynamics found in families of
eating disorder patients.
ANSWER: TRUE
Skill: Conceptual
110) The text case of Lisa, a student athlete diagnosed with anorexia nervosa, demonstrates the
effectiveness of medication as a primary means of successful treatment of an eating disorder.
ANSWER: FALSE
Skill: Factual
Essay:
Student answers will vary but should include elements of the suggested answers given below.
111) Provide an overview of DSM-5 diagnostic criteria for anorexia nervosa. Include a
discussion of associated features.
ANSWER: Anorexia nervosa is marked by weight loss (or failure to gain weight in youth
who are still growing) leading to a body weight of less than 85% of that expected.
Despite low weight, individuals with anorexia nervosa have an intense fear of gaining
weight or becoming fat. They may also have a disturbance in the way in which they
experience their body weight or shape, place extreme importance on their body weight or
shape as measures of self-evaluation, deny the seriousness of their low body weight,
and/or stop having menstrual periods as a consequence of low body weight. In the
restricting type, individuals do not engage in binge eating or purging behavior. In the
binge eating/purging type, people do engage in regular binge eating or purging behavior.
Skill: Conceptual
112) Phyllis and her husband were regulars at Annabelle’s Restaurant. Every Saturday night,
they arrived promptly at 7:00 PM to begin Phyllis’s first dinner meal of the evening. While she
ordered a complete dinner featuring prime rib, baked potato, vegetables and a house salad, her
husband nursed a cup of coffee. Following dinner, the wait staff cleared the table and replaced
the silverware before the couple joining Phyllis and her husband for an 8:30 PM dinner arrived.
Phyllis ordered a meal identical to the one she had eaten earlier and this dinner proceeded as if
this were her first evening meal. Following the second dinner, she routinely went to the ladies’
room for approximately one half hour. Upon her return, the couples left the restaurant. Despite
the large quantity of food she consumed every Saturday evening, Phyllis was rail thin, weighing
approximately 100 lbs. at a height of 5’10”. Several wait staff believed that this pattern was
repeated at least one other time each week at a neighboring restaurant.
On the basis of the information presented, what diagnosis would you expect would be most
likely to be given to Phyllis, and what other associated clinical features might you expect to find
in this case?
ANSWER: Phyllis is most likely suffering from anorexia nervosa, binge eating/purging
subtype. Her behavior of bingeing dinners followed by lengthy visits to the restroom, as
well as her below average body weight, are suggestive of the disorder. It is most likely
that Phyllis has an intense fear of gaining weight and may commonly complain of
“feeling fat” despite the physical evidence that she is underweight. She may also
associate her weight with her sense of self-worth, and fluctuations in her weight may
result in a downward spiral of self-esteem. As a consequence of low body weight, Phyllis
may have amenorrhea, and she may be experiencing denial of her illness and resist
treatment.
Skill: Applied
113) There are many physical and psychological/behavioral features associated with anorexia
nervosa that are outlined in your text. Review four physical and four psychological/behavioral
features presented by the authors.
ANSWER: Physical Features: dehydration; electrolyte imbalance; osteoporosis; lanugo; dry

brittle hair; low body temperature; hypotension; bradycardia; growth retardation;
bloating; constipation; fidgeting; loss of tooth enamel and dentin.
Psychological/Behavioral Features: cognitive impairment; body-checking;
depression; anxiety; low self-esteem; self-absorption; ritualistic behaviors; extreme
perfectionism; self-consciousness.
Skill: Conceptual
114) Discuss the relationship between personality and risk for anorexia nervosa.
ANSWER: Some personality traits do seem to come before the eating disorder, get worse
during the eating disorder, and often persist after recovery. The most important is
perfectionism. People who develop anorexia nervosa are often described as model
children and model students who set extremely high standards for themselves. They also
apply that perfectionism to their pursuit of thinness and hold themselves to dieting
standards above what others could possibly attain. Other common personality factors are
obsessionality, neuroticism, and low self-esteem. This cluster of personality traits may
help explain why adolescence and young adulthood are typical risk periods for the
development of eating disorders. Many of the developmental tasks of this life period
involve substantial change and encounters with unfamiliar stimuli. Such transitions can
be challenging for healthy youth. People who are worriers, tend toward unwavering
perfectionism, and find change difficult may experience this period of life as a trigger for
an underlying predisposition for eating disorders.
Skill: Conceptual
115) What evidence exists to support the notion that bulimia nervosa may be more of a culture-
bound syndrome than anorexia nervosa?
ANSWER: Individuals born after 1960 are at greater risk for the disorder, suggesting that
bulimia nervosa is a more modern disorder than anorexia nervosa. Some believe it
reflects the trend beginning in the 1960’s toward thinner cultural ideals of beauty. It also
tends to be more common in urban areas, suggesting social learning, environmental
exposure, or information transfer may play a role in the development of the disorder.
Anorexia nervosa, by contrast, has been identified as existing even in ancient cultures and
psychologists are unsure as to whether or not we are seeing an actual increase in the rate
of cases or the incidence of the disorder is remaining stable. There is no mention in the
text that anorexia nervosa trends are reflective of a particular culture or that increases in
incidence rates are related to specific time period within a culture.
Skill: Conceptual
116) As disorders, bulimia and anorexia nervosa have significant commonalities and differences
in personality characteristics. Present an overview of key findings in this area.
ANSWER: People with bulimia nervosa share some personality features with those who have
anorexia nervosa, primarily perfectionism and low self-esteem, but differences also exist.
Unlike the classic restricting subtype of anorexia nervosa, people with bulimia tend to be
more impulsive and have higher novelty-seeking behavior. These different personality
traits are intriguing and reflect the symptom profiles of the disorders. Individuals with the
restricting subtype of anorexia nervosa display more rigid and obsessional personalities-
congruent with their rigid eating patterns. By contrast, those with bulimia nervosa exhibit
more erratic and impulsive traits-consistent with the impulsive and fluctuating nature of
alternating starving, binge eating, and compensatory behaviors.
Skill: Conceptual
117) A friend’s 8-year-old son has just been diagnosed with pica after years of surgeries to repair
kidney and lung damage. Explain what causes pica and what factors could increase risk.
ANSWER:
Pica has many different causes. Iron and zinc deficiencies may result in the
urge to ingest certain foods or substances, but many people without these conditions
also engage in pica. Environmental factors (stress and impoverished living
environments) or developmental disorders are important causal factors. Among people without
psychological disorders, pica sometimes begins after
stressful events such as surgery or the loss of a family member.
Because it is so rare, the etiology of rumination disorder is unstudied and, therefore,
unknown. Diff: 3 Page Ref: 249
Skill: Conceptual
118) How, and in what ways, are the social and psychological effects of anorexia nervosa as
disruptive as the physical toll of the disorder?
ANSWER: When anorexia nervosa begins in early adolescence, social and emotional
development are clearly interrupted by its medical and psychological consequences. The
disorder itself and associated symptoms such as depression, anxiety, social withdrawal,
difficulty eating in a social situation, self-consciousness, fatigue, and medical
complications can lead to isolation from peers and family. Often recovery requires facing
challenges that would normally have been faced years before, such as establishing
independence from family, developing trust in relationships, and dating and establishing
romantic relationships. Anorexia nervosa has dramatic effects on the family both
emotionally and financially. Family meals are often a battleground marked by refusal to
eat, power struggles about food, and frustration and tears. Parents struggle to understand
as their child becomes increasingly unreachable and unable to think rationally about a
function, eating, that to them seems a simple fact of life. The needs of siblings and other
family members commonly become secondary to the demands of the eating disorder.
This, coupled with the enormous expense of treatment, can wreak havoc on the most
functional of families.
Skill: Conceptual
119) Compare and contrast the theoretical approaches of the cognitive-behavioral and
sociocultural perspectives on eating disorders.
ANSWER: The cognitive-behavioral model focuses on distorted cognitions about body

shape, weight, eating, and personal control that lead to and maintain unhealthy eating and
weight related behaviors. Proponents of the model emphasize the power of thoughts to
influence feelings and behaviors in eating disorders. By contrast, sociocultural models
emphasize the western cultural preoccupation with thinness as beauty. The sociocultural
model traces exposure to the ideal of thinness, to internalization of this ideal, observation
of a discrepancy between actual and ideal, body dissatisfaction, dietary restraint, and
restriction.
Skill: Conceptual
120) Provide an overview of the factors given consideration in choosing inpatient treatment for a
person suffering from anorexia nervosa.
ANSWER: Treatment of anorexia nervosa is best accomplished using a multidisciplinary

team. Psychotherapy is difficult to conduct when the patient is acutely ill because her
ability to think is impaired by starvation. Weight is not the only factor to consider when
deciding on inpatient care. Other important factors to consider include medical
complications, suicide attempts or plans, failure to improve with outpatient treatment,
comorbid psychiatric disorders, interference with school, work, or family, poor social
support, pregnancy, and the unavailability of other treatment options.
Skill: Conceptual
121) Describe the cognitive-behavioral approach to the treatment of eating disorders. Include
core elements of the paradigm.
ANSWER: Cognitive-behavioral treatment (CBT) focuses on patterns of thinking as they

influence eating patterns. The cognitive-behavioral model focuses on distorted cognitions
about body shape, weight, eating, and personal control that lead to and maintain
unhealthy eating and weight related behaviors. Proponents of the model emphasize the
power of thoughts to influence feelings and behaviors in eating disorders. The therapist
addresses both relatively easily accessible thoughts (automatic thoughts) and deeper core
beliefs. Treatment involves challenging distorted cognitions and replacing them with
health-promoting alternatives. The cognitive component of CBT appears to be the most
critical for behavior change.
In the treatment of bulimia, self-monitoring is a primary focus. Patients keep track
of what they ate, whether it was a binge or purge episode, the situation they were in, who
else was present, and their thoughts and feelings. By analyzing the data, high risk
situations for binge eating and purging may be identified. Subsequent steps involve
mastering the language and concepts of CBT, including recognizing thoughts, feelings,
and behaviors that are associated with unhealthy eating behavior; learning to recognize
cues for and consequences of disordered eating; learning to control automatic thoughts;
and learning to restructure distorted cognitions that perpetuate unhealthy eating
behaviors.
Topic: The Treatment of Eating Disorders
Skill: Conceptual
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we had better only have the kitchen fire in the mornings; but I don't like to
think of you going out to work cold."
"I don't feel the cold," said Luke. "We certainly must make a difference
somehow. Discuss it with mother and see if she can't help. She knows we are
rather in low water."
"I don't see how we can give away so much as you do Luke," said Rachel.
"We really could not afford that £5 that you gave for the heating of the Church
for instance."
Luke looked worried.
"I have always somehow managed to do my part in that way," he said. "I can't
bear not setting an example in giving."
"No, it's horrid," said Rachel. And yet she felt strongly, that if by giving away
money he was deprived of his much needed yearly holiday the work itself
would suffer.
After he had gone, the subject that had caused their talk and had brought to
light their poverty forced itself again upon her.
No holiday! All the summer in this tiny stuffy little house away from the flowers
and the breezy wind. How could she bear it herself, and still more how could
Luke go on working all day and the greater part of the evening in the terrible
heat, which was making her feel giddy and faint already.
She hurried into the drawing-room which was without sun and threw the
window open. Then she looked for her weekly bill books and sat down to
examine them. She saw they were higher than she supposed they ought to
be, but she did not see how she could economise with a man in the house. If it
were only herself and Polly they could do on less; but Luke, though he might
not notice that he was having less would soon reap the consequence and feel
limp.
Rachel leant her arms on the bureau and her chin on the palms of her hands
and gazed out Of the window. How could they manage to get away for a week
if no longer?
Unfortunately Heatherland was impossible.

Her mother found herself so impoverished that she was selling her house and
was on the point of going into a much smaller one in the village. Rachel had
felt very sad when Sybil had written to tell her the news. That her mother, at
her age, should have to uproot again would be a real trial; evidently her family
were in financial difficulties too.
Rachel began to think over her belongings and wondered if she could not sell
some of her wedding presents. There was the pearl necklace that an uncle
who was dead had given her. It was of little use to her now, and in her present
mood she felt that a breath of sea air would compensate for the loss of any
number of pearls.
Yes, she would certainly sell her pearls. She wondered if the day would come
when she would be reduced to selling many of her possessions. It looked like
it. It was a terrible shame that livings should be so small that the very
necessities of life should have to be done without. Well anyhow she would sell
her pearls and not tell Luke till it was done. She would get a cousin of hers to
do the transaction for her. She knew she might be cheated and it would be no
good for Luke to try and sell them. He was no business man and would
without doubt be contented with half their value. No, she would write to her
cousin. They simply must go away somewhere this summer.
She wrote the letter to her cousin and got Polly to run round to the post with it.
Then she began to wonder if she ought not to do what Luke had suggested;
ask the advice of Mrs. Greville. But she was saved the trouble, for late in the
morning her mother-in-law came round to see her.
"Luke tells me you are rather worried about the expenses," she said, "and I
am wondering if I can help you. Shall I look through your books and see what
you could do without?" and as she saw Rachel flush she added, "It is not at all
surprising my dear. Of course you have never been used to economise. I
hope you don't me an interfering old woman," she added kindly, as she saw
signs of distress on Rachel's face.
"It's very good of you," said Rachel; but she bit her lip feeling humiliated in the
extreme.
Mrs. Greville was not long in discovering things which would have to be done
without. For instance, she explained to Rachel she could make quite nice
puddings without eggs. Considering the expense of eggs, 4d each, it was
ruinous to follow the cookery books which prescribed more than one in quite
simple puddings. A great deal of money had been thrown away on
unnecessary eggs and they mounted up at once. Then it was much better in
these days to have margarine rather than butter. She never used anything but
margarine herself, and really you would not know the difference.
Rachel sat by her side smiling. Not being a housekeeper all these economies
seemed so paltry to her, and yet she knew they were necessary. She had of
her own will married a poor clergyman, and must bear the consequences. And
Mrs. Greville was being very kind; and giving as little pain as possible. Her
feelings towards Rachel had somewhat changed since that Sunday on which
she had gathered the girls' choir together. It had struck her mother-in-law as a
sporting action on her part and had pleased her. And now, for the sake of her
son, she was very anxious not to hurt his wife's sensitive spirit more than
necessary, but she had no idea how galling the whole thing was to her pride.
And Rachel was bent on her not guessing it. So she sat by her side smiling,
and watching her mother-in-law making notes for her as to the things that
were really necessary to have and those which were mere luxuries.
"I fear you must give up all luxuries, I hope Luke told you how poor he is,
when he asked you to share his poverty with him?" she said laughing. Rachel
joined in the laugh.
"We had much more interesting things to talk about," she answered. "Luke's
mind does not run on such matters as eggs and margarine."
"That's true," said Mrs. Greville. "The fact is, that some of the poorest people
are the clergy. It ought not to be so. They should not have to worry about eggs
and margarine as you say, they have so much more important things to think
of and they should be spared that. Besides they are expected to help in every
bit of work that goes on in the parish. Unless they have property of their own
the worry of pounds, shillings, and pence, weighs them down. Happily, as you
say, Luke does not worry himself about those kind of things, but then he has a
wife and mother to worry for him. If he had not he would have less time and
strength to think of his people. I don't suppose many realise how the clergy
suffer from poverty, for they suffer in silence."
"Well I hope Luke won't ever be reduced to wearing a coat green from age, as
a poor man in our part of the world at home has to do. Not that I suppose
Luke would notice if his coat were all colours of the rainbow."
Mrs. Greville laughed, and said goodbye while at the door she turned back to
say:
"Remember, not so many eggs, and margarine instead of butter. You'll find
that makes a difference very soon."
CHAPTER XV.
RACHEL'S PEARLS.
Rachel took out her pearls from the jewel box and looked at them. They were
certainly very beautiful. She had not worn them since her wedding day; and
she did not see any chance of wearing them again.
In case the parting with them should grow a little hard she packed them up
quickly and went to the post to register them.
It seemed to her as if she was parting with another link of the old life. But after
all what did that matter! She had Luke; and it was true what Gwen had said,
that Luke compensated for the loss of all else. Besides which, she knew that
they both needed a change and rest, and certainly sea breezes were of more
value just then than pearls locked up in her jewel case could be. Nevertheless
it cost her something to part with their beauty. It was not so much their value
that she had thought of as their beauty; and more than once she had taken
them out simply to have the pleasure of seeing something very lovely. There
was so little beauty surrounding her that she revelled in the sight of her pearls.
RACHEL TOOK OUT HER PEARLS—AND LOOKED AT THEM.
It was some time before the cousin, to whom she had sent them, wrote and
told her that he believed they would fetch a very good price; and one morning
at breakfast she opened a letter that was lying on the table beside her, and a
cheque, much larger than she had hoped for, fell out.
Her exclamation of surprise and pleasure caused Luke to look up from the
paper he was reading.
"What is it?" he asked.
"Something delightful," she answered. "We can now go for our holiday."
"What do you mean? Have you come in for a fortune?"

"I feel as if I had in our present strait," said Rachel still looking down at the
cheque in her hand. "Would you like to see what I have?" She held it out to
him.
Money meant little to Luke, except that it enabled him to carry out plans on
which he had set his heart. And there was a plan of his that sprang at once
into his mind as he looked at the cheque. His face glowed.
"Where did it come from?" he asked, astonished and delighted.
"I sold my pearls."
The smile on his face faded for a moment.
"I did not know you had any, I have never seen them."
"I have never shown them to you as I know that that kind of thing is not in your
line, you don't care for jewels; but I wore them on my wedding day. I hope you
saw them then."
"No, I only saw you. But why didn't you tell me what you were doing?"
"Because I was afraid you would not let me part with them. Uncle Joe gave
them to me, and I was fond of him."
"I shouldn't have prevented you from parting with them. What is the good of
pearls?"
"The good! Why their beauty is their good. They are gifts from God just as
everything else is that is lovely, and of good report. Don't despise them.
Besides," she said, feeling a little sore, "Uncle Joe gave them to me, and I
loved him." Then she added, determined not to give way to any feeling of
disappointment, "and now we can think about our holiday. Where shall we
go?"
She was folding the cheque up and putting it again in the envelope of her
letter. But on noticing that Luke did not answer her question, she glanced up
and found him looking out of the window with a dreamy happy smile on his
face. He was evidently thinking of the holiday. Perhaps his thoughts had flown
to Southwold and the moon's silver pathway on the sea. The happiness
displayed in his expression of face made her feel that the small self-denial that
she had exercised was well worth while.
"I do believe," he said, still looking out of the window, "that at last my dream
will be fulfilled."
"What is your dream?" asked Rachel. She had been right. He was evidently
dreaming of Southwold.
"Why, to put electric light in St. Marks. Think how attractive and bright it would
make the place. I never thought I should be able to do it. How much do you
think it would cost?"
Rachel was silent from astonishment and disappointment.
Then she said slowly:
"You don't suppose, do you Luke, that I have sold my pearls to be able to do
for the Church what the people are far better able to afford to do than we are?
You seem to forget that we are really poor, much poorer than many of the
congregation. No, the first thing we must do," she said decidedly, "is to pay
our bills and to start afresh, and then to go for a holiday."
Rachel's tone of voice was so decided that he turned and looked at her in
surprise.
"But," he said, "it is God's work that you are refusing."
"No," she answered, "I don't think it is. To provide the luxury of electric light in
a place where the gas is quite good and sufficient, seems to me to be not so
much doing the Will of God as paying our debts, and going for a holiday,
which will give you strength to do His work better."
Luke was silent.
"Besides," she added in a lower voice and smiling, "you forget next January."
Luke looked mystified. Then noticing the expression of his wife's eyes, he
remembered.
"I forgot for the moment," he said. "You are quite right."
At the thought of January Rachel's face had lost all the surprise and
disappointment as she looked down again at the envelope containing the
cheque. Then she suddenly drew it out with a gay laugh and flourished it in his
face.
"Happily it's mine," she said, "and you can't get at it."
CHAPTER XVI.
THE CHURCH COUNCIL.
"I know you won't give way," said Rachel, as she helped her husband into his
coat.
Luke did not answer at once.
"If you remain firm this time you will find it easier the next."
"I don't intend to give way," said Luke gravely. "It would be fatal."
"Yes, and you would never forgive yourself." Luke buttoned up his coat and
looked at his wife.
"We should hear the same excuse that that old woman gave for not attending
her Parish Church," he said smiling.
"What was that?"
"That she had been too ill for the last half year to come to the services but she
was proud to say she had not missed a single Whist Drive."
"Oh you mustn't give way," repeated Rachel earnestly. Then she added, laying
a hand on his arm, "You know what I shall be doing."
When Luke smiled his face was transfigured.

He smiled now.
"You will be doing the part of Moses," he said. "I am not sure that I should not
fail if it were not for that." Then he opened the door and was gone.
Rachel stood where he had left her looking absently at the door which he had
shut after him.
That the Church Councils were not always happy meetings she knew. Luke
said the right people were not on it. There were some really in earnest, but
these often seemed afraid of speaking. Those who spoke the most often and
the loudest were those who wanted to make their Church the most popular in
the town by way of parish dances, whist drives, etc. Luke, Rachel knew, had
always stood out against such methods of work, but people were growing
persistent, and the subject was to come up again this evening. His last words
had surprised her and made her anxious, for they showed her that his
resistance was growing weaker and that he felt himself in real danger of giving
way.
She knew what giving way would mean to him. It would lie on his heart like
lead. He would not look for blessing so expectantly and hopefully in his parish
if once his church began to cater for the amusement of his people instead of
putting its full strength into the spiritual work. By this time Rachel knew her
husband so well, that she felt sure that he would grow melancholy and
depressed, and his work would be robbed of zeal and happiness in
consequence.
It was not as if he had any doubts as to the wrongfulness of such methods for
Church work. He absolutely disapproved of them and had made his opinions
known. If he gave way or countenanced such proceedings, in the least,
people would cease to believe in him.
Well there was one thing she could do to help him to be strong; she would go
and do it. And while Luke was wrestling with his Church Council, Rachel was
wrestling in prayer.
Then she went down stairs to listen for his footstep.
When she heard it, it did not inspire her with hope. Luke came in quietly and
made his way slowly into the drawing-room where he knew he would find her.
"Well?" she said.

He took a seat on the sofa near her.
"I have gained my point."
Rachel's eyes shone.
"What good news," she said greatly relieved. "Why do you look so
melancholy?"
"Because though I have gained my point I have lost four of the most regular
members of the congregation. They walked out of the room."
"Oh well, that is not half so bad as if they had gained the victory," said Rachel
cheerfully. Then Luke looked lovingly down at his wife.
"I doubt if I should have taken such a strong attitude if it had not been for you.
I knew you were praying."
"Yes, I was praying."
"The knowledge of that helped me enormously. The four who resigned have
been my most loyal supporters and I can tell you it was hard to stand out
against them. They have been so exceedingly kind to me ever since I have
had the church. It was this fact that made it so difficult. Besides I love peace."
"Peace with honour, but not without."
"That's just it. I felt that my Master's honour was at stake."
"I can't tell you how thankful I am," said Rachel. And under his wife's influence
Luke regained something of his usual spirits. But Rachel had only heard
Luke's side of the question. The next day she was inundated with callers.
"I suppose you know," said Mrs. Moscombe, the wife of the owner of the
principal shop in the parish, "that the Vicar got his way by one vote only. I own
when I heard all the arguments in favour of opening the Hall for such
purposes I began to wonder if we ought not to do what the neighbouring
churches have done to attract the young people."
"I don't think that kind of thing attracts people to Church," said Rachel.
"But as my husband says," continued Mrs. Moscombe, "it saves the boys and
girls from going to worse places. Surely that is the work of the Church."
"It may save them for two or three days, possibly; but it really leads them to go
to unwise places of amusement in the long run, and I know my husband feels
very strongly that the Church loses its spiritual power if it goes in for catering
for amusements."
"But then, dear Mrs. Greville, your husband, forgive me for saying so, is rather
peculiar in his views. He scarcely moves with the times and isn't up to date as
they say."
Rachel flushed.
"The times are not so particularly good that one should wish to move with
them," she said. "I am very thankful that my husband does what he considers
right without swerving or moving with the times."
Rachel was glad to see the last of her visitor, but had hardly said goodbye
when the door opened to admit Mrs. Stone.
"Of course," she said as she took a seat, "your husband has told you all about
last night. I admired him immensely. He didn't give way an inch though the
majority were really against him."
"But anyhow he had a majority of one."
Mrs. Stone laughed.
"And he would not have had that if it had not been for me. I didn't agree with
him in the least! I must tell you, but I voted for his views as I always feel he is
such a good man that he probably knows what is for the good of his people
better than I do. If it had not been for my vote, he would himself have had to
give the casting vote."
"I am very disappointed that you don't agree with us," said Rachel.
"Well I do believe in people keeping up with the times, and girls and boys are
crazy now for dancing and cards. You can't get them if you don't give way.
Things have changed so much since our fathers' times."
Rachel was silent. She felt depressed. She quite expected people like Mrs.
Moscombe and others who had called to see her, and who did not profess to
be religious, to misunderstand Luke's action, but it was a blow to find that her
friend Mrs. Stone also disagreed with him.
But the last caller was the most trying of all.

Rachel heard her mother-in-law open the front door and walk heavily across
the little hall.
"What has Luke been doing?" she exclaimed almost before she was in the
room. "I hear he has quite estranged the four best supporters of the Church."
She looked at Rachel as if she were to blame.
"It was about the amusement question," said Rachel. "He put down his foot at
the proposal to introduce them into the work of the parish."
"Well I call it remarkably silly of him. It is a matter of very little importance and
certainly not worth wrangling over. I am quite thankful I am not a member of
the Council. I could not have voted against my son, but I should have felt very
vexed at being a party to such a loss to the Church."
"You mean?"
"I mean losing his four best financial supporters, and those who give the most
to the Easter offerings. Who is he to look to now, I should like to know? And if
he only waited to consider the state of his own finances and the expense of
food, (eggs are still fourpence a piece), he would not have made such a fatal
mistake."
Rachel was silent, but she disagreed with every word her mother-in-law had
spoken. Then after a pause during which Mrs. Greville tied and untied her
bonnet strings in her agitation, she said:
"I don't suppose any consideration respecting finance would weigh with Luke
against doing what he thinks right."
"My dear, young men often make a fatal mistake in going their own way,
thinking that youth must know better than age. Think of those four gray haired
men who know more of the world than Luke, being set at nought like that. I
have never known Luke to make such a mistake. If he had only consulted me
before he had acted."
Then Rachel spoke.
"But don't you see how noble it was of him to keep to what he felt right even
though he must have known what the result would be. I own am proud of him,
and should have been bitterly disappointed if he had given way. I am sure he
did the right thing."
Mrs. Greville looked at her son's wife and could not but admire the way she
stood up for her son's folly, (as she considered it). There was an expression
on her face that any mother-in-law would have been pleased to see on the
face of her son's wife. But for all that she felt it incumbent on her to give her a
snub.
"I daresay," she said, "that you admire him. So would most young girls who
only look for actions without weighing their cost. We all admire a man who is
not afraid to speak out. But when it comes to flouting those who have been
kind and considerate, and who never hesitate to give money for the work, it is
a different matter. Luke has done a bad thing for the parish by his action of
last night."
"People would never have believed in his convictions again if he had given
way," said Rachel.
"Well now, don't you go and encourage him in that kind of thing," said Mrs.
Greville. "I hope that you recognise the fact that Luke is not a paragon of
wisdom, neither can any one turn him from what he imagines his duty. But he
must remember that he now has a wife to support. He not only will stubbornly
stick to his point even when it means losing money for the work of the parish,
but will give away every penny he possesses without a thought of the
consequences. I daresay you have found that out."
Rachel laughed, thinking of the pearls.
"Well, am I not right?"
"Luke is the most generously minded man that I have ever come across," said
Rachel.
And then Mrs. Greville gave her a kiss. She could not resist it; though she
knew that her action would startle her daughter-in-law.
"My dear," she said, "I do believe that you love that boy of mine as much as I
do."
Rachel was tempted to answer "a great deal more," but forbore, only returning
the kiss with warmth. She was getting almost fond of Mrs. Greville.
"Well, you see," she said with a smile, "he is my husband."

"But that does not always follow I am sorry to say. Wives are generally very
quick in seeing and resenting faults in their husbands. And much as I love my
dear boy I see a great many in him."
"But there are more virtues after all," was Rachel's answer, "and to return to
the subject of whist drives, it is perfectly true what Luke quoted to me from
some speech yesterday. 'The Church has so little power with the world
because the world has so much power over the Church.' Don't you agree?"
"Well perhaps it is so. But when a man's bread and butter is concerned and
when the Church funds are low, I own I feel it is not the time to be too
particular."
"I am afraid I don't agree with you a bit."
"I don't suppose you do; that is because Luke has imbued you with his ideas
of right and wrong."
"Luke has a very high ideal," said Rachel, "and I am trying to live up to it."
And Mrs. Greville went away thinking to herself, "I only hope that Luke
realises what a devoted wife he has. I don't believe he does."
CHAPTER XVII.
LUKE IS DISCOURAGED.
The four members who had left the Church Council when the vote went
against Whist Drives for Church purposes, did not leave the Church. They
valued their Vicar too much to do so suddenly; but they were thoroughly vexed
at the decision arrived at.
It had been a blow to Luke to find that he only had a majority of one. He had
hoped that his congregation had felt with him in the matter, and finding how
strong the stream was towards such means of increasing the popularity of the
Church, depressed him not a little.
Moreover, he felt bound, greatly against his will, to preach against such
methods and to give his reasons for so doing; and though some respected
him for his courage, there were others who resented it. To Rachel, the Sunday
on which he mentioned the matter was a most painful day; though she was
glad that Luke had spoken out on what was much on his mind.
"I am beginning to think," he said, on sitting down to dinner after the service,
"that my time in the parish is about over. It seems to me my influence for good
is not strong enough. It wants a stronger man than I am here."
"You are tired," said Rachel. "That's what is making you downhearted. Last
week was such a very heavy one for you. In a day or two you will see things
differently."
Luke smiled unbelievingly.
"What I should like, and in fact what I have always longed for," he said, "is a
Church in London. Though I doubt if such an honour will ever come my way. I
am not a big enough man to be trusted with a London parish."
"London!" cried Rachel. "Oh Luke, I should hate it of all things. Besides you
must be a man strong in body as well as in soul to work a London parish
satisfactorily. I should be very sorry to see you undertake such a work."
"I'm quite strong enough," said Luke. "The only things that try me are the petty
quarrels and vexations of such a parish as this. I heard this morning that Went
and Ethers have fallen out, and on a ridiculously small matter. I fancy
everything would be larger and more important in London. It is just the petty
matters that worry me."
"Human nature is the same everywhere. I expect you would find small souls in
a London parish just as you do here."
"Would you very much object to London?" asked Luke. "Not that there is the
slightest chance of me being offered a Church there. But it is the dream of my
life. Fancy working in the very hub of the Universe. I should revel in it."
"The work would be enormous, unless you had several curates. And you know
how difficult they are to find now-a-days."
"I shouldn't mind the work. The more the better, so long as it is not spoilt by
bickerings and quarrellings. Should you very much dislike it?"
"Intensely. I don't feel in my present mood, as if I could endure it." Then seeing
a look of disappointment on her husband's face, she added, "But where thou
goest I will go, you know that."
"Yes, I have no doubt of that," he answered.
And his longing for London increased during the next few months. It was a
time of great disappointment for him. When he had first come to Trowsby, he
had had the warmest of welcomes, and the largest congregation in the place.
His preaching was arresting and people congratulated themselves on having
such a Vicar. He had come straight from France where he had been acting as
Chaplain, and had there shown great bravery under fire. Many came to hear
him just because of this. But when the rage for amusements began to show
itself, and it was found that the Vicar had no sympathy with it, and had no new
Gospel to preach, but preached the same Gospel as they had heard before
the war, untouched with modernism and the various other new religious
theories, the congregation that had increased out of curiosity gradually
dwindled, for they said, "He's not up to date." It was disheartening for Luke,
specially as he heard that a Church not very far off was crowded to
overflowing on account of all the social questions that were discussed during
the sermons, and well-known lecturers on the various religions came down
from London, Sunday after Sunday, to preach.
"Nevertheless," he said one day to his wife, "I shall continue to preach the
Gospel; and by-the-bye Rachel, I must somehow get three days of quiet at
least, for some of the men's Bible Class want to discuss those questions
which have been raised by the Modern Churchmen's Conference; and I must
prepare for the discussion. But I really don't see how I can manage it. I am
late as it is with the Parish Magazine."
Rachel was laying the table for dinner at the time and looked up quickly at her
husband.
"Pass that over to me," she said.
Luke looked at her a little doubtfully.
"Do you think you can manage it?" he asked.
Rachel laughed.
"Certainly I could. I am a little more intelligent than you give me credit for.
Have all the people sent in their accounts?"
"No, that's just it. Sargent has never sent in his description of the Temperance
Meeting, nor has Mrs. Lent of the Scripture Union Meeting. They are so often
late. It means a good long walk as there is no time to send them cards to
remind them of their duty. The manuscript ought to go in early to-morrow
morning to the printer or the magazine will not be out in time. I should be
thankful to have at least two quiet uninterrupted days; but then there are sick
people to visit. I don't see how I can."
"You can quite well if you will only trust me," said Rachel, smoothing the table
cloth. "You have never tried me."
"I wonder what my mother would say."
"What does it matter? I don't belong to your mother I belong to you. You must
take the responsibility of me," she added laughing.
And so it was settled and Luke had two whole days of quiet. He did not move
out of his study except for meals, and then he hurried over them and ate them
without speaking. Rachel, knowing what he was going through and in what
dead earnest he was, in his longing to rid his men of the terrible doubts that
had been sown in their hearts, kept silence. It might have been a quiet day
arranged by the Bishop!
Luke had given her a long list of people to visit, and had told her what
information was needed for the magazine, and Rachel set to work asking no
further questions. She dispensed money where she thought it was needed
(not always wisely alas!) and tended to the best of her knowledge the sick
people, singing to many of them; and though it was work just after her own
heart, being utterly unused to it having had no training whatever, it took a
great deal out of her, particularly as she was of a sympathetic nature. But she
felt it was well worth while when, after the two days were over, the strained
tired look on Luke's face had disappeared giving way to one full of peace and
happiness.
He had felt it his duty to face over again, all the arguments and difficulties that
his people might come across; and he realised that he was at war with the
Devil. The words of St. Paul often ran in his mind; "For we wrestle not against
flesh and blood, but against principalities, against powers, against the rulers of
darkness of this world, against spiritual wickedness in high places."
Not even Rachel was conscious of the spiritual warfare that was raging in her
husband's little study, nor how often he threw himself on his knees crying to
God for help in the conflict, nor had Rachel the faintest suspicion of the
victories that were gained within its walls.
She had often wished that her husband was not so preoccupied, and had
more thought for the small things of life which make all the difference to its
comfort. But though she felt that the things of which she complained in her
heart were so insignificant compared to the great matters about which Luke
was engaged, she had no idea that his preoccupation and absentness of mind
were often caused by the fact that he had either lost or won a spiritual battle.
He was thankful now that he had spent so much time in facing the doubts and
difficulties that he had met with in the course of his reading, so that the two
quiet days enabled him to prepare the subject in such a way as to make the
truth plain to his men.
On the night of the meeting Rachel found it rather hard to occupy her thoughts
with anything but the great strain which she knew Luke was passing through.
He was late home and to turn her mind from that which was making her
anxious she sat down to the piano and sang.
She was just finishing her song when she heard the front door open. She sat
still in her suspense, expecting Luke to come at once into the drawing-room.
But instead, she heard him going upstairs to his study, and walking heavily as
if he was tired.
For some moments she sat still where she was, then she followed him. But at
the study door she stopped.
Was that Luke groaning? Was he ill?
She very softly opened the door and looked in.

Luke was on his knees, his arms on the writing table and his face buried in
them. He was praying out loud.
Rachel closed the door and went downstairs again. Her heart was heavy, and
anxious. She knew that his habit was to pray out loud; but his prayer to-night
was mingled with groans and probably tears. What had happened? Rachel
moved restlessly about the room. Her impulse was to go to the piano, and
soothe her anxiety by playing. But she was afraid of disturbing Luke. Then she
took up her work and sat waiting.
It was late before she heard him coming down the stairs.
His face bore no trace of the anguish he had apparently been going through.
He came and sat down by Rachel's side without speaking.
"Well?" she said.
He was silent for a moment, then he said:
"I have never had such a fight with evil as to-night. I feel sure that the Devil is
working with all his might to destroy any good that may have been done."
"What happened?"
"We have been discussing for nearly three hours the articles of our faith. The
men had primed themselves with all the arguments they could lay hold of
against them. The Divinity of our Lord, the Virgin Birth, the Resurrection; and
the very men who I had hoped were on the eve of making the great decision
have been thrown back."
"But there were surely some who were helped by your words?"
"Yes, thank God. There is a small band of faithful Christians as firm in their
faith as I am. They know the Christ; and believing Him to be God take His
Word as truth. But the greatest number have been shaken by these views that
have been scattered broadcast since the Modern Churchmen's Conference at
Cambridge, and there are some who are weak in the faith and just tottering,
as it were." Luke rose up and began to walk about the room.
"I feel," he said, "that a stronger man than I am is wanted for this place. It
seems to me to be the stronghold of Satan."
"When I am weak, then am I strong," said Rachel.

Luke stood and looked at Rachel for a moment. Then his face broke into a
smile.
"Thank God for my wife," he said.
CHAPTER XVIII.
GAS STOVES VERSUS MOUNTAINS.
"Next year," said Rachel one day, as she and Luke were on their way to
Church, "next year we may not be able to afford a holiday. So I am resolved
that we shall have a good one this August. We will go to the Lakes."
Rachel wrote and secured rooms at Rydal and a month after the men's
meeting mentioned in the last chapter, they started off for the North.
What the sight of the beauty that now surrounded them was to Rachel can be
imagined. She told Luke that she had seen nothing that could be called
beautiful ever since coming to Trowsby, with the exception, she took pains to
add, of her primroses and hyacinths in the little garden of which she was
inordinately proud.
To sit by the Lake in the cool of the evening and watch the lights and shadows
on the mountains, was positive bliss to Rachel. She tried to make Luke revel
in it as much as she did, but alas, his thoughts were still engrossed with his
parish, not withstanding all Rachel's efforts to make him forget it.
"It will be so much better for the parish as well as for you if you will only put it
away from your mind," she said.

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Abnormal Psychology 3rd Edition

Beidel Test Bank

2) Among young women in today’s culture, anorexia nervosa is generally interpreted as

3) Select the statement that is FALSE regarding anorexia nervosa.

5) Body mass index (BMI) is a way of expressing

9) A particularly perplexing clinical feature of anorexia nervosa is the

18) Psychological features often associated with anorexia nervosa include

26) Unlike anorexia nervosa, bulimia nervosa is

35) An inappropriate compensatory behavior may be defined as

39) Select the statement below that is TRUE of bulimia nervosa.

46) A common personality trait in both anorexia and bulimia nervosa is

58) Epidemiologic data on eating disorders

70) In approaching the treatment of anorexia nervosa, a multidisciplinary team first

86) Few people die from complications of bulimia nervosa.

ANSWER: Physical Features: dehydration; electrolyte imbalance; osteoporosis; lanugo; dry

ANSWER: The cognitive-behavioral model focuses on distorted cognitions about body

ANSWER: Treatment of anorexia nervosa is best accomplished using a multidisciplinary

ANSWER: Cognitive-behavioral treatment (CBT) focuses on patterns of thinking as they

Luke looked worried.

Unfortunately Heatherland was impossible.

"What is it?" he asked.

"What do you mean? Have you come in for a fortune?"

"Where did it come from?" he asked, astonished and delighted.

"I sold my pearls."

The smile on his face faded for a moment.

Rachel was silent from astonishment and disappointment.

Then she said slowly:

"But," he said, "it is God's work that you are refusing."

Luke was silent.

Luke did not answer at once.

"What was that?"

When Luke smiled his face was transfigured.

Then she went down stairs to listen for his footstep.

"Well?" she said.

"I have gained my point."

Rachel's eyes shone.

"Yes, I was praying."

"Peace with honour, but not without."

"That's just it. I felt that my Master's honour was at stake."

"But anyhow he had a majority of one."

Mrs. Stone laughed.

But the last caller was the most trying of all.

Then Rachel spoke.

Rachel laughed, thinking of the pearls.

"Well, am I not right?"

"Well, you see," she said with a smile, "he is my husband."

"I am afraid I don't agree with you a bit."

Luke smiled unbelievingly.

"Yes, I have no doubt of that," he answered.

Luke looked at her a little doubtfully.

"Do you think you can manage it?" he asked.

"I wonder what my mother would say."

Was that Luke groaning? Was he ill?

She very softly opened the door and looked in.

"Well?" she said.

He was silent for a moment, then he said:

"When I am weak, then am I strong," said Rachel.