IB Psychology HL - Abnormal Psychology

conformity to standard/regular behavioural patterns

behaviour that doesn’t conform to regular patterns

interpretation of abnormal behaviour as behaviour that is statistically infrequent/uncommon

harder to be sure of the average when numbers aren’t involved (e.g. how much hunger is normal/abnormal?)

we need to know more about a person before labelling their behaviour as normal/abnormal

abnormality is often attributed to mental illness

however, not all abnormalities is considered a sign of madness/disorder

people with very low IQ are labeled with disorders, but people with very high IQ are respected and not stigmatised (although both are statistical abnormalities)

social norms dictate proper behavioural responses to specific situations (e.g. it’s acceptable to talk loudly in a noisy cafe but not in a cinema)

when social rules are violated, even if the violations are not statistically infrequent, it is considered abnormal

people who deviate from social norms tend to be considered abnormal and will be attributed to mental illness

social norms vary across cultures

Read et al. (2004) found a historical variation in abnormal behaviour: things that were considered mental illness symptoms are now acceptable in many cultures & situations

social norms are largely determined by groups with social power (e.g. in many cultures it is considered abnormal for a woman to drink too much alcohol but it’s not abnormal for men)

assumption: all humans behave in a way beneficial to themselves (i.e. doesn’t interfere or enhances functioning)

people are expected to develop understanding and conformity to social norms (regardless of agreement)

maladaptive behaviour: behaviour that interferes with one’s ability to function within that social context, e.g. Internet addiction (people may be so hooked on the internet that their real relationships decay)

sometimes people will engage in behavior detrimental to functioning

this is not always because of a serious disorder

e. g. Guillermo Farinas, a political protestor, went on a hunger strike to protest against Internet censorship

maybe one should inquire over another person’s health if they see maladaptive behavior

however, this assumes the other person has the self-awareness to know they’re in distress

e. g. Irritability is a depression symptom that men often overlook as they don’t think it’s important

note that distress is a normal reaction to challenging life events (e.g. death of a loved one)

Marie Jahoda (1958) tried to define normality instead of abnormality

she thought it would be easier to identify abnormal behavior as behavior that deviates from the definition of normality

positive self-schema

growth and development

fitting in well in society

self-government/independence

accurate perception of reality

feeling in control of events in one’s life

This approach suggests that ideal mental health means an individual has:

realistic and positive acceptance of self

consistent resistance to stress

the ability to take voluntary action to accentuate growth in their environment

very few people actually fit in the six criteria

Taylor and Brown (1988): depressed people have a more accurate perception of reality, and functioning adequately requires some extent of self-delusion

describes disorders in clear terms to minimise differing interpretations (so different clinicians will likely reach the same diagnosis)

groups disorders into categories and lists symptoms required for diagnosis of a particular disorder

the disorders listed are not set in stone

enforces multiaxial approach: a clinician should consider a potential patient’s symptoms, medical conditions, and social and environmental problems they may face

this supports the idea that the origin of each person’s problem should be analysed via a bio-psycho-social framework

originally a means of standardising records of causes of death

for classification rather than diagnosis

contains wide range of diseases and conditions

mental disorders section looks similar to DSM as the authoring teams consult each other

culture-specific: it focuses on issues related to Chinese culture

disorders in ICD and DSM that aren’t common in China are left out

some disorders in CCMD aren’t in ICD or DSM (as some are culture-bound)

e. g. Koro, an anxiety/depression disorder caused by a meditative exercise (Qigong)

may not be reliable

not valid to take a medical approach to psychological problems

interpretations of symptoms may vary

e. g. in the Soviet Union, schizophrenia diagnoses were given far more liberally than in USA

ethnic minorities or women might not be treated equally like others in their diagnoses (psychologists may not make an effort to understand cultural differences, etc)

inter-rater reliability

- test-retest reliability

assessed by asking multiple practitioners to diagnose the same person with the same diagnostic system

asking a practitioner to diagnose a person more than once (e.g. on two different days)

to test the reliability of DSM, ICD, and the Great Ormond Street hospital’s diagnostic system using inter-rater reliability

Two practitioners were asked to use ICD/DSM/GOS to diagnose 81 children

The 81 children had complained of eating problems

Inter-rater reliability (rates of agreement between the two practitioners) of:

DSM: 0.636

ICD: 0.357

GOS: 0.879

GOS is most reliable

possibly because GOS was specifically designed for children

expected that with more children, more diagnoses would occur and agreement rates would increase

less than half of the children diagnosed using DSM could be diagnosed with a classified eating disorder, so rates of agreement for DSM could not be fully established

literature review examining evidence related to diagnosis reliability

found that initial schizophrenia diagnoses (especially concerning women) may change as clinicians found out more about their patients

common for clinicians to discover that other conditions caused the symptoms leading to schizophrenia diagnoses

indicates problem of test-retest reliability with schizophrenia diagnoses

whether they correctly diagnose people with disorders, and not give a diagnosis to healthy people

R.D. Laing: diagnosis is closer to being a social fact than a medical one, and is is full of financial, political, and legal implications

diagnosis is not important to treatment

Cosgrove et al. (2006): many advisors serving on DSM panels have financial ties to the pharmaceutical industry

Thomas Szasz: it's wrong to label non-conforming behaviour as indicative of a mental disorder

disorders are essentially labels given to a set of behaviours, emotions, and/or thoughts

Wakefield et al. (2007): a wide range of other life events can account for depression symptoms and there is a lack of clarity about when depression symptoms really indicate a disorder

Caetano (1973) study on Labelling Theory

Rosenhan et al. (1973) study on the varying interpretations of normality

Nicholls et al. (2000) on inter-rater reliability of DSM, ICD, and GOS

Seeman (2007) on how schizophrenia diagnoses can change as clinicians get to know their patients

to demonstrate labelling theory during a diagnosis

the theory that the behavior of the person being diagnosed isn't the most important component of diagnosis

once a diagnosis is made, it tends to stick

any suggestion that the subject is mentally ill will be a powerful influence on any decision

supporting studies:

Caetano (1973)

Rosenhan et al. (1973)

A male psychiatrist is videoed carrying out separate, standardised interviews with a university student and a mental patient

2 groups were shown the videos

77 psychology students

36 psychiatrists

The 2 groups were split into 2 subgroups that were given differing info:

one was told that both were volunteers that were paid to participate

the other was told both were mental patients

They were asked to diagnose the interviewees

psychiatrists with clinical experience were more likely to be persuaded by the info given

the study demonstrates labelling theory

the student could've had an undiagnosed psychiatric disorder

the patient could've been close to normal (he had the appearance and attitude of a hippie on drugs)

to test the ability of diagnoses to tell the difference between normal people and people with disorders

Rosenhan and a group of colleagues and acquaintances went to 12 different hospitals complaining of hearing voices, but presenting their history and current state as normal

They were admitted with a schizophrenia diagnosis

On admission, they ceased complaining of any symptoms

They eventually got out with a diagnosis of schizophrenia in remission

their normality was never detected although descriptions from staff showed no evidence of abnormal behavior

however, staff took all their normal behaviour in a negative light

when taking notes about what happened in the hospital, hospital staff noted their writing was excessive and abnormal

when walking along the corridors because they were bored, they were accused of obsessive pacing

35 of the 118 other patients expressed doubt to the pseudo-patients' presences, suspecting they were checking on the hospital

found that abnormal people can be mistaken for normal

Staff at another's hospital claimed they wouldn't have been fooled by the pseudo patients

In response to Rosenhan's invitation to estimate how many pseudopatients were sent by him to that hospital, staff estimated with confidence that 41 of 193 people admitted during that period were pseudopatients

Rosenhan had sent none - all were genuine patients

Gavin Andrews noted only moderate agreement in the diagnosis of anxiety disorders between DSM and ICD

when a person can diagnosed according to one system but not in another by the same person, this indicates poor validity

Peters et al. (1999) found only moderate agreement between DSM and ICD due to DSM listing distress/impairment to functioning as an anxiety symptom

if a patient's condition improves, we won't be convinced by the diagnosis of improvement

the knowledge of a disorder diagnosis has negative effects on how society treats the person subsequently

although discrimination due to medical condition is illegal, ex-patients can still feel discouraged due to fear of discrimination

Read (2007) found that people have bad attitudes to mental disorders because they associate disorders with dangerousness and unpredictability

Sato (2006) notes that schizophrenia was renamed in Japan because the stigma was so bad that less than 40% of patients diagnosed with it were informed of the diagnosis

92% of UK citizens would be afraid of admitting to a disorder diagnosis because they think it could damage their career

more than half of the respondents to a survey stated they'd rather not hire someone with a mental disorder

treatment after diagnosis may worsen/create symptoms

iatrogenesis may occur

conditions in the institutions may be cruel and dehumanising, in a way that makes returning to society hard

e.g. a depression diagnosis may cause the person to take time off work -> finds it hard to reintegrate upon returning -> loses their job -> spiral into further depression

phenomenon in which treatment for a condition causes other complications

adaptation to life in an institution may cause development of new behaviours

Rosenhan et al. (1973) observed during their stay at institutions that social interactions were lacking in care and concern

Read et al. (2004): migrants and ethnic minorities in Western countries are over-represented in mental institutions

diagnostic biases occur and psychiatry uses diagnosis and institutionalisation instead of trying to understand differences

Morgan et al. (2006): in the UK, incidence of schizophrenia is 9x higher for Afro-Caribbeans and 6x higher for Africans than for Caucasians

diagnostic criteria for depression is a description of normal female responses to social pressure

so women are more likely to be diagnosed with depression

potential denial of treatment to those who need it

severely depressed people who fail to be diagnosed will not get treatment and may carry out a suicide attempt

the safety of the interviewee is more important than potential long-term effects of stigma

maybe a diagnosis isn't the best way to achieve this, but there is a lack of alternatives

perhaps there's an underlying issue that appears differently depending on cultural tradition and expectations

or some groups may be more likely than others to seek help for depression

or there might be genuine biological and/or sociocultural differences

Levav et al (1997) noted that upon comparison of rates of alcoholism and depression across religious groups, Jewish men were more likely to be diagnosed with depression and less likely with alcoholism

another possibility is that the clinician's cultural mindset influences their judgment (e.g. in their interpretation of a symptom)

Read et al. (2004): Maori people are over-represented in mental institutions in NZ. Clinicians think it's acceptable to use European diagnostic systems on non-Europeans, which may lead to misunderstandings and misdiagnosis

Tapsell & Mellsop (2007): affective disorder diagnoses are given to only 16% of Maori vs 30% of Europeans, while schizophrenia diagnoses are given to 60% of Maori diagnoses vs 40% of Europeans. Maori also have more complaints of hallucinations, aggression, and problems with living.

Arroll et al. (2002): Maori are less likely to be medicated for depression than Europeans in NZ

Maori culture: Mate Maori (abnormal behavior breaking cultural norms, especially sacred ones) is treated by going to a tohunga (priest)

it isn't uncommon for Maori to report seeing dead relatives

so it's not always appropriate to consider cultural manifestations as symptoms of disorders

Palmer & Ward (2006): people who experienced trauma in a previous environment will be affected by both difficulties in the present environment and memories of the old

stigma to disorders and language barriers can limit access to psychologists, who may not understand their language or culture

Kirov & Murray (1999) studied a group of patients taking lithium prophylaxis (drug for depression & bipolar disorder). They found a difference in symptoms and diagnoses resulting in the medication. Black patients were less likely than white to have suicidal ideas, and more likely to have manic symptoms, resulting in bipolar diagnoses.

Riordan et al. (2004) found that compulsory institutionalisation was more likely to occur to blacks than whites

5 or more of the following symptoms must be observed during the 2-week period:

frequently depressed/irritable (through self-appraisal or observation)

significantly diminished interest/pleasure in almost all activities (through self-appraisal or observation)

significant weight loss/gain (change of 5+%) when not dieting, or increase/decrease in appetite

frequent insomnia/hypersomnia

psychomotor agitation/retardation (self-appraisal AND observation)

frequent fatigue

diminished concentration and/or indecisiveness (self-appraisal or observation)

recurrent thoughts of death and suicidal ideation, or a suicide attempt

when they can be accounted for by a recent damaging event (only counts up to 2 months after event, or if subject doesn't feel a majority of severe depression symptoms)

when symptoms don't significantly impair the subject's social/working/etc life

when symptoms can be attributed to effects of medication or a medical condition (e.g. hypothyroidism)

Kessler and Merikangas (2004): according to the US National Institute of Mental Health (USNIMH), depression has a lifetime prevalence rate of 16.6% in the US

it affects women more than men, with the difference starting at 13

women are 3 times more likely to get a depression diagnosis

Polish men: 20.4%

Polish women: 32.9%

Russian women: 33.7%

Nicholson et al. (2008)

used self-report data

| - may reflect a reporting bias rather than genuinely higher rates of depression

Hagen et al. (2004): depression could be a psychological adaptation to signal need and get help from others

but that's impossible to test experimentally, and genetic basis needs to be found

research found that reserpine and iproniazid, drugs related to the release and breakdown of catecholamine neurotransmitters, affected mood

led to theory that depression is caused by deficiencies of catecholamine neurotransmitters

supported by research indicating effectiveness of fluoxetine (Prozac)

Lacasse & Leo (2005) noted a lack of evidence that depressed people have low levels of serotonin

Sarek (2006): tianeptine, a drug that does the opposite of Prozac, is commonly used in South America and Europe to treat depression

Kendler et al. (2006): out of 42000 participants, monozygotic twins had concordance rates of 0.44% for female and 0.31% for male while dizygotic twins had 0.16% for female and 0.11% for male. The results indicate a strong genetic component for depression.

research suggests that short alleles of the gene 5-HTT increases chances of depression

Levinson (2005): despite 5-HTT's effect being to hinder serotonin reuptake, depression medication (e.g. Prozac) also prevent serotonin reuptake but improve depression symptoms (opposite effect). She/he also notes that the gene makes people more sensitive to stressful events, and doesn't directly cause depression.

Burke et al. (2005): non-depressed people's cortisol levels rise and fall rapidly under stress, but depressed people remain under stress for longer

Cutuli et al. (2010) found a high correlation between high cortisol levels and a history of negative life events

Fernald and Gunnar (2009): in Mexico, higher levels of cortisol were found in children whose families couldn't participate in poverty help programs, while depressed mothers who participated had lower stress levels in children

- Aaron Beck (1976) suggested that depressed people have a cognitive triad of negative thoughts: about self, the world, and the future - they maintain these beliefs through cognitive biases: over-generalisation (e.g. I always fail tests), selective abstraction, and polar reasoning (attempting to remove ambiguity) - this gives the person a negative self-schema that makes it difficult for a person to think positively - criticism: while it's descriptively powerful, it's still not clear whether info-processing causes depression

Hankin and Abramson (2001) extended the Beck (1976) model

they added that the occurrence of a negative event creates a negative effect before the cognitive triad comes into effect

this explains how trauma contributes to a negative self-schema

Albert Ellis (1962) offers a similar theory

irrational and self-defeating beliefs affects a person's interpretation of events, which lead to negative emotional consequences

Robins and Block (1989): depressed people have negative thinking styles

however, Taylor and Brown (1988) notes that depressed people are more realistic in their interpretation of reality

Brown and Harris (1978) proposed a vulnerability model based on the interaction of vulnerability factors and stimulating events

losing one's mother at an early age

unemployment

3 young children at home

lack of a confiding relationship

while unemployment and poverty are associated with depression, they aren't likely to be responsible for feelings of extreme sadness

however, critics assert that factors are culture-dependent as work and material wealth provide different levels of meaning, status, and identity in different cultures

some cultures place different roles of support on family members, and different values on the existence of intimate relationships

Wu and Anthony (2000): lower prevalence of depression in Hispanic communities as levels of social support are higher

Gabilondo et al. (2010) found that depression occurs less frequently in Spain than in north European countries due to stronger traditional family roles and higher levels of religiousness

Cohen (2002): higher depression rates are observed in countries and historical periods where social inequalities are stronger

possibly due to feelings of powerlessness and worthlessness

also possibly due to perceptions of inequality, unfairness, and inability to participate in the "ideal" society of higher socio-economic groups

Nicholson et al. (2008): men in the most socio-economically-disadvantaged groups in Poland, Russia, and the Czech Republic were 5x more likely to report depression

critics suggest that depression doesn't exist in cultures outside the West, but occur now due to Westernisation

this may not reflect social pressure but change in diagnostic patterns as western diagnostic methods are taken

Okulate et al. (2004): depression is accompanied by somatic symptoms, but certain core symptoms are common across cultures

Binitie et al. (1975): the affective component of depression is most often shared, with somatic symptoms secondary in Africa, while in Europe suicidal thoughts and guilt are more common secondary symptoms

Arrindell et al. (2003): high correlation between prevalence of depression and scores on masculinity-femininity index

Chiao and Blizinsky (2010): depression is associated with individualism and has a negative correlation with the frequency of 5-HTT short alleles

it's possible that cultural norms in collectivistic cultures have developed to protect more biologically-vulnerable groups

due to serotonin theory, many meds aim to prevent the reuptake of serotonin

this increases the efficiency of serotonin present

such drugs are called SSRIs (selective serotonin reuptake inhibitors)

they treat the symptoms but don't cure the disorders

side effects include sexual problems, dry mouth, insomnia, and increase in suicidal thoughts

SSRIs are more helpful in more serious cases because depressive episode have a recurring tendency

however, medication must be used in conjunction with therapy

Kirsch et al. (2008): there is only a small difference between placebo and medication

very few studies are published that show medication is only a little more effective than placebos

Broich (2009): argues that instead of measuring change in severity of symptoms, an absolute criterion should be set and the percentage of patients who reach it should form an additional measure of efficacy

political and economical implications: if Kirsch et al. (2008) findings are accepted, a massive loss of income for the pharmaceutical industry would occur

ethical problem with Kirsch et al. (2008): lying to patients about their treatment is deceptive and dangerous

Cuijpers et al. (2009):

psychotherapy groups do significantly better than control groups (which include discussions as placebo)

medication (especially SSRIs) are more effective than psychotherapy in alleviating symptoms

psychotherapy is effective in improving symptoms and have good long-term effects for milder patients

controversial, severely restricted in many countries

only offered if other treatments have failed

Read et al. (2004): almost half the people who receive ECT are over 65 and majority are female (76% in Finland)

cognitive-behavioural therapy (CBT)

identifies the automatic, negative thoughts perpetuating depression

helps the person see and understand the connection between these thoughts and their condition

by addressing the thoughts together and with assignments like keeping a mood diary, the patient can change their negative self-schema and find the positive side to things

this therapy also aims to help individuals regain the interest in activities they lost during depression

a sympathetic person discusses past experiences with the patient, without theoretical guidance or backing

concentrates on helping the patient develop and use positive social support networks

also improves communication skills

IPT helps adjust patients' expectations to be more realistic

Parker et al. (2006): IPT alone isn't as quick as medication in improving symptoms but improvement is noticed further down

studies comparing IPT and CBT haven't found significant differences but Parker et al. (2006) suggests this is due to psychotherapies not having a purely theoretical basis

Parker et al. (2006):

patients who do IPT primarily and add medication do better than the reverse case

could be due to expectation of the patient to prefer medication to solve problems

Butler et al. (2006):

CBT is extremely effective but not usually greater than effect of medication

however, outcomes are usually better when the two are combined

Hodges and Oei (2007):

because of the power distance between therapist and patient, CBT may be more effective in Chinese culture

due to patients being more likely to accept therapist's advice without question

however, successful CBT requires an element of argument and the therapist must be persuasive

so although the therapist's words are accepted, the argument process being omitted would result in the true nature of the patient's thoughts in depression remaining unidentified

• usually medication + psychotherapy

• as medication is the fastest way to obtain results mild enough for psychotherapy

• it's considered irresponsible to take either one without the other (medication without therapy, or vice versa)

• in the former case it's because the person will become dependent on medication and may relapse if they stop taking it

• in the latter case it's because when a person's thinking is disordered, it becomes difficult to connect to them logically

• successful CBT teaches people skills required to function sans medication

people who may not hear/share when alone with a therapist might do so around others

they might learn vicariously through others' experience

and be more optimistic about their own recovery if they see others who've improved

Hyun et al. (2005): randomly assigned depressed youths at a runaway shelter to group CBT or control (no treatment), and group CBT was extremely effective

McDermut et al. (2001) and Toseland and Siporin (1986) found that group therapy was at least as effective as individual therapy

Truax (2001): group therapy is well validated empirically but meta-analyses tend to omit more severely-depressed patients

so we don't know if CBT is effective for everyone

if dissatisfaction with any member is present, someone might drop out

it might be counterproductive to populate the group with severely depressed people

only 5-15% of anorexia/bulimia patients are male

van Kuyck et al. (2009):

USNIMH suggests that female anorexia patients have a death rate 12x higher than the general female population

anorexia is the disorder with the highest mortality rate

Zandian et al. (2007):

anorexia generally affects households with above-average income

affects 0.3% of the population

begins at the ages of 14-19

anorexia is far more common in western/individualist societies

possibly due to exposure to thin models on the media

also possibly due to social pressure to conform to a particular body type and weight

eating problems are more uncommon in less developed countries or countries that impose stricter regulations on women, but this could be due to anorexia being concealed more

Roland (1970): class and ethnicity are important - most anorexia patients are Caucasian (mostly of Italian or Jewish descent)

rates of anorexia appear to increase during affluent periods and in cultures where food is in abundance

females have higher anorexia rates

bc females may be pushed to conform more

or maybe males with body-image issues perform different behaviours rather than self-starve

refusal to maintain a minimally normal body weight for their age and height (maintaining a body weight of ~85% the recommended weight)

intense fear of gaining fat despite being underweight

denial of seriousness of being severely underweight, or delusions regarding self-appraisal of body weight

amenorrhea occurs (missing 3 or more menstrual cycles)

Surbey (1987)

found that weight loss occurs after amenorrhea, and anorexia occurs mostly in girls maturing early

starvation may be an adaptive response to stress, to delay the fertility status till a better time

females who delay menstruation may enjoy greater reproductive success later

furthermore, adaptive behaviour during a famine is to focus on getting food

however, the reproductive adaption theory excludes males, which is a weakness even if males make up ~15% of patients

Zandian et al. (2007):

anorexia is an expression of an OCD

OCD often precedes anorexia in patients

while the OCD doesn't usually manifest in males as an eating disorder, it does in females due to their biology

Bulik et al. (2006) estimated heritability to be 56%, suggesting a strong genetic component

Striegel-Moore and Bulik (2007): molecular genetic studies isolated genes (particularly related to serotonin receptors) that may cause mood issues in anorexia patients

however, the relation between the genes and the disorder is unclear

Striegel-Moore and Bulik (2007): molecular genetic studies isolated genes (particularly related to serotonin receptors) that may cause mood issues in anorexia patients

serotonin levels are low in many anorexia patients

Zandian et al. (2007):

noted that studies measuring serotonin levels don't have a "before" measure, and if an "after" is included, resumption of regular eating habits and healthy weight occur along with a return to normal serotonin levels

however, serotonin is known to inhibit eating, so it's likely that decreased serotonin levels aren't caused by anorexia but are a result of it (due to less food intake)

van Kuyck et al. (2007):

noted that brain-imaging studies with anorexia patients show that the parietal cortex is frequently inactive

decreased activity could account for patients overestimating their own weight and shape

could lead to anosognosia

the size of the parietal cortex is sexually dimorphic, explaining the large difference in prevalence between genders

however, it's possible that differences in neurological makeup are responsible for anorexia

and poor diet may change the brain distribution in these areas

a patient's lack of knowledge/awareness about their disorder

differing between genders

Zandian et al. (2007):

the risk factors for anorexia development: reduced food intake & reduced physical activity

these 2 factors encourage the release of corticotrophin-releasing factors and cortisol, which stimulate the release of dopamine

this gives anorexia patients a reward for dieting and increases the chances of further anorexic behavior

locks the patient in a cycle of addiction

anorexia may be caused by disordered thinking or incorrect perceptions

idea that dieting and control are related is a schema perpetuated in western culture

sense of control over their eating patterns increases to the point where controlling their food intake becomes a measure of self-worth

Fairburn et al. (1999) explores how low self esteem and an extreme need for control might cause anorexia

Bruch (1962) explores how anorexics may have faulty perceptions of their body size

Lee et al. (1996): a social fat phobia may be an underlying cause of anorexia

anorexia develops most in areas where there's a lot of media influence

anorexic females are more likely to accept beauty standards in media

it's unclear whether this receptiveness is a cause or an effect of anorexia, or if there's another factor

Lee et al. (1996): perhaps increase in anorexia diagnoses in other countries could be due to increased use of Western diagnostic systems

body weight doesn't necessarily indicate psychological disorders: 16% of healthy but slim Chinese women would be classified as anorexic according to Western diagnostics

Yasuhara et al. (2002): anorexia is 4x more prevalent in Japan in 1998 than 1993, likely due to changes in social support networks and moral values

Strahan et al. (2007): the influence of media causes people to think everyone accepts thin models as normal and attractive, instead of convincing them they're the wrong body shape

anorexia represents conformity to the perceived expectations of others

Norton et al. (1996): the probability of finding a woman with Barbie's shape is less than 1:100000

Sypeck et al. (2006): models and beauty contests are becoming increasingly smaller as advertising for diet and exercise has increased

SSRIs are used but there's limited evidence it's effective on its own

Holtkamp et al. (2005): SSRIs can help prevent relapse

Kaye et al. (2001): patients given a placebo over a 1-year period were much more likely to drop out

critics argue that SSRIs target anorexia symptoms that don't cause the disorder, and claim that negative moods don't cause anorexia even if they frequently occur together

weight gains are prioritised, and IV drips may be necessary

patient must be encouraged to eat normally again (likely through CBT)

NOTE: treatment for anorexia is almost always eclectic

Bowers (2002) claimed that neither a physician, psychotherapist, nor a dietician can deal with an anorexic patient alone

to help the patient understand that their mentality causes problems and to help patients change it

to change negative self-statements

to change their basic assumptions (typically high expectations for self) that are resistant to change

to change cognitive schemas associated with weight, food, and control

Spend time talking to the patient to establish the content of the schemas related to food, weight, and control

Allow patients to practice identifying their own thoughts and emotions regarding those areas (as they may have trouble with identifying)

Challenge the patient to produce evidence for their ideas on these areas and come up with alternatives to their negative thoughts

has generally good outcomes

as CBT attempts to address the core of the problem (the negative schemata associated with weight/food/control)

relapse is unusual

operant conditioning approach is usually taken

in which target behaviours are enforced by giving rewards personalised to the patient

staff observe a patient and reward small improvements in their behaviour (e.g. finishing a meal) with rewards (e.g. watching TV)

intended to form immediate feedback about success in learning new eating habits

behaviourist treatments are often successful in helping patients reach normal weight parameters

however, relapse is more likely than CBT

as the core problem of the disorder hasn't been addressed

the reward system must also have been internalised by the patient or supported by their surroundings when the patient leaves the hospital

between individual and group therapy

the family is trained to support the sufferer

the whole family benefits as their communication styles change

some models of causation allege that interactions (particularly mother-daughter) contribute to the development of anorexia

so learning to communicate more effectively is beneficial for many family members, not just the patient

Harris and Kuba (1997) note that there are more individuals with eating disorders than are diagnosed, and that treatment for minority groups require special attention (therapy should involve the family, community, and maybe people of cultural significance to them, like a shaman or other spiritual leaders)

Woodside and Kaplan (1994) put patients in group therapy to specifically target negative attitudes to eating, using a CBT-like approach. All patients showed improvement on the eating attitudes test

very common for patients

for inpatients, to help them get better

also for outpatients, to help prevent relapse

cost-effective

allows patients to interact with others who are at different stages of recovery

provides hope for those in early stages

provides confirmation of progress and increased self-esteem for patients farther along stages, as they get to help others

Polivy (1981): being in a group with other anorexic patients prevents patients from developing an identity apart from that of group membership

this makes it hard for patients to create their own identity, without resorting to individual therapy

members of the group may also teach other (maybe unintentionally) strategies to hide weight loss or avoid weight gain

Bruch (1962) suggested that anorexics overestimate body size

Fairburn et al. (1999):

low self-esteem and an extreme need for control might be the cause of anorexia

the need for control might be met more easily in eating than other domains

attention bias to negative info

patients may stop looking at their body for improvements, so they continue even if they have lost adequate weight

extreme perceptions and low self-esteem may be common among women

Fallon and Rozin (1988) found that when families compared their body shape to their ideal, only the sons reported their body shape was good while the women believed that they weren't thin enough

psychologists suggest that Beck's model for depression could be applied to anorexia as well