• media images and cultural ideal of feminine beauty 
• increase in eating disorders in last 30 years
• 90-95% are women (commonly young women/ adolescent)

Eating Disorders

(integrated understanding)

• diathesis-stress explanation= predisposed + stress as trigger
• Multidemensional Risk Perspective= key factors, more present the higher the risk

key factors: 1) Cultural ideal of beauty, 2) Family Values, 3) Psychological factors- depression, anxiety, low self-esteem

• Problematic family dynamics- controlling & perfectionistic mother
• Feeling out of control
• Obsessive- Compulsive Tendencies
• Issues around femininity and growing up

• Dieting as trigger
• Stressful life event(s) as precursor
• Solcial motivation
• Fear of gaining weight
• Centered around control 
• Link to OCD
• Distorted body image

2 main goals of treatment: 1) Correct the dangerous eating pattern, 2) Address psychological factors that led to the problem

Supportive Nursing Care

Psychotherapy & Education (combo of individual, group, and family therapy)

Treatment often takes place through clinic

• Sociocultural factors
• Psychological factors: 1) Mood swings & Personality disorders, 2) Pleasing others, 3) Feeling Anious and Unfulfilled-feeling empty, 4) Eating as a way of copng w/ these feelings and feeling full & pregnant

• Dieting as trigger
• Stressful life event(s) as precursor
• Social motivation
• Fear of gaining weight
• Issues around lack of control
• Dieting triggers a physiological process
• Tension precedes binging
• Binge dynamics
• Binge aftermath
• Compensatory behaviors
• Cycle develops

• 2 Goals of treatment: 1) Eliminate binge-purge eating pattern, 2) Address underlying psychological issues
• Education & Psychotherapy: Combo of insight-oriented, behavioral, group therapy, and medication

• Onset: develops between late teens- early 20's; have previously functioned well then faced w/ increased psychological stress they deteriorate
• Psychosis: loss of contact w/ reality 
• Delusions: false beliefs (persecution most common); & Hallucinations: false sensory perceptions (auditory most common)
• Thought Disorders- loose associations (word salad)
• Breakdown of functioning

• Prodromal phase: symptoms aren't apparent but patient beginning to deteriorate, may withdraw socially &/or speak in vague ways
• Active phase: symptoms apparent, triggered by stress
• Residual phase: symptoms subside but usually some residual symptoms 

• Positive: delusions, hallucinations, disorganized thought and speach, inappropriate affect
• Negative: poverty of speach, blunted affect, loss of violition, social withdrawal
• Psychomotor: relate to bodily movement

• Type I (positive symptoms) & Type II (negative symptoms)
• Disorganized Type: confusion, incoherence, social withdrawal, odd mannerisms
• Catatonic Type: psychomotor disturbances, agitated movement, or lack of movement
• Paranoid Type: life guided by organized system of delusions and hallucinations involving persecution
• Undifferentiated Type: don't fall neatly into other categories

Schizophrenia seen as group of related disorders , dif forms can be caused by dif factors or combo of factors

25% have bout of Schizophrenia and then fully recover

25% recover mostly but may still show some symptoms

25% recover some but show more symptoms

25% do not recover must be institutionalized

• Diathesis- stress (genetic predisposition & psychological stress)
• Precise interaction of variables unknown
• Biological factors: 1) dopamine hypothesis (too much dopamine)- type I, 2) Abnormal brain structure (enlarged venticles, brain cavities containing cerobrospinal fluid)- Type II, 3) Identical twins illustrate importance of other factors (48% chance of developing Schizophrenia if twin has it)
• Psychological factors: 1) Decompensation in face of overwhelming situation, 2) Problematic background, 3) Psychological & Sociocultural predispostions

• Antipsychotic medication- conventional vs. atypical (a= less side effect & more effective)
• Milieu Therapy (participate in making rules & running own lives) & Token Economy (rewarded for behaving properly, sometimes patients just hide symptoms to recieve tokens)
• Psychotherapy
• Community: 1) Short-term hospitalization, 2) Partial hospitalization, 3) half-way house, 4) Occupational training; fewer than half of patients recieve services they need

• very rigid pattern of inner experience and outward behavior that differ from what is culturally expected
• most difficult to disorders to treat
• 3 clusters: Odd, Dramatic, Anxious

• Paranoid: distrust everyone, critical of weakness and faults in others can't see their own, see threats everywhere
• Schizoid: "loaners", rarely show any emotion, avoid social relationships, not affected by criticism or praise
• Schizotypal: discomfort in close relationships, ideas of reference (see unrelated events as pertaining to themselves), some believe they have magic powers, conversations vague some loose associations

• Antisocial: persistently disregard and violate others' rights, reckless, lack moral conscience
• Borderline: major shifts in mood, unstable self-image, impulsivity, some self mutilate, suicidal threats and actions common, fear abondonment, dramatic shifts in identity
• Histionic: "emotionaly charged", theatrical, vain, self-centered
• Narcissistic: grandiose, need much admiration, feel no empathy toward others, expect constant attention and admiration from others

• Avoidant: uncomfortable and inhibited in social situations, feel inadequate, sensitive to negative evaluation, fear rejection
• Dependent: persistent, excessive need to be taken care of, clingy and obedient, fear separation, cannot make decisions for themselves
• Obsessive- Compulsive: preoccupoied with order, perfection, and control; unreasonably high standards for self and others, rigid and stubborn 

• disturbances of mood that interfere with day to day functioning
• Mania (state of euphoria, high energy, frenzied activity, exaggerated sense of self and abilities, decreased need for sleep, talkativeness, flight of ideas, grandiosity) & Depression (low, sad or empty satae, overwhelmed by life, lack of energy, low self-esteem, trouble concentrating, apathy, hoplessness, thoughts of death or suicide) 

• Unipolar: episodes of depression w/o episodes of mania
• Bipolar: periods of depression alternate with periods of mania
• Major Depression (Clinical Depression): depressive episode w/o history of mania (lasting 2 weeks or longer) 

Depression

Normal vs. Clinical (or Major)

• depression is normal at times but is usually overcome within a few days to a week
• Known as common cold of mental disorders
• clinical lasts for at least two weeks 
• clinical is more severe and interferes with daily functioning to a higher degree

• Emotional: sad, dejected, empty, w/o hope
• Motivational: lose interest in usual activities
• Behavioral: less active and less productive
• Cognitive: low self-esteem, inadequate, undesirable, inferior

• correllation between depression & lower serotonin & norepinephrine levels= chemical imbalance in brain causes depression
• Flawed: correlation dosn't = causation

• Purpose or Value: growth, maturity, address issues, must know pain to know true joy
• Society wants to defend against the dark believing depression to be a disease leading to medication 
• Comparison between Physical & Psychological Pain: pain tells us something is wrong or needs to be changed or addressed
• Psychological Purpose or Function: 1) Psychological Impasse, 2) Adaptive Function
• Process of Productive Depression: 1) Withdrawl, 2) Psychological/ Spiritual transformation
• Productive (learning, growth, change) vs. Unproductive (no growth): outcome depends on severity of event leading to depression and the patients resources to combat it, must also accept and tolerate depression, overcome obstacles (ex. our society's view)
• Psychopathology often gives rise to Depression
• Medication can prevent Depression from serving it's purpose 

• Medication- MAO inhibiters, Tricyclics, SSRIs (SSRIs stall re-uptake of serotonin & increase its activity)
• E.C.T.- Electroconvulsive Therapy- electrical currents through brain, not sure why or if it fact it works
• Psychotherapy: 1) Cognitive (most effective, recognize and change maladaptive assumptions and negative thinking), 2) Alternative (Combo cognitive, insight-oriented, psychodynamic)

• Mood Cycling: manic episodes and depressive episodes, gradual cycles weeks to months of each (distinguish from drug abuse which has swift changes)
• Onset: usually adolescence or early adulthood

• Bipolar I: full manic and major depressive episodes
• Bipolar II: alternate between hypomanic and major depressive
• Cyclothymic: numerous periods of hypomanic symptoms and mild depressive symptoms
• Hypomania: mania symptoms less sever casing little impairment to person's functioning 

•  Ionic Theory: improper functioning of nuerons, involving flow of sodium and potassium ions in and out of cells, fire too easily= mania, resist firing=depression; abnormal functinoning in protiens that transport ions also found
• Genetic factor: biological predisposition, family pedigree studies support conlcusion

• Lithium: element found in mineral salt, proven effective, 60% of patients improve, helps more w/ mania than depression; too low dose= no effect, too high= lithium intoxication (poisoning) includes vomitting, sluggishness, tremors, dizziness, death
• Tegretol & Depakote as newwer meds
• Combo of drugs sometimes used
• Adjunctive psychotherapy: help people deal w/ problems that arise due to their disorder
• E.C.T. not proven effective, expose patients to harm and risk

• Loss of Soul as the Malady of our Age: materialism, and sped up life we ignore soul
• Care of Soul as Essence of Psychological Health
• Important Ingredients of Soulful Living: simple joys, slow down and enjoy
• Psychlogical Problems and Symptos as Voice of Soul: symptoms result from ignoring the soul and the soul's needs

• Psychological variables- upbringing & lifestyle
• Sociocultural variabls- family dynamics & religion

• Delusions & Hallucinations
• Television Jingles as defense
• Psychotic Disorder- Not otherwise specified

• Psychodynamic approach
• Development of relationship and rapport
• Psychic detective
• Enters Alan's world
• Helps him come to terms with traumatic event
• Transform experience of world and ways of being

• Professinoal questions: 1) Adjustment to societal norms, 2) Magnetized moments
• Societal questions: 1) Passion & worship, 2) Worship all

• Deviant: depends upon cultural norms
• Distressing/disturbing: to themselves or others
• Dysfunctional: interferes with daily functioning
• Destructive: to themselves or others
• Unjustifiable: can't be explained away by immediate events

Dangerous is not included becuase statistically those with pathologies are no more likely to commit violent crimes than those who do not, they are actually more likely to be the victum of a violent crime

current Diagnostic and Statistical Manual of Mental Disorders (Text Revised)

5 Axis

1. All mental disorders except personality disorders
2. Mental retardation and personality disorders
3. Relavent medical conditions
4. Relevant social/ environmental info
5. GAF (rating between 0-100, similar to grades in school, higher the score= higher level of functioning)

• theoretical framework from within which human beings and human psychology are understood
• different models have different theoretical assumptions about human psychology and different approaches to understanding, researching, and treating psychopatholgy