Psychosocial Development Friday December 4 2015 10 49 AM Eating Disorders Rates are especially high among adolescent girls and young women Nearly 10 of adolescents and young women experience clinical subclinical eating disorders Anorexia Nervosa AN 1 Restricted intake of nourishment leading to low body weight 2 Intense fear of gaining weight behavior that interferes with weight gain even though underweight 3 Disturbed body perception undue influence of weight or shape on self evaluation or persistent denial of the seriousness of the current low weight Anorexia Nervosa AN Primary goal is thinness but what drives this o Fear of o Gaining weight becoming obese o Giving into their desire to eat o Losing control of size and shape of body Distorted thoughts o Low opinion of body shape o Overestimate actual size o Belief overweight regardless of weight o Discount physical attractiveness Preoccupation with food weight appearance Disturbed attitude towards food and eating Struggle with anxiety depression obsessiveness and perfection Anorexia Nervosa AN Approximately 90 95 of cases are females o Peak age between 14 18 o Female to male 10 1 Typically begins by dieting May follow stressful events Developmental course looks different for everyone o Some people develop AN very quickly o Others spend years developing full blown AN symptoms Bulimia Nervosa BN 1 Recurrent episodes of binge eating 2 Recurrent inappropriate compensatory behavior in order to prevent weight gain 3 Symptoms continuing on average at least once a week for three months 4 Undue influence of weight or shape on self evaluation o Approximately 90 95 of cases are females Peak age between 15 21 years of age o o o Female to male ratio 10 1 Typically begins by dieting May follow stressful events Developmental course looks different for everyone Many patients go on to develop BN after AN Course is often intermittent Bulimia Nervosa Binge Purge Cycle Binge purge cycle eventually leads to feelings of disgust Bulimia Nervosa patients often begin to purge after any meal o Even of meal is not a binge Cycle begins after a period of intense dieting or Anorexia Nervosa o Especially after receiving praise for weight loss Compensatory Behaviors Attempts to prevent weight gain in response to a binge Purging self induced vomiting o Fails to prevent the absorption of half of the calories of a binge o Temporarily relieve uncomfortable feelings of fullness o Often reduces anxiety Use of laxatives and diuretics Excessive exercising Psychological Aspects Often a history of mood swings Often concerned with pleasing others Overlap with themes in anorexia o Preoccupation with food weight and appearance o Fear of gaining weight o Struggles with depression and anxiety Origins of Disordered Eating Cultural images of thinness media Cultural obsession with weight loss and dieting Pro anorexia websites Stress Puberty Hormones Hypothalamus malfunction tells you when you are hungry Genetics Childhood patterns of eating healthy together Family Environment Families play important role in onset and maintenance of eating disorders Many families emphasize o Thinness and physical appearance o Comments from parents are a major trigger Includes comments to other family members or negative comments about self in front of other family members Especially mothers o Parents or siblings who diet Enmeshed family pattern can lead to eating disorders o Over involved in patient s life o Family structure can vary widely Role of Culture Subculture US has developed national obsession with weight loss and dieting Western society equate thinness with health beauty Adolescents particularly vulnerable to this Gender Differences in Eating Disorders Males account for 5 10 of eating disorder cases o Society s double standard o This is likely an underestimate Men more often use exercise to control weight o Women use dieting Why do men develop eating disorders o Some liked to requirements of job sport o Body image is key issue Muscle dysmorphia men see themselves as scrawny in spite of muscular build Prevention of Eating Disorders Low levels of success with treatment focus more on prevention Oppositional Defiant Disorder and Conduct Disorder Types of symptoms o Extreme hostility o Defiance May qualify for diagnosis of oppositional defiant disorder or conduct disorder Oppositional Defiant Disorder Argumentative and defiant Angry Irritable Vindictive More common in boys than girls before puberty o Equal in both after puberty Conduct Disorder More severe problem Repeatedly violate the basic rights of others o Often aggressive and may be physically cruel to people animals o Steal from threaten harm victims committing crimes like shoplifting forgery mugging armed robbery Lie to get things from others favors get out of trouble Steal from parents others school shops Start fights bully threaten others Running away Staying out late Skipping school Truant Age Age 7 15 Increased incidence in adolescence 10 of children 3 4 are boys Poorest outcomes when symptoms are at early age Emotional and Interpersonal Style Callous unemotional interpersonal style Limited prosocial behavior o Empathy is limited o Lack of guilt o Show little concern for others feelings wishes well being Delinquency and Disobedience Breaking the law o Prevalence and incidence of criminal activities more common in adolescence o 1 4 of young lawbreakers caught Most do obey the law Children with mild conduct disorder may improve over time Severe cases frequently continue into adulthood o Develop into antisocial personality disorder or other psychological problems Causes of Conduct Disorder Genetic biological factors Drug abuse Poverty Traumatic events Exposure to violent peers or community violence Tied to o Troubled parent child relationships o Inadequate parenting o Family conflict o Marital conflict o Family hostility Higher Rates in Families Strong interaction effect between biology and environment o EX Difficult temperament Parents substance abuse crime Parents lack parenting skills or neglect child Lack of supervision Neighborhood poverty overcrowding violence Begin to do poorly in school Conduct Disorder Many with conduct disorder are suspended from school Placed in foster homes Incarcerated o When children from ages 8 18 break the law labeled as juvenile delinquents o Boys are more involved in juvenile crime than girls o Rates for girls are on the increase Prevention Early Intervention Identify children at risk o Smoking