Psychosocial DevelopmentFriday, December 4, 201510:49 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 weight2. Intense fear of gaining weight, behavior that interferes with weight gain, even though underweight3. 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?oFear of:oGaining weight/becoming obeseoGiving into their desire to eatoLosing control of size and shape of body-Distorted thoughtsoLow opinion of body shapeoOverestimate actual sizeoBelief overweight regardless of weightoDiscount 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 femalesoPeak age between 14-18oFemale to male: 10:1-Typically begins by dieting-May follow stressful events-Developmental course looks different for everyoneoSome people develop AN very quicklyoOthers spend years developing full-blown AN symptoms Bulimia Nervosa (BN)1. Recurrent episodes of binge eating2. Recurrent inappropriate compensatory behavior in order to prevent weight gain3. Symptoms continuing, on average, at least once a week for three months4. Undue influence of weight or shape on self-evaluationoApproximately 90-95% of cases are females-Peak age between 15-21 years of age-Female to male ratio 10:1oTypically begins by dietingoMay follow stressful eventsoDevelopmental 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 mealoEven of meal is not a binge-Cycle begins after a period of intense dieting or Anorexia NervosaoEspecially after receiving praise for weight loss Compensatory Behaviors-Attempts to prevent weight gain in response to a binge-Purging (self-induced vomiting)oFails to prevent the absorption of half of the calories of a bingeoTemporarily relieve uncomfortable feelings of fullnessoOften 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 anorexiaoPreoccupation with food, weight and appearanceoFear of gaining weightoStruggles 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 emphasizeoThinness and physical appearanceoComments from parents are a major trigger-Includes comments to other family members or negative comments about self infront of other family members-Especially mothersoParents or siblings who diet-Enmeshed family pattern can lead to eating disordersoOver involved in patient's lifeoFamily 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 casesoSociety's double standardoThis is likely an underestimate-Men more often use exercise to control weightoWomen use dieting-Why do men develop eating disorders?oSome liked to requirements of job/sportoBody 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 symptomsoExtreme hostilityoDefiance-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 pubertyoEqual in both, after puberty Conduct Disorder-More severe problem-Repeatedly violate the basic rights of othersoOften aggressive and may be physically cruel to people/animalsoSteal 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:oEmpathy is limitedoLack of guiltoShow little concern for others feelings, wishes, well-being Delinquency and Disobedience-Breaking the lawoPrevalence and incidence of criminal activities more common in adolescenceo1/4 of young lawbreakers caught-Most do obey the law-Children with mild conduct disorder may improve over time-Severe cases frequently continue into adulthoodoDevelop 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:oTroubled parent-child relationshipsoInadequate parentingoFamily conflictoMarital conflictoFamily hostility Higher Rates in Families-Strong interaction effect between biology and environmentoEX:-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-IncarceratedoWhen children from ages 8-18 break the law, labeled as juvenile delinquentsoBoys are more involved in juvenile crime than girlsoRates for girls are on the increase Prevention, Early Intervention-Identify children at riskoSmoking, alcohol, substance use, early