Abnormal Psychology

• Discuss to what extent biological, cognitive, and sociocultural factors influence abnormal behaviour

• Evaluate psychological research (theories and studies) relevant to the study of abnormal behaviour

• Examine the concepts of normality and abnormality• Discuss validity and reliability of diagnosis• Discuss cultural and ethical considerations in diagnosis

Abnormal psychology – the branch of psychology that deals with studying, explaining and treating abnormal behaviour.

• Three groups of disorders:• Anxiety disorders• Affective disorders• Eating disorders

Different definitions of abnormal:

• Statistical abnormality – useful for quantitative descriptions (I.Q.) leading to descriptive and inferential ways of defining abnormal objectively as extremely rare.

• However, situational and dispositional factors for behaviour must be known to define behaviour as rare. Not all behaviour that is statistically infrequent is a sign of mental illness.

Deviation from social norms

• behaving contrary to socially expected ways. In a given context, this approach assumes that there is an expected behaviour

• Problems:– Social norms vary across and within cultures– Social normality has changed across time– Social normality has been defined to reinforce

gender or power relations among classes

Maladaptiveness and adequate functioning

• assumes that we all seek out things that are good for us and positively affect our capacity to function well

• Useful for clinical definitions - eating disorders and alcoholism – but not for other behaviours – thrill seeking, etc.

Suffering and distress

• focusses on the patient’s needs and on the result of behaviours rather than defining behaviours as in themselves abnormal. Allows for the patient to define for themselves which interventions are required.

• Effective clinical definition but assumes that patients will always have clarity/insight to assess their own state – not always the case.

• Further – some distress/suffering should occur as a healthy reaction to crisis. Actually a sign of psychological health.

Jahoda’s positive mental health• developed by Marie Jahoda (1958) – tried defining normal rather than

abnormal. • 6 components of ideal mental health:

– Positive attitude toward self– Growth, development, self-actualization– Integration– Autonomy– Accurate perception of reality– Environmental mastery

• It logically follows that the opposite of these states defines abnormal.• An effective definition however few people would attain all 6

components and in some ways we shouldn’t • Taylor and Brown (1988) – some people with depression actually have

a more accurate picture of the world and healthy functioning required some elements of self-delusion

Diagnostic systems and the validity and reliability of diagnosis

• DSM-IV-TR - published by the APA first in 1952. Fourth edition revised and fifth recently released.

• Seeks to make diagnosis more reliable, valid, and standardized across different clinicians. Groups disorders into categories and lists symptoms required for diagnosis when cultural, other medical conditions, social and environmental factors, and general functioning are taken into considerations.

• ICD – International Classification of Diseases – conceived by the WHO to standardize records of cause of death. In 10th revision. Used more widely than DSM. Focus is on classification rather than diagnosis

• CCMD – Chinese Classification of Mental Disorders – in 3rd revision. Focussed on Chinese culture omitting some diagnoses viewed as specific to Western culture

Ethical concerns

• Medical usage of diagnostic systems varies from country to country. Causes compulsory incarceration, involuntary treatment, some diagnoses are considered a treatable disorder in some countries and not abnormal at all in others.

Reliability – 2 main issues

• Inter-rater reliability – Nicholls et al (2000) – 81 children at an eating disorder clinic diagnosed according to three different systems resulted in differing rates of agreement between each other – some not diagnosed at all

• Test-retest reliability – Seeman (2007) – literature review showed that women diagnosed with schizophrenia would have changing diagnoses as their clinicians learned more and more about the patients

Validity issues

• Liang – systematic diagnosis is made by categorizing behaviour rather than with biomedical data. Making diagnosis a social label rather than a scientific one. Diagnosis comes with political, legal and financial consequences – particularly for medications and the pharmaceutical industry.

• Szasz – invalid to view behaviours as contrary to expectations and therefore diseases. Biological factors are not fully known and underlying causes unknown therefore courses of treatment may not have basis for judging success.

• Eg. Life events may be a valid explanation for symptoms and therefore medications would not be appropriate

Your homework - Relevant research pp. 151-52

Caetano (1973) - Labelling Theory• Aims – to investigate the impact of prior knowledge on

influencing psychological diagnoses• Methods – a standardized interview was conducted with a

psychology student and a hospitalized mental patient. These interviews were then shown to 77 other psych students and 36 clinical psychologists. Each viewing was randomly accompanied by information that the interviewee was either a paid volunteer or a hospitalized mental patient.

• Conclusions – psychiatrists with clinical experience more likely persuaded by information.

• “patients” – mentally ill• “volunteers” – not mentally ill

Rosenhan (1973)• Aims – to challenge reliability of diagnosis of schizophrenia at

mental health facilities• Methods – Participant observation - Rosenhan and colleagues

presented as patients at 12 different hospitals with symptoms of “hearing voices”

• All but one admitted• Once admitted – participants were instructed to cease all

reporting of symptoms with the goal to get released• Conclusions – all eventually released with diagnoses of

schizophrenia in remission in 7 to 52 days (mean=19)• 35 of 118 patients complained of the surveillance• Follow up study – asked wards how many pseudo-patients

actually reported during the study, highest result was 41 of 193. Yet none were pseudopatients, all were genuine

Culture, gender, ethics of treatment and diagnosis

• Labelling Theory – shows lack of validity and reliability regardless of improvement

• Significant negative side effects of diagnosis – stigma– Damaging to career– Reluctance for others to engage in relationships (Read,

2007)– Perception of unpredictability, dangerousness, and fear

(Read, 2007)• Only 40% of schizophrenia patients in Japan were given

the diagnosis by their MDs – name changed to avoid this (Sato, 2006)

Iatrogenesis – treatment for a condition causes other problems

• Important concept for military, prisons, schools, etc.

• Adaptation to new conditions results in behaviours considered symptoms

• Explains increasing pathology/intensity of affective disorders

Rates of diagnosis varies widely between gender/ethnic groups

• Morgan et al. (2006) – in UK, Schizophrenia 9x more likely in Afro-Carribean, 6x higher in African compared to white population

• Read et al. (2004) – migrants and ethnic minorities over represented in mental hospital populations in Anglo-American/European countries

False negative effect

• Denial of treatment to afflicted resulting in death or harm

• Results in precautionary diagnosis• Immediate safety of patient trumps long term

negative effects such as stigma; iatrogenesis

Cultural behavioural interpretation

• “Dangerousness and violation of social norms” is part of DSM diagnostic criteria – forces culture bound syndromes/diagnosis

• Culture-bound disorders – those disorders occurring only within a specific culture– Levav et al (1997) – Jewish males much more likely to

diagnose as depressed, much less likely to diagnose as alcoholic

– Few MH workers are members of cultural minorities – diagnose according to their cultural influence

New Zealand

• Maori – 16% of MH diagnosis as depressed: 30% European• Maori – 60% MH diagnosis for schizophrenia: 40%

European• Maori – report different symptoms, hallucinations,

aggression (Tapsell and Mellsop, 2007)• Mate Maori – concept of ill health and strange behaviour

resulting from breaking tribal law - contact with “tohunga” is recommended

• Whakama – set of behaviours arising from sense of disadvantage or loss of standing; included slowness of movement, lack of responsiveness, pained or worried look, etc. (Best Practice Advocacy Center of New Zealand, 2008)

The U.K.

• Minorities or newcomers often affected my trauma in previous countries as well as new situations: homelessness, poverty, dislocation, language barriers, etc.

• Kirov and Murray (1999) – studied patients prescribed lithium– Clear differences in symptoms and diagnoses– Black patients less likely to verbalize suicidal ideation, attempts– Black patients more likely to exhibit manic episodes – resulting

in bipolar diagnoses– Compulsory hospitalization more likely for black patients in UK

(Riordan et al. 2004)

Outcomes• Describe the symptoms and prevalence of one disorder from

two of the following groups:– Anxiety disorders– Affective disorders– Eating disorders

• Analyze etiologies in terms of biological, cognitive and or sociocultural of one disorder from two of the above groups

• Discuss cultural and gender variations in prevalence of disorders• Examine biomedical, individual, and group approaches to

treatment• Evaluate the use of biomedical, individual, and group

approaches to treatment of one disorder• Discuss the use of eclectic approaches in treatment

Anxiety disorders

Anxiety disordersDSM – IV TR• Marked and persistent fear that is excessive or unreasonable cued by the

presence or anticipation of a specific object• Exposure to the phobic stimulus almost invariably provokes an immediate

anxiety response –panic attack• The person recognizes that the fear is excessive or unreasonable • The phobic situation is avoided or else endured with intense anxiety or distress• The avoidance, anxious anticipation, or distress in the feared situation

interferes significantly with the persons normal routine, occupational functioning, or social activities or relationships or there is a marked stress about having the phobia

• In individuals under the age of 18. The duration has to be of 6 months at least. • The anxiety, panic attacks, or phobic avoidance, associated with the specific

object or situation are not better accounted for by another mental disorder. OCD, PTSD, Sep. Anxiety, etc.

Changes in the DSM 5• OCD (moved to its own grouping) and PTSD/ACD (moved to

trauma/stressor related disorders) have been removed• Selective mutism added• Separation Anxiety Disorder - more inclusive for adults (avoidance of

workplace, age of onset after 18)• Social Anxiety Disorder – generalized specifier split into performance

based subset• Specific Phobias - no longer a requirement that individuals over 18

recognize fear and anxiety are excessive or unreasonable, and the duration requirement now applies to all ages.

• Agoraphobia and Panic Disorder – diagnoses split into two distinct groups

• Panic Disorder – subsets changed to “expected and unexpected”• Agoraphobia, SAD, Phobias - deletion of requirement that individuals

over 18 recognize anxiety is excessive or unreasonable. Anxiety must be out of proportion to the actual danger or threat, after taking cultural contextual factors into account.

Types of anxiety

• Animal types• Natural environment types (heights, storms,

water)• Blood, injection, injury type • Situational type (airplanes, elevators, enclosed

spaces)

DSM IVTR – 4 types of symptoms

• Affective• Behavioural• Cognitive• Somatic• Anxiety Disorders – characterized by the

experience of anxiety or fear• ICD-10 - Referred to as neurotic, stress-related

and somaform disorders

Prevalence - Anxiety

• Specific phobia – most common diagnosed anxiety

• Lifetime prevalence – 12.5% USA; 0.63% Italy• More common in women• Symptoms begin age 7• Prevalence rates reflect underdiagnosis –

patients can avoid phobic stimuli and maintain functioning

Biological level of analysis• Fight or flight – activates sympathetic nervous

system – adrenaline, GABA (responsible for returning the body to original state), and ACH – higher levels correlated to acquisition of new fears (Merkelbach, 1996)

• GABA – higher levels correlated with prevention of anxious reactions

• Classical conditioning – biological process involving the unconscious strengthening of neural connections in the brain according to experience

StudiesOhman et al (1975)• Aim – testing whether fear could be triggered by pictures of prepared

stimuli compared to unprepared stimuli• Results - easier to create a fear response for prepared items – generally

lasted longer than others• Conclusions – suggests that humans are biologically predisposed through

education to fear some objects more than othersAhs 2009• Aim – to determine the role of the amygdala on the fear response to

phobic items• Method – 16 female volunteers screened for phobias of spiders or snakes.

Participants were shown pictures of either spiders, snakes or both. PET scans were taken during viewing to compare self-reported levels of anxiety and brain activity

• Conclusion – strong correlation between activity in the amygdala and distress levels

Studies contd.Davey et al (1998) – suggested that human evolution fear of stimuli associated with disease was selected for rating rather than fear of predatory attack• Procedure – Cross-cultural study: USA, UK, India, Japan, Hong Kong, S. Korea,

Netherlands• Results – ratings of fear were strongest for disgust related. Animals higher in

India than Japan• Conclusions – animal trigger disgust response can be an adaptive response to

help humans avoid disease – trigger fight or flight responseBennett-Levy and Marteau (1984) • Aim – Explaining Ohman’s conclusion using correlational study that measured

fear of animals• Procedure – asked participants to rate animals on characteristics like ugliness

and how suddenly they move• Results – Ugliness and quickness showed strong correlations with fear response• Conclusion – people have a natural tendency to fear the characteristics and

qualities of the animals rather than the animals themselves.

Biological etiologyTwin Studies• Lack concrete biological evidence• Twin studies give support for biological causes

(genetic)Skre et al (2000) – specific phobias shared by twins more often than non-identicalMerckelbach et al (1996) – twin studies show support for genetic inheritance• Specific phobias are not inherited but a general

tendency for neurotic responses –exception – blood phobias

Weaknesses for the BLOA of phobias

• research tends to study animal phobias rather than situational

• More research needed to see similarities between phobia types

Physical symptoms of anxiety

• Pounding heart• Sweating• Stomach upset or dizziness• Frequent urination or diarrhea• Shortness of breath tremors• Insomnia

Cognitive etiology• Causes of phobias have been linked to Bandura’s self-efficacy theory

(1982) – people have fears but anxiety intensifies with anticipation of fear inducing stimuli

• Beck and Emery (2006) – cognitive schemas are responsible for bad/increased perception of threat and a misinterpretation of environmental stimuli, as well as making the person focus too much attention on themselves and the threat

• Threat – primary appraisal, whether they can cope with it – secondary appraisal

• If either appraisals is influenced in a bad/maladaptive way the chances of a strong anxiety reaction increase (can be reduced with learned avoidance tactics)

• Most people don’t think about the phobia until it happens suggesting that normal/rational people have phobias, but this thinking is overcome when maladaptive appraisals when anxiety occurs.

Studies• Sartory and Dorum (1992) – Arntc et al (1993) – suggest that the

higher the unpredictability of the stimulus, the more likely a person will be afraid of it.

• Armfield (2006) • Lists cognitive factors (negative self-focused attention, memory

bias, attention bias), but there is a lack of cause-effect, so we are unsure if these cause the phobia or if the phobia causes them

• Person with has vulnerability schema (created by traits, biological dispositions combines uncontrollability, unpredictability, danger and disgust), this schema is automatically activated when the triggering stimulus occurs

• Overall – cognitive models help explain the phobia and fit well with the biological level of analysis, but it is impossible to prove a cause-effect relationship.

Socio-cultural etiology

• Environmental influences such as social climate, social expectations, and personal or biological factors contribute to phobias

• Widespread phobias are transmitted intergenerationally and socially – Japan – specific phobias related to the disgustingness of one’s own body not found in western cultures

• Ratings of fear and disgust of some animals were much lower in India than Japan

• African-Americans held more fears grouped in the natural environment while Caucasians tended to hold fear over situations such as public speaking

• Anxiety is thought to be much higher in the males of masculine societies and much lower in countries such as Sweden and Spain

• Iancu (2007) – found that anxiety levels were much higher in those who had not graduated high school, those not in romantic relationships, and those with less than 2 good friends.

Treatments for phobias• Biomedical Therapy – focuses on medication to alleviate anxiety symptoms and

biofeedback training to help the individual manage their own psychological arousal. • Choy et al (2007) - Use of medication by people with a fear of flying, less anxiety

was reported during a flight by patients using alprazolam but the effects did not last into another event a week later but were also worse than in a group who had taken the placebo the week before.

• Individual Therapy – two most successful treatments – behavioural and cognitive. Systematic desensitization is probably the best known approach. Hierarchical set of fear situations relating to the phobic stimuli, training in muscle relaxation, and then exposure to the stimuli through imagination. Desensitization images progressively worsen as they learn to relax they replace the response of fear and anxiety with a relaxation response.

• Choy et al (2007) – systematic desensitization reduces symptoms but not avoidance behvaiours

• Benefits – long lasting, up to 3.5 years with no further treatment.

Treatments contd• Group Therapy – receive treatment with modeling from the

therapist. • Ost et al (1991) - Each participant is given four spiders to touch

each increasing in size as treatment for phobia. A second group observed a person getting this therapy and a third group watched this treatment on a video. The group participants exhibited the largest reduction in anxiety.

• Benefits – have good long term outcomes due to observing peers develop new skills in dealing with anxiety

• Eclectic approach has intuitive appeal but requires therapists to undergo wide range of areas of specialization. The therapists need to know the clients gender, class, previous therapies and thinking style

Affective Disorders

Affective Disorders• Affective = moodFocus on - Major Depressive DisorderDSM5 Criteria – unchanged from DSM IVTR• 5 or more symptoms from the following list for at least 2 weeks representing a change from

previous functioning:One symptom must be:• depressed mood• loss of interest or pleasureexcluding medical conditions, mood-incongruent delusions or hallucinations:• significant weight loss• insomnia or hypersomnia• psychomotor retardation or agitation• fatigue or loss of energy• feelings of worthlessness or excessive or inappropriate guilt• diminished thinking or concentration ability• thoughts of death, suicidal ideation without specific plan

Prevalence• USNIMH – major depressive disorder is the leading cause of

disability in the US between 15 and 44• Lifetime prevalence of 16.6%• Affects women more than men by 3x• Wide variance from country to country. Eg. Polish men – 20.4%,

women – 32.9%• Issues with diagnosis• Most psychiatrists tend to be males• Most psychiatrists tend to be from the dominant culture• This could result in over diagnosis• Disparity in help seeking behaviour• Diversity of definitions of “help” sources

Etiology - Biological• Evolutionary - psychological adaptation favored by a natural selection and

serves 2 main functions – to signal need and to elicit help from others in the social group

• Supported by evidence – most suicide attempts are preceded by a threat• Genetic – using twin studies and gene mapping. Results indicate a strong

genetic component but not strong enough to rely totally on genetics• Gene identified for low serotonin function – 5HTT• However, effects of gene mimic actions of SSRIs – same cause and

treatment • Kendler 2006 – 42000 participants in a phone survey of twins in Sweden.

Concordance rates for medicated depression were significant but not universal but still indicate a strong genetic component.

Catecholamine theory - 1965

• Focus on neurochemistry – catecholamine class of neurotransmitters: serotonin, dopamine, noradrenaline.

• Some drugs for other conditions (TB, hypertension) elicited mood altering properties.

• Theory developed that depression was a result of low functioning of catecholamines – mainly serotonin. Led to development of SSRIs

However

• little evidence that depressed people have low levels of serotonin.

• Circular logic in diagnosis, if drug is effective then diagnosis is made – reversed

• Other drugs with the opposite function are effective – tianeptine

Cortisol

• Depressed people react differently to stressors• Burke et al. (2005) - Cortisol levels rise and fall

sharply in normal people, depressed people show more blunted and longer lasting stress cortisol reactions.

• High levels of cortisol found in homeless children with history of negative life events – Cutuli et al (2010)

Etiology - Cognitive

• Cognitive – people who have certain cognitive characteristics are more likely to become depressed

• Beck (1976) – Cognitive Triad for Depression:• Negative thoughts about the self• Negative thoughts about the world• Negative thoughts about the future

Cognitive Patterns

• Developed through a series of cognitive biases – lead to a negative self-schema

• Causal link to this description is still weak• Gender differences used to confirm this

approach – traumatic experiences cause the creation of negative self-schemas, become targets for therapy

Albert Ellis (1962) – negative cognitive styles

• Irrational• Self defeating• Affect interpretations of precipitating events

Cognitive Patterns

• These cognitive defaults lead to negative emotional consequences.

• Depressed people have negative thinking styles (Robins and Block, 1989)

• However, • Depressed people actually have more realistic

interpretations of events (Taylor and Brown, 1988)

Etiology - Socio-cultural

• Brown and Harris (1978) – cite vulnerability factors for MDD:– Losing one’s mother at an early age– Lack of a confiding relationship– More than 3 young children at home– Unemployment

Contributing factors?

• Unemployment and poverty are provoking factors especially in cultures where wealth and material possessions provide meaning and status

• Nicholson et al. 2008 – socially disadvantaged groups report higher levels of depressive symptoms than higher socio-economic groups in Poland, Russia, and the Czech Republic

• Wu and Anthony, 2000 – lower prevalence of depression in Hispanic communities in the USA

• Gabilondo et al. – 2010 – less suicide and depression in Spain compared to Northern Europe

Cohen, 2002

• Rates of depression are higher in countries with historical socio-economic inequalities

• 2 causes:• Persistent physical effects (stress,

malnourishment) of powerlessness/worthlessness

• Subjective product of socialization into materialist/individualist society where ideals are required but not achievable

Possible cultural factors:

• Religiosity• Levels of family/social support• Style of family – traditional/non-traditional

As “Westernization” has increased, depression has increased

• New social pressures channeling unhappiness into symptom sets

• Westernized diagnostics causing increased prevalence

• Okulate et al. 2004 – Africa/Asia – depression linked with somatic symptoms; core symptom set common across all cultures – affective depression

• Binitie – 1975 – guilt and suicide ideation more common in European patients

Hofstede’s Cultural Dimensions

• High correlation between prevalence of depression and scores on the Masculinity-Femininity Index – Arrindell et al. 2003

• Individualism related to high levels of depression and correlated with the short allele for serotonin tranporters – Chiao and Blizinsky (2010)

• Theory – increased social supports protects vulnerable people, allows for their reproduction.

Treatments - Biomedical• Focussed on Serotonin Hypothesis - selective serotonin reuptake

inhibitors (SSRIs) – fluoxetine (Prozac) Weaknesses• Treats symptoms but does not cure• Significant side effects• Helpful in more serious cases of depression, but must be used

with therapy• Much negative research goes unpublished – supressed?• Ethical issues of blind/control group studies – denial of treatment

for control subjects?• Kirsch et al. (2008) – only a small difference between performance

of drug vs placebo with SSRIs

Cuijpers et al. (2009)

• Psychotherapy groups do better than control therapy groups

• Medication does better than therapy in symptom reduction

• Best results found in combination trials – drugs and therapy

ECT

• Electroconvulsive therapy (ECT) • Controversial, used when other forms of

treatment fail.• Majority of patients are female, older

Individual therapy

• Most well known, cognitive-behavioural therapy (CBT) Beck

• Identifying negative, automatic, latent schemas that affect interpretations

• Identify behaviour patterns that reinforce status quo

Interpersonal therapy (IPT)

• Helps clients develop and use any positive social support networks, grew out of success of control groups using simple discussion in CBT studies

• Butler (2006) – CBT and IPT show equal success but not all therapy is delivered strictly according to theories. All work better in combination with drug therapies

Cultural variations in therapy

• Power distance in Chinese culture may facilitate therapies – impact on therapist/client relationship – less resistance to CBT interventions

• However, this may also inhibit genuine introspection through argument with little or no resistance to the therapist

Group Therapy

• Participants may be more likely to share when initiated by other group members

• Vicarious learning becomes a possibility• Hyun et al. (2005) – found group therapy beneficial in S.

Korea• Supported by McDermut et al. (2001) – group CBT is at

least as effective as individual CBT• However, most group CBT excludes more severe cases of

depression causing a skew in results – Truax (2001) - Dissatisfaction with other group members leads to increased dropout

Eating Disorders

Eating Disorders

• Affects females vastly more than males: 5-15% of cases are male

• Females – 12x higher mortality rate from eating disorders compared to population

• Affects higher income households more, .3% of total population – Zandian (2007)

• Onset – between 14 and 19• More common in western/individualist cultures.• Majority of anorexia patients are white, Italians and

Jewish patients are over-represented

DSM IVTR

• Refusal to maintain body weight – 85% of expected for age/height

• Intense fear of becoming fat or becoming overweight

• Disturbance of body weight and shape experience, undue influence of weight/shape in self-evaluation, denial of weight related health issues

• Two identified types: Restricting vs. binge/purge

Biological Etiology

• Possible evolutionary adaptive advantage –reproductive suppression model – Surbey (1987)– Weight loss usually comes after amenorrhea– Occurs in early maturing females– Starvation as an adaptive response to stress– Delays reproductive availability for a more suitable

time• Weakness – does not explain anorexic males,

longitudinal studies needed to determine if reproductive success is higher

• Zandian (2007) – underlying OCD, manifests in males in other ways – in females, combines with biology to become an eating disorder.

• Bulik (2006) – Twin study controlling for upbringing, found heritability estimate 56%

• Striegel – Moore and Bulik (2007) – found gene responsible for serotonin receptors involved in mood for anorexic patients

However, serotonin also responsible for eating – can precede disorder or be a result of disorder. • Van Kuycek et al (2007) – scans reveal underactivity in

parietal cortex in anorexic subjects – different in males and females – accounts for gender difference in disorder

Zandian (2007)

• 2 main risk factors:• Restricting diet• Exercise• Cause release of corticotrophin-releasing

factor and cortisol, triggers dopamine circuitry – reward for restrictive behaviours and habit forms

Cognitive Etiology

Fairburn et al (1999) - two factors:• Low self-esteem• Extreme need for control • Negative self-schema• Control expressed through diet is a result of western cultural

paradigms• Control over eating linked to self-worth• Checking for weight loss introduced reward resulting behaviours

or could be distorted by cognitive biases/attentional bias toward negative info

• Exacerbated by presence of schema reinforcing images in media

• Fallon and Rozin (1988) - Males reporting approval of female body shapes, females report perception that same males preferred thinner bodies than they actually do

• Brusch (1962) – negative body-image distortion hypothesis, most women overestimate their body size

Etiology – Socio-cultural

• Generally considered a Western phenomenon• Lee et al (1996) – anorexia based in fat phobia

which is common in Western world but spreading to other cultures

• 16% of Chinese women would be classified as anorexic in western world

Media – influencing anorexia or conforming to it?

• Strahan et al (2007) - media does not influence women to think they are the wrong shape but that everyone else thinks a certain shape is correct and another is wrong

• Norton et al (1996) – toys present unrealistic body shapes – a Barbie body occurs in less than 1 in 100000 females

• Sypeck et al (2006) – magazine centerfolds and beauty pageant winners are getting smaller and thinner while advertising for dieting and exercise products has increased.

• However, not all members in a society are affected by socio-cultural factors, points to likely underlying cause

• http://www.youtube.com/watch?v=qRuNxHqwazs&safe=active

Treatments - Biomedical treatment

• SSRIs used frequently but little evidence to show effectiveness alone

• Usually, returning to eating habits is a requirement to begin biological interventions – IV if necessary

• Kaye et al. (2001) – patientse given placebos did significantly worse in treatments

• Eclectic approaches almost always used

Individual therapy

• Team of physicians with therapist and dietician – understand the patients problems

• CBT focus:– Negative self-statements– Basic assumptions that resist change– Alteration of negative schema around food,

weight, control etc,

Behavioural treatments

• Rewards for success and progress, operant conditioning approach, less effective than CBT in preventing relapse: 1) negative pattern origin not dealt with, 2) token reward economies end when treatment is ceased– Family therapy is often considered – combines individual and group therapies– has a continuing support network– focuses on communication styles that may be reinforcing

• Harris and Kuba (1997) – family therapy can account for culture, race, differences in eating disorders

Group therapy

Very common for patients – as outpatient as well to prevent relapse, has shown effectiveness in male and female mixed groups (Woodside and Kaplan (1994)– Strengths – more cost effective; offers personal

interaction modelling – Weaknesses – models can serve as triggers for

relapse – teach strategies for therapy avoidance. New group identity set out reinforced by anorexic behaviours (Polivy (1981)