Psychology 314
Table of Contents
Psychology 314 .......................................................................................................................................1
Chapter 8: Eating Disorders ........................................................................................................................... 2
Bulimia nervosa .......................................................................................................................................................................... 2
Anorexia nervosa ........................................................................................................................................................................ 3
Binge-eating disorder .................................................................................................................................................................. 4
Causes ......................................................................................................................................................................................... 4
Management................................................................................................................................................................................ 5
Chapter 10: Sexual Dysfunctions, Paraphilic Disorders and Gender Dysphoria ............................................. 7
Assessing sexual behaviour ........................................................................................................................................................ 9
Causes of sexual dysfunction .................................................................................................................................................... 10
Treatment .................................................................................................................................................................................. 11
Paraphilic disorders ................................................................................................................................................................... 12
Causes of paraphilic disorders .................................................................................................................................................. 14
Assessing + treating paraphilic disorders ................................................................................................................................. 14
Gender dysphoria ...................................................................................................................................................................... 14
Chapter 11: Substance-Related, Addictive and Impulse-Control Disorders .................................................. 17
Alcohol-related disorders .......................................................................................................................................................... 18
Sedative, hypnotic, or anxiolytic-related disorders................................................................................................................... 19
Stimulants ................................................................................................................................................................................. 19
Opioids ...................................................................................................................................................................................... 21
Other drugs................................................................................................................................................................................ 22
Causes ....................................................................................................................................................................................... 23
Treatment .................................................................................................................................................................................. 25
Impulse-control disorders ......................................................................................................................................................... 27
Chapter 12: Personality Disorders ................................................................................................................ 29
Cluster A ................................................................................................................................................................................... 30
Cluster C ................................................................................................................................................................................... 36
Reading: Salsman...................................................................................................................................................................... 37
Chapter 13: Schizophrenia Spectrum and Other Psychotic Disorders .......................................................... 40
Schizophrenia ............................................................................................................................................................................ 40
Other psychotic disorders ......................................................................................................................................................... 47
Catatonia ................................................................................................................................................................................... 49
Psychotic disorders ................................................................................................................................................................... 49
Reading: Swingler..................................................................................................................................................................... 51
Mariska Bester 2021 © 1
,Chapter 8: Eating Disorders
- Expected to develop an understanding of what each of the disorders are, and how to broadly identify them.
i.e. you will not be expected to list diagnostic criteria.
- Persistent disturbances to eating, and associated behaviours, cause significant impairments in both bodily
and psychological health
- Chief characteristic – all-encompassing drive to attain and maintain a low weight and to be thin
- Not found in all developing countries – seems to be culturally specific; in USA, African-American women
have less body dissatisfaction than white girls. In SA, no marked difference between black and white
people
- Adolescent girls most at risk; mean age of onset – 18-21, yet some at 10 already
o Girls gain weight (fat tissue) and boys develop muscle during puberty – thus men go closer to the
ideal, while girls move further away
- Major types of DSM-5 eating disorders
o Anorexia nervosa + Bulimia nervosa
Both severe disruptions in eating behaviour
Weight and shape have disproportionate influence on self-concept
Extreme fear + apprehension about gaining weight
Strong sociocultural origins – driven by Western emphasis on thinness
Disturbance in person’s thoughts, actions, and emotions
o Additional: Binge-eating disorder
Involves disordered eating behaviour (binges)
May involve fewer cognitive distortions about weight and shape
Bulimia nervosa
- Do not need to memorize but DSM-5 criteria includes:
o Recurrent episodes of binge-eating – eating in a discrete period of time an amount of food that is
larger than most people would eat during the same period; sense of lack of control over eating
during this episode that one cannot stop
o Recurrent inappropriate compensatory behaviour in order to prevent weight gain + offset intake of
excessive food (self-induced vomiting, laxatives, fasting, excessive exercise)
o Self-evaluation is unduly influenced by body shape and weight
o Ashamed of both their eating issues + their lack of control
- Binge-eating – hallmark of bulimia nervosa and binge-eating disorder
o Eating excess amounts of food in a discrete period of time
o Eating is perceived as uncontrollable
o May be associated with guilt, shame or regret
o May hide behaviour from family members
o Foods consumed are often high in sugar, fat or carbohydrates
- Compensatory behaviours – designed to ‘make up for’ binge eating
o Most common: Purging
Most common purging method: Self-induced vomiting
May also include use of diuretics or laxatives
o Excessive exercise
o Fasting or food restriction
- Associated medical features
o Most are within 10% of normal body weight
o Purging methods can result in severe medical problems
Erosion of dental enamel, electrolyte imbalance
Kidney failure, cardiac arrhythmia, seizures, intestinal problems, permanent colon damage
Nutritional deficiencies, electrolyte + metabolic problems, local tissue damage
Tearing of oesophagus
Mariska Bester 2021 © 2
,- Associated psychological features
o Most are overly concerned with body shape
o Fear of gaining weight
o Closer related to anxiety, less so to mood and substance-use disorders
o Most have comorbid psychological disorders
20% meet criteria for a mood disorder
50–70% have met criteria for a mood disorder at some point
80% have met criteria for an anxiety disorder at some point
Nearly 2/5 abuse substances – novelty seeking, emotional instability
o Sometimes display features of borderline personality disorder – labile moods, erratic behaviours,
pervasive anxiety, turbulent interpersonal relationships, deliberate self-harm
Anorexia nervosa
- Do not need to memorize but DSM-5 criteria includes:
o Restriction of energy intake relative to requirements, leading to significant low body weight (weight
that is less than minimally normal)
o Intense fear of gaining weight / becoming fat or persistent behaviour that interferes with weight
gain, even though at a significantly low weight
o Disturbance in the way in which one’s body weight or shape is experienced, undue influences of
body weight / shape on self-evaluation, or persistent lack of recognition of the seriousness of the
current low body weight
o Highest mortality rate for any psychological disorder – due to suicide, metabolic, nutritional and
surgical complications
- Extreme weight loss – hallmark of anorexia
o Restriction of calorie intake below energy requirements – eating can become ritualised
o Intense fear of weight gain
o Often begins with dieting – external validation
o Usually combine caloric restriction, exercise, and purging
o Subtypes:
Restricting: diet to limit calorie intake
Binge-eating-purging: purge to limit calorie intake; binge on small amounts of food, more
consistently – may just reflect a certain phase of anorexia
- Associated features
o Most show marked disturbance in body image – almost delusional thoughts about self
o Most have comorbid psychological disorders
70% are depressed at some point
Higher than average rates of substance abuse and OCD
o Starving body borrows energy from internal organs, leading to organ damage including cardiac
damage; can cause heart attack
o Intense panic, anxiety, depression if they do gain any weight
- Associated features – medical consequences
o Chronic state of catabolism – breaking down of the body
o Amenorrhoea (loss of periods in women)
o Dry skin; yellow almost
o Brittle hair and nails
o Sensitivity to cold temperatures; abnormally low levels of body fat
o Lanugo – very thin, soft, unpigmented, downy hair that is sometimes found on the body of a baby
o Cardiovascular problems
o Oesophageal rupture
o Electrolyte imbalance
It is most deadly mental disorder due to organ damage
- OCD is common comorbid condition – in which unpleasant thoughts are focused on gaining weight, and
patients engage in variety of behaviours, some of them ritualistic, to rid themselves of such thoughts
- Substance abuse also common; strong predictor of mortality
Mariska Bester 2021 © 3
, Binge-eating disorder
- New in DSM-5
- Marked distress about binge eating without associated compensatory behaviours
- Associated with distress and / or functional impairment (health risk, feelings of guilt, inadequate)
- Excessive concern with weight / shape may / may not be present
- Associated features
o Approximately 20% of individuals in weight-control programmes suffer from BED
o Approximately half of candidates for bariatric surgery suffer from BED
o Better response to treatment than other eating disorders – don’t have all the same thought processes
present in anorexia / bulimia
o Tend to be older than sufferers of anorexia and bulimia
o Higher rates of psychopathology than non-bingeing obese individuals
- Do not need to memorize but DSM-5 criteria includes:
o Recurrent episodes of binge-eating – eating an amount of food that is larger than most would eat in
same time period; sense of lack of control over how much they can eat
o Episodes are associated with 3 / more – eating much more rapidly than normal; eating until feeling
uncomfortably full; eating large amounts of food when not feeling physically hungry; eating alone
because of feeling embarrassed by how much one is eating; feeling disgusted with oneself,
depressed or very guilty afterwards
o Marked distressed about binge eating – binge to alleviate ‘bad moods’ or negative affect
o Not due to compensatory behaviour of anorexia / bulimia
Causes
- All have similar causal influences – similar inherited biological vulnerabilities, similar sociocultural
influences, family influences, personality development
- Share psychological attributes – anxiety about physical appearance + presentation to others, distorted
body image, and maladaptive eating-related behaviour
- No one factor seems sufficient to cause them
- May share biological vulnerabilities with anxiety disorders – excessive responsiveness to adverse life
events
- Negative emotions + mood intolerance seem to trigger binge-eating in many patients
- Social + cultural pressures about thin body motivate significant restriction of eating (through dieting)
- Also relevant – nature of relationships + interactions in high-achieving families – focus on appearance,
achievement – overriding importance of physical appearance to popularity + success
- Attitudes also reinforced in peer groups
- Differences– some ‘successfully’ control their intake (anorexia) and some lose control + compensate
(bulimia) – may be biologically determined and modified by personality development
Mariska Bester 2021 © 4
Table of Contents
Psychology 314 .......................................................................................................................................1
Chapter 8: Eating Disorders ........................................................................................................................... 2
Bulimia nervosa .......................................................................................................................................................................... 2
Anorexia nervosa ........................................................................................................................................................................ 3
Binge-eating disorder .................................................................................................................................................................. 4
Causes ......................................................................................................................................................................................... 4
Management................................................................................................................................................................................ 5
Chapter 10: Sexual Dysfunctions, Paraphilic Disorders and Gender Dysphoria ............................................. 7
Assessing sexual behaviour ........................................................................................................................................................ 9
Causes of sexual dysfunction .................................................................................................................................................... 10
Treatment .................................................................................................................................................................................. 11
Paraphilic disorders ................................................................................................................................................................... 12
Causes of paraphilic disorders .................................................................................................................................................. 14
Assessing + treating paraphilic disorders ................................................................................................................................. 14
Gender dysphoria ...................................................................................................................................................................... 14
Chapter 11: Substance-Related, Addictive and Impulse-Control Disorders .................................................. 17
Alcohol-related disorders .......................................................................................................................................................... 18
Sedative, hypnotic, or anxiolytic-related disorders................................................................................................................... 19
Stimulants ................................................................................................................................................................................. 19
Opioids ...................................................................................................................................................................................... 21
Other drugs................................................................................................................................................................................ 22
Causes ....................................................................................................................................................................................... 23
Treatment .................................................................................................................................................................................. 25
Impulse-control disorders ......................................................................................................................................................... 27
Chapter 12: Personality Disorders ................................................................................................................ 29
Cluster A ................................................................................................................................................................................... 30
Cluster C ................................................................................................................................................................................... 36
Reading: Salsman...................................................................................................................................................................... 37
Chapter 13: Schizophrenia Spectrum and Other Psychotic Disorders .......................................................... 40
Schizophrenia ............................................................................................................................................................................ 40
Other psychotic disorders ......................................................................................................................................................... 47
Catatonia ................................................................................................................................................................................... 49
Psychotic disorders ................................................................................................................................................................... 49
Reading: Swingler..................................................................................................................................................................... 51
Mariska Bester 2021 © 1
,Chapter 8: Eating Disorders
- Expected to develop an understanding of what each of the disorders are, and how to broadly identify them.
i.e. you will not be expected to list diagnostic criteria.
- Persistent disturbances to eating, and associated behaviours, cause significant impairments in both bodily
and psychological health
- Chief characteristic – all-encompassing drive to attain and maintain a low weight and to be thin
- Not found in all developing countries – seems to be culturally specific; in USA, African-American women
have less body dissatisfaction than white girls. In SA, no marked difference between black and white
people
- Adolescent girls most at risk; mean age of onset – 18-21, yet some at 10 already
o Girls gain weight (fat tissue) and boys develop muscle during puberty – thus men go closer to the
ideal, while girls move further away
- Major types of DSM-5 eating disorders
o Anorexia nervosa + Bulimia nervosa
Both severe disruptions in eating behaviour
Weight and shape have disproportionate influence on self-concept
Extreme fear + apprehension about gaining weight
Strong sociocultural origins – driven by Western emphasis on thinness
Disturbance in person’s thoughts, actions, and emotions
o Additional: Binge-eating disorder
Involves disordered eating behaviour (binges)
May involve fewer cognitive distortions about weight and shape
Bulimia nervosa
- Do not need to memorize but DSM-5 criteria includes:
o Recurrent episodes of binge-eating – eating in a discrete period of time an amount of food that is
larger than most people would eat during the same period; sense of lack of control over eating
during this episode that one cannot stop
o Recurrent inappropriate compensatory behaviour in order to prevent weight gain + offset intake of
excessive food (self-induced vomiting, laxatives, fasting, excessive exercise)
o Self-evaluation is unduly influenced by body shape and weight
o Ashamed of both their eating issues + their lack of control
- Binge-eating – hallmark of bulimia nervosa and binge-eating disorder
o Eating excess amounts of food in a discrete period of time
o Eating is perceived as uncontrollable
o May be associated with guilt, shame or regret
o May hide behaviour from family members
o Foods consumed are often high in sugar, fat or carbohydrates
- Compensatory behaviours – designed to ‘make up for’ binge eating
o Most common: Purging
Most common purging method: Self-induced vomiting
May also include use of diuretics or laxatives
o Excessive exercise
o Fasting or food restriction
- Associated medical features
o Most are within 10% of normal body weight
o Purging methods can result in severe medical problems
Erosion of dental enamel, electrolyte imbalance
Kidney failure, cardiac arrhythmia, seizures, intestinal problems, permanent colon damage
Nutritional deficiencies, electrolyte + metabolic problems, local tissue damage
Tearing of oesophagus
Mariska Bester 2021 © 2
,- Associated psychological features
o Most are overly concerned with body shape
o Fear of gaining weight
o Closer related to anxiety, less so to mood and substance-use disorders
o Most have comorbid psychological disorders
20% meet criteria for a mood disorder
50–70% have met criteria for a mood disorder at some point
80% have met criteria for an anxiety disorder at some point
Nearly 2/5 abuse substances – novelty seeking, emotional instability
o Sometimes display features of borderline personality disorder – labile moods, erratic behaviours,
pervasive anxiety, turbulent interpersonal relationships, deliberate self-harm
Anorexia nervosa
- Do not need to memorize but DSM-5 criteria includes:
o Restriction of energy intake relative to requirements, leading to significant low body weight (weight
that is less than minimally normal)
o Intense fear of gaining weight / becoming fat or persistent behaviour that interferes with weight
gain, even though at a significantly low weight
o Disturbance in the way in which one’s body weight or shape is experienced, undue influences of
body weight / shape on self-evaluation, or persistent lack of recognition of the seriousness of the
current low body weight
o Highest mortality rate for any psychological disorder – due to suicide, metabolic, nutritional and
surgical complications
- Extreme weight loss – hallmark of anorexia
o Restriction of calorie intake below energy requirements – eating can become ritualised
o Intense fear of weight gain
o Often begins with dieting – external validation
o Usually combine caloric restriction, exercise, and purging
o Subtypes:
Restricting: diet to limit calorie intake
Binge-eating-purging: purge to limit calorie intake; binge on small amounts of food, more
consistently – may just reflect a certain phase of anorexia
- Associated features
o Most show marked disturbance in body image – almost delusional thoughts about self
o Most have comorbid psychological disorders
70% are depressed at some point
Higher than average rates of substance abuse and OCD
o Starving body borrows energy from internal organs, leading to organ damage including cardiac
damage; can cause heart attack
o Intense panic, anxiety, depression if they do gain any weight
- Associated features – medical consequences
o Chronic state of catabolism – breaking down of the body
o Amenorrhoea (loss of periods in women)
o Dry skin; yellow almost
o Brittle hair and nails
o Sensitivity to cold temperatures; abnormally low levels of body fat
o Lanugo – very thin, soft, unpigmented, downy hair that is sometimes found on the body of a baby
o Cardiovascular problems
o Oesophageal rupture
o Electrolyte imbalance
It is most deadly mental disorder due to organ damage
- OCD is common comorbid condition – in which unpleasant thoughts are focused on gaining weight, and
patients engage in variety of behaviours, some of them ritualistic, to rid themselves of such thoughts
- Substance abuse also common; strong predictor of mortality
Mariska Bester 2021 © 3
, Binge-eating disorder
- New in DSM-5
- Marked distress about binge eating without associated compensatory behaviours
- Associated with distress and / or functional impairment (health risk, feelings of guilt, inadequate)
- Excessive concern with weight / shape may / may not be present
- Associated features
o Approximately 20% of individuals in weight-control programmes suffer from BED
o Approximately half of candidates for bariatric surgery suffer from BED
o Better response to treatment than other eating disorders – don’t have all the same thought processes
present in anorexia / bulimia
o Tend to be older than sufferers of anorexia and bulimia
o Higher rates of psychopathology than non-bingeing obese individuals
- Do not need to memorize but DSM-5 criteria includes:
o Recurrent episodes of binge-eating – eating an amount of food that is larger than most would eat in
same time period; sense of lack of control over how much they can eat
o Episodes are associated with 3 / more – eating much more rapidly than normal; eating until feeling
uncomfortably full; eating large amounts of food when not feeling physically hungry; eating alone
because of feeling embarrassed by how much one is eating; feeling disgusted with oneself,
depressed or very guilty afterwards
o Marked distressed about binge eating – binge to alleviate ‘bad moods’ or negative affect
o Not due to compensatory behaviour of anorexia / bulimia
Causes
- All have similar causal influences – similar inherited biological vulnerabilities, similar sociocultural
influences, family influences, personality development
- Share psychological attributes – anxiety about physical appearance + presentation to others, distorted
body image, and maladaptive eating-related behaviour
- No one factor seems sufficient to cause them
- May share biological vulnerabilities with anxiety disorders – excessive responsiveness to adverse life
events
- Negative emotions + mood intolerance seem to trigger binge-eating in many patients
- Social + cultural pressures about thin body motivate significant restriction of eating (through dieting)
- Also relevant – nature of relationships + interactions in high-achieving families – focus on appearance,
achievement – overriding importance of physical appearance to popularity + success
- Attitudes also reinforced in peer groups
- Differences– some ‘successfully’ control their intake (anorexia) and some lose control + compensate
(bulimia) – may be biologically determined and modified by personality development
Mariska Bester 2021 © 4
