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Copy of Myers' Psychology for AP, 2nd Edition

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Transcript of Copy of Myers' Psychology for AP, 2nd Edition

Myers' Psychology for AP, 2nd Edition
Unit 12: Abnormal Behavior (8-10% of AP Exam)

Module 65
Defining Psychological
Disorders

Module 66
Anxiety
Disorders

Module 67
Mood Disorders
Module 68
Schizophrenia
Image by goodtextures: http://fav.me/d2he3r8
Module 69
Understanding Psychological
Disorders

Classifying Psychological
Disorders

Defining "Mental Disorders"
1. Write your definition of a mental disorder. Include the characteristics or behaviors that define it.
2. Get into groups of four or five. Each person share their definition. Come to a consensus definition in your group.
3. Individually read the four case studies on Handout 65-2. Discuss whether each is suffering from a mental disorder or not.
Rosenhan Experiment
Prevalence of
Psychological Disorders
ADHD
psychological disorder: a syndrome marked by a clinically significant disturbance in an individual’s cognition, emotion regulation, or behavior.
Disturbed, or dysfunctional, behaviors are maladaptive—they interfere with normal day-to-day life. An intense fear of spiders may be abnormal, but if it doesn’t interfere with your life, it is not a disorder.
attention-deficit/hyperactivity disorder (ADHD): a psychological disorder marked by the appearance by age 7 of one or more of three key symptoms: extreme inattention, hyperactivity, and impulsivity.
DSM-5 Criteria for ADHD

People with ADHD show a persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development:
1.Inattention: Six or more symptoms of inattention for children up to age 16, or five or more for adolescents 17 and older and adults; symptoms of inattention have been present for at least 6 months, and they are inappropriate for developmental level: ◦Often fails to give close attention to details or makes careless mistakes in schoolwork, at work, or with other activities.
◦Often has trouble holding attention on tasks or play activities.
◦Often does not seem to listen when spoken to directly.
◦Often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (e.g., loses focus, side-tracked).
◦Often has trouble organizing tasks and activities.
◦Often avoids, dislikes, or is reluctant to do tasks that require mental effort over a long period of time (such as schoolwork or homework).
◦Often loses things necessary for tasks and activities (e.g. school materials, pencils, books, tools, wallets, keys, paperwork, eyeglasses, mobile telephones).
◦Is often easily distracted
◦Is often forgetful in daily activities.
Hyperactivity and Impulsivity: Six or more symptoms of hyperactivity-impulsivity for children up to age 16, or five or more for adolescents 17 and older and adults; symptoms of hyperactivity-impulsivity have been present for at least 6 months to an extent that is disruptive and inappropriate for the person’s developmental level: ◦Often fidgets with or taps hands or feet, or squirms in seat.
◦Often leaves seat in situations when remaining seated is expected.
◦Often runs about or climbs in situations where it is not appropriate (adolescents or adults may be limited to feeling restless).
◦Often unable to play or take part in leisure activities quietly.
◦Is often "on the go" acting as if "driven by a motor".
◦Often talks excessively.
◦Often blurts out an answer before a question has been completed.
◦Often has trouble waiting his/her turn.
◦Often interrupts or intrudes on others (e.g., butts into conversations or games)


In addition, the following conditions must be met:
•Several inattentive or hyperactive-impulsive symptoms were present before age 12 years.
•Several symptoms are present in two or more setting, (e.g., at home, school or work; with friends or relatives; in other activities).
•There is clear evidence that the symptoms interfere with, or reduce the quality of, social, school, or work functioning.
•The symptoms do not happen only during the course of schizophrenia or another psychotic disorder. The symptoms are not better explained by another mental disorder (e.g. Mood Disorder, Anxiety Disorder, Dissociative Disorder, or a Personality Disorder).

Based on the types of symptoms, three kinds (presentations) of ADHD can occur:

Combined Presentation: if enough symptoms of both criteria inattention and hyperactivity-impulsivity were present for the past 6 months

Predominantly Inattentive Presentation: if enough symptoms of inattention, but not hyperactivity-impulsivity, were present for the past six months

Predominantly Hyperactive-Impulsive Presentation: if enough symptoms of hyperactivity-impulsivity but not inattention were present for the past six months.

Because symptoms can change over time, the presentation may change over time as well.
The controversy centers on whether the growing number of ADHD cases reflects overdiagnosis or increased awareness of the disorder. Long-term effects of stimulant-drug treatment for ADHD are not yet known.
How do the medical model and the biopsychosocial approach understand psychological disorders?


•The medical model assumes that psychological disorders are mental illnesses with physical causes that can be diagnosed, treated, and, in most cases, cured through therapy, sometimes in a hospital.


•The biopsychosocial approach assumes that three sets of influences—biological (evolution, genetics, brain structure and chemistry), psychological (stress, trauma, learned helplessness, mood-related perceptions and memories), and social-cultural (roles, expectations, definitions of “normality” and “disorder”)—interact to produce specific psychological disorders.
To explain puzzling behavior, people in earlier times often presumed the work of strange forces—the movements of the stars, godlike powers, or evil spirits.
Until the last two centuries, “mad” people were sometimes caged in zoo-like conditions or given “therapies” appropriate to a demon: beatings, burning, or castration. In other times, therapy included pulling teeth, removing lengths of intestines, cauterizing the clitoris, or giving transfusions of animal blood (Farina, 1982).


Today’s psychology studies how biological, psychological, and social-cultural factors interact to produce specific psychological disorders.
DSM-5: the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition; a widely used system for classifying psychological disorders.
In this new DSM edition, some diagnostic labels have changed. For example, “autism” and “Asperger’s syndrome” are no longer included; they have been combined into “autism spectrum disorder.” “Mental retardation” has become “intellectual disability.” New categories include “hoarding disorder” and “binge-eating disorder.”
Critics have long faulted the DSM for casting too wide a net and bringing “almost any kind of behavior within the compass of psychiatry” (Eysenck et al., 1983). They worry that the DSM-5 will extend the pathologizing of everyday life—for example, by turning bereavement grief into depression and boyish rambunctiousness into ADHD (Frances, 2013). Others respond that depression and hyperactivity, though needing careful definition, are genuine disorders even, for example, those triggered by a major life stress such as a death when the grief does not go away (Kendler, 2011; Kupfer, 2012).
Why do some psychologists criticize the use of diagnostic labels?


•Other critics view DSM diagnoses as arbitrary labels that create preconceptions which bias perceptions of the labeled person’s past and present behavior. The legal label, “insanity,” raises moral and ethical questions about whether society should hold people with disorders responsible for their violent actions.


•Most people with disorders are nonviolent and are more likely to be victims than attackers.

Who is most vulnerable to mental disorders?
As we have seen, the answer varies with the disorder. One predictor of mental disorder, poverty, crosses ethnic and gender lines. The incidence of serious psychological disorders has been doubly high among those below the poverty line (CDC, 1992). Like so many other correlations, the poverty-disorder association raises a chicken-and-egg question: Does poverty cause disorders? Or do disorders cause poverty? It is both, though the answer varies with the disorder. Schizophrenia understandably leads to poverty. Yet the stresses and demoralization of poverty can also precipitate disorders, especially depression in women and substance use disorder in men (Dohrenwend et al., 1992).
At what times of life do disorders strike?
Usually by early adulthood. “Over 75 percent of our sample with any disorder had experienced its first symptoms by age 24,” reported Lee Robins and Darrel Regier (1991, p. 331). The symptoms of antisocial personality disorder and of phobias are among the earliest to appear, at a median age of 8 and 10, respectively. Symptoms of alcohol use disorder, obsessive-compulsive disorder, bipolar disorder, and schizophrenia appear at a median age near 20. Major depression often hits somewhat later, at a median age of 25. Such findings make clear the need for research and treatment to help the growing number of people, especially teenagers and young adults, who suffer the bewilderment and pain of a psychological disorder.

Obsessive-Compulsive
Disorder

Posttraumatic
Stress Disorder

anxiety disorders: psychological disorders characterized by distressing, persistent anxiety or maladaptive behaviors that reduce anxiety.
generalized anxiety disorder: an anxiety disorder in which a person is continually tense, apprehensive, and in a state of autonomic nervous system arousal.
The symptoms of this disorder are commonplace; their persistence, for six months or more, is not. People with this condition—two-thirds are women (McLean & Anderson, 2009)—worry continually, and they are often jittery, agitated, and sleep-deprived. Concentration is difficult as attention switches from worry to worry, and their tension and apprehension may leak out through furrowed brows, twitching eyelids, trembling, perspiration, or fidgeting.
panic disorder: an anxiety disorder marked by unpredictable, minutes-long episodes of intense dread in which a person experiences terror and accompanying chest pain, choking, or other frightening sensations. Often followed by worry over a possible next attack.
Panic strikes suddenly, wreaks havoc, and disappears. For the 1 person in 75 with this disorder, anxiety suddenly escalates into a terrifying panic attack—a minutes-long episode of intense fear that something horrible is about to happen. Heart palpitations, shortness of breath, choking sensations, trembling, or dizziness typically accompany the panic, which may be misperceived as a heart attack or other serious physical ailment. Smokers have at least a doubled risk of panic disorder (Zvolensky & Bernstein, 2005). Because nicotine is a stimulant, lighting up doesn’t lighten up.
phobia: an anxiety disorder marked by a persistent, irrational fear and avoidance of a specific object, activity, or situation.

Dutch national interview study identified the commonality of various specific fears. A strong fear becomes a phobia if it provokes a compelling but irrational desire to avoid the dreaded object or situation.
social anxiety disorder: intense fear of social situations, leading to avoidance of such. (Formerly called social phobia.)
agoraphobia: fear or avoidance of situations, such as crowds or wide-open places, where one has felt loss of control and panic.
obsessive-compulsive disorder (OCD): a disorder characterized by unwanted repetitive thoughts (obsessions) and/or actions (compulsions).
Obsessive thoughts and compulsive behaviors cross the fine line between normality and disorder when they persistently interfere with everyday living and cause distress. Checking to see you locked the door is normal; checking 10 times is not. Washing your hands is normal; washing so often that your skin becomes raw is not. (Table 66.1 offers more examples.) At some time during their lives, often during their late teens or twenties, 2 to 3 percent of people cross that line from normal preoccupations and fussiness to debilitating disorder (Karno et al., 1988). Although the person knows them to be irrational, the anxiety-fueled obsessive thoughts become so haunting, the compulsive rituals so senselessly time-consuming, that effective functioning becomes impossible.

post-traumatic stress disorder (PTSD): a disorder characterized by haunting memories, nightmares, social withdrawal, jumpy anxiety, numbness of feeling, and/or insomnia that lingers for four weeks or more after a traumatic experience.
The toll seems at least as high for veterans of the Iraq war, where 1 in 6 U.S. combat infantry personnel has reported symptoms of PTSD, depression, or severe anxiety in the months after returning home (Hoge et al., 2006, 2007). In one study of 103,788 veterans returning from Iraq and Afghanistan, 1 in 4 was diagnosed with a psychological disorder, most frequently PTSD (Seal et al., 2007).
So what determines whether a person suffers PTSD after a traumatic event? Research indicates that the greater one’s emotional distress during a trauma, the higher the risk for post-traumatic symptoms (Ozer et al., 2003). Among New Yorkers who witnessed the 9/11 attacks, PTSD was doubled for survivors who were inside rather than outside the World Trade Center (Bonanno et al., 2006). And the more frequent an assault experience, the more adverse the long-term outcomes tend to be (Golding, 1999). In the 30 years after the Vietnam war, veterans who came home with a PTSD diagnosis had twice the normal likelihood of dying (Crawford et al., 2009).

A sensitive limbic system seems to increase vulnerability, by flooding the body with stress hormones again and again as images of the traumatic experience erupt into consciousness (Kosslyn, 2005; Ozer & Weiss, 2004). Brain scans of PTSD patients suffering memory flashbacks reveal an aberrant and persistent right temporal lobe activation (Engdahl et al., 2010). Genes may also play a role. In one study, combat-exposed men had identical twins who did not experience combat. But these nonexposed co-twins still tended to share their brother’s risk for cognitive difficulties, such as unfocused attention. Such findings suggest that some PTSD symptoms may actually be genetically predisposed (Gilbertson et al., 2006).
How do the learning and biological perspectives explain anxiety disorders, OCD, and PTSD?

•The learning perspective views anxiety disorders, OCD, and PTSD as products of fear conditioning, stimulus generalization, fearful-behavior reinforcement, and observational learning of others’ fears and cognitions (interpretations, irrational beliefs, and hypervigilance).

•The biological perspective considers the role that fears of life-threatening animals, objects, or situations played in natural selection and evolution; genetic predispositions for high levels of emotional reactivity and neurotransmitter production; and abnormal responses in the brain’s fear circuits.
Biological & Social-Cognitive Perspective of Mood Disorders
Suicide &
Self Injury

major depressive disorder: a mood disorder in which a person experiences, in the absence of drugs or another medical condition, two or more weeks with five or more symptoms, at least one of which must be either (1) depressed mood or (2) loss of interest or pleasure.
mood disorders: psychological disorders characterized by emotional extremes. See major depressive disorder, mania, and bipolar disorder.
Although phobias are more common, depression is the number-one reason people seek mental health services. At some point during their lifetime, depression plagues 12 percent of Canadian adults and 17 percent of U.S. adults (Holden, 2010; Patten et al., 2006). Moreover, it is the leading cause of disability worldwide (WHO, 2002). In any given year, a depressive episode plagues 5.8 percent of men and 9.5 percent of women, reports the World Health Organization.

Adults diagnosed with persistent depressive disorder (also called dysthymia) experience a mildly depressed mood more often than not for at least two years (American Psychiatric Association, 2013). They also display at least two of the following symptoms:

1.Problems regulating appetite

2.Problems regulating sleep

3.Low energy

4.Low self-esteem

5.Difficulty concentrating and making decisions

6.Feelings of hopelessness
mania: a mood disorder marked by a hyperactive, wildly optimistic state.
bipolar disorder: a mood disorder in which a person alternates between the hopelessness and lethargy of depression and the overexcited state of mania. (Formerly called manic-depressive disorder.)
Adolescent mood swings, from rage to bubbly, can, when prolonged, produce a bipolar diagnosis. Between 1994 and 2003, U.S. National Center for Health Statistics annual physician surveys revealed an astonishing 40-fold increase in diagnoses of bipolar disorder in those 19 and under—from an estimated 20,000 to 800,000 (Carey, 2007; Flora & Bobby, 2008; Moreno et al., 2007). The new popularity of the diagnosis, given in two-thirds of the cases to boys, has been a boon to companies whose drugs are prescribed to lessen mood swings. The DSM-5 will likely reduce the number of child and adolescent bipolar diagnoses, by classifying as disruptive mood dysregulation disorder some of those with emotional volatility (Miller, 2010).
During the manic phase, people with bipolar disorder are typically overtalkative, overactive, and elated (though easily irritated); have little need for sleep; and show fewer sexual inhibitions. Speech is loud, flighty, and hard to interrupt. They find advice irritating. Yet they need protection from their own poor judgment, which may lead to reckless spending or unsafe sex.
It is as true of emotions as of everything else: What goes up comes down. Before long, the elated mood either returns to normal or plunges into a depression. Though bipolar disorder is much less common than major depressive disorder, it is often more dysfunctional, claiming twice as many lost workdays yearly (Kessler et al., 2006). Among adults, it afflicts men and women about equally.
In thousands of studies, psychologists have been accumulating evidence to help explain mood disorders and suggest more effective ways to treat and prevent them. Researcher Peter Lewinsohn and his colleagues summarized the facts that any theory of depression must explain, including the following:

Many behavioral and cognitive changes accompany depression.
People trapped in a depressed mood are inactive and feel unmotivated. They are sensitive to negative happenings (Peckham et al., 2010). They more often recall negative information.

Depression is widespread.
Its commonality suggests that its causes, too, must be common.

Women’s risk of major depression is nearly double men’s
.

•Most major depressive episodes self-terminate.
Although therapy often helps and tends to speed recovery, most people suffering major depression eventually return to normal even without professional help. The plague of depression comes and, a few weeks or months later, it goes, though for about half of people it eventually recurs (Burcusa & Iacono, 2007; Curry et al., 2011; Hardeveld et al., 2010).
•Stressful events related to work, marriage, and close relationships often precede depression.
•With each new generation, depression is striking earlier (now often in the late teens) and affecting more people, with the highest rates in developed countries among young adults.
The increase appears partly authentic, but it may also reflect today’s young adults’ greater willingness to disclose depression.
The Biological Perspective

Mood disorders run in families. As one researcher noted, emotions are “postcards from our genes” (Plotkin, 1994). The risk of major depression and bipolar disorder increases if you have a parent or sibling with the disorder (Sullivan et al., 2000). If one identical twin is diagnosed with major depressive disorder, the chances are about 1 in 2 that at some time the other twin will be, too. If one identical twin has bipolar disorder, the chances are 7 in 10 that the other twin will at some point be diagnosed similarly. Among fraternal twins, the corresponding odds are just under 2 in 10 (Tsuang & Faraone, 1990).

Many studies have found diminished brain activity during slowed-down depressive states, and more activity during periods of mania. The left frontal lobe and an adjacent brain reward center are active during positive emotions, but less active during depressed states (Davidson et al., 2002; Heller et al., 2009). In one study of people with severe depression, MRI scans also found their frontal lobes 7 percent smaller than normal (Coffey et al., 1993). Other studies show that the hippocampus, the memory-processing center linked with the brain’s emotional circuitry, is vulnerable to stress-related damage.
Neurotransmitter systems influence mood disorders. Norepinephrine, which increases arousal and boosts mood, is scarce during depression and overabundant during mania. (Drugs that alleviate mania reduce norepinephrine.) Many people with a history of depression also have a history of habitual smoking, and smoking increases one’s risk for future depression (Pasco et al. 2008). This may indicate an attempt to self-medicate with inhaled nicotine, which can temporarily increase norepinephrine and boost mood (HMHL, 2002b).

Researchers are also exploring a second neurotransmitter, serotonin (Carver et al., 2008). One well-publicized study of New Zealand young adults found that the recipe for depression combined two necessary ingredients—significant life stress plus a variation on a serotonin-controlling gene (Caspi et al., 2003; Moffitt et al., 2006). Depression arose from the interaction of an adverse environment plus a genetic susceptibility, but not from either alone. But stay tuned: The story of gene-environment interactions is still being written, as other researchers debate the reliability of this result (Caspi et al., 2010; Karg et al., 2011; Munafò et al., 2009; Risch et al., 2009; Uher & McGuffin, 2010).
Drugs that relieve depression tend to increase norepinephrine or serotonin supplies by blocking either their reuptake (as Prozac, Zoloft, and Paxil do with serotonin) or their chemical breakdown. Repetitive physical exercise, such as jogging, reduces depression as it increases serotonin (Ilardi, 2009; Jacobs, 1994). Boosting serotonin may promote recovery from depression by stimulating hippocampus neuron growth (Airan et al., 2007; Jacobs et al., 2000).

What’s good for the heart is also good for the brain and mind. People who eat a heart-healthy “Mediterranean diet” (heavy on vegetables, fish, and olive oil) have a comparatively low risk of developing heart disease, late-life cognitive decline, and depression—all of which are associated with inflammation (Dowlati et al., 2010; Sánchez-Villegas et al., 2009; Tangney et al., 2011). Excessive alcohol use also correlates with depression—mostly because alcohol misuse leads to depression (Fergusson et al., 2009).
The Social-Cognitive Perspective
Depression is a whole-body disorder. Biological influences contribute to depression but don’t fully explain it. The social-cognitive perspective explores the roles of thinking and acting.
Research reveals how self-defeating beliefs and a negative explanatory style feed depression’s vicious cycle.
So it is with depressed people, who tend to explain bad events in terms that are stable (“It’s going to last forever”), global (“It’s going to affect everything I do”), and internal (“It’s all my fault”) (Figure 67.5). Depression-prone people respond to bad events in an especially self-focused, self-blaming way (Mor & Winquist, 2002; Pyszczynski et al., 1991; Wood et al., 1990a,b). Their self-esteem fluctuates more rapidly up with boosts and down with threats (Butler et al., 1994).
The vicious cycle of depressed thinking
Cognitive therapists attempt to break this cycle, as we will see in Module 71, by changing the way depressed people process events. Psychiatrists attempt to alter with medication the biological roots of persistently depressed moods.
What factors affect suicide and self-injury, and what are some of the important warning signs to watch for in suicide-prevention efforts?

•Suicide rates differ by nation, race, gender, age group, income, religious involvement, marital status, and (for gay and lesbian youth) social support structure.

•Those with depression are more at risk for suicide than others are, but social suggestion, health status, and economic and social frustration are also contributing factors.

•Environmental barriers (such as jump barriers) are effective in preventing suicides.

•Forewarnings of suicide may include verbal hints, giving away possessions, withdrawal, preoccupation with death, and discussing one’s own suicide.

•Nonsuicidal self-injury (NSSI) does not usually lead to suicide but may escalate to suicidal thoughts and acts if untreated.

•People who engage in NSSI do not tolerate stress well and tend to be self-critical, with poor communication and problem-solving skills.
Other
Disorders

schizophrenia: a psychological disorder characterized by delusions, hallucinations, disorganized speech, and/or diminished or inappropriate emotional expression.
psychosis: a psychological disorder in which a person loses contact with reality, experiencing irrational ideas and distorted perceptions.
Literally translated, schizophrenia means “split mind.” It refers not to a multiple-personality split but rather to a split from reality that shows itself in disturbed perceptions, disorganized thinking and speech, and diminished, inappropriate emotions. As such, it is the chief example of a psychosis, a psychotic disorder marked by irrationality and lost contact with reality.
delusions: false beliefs, often of persecution or grandeur, that may accompany psychotic disorders.
hallucinations: false sensory experiences, such as seeing something in the absence of an external visual stimulus.
Symptoms of schizophrenia
Diminished and Inappropriate Emotions
Maxine laughed after recalling her grandmother’s death. On other occasions, she cried when others laughed, or became angry for no apparent reason. Others with schizophrenia lapse into an emotionless state of flat affect. Most also have difficulty perceiving facial emotions and reading others’ states of mind (Green & Horan, 2010; Kohler et al., 2010).
How do chronic and acute schizophrenia differ?

•Schizophrenia symptoms may be positive (the presence of inappropriate behaviors) or negative (the absence of appropriate behaviors).

•In chronic (or process) schizophrenia, the disorder develops gradually and recovery is doubtful.


•In acute (or reactive) schizophrenia, the onset is sudden, in reaction to stress, and the prospects for recovery are brighter.
How do brain abnormalities and viral infections help explain schizophrenia?

•People with schizophrenia have increased dopamine receptors, which may intensify brain signals, creating positive symptoms such as hallucinations and paranoia.

•Brain abnormalities associated with schizophrenia include enlarged, fluid-filled cerebral cavities and corresponding decreases in the cortex.

•Brain scans reveal abnormal activity in the frontal lobes, thalamus, and amygdala.

•Interacting malfunctions in multiple brain regions and their connections may produce schizophrenia’s symptoms.

•Possible contributing factors include viral infections or famine conditions during the mother’s pregnancy and low weight or oxygen deprivation at birth.
Are there genetic influences on schizophrenia? What factors may be early warning signs of schizophrenia in children?

•Twin and adoption studies indicate that the predisposition to schizophrenia is inherited, and environmental factors influence gene expression to enable this disorder, which is found worldwide.

•No environmental causes invariably produce schizophrenia.

•Possible early warning signs of later development of schizophrenia include both biological factors (a mother with severe and long-lasting schizophrenia; oxygen deprivation and low weight at birth; short attention span and poor muscle coordination) as well as psychological factors (disruptive or withdrawn behavior; emotional unpredictability; poor peer relations and solo play).
somatic symptom disorder: a psychological disorder in which the symptoms take a somatic (bodily) form without apparent physical cause.
conversion disorder: a disorder in which a person experiences very specific genuine physical symptoms for which no physiological basis can be found. (Also called functional neurological symptom disorder.)
illness anxiety disorder: a disorder in which a person interprets normal physical sensations as symptoms of a disease. (Formerly called hypochondriasis.)
dissociative disorders: disorders in which conscious awareness becomes separated (dissociated) from previous memories, thoughts, and feelings.
dissociative identity disorder (DID): a rare dissociative disorder in which a person exhibits two or more distinct and alternating personalities. Formerly called multiple personality disorder.
Eating Disorders
anorexia nervosa: an eating disorder in which a person (usually an adolescent female) maintains a starvation diet despite being significantly (15 percent or more) underweight.
bulimia nervosa: an eating disorder in which a person alternates binge eating (usually of high-calorie foods) with purging (by vomiting or laxative use) or fasting.
binge-eating disorder: significant binge-eating episodes, followed by distress, disgust, or guilt, but without the compensatory purging or fasting that marks bulimia nervosa.
Cultural pressures, low self-esteem, and negative emotions interact with stressful life experiences and genetics to produce eating disorders.
personality disorders: psychological disorders characterized by inflexible and enduring behavior patterns that impair social functioning.
Anxiety is a feature of one cluster of these disorders, such as a fearful sensitivity to rejection that predisposes the withdrawn avoidant personality disorder.

A second cluster expresses eccentric or odd behaviors, such as the emotionless disengagement of the schizoid personality disorder.

A third cluster exhibits dramatic or impulsive behaviors, such as the attention-getting histrionic personality disorder and the self-focused and self-inflating narcissistic personality disorder.
antisocial personality disorder: a personality disorder in which a person (usually a man) exhibits a lack of conscience for wrongdoing, even toward friends and family members. May be aggressive and ruthless or a clever con artist.
The person (sometimes called a sociopath or a psychopath) is typically a male whose lack of conscience becomes plain before age 15, as he begins to lie, steal, fight, or display unrestrained sexual behavior (Cale & Lilienfeld, 2002). About half of such children become antisocial adults—unable to keep a job, irresponsible as a spouse and parent, and assaultive or otherwise criminal (Farrington, 1991).
Genetic predispositions may interact with the environment to produce the altered brain activity associated with antisocial personality disorder.
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