Subject: Psychology Topic: EATING, ELIMINATION & IMPULSECONTROL DISORDERS Lecturer: Luzviminda S.

Katigbak, MD Date of Lecture: February 01, 2012 Transcriptionists: dj anne Editor: dj anne Pages: 3
EATING, ELIMINATION & IMPULSE-CONTROL DISORDERS A. EATING DISORDERS I. Anorexia Nervosa II. Bulimia Nervosa III. Obesity I. ANOREXIA NERVOSA Self-induced starvation to a significant degree Relentless drive for a thinness or a morbid fear of fatness Presence of medical signs and symptoms resulting from starvation o Amenorrhea o Skinny due to decreased muscle mass o Poor skin turgor due to dehydration o Hair loss o Dry skin and mucosal dryness Disturbances of body image- see themselves as very fat below 85% of ideal body weight is considered anorexic Reducing food intake, or binge eating followed by purging behaviors Refuse to maintain a minimally normal weight, intensely fear gaining weight, significantly misinterpret its their body shape and its shape Females > males Onset in adolescence o Conflicts surrounding transition from girlhood to womanhood o Recall: erikson- identity vs role confusion Helplessness, difficulty establishing autonomy BIOLOGICAL FACTORS o Increase endogenous opioids denial of hunger Recall: opioids give the sense of euphoria o Starvation Hypercortisolemia and nonsuppression by dexamethasone, i.e. depression o Thyroid function suppressed o Amenorrhea due to lowered LH, FSH, GRH o Enlarged CSF spaces (sulci, ventricles) o Caudate nucleus metabolism is higher o HP axis dysfunction Recall: center of satiety is found in our hypothalamus o Dysfunction in 5HT, DA, NE involved in regulating eating behavior in the paraventricular nucleus of the hypothalamus See Table 23.1-1 SOCIAL FACTORS o Close but troubled relationships with their parentspassive aggressive behavior(they cant directly hurt their parents so they opt

to hurt themselves as a way to rebel and get back to their parents) o A sign for a cry for help o High levels of hostility, chaos, isolation and low levels of nurturance and empathy o Ballets schools-ballerina are expected by society to be skinny. This certain perception and expectation of society may cause one to have an eating disorder. o Perfectionistic(manifestation of obsessive compulsive) and preserving youth o Gay orientation PSYCHOLOGICAL FACTORS o To increase social and sexual functioning among adolescents o Substitute preoccupations with eating and weight gain for other normal adolescent pursuits adolescent pursuits pertains to goals they want to achieve such as academic, sports, friends, acceptance by peers, etc; ex. Cant become the star player of basketball so he/she opt to control what he/she can such as his/her weight. o Lack sense of autonomy and selfhood to gain validation as a unique and special person, through self-discipline o Unable to separate psychologically from their mothers We were once introjected in our mother. And if your mother is controlling and you unconsciously hate her, to get even, you starve that part of your mother within you. o Oral desires are greedy and unacceptableleads to starving oneself o Oral impregnation

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BULIMIA NERVOSA Failed attempt at anorexia nervosa Binge eating panic purging or excessive exercise Binge eating + inappropriate ways of stopping weight gain Normal body weight BIOLOGICAL, SOCIAL, PSYCHOLOGICAL etiologies are the same as anorexia nervosa o not much loss of body weight, hence, not much endocrinologic disturbance o Please note under biological etiology: theres genetic predisposition, hence a bulimic patient may have a relative with bulimia

SY 2011-2012

III. OBESITY Genetic susceptibility + increased availability of high-energy foods + decreased requirement for physical activity in modern society Excess of body fat: 25% in women, 18% in men Recall: Normal BMI : 20-25% kg/m2 o 25-27% - elevated risk o 27% - increased risk o >30% - greatly increased risk BIOLOGICAL o Satiety o Genetic Factors(familial) o Developmental Factors o Physical Activity Factors Sedentary lifestyle o Brain-Damage Factors Lateral ventromedial o Health Factors Hypothyroidism-low metabolism DM Cushingss o Psychotropic Drugs PSYCHOLOGICAL o stress SOCIAL o Peer pressure o Filipino culture- theres always food even in simple meetings B. ELIMINATION DISORDER I. Encopresis II. Enuersis Biological etiologies of elimination disorder are inherent problems with the external sphincters Psychological etiologies: stress causing regression I. ENCOPRESIS Defined as repeated involuntary defecation

Pathogenesis of Impulse control Disorder: Mounting tension & arousal Conscious anticipatory pleasure Action Immediate gratification & relief Remorse, guilt, self-reproach & dread ETIOLOGY o Psychodynamic o Psychosocial o Biological

somewhere other than a toilet by a child age four or older that continues for at least one month.

Psychodynamic etiology Definition of terms: o Impulse disposition to act to decrease heightened tension caused by the buildup of instinctual drives or by diminished ego defenses against the drives either increased id or decrease ego defenses o Impulse control disease attempt to bypass the experience of disabling symptoms or painful affects by acting on the environment Weak superego and weak ego structures associated with trauma produced by childhood deprivation August Aichhorn Attempts to master anxiety, guilt, depression, and other painful affects by means of action Otto Fenichel Incomplete sense of self Heinz Kohut A way to recapture a primitive maternal relationship Psychosocial etiology Improper models for identification, such as parents who had difficulty controlling impulses Exposure to violence in the home, alcohol abuse, promiscuity, and antisocial behavior Ex. Parents are gambler and he also became a gambler Biological etiology Limbic system Low CSF levels of 5-HIAA Increased serotonin binding sites Dopaminergic and noradrenergic systems Testosterone(related to aggression) Temporal lobe epilepsy Head trauma Mixed cerebral dominance ADHD o three components: inattention, hyperactivity and impulse control problem Mental deficiency

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Bowel control is established by 4-5 y/o Males 6x more likely than females

PSYCHOGENIC MEGACOLON Kids cant empty their stomach

III. ENURESIS refers to a repeated inability to control urination Bowel control established by the age of 5 y/o C. IMPULSE-CONTROL DISORDERS I. Intermittent Explosive Disorder II. Kleptomania III. Pyromania IV. Pathological Gambling V. Trichotillomania VI. Impulse-Control Disorder NOS Definition of Impulse control disorders: o Inability to resist an intense impulse, drive, or temptation to perform a particular impulse that is obviously harmful to self or others, or both o Other examples: addiction, suicide, anger management issues, impulsive shopping

 I. INTERMITTENT EXPLOSIVE DISORDER Discrete episode of losing control of aggressive impulses serious assault or destruction of property Aggressiveness > stressors Spells or attacks appear within minutes or hours, remit spontaneously and quickly Epileptoid personality o auras, postictal- like changes, hypersensitivity to photic, aural or auditory stimuli Ex. Got upset because of missing ballpen and gone berserk! KLEPTOMANIA Recurrent failure to resist impulses to steal objects not needed for personal use or for monetary value Stealing is not planned and does not involve others The act of stealing is the goal, and not the object

usually 1 seen by derma and surgeon and referred to psych

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VI. IMPULSE-CONTROL DISORDER NOS 1. Compulsive Buying 2. Internet Compulsion

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III. PYROMANIA Recurrent, deliberate, and purposeful setting of fires Tension or affective arousal before setting the fires Fascination with, interest in, curiosity about, or attraction to fire and the activities and equipment associated with firefighting Pleasure, gratification, or relief when setting fires or when witnessing or participating in their aftermath Arson (pyromania vs arson) o financial gain, revenge or other reasons; planned beforehand IV. PATHOLOGICAL GAMBLING Persistent and recurrent maladaptive gambling that causes economic problems and significant disturbances in personal, social, or occupational functioning Preoccupation with gambling Need to gamble with increasing amounts of money to achieve the desired excitement o Phenomenon of tolerance Repeated unsuccessful efforts to control, cut back or stop gambling Gambling a s a way of escape to problems Lying to conceal the extent of the involvement with gambling Commission of illegal acts to finance gambling Jeopardizing or losing personal and vocational relationships Reliance on others for money to pay off debts Gambling is like substance abuse. V. TRICHOTILLOMANIA Repetitive hair pulling, driven by escalating tension and causing variable hair loss that is usually but not always visible to others Trichobezoars o hairballs accumulating in the alimentary tract from hair pulling and swallowing