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Anorexia Nervosa After years of struggling with bulimia hypertension jnc buy 2.5 mg bystolic amex, Marya Hornbacher began "inching" toward anorexia; she gradually became significantly underweight by severely restricting her food intake arteria femoralis cheap bystolic 2.5 mg visa, refusing to prehypertension 20 years old purchase bystolic 5 mg overnight delivery eat enough to heart attack news purchase 5 mg bystolic amex obtain a healthy weight: Anorexia started slowly. There were an incredible number of painfully thin girls at [school], dancers mostly. We sat at our cafeteria tables, passionately discussing the calories of lettuce, celery, a dinner roll, rice. Hornbacher wanted to be thin, to be in control of her eating, and to feel more in control of herself generally. She began to eat less and less, to the point where she began to pass out at school. A key feature of anorexia nervosa (often referred to simply as anorexia) is that the person will not maintain at least a low normal weight and employs various methods to prevent weight gain (American Psychiatric Association, 2000). Despite medical and psychological consequences of a low weight, those with anorexia nervosa continue to pursue extreme thinness. This young woman had been on her college swim team when she suffered a heart attack; her anorexia persisted and she was considered to be a danger to herself and banned from campus. A refusal to obtain or maintain a healthy weight (at least 85% of expected body weight, based on age and height). An intense fear of becoming fat or gaining weight, despite being significantly underweight. This fear is often the primary reason that the person refuses to attain a healthy weight. Those who have anorexia are obsessed with their body Eating Disorders 4 3 7 and food, and their thoughts and beliefs about these topics are usually illogical or irrational, such as imagining that wearing a certain clothing size is "worse than death. If someone with anorexia eats 50 more calories (for comparison, a single pat of butter provides about 35 calories) than she had allotted for her daily intake, she may experience intense feelings of worthlessness. People who suffer from anorexia often deny that they have a problem and do not see their low weight as a source of concern. People with anorexia often feel that their bodies are bigger and "fatter" than they actually are (see Figure 10. The suppression of menstruation, called amenorrhea, which is diagnosed after three consecutive missed menstrual cycles in females who have already begun menstruating. If a woman must take hormones to menstruate, she is considered to have amenorrhea. For children and adolescents who have not yet begun menstruating, this criterion does not apply. Refusal to maintain body weight at or above a minimally normal weight for age and height. In postmenarcheal females [those who have already begun menstruating], amenorrhea, i. The most common types of comorbid disorders are depression, anxiety disorders, and personality disorders (Agras, 2001; Blinder, Cumella, & Sanathara, 2006; Cassin & van Ranson, 2005; Godart et al. Half of the deaths are from suicide, and the others are from medical complications of the disorder. People with anorexia who also abuse substances have an even higher risk of death (Keel et al. Some people with anorexia gain enough weight that they no longer meet the criteria for the disorder, but meet the criteria for bulimia nervosa (Keel et al.

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Toward evidence based treatment: Child-Parent Psychotherapy with preschoolers exposed to hypertension 7101 5mg bystolic marital violence heart attack 10 hours order 2.5 mg bystolic with amex. The continuance and spillover of everyday tensions in distressed and nondistressed families hypertension 130 90 bystolic 2.5 mg. Families coping with illness: the resiliency model of family stress blood pressure 100 over 60 generic bystolic 2.5 mg without prescription, adjustment, and adaptation. Posttraumatic stress disorder and interpersonal functioning in Vietnam War Veterans: A mediational model. Psychosocial and family functioning in children with insulin-dependent diabetes at diagnosis and one year later. When individual child psychotherapy exacerbates family systems problems in child abuse cases: A clinical analysis. Latent models of family processes in African American families: Relationships to child competence, achievement, and problem behavior. Multisystemic therapy and neighborhood partnerships: Reducing adolescent violence and substance abuse. Indigenous resources and strategies of resistance: Informal caregiving and racial socialization in black communities. There is much more to understand about the complex mechanics of intergenerational transmission of risk and protective factors in the context of urban poverty and the interventions that may positively affect outcomes. Theory Several authors have attempted to organize the literature regarding the mechanisms of transmission of intergenerational trauma effects into models or frameworks. They identify four primary mechanisms for this transmission: silence, overdisclosure, identification, and reenactment. Bowen (1978) contributed to contemporary understanding of intergenerational transmission of trauma by articulating the transmission of emotional processes from one generation to the next. He notes that the current family system and functioning difficulties, including experiences with and impacts of trauma, are often influenced by previous generations of the family. Kira (2001) put forward a complex classification of trauma types and transmission mechanisms. This system views poverty as a form of trauma that acts through a "collective cross-generational transmission" and "community violence as survival trauma. In their review of the literature on influence of family-of-origin violence on later involvement in violent relationships, Delso & Margolin (2004) identify the main theoretical perspectives used both in this specific context and more generally regarding intergenerational effects of trauma. It is well established in the trauma literature that adults with histories of childhood maltreatment have noted problems with modulating feelings states (van der Kolk, B. Those difficulties make the task of responding to the strong negative affect states of their children especially difficult. Key Research Findings the original research regarding the intergenerational transmission of trauma effects grew out of studies done with survivors of the Holocaust and their children. The first is the resilience perspective, which maintains that children of survivors who were able to cope with their traumatic experiences will have increased resilience in the face of future trauma. The second is the vulnerability perspective, which contends that the "permanent psychic damage" of trauma leaves children of survivors more vulnerable to future negative impacts of trauma (Danieli, 1998). Summarizing a variety of studies, Felsen (1998) described the presence of a "common constellation of personality characteristics" in children of Holocaust survivors that fall into the vulnerable range of psychological functioning, including higher tendency to depressive experiences, mistrustfulness, elevated anxiety, difficulties in expressing emotions, difficulties in the regulation of aggression, higher feelings of guilt and self-criticism, and a higher incidence of psychosomatic complaints. Children of Holocaust survivors also seem to experience greater difficulty in the area of psychological separation-individuation (Felsen, 1998), which has been related to parental overprotection and the parentification of children in this population (Bar-On et al. A prominent theme throughout these studies is the conspiracy of silence, which describes how survivors were not listened to and not believed immediately following the Holocaust, silencing the voices of some survivors (Danieli, 1998). Studies have shown that the survivors who had difficulties communicating their traumatic experiences to their families had children with more adverse effects, with female children showing greater adverse effects than male children. Although a history of childhood exposure to family violence increases the risk for adult marital violence, it is not predictive and can be interrupted at various stages. Delsol and Margolin (2004) compiled the results of nine relevant studies and found that approximately 60% of maritally violent men report family-of-origin violence compared to approximately 20% of non-maritally violent men. For example, a male child raised in a family with father-to-mother violence is not necessarily more likely to become a perpetrator, and a female child raised in a family with father-to-mother violence is not necessarily more likely to become a victim. However, both male and female children raised in families with father-to-mother violence have significantly higher rates of involvement in abusive relationships of some sort, whether intimate or parent-child (Kwong et al. Family-of-origin violence has been linked to higher rates of future child abuse, with co-occurrence rates ranging from 6% to 14% (Margolin et al.

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Narcissistic personality disorder is characterized by a grandiose sense of self-importance and a constant desire for praise and admiration blood pressure medication gain weight order 5mg bystolic with visa. Now in his 30s arteria poplitea discount 2.5 mg bystolic, he travels a lot artery dorsalis pedis cheap bystolic 5mg visa, making presentations for his job blood pressure quickly lower bystolic 5 mg low price, and so has a lot of independence. He likes the freedom of not having a boss looking over his shoulder all the time, and he enjoys making presentations. Because no one really knows how many hours he works, he sometimes starts late in the morning or quits early; then, he heads for a bar to down a few beers. In what ways does Will seem typical of someone with a Cluster B (dramatic/erratic) personality disorder? What would you need to know before you could decide whether he had a dramatic/ erratic personality disorder? Which specific personality disorder seems most likely from the description of him, and why? What other types of information would you want to have (for example, about cultural issues), and why? If so, which one, and what would you need to know to be relatively certain of that? Summary of Fearful/Anxious Personality Disorders the hallmark of avoidant personality disorder is social inhibition, which usually stems from feeling inadequate or being overly sensitive to negative evaluation. Although similar to social phobia, avoidant personality disorder has criteria that are more pervasive and involves a more general reluctance to take risks. These rigid personality traits may lead these people to have difficulty prioritizing and making decisions, and they are often intolerant of emotional or "illogical" behavior in others. Lela and Carlos are trying to figure out what, exactly, the problems are and what can be done about them. Like Richie, Pia, and Javier, many children have problems socially or academically or achieve developmental milestones, such as walking and talking, later than the average child. When are such difficulties part of the range of normal development, and when do they signal a larger problem? For these disorders, the timing of the diagnosis contrasts with that of most of the disorders discussed in previous chapters. Nonetheless, children can be diagnosed with many of the Axis I disorders discussed in previous chapters. We begin this chapter by examining mental retardation-a disorder that can profoundly affect the lives of children and their families and that may require special schools or residential placements as well as other special services. We then examine a set of disorders referred to as pervasive developmental disorders, which are often comorbid with mental retardation and may require special school placements and special services. We next turn to disorders that may Pervasive Developmental Disorders Autism Spectrum Disorders Other Pervasive Developmental Disorders Learning Disorders: Problems with the Three Rs What Are Learning Disorders? Understanding Learning Disorders Treating Learning Disorders Disorders of Disruptive Behavior and Attention What Is Conduct Disorder? In the final section, we examine briefly other disorders of childhood, which have symptoms that can overlap with those of other psychological disorders or problems. Individuals and their family members can become adept at managing, compensating for, and working around the symptoms of these disorders. Neurological factors are often the most direct cause of many of the disorders discussed in this chapter, such as mental retardation and learning disorders; psychological and social factors may play a role, but often only an indirect one. For instance, poor pregnant mothers and children raised in poverty (social factor) may be more likely to be exposed to substances that cause certain types of mental retardation in children. Psychological and social factors also play a role in how well an individual adapts to and compensates for his or her disorder. For many of the disorders in this chapter, the specific mechanisms of feedback loops among the three factors are not as well documented as they are for disorders discussed in most other chapters. For this reason, some of the sections that describe the contributions of neurological, psychological, and social factors do not include information on feedback loops among these factors. The term intellectual disability is sometimes used as a synonym for mental retardation. People in this mild Childhood Disorders 6 2 7 range may be able to function relatively independently with training but usually need additional help and support during stressful periods. Although they are not able to function independently, with training and supervision, people in this group may be able to perform unskilled work and take basic care of themselves. Adults in this group are likely to live with their family or in a supervised setting and are able to perform simple tasks only with close supervision.

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At this stage of her illness if something had been moved in the room or someone had entered or left it [during her other state of consciousness] she would complain of having "lost" some time and would remark upon the gap in her train of conscious thoughts hypertension 16070 discount 5 mg bystolic with visa. These "absences" had already been observed before she took to arrhythmia mayo clinic generic 5mg bystolic overnight delivery her bed; she [would] stop in the middle of a sentence blood pressure pulse rate bystolic 2.5mg amex, repeat her last words and after a short pause go on talking hypertension over the counter medication cheap bystolic 5 mg overnight delivery. These interruptions gradually increased till they reached the dimensions that have just been described. At the moments when her mind was quite clear she would complain of the profound darkness in her head, of not being able to think. Cultural Variations in Pathological Dissociation People in different cultures may express dissociative symptoms differently. For example, latah, experienced by people-mostly women-in Indonesia and Malaysia (Bartholomew, 1994), involves fleeting episodes in which the individual uses profanity and experiences amnesia and trancelike states. Symptoms of hysteria were common among middle- and upper-class women of the Victorian era, the period in which Anna O. Women of that time and social class led severely limited lives: They were expected to marry, have children, and run the home; they were allowed to pursue only a restricted range of other activities. Some researchers hypothesize that the hysterical symptoms of Victorian women like Anna who wanted a different life were one of the few means of social protest they could employ (Kimball, 2000). Dissociative amnesia is a dissociative disorder in which the sufferer has significantly impaired memory for important experiences or personal information that cannot be explained by ordinary forgetfulness (see Table 8. The experiences or information typically involve traumatic or stressful events, such as occasions when the patient has been violent or tried to hurt herself or himself; the amnesia can come on suddenly. For example, soon after a bloody and dangerous battlefield situation, a soldier may not be able to remember what happened. To qualify as Soldiers with dissociative amnesia may forget dissociative amnesia, the memory problem cannot be explained better by another combat experiences that were particularly psychological disorder, a medical disorder, or substance use; as with all dissociative troubling or traumatic. This soldier is attending disorders, it must also significantly impair functioning or cause distress (American a memorial service in Iraq for three of his comrades who were killed in a convoy attack. The predominant disturbance is one or more episodes of inabilappear to be best explained as dissociative amnesia. The disturbance does not occur exclusively during the course of Dissociative Identity Disorder, Dissociative Fugue [both discussed later in this chapter], Posttraumatic Stress Disorder, Acute Stress Disorder [both in Chapter 7], or Somatization Disorder [discussed later in this chapter] and is not due to the direct physiological effects of a substance. Although common in television shows, this type of amnesia is, in fact, extremely rare. For instance, a soldier may forget about a particularly traumatic battlefield skirmish, but remember what he and another person spoke about between phases of this skirmish. She remembered what happened in the accident, and immediately preceding it, but suddenly had total loss of memory for the previous 12 years. She also had good autobiographical memory for her life events up to the age of 37. She was not only amnesic for these reputedly painful events, [but was unable] to recognize any of the friends she had made during that time. This included her present man friend, who was the passenger in her car at the time of the accident. Some people may spontaneously remember the forgotten experiences or information, particularly if their amnesia developed in response to a traumatic event and they leave the traumatic situation behind, as when a soldier with localized amnesia in response to combat leaves the battlefield. Understanding Dissociative Amnesia the following sections apply the neuropsychosocial approach as a framework for understanding the nature of dissociative amnesia. Unfortunately, because the disorder is so rare, not much is known about either the specific factors that give rise to it or how those factors might influence each other.

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