Slides for Childhood Disorder chapter, Abnormal Psychology

Chapter 22. Childhood Disorders, Part 2

Slide 19: Time to think...

Some of you will be working with teens or in schools. What would you do to reduce the probability of school violence? Why?

Slide 20: Conduct disorder (APA, 1994)

A. A repetitive & persistent pattern of behavior in which the basic rights of others or major age-appropriate societal norms/rules are violated (3+ in last 12 mos., 1+ in last six):

aggression to people and animals:

1. often bullies threatens/intimidates;
2. often initiates physical fights;
3. has used a weapon that can cause serious physical harm to others;
4. has been physically cruel to others;
5. has been physically cruel to animals;
6. has stolen while confronting a victim;
7. has forced someone into sexual activity;

destruction of property:

8. has deliberately engaged in firesetting with the intention of causing serious damage;
9. has deliberately destroyed others' property

deceitfulness or theft:

10. has broken into house, building or car;
11. often lies to obtain goods or favors or to avoid obligations;
12. has stolen items of nontrivial value without confronting a victim

serious violations of rules:

13. often stays out at night despite parental prohibitions, beginning before 13 y.o.;
14. has run away from home overnight at least 2x while living with parent or surrogate (or 1x if for lengthy period);
15. often truant, beginning before 13 years old

B. Causes significant impairment in social, academic, occupational functioning
C. If 18 years or older, does not meet criteria for Antisocial Personality Disorder.

Slide 21. Gender and age differences in diagnosis with ODD (Cohen, 1993)

Slide 22: Problems may have multiple causes

Biological problem
Problems at home
Poor teacher/student match
Frustration with learning process
Poor peer or dating relationships
Confusion about sexual orientation -- up to 50% of suicides are attributed to this
Poor social skills

How do you choose among these?
More than one problem may contribute.

Slide 23: Predictors of school violence

Witnessing violence at home, in the community or in the media
The need for attention or respect
Early childhood abuse or neglect
Feelings of low self-worth
Peer pressure
Easy access to weapons

These factors double a boy's risk of becoming a murderer:

Coming from a family with a history of criminal violence
Being abused
Belonging to a gang
Abusing drugs or alcohol

Any of these factors -- in addition to the previous ones -- triple a boy's risk of becoming a killer:

Using a weapon
Having been arrested
Having a neurological problem that impairs thinking or feeling
Having had problems at school

Slide 24: Limits to prediction

Violence is a low frequency behavior. We tend to overpredict its presence.
While there are factors that increase or decrease risk of suicide or violence, we can not predict violence with a large degree of certainty.
Predictors may be overlooked when we focus on the likeable aspects of a child.

On the other hand, focusing on the likeable parts of a child can help them change.

Slide 25: Risk factors at Columbine

Harris and Klebold:

Were members of the Trenchcoat mafia
Felt alienated and disrespected by peers
Had been arrested for breaking into a van and stealing electronics
Were on probation
Described how to make bombs on web page
Had threatened another student with a gun
Were enamored of the Nazi culture

Slide 26: On the other hand...

Harris and Klebold:

Came from ÒgoodÓ families
Were excellent students and bright

Their probation officers:
"Eric is a very bright young man who is likely to succeed in life. He is intelligent enough to achieve lofty goals as long as he stays on task and remains motivated."

"Dylan is a bright young man who has a great deal of potential. He is intelligent enough to make any dream a reality but he needs to understand hard work is part of it."

"No one can predict lethality. If every murderer looked like Charles Manson, it would be easier. But if they look like Ted Bundy, you're in trouble.Ó
Supervisor of probation officer
Who evaluated Harris and Klebold

Slide 27: Moral of the story

While we cannot predict violence accurately 100% of the time, there are factors that put teens at risk.
We can do things that decrease the probability of violence.
The nature of these interventions are such that almost every child can profit.

Slide 28: What can we do?

Reduce scapegoating and prejudice.
Help all students develop a healthy and realistic self-esteem.
Create primary prevention programs for children at-risk of being abused and intervene early.
Find mentors for all students.
Recognize studentsÕ strengths as well as their weaknesses.
Teach anger management techniques.
Make weapons unavailable.
Identify students with mental health issues and get them help.
Take threats seriously.
Recognize risk factors and get at-risk students help.
Remember our tendency to excuse ÒgoodÓ or quiet kids.

Slide 29: Time to think...

Are there ways that our culture might reduce the emphasis (in the media and elsewhere) on attractiveness?
Do you think this would reduce the frequency of eating disorders? Why or why not?

Slide 30: How do we teach body image?

Slide 31: CultureÕs role in eating disorders

Not found in cultures where access to food is an issue, only where it is plentiful.
In US:

90-95% women, often White, middle-class, living in a competitive environment
low incidence among Blacks, Hispanics, Native Americans

Typical age of onset 16-19
6-8% of college women are bulimic
Increased risk in recent years, increased risk with younger girls
"Typical" anorexic family: Successful, driven, eager to maintain harmony, concerned about appearances

Slide 32: Messages about weight in the media

                                                                                                                   Predicted
                                                      Height               Real Wgt                        Wgt
Paula Abdul                                   5Õ 2Ó                    105                              110
Jennifer Aniston                            5Õ 5 1/2Ó               112                             127.5
Tyra Banks                                    5Õ 11Ó                  125                              155
Halle Berry                                    5Õ 6Ó                    112                              130
Toni Braxton                                 5Õ 2Ó                      98                              110
Mariah Carey                                5Õ 9Ó                     107                             145
Cher                                              5Õ 8 1/2Ó               110                             142.5
Courtney Cox                               5Õ 5Ó                     108                             125
Morgan Fairchild                          5Õ 4Ó                       93                             120
Mia Farrow                                   5Õ 4Ó                     113                             120
Whitney Houston                         5Õ 8Ó                     108                             140
Rosie OÕDonnell                          5Õ 7Ó                     210                             135
Oprah Winfrey                             5Õ7Ó                      150                             135
                                                                                                            National Enquirer, June 16, 1998

Slide 33: Titian's Woman with a mirror (c.1513-1515)

Slide 34: Manet's The surprised nymph (1861)

Slide 35: Renoir's Bathers (1918)

Slide 36: Gucci advertisement

Slide 37: Bulimia nervosa (APA, 1994)

A. recurrent episodes of binge eating characterized by:

(1) eating in a discrete period of time (e.g. within any 2-hour period), an amount of food that is definitely larger than most people would eat during a similar period of time and under similar circumstances and
(2) a sense of lack of control over eating during the episode (e.g. a feeling that one cannot stop eating or control what or how much one is eating);

B. recurrent inappropriate compensatory behavior in order to prevent weight gain, such as self-induced vomiting; misuse of laxatives, diuretics, enemas, or other medications; fasting; or excessive exercise;
C. the binge eating and inappropriate compensatory behaviors both occur, on average, at least twice a week for 3 months;
D. self-evaluation is unduly influenced by body shape and weight;
E. the disturbance does not occur exclusively during episodes of anorexia nervosa.
p. 340

Slide 38: What is a binge?

Feeling of being out of control while eating
More "junk food" than typical (Rosen et al., 1986)
How big?

27% > 2000 cal, 33%< 600 cal
Mn = 1459.
"Nonbinge" episode = 321 cal.

How much is this?

12 oz sweetened ice tea (131 cal) & Hershey's with almonds (230 cal) = 361cal
18 chocolate chip cookies (810 cal) & 4 oz of corn chips (612 cal) = 1422 cal
4 c popcorn with 2T butter (424) & 4 slices Pizza Hut thin crust pizza (820 cal) & Whopper with cheese (730) = 1974

Slide 39: And purging?

Attempts to compensate for binge and weight gain

Laxatives: 15%
Purging: 70-90%
Diuretics (at least occasional): 33%
Fasting
Enemas: 7%
Chew & spit to avoid swallowing: 65%
Exercise

Purgers show more pathology (more binging, higher prevalence of depression and panic across lifespan, higher scores on measures of pathological eating attitudes & behavior)

Slide 40: Medical complications

Most are within 10% of normal weight
Salivary gland enlargement, giving face a "chubby" look
Decay of dental enamel
Menstrual problems
Electrolyte imbalance, causing serious complications including heart attacks and death
Callouses on fingers or back of hands from causing vomiting

Slide 41: Why?

Slide 42: And also...

Slide 43: Anorexia nervosa (APA, 1994)

(A) refusal to maintain body weight at or above a minimally normal weight for age and height (e.g., weight loss leading to maintenance of body weight less than 85% of that expected; or failure to make expected weight gain during period of growth, leading to body weight less than 85% of that expected);
(B) intense fear of gaining weight or becoming fat, even though underweight;
(C) disturbance in the way in which one's body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or denial of the seriousness of the current low body weight;
(D) in postmenarcheal females, amenorrhea, i.e., the absence of at least three consecutive menstrual cycles
(A woman is considered to have amenorrhea if her periods occur only following hormone administration).
p. 339

Slide 44: Anorexia nervosa, cont.

Loss of weight, but low weight may be due to other reasons
Refusal to maintain greater weight
Fear of obesity & attempts to lose weight
Often good at saying the things they believe their doctors want them to say.
Often involuntary clients
Two types:

restrictor
binge/purge -- Small amounts of food in "binge"

More stealing, drug and alcohol use, self-mutilation, variable moods

Slide 45: Important therapeutic issues

Control
Poor discussion of feelings and problems in family
Overconcern with maintaining appearances
Difficulty individuating from family

Slide 46: Medical complications

Amenorrhea
Brittle hair or nails, dry skin
Intolerance of cold, decreased body temperature
Low blood pressure
Downy hair on limbs & side of face
Heart arrhythmias
Slowed bone growth
Anemia
Electrolyte imbalance, causing serious complications including heart attacks and death

Slide 47: Percentage change in bingeing (Agras et al, 1994)

Slide 48: Percentage change in purging (Agras et al, 1994)

Slide 49: Treatments

Cognitive-behavioral therapy

What are triggers for binges and purges?
What are cognitions around stress and eating?
Good response, low to moderate relapse

Antidepressants (SSRIs)

Useful for people with bulimia, but high relapse rates when used alone

Family therapy

Good response. Moderate relapse rates

Most treatments are multimodal, using several approaches in combination

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Last modified October 24, 2001.