Eating, Elimination and Impulse Control Disorders

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EATING, ELIMINATION & IMPULSE-CONTROL

DISORDERS

A. EATING DISORDERSI. Anorexia Nervosa

II. Bulimia NervosaIII. 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 non-

suppression 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

hypothalamuso Dysfunction in 5HT, DA, NE

involved in regulating eating behavior

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 andunacceptableleads to starving oneself

o Oral impregnation

II. 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 disturbancePl d bi l i l i l

Subject: PsychologyTopic: EATING, ELIMINATION & IMPULSE-

CONTROL DISORDERS

Lecturer: Luzviminda S. Katigbak, MD

Date of Lecture: February 01, 2012

Transcriptionists: dj anne

Editor: dj annePages: 3


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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

BIOLOGICALo 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 DISORDERI. EncopresisII. Enuersis Biological etiologies of elimination disorder are

inherent problems with the external sphincters

Psychological etiologies: stress causingregression

I. ENCOPRESIS Defined as repeated involuntary defecation

somewhere other than a toilet by a child agefour or older that continues for at least onemonth.

Bowel control is established by 4-5 y/o

Males 6x more likely than females

II. 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 DISORDERSI. Intermittent Explosive Disorder

II. KleptomaniaIII. PyromaniaIV. Pathological GamblingV. Trichotillomania

VI. Impulse-Control Disorder NOS Definition of Impulse control disorders:

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

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 actionOtto 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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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!

II. 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 theobject

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 excitemento 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

usually 1st

seen by derma and surgeon and

referred to psych

VI. IMPULSE-CONTROL DISORDER NOS

1. Compulsive Buying

2. Internet Compulsion


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Eating, Elimination and Impulse Control Disorders