1. Psychological Compromises of Physical Health Behavioral Medicine- interdisciplinary approach to the treatment of physical disorders thought to have psychosocial factors as major aspect in their maintenance and causation Psychogenic Illness- psychologically induced or maintained disease

2. Cardiovascular Disease The Psychological Contribution Historically viewed as related to Type A Historically viewed as related to Type A Excessive, Competitive Drive, Impatience, Time Urgency, Hostility or Free Floating Anger. Currently Hostility Viewed as Major Contributor Currently Hostility Viewed as Major Contributor Free-Floating (non-specific, cynically distrustful) Possible Association with Status Insecurity Changing ones emotional style can reduce risk. Changing ones emotional style can reduce risk.

3. Eating Disorders High Frequency of comorbidity Depression, Addiction, Restricting Types of Obsessive Compulsive Disorder Depression, Addiction, Restricting Types of Obsessive Compulsive Disorder Significant increase in disorder appears to be due in part to societies “ideal body” focus Significant increase in disorder appears to be due in part to societies “ideal body” focus Prevalence estimates are 4% Prevalence estimates are 4%

4. Anorexia Nervosa Anorexia Nervosa Criteria Intense fear of gaining weight Intense fear of gaining weight Refusal to maintain adequate nutrition Refusal to maintain adequate nutrition Loss of original body weight (85%) Loss of original body weight (85%) Disturbance of body image Disturbance of body image Absence of 3 menstrual periods Absence of 3 menstrual periods Subtypes are restricting and Binge- eating/Purging Subtypes are restricting and Binge- eating/Purging

5. Bulimia Nervosa Criteria include Frequent occurrence of binge eating with a sense of loss of control of the overeating process Frequent occurrence of binge eating with a sense of loss of control of the overeating process Recurrent inappropriate behavior intended to prevent weight gain Recurrent inappropriate behavior intended to prevent weight gain Purgatives, exercise, thyroid meds Freq 1-2 times per week for 3 mos Freq 1-2 times per week for 3 mos Undue concern of body image Undue concern of body image

6. Bulimia Nervosa (cont) Subtypes include purging (usually more severe) and nonpurging Compared to the denial and complacency of anorexia nervosa, the bulimic is preoccupied with control. Lack of leads to guilt etc. Eating Disorder Not Otherwise Specified

7. General Causal Factors Self-Ideal Body Image Discord Average body weight of women have increased while icons have decreased at same rate Average body weight of women have increased while icons have decreased at same rate Biological Factors Set point theory (drives hunger) Set point theory (drives hunger) Psychopathological Vulnerability Personality Neuroticism Personality Neuroticism Dysfunctional Cognitive Styles

8. Specific Risk and Causal Factors Personality Characteristics Highly emotionally reserve and cognitively restrictive Highly emotionally reserve and cognitively restrictive Prefer routine, predictable, and adapt poorly to change Prefer routine, predictable, and adapt poorly to change Show heightened conformity Show heightened conformity Avoid risk and experience strong feelings of distress Avoid risk and experience strong feelings of distress Focus excessively on perfectionism Focus excessively on perfectionism

9. Specific Causal (cont) Family Patterns Mothers as overbearing, controlling, ambivalent with affection Mothers as overbearing, controlling, ambivalent with affection Fathers as emotional absentees Fathers as emotional absentees Limited tolerance of disharmonious affect Limited tolerance of disharmonious affect Emphasis on rule-mindedness Emphasis on rule-mindedness Overdirection and Autonomy restrictive Overdirection and Autonomy restrictive Poor conflict resolution skills Poor conflict resolution skills Double messages (bulimic) Double messages (bulimic)

10. Treatment of Eating Dis. Anorexia Nervosa Stabilize the Patient Stabilize the Patient CBT CBT Bulimia Nervosa CBT CBTNormalize Replace Binge and Purge (Smaller Portions) Scheduled Diet Change Dysfunctional Thought Patterns