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Unformatted text preview: OMITANT PERSONALITY DISORDERS
CONCOMITANT PERSONALITY DISORDERS
Piran, et al 1988 • CLUSTER 1 ( A )
• 0 – 1% of Anorexics and Bulimics
Paranoid, Schizoid, Schizotypal • CLUSTER 2 ( B )
• 2% of Anorexics • 56% of Bulimics
• Borderline, Histrionic, Narcissistic, Antisocial
• CLUSTER 3 ( C )
• 72% of Anorexics
29% of Bulimics
Anxious * Dependent * Avoidant * Compulsive * PassiveAggressive Sexuality, Confusion & Related Challenges
Sexuality, Shame, Guilt, Collusion & Enjoyment Confusion about Bodily Pleasure Indulgence or Avoidance SelfLoathing and Narcissism Dichotomous Thinking & Living Family Dynamics Parent FoodRelated Attitudes Questionnaire
Parent FoodRelated Attitudes Questionnaire
Better Way of Health Consulting, Inc. 1996 •
• 1. I follow a lowfat diet and try to get the rest of my family to do the same. 2. I worry about what other family members eat.
3. I have been on many diets.
4. I frequently talk about food, calories, diets and weight. 5. I frequently talk about recipes and cooking.
6. I try to get other people to eat the way I do.
7. I eat differently when I am alone than I do when I eat with my family.
8. I monitor the weights of family members.
9. I have suggested to family members that they should weigh less or more.
10. Food is used as a reward in our home.
11. Dinnertime is often in front of the TV or on the run.
12. I keep my own secret stash of _____________. (Name the food)
13. I have offered gifts to family members as incentives to lose or gain weight.
14. We have family nicknames that focus on a person’s weight, like “Thunder Thighs” o
We have family nicknames that focus on a person’s weight, like “Thunder Thighs” “Toothpick”.
15. I identify people according to their physical characteristics (the fat one, the skinny g
the pretty girl, and the lady with the big hips).
(continued on handout) Medications
• SSRIs – Prozac, , Paxil, Luvox, Celexa – • Tricylcic Antidepressants
– Imipramine, Norpramine, Elavil, Desipramine • Atypical Antidepressants – Wellbutrin, Effexor, Serzone, Stattera • AntiAnxiety Agents – Buspar, Klonopin, Ativan, Valium • Mood Stabilizers – Lithium, Tegretol, Depakote, Neurontin, Lamictal,
Topomax • Psychostimulants – Concerta, Adderall,Ritalin, Dextroamphetamine • AntiPsychotics – From Thorazine to Geodon Integrated Treatment Approach Multidisciplinary team Multiple orientations & techniques Multiple modalities Treatment is usually longterm (1 – 5 years) May require repeat hospitalization Emergency Treatment
Organic brain syndrome – cognitive interference; disorientation
– changes in consciousness
Bradycardia (HR slower than 40 beats/minute)
Tachycardia (other HR irregularities)
Chest pain Painful muscles spasms
Quickly tired & weak when exerting Low urine output (less than 40 cc / day)
Severe electrolyte imbalance
Rapid unhealthy weight loss (15 lbs in 1 month) Treatment Approaches
Treatment • Interpersonal: Family & Individual Therapy – Reduce social anxiety & Improve social skills
– Family interaction patterns – Relationship to identity & symptoms • InsightOriented – Address historical, developmental issues
– Redefine sense of self from empowered vs victim role • Habit Control: Behavioral Methods
– Realistic goalsetting
Stimulus cue identification
Increase repertoire of selfsoothing/relaxation
Increase availability of alternative reinforcers • Cognitive & Dialectic Behavior Therapy Methods
– Enhance selfregulation skills
Decrease cognitive rigidity Mood Regulation
• Charting mood changes •
• Rate mood on 110 Scale
Keep Mood Log
Cognitive “split voices” lists & associated emotions • Medication • Medication responsibility • Sleep & Eating regulation •
• Keep log of hours slept, time to bed and awake
Note moods associated with patterns
Breakfast is a MUST Treatment Challenges
• Sexual abuse history may not be revealed
for months or years • Concomitant Compulsions/Addictions
– Promiscuity, Drugs, Alcohol • Deception manipulation
• Dissociation – delusional distortions
• Severe anorexia (20% weight loss)
– limits cognitive capacity • Recurrent relapses & hospitalizations “ I am not the same having seen the moon from the other side of the world”
Author unknown http://www.youtube.com/watch?v=DGOuSG9q http://www.health.umd.edu/mentalhealth/eatin
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- Spring '11