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PSY205 Keiser University Anorexia Nervosa Questions Response

GRADING OF THE CASE paper Each question is worth 5 points and is graded individually. EACH QUESTION SHOULD BE ANSWERED IN 2 PARAGRAPHS.Sources must be cited, USE AT LEAST 2 OUTSIDE SOURCES. (this included a reference page) in your answers or will receive automatic 0. 5 points for thorough, complete, correct, detailed, insightful answer. Examples from the case are given to illustrate you points. Questions are listed. Sources cited in APA format (this means in-text citations and a reference page). This includes the text where the case studies are as well as your textbook if you use that. 4-3 points for correct, thorough answer. Maybe missing some details or insights or questions not listed. Sources not complete. 2-1 point for cursory, brief answer lacking in some detail. Incomplete in some fashion. 0 for unanswered or incorrectly answered question or no sources cited.*You should use APA format for your paper. IF you are not familiar with APA format- look under “how do I?” and you will see a link to APA format.**I repeat: Be sure to cite all sources!————————-1. What special challenges does anorexia nervosa pose for family relationships?How does it affect patients in their roles as children, spouses, and parents?2. What does anorexia nervosa have in common with substance-abuse disorders?3. A lot of research has focused on the role of the media and standards of beautyand the thin ideal in the etiology of anorexia nervosa. Do you think these fac-tors are improving or worsening? Is there more or less pressure on adolescentgirls and young adult women today to be thin? What about pressures forattractiveness on adolescent boys and young men?4. No treatments have consistently been shown effective with adults with ano-rexia nervosa. If you were a psychologist treating a college student with thedisorder, what treatment approach would you use? Why?PLEASE LOOK AT BOOK PAGES 221-233 IN ORDER TO ANSWER THE QUESTIONS (about anorexia)

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Case Studies
in Abnormal
Psychology
Ninth Edition
Thomas F. Oltmanns
Washington University in St. Louis
Michele T. Martin
Wesleyan College
John M. Neale
State University of New York at Stony Brook
Gerald C. Davison
University of Southern California
John Wiley & Sons, Inc.
ffirs.indd i
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Library of Congress Cataloging-in-Publication Data
Case studies in abnormal psychology / Thomas F. Oltmanns. . . [et al.]. — 9th ed.
p. cm.
Includes bibliographical references and index.
ISBN 978-1-118-08619-3 (pbk.)
1. Psychology, Pathological—Case studies. 2. Psychiatry—Case studies. I. Oltmanns,
Thomas F.
RC465.O47 2012
616.89—dc23
2011039949
Printed in the United States of America
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“To Presley, Riley, and Kinley”
—TFO
“To Matt, Caroline, Grace, and Thomas”
—MTM
“To Gail and Sean”
—JMN
“To Kathleen, Eve, and Asher”
—GCD
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PREFACE
Most textbooks on abnormal psychology include short descriptions of actual
clinical cases. However, those presentations are necessarily brief and too fragmented for students to gain a clear understanding of the unique complexities of
a person’s troubled life. They cannot describe the client’s developmental history, the manner in which a therapist might conceptualize the problem, the formulation and implementation of a treatment plan, or the trajectory of a disorder
over a period of many years. In contrast to such brief descriptions, a detailed
case study can provide a foundation on which to organize important information about a disorder. This enhances the student’s ability to understand and recall
abstract theoretical and research issues.
The purpose of Case Studies in Abnormal Psychology, 9e is therefore threefold: (a) to provide detailed descriptions of a range of clinical problems, (b) to
illustrate some of the ways in which these problems can be viewed and treated,
and (c) to discuss some of the evidence that is available concerning the prevalence and causes of the disorders in question. The book is appropriate for both
undergraduate and graduate courses in abnormal psychology. It may also be useful in courses in psychiatric social work or nursing and could be helpful to students enrolled in various practicum courses that teach how best to conceptualize
mental-health problems and plan treatment. It may be used on its own or as a
supplement to a standard textbook in abnormal psychology.
In selecting cases for inclusion in the book, we sampled from a variety of
problems, ranging from psychotic disorders (e.g., schizophrenia and bipolar
mood disorder) to personality disorders (e.g., paranoid and antisocial) to various disorders of childhood and aging (e.g., attention-deficit/hyperactivity disorder). We focused deliberately on cases that illustrate particular problems that
are of interest to students of abnormal psychology. We do not mean to imply,
however, that all the cases fit neatly into specific diagnostic molds. In addition to
describing “classic” behavioral symptoms (e.g., hallucinations, compulsive rituals, or specific fears), we emphasized the social context in which these disorders
appear as well as life problems that are significant in determining the person’s
overall adjustment, even though they may not be relevant from a diagnostic
v
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vi
Preface
standpoint. For example, our case on hypertension considers issues in etiology
and treatment when the person is African American. Several of the cases include
a consideration of marital adjustment and parent–child relationships.
Our coverage extends to examples of eating disorders, dissociative identity disorder, gender identity disorder, borderline personality, and posttraumatic
stress disorder (following rape). Each of these disorders represents an area that
has received considerable attention in the contemporary literature, and each has
been the focus of theoretical controversy.
We have added one new chapter to this ninth edition. It describes a woman
who experienced terrifying nightmares and an associated sleep paralysis. The new
case provides important coverage of sleep disorders, which affect large numbers
of people and have received increased attention in the professional literature.
Our cognitive-behavioral perspective is clearly evident in most of these case
discussions. Nevertheless, we also present and discuss alternative conceptual
positions. The cases can therefore be used to show students how a given problem can be reasonably viewed and treated from several different perspectives.
Although most of the interventions described illustrate a cognitive-behavioral
approach to treatment, we have also described biological treatments (e.g., medication, electroconvulsive therapy, and psychosurgery) when they are relevant to
the case. In some cases, the outcome was not positive. We have tried to present
an honest view of the limitations, as well as the potential benefits, of various
treatment programs. Note also that three of the cases were not in treatment. We
believe that it is important to point out that many people who have psychological
disorders do not see therapists.
Each case study concludes with a discussion of current knowledge about
causal factors. Some of these discussions are necessarily briefer than others.
More research has been done on schizophrenia, for example, than on gender
identity disorder or paranoid personality disorder. We had two goals in mind for
these discussions. First, we have tried to use the case material to illustrate the
application of research to individual clients’ problems. Second, we alert readers to important gaps in our knowledge of abnormal psychology, our abiding
belief being that realizing what we do not know is as important as appreciating
what we do know. All these discussions have been revised in the ninth edition to
include new ideas and empirical evidence that are changing the way that particular disorders are viewed and treated.
We have included discussions of issues associated with gender, culture, and
ethnicity in all the previous editions of this book. For example, issues of race
and psychotherapy are considered in the case of hypertension. Attention to these
issues, particularly those involving gender, have been strengthened in this ninth
edition. The case on parasomnia (nightmare disorder) also discusses important
issues related to race and gender. Our description of posttraumatic stress disorder following rape trauma includes many issues that are particularly important
for women (e.g., helpful and harmful ways in which other people react to the
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Preface
vii
victim; decisions by the victim, her therapist, and her professor about whether
to report the rapist; and so on). Our discussion of the causes of major depression
includes consideration of possible explanations for gender differences in this disorder. The chapters on dissociative identity disorder and borderline personality
disorder both discuss the impact of prior sexual abuse on subsequent development of psychopathology. Both cases of eating disorder involve extended consideration of cultural attitudes that affect women’s feelings and beliefs about
themselves. These are only a few of the instances in which we have attempted to
address gender issues in relation to the etiology and treatment of mental disorders. We are grateful to Patricia Lee Llewellyn (University of Virginia) for many
helpful comments on these issues.
All the cases in this book are based on actual clinical experience, primarily our own, but, in some instances, that of our colleagues and students. Various
demographic characteristics (names, locations, and occupations) and some concrete clinical details have been changed to protect the anonymity of clients and
their families. In some instances, the cases are composites of clinical problems
with which we have dealt. Our intent is not to put forth claims of efficacy and
utility for any particular conceptualization or intervention but instead to illustrate
the ways clinicians think about their work and implement abstract principles to
help a client cope with life problems. The names used in the case studies are fictitious; any resemblance to actual persons is purely coincidental.
As in the first eight editions of this book, we have not identified the authors
of specific case studies. This procedure has been adopted and maintained to preserve the clients’ anonymity. We are grateful to Amy Bertelson, Serrita Jane,
Ron Thompson, Kevin Leach, and Kimble Richardson, who provided extensive consultation on five of these cases. We also thank Elana Farace and Sarah
Liebman for drafting two others.
We would like to thank the following reviewers for their helpful and constructive comments: Eynav E. Accortt, Wright State University; Dorothy
Bianco, Rhode Island College; Mia Smith Bynum, Purdue University; Bernardo
Carducci, Indiana University Southeast; Ron Evans, Washburn University; Jan
Hastrup, SUNY at Buffalo; Russell Jones, Virginia Polytechnic Institute and
State University; Katherine M. Kitzmann, University of Memphis; Patricia Lee
Llewellyn, University of Virginia; Richard McNally, Harvard University; Janet
Morahan Martin, Bryant College; Linda Musun Miller, University of Arkansas
at Little Rock; Mark Pantle, Baylor University; Esther Rothblum, University
of Vermont; Gary Sterner, Eastern Washington University; Sondra Solomon,
University of Vermont; and John Wixted, University of California–San Diego.
We also want to express our sincere appreciation to the superb staff at
Wiley, especially Eileen McKeever, Associate Editor, Psychology; Christopher
Johnson, Executive Editor, Psychology; Maura Gilligan, Editorial Assistant; and
Yee Lyn Song, Assistant Production Editor. Their conscientious efforts were
essential to the successful completion of this revision.
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viii
Preface
Finally, we remain grateful to our families for their continued love and
encouragement. Gail Oltmanns and Matt Martin have both provided invaluable
support throughout the preparation of this new edition.
Thomas F. Oltmanns
Michele T. Martin
John M. Neale
Gerald C. Davison
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CONTENTS
Preface
1. Obsessive-Compulsive Disorder
2. Panic Disorder with Agoraphobia
3. Posttraumatic Stress Disorder: Rape Trauma
4. Hypertension in an African American Man
5. Dissociative Identity Disorder: Multiple Personality
6. Major Depressive Disorder
7. Bipolar Disorder
8. Somatization Disorder
9. Schizophrenia: Paranoid Type
10. Psychotic Disorder (NOS), Substance Dependence, and Violence
11. Alcohol Dependence
12. Sexual Dysfunction: Female Orgasmic Disorder and Premature
Ejaculation
13. Paraphilias: Exhibitionism and Frotteurism
14. Gender Identity Disorder: Transsexualism
15. Eating Disorder: Anorexia Nervosa
16. Eating Disorder: Bulimia Nervosa
17. Parasomnia: Nightmare Disorder and Isolated Sleep Paralysis
18. Paranoid Personality Disorder
19. Borderline Personality Disorder
20. Antisocial Personality Disorder: Psychopathy
21. Autistic Disorder
22. Attention-Deficit/Hyperactivity Disorder
23. Oppositional Defiant Disorder
References
Index
v
1
17
35
52
68
87
102
115
130
145
159
171
188
202
221
234
251
265
283
297
309
323
336
351
391
ix
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CHAPTER 1
Obsessive-Compulsive Disorder
Karen Rusa was a 30-year-old married woman and the mother of four children.
Although she had been having anxiety-related problems for a number of years,
she had never sought professional help prior to this time. During the preceding
3 months, she had become increasingly depressed; her family physician finally
suggested that she seek psychological services.
For the past several months, Karen had been experiencing intrusive, repetitive thoughts that centered on her children’s safety. She frequently found herself imagining that a serious accident had occurred, and she was unable to put
these thoughts out of her mind. On one such occasion, she imagined that her
son, Alan, had broken his leg playing football at school. There was no reason to
believe that an accident had occurred, but Karen brooded about the possibility
until she finally called the school to see if Alan was all right. Even after receiving reassurance that he had not been hurt, she was somewhat surprised when he
later arrived home unharmed.
Karen also noted that her daily routine was seriously hampered by an extensive series of counting rituals that she performed throughout each day. Specific
numbers had come to have a special meaning to Karen; she found that her preoccupation with these numbers was interfering with her ability to perform everyday activities. One example was grocery shopping. Karen believed that if she
selected the first item (e.g., a box of cereal) on the shelf, something terrible
would happen to her oldest child. If she selected the second item, some unknown
disaster would befall her second child, and so on for the four children. The children’s ages were also important. The sixth item in a row, for example, was associated with her youngest child, who was 6 years old. Thus, specific items had to
be avoided to ensure the safety of her children. Obviously, the rituals required
continuing attention because the children’s ages changed. Karen’s preoccupation
with numbers extended to other activities, most notably the pattern in which she
smoked cigarettes and drank coffee. If she had one cigarette, she believed that
she had to smoke at least four in a row or one of the children would be harmed
in some way. If she drank one cup of coffee, she felt compelled to drink four.
1
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2
Case Studies in Abnormal Psychology
Karen acknowledged the irrationality of these rituals but, nevertheless,
maintained that she felt much more comfortable when she observed them conscientiously. When she was occasionally in too great a hurry to perform the rituals, she experienced considerable anxiety in the form of a subjective feeling of
dread and apprehension. She described herself as tense, jumpy, and unable to
relax during these periods. Her fears were most often confirmed because something unfortunate invariably happened to one of the children within a few days
after each such “failure.” The fact that minor accidents are likely to occur at a
fairly high rate in any family of four children did not diminish Karen’s conviction that she had been directly responsible because of her inability to observe the
numerical rules.
In addition to her obsessive ideas and compulsive behaviors, Karen reported
dissatisfaction with her marriage and problems in managing her children. Her
husband, Tony, had been placed on complete physical disability 11 months prior
to her first visit to the mental health center. Although he was only 32 years old,
Tony suffered from a serious heart condition that made even the most routine
physical exertion potentially dangerous. Since leaving his job as a clerk at a
plumbing supply store, he had spent most of his time at home. He enjoyed lying
on the couch watching television and did so for most of his waking hours. He
had convinced Karen that she should be responsible for all the household chores
and family errands. Her days were spent getting the children dressed, fed, and
transported to school; cleaning; washing; shopping; and fetching potato chips,
dip, and beer whenever Tony needed a snack. The inequity of this situation was
apparent to Karen and was extremely frustrating, yet she found herself unable to
handle it effectively.
The children were also clearly out of her control. Robert, age 6, and Alan,
age 8, were very active and mischievous. Neither responded well to parental discipline, which was inconsistent at best. Both experienced behavioral problems at
school, and Alan was being considered for placement in a special classroom for
particularly disruptive children. The girls were also difficult to handle. Denise,
age 9, and Jennifer, age 11, spent much of their time at home arguing with each
other. Jennifer was moderately obese. Denise teased her mercilessly about her
weight. After they had quarreled for some time, Jennifer would appeal tearfully
to Karen, who would attempt to intervene on her behalf. Karen was becoming
increasingly distressed by her inability to handle this confusing situation, and
she was getting little, if any, help from Tony. During the past several weeks, she
had been spending more and more time crying and hiding alone in her bedroom.
Social History
Karen was raised in New York City by Italian immigrant parents. She was the
first of four children. Her family was deeply religious, and she was raised to be
a devout Roman Catholic. She attended parochial schools from the first grade
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Chapter 1
Obsessive-Compulsive Disorder
3
through high school and was a reasonably good student. Her …

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