Introduction to Psychological Disorders

Defining Psychological Disorders

LOQ: How should we draw the line between normality and disorder?

A psychological disorder is marked by a “clinically significant disturbance in an individual’s cognition, emotion regulation, or behavior”

• These thoughts, emotions, or behaviors are dysfunctional or maladaptive when they interfere with normal day-to-day life

Distress often accompanies such dysfunction. Marc, Greta, and Stuart were all distressed by their thoughts, emotions, or behaviors.

Psychological Disorder: a syndrome marked by a clinically significant disturbance in an individual’s cognition, emotion regulation, or behavior.

Understanding Psychological Disorders

LOQ: How do the medical model and the biopsychosocial approach influence our understanding of psychological disorders?

The Medical Model

Hospitals replaced asylums, and the medical model of mental disorders was born

• Psychopathology needs to be diagnosed on the basis of its symptoms

  • needs to be treated through therapy, which may include time in a psychiatric hospital

Medical Model: the concept that diseases, in this case psychological disorders, have physical causes that can be diagnosed, treated, and, in most cases, cured, often through treatment in a hospital.

The Biopsychosocial Approach

Cultures also differ in their sources of stress and in their traditional ways of coping.

• Disorders reflect genetic predispositions and physiological states, inner psychological dynamics, and social and cultural circumstances

• biopsychosocial approach gave rise to the vulnerability-stress model

  • argues that individual characteristics combine with environmental stressors to increase or decrease the likelihood of developing a psychological disorder

Research on epigenetics  supports the vulnerability-stress model by showing how our DNA and our environment interact.

• In one environment, a gene will be expressed, but in another, it may lie dormant. For some, that will be the difference between developing a disorder or not developing it

Epigenetics: the study of environmental influences on gene expression that occur without a DNA change.

Classifying Disorders—and Labeling People

LOQ: How and why do clinicians classify psychological disorders, and why do some psychologists criticize the use of diagnostic labels?

In the United States, the most common tool for describing disorders and estimating how often they occur is the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-5)

• Physicians and mental health workers use the detailed “diagnostic criteria and codes” in the DSM-5 to guide medical diagnoses and treatment

• The DSM-5 is very close to the WHOs ICD (International Classification of Disease)

  • This makes it easy to track psychological disorders

Critics have long faulted the DSM for casting too wide a net and bringing “almost any kind of behavior within the compass of psychiatry”

• Ex. the DSM has broadened the diagnostic criteria for attention-deficit/hyperactivity disorder (ADHD)

DSM-5: the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition; a widely used system for classifying psychological disorders.

Attention-Deficit/Hyperactivity Disorder (ADHD): a psychological disorder marked by extreme inattention and/or hyperactivity and impulsivity

Does Disorder Equal Danger?

LOQ:  Do psychological disorders predict violent behavior?

Rates of Psychological Disorders

LOQ: How many people have, or have had, a psychological disorder? Is poverty a risk factor?

What increases vulnerability to mental disorders?

• there is a wide range of risk and protective factors for mental disorders

  • Poverty is a big indicator for mental disorders

At what times of life do disorders strike?

• Over 75 percent of people with any disorder have experience their first symptoms by age 24

  • Earliest symptoms of antisocial personality disorder (median age 8) and phobias (median age 10)

  • Alcohol use disorder, obsessive-compulsive disorder, bipolar disorder, and schizophrenia symptoms appear at a median age near 20.

  • Major depressive disorder symptoms start at a median age of 25

Anxiety Disorders, OCD, and PTSD

Anxiety Disorders

LOQ: How do generalized anxiety disorder, panic disorder, and phobias differ?

Anxiety disorders are marked by distressing, persistent anxiety or by dysfunctional anxiety-reducing behaviors

• Ex. people with social anxiety disorder become extremely anxious in social settings where others might judge them

There are several different types of other anxiety disorder

• Generalized anxiety disorder, in which a person is unexplainably and continually tense and uneasy

• Panic disorder, in which a person experiences panic attacks—sudden episodes of intense dread—and fears the next episode’s unpredictable onset

• Phobias, in which a person is intensely and irrationally afraid of a specific object, activity, or situation.

Anxiety Disorders: psychological disorders characterized by distressing, persistent anxiety or maladaptive behaviors that reduce anxiety

Generalized Anxiety Disorder

Generalized anxiety disorder is marked by excessive and uncontrollable worry that lasts for six months or longer

• ⅔ of people with this disorder are women

• They are often jittery, agitated, sleep-deprived, and become fixated on potential threats

Generalized Anxiety Disorder: an anxiety disorder in which a person is continually tense, apprehensive, and in a state of autonomic nervous system arousal.

Panic Disorder

Panic attack is described as repeated panic attacks, with symptoms such as irregular heartbeat, shortness of breath, and dizziness

• 3% of the population has panic disorder

• Smokers have at least a doubled risk of panic disorder and have more severe symptoms during attacks

Panic Disorder: an anxiety disorder marked by unpredictable, minutes-long episodes of intense dread in which a person may experience terror and accompanying chest pain, choking, or other frightening sensations; often followed by worry over a possible next attack.

Phobias

People with phobias are consumed by a persistent, irrational fear and avoidance of some object, activity, or situation.

• Many people avoid the triggers (such as high places) that arouse their fear, and they manage to live with their phobia

Phobia: an anxiety disorder marked by a persistent, irrational fear and avoidance of a specific object, activity, or situation.

Obsessive-Compulsive Disorder (OCD)

LOQ: What is OCD?

Obsessive-compulsive disorder (OCD) are behaviors we can see within anxiety disorder

• Obsessive thoughts are unwanted and so repetitive it may seem they will never go away.

• Compulsive behaviors are responses to those thoughts

Some people experience other OCD-related disorders such as

• Hoarding disorder

• Body dysmorphic disorder

• Trichotillomania

• Excoriation disorder

Obsessive-Compulsive Disorder (OCD): a disorder characterized by unwanted repetitive thoughts (obsessions), actions (compulsions), or both.

Post Traumatic Stress Disorder (PTSD)

LOQ: What is PTSD?

Survivors of accidents, disasters, and violent and sexual assaults have also experienced PTSD symptoms

• Some psychologists believe that PTSD has been overdiagnosed

Posttraumatic Stress Disorder (PTSD): a disorder characterized by haunting memories, nightmares, hypervigilance, social withdrawal, jumpy anxiety, numbness of feeling, and/or insomnia that lingers for four weeks or more after a traumatic experience

Understanding Anxiety Disorders, OCD, and PTSD

LOQ: How do conditioning, cognition, and biology contribute to the feelings and thoughts that mark anxiety disorders, OCD, and PTSD?

Conditioning

Through classical conditioning, our fear responses can become linked with formerly neutral objects and events.

• research helps explain why anxious or traumatized people learn to associate their anxiety with certain cues

Even a single painful and frightening event may trigger a full-blown phobia, thanks to two conditioning processes

• classical conditioning’s stimulus generalization and operant conditioning’s reinforcement.

Stimulus generalization occurs when a person experiences a fearful event and later develops a fear of similar events.

Reinforcement helps maintain learned fears and anxieties. Anything that enables us to avoid or escape a feared situation can reinforce maladaptive behaviors.

Cognition

Conditioning influences our feelings of anxiety, but so does cognition—our thoughts, memories, interpretations, and expectations.

• By observing others, we can learn to fear what they fear

• past experiences shape our expectations and influence our interpretations and reaction

  • People with anxiety disorders tend to be hypervigilant.

Biology

Genes

Fearfulness runs in families, and so does anxiety

• Some genes influence disorders by regulating brain levels of neurotransmitters

  • This include serotonin and glutamate

• experience affects gene expression.

  • a history of child abuse leaves long-term epigenetic marks

The Brain

Our experiences change our brain, paving new pathways

• Traumatic fear-learning experiences can leave tracks in the brain, creating fear circuits

Generalized anxiety disorder, panic attacks, phobias, OCD, and PTSD express themselves biologically as overarousal of brain areas involved in impulse control and habitual behaviors

• These disorders reflect a brain danger-detection system gone hyperactive—producing anxiety when no danger exists

Natural Selection

We seem biologically prepared to fear threats faced by our ancestors.

• Ex. phobias such as spiders, snakes, and heights

Compare our easy-to-learn fears with those we do not easily learn.

• our phobias focus on dangers faced by our ancestors, our compulsive acts typically exaggerate behaviors that contributed to our species’ survival

• natural selection shaped our behaviors, when taken to an extreme, these behaviors can interfere with daily life.

Depressive Disorders, Bipolar Disorder, Suicide, and Self-Injury

LOQ: How do major depressive disorder, persistent depressive disorder, and bipolar disorder differ?

Major Depressive Disorder

Major depressive disorder occurs when at least five signs of depression last two or more weeks

• These signs include depressed mood or loss of interest or pleasure

Adults diagnosed with persistent depressive disorder (also called dysthymia) experienced a mildly depressed mood more often than not for two years or more and also display at least two of the following

• Difficulty with decision making and concentration

• Feeling hopeless Poor self-esteem

• Reduced energy levels

• Problems regulating sleep

• Problems regulating appetite

Major Depressive disorder: a disorder in which a person experiences, in the absence of drugs or another medical condition, two or more weeks with five or more symptoms, at least one of which must be either (1) depressed mood or (2) loss of interest or pleasure

Bipolar Disorder

In bipolar disorder, people bounce from one emotional extreme to the other (week to week, rather than day to day or moment to moment

• When a depressive episode ends, a euphoric, overly talkative, wildly energetic, and extremely optimistic state called mania follow

During manic episodes, they typically have little need for sleep, show fewer sexual inhibitions, and positive emotions persistent

Bipolar disorder is much less common the major depressive disorder but it is often more dysfunctional

• The DSM-5 classifications have begun to to reduce the number of child and adolescent bipolar diagnoses

  • Some people who are persistently irritable and who have frequent and recurring behavior outbursts are now instead diagnosed with disruptive mood dysregulation disorder

Bipolar Disorder: a disorder in which a person alternates between the hopelessness and lethargy of depression and the overexcited state of mania. (Formerly called manic-depressive disorder.)

Mania: a hyperactive, wildly optimistic state in which dangerously poor judgment is common.

Understanding Depressive Disorders and Bipolar Disorder

LOQ: How can the biological and social-cognitive perspectives help us understand depressive disorders and bipolar disorder?

One research group summarized that any their of depression needs to explain

• Behavioral and cognitive changes accompany depression. People trapped in a depressed mood become inactive and feel alone, empty, and without a bright or meaningful future

• Depression is widespread. Worldwide, 350 million people have major depressive disorder and 60 million people have bipolar disorder

• Women’s risk of major depressive disorder is nearly double men’s. In 2009, when Gallup pollsters asked more than a quarter-million Americans if they had ever been diagnosed with depression, 13 percent of men and 22 percent of women said they had

• Most major depressive episodes self-terminate. Therapy often helps and tends to speed recovery. But even without professional help, most people recover from depression and return to normal.

• Stressful events related to work, marriage, and close relationships often precede depression. As anxiety is a response to the threat of future loss, depression is often a response to past and current stress.

• Compared to generations past, depression strikes earlier (now often in the late teens) and affects more people, with the highest rates among young adults in developed countries.

The Biological Perspective

Genetic Influences

Compared to generations past, depression strikes earlier (now often in the late teens) and affects more people, with the highest rates among young adults in developed countries.

• The risk of being diagnosed with one of these disorders increases if your parent or sibling has the disorder

Researchers have turned to linkage analysis

• geneticists find families in which the disorder appears across several generations

• Then researchers examine DNA from affected and unaffected family members, looking for differences

• Linkage analysis points them to a chromosome neighborhood

The Depressed Brian

Many studies have found diminished brain activity during slowed-down depressive states, and more activity during periods of mani

• Depression can cause the brain’s reward centers to become less active

• During positive emotions, the left frontal lobe and an adjacent reward center become more active

Neuroscientists have also discovered altered brain structures in people with bipolar disorder

• These studies found decreased white matter (myelinated axons) and enlarged fluid-filled ventricles

Neurotransmitter systems also influence depressive disorders and bipolar disorder.

• Norepinephrine, which increases arousal and boosts mood, is scarce during depression and overabundant during mania

• Serotonin is also scarce or inactive during depression

Nutritional Effects

What’s good for the heart is also good for the brain and mind

• Excessive alcohol use also correlates with depression, partly because depression can increase alcohol use but mostly because alcohol misuse leads to depression

The Social-Cognitive Perspective

Biological influences contribute to depression

• Diet, drugs, stress, and other environmental influences lay down epigenetic marks

Depressed people magnify bad experiences and minimize good ones

• self-defeating beliefs and their negative explanatory style feed their depression

Negative Thoughts, Negative Moods, and Gender

Women respond more strongly to stress

• The gender stress difference explains why beginning in their early teens, women have been nearly twice as vulnerable to depression.

• Relentless and self-focused rumination can distract us, increase negative emotion, and disrupt daily activity

  • Comparisons can also feed misery

Self-defeating beliefs may arise from learned helplessness

• Pessimistic, overgeneralized, self-blaming attributions may create a depressing sense of hopelessness

Rumination: compulsive fretting; overthinking our problems and their causes.

Depression's Vicious Cycle

Depression is both a cause and an effect of stressful experiences

• Theses distractions can lead to brooding, which amplifies negative feelings

Depression is usually consisted of

• Stressful experiences

• Negative explanatory style

• Depressed mood

• Cognitive and behavioral changes

Suicide and Self-Injury

LOQ: What factors increase the risk of suicide, and what do we know about nonsuicidal self-injury?

Researches have found a pattern when comparing suicide rates of different groups

• national differences: In Britain, Italy, and Spain, suicide rates have been little more than half those of Canada, Australia, and the United States. Austria’s and Finland’s are about double

• racial differences: Within the United States, Whites and Native Americans kill themselves twice as often as Blacks, Hispanics, and Asian

• gender differences: Women are much more likely than men to attempt suicide. But men are two to four times more likely (depending on the country) to actually end their lives

• age differences and trends: In late adulthood, rates increase, with the highest rate among 45- to 64-year-olds and the second-highest among those 85 and older

• other group differences: Suicide rates have been much higher among the rich, the nonreligious, and those single, widowed, or divorced

• day of the week and seasonal differences: Negative emotion tends to go up midweek, which can have tragic consequences

Nonsuicidal Self-Injury

Self-harm takes many forms

• This includes nonsuicidal self-injury (NSSI)

  • This is more common in adolescence and females

  • Some forms of this include burning, hitting, inserting objects into nails or skin, or tattooing themselves

There are several reasons people self injure

• find relief from intense negative thoughts through the distraction of pain.

• attract attention and possibly get help.

• relieve guilt by punishing themselves.

• get others to change their negative behavior (bullying, criticism).

• fit in with a peer group.

Schizophrenia

People with schizophrenia live in a private inner world, preoccupied with the strange ideas and images that haunt them.

• “Schizo” means split and “phrenia” means mind

  • It doesn't refer t to a multiple personality split but rather to the mind’s split from reality

Schizophrenia is the chief example of a psychotic disorder

Schizophrenia: a disorder characterized by delusions, hallucinations, disorganized speech, and/or diminished, inappropriate emotional expression.

Psychotic Disorders: a group of disorders marked by irrational ideas, distorted perceptions, and a loss of contact with reality

Symptoms of Schizophrenia

LOQ: What patterns of perceiving, thinking, and feeling characterize schizophrenia?

Schizophrenia comes in varied forms

• symptoms that are positive (inappropriate behaviors are present)

  • Those with positive symptoms may experience hallucinations, talk in disorganized and deluded ways, and exhibit inappropriate laughter, tears, or rage

• negative (appropriate behaviors are absent).

  • Those with negative symptoms may have toneless voices, expressionless faces, or mute and rigid bodies.

Disturbed Perceptions and Beliefs

People with schizophrenia sometimes have hallucinations

• They might see, feel, taste, smell things, or most often hear voices only on their mind

Hallucinations are false perceptions

• People with schizophrenia also have delusions

  • If they have paranoid tendencies, they may believe they are being threatened or pursued.

  • Selective attention is a cause of disorganized thinking

Delusion: a false belief, often of persecution or grandeur, that may accompany psychotic disorders.

Disorganized Speech

Jumbled ideas may make no sense even within sentences, forming what is known as word salad.

Diminished and Inappropriate Emotions

Expressed emotions of schizophrenia are often utterly inappropriate, split off from reality

• with schizophrenia lapse into an emotionless flat affect state of no apparent feeling

• Most also have an impaired theory of mind

• those with schizophrenia struggle to feel sympathy and compassion

People with schizophrenia may experience catatonia, characterized by motor behaviors ranging from a physical stupo including

• remaining motionless for hours

• senseless, compulsive actions

• severe and dangerous agitation

Onset and Development of Schizophrenia

LOQ: How do chronic schizophrenia and acute schizophrenia differ?

Slow developing schizophrenia is called chronic schizophrenia

• Recovery is not often achievable

• People with this typically withdrawal, a negative symptom, is often found among those with chronic schizophrenia

People develop schizophrenia rapidly following particular life stresses is called acute schizophrenia

• They more often have positive symptoms that respond to drug therapy

Chronic Schizophrenia: (also called process schizophrenia) a form of schizophrenia in which symptoms usually appear by late adolescence or early adulthood. As people age, psychotic episodes last longer and recovery periods shorten.

Acute Schizophrenia: (also called reactive schizophrenia) a form of schizophrenia that can begin at any age, frequently occurs in response to an emotionally traumatic event, and has extended recovery periods.

Understanding Schizophrenia

Brain Abnormalities

LOQ: What brain abnormalities are associated with schizophrenia?

Scientists are searching for blood proteins that might predict schizophrenia onset and are tracking the mechanisms by which chemicals produce hallucinations and other symptoms.

Dopamine Overactivity

researchers examined schizophrenia patients’ brains after death

• They found an excess number of dopamine receptor

  • With hyper-responsive dopamine system may intensify brain signals in schizophrenia, creating positive symptoms such as hallucinations and paranoia

Abnormal Brain Activity and Anatomy

Some people diagnosed with schizophrenia have abnormally low brain activity in the frontal lobes

• Brian scans also show a noticeable decline in the brain waves that reflect synchronized neural firing in the frontal lobes

• The greater the brain shrinkage, the more severe the thought disorder

Schizophrenia involves not one isolated brain abnormality but problems with several brain regions and their interconnections

Prenatal Environment and Risk

LOQ: What prenatal events are associated with increased risk of developing schizophrenia?

Some scientist think that brain abnormalities occur during prenatal development or delivery

• Risk factors include low birth weight, maternal diabetes, older paternal age, and oxygen deprivation during delivery, as well as famine

Genetic Factors

LOQ: How do genes influence schizophrenia? What factors may be early warning signs of schizophrenia in children?

Fetal-virus infections may increase the odds that a child will develop schizophrenia

Scientists from 35 countries pooled data from the genomes of 37,000 people with schizophrenia and 113,000 people without

• They found 103 genome locations linked with this disorder

  • Some genes influence the effects of dopamine and other neurotransmitters in the brain. Others affect the production of myelin, a fatty substance that coats the axons of nerve cells and lets impulses travel at high speed through neural networks.

Environmental Triggers for Schizophrenia

researchers have compared the experiences of high-risk children and identified other possible early warning signs, including a mother whose schizophrenia was severe and long lasting

• This includes birth complications, separation from parents, short attention span and poor muscle coordination; disruptive or withdrawn behavior; emotional unpredictability; poor peer relations and solo play; and childhood physical, sexual, or emotional abuse

Dissociative, Personality, and Eating Disorder

Dissociative Disorders

LOQ: What are dissociative disorders, and why are they controversial?

Dissociative disorders, in which a person’s conscious awareness dissociates (separates) from painful memories, thoughts, and feelings

• This may be cause by fugue state, a sudden loss of memory or change in identity, often in response to an overwhelmingly stressful situation

Dissociation itself is not so rare

• When we face trauma, dissociative detachment may protect us from being overwhelmed by emotion.

Dissociative Disorders: controversial, rare disorders in which conscious awareness becomes separated (dissociated) from previous memories, thoughts, and feelings.

Dissociative Identity Disorder

Dissociative identity disorder (DID—formerly called multiple personality disorder) is when two or more distinct identities—each with its own voice and mannerisms—seem to control a person’s behavior at different times

• People with DID are rarely violent but have been reported of dissociations into a “good” and a “bad”

Dissociative Identity Disorder (DID): a rare dissociative disorder in which a person exhibits two or more distinct and alternating personalities. (Formerly called multiple personality disorder.)

Understanding Dissociative Identity Disorder

Skeptics questions DID and thought that instead of being a real disorder, DID could be an extension of our normal capacity for personality shifts

• They find it suspicious that the disorder has such a short and localized history

Other researchers and clinicians believe DID is a real disorder. They cite findings of distinct body and brain states associated with differing personalities

• Abnormal brain anatomy and activity can also be apart of DID

Both the psychodynamic and learning perspectives have interpreted DID symptoms as ways of coping with anxiety

• Some people include dissociative disorders under the umbrella of posttraumatic stress disorder as a protective response to traumatic experiences during childhood such as being physically, sexually, or emotionally abused

Personality Disorders

LOQ: What are the three clusters of personality disorders? What behaviors and brain activity characterize the antisocial personality?

The ten disorders in DSM-5 tend to form three clusters, characterized by

• anxiety, such as a fearful sensitivity to rejection that predisposes the withdrawn avoidant personality disorder.

• eccentric or odd behaviors, such as the emotionless disengagement of schizotypal personality disorder.

• dramatic or impulsive behaviors, such as the attention-getting borderline personality disorder, the self-focused and self-inflating narcissistic personality disorder, and—what we next discuss as an in-depth example— the callous, and often dangerous, antisocial personality disorder.

Personality Disorders: inflexible and enduring behavior patterns that impair social functioning.

Antisocial Personality Disorder

People with antisocial personality disorder, usually male, can display symptoms by age 8

• lack of conscience becomes plain before age 15, as they begin to lie, steal, fight, or display unrestrained sexual behavior

• People with antisocial personality disorder (sometimes called sociopaths or psychopaths) may show lower emotional intelligence

Antisocial Personality Disorder: a personality disorder in which a person (usually a man) exhibits a lack of conscience for wrongdoing, even toward friends and family members; may be aggressive and ruthless or a clever con artist.

Understanding Antisocial Personality Disorder

Antisocial personality disorder is woven of both biological and psychological strands

• Molecular geneticists have identified some specific genes that are more common in those with antisocial personality disorder

Genetic influences, often in combination with negative environmental factors such as childhood abuse, family instability, or poverty, help wire the brain

• people with antisocial criminal tendencies, the emotion-controlling amygdala is smaller

• The frontal lobe is less active

Everything psychological is also biological.

Eating Disorders

LOQ: What are the three main eating disorders, and how do biological, psychological, and social-cultural influences make people more vulnerable to them?

There are three definitive eating disorder:

• Anorexia nervosa typically begins as a weight-loss diet. People with anorexia—usually female adolescents, but some women, men, and boys as well—drop significantly below normal weight. Yet they feel fat, fear being fat, diet obsessively, and sometimes exercise excessively. About half of those with anorexia display a binge-purge-depression cycle.

• Bulimia nervosa, unlike anorexia, is marked by weight fluctuations within or above normal ranges, making the condition easy to hide. Bulimia may also be triggered by a weight-loss diet, broken by gorging on forbidden foods. People with this disorder—mostly women in their late teens or early twenties (but also some men)—eat in spurts, sometimes influenced by negative emotion or by friends who are bingeing

• Those with binge-eating disorder engage in significant bouts of overeating, followed by remorse. But they do not purge, fast, or exercise excessively and thus may be overweight

anorexia nervosa: an eating disorder in which a person (usually an adolescent female) maintains a starvation diet despite being significantly underweight; sometimes accompanied by excessive exercise.

bulimia nervosa: an eating disorder in which a person’s binge eating (usually of high-calorie foods) is followed by inappropriate weight-loss promoting behavior, such as vomiting, laxative use, fasting, or excessive exercise.

binge-eating disorder: significant binge-eating episodes, followed by distress, disgust, or guilt, but without the compensatory behavior that marks bulimia nervosa.

Understanding Eating Disorders

Eating disorders are not a telltale sign of childhood sexual abuse

• Those with eating disorders often have low self-evaluations, set perfectionist standards, fret about falling short of expectations, and are intensely concerned with how others perceive them

Those with eating disorders often have low self-evaluations, set perfectionist standards, fret about falling short of expectations, and are intensely concerned with how others perceive them

• Data from 15 studies indicate that having a gene that reduces available serotonin adds 30 percent to a person’s risk of anorexia or bulimia

eating disorders also have cultural and gender components

• Ideal shapes vary across culture and time.

• In countries with high rates of poverty— where plump means prosperous and thin can signal poverty or illness— bigger often seems better

• Bigger less often seems better in Western cultures where eating disorders in the last half of the twentieth century coincided with a dramatic increase in women having a poor body image

There is, however, more to body dissatisfaction and anorexia than media effects

• Peer influences, such as teasing, also matter. Nevertheless, the sickness of today’s eating disorders stems in part from today’s weight-obsessed culture that motivates millions of women to diet constantly

Most people diagnosed with an eating disorder do improve

• 2 in 3 women with anorexia nervosa or bulimia nervosa had recovered

It’s also possible to prevent people from developing these disorders

• Interactive programs that teach people (especially girls over age 15) to accept their bodies reduce the likelihood of an eating disorder