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Chapter 9: Eating Disorders and Obesity Multiple-Choice Questions 1. Which of the following accounts for more morbidity and mortality than all eating disorders combined? a. anorexia nervosa b. bulimia nervosa c. binge-eating disorder d. obesity Answer: d. obesity 2. Which of the following is not a condition found in the DSM? a. Anorexia nervosa b. Bulimia nervosa c. Binge-eating disorder d. Obesity Answer: d. obesity 3. Which of the following is a controversial aspect of the diagnostic criteria for anorexia nervosa? a. refusal to maintain normal body weight b. distorted perception of body size and shape c. amenorrhea d. denial Answer: c. amenorrhea 4. Which of the following is characteristic of the binge-eating/purging type of anorexia? a. the use of laxatives b. 30 to 50 percent of those who begin by binge-eating and purging become restricting type anorexics c. body weight is within normal range d. efforts to restrict food intake Answer: a. the use of laxatives 5. Andrea has anorexia nervosa, restricting type. Which of the following behaviors would you expect her to have? a. self-induced vomiting b. cutting up her food into little pieces when she eats c. normal menstrual periods d. occasional bouts of overeating Answer: b. cutting up her food into little pieces when she eats 6. Cindy is 5 “6” tall and weighs 92 pounds. She is very concerned about her weight. However, at times she finds herself eating large amounts of food - several boxes of cookies, gallons of ice cream, entire cakes - all in an evening. Afterwards, she makes herself throw up. Cindy's most likely diagnosis is a. bulimia nervosa, purging type. b. anorexia nervosa, binge-eating/purging type. c. anorexia nervosa, restricting type. d. no disorder. Answer: b. anorexia nervosa, binge-eating/purging type. 7. Which of the following is a potential consequence of anorexia nervosa? a. memory loss b. excessive hair growth c. hearing and vision impairment d. death Answer: d. death 8. How do you distinguish between the binge-eating/purging type of anorexia nervosa and bulimia nervosa, purging type? a. The bulimic type involves throwing up, and the anorexic type involves fasting. b. Altered eating and exercise habits result in missed periods in the bulimic type only. c. The bulimic type results in more severe health consequences than the anorexic type. d. People with the bulimic type are normal weight, people with the anorexic type are underweight. Answer: d. People with the bulimic type are normal weight, people with the anorexic type are underweight. 9. Which of the following do those with anorexia nervosa and bulimia nervosa have in common? a. fear of being or becoming fat b. a sense of control c. below normal weight d. restricted eating Answer: a. fear of being or becoming fat 10. In order to make a diagnosis of bulimia nervosa, the client must a. have a distorted body image. b. not meet the criteria for anorexia nervosa. c. have missed three consecutive menstrual periods. d. admit that she has a problem. Answer: b. not meet the criteria for anorexia nervosa. 11. Someone who binges and purges and is severely underweight is diagnosed as anorexic, not bulimic. Treating physicians must be precise with this diagnosis because a. the patient will eventually stop bingeing and purging and start fasting. b. anorexia is considered the more reliable diagnosis. c. anorexia has a much higher death rate than bulimia. d. bingeing and purging are not considered very important symptoms. Answer: c. anorexia has a much higher death rate than bulimia. 12. Elena binges on high calorie foods and then makes herself throw up. She feels terribly ashamed and horrified by what she does. You would predict a. she will stop making herself throw up because she is ashamed and distressed. b. she will not stop because her vomiting is reinforced by reducing her fear of gaining weight. c. she will stop because her vomiting is being punished by the feelings of disgust and shame. d. she will not stop because she has become physiologically addicted to vomiting. Answer: b. she will not stop because her vomiting is reinforced by reducing her fear of gaining weight. 13. The mindset of people with bulimia and people with anorexia a. is basically the same. b. is very different - people with anorexia eventually become satisfied with their weight loss and people with bulimia never do. c. is very different - people with bulimia don't seem bothered by other people's opinion (usually distress) about them and people with anorexia are very concerned and will do their best to hide their disorder. d. is very different - people with anorexia don't seem bothered by other people's opinion (usually distress) about them and people with bulimia are very concerned and will do their best to hide their disorder. Answer: d. is very different - people with anorexia don't seem bothered by other people's opinion (usually distress) about them and people with bulimia are very concerned and will do their best to hide their disorder. 14. The text presented the case of Catherine, a woman with bulimia nervosa. She is typical of such individuals because she a. had suffered few health problems. b. had few thoughts of food except when she was eating. c. experienced shame, guilt, and self-deprecation. d. did not realize that her eating habits were abnormal. Answer: c. experienced shame, guilt, and self-deprecation. 15. Callie and Raquel both have problems with binging and purging. They both eat large evening meals and both then purge what they have eaten. Callie engages in this three to four times a week, and Raquel does so once a week on Sundays. What would be the diagnosis for each of these individuals? a. Callie’s diagnosis would be bulimia nervosa; Raquel does not meet DSM criteria. b. Callie’s diagnosis would be anorexia nervosa; Raquel does not meet DSM criteria. c. Callie’s diagnosis would be bulimia nervosa; Raquel’s diagnosis would be anorexia nervosa. d. Callie’s diagnosis would be bulimia nervosa; Raquel’s diagnosis would be bulimia nervosa. Answer: d. Callie’s diagnosis would be bulimia nervosa; Raquel’s diagnosis would be bulimia nervosa. 16. In her mid-thirties, Cheryl became preoccupied with her weight and began dieting and exercising. After losing a substantial amount of weight, she was still not happy with how she looked and continued to restrict her food intake. After several fainting spells resulting from her low calorie intake, her employer referred her to a clinician who recognized the signs of anorexia nervosa. Which of the following is unique about Cheryl's case? a. Eating disorders rarely start during the mid-thirties. b. The likelihood of anorexia being so readily recognized and diagnosed is slim. c. Few women with anorexia exercise. d. A diagnosis of anorexia is rarely made before the condition becomes life-threatening. Answer: a. Eating disorders rarely start during the mid-thirties. 17. Which of the following has been identified as a risk factor for eating disorders in men? a. heterosexuality b. bicycling c. homosexuality d. painting Answer: c. homosexuality 18. Felicia has been diagnosed with bulimia nervosa with purging. We should expect that she a. purges only once every few years b. is unconcerned about becoming fat. c. experiences electrolyte imbalances and mineral deficiencies. d. is less than 85 percent of normal body weight but still considers herself "fat." Answer: c. experiences electrolyte imbalances and mineral deficiencies. 19. Lanugo a. is a soft hair that grows on the body of people with anorexia. b. is another name for an eating binge. c. is the term for the stopping of a woman's menstrual periods. d. is the lack of concern people with anorexia show about their condition. Answer: a. is a soft hair that grows on the body of people with anorexia. 20. A common sign of bulimia nervosa is a. lanugo. b. intolerance to cold. c. kidney failure. d. damaged teeth and mouth ulcers. Answer: d. damaged teeth and mouth ulcers. 21. Ellen is underweight but not less than 85 percent of normal body weight. She often restricts her eating because she is intensely fearful of becoming fat. She purges at least twice a week, even though she does not eat large amounts of food at any sitting. According to the DSM-5 she should be diagnosed a. with anorexia nervosa, binge/purge subtype. b. with eating disorder not otherwise specified. c. with binge eating disorder. d. with purging disorder. Answer: d. with purging disorder. 22. Delilah is overweight. She likes to eat cookies and other sugary snacks, and often eats an entire package at one sitting. She is upset by this because she knows how important weight is to health, but she does not engage in any compensatory behaviors. Which of the following would be a likely diagnosis? a. anorexia nervosa b. bulimia nervosa c. binge eating disorder d. purging disorder Answer: c. binge eating disorder 23. Binge-eating disorder a. is an extremely rare variant of bulimia nervosa. b. is diagnosed when a person binges and then purges by using laxatives or self-induced vomiting. c. cannot be diagnosed if a person is overweight. d. involves binges comparable to those in bulimia but without any inappropriate "compensatory" behavior to limit weight gain. Answer: d. involves binges comparable to those in bulimia but without any inappropriate "compensatory" behavior to limit weight gain. 24. Binge-eating disorder a. is an eating disorder diagnosis most recently added to the DSM-5. b. has not yet been formally recognized as a distinct clinical syndrome. c. usually develops into anorexia, binge-eating/purging subtype. d. is more common in males than in females. Answer: a. is an eating disorder diagnosis most recently added to the DSM-5. 25. What is unique about binge-eating disorder (BED) as compared to the eating disorders currently found in the DSM? a. Those with BED are commonly of normal body weight. b. The patient age is usually older. c. It develops earlier in life than other eating disorders. d. Few of those with BED develop weight-related health problems. Answer: b. The patient age is usually older. 26. Which statement about the diagnosis of eating disorders is accurate? a. A person meeting the criteria for bulimia rarely, if ever, has been diagnosed with anorexia. b. There is quite a lot of diagnostic crossover in eating disorders. c. Although the symptoms of anorexia and bulimia do not overlap, women with eating disorders often have other diagnosable psychiatric conditions. d. Although anorexia and bulimia are quite similar, women with eating disorders rarely have a comorbid psychological condition. Answer: b. There is quite a lot of diagnostic crossover in eating disorders. 27. What disorders are often comorbid with eating disorders? a. post-traumatic stress disorder and depression b. panic disorder and personality disorders c. generalized anxiety disorder and substance abuse d. depression and personality disorders Answer: d. depression and personality disorders 28. Which of the following complicates the study of personality traits and eating disorders? a. Personality disorders are always seen in those with eating disorders. b. Personality may be altered by malnourishment. c. Eating disorders may merely be a symptom of a personality disorder. d. Both personality disorders and eating disorders are highly subjective diagnostic categories, thus the collection of empirical data is tainted by the nature of these conditions. Answer: b. Personality may be altered by malnourishment. 29. Ginger suffers from anorexia. She is often angry and irritable. These feelings a. may be the result of her starving herself. b. were probably modeled by her father and mother. c. suggest that she does not suffer from "neuroticism." d. must have predated the onset of the anorexia. Answer: a. may be the result of her starving herself. 30. Which of the following statements about the prevalence of eating disorders in the 20th century is true? a. While the incidence of anorexia has been increasing, the incidence of bulimia seems to be declining. b. While there is no evidence to indicate that the incidence of anorexia has been changing, the incidence of bulimia has been declining. c. While the incidence of anorexia has been increasing, there is no evidence to suggest a change in the incidence of bulimia. d. While there is no evidence to indicate that the incidence of anorexia has been changing, bulimia appears to be increasing in frequency. Answer: a. While the incidence of anorexia has been increasing, the incidence of bulimia seems to be declining. 31. Which of the following is likely to put whites at higher risk of developing an eating disorder than non-whites? a. body dissatisfaction b. living in an industrialized society c. fear of stomach bloating d. desire to please the family Answer: a. body dissatisfaction 32. Rates of eating disorders tend to be much lower in black women than in white women. However, one factor that can increase risk in black women is a. their age - younger black women have higher rates of eating disorders than older. b. assimilation into white culture and middle class values. c. their weight - very overweight black women have the same rates of eating disorders as whites do. d. whether they were recent immigrants. Answer: b. assimilation into white culture and middle class values. 33. Which of the following characterizes the prevalence of eating disorders in Iran? a. Iran does not recognize eating disorders. b. Iran has a low incidence of eating disorders. c. Iran’s prevalence of eating disorders is comparable the United States. d. Iran has a very high prevalence of eating disorders. Answer: c. Iran’s prevalence of eating disorders is comparable the United States. 34. What is the prognosis for anorexia nervosa? a. Relapse rates are high, but recovery can often happen in the long run. b. Most people improve fairly quickly and don't relapse. c. Anorexia has an excellent recovery rate, but the other disorders don't. d. The prognosis is extremely poor, with few recovering from it. Answer: a. Relapse rates are high but recovery can often happen in the long run. 35. In studies of the long-term outcomes of women treated for eating disorders, which of the following predicted poor outcomes for those diagnosed with anorexia or bulimia? a. Depression b. Presence of a personality disorder c. Substance abuse d. OCD Answer: c. Substance abuse 36. Which of the following statements about the role of genetics as a risk factor for eating disorders is true? a. While the gene underlying the restrictive type of anorexia nervosa has been identified, the role of genes in the development of other forms of eating disorders is not clear. b. The lack of adoption studies has made it impossible to determine the heritability of eating disorders. c. Due to the complex nature of eating disorders and the probability that multiple genes contribute to their development, a role for genes in such disorders has yet to be established. d. Although the findings to date are mixed, the evidence does indicate that a susceptibility to eating disorders may be inherited along with a diathesis for other psychological conditions. Answer: d. Although the findings to date are mixed, the evidence does indicate that a susceptibility to eating disorders may be inherited along with a diathesis for other psychological conditions. 37. What neurotransmitter seems to be involved in both eating disorders and depression? a. dopamine b. serotonin c. GABA d. norepinephrine Answer: b. serotonin 38. According to set-point theory a. anorexics have successfully adjusted their bodies to a new lower set-point. b. hunger serves to maintain the body at its established set-point. c. behavioral means of altering body weight can never overcome the body's ability to compensate physiologically. d. the body weight that is maintained in the absence of dieting is the one at which health is maximized. Answer: b. hunger serves to maintain the body at its established set-point. 39. Set-point theory explains why a. losing those last few pounds is easier than losing the first few. b. the desire for fatty high calorie foods decreases over time when deprived of food. c. binge eating is likely after a period of caloric restriction. d. serotonin levels change with fasting. Answer: c. binge eating is likely after a period of caloric restriction. 40. Set-point theory about weight suggests that a. dieting can establish a new set-point that stabilizes the near-starvation seen in people with anorexia. b. people with anorexia are biologically programmed to be underweight. c. the hunger that occurs by being well below one's set-point can trigger binges. d. sociocultural factors play very little role in the development of unrealistic body image goals. Answer: c. the hunger that occurs by being well below one's set-point can trigger binges. 41. A dysfunction in which of the following neurotransmitters has been observed in both anorexics and bulimics? a. dopamine b. epinephrine c. GABA d. serotonin Answer: d. serotonin 42. One of the reasons it is difficult to know if a disruption in the serotonin system causes eating disorders is a. research has not supported the theory. b. people with eating disorders often have depression as well. c. serotonin doesn't seem to have anything to do with appetite or eating behaviors. d. after recovery from eating disorders, serotonin levels don't change. Answer: b. people with eating disorders often have depression as well. 43. The influence of television on the attitudes toward eating in Fiji demonstrate that a. biological factors play a minimal role in the etiology of eating disorders. b. environmental factors can alter societal attitudes such that the risk of developing eating disorders is increased. c. definitions of beauty are not changed over time. d. there is no relationship between physical standards of beauty and desirable personality traits. Answer: b. environmental factors can alter societal attitudes such that the risk of developing eating disorders is increased. 44. Families of people with anorexia a. do not have any characteristic features. b. tend to provide few rules and limits. c. exhibit tendencies towards perfectionism. d. emphasize individuality. Answer: c. exhibit tendencies towards perfectionism. 45. Which of the following is most commonly found in families of girls with anorexia? a. Parents who are unconventional, dramatic, and antisocial. b. Parents who emphasize rules, control, and good physical appearance. c. Sibling rivalry that breaks out into physical and verbal aggression. d. Children who reduce psychological tension in the family by dominating their parents. Answer: b. Parents who emphasize rules, control, and good physical appearance. 46. Which of the following is the strongest predictor of a person developing bulimic symptoms? a. The amount of control families tried to have over the person b. The degree of overprotectiveness parents displayed c. The amount of marital conflict between the parents d. The amount of critical comments family members made about the person's appearance Answer: d. The amount of critical comments family members made about the person's appearance 47. The most common quality of parents' interactions with their daughters who have eating disorders is a. unconditional love and acceptance. b. neglect. c. criticism. d. lack of direction and rules. Answer: c. criticism. 48. Internalizing the "thin ideal" is strongly associated with a. body satisfaction. b. negative affect. c. recovery from eating disorders. d. attitudes about interpersonal relationships. Answer: b. negative affect. 49. A lack of body distortions among the Amish a. provides evidence against a role for sociocultural factors in the development of eating disorders. b. indicates that the Amish do not value physical beauty. c. suggests that the influence of the Western media is not as great as commonly perceived. d. suggests that there should be a low prevalence of eating disorders among these peoples. Answer: d. suggests that there should be a low prevalence of eating disorders among these peoples. 50. When it comes to comparing one's actual body image with the ideal body, a. young men are just as likely to see themselves as too fat as young women. b. most young women want a body that is more "curved" than the media-encouraged ideal. c. young women often falsely believe that men prefer larger women than they actually do. d. young women are more likely to be dissatisfied than young men. Answer: d. young women are more likely to be dissatisfied than young men. 51. Which statement best describes trends in actual and ideal weight in American young women? a. While the weight of the average woman is decreasing, the average weight of the ideal woman is decreasing even faster. b. While the weight of the average woman is increasing, the average weight of the ideal woman is decreasing. c. While the weight of the average woman is increasing, the average weight of the ideal woman is increasing even faster. d. Weight of the average woman doesn't seem to be affected by the average weight of the ideal woman. Answer: b. While the weight of the average woman is increasing, the average weight of the ideal woman is decreasing. 52. What is the link between dieting and eating disorders? a. Dieting is a risk factor for both anorexia and bulimia. b. Dieting is a risk factor for bulimia. c. Dieting is not a risk factor for the development of eating disorder. d. When done properly, dieting seems to decrease eating disorder symptoms for a while and then leads to a sharp increase in symptoms. Answer: a. Dieting is a risk factor for both anorexia and bulimia. 53. Which of the following appears to be an enduring personality trait of people who are susceptible to developing an eating disorder? a. neuroticism b. perfectionism c. pessimism d. individualism Answer: b. perfectionism 54. Which of the following statements best summarizes the relationship between sexual abuse and the development of eating disorders? a. There appears to be a relationship, but it appears to be indirect, involving an array of intervening variables. b. There is no relationship between early sexual abuse and the development of eating disorders later in life. c. Early sexual abuse may lead to a denial of one's sexuality and a desire to maintain a child-like appearance, resulting in attempts to prevent the development of a more mature figure through dieting. d. While sexual abuse has been found to increase the risk of developing anorexia, no relationship has been observed between abuse and other eating disorders. Answer: a. There appears to be a relationship, but it appears to be indirect, involving an array of intervening variables. 55. What is the most serious challenge in treating eating disorders? a. making a diagnosis before the disorder becomes life threatening b. engaging the family in the treatment process c. finding an effective pharmacological treatment d. overcoming the patient's ambivalence toward treatment Answer: d. overcoming the patient's ambivalence toward treatment 56. After her dentist commented on the damage her practice of vomiting had caused to her teeth, Hilda realized that she had a problem. After seeing a psychiatrist, Hilda was diagnosed with anorexia, binge-eating/purging sub-type. Due to the severity of her condition, her doctor suggested that she be hospitalized. Hilda immediately entered an inpatient treatment program and embraced all aspects of the treatment regimen. What is unique about Hilda's case? a. Dental problems are not seen in those with anorexia. b. Psychiatrists rarely suggest hospitalization for this type of anorexia. c. Hilda's lack of ambivalence about treatment. d. The failure to use outpatient treatment before hospitalization. Answer: c. Hilda's lack of ambivalence about treatment. 57. Which of the following best explains the lack of well-controlled studies on the effectiveness of treatment for anorexia nervosa? a. Few people with anorexia who are in treatment are willing to participate with bulimics. b. Few people with anorexia achieve full remission. c. The high mortality rate with anorexia results in sample sizes too small to yield valid conclusions. d. Few people with anorexia are willing to seek treatment, and they are likely to drop out prematurely from treatment. Answer: d. Few people with anorexia are willing to seek treatment, and they are likely to drop out prematurely from treatment. 58. Which statement about the treatment of eating disorders is most accurate? a. There are very few options available in the treatment of eating disorders. b. Family support and the patient's commitment to change are important to lasting recovery. c. There are virtually no situations in which hospitalization is necessary to treat eating disorders. d. Family involvement in treatment tends to undercut the chances of lasting recovery in the patient. Answer: b. Family support and the patient's commitment to change are important to lasting recovery. 59. In the treatment of eating disorders, medications a. have proven to be especially helpful in treating patients with anorexia. b. may be useful, but are not a primary treatment. c. are commonly used to stimulate appetite. d. have been found to be more effective than most psychological interventions. Answer: b. may be useful, but are not a primary treatment. 60. Why is family therapy currently being investigated as a treatment for anorexia? a. Family therapy has been found to be the most effective form of therapy for bulimia. b. Healthier family relationships have been found to affect treatment outcome. c. The well-established role of the family in the development of eating disorders necessitates the involvement of the family in their treatment. d. CBT and other forms of individual psychotherapy have been found to be ineffective. Answer: b. Healthier family relationships have been found to affect treatment outcome. 61. Which of the following best explains why cognitive-behavioral therapy is a logical approach to the treatment of eating disorders? a. It is the therapy of choice for most disorders. b. The role of learning in the development of eating disorders is well-established. c. Medical interventions have proven ineffective. d. Both thoughts and behaviors need to be altered to achieve a lasting outcome. Answer: d. Both thoughts and behaviors need to be altered to achieve a lasting outcome. 62. Research suggests that ___________ provides the best immediate and long-term outcomes in the treatment of bulimia nervosa. a. systematic desensitization b. family therapy c. antidepressant medication d. cognitive-behavioral therapy Answer: d. cognitive-behavioral therapy 63. Family therapy for anorexia appears to be most effective when it is used to treat a. adolescents. b. adults. c. men. d. those with comorbid depressive and/or anxiety symptoms. Answer: a. adolescents. 64. Which of the following is an effect of antidepressants on symptoms of bulimia nervosa? a. Decreased mood. b. Decreased appetite. c. Lessened preoccupation with physical appearance. d. Increased frequency of binges. Answer: c. Lessened preoccupation with physical appearance. 65. Our current knowledge of the efficacy of treating eating disorders a. is quite thorough because there are many controlled studies comparing long-term outcomes. b. is much more detailed for anorexia nervosa than for bulimia nervosa. c. suggests that hospitalization is most effective for long-term maintenance of treatment gains. d. suggests that cognitive-behavioral therapy is one of the treatments of choice. Answer: d. suggests that cognitive-behavioral therapy is one of the treatments of choice.. 66. Which of the following has been indicated as the best approach in the treatment of binge eating disorder? a. psychodynamic psychotherapy b. behavior therapy c. mindfulness therapy d. interpersonal psychotherapy Answer: d. interpersonal psychotherapy 67. In addition to altering the eating patterns of clients with Binge Eating Disorder, therapists using cognitive-behavioral therapy will also a. teach the clients to be greater risk-takers. b. educate the clients that fat people have certain character flaws. c. provide factual information about eating and dieting. d. help the client to emotionally separate from her family. Answer: c. provide factual information about eating and dieting. 68. Obesity a. is based on an individual’s subjective opinion of their own weight. b. rates vary little across Western cultures. c. is not associated with any form of stigma. d. has been increasing in many countries, including the United States. Answer: d. has been increasing in many countries, including the United States. 69. In which of the following countries are at least one-third of adults obese? a. China b. Japan c. United Kingdom d. United States Answer: d. United States 70. What is the relationship between obesity and social class? a. There is none. b. Obesity occurs much more frequently in lower social class adults and children. c. Obesity occurs much more frequently in lower social class adults but higher SES children. d. Obesity occurs much more frequently in higher social class adults and children. Answer: b. Obesity occurs much more frequently in lower social class adults and children. 71. Which of the following is a danger associated with obesity? a. asthma b. cancer c. low blood pressure d. joint disease Answer: b. cancer 72. Which of the following statements about obesity and health is true? a. The heavier the person, the greater the health risks. b. Only when obesity has a behavioral cause is it dangerous. c. Individuals who are obese, but active, are not at a higher risk of cardiovascular disease. d. Obesity is only a threat to health in cultures where the obesity is due to the consumption of fatty foods and relative inactivity. Answer: a. The heavier the person, the greater the health risks. 73. Which of the following factors is associated with an increased risk for obesity? a. High socioeconomic status b. Living in an Asian culture c. Being well-cared-for as a child d. Low parental education Answer: d. Low parental education 74. Which of the following best explains the current trend in the prevalence of obesity? a. Obesity is no longer a factor that decreases survival, thus genes for obesity are becoming more prevalent in the general population. b. the tendency to underfeed children who then overeat as adults c. the adoption of unhealthy life styles d. the popularity of dieting Answer: c. the adoption of unhealthy lifestyles 75. Leptin a. is a hormone that usually leads to decreased food intake. b. is a hormone that is not related in any way to obesity. c. is a hormone that helps the body regain its set-point. d. is a hormone that is an appetite stimulator. Answer: a. is a hormone that usually leads to decreased food intake. 76. Grehlin a. is a hormone that usually leads to decreased food intake. b. is a hormone that is not related in any way to obesity. c. is a hormone that helps the body regain its set-point. d. is a hormone that is an appetite stimulator. Answer: d. is a hormone that is an appetite stimulator. 77. Why are family attitudes about obesity important? a. because they reflect the genetic influences on obesity b. because they will cause people to be happier when obese c. because the consequences are likely to remain with us d. they aren't - peer influence is more important Answer: c. because the consequences are likely to remain with us 78. Comfort food a. does nothing physiologically, any effects are due to expectation. b. may help reduce activation in the stress response system. c. changes the hormonal balance of the body and makes people want to eat more. d. affects the brain in such a way as to make it unable to tell when the body is full. Answer: b. may help reduce activation in the stress response system. 79. What cyclical pathway can develop that eventually leads to obesity? a. A child stops eating because of low self-esteem, becomes anorexic and then is successfully treated but still has negative feelings about her- or himself. b. A thin child eats normally but is teased about his or her weight and begins to diet further. c. A child eats because of feelings of depression and low self-esteem, gains weight, is rejected by peers, binges, and continues to gain weight. d. A thin child binges because of depression and low self-esteem, purges and feels better, then feels safe to binge again, eating more later. Answer: c. A child eats because of feelings of depression and low self-esteem, gains weight, is rejected by peers, binges, and continues to gain weight. 80. Which of the following is a medication currently approved by the FDA for use in the treatment of obesity? a. amphetamine b. phentermine c. fenfluramine d. sibutramine Answer: d. sibutramine 81. Orlistat, which works by interfering with the absorption of fat, a. works very well for obesity. b. works very well for extreme obesity but not regular obesity. c. works modestly well for obesity. d. results have been uncertain. Answer: c. works modestly well for obesity. 82. Sibutramine acts to reduce appetite by a. inhibiting the reuptake of serotonin and norepinephrine. b. decreasing the activity of serotonin and norepinephrine. c. blocking receptors for serotonin and norepinephrine. d. interfering with digestion. Answer: a. inhibiting the reuptake of serotonin and norepinephrine. 83. After bariatric surgery, a. patients stay normal weight the rest of their lives. b. some patients do not lose any weight. c. most patients do not survive. d. some patients regain their weight, but most lose a great deal of weight. Answer: d. some patients regain their weight, but most lose a great deal of weight. 84. Gastric bypass surgery makes it a. possible to binge and not gain weight. b. slightly more likely that people will lose weight. c. impossible to regain weight once it is lost. d. impossible to binge eat but still possible to regain weight. Answer: d. impossible to binge eat, but still possible to regain weight. Fill-in-the-Blank Questions 1. Three types of purging or compensatory behaviors that people with bulimia may engage in are __________, laxative abuse, or excessive exercise. Answer: vomiting 2. ____________ is the most common form of eating disorder. Answer: Binge-eating disorder 3. The neurotransmitter called __________ is implicated in obesity. Answer: serotonin 4. For adolescents with anorexia nervosa, the best studied family therapy approach is known as the __________ model. Answer: Maudsley 5. The hormone __________ is the hormone produced by the stomach that stimulates appetite. Answer: grehlin 6. The hormone __________ reduces our intake of food. Answer: leptin Short Answer Questions 1. Why is the term "anorexia nervosa" a misnomer? Answer: The term "anorexia nervosa" literally means a lack of appetite. The individual with anorexia nervosa does not lack an appetite. The true problem with the anorexic is a fear of gaining weight, which leads to not eating, as opposed to a true lack of desire for food. 2. What most clearly separates the anorexic from the bulimic? Answer: While the binge-eating/purging anorexic and the bulimic may share many features, the clear factor that distinguishes the two is the below normal weight that is a defining feature of anorexia. 3. What are the differences between binge-eating disorder and bulimia nervosa? Answer: People with binge-eating disorder have food binges like people with bulimia but don't do any compensatory behaviors. They don't restrict their diet between binges as much as people with bulimia. People with binge-eating disorder tend to be older than people with bulimia and are more likely to be overweight or obese. 4. What puts whites at higher risk for eating disorders as compared to non-whites? Answer: Research finds that whites show much more body dissatisfaction, dietary restraint, and a drive for thinness than their non-white counterparts. Clearly, these are all factors that set the stage for the development of abnormal eating patterns and, possibly, diagnosable eating disorders. 5. There is evidence of serotonergic abnormalities in anorexics and bulimics. Can it be concluded that a dysfunction in the serotonin system underlies these eating disorders? Why or why not? Answer: Although altered serotonergic levels have been observed in individuals with eating disorders, causal conclusions cannot be made. Changes in neurochemical function may be a cause and/or consequence of the psychological disorder. In order to conclude that altered serotonin function plays a causal role in eating disorders, changes in serotonergic function would need to be observed prior to the development of the eating disorder. 6. How does the set-point impact eating disorders? Answer: This is the tendency of the body to resist variation from a biologically determined set-point. As someone loses weight, hunger rises and can trigger strong impulses to binge eat. 7. Why is dieting a risk factor for the development of eating disorders? Answer: The desire to diet suggests that there is some body dissatisfaction, a clear risk factor for the development of an eating disorder. In addition, the practice of dieting increases the likelihood of overeating, as caloric restriction leads to hunger. When the dieter gives in to temptation, this is likely to lead to negative affect. Resumed dieting then continues this pattern, which may then evolve into any one of the recognized eating disorders. As research has demonstrated, going on a diet may actually make us eat more and, as a consequence, feel worse about ourselves and evolve into even more problematic eating patterns. 8. What medications are commonly used in the treatment of bulimia nervosa? What evidence is there that medications are beneficial in treating this condition? Answer: Antidepressants are commonly used, alone or, ideally, in addition to CBT. Many patients with bulimia also suffer from mood disorders. In addition to the potential beneficial effects of antidepressants on mood, they have also been shown to decrease both the frequency of binges and the typical preoccupation with shape and weight that is characteristic of those with bulimia. 9. What are leptin and grehlin and how do they influence appetite and weight? Answer: Leptin is a hormone that is produced by fat cells. It acts to reduce intake of food. An increase in body fat leads to an increase in leptin, which leads in turn to a decrease in food intake. However, overweight people are resistant to the effects of leptin. Grehlin is a hormone produced by the stomach. It is a powerful appetite stimulator. It rises before meals and decreases after eating. If there is a disturbance in its normal process, this can lead to overeating. Essay Questions 1. Discuss the risk of suicide in anorexia and bulimia. Answer: With medical complications being the number one cause of death, the second most common cause of death in those who suffer from anorexia nervosa is suicide. Recent estimates suggest that one out of five deaths in individuals with anorexia nervosa is the result of suicide (Arcelus et al., 2011). Somewhere between 3 and 23 percent of patients with anorexia will make a suicide attempt, and rates of completed suicide are 50 times greater than they are in the general population (Franko & Keel, 2006; Keel et al., 2003). It has been suggested that patients who have lost their ability to maintain an “emotionally protective” low body weight are at particularly high risk of suicide (Crisp et al., 2006). Patients who are older when they first receive clinical attention for their disorder are also more likely to have a premature death (Arcelus et al., 2011). Bulimia nervosa is not associated with increased risk of completed suicide, although suicide attempts are made in 25 to 30 percent of cases (Franko & Keel, 2006). 2. What factors put males at risk for developing eating disorders? Answer: One established risk factor for eating disorders in men is homosexuality. Gay and bisexual men have higher rates of eating disorders than heterosexual men do (Feldman & Meyer, 2007). Gay men (like heterosexual men) value attractiveness and youth in their romantic partners. Because gay men (like women) are seeking to be sexually attractive to men, body dissatisfaction may therefore be more of an issue for gay men than it is for heterosexual men. In support of this idea, Smith and colleagues (2011) found that gay men were more dissatisfied with their bodies and had higher levels of disordered eating than heterosexual men did. Moreover, gay men tended to believe that a potential mate would want them to be leaner than they themselves wanted to be. Other specific subgroups of men who are at higher risk of eating disorders are wrestlers and jockeys, who need to “make weight” in order to compete or work (Carlat et al., 1997). 3. Discuss the studies on rats and "comfort food." Answer: Like many humans, rats under chronic stress selected high fat and sugar diets. They gained weight in their bellies and became calmer in the face of new, acute stress. People may also eat in response to aversive emotional states as well, and experience the same calming effect. This shows that learning is involved, as well as biochemical effects. Eating in response to emotional cues is reinforced because tension is reduced, leading to an increased likelihood of eating in response to those cues later on. Test Bank for Abnormal Psychology: DSM 5 James N. Butcher, Jill M. Hooley, Susan M. Mineka 9780205965090, 9780205944286

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