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Abnormal Ch. 3

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Sara is conducting a clinical assessment using methods that assess her client’s personality and probes for unconscious conflicts. Sara is most likely a _____ clinician.
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psychodynamic
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_____ tests require that clients interpret vague stimuli, such as inkblots or ambiguous pictures, or follow open-ended instructions to draw a person, place, or tree.
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Projective
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_____ inventories are used to reveal a person’s typical thoughts and assumptions in order to uncover counterproductive patterns of thinking.
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Cognitive
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The common standard against which later individual scores can be measured is called:
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a norm
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People who experience anxiety, fears, and panic fall under which DSM-5 category?
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anxiety disorders
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What has the rapprochement movement tried to identify that makes all therapies effective?
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common strategies
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Some people are diagnosed with more than one disorder. This is called:
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comorbidity.
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According to surveys, people living in which region of the United States are MOST likely to have seen a therapist?
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West
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The International Classification of Diseases (ICD) is used by therapists in:
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most countries in the world besides the United States.
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Altogether more than _____ forms of therapy are currently practiced in the clinical field.
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400
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Studies that measure the effectiveness of various treatments are called:
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treatment outcome studies.
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According to the text, research has shown that behavioral approaches are most effective in treating:
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phobias.
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Therapy outcome studies measure the effectiveness of:
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various treatments.
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idiographic understanding
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An understanding of the behavior of a particular individual.
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assessment
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The process of collecting and interpreting relevant information about a client or research participant.
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standardization
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The process in which a test is administered to a large group of people whose performance then serves as a standard or norm against which any individual’s score can be measured.
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reliability
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A measure of the consistency of test or research results.
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validity
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The accuracy of a test’s or study’s results; that is, the extent to which the test or study actually measures or shows what it claims.
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mental status exam
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A set of interview questions and observations designed to reveal the degree and nature of a client’s psychological functioning.
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clinical test
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A device for gathering information about a few aspects of a person’s psychological functioning from which broader information about the person can be inferred.
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projective test
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A test consisting of ambiguous material that people interpret or respond to.
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personality inventory
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A test designed to measure broad personality characteristics, consisting of statements about behaviors, beliefs, and feelings that people evaluate as either characteristic or uncharacteristic of them.
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response inventories
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Tests designed to measure a person’s responses in one specific area of functioning, such as affect, social skills, or cognitive processes.
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psychophysiological test
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A test that measures physical responses (such as heart rate and muscle tension) as possible indicators of psychological problems.
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neurological test
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A test that directly measures brain structure or activity.
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neuroimaging techniques
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Neurological tests that provide images of brain structure or activity, such as CT scans, PET scans, and MRIs. Also called brain scans.
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neuropsychological test
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A test that detects brain impairment by measuring a person’s cognitive, perceptual, and motor performances.
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intelligence test
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A test designed to measure a person’s intellectual ability.
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intelligence quotient (IQ)
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A score derived from intelligence tests that theoretically represents a person’s overall intellectual capacity.
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diagnosis
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A determination that a person’s problems reflect a particular disorder.
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syndrome
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A cluster of symptoms that usually occur together.
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classification system
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A list of disorders, along with descriptions of symptoms and guidelines for making appropriate diagnoses.
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empirically supported treatment
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A movement in the clinical field that seeks to identify which therapies have received clear research support for each disorder, to develop corresponding treatment guidelines, and to spread such information to clinicians. Also known as evidence-based treatment.
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rapprochement movement
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An effort to identify a set of common strategies that run through the work of all effective therapists.
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psychopharmacologist
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A psychiatrist who primarily prescribes medications. Also called pharmacotherapist.
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1. What forms of reliability and validity should clinical assessment tools display? pp. 78-79
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1. Reliability- refers to the consistency of assessment measures. Must be standarized. Clinicians should use test-retest reliability. participants are tested on two occasions and the scores are correlated. 2. Validity- it must accurately measure what its suppose to measure.. Must be standarized. Clinicians should use this only if their assessment tool has predictive validity or concurrent validity.
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2.What are the strengths and weaknesses of structured and unstructured interviews? pp. 80-81
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1. structured Strengths- ensures that clinicians will cover the same kind of important issues in all of their interviews and enables them to compare the responses of different individuals. Weaknesses- lack validity. Individuals may intentionally mislead, or avoid discussing embarrassing topics. Interviewers may slant information they gather. Similarly, a clinicians race, gender, and age biases, may influence a clients response. 2. Unstructured ones Strengths- lack of structure allows the interviewer to follow leads and explore relevant topics that could not be anticipated before the interview. Weaknesses-Individuals may intentionally mislead, or avoid discussing embarrassing topics. Interviewers may slant information they gather. May lack reliability. Similarly, a clinicians race, gender, and age biases, may influence a clients response.
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List and describe today’s leading projective tests. pp. 82-83
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Projective test- a test consisting of ambiguous material that people interpret or respond to. 1. Rorschach test- Clinicians administer one ink bot card at a time and ask respondents what they see, what the ink bot seems to be, or what it reminds them of. 2. Thematic Appreciation Test(TAT)- is a pictorial projective test. People are commonly shown 30 cards with black-and-white pictures of individuals in vague situations and are asked to make up dramatic stories about each card. Whats happening, what led up to it, and what is the outcome of the situation will be. 3. Sentence completion test- the test-taker completes a series of unfinished sentences, such as I wish, or my Father…. 4. Drawings- On the assumption that the drawing tells us something about the creator. (Draw-a-Person also known as DAP test, the most popular of the drawing test. First are told to draw a person, and then draw a person of the other sex.
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What are the key features of the MMPI? pp. 84-85
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MMPI( also known as the Minnesota Multiphasic Personality Inventory)- consists of more than 500 self-statements, to be labeled true, false, or cannot say. Altogether the staements make up 10 clinical scales. , on each an individual can score from 0-200. Measures the following 1. Hypochondrasis- items showing abnormal concern with bodily functions 2. Depression 3. Hysteria- person may use physical or mental symptoms as a way of unconsciously avoiding conflicts or responsibilities. 4. Psychopathic deviate- showing a repeated and gross disregard for social customs and a emotional shallowness. 5. Masculinity-femininity–Items thought to be seperate male and female respondents 6. Paranoia 7-Psychasthenia- items that show obsessions, compulsions, abnormal fears, and guilt and indecisveness 8. Schizophrenia- items that show bizarre or unusual thoughts or behaviors 9. Hypomania- items that show emotional excitement, overactivity, and flight of ideas. 10. Social introversion- items that show shyness, little interest in people, and insecurity.
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What are the strengths and weaknesses of projective tests (p. 84), personality inventories (pp. 85-86), and other kinds of clinical tests (pp. 86-89)?
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1. Projective test- Strengths- clinicians and researchers have relied on them largely to gaing “supplementary” insights Weaknesses- in validity test there are bias responses. In reliabiltity the conclusions often fail to match the self-report of the client. 2. Personality Inventories- Strengths- computerized or paper-and-pencil test, they do not take much time to administer, and they are objectively scored. score great test-retest reliability. Weaknesses-personality traits the that the test seek to measure cannot be examined directly. Cultural limitations 3. other kinds & Clinical test a. strengths- response inventories(focus on one specific area of functioning weaknesses- lack of being tested for accuracy and consistency b. Psychophsiological test- strengths are it measures physiological responses as possible indicators of physiological problems. weaknesses- expensive equipment & may arouse a participants nervous system and thus change his or her physical responses. c. neurological and neuropsychological test strengths are it pinpoints brain abnormalities. some test take pictures of brain structure, or brain activity. weaknesses- sometimes are unable to detect subtle brain abnormalities. d. intelligence test strengths are it plays a key role in the diagnosis of intellectual disability. most carefull produced of all clinical test. Clinicians have a good idea of how each individuals scores compares with the performance of the population at large.
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How do clinicians determine whether psychological problems are linked to brain damage? pp. 88-89
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Use Neurological (measures brain activity, CT scans, PET scans, and MRI’s) Neuropsychological test( measures a person’s cognitive, perceptual, and motor performances)
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Describe the ways in which clinicians may make observations of clients’ behaviors. pp. 89-91
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1. Naturalistic observation- clinicians observe clients in their everyday environment. 2. Analog environment- they observe them in artificial settings, such as a clinical office or laboratory. 3. Self-monitoring- clients are instructed to observe themselves.
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What is the purpose of clinical diagnoses? p. 92
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determination that a person’s psychological problems constitute a particular disorder. They can then apply what is generally known about the disorder to the particular individual they are trying to help.
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Describe DSM-5. What problems may accompany the use of classification systems and the process of clinical diagnosis? pp. 93-95, 96-9
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1.Took more than a decade to produce. Contains numerous additions and changes to the diagnostic categories. list more than 500 mental disorders. Each entry describes the criteria for diagnosing the disorder and the key clinical features of the disorder. 2. based on weak research and that others may reflect gender or racial bias. It is also sorely lacking validity.
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According to therapy outcome studies, how effective is therapy? pp. 99-100
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1.Studies suggest that therapy often is more helpful than no treatment or than placebos. 2. The various therapies do not appear to differ dramatically in their general effectiveness. 3. Certain therapies or combination of therapies do appear to be more effective than others for certain disorders.
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o Purposes of clinical assessment
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To understand the individual To predict behavior To plan treatment To evaluate treatment outcome
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Clinical Assessment
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Clinical assessment broadly falls into 3 categories 1. Clinical Interviews 2. Tests and Measures 3. Observations o To be useful, assessment tools must be standardized and have clear reliability and validity
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Mental Status Exam (part of the clinical Interview
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Mental status exam Appearance and behavior Thought processes Mood and affect Intellectual functioning Sensorium Note: a physical exam may be indicated (not typically conducted in outpatient settings) Gen Med is often the “first pit stop” More psychotropic meds are prescribed by gen med than psychiatrists or other mental health professionals combined Useful if disorder has organic or biological cause (e.g., TBI; dementia due to undetermined cause) Compone
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Tests or Measures
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More than 500 TESTS are currently in use in the U.S. and fall into six categories. Many overlap. Varying degrees of reliability and validity……. Types: 1. Projective (subjective) tests (e.g., Rorschach; TAT; Complete-a-Sentence) 2. Objective tests (validated/normed): • Personality inventories (e.g., PAI; MMPI-2-R) • Response inventories (e.g., BDI) • Psychophysiological tests (e.g., EEG) • Neuropsychological tests (e.g., Bender) • Intelligence tests (e.g., WAIS; WISC)
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Testing: Projective Tests
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Rooted in psychoanalytic tradition Used to assess unconscious processes Project aspects of personality onto ambiguous test stimuli Require high degree of inference in scoring and interpretation Highly subjective Lack validity/reliability
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Testing: Objective Tests
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Roots in empirical tradition Test stimuli are less ambiguous Require minimal clinical inference in scoring and interpretation Many are rigorously normed and validated Standardized administration Rely on client to be motivated, honest and accurate in responding
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Personality tests
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Designed to measure broad personality characteristics and psychological functioning Focus on behaviors, beliefs, and feelings Usually based on self-reported responses Some are very well validated (MMPI-2-R)… many other are not
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Observations
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CLINICAL OBSERVATIONS Are systematic observations of behavior o Techniques Naturalistic Analog Self-monitoring
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Psychophysiological Assessment
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Uses of routine psychophysiological assessment Disorders involving a strong physiological component Assess structure, function, or activity of the nervous system Electroencephalogram (EEG) – brain wave activity. Polygraph – physiological indicators of stress o Examples sexual dysfunctions, sleep disorders Headache and hypertension
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Diagnosing Psychological Disorders
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o Diagnostic classification Classification is central to all sciences Assignment to categories based on shared attributes, symptoms or relationships Increases reliability and validity North America DSM Elsewhere ICD
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Neurological Tests
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• Directly measure brain function by assessing brain structure and activity • EEG • CAT SCANS • PET SCANS • MRI • fMRI
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Neuropsychological Testing
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Purpose and goals • Indirectly assess brain function by assessing cognitive, perceptual, and motor functioning Assess broad range of skills and abilities Goal is to understand brain-behavior relations o Examples Most widely used is Bender Visual-Motor Gestalt Luria-Nebraska and Halstead-Reitan • Designed to assess for brain damage • Test diverse skills ranging from grip strength to sound recognition, attention, concentration
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The Stigma continues
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33% Americans who would not seek counseling for fear of being labeled “mentally ill” 67% Americans who would not tell their employer that they were seeking treatment 37% Americans who would be reluctant to seek treatment because of confidentiality concerns
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figure 3-3
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How many people in the United States qualify for DSM diagnosis during their lives 53.6% no disorders 18.7% one disorder 17.3 three or more dis orders 10.4% one disorder
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Number of categories of psychological dysfunctioning listed in the 1840 U.S. census
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1
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Number of categories listed in DSM-1 in 1952
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60
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Number of categories listed in DSM-5
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541
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Online dis inhibition effect
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the tendency for people to show less restraint when on the internet
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Drunkorexia
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women dont eat all day, so the can party and get drunk all night without gaining weight
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Contradictory Trends
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since 1998, the number of patients receiving psychotherapy alone has fallen by 34 percent. The number receiving medication alone has increased by 23 percent