Eating disorders, substance abuse, sexual, gender identity, and personality disorders reduce the capacity for normal human functioning. Although their components vary widely, understanding each reduces the stigmatized perception of these disorders and promotes the realistic application of interventions and preventions to support and resume normalcy.
Biological components include a genetic basis, hormonal excesses and deficiencies, and abnormal neural activity. Individuals with anorexia and bulimia have unusually low serotonin levels as well as structural brain abnormalities. Brain alterations may be a response to changes to the endocrine and metabolic reactions to starvation (Krieg, Lauer, & Pirke, 1989).
Disordered eating may be a complex reaction to high expectations initially set by parents and promoted by the individual. It may also function as a self-protection from adult sexuality or a response to a sexually abusive experience. Many strive toward high expectations and suffer the effects of not reaching them (Hansell & Damour, 2008).
Cognitive explanations of eating disorders focus on eating or starvation experiences that reinforce eating such as distorted thoughts about food and body weight. Individuals may have distorted body images, and persevere in the belief they need to lose weight, or are deathly afraid of gaining weight.
Common to this disorder is binging, then purging by vomiting, using laxatives or diuretics, fasting or excessive exercise to prevent weight gain. In anorexia, individuals find comfort in starvation. From a cognitive-behavioral standpoint, eating disorders are a result of inappropriate thoughts and experiences that reinforce chaotic eating behaviors (Hansell & Damour, 2008).
Substance Use Disorders
Approximately 50 percent of substance use disorders can originate in individuals self-medicating biological or chemical deficiencies. Contemporary research asserts all drug use affects dopamine neurotransmitters and the release of dopamine into a specific brain areas activates an internal reward system and causes a surge of pleasure (Hansell & Damour, 2008) and results from neuroimaging implicate the frontal cortex (Goldstein & Volkow, 2002).
Current psychodynamic theorists view substance misuse as a maladaptive defense
mechanism for coping with repressed memories and emotions. Many individuals with substance abuse disorders demonstrate low self-esteem and a proclivity toward depression or depressive tendencies (Hansell & Damour, 2008).
Substance abuse perpetuates the maladaptive belief that abuse supports the individual in coping with daily stressors and excessive tensions, and reduces the inability to relax. Individuals with abusive patterns often have negative beliefs, schemas, and expectancies. Restructuring maladaptive perceptions supports change to existing beliefs and expectancies.
Classical and operant conditioning and social learning have important roles in explaining behavioral components of substance abuse. According to the operant conditioning paradigm, drugs are powerful reinforcers because they induce pleasure (positive reinforcement) and remove negative experiences such as stress (negative reinforcement) consequently inspiring the continuation of behavior (Hansell & Damour, 2008).
Biological components include medical illness, poor diet, medications, aging, and cigarette smoking. Temporal lobe epilepsy, brain tumors or injuries, and some degenerative diseases have been implicated in paraphilias. Research has discovered a possible connection in gender identity disorder to predispositions in the endocrine system which affects sexual and gender behaviors (Hansell & Damour, 2008).
Often women accused of sexual offenses have sustained some type of childhood abuse. Freud believed deviant sexual behavior is a defense mechanism in response to an internal emotional conflict and such behaviors provide a protective function. The inability to cope with and exert control over past humiliation is a central theme to other paraphilias (Hansell & Damour, 2008). In gender identity disorders, research emphasizes deviant or deficient parental relationships (Hansell & Damour, 2008).
Cognitivism associates maladaptive thoughts and schemas with sex and arousal in the development of paraphilias. The individual is sexually aroused to deviant stimuli, which create maladaptive thought processes to accommodate the perceived deviance. The inappropriate behavior perpetuates the maladaptive thoughts required to accommodate the behavior (Hansell & Damour, 2008).
Deviant sexual behavior can be learned by observing abnormal sexual behavior or participating in such behavior during childhood. Children rewarded for inappropriate sexual behaviors (such as viewing or participating in pornography) can develop paraphilia. Therapy can focus on re-establishing healthy sexual behavior by reinforcing more appropriate behaviors (Hansell & Damour, 2008).
Biological components in personality disorders include altered brain structures and reduced gray and white matter volume, various neurotransmitter abnormalities, prenatal substance exposure, and low serotonin levels. Research sustains the belief that some personality disorders are the result of an overlap of genetics and environmental effects.
Personality disorders generally reflect a disruptive childhood from which the child learns to rely on maladaptive defense mechanisms. Parental criticism and ridicule are central themes underlying these disorders. Additional research supports claims of childhood sexual or physical abuse, although this is not always characteristic in these disorders (Hansell & Damour, 2008).
Cognitive components of personality disorders include the notion that childhood experiences shape specific thought patterns or schemas, and have a significant effect on patterns of the individual's behavior and perception which subsequently becomes the personality. Maladaptive beliefs and behaviors are characteristic in personality disorders and therapies work toward replacing these beliefs and behaviors with more effective and appropriate ones.
People afflicted with personality disorders dictate unyielding beliefs onto every facet of their lives, yet have difficulty questioning these beliefs. They continue to act out their beliefs although the behavior is self-defeating. Personality disorder are produced by maladaptive behaviors and thought processes created in childhood which persist because individuals are usually attracted to experiences that fit into their schemas whether or not they are maladaptive, therefore, the maladaptive behaviors are maintained (Hansell & Damour, 2008)
Although disordered eating, sexual dysfunctions, substance abuse, and personality disorders seem to have little in common, biological components and internal conflicts involving distressing experiences persist in their explanations. By addressing these components and the cognitive and behavioral factors, psychological science develops a more lucid understanding of these disorders in an effort to engage the individuals in successful therapeutic applications.
Goldstein, R. Z., & Volkow, N. D. (2002). Drug Addiction and Its Underlying Neurobiological Basis: Neuroimaging Evidence for the involvement of the frontal cortex. The American Journal of Psychiatry, 159(10), 1642-1652
Hansell, J., & Damour, L. (2008). Abnormal psychology. Hoboken, NJ: Wiley.
Krieg, J., Lauer, C., & Pirke, K. (1989). Structural brain abnormalities in patients with bulimia nervosa. Psychiatry Research, 27(1), 39-48. doi: 10.1016/0165-1781(89)90007-3