MCAT Psychology and Sociology Practice Test 5: personality, motivation, attitudes, and psychological disorders

In the late 1800s, psychiatrist William Gull described one of his patients as suffering from a "perversion of the will" that resulted in "simple starvation." Today, Gull's patient would likely be diagnosed with anorexia nervosa (AN), which is characterized by a dramatic distortion of perceived body image and dangerously low weight achieved through food restriction, excessive exercise, or other extreme means (abuse of diet pills, laxatives, etc.). According to multiple studies, AN has the highest mortality rate of all mental illnesses. This finding is likely due to the severe health consequences associated with AN, including cardiovascular stress, gastrointestinal dysfunction, and malnutrition.

Several theories have been advanced to explain the etiology or risk factors of AN and other eating disorders. Some researchers posit that AN is primarily a sociocultural phenomenon rooted in Western culture's espousal of a thin body ideal. According to these theorists, the disorder initially progresses through three stages: exposure to the thin ideal, internalization of the thin ideal, and perceived discrepancy between oneself and the thin ideal. In an effort to conform to the thin ideal, individuals who have AN employ extreme behaviors to reduce their weight. Other researchers point to intrapersonal personality traits or family dynamics as the primary sources of AN pathology. Finally, some theorists prefer to view AN from an addictions perspective.

In an effort to determine best treatment practices for AN and other eating disorders, some studies have compared treatment results of various clinical interventions. For example, Britain's National Institute for Clinical Excellence (NICE) conducted a comprehensive review of both inpatient and outpatient interventions for all of the AN treatment centers in the United Kingdom, collecting data on psychoanalytic therapy, behavioral therapy (BT), cognitive behavioral therapy (CBT), and family-based treatment (FBT). Published in 2004, the NICE study concluded that no particular treatment approach was significantly superior to any other particular approach in terms of treatment outcome. In another study conducted in 2010, researchers examined treatment outcome differences between FBT and ego-oriented individual therapy (EOIT) with adolescent patients. Selection criteria required a diagnosis of AN between twelve and eighteen months prior to therapy, as well as therapy duration between twelve and twenty sessions. The FBT group contained fifty-two subjects, while the EOIT group contained fifty subjects. Figure 1 displays the results of this study.

Figure 1 Treatment Outcome Results for FBT and EOIT

Material used in this particular passage was adapted from the following sources:

Risk Factors for Eating Disorders, R. H. Striegel-Moore and C.M. Bulik, in American Psychologist. © 2007 by the American Psychological Association.

Eating Disorders: Core interventions in the treatment and management of anorexia nervosa, bulimia nervosa, and related eating disorders. © 2004 by the British Psychological Society and the Royal College of Psychiatrists.

Randomized clinical trial comparing family-based treatment with adolescent-focused individual therapy for adolescents with anorexia nervosa. J. Lock, D. Le Grange, W. S. Agras, A. Moye, S. W. Bryson, and B. Jo, in the Archives of General Psychiatry. © 2010 by the American Medical Association.

1. Most AN sufferers demonstrate largely consistent eating patterns marked by some sporadic binging; AN sufferers generally stick to a very specific restrictive diet, eating only "safe foods" a majority of the time, but binging occasionally on other foods. Despite this irregularity in behavior, AN sufferers' attitudes about food remain consistent. What concept best describes this behavior, in terms of AN sufferers maintaining a specific attitude about food, but demonstrating slightly inconsistent eating behavior?

• A. The reality principle
• B. The principle of aggregation
• C. The self-actualizing tendency
• D. Vicarious learning

2. Heather was recently diagnosed with anorexia nervosa, and she has experienced continued weight loss and severe stomach pain. According to Learning Theory, for Heather, her physical symptoms would be considered:

I. positive reinforcement.

II. extinction.

III. punishment.

• A. I only
• B. III only
• C. I and III only
• D. I, II, and III

3. Which of the following is implied by the thin-ideal hypothesis?

• A. Canonic perspectives
• B. Illusory contours
• C. Echoic memory
• D. Object relations theory

4. An empirical basis for the addiction model of AN would most likely come from research that:

• A. discovers that a majority of those diagnosed with AN have at least one parent who is alcohol dependent.
• B. identifies high comorbidity of AN and tobacco dependence.
• C. proves that there is an inverse relationship between dopamine production in the brain and the activity of the satiety center controlled by the hypothalamus in individuals with AN.
• D. shows that those with AN have a higher mortality rate than individuals dependent on methamphetamines.

5. Which of the following scenarios best reflects how a psychoanalytic therapist would treat a patient with AN?

• A. The therapist would make sure to establish a relationship with the client based on rapport and mutual trust, and would always provide unconditional positive regard to the client.
• B. The therapist would help the patient gain awareness of his or her unconscious motives for his or her behavior, and help the patient to transition from self-loathing and guilt to reality.
• C. The therapist would attempt to recondition negative behaviors.
• D. The therapist would help the patient pinpoint negative thoughts and feelings, and help the patient learn positive self-talk and healthier behaviors.

6. Noreen, who was diagnosed with AN, now participates in family therapy. Based on the chart in Figure 1, what should the therapist expect?

• A. Noreen will gain approximately 10% of her ideal body weight by the end of 12 months.
• B. Noreen will gain approximately five pounds by the end of six months.
• C. Noreen's weight will double halfway through the treatment.
• D. Noreen will gain ten pounds by the end of treatment.

7. Which of the following conclusions can be inferred from the results displayed in Figure 1?

• A. Family-based therapy is superior to ego-oriented individual therapy in reducing the negative thought processes associated with AN.
• B. The distortions in self-image characteristic of those with AN derive from an underdeveloped ego.
• C. Attachment theory is relevant to treating AN.
• D. AN typically derives from poor parenting.