Chapter 8 Eating and Sleep Disorders Eating Disorders

Chapter 8 Eating and Sleep Disorders

Eating Disorders: An Overview • Two major types of DSM-IV-TR eating disorders – Anorexia nervosa and bulimia nervosa – Severe disruptions in eating behavior – Extreme fear and apprehension about gaining weight – Strong sociocultural origins – Westernized views

Eating Disorders: An Overview • Other subtypes of DSM-IV-TR eating disorders – Binge eating disorder • Obesity – A growing epidemic

Bulimia Nervosa: Overview and Defining Features • Binge eating – hallmark of bulimia – Binge • Eating excess amounts of food – Eating is perceived as uncontrollable

Bulimia Nervosa: Overview and Defining Features • Compensatory behaviors – Purging • Self-induced vomiting, diuretics, laxatives – Some exercise excessively, whereas others fast

Bulimia Nervosa: Overview and Defining Features • DSM-IV-TR subtypes of bulimia – Purging subtype – most common subtype – Nonpurging subtype – about one-third of bulimics

Bulimia Nervosa: Associated Features • Associated medical features – Most are within 10% of target body weight – Purging methods can result in severe medical problems • Erosion of dental enamel, electrolyte imbalance • Kidney failure, cardiac arrhythmia, seizures, intestinal problems, permanent colon damage

Bulimia Nervosa: Associated Features • Associated psychological features – Most are overly concerned with body shape – Fear of gaining weight – Most have comorbid psychological disorders

Anorexia Nervosa: Overview and Defining Features • Successful weight loss – hallmark of anorexia – Defined as 15% below expected weight – Intense fear of obesity and losing control over eating – Anorexics show a relentless pursuit of thinness – Often begins with dieting

Anorexia Nervosa: Overview and Defining Features • DSM-IV-TR subtypes of anorexia – Restricting subtype – limit caloric intake via diet and fasting – Binge-eating-purging subtype

Anorexia Nervosa: Overview and Defining Features • Associated features – Most show marked disturbance in body image – Most are comorbid for other psychological disorders – Methods of weight loss have life threatening consequences

Binge-Eating Disorder: Overview and Defining Features • Binge-eating disorder – appendix B of DSM-IV-TR – Experimental diagnostic category – Engage in food binges without compensatory behaviors

Binge-Eating Disorder: Overview and Defining Features • Associated features – Many persons with binge-eating disorder are obese – Concerns about shape and weight – Often older than bulimics and anorexics – More psychopathology vs. non-binging obese people

Bulimia and Anorexia: Facts and Statistics • Bulimia – Majority are female – 90%+ – Onset around 16 to 19 years of age – Lifetime prevalence is about 1. 1% for females, 0. 1% for males – 6 -7% of college women suffer from bulimia – Tends to be chronic if left untreated

Bulimia and Anorexia: Facts and Statistics (continued) • Anorexia – Majority are female and white – From middle- to upper-middle-class families – Usually develops around age 13 or early adolescence – More chronic and resistant to treatment than bulimia • Cross-cultural considerations • Developmental considerations

Causes of Bulimia and Anorexia: Toward an Integrative Model • Media and cultural considerations – Being thin = success, happiness. . really? – Cultural imperative for thinness • Translates into dieting – Standards of ideal body size • Change as much as fashion – Media standards of the ideal • Are difficult to achieve • Biological considerations – Can lead to neurobiological abnormalities

Causes of Bulimia and Anorexia: Toward an Integrative Model • Psychological and behavioral considerations – Low sense of personal control and self-confidence – Perfectionistic attitudes – Distorted body image – Preoccupation with food – Mood intolerance

Causes of Bulimia and Anorexia: Toward an Integrative Model • • • Dietary restraint Family influences Biological dimensions Psychological dimensions An integrative model

Medical and Psychological Treatment of Bulimia Nervosa • Psychosocial treatments – Cognitive-behavioral therapy (CBT) • Is the treatment of choice • Basic components of CBT • Medical and drug treatments – Antidepressants • Can help reduce binging and purging behavior • Are not efficacious in the long-term

Medical and Psychological Treatment of Binge Eating Disorder • Medical treatment – Sibutramine (Meridia) • Psychological treatment – CBT • Similar to that used for bulimia • Appears efficacious – Interpersonal psychotherapy • Equally as effective as CBT – Self-help techniques • Also appear effective

Goals of Psychological Treatment of Anorexia Nervosa • General goals and strategies – Weight restoration • First and easiest goal to achieve – Psychoeducation – Behavioral and cognitive interventions • Target food, weight, body image, thought and emotion – Treatment often involves the family – Long-term prognosis for anorexia is poorer than for bulimia • Preventing eating disorders

Obesity: Background and Overview • Not a formal DSM disorder • Statistics – In 2000, 30. 5% of adults in the United States were obese; 33. 8% in 2008 – Mortality rates • Are close to those associated with smoking – Increasing more rapidly • For teens and young children – Obesity • Is growing rapidly in developing nations

Obesity and Disordered Eating Patterns • Obesity and night eating syndrome – Occurs in 7 -19% of treatment seekers – Occurs in 42% of individuals seeking bariatric surgery – Patients are wide awake and do not binge eat

Obesity and Disordered Eating Patterns • Causes – Obesity is related to technological advancement – Genetics account for about 30% of obesity cases – Biological and psychosocial factors contribute as well

Obesity Treatment • Treatment – Moderate success with adults – Greater success with children and adolescents • Treatment progression – from least to most intrusive options

Obesity Treatment • First step – Self-directed weight loss programs • Second step – Commercial self-help programs • Third step – Behavior modification programs • Last step – Bariatric surgery

Sleep Disorders: An Overview • Two major types of DSM-IV-TR sleep disorders – Dyssomnias • Difficulties in amount, quality, or timing of sleep – Parasomnias • Abnormal behavioral and physiological events during sleep

Sleep Disorders: An Overview • Assessment of disordered sleep: Polysomnographic (PSG) evaluation – Electroencephalograph (EEG) – brain wave activity – Electrooculograph (EOG) – eye movements – Electromyography (EMG) – muscle movements – Detailed history, assessment of sleep hygiene and sleep efficiency • Actigraph • Sleep efficiency (SE)

The Dyssomnias: Overview and Defining Features of Insomnia • Insomnia and primary insomnia – One of the most common sleep disorders – Microsleeps – Problems initiating/maintaining sleep, and/or nonrestorative sleep – Primary insomnia – unrelated to any other condition – 35% of adults report daytime sleepiness

The Dyssomnias: Overview and Defining Features of Insomnia • Facts and statistics – Often associated with medical and/or psychological conditions – Affects females twice as often as males • Associated features – Unrealistic expectations about sleep – Believe lack of sleep will be more disruptive than it usually is • An integrative model

The Dyssomnias: Overview and Defining Features of Hypersomnia • Hypersomnia and primary hypersomnia – Sleeping too much or excessive sleep – Experience excessive sleepiness as a problem – Primary hypersomnia – unrelated to any other condition

The Dyssomnias: Overview and Defining Features of Hypersomnia • Facts and statistics – Often associated with medical and/or psychological conditions • Associated features – Complain of sleepiness throughout the day – Able to sleep through the night

The Dyssomnias: Overview and Defining Features of Narcolepsy • Narcolepsy – daytime sleepiness and cataplexy – Cataplexic attacks • REM sleep, precipitated by strong emotion

The Dyssomnias: Overview and Defining Features of Narcolepsy • Facts and statistics – rare condition – Affects about. 03% to. 16% of the population – Equally distributed between males and females – Onset during adolescence – Typically improves over time

The Dyssomnias: Overview and Defining Features of Narcolepsy • Associated features – Cataplexy, sleep paralysis, and hypnagogic hallucinations – Daytime sleepiness does not remit without treatment

The Dyssomnias: Overview of Breathing -Related Sleep Disorders • Breathing-related sleep disorders – Sleepiness during the day and/or disrupted sleep at night – Sleep apnea • Restricted air flow and/or brief cessations of breathing

The Dyssomnias: Overview of Breathing -Related Sleep Disorders • Subtypes of sleep apnea – Obstructive sleep apnea (OSA) • Airflow stops, but respiratory system works – Central sleep apnea (CSA) • Respiratory systems stops for brief periods – Mixed sleep apnea • Combination of OSA and CSA

The Dyssomnias: Facts and Features Associated With Breathing-Related Sleep Disorders • Facts and statistics – Occurs in 1 -2% of population – More common in males – Associated with obesity and increasing age

The Dyssomnias: Facts and Features Associated With Breathing-Related Sleep Disorders • Associated features – Persons are usually minimally aware of apnea problem – Often snore, sweat during sleep, wake frequently – May have morning headaches – May experience episodes of falling asleep during the day

Circadian Rhythm Sleep Disorders • Circadian rhythm disorders – Disturbed sleep (i. e. , either insomnia or excessive sleepiness) – Due to brain’s inability to synchronize day and night

Circadian Rhythm Sleep Disorders • Nature of circadian rhythms and body’s biological clock – Circadian rhythms – do not follow a 24 hour clock – Suprachiasmatic nucleus • Brain’s biological clock, stimulates melatonin • Types of circadian rhythm disorders – Jet lag type – Shift work type

Medical Treatments • Insomnia – Benzodiazepines and over-the-counter sleep medications – Prolonged use • Can cause rebound insomnia, dependence – Best as short-term solution • Hypersomnia and narcolepsy – Stimulants (i. e. , Ritalin) – Cataplexy • Usually treated with antidepressants

Medical Treatments • Breathing-related sleep disorders – May include medications, weight loss, or mechanical devices • Circadian rhythm sleep disorders – Phase delays • Moving bedtime later (best approach) – Phase advances • Moving bedtime earlier (more difficult) – Use of very bright light • Trick the brain’s biological clock • Environmental treatments

Psychological Treatments • Relaxation and stress reduction – Reduces stress and assists with sleep – Modify unrealistic expectations about sleep • Stimulus control procedures – Improved sleep hygiene – bedroom is a place for sleep – For children – setting a regular bedtime routine

Psychological Treatments • Combined treatments – Insomnia – short-term medication plus psychotherapy – Other dyssomnias • Little evidence for the efficacy of combined treatments

The Parasomnias: Nature and General Overview • Nature of parasomnias – The problem is not with sleep itself – Problem is abnormal events during sleep, or shortly after waking

The Parasomnias: Nature and General Overview • Two classes of parasomnias – Those that occur during REM (i. e. , dream) sleep – Those that occur during non-REM (i. e. , nondream) sleep

The Parasomnias: Overview of Nightmare Disorder • Nightmare disorder – 10%-50% of children and 1% of adults have nightmares – Occurs during REM sleep – Involves distressful and disturbing dreams – Such dreams interfere with daily life functioning and interrupt sleep

The Parasomnias: Overview of Nightmare Disorder • Facts and associated features – Dreams often awaken the sleeper – Problem is more common in children than adults • Treatment – May involve antidepressants and/or relaxation training

The Parasomnias: Overview of Sleep Terror Disorder • Sleep terror disorder – 5% of children and <1% of adults have sleep terror – Recurrent episodes of panic-like symptoms during non-REM sleep – Often noted by a piercing scream

The Parasomnias: Overview of Sleep Terror Disorder • Facts and associated features – More common in children than adults – Child cannot be easily awakened during the episode – Child has little memory of it the next day • Treatment – a wait-and-see posture – Scheduled awakenings prior to the sleep terror – Severe cases • Antidepressants (i. e. , Imipramine) or benzodiazepines

The Parasomnias: Overview of Sleep Walking Disorder • Sleep walking disorder – somnambulism – Occurs during non-REM sleep – Usually during first few hours of deep sleep – Person must leave the bed • Facts and associated features – Problem is more common in children than adults – Problem usually resolves on its own without treatment – Seems to run in families

The Parasomnias: Overview of Sleep Walking Disorder • Related conditions – Nocturnal eating syndrome – Person eats while asleep

Summary of Eating and Sleep Disorders • All eating disorders share – Gross deviations in eating behavior – Fear or concern about weight, body size, appearance – Heavily influenced by social, cultural, and psychological factors

Summary of Eating and Sleep Disorders • All sleep disorders share – Interference with normal process of sleep – Interference results in problems during waking – Heavily influenced by psychological and behavioral factors • Incidence of eating and sleep disorders is increasing • More effective treatments for eating and sleep disorders are needed