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 (continued) • 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 (continued) • Compensatory Behaviors – Purging • Self-induced vomiting, diuretics, laxatives – Some exercise excessively, whereas others fast

Bulimia Nervosa: Overview and Defining Features (continued) • 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 (continued) • Associated Psychological Features – Most are over 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 (continued) • DSM-IV-TR Subtypes of Anorexia – Restricting subtype – Limit caloric intake via diet and fasting – Binge-eating-purging subtype – About 50% of anorexics

Anorexia Nervosa: Overview and Defining Features (continued) • 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 of DSM-IVTR – Experimental diagnostic category – Engage in food binges without compensatory behaviors

Binge-Eating Disorder: Overview and Defining Features (continued) • 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 – Onset around 16 to 19 years of age – Lifetime prevalence is about 1. 1% for females, 0. 1% for males – 6 -8% 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 • Both Bulimia and Anorexia Are Found in Westernized Cultures

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

Causes of Bulimia and Anorexia: Toward an Integrative Model (continued) – 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 selfconfidence – Perfectionistic attitudes – Distorted body image – Preoccupation with food – Mood intolerance • An Integrative Model

Fig. 8. 4, p. 315

Medical and Psychological Treatment of Bulimia Nervosa • Medical and Drug Treatments – Antidepressants • Can help reduce binging and purging behavior • Are not efficacious in the long-term

Medical and Psychological Treatment of Bulimia Nervosa (continued) • Psychosocial Treatments – Cognitive-behavior therapy (CBT) • Is the treatment of choice • Basic components of CBT – Interpersonal psychotherapy • Results in long-term gains similar to CBT

Goals of Psychological Treatment of Anorexia Nervosa • General Goals and Strategies – Weight restoration • First and easiest goal to achieve – Psychoeducation

Goals of Psychological Treatment of Anorexia Nervosa (continued) – 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

Medical and Psychological Treatment of Binge Eating Disorder • Medical Treatment – Sibutramine (Meridia) • Psychological Treatment – CBT • Similar to that used for bulimia • Appears efficacious

Medical and Psychological Treatment of Binge Eating Disorder (continued) – Interpersonal psychotherapy • Equally as effective as CBT – Self-help techniques • Also appear effective

Obesity: Background and Overview • Not a formal DSM disorder • Statistics – In 2000, 20% of adults in the United States were obese – Mortality rates • Are close to those associated with smoking

Obesity: Background and Overview (continued) – 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 -15% of treatment seekers – Occurs in 27% of individuals seeking bariatric surgery – Patients are wide awake and do not binge eat

Obesity and Disordered Eating Patterns (continued) • 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 (continued) • 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 (continued) • 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

The Dyssomnias: Overview and Defining Features of Insomnia • Insomnia and Primary Insomnia – One of the most common sleep disorders – Problems initiating, maintaining, and/or nonrestorative sleep – Primary insomnia – Unrelated to any other condition (rare!)

The Dyssomnias: Overview and Defining Features of Insomnia (continued) • 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

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 (rare!)

The Dyssomnias: Overview and Defining Features of Hypersomnia (continued) • Facts and Statistics – About 39% have a family history of hypersomnia – 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 (continued) • 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 (continued) • 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 (continued) • 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 (continued) • 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 (continued) • 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

Medical Treatments (continued) • 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

Medical Treatments (continued) • 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

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 (continued) • 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 (continued) • Two Classes of Parasomnias – Those that occur during REM (i. e. , dream) sleep – Those that occur during non-REM (i. e. , non -dream) sleep

The Parasomnias: Overview of Nightmare Disorder • Nightmare Disorder – 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 (continued) • 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 – Recurrent episodes of panic-like symptoms during non-REM sleep – Often noted by a piercing scream

The Parasomnias: Overview of Sleep Terror Disorder (continued) • 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

The Parasomnias: Overview of Sleep Terror Disorder (continued) • 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

The Parasomnias: Overview of Sleep Walking Disorder (continued) • 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 (continued) • 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 (continued) • All Sleep Disorders Share – Interference with normal process of sleep – Interference results in problems during waking – Heaving influenced by psychological and behavioral factors • Incidence of Eating and Sleep Disorders Is Increasing • More Effective Treatments for Eating and Sleep Disorders Are Needed