Chapter 8 Eating and Sleep Disorders

1
Chapter 8 Eating and Sleep Disorders
2
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

3
Eating Disorders An Overview (continued)

• Other Subtypes of DSM-IV-TR Eating Disorders
• Binge eating disorder
• Obesity A Growing Epidemic

4
Bulimia Nervosa Overview and Defining Features

• Binge Eating Hallmark of Bulimia
• Binge
• Eating excess amounts of food
• Eating is perceived as uncontrollable

5
Bulimia Nervosa Overview and Defining Features
(continued)

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

6
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

7
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

8
Bulimia Nervosa Associated Features (continued)

• Associated Psychological Features
• Most are over concerned with body shape
• Fear of gaining weight
• Most have comorbid psychological disorders

9
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

10
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

11
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

12
Binge-Eating Disorder Overview and Defining
Features

• Binge-Eating Disorder Appendix of DSM-IV-TR
• Experimental diagnostic category
• Engage in food binges without compensatory
  behaviors

13
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

14
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

15
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

16
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

17
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

18
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
• An Integrative Model

19
Fig. 8.4, p. 315
20
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

21
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

22
Goals of Psychological Treatment of Anorexia
Nervosa

• General Goals and Strategies
• Weight restoration
• First and easiest goal to achieve
• Psychoeducation

23
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

24
Medical and Psychological Treatment of Binge
Eating Disorder

• Medical Treatment
• Sibutramine (Meridia)
• Psychological Treatment
• CBT
• Similar to that used for bulimia
• Appears efficacious

25
Medical and Psychological Treatment of Binge
Eating Disorder (continued)

• Interpersonal psychotherapy
• Equally as effective as CBT
• Self-help techniques
• Also appear effective

26
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

27
Obesity Background and Overview (continued)

• Increasing more rapidly
• For teens and young children
• Obesity
• Is growing rapidly in developing nations

28
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

29
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

30
Obesity Treatment

• Treatment
• Moderate success with adults
• Greater success with children and adolescents
• Treatment Progression -- From least-to-most
  intrusive options

31
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

32
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

33
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

34
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!)

35
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

36
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!)

37
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

38
The Dyssomnias Overview and Defining Features
of Narcolepsy

• Narcolepsy -- Daytime sleepiness and cataplexy
• Cataplexic attacks
• REM sleep, precipitated by strong emotion

39
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

40
The Dyssomnias Overview and Defining Features
of Narcolepsy (continued)

• Associated Features
• Cataplexy, sleep paralysis, and hypnagogic
  hallucinations
• Daytime sleepiness does not remit without
  treatment

41
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

42
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

43
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

44
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

45
Circadian Rhythm Sleep Disorders

• Circadian Rhythm Disorders
• Disturbed sleep (i.e., either insomnia or
  excessive sleepiness)
• Due to brains inability to synchronize day and
  night

46
Circadian Rhythm Sleep Disorders (continued)

• Nature of Circadian Rhythms and Bodys Biological
  Clock
• Circadian Rhythms Do not follow a 24 hour clock
• Suprachiasmatic nucleus
• Brains biological clock, stimulates melatonin
• Types of Circadian Rhythm Disorders
• Jet lag type
• Shift work type

47
Medical Treatments

• Insomnia
• Benzodiazepines and over-the-counter sleep
  medications
• Prolonged use
• Can cause rebound insomnia, dependence
• Best as short-term solution

48
Medical Treatments (continued)

• Hypersomnia and Narcolepsy
• Stimulants (i.e., Ritalin)
• Cataplexy
• Usually treated with antidepressants

49
Medical Treatments

• Breathing-Related Sleep Disorders
• May include medications, weight loss, or
  mechanical devices
• Circadian Rhythm Sleep Disorders

50
Medical Treatments (continued)

• Phase delays
• Moving bedtime later (best approach)
• Phase advances
• Moving bedtime earlier (more difficult)
• Use of very bright light
• Trick the brains biological clock

51
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

52
Psychological Treatments (continued)

• Combined Treatments
• Insomnia Short-term medication plus
  psychotherapy
• Other Dyssomnias
• Little evidence for the efficacy of combined
  treatments

53
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

54
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

55
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

56
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

57
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

58
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

59
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

60
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

61
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

62
The Parasomnias Overview of Sleep Walking
Disorder (continued)

• Related Conditions
• Nocturnal eating syndrome Person eats while
  asleep

63
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

64
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