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Eating and Sleeping Disorders Chapter 16


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Title: Eating and Sleeping Disorders Chapter 16

Eating and Sleeping DisordersChapter 16
Eating Disorders
  • 13.4 of girls and 7.1 of boys engage in
    disordered eating patterns.
  • Paradox As emphasis on thinness is increasing,
    so is the problem of obesity.
  • 7 million women and 1 million men in the U.S.
    suffer from eating disorders.
  • 15 of young women have substantially
    disordered eating attitudes and behaviors.

Factors Associated with Disordered Eating Patterns
  • Being overweight
  • Low self-esteem
  • Depression
  • Substance use
  • Suicidal ideation
  • More prevalent among females
  • Least likely among African American females

Eating DisordersPrevalence of Weight Concerns of
Youth in Grades 5-12
Disorders Chart Eating Disorders
Disorders Chart Eating Disorders
Eating DisordersAnorexia Nervosa
  • Anorexia Nervosa Eating disorder characterized
  • Refusal to maintain a body weight above the
    minimum normal weight for a persons age and
  • Intense fear of becoming obese that does not
    diminish with weight loss.
  • Body image distortion
  • In females, absence of at least 3 consecutive
    menstrual cycles otherwise expected to occur.

Eating DisordersAnorexia Nervosa
  • Subtypes
  • Restricting Lose weight through dieting or
  • Binge-Eating/Purging Lose weight through use of
    self-induced vomiting, laxatives, or diuretics.

Eating DisordersAnorexia Nervosa
  • Physical complications
  • Cardiac arrhythmia, low blood pressure, slow
    heart rate, weakened heart muscle
  • Lethargy, dry skin, brittle hair, swollen parotid
    glands, hypothermia
  • Males Osteoporosis, substance use disorder,
    antisocial personality disorder
  • Associated characteristics
  • Obsessive-compulsive behaviors and thoughts about
  • Control

Eating DisordersAnorexia Nervosa
  • Associated characteristics
  • Personality disorders/characteristics
  • Restricting introversion, conformity,
    perfectionism, rigidity
  • Binge eating/purging Extroverted, histrionic,
    emotionally volatile, impulse control problems,
    substance abuse

Eating DisordersAnorexia Nervosa
  • Course and outcome Highly variable
  • Usually begins in adolescence
  • Better outcome for binge-eating/purging
  • More severe is associated with constricted/
    overcontrolled profile
  • 44 recover completely, 28 show some weight
    gain but remain underweight, poor outcome for
  • Death 5-20, primarily from cardiac arrest or

Eating DisordersBulimia Nervosa
  • Bulimia Nervosa Eating disorder characterized
  • Recurrent episodes of binge eating (rapid
    consumption of large quantities of food) at least
    twice a week for 3 months, during which the
    person loses control over eating and uses
    vomiting, laxatives, and excess exercise to
    control weight.
  • More psychopathology than non-bulimics Greater
    external locus of control, lower self-esteem and
    sense of personal effectiveness, negative
    self-image, although most are within normal
    weight range.

Eating DisordersBulimia Nervosa
  • More prevalent than anorexia
  • Up to 3 of women suffer from bulimia, another
    10 report some symptoms
  • 10 of bulimics are male
  • Physical complications
  • Effects of vomiting Erosion of tooth enamel,
    dehydration, swollen parotid glands, low
    potassium (can weaken heart and cause arrhythmia
    and cardiac arrest)
  • Binge eating may cause stomach ruptures
  • Gastrointestinal disturbances

Eating DisordersBulimia Nervosa
  • Related to
  • Coping responses to stress
  • Mood disorders, especially seasonal affective
  • Also shares characteristics of borderline

Eating DisordersBulimia Nervosa
  • Course and outcome
  • Generally begins late adolescence/early adulthood
  • Mixed, but better course than for anorexia
  • Some bulimics continue to show disturbed eating
    patterns, low self-esteem, depressive disorder,
    but most recover either fully or partially.
  • Poorer prognosis with associated history of
    substance use and longer duration before

Eating DisordersBinge-Eating Disorder (BED)
  • Diagnostic category provided for further study
    in DSM-IV-TR
  • Binge Eating Disorder Involves a large
    consumption of food over a short period of time
    at least twice weekly for 6 months
  • Unlike bulimia, does not involve use of extreme
    behavioral attempts of vomiting, fasting, or
    excessive exercise as compensation for binge
  • Diagnosis History of binge-eating episodes at
    least 2 days/week for 6 months

Eating DisordersBinge-Eating Disorder
  • Prevalence
  • Prevalence 0.7-4 of population
  • Females are 1.5 times as likely as males to have
    the disorder.
  • Prevalent among white, African American, and
    American Indian women (possibly 10), although
    white women are more likely to be seen for the

Eating DisordersBinge-Eating Disorder
  • Associated characteristics/risk factors
  • Overweight with history of weight fluctuation
  • Prevalence 2-5
  • Adverse childhood experiences, parental
    depression, vulnerability to obesity, repeated
    negative comments re weight and body
  • Binges preceded by poor mood, low alertness,
    feelings of poor eating control, cravings for
  • Complications High blood pressure, high
    cholesterol, diabetes, and depression

Eating DisordersBinge-Eating Disorder
  • Comorbid features
  • Major depressive disorder
  • Obsessive-compulsive personality disorder
  • Avoidant personality disorder
  • Course and outcome
  • Begins in late adolescence/early adulthood
  • Positive course compared with other eating
    disorders Most recover within 5 years
  • Weight remains high (over time, 1/3 meet
    criteria for obesity)

Eating DisordersEating Disorder Not Otherwise
  • Eating Disorder Not Otherwise Specified Eating
    disorders not meeting criteria for anorexia or
    bulimia nervosa
  • Individuals with binge-eating disorder
  • Female who meets criteria for anorexia but has
    regular menses
  • Individual who has lost significant weight but is
    in normal weight range

Eating DisordersHyperphagia
  • Hyperphagia Excessive hunger and overly large
    amounts of food ingestion.

Eating DisordersRumination
  • Rumination An eating disorder characterized by
    having the contents of the stomach drawn back up
    into the mouth, chewed for a second time, and
    swallowed again. This regurgitation appears
    effortless, may be preceded by a belching
    sensation, and typically does not involve
    retching or nausea. In rumination, the
    regurgitant does not taste sour or bitter. The
    behavior must exist for at least 1 month, with
    evidence of normal functioning prior to onset.

Eating DisordersPica
  • Pica An appetite for non-foods (e.g., coal,
    soil, chalk, paper etc.) or an abnormal appetite
    for some things that may be considered foods,
    such as food ingredients (e.g., flour, raw
    potato, starch). In order for these actions to be
    considered pica, they must persist for more than
    one month, at an age where eating dirt, clay,
    etc., is considered developmentally
  • Geophagia Eating of dirt or clay.

Do You Have an Eating Disorder?
Overview of Major Risk Factors for Eating
Hunger and Satiety
  • Ig Nobel awards celebrate the sillier side of
  • The Ig Nobel for nutrition went to a concept that
    sounds like a restaurant marketing ploy a
    bottomless bowl of soup.
  • Cornell University professor Brian Wansink used
    bowls rigged with tubes that slowly and
    imperceptibly refilled them with creamy tomato
    soup to see if test subjects ate more than they
    would with a regular bowl.
  • "We found that people eating from the refillable
    soup bowls ended up eating 73 percent more soup,
    but they never rated themselves as any more
    full," said Wansink, a professor of consumer
    behavior and applied economics. "They thought
    'How can I be full when the bowl has so much left
    in it?' "
  • His conclusion "We as Americans judge satiety
    with our eyes, not with our stomachs.
  • CNN.Com 10-7-07

Hunger and Satiety
Eating DisordersEtiology
  • Societal influences
  • Mass media portray ideal female body as 57 110
    lbs actual average is 54 162 lbs
  • Sociocultural demand for thinness
  • Peer influences
  • Criticisms by family members about weight
  • Dating

Eating DisordersEtiology
  • Body dissatisfaction
  • Males see their bodies as smaller than what they
    believe is preferred females see their bodies as
    larger than what they believe is preferred
  • Most dissatisfaction parallels low self-esteem
  • Certain predisposition and characteristics lead
    some people to interpret images of thinness as
    evidence of their own inadequacy.

Eating DisordersEtiology
  • Exposure to ultra-thin ideal by media can lead
  • Internalization of that image and eating patterns
    intended to bring about that ideal
  • Negative affect, which triggers dieting
  • Social comparison, which leads to disordered
    eating to meet external standards of comparison.

Eating DisordersEtiology
  • Top figure
  • Body image ratings of women who score high on
    measure of distorted eating behaviors.
  • Bottom Figure
  • Body image ratings of women who score low on
    measure of distorted eating behaviors.

Route to Eating Disorders
Eating DisordersEtiology
  • Family and peer influences
  • Psychodynamic (for anorexia)
  • Fear of maturation
  • Growing up and separating from family
  • Developing own identity
  • Fulfills unconscious desire to remain a child
  • Family systems Problematic family communication
    patterns result in anorexia
  • Socialization agents (peers and family)
  • Relationship problems and role models

Eating DisordersEtiology
  • Cultural factors
  • Culture-bound (Western cultures) and other
    societies influenced by Western culture.
  • Many African Americans seem insulated from
    thinness standard, but equally as likely to have
    binge-eating disorder.
  • Internalization of U.S. societal values regarding
    attractiveness affects self-esteem and body

Differences in Body Image and Weight Concerns
Among African American and White Females
Eating DisordersOther Etiological Factors
  • Personality characteristics and negative
    emotional moods
  • Sexual abuse
  • Low self-esteem and feelings of helplessness
  • Passivity, dependence, nonassertivness
  • Anorexia Perfectionism, obedience, academic and
    athletic success, model children
  • Bulimia Perfectionism, seasonal affective
  • Genetic factors First-degree relatives

Eating DisordersTreatment
  • Prevention programs
  • Goals of school-based intervention program
  • Develop positive attitude toward ones body
  • Become aware of societal messages re being female
  • Develop healthier eating/exercise habits
  • Increase comfort in expressing feelings
  • Develop healthy strategies to deal with stress
  • Increase assertiveness skills
  • Teach females to examine consequences of gender
  • Institutional awareness of the problem is critical

Eating DisordersTreatment
  • Anorexia nervosa
  • Inpatient/outpatient depends on weight and health
    of individual
  • Initial goal Restore weight with psychological
  • Nutritional/physical rehabilitation
  • Identify/understand dysfunctional attitudes
  • Improve interpersonal/social functioning
  • Address comorbid psychopathology/psychological

Eating DisordersTreatment
  • Anorexia nervosa
  • Family therapy Parents involved in meal
    planning, reduce criticism (understanding
    seriousness of anorexia), negotiate new
    relationship patterns, move toward separation and

Eating DisordersTreatment
  • Bulimia nervosa
  • Identify conditions contributing to purging
  • Identify physical conditions resulting from
  • Normalize eating pattern and eliminate
    binge-purge cycle

Eating DisordersTreatment
  • Bulimia nervosa
  • Cognitive-behavioral therapy and use of
  • Encourage eating 3 or more balanced meals a day
  • Reduce rigid food rules and body image concerns
  • Develop cognitive and behavioral strategies

Eating DisordersTreatment
  • Binge-Eating Disorder
  • Similar to treatments for bulimia with fewer
    physical complications
  • Because most are overweight, therapy programs try
    to help individual lose weight
  • Three phases
  • Determine underlying cognitive factors
  • Use cognitive strategies to change distorted
    beliefs about eating
  • Relapse prevention strategies

Primary Sleep Disorders
  • Most adults require 8 hours of sleep to function
  • Insufficient sleep results in lapses in
    attention, vigilance, and deterioration of
  • Five stages of sleep
  • Stage 1 (5) Transition from wakefulness to
  • Stage 2 sleep (50)
  • Stages 3-4 (10-20) Deepest level
  • Rapid eye movement (REM-20-25) Dream sleep

Primary Sleep DisordersDyssomnias
  • Most problems are either inability to initiate or
    maintain sleep at night or excessive daytime
  • Dyssomnias Difficulties in getting to sleep,
    maintaining sleep, or complaints of excessive
    sleepiness during the day.

Primary Sleep DisordersPrimary Insomnia
  • Primary Insomnia Characterized by difficulty
    getting to sleep, maintaining sleep, or having
    nonrestorative sleep for at least one month,
    causing clinically significant distress in
    social, occupational, or other areas of
  • Causative factors caffeine, alcohol, heavy
    meals, exercising 2 hours before bedtime,
    stress, intrusive/ uncontrollable cognitive
    activity, altered sleep habits
  • Highest rate 52 of older adults

Primary Sleep DisordersPrimary Insomnia
  • Many people with primary insomnia have
    undiagnosed sleep Apnea or Restless Leg Syndrome.
  • RLS (which is also sometimes referred to as Jimmy
    Legs, spare legs or "the kicks") may be described
    as uncontrollable urges to move the limbs in
    order to stop uncomfortable, painful or odd
    sensations in the body, most commonly in the
    legs. Moving the affected body part eliminates
    the sensation, providing temporary relief. The
    sensations and need to move may return
    immediately after ceasing movement, or at a later
    time. RLS may start at any age, including early
    childhood, and is a progressive disease for a
    certain percentage of sufferers, although it has
    been known for the symptoms to disappear
    permanently in some sufferers.

Primary Sleep DisordersPrimary Hypersomnia
  • Primary Hypersomnia Characterized by excessive
    daytime sleepiness or prolonged nighttime sleep
    for at least one month, causing significant
    distress or impairment in social, occupational,
    or other important areas of functioning.
  • Compelling need to nap during the day that
    provides no relief from sleepiness.
  • Results in problems with driving, work
    performance, or social functioning.

Primary Sleep DisordersNarcolepsy
  • Narcolepsy Characterized by overwhelming need
    for daytime sleep even when adequate sleep
    occurs at night daily for at least 3 months,
    together with at least 2 of the following
  • Irresistible drowsiness/falling asleep without
  • Cataplexy
  • Sleep paralysis during wakefulness
  • Hypnogogic hallucinations before falling asleep

Primary Sleep DisordersBreathing-Related Sleep
  • Breathing-Related Sleep Disorder Excessive
    sleepiness caused by sleep disruption through
    abnormalities of breathing during sleep
  • Obstructive Sleep Apnea Upper-airway obstruction
    during sleep
  • Undiagnosed in 75 of treatable cases
  • Disruptive snoring, breathing pauses, gasping,
    excessive daytime sleepiness
  • Obstruction of airway prevents breathing during
  • Central sleep apnea syndrome
  • Central alveolar hypoventilation syndrome

Primary Sleep DisordersCircadian Rhythm Sleep
  • Circadian Rhythm Sleep Disorder Pattern of
    recurrent sleep disruption caused by disruption
    of the biological sleep-wake cycle or mismatch
    between internal clock for sleeping and waking
    and environmental demands.
  • Jet lag, shift work
  • Associated with major disasters (e.g., Exxon
    Valdez oil spill)

Primary Sleep DisordersDyssomnias Not Otherwise
  • Dyssomnias Not Otherwise Specified Do not meet
    criteria for specific dyssomnia, but produce
    significant impairment
  • Insomnia caused by environmental factors
  • Excessive sleepiness caused by sleep deprivation
  • Restless leg syndrome
  • Periodic limb movement disorder

Primary Sleep DisordersParasomnias
  • Parasomnias Activation of physiological systems
    at inappropriate times during the sleep-wake
  • Generally involve activation of the autonomic
    nervous system, including cognitive processes
    during sleep or sleep-wake transitions.

Primary Sleep DisordersParasomnias
  • Nightmare disorder Nightmares several times/week
    during REM sleep.
  • 3 of preschoolers and school-aged children
  • Sleep Terror Disorder Vivid nightmares during
    first third of deep sleep (non-REM) child
    screams with terror, is not fully aroused, and
    does not remember what happened.
  • 6 of children, disappears in adolescence
  • In adults age 20-30 it has a chronic course

Primary Sleep DisordersParasomnias
  • Sleepwalking Disorder Motor activity ranging
    from sitting up to getting out of bed and walking
    about while still asleep.
  • 2 of school-aged children sleepwalk at least a
    few nights a week
  • Up to 30 of children sleepwalk at least once
  • 1-5 of children have sleepwalking disorder
  • Tends to disappear in adolescence in adults it
    will have a chronic waxing/waning course.

Primary Sleep DisordersParasomnias
  • Parasomnias Not Otherwise Specified
  • REM sleep behavior disorder Violent motor
    behavior during REM sleep
  • Sleep paralysis/inability to move during
    transition from wakefulness and sleep

Primary Sleep DisordersEtiology and Treatment of
  • Etiology Subclinical anxiety and depression,
    environmental changes, health and behavioral
    habits for some etiology is unknown but may
  • Cognitions or intrusive, uncontrollable thoughts
  • Personality and psychological adjustment problems
  • Lifestyle factors
  • Nocturnal activities that interfere with sleep

Primary Sleep DisordersEtiology and Treatment of
  • Treatment for specific disorders
  • Excessive sleepiness (narcolepsy or hypersomnia)
    Stimulants, though more success with hypersomnia
    than narcolepsy.
  • Insomnia Sleep pills, which tend to become
    ineffective over the long-term.
  • Sleep apnea Avoid medications, alcohol and other
    substances lose weight if overweight sleep on
    side rather than back pressure mask during sleep
    may also help with moderate and severe apnea.

Primary Sleep DisordersEtiology and Treatment of
  • Treatment for RLS and PLMD Behavioral treatment,
    medications for RLS
  • Treatment for sleep disorders generally
  • Relaxation/focusing procedures
  • Changing mental state prior to bedtime
  • Slow deep breaths
  • Eliminate distractions
  • Avoid daytime naps, caffeine late in day, heavy
    meals/exercise/alcohol/nicotine 2 hours before