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Chapter 8 Eating and Sleep Disorders

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... IV-TR Eating Disorders. Anorexia nervosa ... Intense fear of obesity and losing control over eating ... Binge-eating-purging subtype About 50% of anorexics ... – PowerPoint PPT presentation

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Title: 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
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