Chapter 14

1. Chapter 14 Psychology and Children’s Health

2. Eating Disorders • Anorexia Nervosa • Bulimia • Obesity

3. 4 characteristics often observed in victims of anorexia nervosa • Most often between 14 and 18 years old • Primarily female • Often have perfectionist tendencies • Face a real risk of death

4. Social History of Anorexia Nervosa • 1920s, “flapper” styles - eating disorders increased • increasing prevalence of restrictive eating disorders in the 20th century, in the richer, more industrialized countries with thriving fashion industries • True anorexia nervosa extremely rare in economically deprived groups and during wars and famines

5. Personality Traits Associated with Anorexia Nervosa • Perfectionist tendencies • Excessive self-criticism, guilt, depression • Driven by need to be thin • Only a few had history of being overweight • Can run in families

6. The Course of Anorexia Nervosa • Most describe experiences that they believe prompted or precipitated their unusual eating behavior • onset usually quite sudden • Despite even strong objections from others, anorexics deny that they are thin and continue behavior • True anorexic pursues the destructive routine until physically unable to go on

7. Etiology of Anorexia Nervosa • Why do seemingly trivial occurrences trigger their anorexia? • Despite much study, the etiology of anorexia nervosa remains unclear • genetic factors • hormonal and endocrine problems • obsessive-compulsive tendencies, depression, • Neither genetic nor environmental influences can be ruled out

8. Treatment of Anorexia Nervosa • correct the individual’s nutrition problem and achieve medical stabilization • Restore a normal diet, which can be difficult if patients resist • Treatment must address a variety of factors since the weight and nutrition problems may be symptoms of other persistent psychological difficulties • Therapy approaches often include family counseling. Family therapy seems to have more lasting effects

9. Bulimia Nervosa • Bulimia vs. Anorexia • Bulimia Nervosa: frequent episodes of uncontrolled binge eating alternately purging. Can co-occur with Anorexia Nervosa • With Bulimia, individuals usually maintain weight close to appropriate level; with anorexia individual greatly underweight

10. With Bulimia individuals fluctuate between gaining and loosing weight • With Anorexia, individuals suffer extreme, life-threatening, weight loss.

11. Etiology of Bulimia Nervosa • Causes of bulimia are somewhat unclear at this time. • Preoccupation with food and have a persistent urge to eat • Those with bulimia seem to have more affective disturbance, particularly depression, than most people. • Higher than normal level of substance abuse, and some report a history of sexual abuse. • Similar to anorexia, bulimia probably stems in part from cultural and social pressures to be thin

12. Treatment of Bulimia Nervosa • medical evaluation of the individual should be undertaken at the outset. • may be ruptures in the gastric or esophageal areas due to vomiting • metabolic complications from either the vomiting or the abuse of laxatives • Serious dental complications include erosion of tooth enamel from highly acidic vomit

13. Approaches to bulimia have included medication and various combinations of education, counseling, and behavior management • Antidepressants are helpful in reducing binge eating, despite a substantial relapse rate when discontinued • Various strategies are used in behavioral therapy approaches • Training in self-monitoring

14. Cognitive-behavioral therapies • basic behavioral management • interrupting the disordered eating and then examining connections between certain cognitions and eating • self-monitoring training and management of self-reinforcement contingencies • relapse prevention and the use of multiple interventions Obesity

15. Obesity • Obese individuals have excess body fat and weigh approximately 30% more than is considered normal • 5 – 10% of preschool children are obese • 27% of ages 6-11 are obese • 22% of teenagers • Prevalence especially among children has increased substantially in last 15 years

16. Childhood Obesity • Serious health risk because it usually precedes a lifelong battle with obesity • Depression • Social maladjustment

17. Causes of Obesity • Theories vary and often appear to be in conflict • One view hereditary or constitutional condition • Physiologically, there seem to be two types of obesity • Hyperplastic obesity occurs when an individual has an abnormally high number of fat cells • Hypertrophic obesity occurs when individuals are overweight primarily because of extremely enlarged fat cells.

18. Biological or physiological explanations feature the inheritance of a tendency toward obesity or slimness • Many view learned behavior as an important cause of obesity • Research suggests that obesity in youngsters does predict adult obesity

19. Being grossly overweight has psychological con-sequences as well as physical dangers • negative physical self-perceptions • score lower on general self-worth than non-obese peers.

20. Treatment of Obesity • Solutions and treatments for being overweight that might seem uncomplicated on the surface, often fail in the context of chronic obesity • behavioral therapies • medical treatments

21. Treatment must be approached in a systematic fashion • multidisciplinary team (perhaps consisting of a physician, nutritionist, psychologist, and exercise therapist) is more effective • The ability to monitor one’s own behavior is important

22. Pharmacological Treatments • Drugs that suppress appetite often have a number of undesirable or intolerable side effects • lost weight is rapidly regained once the medication is discontinued • Amphetamine-based medications that suppress appetite, increase activity, and heighten mood have been popular in both over-the-counter and prescription forms • The benefits may be short-lived

23. Surgical Interventions • restrict stomach capacity, either by stapling procedures or by inserting balloon-type devices into the gastric cavity • These approaches should be employed only in the most severe cases when other therapies have been unsuccessful

24. Behavioral interventions • Multifaceted behavioral treatment successfully treated obese children • Children only age group for whom weight-reduction programs of any type have produced lasting benefits • Behavioral programs tend to focus on managing eating behavior rather than attempting to change personality

25. Self-monitoring capacity • Obese people frequently do not realize the unsuitability of the foods they consume and how quickly and often they eat • Self-monitoring allows the person to become conscious of behaviors that contribute to undesirable eating, which can then be targeted for modification

26. Toileting Problems • Encopresis: Abnormal or unacceptable patterns of fecal expulsion by children beyond the age of toilet training and lacking organic pathology • Enuresis: Recurrent bed-wetting or wetting of clothing at least twice a week for 3 months, diagnosed in children over 5

27. Encopresis • Retentive encopresis: an excessive retention of fecal material • Non-retentive encopresis: uncontrolled expulsion of feces (incontinence) resulting in soiled clothing and bedding • discontinuous, or secondary, encopresis • continuous, or primary, encopresis • Distinctions are very important in trying to establish causation and devise treatment

28. Treatment of Encopresis • medical • psychoanalytic • behavioral

29. Medical treatment • emphasize direct physical control of fecal matter using enemas, laxatives, and stool softeners along with modified diet and sometimes pediatric counseling • In some cases, medication employed to control bowel actions • Most view encopresis as a combined physiological and behavioral problem • Multimodal treatments may include behavioral shaping as well as the physical control techniques mentioned above

30. Enuresis • DSM-IV-TR cites prevalence for 5 – 10% for children at 5 years of age, 3 – 5% by age 10 and a lingering 1% of 15 year olds • Most clinicians view urinary incontinence after about 3 to 5 years of age as a problem

31. Functional Nocturnal Enuresis • May happen during the day • Connection between sleep and urinary incontinence • Considerable attention given to the relationship between enuresis and sleep patterns • Some literature relates sleep cycles and sleep abnormalities to enuresis

32. The Psychodynamic • interprets enuresis as a symptom of an inner conflict • Effectiveness of psychoanalytic treatment has been poorly documented, and there is little research evidence for a success rate

33. Medical explanations • Include developmental or maturational lag, genetic influences, abnormalities of the urinary tract, and a deficit in cortical control

34. Treatment • Medications have been used • Fluvoxamine is one popular alternative • Behavioral approaches focus on the environmental contingencies related to urination. • Urine alarms viewed as treatment of choice when combined with other treatments

35. Sleep Disorders • May occur in 30-45% of very young children • Specific sleeping difficulties, such as insomnia, are reported by a similar proportion of adults

36. Normal Sleep Cycle • 2 distinct states • REM sleep: period during which rapid eye movements occur and an individual dreams • NREM sleep: lacks rapid eye movements, made up of 4 distinguishable stages • Stage 1 : transitional period between wakefulness and sleep • Stages 2, 3, and 4: characterized by differences in amount and type of brain-wave activity, generally spoken of as increasing in “depth” of sleep

37. Parasomnias • sleep disruptions associated with specific parts of the sleep cycle, stages of sleep, or sleep-wake shifts • Activation of physiological systems at inappropriate times during the sleep-wake cycle” • Relate to cognitive processes

38. Nightmares and Night Terrors • Sleep disorders in the parasomnia category • For some children, sleep disturbances are frequent, persistent, and intense, and are then considered serious enough to be considered disorders • tend to happen at different times of night and during different sleep stages. from ordinary dreams

39. Differences between nightmares and night terrors • Children experiencing night terrors typically sleep through the episode, even though their behavior is extremely agitated. • Eyes are often wide open, as though they were staring at something in terror; they make grimaces and exhibit considerable physical movement, sometimes running about the room frantically; they may also shout and scream.

40. In nightmares, Children’s movements and verbalization much more subdued, typically restricted to moaning and slight movements in bed

41. Nightmares followed by a period during which the child is awake, recognizes people and surroundings, can provide a coherent account of what has transpired, and can remember the contents of the dream • Night terrors followed by instant and peaceful sleep, lack of recognition of people and surroundings, and frequently, complete amnesia regarding both contents and occurrence

42. Causes of nightmares and night terrors • Largely unknown at this time • Theories • sexual impulses that are not understood by the individual or experiences in a previous life • associated with a variety of other conditions such as bronchial asthma, milk intolerance, night-time feeding, and genetic disposition • multiple causes appear to be

43. Sleep-Walking Disorder (Somnambulism) • Somnambulism and night terrors have a number of common features; not unusual to find both problems in the same child • Can create serious problems since children can place themselves in danger by walking in unsafe places such as balconies and stairways • senses are not functioning in a manner that would protect them from falling or other types of accidents

44. Most often attributed to some type of emotional stress • Treatment has followed several approaches with varying degrees of success

45. Dyssomnias • Sleep disorders in which the affected individual has significant and chronic difficulty related to the “amount, quality, or timing of sleep”

46. Primary Insomnia • Involves a problem in falling asleep that has a duration of at least a month, causes substantial impairment in several areas of functioning, and is not related to substance effects or a general medical condition • Seems to begin in the early adult years and is relatively rare during childhood or adolescence

47. Causes • Anxiety or worrying is a significant contributor to insomnia • Some evidence suggests that stress, anxiety, and panic attacks are more frequent among individuals with serious insomnia conditions

48. Treatments • Medication widely employed, but with mixed results • Non-pharmacological treatments have the advantage of avoiding harmful side effects and placing the patient in greater control • Comprehensive behavioral treatment packages have had high success rates

49. Narcolepsy • Disorder in which individuals encounter “sleep attacks” at times when they are trying to stay awake • often thought of as excessive sleep, but should more correctly be viewed as inappropriate sleep

50. Cause of Narcolepsy • Largely eluded researchers to date • One factor that has been identified relates to disturbances of REM sleep