CHAPTER 23 Eating and Sleeping Disorders

1. CHAPTER 23Eating and Sleeping Disorders

2. Eating Disorders • Body Image- collection of perceptions, thoughts, feelings, and behaviors that relate to one’s body size and appearance • Body Image: • Anxiety • Depression • Anorexia nervosa • Bulimia • obesity

3. Body Image • Early Europeans- large fleshy body= wealth • poor were thin because they could not afford food and worked hard • Modern society- high value on thin • Fear of obesity is prevalent • Children learn body image- • Boys imitating muscle men • Girls dieting too look like a model

4. Eating Disorders • An ongoing disturbance in behaviors associated with ingestion of food • Criteria for diagnosis • Problems interfere daily with the client’s quality of life • Clients do not maintain normal body weight • Distorted emphasis placed on body weight and shape • Inappropriate eating behaviors (Cont’d…)

5. Adolescents • Exercise • Skip meals • Take diet pills • vomit

6. The Quest for the Perfect Body

7. Anorexia Nervosa (…Cont’d) • Anorexia nervosa, one of the most serious eating disorders, is a condition in which an individual refuses to maintain normal body weight because of intense fear of becoming fat. • Mania to be thin • 90-95% are female • 1 million males yearly • Seldom before puberty • Rare after 40 years old • Avg onset 17 yrs • High risk- • Those with professions that focus on appearance • Children from dysfunctional or abusive families

8. Anorexia Nervosa • Personality factors associated: • Tense • Alert • Hyperactive • Rigid • Young • Woman • Thinks, talks and walks rapidly • Ambitious – drives to perfection • Sensitive • Insecure • Serious with a conscience that works overtime

9. contd • Neatness, self will and stubborness make her difficult to treat • Lack of warmth and friendliness allows her to make few friends • “relentless and successful pursuit of thinness that results in psychological and physiological disturbances”

10. Anorexia – clinical presentation • Quest for thinness in refusal to maintain body weight norm • Self esteem depends highly on body shape and size • Weigh selves 3-4 times a day • Looking in mirror for areas of excess fat • Losing weight is a sign of control • Deny seriousness of their thinness

11. contd • Anorexia is a life threatening disorder • Complications due to starvation or suicide • Death: • Dehydration • Loss of critical muscle mass • Electrolyte imbalances • Suicide

12. contd • Little interest in sex • Inability to cope or solve problems exist • History : • Anxiety • Depression • Substance abuse

13. Anorexia Nervosa (…Cont’d) • Criteria for diagnosis of anorexia nervosa • Refusal to maintain a body weight that is no more than 15% below normal • Though underweight, clients have an immense fear of becoming fat. • Significance of body weight and shape is distorted; clients feel and perceive selves as fat • In a female past menarche, three missed menses (Cont’d…)

14. Bulimia • Bulimia is a disorder of binge eating and the use of inappropriate methods to prevent weight gain. • More common than anorexia nervosa • College age incidence 19% (women) • Young • White • Middle class/upper class • Men 1 out 9 cases

15. Bulimia • Psychological profile: • Anxiety • Drug use • Depression • Adolescents with chronic depression at higher risk for bulimia

16. Eating Disorders (…Cont’d) • Criteria for diagnosis of bulimia • Recurring episodes of binge eating followed by inappropriate behaviors to prevent weight gain • Binges occur at least twice a week for at least 3 months. • Excessive emphasis on body shape and weight in determining self-esteem • Untreated, eating disorders have a high mortality rate. (Cont’d…)

17. Eating Disorders (…Cont’d) • Obesity: Excessive body weight • Mild obesity: 20% to 40% above normal • Moderate obesity: 41% to 100% above normal • Morbid obesity: more than 100% above normal • Like others with eating disorders, obese persons lose control over their eating. • Eating patterns of obese persons do not pose an immediate threat, but chronic obesity eventually results in severe physical and emotional problems. (Cont’d…)

18. Binge Eating • Consuming amounts larger than most than most individuals would eat in similar circumstances • Large amounts of carbs • 5,000 calories :donuts, cakes, sweets • Lasts 1-2 hours followed by guild and wanting to rid the body of amount consumed

19. 2 forms of Bulimia • Presence or absence of purging • Purging- attempt to rid body of unwanted food • Vomiting • Diuretics • Laxatives • Enemas • Syrup of ipecac • Non Purging- does not purge after binging but goes through extremes to prevent weight gain- fasting and excessive exercise

20. Bulimia • Personality traits different than anorexia nervosa’s • Slightly older • More outgoing • Socially and sexually active • Distressed about her behaviors • Body weight is normal to above average • Other problems present • Substance abuse • Self mutiliation • hysteria

21. contd • View themselves as fat or thin • Fears of lifelong dieting • Perfectionism is important • Unrealistic expectations of selves • Failure= unable to reach goal due to weakness, inadequacy, unloveable • Life based on all-or-nothing principle

22. Clinical presentation- Bulimia • Essential feature- recurring episodes of binge eating • Ashamed and eat in secret • Episodes may be planned in advance • Must occur at least 2 x per week for at least 3 months • Trigger: stressful event or experience

23. Contd • Complications: • Fluid and electrolyte imbalances • Cardiac or skeletal muscle wasting – ipecac • Death is rare • Underlying psychological problems are often more severe than the anorexic (nervosa)

24. Obesity • Not consistently associated with mental health or behavioral problems • Linked to many physical and psychological problems that cause distress • Obesity- excess of body weight

25. Obesity • Mild- 20-40% over IBW • Moderate-41-100% over IBW • Severely-Morbidly- more than 100% above IBW • Too many calories consumed not enough calories burned • Loss of control over eating

26. Obesity • Factors : • Neurochemical that help control appetite • Heredity • Lack of sufficient exercise • Faulty eating behaviors being in childhood • Eating helps relieve childhood stress • Lessening emotional pain by eating is called ‘Compulsive Eating’

27. Obesity • Clinical presentation • Ht weight history children >20% overweight should be assessed closely • Obtain thorough family history and childhood history

28. Obesity • Society disapproves: • Child becomes aware and diet and exercise (to excess) or continue to find more comfort in food • Adolscence-weight becomes important part of forming body image • Teens rebel against parental nagging • Teens may resort to unhealthy means • “cycle”

29. Pica • Persistent eating of nonfood items that last for more than 1 month • Clay • Laundry starch • Insects • Leaves • Pebbles • Still enjoy food • Overwhelming need to eat nonfood item • Can be traced to vitamin, mineral or calorie deficiency

30. Rumination • Regurgitation and rechewing of food • Ejected from the mouth • Rechewed and swallowed • Death from malnutrition can result

31. Eating Disorders (…Cont’d) • Therapeutic goals • Establish behaviors that promote health • Assist clients in identifying and coping with the problem that led to inappropriate eating • Treatments and therapies for eating disorders require medical and mental health interventions. (Cont’d…)

32. Eating Disorders (…Cont’d) • Short-term therapeutic goals • Stabilize existing medical problems. • Reestablish normal nutrition and eating patterns. • Help client resolve the psychological and emotional issues that underlie their disordered eating behaviors. • Long-term therapeutic goals • Teaching clients about good nutrition and help them develop appropriate eating habits. • Mental health goals • Assist clients in improving self-esteem and developing more effective coping mechanisms.

33. Sleep Disorders • Normal sleep • Bodily functions and metabolic rate slow. • Muscles relax and body conserves energy. • Renewal and repair of cells and tissues occurs. • Brain activity important for learning, memory, and behavioral adaptation occurs. • Dreaming allows humans to gain insights, solve problems, work through emotional reactions, and prepare for the future. • Sleeping disorder: a condition or problem that repeatedly disrupts an individual’s plan of sleep (Cont’d…)

34. Sleep Disorders (…Cont’d) • Insomnia: A disorder of falling asleep or maintaining sound sleep • Often associated with increased physical and mental alertness at night and sleepiness during the day • Often results in preoccupation with sleep problem and in distress, which contributes to more anxiety about sleep and sets in motion a vicious cycle (Cont’d…)

35. Sleep disorders • Polysomnogram- monitors electrophysical responses during sleep • Sleep labs

36. Sleep Disorders • Primary- r/t to abn functioning of sleep wake or timing mechanism • 2 types dyssomnias and parasomnias • Dyssomnias- abnormal amt, quality or timing of sleep • Insomnia • Hypersomnia • Narcolepsy • Breathing related • Circadian rhythm related

37. Insomnia • Disorder of falling asleep or maintaining a sound sleep • Increased physical and mental alertness at night with sleepiness during the day • They will become preoccupied and distressed • Cycle of anxiety over no sleep and no sleep • Chronic insomnia- continual negative perception anticipated sleep will be poor • Decreased well being during waking hours • Lack of energy and motiviation • Decr. Attention span • Worsening of mood • 30-40% adults have problems with insomnia • More often in women • Begins in young adulthood or middle age

38. Insomnia • Primary hypersomnia • Excessive sleepiness betw. 15 and 30 yrs • Progresses over weeks or months • Becomes chronic and stable • Prolonged sleep episodes or daytime sleeping that occurs for more than a month • Impairment of ADLs • Nightime sleep may be 8-12 hours difficulty waking, excessive sleepiness during the day • Difficult to meet social or business obligations • Thought to be lazy or indifferent

39. Narcolepsy • Repeated attacks of sleep • Apparent during adolescence • Pattern of sleepiness can be traced to childhood • Onset follows a change in the persons sleep wake schedule or stressful event • Episode is irresistable • Sleep is 10-20 minutes regardless of inpropriety

40. narcolepsy • Cataplexy- sudden episode of muscle weakness and loss of muscle tone lasts for seconds to minutes • Brought on by episodes of emotions • Inappropriate REM- during transition between sleep and wakefulness • Dreamlike hallucinations or paralysis of voluntary muscle occurs

41. Apnea • Obstructive sleep apnea-partially obstructed upper airway causes periods of apnea • Repeatedly awakens the individual • Loud snoring followed by apnea lasting as long as 90 secs • Event ends with gasps, moans, mumbles, shakes, loud air gulping snores • Excessively sleepy during the day • Extremely overweight are at risk for this disorder

42. Pickwickian- apneic disorder based on weight • Circadian rhythm disorder- shift workers or frequently traveled • RLS-restless leg syndrome-prickling, tingling, itching or crawling occurs while falling asleep or during sleep • Nocturnal Myoclonus- repeated brief jerks in legs at beginning of sleep decrease in deeper REM, disturb normal sleep patterns

43. Parasomnias • Characterized by abnormal behavioral or physical events during sleep • Sleep walking- complex motor movement during sleep, rise from bed and walk around not resonsive to communication , remember little about the event • First seen between ages 4 and 8yrs, peaks 12 yrs, usually disappears by adolescence • Sleep terrors-frightening dream, abrupt awakening, with panicky cry or scream and intense fear, symp response • Nightmares disorder- repeated frightening dream that lead to abrupt awakenings- symp. Response may be present, anxiety may linger

44. Nocturnal sleep related eating disorder • Binge eating during sleep • Rapid uncontrolled ingestion of food during partial or full awakening of sleep, variable recall of event

45. General Causes of Sleep Disorders • Medical condition • Mental health condition • Chemical substance use • Neurological, cardiovascular or respiratory disorder • Pain, anxiety • Moods-dpression, anxiety, adjustment, somatiform, personality disorders • Flare ups of schizophrenia • Prescribed meds • Inflammatory process etc.

46. Sleep Disorders (…Cont’d) • Interventions for sleep disorders • First step: teach prevention • Teach client to establish and maintain a sleeping routine by preparing both body and mind for sleep. • Therapeutic interventions are aimed at promoting comfort, controlling physical disturbances and marinating a quiet, restful environment. • Hypnotics should be utilized only when other methods of inducing sleep have failed. (Cont’d…)