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 brain’s inability to synchronize day and night

46. Circadian Rhythm Sleep Disorders (continued) • Nature of Circadian Rhythms and Body’s Biological Clock • Circadian Rhythms – Do not follow a 24 hour clock • Suprachiasmatic nucleus • Brain’s 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 brain’s biological clock