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Chapter 8 Eating and Sleep Disorders. Eating Disorders: An Overview Two Major Types of DSM-IV-TR Eating Disorders –Anorexia nervosa and bulimia nervosa.

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Presentation on theme: "Chapter 8 Eating and Sleep Disorders. Eating Disorders: An Overview Two Major Types of DSM-IV-TR Eating Disorders –Anorexia nervosa and bulimia nervosa."— Presentation transcript:

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

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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