Chapter 8 Eating and Sleep Disorders

Bulimia Nervosa Binge Eating – Hallmark of Bulimia Binge -eating excess amounts of food Eating is perceived as uncontrollable Compensatory Behaviors Purging -self-induced vomiting, diuretics, laxatives Some exercise excessively, whereas others fast

Bulimia Nervosa 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 Comorbid with other disorders (mood, anxiety, substance abuse)

Anorexia Nervosa 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 2 subtypes: restrictive & binge-eating/purging

Anorexia Medical Consequences Amenorrhea – menstruation stops (most common) Dermatological (skin) problems Lanugo – hair on limbs Cardiovascular problems Gastrointestinal problems Similar vomiting consequences as bulimia Most are comorbid for other psychological disorders

Binge-Eating Disorder Engage in food binges without compensatory behaviors 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

Bulimia and Anorexia: Facts and Statistics Majority are female and white Onset around 16 to 19 years of age Lifetime prevalence is about 1.5% for females, 0.5% for males 6-8% of college women suffer from bulimia Tends to be chronic if left untreated

Bulimia and Anorexia: Facts and Statistics Majority are female and white From middle-to-upper middle class families Usually develops in adolescence More chronic and resistant to treatment than bulimia Both Bulimia and Anorexia Are Found in Westernized Cultures

Causes of Bulimia and Anorexia Culture & Standards Cultural imperative for thinness/increased dieting Standards of ideal body size changing Male vs. female standards/Social group pressures Family issues & Genetics Family is success driven Runs in families Psychological Dimensions Low sense of personal control/self-confidence Perfectionistic attitudes & distorted body image Mood intolerance/anxiety

Treatment of Eating Disorders Medical and Drug Treatments – antidepressants effective for bulimia but not anorexia Weight restoration for anorexics Long-term prognosis for anorexia is poorer than for bulimia Psychosocial Treatments Cognitive-behavior therapy (CBT) Interpersonal psychotherapy Self-help programs (OA) Preventing eating disorders Early concern over weight is predictor Emphasis on normalcy of weight gain after puberty

Obesity In 2000, 30.5% of adults in the U.S. were obese; in 2004, 32.2% of adults; in 2010 35.7% of adults Mortality rates are close to those associated with smoking Obesity and Night Eating Syndrome Occurs in 6-16% of treatment seekers Patients are wide awake and do not binge eat Causes Obesity is related to technological advancement Genetics account for about 30% of obesity cases Biological & psychosocial factors contribute

Obesity Treatment Moderate success with adults Greater success with children and adolescents Treatment Progression -- From least-to-most intrusive options 1. Self-directed weight loss programs 2. Commercial self-help programs 3. Behavior modification programs 4. Bariatric surgery

Sleep Disorders Assessment of Disordered Sleep: Polysomnographic (PSG) Evaluation Electroencephalograph (EEG): Brain wave activity Electrooculograph (EOG): Eye movements Electromyography (EMG): Muscle movements Electrocardiogram – heart activity Detailed history, assessment of sleep hygiene and sleep efficiency

The Dyssomnias: Insomnia Disorder Most common sleep disorder Problems initiating, maintaining, and/or nonrestorative sleep Affects females twice as often as males Unrealistic expectations about sleep Believe lack of sleep will be more disruptive than it usually is

The Dyssomnias: Hypersomnolence Disorder Sleeping too much or excessive sleep Experience excessive sleepiness as a problem Complain of sleepiness throughout the day Able to sleep through the night

The Dyssomnias: Narcolepsy Daytime sleepiness and cataplexy Affects about .03% to .16% of the population – rare condition Equally distributed between males and females Onset during adolescence Typically improves over time Causes aren’t clear, but possibly related to brain cell loss and genetic components

The Dyssomnias: 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 Occurs in 10-20% of population More common in males Associated with obesity and increasing age

The Dyssomnias: Circadian Rhythm Sleep Disorders Disturbed sleep (i.e., either insomnia or excessive sleepiness) Due to brain’s inability to synchronize day and night Suprachiasmatic nucleus - Brain’s biological clock, stimulates melatonin Types of Circadian Rhythm Disorders Jet lag type and shift work type

Medical Treatments for Sleep Disorders Insomnia Benzodiazepines/anti-anxiety medications and over-the-counter sleep medications Prolonged use can cause rebound insomnia, dependence Best as short-term solution Hypersomnolence and Narcolepsy Stimulants (i.e., Ritalin) Cataplexy - usually treated with antidepressants

Medical Treatments (continued) Breathing-Related Sleep Disorders May include medications, weight loss, or mechanical devices Circadian rhythm disorders 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

Psychological & Environmental Treatments Cognitive-behavioral therapy approaches 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

The Parasomnias Nature of Parasomnias – abnormal events during sleep Nightmare Disorder - occurs during REM sleep Sleep Terror Disorder - Recurrent episodes of panic- like symptoms during non-REM sleep Sleep Walking Disorder (Somnambulism): occurs during non-REM sleep