Chapter 12 Eating, Feeding, and Sleep-Wake 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 Tend to be normal weight or slightly overweight 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 Very low weight for age, height, and sex Intense fear of obesity and losing control over eating Relentless pursuit of thinness Misperceptions about body shape/size 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

Eating Disorders Statistics Lifetime prevalence of anorexia (U.S.A.) 1% for women; .3% for men Lifetime prevalence of bulimia (U.S.A.) 1.5% for women; .5% for men Lifetime prevalence of binge-eating disorder (U.S.A.) 3.5% for women; 2% for men Most cases of anorexia, bulimia, and binge-eating disorder begin during adolescence and young adulthood.

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

Types of Sleep-Wake Disorders Insomnia disorder Hypersomnolence disorder Narcolepsy Obstructive sleep apnea hypopnea Circadian rhythm sleep disorder Substance/medication-induced sleep disorder Parasomnias

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) Obstructive sleep apnea hypopnea 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