1. Chapter 8 Eating and Sleep Disorders

2. 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

3. 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)

4. 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

5. 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

6. 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

7. 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

8. 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

9. 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

10. 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

11. Obesity
In 2000, 30.5% of adults in the U.S were obese; in 2004, 32.2% of adults; in % 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

12. 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

13. 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

14. 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

15. 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

16. 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

17. 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

18. 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

19. 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

20. 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

21. 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

22. 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