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
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)
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. Figure 8.4 An integrative causal model of eating disorders
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
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
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
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