1. Chapter 12 Eating, Feeding, and Sleep-Wake 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
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)

4. 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

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. 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.

8. 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

9. 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

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

11. 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

12. 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

13. 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