1. Eating and Sleeping Disorders
Chapter 23
Eating and Sleeping Disorders

2. Intro Body Image Positive image Negative image 1900’s things changed
Used to be thought that “fat is where it is at” and then thought changed to “thin is in”
Society puts a high value on the “thin body” for females and boys are to be “muscular”
Adults dieting or trying to gain weight for “perfect body”
What criteria are needed for the diagnosis of an eating disorder?
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3. Result of the quest for the perfect body
Eating Disorders
Eating disorder
An ongoing disturbance in behaviors associated with the ingestion of food
30% of all adults believe that their actual weight is greater than their desirable weight.
Result of the quest for the perfect body
Most common eating disorders anorexia nervosa and bulimia
Another issue is obesity-30% of adults believe they are overweight
What criteria are needed for the diagnosis of an eating disorder?
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4. Eating Disorders cont’d.
Anorexia nervosa
Individual does not maintain a normal body weight because of an intense fear of becoming fat.
Approximately 90% to 95% of people with anorexia nervosa are female.
Classic description of person with anorexia nervosa:
Tense
Alert
Hyperactive
Rigid
Young woman
Ambitious
Drives self to perfection
Struggles to gain self respect
Main issue is “control” so will deny hunger
Severe weight loss
Introverted personality
What population is most affected by anorexia nervosa?
Why are young females at greater risk for developing anorexia nervosa?
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5. Eating Disorders cont’d.
Clinical presentation
Anorexia nervosa is a life-threatening disorder.
For the client with anorexia, the smallest gain in weight is seen as a threat and a failure in self-control.
Seldom seen in puberty and rarely after 40; average age is 17
Death results from dehydration, loss of critical muscle mass, electrolyte imbalance, or suicide; kidney, heart damage; intestinal disorders; multiorgan failure
Criteria
Refusal to maintain a body weight greater than 15% below normal
Even though the individual is underweight, he or she has an intense fear of becoming fat. A distorted significance is placed on body weight and shape.
Absence of at least three menstrual cycles in a female who has previously menstruated
Individuals with anorexia often go to great measures to monitor their bodies, such as weighing themselves three to four times each day, measuring body parts, and frequently looking in the mirror to check areas for fat.
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6. Eating Disorders cont’d.
Clinical presentation
Mortality rate for anorexia is due to
Complications of starvation
Cardiac arrest
Suicide
The death rate associated with anorexia disorders is far higher than for any other mental illness.
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7. Eating Disorders cont’d.
Bulimia
A disorder of binge eating and the use of inappropriate methods to prevent weight gain
Binge and purge at least twice a week for at least 3 months
Binge on larger amount of foods usually consisting of carbohydrates
Most common method of purging is vomiting, laxatives and diuretics
Often found in young, white, middle-class, and upper-class women
Even if body weight is normal or slightly above not satisfied
Perfectionism is important with bulimia and contributes to maintenance of bulimic behaviors. Excessive emphasis is on body shape and weight
Identify the population most affected by bulimia.
Why are individuals from modern, industrialized countries more at risk for developing bulimia?
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8. Eating Disorders cont’d.
Obesity
Excess of body weight
Result of too many calories consumed or not enough calories burned
It has not been established that obesity is consistently associated with mental health or behavioral problems.
Explain why obesity can be characterized as an eating disorder.
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9. Eating Disorders cont’d.
Other eating disorders
Pica
Persistent eating of nonfood items that lasts for longer than 1 month
Cravings for substances such as
Clay
Laundry starch
Insects
Leaves
Pebbles
Rumination disorder
The regurgitation and rechewing of food
Discuss the outcome that a client might experience if an eating disorder goes undiagnosed.
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10. Eating Disorders cont’d.
Guidelines for intervention
Main therapeutic goal for all eating disorders is to establish behaviors that promote health for the client.
Have clients do interventions voluntarily like eating
Treatment and therapies
Stabilize existing medical problems.
Reestablish normal nutrition and eating patterns.
Resolve the psychological/emotional issues that underlie disordered eating behaviors.
What is the main therapeutic goal in the treatment of clients with an eating disorder?
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11. Eating Disorders cont’d.
Treatment and therapies
Antidepressants can be used carefully in people with anorexia before gaining weight
Antidepressants and lithium are successful have been successful in treating bulimia
If medication is used to help treat also need to have client participate in psychoanalysis
Clients are assisted in identifying how food is used to provide comfort and reduce anxiety.
Clients are helped to replace a distorted body image.
Clients are taught problem-solving skills.
DRUG ALERT BOX
List therapeutic interventions for clients with an eating disorder.
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12. Sleep Disorders Normal sleep Bodily functions and metabolic rate slow
Muscles relax and body conserves energy
Renewal and repair of cells and tissues occurs.
Dreaming allows humans to gain insights, solve problems, work through emotional reactions, and prepare for the future.
Two phases of sleep:
Non–rapid eye movement (NREM) sleep
Rapid eye movement (REM) sleep
What are the developmental considerations related to sleep disorders?
Older adults usually do not have a full night of uninterrupted sleep.
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13. Sleep Disorders cont’d.
Condition or problem that repeatedly disrupts an individual’s pattern of sleep
Occurs more often in older or elderly adults
Diagnosis of a sleep disorder is based on
Thorough history
Physical examination findings
Results of several tests:
Polysomnogram
Electroencephalogram
Electromyogram
Electrooculogram
Primary sleep disorders
Related to abnormal functioning of the sleep-wake or timing mechanisms of the body
Dyssomnias
Parasomnias
Secondary sleep disorders
Caused by illness
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14. Dyssomnias Insomnia Primary hypersomnia Narcolepsy-
Disorder of falling asleep or maintaining a sound sleep
Approximately 30 to 40% adults have insomnia
Primary hypersomnia
Excessive sleepiness that usually begins at between 15 and 30 years of age
Narcolepsy-
A condition in which an individual has repeated attacks of sleep
Individual may experience cataplexy and inappropriate rapid eye movement. Cataplexy-episode of muscle weakness and loss of muscle tone lasts seconds to minutes
List the signs and symptoms of a client who is experiencing insomnia.
What is cataplexy?
What is inappropriate rapid eye movement?
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15. Dyssomnias cont’d. Obstructive sleep apnea syndrome
Periods of apnea that repeatedly awaken the individual
Circadian rhythm sleep disorder
Persistent pattern of sleep disruption that results from a mismatch between personal body rhythms and environmental demands
Restless legs syndrome or Nocturnal myoclonus
Disagreeable sensations (tingling, itching) that occur while an individual is falling asleep or is asleep; nocturnal myoclonus are brief jerks that occur mostly at beginning of sleep cycle and decrease at stage 4 (NREM)
Obese people are at higher risk for obstructive sleep apnea.
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16. Parasomnias
These experiences are characterized by abnormal behavioral or physical events during sleep
Nightmare disorder
Repeated frightening dreams that lead to abrupt awakenings
Sleep terror disorder
Repeated nightmares and abrupt awakenings accompanied by a panicky cry or scream and intense fear; seen in people with intense stress
Sleepwalking disorder
Episodes of complex motor movement during sleep
What physical signs of stress accompany sleep terrors?
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17. Guidelines for intervention
First step is to teach prevention
Maintain a regular sleeping routine.
Promote comfort.
Control physical disturbances.
Maintain a quiet, restful environment.
List nursing interventions that can be used to assist clients with sleeping problems.
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