Eating and Sleeping Disorders Chapter 16

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Eating and Sleeping DisordersChapter 16
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Eating Disorders

• 13.4 of girls and 7.1 of boys engage in
  disordered eating patterns.
• Paradox As emphasis on thinness is increasing,
  so is the problem of obesity.
• 7 million women and 1 million men in the U.S.
  suffer from eating disorders.
• 15 of young women have substantially
  disordered eating attitudes and behaviors.

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Factors Associated with Disordered Eating Patterns

• Being overweight
• Low self-esteem
• Depression
• Substance use
• Suicidal ideation
• More prevalent among females
• Least likely among African American females

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Eating DisordersPrevalence of Weight Concerns of
Youth in Grades 5-12
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Disorders Chart Eating Disorders
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Disorders Chart Eating Disorders
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Eating DisordersAnorexia Nervosa

• Anorexia Nervosa Eating disorder characterized
  by
• Refusal to maintain a body weight above the
  minimum normal weight for a persons age and
  height.
• Intense fear of becoming obese that does not
  diminish with weight loss.
• Body image distortion
• In females, absence of at least 3 consecutive
  menstrual cycles otherwise expected to occur.

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Eating DisordersAnorexia Nervosa

• Subtypes
• Restricting Lose weight through dieting or
  exercising.
• Binge-Eating/Purging Lose weight through use of
  self-induced vomiting, laxatives, or diuretics.

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Eating DisordersAnorexia Nervosa

• Physical complications
• Cardiac arrhythmia, low blood pressure, slow
  heart rate, weakened heart muscle
• Lethargy, dry skin, brittle hair, swollen parotid
  glands, hypothermia
• Males Osteoporosis, substance use disorder,
  antisocial personality disorder
• Associated characteristics
• Obsessive-compulsive behaviors and thoughts about
  food
• Control

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Eating DisordersAnorexia Nervosa

• Associated characteristics
• Personality disorders/characteristics
• Restricting introversion, conformity,
  perfectionism, rigidity
• Binge eating/purging Extroverted, histrionic,
  emotionally volatile, impulse control problems,
  substance abuse

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Eating DisordersAnorexia Nervosa

• Course and outcome Highly variable
• Usually begins in adolescence
• Better outcome for binge-eating/purging
• More severe is associated with constricted/
  overcontrolled profile
• 44 recover completely, 28 show some weight
  gain but remain underweight, poor outcome for
  24
• Death 5-20, primarily from cardiac arrest or
  suicide

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Eating DisordersBulimia Nervosa

• Bulimia Nervosa Eating disorder characterized
  by
• Recurrent episodes of binge eating (rapid
  consumption of large quantities of food) at least
  twice a week for 3 months, during which the
  person loses control over eating and uses
  vomiting, laxatives, and excess exercise to
  control weight.
• More psychopathology than non-bulimics Greater
  external locus of control, lower self-esteem and
  sense of personal effectiveness, negative
  self-image, although most are within normal
  weight range.

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Eating DisordersBulimia Nervosa

• More prevalent than anorexia
• Up to 3 of women suffer from bulimia, another
  10 report some symptoms
• 10 of bulimics are male
• Physical complications
• Effects of vomiting Erosion of tooth enamel,
  dehydration, swollen parotid glands, low
  potassium (can weaken heart and cause arrhythmia
  and cardiac arrest)
• Binge eating may cause stomach ruptures
• Gastrointestinal disturbances

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Eating DisordersBulimia Nervosa

• Related to
• Coping responses to stress
• Mood disorders, especially seasonal affective
  disorder
• Also shares characteristics of borderline
  personality

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Eating DisordersBulimia Nervosa

• Course and outcome
• Generally begins late adolescence/early adulthood
• Mixed, but better course than for anorexia
• Some bulimics continue to show disturbed eating
  patterns, low self-esteem, depressive disorder,
  but most recover either fully or partially.
• Poorer prognosis with associated history of
  substance use and longer duration before
  treatment.

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Eating DisordersBinge-Eating Disorder (BED)

• Diagnostic category provided for further study
  in DSM-IV-TR
• Binge Eating Disorder Involves a large
  consumption of food over a short period of time
  at least twice weekly for 6 months
• Unlike bulimia, does not involve use of extreme
  behavioral attempts of vomiting, fasting, or
  excessive exercise as compensation for binge
  eating.
• Diagnosis History of binge-eating episodes at
  least 2 days/week for 6 months

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Eating DisordersBinge-Eating Disorder

• Prevalence
• Prevalence 0.7-4 of population
• Females are 1.5 times as likely as males to have
  the disorder.
• Prevalent among white, African American, and
  American Indian women (possibly 10), although
  white women are more likely to be seen for the
  disorder.

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Eating DisordersBinge-Eating Disorder

• Associated characteristics/risk factors
• Overweight with history of weight fluctuation
• Prevalence 2-5
• Adverse childhood experiences, parental
  depression, vulnerability to obesity, repeated
  negative comments re weight and body
• Binges preceded by poor mood, low alertness,
  feelings of poor eating control, cravings for
  sweets.
• Complications High blood pressure, high
  cholesterol, diabetes, and depression

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Eating DisordersBinge-Eating Disorder

• Comorbid features
• Major depressive disorder
• Obsessive-compulsive personality disorder
• Avoidant personality disorder
• Course and outcome
• Begins in late adolescence/early adulthood
• Positive course compared with other eating
  disorders Most recover within 5 years
• Weight remains high (over time, 1/3 meet
  criteria for obesity)

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Eating DisordersEating Disorder Not Otherwise
Specified

• Eating Disorder Not Otherwise Specified Eating
  disorders not meeting criteria for anorexia or
  bulimia nervosa
• Individuals with binge-eating disorder
• Female who meets criteria for anorexia but has
  regular menses
• Individual who has lost significant weight but is
  in normal weight range

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Eating DisordersHyperphagia

• Hyperphagia Excessive hunger and overly large
  amounts of food ingestion.

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Eating DisordersRumination

• Rumination An eating disorder characterized by
  having the contents of the stomach drawn back up
  into the mouth, chewed for a second time, and
  swallowed again. This regurgitation appears
  effortless, may be preceded by a belching
  sensation, and typically does not involve
  retching or nausea. In rumination, the
  regurgitant does not taste sour or bitter. The
  behavior must exist for at least 1 month, with
  evidence of normal functioning prior to onset.

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Eating DisordersPica

• Pica An appetite for non-foods (e.g., coal,
  soil, chalk, paper etc.) or an abnormal appetite
  for some things that may be considered foods,
  such as food ingredients (e.g., flour, raw
  potato, starch). In order for these actions to be
  considered pica, they must persist for more than
  one month, at an age where eating dirt, clay,
  etc., is considered developmentally
  inappropriate.
• Geophagia Eating of dirt or clay.

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Do You Have an Eating Disorder?
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Overview of Major Risk Factors for Eating
Disorders
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Hunger and Satiety

• Ig Nobel awards celebrate the sillier side of
  science
• The Ig Nobel for nutrition went to a concept that
  sounds like a restaurant marketing ploy a
  bottomless bowl of soup.
• Cornell University professor Brian Wansink used
  bowls rigged with tubes that slowly and
  imperceptibly refilled them with creamy tomato
  soup to see if test subjects ate more than they
  would with a regular bowl.
• "We found that people eating from the refillable
  soup bowls ended up eating 73 percent more soup,
  but they never rated themselves as any more
  full," said Wansink, a professor of consumer
  behavior and applied economics. "They thought
  'How can I be full when the bowl has so much left
  in it?' "
• His conclusion "We as Americans judge satiety
  with our eyes, not with our stomachs.
• CNN.Com 10-7-07

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Hunger and Satiety
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Eating DisordersEtiology

• Societal influences
• Mass media portray ideal female body as 57 110
  lbs actual average is 54 162 lbs
• Sociocultural demand for thinness
• Peer influences
• Criticisms by family members about weight
• Dating

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Eating DisordersEtiology

• Body dissatisfaction
• Males see their bodies as smaller than what they
  believe is preferred females see their bodies as
  larger than what they believe is preferred
• Most dissatisfaction parallels low self-esteem
• Certain predisposition and characteristics lead
  some people to interpret images of thinness as
  evidence of their own inadequacy.

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Eating DisordersEtiology

• Exposure to ultra-thin ideal by media can lead
  to
• Internalization of that image and eating patterns
  intended to bring about that ideal
• Negative affect, which triggers dieting
• Social comparison, which leads to disordered
  eating to meet external standards of comparison.

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Eating DisordersEtiology

• Top figure
• Body image ratings of women who score high on
  measure of distorted eating behaviors.
• Bottom Figure
• Body image ratings of women who score low on
  measure of distorted eating behaviors.

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Route to Eating Disorders
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Eating DisordersEtiology

• Family and peer influences
• Psychodynamic (for anorexia)
• Fear of maturation
• Growing up and separating from family
• Developing own identity
• Fulfills unconscious desire to remain a child
• Family systems Problematic family communication
  patterns result in anorexia
• Socialization agents (peers and family)
• Relationship problems and role models

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Eating DisordersEtiology

• Cultural factors
• Culture-bound (Western cultures) and other
  societies influenced by Western culture.
• Many African Americans seem insulated from
  thinness standard, but equally as likely to have
  binge-eating disorder.
• Internalization of U.S. societal values regarding
  attractiveness affects self-esteem and body
  dissatisfaction.

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Differences in Body Image and Weight Concerns
Among African American and White Females
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Eating DisordersOther Etiological Factors

• Personality characteristics and negative
  emotional moods
• Sexual abuse
• Low self-esteem and feelings of helplessness
• Passivity, dependence, nonassertivness
• Anorexia Perfectionism, obedience, academic and
  athletic success, model children
• Bulimia Perfectionism, seasonal affective
  disorder
• Genetic factors First-degree relatives

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Eating DisordersTreatment

• Prevention programs
• Goals of school-based intervention program
• Develop positive attitude toward ones body
• Become aware of societal messages re being female
• Develop healthier eating/exercise habits
• Increase comfort in expressing feelings
• Develop healthy strategies to deal with stress
• Increase assertiveness skills
• Teach females to examine consequences of gender
  messages
• Institutional awareness of the problem is critical

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Eating DisordersTreatment

• Anorexia nervosa
• Inpatient/outpatient depends on weight and health
  of individual
• Initial goal Restore weight with psychological
  support
• Nutritional/physical rehabilitation
• Identify/understand dysfunctional attitudes
• Improve interpersonal/social functioning
• Address comorbid psychopathology/psychological
  conflicts

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Eating DisordersTreatment

• Anorexia nervosa
• Family therapy Parents involved in meal
  planning, reduce criticism (understanding
  seriousness of anorexia), negotiate new
  relationship patterns, move toward separation and
  individuation.

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Eating DisordersTreatment

• Bulimia nervosa
• Identify conditions contributing to purging
• Identify physical conditions resulting from
  purging
• Normalize eating pattern and eliminate
  binge-purge cycle

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Eating DisordersTreatment

• Bulimia nervosa
• Cognitive-behavioral therapy and use of
  antidepressants
• Encourage eating 3 or more balanced meals a day
• Reduce rigid food rules and body image concerns
• Develop cognitive and behavioral strategies

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Eating DisordersTreatment

• Binge-Eating Disorder
• Similar to treatments for bulimia with fewer
  physical complications
• Because most are overweight, therapy programs try
  to help individual lose weight
• Three phases
• Determine underlying cognitive factors
• Use cognitive strategies to change distorted
  beliefs about eating
• Relapse prevention strategies

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Primary Sleep Disorders

• Most adults require 8 hours of sleep to function
  optimally.
• Insufficient sleep results in lapses in
  attention, vigilance, and deterioration of
  performance.
• Five stages of sleep
• Stage 1 (5) Transition from wakefulness to
  sleep
• Stage 2 sleep (50)
• Stages 3-4 (10-20) Deepest level
• Rapid eye movement (REM-20-25) Dream sleep

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Primary Sleep DisordersDyssomnias

• Most problems are either inability to initiate or
  maintain sleep at night or excessive daytime
  sleepiness.
• Dyssomnias Difficulties in getting to sleep,
  maintaining sleep, or complaints of excessive
  sleepiness during the day.

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Primary Sleep DisordersPrimary Insomnia

• Primary Insomnia Characterized by difficulty
  getting to sleep, maintaining sleep, or having
  nonrestorative sleep for at least one month,
  causing clinically significant distress in
  social, occupational, or other areas of
  functioning.
• Causative factors caffeine, alcohol, heavy
  meals, exercising 2 hours before bedtime,
  stress, intrusive/ uncontrollable cognitive
  activity, altered sleep habits
• Highest rate 52 of older adults

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Primary Sleep DisordersPrimary Insomnia

• Many people with primary insomnia have
  undiagnosed sleep Apnea or Restless Leg Syndrome.
• RLS (which is also sometimes referred to as Jimmy
  Legs, spare legs or "the kicks") may be described
  as uncontrollable urges to move the limbs in
  order to stop uncomfortable, painful or odd
  sensations in the body, most commonly in the
  legs. Moving the affected body part eliminates
  the sensation, providing temporary relief. The
  sensations and need to move may return
  immediately after ceasing movement, or at a later
  time. RLS may start at any age, including early
  childhood, and is a progressive disease for a
  certain percentage of sufferers, although it has
  been known for the symptoms to disappear
  permanently in some sufferers.

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Primary Sleep DisordersPrimary Hypersomnia

• Primary Hypersomnia Characterized by excessive
  daytime sleepiness or prolonged nighttime sleep
  for at least one month, causing significant
  distress or impairment in social, occupational,
  or other important areas of functioning.
• Compelling need to nap during the day that
  provides no relief from sleepiness.
• Results in problems with driving, work
  performance, or social functioning.

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Primary Sleep DisordersNarcolepsy

• Narcolepsy Characterized by overwhelming need
  for daytime sleep even when adequate sleep
  occurs at night daily for at least 3 months,
  together with at least 2 of the following
• Irresistible drowsiness/falling asleep without
  warning
• Cataplexy
• Sleep paralysis during wakefulness
• Hypnogogic hallucinations before falling asleep

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Primary Sleep DisordersBreathing-Related Sleep
Disorder

• Breathing-Related Sleep Disorder Excessive
  sleepiness caused by sleep disruption through
  abnormalities of breathing during sleep
• Obstructive Sleep Apnea Upper-airway obstruction
  during sleep
• Undiagnosed in 75 of treatable cases
• Disruptive snoring, breathing pauses, gasping,
  excessive daytime sleepiness
• Obstruction of airway prevents breathing during
  sleep
• Central sleep apnea syndrome
• Central alveolar hypoventilation syndrome

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Primary Sleep DisordersCircadian Rhythm Sleep
Disorder

• Circadian Rhythm Sleep Disorder Pattern of
  recurrent sleep disruption caused by disruption
  of the biological sleep-wake cycle or mismatch
  between internal clock for sleeping and waking
  and environmental demands.
• Jet lag, shift work
• Associated with major disasters (e.g., Exxon
  Valdez oil spill)

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Primary Sleep DisordersDyssomnias Not Otherwise
Specified

• Dyssomnias Not Otherwise Specified Do not meet
  criteria for specific dyssomnia, but produce
  significant impairment
• Insomnia caused by environmental factors
• Excessive sleepiness caused by sleep deprivation
• Restless leg syndrome
• Periodic limb movement disorder

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Primary Sleep DisordersParasomnias

• Parasomnias Activation of physiological systems
  at inappropriate times during the sleep-wake
  cycle.
• Generally involve activation of the autonomic
  nervous system, including cognitive processes
  during sleep or sleep-wake transitions.

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Primary Sleep DisordersParasomnias

• Nightmare disorder Nightmares several times/week
  during REM sleep.
• 3 of preschoolers and school-aged children
• Sleep Terror Disorder Vivid nightmares during
  first third of deep sleep (non-REM) child
  screams with terror, is not fully aroused, and
  does not remember what happened.
• 6 of children, disappears in adolescence
• In adults age 20-30 it has a chronic course

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Primary Sleep DisordersParasomnias

• Sleepwalking Disorder Motor activity ranging
  from sitting up to getting out of bed and walking
  about while still asleep.
• 2 of school-aged children sleepwalk at least a
  few nights a week
• Up to 30 of children sleepwalk at least once
• 1-5 of children have sleepwalking disorder
• Tends to disappear in adolescence in adults it
  will have a chronic waxing/waning course.

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Primary Sleep DisordersParasomnias

• Parasomnias Not Otherwise Specified
• REM sleep behavior disorder Violent motor
  behavior during REM sleep
• Sleep paralysis/inability to move during
  transition from wakefulness and sleep

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Primary Sleep DisordersEtiology and Treatment of
Dyssomnias

• Etiology Subclinical anxiety and depression,
  environmental changes, health and behavioral
  habits for some etiology is unknown but may
  include
• Cognitions or intrusive, uncontrollable thoughts
• Personality and psychological adjustment problems
• Lifestyle factors
• Nocturnal activities that interfere with sleep

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Primary Sleep DisordersEtiology and Treatment of
Dyssomnias

• Treatment for specific disorders
• Excessive sleepiness (narcolepsy or hypersomnia)
  Stimulants, though more success with hypersomnia
  than narcolepsy.
• Insomnia Sleep pills, which tend to become
  ineffective over the long-term.
• Sleep apnea Avoid medications, alcohol and other
  substances lose weight if overweight sleep on
  side rather than back pressure mask during sleep
  may also help with moderate and severe apnea.

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Primary Sleep DisordersEtiology and Treatment of
Dyssomnias

• Treatment for RLS and PLMD Behavioral treatment,
  medications for RLS
• Treatment for sleep disorders generally
• Relaxation/focusing procedures
• Changing mental state prior to bedtime
• Slow deep breaths
• Eliminate distractions
• Avoid daytime naps, caffeine late in day, heavy
  meals/exercise/alcohol/nicotine 2 hours before
  bedtime.