436008.ppt

Chapter 8 Eating and Sleep Disorders

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

Eating Disorders: An Overview (continued)

• Other Subtypes of DSM-IV-TR Eating Disorders

– Binge eating disorder

• Obesity – A Growing Epidemic

Bulimia Nervosa: Overview and Defining Features

• Binge Eating – Hallmark of Bulimia

– Binge

• Eating excess amounts of food

– Eating is perceived as uncontrollable

Bulimia Nervosa: Overview and Defining Features (continued)

• Compensatory Behaviors

– Purging

• Self-induced vomiting, diuretics, laxatives

– Some exercise excessively, whereas others fast

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

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

Bulimia Nervosa: Associated Features (continued)

• Associated Psychological Features

– Most are over concerned with body shape

– Fear of gaining weight

– Most have comorbid psychological disorders

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

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

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

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

Binge-Eating Disorder: Overview and Defining Features (continued)


– 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

Bulimia and Anorexia: Facts and Statistics

• Bulimia

– 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

Bulimia and Anorexia: Facts and Statistics (continued)

• Anorexia

– 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

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

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

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

Fig. 8.4, p. 315

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

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

Goals of Psychological Treatment of Anorexia Nervosa

• General Goals and Strategies

– Weight restoration

• First and easiest goal to achieve

– Psychoeducation

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

Medical and Psychological Treatment of Binge Eating Disorder

• Medical Treatment

– Sibutramine (Meridia)

• Psychological Treatment

– CBT

• Similar to that used for bulimia

• Appears efficacious

Medical and Psychological Treatment of Binge Eating Disorder (continued)

– Interpersonal psychotherapy

• Equally as effective as CBT

– Self-help techniques

• Also appear effective

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

Obesity: Background and Overview (continued)

– Increasing more rapidly

• For teens and young children

– Obesity

• Is growing rapidly in developing nations

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

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

Obesity Treatment

• Treatment

– Moderate success with adults

– Greater success with children and adolescents

• Treatment Progression -- From least-to-most intrusive options

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

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

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

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!)

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


– Unrealistic expectations about sleep

– Believe lack of sleep will be more disruptive than it usually is

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!)

The Dyssomnias: Overview and Defining Features of Hypersomnia (continued)


– About 39% have a family history of hypersomnia

– Often associated with medical and/or psychological conditions


– Complain of sleepiness throughout the day

– Able to sleep through the night

The Dyssomnias: Overview and Defining Features of Narcolepsy

• Narcolepsy -- Daytime sleepiness and cataplexy

– Cataplexic attacks

• REM sleep, precipitated by strong emotion

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

The Dyssomnias: Overview and Defining Features of Narcolepsy (continued)


– Cataplexy, sleep paralysis, and hypnagogic hallucinations

– Daytime sleepiness does not remit without treatment

The Dyssomnias: Overview of Breathing-Related Sleep Disorders

• 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

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

The Dyssomnias: Facts and Features Associated With Breathing-

Related Sleep Disorders


– Occurs in 1-2% of population

– More common in males

– Associated with obesity and increasing age

The Dyssomnias: Facts and Features Associated With Breathing-Related Sleep Disorders

(continued)


– 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

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

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

Medical Treatments

• Insomnia

– Benzodiazepines and over-the-counter sleep medications

– Prolonged use

• Can cause rebound insomnia, dependence

– Best as short-term solution

Medical Treatments (continued)

• Hypersomnia and Narcolepsy

– Stimulants (i.e., Ritalin)

– Cataplexy

• Usually treated with antidepressants

Medical Treatments

• Breathing-Related Sleep Disorders

– May include medications, weight loss, or mechanical devices

• Circadian Rhythm Sleep Disorders

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

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

Psychological Treatments (continued)

• Combined Treatments

– Insomnia – Short-term medication plus psychotherapy

– Other Dyssomnias

• Little evidence for the efficacy of combined treatments

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

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

The Parasomnias: Overview of Nightmare Disorder

• Nightmare Disorder

– Occurs during REM sleep

– Involves distressful and disturbing dreams

– Such dreams interfere with daily life functioning and interrupt sleep

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

The Parasomnias: Overview of Sleep Terror Disorder

• Sleep Terror Disorder

– Recurrent episodes of panic-like symptoms during non-REM sleep

– Often noted by a piercing scream

The Parasomnias: Overview of Sleep Terror Disorder (continued)


– More common in children than adults

– Child cannot be easily awakened during the episode

– Child has little memory of it the next day

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

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

The Parasomnias: Overview of Sleep Walking Disorder (continued)


– Problem is more common in children than adults

– Problem usually resolves on its own without treatment

– Seems to run in families

The Parasomnias: Overview of Sleep Walking Disorder (continued)

• Related Conditions

– Nocturnal eating syndrome – Person eats while asleep

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

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

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