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Eating and Sleep Disorders

Eating Disorders: An Overview

• Two Major Types of DSM-IV Eating Disorders
  • Anorexia nervosa and bulimia nervosa
  • Both involve severe disruptions in eating behavior
  • Both involve extreme fear and apprehension

about gaining weight

• Both have strong sociocultural origins –

Westernized views

Bulimia Nervosa: Overview and Defining Features (cont.)

• Associated Features
  • Most are over concerned with body shape, fear

gaining weight

• Most have comorbid psychological disorders
• Purging methods can result in severe medical

problems

• Most are within 10% of target body weight

Anorexia Nervosa: Overview and Defining Features

 Successful Weight Loss – Hallmark of Anorexia

◦ Intense fear of obesity and losing control over eating ◦ Anorexics show a relentless pursuit of thinness, often beginning with dieting ◦ Defined as 15% below expected weight

 DSM-IV Subtypes of Anorexia

◦ Restricting subtype – Limit caloric intake via diet and fasting ◦ Binge-eating-purging subtype – About 50% of anorexics

 Associated Features

◦ Most show marked disturbance in body image ◦ Methods of weight loss can have severe life threatening medical consequences ◦ Most are comorbid for other psychological disorders

Bulimia and Anorexia: Facts and Statistics

 Bulimia

◦ Majority are female, with 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

 Anorexia

◦ Majority are female and white, from middle-to-upper middle class families

◦ Usually develops around age 13 or early adolescence

◦ Tends to be 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

◦ Standards of ideal body size change as much as clothes

◦ With improved nutrition, media standards of the ideal are difficult to achieve

 Psychological and Behavioral Considerations

◦ Low sense of personal control and self-confidence

◦ Food restriction often leads to a preoccupation with food

 An Integrative Model

Figure 8.

An integrative causal model of eating

disorders

Medical and Psychological Treatment of Bulimia Nervosa

Drug Treatments

◦ Antidepressants can help reduce binging and

purging behavior

◦ Antidepressants are not efficacious in the long-

term

Psychosocial Treatments

◦ Cognitive-behavior therapy (CBT) is the treatment

of choice

◦ Interpersonal psychotherapy results in long-term

gains similar to CBT

Other Eating Disorders

 Rumination Disorder

◦ Chronic regurgitation and reswallowing of partially digested food ◦ Most prevalent among infants and persons with mental retardation

 Pica

◦ Repetitive eating of inedible substances

◦ Seen in infants and persons with severe developmental/intellectual disabilities

◦ Treatment involves operant procedures

 Feeding Disorder

◦ Failure to eat adequately, resulting in insufficient weight gain

◦ Disorder of infancy and early childhood

◦ Treatment involves regulating eating and family therapy

Sleep Disorders: An Overview

 Two Major Types of DSM-IV Sleep Disorders

◦ Dyssomnias – Difficulties in getting enough sleep, problems

in the timing of sleep, and complaints about the quality of

sleep

◦ Parasomnias – Abnormal behavioral and physiological

events during sleep

 Assessment of Disordered Sleep: Polysomnographic

(PSG) Evaluation

◦ Electroencephalograph (EEG) – Leg movements and brain

wave activity

◦ Electrooculograph (EOG) – Eye movements

◦ Electromyography (EMG) – Muscle movements

◦ Includes detailed history, assessment of sleep hygiene and

sleep efficiency

The Dyssomnias: Overview and Defining Features of Hypersomnia

 Hypersomnia and Primary Hypersomnia

◦ Problems related to sleeping too much or excessive sleep

◦ Person experiences excessive sleepiness as a problem

◦ Primary hypersomnia – Means hypersomnia unrelated to any other condition (rare!)

 Facts and Statistics

◦ About 39% have a family history of hypersomnia

◦ Hypersomnia is often associated with medical and/or psychological conditions

 Associated Features

◦ Complain of sleepiness throughout the day, but do 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

 Facts and Statistics

◦ Narcolepsy is rare – Affects about .03% to .16% of the population

◦ Equally distributed between males and females

◦ Onset during adolescence, and typically improves over time

 Associated Features

◦ Cataplexy, sleep paralysis, and hypnagogic hallucinations improve over time

◦ Daytime sleepiness does not remit without treatment

The Dyssomnias: Overview of Breathing-Related Sleep Disorders (cont.)

Facts and Statistics

◦ More common in males, occurs in 1-2% of

population

Associated Features

◦ Persons are usually minimally aware of apnea

problem

◦ Often snore, sweat during sleep, wake frequently,

and have morning headaches

◦ May experience episodes of falling asleep during

the day Docsity.com

Circadian Rhythm Sleep Disorders

 Circadian Rhythm Disorders

◦ Disturbed sleep (i.e., either insomnia or excessive sleepiness during the day)

◦ Problem is due to brain’s inability to synchronize day and night

 Nature of Circadian Rhythms and Body’s Biological Clock

◦ Circadian Rhythms – Do not follow a 24 hour clock

◦ Suprachiasmatic nucleus – The brain’s biological clock, stimulates melatonin

 Types of Circadian Rhythm Disorders

◦ Jet lag type – Sleep problems related to crossing time zones

◦ Shift work type – Sleep problems related to changing work schedules