PSYC 451 Ch. 8
Obesity statistics
The prevalence of obesity (BMI 30 or greater) among adults in the U.S. in 2008 was 33.8% of adults, climbing to 37.5% in 2010. The mortality rates of obesity are close to those associated with smoking. Obesity is increasing even more rapidly in children/teens as well as in developing countries. Ethnicity is also a factor: African American and Latino individuals are more likely to be obese.
Binge eating disorder
A new disorder in the DSM-5 characterized by binge eating without associated compensatory behaviors, and distress and/or functional impairment such as health risk or feelings of guilt. These individuals may or may not have excessive concern with weight or shape. These individuals have a better response to treatment than other eating disorders, but higher rates of psychopathology than non-bingeing obese individuals.
Binge-eating-purging type
This describes anorexic individuals that binge on relatively small amounts of food and purge more consistently, in some cases each time they eat. Half of anorexic individuals engage in this behavior.
Rebound insomnia
This describes where sleep symptoms reappear, sometimes worse, when medication is withdrawn.
Hypersomnolence disorder
This disorder involves sleeping too much or excessive sleep. May manifest as long nights of sleep or frequent napping with the experience of excessive sleep as a problem.
Somnambulism
This disorder is also called sleepwalking and occurs during non-REM sleep, usually in the first few hours of deep sleep. People with this disorder must leave the bed and may be accompanied by nocturnal eating or sexomania. Sleepwalking is more common in children than adults and seems to run in families. The problem usually resolves itself without treatment.
Narcolepsy
This disorder is characterized by a recurrent intense need for sleep and lapses into sleep or napping and accompanied by at least one of: -(1) cataplexy: sudden loss of muscle tone -(2) Hypocretin deficiency -(3) Entering REM sleep abnormally fast.
Circadian rhythm sleep disorder
This disorder is characterized by disturbed sleep due to the brain's inability to synchronize day and night. This affects the suprachiasmatic nucleus in the hypothalamus, which stimulates melatonin and regulates sense of night and day. -(1) jet lag type: crossing multiple time zones -(2) Shift work type: job leads to irregular hours -(3) Familial type: family history of dysregulated rhythms -(4) Delayed/advanced sleep phase type: person's biological clock is naturally "set" earlier or later than a normal bedtime.
Anorexia nervosa
This disorder is characterized by extreme weight loss and restriction of calorie intake below energy requirements (sometimes defined as 15% below expected weight). These individuals have an intense fear of weight gain and losing control over eating, and this disorder often begins with dieting.
Binge-eating disorder
This disorder is characterized by individuals binging repeatedly and finding it distressing, but they do not attempt to purge the food. This may involve fewer cognitive distortions about weight and shape.
Insomnia
This disorder is characterized by microsleeps and problems initiating/maintaining sleep, including trouble falling asleep, waking up during the night, and waking too early in the morning. 35% of adults with this disorder report daytime sleepiness. Individuals may have unrealistic expectations about sleep and believe lack of sleep will be more disruptive than it usually is.
Sleep terrors
This disorder is characterized by recurrent episodes of panic-like symptoms during non-REM sleep in which the individual has no memory of the episodes. More common in children (6%) than adults (2%). Can be reduced with scheduled awakenings
Breathing-related sleep disorder treatment
Treatment for breathing-related sleep disorder focuses on medication, weight loss (rare), and mechanical devices such as a CPAP (continuous positive air pressure) machine. Some people have issues of comfort of claustrophobia because of CPAPs.
Eating disorder dietary causes
Adolescent girls who diet are 8 times more likely to develop an eating disorder. Adolescents tend to internalize the standards of friendship groups, e.g. a teenager is more likely to diet if her friends also diet. This may paradoxically cause weight gain by producing stress and withdrawal symptoms that increase cravings, leading to a 300% greater risk of obesity
Eating disorder medications
Antidepressants are generally ineffective for anorexia nervosa, but may be useful for some people with bulimia, particularly during the bingeing and purging cycle. However, antidepressants do not have substantial long-lasting effects on bulimia nervosa.
Anorexia nervosa psychological consequences
Anxiety and mood disorders are often present in individuals with anorexia, with rates of depression at some point in one's life as high as 70% of cases. Anorexic individuals also suffer from higher than average rates of substance abuse and OCD.
Eating disorder developmental considerations
Because most cases of eating disorders begin in adolescence, it is clear that anorexia and bulimia are related to development, possible because sexual development brings men closer to body ideals (tall and muscular) and bring women further away from body ideals (ideal = thin and prepubertal, puberty leads to fat tissue)
Purging techniques
Behaviors used by bulimic individuals to "make up for" binge eating. The most common method is self-induced vomiting. Using diuretics or laxatives is also common, as is excessive exercise and fasting or food restrictions.
Insomnia medications
Benzodiazepines and over-the-counter sleep medications are effective in the short term, but there is risk of developing dependence or suffering from rebound insomnia.
binge eating disorder psychological treatments
Binge eating disorder responds well to CBT similar to that used for bulimia. Interpersonal psychotherapy is every bit as effective as CBT. Self-help techniques also seem to be effective.
Non-purging type
Bulimia nervosa in which individuals use exorcise and/or fasting as a compensatory mechanism. This accounts for only 6-8% of patients with bulimia.
Obesity treatment
Obesity treatment is only moderately successful at the individual level, with somewhat greater effectiveness with children than adults. Treatment is usually organized in a series of steps from least intrusive to most intrusive. -(1) Self-directed weight loss programs -(2) Commercial self-help programs -(3) Behavior modification programs: may produce 20% reduction in overweight children, especially if parents are involved. -(4) Bariatric surgery for individuals with a BMI of 40.
Eating disorder cultural causes
The media portrays thinness as linked to success and has a cultural emphasis on dieting. Standards of ideal body size are frequently changing and difficult to achieve.
Sleep efficiency
The amount of time a person actually spends asleep, not just trying to sleep
Hypersomnolence causes
The causes of hypersomnolence are not well understood due to limited research, but it is often associated with other medical and/or psychological conditions. Hypersomnolence is only diagnosed if other conditions don't adequately explain hypersomnia.
Anorexia statistics
The majority of anorexic individuals are female and white and are from middle- to upper-class families. The disorder usually develops around adolescence and is thought to be more chronic and resistant than bulimia. Lifetime prevalence is approximately 1%.
Anorexia nervosa psychological treatments
The most important initial goal for anorexia treatment is to restore the patient's weight to a point that is at least within the low-normal range. However, without psychoeducation focusing on the patient's underlying dysfunctional attitudes about body shape and interpersonal disruptions in her life, they will relapse. An effective treatment is CBT-E as used for bulimia. The family is included to eliminate dysfunctional communication in the family regarding food and to discuss attitudes towards body shape and image distortion.
Dyssomnias
These sleep-wake disorders involve difficulties in not getting enough sleep, problems with sleeping when you want to, and complaints about the quality of sleep.
binge eating disorder statistics
20% of individuals in weight-control programs suffer from BED, and half of candidates for bariatric surgery suffer from BED. These individuals tend to be older than sufferers of anorexia and bulimia.
Sleep apnea
A breathing-related sleep disorder in which people snore through the night wake in the morning with dry mouth and a headache, leading to excessive daytime sleepiness.
Purging type
Bulimia nervosa in which individuals use laxatives or induced vomiting as a compensatory mechanism.
dietary restraint
During periods of restricted food intake, people become preoccupied with food and eating as shown by a classic WWII era study with volunteers placed on strict diets.
Hypersomnia and narcolepsy medications
Hypersomnia and narcolepsy are treated with stimulants like Ritalin or modafinil. Cataplexy can be treated with antidepressant medication because they suppress REM sleep.
Eating disorder prevention
Prevention programs focus on eliminating an exaggerated focus on body shape or weight and encouraging acceptance of one's body in adolescent girls. Such programs focus on at-risk groups and provide education on normal weight limits and the effects of calorie restrictions.
Hypnagogic hallucinations
A characteristic of narcoleptic individuals. Vivid and often terrifying experience that begin at the start of sleep and are said to be unbelievably realistic because they include not only visual aspects but touch, hearing, and body movement.
Circadian rhythm sleep disorders
Circadian rhythm disorders can be treated with: -(1) phase delays: moving bedtime later (best approach) -(2) phase advances: moving bedtime earlier (difficult) -(3) use of very bright light: trick brain's biological clock.
Parental effects on children's sleep
Parent's negative beliefs about sleep are linked to more infant waking during the night. Parents who do not tend to their infant's cries are potentially harming children's sleep patterns. Some kids learn to fall asleep only with a parent present.
Sleep disorder psychological treatments
-(1) Insomnia can be treated with CBT-I: psychoeducation about sleep, changing beliefs about sleep, extensive monitoring using sleep diary, and practicing better sleep-related habits. -(2) Relaxation and stress reduction: reduce stress and assists with sleep, modify unrealistic expectations about sleep. -(3) Stimulus control procedures: improved sleep hygiene (bedroom is a place for sleep. For children, setting regular bedtime.
Sleep paralysis
A characteristic of narcoleptic individuals in which, for a brief period after awakening, the individual can't move or speak.
Actigraph
A portable wearable device sensitive to movement that can detect different stages of wakefulness and sleep to determine the length and quality of sleep.
Insomnia statistics
A third of the population reports some symptoms for insomnia in any given year. Women report insomnia twice as often as men. Insomnia is often comorbid with anxiety, depression or substance abuse.
Polysomnographic evaluation
An evaluation of sleep habits using measurements of: -(1) respiration and oxygen desaturation -(2) leg movements -(3) brain wave activity measured by an electroencephalogram -(4) eye movement measured by an electrooculograph, -(5) muscle movements measured by an electromyogram -(6) heart activity measured by an electrocardiogram.
Anorexia nervosa medical consequences
Anorexia nervosa leads to amenorrhea (cessation of menstruation), dry skin, brittle hair and nails, sensitivity to cold temperatures, lanugo (downy hair on the limbs and cheeks), cardiovascular problems, and electrolyte imbalance. This is the most deadly mental disorder due to organ damage. The starving body borrows energy from internal organs, leading to organ damage and heart attack.
Bulimia nervosa psychological treatments
Bulimia can be treated with CBT (treatment of choice) and antidepressants (help reduce bingeing and purging behavior; not efficacious in the long run). Interpersonal therapy is as effective as CBT, but takes longer to work. Self-help therapy also appears effective, as does family therapy to address conflicts. Short-term cognitive behavioral treatments: -(1) The first stage is teaching the patient the physical consequences of binge eating and purging, as well as the ineffectiveness of vomiting and laxative abuse for weight control. -(2) Later stages focus on dysfunctional thoughts about body weight, shape, and eating and developing coping strategies.
Eating disorders
Disorders like anorexia nervosa and bulimia nervosa characterized by severe disruptions in eating behavior, disproportionate influence of weight and shape on self-concept, extreme fear and apprehension about weight. These disorders have strong sociocultural origins, driven by the western emphasis on thinness.
Eating disorder biological factors
Eating disorders run in families and seem to have a genetic component. Relatives of people with eating disorders are 4-5 times more likely to develop an eating disorder. There is no clear agreement on what is inherited; it may be nonspecific traits such as emotional instability or poor impulse control, or perfectionist traits along with negative affect. Low levels of serotonergic activity is often found in eating disorders. It is not clear whether this is a cause or effect of eating disorders, but it likely contributes to maintenance.
Eating disorder cross-cultural considerations
Eating disorders tend to develop in non-western women after they move to Western countries. Eating disorders are less common in African American women, who have lower levels of body dissatisfaction than men.
Insomnia causes
Insomnia accompanies pain, physical discomfort, physical inactivity during the day, and respiratory problems. In addition, delayed temperature drops associated with the biological clock can lead to delayed drowsiness. Sleeping environment issues, such as light, noise, and temperature can also influence the ability to sleep. Sleep disorders like apnea and periodic limb movement disorder can cause secondary insomnia. Finally, individuals with insomnia often suffer from stress and anxiety.
Bulimia statistics
More than 90% of individuals presenting with bulimia are female, and male sufferers are more likely to be gay or bisexual. The lifetime prevalence is about 1.1% for females and 0.1% for males. 6-7% of college women suffer from bulimia at some point. Onset is typically in adolescence, and course is chronic if untreated.
Bulimia nervosa psychological features
Most individuals with bulimia nervosa are overly concerned with body shape and have a fear of gaining weight. Most also have comorbid psychological disorders. 20% meet the criteria for a mood disorder and 50-70% have met the criteria for a mood disorder at some point. 80% have met criteria for an anxiety disorder at some point. Nearly 2 in 5 abuse substances. Depression follows bulimia and may be a reaction to it.
Bulimia nervosa medical features
Most individuals with bulimia nervosa are within 10% of normal body weight. Purging methods can result in severe medical problems. Salivary gland enlargement can occur due to repeated vomiting, which gives the face a chubby appearance. Repeated vomiting may also erode the dental enamel on the inner surface of the front teeth and tear the esophagus. Continued vomiting can lead to electrolyte imbalance and kidney failure, cardiac arrhythmia, seizures, intestinal problems, and permanent colon damage (with laxative abuse)
Narcolepsy statistics
Narcolepsy is a rare condition, affecting only 0.03-0.16% of the population. It is equally distributed between males and females and has an adolescent onset. It typically improves over time.
Obesity causes
Obesity is related to technological advances that promote inactive, sedentary lifestyle and consumption of high-fat, energy-dense diets. Genetics account for about 30% of obesity cases (number of adipocytes, likelihood of fat storage, activity levels), and psychosocial factors may contribute as well.
Breathing-related sleep disorder statistics
Obstructive sleep apnea occurs in 10-20% of the population, and is more common in males. Breathing-related sleep disorders are associated with obesity and increasing age.
Eating disorder family influences
Parents with distorted perception of food and eating my restrict children's intake too. Families of individuals are often high achieving, concerned with external appearances, and overly motivated to maintain harmony (poor communication and denial of problems). Disordered eating also strains family relationships, causing paternal guilt and frustration.
Sleep disorder prevention
The best approach to preventing sleep disorders is to practice sleep hygiene: behaviors that lead to adequate quality and quantity of sleep, such as setting regular bedtimes. In addition, it is also helpful to educate parents about good sleep habits for children.
Breathing-related sleep disorders
These disorders include individuals whose breathing is interrupted during their sleep, often experiencing brief arousals and who do not feel rested after 8-9 hours of sleep. Persons are usually minimally aware of apnea problems, and often snore, sweat during sleep and wake frequently. Morning headaches and episodes of falling asleep during the day also occur. -(1) Obstructive sleep apnea hypopnea syndrome: airflow stops, but respiratory system works. -(2) Central sleep apnea: respiratory system stops for brief periods of time -(3) Sleep-related hypoventilation: decreased breathing during sleep not better explained by another sleep disorder
Parasomnias
These sleep-wake disorders are characterized by abnormal behavior or physiological events that occur during sleep such as nightmares and sleepwalking. Two classes: -(1) Those that occur during REM sleep -(2) Those that occur during non-REM sleep.
binge eating
This behavior is a hallmark of bulimia nervosa and binge eating disorder. It is marked by eating excess amounts of food in a discrete period of time. This eating is considered uncontrollable and may be associated with guilt, shame or regret. These behaviors may be hidden from family members. Foods consumed are often high in sugar, fat or carbohydrates.
Restricting type
This describes anorexic individuals that diet to limit calorie intake
Bulimia nervosa
This disorder is characterized by recurrent binge eating followed by recurrent compensatory behaviors in order to prevent weight gain. Individuals must eat, in a 2 hour period, a portion of food that is definitely larger than most people would consume in a similar amount of time under similar circumstances and must have a sense of lack of control over eating during the episode. The binge eating and inappropriate compensatory behaviors must both occur at least once a week for 3 months. Self-evaluation is unduly influenced by body shape and weight.
Nightmare disorder
This disorder occurs during REM sleep and is characterized by repeated episodes of extended, extremely dysphoric dreams leading to distress and/or impairment in daily life. These are bad dreams that awaken the sleeper. They occur in 10-50% of children and 1% of adults.
Night eating syndrome
This maladaptive eating disorder occurs in 6-16% of obese treatment seekers, and 55% of those seeking bariatric surgery. These individuals consume a third or more of their daily calory intake and get out of bed at least once during the night to eat. These individuals do not binge eat.
Obesity
This phenomenon is not considered an official disorder in the DSM-5, but is a significant public health issue. It is considered a symptom of some eating disorders, but not a disorder in and of itself. This presents serious health risks such as cardiovascular strain, increased risk of early death.
Eating disorder psychological factors
Women with eating disorders have a diminished sense of personal control and confidence in their own abilities and talents, which may manifest in low self-esteem. They also display more perfectionistic attitudes, which may reflect attempts to exert control over important life events. Individuals also have a distorted body image, preoccupation with food, and difficulty tolerating negative emotion.
