Chapter 8 - Eating and sleep - week disorders

Chief characteristics of eating disorders

- And overwhelming, all encompassing drive to be thin - They tend to be culturally specific (Not found in developing countries were access to sufficient food is often a daily struggle) - More than 90% of the severe cases are young females who live in a socially competitive environment -In these disorders, unlike most others, the strongest contributions to etiology seem to be socio-cultural rather than psychological or biological

Insomnia disorder

-Difficulty falling asleep, staying asleep, or early rising without being able to go back to sleep. Or even if they sleep a reasonable number of hours but are still not rest of the next day. Microsleeps Primary insomnia

Clinical description of bulimia nervosa

-Eating a larger amount of food typically, more junk food then fruits and vegetables, than most people would eat under similar circumstances -Just as important as the amount of food eaten and that the eating is experienced as out of control -People compensate for the binge eating and potential weight gain almost always by purging techniques (Which is not a very effective methods of reducing caloric intake - only 50%) - Many people with bulimia have a history of anorexia

Clinical description of binge eating disorder

-People who experience marked distress because of binge eating but do not engage in extreme compensatory behaviors -This shows somewhat different patterns of heritability compared with other eating disorders, as well as a greater likelihood of occurring in males and a later age of onset -There is also a greater likelihood of her mission and a better response to treatment in BED compared with other eating disorders -About 20% of individuals in weight loss programs engage and binge eating - Individuals with BED have some of the same concerns about shape and wait as people with anorexia and bulimia, which distinguishes them from individuals who are obis without the BED

treatment for obesity

1 - self-directed weight loss programs, 2 - commercial self-help programs, 3 - behavior modification programs (most successful - especially if they attend a group maintenance program), 4 - surgery Similarly, drug treatment that reduce internal Qs signaling hunger may have some effects, particularly if combined with a behavioral approach targeting lifestyle change, but concerns about cardiovascular side effects have plagued these medications. As with all weight loss programs, patients typically regain up to 50% of their list wait in the year following treatment.

Timeframe for insomnia

3 nights per week for 3 months or more

Diagnosed the sleep problem: Jack has made a serious commitment to his diet for more than a month but continues to gain weight. He has no memory of eating but notice that food is always missing from the fridge: A) Nocturnal eating syndrome B) Sleep terrors C) Nightmares

A

Identify the proper disorder: I noticed Alina eating a whole pie, a cake, and two bags of potato chips the other day when she didn't know I was there. She ran to the bathroom when she was finished and it sounded like she was vomiting. This disorder can lead to an electrolyte in balance, resulting in serious medical problems. A) Bulimia nervosa B) Anorexia nervosa C) Binge eating disorders

A

Identify the proper disorder: Jo eats large quantities of food and a short time she then takes laxatives and exercises for long periods of time to prevent weight gain. She has been doing this almost daily for several months and feel she will become worthless an ugly if she gains even an ounce. A) Bulimia nervosa B) Anorexia nervosa C) Binge eating disorders

A

Research on bulimia nervosa suggests that it most often Cooccurs with: A) Anxiety disorders B) Mood disorders C) Psychotic disorders D) Substance use disorders

A

Which of the following statements is true of CBT and interpersonal therapy (IPT) in the treatment of bulimia: A) CBT appears to work faster than IPT, but they both seem to have the same positive affect at a one-year follow-up B) CBT and IPT appear to have the same impact in both the short and long-term C) IPT appears to work faster than CBT, but they both seem to have the same positive affect on a one-year follow-up D) Neither CBT or IPT appear to be effective in the treatment of bulimia

A

Obstructive Sleep Apnea Hypopnea

A serious disturbance of non-REM sleep characterized by complete absence of air flow (apnea) or reduced air flow (hypopnea). -Obesity is sometimes associated with this problem, as is increasing age and is most common in males

Narcolepsy

A sleep disorder characterized by sudden and uncontrollable sleep attacks. The sufferer may lapse directly into REM sleep, often at inopportune times. -In addition some people with this disorder experience cataplexy (Sudden loss of muscle tone and can be brought on by laughing or joking) - can have grimaces or tongue thrusting Two other characteristics: -These people commonly report sleep paralysis -hypnagogic hallucinations It appears that there is a significant loss of a certain type of nerve cell (hypocretin neurons) those with narcolepsy

REM sleep behavior disorder

A sleep disturbance in which the mechanism responsible for paralyzing the body during REM sleep is not functioning, resulting in the acting out of dreams.

Parasomnias

Abnormal behaviors such as nightmares or sleepwalking that occur during sleep.

Causes of eating disorders: an integrative approach

Anxiety and mood disorders are also common and families of individuals with eating disorders and negative emotions, along with mood and tolerance, seems to trigger binge eating and many patients. -Drug and psychological treatments with proven effectiveness for anxiety disorders are also the treatment of choice for eating disorders. (We can conceptualize eating disorders as anxiety disorders focus exclusively on fear of becoming overweight) It is also important to note that the social interactions and high achieving families play at least some role Most individuals with anorexia do you go on to binge and purge at some point

polysomnographic evaluation (PSG)

Assessment of sleep disorders in which a client sleeping in the lab is monitored for heart, muscle, respiration, brain wave, and other functions.

Time frame for bulimia nervosa

At least one time a week for three months

Timeframe for narcolepsy

At least three times a week over the past three months

Disorders often associated with sleep complaints

Autism spectrum disorders Schizophrenia Major depression Bipolar disorder Anxiety related disorders

Diagnosed the sleep problem: Sherry's parents hear her piercing screams on many nights and rush to comfort her, but she does not respond. During these episodes, her heart rate is elevated, and her pajamas are soaked in sweat. When she gets up the next day, she has no memory of the experience: A) Nocturnal eating syndrome B) Sleep terrors C) Nightmares

B

Identify the proper disorder: Christine has lost several pounds and now weighs less than 90 pounds. She eats only a small portion of the food her mother serves her and fears that intake above her current 500 cal daily will make her fat. Since losing the way, Kristin has stopped having periods. She sees a fat person in the mirror. A) Bulimia nervosa B) Anorexia nervosa C) Binge eating disorders

B

In a study by Fallon and Rozin, female undergraduates: A) Rated their current body size the same as the ideal body size B) Rated the ideal body size smaller than the attractive body size C) Rated the ideal body size heavier than the attractive body size D) Rated the current body size smaller than the ideal body size

B

It is estimated that ________ of individuals with eating disorders die as a result of the disorder, with as many as 50% of those desk coming from ______: A) 20%; homicide B) 20%; suicide C) 50%; homicide D) 50%; suicide

B

Match the following with the correct term: Melinda sleeps all night and still finds her self falling asleep throughout the next day. This happens even when she goes to bed early and gets up as late as possible: A) Cataplexy B) hypersomnolence C) Insomnia disorder D) Sleep apnea E) Sleep paralysis F) Narcolepsy G) Circadian rhythm sleep disorder H) Breathing related sleep disorder

B

The typical age of onset for anorexia nervosa and bulimia nervosa is _________, with younger cases of anorexia tending to begin at _______, and younger cases of bulimia tending to begin at ________: A) 30; 25; 20 B) 20; 15; 10 C) 15; 10; 5 D) 15; 13; 12

B

While sleeping at night, Michael, a 55-year-old overweight male, experiences a cessation in his breathing for short periods of time. Michael's wife reports that he snores continuously and never feels rested. Michael's symptoms are consistent with: A) Narcolepsy B) Sleep apnea C) Sleep week schedule disorder D) Cataplexy

B

causes of insomnia

Biological, psychological factors are present in most cases. Biological vulnerabilities may, in turn, interact with sleep stress. Caffeine, alcohol, smoking, stress, lack of exercise Higher body temperatures, drug use, environmental influences such as changes in light, noise, or temperature, other sleep disorders, and psychological stressors, sleep hygiene, naps Cultural factors, in the US kids sleep on their own and in other cultures the child spends the first few years in the same room and sometimes the same bed as the mother. Sleep can be affected by cultural norms.

causes of eating disorders

Biological, psychological, and social factors contributing to the development of these serious eating disorder's. The most dramatic factors are social and cultural.

Diagnosed the sleep problem: Jacqueline's dad is sometimes awakened by his daughter screams. He runs into her room to comfort her and was eventually able to calm her down. Jacqueline usually explains that she was being chased by a big, one eyed, purple monster. This event typically happens after watching scary movies with friends. A) Nocturnal eating syndrome B) Sleep terrors C) Nightmares

C

Identify the proper disorder: Manny has been having episodes lately where he eats prodigious amounts of food. He's been putting on a lot of weight because of it. A) Bulimia nervosa B) Anorexia nervosa C) Binge eating disorders

C

The primary difference between sleep terrors and nightmares is: A) Sleep terrors usually begin with a scream B) Children do not remember nightmares C) Sleep terrors occur during NREM sleep D) Sleep terrors are more prevalent in the population

C

night eating syndrome

Consuming a third or more of daily food intake after the evening meal and getting out of bed at least once during the night to have a high-calorie snack. In the morning, individuals with night eating syndrome are not hungry and do not usually eat breakfast. These individuals do not binge during their night eating and seldom purge. - Night eating syndrome is an important target for treatment in any obesity program to re-regulate patterns of eating so that individuals eat more during the day, when their energy expenditure is highest.

Dr. Thompson sees a patient with a chubby face, calluses on your finger, and a small scar on the back of our hands. Tests indicate that the patient weighs slightly more than her expected weight and that she has an electrolyte in balance. The patient reports that she is having persistent constipation and that she feels as if her heart has been skipping beats these symptoms are consistent with: A) Depression B) Anxiety C) Anorexia nervosa D) Bulimia nervosa

D

Match the following with the correct term: Ron is extremely overweight. His wife suspects he may be suffering from _______because he snores every night and often wakes up exhausted: A) Cataplexy B) hypersomnolence C) Insomnia disorder D) Sleep apnea E) Sleep paralysis F) Narcolepsy G) Circadian rhythm sleep disorder H) Breathing related sleep disorder

D

Which of the following is used to measure our movement as an indicator of sleep activity and sleep quality: A) Electrocardiogram B) Electromyography C) Electroencephalogram D) Actigraph

D

primary insomnia

Difficulty in initiating, maintaining, or gaining from sleep; not related to other medical or psychological problems. - Looking at sleep wake disorders as primary recalls the overlap of sleep problems with psychological disorders such as anxiety and depression Although most people can carry out day to day activities, their inability to concentrate can have serious consequences

Sleep wake disorders are divided into two major categories:

Dyssomnias (disturbances of sleep) Parasomnias (Abnormal events that either occur during sleep or that twilight time between sleeping and waking)

Match the following with the correct term: Jamie sometimes awakens and cannot move or speak. This is a frightening experience known as: A) Cataplexy B) hypersomnolence C) Insomnia disorder D) Sleep apnea E) Sleep paralysis F) Narcolepsy G) Circadian rhythm sleep disorder H) Breathing related sleep disorder

E

bulimia nervosa

Eating disorder involving recurrent episodes of uncontrolled excessive binge eating followed by compensatory actions to remove the food (ie- Deliberate vomiting, laxative abuse, and excessive exercise). Most people are within 10% of their normal weight.

sleep terrors

Episodes of apparent awakening from sleep, accompanied by signs of panic, followed by disorientation and amnesia for the incident. These occur during nonrapid eye movement sleep and so do not involve frightening dreams. -During these children cannot be easily awakened - Treatment for this usually begins with a recommendation to wait and see if they disappear on their own (One approach to reducing chronic sleep terrors is to use scheduled awakenings)

obesity

Excess of body fat resulting in a body mass index (BMI), a ratio of weight to height of 30 or more. - Not considered an official disorder in the DSM but the excessive eating at the core of the problem is the reason that obesity could be considered a disorder of eating. -Can be difficult to treat: professionally directed behavior modification programs are moderately successful. - Prevention efforts seem the most promising

Match the following with the correct term: Sonia has problems staying awake throughout the day. Even while talking on the phone or riding the bus, she unexpectedly loses muscle tone and falls asleep. This is due to: A) Cataplexy B) hypersomnolence C) Insomnia disorder D) Sleep apnea E) Sleep paralysis F) Narcolepsy G) Circadian rhythm sleep disorder H) Breathing related sleep disorder

F

Fatty foods and technology are not to blame for the obesity epidemic in the United States. True or false

False

One study showed that males consider a smaller female body to be more attractive than women do. True or false

False

Individuals with night eating syndrome consume at least half their daily intake after their evening meal. True or false

False- at least 1/3 or more

And I depressants help individuals overcome anorexia but have no effect on bulimia. True or false

False- they help with bulimia, not anorexia

Causes of eating disorders: social dimensions

For many young women, looking good is more important than being healthy. Men have different body image perceptions than women - men desire to be heavier and more muscular than they are If your friends tend to use extreme dieting or other weight loss techniques, there is a greater chance that you will too (And people tend to choose friends who already share these attitudes so treatment must take this into consideration) Adolescent girls who dieted were eight times more likely to develop an eating disorder one year later than those who weren't dieting -Girls who attempted dieting faced more than 300% greater risk of obesity than those who did not diet. Family influence is: the "typical" family of someone with anorexia is successful, hard driving, concerned about external appearance, eager to maintain harmony. - Whatever the pre-existing relationship, after the onset of an eating disorder, particularly anorexia, family relationships can deteriorate quickly.

Nightmare Disorder

Frightening and anxiety-provoking dreams occurring during rapid eye movement sleep. The individual recalls the bad dreams and recovers alertness and orientation quickly. -DSM says to qualify as a disorder, these experiences must be so distressful that they impair a persons ability to carry on normal activities (ie- Too anxious to sleep at night) -Nightmares are thought to be influenced by genetics, trauma, medication use, and are associated with some psychological disorders (ie- Substance abuse, anxiety, BPD, schizophrenia) - Research on the treatment of nightmares suggest that both psychological intervention and pharmacological treatment can help reduce these unpleasant sleep events

Match the following with the correct term: Brett has started a new job that requires him to change shifts monthly. He sometimes has day shifts and at other times has night shifts. Since then he has had considerable trouble sleeping. A) Cataplexy B) hypersomnolence C) Insomnia disorder D) Sleep apnea E) Sleep paralysis F) Narcolepsy G) Circadian rhythm sleep disorder H) Breathing related sleep disorder

G

causes of hypersomnolence

Genetic influences seem to be involved in a portion of cases. A significant sub group of people diagnosed with this disorder previously were exposed to a viral infection such as mono, hepatitis, and viral pneumonia, which suggests there may be more than one cause

Match the following with the correct term: Timothy wakes up frequently every night because he feels he is about to hyperventilate. He can't seem to get enough air, and many times his wife were awake to tell him to quit snoring. He is suffering from: A) Cataplexy B) hypersomnolence C) Insomnia disorder D) Sleep apnea E) Sleep paralysis F) Narcolepsy G) Circadian rhythm sleep disorder H) Breathing related sleep disorder

H

Psychological treatments for anorexia nervosa

If body weight is below 75% of healthy body weight, or if weight has been lost rapidly and the individual continues to refuse food, inpatient treatment is recommended because severe medical complications occur if weight is not restored immediately. Without attention to the patients dysfunctional attitudes about body shape, as well as interpersonal disruptions in her life, she will most always relapse. Treatment for restricting anorexics are similar to those for patients with bulimia- particularly in the CBT-E approach Every effort is made to include the family: first, the dysfunctional communication regarding eating must be eliminated. Second attitudes towards body shape an image or discussed in family sessions. Family-based therapy has the most support for treating adolescents with anorexia, but also some support and treating bulimia.

Psychological treatment for binge eating disorder

In contrast to results with bulimia, it appears that I PT is as effective as CBT for binge eating -Prozac was ineffective and did not add anything to CBT Some racial and ethnic differences are a parent and people with BET seeking treatment. Some cultures have higher BMI and Taylor in treatment to these ethnic groups would be useful. It appears that self-help procedures maybe useful in treatment of BED and should be the first treatment offered before engaging in more expensive and time-consuming therapist lead treatment. -Much as with bulimia, however, more severe cases may need a more intensive treatment developed by a therapist, particularly cases with multiple disorders in addition to be ED, as well as low self-esteem

central sleep apnea

Involves the complete cessation of respiratory activity for brief periods and is often associated with a certain central nervous system disorder, such as cerebral vascular disease, head trauma, and degenerative disorders: -Those with this wake up frequently during the night but they tend not to report excessive daytime sleepiness and often are not aware of having a serious breathing problem

sleepwalking (somnambulism)

Parasomnia that involves leaving the bed during nonrapid eye movement sleep. Waking someone during this episode is difficult -There also seems to be a genetic component to sleep walking, with a higher incidence observed within families

binge eating disorder

Pattern of eating involving the stress inducing binges not followed by purging behaviors; being considered as a new DSM diagnostic category. 3 or more of: -Include eating rapidly, until uncomfortably full, eating lots were not hungry, eating alone because of embarrassment, and feeling disgusted

Clinical description of anorexia nervosa

People with this are proud of their diets and their control, whereas people with bulimia or ashamed of their eating and lack of control. -Although weight loss is most notable, it is not the core of anorexia. People with anorexia have an intense fear of obesity and relentlessly pursue thinness -Another key criterion - a marked disturbance in body image (seeing something about themselves than what others see - So these people rarely seek treatment on their own) - These individuals also show an increased interest in food -Only consider the past three months when subtyping

Causes of Eating Disorders: Biological Factors

Relatives of patients with eating disorders are 4 to 5 times more likely than the general population to develop eating disorders. -Genetic make up is about half the equation -Personality traits such as emotional instability and poor impulse control might be inherited, perfectionist traits, and I need for order Low levels of serotonergic Activity, the system most associated with eating disorders, are associated with impulsivity and binge eating. Bus most drugs understudy as treatments for eating disorders target the serotonin system. Investigators are also interested in the influence of hormones on eating behavior. The onset of puberty and hormonal changes may "turn on" certain hormone response risk jeans and women prone to binge eating. If true, this would be an example of the gene environment interaction.

Psychological treatments for bulimia

Short term CBT that target problem eating behavior and attitudes about body weight and shape. * (Treatment of choice) Cognitive behavioral therapy enhanced (CBT-E) - the principal focus of this protocol is one the distorted evaluation of body shape and wait, and maladaptive attempts to control wait in the form of strict dieting possibly accompanied by binge eating, and methods to compensate for over eating such as purging. -The first stage is teaching the patient the physical consequences of binge eating and purging as well as the ineffectiveness of vomiting and laxatives. The adverse effects of dieting are also described and patients are scheduled to eat small amounts of food 5 to 6 times per day -In later stages of treatment it focuses on altering dysfunctional thoughts and attitudes about body shape, weight, and eating. Coping strategies for resisting the impulse to binge and/or purge are also developed

Disorder of arousal during non-REM sleep includes:

Sleepwalking Sleep tears Amnesia for the episodes Significant distress or impairment

causes of obesity

The promotion of an in active, sedentary lifestyle and the consumption of a high fat, energy dense diet is the largest single contributing factor to the obesity epidemic -Jeans are thought to account for about 30% of the equation and causation of obesity, but this is misleading because it takes a "toxic" environment to turn on these jeans. It seems that obesity spreads through social networks And interaction of biological and psychological factors with a notably strong environmental and cultural contribution provides the most complete account Psychological processes of emotional regulation, impulse control, attitudes and motivation toward eating, and responsiveness to the consequence of eating are also important

Disordered eating patterns in cases of obesity

There are two forms of maladaptive eating patterns in people who are obese: - Binge eating (Only 7 to 19% of patients with obesity present with patterns of binge eating -Night eating syndrome

Parasomnias

These are not problems with sleep at self but abnormal events that occur either during sleep or during that twilight time between sleeping and waking: - Nightmares - Sleep terrors -Sleepwalking -Nocturnal eating syndrome - sexsomnia

Cross cultural considerations for eating disorders

These disorders develop in immigrants who have recently moved to western countries African-American adolescent girls have less body dissatisfaction than Caucasian girls - Young white males preferred somewhat thinner figures in women than African-American males Eating disorders are generally more common among Native Americans than other ethnic groups Anorexia and bulimia are relatively homogeneous, and both - particularly bulimia - were overwhelmingly associated with western cultures until recently

circadian rhythm sleep disorder

a sleep disturbance resulting in sleepiness or insomnia, caused by the body's inability to synchronize its sleep patterns with the current pattern of day and night -Jet lag type (Shown to increase cancer risk in mice) -Shift work type (Unfortunately, the problems of working at unusual times can go beyond sleep and may contribute to cardiovascular disease, ulcers, and breast cancer in women) Scientists believe the hormone melatonin contributes to the setting of our biological clocks that tell us went to sleep. - The hormone is produced by the penal gland in the center of the brain. When our eyes see that it is night time, this information is passed onto the penal gland, which, in turn, begins producing melatonin.

disorder of arousal

category of sleep disorder during NREM sleep that includes sleepwalking and sleep terrors

sleep-related hypoventilation

episodes of decreased breathing associated with high carbon dioxide levels

Dyssomnias

problems in getting to sleep or in obtaining sufficient quality sleep

Hypersomnolence Disorder

sleep dysfunction involving an excessive amount of sleep that disrupts normal routines -The DSM5 criteria also includes the subjective impression of the problem. 1. Recurrent periods of sleep or lapses into sleep within the same day 2. Prolong main sleep episodes of greater than nine hours per day and non-restorative 3. Difficulty being fully awake after abrupt awakening Several factors that can cause excessive sleepiness would not be considered for this disorder. For example - people with insomnia disorders or other disorders like sleep apnea or other reasons for sleepiness during the day

Cataplexy

sudden loss of muscle tone This occurs while the person is awake and can range from slight weakness in their facial muscles to complete physical collapse. It lasts from several seconds to several minutes; it is usually preceded by strong emotions such as anger or happiness. It appears to result from a sudden onset of REM

mixed sleep apnea

type of sleep apnea that occurs when central sleep apnea and obstructive sleep apnea occur simultaneously -A decrease in airflow without a complete pause and breathing

hypnagogic hallucinations

vivid sensory phenomena that occur during the onset of sleep And are said to be unbelievably realistic because they include not only visual aspects but also touch, hearing, and even the sensation of body movement.

sleep apnea

a sleep disorder characterized by temporary cessations of breathing during sleep and repeated momentary awakenings - Obstructive sleep apnea (Include breathing disturbances such as snoring, snorting/gasping, or breathing pauses), daytime sleepiness - Central sleep apnea

Timeframe for hypersomnolence

Three times a week for at least three months

Attention must be focused on dysfunctional attitudes about body shape in anorexia or relapse will most likely occur. True or false

True

Biological limitations, as well as the societal pressure to use diet and exercise to achieve nearly impossible weight goals, contribute to the number of people with anorexia and bulimia. True or false

True

CBT and interpersonal psychotherapy (IPT) are both successful treatments for bulimia, although CBT is the preferred method. True or false

True

Mini young women with eating disorders have a diminished sense of personal control and confidence in their own abilities, are perfectionists, and/or are preoccupied with how they appear. True or false

True

Obesity is the single most expensive health problem in the United States, surpassing both smoking and alcohol abuse. True or false

True

Professionally directed behavior modification programs represent the most successful treatment for obesity. True or false

True

Causes of eating disorders: psychological dimensions

When perfectionism is directed to disordered perception of body image, a powerful engine to drive eating disorder behavior is in place. Social deficits are likely to increase as a consequence of the eating disorder, further isolating the individual from the larger social world. Studies suggest that the common factors driving eating disorders include the experience of intense emotions triggered by food Qs and fear of becoming fat as well as faulty attempts to regulate these emotions.

sleep hygiene

nonpharmacologic recommendations like reviewing and changing lifestyles and environment that help an individual get a better night's sleep

nocturnal eating syndrome

when individuals rise from their beds and eat while they are still asleep