Psych 242 final pt. 8

medical consequences of anorexia nervosa

1. Amenorrhea (loss of periods in women) 2. Dry skin 3. Brittle hair and nails 4. Sensitivity to cold temps 5. Lanugo (downy hair on limbs or cheeks) 6. Cardiovascular problems 7. Electrolyte imbalance 8. Most deadly mental disorder due to organ damage

Psychological treatment for binge eating disorder

1. Cognitive behavioral treatment (CBT)—effective 2. Interpersonal psychotherapy—equally effective as CBT 3. Self-help techniques—effective IPT was effective for both rapid and nonrapid responders

Two major types of sleep disorders

1. Dyssomnias: Difficulties in amount, quality, or timing of sleep 2. Parasomnias: Abnormal behavioral and physiological events during sleep

Psychological causes of eating disorders

1. Low sense of personal control and self-confidence 2. Perfectionistic attitudes 3. Distorted body image 4. Preoccupation with food 5. Mood intolerance

Breathing-Related Sleep Disorders

1. Obstructive sleep apnea hypopnea: Airflow stops, but respiratory system works 2. Central sleep apnea (CSA): Respiratory systems stops for brief periods 3. Sleep-related hypoventilation: Decreased breathing during sleep not better explained by another sleep disorder, Obstructive sleep apnea occurs in 10 to 20% of population, More common in males, Associated with obesity and increasing age, 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 (due to poor sleep quality at night)

average night sleep

8 hrs, 24 minutes

facts and stats about narcolepsy

Affects about .03% to .16% of the population, Equally distributed between males and females, Onset during adolescence, Typically improves over time

Binge-Eating Disorder: Associated Features

Approximately 20% of individuals in weight-control programs suffer from BED, Approximately half of candidates for bariatric surgery suffer from BED, Better response to treatment than other eating disorders , Tend to be older than sufferers of anorexia and bulimia, Higher rates of psychopathology than non-bingeing obese individuals

treatments for insomnia

Benzodiazepines and over-the-counter sleep medications, Prolonged use: Can cause rebound insomnia, dependence, Cognitive behavioral therapy: Psychoeducation about sleep Changing beliefs about sleep Extensive monitoring using sleep diary Practicing better sleep-related habits Changing assumptions that they can't function well on little sleep

Preventing Sleep Disorders

Best approach: Practice healthy "sleep hygiene" (behaviors that lead to adequate quality and quantity of sleep), Also helpful to educate parents about good sleep habits for children

Bulimia Nervosa

Binge eating - hallmark of bulimia nervosa and binge eating disorder, Eating excess amounts of food in a discrete period of time, Eating is perceived as uncontrollable, May be associated with guilt, shame, or regret, May hide behavior from family members, Foods consumed are often high in sugar, fat, or carbohydrates

Cross-cultural factors

Develop in non-Western women after moving to Western countries

Diagnostic Criteria for Insomnia Disorder

Dissatisfaction with sleep quantity or quality, Sleep disturbance causes significant distress , Sleep difficulty occurs 3 nights per week or more for at least 2 months, Difficulty occurs even when there is possibility for sleep, No other physiological, medical, or mental disorders better explain symptoms

Circadian Rhythm Sleep-Wake Disorders

Disturbed sleep (e.g., either insomnia or excessive sleepiness) leading to distress and/or functional impairment (e.g. significantly decreased productivity at work) ,Specifically due to brain's inability to synchronize day and night, Affects suprachiasmatic nucleus, which stimulates melatonin and regulates sense of night and day 1. Shift work type - job leads to irregular hours 2. Familial type - associated with family history of dysregulated rhythms 3. Delayed or advanced sleep phase type - person's biological clock is naturally "set" earlier or later than a normal bedtime

Insomnia disorder

Dyssomnia, One of the most common sleep disorders, Microsleeps, Problems initiating/maintaining sleep (e.g., trouble falling asleep, waking during night, waking too early in the morning), 15% of adults report daytime sleepiness, Only diagnosed as a sleep disorder if it is not better explained by a different condition (e.g., generalized anxiety disorder)

Polysomnographic (PSG) evaluation of sleep

Electroencephalograph (EEG) - brain waves Electrooculograph (EOG) - eye movements Electromyography (EMG) - muscle movements Detailed history, assessment of sleep hygiene and sleep efficiency

Anorexia Nervosa

Extreme weight loss - hallmark of anorexia, Restriction of calorie intake below energy requirements (Sometimes defined as 15% below expected weight), Intense fear of weight gain, Often begins with dieting

Bulimia facts and stats

Majority are female - 90%+, Some binge eating symptoms are relatively common in men, Incidence among males is increasing, 0.8* bulimia, 2.9% BED, 6 to 7% of college women suffer from bulimia at some point, Onset typically in adolescence, Tends to be chronic if left untreated

Anorexia: Facts and Statistics

Majority are female and white, From middle- to upper-middle-class families, Usually develops around early adolescence, More chronic and resistant than bulimia, Lifetime prevalence approximately 1%

treatment for Breathing-related sleep disorders

May include medications, weight loss, or mechanical devices

Social causes of eating disorders

Media portrayals: thinness linked to success, happiness, Cultural emphasis on dieting, Standards of ideal body size (constantly changing and hard to achieve), Using dietary supplements can lead to other serious problems such as binge drinking or other drug addictions, Adolescent dieting leads to an 8 times greater risk of developing 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), Produces stress and withdrawal symptoms that increase cravings for food, During periods of restricted food intake, people become preoccupied with food and eating (during WWII: Volunteers placed on strict diets started thinking, writing, and reading more about food)

sleep terrors

More common in children (~6%) than adults Child cannot be easily awakened during the episode Child has little memory of it the next day

Associated psychological features of bulimia nervosa

Most are overly concerned with body shape, Fear of gaining weight, 20% meet criteria for a mood disorder, 50 to 70% have met criteria for a mood disorder at some point, 80% have met criteria for an anxiety disorder at some point, Nearly two in five people abuse substances

Associated medical features of bulimia nervosa

Most are within 10% of normal body weight, Purging methods can result in severe medical problems: 1. Erosion of dental enamel, electrolyte imbalance which, in turn, can lead to potentially fatal cardiac arrhythmia and renal failure 2. Kidney failure, cardiac arrhythmia, seizures, intestinal problems, permanent colon damage 3. Salivary gland enlargement causes by repeated vomiting. May result in a chubby facial appearance 4. also develop marked calluses on the fingers and backs of hands resulting from efforts to vomit by stimulating the gag reflex.

Anorexia Nervosa: Defining Features

Most show marked disturbance in body image, 70% are depressed at some point, Higher than average rates of substance abuse and OCD, Starving body borrows energy from internal organs, leading to organ damage including cardiac damage > can cause heart attack

Non-REM Sleep Arousal Disorders

New DSM-5 Diagnosis, Sleep terrors (recurrent episodes of panic-like symptoms during non-REM sleep, Sleepwalking, Individual has no memory of the episodes

Binge Eating Disorder

New disorder in DSM-5, Binge eating without associated compensatory behaviors, Associated with distress and/or functional impairment (e.g., health risk, feelings of guilt), Excessive concern with weight or shape may or may not be present

facts and stats about insomnia

Often associated with medical and/or psychological conditions (Anxiety, depression, substance use), Affects females twice as often as males, Unrealistic expectations about sleep, Believe lack of sleep will be more disruptive than it usually is

Preventing Eating Disorders

Often focuses on promoting body acceptance in adolescent girls, Identify specific targets, Screening for at-risk groups (e.g. Sororities), Provide education (normal weights, Effects of calorie restriction)

Causes of Insomnia Disorder

Pain, physical discomfort, Delayed temperature rhythm (body temperature doesn't drop until later, leading to delayed drowsiness), Light, noise, and temperature influence ability to sleep, Other sleep disorders cause secondary insomnia (apnea, Periodic limb movement disorder), Stress and anxiety, Parents' negative beliefs about sleep linked to more infant waking during the night, Some kids learn to fall asleep only with a parent present

Family Influences of eating disorders

Parents with distorted perception of food and eating may restrict children's intake too (e.g., put chubby toddlers on unnecessary diets), Families of individuals with anorexia are often high achieving, Concerned with external appearances, and Overly motivated to maintain harmony > leads to poor communication and denial of problems, Causes parental guilt and frustration and is associated with poorer outcomes

treatment for Circadian rhythm sleep-wake disorders

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

Actigraph

Portable wearable device sensitive to movement - can detect different stages of wakefulness/sleep

Narcolepsy

Principal symptom: Recurrent intense need for sleep, lapses into sleep, or napping, Also accompanied by at least one: 1. Cataplexy 2. Hypocretin deficiency 3. Going into REM sleep abnormally fast (<15 min), as evidenced by polysomnographic measures

Diagnostic Criteria for Binge-Eating Disorder

Recurrent episodes of binge eating, Binge-eating episodes are associated with three or more of the following: 1. Eating much more than normal 2. Eating until feeling uncomfortably full 3. Eating large amounts when not hungry 4. Eating alone because embarrassed how much one is eating 5. Feeling disgusted/guilty after eating Marked distress regarding binge eating, Binge eating not associated with bulimia

Diagnostic Criteria for Bulimia Nervosa

Recurrent episodes of binge eating, Recurrent inappropriate compensatory behavior in order to prevent weight gain, The binge eating and inappropriate compensatory behaviors both occur on average at least once a week for 3 months, Self-evaluation is unduly influenced by body shape and weight, Disturbance does not occur exclusively during anorexia

Psychological Treatments for Sleep Disorders

Reduces stress and assists with sleep Modify unrealistic expectations about sleep Improved sleep hygiene - bedroom is a place for sleep For children - setting a regular bedtime routine

biological causes of eating disorders

Relatives of people with eating disorders are 4 to 5 times more likely to develop an eating disorder, Not clear what is inherited, May be nonspecific traits like emotional instability or impulsivity, Low levels of serotonergic activity often found in eating disorders, Hormones may influence eating behavior

subtypes of anorexia nervosa

Restricting: Diet to limit calorie intake Binge-eating-purging: Purge to limit calorie intake

Diagnostic Criteria for Anorexia Nervosa

Restriction of energy intake relative to requirements, leading to significantly low body weight, Intense fear of gaining weight or becoming fat, Disturbance in the way in which one's body weight or shape is experienced

sleep walking

Sleep walking disorder - somnambulism , Occurs during non-REM sleep, Usually during first few hours of deep sleep, Person must leave the bed, More common in children than adults, Problem usually resolves on its own without treatment, Seems to run in families, May be accompanied by nocturnal eating

Hypersomnolence Disorder

Sleeping too much or excessive sleep, May manifest as long nights of sleep or frequent napping, Experience excessive sleepiness as a problem, Causes are not well understood due to limited research, Often associated with other medical and/or psychological conditions, Only diagnosed if other conditions don't adequately explain hypersomnia, which should be the primary complaint, Complain of sleepiness throughout the day, Able to sleep through the night

treatment for Hypersomnia and narcolepsy

Stimulants (i.e., Ritalin) Cataplexy usually treated with antidepressants

The Parasomnias

The problem is not with sleep itself, Problem is abnormal events during sleep, or shortly after waking, Two classes of parasomnias: 1. Those that occur during REM (i.e., dream) sleep 2. Those that occur during non-REM (i.e., non-dream) sleep

Psychological Treatment of Anorexia Nervosa

Weight restoration: first and easiest goal to achieve, Psychoeducation, Target food, weight, body image, thought, and emotion, Treatment often involves the family, FBT has the most support from clinical trials for treating adolescents with anorexia

Compensatory behaviors for bulimia nervosa

designed to "make up for" binge eating, Most common: Purging (Self-induced vomiting and May also include use of diuretics or laxatives), Excessive exercise, Fasting or food restriction

Drug treatments for eating disorders

primarily antidepressants (Tricyclics and SSRI (Prozac), Generally ineffective for anorexia nervosa, SSRIs good for bulimia, help reduce frequency of binging and purging

Psychological treatments for eating disorders

usually cognitive behavioral therapy (Treatment of choice), Emphasis on core pathological mechanism: Distorted body image