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
