Week 7 Eating and Sleep Disorders

Cognitive Behavioral Factors: Bulimia Nervosa and Binge Eating Disorder

People with bulimia nervosa are also thought to be overly concerned with weight gain and body appearance; indeed, they often view their self-worth in terms of their weight and shape. They may have low self-esteem, and because weight and shape are somewhat more controllable than are other features of the self, they tend to focus on weight and shape, hoping their efforts in this area will make them feel better generally. They try to follow a very rigid pattern of restrictive eating, with strict rules regarding how much to eat, what kinds of food to eat, and when to eat. These strict rules are inevitably broken, and the lapse escalates into a binge. After the binge, feelings of disgust and fear of becoming fat build up, leading to compensatory actions such as vomiting. Although purging temporarily reduces the anxiety from having eaten too much, this cycle lowers the person's self-esteem, which triggers still more bingeing and purging—a vicious cycle that maintains desired body weight but has serious medical consequences. People with bulimia nervosa or binge eating disorder typically binge when they encounter stress and experience negative emotions, as has been shown in several studies. In fact, the propensity to experience negative emotions has been shown to predict the onset of eating disorders. Using ecological momentary assessment, investigators show how specific binge-and-purge events are linked to changes in emotions and stress in the course of daily life. A meta-analysis of 82 EMA studies found that negative emotion preceded the onset of a binge among people with bulimia or binge eating disorder, but the effect sizes were stronger for binge eating disorder than for bulimia. The binge may therefore function as a means of regulating negative emotions. However, the meta-analysis of EMA studies also showed that people with bulimia or binge eating disorder experienced more negative emotion after the binge, so the use of bingeing as a way to regulate affect appears not to be very successful. Evidence also supports the idea that stress and negative emotions are relieved by purging. That is, negative emotion levels decline and positive emotion levels increase after a purge event, supporting the idea that purging is reinforced by negative affect reduction .

Sleep efficiency (SE)

Percentage of time actually spent sleeping of the total time spent in bed.

Prognosis of Binge Eating Disorder

Perhaps because it is a relatively new diagnosis, fewer studies have assessed the prognosis of binge eating disorder. Research so far suggests that 25 to 82 percent of people recover. One epidemiological study of binge eating disorder in several countries reported a duration of just over 4 years..

Treatment of dyssomnias

Prevention by establishing good sleeping habits. Short-acting drugs that induce sleep (but don't cause anxiety). Long-acting drugs may have more side effects, dependence is a risk, REBOUND insomnia, risk of injury/death due to sleepwalking. Phase delays. Use of light to reorient sleep cycle. Psychological stimulus control (bed only for sleep), CBT.

In the eating disorder bulimia nervosa, the self-induced vomiting or laxative abuse used to compensate for excessive food ingestion.

Purging techniques

1. Periodic intervals of sleep during which the eyes move rapidly from side to side, and dreams occur, but the body is inactive. 2. REM sleep seems related to depression 3. CBT

Rapid eye movement (REM) sleep

REM sleep behavior disorder

Repeated episodes of arousal during REM sleep including motor behaviors and vocalizations. Usually at least 90 min after onset of sleep. Individual is completely unaware of actions during episode and after awakening. Upon awakening, is completely alert and not confused. Ex: violence including murder, sexsomnia, and nocturnal eating syndrome.

Medical consequences of bulimia nervosa

Salivary gland enlargement, erosion of dental enamel, electrolyte imbalance (kidney failure, cardiac arrhythmia, seizures), intestinal problems, permanent colon damage, hand calluses.

Karen wakes up screaming every night, disregarding her parents' efforts to comfort her. Her heart rate is elevated in these episodes, and her pajamas are soaked in sweat. The next day, she has no memory of the experience. To help reduce these night terrors. Karen's pediatrician used ____________.

Scheduled awakenings

Treatment for obesity

Self-directed weight loss problems, commercial self-help programs, behavioral modification programs, bariatric surgery. Moderately effective for adults. More effective for kids and adolescents, esp. with family involvement.

Racial and Ethnic Differences

There is a somewhat greater incidence of eating disturbances and body dissatisfaction among white women than black women but differences in actual eating disorders, particularly bulimia, do not appear to be as great. In addition, the greatest differences between white and black women in eating disorder pathology appear to be most pronounced in college student samples; fewer differences are observed in either high school or nonclinical community samples. A meta-analysis found more similarities than differences in body dissatisfaction among ethnic groups in the United States. White women and Hispanic women reported greater body dissatisfaction than African American women, but no other ethnic differences were reliably found. Little is known about the prevalence of eating disorders among Latina or Native American women, and this remains a much-needed research focus.

Anorexia Medical Consequences

• Cessation of menstruation (amenorrhea) - it was dropped from the DSM criteria though however • Dry skin, brittle hair or nails, and sensitivity to or intolerance of cold temperatures. • Cardiovascular problems, such as chronically low blood pressure and heart rate. • If vomiting is apart of anorexia, electrolyte imbalance and resulting cardiac and kidney

Psychological Treatment of Binge Eating Disorder

Although not as extensively studied as with bulimia nervosa, CBT has been shown to be effective for binge eating disorder in several studies. CBT for binge eating disorder targets binges as well as emphasizing self-monitoring, self-control, and problem solving related to eating. Gains from CBT appear to last up to 1 year after treatment. CBT also appears to be more effective than treatment with fluoxetine. Randomized controlled clinical trials have shown that IPT is as effective as CBT and guided self-help CBT for binge eating disorder. These three treatments are more effective than behavioral weight-loss programs, which are often used to treat obesity. More specifically, CBT and IPT reduce binge eating (but not necessarily weight), whereas behavioral weight-loss programs may promote weight loss but do not curb binge eating. One study compared three treatments for binge eating disorder: (1) therapist-led group CBT (2) therapist-assisted group CBT (3) structured self-help group CBT with no therapist. Results showed that people in the therapist-led group CBT had the greatest reduction in binge eating at 6-month and 12-month follow-ups but that all groups had a greater reduction in binges than a group of people assigned to a wait-list control group. Fewer people dropped out of the therapist-led group as well. Thus, having a therapist lead a CBT group may help keep people in treatment and help reduce binges, but, importantly, people in the therapist-assisted and "therapist-free" groups also showed reductions in binges. Given that therapist cost and/or availability may limit treatment for some people, having options such as these available is promising.

Sleep stage 3 (and 4 is same but more intense

Deep sleep. Called slow-wave, or delta, sleep. If aroused, a person may feel disoriented for a few minutes. Body repairs and regenerates tissues, builds bone and muscle, and may strengthen the immune system. As you age, you sleep more lightly and get less deep sleep and less sleep overall--but your need for it does not decrease.

Primary insomnia

Difficulty in initiating, maintaining, or gaining from sleep; not related to other medical or psychological problems.

Effects of little sleep

Disrupted sleep is common; many ppl sleep <6 hrs/day. If chronic--problematic in brain function and impairs concentration, causes unclear thinking, irritability, physical exhaustion, and more susceptibility to illnesses. Associated with many mental disorders.

Treatment of eating disorders

Drug treatments (not effective for anorexia), short-term efficacy of antidepressants (tricyclics and prozac) for bulimia, when used to supplement psychological treatment.

Hypnic myoclonia

During stage 1. Feeling of falling asleep, may cause a sudden muscle contraction.

non-24-hour sleep-wake type

E.g. sleeping on a 25-or 26-hour cycle with later and later bedtimes ultimately going throughout the day

Advanced sleep phase type

Early to bed and early to rise

Many young women with ______ disorders have a diminished sense of personal control and confidence in their own abilities and talents, are perfectionists, and/or are intensely preoccupied with how they appear to others.

Eating

Genetic Factors

Eating disorders run in families. First-degree relatives of women with anorexia nervosa are more than 10 times more likely than average to have the disorder themselves Similar results are found for bulimia nervosa, where first-degree relatives of women with bulimia nervosa are about four times more likely than average to have the disorder. Heritability estimates for anorexia range from .48 to .74 and for bulimia from .55 to .62.

Subscales and Illustrative Items from the Eating Disorders Inventory: Interoceptive awareness

I get confused about what emotion I am feeling. I don't know what's going on inside me. I get confused as to whether or not I am hungry.

Scheduled awakenings

1. Instructed parents of children who were experiencing almost nightly sleep terrors to awaken their child briefly approximately 30 minutes before a typical episode (these usually occur around the same time each evening) 2. This simple technique, which was faded out over several weeks, was successful in almost eliminating these disturbing events.

There are several types of circadian rhythm sleep disorders

1. Jet lag type 2. Shift work type 3. Sleep phase type 4. Advanced sleep phase type 5. Irregular sleep-wake type 6. non-24-hour sleep-wake type

Nightmares

1. Occur during REM or dream sleep 2. About 10% to 50% of children and about 9% to 30% of adults experience them regularly 3. These experiences must be so distressful that they impair a person's ability to carry on normal activities 4. Distinguish nightmares from bad dreams by whether or not you wake up as a result 5. Disturbing dreams that awaken the sleeper; bad dreams are those that do not awaken the person experiencing them. 6. Are thought to be influenced by genetics, trauma, medication use, and are associated with some psychological disorders 7. Both psychological intervention and pharmacological treatment

2 Psychological treatments of bulimia nervosa

1) Cognitive-behavior therapy (CBT)--treatment of choice, target problem eating behaviors and dysfunctional thoughts; may work quicker. 2) Interpersonal psychotherapy--improve interpersonal functioning, similarly effective, long-term.

Sexsomnia

1. Acting out sexual behaviors such as masturbation and sexual intercourse with no memory of the event 2. Can cause relationship problems and, in extreme cases, legal problems when cases occur without consent or with minors.

Shift work type

1. Are associated with work schedules 2. Work at night or must work irregular hours 3. May have problems sleeping or experience excessive sleepiness during waking hours 4. May contribute to cardiovascular disease, ulcers, and breast cancer in women

Polysomnographic (PSG) evaluation

1. Assessment of sleep disorders in which a client sleeping in the lab is monitored for heart, muscle, respiration, brain wave, and other functions. 2. The patient spends one or more nights sleeping in a sleep laboratory and being monitored on a number of measures, including respiration and oxygen desaturation (a measure of airflow); leg movements; brain wave activity, measured by an electroencephalogram; eye movements, measured by an electrooculogram; muscle movements, measured by an electromyogram; and heart activity, measured by an electrocardiogram.

Sleep apnea

1. Breathing is contricted a great deal and may be labored (hypoventilation) or, in the extreme, there may be short periods (10 to 30 seconds) when they stop breathing altogether, called sleep apnea. 2. Only minimally aware of breathing difficulties and doesn't attribute the sleep problems to the breathing.

3 treatments of binge eating disorder

1. CBT- similar to bulimia. 2. IPT- as effective as CBT. 3. Medications- possible benefit from, Meridia, no benefit from Prozac.

Jet lag type

1. Caused by rapidly crossing multiple time zones 2. Usually report difficulty going to sleep at the proper time nd feeling fatigued during the day

Sleep apnea

1. Disorder involving brief periods when breathing ceases during sleep. 3 kinds--obstructive, central, mixed. 2. Have difficulty breathing at night 3. Often snore loudly, pause between breaths, and wake in the morning with a dry mouth and headache.

2 categories of sleep disorders.

1. Dyssomnias. 2. Parasomnias. DSM now includes criteria for data from polysomographic studies and sometimes medical tests.

Delayed sleep phase type

1. Extreme night owls, people who stay up late and sleep late, may have this problem

2 subtypes of bulimia nervosa

1. Purging (most common)--vomiting, laxatives, or diuretics. 2. Nonpurging--exercising and/or fasting.

2 subtypes of anorexia nervosa

1. Restricting (limit caloric intake through diet and fasting). 2. Binge-eating-purging (~1/2 of anorexics).

Breathing-related sleep disorders

1. Sleep disruption leading to excessive sleepiness or insomnia, caused by a breathing problem such as interrupted (sleep apnea) or labored (hypoventilation) breathing. 2. People whose breathing is interrupted during their sleep often experience numerous brief arousals throughout the night and do not feel rested even after 8 or 9 hours asleep. 3. Breathing is contricted a great deal and may be labored (hypoventilation) or, in the extreme, there may be short periods (10 to 30 seconds) when they stop breathing altogether, called sleep apnea. 4. Only minimally aware of breathing difficulties and doesn't attribute the sleep problems to the breathing.

Bariatric surgery

1. Surgical approach to extreme obesity, usually accomplished by stapling the stomach to create a small stomach pouch or bypassing the stomach through gastric bypass surgery

Sleep terrors

1. scheduled awakenings ~30 min before usual time of episode, use for several weeks and fade. 2. Episodes of apparent awakening from sleep (usually during 1st to 3rd phase), accompanied by scream and signs of panic, followed by disorientation and amnesia for the incident. Intense fear and signs of autonomic arousal such as mydriasis, tachycardia, rapid breathing and sweating. Relatively unresponsive to ppl trying to comfort them. More children and more males. These occur during non-REM sleep and so do not involve frightening dreams. 3. Which most commonly afflict children, usually begin with a piercing scream. 4. The child is extremely upset, often sweating, and frequently has a rapid heartbeat. 5. Appear to resemble nightmares- the child cries and appears frightened- but they occur during NREM sleep and therefore are not caused by frightening dreams. 6. Children cannot be easily awakened and comforted, as they can during a nightmare. 7. Children do not remember sleep terrors

Sleep stages

A complete sleep cycle is the progression of the 4 stages of non-REM, then--about 90 min after sleep onset--REM. After a period of REM, the sleep cycle restarts--each recurring stage lengthens and final one may last an hour.

Preventive Interventions for Eating Disorders

A different approach to treating eating disorders involves prevention. Intervening with children or adolescents before the onset of eating disorders may help to prevent these disorders from ever developing. Broadly speaking, three diff erent types of preventive interventions have been developed and implemented: 1. Psychoeducational approaches. The focus is on educating children and adolescents about eating disorders to prevent them from developing the symptoms. 2. Deemphasizing sociocultural influences. The focus here is on helping children and adolescents resist or reject sociocultural pressures to be thin. 3. Risk factor approach. The focus here is on identifying people with known risk factors for developing eating disorders (e.g., weight and body-image concern, restricting food) and intervening to alter these factors.

Sleep stage 1

A reduction in movement and all body activity between wakefulness and stage 1 sleep. Eyes closed. Can be awakened easily. If aroused, may feel as if haven't slept. May last 5-10 minutes. May experience hypnic myoclonia.

Personality Influences

A study of semistarvation in male conscientious objectors conducted in the late 1940s supports the idea that the personality of people with eating disorders, particularly those with anorexia, is affected by their weight loss. On average, the men lost 25 percent of their body weight. They all soon became preoccupied with food; they also reported increased fatigue, poor concentration, lack of sexual interest, irritability, moodiness, and insomnia. Four became depressed, and one developed bipolar disorder. This research shows vividly how severe restriction of food intake can have powerful effects on personality and behavior, which we need to consider when evaluating the personalities of people with anorexia and bulimia. A prospective study found that perfectionism predicted the onset of anorexia in young adult women.. Perfectionism combined with body dissatisfaction also predicts drive for thinness and concern about weight. Additional research has taken a closer look at the link between perfectionism and anorexia. Perfectionism is multifaceted and may be self-oriented (setting high standards for oneself), other-oriented (setting high standards for others), or socially oriented (trying to conform to the high standards imposed by others). Nevertheless, the evidence that perfectionism prospectively predicts the onset of anorexia is limited, largely because there are so few prospective studies

Parasomnias

Abnormal behaviors or psychological events such as nightmares or sleepwalking that occur during sleep. Ex: non-REM sleep arousal disorders (sleep terror disorder), nightmare disorder, REM sleep behavior disorder, nocturnal eating syndrome, hypnagogic hallucinations

Developmental considerations of eating disorders

Adolescent onset (parent, peer, and cultural considerations). Weight gain with normal hormonal changes and changes in body associated with puberty and maturation. Media impact--interaction with social ideals.

Obstructive apnea

Airflow stops despite continued activity by the respiratory system (narrow airway, abnormality, or damage associated with age, obesity, use of drugs such as ecstasy) about 10-20% of US population; more males

Treatment of Parasomnias

All decrease with age. No treatment/definitive research for nightmare disorder. Also no effective treatment for sleepwalking disorder. Sleep terror disorder--scheduled awakenings ~30 min before usual time of episode, use for several weeks and fade

Which of the following are characteristics of both anorexia and bulimia? a. They involve a good deal of weight loss. b. They are more common in women than men. c. They have physical side effects (e.g., menstrual irregularities). d. All the above but a are correct.

All the above but a are correct.

1. an eating disorder characterized by recurrent food refusal, leading to dangerously low body weight 2. 15% below expected weight (usually much lower when seek treatment). Eating disorder characterized by recurrent food refusal, leading to dangerously low body weight. Intense fear of gaining weight. Out-of-control and overly successful weight loss. Westernized sociocultural origins, often begins as dieting. 2 subtypes.

Anorexia

A. restriction of food intake leading to significant low body weight B.intense fear of gaining weight or becoming fat, or persistent behavior that interferes with weight gain C. disturbance in body image, undue influence of weight on self-esteem, lack of recognition of seriousness of current body weight

Anorexia Nervosa Subtypes: Restricting Type: During the last 3 months, the individual has not engaged in recurrent episodes of binge eating or purging behavior (i.e., self-induced vomiting or the misuse of laxatives, diuretics, or enemas). This subtype describes presentations in which weight loss is accomplished primarily through dieting, fasting, and/or excessive exercise. ( F50.02) Binge-eating/purging type: During the last 3 months, the individual has engaged in recurrent episodes of binge eating or purging behavior (i.e., self-induced vomiting or the misuse of laxatives, diuretics, or enemas). Specify if: partial remission or full remission Specify current severity: Mild, Moderate, Serve and Extreme Mild: BMI ≥ 17 kg/m 2 Moderate: BMI 16- 16.99 kg/m 2 Severe: BMI 15- 15.99 kg/m 2 Extreme: BMI < 15 kg/m 2

Kirsten 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 calories daily will make her fat. Since losing the weight, Kirsten has stopped having periods. She sees a fat person in the mirror. Which disorder?

Anorexia nervosa

Biological limitations, as well as the societal pressure to use diet and exercise to achieve nearly impossible weight goals, contribute to the high numbers of people with _____ ______ and _____ ______.

Anorexia nervosa and bulimia nervosa

Comorbidity of anorexia nervosa

Anxiety (OCD-rituals to avoid eating), mood disorders, substance abuse (suicide).

Comorbidity of bulimia nervosa

Anxiety, mood disorders, and substance abuse (respectively). And substance abuse increases suicide risk.

Sociocultural Factors

As society has become more health conscious, dieting to lose weight has become more common; in results from a survey of over 4000 women ages 25 to 45, a third of the women reported spending more than half of their lifetime trying to lose weight. Diet crazes come and go. Are some diets more effective than others? A study in the New England Journal of Medicine reported that diets were equally effective, whether they cut carbs, fat, or protein. Research also indicates that the number of calories may not be as important as the type of calories when it comes to losing weight. People differ in body type and metabolism of different types of calories. Procedures such as liposuction (vacuuming out fat deposits just under the skin) and bariatric surgery (surgically changing the stomach so that it cannot digest as much food) remain popular despite their risks. Women are more likely than men to be dieters. The onset of eating disorders is typically preceded by dieting and other concerns about weight, supporting the idea that social standards stressing the importance of thinness plays a role in the development of these disorders. It is likely that women who either are overweight or fear becoming so are also dissatisfied with their bodies. Not surprisingly, studies have found that women and adolescent girls with both a high BMI and body dissatisfaction are at higher risk for developing eating disorders. Preoccupation with being thin or feeling pressure to be thin predicts an increase in body dissatisfaction among adolescent girls, which in turn predicts more dieting, eating pathology, and negative emotions. Finally, exposure to media portrayals of unrealistically thin models can influence reports of body dissatisfaction. The sociocultural ideal of thinness is a likely vehicle through which people learn to fear weight gain or even feeling fat. Obese people are viewed by others as less smart and are stereotyped as lonely, shy, and greedy for the aff ection of others. Even more disturbing, health professionals who specialize in obesity have also exhibited beliefs that obese people are lazy, stupid, or worthless. Not only does the fear of weight gain contribute to eating pathology, but the celebration of extreme thinness via websites, blogs, and magazines may also play a role. Websites that are "pro-ana" (short for anorexia) or "pro-mia" (short for bulimia) and other "thinsperation" websites and blogs have developed a following of women who seek support and encouragement for losing weight, often to a dangerously low level. These sites often post photos of female celebrities who are extremely thin as inspiration (hence, the term thinsperation). Low BMI that goes along with extreme thinness has been shown to prospectively predict the onset of anorexia, and therefore sites that promote such low weight may nurture a risk factor for anorexia.

1. Surgical approach to extreme obesity, usually accomplished by stapling the stomach to create a small stomach pouch or bypassing the stomach through gastric bypass surgery

Bariatric surgery

Medications

Because bulimia nervosa is often comorbid with depression, it has been treated with various antidepressants. On the negative side, many people with bulimia stop taking medications. In contrast, in one study fewer than 5 percent of women dropped out of CBT. Moreover, most people relapse when various kinds of antidepressant medications are stopped. There is some evidence that this tendency to relapse is reduced if antidepressants are given in the context of CBT. Medications have also been used to treat anorexia nervosa with little success in improving weight or other core features of anorexia. Medication treatment for binge eating disorder has not been as well studied. Limited evidence suggests that antidepressant medications are not effective in reducing binges or weight loss. Clinical trials of anti-obesity drugs, such as sibutramine and atomoxetine, show some promise in binge eating disorder, but additional clinical trials are needed. A randomized controlled trial compared the antidepressant medication fluoxetine (Prozac) with CBT plus placebo, or CBT plus fluoxetine and found that that CBT plus placebo was more effective in reducing binge episodes than either condition including fluoxetine, and this remained the case at a 12-month follow-up.

Professionally directed _____ _____ programs represent the most successful treatment for obesity

Behavior modification

After George's wife died at the age of 68, he could not sleep. To help him through the hardest first week, Dr. Brown prescribed _________ for his insomnia.

Benzodiazepines

A. recurrent episodes of binge eating Eating, in discrete period of time, amt of food definitely larger than most would eat in similar time Lack of control during episode B. binges are assoc with 3+: Eating much more rapidly Eating until uncomfortably full Eating large amts when not hungry Eating alone bc embarrassed Self-disgust, depression, or guilt C. marked distress D. occurs 1xweek for 3 months E. no purging, R/O bulimia, anorexia

Binge Eating Disorder Specify if: partial or full remission Specify current severity: Mild, Moderate, Severe and Extreme Mild: 1- 3 binge-eating episodes per week. Moderate: 4- 7 binge-eating episodes per week. Severe: 8- 13 binge-eating episodes per week. Extreme: 14 or more binge-eating episodes per week.

1. A pattern of eating involving distress-inducing binges not followed by purging behaviors; being considered as a new DSM diagnostic category 2. Pattern of eating involving distress-inducing binges not followed by purging behaviors (so not bulimia); being considered as a new DSM diagnostic category. Better response to treatment than others. Many are obese, tend to be older, more psychopathology vs non-binging obese. Concerned about shape/weight. Westernized sociocultural origins.

Binge-eating disorder

Manny has been having episodes lately when he eats prodigious amounts of food. He's been putting on a lot of weight because of it. Which disorder?

Binge-eating disorder

Relatively brief episode of uncontrolled, excessive consumption, usually of food or alcohol.

Binges

Physical Consequences of Anorexia Nervosa

Blood pressure often falls, heart rate slows, kidney and gastrointestinal problems develop, bone mass declines, the skin dries out, nails become brittle, hormone levels change, and mild anemia may occur. Some people lose hair from the scalp, and they may develop lanugo—a fine, soft hair—on their bodies. potassium and sodium, are altered. These ionized salts, present in various bodily fluids, are essential to neural transmission, and lowered levels can lead to tiredness, weakness, cardiac arrhythmias, and even sudden death

Research on prevention programs has shown that two programs show promise up to 3 years after the intervention:______________ and____________________.

Body Project, Healthy Weight

Associated features and medical consequences of anorexia nervosa

Body image disturbance, pride in diet and control, rarely seek treatment. Amenorrhea (although dropped from DSM 5), dry skin, brittle hair/nails, sensitivity to cold temps, lanugo (downy hair on limbs/face), cardiovascular problems, electrolyte imbalance.

Attention must be focused on dysfunctional attitudes about ___ ___ in anorexia, or relapse will most likely occur after treatment.

Body shape

REM

Brainwave patterns similar to being awake. Eyes move rapidly in different directions. Intense dreaming occurs as result of heightened brain activity. Paralysis of major voluntary muscle groups + brain (encephalic) excitement = paradoxical sleep. Infants get most, least in elderly.

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 will wake him to tell him to quit snoring. What type of disorder?

Breathing-related sleep disorder

A. recurrent episodes of binge eating Eating, in discrete period of time, amt of food definitely larger than most would eat in similar time Lack of control during episode B. recurrent inappropriate compensatory behaviors (e.g. vomiting, laxatives, fasting, exercise) C. binge/purge occur on average 1x week for 3 months D. self-evaluation unduly influenced by body/weight E. R/O anorexia

Bulimia Nervosa Specify if: partial or full remission Specify current severity: Mild, Moderate, Severe and Extreme Mild: An average of 1- 3 episodes of inappropriate compensatory behaviors per week. Moderate: An average of 4- 7 episodes of inappropriate compensatory behaviors per week. Severe: An average of 8- 13 episodes of inappropriate compensatory behaviors per week. Extreme: An average of 14 or more episodes of inappropriate compensatory behaviors per week.

1. An eating disorder involving recurrent episodes of uncontrolled excessive (binge) eating followed by compensatory actions to remove the food (for example: deliberate vomiting, laxative abuse, and excessive exercise) 2. Eating disorder involving recurrent episodes of uncontrolled excessive (binge) eating followed by compensatory/purging actions to remove the food (for example, fasting, deliberate vomiting, laxative abuse, and excessive exercise). Intense fear of gaining weight. Belief that others' impressions, popularity, and self-esteem are determined by weight and body shape. Usually close to normal weight. Westernized sociocultural origins.

Bulimia nervosa

I noticed Elena 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 imbalance, resulting in serious medical problems. Which disorder?

Bulimia nervosa

Joo-Yeon eats large quantities of food in a short time. She then takes laxatives and exercises for long periods to prevent weight gain. She has been doing this almost daily for several months and feels she will become worthless and ugly if she gains even an ounce. Which disorder?

Bulimia nervosa

Subscales and Illustrative Items from the Eating Disorders Inventory: Ineffectiveness

I feel inadequate. I have a low opinion of myself. I feel empty inside (emotionally).

Cognitive-behavioral treatment (CBT) and interpersonal psychotherapy (IPT) are both successful treatments for bulimia nervosa, although ___ is the preferred method.

CBT

Psychological Treatment of Anorexia Nervosa

CBT is the best-validated and most current standard for the treatment of bulimia. In CBT, people with bulimia are encouraged to question society's standards for physical attractiveness. with bulimia must also uncover and then change beliefs that encourage them to starve themselves to avoid becoming overweight. They must be helped to see that healthy body weight can be maintained without severe dieting and that unrealistic restriction of food intake can often trigger a binge. They are taught that all is not lost with just one bite of high-calorie food and that snacking need not trigger a binge, which will be followed by induced vomiting or taking laxatives, which in turn will lead to still lower self-esteem and depression. Altering this all-or-nothing thinking can help people begin to eat more moderately. They also learn assertiveness skills, which help them cope with unreasonable demands placed on them by others, as well as more satisfying ways of relating to people. The overall goal of treatment in bulimia nervosa is to develop more healthy eating patterns. People with bulimia need to learn to eat three meals a day and even some snacks between meals without sliding back into bingeing and purging. Regular meals control hunger and thereby, it is hoped, the urge to eat enormous amounts of food, the effects of which are counteracted by purging. Findings from several studies indicate that CBT is effective, and it often results in less frequent bingeing and purging, with reductions ranging from 70 to more than 90 percent. CBT alone is more effective than any available medication, and a meta-analysis showed that CBT yielded better results than antidepressant medications. But are outcomes better when antidepressant medication is added to CBT? Evidence on this front is mixed. Adding antidepressant drugs, however, may be useful in helping to alleviate the depression that often occurs with bulimia Another form of CBT, called guided self-help CBT, has also shown promise for some people. In this type of treatment, people receive self-help (book or on the internet) on topics such as perfectionism, body image, negative thinking, and food and health. Participants meet for a small number of sessions with a therapist who helps guide them through the self-help material. This appears to be an effective treatment compared to a wait-list control group and to traditional CBT for bulimia. It may be more effective for binge eating disorder than bulimia, though additional research is needed. Family therapy may also be effective for bulimia, though it has been studied less frequently than either CBT or IPT. A randomized clinical trial demonstrated that family-based therapy was superior to supportive psychotherapy for adolescents with bulimia with respect to decreasing bingeing and purging up to 6 months after treatment was completed.

Problems in getting to sleep or in obtaining sufficient quality sleep (amount, quality, or timing of sleep). Ex: insomnia disorder, hypersomnolence disorder, narcolepsy, all breathing-related sleep disorders.

Dyssomnias

Comorbidity of sleep-wake disorders.

Can be comorbid with other psychological disorders. "Disturbed sleep"--Schizophrenia, ASD, Major Depression, and Anxiety Related Disorders. Substance use disorders can also significantly impact sleep cycle and are associated with sleep disorders.

A. pattern of sleep disruption primarily due to alteration of the circadian system or misalignment between system and external demands B. leads to excessive sleepiness or insomnia or both C. distress or impairment

Circadian Rhythm Sleep-Wake Disorders Subtypes: Delayed Sleep Phase Advanced Sleep Phase Irregular Sleep-Wake Non-24 Hour Sleep-Wake Shift Work Unspecified Specify if: Episodic: Symptoms last at least 1 month but less than 3 months. Persistent: Symptoms last 3 months or longer. Recurrent: Two or more episodes occur within the space of 1 year.

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

Circadian rhythm sleep disorder

Research suggests that therapy is an effective treatment for bulimia, both in the short and long term.

Cognitive Behavior

Mixed apnea

Combination of obstructive and central

Central apnea

Complete cessation of breathing associated with damage to central nervous system - wake frequently, tend not to report, and often unaware (not well studied)

Nocturnal eating syndrome

Consuming 1/3 or more of daily food intake after the evening meal and waking up at least once (up to 4x) during the night to have a high-calorie snack. In the morning, however, they are not hungry and do not usually eat breakfast. Do not binge during their night eating and seldom purge. Usually wake up during episode. Display unrestrained compulsive and aggressive behavior during episode. Associated with obesity. Onset in 30s. About equal men and women. Can be caused by stressful life events.

Cross-Cultural Studies

Evidence for eating disorders across cultures depends on the disorder. Anorexia has been observed in several cultures and countries besides the United States; for example, in Hong Kong, China, Taiwan, England, Korea, Japan, Denmark, Nigeria, South Africa, Zimbabwe, Ethiopia, Iran, Malaysia, India, Pakistan, Australia, the Netherlands, and Egypt. Furthermore, cases of anorexia have been documented in cultures with very little Western cultural influence. An important caveat must be made, however. The anorexia observed in these diverse cultures does not always include the intense fear of gaining weight that is part of the DSM criteria, at least initially. Thus, intense fear of weight gain likely reflects an ideal more widely espoused in more Westernized cultures.

Anorexia appears to be specific to Western culture; bulimia is seen all over the world and is thus not culture specific. True or False

False

The brain structure linked to the cause of eating disorders is the hypothalamus. True or False

False

One study showed that ____ consider a smaller female body size to be more attractive than ____ do.

Females; men

Prognosis of Anorexia Nervosa

Fifty to seventy percent of people with anorexia eventually recover or at least significantly improve. However, recovery often takes 6 or 7 years, and relapses are common before a stable pattern of eating and weight maintenance is achieved

Physical Consequences of Bulimia Nervosa

For example, frequent purging can cause potassium depletion. Heavy use of laxatives induces diarrhea, which can also lead to changes in electrolytes and cause irregularities in the heartbeat. Recurrent vomiting may lead to tearing of tissue in the stomach and throat and to loss of dental enamel as stomach acids eat away at the teeth, which become ragged. The salivary glands may become swollen. Death from bulimia nervosa is less common than from anorexia nervosa, but mortality rates are higher than for other disorders.

For anorexia, may be required to get the patient to gain weight. There are not many that have been shown to be effective. The most common type of therapy used to treat anorexia is.

Hospitalization, medications, family therapy

Melinda sleeps all night and still finds herself falling asleep throughout the next day. This happens even when she goes to bed early and gets up as late as possible. Which disorder?

Hypersomnolence disorder

A. self-reported excessive sleepiness Recurrent sleep within same day 9+ hours main sleep episode that is non-restorative Sleep inertia, difficulty being fully awake B. 3+ x week, 3+ months, at least 7 hours sleep C. distress or impairment D. R/O other sleep disorders E. R/O substance-induced F. comorbid mental or medical conditions do not adequately explain the insomnia

Hypersomnolene Disorder Specify if: With mental disorder , including substance use disorders With medical condition With another sleep disorder Specify if: Acute: Duration of less than 1 month. Subacute: Duration of 1- 3 months. Persistent: Duration of more than 3 months. Specify current severity: Mild: Difficulty maintaining daytime alertness 1- 2 days/week. Moderate: Difficulty maintaining daytime alertness 3- 4 days/week. Severe: Difficulty maintaining daytime alertness 5- 7 days/week.

Subscales and Illustrative Items from the Eating Disorders Inventory: Interpersonal distrust

I have trouble expressing my emotions to others. I need to keep people at a certain distance (feel uncomfortable if someone tries to get too close).

Subscales and Illustrative Items from the Eating Disorders Inventory: Bulimia

I stuff myself with food. I have gone on eating binges where I have felt that I could not stop. I have the thought of trying to vomit in order to lose weight.

Subscales and Illustrative Items from the Eating Disorders Inventory: Drive for thinness

I think about dieting. I feel extremely guilty after overeating. I am preoccupied with the desire to be thinner.

Subscales and Illustrative Items from the Eating Disorders Inventory: Body dissatisfaction

I think that my thighs are too large. I think that my buttocks are too large. I think that my hips are too big.

Subscales and Illustrative Items from the Eating Disorders Inventory: Maturity fears

I wish that I could return to the security of childhood. I feel that people are happiest when they are children. The demands of adulthood are too great.

Prevention of eating disorders

Identify specific targets (early weight concerns). Screening for at-risk groups. Provide education (normal weight limits, effects of calorie restriction, "healthy weight").

Rebound insomnia

In a person with insomnia, the worsened sleep problems that can occur when medications are used to treat insomnia and then withdrawn.

Cataplexy

In narcolepsy--you are awake and experience a strong emotion, lose muscle tone, immediately falls into deep (REM) sleep.

A. predominant complaint of dissatisfaction with sleep quantity or quality, associated with one (or more) of the following symptoms: 1. Difficulty initiating sleep. (In children, this may manifest as difficulty initiating sleep without caregiver intervention.) 2. Difficulty maintaining sleep, characterized by frequent awakenings or problems returning to sleep after awakenings. (In children, this may manifest as difficulty returning to sleep without caregiver intervention.) 3.Early-morning awakening with inability to return to sleep. B. The sleep disturbance causes clinically significant distress or impairment in social, occupational, educational, academic, behavioral, or other important areas of functioning. C. The sleep difficulty occurs at least 3 nights per week. D. The sleep difficulty is present for at least 3 months. E. The sleep difficulty occurs despite adequate opportunity for sleep. F. The insomnia is not better explained by and does not occur exclusively during the course of another sleep-wake disorder (e.g., narcolepsy, breathing-related sleep disorder, a circadian rhythm sleep-wake disorder, a parasomnia). G. The insomnia is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication). H. Coexisting mental disorders and medical conditions do not adequately explain the predominant complaint of insomnia.

Insomnia Disorder Specify if: - With non- sleep disorder mental comorbidity, including substance use disorders - With other medical comorbidity - With other sleep disorder Specify if: Episodic: Symptoms last at least 1 month but less than 3 months. Persistent: Symptoms last 3 months or longer. Recurrent: Two (or more) episodes within the space of 1 year.

Which statement is true regarding binge eating disorder? a. It is more common in men than women. b. It was not an eating disorder category in DSM-IV-TR. c. It is synonymous with obesity. d. It includes binges and purges.

It was not an eating disorder category in DSM-IV-TR.

Sleepwalking/somnambulism

Leaves bed or sits up in bed. Repeated sleepwalking that occurs during non-REM sleep and so is not the acting out of a dream. The person is difficult to waken and does not recall the experience. Typically occurs during early hours of sleep. Blank, staring face, hard to awaken. May be disoriented if awakened but will come around in a few minutes. More children than adults.

Sleep stage 2

Light sleep. Spontaneous periods of muscle tension mixed with periods of muscle relaxation. Heart rate slows, body temp decreases. Body prepares to enter into deep sleep.

List three factors that contribute to obesity.

Limited availability of healthy food; minimal awareness of portion size; abundance of food/cheap price; genetics; marketing/advertising

Prognosis of Bulimia Nervosa

Long-term follow-ups of people with bulimia nervosa reveal that 68 to 75 percent of them recover, although about 10 to 20 percent remain fully symptomatic. Intervening soon after a diagnosis is made (i.e., within the first few years) is linked with an even better prognosis. People with bulimia nervosa who binge and vomit more and who have comorbid substance use or a history of depression have a poorer prognosis than people without these factors.

Preventing sleep disorders

Maintaining a regular bedtime, having a regular bedtime routine. Avoiding caffeine, alcohol, and nicotine. Use bedroom only for sleep, avoid stressful activities in bedroom. Wake at same time each day. Exercise in day, but not 2 hrs before bedtime. Reduce noise/light and avoid extreme heat in bedroom. Drink milk before bed. Increase exposure to daytime natural light.

Physical Consequences of Binge Eating Disorder

Many of the physical consequences are likely a function of associated obesity, including increased risk of type 2 diabetes, cardiovascular problems, chronic back pain, and headaches even after controlling for the independent effects of other comorbid disorders. Other research shows that many physical problems are present among people with binge eating disorder that are independent from co-occurring obesity, including sleep problems, anxiety, depression, irritable bowel syndrome, and, for women, early onset of menstruation.

Jaclyn's dad is sometimes awakened by his daughter's screams. He runs to Jaclyn's room to comfort her and is eventually able to calm her down. Jaclyn usually explains that she was being chased by a big, one-eyed, purple monster. The events typically happen after watching scary movies with friends. Which sleep problem?

Nightmares

Cognitive Behavioral Factors: Anorexia Nervosa

Many people who develop anorexia symptoms report that the onset followed a period of weight loss and dieting. Behaviors that achieve or maintain thinness are negatively reinforced by the reduction of anxiety about gaining weight as well as positively reinforced by comments from others (Did you lose weight? You look great!). Dieting and weight loss may also be positively reinforced by the sense of mastery or self-control they create. Some theories also include personality and sociocultural variables to explain how body-image disturbances develop. For example, perfectionism and a sense of personal inadequacy may lead a person to become especially concerned with his or her appearance, making dieting a potent reinforcer. Similarly, seeing portrayals in the media of thinness as an ideal, being overweight, and tending to compare oneself with especially attractive others all contribute to dissatisfaction with one's body. Another important factor in producing a strong drive for thinness and a disturbed body image is criticism from peers and parents about being overweight. In one study supporting this conclusion, adolescent girls ages 10 to 15 were evaluated twice, with a 3-year interval between assessments. Obesity at the first assessment was related to being teased by peers, and at the second assessment it was linked to dissatisfaction with their bodies. Dissatisfaction was in turn related to symptoms of an eating disorder. People often binge when diets are broken. Thus, when a person with anorexia nervosa experiences a lapse in her strict dieting, the lapse is likely to escalate into a binge. The purging after an episode of binge eating may be motivated by the fear of weight gain elicited by the binge.

Statistics of anorexia nervosa

More females than males. Caucasian, middle to upper class. Onset age 13-18. Chronic, resistant to treatment.

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 for a while. Which disorder?

Narcolepsy

1. One of the forms of maladaptive eating patterns in people who are obese. 2. Occurs in between 6% and 16% of obese individuals seeking weight-loss treatment but in as many as 55% of those with extreme obesity seeking bariatric surgery 3. Consume a third or more of their daily intake after their evening meal and get out of bed at least once during the night to have a high-calorie snack. 4. In the morning, however, they are not hungry and do not usually eat breakfast. 5. Do not binge during their night eating and seldom purge. 6. Occasionally, nonobese individuals will engage in night eating, but the behavior is overwhelmingly associated with being overweight or obese.

Night eating syndrome

Individuals with ___ _____ _____ consume at least 1/3 or more of their daily intake after their evening meal.

Night eating syndrome

A. repeated extended, dysphoric, and well-remembered dreams B. on awakening, person is oriented and alert C. distress or impairment D. R/O substance E. Coexisting mental and mental disorder do not adequately explain the predominant complaint of dysphoric dreams.

Nightmare Disorder Specify if: Acute: Duration of period of nightmares is 1 month or less. Subacute: Duration of period of nightmares is greater than 1 month but less than 6 months. Persistent: Duration of period of nightmares is 6 months or greater. Specify current severity: Mild: Less than one episode per week on average. Moderate: One or more episodes per week but less than nightly. Severe: Episodes nightly.

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 noticed that food is always missing from the refrigerator. Which sleep problem?

Nocturnal eating syndrome

A. incomplete awakening from sleep, 1+: Sleepwalking Sleep terrors B. No/minimal dream imagery is recalled C. amnesia for episode D. distress or impairment E. R/O substance or medical

Non-REM Sleep Arousal Disorder Specify if: Episodic: Symptoms last at least 1 month but less than 3 months. Persistent: Symptoms last 3 months or longer. Recurrent: Two or more episodes occur within the space of 1 year.

Cross-cultural considerations for eating disorders

North American minority populations. Immigrants to Western cultures experience significant changes in eating and foods available--increase in eating disorders and obesity. Cultural values. Standards for body image.

1. excessive weight or body fat. Individuals are considered obese if they have a BMI of 30 or greater • Not considered an official disorder in the DSM • The more overweight someone is at a given height, the greater the risks to health 2. Excess of body fat resulting in a body mass index (BMI, a ratio of weight to height) of 30 or more. Not an eating disorder under DSM. Epidemic in US. Related to heart disease, stroke, type 2 diabetes, and certain types of cancer. Huge medical costs. Increasing statistics.

Obesity

_____ is the single most expensive health problem in the United States, surpassing both smoking and alcohol abuse.

Obesity

Fatty foods and technology are to blame for the ____ _____ in the United States.

Obesity epidemic

Subscales and Illustrative Items from the Eating Disorders Inventory: Perfectionism

Only outstanding performance is good enough in my family. As a child, I tried hard to avoid disappointing my parents and teachers. I hate being less than best at things.

Sleep-wake type

People who experience highly varied sleep cycles

Microsleeps

Short, seconds-long periods of sleep that occur in people who have been deprived of sleep.

Rama is extremely overweight. His wife suspects he may be suffering from ___ ___ because he snores every night and often wakes up exhausted as though he never slept.

Sleep apnea

Narcolepsy

Sleep disorder involving sudden and irresistible sleep attacks. Rare disorder. Includes both daytime irrepressible sleepiness and cataplexy. Occurs 3x per week for at least 3 months. Often also report sleep paralysis. DSM 5 criteria reference CSF testing and criteria from nocturnal polysomograph.

Circadian rhythm sleep disorder

Sleep disturbances resulting in sleepiness or insomnia, caused by the body's inability to synchronize its sleep patterns with the current pattern of day and night (associated with hypothalamus). Light usually determines sleepiness/awakeness. Health impact can be extreme: increased rates of cardiovascular disease, ulcers, breast cancer, and greater risk of personality disorders. Can be jet lag type, shift work type, delayed sleep phase type

Hypersomnolence disorders

Sleep dysfunction involving an excessive amount of sleep (hypersomnia) that disrupts normal routines. Sleep all night; appear rested when awakened, but fall asleep during the day. Have to rule out other potential causes: sleep apnea, insomnia, and other psychological considerations.

Hypersomnolence

Sleep dysfunction involving an excessive amount of sleep (hypersomnia) that disrupts normal routines. Sleep all night; appear rested when awakened, but fall asleep during the day. Have to rule out other potential causes: sleep apnea, insomnia, and other psychological considerations.

Carl's doctor suggested some relatively simple lifestyle changes otherwise known as good when he expressed concern about developing a sleep disorder.

Sleep hygiene

Jaime sometimes awakens and cannot move or speak. What is this frightening experience called?

Sleep paralysis

Polysomnography are

Sleep readings

Sho-jen'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, however, she has no memory of the experience. Which sleep problem?

Sleep terrors

Actigraph

Small electronic device that is worn on the wrist like a watch and records body movements. This device can be used to record sleep-wake cycles.

Causes of eating disorders

Social dimensions (cultural imperatives, thin=success, happy), dieting. Ideal body size standards. Artificial standards in media. Internal and perceived social and gender standards. Family influences (driven, success, history of mother dieting). Biological (perfectionism, hypothalamus/serotonin, reaction to stress). Psychological (loss of control, low self-confidence, mood intolerance, etc).

Causes of obesity

Spread of modernization (sedentary lifestyle + high fat foods). Genetics (~30% of the cause). Biological factors. Psychosocial factors (impulse control, etc).

Characteristics of Families

Studies of the characteristics of families of people with eating disorders have yielded variable results. Some of the variation stems, in part, from the diff erent methods used to collect the data and from the sources of the information. For example, self-reports of people with eating disorders reveal high levels of conflict in the family. Reports of parents, however, do not necessarily indicate high levels of family problems. Indeed, parent and child reports do not always agree when it comes to describing family characteristics in eating disorders. To better understand the role of family functioning, it is necessary to study these families directly by observational measures rather than by self-reports alone. Although an adolescent's perception of his or her family's characteristics is important, we also need to know how much of reported family discord is perceived and how much is consistent with others' perceptions. In one of the few observational studies conducted thus far, parents of children with eating disorders did not appear to be very diff erent from parents of children with no eating disorders. The two groups did not diff er in the frequency of positive and negative messages given to their children, and the parents of children with eating disorders were more self-disclosing. The parents of children with eating disorders did lack some communication skills, however, such as the ability to request clarification of vague statements. Observational studies such as this, coupled with data on perceived family characteristics, would help determine whether actual or perceived family characteristics are related to eating disorders.

Neurobiological Factors

The hypothalamus is a key brain center for regulating hunger and eating. Research on animals with lesions to the lateral hypothalamus indicates that they lose weight and have no appetite. Thus, it is not surprising that the hypothalamus has been proposed to play a role in anorexia. The level of some hormones regulated by the hypothalamus, such as cortisol, is indeed diff erent in people with anorexia. Rather than causing the disorder, however, these hormonal differences occur as a result of self-starvation, and levels return to normal after weight gain. Furthermore, the weight loss of animals with hypothalamic lesions does not parallel what we know about anorexia. These animals appear to have no hunger and to become indifferent to food, whereas people with anorexia continue to starve themselves despite being hungry and having an interest in food. Nor does the hypothalamic model account for body-image disturbance or fear of gaining weight. Thus, a dysfunctional hypothalamus does not seem a likely causal factor in anorexia nervosa. Endogenous opioids are substances produced by the body that can reduce pain sensations, enhance mood, and suppress appetite. Opioids are released during starvation and have been hypothesized to play a role in anorexia, bulimia, and binge eating disorder. Starvation among people with anorexia may increase the levels of endogenous opioids, resulting in a positively reinforcing positive mood state. Furthermore, the excessive exercise seen among some people with eating disorders would increase opioids and thus be reinforcing.

Prevention by establishing good sleeping habits. Short-acting drugs that induce sleep (but don't cause anxiety). Long-acting drugs may have more side effects, dependence is a risk, REBOUND insomnia, risk of injury/death due to sleepwalking. Phase delays. Use of light to reorient sleep cycle. Psychological stimulus control (bed only for sleep), CBT

Treatment of dyssomnias

Insomnia disorder

Trouble falling asleep (initiating), staying asleep (maintaing), or wake up too early and can't go back to sleep. Can be episodic (less than 3 months, but at least 1 per month), persistent (lasts >3 months), or recurrent (2 or more episodes in a year). Many people experience it during times of stress.

Animal research has shown that serotonin promotes feeling full. True or False

True

Cognitive behavioral views of bulimia suggest that women judge their self-worth by their weight and shape. True or False

True

Dopamine has been studied in all the eating disorders. True or False

True

Factors Cognitive behavioral theories of eating disorders focus on understanding the thoughts, feelings, and behaviors that contribute to distorted body image, fear of weight gain, and loss of control over eating. True or False

True

Prospective studies of personality and eating disorders indicate that the tendency to experience negative emotions is related to disordered eating. True or False

True

Hypnagogic hallucinations

Vivid and terrifying experiences at the beginning of sleep (either during daytime sleep episodes or at night). Very realistic and include visual (simple forms, color), tactile, hearing, and sensations of body movement.

Statistics of bulimia nervosa

WOMEN: Mostly female Caucasian, middle to upper class. Onset age 10-21. Chronic if untreated. MEN: Some men Caucasian, middle to upper class. Gay or bisexual men or athletes with weight regulations. Onset later than women.

Gender Influences

We have discussed the fact that eating disorders are more common in women than in men. One primary reason is likely the fact that Western cultural standards emphasize and reinforce the desirability of being thin more for women than for men. For men, magazines focus attention on the masculine ideal of normal body weight or on increased muscle mass. The risk for eating disorders among groups of women who might be expected to be particularly concerned with thinness and their weight— for example, models, dancers, and gymnasts, as in the case of Jill—appears to be especially high. Another sociocultural factor, though, has remained remarkably resilient to change— namely, the objectification of women's bodies. Women's bodies are often viewed through a sexual lens; in effect, women are defined by their bodies, whereas men are esteemed more for their accomplishments. According to objectification theory, the prevalence of objectification messages in Western culture (in television, advertisements, and so forth) has led some women to "self-objectify," which means that they see their own bodies through the eyes of others. Research has shown that self-objectification causes women to feel more shame about their bodies. Shame is most often elicited in situations where an individual's ideal falls short of a cultural ideal or standard. Thus, women likely experience body shame when they observe a mismatch between their ideal self and the cultural (objectified) view of women. Research has also shown that both self-objectification and body shame are associated with disordered eating Do eating disorders and weight concerns go away as women get older? A large, 20-year prospective study of over 600 men and women reported important differences in dieting and other eating disorder risk factors for men and women. The researchers found that after 20 years, women dieted less and were less concerned about their weight and body image than they were in college, even though they weighed more now. In addition, eating disorder symptoms decreased over the 20 years for women, as did the risk factors for eating disorders (concern about body image, frequency of dieting). Changes in life roles—having a life partner, having a child—were also associated with decreases in eating disorder symptoms for women. By contrast, men were more concerned about their weight and were dieting more. Like women, they weighed more in their early 40s than when they were in college. Decreases in risk factors such as concern about body image and dieting frequency were also associated with decreases in eating disorder symptoms for men.

Psychological treatment of anorexia nervosa

Weight restoration; may require hospitalization. Target dysfunctional attitudes--body shape, control, and thinness=worth idea. Family involvement (communication about eating/food, attitudes about body shape). Long-term prognosis is poorer than bulimia.

Insomnia disorder statistics

Women report it more than men. 25-40% of children. Higher rates among teens, more than 1/4 of older adults, about 21% over 65. Maybe partly due to learned behavior.

Antidepressants help individuals overcome ______ but have no effect on _____.

bulimia nervosa; anorexia nervosa

All the following are symptoms of anorexia except: a. fear of gaining weight b. unwillingness to maintain normal weight c. perfectionism d. distorted body image

perfectionism

Anorexia DSM

• DSM-5 Disorder Criteria • Restriction of energy intake relative to requirements, leading to a significantly low body weight in the context of age, sex, developmental trajectory, and physical health• Intense fear of gaining weight, or persistent behavior that interferes with eight gain, even though at a significantly low weight • Disturbance in the way in which one's body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or persistent lack of recognition of the seriousness of the current low body weight • DSM-5 specifies two subtypes of anorexia nervosa (subtypes mean only in the last 3 months) • Restricting type: individuals diet to limit calorie intake • Binge-eating-purging type: they rely on purging. Unlike individuals with bulimia, binge-eating-purging anorexics binge on relatively small amounts of food and purge more consistently, in some cases each time they eat • Staying the same weight or gaining any amount of weight from one day to the other is likely to cause intense panic, anxiety, and depression

Binge Eating DSM

• Recurrent episodes of binge eating • The binge-eating episodes are associated with three or more of the following (1) eating much more rapidly than normal (2) eating until feeling uncomfortably fill, (3) eating large amounts of food when not hungry, (4) eating alone because of feeling embarrassed by how much one is eating and (5) feeling disgusted with oneself, depressed, or guilty afterward • Marked distress regarding binge eating is present • The binge eating occurs, on average, at least once a week for 3 months • The binge eating is not associated with the recurrent use of inappropriate compensatory behavior

DSM Bulimia

• Recurrent episodes of binge eating, characterized by an abnormally large intake of food within a discrete period of time combined with a sense of lack of control over eating during the episode • Recurrent, inappropriate compensatory behavior in order to prevent weight gain, such as self-induced vomiting, misuse of laxatives or diuretics, fasting or excessive exercise • On average, the binge eating and inappropriate compensatory behaviors both occur at least once a week for 3 months • Self-evaluation is unduly influenced by body shape and weight

Bulimia Medical Consequences

• Salivary gland enlargement caused by repeated vomiting, which gives the face a chubby appearance. • Erode the dental enamel on the inner surface of the front teeth as well as tear the esophagus• Upset the chemical balance of bodily fluids, including sodium and potassium levels • This condition, called an electrolyte imbalance, can result in serious medical complications if unattended, including cardiac arrhythmia (disrupted heartbeat) seizures, and renal (kindey) failure, all of which can be fatal • Young women with bulimia also develop more body fat than age - and weight matched healthy controls