eating and sleep-wake
l The median age of onset for all eating-related disorders occurred in a narrow range of ________.
18 to 21 years
widely available behavioral weight loss programs for obese patients with BED, such as ______, have some positive effect on binging, but not nearly so much as CBT. Fortunately, it appears that ________ may be useful in the treatment of BED.
Weight Watchers; self-help procedures
l One alternative to the comprehensive assessment of sleep is to use a wristwatch-size device that records the number of arm movements, and the data can be downloaded into a computer to determine the length and quality of sleep. Several studies have now tested the usefulness of this type of device in measuring the sleep of astronauts during space travel, and they find it can reliably detect when they fall asleep, when they wake up, and how restful their in-space sleep is.
actigraph
l Among women, ______are most at risk for eating disorders.
adolescent girls
In later stages of bulimia nervosa treatment, CBT-E focuses on ___________.
altering dysfunctional thoughts and attitudes about body shape, weight, and eating
Ø Other medical signs and symptoms of _____ include dry skin, brittle hair or nails, and sensitivity to or intolerance of cold temperatures.
anorexia
Ø People with ________ are proud of both their diets and their extraordinary control.
anorexia
l Individuals with _______ (which literally means a "nervous loss of appetite"— an incorrect definition because appetite often remains healthy) differ in one important way from individuals with bulimia.
anorexia nervosa
the person eats nothing beyond minimal amounts of food, so body weight sometimes drops dangerously.
anorexia nervosa
In a study examining the effectiveness of the ________- compared with CBT for BED, Prozac was ineffective (compared with placebo) and the drug did not add anything to CBT when the two treatments were combined.
anti-depressant drug Prozac
l The drugs generally considered the most effective for bulimia are the same __________ proven effective for mood disorders and anxiety disorders.
antidepressant medications
l An individual with bulimia usually presents with additional psychological disorders, particularly __________ 2.
anxiety and mood disorders
l In summary, bulimia seems strongly related to________ and somewhat less so to mood and substance use disorders.
anxiety disorders
l As with bulimia nervosa, __________ (2) are often present in individuals with anorexia.
anxiety disorders and mood disorders
l Finally, the surgical approach to extreme obesity— called __________—is an increasingly popular approach for individuals with a BMI of at least 40. In the most common surgery, the stomach is stapled to create a small stomach pouch at the base of the esophagus, which severely limits food intake. Alternatively, a _______ operation creates a bypass of the stomach, as the name implies, which limits not only food intake but also absorption of calories.
bariatric surgery; gastric bypass
Again, _________ include a number of strategies to change dietary habits, particularly decreasing high-calorie, high-fat snacks. These programs also target reduction of sedentary habits in children and adolescents such as viewing television, playing video games, and sitting in front of a computer.
behavior modification programs for obesity
In bulimia nervosa, just as important as the amount of food eaten is that the eating is experienced as out of control, a criterion that is an integral part of the definition of _______.
binge eating
l There are two forms of maladaptive eating patterns in people who are obese.
binge eating & night eating syndrome
individuals may binge repeatedly and find it distressing, but they do not attempt to purge the food.
binge-eating disorder
l Recent investigations confirm that the major features of the bulimia nervosa disorder (________ 3) "cluster together" in someone with this problem, which strongly supports the validity of the diagnostic category.
bingeing, purging, overconcern with body shape
Ø The light we see in the morning and the decreasing light at night signal the brain to reset the _________ each day.
biological clock
l Sometimes insomnia is related to problems with the __________.
biological clock and its control of temperature
l Another strategy to help people with sleep problems involves using _________ to trick the brain into readjusting the biological clock.
bright light (phototherapy)
Surprisingly, young women with ________ also develop more body fat than age- and weight-matched healthy controls, the very effect they are trying to avoid!
bulimia
l Short-term cognitive-behavioral treatments target problem eating behavior and associated attitudes about the overriding importance and significance of body weight and shape, and these strategies became the treatment of choice for ________.
bulimia
Ø People with ______ are ashamed of both their eating issues and their lack of control.
bulimia
out-of-control eating episodes or binges, are followed by self-induced vomiting, excessive use of laxatives, or other attempts to purge (get rid of) the food.
bulimia nervosa
Ø Avoiding the use of ______(2)—which are both stimulants—can also help prevent problems such as nighttime awakening.
caffeine and nicotine
Several studies have compared the most popular diet programs, such as the Atkins (______), Ornish (_______), Zone (______), and Weight Watchers (_______) diets. The most successful programs are professionally directed behavior modification programs, particularly if patients attend group maintenance sessions periodically in the year following initial weight reduction.
carbohydrate restriction; fat restriction; macronutrients balance; calorie restriction
sleep-related hypoventilation tends to cause an increase in ______, because insufficient air is exchanged with the environment. All these breathing difficulties interrupt sleep and result in symptoms similar to those of _________.
carbon dioxide (CO2) levels; insomnia
The second type of apnea involves the complete cessation of respiratory activity for brief periods and is often associated with certain central nervous system disorders, such as cerebral vascular disease, head trauma, and degenerative disorders.
central sleep apnea
l Subtyping may not be useful in predicting the future course of the disorder but rather may reflect a __________, a finding confirmed in a more recent study. For this reason, DSM-5 criteria specify that subtyping refer only to the _________.
certain phase or stage of anorexia; last 3 months
l One common medical complication of anorexia nervosa is ________, which also occurs relatively often in bulimia.
cessation of menstruation (amenorrhea)
Ø Sleepwalking is primarily a problem during ______, although a small proportion of adults are affected.
childhood
l Previous research with Doberman pinschers and Labrador retrievers, which also inherit this disorder, suggests that narcolepsy is associated with a cluster of genes on ________-, and it may be an __________.
chromosome 6; autosomal recessive trait
In anorexia, Cardiovascular problems, such as __________ (2), can also result.
chronically low blood pressure and heart rate
l Research indicates that bright light (also referred to as phototherapy) may help people with ______ readjust their sleep patterns.
circadian rhythm problems
l Because these rhythms don't exactly match our 24-hour day, they are called ________ (from circa meaning "about" and dian meaning "day"). If our circadian rhythms don't match the 24-hour day, why isn't our sleep completely disrupted over time? our brains have a mechanism that keeps us in sync with the outside world. Our biological clock is in the _______ in the __________. Connected to the suprachiasmatic nucleus is a pathway that comes from our eyes.
circadian; suprachiasmatic nucleus in the hypothalamus
l One important study, using a randomized placebo control design, found that _____ may be more successful treating sleep disorders in older adults than a medical (drug) intervention.
cognitive-behavioral therapy (CBT)
l Individuals with anorexia and a very low weight—BMI of 17.5 or less—who would need inpatient treatment would be excluded until their weight was restored to an adequate level when they could then benefit from the program. Fairburn refers to this treatment as ____________.
cognitive-behavioral therapy enhanced (CBT-E)
l The gold standard for the treatment of obstructive sleep apnea involves the use of a mechanical device—called the________—that improves breathing.
continuous positive air pressure (CPAP) machine
Ø Melatonin (don't confuse this with melanin, the chemical that determines skin color) has been nicknamed the "Dracula hormone" because its production is stimulated by _______ and ceases in __________.
darkness; daylight
l Although ______ is the most notable feature of anorexia nervosa, it is not the core of the disorder. Many people lose weight because of a medical condition, but people with anorexia have an intense fear of _________ and relentlessly pursue ________-.
decreased body weight; obesity; thinness
l A number of psychological disorders are associated with insomnia. Total sleep time often __________ with depression, substance use disorders, anxiety disorders, and neurocognitive disorder due to Alzheimer's disease.
decreases
higher rate in reports of sleeping problems among older people makes sense when you remember that the number of hours we sleep _______. It is not uncommon for someone over 65 to sleep fewer than 6 hours and wake up several times each night.
decreases as we age
amenorrhea can be an objective physical index of the ________, but is inconsistent because it does not occur in all cases of anorexia. Because of this inconsistency, amenorrhea was dropped as a diagnostic criterion in DSM-5.
degree of food restriction
l Some people who can't fall asleep at night may have a _________: Their body temperature doesn't drop and they don't become drowsy until later at night.
delayed temperature rhythm
Most overweight individuals are subjected to prejudice and discrimination in college, at work, and in housing. Ridicule and teasing in children may increase obesity through __________ (2).
depression and binge eating
l Another key criterion of anorexia is a marked _________.
disturbance in body image
Ø SE is calculated by ___________.
dividing the amount of time sleeping by the amount of time in bed
l Sleep-wake disorders are divided into two major categories:
dyssomnias and parasomnias
Ø During sleep terrors, children cannot be __________, as they can during a nightmare.
easily awakened and comforted
l The hallmark of bulimia nervosa is ______—typically, more junk food than fruits and vegetables—than most people would eat under similar circumstances.
eating a larger amount of food
Chronic bulimia with purging consequence: continued vomiting may upset the chemical balance of bodily fluids, including sodium and potassium levels. This condition, called an ________, can result in serious medical complications if unattended, including cardiac arrhythmia (disrupted heartbeat), seizures, and renal (kidney) failure, all of which can be fatal.
electrolyte imbalance
Ø Night eating syndrome is an important target for treatment in any obesity program to reregulate patterns of eating so that individuals eat more during the day, when their ___________ is highest. More interesting is the pattern of night eating syndrome that 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 ______.
energy expenditure; bariatric surgery
l There are several drawbacks to medical treatments for insomnia. First, benzodiazepine medications can cause ______. Second, people can easily become ________ and rather easily misuse them, deliberately or not. Third, these medications are meant for ______ and are not recommended for use longer than _______. Longer use can cause ____________ (2)
excessive sleepiness; dependent on them; short-term treatment; 4 weeks; dependence and rebound insomnia
l For a number of years, one prominent theory suggested that eating disorders are simply a way of _______-. But most evidence indicates that ____ follows bulimia and may be a reaction to it.
expressing depression; depression
Ø We do not yet clearly understand why some people sleepwalk, although factors such as _________ (4) have been implicated.
extreme fatigue, previous sleep deprivation, the use of sedative or hypnotic drugs, and stress
Ø Setting a regular time to go to sleep and awaken each day can help make _________.
falling asleep at night easier
Eating disorders were included for the first time as a separate group of disorders in the ______, published by the American Psychiatric Association in 2000.
fourth edition of the Diagnostic and Statistical Manual (DSM-IV)
l Beginning in the 1990s, research focused on a group of individuals who experience marked distress because of binge eating but do not engage in extreme compensatory behaviors and therefore cannot be diagnosed with bulimia. After classification in DSM-IV as a disorder needing further study, BED is now included as a ________
full-fledged disorder in DSM-5.
l Males with bulimia have a slightly later age of onset, and a large minority are predominantly __________ (2). Male _________, such as wrestling, are another large group of males with eating disorders.
gay males or bisexual; athletes in sports that require weight regulation
l On average, _______may constitute a smaller portion of the cause of obesity than cultural factors, but it helps explain why some people become obese and some don't when exposed to the same environment. For example, genes influence the number of fat cells an individual has, the likelihood of fat storage, and, most likely, activity levels.
genetic contributions
l If the weight loss has been more _________ in anorexics, weight restoration can be accomplished on an outpatient basis.
gradual and seems to have stabilized
Physiological processes, particularly _________, play a large role in the initiation and maintenance of eating and vary considerably from individual to individual.
hormonal regulation of appetite
l The DSM-5 diagnostic criteria for ________ include not only the excessive sleepiness that Ann described but also the subjective impression of this problem.
hypersomnolence
l Biological processes are quite active in the regulation of eating and thus of eating disorders, and substantial evidence points to the _______ as playing an important role.
hypothalamus
promotion of an________ and the consumption of a ________ is the largest single contributor to the obesity epidemic.
inactive, sedentary lifestyle; high-fat, energy-dense diet
Several factors that can cause excessive sleepiness would not be considered hypersomnolence. For example, people with ______ (who get inadequate amounts of sleep) often report being tired during the day. Another sleep problem that can cause a similar excessive sleepiness is a _____ sleep disorder called sleep apnea. People with this problem have difficulty breathing at night. They often snore loudly, pause between breaths, and wake in the morning with a dry mouth and headache.
insomnia disorder; breathing-related
In identifying hypersomnolence, the clinician needs to rule out ___________ (3).
insomnia, sleep apnea, or other reasons for sleepiness during the day
l People are considered to have _____ if they have trouble falling asleep at night (_______), if they wake up frequently or too early and can't go back to sleep (______), or even if they sleep a reasonable number of hours but are still not rested the next day (________).
insomnia; difficulty initiating sleep; difficulty maintaining sleep; nonrestorative sleep
l Among the other factors that can _________ are drug use and a variety of environmental influences such as changes in light, noise, or temperature.
interfere with sleeping
l Sleep paralysis commonly co-occurs with anxiety disorders, in which case the condition is termed _________.
isolated sleep paralysis
Ø Also, it is relatively common to see ______ in anorexics, downy hair on the limbs and cheeks.
lanugo
preferred when negative effects such as daytime anxiety are observed in people with insomnia taking the short-acting drugs.
long-acting medications
l Drug treatments that reduce internal cues signaling hunger may have some effect in obesity treatment, particularly if combined with a behavioral approach targeting lifestyle change, but concerns about cardiovascular side effects have plagued these medications. Currently the FDA has only a few approved drugs approved for this purpose, such as ________ (2). Another drug, _______, was removed from the market in 2010 due to adverse cardiovascular side effects.
lorcaserin (Belviq), and phentermine/topiramate (Osymia); sibutramine (Meridia)
l Until the 1980s, psychological treatments for people with eating disorders were directed at the patient's ___________ (2). Disordered patterns of __________ were also targeted for treatment.
low self-esteem and difficulties in developing an individual identity; family interaction and communication
Ø Obstructive sleep apnea is most common in ____ and is thought to occur in 10% to 20% of the population.
males
For restricting anorexics, the focus of treatment must shift to their __________, as well as to their undue emphasis on _______ as a determinant of selfworth, happiness, and success.
marked anxiety over becoming obese and losing control of eating; thinness
l Scientists believe the hormone _______- contributes to the setting of our biological clocks that tell us when to sleep. This hormone is produced by the pineal gland, in the center of the brain.
melatonin
To help people with hypersomnolence or narcolepsy, physicians usually prescribe a stimulant such as __________ (2).
methylphenidate (Ritalin) or modafinil
l Both anorexia and bulimia are characterized by a ___________ (2).
morbid fear of gaining weight and losing control over eating
every effort is made to include the family to accomplish two goals in anorexics. First, the _____ must be eliminated and meals must be made more ______. Second, attitudes toward ________ are discussed at some length in family sessions. _______ directed at the goals mentioned above seems effective, particularly with young girls (less than 19 years of age) with a short history of the disorder.
negative and dysfunctional communication in the family regarding food and eating ; structured and reinforcing; body shape and image distortion; Family therapy
the individuals are awake as they go about their nightly eating patterns. In the morning, however, they are not hungry and do not usually eat breakfast.
night eating syndrome
Ø Individuals with ______ 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.
night eating syndrome
according to DSM-5 criteria, these experiences must be so distressful that they impair a person's ability to carry on normal activities (such as making a person too anxious to try to sleep at night).
nightmare disorder
individuals get up during the night and raid the refrigerator but never wake up. They also may eat uncooked or other dangerous foods while asleep.
nocturnal eating syndrome
Carter et al. reported similar findings and both studies demonstrate the ineffectiveness of ______alone in anorexics..
nutritional counseling
l BMI 30 or greater.
obese
l Rates of anxiety and mood disorders are only somewhat elevated over the normal population among ____ people, and rates of substance abuse are actually somewhat lower.
obese
l But Hudson and colleagues concluded that BED is a disorder caused by a separate set of factors from _______ and is associated with more severe ______-
obesity without BED; obesity.
l Interestingly, one anxiety disorder that seems to co-occur often with anorexia is ________.
obsessive-compulsive disorder (OCD)
Ø Occurs when airflow stops despite continued activity by the respiratory system.
obstructive sleep apnea hypopnea
l There are three types of apnea, each with different causes, daytime complaints, and treatment:
obstructive, central, and mixed sleep apnea.
The chief characteristic of eating related disorders is _________.
overwhelming, all-encompassing drive to be thin
In polysomnographic (PSG) evaluation, patient spends one or more nights sleeping in a sleep laboratory and being monitored on a number of measures, including respiration and ____________ (a measure of airflow); leg movements; brain wave activity, measured by an________-; eye movements, measured by an _____ ; muscle movements, measured by an ________; and heart activity, measured by an _________. __________- (2) are also noted—for example, whether the person uses drugs or alcohol, is anxious about work or interpersonal problems, takes afternoon naps, or has a psychological disorder.
oxygen desaturation; electroencephalogram; electrooculogram; electromyogram; electrocardiogram; Daytime behavior and typical sleep patterns
l There is also good evidence that family therapy directed at the _______ with an adolescent who has an eating disorder can be helpful.
painful conflicts present in families
young women with eating disorders have a diminished sense of _______in their own abilities and talents. They also display more _________ attitudes, perhaps learned or inherited from their families, which may reflect attempts to exert control over important events in their lives. They also perceive themselves as ______, considering false any impressions they make of being adequate, self-sufficient, or worthwhile. In this sense, they feel like ____ in their social groups and experience heightened levels of _______, which may explain why they choose social groups with similar attitudes towards eating and body shape.
personal control and confidence; perfectionistic; frauds; impostors; social anxiety
l The clearest and most comprehensive picture of sleep habits can be determined only by a _____
polysomnographic (PSG) evaluation.
Ø Research on the treatment of nightmares suggests that both _______ (2) can help reduce these unpleasant sleep events.
psychological intervention (e.g., cognitive behavior therapy) and pharmacological treatment (i.e., prazosin)
l Finally, various _______ can also disrupt your sleep. For example, one study looked at how medical and dental school students were affected by a particularly stressful event—in this case, participating in cadaver dissection. Among the effects reported by the students was a decrease in their ability to sleep.
psychological stresses
l Another important criterion in bulimia nervosa is that the individual attempts to compensate for the binge eating and potential weight gain, almost always by _______-.
purging techniques
Bulimia nervosa was subtyped in DSM-IV-TR into _______(e.g., vomiting, laxatives, or diuretics) or ________ (e.g., exercise and/or fasting). But the latter type has turned out to be quite rare, accounting for only 6% to 8% of patients with bulimia. Furthermore, these studies found little evidence of any differences between the types of bulimia, nor were any differences evident in severity of psychopathology, frequency of binge episodes, or prevalence of major depression and panic disorder. As a result, this distinction was dropped in DSM-5.
purging type; nonpurging type
l Newer medications, such as those that work directly with the melatonin system (e.g., ______), are also being developed to help people fall and stay asleep.
ramelteon [Rozerem]
a brain circuit in the limbic system may be involved with anxiety. We know that this region of the brain is also involved with our dream sleep, which is called _________. This mutual neurobiological connection suggests that _________ may be interrelated in important ways, although the exact nature of the relationship is still unknown.
rapid eye movement (REM) sleep; anxiety and sleep
l Many people react to disrupted sleep by taking over-the-counter sleeping pills. Unfortunately, most people are not aware that ________—where sleep problems reappear, sometimes worse—may occur when the medication is withdrawn.
rebound insomnia
Unlike individuals with bulimia, binge-eating-purging anorexics binge on _____ and purge _______, in some cases each time they eat.
relatively small amounts of food; more consistently
In anorexia, the most important initial goal is to ___________. If body weight is below 85% of the average healthy body weight for a given individual or if weight has been lost rapidly and the individual continues to refuse food, _______ is recommended, because severe medical complications, particularly ______, could occur if weight is not restored immediately.
restore the patient's weight to within the low-normal range; inpatient treatment; acute cardiac failure
l DSM-5 specifies two subtypes of anorexia nervosa. In the_______, individuals diet to limit calorie intake; in the ________, they rely on purging.
restricting type; binge-eating-purging type
individuals with addictive obese eating behavior, including less control over eating and feelings of withdrawal if access to food is limited, show similar patterns of _________ in the brain as do those with __________.
reward neurocircuitry; substance abuse
Chronic bulimia with purging consequence: _________ caused by repeated vomiting, which gives the face a chubby appearance.
salivary gland enlargement
Ø Children do not remember sleep terrors, despite their often dramatic effect on the observer. One approach to reducing chronic sleep terrors is the use of ___________.
scheduled awakenings
l The first step in obesity treatment is usually a ________ in individuals who buy a popular diet book.
self-directed weight-loss program
Purging techniques include ______ immediately after eating, and using ____ (drugs that relieve constipation) and ____ (drugs that result in loss of fluids through greatly increased frequency of urination). Some ______ (although it is more usually a characteristic of anorexia nervosa.) Others _____ between binges.
self-induced vomiting; laxatives; diuretics; exercise excessively; fast for long periods
l Low levels of _________, the system most often associated with eating disorders, are associated with impulsivity generally and binge eating specifically.
serotonergic activity
l For young children, some cognitive treatments may not be possible in sleep disorders. Instead, treatment often includes _______ such as a bath, followed by a parent's reading a story, to help children go to sleep at night. ______ has been used with some success for bedtime problems, as well as for waking up at night.
setting up bedtime routines; Graduated extinction
Chronic bulimia with purging consequence: Intestinal problems resulting from laxative abuse are also potentially serious; they can include _________ 2
severe constipation or permanent colon damage.
l It's also increasingly clear that individuals with BED have some of the same concerns about _______ 2 as people with anorexia and bulimia, which distinguishes them from individuals who are obese without BED.
shape and weight
l Other sleep disorders, such as ________- (a disorder that involves obstructed nighttime breathing) or _________ (excessive jerky leg movements), can cause interrupted sleep and may seem similar to insomnia.
sleep apnea; periodic limb movement disorder
Often the affected person is only minimally aware of breathing difficulties and doesn't attribute the sleep problems to the breathing. A bed partner usually notices loud snoring (which is one sign of this problem), however, or will have noticed frightening episodes of interrupted breathing. Other signs that a person has breathing difficulties are heavy sweating during the night, morning headaches, and episodes of falling asleep during the day (_________) with no resulting feeling of being rested.
sleep apnea; sleep attacks
clinicians and researchers find it helpful to know the average number of hours the individual sleeps each day, taking into account ___________, the percentage of time actually spent asleep, not just lying in bed trying to sleep.
sleep efficiency (SE)
l Sleep professionals generally agree that a significant portion of the sleep problems people experience daily can be prevented by following a few steps during the day. Referred to as ______, these changes in lifestyle can be relatively simple to follow and can help avoid problems such as insomnia for some people.
sleep hygiene
l Although we may intuitively assume that biological factors come first, extrinsic influences such as poor ______ (the daily activities that affect how we sleep) can affect the physiological activity of sleep. One of the most striking examples of this phenomenon is ________, in which people's sleep patterns are disrupted, sometimes seriously, when they fly across several time zones.
sleep hygiene; jet lag
l Two other characteristics distinguish people who have narcolepsy. ______, a brief period after awakening when they can't move or speak that is often frightening to those who go through it. The last characteristic of narcolepsy is ________ , vivid and often terrifying experiences that begin at the start of sleep and are said to be unbelievably realistic because they include not only visual aspects but also touch, hearing, and even the sensation of body movement.
sleep paralysis; hypnagogic hallucinations
most commonly afflict children, usually begin with a piercing scream. The child is extremely upset, often sweating, and frequently has a rapid heartbeat.
sleep terrors
Ø The third breathing disorder, is a decrease in airflow without a complete pause in breathing.
sleep-related hypoventilation
Ø Because _______ occurs during the deepest stages of sleep, waking someone during an episode is difficult; if the person is wakened, she typically will not remember what has happened.
sleepwalking
Ø The DSM-5 criteria for _______ require that the person leave the bed, although less active episodes can involve small motor behaviors, such as sitting up in bed and picking at the blanket or gesturing.
sleepwalking
A newer concern for some insomnia medications (e.g., Ambien) is that they may increase the likelihood of _______, such as sleep-related eating disorder.
sleepwalking- related problems
In some people, the airway is too narrow; in others, some abnormality or damage interferes with the ongoing effort to breathe. Everyone in a group of people with obstructive sleep apnea hypopnea syndrome reported ______.
snoring at night
l More than 90% of the severe cases of eating disorders are young females who live in a ________. Increasingly, this group of girls and young women with eating disorders seek one another out on the Internet through ___ and ____ websites and social networks, where they find support and, in some cases, inspiration.
socially competitive environment; "pro-ana" (anorexia) and "pro-mia" (bulimia)
l In eating disorders, unlike most others, the strongest contributions to etiology seem to be _______ rather than psychological or biological factors.
sociocultural
Ø Evidence that supports BED's elevation to disorder status includes _________ compared with other eating disorders, as well as a greater likelihood of occurring in males and a later age of onset.
somewhat different patterns of heritability
sleepwalking (also called _______) occurs during _______. This means that when people walk in their sleep, they are probably not acting out a dream.
somnambulism; NREM sleep
l Henderson and Brownell make a point that this obesity epidemic is clearly related to the _____. In other words, as we advance technologically, we are getting fatter. Kelly Brownell notes that in our modern society individuals are continually exposed to heavily advertised, inexpensive fatty foods that have low nutritional value.
spread of modernization
Chronic bulimia with purging consequence: some individuals with bulimia have marked calluses on their fingers or the backs of their hands caused by the friction of contact with the teeth and throat when repeatedly sticking their fingers down their throat to ________.
stimulate the gag reflex
l For adult sleep problems,_________ may be recommended. People are instructed to use the bedroom only for sleeping and for sex and not for work or other anxiety-provoking activities (for example, watching the news on television).
stimulus control
In addition to daytime sleepiness, some people with narcolepsy experience cataplexy, a _______.
sudden loss of muscle tone
l Cataplexy appears to result from a ________. Instead of falling asleep normally and going through the _________ stages that typically precede REM sleep, people with _________ periodically progress right to this dream-sleep stage almost directly from the state of being awake.
sudden onset of REM sleep; four nonrapid eye movement (NREM); narcolepsy
Cataplexy, or loss of muscle tone, can be treated with antidepressant medication, not because people with narcolepsy are depressed, but because antidepressants ___________.
suppress REM (or dream) sleep
l Severe breathing problems may require _________ to help remove blockages in parts of the airways.
surgery
Bulimia Nervosa treatment based on Fairburn's CBT-E: The first stage is __________, as well as the ineffectiveness of vomiting and laxative abuse for weight control. The adverse effects of dieting are also described, and patients are scheduled to eat small, manageable amounts of food five or six times per day with no more than a 3-hour interval between any planned meals and snacks, which eliminates the _________ that are hallmarks of bulimia.
teaching the patient the physical consequences of binge eating and purging; alternating periods of overeating and dietary restriction
l The cultural imperative for ________ directly results in __________, the first dangerous step down the slippery slope to anorexia and bulimia.
thinness; dieting
Ø On occasion, sleepwalking episodes have been associated with _______, including _______ (2).
violent behavior; homicide and suicide
Ø If ______ is part of the anorexia, electrolyte imbalance and resulting cardiac and kidney problems can result, as in bulimia.
vomiting
Ø Unlike people with obstructive sleep apnea hypopnea syndrome, those with central sleep apnea __________ but they tend not to report _________ and often are not aware of having a ________ .
wake up frequently during the night; excessive daytime sleepiness; serious breathing problem
l Treatment of breathing-related sleep disorders focuses on helping the person breathe better during sleep. For some, this means recommending ______.
weight loss
The major difference of anorexia and bulimia seems to be _________.
whether the individual is successful at losing weight
Among those who present for treatment, the overwhelming majority (90% to 95%) of individuals with bulimia are _____.
women
circadian rhythm disorder which is "early to bed and early to rise". Here, sleep is advanced or earlier than normal bedtime.
Advanced sleep phase type
has the highest mortality rate of any psychological disorder reviewed in this book, including depression.
Anorexia nervosa
Ø There is also a greater likelihood of remission and a better response to treatment in _____ compared with other eating disorders.
BED
l At a ______, risk of mortality increases by 30%, and at a_______, risk of mortality is 100% or more. Because 6.3% of the adult population has a BMI over 40, a substantial number of people, perhaps 10 million or more in the United States alone, are in serious danger.
BMI of 30; BMI of 40 or more
Convention says to go to sleep at this new time while our brains are saying something different. If the struggle continues for any length of time, you may have what is called a__________. This disorder is characterized by disturbed sleep (either insomnia or excessive sleepiness during the day) brought on by the brain's inability to synchronize its sleep patterns with the current patterns of day and night.
Circadian Rhythm Sleep Disorder
Bulimia Nervosa treatment based on Fairburn's CBT-E: ________ are also developed, including arranging activities so that the individual will not spend time alone after eating during the early stages of treatment.
Coping strategies for resisting the impulse to binge and/or purge
circadian rhythm disorder with Extreme night owls, people who stay up late and sleep late. Sleep is delayed or later than normal bedtime.
Delayed sleep phase type
involve difficulties in getting enough sleep, problems with sleeping when you want to (not being able to fall asleep until 2 a.m. when you have a 9 a.m. class), and complaints about the quality of sleep, such as not feeling refreshed even though you have slept the whole night.
Dyssomnias
_______, particularly _______, were not found in developing countries, where access to sufficient food is so often a daily struggle; only in the West, where food was generally plentiful, have they been rampant. Now this has changed; evidence suggests that these disorders are going global. For example, recent studies show estimates of prevalence in China and Japan are approaching those in the United States and other Western countries.
Eating disorders; bulimia
waking a sleepwalker is somehow dangerous. True or false?
FALSE
Bulimia Nervosa treatment based on the CBT-E pioneered by _________
Fairburn
_________ have also been discussed as a way to raise revenue that could be used in the fight against the obesity epidemic to promote education and policy changes on food consumption. Could the government make it more attractive to eat healthy foods and less attractive to eat unhealthy foods by making the former less expensive and the latter more expensive?
Food taxes
_______ tended to share the same attitudes toward body image, dietary restraint, and the importance of attempts to lose weight.
Friendship cliques
For some, breathing is constricted a great deal and may be labored (_______) or, in the extreme, there may be short periods (10 to 30 seconds) when they stop breathing altogether, called ________.
Hypoventilation; sleep apnea
______ accompanies many medical and psychological disorders, including pain and physical discomfort, physical inactivity during the day, and respiratory problems.
Insomnia
______ involves not getting enough sleep (the prefix in means "lacking" or "without"), and _________ involve sleeping too much (hyper means "in great amount" or "abnormal excess").
Insomnia disorder; hypersomnolence disorders
one of the most common sleep-wake disorders. You may picture someone with this disorder as being awake all the time. It isn't possible to go completely without sleep, however. For example, after being awake for one or two nights, a person begins having ____- that last several seconds or longer.
Insomnia; microsleeps
l Because sleep problems are so widespread, there is a growing interest in developing _______ to determine if certain sufferers can help themselves with appropriate guidance.
Internet-based treatments
In contrast to results with bulimia, it appears that _____ is every bit as effective as CBT for binge eating.
Interpersonal therapy
circadian rhythm disorder where people experience highly varied sleep cycles.
Irregular sleep-wake type
Ø On the surface, sleep terrors appear to resemble nightmares—the child cries and appears frightened—but they occur during _____ and therefore are not caused by _______.
NREM sleep; frightening dreams
sleeping disorder that is relatively rare, occurring in 0.03% to 0.16% of the population, with the numbers approximately equal among males and females.
Narcolepsy
________ are thought to be influenced by genetics, trauma, medication use, and are associated with some psychological disorders (e.g., substance abuse, anxiety, borderline personality disorder, and schizophrenia spectrum disorders).
Nightmares
________are disturbing dreams that awaken the sleeper;_________ are those that do not awaken the person experiencing them.
Nightmares; bad dreams
individuals rise from their beds and eat while they are still asleep. may be more frequent than previously thought; it was found in almost 6% of individuals in one study who were referred because of insomnia complaints.
Nocturnal eating syndrome
circadian rhythm disorder where people are sleeping on a 25- or 26-hour cycle with later and later bedtimes ultimately going throughout the day.
Non-24-hour sleep-wake type
Psychological processes of emotional regulation (for example, eating to try to cheer yourself up when you're feeling down), impulse control, attitudes and motivation toward eating, and responsiveness to the consequences of eating are also important in _________.
Obese
_____ is not considered an official disorder in the DSM, but we consider it here because it is thought to be one of the most dangerous epidemics confronting public health authorities around the world today.
Obesity
__________ is sometimes associated with obstructive sleep apnea hypopnea, as is ______
Obesity; increasing age.
not problems with sleep itself but abnormal events that occur either during sleep or during that twilight time between sleeping and waking.
Parasomnias
characterized by abnormal behavioral or physiological events that occur during sleep, such as ___________- (2).
Parasomnias; nightmares and sleepwalking
l _______ reduce the physical tension that seems to prevent some people from falling asleep at night.
Relaxation treatments
Chronic bulimia with purging consequence: ________ also may erode the dental enamel on the inner surface of the front teeth as well as tear the esophagus.
Repeated vomiting
acting out sexual behaviors such as masturbation and sexual intercourse with no memory of the event while asleep. This rare problem can cause relationship problems and, in extreme cases, legal problems when cases occur without consent or with minors.
Sexsomnia
s circadian rhythm sleep disorder associated with work schedules.
Shift work type sleep problem
_______ (those that cause only brief drowsiness) are preferred in insomnia, because the long-acting drugs sometimes do not stop working by morning and people report more daytime sleepiness.
Short-acting drugs
may cause the difficulties people experience in everyday life, or they may result from some disturbance common to a psychological disorder.
Sleep problems
__________ is also common in individuals with anorexia nervosa, and, in conjunction with anorexia, is a strong predictor of mortality, particularly by suicide.
Substance abuse
l Olivardia, Pope, and Hudson have described a syndrome in men, particularly male weight lifters, that they initially termed ________. Men with this syndrome reported they were extremely concerned about looking small, even though they were muscular.
"reverse anorexia nervosa"
Levine and Smolak refer to _________in magazines and on television, where most females are thinner than the average American woman. Grabe, Ward, and Hyde, reviewing 77 studies, demonstrated a strong relationship between exposure to media images depicting the thin-ideal body and body image concerns in women.
"the glorification of slenderness"
________ occurs while the person is awake and can range from slight weakness in the facial muscles to complete physical collapse. It lasts from several seconds to several minutes; it is usually preceded by strong emotion such as anger or happiness. Imagine that while cheering for your favorite team, you suddenly fall asleep; while arguing with a friend, you collapse to the floor in a sound sleep.
Cataplexy
______ has a number of medical consequences:
Chronic bulimia with purging
l Although the study was conducted prior to the publication of DSM-5, the ____ duration required for BED (or subthreshold BED), found in DSM-5, rather than the 6 months required in DSM-IV-TR, was used. Finally, if binge eating occurred at least twice a week for 3 months—even if it was just a symptom of the four other disorders rather than a separate condition— the case was listed under _____.
3-month; "Any binge eating."
l People who complain of insomnia to a medical professional are likely prescribed one of several _____ or related medications, which include short-acting drugs such as _______ (3) and long-acting drugs such as ______.
Benzodiazepine; triazolam (Halcion), zaleplon (Sonata), and zolpidem (Ambien); flurazepam (Dalmane)
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.
Breathing-Related Sleep Disorders
Bulimia Nervosa treatment: The investigators found that, for those who completed treatment, ___ was significantly superior to IPT at the end of treatment, with 45% recovered in the former group versus 8% in the IPT group.
CBT
l The investigators concluded that _______ is the preferred psychological treatment for bulimia nervosa because it worked______. Nevertheless, it is intriguing, again, that IPT was almost as effective after 1 year even though this treatment concentrates not directly on disordered eating patterns but rather on the interpersonal relationships of the patient. The former remains the preferred treatment for bulimia and is superior to medication alone.
CBT; significantly faster
circadian rhythm sleep disorder caused by rapidly crossing multiple time zones.
Jet lag type
l There are several types of circadian rhythm sleep disorders.
Jet lag type, Shift work type sleep problem, Delayed sleep phase type, Advanced sleep phase type, Irregular sleep-wake type, Non-24-hour sleep-wake type
Some work now suggests that the use of _______ can lead to obstructive apnea hypopnea syndrome even in young and otherwise healthy adults.
MDMA (ecstasy)
l The Food and Drug Administration (FDA) in 1996 approved _____ as effective for eating disorders. Effectiveness is usually measured by reductions in the frequency of binge eating, as well as by the percentage of patients who stop binge eating and purging altogether, at least for a while.
Prozac
