PSY110P-Chapter-8-Eating-Disorders-and-Sleep-Wake-Disorders.pptx

Eating Disorders and Sleep-Wake Disorders Bulimia Nervosa • Binge eating • Excess amounts of food • Perceived as ‘out of control’ • Compensatory behaviors • Purging • Excessive exercise • Fasting • Belief that popularity and self-esteem are determined by weight and body shape DSM IV TR Subtype...

Eating Disorders and Sleep-Wake Disorders Bulimia Nervosa • Binge eating • Excess amounts of food • Perceived as ‘out of control’ • Compensatory behaviors • Purging • Excessive exercise • Fasting • Belief that popularity and self-esteem are determined by weight and body shape DSM IV TR Subtypes • Subtypes • Purging (most common) • Vomiting, laxatives, or diuretics • Nonpurging • Exercise and/or fasting • 6-8% of Bulmics • Most are within 10% of normal weight • Medical consequences • Salivary gland enlargement causes by repeated vomiting. The result is a chubby facial appearance. • Erosion of dental enamel on the inner surface of the front teeth. • May produce an electrolyte imbalance (i.e., disruption of sodium and potassium levels) which, in turn, can lead to potentially fatal cardiac arrhythmia and renal failure. • Intestinal problems resulting from laxative abuse are also potentially serious. • Some individuals with bulimia also develop marked calluses on the fingers and backs of hands resulting from efforts to vomit by stimulating the gag reflex. • Associated psychological disorders • Anxiety (80.6%) • Mood disorders (50-70%) • Substance abuse (36.8%) • Bulimia • 90-95% female • Caucasian, middle to upper class • Onset = age 10 to 21 • Chronic, if untreated • Bulimia in men • 5-10% male • Caucasian, middle to upper class • Gay or bisexual • Athletes with weight regulations • Onset = older Anorexia Nervosa • “Overly-successful” weight loss • 15% below expected weight • Intense fears • Gaining weight • Losing control of eating • Relentless pursuit of thinness • Often begins with dieting • Subtypes • Restricting—Limit caloric intake via diet and fasting • Binge-eating-purging—About 50% of anorexics • Associated features • Body image disturbance • Pride in diet and control • Rarely seek treatment • Associated psychological disorders • Anxiety • OCD • Mood disorders (71%) • Substance abuse • Suicide • Anorexia • More female than males • Caucasian, middle to upper class • Onset = age 13 to 18 • Chronic • Resistant to treatment Bulimia and Anorexia: Statistics Binge Eating Disorder • Marked distress because of binge eating but do not engage in extreme compensatory behaviors and therefore cannot be diagnosed with bulimia • Often found in weight-control programs 20% • 50% among candidates for bariatric surgery • Better response to treatment • Associated Features • Many are obese • Older • More psychopathology • vs. non-binging obese • Concerned about shape and weight Etiology of Eating Disorder • Social dimensions • Cultural imperatives in a highly competitive environment • Thinness = success, happiness • Media • few fat female characters gives a strong message to women • Social and gender standards • Internal and perceived Causes of Eating Disorders • Dieting – 8x more likely to develop eating disorder • Girls who attempted dieting faced more than 300% greater risk of obesity than those who did not diet. Repeated cycles of “dieting” seems to produce stressrelated withdrawal symptoms in the brain, much like other addictive substances, resulting in more eating than would have occurred without dieting. Causes of Eating Disorders • Family influences • “Typical” family of an individual with anorexia • Successful • Driven • Concerned about appearance • Eagers to maintain harmony • History of dieting, eating disorders • Self (patient) reported family conflicts • Biological dimensions • Heritability studies (.56) • Relatives = 4-5x higher • Fraternal twins = 9% • Identical twins = 23% • Inherited tendency to be emotionally responsive to stress, eat impulsively • Hypothalamus • Low serotonin levels ”serotonin promotes satiety.” • Low levels of endorphins • Psychological Dimensions • Perfectionism (needing to have things exactly right) has long been regarded as an important risk factor for eating disorders. This is because people who are perfectionistic may be much more likely to subscribe to the thin ideal and relentlessly pursue the “perfect body.” • Negative affect (feeling bad) is a causal risk factor for body dissatisfaction. When we feel bad, we tend to become very self-critical. • Childhood sexual abuse has been implicated in the development of eating disorders Treatment of Eating Disorders • Drug treatments of eating disorders • Anorexia • No demonstrated efficacy • Bulimia • Antidepressants • May enhance psychological treatment • No long-term efficacy Psychological Treatment of Bulimia • Cognitive-behavior therapy (CBT) • Treatment of choice • Target problem eating behaviors • Target dysfunctional thoughts • Interpersonal psychotherapy • Improve interpersonal functioning • Similarly effective, long-term • CBT may work quicker Psychological Treatment of Binge-eating Disorder • Cognitive-behavior therapy • Similar format to bulimia • Interpersonal psychotherapy • As effective as CBT • Medications • Prozac • No benefit • Meridia - antiobesity drug that reduces feelings of hunger • Possible benefits Psychological Treatment of Anorexia Nervosa • Weight restoration • May require hospitalization • Target dysfunctional attitudes • Body shape • Control • Thinness = worth Psychological Treatment of Anorexia Nervosa • Family involvement • Communication about eating/food • Attitudes about body shape • Long-term prognosis • Poorer than bulimia DSM 5 Additional Eating Disorders • Pica – Persistent eating of non nutritive, non food substance over a period of at least 1 month. • Rumination Disorder – Repeated regurgitation of food over a period of at least 1 month • Avoidant/ Restrictive Food Intake Disorder – feeding disturbance of apparent lack of interest in eating food. Sleep-Wake Disorders Rapid eye movement (REM) sleep • Dream sleep Limbic System • neurobiological connection suggests that anxiety and sleep may be interrelated in important ways Sleep efficiency (SE) • the percentage of time actually spent asleep, not just lying in bed trying to sleep. Polysomnographic (PSG) evaluation • Detailed history • Sleep hygiene & efficiency • Electrooculogram, eye movements • Electromyogram, muscle movements • Electrocardiogram, heart activity • EEG—Brain wave activity • EOG—Eye movements • EMG—Muscle movements • Actigraph—wristwatch-sized monitor that is an alternative to a comprehensive assessment Sleep-wake disoders Dyssomnias • involve difficulties in getting enough sleep, problems with sleeping when you want to Parasomnias • characterized by abnormal behavioral or physiological events that occur during sleep, such as nightmares and sleepwalking. Dyssomnias • Insomnia Disorder Difficulty falling asleep at bedtime, problems staying asleep throughout the night, or sleep that does not result in the person feeling rested even after normal amounts of sleep. Insomnia Disorder • Statistics • Prevalence = 35% (year) older adults • Female : Male = 2:1 • More likely to report? • Frequently associated with: • Anxiety • Depression • Substance use disorder • Dementia of the Alzheimer’s type Causes • Pain, physical discomfort • Delayed temperature rhythm - people with insomnia seem to have higher body temperatures • than good sleepers, and their body temperatures seem to vary less; • Light, noise, temperature • Other sleep disorders • Apnea - a disorder that involves obstructed nighttime breathing) • Periodic limb movement disorder excessive jerky leg movements • Stress and Anxiety • Alcohol – used to initiate sleep but interrupts ongoing sleep, which causes anxiety, with leads to repeated alcohol use. Dyssomnias • Hypersomnolence Disorders Excessive sleepiness that is displayed as either sleeping longer than is typical or frequent falling asleep during the day. • Hypersomnolence disorders • Sleeping too much • Excessive sleepiness • Subjective experience as a problem • Unrelated to other condition • Rare Dyssomnias • Narcolepsy - Episodes of irresistible attacks of refreshing sleep occurring daily, accompanied by episodes of brief loss of muscle tone (cataplexy). • Narcolepsy • Daytime sleepiness • Cataplexy • Cataplexic attacks • REM sleep • Triggered by strong emotion • Sleep paralysis • Statistics • Prevalence = .03% to .16% • Female : Male = 1:1 • Typically improves over time • Daytime sleepiness persists without treatment Breathing related Sleep Disorder • Obstructive sleep apnea (OSA)—Airflow stops, but respiratory system works • Central sleep apnea (CSA)—Respiratory system stops for brief periods , patients frequently during the night but they tend not to report excessive daytime sleepiness and often are not aware of having a serious breathing problem. • Mixed sleep apnea—Combination of OSA and CSA Breathing related Sleep Disorder • Statistics • Obstructive sleep apnea = 10-20% • Female < Male • Associated with • Obesity • Increasing age Circadian Rhythm Sleep Disorder • Insomnia or hypersomnia • Inability to synchronize day and night • Suprachiasmatic nucleus (part of hypothalamus, right above the Optic Chiasm) • Brain’s biological clock • Stimulates melatonin • Jet lag type—Problems related to crossing time zones • People with jet lag usually report difficulty going to sleep at the proper time and feeling fatigued during the day. • Westward traveling > Eastward and/or less than three time zones • Shift work type—Problems related to work schedule • Many people, such as hospital employees, police, or emergency personnel, work at night or • Delayed Sleep Phase Type – ‘sleeps late, wakes up late’ • Advanced Sleep Phase Type – ‘sleeps early, wakes up early’ • Irregular Sleep Wake Type – ‘variable sleep patters’ • Non-24-hour Sleep-Wake Type – sleeping on a 25- or 26-hour cycle with later and later bedtimes ultimately going throughout the day Medical Treatment of Sleep Disorders • Insomnia • Benzodiazepines • Short-term solutions • Excessive sleepiness • Rebound insomnia - sleep problems reappear, sometimes worse—may occur when the medication is withdrawn • Dependence • Sleep-walking (Ambien) Environmental Treatments for Dyssomnias • Circadian rhythm sleep disorders • Phase delays—Moving bedtime later (best approach) • Phase advances—Moving bedtime earlier (more difficult) • Phototherapy—Use of very bright light to trick the brain’s biological clock Medical Treatment of Sleep Disorders • Hypersomnia/narcolepsy • Stimulants • Ritalin, amphetamine, modafrinil • Cataplexy • Antidepressant medications suppress REM or dream sleep, thus maintain muscle tone Psychological Treatment • Cognitive • This approach focuses on changing the sleepers’ unrealistic expectations and beliefs about sleep. • Guided imagery relaxation • uses meditation or imagery to help with relaxation at bedtime or after a night waking to lessen anxiety • Graduated extinction • Monitoring of a desired behavior, such as sleeping or compliance by children, with decreasing frequency to encourage independence. • Paradoxical intention • Instructing individuals in the opposite behavior from the desired outcome to relieve the performance anxiety surrounding efforts to try to fall asleep. • Progressive relaxation • This technique involves relaxing the muscles of the body in an effort to introduce drowsiness. Parasomnia Nightmare Disorder • REM sleep • Involves dreams: • Distressing & disturbing • Disrupt sleep, cause awakening • Interfere with functioning • More common in children Sleep Terror • More common in children • Piercing scream • Signs of elevated arousal (e.g., sweating) • Person looks extremely upset • Difficult to awaken • Little memory of the event • Prevalence • Children 6% • Adults 2% • More boys than girls sleepwalking (also called somnambulism) • Somnambulism • Non-REM sleep • Usually during first few hours of deep sleep • Person must leave the bed • Related Conditions • Nocturnal eating syndrome • Person eats while asleep • Somnambulism • Non-REM sleep • First few hours of deep sleep • Person must leave the bed • More common in children 15-30% • Difficult (not dangerous) to wake • Genetic component • Usually resolves on its own • Related to nocturnal eating syndrome • Person eats while asleep • Sexsomnia • REM sleep behavior disorder – • muscle paralysis is absent or incomplete and the person may suddenly kick or flail the arms during REM sleep, potentially causing injuries to the self or the bed partner.