Eating Disorders, Obesity & Sleep Disorders
Eating Disorders, Obesity & Sleep Disorders
Eating Disorders
* Characterized by severe disturbances in eating behavior
* Types of eating disorders:
o Anorexia Nervosa (peak onset – 14-18 yrs)
o Bulimia Nervosa (peak onset – late adolescence to early adulthood)
o Binge-eating Disorder (unknown)
Anorexia Nervosa
* Essential features:
o Refusal to maintain a minimally normal body weight (for height and age)
o Intensely afraid of gaining weight
o Exhibit a severe disturbance in perception of shape/size of one’s body
o Absence of at least 3 consecutive menstrual periods
* Self-esteem highly dependent on shape/size
* Refusal to maintain minimal body weight:
o Generally weigh less than 85% of the normal body weight
* Weight loss is usually a result of:
o Reduction of food
o Purging (vomiting, laxatives)
o Excessive exercise regimes
* Intensely afraid of gaining weight:
o Fear of becoming fat is not alleviated by weight loss
o Weight loss is seen as an impressive achievement and a sign of self-discipline
o Weight gain is viewed as failure of self-control
* Distorted view of body weight and shape
o Some feel overweight all over, no matter how thin they become
+ Others feel that a particular part of the body is “too fat”
o Some demonstrate excessive weighing
+ Measure body parts
+ Use mirrors to check body parts for fat
* Resulting physiological problems:
o Constipation, impaired renal functioning
o Cold intolerance lanugo
o Emaciation, yellowing of the skin, dry skin
o Tend to lose 20-25% of body weight, some lose up to 35%;
o Cardiovascular/heart problems, amenorrhea, osteoporosis & death
Bulimia Nervosa
* Essential features:
o Binge eating
o Inappropriate compensatory methods to prevent weight gain
o Binge eating and compensatory behaviors must occur, on average, at least 2x/wk for 3 months
o Perception of self is excessively influenced by one’s body shape and weight.
* Binge eating:
o Eating an amount of food that is definitely larger than most individuals would eat under similar circumstances
+ Binges can last up to 2 hours
o Could occur in one setting or as a continuation of eating
* Food consumed typically includes sweet, high-caloric foods
* Usually ashamed of the eating problem
o Attempt to hide their symptoms
* Binge eating usually occurs in secrecy, or as inconspicuously as possible:
o Binges may be planned in advance
o Usually characterized by rapid consumption
o Eating continues until person is uncomfortably, even painfully full
o The individual experiences a sense of a lack of control during the binge-eating episode
* Recurrent use of inappropriate compensatory behaviors:
o 80-90% of binge eaters who seek treatment report self-induced vomiting relief from discomfort/fear of gaining weight eventually can vomit at will
o Others use laxatives, diuretics and enemas
* Compensatory behaviors (cont.)
o Individuals with bulimia may fast for a day or more to compensate for binges
o They may compensate by exercising excessively
* Similar to Anorexia Nervosa in that the individual:
o Has a fear of gaining weight
o Has a desire to lose weight
o Are dissatisfied with their bodies
* Different from Anorexia Nervosa in that:
o Individuals with Bulimia recognize their behavior is not normal
+ People with Anorexia Nervosa don’t
o Despite behaviors, weight is usually normal
+ People with anorexia become very thin
o Individuals with Bulimia are more likely to seek and respond to treatment.
* Resulting physiological problems:
o Skin irritations (esp. around mouth and fingers due to contact with stomach acid)
o Tooth decay and cavities
o Damaged taste receptors
o Abdominal pain, bowel problems
o Digestive disorders
o Possible cessation of menstruation
Theoretical Perspectives: Anorexia and Bulimia Nervosa
* Sociocultural factors:
o http://www.youtube.com/watch?v=knEIM16NuPg
o http://www.youtube.com/watch?v=I0u0wWOMIsE&feature=related
o Social learning theory:
o Purging is a negative reinforcer; it alleviates the fear of gaining weight
* Cognitive theory:
o Behaviors are a result of irrational thoughts
* Family factors
o Tend to be dysfunctional
+ Critical, less nurturing, overprotective
+ Mother tends to feel daughter is unattractive and needs to lose weight
o Identified patient
* History of childhood physical/sexual abuse
o Especially with bulimia
* Biological factors:
o Low serotonin levels may prompt binge eating in people with bulimia, esp. carbohydrate cravings
o Genetics
+ Eating disorders tend to run in families
Binge Eating Disorder
* Essential features:
o Binge eating without purging or compensatory behaviors
o Must average at least 2 episodes/week for 6 months or longer
o Impaired control over eating
o Experience significant distress due to the eating behavior
* Impaired control over eating:
o Eating rapidly
o Eating until painfully full
o Eating large amounts when not hungry
* Significant distress
o Eating alone out of embarrassment
o Feeling disgust, guilt or depressed after the eating episode
o Concern over how episodes will affect body size/shape
* Associated features:
o Some episodes are triggered by depression or anxiety
+ Others report no specific trigger, though report the behavior initially relieves tension
o Some report a dissociative quality during the episodes
o Most are overweight & were yo-yo dieters.
Obesity: A Chronic Medical Disease
* Weighing 20% above the recommended weight
* Americans eat 815 billion calories daily
o That’s 200 billion more than is necessary to maintain their weight
o Those extra calories would sustain a country of 80 million people
* Potential Causes
o High set-point
o Genetics
o Hypothalamus
o Coping technique
o Clock-watchers
o Addiction
o Eat too much + inactivity
Sleep Disorders
* Dyssomnias:
o Disorders in which a person has difficulty getting to sleep, staying asleep or sleeping too much
* Characterized by a disturbance in the:
o Amount of sleep
o Quality of sleep
o Or the timing of sleep
* Dyssomnia disorders include:
o Primary Insomnia
o Primary Hypersomnia
o Narcolepsy
o Breathing-Related Sleep Disorder
o Circadian Rhythm Sleep Disorder
Primary Insomnia
* Essential features:
o Difficulty falling asleep, staying asleep, or awakening too early that lasts at least one month (some report nonrestorative sleep)
o Causes distress or impairment in social, occupational or other important areas of functioning
* Some facts:
o As much as 30% of the population suffers from this; 9-15% have chronic bouts; nearly everyone has bouts at some point
o Primarily affects middle-age and older pop.; affects more females than males
* Most probable cause of insomnia – stress
o Person goes to bed thinks about the days events or problems in life mind races can’t get to sleep think about the fact s/he can’t get to sleep causes bodily arousal and more anxiousness makes it even less likely s/he will get to sleep
* Question
o What should you do if you don’t fall asleep within about 20 minutes of getting in bed?
Primary Hypersomnia
* Essential feature:
* Excessive sleepiness for at least 1 month
o Prolonged sleep episodes
o Daytime sleep episodes which occur almost daily
o Must be severe enough to cause distress or impairment in social, occupational or other important areas of functioning
Primary Hypersomnia
* Duration of major sleep episodes range from 8-12 hours
o Often followed by difficulty awakening
* Excessive sleep during normal waking hours takes the form of
o Intentional naps
o Inadvertent episodes of sleep
* Daytime naps
o Are relatively long (lasting an hour or more)
o Are not refreshing
o Do not lead to heightened alertness
* Unintentional sleep episodes occur in low-stimulation and low-activity situations
o Such as?
* Hypersomnia can lead to distress and dysfunction:
o Difficulty in meeting morning obligations
o Unintentional daytime sleep episodes can be dangerous and embarrassing
o Low level of alertness can lead to poor efficiency, poor concentration, and poor memory
Narcolepsy
* Essential features:
o Repeated irresistible attacks of refreshing sleep
o Cataplexy and/or
o Intrusion of REM sleep between wakefulness and periods of sleep
* For diagnostic purposes, the sleep attacks must occur daily over a period of at least 3 months
* Repeated irresistible attacks of refreshing sleep:
o Sleep is irresistible; results in unintended sleep in inappropriate places
o Sleep episodes usually last 10-20 minutes, but can last up to an hour
o Individuals typically have 2-6 daily episodes
+ some attempt to control sleepiness by taking naps
* Cataplexy: Loss of muscle tone during episodes (usually lasts only seconds):
o Can be subtle or dramatic
o Person is fully conscious/alert during episode
o Occurs in approx. 70% of cases
+ Often develops years after onset
+ Triggered by strong emotions
* Approx. 20-40% experience intense dreamlike imagery:
o Hypnagogic hallucinations – just prior to falling asleep
o Hypnopompic hallucinations – just after awakening
o Most hallucinations are visual and incorporate elements of one’s environment
* Approximately 30-50% of individuals with narcolepsy experience sleep paralysis:
o Occurs just on falling asleep or awakening
o Individual is awake but unable to move or speak
+ Some feel like they can’t breathe
o Hallucinations and paralysis can occur simultaneously
+ Typically lasts seconds–minutes, ends abruptly
Narcolepsy
* Causes:
o Unknown
o May be genetic – higher degree of incidence among biological relatives
o May be partly due to a loss of certain brain cells in hypothalamus
+ Produce sleep-regulating chemical
Breathing-Related Sleep Disorder
* Essential feature:
o Sleep disruption, leading to excessive sleepiness or insomnia, that is due to abnormalities of ventilation during sleep
o Daytime sleepiness is the most frequently reported complaint
* Obstructive sleep apnea syndrome
o Temporary cessation of breathing during sleep
+ Seems to be a result of blocked upper air passages, causing breathing to stop temp.
# Enlargement of soft tissue may cause airways to narrow
+ May also be the result of structural deformities
+ Cessation of breathing lasts from 15-90 seconds
+ Individual may wake up as many as 500x/night
o Individual may wake up gasping for air, making a loud snorting sound, and go back to sleep
+ Individual is usually not aware of these interruptions of sleep
o Approx. 20 million Americans suffer from this disorder; men are 2x as like as women to suffer from it; usually occurs in overweight people
* Things that may help:
o Dieting
o Surgery (tonsils and adenoids)
o Dental appliances which reposition the tongue
o Ventilating machines
Circadian Rhythm Sleep Disorder
* Essential features:
o Disruption of normal sleep wake pattern
o Must be severe enough to cause severe distress or impairment of social, occupational or other important functioning
o Result of jet lag, working swing shifts, etc
Parasomnias
* Sleep disorders characterized by abnormal behavior or physiological events that occur in association with:
o Sleep
o Specific sleep stages or
o Sleep-wake transitions
* Usually complain of unusual behavior during sleep
Parasomnias
* Parasomnias include:
o Nightmare Disorder
o Sleep Terror Disorder
o Sleepwalking Disorder
Nightmare Disorder
* Essential Feature:
o Repeated occurrence of frightening dreams that lead to awakenings from sleep
o Must result in significant distress or result in social or occupational dysfunction
* Nightmares defined:
o A lengthy, elaborate dream sequence that is highly anxiety provoking or terrifying
* Dream content:
o Usually focuses on imminent danger to the individual
+ Sometimes the danger is more subtle, as involving personal failure or embarrassment
* Nightmares may replicate a real life traumatic experience a person had
o But not usually
* Individuals are alert upon wakening
o Can describe the dream in detail
* Occur almost exclusively during REM sleep
* Believed to be caused by stress
* Upon awakening, the individual experiences a lingering sense of anxiety or fear difficulty returning to sleep
* Some individuals avoid sleeping, resulting in
o Excessive sleepiness
o Poor concentration, irritability
o Depression/anxiety
Sleep Terror Disorder
* Def: repeated abrupt awakenings from NREM sleep accompanied by:
o Intense physiological arousal
o Feelings of panic
* Often occurs during times of stress
* Most frequently occurs in children (up to 6%); rare in adults (<1%)
* Typical experience (lasts 1-10 minutes):
o Wake up in a state of panic, screaming
+ Body is in full physiological arousal
o Child may thrash about while still sleeping
o If awakened, the child is usually confused and incoherent
+ Soon fall back into deep sleep
Sleep Terror Disorder
o Children do not remember the incident in the morning; more terrifying to the parent
o Sleepwalking and sleep-talking may accompany sleep terror disorder
* Typically outgrown by adolescence
o Though some cases last into adulthood
* Cause is unknown
o But it is thought to be associated with stress
Sleepwalking Disorder
* Essential features:
o Arising from bed and walking about while asleep
* During episodes, the person has
o Reduced alertness/responsiveness
o A blank stare
o Is unresponsive to communication with others or efforts to wake them
Sleepwalking Disorder
* Individual typically has little recall of the incident upon awakening
* For diagnosis, the sleepwalking must cause severe distress or impairment of social or occupational functioning
* Sleepwalking episodes can include a variety of behaviors:
o May sit up in bed, look around, pick at blankets
o May walk into closets, out of the room, down stairs and even out of a building
o Some use the bathroom, eat or talk
o On occasion, some run from a perceived threat
o Some have operated machinery
* Particularly during childhood, sleepwalking can include inappropriate behavior
o E.g. Urinating in a closet
* Individuals often wake up in another place
o Or with evidence they performed some activity
* Most episodes last minutes to half an hour
* Cause: Unknown
o Genetics and environment may be involved
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