lecture9.ppt

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Eating and SleepEating and SleepDisordersDisorders

Chapter 8Chapter 8



Eating Disorders: An Overview

• Two Major Types of DSM-IV Eating Disorders

– Anorexia nervosa and bui!ia nervosa

– "ot# invove severe disruptions in eating be#avior

– "ot# invove extre!e fear and appre#ension about gaining weig#t

– "ot# #ave strong so$io$utura origins –%esterni&ed views



Bulimia Nervosa: Overview and Defining Features

• "inge Eating – 'a!ar( of "ui!ia

– "inge – Eating ex$ess a!ounts of food

– Eating is per$eived as un$ontroabe

• )o!pensatory "e#aviors

–*urging – Sef-indu$ed vo!iting+ diureti$s+ axatives

– So!e exer$ise ex$essivey+ w#ereas ot#ers fast

• DSM-IV Subtypes of "ui!ia

– *urging subtype – Most $o!!on subtype ,eg+ vo!iting+ axatives+ene!as.

– /onpurging subtype – About one-t#ird of bui!i$s ,eg+ ex$essexer$ise+ fasting.



Bulimia Nervosa: Overview and Defining Features (cont.)

• Asso$iated 0eatures

– Most are over $on$erned wit# body s#ape+ fear gaining weig#t

– Most #ave $o!orbid psy$#oogi$a disorders

– *urging !et#ods $an resut in severe !edi$a probe!s

–Most are wit#in 123 of target body weig#t



Anorexia Nervosa: Overview and Defining Features

• Su$$essfu %eig#t 4oss – 'a!ar( of Anorexia

– Intense fear of obesity and osing $ontro over eating

– Anorexi$s s#ow a reentess pursuit of t#inness+ often beginning wit#dieting

– Defined as 153 beow expe$ted weig#t

• DSM-IV Subtypes of Anorexia

– 6estri$ting subtype – 4i!it $aori$ inta(e via diet and fasting

– "inge-eating-purging subtype – About 523 of anorexi$s


– Most s#ow !ar(ed disturban$e in body i!age

– Met#ods of weig#t oss $an #ave severe ife t#reatening !edi$a$onse7uen$es

– Most are $o!orbid for ot#er psy$#oogi$a disorders



Binge-Eating Disorder: Overview and Defining Features

• "inge-Eating Disorder – Appendix of DSM-IV

– Experi!enta diagnosti$ $ategory

– Engage in food binges+ but do not engage in $o!pensatory

be#aviors


– Many persons wit# binge-eating disorder are obese

– S#are si!iar $on$erns as anorexi$s and bui!i$s regarding s#ape

and weig#t



Bulimia and Anorexia: Facts and tatistics

• "ui!ia

– Majority are fe!ae+ wit# onset around 18 to 19 years of age

– 4ifeti!e prevaen$e is about 113 for fe!aes+ 213 for !aes

– 8-:3 of $oege wo!en suffer fro! bui!ia

– Tends to be $#roni$ if eft untreated

• Anorexia

– Majority are fe!ae and w#ite+ fro! !idde-to-upper !idde $ass

fa!iies

– ;suay deveops around age 1< or eary adoes$en$e

– Tends to be !ore $#roni$ and resistant to treat!ent t#an bui!ia

• "ot# "ui!ia and Anorexia Are 0ound in %esterni&ed )utures



!auses of Bulimia and Anorexia: "oward an #ntegrative $odel

• Media and )utura )onsiderations

– "eing t#in = Su$$ess+ #appinessreay>

– )utura i!perative for t#inness transates into dieting

– Standards of idea body si&e $#ange as !u$# as $ot#es

– %it# i!proved nutrition+ !edia standards of t#e idea are diffi$ut toa$#ieve

• *sy$#oogi$a and "e#aviora )onsiderations

– 4ow sense of persona $ontro and sef-$onfiden$e

– 0ood restri$tion often eads to a preo$$upation wit# food

• An Integrative Mode



0igure :<

$ale and female ratings of %od& si'e



0igure :5

An integrative causal model of eating disorders



$edical and s&cological "reatment of Bulimia Nervosa

• Drug Treat!ents

– Antidepressants $an #ep redu$e binging and purging be#avior

– Antidepressants are not effi$a$ious in t#e ong-ter!

• *sy$#oso$ia Treat!ents

– )ognitive-be#avior t#erapy ,)"T. is t#e treat!ent of $#oi$e

– Interpersona psy$#ot#erapy resuts in ong-ter! gains si!iar to

)"T



$edical and s&cological "reatment of Anorexia Nervosa

• Medi$a Treat!ent

– T#ere are none wit# de!onstrated effi$a$y

• *sy$#oogi$a Treat!ent

– %eig#t restoration – 0irst and easiest goa to a$#ieve

– Treat!ent invoves edu$ation+ be#aviora+ and $ognitiveinterventions

– Treat!ent often invoves t#e fa!iy

– 4ong-ter! prognosis for anorexia is poorer t#an for bui!ia



Oter Eating Disorders

• 6u!ination Disorder

– )#roni$ regurgitation and reswaowing of partiay digested food

– Most prevaent a!ong infants and persons wit# !enta retardation

• *i$a

– 6epetitive eating of inedibe substan$es

– Seen in infants and persons wit# severe deveop!enta?intee$tuadisabiities

– Treat!ent invoves operant pro$edures

• 0eeding Disorder

– 0aiure to eat ade7uatey+ resuting in insuffi$ient weig#t gain

– Disorder of infan$y and eary $#id#ood

– Treat!ent invoves reguating eating and fa!iy t#erapy



lee* Disorders: An Overview

• Two Major Types of DSM-IV Seep Disorders

– D&ssomnias – Diffi$uties in getting enoug# seep+ probe!s in t#eti!ing of seep+ and $o!paints about t#e 7uaity of seep

– arasomnias – Abnor!a be#aviora and p#ysioogi$a eventsduring seep

• Assess!ent of Disordered Seep@ *oyso!nograp#i$ ,*S. Evauation – Ee$troen$ep#aograp# ,EE. – 4eg !ove!ents and brain wave

a$tivity

– Ee$troo$uograp# ,EB. – Eye !ove!ents

– Ee$tro!yograp#y ,EM. – Mus$e !ove!ents

– In$udes detaied #istory+ assess!ent of seep #ygiene and seepeffi$ien$y



"e D&ssomnias: Overview and Defining Features of #nsomnia

• Inso!nia and *ri!ary Inso!nia

– Bne of t#e !ost $o!!on seep disorders

– Diffi$uties initiating seep+ !aintaining seep+ and?or nonrestorativeseep

– *ri!ary inso!nia – Means inso!nia unreated to any ot#er $ondition,rareC.

• 0a$ts and Statisti$s

– Inso!nia is often asso$iated wit# !edi$a and?or psy$#oogi$a$onditions

– 0e!aes reported inso!nia twi$e as often as !aes


– Many #ave unreaisti$ expe$tations about seep

– Many beieve a$( of seep wi be !ore disruptive t#an it usuay is



"e D&ssomnias: Overview and Defining Features of +&*ersomnia

• 'yperso!nia and *ri!ary 'yperso!nia

– *robe!s reated to seeping too !u$# or ex$essive seep

– *erson experien$es ex$essive seepiness as a probe!

– *ri!ary #yperso!nia – Means #yperso!nia unreated to any ot#er

$ondition ,rareC.


– About <93 #ave a fa!iy #istory of #yperso!nia

– 'yperso!nia is often asso$iated wit# !edi$a and?or psy$#oogi$a

$onditions


– )o!pain of seepiness t#roug#out t#e day+ but do seep t#roug#

t#e nig#t



"e D&ssomnias: Overview and Defining Features of Narcole*s&

• /ar$oepsy

– Dayti!e seepiness and $atapexy

– )atapexi$ atta$(s – 6EM seep+ pre$ipitated by strong e!otion


– /ar$oepsy is rare – Affe$ts about 2<3 to 183 of t#e popuation

– E7uay distributed between !aes and fe!aes

– Bnset during adoes$en$e+ and typi$ay i!proves over ti!e


– )atapexy+ seep paraysis+ and #ypnagogi$ #au$inations i!prove

over ti!e

– Dayti!e seepiness does not re!it wit#out treat!ent



"e D&ssomnias: Overview of Breating-,elated lee* Disorders

• "reat#ing-6eated Seep Disorders

– Seepiness during t#e day and?or disrupted seep at nig#t

– Seep apnea – 6estri$ted air fow and?or brief $essations of

breat#ing

• Subtypes of Seep Apnea

– Bbstru$tive seep apnea ,BSA. – Airfow stops+ but respiratory

syste! wor(s

– )entra seep apnea ,)SA. – 6espiratory syste!s stops for brief

periods

– Mixed seep apnea – )o!bination of BSA and )SA



"e D&ssomnias: Overview of Breating-,elated lee* Disorders (cont.)


– More $o!!on in !aes+ o$$urs in 1-3 of popuation


– *ersons are usuay !ini!ay aware of apnea probe!

– Bften snore+ sweat during seep+ wa(e fre7uenty+ and #ave!orning #eada$#es

– May experien$e episodes of faing aseep during t#e day



!ircadian ,&tm lee* Disorders

• )ir$adian 6#yt#! Disorders

– Disturbed seep ,ie+ eit#er inso!nia or ex$essive seepiness

during t#e day.

– *robe! is due to brains inabiity to syn$#roni&e day and nig#t

• /ature of )ir$adian 6#yt#!s and "odys "ioogi$a )o$(

– )ir$adian 6#yt#!s – Do not foow a F #our $o$(

– Supra$#ias!ati$ nu$eus – T#e brains bioogi$a $o$(+ sti!uates

!eatonin

• Types of )ir$adian 6#yt#! Disorders

– Get ag type – Seep probe!s reated to $rossing ti!e &ones

– S#ift wor( type – Seep probe!s reated to $#anging wor(

s$#edues



$edical "reatments

• Inso!nia

– "en&odia&epines and over-t#e-$ounter seep !edi$ations

– *roonged use $an $ause rebound inso!nia+ dependen$e

– "est as s#ort-ter! soution

• 'yperso!nia and /ar$oepsy

– Sti!uants ,ie+ 6itain.

– )atapexy is usuay treated wit# antidepressants



$edical "reatments

• "reat#ing-6eated Seep Disorders

– May in$ude !edi$ations+ weig#t oss+ or !e$#ani$a devi$es

• )ir$adian 6#yt#! Seep Disorders

– *#ase deays – Moving bedti!e ater ,best approa$#.

– *#ase advan$es – Moving bedti!e earier ,!ore diffi$ut.

– ;se of very brig#t ig#t – Tri$( t#e brains bioogi$a $o$(



s&cological "reatments

• 6eaxation and Stress 6edu$tion

– 6edu$es stress and assists wit# seep

– Modify unreaisti$ expe$tations about seep

• Sti!uus )ontro *ro$edures

– I!proved seep #ygiene – "edroo! is a pa$e for seep and sexony

– 0or $#idren – Setting a reguar bedti!e routine

• )o!bined Treat!ents

– Inso!nia – S#ort-ter! !edi$ation pus psy$#ot#erapy is best

– 4a$( eviden$e for t#e effi$a$y of $o!bined treat!ents wit# ot#er

dysso!nias



"e arasomnias: Nature and eneral Overview

• /ature of *araso!nias

– T#e probe! is not wit# seep itsef

– *robe! is abnor!a events during seep+ or s#orty after wa(ing

• Two )asses of *araso!nias

– T#ose t#at o$$ur during 6EM ,ie+ drea!. seep

• nig#t!are disorder

– T#ose t#at o$$ur during non-6EM ,ie+ non-drea!. seep

• seep terror

• seep-wa(ing



"e arasomnias: Overview of Nigtmare Disorder

• Nigtmare Disorder

– B$$urs during 6EM seep

– Invoves distressfu and disturbing drea!s

– Su$# drea!s interfere wit# daiy ife fun$tioning and interrupt seep

• 0a$ts and Asso$iated 0eatures

– Drea!s often awa(en t#e seeper

– *robe! is !ore $o!!on in $#idren t#an aduts



"e arasomnias: Overview of Nigtmare Disorder (cont.)

• lee* "error Disorder – Invoves re$urrent episodes of pani$-i(e sy!pto!s

– B$$urs during non-6EM seep



– Bften noted by a pier$ing s$rea!

– )#id $annot be easiy awa(ened during t#e episode and #as itte!e!ory of it

• Treat!ent

– Bften invoves a wait-and-see posture

– Antidepressants ,ie+ i!ipra!ine. or ben&odia&epines for severe $ases

– S$#edued awa(enings prior to t#e seep terror $an ei!inate t#e probe!



"e arasomnias: Overview of lee* al/ing Disorder

• lee* al/ing Disorder 0 omnam%ulism

– B$$urs during non-6EM seep

– ;suay during first few #ours of deep seep

– *erson !ust eave t#e bed


– Diffi$ut+ but not dangerous+ to wa(e so!eone during t#e episode


– *robe! usuay resoves on its own wit#out treat!ent

– See!s to run in fa!iies

• 6eated )onditions

– /o$turna eating syndro!e – *erson eats w#ie aseep



0igure :H

An integrative multidimensional model of slee* distur%ance

lecture9.ppt

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