Chapter 8

Eating and Sleep Disorders

 Eating Disorders: An Overview

Two Major Types of DSM-IV-TR Eating

Disorders
Anorexia nervosa and bulimia nervosa
Severe disruptions in eating behavior
Extreme fear and apprehension about
gaining weight
Strong sociocultural origins Westernized
views
 Eating Disorders: An Overview (continued)

Other Subtypes of DSM-IV-TR Eating

Disorders
Binge eating disorder
Obesity A Growing Epidemic
 Bulimia Nervosa: Overview and Defining
Features

Binge Eating Hallmark of Bulimia

Binge
Eating excess amounts of food
Eating is perceived as uncontrollable
 Bulimia Nervosa: Overview and Defining
Features (continued)

Compensatory Behaviors
Purging
Self-induced vomiting, diuretics,
laxatives
Some exercise excessively, whereas
others fast
 Bulimia Nervosa: Overview and Defining
Features (continued)

DSM-IV-TR Subtypes of Bulimia

Purging subtype Most common subtype
Nonpurging subtype About one-third of
bulimics
 Bulimia Nervosa: Associated Features

Associated Medical Features

Most are within 10% of target body weight
Purging methods can result in severe
medical problems
Erosion of dental enamel, electrolyte
imbalance
Kidney failure, cardiac arrhythmia,
seizures, intestinal problems, permanent
colon damage
 Bulimia Nervosa: Associated Features
(continued)

Associated Psychological Features

Most are over concerned with body shape
Fear of gaining weight
Most have comorbid psychological
disorders
 Anorexia Nervosa: Overview and Defining
Features

Successful Weight Loss Hallmark of

Anorexia
Defined as 15% below expected weight
Intense fear of obesity and losing control
over eating
Anorexics show a relentless pursuit of
thinness
Often begins with dieting
 Anorexia Nervosa: Overview and Defining
Features (continued)

DSM-IV-TR Subtypes of Anorexia

Restricting subtype Limit caloric intake
via diet and fasting
Binge-eating-purging subtype About 50%
of anorexics
 Anorexia Nervosa: Overview and Defining
Features (continued)

Associated Features
Most show marked disturbance in body
image
Most are comorbid for other psychological
disorders
Methods of weight loss have life
threatening consequences
 Binge-Eating Disorder: Overview and
Defining Features

Binge-Eating Disorder Appendix of DSM-IV-

TR
Experimental diagnostic category
Engage in food binges without
compensatory behaviors
 Binge-Eating Disorder: Overview and
Defining Features (continued)

Associated Features
Many persons with binge-eating disorder
are obese
Concerns about shape and weight
Often older than bulimics and anorexics
More psychopathology vs. non-binging
obese people
Bulimia and Anorexia: Facts and Statistics

Bulimia
Majority are female
Onset around 16 to 19 years of age
Lifetime prevalence is about 1.1% for
females, 0.1% for males
6-8% of college women suffer from bulimia
Tends to be chronic if left untreated
Bulimia and Anorexia: Facts and Statistics
(continued)
Anorexia
Majority are female and white
From middle-to-upper middle class families
Usually develops around age 13 or early
adolescence
More chronic and resistant to treatment
than bulimia
Both Bulimia and Anorexia Are Found in
Westernized Cultures
Causes of Bulimia and Anorexia: Toward an
Integrative Model

Media and Cultural Considerations

Being thin = Success, happiness....really?
Cultural imperative for thinness
Translates into dieting
Causes of Bulimia and Anorexia: Toward an
Integrative Model (continued)

Standards of ideal body size

Change as much as fashion
Media standards of the ideal
Are difficult to achieve
Biological Considerations
Can lead to neurobiological abnormalities
Causes of Bulimia and Anorexia: Toward an
Integrative Model

Psychological and Behavioral Considerations

Low sense of personal control and self-
confidence
Perfectionistic attitudes
Distorted body image
Preoccupation with food
Mood intolerance
An Integrative Model
Fig. 8.4, p. 315
 Medical and Psychological Treatment of
Bulimia Nervosa

Medical and Drug Treatments

Antidepressants
Can help reduce binging and purging
behavior
Are not efficacious in the long-term
 Medical and Psychological Treatment of
Bulimia Nervosa (continued)

Psychosocial Treatments
Cognitive-behavior therapy (CBT)
Is the treatment of choice
Basic components of CBT
Interpersonal psychotherapy
Results in long-term gains similar to
CBT
 Goals of Psychological Treatment of
Anorexia Nervosa

General Goals and Strategies

Weight restoration
First and easiest goal to achieve
Psychoeducation
 Goals of Psychological Treatment of
Anorexia Nervosa (continued)

Behavioral, and cognitive interventions

Target food, weight, body image, thought
and emotion
Treatment often involves the family
Long-term prognosis for anorexia is poorer
than for bulimia
 Medical and Psychological Treatment of
Binge Eating Disorder

Medical Treatment
Sibutramine (Meridia)
Psychological Treatment
CBT
Similar to that used for bulimia
Appears efficacious
Medical and Psychological Treatment of
Binge Eating Disorder (continued)

Interpersonal psychotherapy
Equally as effective as CBT
Self-help techniques
Also appear effective
 Obesity: Background and Overview

Not a formal DSM disorder

Statistics
In 2000, 20% of adults in the United States
were obese
Mortality rates
Are close to those associated with
smoking
 Obesity: Background and Overview
(continued)

Increasing more rapidly

For teens and young children
Obesity
Is growing rapidly in developing nations
 Obesity and Disordered Eating Patterns

Obesity and Night Eating Syndrome

Occurs in 7-15% of treatment seekers
Occurs in 27% of individuals seeking
bariatric surgery
Patients are wide awake and do not binge
eat
 Obesity and Disordered Eating Patterns
(continued)

Causes
Obesity is related to technological
advancement
Genetics account for about 30% of obesity
cases
Biological and psychosocial factors
contribute as well
 Obesity Treatment

Treatment
Moderate success with adults
Greater success with children and
adolescents
Treatment Progression -- From least-to-most
intrusive options
 Obesity Treatment (continued)

First step
Self-directed weight loss programs
Second step
Commercial self-help programs
Third step
Behavior modification programs
Last step
Bariatric surgery
 Sleep Disorders: An Overview

Two Major Types of DSM-IV-TR Sleep

Disorders
Dyssomnias
Difficulties in amount, quality, or timing of
sleep
Parasomnias
Abnormal behavioral and physiological
events during sleep
 Sleep Disorders: An Overview (continued)

Assessment of Disordered Sleep:

Polysomnographic (PSG) Evaluation
Electroencephalograph (EEG) Brain
wave activity
Electrooculograph (EOG) Eye
movements
Electromyography (EMG) Muscle
movements
Detailed history, assessment of sleep
hygiene and sleep efficiency
 The Dyssomnias: Overview and Defining
Features of Insomnia

Insomnia and Primary Insomnia

One of the most common sleep disorders
Problems initiating, maintaining, and/or
nonrestorative sleep
Primary insomnia Unrelated to any other
condition (rare!)
 The Dyssomnias: Overview and Defining
Features of Insomnia (continued)

Facts and Statistics

Often associated with medical and/or
psychological conditions
Affects females twice as often as males
Associated Features
Unrealistic expectations about sleep
Believe lack of sleep will be more
disruptive than it usually is
 The Dyssomnias: Overview and Defining
Features of Hypersomnia

Hypersomnia and Primary Hypersomnia

Sleeping too much or excessive sleep
Experience excessive sleepiness as a
problem
Primary hypersomnia Unrelated to any
other condition (rare!)
 The Dyssomnias: Overview and Defining
Features of Hypersomnia (continued)
Facts and Statistics
About 39% have a family history of
hypersomnia
Often associated with medical and/or
psychological conditions
Associated Features
Complain of sleepiness throughout the day
Able to sleep through the night
 The Dyssomnias: Overview and Defining
Features of Narcolepsy

Narcolepsy -- Daytime sleepiness and

cataplexy
Cataplexic attacks
REM sleep, precipitated by strong
emotion
 The Dyssomnias: Overview and Defining
Features of Narcolepsy (continued)

Facts and Statistics Rare Condition

Affects about .03% to .16% of the
population
Equally distributed between males and
females
Onset during adolescence
Typically improves over time
 The Dyssomnias: Overview and Defining
Features of Narcolepsy (continued)

Associated Features
Cataplexy, sleep paralysis, and hypnagogic
hallucinations
Daytime sleepiness does not remit without
treatment
 The Dyssomnias: Overview of Breathing-
Related Sleep Disorders

Breathing-Related Sleep Disorders

Sleepiness during the day and/or disrupted
sleep at night
Sleep apnea
Restricted air flow and/or brief
cessations of breathing
 The Dyssomnias: Overview of Breathing-
Related Sleep Disorders (continued)

Subtypes of Sleep Apnea

Obstructive sleep apnea (OSA)
Airflow stops, but respiratory system works
Central sleep apnea (CSA)
Respiratory systems stops for brief periods
Mixed sleep apnea
Combination of OSA and CSA
 The Dyssomnias:
Facts and Features Associated With Breathing-
Related Sleep Disorders

Facts and Statistics

Occurs in 1-2% of population
More common in males
Associated with obesity and increasing age
 The Dyssomnias:
Facts and Features Associated With
Breathing-Related Sleep Disorders
(continued)
Associated Features
Persons are usually minimally aware of
apnea problem
Often snore, sweat during sleep, wake
frequently
May have morning headaches
May experience episodes of falling asleep
during the day
 Circadian Rhythm Sleep Disorders

Circadian Rhythm Disorders

Disturbed sleep (i.e., either insomnia or
excessive sleepiness)
Due to brains inability to synchronize day
and night
 Circadian Rhythm Sleep Disorders
(continued)
Nature of Circadian Rhythms and Bodys
Biological Clock
Circadian Rhythms Do not follow a 24 hour
clock
Suprachiasmatic nucleus
Brains biological clock, stimulates
melatonin
Types of Circadian Rhythm Disorders
Jet lag type
Shift work type
 Medical Treatments

Insomnia
Benzodiazepines and over-the-counter
sleep medications
Prolonged use
Can cause rebound insomnia,
dependence
Best as short-term solution
 Medical Treatments (continued)

Hypersomnia and Narcolepsy

Stimulants (i.e., Ritalin)
Cataplexy
Usually treated with antidepressants
 Medical Treatments

Breathing-Related Sleep Disorders

May include medications, weight loss, or
mechanical devices
Circadian Rhythm Sleep Disorders
 Medical Treatments (continued)

Phase delays
Moving bedtime later (best approach)
Phase advances
Moving bedtime earlier (more difficult)
Use of very bright light
Trick the brains biological clock
 Psychological Treatments

Relaxation and Stress Reduction

Reduces stress and assists with sleep
Modify unrealistic expectations about sleep
Stimulus Control Procedures
Improved sleep hygiene Bedroom is a
place for sleep
For children Setting a regular bedtime
routine
 Psychological Treatments (continued)

Combined Treatments
Insomnia Short-term medication plus
psychotherapy
Other Dyssomnias
Little evidence for the efficacy of
combined treatments
 The Parasomnias: Nature and General
Overview

Nature of Parasomnias
The problem is not with sleep itself
Problem is abnormal events during sleep,
or shortly after waking
 The Parasomnias: Nature and General
Overview (continued)

Two Classes of Parasomnias

Those that occur during REM (i.e., dream)
sleep
Those that occur during non-REM (i.e.,
non-dream) sleep
 The Parasomnias: Overview of Nightmare
Disorder

Nightmare Disorder
Occurs during REM sleep
Involves distressful and disturbing dreams
Such dreams interfere with daily life
functioning and interrupt sleep
 The Parasomnias: Overview of Nightmare
Disorder (continued)

Facts and Associated Features

Dreams often awaken the sleeper
Problem is more common in children than
adults
Treatment
May involve antidepressants and/or
relaxation training
The Parasomnias: Overview of Sleep Terror
Disorder

Sleep Terror Disorder

Recurrent episodes of panic-like symptoms
during non-REM sleep
Often noted by a piercing scream
The Parasomnias: Overview of Sleep Terror
Disorder (continued)

Facts and Associated Features

More common in children than adults
Child cannot be easily awakened during
the episode
Child has little memory of it the next day
The Parasomnias: Overview of Sleep Terror
Disorder (continued)

Treatment -- A Wait-and-See Posture

Scheduled awakenings prior to the sleep
terror
Severe Cases
Antidepressants (i.e., imipramine) or
benzodiazepines
 The Parasomnias: Overview of Sleep
Walking Disorder

Sleep Walking Disorder Somnambulism

Occurs during non-REM sleep
Usually during first few hours of deep sleep
Person must leave the bed
 The Parasomnias: Overview of Sleep
Walking Disorder (continued)

Facts and Associated Features

Problem is more common in children than
adults
Problem usually resolves on its own
without treatment
Seems to run in families
 The Parasomnias: Overview of Sleep
Walking Disorder (continued)

Related Conditions
Nocturnal eating syndrome Person eats
while asleep
 Summary of Eating and Sleep Disorders

All Eating Disorders Share

Gross deviations in eating behavior
Fear or concern about weight, body size,
appearance
Heavily influenced by social, cultural, and
psychological factors
 Summary of Eating and Sleep Disorders
(continued)
All Sleep Disorders Share
Interference with normal process of sleep
Interference results in problems during
waking
Heaving influenced by psychological and
behavioral factors
Incidence of Eating and Sleep Disorders Is
Increasing
More Effective Treatments for Eating and
Sleep Disorders Are Needed