Chapter 8: Sleep-Wake and Eating Disorders Flashcards
Feeding and Easting Disorders
psychological disorders involving disturbed eating patterns and maladaptive ways of controlling body weight
Anorexia Nervosa
eating disorder, primarily affecting young women
characterized by maintenance of an abnormally low body weight, distortions of body image, and intense fears of gaining weight
Bulimia Nervosa
eating disorder characterized by a recurrent pattern of binge eating followed by inappropriate compensatory behaviors to prevent weight gain and accompanied by persistent overconcern with body weight and shape
Binge-Eating Disorder
eating disorder characterized nu repeated episodes in which binge eating occurs but is not followed by purging
Amenorrhea
absence of menstruation, a possible sign of anorexia nervosa
Osteoporosis
physical disorder caused by calcium deficiency that is characterized by extreme bitterness of the bones
Systems Perspective
view that problems reflect the systems (family, social, school, ecological, etc.) in which they are embedded
Sleep-Wake Disorders
diagnostic category represented persistent or recurrent sleep-related problems that cause significant personal distress or impaired functioning
Polysomnographic (PSG) Recording
the simultaneous measurement of multiple physiological responses during sleep or attempted sleep
Insomnia
term applying to difficulties falling asleep, remaining asleep, or achieving restorative sleep
Hypersomnolence Disorder
sleep-wake disorder involving a persistent pattern of excessive sleepiness during the day
Narcolepsy
sleep-wake disorder characterized by sudden, irresistible episodes of sleep (sleep attacks)
Cataplexy
brief, sudden loss of muscular control, typically lasting from a few seconds to as long as two minutes
REM Sleep
REM (rapid eye movement) sleep is the stage of sleep associated with dreaming that is characterized by the appearance of rapid eye movements under closed eyelids
hypocretin neurotransmitter is involved in arousal and wakefulness
Neuropeptide
an amino acid found in cerebrospinal fluid that plays a role in neuronal transmission and the modulation of brain circuits or regions
Breathing-Related Sleep Disorders
sleep disorders in which sleeping is repeatedly disrupted due to difficulties breathing normally
Obstructive Sleep Apnea Hypopnea
type of breathing-related disorder involving repeated episodes of either complete or partial obstruction of breathing during sleep
Apnea
temporary cessation of breathing
Circadian Rhythm Sleep-Wake Disorders
sleep disorders characterized by disruption of sleep caused by a mismatch in sleep schedules between the body’s internal sleep-wake cycle and demands of the environment
Parasomnia
category of sleep-wake disorders involving the occurrence of abnormal behavior or physiological events during sleep or at the tension between wakefulness and sleep
Nightmare Disorder
sleep-wake disorder characterized by recurrent awakenings from sleep because of frightening nightmare
formerly called dream anxiety disorder
Non-Rapid Eye Movement Sleep Arousal Disorders
sleep-wake disorders involving recurrent episodes of incomplete arousals during sleep that are accompanied by sleep terrors or sleepwalking
Anxiolytics
drugs, such as sedatives and anesthetics, that include partial or complete unconsciousness and are commonly used in the treatment of sleep-wake disorders
What are feeding and eating disorders?
eating disorders like bulimia nervosa & anorexia nervosa often affect people of high school or college age, especially young women
incidence tends to be significantly higher in females than males
What are the two main types of eating disorders?
anorexia nervosa and bulimia nervosa
What is anorexia nervosa?
an eating disorder primarily affecting young women, characterized by maintenance of an abnormally low body weight, distortions of body image, intense fear of gaining weight, and amenorrhea in females
for males, check for tumors
What is the DSM-5 criteria for anorexia nervosa?
restriction of energy intake relative to requirements, leading to a significantly low body weight in the context of age, sex, developmental trajectory, and physical health
intense fear of gaining weight
disturbance in the way in which one’s body weight or shape is experienced
What are the two subtypes of anorexia nervosa?
restricting type
binge eating/purging type
What is body mass index (BMI)?
severity is based largely on Body Mass Index (BMI), which is calculated from weight (in kilograms) and height (in meters)
problem: it fails to take body composition into account
BMI = kg/m^2
extreme: <15
What is anorexia nervosa in partial remission?
some but not all criteria met for a “sustained period”
What is anorexia nervosa in full remission?
no criteria met for a “sustained period of time”
What are the medial complications of anorexia?
amenorrhea: no period, low estrogen, low iron
osteoporosis: brittle bones, fractures, inadequate dietary calcium
kidney damage: dehydration (not enough fluids), laxative abuse (affect electrolyte balance)
heart arrhythmias (irregular beats)
hypotension
anemia
death: about 15% of patients, malnutrition (direct, physiological), suicide (indirect, high risk of depression)
What is bulimia nervosa?
an eating disorder characterized by a recurrent pattern of binge eating followed by self-induced purging and accompanied by persistent overconcern with body weight & image
What are the DSM-5 criteria for bulimia nervosa?
recurrent episodes of binge eating
recurrent inappropriate compensatory behaviors in order to prevent weight gain, such as self-induced vomiting
the binge eating and compensatory behaviors both occur, on average, at least once a week for 3 months
self-evaluation is unduly influenced by body shape
the disturbance does not occur exclusively during episodes of anorexia nervosa
What is the DSM-5 criteria for an episode of binge eating?
eating, in a discrete period of time, an amount of food that is definitely larger than what most individuals would eat in a similar period of time under similar circumstances
a sense of lack of control over eating during the episode (e.g. a feeling that one cannot stop eating or control what or how much one is eating)
What are the specifiers of bulimia nervosa?
mild: 1-3 per week
moderate: 4-7 per week
severe: 8-13 per week
extreme: 14 or more
in partial remission, in full remission
What is binge-eating disorder?
involves the same binge-eating features found in bulimia nervosa but without the behavior aiming to compensate for the binging (e.g. purging)
What are medical complications of bulimia?
tooth erosion, cavities, and gum problems
blockage of salivatory ducts (poor bacterial control)
pancreatitis (inter-abdominal pressure causes damage)
water retention, swelling, and abdominal bloating
acute stomach distress
fluid loss with low potassium levels (extreme weakness, near paralysis, heart arrhythmias)
irregular periods
esophagus damage (including rupture)
weakening of rectal walls
What are behavioral complications of bulimia?
substance abuse (30 to 70%)
impulsive behaviors (up to 50%): promiscuity, cutting, theft
What are the risk factors for both anorexia and bulimia?
participation in competitive activities that emphasize endurance, aesthetics, and weight levels put athletes at risk for developing an eating disorder
female gender
age in late teens to early 20s
having a first degree relative with any kind of eating disorder
social pressures including disorted media protrayals
emotional issues such as: low self-esteem, perfectionism, anger issues, depression, anxiety, OCD, impulsivity, need for control
What are the causes of anorexia and bulimia?
sociocultural factors: food is celebrated in many cultures
psychosocial factors: media portrayals of body standards
family factors: systems perspective, how is this an indicator of the broader stresses they’re going through?
biological factors: tumors in the hypothalamus (eat too much or too little), drug abuse
What are treatments for anorexia nervosa and bulimia nervosa?
hospitalization: needs to be supervised when eating
cognitive analytic therapy
family therapy: multi-level thing, don’t just treat bulimia, might be trying to go against family norms
CBT: treating the thoughts that go with the disorder
interpersonal psychotherapy: individualized systems therapy, meaning of the relationships in life
What is pica?
ingestion of non-nutritive substances
teenager or adult eating something that isn’t good for them
What is rumination disorder?
food is regurgitated, chewed, and either spat out or re-swallowed
What is Prader-Willi Syndrome?
lower than normal IQ
no matter how much they eat they don’t get sick to their stomach
What is Cyclic Vomiting Syndrome?
several times an hour over a period of hours or days
not binging and purging
don’t eat it or swallow it again, partially threw up
What are conditions related to feeding and eating disorders in adolescents and adults?
anorexia athletica
muscle dysmorphia (bigorexia)
orthexia nervosa: need to eat super healthy foods
night-eating syndrome: at least half their calories are consumed at night
nocturnal sleep-related eating disorder: sleep walking + eating
gourmand syndrome: super consumed with having fancy and unusual food
What is avoidant/restrictive food intake disorder?
don’t have morbid fear of gaining weight
What are sleep-wake disorders?
diagnostic category representing persistent or recurrent sleep-related problems that cause significant personal distress or impaired functioning
What are the dyssomnia sleep disorders?
concerned with timing or amount
insomnia disorder: don’t sleep enough
hypersomnolence disorder: sleeping much more than they should
narcolepsy: no control over the tendency to fall asleep
What are the breathing-related sleep disorders?
much less to do with mental health
central sleep apnea: stop breathing
sleep-related hypoventilation: not breathing deeply enough
circadian rhythm sleep-wake disorders: natural rhythm is interrupted
What are the parasomnia sleep disorders?
occurs with sleep
nightmare disorder (during REM stage)
non-REM sleep arousal disorders
REM sleep behavior disorder
restless leg syndrome
substance/medication induced
What is sleep stage one (N1)?
light transitional from wakefulness
high amplitude theta (slow) waves on EEG
lasts about 5-10 minutes
What is sleep stage two (N2)?
EEG shows bursts of fast activity (sleep spindles)
HR and temperature drops
What is sleep stage three (N3)?
moving from transitional to deeper stages
deep, increasing slow wave EEG activity (delta band)
What is sleep stage four (N4)?
“delta sleep” predominance of delta band EEG activity
lasts about 30 minutes
if sleeper is prone to enuresis or sleepwalking, it will most likely start here
What is sleep stage five (REM)?
REM sleep or “paradoxical sleep”, daydreaming occurs
voluntary muscles are paralyzed, brain active, respiration increases
What is sleep architecture?
on average we enter REM sleep about once every 90 minutes
typically 4 to 5 cycles per night
REM stage typically lasts longer upon each successive cycle
if you get up in the night, return to the stage you were at or the stage right before
What happens to the sleep cycles as we age?
as we age, slow wave (stages 3 & 4) sleep decreases and Stage 1 increases which makes us easier to wake
hence there is heighten incidence of insomnia
What is insomnia disorder?
three main varieties, can have one, two, or all three
onset: just can’t fall asleep
interrupted: tossing, turning, physical discomfort, can’t navigate stages
early: get up earlier, earlier, and earlier
What is hypersomnia (hypersomnolence disorder)?
sleeping beauty syndrome
sleep for 24 hours
What is narcolepsy?
loss of the chemical hypocretin in the hypothalamus
cataplexy” collapsing
dysregulation of sleep stages: awake from straight to stage five, fast movement into deep sleep = muscle paralysis at dangerous times
What are breathing-related sleep disorders?
apnea, snoring
airway closes partially or completely
more likely in obese or sedated individuals (e.g. sleeping pills or alcohol)
airway may remain closed up to 90 seconds
usually sleeper reflexively in sleep as it occurs many times per night
poor oxygenation
highly disruptive to sleeping partner
What are treatments for breathing-related sleep disorders?
CPAP (continuous positive air pressure) machine: high rate of non-compliance
surgery (usually laser) to remove excess tissue enlargements: uncomfortable recovery and infection rate
What is Kleine-Levin Syndrome (KLS) “Sleeping Beauty” Syndrome?
recurring periods of excessive amounts of sleep, behavior changes, and impaired understanding of the world
no treatment
not in a coma, still eat
episodes may continue for 10 years or more (sometimes spontaneously recovers)
How are anxiolytics used to treat sleep-wake disorders?
should only be used short-term (develop tolerance, high level of addiction)
benzos, suppress CNS
many drugs can suppress REM sleep (less restorative sleep)
What are psychological approaches to treating sleep-wake disorders?
cognitive-behavioral techniques lower physiological arousal and address sleep hygiene and emotional state
deep relaxation techniques
figure out a good bed time routine
What is nightmare disorder?
during REM
wakes up
tend to remember (because it occurs during REM)
What are sleep terror disorders?
stages 3 and 4
not remembered (because its not in REM)
awaken confused and disoriented
What is sleepwalking?
rarely occurs in stage 5 because sleep paralysis sets in
don’t usually wake up
often confused and disoriented if awoken (not dangerous to wake them up)
little recollection of dream content (because it takes place in non-REM sleep)
“sexomnia” variant: engage in sex while asleep
What are the biological approaches to the treatment of sleep disorders?
benzodiazepines (anxiolytics)
risk of dependence diminished REM
What are the psychological approaches to the treatment of sleep disorders?
cognitive-behavioral techniques
people can develop anticipatory anxiety that may respond to identifying rational alternate thoughts
don’t go to bed thinking you’ll have a bad sleep
What are ten steps to overcoming insomnia?
- retire to bed only when you feel sleepy
- limit bed activities to sleeping
- if after 20 minutes you are unable to fall asleep, get out of bed and relax
- establish a regular routine
- avoid naps during the daytime
- avoid ruminating in bed
- relax before sleeping
- establish a regular daytime exercise schedule
- avoid caffeinated beverages
- practice rational restructuring for self-defeating thoughts
