chapter 9 Flashcards
eating disorders
Involve disordered eating behaviors and maladaptive ways of controlling body weight
- Often occur together with other psychological disorders such as depression, anxiety disorders, and substance abuse disorders
eating disorders demographics
Typical onset in adolescence
Mainly reported as impacting women, though impacts all genders
Disorders involve interplay of body weight, food consumption, and compensatory behaviors
anorexia nervosa
An eating disorder characterized by maintenance of an abnormally low body weight, a distorted body image, and intense fears of gaining weight
Rarely lose their appetite
Other common features:
- Failure to recognize the risks posed by maintaining body weight at abnormally low levels
Two subtypes: binge eating/purging type and restricting type
criteria for anorexia nervosa
A) 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. Significantly low weight is defined as a weight that is less than minimally normal or, for children and adolescents, less than minimally expected
B) Intense fear of gaining weight or of becoming fat, or persistent behavior that interferes with weight gain, even though at a significantly low weight
C) Disturbance in the way in which one’s body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or persistent lack of recognition of the seriousness of the current low body weight
Restricting type
During the last 3 months, the individual has not engaged in recurrent episodes of binge-eating or purging behavior. This subtype describes presentations in which weight loss is accomplished primarily through dieting, fasting, and/or excessive exercise
Does not have binging or purging episodes
Tend to rigidly, even obsessively, control their diet and appearance
Binge-eating/purging type
During the last 3 months, the individual has engaged in recurrent episodes of binge-eating or purging behavior
Characterized by frequent episodes during the prior three month period of binge eating or purging (such as by self induced vomiting or overuse of laxatives, diuretics, or enemas)
Difficulties with impulse control - may lead to problems with substance abuse
Tend to alternate between periods of rigid control and impulsive behavior
Body mass index (BMI)
A measure of height-adjusted weight, and a level of 18.5 is considered the minimal standard of healthy weight
anorexia nervosa specify if in
In partial remission
After full criteria for anorexia nervosa were previously met, Criterion A (low body weight) has not been met for a sustained period, but either Criterion B (intense fear of gaining weight or becoming fat or behavior that interferes with weight gain) or Criterion C (disturbances in self-perception of weight and shape) is still met
In full remission
After full criteria for anorexia nervosa were previously met, none of the criteria have been meet for a sustained period of time
Medical Complications of Anorexia Nervosa
Dermatological:
Skin cracking, drying and discoloration, thinning of hair
Cardiovascular:
Heart irregularities, low blood pressure, dizziness
Gastrointestinal:
Constipation, abdominal pain, impacted bowels
Menstrual:
Amenorrhea
Loss of period
Musculoskeletal:
Muscular weakness and abnormal bone growth
Suicide risk:
8x more likely than general population
Bulimia Nervosa
An eating disorder characterized by recurrent binge eating followed by self-induced purging, accompanied by over concern with body weight and shape
At least once a week for three months
Late adolescence or early adulthood
criteria for bulimia nervosa
A) Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following:
- Eating, in a discrete period of time (within any 2 hour period), 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
B) Recurrent inappropriate compensatory behaviors in order to prevent weight gain, such as self-induced vomiting; misuse of laxatives, diuretics, or other medications; fasting; or excessive exercise
C) The binge eating and inappropriate compensatory behaviors both occur, on average, at least once a week for 3 months
D) Self evaluation is unduly influenced by body shape and weight
E) The disturbance does not occur exclusively during episodes of anorexia nervosa
severity of bulimia nervosa
Severity based on average episodes of inappropriate compensatory behaviors per week
Mild: 1-3
Moderate: 4-7
Severe: 8-13
Extreme: 14 or more
bulimia nervosa specify if in
In partial remission
After full criteria for bulimia nervosa were previously meet, some, but not all, of the criteria have been met for a sustained period of time
In full remission
After full criteria for bulimia nervosa were previously met, not of the criteria have been met for a sustained period of time
Medical Complications of Bulimia Nervosa
Impact of constant vomiting and exposure to stomach acid
- Skin irritation
- Tooth decay
- Dental cavities
- Decrease taste receptor sensitivity
Musculoskeletal:
Abnormal pain, impacted relational with bowels and reflexive elimination, muscular weakness
Menstrual:
Amenorrhea
Loss of period
Sociocultural factors eating disorders
Common in western cultures
Idealization of thinness
Gendered expectations of body
Comparison to others
Cultural value on body composition
Psychosocial and emotional factors of eating disorders
Not all exposed develop eating disorders
Tie to deep emotional issues
Linked to abusive histories
Negative emotions can trigger episodes
‘Relief’ of upsetting emotions
differences of binging, purging, restriction
Binging: intake, endorphin rush
Purging: release and relief
Restriction: control, mastery
Learning perspectives of eating disorders
Weight phobia theory
Negative reinforcement of relief through compensatory behaviors
Cognitive factors of eating disorders
Black and white thinking
Negative beliefs about self
Family factors of eating disorders
“Identified patient” represents family dysfunction
Disordered eating often as a response to chaos in home
Biological factors of eating disorders
Brain abnormalities related to hunger and appetite
Genetic predispositions
Binge-eating disorder
Repeated binge-eating episodes, but there is no compensatory behavior afterward to reduce weight
Average of at least once a week for three months
Lack of control over eating, consuming far greater amounts of food than people typically eat in the same span of time
Tend to be more depressed, have greater difficulty regulating their emotions, and have more disturbed eating behaviors
Strongly linked to obesity
May fall in the broader domain of compulsive disorders
CBT
criteria of binge eating disorder
A) Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following:
- eating, in a discrete period of time (within any 2 hour period), an amount of food that is definitely larger than what most people would eat in a similar period of time under similar circumstances
- A sense of lack of control over eating during the episode
B) The binge eating episodes are associated with three (or more) of the following:
- eating much more rapidly than normal
- eating until feeling uncomfortably full
- eating large amounts of food when not feeling physically hungry
- eating alone because of feeling embarrassed by how much on is eating
- feeling disgusted with oneself, depressed, or very guilt afterward
C) Marked distress regarding binge eating is present
D) The binge eating occurs, on average, at least once a week for 3 months
E) The binge eating is not associated with the recurrent use of inappropriate compensatory behavior as in bulimia nervosa and does not occur exclusively during the course of bulimia nervosa or anorexia nervosa
Orthorexia
Not an official diagnosis, but proposed
A) Obsessive focus on “healthy” eating, as defined by a dietary theory or set of beliefs whose specific details may vary; marked by exaggerated emotional distress in relationship to food choices perceived as unhealthy; weight loss may ensue, but this is conceptualized as an aspect of ideal health rather than as the primary goal. As evidenced by the following:
- Compulsive behavior and/or mental preoccupation regarding affirmative and restrictive dietary practices believed by the individual to promote optimum health
- Violation of self imposed dietary rules causes exaggerated fear of disease, sense of personal impurity and/or negative physical sensations, accompanied by anxiety and shame
- Dietary restrictions escalate over time, and may come to include elimination of entire food groups and involve progressively more frequent and/or severe “cleanses” (partial fasts) regarded as purifying or detoxifying. This escalation commonly leads to weight loss, but the desire to lose weight is absent, hidden or subordinate to ideation about healthy food.
B) The compulsive behavior and mental preoccupation becomes clinically impaired by an of the following:
- malnutrition, severe weight loss or other medical complications from restricted diet
- intrapersonal distress or impairment of social, academic or vocational functioning secondary to beliefs or behaviors about healthy diet
- positive body image, self-worth, identity and/or satisfaction excessively dependent on compliance with self-defined “healthy” eating behavior
Treatment of Eating Disorders
Hospitalization:
- Monitored feeding
- Behavioral therapy – cycle breaking
CBT:
- Addressing maladaptive beliefs about body image, eating, and self value
- Exposure response prevention for purging
Psychodynamic:
- Healing of psychological conflicts and family dynamics leading to the urge to control/purge/binge
SSRIs:
- Appetite regulation
Sleep-wake disorders
Sleep problems of sufficient severity and frequency that they lead to significant personal distress or impaired functioning in social, occupational, or other roles
Lower productivity and increased absences from work
Sleep centers - to provide more comprehensive assessment and diagnosis of sleep related problems than is possible in a typical office setting
- PSG - polysomnographic
Sleep stages (definition)
Length of sleep stages differs for everyone, but on average, your body cycles through the stages 4 to 6 times during the night. Your body spends more time in NREM sleep than REM sleep
Insomnia
Difficulties falling asleep, remaining asleep, or achieving restorative sleep
Insomnia Disorder
A sleep-wake disorder characterized by chronic or persistent insomnia not caused by another psychological or physical disorder or by the effects of drugs or medications
insomnia disorder criteria
A) A predominant complaint of dissatisfaction with sleep quantity or quality, associated with one (or more) of the following symptoms:
1. Difficulty initiating sleep (in children, this may manifest as difficulty initiating sleep without caregiver intervention)
2. Difficulty maintaining sleep, characterized by frequent awakenings or problems returning to sleep after awakenings (in children, this may manifest as difficulty returning to sleep without caregiver intervention)
3. Early-morning awakening with inability to return to sleep
B) The sleep disturbance causes clinically significant distress or impairment in social, occupational, educational, academic, behavioral, or other important areas of functioning
C) The sleep difficulty occurs at least 3 nights per week
D) The sleep difficulty is present for at least 3 months
E) The sleep difficulty occurs despite adequate opportunity for sleep
F) The insomnia is not better explained by and does not occur exclusively during the course of another sleep-wake disorder
G) The insomnia is not attributable to the physiological effects of a substance
H) Coexisting mental disorders and medical conditions do not adequately explain the predominant complaint of insomnia
specify if (insomnia disorder)
Episodic
Symptoms last at least 1 month but less than 3 months
Persistent
Symptoms last 3 months or longer
Recurrent
Two (or more) episodes within the space of 1 year
With medical disorder, including substance use disorders
With medical conditions
With another sleep condition
Hypersomnolence disorder
Persistent pattern of excessive sleepiness throughout the day
May sleep 9+ hours a night and still not feel refreshed upon awakening
Treated with stimulant medication
Increased activity of GABA
Hypersomnolence disorder criteria
A) Self-reported excessive sleepiness (hypersomnolence) despite a main sleep period lasting at least 7 hours, with at least one of the following symptoms:
1. Recurrent periods of sleep or lapses into sleep within the same day
2. A prolonged main sleep episodes of more than 9 hours per day that is non restorative
3. Difficulty being fully awake after abrupt awakening
B) The hypersomnolence occurs at least three times per week, for at least 3 months
C) The hypersomnolence is accompanied by significant distress or impairment in cognitive, social, occupational, or other important areas of functioning
D) The hypersomnolence is not better explained by and does not occur exclusively during the course of another sleep disorder
E) The hypersomnolence is not attributable to the physiological effects of a substance
Hypersomnolence disorder specify if
Acute
Duration of less than 1 month
Subacute
Duration of 1-3 months
Persistent
Duration of more than 3 months
Mild
Difficulty maintaining daytime alertness 1-2 days/week
Moderate
Difficulty maintaining daytime alertness 3-4 days/week
Severe
Difficulty maintaining daytime alertness 5-7 days/week
With mental disorder, including substance use disorders
With medical condition
With another sleep disorder
Narcolepsy
A sleep-wake disorder characterized by sudden, irresistible episodes of sleep
Sleep attacks, without warning - 15 minutes
Almost immediate transition from wakefulness to REM
cataplexy, sleep paralysis, hypnagogic hallucinations, hypocretin/orexin deficiency
Cataplexy
Loss of muscle tone and voluntary muscle control
Sleep paralysis
Temporary state of paralysis (feel incapable of moving or talking) upon waking
Hypnagogic hallucinations
Frightening hallucinations just before sleep begins or shortly after awakening
Hypocretin/orexin deficiency
Decreased wake drive and a disinhibition of REM sleep occurrence
narcolepsy criteria
A) Recurrent periods of an irrepressible need to sleep, lapsing into sleep, or napping occurring within the same day. These must have been occurring at least three times per week over the past 3 months
B) The presence of at least one of the following:
1. Episodes of cataplexy, defined as either (a) or (b), occurring at least a few times per week:
a. In individuals with long standing disease, brief (seconds to minutes) episodes of sudden bilateral loss of muscle tone with maintained consciousness that are precipitated by laughter or joking
b. In children or in individuals within 6 months of onset, spontaneous grimaces or jaw-opening episodes with tongue thrusting or a global hypotonia, without any obvious emotional triggers
C) Hypocretin deficiency, as measured using cerebrospinal fluid (CSF) hypocretin-1 immunoreactivity values (less than or equal to one-third of values obtained in healthy subjects tested using the same assay, or less than or equal to 110 pg/mL). Low CSF levels of hypocretin-1 must not be observed in the context of acute brain injury, inflammation, or infection
D) Nocturnal sleep polysomnography showing rapid eye movement (REM) sleep latency less than or equal to 15 minutes, or a multiple sleep latency test showing a mean sleep latency less than or equal to 8 minutes and two or more sleep onset REM periods
DONT NEED TO KNOW C AND D
specify if (narcolepsy)
Whether with/without cataplexy or hypocretin deficiency
Mild
Need for naps only once or twice per day. Sleep disturbance, if present, is mild. Cataplexy, when present, is infrequent (occurring less than once per week)
Moderate
Need for multiple naps daily. Sleep may be moderately disturbed. Cataplexy, when present, occurs daily or every few days
Severe
Nearly constant sleepiness and, often, highly disturbed nocturnal sleep (which may include excessive body movement and vivid dreams). Cataplexy, when present, is drug resistant, with multiple attacks daily
Breathing related sleep disorders
Experience of repeated disruptions of sleep due to respiratory problems
Subtype: obstructive sleep apnea hypopnea syndrome
obstructive sleep apnea hypopnea syndrome
Aka obstructive sleep apnea
Involves repeated episodes during sleep of snorting or gasping for breath, pauses of breath, or abnormally shallow breathing
Loud snoring
Occurs when airways become narrowed or blocked during sleep
Leads to excessive daytime sleepiness, fatigue, and complaints of unrefreshing sleep
Middle-aged and older adults; affects men more
Linked to hypertension and other cardiovascular issues
Circadian rhythm sleep-wake disorders
Involve a persistent disruption of the person’s natural sleep-wake cycle
Can lead to insomnia or hypersomnolence and result in daytime sleepiness
Impairs a person’s ability to function in social, occupational, or other roles
Treatment - a program of gradual adjustments in the sleep schedule
Circadian rhythm sleep-wake disorders criteria
A) A persistent or recurrent pattern of sleep disruption that is primarily due to an alteration of the circadian system to a misalignment between the endogenous circadian rhythm and the sleep-wake schedule required by an individual’s physical environment or social or professional schedule e
B) The sleep disruption leads to excessive sleepiness or insomnia, or both
C) The sleep disturbance causes clinically significant distress or impairment in social, occupational, and other important areas of functioning
Circadian rhythm sleep-wake disorders specify if (type)
Delayed sleep phase type
Advanced sleep phase type
Irregular sleep-wake type
Non 24 sleep wake type
Shift work type
Circadian rhythm sleep-wake disorders specify if (NOT TYPE)
Episodic
Symptoms last at least 1 month but less than 3 months
Persistent
Symptoms last 3 months or longer
Recurrent
Two or more episodes occur within the space of 1 year
Parasomnias (not definition)
parasomnias
sleep terrors
sleepwalking
rapid eye movement sleep behavior disorder
nightmare disorder
Parasomnias
Abnormal behavior patterns associated with partial or incomplete arousals
Sleep terrors
Recurrent terror arousal during sleep, typically outgrow by adolescence
Sleepwalking
Complex motor responses completed out of consciousness
Rapid eye movement sleep behavior disorder
Paralysis is absent or incomplete, leading to movement and action during sleep
Nightmare disorder
Related to stress and trauma, vividly remembered intense nightmares
Biological approaches
Treatment of Sleep-Wake Disorders
Antianxiety drugs (benzodiazepines)
Sleeping medications (Ambien)
Decrease in arousal, inducing calm feeling
Good at getting to sleep, not getting good quality sleep
Physiological and psychological dependence
Stimulants for narcoleptics/hypersomnolence
Psychological approaches Treatment of Sleep-Wake Disorders
CBT
- Stimulus control
- Changes in sleep environment
- Consistent sleep/wake cycle
- Addressing self defeating thoughts related to sleep
Psychodynamic
- Address energizing conflicts and concerns
- Mindfulness training
Sleep Hygiene (list)
exercise
napping
having a bedtime routine
relaxation
exercise
Physiological arousal created by exercise opposes the sleep process
- Avoid exercise within 3 hours of bedtime
- Exercising regularly during the afternoon or early evening hours enhances sleep quality but there’s a caveat
Napping
Naps of less than 30 minutes can be useful in the mid afternoon, avoid long naps
Longer naps can make you drowsy and interfere with a good night’s sleep
Having a bedtime routine
Stick to a specific bedtime and wake time
- Works on circadian rhythm
Having a bedtime routine decreases insomnia and increases daytime alertness
Relaxation
Read a book
Listen to calm music
Meditation
avoid… (sleep hygiene)
Avoid arousing activities before bedtime (loud music, television, stressful work)
Avoid computers before bedtime (refrain from looking at the bright LCD screen for 45 - 60 minutes before sleep)
bedroom setting (sleep hygiene)
Comfortable
Dark
Quiet
Things that can help (sleep hygiene)
Black out curtains
White noise (fans, humidifiers)
Ear plugs
