Eating and sleep Wake disorders Flashcards
1
Q
Eating Disorders Overview
A
- Three major types: anorexia nervosa, Bulimia, binge eating disorder
- All involve severe disruptions in eating behavior
- AN and BN involve extreme preoccupation w weight
- BED involves less distortions about weight
2
Q
Bulimia Nervosa
A
- Binge eating: hallmark of bulimia
- Eating excessive amounts in a discrete period of time
- Eating is perceived as uncontrollable
- may be associated w guilt shame or regret
- may hide behavior from family members
- foods consumed often in fat sugar or carbs
- Compensatory behavior to prevent weight gain
- Purging: use of diuretics, laxatives, self-induced vomiting– most common
- Excessive exercise
- Fasting or food restriction (must coincide w binging)
- Once a week for at least 3 months
- Self-evaluation influenced by body shape and weight
3
Q
Bulimia Associated features (medical, psychological)
A
- Medical
- most are within 10% of normal body weight
- purging can result in severe medical problems
- Erosion of dental enamel, electrolyte imbalance (laxatives), kidney failure, cardiac arrhythmia, seizures, intestinal problems, permanent colon damage
- psychological features
- Concern w body weight
- Most are comorbid w psychological disorders
4
Q
Anorexia Nervosa: Overview
A
- Extreme weight loss- hallmark of anorexia
- intense fear of weight gain
- often begins w dieting
- restriction of calorie intake below energy requirements
- sometimes 15% below expected weight
- Self control and pride with weight loss as opposed to feeling out of control and trying to hide it (as occurs in bulimia)
5
Q
DSM V Criteria Anorexia nervosa
A
- Restriction of aloric intake that lead to significantly low body weight
- Intense fear of gaining weight
- Overemphasis on body weight or shape in self-evaluations or denial of current low weight
- Subtypes
- Restricting
- Binge-eating-purging:
- Not binging as much as bulimia purging more
- Severely underweight in anorexia not bulimia
6
Q
Anorexia Nervosa: associated features (medical and psychological)
A
- Medical
- Most deadly mental disorder
- 20% may die as a result
- starving body borrows energy from organs leading to damage
- Also leads to loss of periods, dry/brittle hair and nails, electrolyte imbalance, decreased cognitive functioning, electrolyte imbalance
- Most deadly mental disorder
- Psychological features
- Disturbance in body image
- Most have comorbid psychological disorders
- 70% depression at some point
- higher than average substance abuse and OCD
7
Q
Binge eating overview
A
- Binge eating without compensatory features
- Associated with distress or functional impairment
- Excessive concern with weight not present
- More often in men
- Better response to treatment than other EDs
8
Q
Binge Eating DSM criteria
A
- Recurrent binge eating:
- eating large amount than is typical for others in that situation
- Lack of control
- At least three of the following
- Eating more rapidly than normal
- Eating until uncomfortably full
- eating alone due to embarassment about large amounts of food
- Feeling disgusted with oneself or guilty after eating
- Distress
- At least 1x per week on average for 3 weeks
9
Q
Associated Features Binge eating
Medical psychological
A
- Medical
- Often overweight or obese
- Psychological
- May or may not have concerns about body weight and shape
- Emotional or night eating e.g. eating when depressed or bored
- More psychopathology than non-binging obese individuals
- Some transition to bulimia
10
Q
Bulimia and Anorexia Facts and Statistics
A
Bulimia:
- Most common eating disorder
- More prevalent in women than men (but men rising)
- Chronic if untreated especially if lifetime preoccupation with body (can be family induced)
- Common in college-age women (5-8%)
- onset 16-19 years old
Anorexia
- Majority female and white
- Middle and upper-middle-class families
- More chronic resistant to treatment than bulimia
- age of onset around 13
11
Q
Demographic differences Anorexia and Bulimia
A
- Gender differences
- Bodily concerns primarily thinnes women & muscle for men
- Men most common subgroups
- Gay/bi men
- Sports concerned with weight class
- Ethnic considerations
- Older research showed less prevalence in African American women but the disparity is decreasing (idea that African American men liked larger women in the past)
- Cross cultural factors
- mostly in western world
- non-western women may develop after moving to western countries
- Strong socio-cultural origins for ED
12
Q
Media and cultural considerations
A
- Media and cultural considerations
- Thinness associated with success
- Cultural emphasis on dieting
- Standards of ideal body size
- Thinnes is not possible for many, society still puts value in “thin ideal”
- Standard leads to low self-esteem and burden for overweight and obese individuals
13
Q
Family influences Eating disorders (social and biological)
A
- Parents with distorted perception of food intake may restrict childrens intakes too
- Families of anorexic individuals
- High achieving
- Concerned with external appearances
- Overly motivated to maintain harmony (anorexia form of coping if there is no open communication in family)
- Disordered eating also causes family strains: parental guilt and frustration which leads to poorer outcomes
- Some genetic components
- More likely to develop if family has
- Could be due to inherited personality traits like emotional instability or impulsivity
- Some evidence of NT and Hormone dysregulation in eating disorders
14
Q
ED psychological dimensions
A
- Low sense of personal control and self confidence
- Socially competitive environment
- Perfectionistic attitudes
- Distorted body image
- preoccupation with food
- Extreme self-focus– especially in performing arts (e.g. dancing where looking at self in the mirror constantly)
- Distress intolerance: using compensatory behavior to feel better regulated mood
15
Q
Treatments Psychosocial Bulimia and binge eating
A
CBT
- Address maladaptive beliefs (e.g. “I’m overweight so no one will love me)
- Psychoeducation (health consequences; awareness of hunger and satiation cues)
- food logs (but could lead to obsession, should be for informational purposes)
- Treat comorbid anxiety/depression
- Binge eating: including weight loss strategies
Medication
Andidepressants
- SSRIs can help reduce binging and purging behaviors
- Not efficacious long run
16
Q
Anorexia Treatment
A
- General goals and strategies
- Weight restoration: first and easiest goal
- Psychoeducation
- Cognitive and behavioral interventions
- Target distortions about food and weight
- provide healthier ways to cope with negative thoughts and emotions
- Treatment often involves family– especially with youth
- Depending on the severity, inpatient program might be suggested
- Medication is generally ineffective
17
Q
A
18
Q
Introduction to sleep wake disorders: importance of sleep
A
- Average adult needs ~8.4 hours of sleep (for full restorative properties)
- Functionality varies widely
- A few hours of sleep deprivation decreases immune functioning
- Sleep deprivation affects: energy mood memory attention
- Sleep loss can bring feelings of depression
- paradoxically can have an antidepressant effect in depressed individuals
19
Q
Types of Sleep dysorders
A
- Dyssomnias: difficulties in amount quality or timing of sleep
- Parasomnias: abnormal behaviors during sleep
20
Q
A
21
Q
Insomnia Disorder
A
- One of most common sleep disorders
- Problems falling asleep, waking up at night or waking up in morning
- Distress
- Occurs 3 times a week or more
- lasts for at least 3 months
- Difficulty occurs even when possibility for sleep
- Not better explained by other disorder
- 15% report daytime sleepiness
*
22
Q
Insomnia Disorder Facts and Statistics
A
- Common 1/3 population experiences occasional insomnia during the year
- Ofter associated with medical or psychological conditions
- anxiety, depression substance use
- Females twice as common as males
- Associated features
- Unrealistic expectations of sleep (e.g. “I need 8 hours of sleep to function)
- Belief that lack of sleep is more disruptive than it is
- Maladaptive expectations about sleep intervene with ability to sleep
23
Q
Insomnia: Causes
A
- Pain physical discomfort
- Delayed temperature rhythm
- Body temp doesn’t drop til later so drowsiness doesn’t occur
- light, noise, room temp, all affect ability to sleep
- Other disorders cause secondary insomnia
- apnea
- Periodic limb movement disorder (jerky leg movements occurring every 20-40 seconds)
- Stress and Anxiety
- Parental effects on children’s sleep
- Parents negative beliefs about sleep linked to more infant waking during night
- some kids learn to fall asleep only with parent present
24
Q
Hypersomnia
A
- Sleeping too much
- Long nights or frequent napping
- Causes excessive sleepiness
- Causes not well understood bc limited research
- Often associated with other medical and/psychological conditions (e.g. depression)
- Only diagnosed if other conditions don’t adequately explain hypersomnia
- Associated features
- Complain of sleepiness through the day
- Ab;e to sleep through the night
25
Narcolepsy
* Principal symptom: recurrent intense need for sleep, lapses into sleep, or napping
* Going into REM fast (skips first two stages of sleep)
* Thought to be caused by hypocretin deficiency
* Hypocretin = NT that sustains alertness and prevents REM sleep from occurring at wrong time
* Rare .03-.16% population
* Equally distributed
* Adolescent onset
* Improves over time
26
Circadian Rhythm Sleep Wake disorder
* Disturbed sleep (insomnia or excessive sleepiness during day) due to brains inability to syncronize brains sleep patterns with day and nigh
* Different types/causes:
* Jet lag: rapidly cross multiple time zones
* Shift work: irregular hours
* Familial type: associated w family history of irregular sleep patterns
* Delayed or advanced sleep phase: persons natural clock naturally set earlier or later than a normal bedtime
* Suprachiasmatic nucleus, which secretes melatonin and regulates day and nigh time is involved
* Leads to distress/impairement
27
SLeep wake disorders: Evaluation (Measuring methods
* Polysonmographic (PSG) evaluation of sleep
* Electroencephalograph (EEG) brain waves
* Electroculograph (EOG): eye movements
* Electromyography (EMG) muscle movements
* Actigraph: portable wearable device (looks like a watch) sensitive to movement can detect different stages of wakefulness
* Detailed history and assessment of sleep hygeine and sleep efficiency
28
Biological Treatments for sleep disorders: insomnia, Hypersomnia/narcolepsy, Circadian rhythm sleep-wake disorders
* Insomnia
* Benzodiazepines and over the counter medication (can lead to further dependence)
* Prolonged use can cause rebound insomnia, dependence
* Hypersomnia/narcolepsy: stimulants (e.g.) ritalin
* Circadian rhythm sleep wake disorders
* Phase delay: moving bedtime later (best approach)
* Phase advances: moveing bedtime closer (harder to do)
* Use of bright light to trick brain
29
Psychological treatments for sleep disorders
* CBT for insomnia
* psychoeducation about sleep
* Changing beliefs about sleep (that one can't function on little sleep)
* Extensive monitoring using sleep diary
* Practicing better sleep habits
* Relaxation and stress reduction:
* reduce stress and assists with sleep
* modify unrealistic expectations about sleep (mindfulness "i'm having this thought about sleep, it's just a thought)
* Stimulus control procedures
* looking at patient's sleep habits and targeting behaviors interfering w sleep
* e.g. cutting down on caffeine, setting regular bedtime routine (especially for children)
30
Preventing sleep disorders
* Sleep hygiene
* Regular sleep schedule
* Avoid screens before bed
* don't exercise before bed
* create calm quiet setting
* don't watch tv in bed
* Avoid nicotine caffeine and alcohol before bed
* Educate parents about sleep habits for their kids
31
Para somnias
* Abnormal events during sleep or shortly after waking
* two major classes
* Occur during REM (i.e. dream) sleep
* Nighmare disorder: reoccuring dysphoric dreams in which individual is highly alert when awakens
* Occur during non REM
* Sleep terrors
* Sleep Walking
32
Sleep terrors and sleepwalking
* Sleep terrors
* Recurrent episodes of panic-like symptoms that occur during sleep
* More common in children
* More common in boys than girls
* Child cannot be easily awoken
* Child will likely not remember it the next day
* Sleep-walking disorder somnambulism
* usually during the first few hours of deep sleep
* Person must leave the bed
* seems to run in families
* more in children than adults
* tends to resolve on it's own
