Eating and sleep Wake disorders

Question 1

Eating Disorders Overview

Answer 1

• 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

Question 2

Bulimia Nervosa

Answer 2

• 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

Question 3

Bulimia Associated features (medical, psychological)

Answer 3

• 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

Question 4

Anorexia Nervosa: Overview

Answer 4

• 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)

Question 5

DSM V Criteria Anorexia nervosa

Answer 5

• 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

Question 6

Anorexia Nervosa: associated features (medical and psychological)

Answer 6

• 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
• Psychological features
  
  • Disturbance in body image
  • Most have comorbid psychological disorders
    
    • 70% depression at some point
    • higher than average substance abuse and OCD

Question 7

Binge eating overview

Answer 7

• 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

Question 8

Binge Eating DSM criteria

Answer 8

• 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

Question 9

Associated Features Binge eating

Medical psychological

Answer 9

• 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

Question 10

Bulimia and Anorexia Facts and Statistics

Answer 10

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

Question 11

Demographic differences Anorexia and Bulimia

Answer 11

• 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

Question 12

Media and cultural considerations

Answer 12

• 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

Question 13

Family influences Eating disorders (social and biological)

Answer 13

• 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

Question 14

ED psychological dimensions

Answer 14

• 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

Question 15

Treatments Psychosocial Bulimia and binge eating

Answer 15

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

Question 16

Anorexia Treatment

Answer 16

• 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

Question 18

Introduction to sleep wake disorders: importance of sleep

Answer 18

• 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

Question 19

Types of Sleep dysorders

Answer 19

• Dyssomnias: difficulties in amount quality or timing of sleep
• Parasomnias: abnormal behaviors during sleep

Question 21

Insomnia Disorder

Answer 21

• 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
  *

Question 22

Insomnia Disorder Facts and Statistics

Answer 22

• 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

Question 23

Insomnia: Causes

Answer 23

• 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

Question 24

Hypersomnia

Answer 24

• 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

Question 25

Narcolepsy

Answer 25

• 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

Question 26

Circadian Rhythm Sleep Wake disorder

Answer 26

• 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

Question 27

SLeep wake disorders: Evaluation (Measuring methods

Answer 27

• 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

Question 28

Biological Treatments for sleep disorders: insomnia, Hypersomnia/narcolepsy, Circadian rhythm sleep-wake disorders

Answer 28

• 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

Question 29

Psychological treatments for sleep disorders

Answer 29

• 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)

Question 30

Preventing sleep disorders

Answer 30

• 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

Question 31

Para somnias

Answer 31

• 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

Question 32

Sleep terrors and sleepwalking

Answer 32

• 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