Lecture 6: Eating and Sleep Disorders Flashcards
Three major types of DSM-V-TR eating disorders
- anorexia nervosa
- bulimia nervosa
- binge eating disorder
eating disorders involve
- severe disruptions in eating behaviour
- extreme fear and apprehension about gaining weight
- strong sociocultural origins
Bulimia nervosa
- eating larger amounts of food (usually junk food)
- eating is experienced as “out of control”
- almost always purging techniques
- vomiting, laxatives, diuretics, fasting, excessive exercise
- 57& exercise excessively
2 subtypes of bulimia nervosa
- purging type (2/3 cases)
- non purging type
medical consequences of bulimia nervosa
- salivary gland enlargement
- dental enamel erosion (inner surface of front teeth)
- electrolyte imbalance can lead to cardiac arrhythmia, renal failure
- increase in mood disorders and substance abuse
anorexia nervosa
- nervous loss of appetite
- less common than Bulimia (there is overlap between the two disorders)
- lives are put in danger because they are so successful at losing weight
- proud of their diets and self-control
- intense fear of obesity (punishing exercise common)
diagnosis of anorexia nervosa
- body weight 15% below what is expected and marked disturbance in body image
- e.g. 150lb - 15% = 127lb where Dr. can diagnose
2 types of anorexia nervosa
- restricting type
- binge-eating-purging type (diff than bulimia: smaller amounts of food and consistent purges)
medical consequences of anorexia nervosa
- amenorrhea
- dry skin, brittle hair/nails, sensitivity to cold
- common to see lanugo (downy hair on limbs)
- cardiovascular problems (low bp and HR)
- if vomiting, bulimia consequences
Anorexia and Bulimia Statistics
Bulimia:
- became a distinct disorder in 1970s
- 90-95% are women
- sometimes in men (often athletes)
- onset 16-19
- 6-8% women on uni campuses
- lifetime prevalence 1.1% female and 0.1% male
Anorexia:
- 90-95% female
- onset age 13
- more chronic and more resistant to treatment than Bulimia
Causes of eating disorders
- Social Dimensions
- most culturally specific disorder diagnosed
- strong relationships between media and eating disorder symptoms
- friendship cliques are important to eating behaviours and body image - Family Influences
- the family is often successful, hard-driving, concerned about external appearances
- often deny or ignore conflicts
- mothers = society’s messengers in wanting daughters to be thin - Biological Dimensions
- genetic component (tends to run in families)
- emotional instability
- poor impulse control
- hypothalamus involvement and major neurotransmitter systems
- low serotonin associated with impulsivity and binge - Psychological Dimensions
- diminished sense of personal control and confidence
- perfectionistic (must first consider themselves overweight)
- low self-esteem
- preoccupied with appearances
- perceive themselves as frauds
- distortions in perceptions of body shape
Binge-eating disorder
- engage in food binges but do not engage in compensatory behaviours
- associated with 3+ of the following:
- eating rapidly
- eating until feeling uncomfortably full
- eating large portions when not hungry
- eating alone due to embarrassment
- feeling disgusted at oneself
features of the binge-eater
- many are obese
- most are older than bulimics and anorexics
- more psychopathology than obese people who do not binge
- share similar concerns as anorexics and bulimics regarding shape and weight
types of sleep-wake disorders
- insomnia disorder
- hypersomnolence disorder
- narcolepsy
- breathing-related sleep disorder
- circadian rhythm sleep-wake disorder
- non-rapid eye movement (NREM) sleep arousal disorder
- restless legs syndrome
- substance/medication-induced sleep disorder
methods of assessing disordered sleep
- polysomnographic evaluation (PSG)
- electroencephalography (EEG) leg movements and brain wave activity
- electrooculography (EOG) eye movements
How much do we sleep?
- we spend 1/3 of our lives sleeping
- ideal amount 5-9+ hours
- infants: up to 16 hours/day
-early adulthood 7-8 hours
-age 50+ often 6 or less
2 major categories of sleep disorders
- dyssomnias: difficulties in getting enough sleep, problems sleeping when you want to, complaints about the quality of sleep
- parasomnias: characterized by abnormal behavioural or physiological events that occur during sleep
Insomnia Disorder
- one of the most common sleep disorders
- isn’t being awake all the time (after 40 hours, micro sleeps start to occur)
- difficulties initiating, maintaining sleep, or if sleep is non-restorative
- not related to other medical or psychiatric problems
- 1/3 of the population report some symptoms in a given year
- more freq. with women 1.3:1
- increases with age
Primary Insomnia causes
- sometimes problems with biological clock and temperature regulation
- delayed temperature rhythm
- higher body temperature as a group as less variation in body temperature
- drug use
- environmental characteristics
- psychological stressors
- unrealistic expectations about how much sleep they need
- learned behaviour (associate bedroom with insomnia)
- in children (sleeping with parents for first few months/years)
Hypersomnolence Disorder
- excessive sleepiness (in class, driving, etc.)
- get sufficient sleep at night, may awake refreshed but still complain of excessive sleepiness
- need to rule out insomnia, sleep apnea, or other reasons
- sig. subgroup were exposed to viral infection
Narcolepsy
- daytime sleepiness and cataplexy: sudden loss of muscle tone
- rare: affected 0.02-0.05% of the adult general pop
- can range in weakness in facial muscles to complete collapse
- cataplexy can last several seconds to several minutes (often preceded by strong emotion)
- narcoleptics commonly report:
- sleep paralysis: a brief period after awakening when they can’t move or speak
- hypnagogic hallucinations: vivid illusions/experiences at the beginning of sleep
What is breathing-related sleep disorder
- sleepiness during the day or disrupted sleep at night
- interrupted breathing and brief arousals
- muscle in upper airway normally relax but if excessive, breathing very difficult
- if breathing stops altogether: sleep apnea
- person only minimally aware of the breathing difficulties but a bed partner will notice loud snoring or interrupted breathing
- heavy sweating at night, morning headaches, sleep attacks during day
- more common in males and overweight
-CPC machine forces air and prevents hypoventilation
treatment of insomnia
Medical:
- prescription drugs or OTC meds
- benzodiazepines often prescribed
- may cause dependence, effectiveness is short-term can lead to rebound insomnia
obstructive sleep apnea: often offer mechanical breathing devices, medications can help, surgery if severe
Psychological:
- cognitive: change unrealistic expectations
- cognitive relaxation: meditation ro imagery
- paradoxical intention: involves instructing people in the opposite behaviour from the desired outcome
- progressive relaxation: relaxing muscles of the body to introduce drowsiness
good sleep habits
- set bedtime routine
- regular bedtime and time to awaken
- eliminate food/drink with caffeine 6 hours prior to bedtime
- limit use of alcohol and tobacco
- go to bed only when sleepy
- balanced diet (lower fat)
- exercise
- reduce noise/light
- increase exposure to natural and bright light during the day
- avoid extreme temperature changes in the bedroom
types of parasomnias
abnormal events during sleep or between sleeping and waking
1. nightmares
20% children, 5-10% adults
2. sleep terrors
children up to 5%
3. sleepwalking
