Eating Disorders and Sleep Disorders
Eating Disorders and Sleep Disorders
Alice Cheng, Ph.D.
University of Hartford
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Eating Disorders
The two most common forms of eating disorders are
anorexia nervosa
bulimia nervosa
At the heart of both disorders is
an intense and pathological fear of becoming overweight and fat
a pursuit of thinness that is relentless and sometimes deadly
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Anorexia Nervosa
Anorexia nervosa is characterized by
a fear of gaining weight
a refusal to maintain a normal weight
There are two types of anorexia nervosa:
restricting type
binge-eating/purging type
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Eating Disorders
Results of a large, population based survey indicate that anorexia affects about 0.9% of women in our society (about 9 in 1,000).
Bulimia is believed to affect about 1% to 3% of women.
Rates of anorexia and bulimia among men are estimated at about 0.3% (3 in 1,000) for anorexia and 0.1% 0.3% (1 to 3 in a thousand) for bulimia.
Many men with anorexia participate in sports, such as wrestling, that impose pressures on maintaining weight within a na
ow range.
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Overview of Eating Disorders
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DSM-IV-TR criteria
Refusal to maintain body weight at or above a minimally normal weight for age and height (e.g. weight loss leading to maintenance of body weight less than 85% of that expected; or failure to make expected weight gain during period of growth, leading to body weight less than 85% of that expected).
Intense fear of gaining weight or becoming fat, even though underweight.
Distu
ance in the way in which one's body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or denial of the seriousness of the cu
ent low body weight.
In postmenarcheal females, ameno
hea, i.e., the absence of at least three consecutive menstrual cycles. (A woman is considered to have ameno
hea if her periods occur only following hormone, e.g., estrogen, administration.)
Subtypes of Anorexia
There are two general subtypes of anorexia:
A binge eating/purging type and a restrictive type.
The first type is characterized by frequent episodes of binge eating and purging; the second type is not.
Individuals with the eating/purging type tend to have problems relating to impulse control, which in addition to binge-eating episodes may involve substance abuse or stealing.
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Anorexia Nervosa
The mortality rate for females with anorexia nervosa is more than twelve times higher than the mortality rate for females aged 15–24 in the general population
http:
www.youtube.com/watch?v=VS2mfWDryPE&feature=channel
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Medical Complications of Anorexia
Losses of as much as 35% of body weight may occur, and anemia may develop.
Females suffering from anorexia are also likely to encounter dermatological problems such as dry, cracking skin; fine, downy hair; even a yellowish discoloration of the skin that may persist for years after weight is regained.
Cardiovascular complications include heart i
egularities, hypotension (low blood pressure), and associated dizziness upon standing, sometimes causing blackouts.
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Bulimia Nervosa
Bulimia nervosa is characterized by
frequent episodes of binge eating
lack of control over eating
recu
ent inappropriate behavior to prevent weight gain
Unlike patients with anorexia nervosa, bulimic patients are typically of normal weight
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Bulimia Nervosa
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Medical Complications of Anorexia Nervosa and Bulimia Nervosa
Anorexia can lead to
death from heart a
hythmias
kidney damage
renal failure
Bulimia can lead to
electrolyte imbalances
hypokalemia (low potassium)
damage to hands, throat, and teeth from induced vomiting
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Eating Disorders and Other Forms of Psychopathology
Eating disorders are associated with the following disorders:
Clinical depression
Obsessive-compulsive disorde
Substance abuse disorders
Various personality disorders
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Prevalence of Eating Disorders
The lifetime prevalence of anorexia nervosa is around 0.5%
The lifetime prevalence of bulimia is around 1–3%
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Eating Disorders Across Cultures
Eating disorders are becoming a problem worldwide
The attitudes that lead to eating disorders are more common in Whites and Asians than African Americans
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21%
Partially
Recovered
Course and Outcomes
Löwe and colleagues XXXXXXXXXXlooked at the clinical outcomes of patients with anorexia nervosa 21 years after they had first sought treatment
16%
No Longer
Alive
10%
Not Recovered
51%
Fully Recovered
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Causes of Anorexia and Bulimia
Like other psychological disorders, anorexia and bulimia involve a complex interplay of factors (Polivy & Herman, 2002).
Most significant are social pressures that lead young women to base their self-worth on their physical appearance, especially their weight.
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Sociocultural Factors
The pressure to achieve an unrealistic standard of thinness, combined with the importance attached to appearance in defining the female role in society, can lead young women to become dissatisfied with their bodies (Stice, 2001).
These pressures are underscored by findings that among college women in one sample, 1 in 7 (14%) reported that buying a single chocolate bar in a store would cause them to feel emba
assed (Rozin, Bauer, & Catanese, 2003).
In another study, peer pressure to adhere to a thin body shape emerged as a strong predictor of bulimic behavior in young women (Young,McFatter,& Clopton, 2001).
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Sociocultural Factors
Exposure to media images of ultrathin women can lead to the internalization of a thin ideal, setting the stage for body dissatisfaction (Blowers et al., 2003; Cafri et al., 2005).
Even in children as young as eight, girls express more dissatisfaction with their bodies than do boys (Ricciardelli & McCabe, 2001).
Body mass index (BMI) - A standard measure of overweight and obesity that takes both body weight and height into account.
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Thinner and thinner.
Note the downward trend in the body mass index levels (BMIs) of Miss America contest winners over time. What might these data suggest about changes in society’s view of the ideal female form?
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Risk and Causal Factors in Eating Disorders
Women rate their body shape as heavier than their ideal and heavier than what they think is attractive
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Risk and Causal Factors in Eating Disorders
Adapted from A.E. Fallon & P. Rozin, “Sex Differences in Perception of Desirable Body Shape.” Journal of Abnormal Psychology, XXXXXXXXXX): XXXXXXXXXX
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Own ideal
Cu
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Attractive
Peer ideal
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Risk and Causal Factors in Eating Disorders
Men rate their body shape as close to both their ideal and what they think is attractive
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Risk and Causal Factors in Eating Disorders
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Own ideal
Cu
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Attractive
Peer ideal
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Family Factors
Eating disorders frequently develop against a backdrop of family problems and conflicts.
Some theorists focus on the
utal effect of self-starvation on parents.
They suggest that some adolescents refuse to eat to punish their parents for feelings of loneliness and alienation they experience in the home.
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Family Factors
Families of young women with eating disorders tend to be more often conflicted, less cohesive and nurturing, yet more overprotective and critical than those of reference groups (Fai
urn et al., 1997).
The parents seem less capable of promoting independence in their daughters.
Conflicts with parents over issues of autonomy are often implicated in the development of both anorexia nervosa and bulimia.
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Biological Factors
Low levels of the chemical, or lack of sensitivity of serotonin receptors in the
ain, may prompt binge-eating episodes, especially ca
ohydrate bingeing (Levitan et al., 1997).
This line of thinking is buttressed by evidence that antidepressants, such as Prozac, which increases serotonin activity, can decrease binge-eating episodes in bulimic women (Walsh et al., 2004).
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Risk and Causal Factors in Eating Disorders
Nearly all instances of eating disorders begin with normal dieting
Other risks factors include
negative affect
perfectionism
Childhood sexual abuse may play a role
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Treatment of Eating Disorders
Common treatments of anorexia nervosa include
emergency procedures to restore weight
cognitive-behavioral therapy
Interpersoanl therapy
antidepressants or other medications
family therapy
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Treatment of Eating Disorders
Common treatments of bulimia nervosa include
antidepressants or other medications
cognitive-behavioral therapy
Little is known about treatment of binge-eating disorder, but cognitive-behavioral therapy techniques look promising
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Binge-Eating Disorde
Binge-eating disorder (BED) - A disorder characterized by recu
ent eating binges without purging; classified as a potential disorder requiring further study.
Binge-eating disorder is classified in the DSM manual as a potential disorder requiring further study.
Too little is known about the characteristics of people with BED to include it as an official diagnostic category.
However, we do know that BED is more common than either anorexia or bulimia, affecting about 3% of women and 2% of men at some point in their lives.
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Sleep Disorders
Sleep Disorders
Sleep disorders - Persistent or recu
ent sleep-related problems that cause distress or impaired functioning.
People with sleep disorders may spend a few nights at a sleep center, where they are wired to devices that track their physiological responses during sleep or attempted sleep—
ain waves, heart and respiration rates, and so on.
The DSM groups sleep disorders within two major categories: dyssomnias and parasomnias.
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Types of Sleep Disorders
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Dyssomnias
Dyssomnias - Sleep disorders involving distu
ances in the amount, quality, or timing of sleep.
There are five specific types of dyssomnias:
Primary insomnia
Primary hypersomnia
Narcolepsy
Breathing-related sleep disorde
Circadian rhythm sleep disorder.
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Insomnia
Insomnia - Difficulties falling asleep, remaining asleep, or achieving restorative sleep.
Primary insomnia - A sleep disorder characterized by chronic or persistent insomnia not caused by another psychological or physical disorder or by the effects of drugs or medications.
Chronic insomnia lasting a month or longer is often a sign of an underlying physical problem or a psychological disorder, such as depression, substance abuse, or physical illness.
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Hypersomnia
The word hypersomnia is derived from the Greek hyper, meaning “over” or “more than normal,” and the Latin somnus, meaning “sleep.”
Hypersomnia - A pattern of excessive sleepiness during the day.
The excessive sleepiness (sometimes refe
ed to as “sleep drunkenness”) may take the form of difficulty awakening following a prolonged sleep period (typically 8 to 12 hours).
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Narcolepsy
The word narcolepsy derives from the Greek narke, meaning “stupor” and lepsis, meaning “an attack.”
Narcolepsy - A sleep disorder characterized by sudden, i
esistible episodes of sleep.
They remain asleep for about 15 minutes.
The person can be in the midst of a conversation at one moment and slump to the floor fast asleep a moment later.
http:
www.youtube.com/watch?v=-zVCYdrw-1o
http:
www.youtube.com/watch?v=_OuEDV1hBYw
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Breathing-Related Sleep Disorde
Breathing-related sleep disorder - A sleep disorder in which sleep is repeatedly disrupted by difficulty with
eathing normally.
The subtypes of the disorder are distinguished in terms of the underlying causes of the
eathing problem.
The most common type is obstructive sleep apnea, which involves repeated episodes of either complete or partial obstruction of
eathing during sleep.
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Circadian Rhythm Sleep Disorde
Circadian rhythm sleep disorder - A sleep disorder characterized by a