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29 Cards in this Set
- Front
- Back
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Eating Disorders: General
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Types: Bulimia nervosa and Anorexia Nervosa
-disruptions in eating behavior -fear of gaining weight Obesity -65% of US adults are overweight -30% are obese Morbidly Obese- life complicating illness |
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Bulimia
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Binge eating disorder- eating excessive amounts of food that is percieved as 'out of control'
Compensatory Behaviors- compensates for binge -purging -excessive exercise -Fasting/laxitives **may not necessarily be trying to lose weight, rather than to compensate for the binge **binge eating disorder has a higher association wiht obesity than bulimia or anorexia Subtypes: Purging vs Nonpurging -Purging is most common-direct action to get food out, usually ineffective -Nonpurging only (6-8%) - exercise **Most bulimics are within 10% of normal weight range |
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Bulimia Consequences
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-Salivary gland enlargement
-Erosion of dental enamel -Electrolyte imbalance -Kidney failure -Cardiac arrhythmia -Seizures -Intestinal problems -Permanent colon damage Associated Psychological Disorders -Anxiety (75%)-Social phobia and GAD -Mood Disorders (50-70%) -Substance abuse (36.8%) |
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Anorexia Nervosa
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More keyed towards weight-loss
-overly successful weight loss -15% below expected weight -Intense fears of weight gain, or losing control of eating Subtypes: -Restricting: most common -Binge-eating-purging - it's possible to be anorexia when doing this, must be 85% less than normal weight range to meet criteria These patients are disturbed by their body images (too fat), have pride in their diet and control, rarely seek treatment |
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Anorexia Consequences
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Usually more life threatening than bulimia
-Amenorrhea -Dry skin -Brittle hair and nails -sensitivity to cold temps -Lanugo - peach fuzz hair -Cardiovascular problems -Electrolyte imbalance Associated Psychological Disorders -Anxiety: (OCD) - Mood disorders (33-60%) -Substance abuse -Suicide - rates among the highest if not highest out of all psych disorders |
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Binge-Eating Disorder
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Binges- patient experiences what they eat as too much whether or not other ppl think so. Subjective to person.
-**No compesatory behaviors** -in teh appendix of DSM -Experimental diagnostic category |
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Bulimia Stats
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Bulimia
-90-95% female Caucasian upper middle class Age 16-19 Lifetime prevalence: Females 1.1%, college females: 6-8% Chronic if untreated = older people may present symptoms of eating disorders along with other problems Bulimia in Men -5-10% male Caucasian upper middle class usually gay or bisexual, or athletes with weight regulations -onset is older in age |
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Anorexia Stats
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90-95% F
Caucasian upper middle class Onset 13-15 yrs Chronic Treatments don't work very well, patients tend to resist strongly |
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Causes of Eating Disorders (Social/Familial)
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Social Dimensions
-Cultural: thinness=happiness -Ideal body size standards -Media standards -Social/gender standards Dieting Family Influences -Typical family=successful/driven/concerned about appearance; History of dieting/eating disorders in mothers?* |
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Causes of Eating Disorders Biological/Psychological
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Biological
Heritability studies - inherited predisposition for impulsivity or perfectionism -Hypothalamus? Serotonin Psychological -Low sense of *control* -Low self-confidence -Perfectionistic attitudes -Distorted body image -Preoccupation with food/appearance -Mood intolerance - can't tolerate certain emotions so resort to disordered eating |
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Drug treatments of Eating Disorders
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Anorexia - no demonstrated efficacy
Bulimia - antidepressants - help to some degree as an augmentation of CBT, so may enhance psychological treatment, but don't work in the long run |
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Psychological Treatment for Bulimia
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CBT - cognitively targeting problem thoughts and eating behaviors
Stopping problem behavior Interpersonal psychotherapy - Improve interpersonal functioning - focuses more on developing person's sense of worth/self and hoping it translates to change in eating disordered behavior Similar long-term efficacy - but CBT may work quicker |
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Psychological Treatment of Binge-eating disorder
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CBT - similar to format of bulimia
Interpersonal Psychotherapy - as effective as CBT Medications - don't typically work for eating disorders Prozac, no benefit Meridia - possibly benefits by reducing feelings of hunger |
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Psychological Treatent of Anorexia
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Weight restoration is first step** is easier than weight sustainance
- may require hospitalization Psychoeducation - is not enough Target dysfunctional attitudes -body shape -control -Thinness = worth Family involvement -Communication about eating/food -attitudes about body/shape Long term prognosis is worse than bulimia |
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Preventing Eating Disorders
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Identify Specific Targets - early weight concerns
Screening for at -risk groups Provide education - normal weight limits, effects of calorie restriction |
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Sleep Disorders General
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Types:
Dyssomnias - How much sleep, when you fall asleep, how well you sleep Parasomnias - Abnormal behaviors, psychological events, night mares Polysomnographic evaluation (PSG) - detailed history -sleep hygiene & efficiency - healthy sleep behavior -EEG/EOG/EMG Psychophysiological assessment is common - several days watch while sleeping Actigraph - a kind of physiological test that measures movement |
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Dyssomnia: Insomnia
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-Primary insomnia - difficulty getting enough sleep that is unrelated to any other condition
33% (year) F:M 2:1 Frequently associated with Anxiety, depression, substance use |
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Insomnia: Causes
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-Pain physical discomfort
-Delayed temperature rhythm -Light, noise, temp -Other sleep disorders: Apnea - breathing troubles Periodic limb movement disorder -Stress -Anxiety -Cultural and social expectations -Poor sleep habits -Sleeping pills: short term are OK, habitual: will not work well afterward, insomnia may become worse - rebound insomnia |
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Dyssomnia: Hypersomnia
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Sleeping too much, excessive sleepiness, subjective experience as a problem
Primary Hypersomnia - Unrelated to other conditions, rare, 39% have family history, associated with exposures to viral infections |
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Dyssomnia: Narcolepsy
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Daytime sleepiness - not a nap, or tiredness: it's routine, suddenly fall asleep during the day
Cataplexy - suddenly muscles become limp Sleep paralysis - inability to move Hypnagogic hallucinations - see/experience things while halfway asleep Stats: .03-.16% F:M 1:1 Onset = adolescence Typically improves over time will persist w/o treatment |
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Dyssomnia: Breathing related disorders
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Daytime sleepiness
Disrupted sleep at night Sleep apnea - restricted air flow, brief cessations of breathing: keeps brain from having natural sleep cycle Stats: 10-20% F<M Associated with obesity/increasing age Treatment - lose weight, hook up to machines, surgery |
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Dyssomnia: Circadian Rhythm Disorders
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Insomnia/Hypersomnia
Inability to synchronize day vs night Suprachiasmatic nucleus - brain's biological clock, stimulates melatonin Types: jet lag, shift work |
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Medical Treatment of Sleep Disorders
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Benzodiazepines (xanax, valium)
-short term solutions -excessive sleepiness -rebound insomnia -dependence -sleep-walking (ambien) Hypersomnia/Narcolepsy -Stimulants (ritalin, amphetamine, modafrinil) are given and do work Cataplexy -antidepressants Breathing-related Sleep disorders -medications (tricyclics) -weight loss -mechanical devices/surgery |
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Environmental Treatments for Dyssomnias
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Circadian Rhythm Sleep Disorders
-phase delays - wait to sleep later= easier than force to sleep earlier -Phase advances -Phototherapy - bright lights to trick brain Stimulus control: imrpove sleep hygiene, regular bedtime routine - using a stimulus to engineer a behavior depending on the environment you're in -relaxation -reduce stress -modify unrealistic expectations about sleep -combined medication/behavioral treatments |
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Preventing Sleep Disorders
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Improving sleep hygiene
-setting regular sleep and wake up times -avoiding stimulants caffeine/nicotine Educating parents about child's sleep patterns |
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Parasomnias General
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Abnormal events during sleep or transition between sleep and waking
types: REM sleep NREM sleep (whether or not you're dreaming) |
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Parasomnias: Nightmare Disorder
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REM Sleep
Involves dreams -distressing/disturbing -disrupts sleep, causes awakening -interfere with funtioning More common in children Treatment: Most first line treatments = wait and see. antidepressants/relaxation training |
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Parasomnia: Sleep Terror Disorder
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nonREM sleep
-more common in children -piercing scream -signs of elevated arousal (sweating) -Very upset, difficult to wake up -little memory of the event Treatment: wait and see. Scheduled awakenings - before sleep terror onset Medications: antidepressants/benzodiazepines |
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Parasomnia: Sleep Walking Disorder
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Somnambulism(sleep walking)
NonREM sleep, usually during the first hours of deep sleep -person must leave bed -more common in children -difficult/not dangerous to wake' -genetic component -usually resolves on its own -Happens alot, becomes a disorder Related conditions -Nocturnal eating syndrome - person eats while asleep |
