Chapter 10: Eating Disorders, Obesity, and Sleep...
Transcript of Chapter 10: Eating Disorders, Obesity, and Sleep...
Chapter 10: Eating Disorders, Obesity, and Sleep Disorders
Rick Grieve, Ph.D.PSY 440Western Kentucky University
Eating Disorders
Becoming big concernPrevalence Rate– Age 15-19; Age 20-24– Over 8 million diagnosed with ED– 90% young women– 9% of girls had eating disorder– Scary stats with precursors of ED
Anorexia Nervosa
Diagnostic Criteria– Dread of being fat
Refusal to maintain a minimally normal body weight– Compulsion to be thin
Fear of gaining weight or being fat– Substantial weight loss
< 85% of ideal body weight< 17.5 BMI
Anorexia Nervosa
– Distorted external and internal perceptions of the body
Undue influence of body shape on self-evaluationFocus on one part of the bodyDenial of seriousness of current low body weightOverestimate of body width
– AmenorrheaAssociated Features– Inflexibility in thinking and behaving
Anorexia Nervosa
– Perfectionism– View achievements in black and white terms– Cognitive Difficulties
Types of AN– Restricting Type– Binge-Eating/Purging Type
Prevalence– 0.2-0.3% for females
0.5-0.8% for adolescent females
Anorexia Nervosa
– 0.02% for males– Increasing in recent years
Course– Age of onset is between 13 and 20 years– Begins with dieting– Seriously restricts food intake– Number of physical complications and even
death if not treated
Anorexia Nervosa
– Sometimes remits after 12 months, but usually continues for years
Do the symptoms go away with treatment?Nutritionally, clients can recover within 2-3 yearsRecovery rates
– Long-term problemsEtiology– Genetics– Gender additive model
Anorexia Nervosa
– Dieting– Dysfunctional Beliefs About Appearance– Societal Pressure– Media Influence– Sexual Abuse– Chaotic Family Life– Perfectionism– Need for Control– Early Maturation
Anorexia Nervosa
– Parental Influence– Neurological Findings
Treatment for AN– Efficacy for tx is limited due to dearth of studies– Goals of treatment
Keep client aliveEstablish adequate nutritionTreat physical complicationsCorrect abnormal eating habits
Anorexia Nervosa
Change family interaction patternEnhance self-control, identity, and autonomyCorrect defects in affect/behavior regulation
– Starts w/hospitalizationLow body weight/brain dysfunction connectionFed regularly in hospital
– Needs to be monitored– Client needs to gain ¼ to ½ pound per day– Some hospitals use strict behavioral program to
increase the likelihood of appropriate feedingInvoluntary hospitalization vs. compulsory treatment
Anorexia Nervosa
– Family TherapyParents should not be responsible for client careParents can see client after client begins to gain weightFocus is on re-establishing appropriate parent-child interactions
– Individual TherapyCBT
– Group Therapy– Medication
Bulimia Nervosa
“hunger of an ox”Diagnostic Criteria– Binge Eating
Eating in a discrete period of time an amount of food that is definitely larger than most people would eat over a comparable time periodFeeling out of control while eating
– Objective vs. Subjective binges
– Recurring inappropriate compensatory behavior designed to prevent weight gain
Bulimia Nervosa
– Both binge eating and compensatory behavior occur for a minimum 2x/wk for at least 3 months
– Self-evaluation is unduly influenced by body shape and weight
Reasons for Binge Eating– Dysphoria– Feeling anxious or tense– Craving certain foods– “can’t control appetite”
Bulimia Nervosa
– Hunger– Insomnia
Prevalence RatesAssociated Features– Preoccupied with appearance, body image,
sexual attractiveness– Preoccupied with how others perceive them– Alcohol & illicit drug use may help maintain BN– Drive for thinness– Perfectionism
Bulimia Nervosa
– Excessive drive for symmetry and exactnessBulimia: Continuous or Discontinuous?Etiology– Binge Eating– History of Weight Fluctuation– Frequent Exercise and/or Dieting– Negative Self-Evaluation– Parental Alcoholism– Low Levels of Parental Contact
Bulimia Nervosa
– High Levels of Neuroticism– High Levels of Parental Expectation– Genetic Evidence– Neurobiological Findings– Role of Puberty
Treatment for BN– Medical complications need to be addressed
first– Hospitalization
Not automatic, but there are times when it is necessary
Bulimia Nervosa
– Medication– Therapy
CBT– Components of CBT– Two Phases:
Break the Binge-Purge CycleFocus on Broad Areas of Behavior and Attitudes
Pretreatment variables associated with poor outcomePretreatment variables associated with drop out
Bulimia Nervosa
– Interpersonal Therapy– Group Therapy– Family Therapy– Combined Treatment
A brief word on preventing Eating Disorders
A Quick Word About Obesity and Obesity Treatment
Definition:– 25% over ideal body weight as defined by the
Metropolitan Life Scales– OR Body Mass Index (BMI) of > 30
60% of Americans are overweight– BMI 25-30
25% are obese
A Quick Word About Obesity and Obesity Treatment
Controversy over obesity treatment– Most treatments fail– Dieting and failure have huge psychological
costs– Morbidity and mortality have a curvilinear
relationship with weight– Dieting is not advisable
Successful treatments
Sleep Disorders
SleepDyssomnias– Primary Insomnia
Persistent difficulty in falling asleep, remaining asleep, or achieving restive sleepLasts more than 1 monthAssociated FeaturesPrevalence
Sleep Disorders
– HypersomniaPattern of excessive sleepiness during the day that continues for at least one monthDifficulty awakeningSleep episodes during the day, almost every dayNot accounted for by poor sleep the night beforeAssociated FeaturesPrevalence Rate
Sleep Disorders
– NarcolepsyCharacterized by sudden, irresistible sleep episodes at all times of the dayMust occur at least daily over the course of 3 monthsNeeds to have one of the following:
– Cataplexy– Intrusions of REM Sleep
Associated Features
Sleep Disorders
– Sleep paralysis– Hypnogogic hallucinations
Prevalence ratesEtiology
– Breathing-Related Sleep DisordersObstructive Sleep Apnea Syndrome
– Repeated episodes of complete or partial obstruction of breathing during sleep
– Associated Features– Prevalence Rates
Sleep Disorders
– Circadian Rhythm DisorderCircadian rhythm is grossly disturbed due to a mismatch between it and the sleep demands imposed by the environment
Parasomnias– Nightmare Disorder
Recurrent awakenings from sleep because of frightening nightmares
Sleep Disorders
– Sleep Terror DisorderRecurrent episodes of sleep terror that result in abrupt awkeningsOften found in childrenPrevalence rates
– Sleepwalking DisorderRepeated episodes in which the sleeper arises from bed and walks around the house while remaining fully asleepAssociated FeatuersPrevalence Rates
Sleep Disorders
Treatment for Sleep Disorders– Biological
Medication– Anxioytics– Benzodiazepines
– PsychologicalCBT
– Relaxation Training– Stress Management– Sleep Hygiene– Stimulus Control– Rational Restructuring
References
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References
DeAngelis, T. (2002c). Promising treatments for anorexia and bulimia: Research boosts support for tough-to-treat eating disorders. APA Monitor on Psychology, 33(3), 38-43.Epstein, L. H., Valoski, A., Wing, R. R., & McCurley, J. (1994). Ten-year outcomes of behavioral family-based treatment for childhood obesity. Psychological Bulletin, 101, 331-342.Fairburn, C. G., Welch, S. L., Doll, H. A., Davies, B. A., & O’Connor, M. E. (1997). Risk factors for bulimia nervosa: A community-based case-control study. Archives of General Psychiatry, 54, 509-517.Ferguson, C. P., & Pigott, T. A. (2000). Anorexia and bulimia nervosa: Neurobiology andpharmacotherapy. Behavior Therapy, 31(2), 237-264.French, S. A., Perry, C. L., Leon, G. R., & Fulkerson, J. A. (1995). Dieting behaviors and weight change history in female adolescents. Health Psychology, 14, 548-555.Halmi, K. A., Sunday, S. R., Strober, M., Woodside, D. B., Fichter, M., Treasure, J., Berrettini, W. H., & Kaye, W. H. (2000). Perfectionism in anorexia nervosa: Variation by clinical subtype, obsessionality, and pathological eating behavior. American Journal of Pschiatry, 157 (11), 1799-1805.Groesz, L. M., Levine, M. P., & Murnen, S. K. (2001). The effect of experimental presentation of thin media images on body satisfaction: A meta-analytic review. International Journal of Eating Disorders, 31, 1-16.Harvard Medical School (2002). Treatment of bulimia and binge eating. Harvard Mental Health Letter, 19 (1), 1-4.
References
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References
Shaw, H. E., & Stice, E. (2001). Body image and eating disturbances as risk factors for depression. The Prevention Researcher, 8(4), 10-11.Spangler, D. L. (2002). Testing the cognitive model of eating disorders: The role of dysfunctional beliefs about appearance. Behavior Therapy, 33 (1), 87-105.Stice, E., Schupak-Neuberg, E., Shaw, H. E., & Stein, R. I. (1994). Relation of media exposure to eating disorder symptomatology: An examination of mediating mechanisms. Journal of Abnormal Psychology, 103, 836-840.van Hoeken, D., Lucas, A. R., & Hoek, H. W. (1998). Epidemiology. In H. W. Hoek, J. L. Treasure, & M. A. Katzman (Eds.), Neurobiology in the treatment of eating disorders (pp. 97-126). New York: Wiley.Vogeltanz-Holm, N. D., Wonderlich, S. A., Lewis, B. A., Wilsnack, S. C., Harris, T. R., Wilsnack, R. W., & Kristjanson, A. F. (2000). Longitudinal predictors of binge eating, intense dieting, and weight concerns in a national sample of women. Behavior Therapy, 31(2), 221-236.Wade, T. D., Bulik, C. M., Sullivan, P. F., Neale, M. C., & Kendler, K. S. (2000). The relation between risk factors for binge eating and bulimia nervosa: A population-based female twin study. Health Psychology, 19(2), 115-123.
References
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