Chapter 8
Eating and Sleep
Disorders
Amber Gilewski
Tompkins Cortland Community College
Bulimia Nervosa
Binge Eating – Hallmark of Bulimia
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Binge -eating excess amounts of food
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Eating is perceived as uncontrollable
Compensatory Behaviors
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Purging -self-induced vomiting, diuretics,
laxatives
Some exercise excessively, whereas others fast
Bulimia Nervosa
Associated Medical Features

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Most are within 10% of target body weight
Purging methods can result in severe medical
problems
Erosion of dental enamel, electrolyte imbalance
Kidney failure, cardiac arrhythmia, seizures,
intestinal problems, permanent colon damage

Comorbid with other disorders (mood, anxiety,
substance abuse)
Anorexia Nervosa
Successful Weight Loss – Hallmark of Anorexia

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Defined as 15% below expected weight
Intense fear of obesity and losing control over
eating
Anorexics show a relentless pursuit of
thinness

Often begins with dieting

2 subtypes: restrictive & binge-eating/purging
Anorexia Medical Consequences
Amenorrhea – menstruation stops (most common)
Dermatological (skin) problems
Lanugo – hair on limbs
Cardiovascular problems
Gastrointestinal problems
Similar vomiting consequences as bulimia
Most are comorbid for other psychological disorders
Binge-Eating Disorder

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Experimental diagnostic category
Engage in food binges without compensatory
behaviors
Associated Features

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Many persons with binge-eating disorder are
obese
Concerns about shape and weight
Often older than bulimics and anorexics
More psychopathology vs. non-binging obese
people
Bulimia and Anorexia:
Facts and Statistics
Bulimia

Majority are female

Onset around 16 to 19 years of age

Lifetime prevalence is about 1.5% for females,
0.5% for males

6-8% of college women suffer from bulimia

Tends to be chronic if left untreated
Bulimia and Anorexia:
Facts and Statistics
Anorexia

Majority are female and white

From middle-to-upper middle class families

Usually develops in adolescence

More chronic and resistant to treatment than
bulimia
Both Bulimia and Anorexia Are Found in
Westernized Cultures
Causes of Bulimia and Anorexia
Culture & Standards

Cultural imperative for thinness/increased dieting

Standards of ideal body size changing

Male vs. female standards/Social group pressures
Family issues & Genetics

Family is success driven

Runs in families
Psychological Dimensions

Low sense of personal control/self-confidence

Perfectionistic attitudes & distorted body image
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Mood intolerance/anxiety
Treatment of Eating Disorders
Medical and Drug Treatments – antidepressants
effective for bulimia but not anorexia

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Weight restoration for anorexics
Long-term prognosis for anorexia is poorer than for
bulimia
Psychosocial Treatments

Cognitive-behavior therapy (CBT)

Interpersonal psychotherapy
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Self-help programs (OA)
Preventing eating disorders

Early concern over weight is predictor

Emphasis on normalcy of weight gain after puberty
Obesity

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In 2000, 30.5% of adults in the U.S.
were obese; in 2004, 32.2% of adults;
estimates in 2010 between 44-48%
Mortality rates are close to
those associated with smoking
Obesity and Night Eating Syndrome

Occurs in 7-15% of treatment seekers

Patients are wide awake and do not binge eat
Causes

Obesity is related to technological advancement

Genetics account for about 30% of obesity cases

Biological & psychosocial factors contribute
Obesity Treatment

Moderate success with adults

Greater success with children and adolescents
Treatment Progression -- From least-to-most
intrusive options
1. Self-directed weight loss programs
2. Commercial self-help programs
3. Behavior modification programs
4. Bariatric surgery
Sleep Disorders
Assessment of Disordered Sleep:
Polysomnographic (PSG) Evaluation
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Electroencephalograph (EEG):
Brain wave activity
Electrooculograph (EOG):
Eye movements
Electromyography (EMG):
Muscle movements
Electrocardiogram – heart activity
Detailed history, assessment of sleep hygiene and
sleep efficiency
The Dyssomnias: Primary Insomnia
Most common sleep disorder

Problems initiating, maintaining, and/or
nonrestorative sleep
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Affects females twice as often as males
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Unrealistic expectations about sleep
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Believe lack of sleep will be
more disruptive than
it usually is
The Dyssomnias:
Primary Hypersomnia
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Sleeping too much or excessive sleep
Experience excessive sleepiness as a
problem
About 39% have a family history of
hypersomnia
Complain of sleepiness throughout the
day
Able to sleep through the night
The Dyssomnias: Narcolepsy
Daytime sleepiness and cataplexy

Affects about .03% to .16% of the population –
rare condition

Equally distributed between males and females

Onset during adolescence

Typically improves over time

Causes aren’t clear, but possibly
related to brain cell loss
and genetic components
The Dyssomnias:
Breathing-Related
Sleep Disorders

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Sleepiness during the day and/or disrupted sleep
at night
Sleep apnea
Restricted air flow and/or brief cessations of
breathing

Occurs in 10-20% of population

More common in males

Associated with obesity and increasing age
The Dyssomnias:
Circadian Rhythm Sleep Disorders

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Disturbed sleep (i.e., either insomnia or excessive
sleepiness)
Due to brain’s inability to synchronize day and
night
Suprachiasmatic nucleus - Brain’s biological
clock, stimulates melatonin
Types of Circadian Rhythm Disorders

Jet lag type and shift work type
Medical Treatments
for Sleep Disorders
Insomnia

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Benzodiazepines/anti-anxiety medications and
over-the-counter sleep medications
Prolonged use can cause rebound insomnia,
dependence
Best as short-term solution
Hypersomnia and Narcolepsy

Stimulants (i.e., Ritalin)

Cataplexy - usually treated with antidepressants
Medical Treatments (continued)
Breathing-Related Sleep Disorders

May include medications, weight loss, or
mechanical devices
Circadian rhythm disorders

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Phase delays:
moving bedtime later (best approach)
Phase advances: moving bedtime earlier (more
difficult)
Use of very bright light trick the brain’s biological clock
Psychological &
Environmental Treatments
Cognitive-behavioral therapy approaches
Relaxation and Stress Reduction


Reduces stress and assists with sleep
Modify unrealistic expectations about
sleep
Stimulus Control Procedures

Improved sleep hygiene –
Bedroom is a place for sleep
The Parasomnias
Nature of Parasomnias – abnormal events during
sleep
Nightmare Disorder - occurs during REM sleep
Sleep Terror Disorder - Recurrent episodes of paniclike symptoms during non-REM sleep
Sleep Walking Disorder (Somnambulism):
occurs during non-REM sleep