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1

Eating disorders
-onest

Characterized by disturbed pattens of eating and maladpative ways of controlling weight. Often comorbid with depression, anxiety, and substance abuse disorders
-typically begin during adolescence or early adulthood

2

Anorexia
-prevalence & onset

maintenance of an abnormally low body weight, distorted body image, and intense fears of gaining weight. Most common sign is weight loss. Two subtypes: binge eating/purging and restrictive type
-0.9% women (9 in 1,000) , 0.3% men
- onset between 12 and 18 common after puberty

3

Subtypes of anorexia

Binge eating /purging type- frequent episodes during the prior three month period of binge eating or purging through use of vomitting, laxatives ect. Impulse control problems and sub abuse or stealing

Restrictive type- no binging/ purging. Obsessive

- distinction between the two is the personality patterns.

4

Medical complication of anorexia

Anemia (caused by losing 35% body weight), dermatological problems, amenorrhea

5

Death and suicide stats on anorexia (3)

5-20% of those with anorexia die due to suicide or malnutrition.
Women with anorexia 8x more likely to commute suicide
Anorexic study, 1 in 5(17%) made suicide attempt; 95% were females.

6

Bulimia
- to diagnose
- prevalence
- onset

Recurrent binge eating followed by self-induced purging accompanied by over concern with weight. Binges last between 30-60minutes consuming 5,000-10,000 cals.
- Requires binge episodes and compensatory behaviors occurring at avg freq of at least once a week for three months.
-0.9-1.5% in women; 0.1%-0.5% men
- affect those in late adolescence or early adulthood

7

Medical complications in bulimia (10)
- suicide rate

Skin irritation around mouth, blockage of salivary ducts, decay of tooth enamel, damage taste receptors, Hiatal hernia, pancreatitis, lose of bowl eliminatory response, convulsions from salty binges, potassium deficiency, death (especially when diuretics are used)
- 25-35% attemept suicide

8

Social cultural theory of eating disorders (10)

1. Girls as young as 8 dissatisfied with bodies more than boys
2. 1 in 7 (14%) college women embarrassed to buy choc bar
3. 4 out of 5 women dieted by 18th birthday
4. 80% college students reported dieting
5. ED's less common in Non western countries
6. However still in East Africa, Korean children, Taiwan
7. African Ghana fast for religion; can explain ED's
8. ED's higher in Whites than blacks but expected to raise
9. Disturbed eating in Indians
10. Same factors assoc with Girl's ED's as boys

9

Emotional factors of ED's
- Anorexia
- Bulimia (3)

1. Anorexics may restrict in attempt to relieve upsetting emotions by seeking mastery control
2. Bulimics tend to be shy
3. Bulimia often comorbid with others suggesting that binging is attempt at coping with emotional distress
4. Bulimics more likely than any other women to have been abused.

10

Learning perspective of ED's
-Reinforcment in bulimia and anorexia

View ED's as type of weight phobia; relief from anxiety is negatively reinforced. Binge/purge cycle arises after strict dieting and when strict dietary controls fail it leads to loss of inhibitions which prompts binges. Binges induce fear of weight gain which prompt vomittig.
-Purging negatively reinforced by relief from anxiety. Anorexics food rejecting reinforced by relief from anxiety.

11

Cognitive perspective of ED's
- factors in ED's
- Bulimic thoughts

Biggest factors are perfectionism and over concern of making mistakes. Dieting gives sense of control they lack. Women with ED tend to blame self for negative events
-Bulimics tend to have dichotomous thoughts (one mistake and they think they have failed)

12

Psychodynamic perspective of ED's

Anorexics have difficulty separating from their families and making separate identity. Represents girls unconscious efforts to remain pubescent

13

Family factors in ED's (5)

1. Some suggest child refuses to eat to punish parents for feelings of loneliness.
2. Parents tend to be overprotective and less nurturing.
3. Humphrey suggest binge eating is metaphoric effort to gain nurturance and comfort thru food that child is lacking
4. Families are systems that regulate themselves in ways that minimize open expression of conflict and reduce need for change. Therefore child with anorexia may help maintain balance in dysfunctional family by displacing attention and being identified patient.
5. Social reinforcement thru family paying attention to them.

14

Biological factors in ED's

Abnormalities in brain structures controlling hunger and satiety involved in bulimia due to serotonin. Serotonin regulates appetite and controls cravings for carbs. Antidepressants like prozac and zoloft help decrease binges

15

Behavioral therapy for ED's

Used in hospitalization; offers rewards to adherence of refeeding. Reinforcers are ward privileges and social opportunities; high relapse rate (50% of inpats rehospitalized within year of discharge)
- psychodynamics therapy sometimes combined to probe fore psych conflicts

16

CBT therapy for ED's

Recent support for CBT in treating bulimia; CBT cured 2 out of 3 ppl in study. Helps them challenge self defeating thoughts which causes them to purge. ERP used to prevent vomiting by exposing them to fear foods.

17

ITP

Used for those that fail to respond to CBT; focuses on resolving interpersonal issues based on beliefs that effective interpersonal functioning will lead to healthier food habits and attitudes.

18

Binge-eating disorder
- to diagnose
- prevalence
-comorbid
- treatment

recurrent eating binges without purging
- occur on avg at least once a week for period of three months
-more common than anorexia or bulimia; affects 3.5% of women and 2% of men (most freq ED in men), 8 million struggle with it
- older ppl; develops around 30's or 40's
- depression and gambling or sub abuse
- CBT best; better than meds

19

Sleep-wake disorders
- major sw disorders

Persistent and recurrent probs that cause distress or impaired functioning; replaced term sleep disorder; freq occurs with depression or med conditions like CVD; accounts for 250 million sick days and 63 billion loss
- insomnia, hypersomnolence, narcolepsy, breathing realted, circadian rythym, parasomnias

20

Sleep centers

provide comprehensive assessment and diagnosis of sleep problems, track physio responses during sleep. Use of polysomnographic recording which is an assessment during sleep that simultaneously measures phyiso responses like brain waves, eye movements, muscle movements, and respiration.

21

Insomnia disorder
- to diagnose
- prevalence
- onset

Chronic or persistent insomnia; AKA primary insomnia
- requires at least three months that it occurs at least three nights per week
- 6-10%
-Freq affects those over 40

22

Affects of insomnia

unable to concentrate, difficulty remembering, hyperactivity, impulsivity, aggression.
May lead to poor immune system functioning; those who slept less than 7 hours a night had threefold risk of developing cold.

23

Psychological factors of insomnia

Tendency to bring anxiety to bed which raises arousal preventing natural sleep; performance anxiety is pressure felt from thinking you must get full nights sleep.

24

Learning perspective of insomina

Classical conditioning explains chronic insomnia: pair anxious, sleepless nights with bedroom, by entering bedroom you elicit bodily arousal impairing sleep; Heightened arousal becomes CR elicited by the bedroom(CS)

25

Hyper somnolence disorder
- to diagnose
- prevalence
- causes (2)
- treatment

AKA primary hypersomnia; persistent pattern of excessive sleepiness during the day; Naps last an hour or more but does not leave you refreshed; not linked to inadequate sleep at night
- Occurs at least three days a week for period of at leas three months
- 1.5%
- defect in sleep-wake mechanism in brain; in some cases a substance in brain acts as natural sleeping pill increasing activity of GABA
- treated with stimulant med to help person maintain daytime wakefulness

26

Narcolepsy
- prevalence

Sudden, irresistible episodes of sleep; person falls asleep for about 15 mins; attacks assoc with transition form awake to REM (sleep stage assoc with dreaming) Can involve cataplexy episodes and hypnagogic hallucinations. Most common type is narco/hypocretic deficiency syndrome
- at least 3x a week for 3 months
- 0.02-0.04%, affects both genders equally

27

Narcolepsy/hypocretin syndrome

deficiency in brain of hypocretin (orexin)- a protein like molecule produced by hypothalamus that plays role in sleep wake cycle

28

Cataplexy
- cause

often assoc with narcolepsy; medical condition were person experiences a loss of muscle tone ranging from mild weakness in legs to complete loss causing person to collapse; triggered by emotional reactions like laughing or crying. Person slumps to floor unable to move with blurry vision but able to hear.
- deficiency in hypocretin

29

Sleep paralysis

temporary state following awakening in which they feel incapable of moving or talking

30

Hypnagogic hallucinations

frightening hallucinations occurring before onset of sleep or upon awakening