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Eating and Sleep Disorders

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PSYC 3140
Kendra Thomson

PSYC3140 Kendra Thomson November 1, 2013 Reading 6 – Eating and Sleep Disorders Eating Disorders  In bulimia nervosa, out of control eating episodes (binges) are followed by self-induced vomiting, excessive use of laxatives or other attempts to purge (get rid of food)  In anorexia nervosa the person he’s nothing beyond minimal amounts of food so bodyweight sometimes drops dangerously  Patients with bulimia nervosa do not differ from those of anorexia nervosa in terms of trying to be even  As many as 30% of anorexia related deaths are suicide  Until recently eating disorders when I found in developing countries; where access to sufficient food is so often a daily struggle; only in the west where food is generally plentiful have a been rented  Now this is changing and evidence suggests that eating disorders are going global  More than 90% of the severe cases are young females mostly families with upper middle and upper-class socioeconomic status who live in a socially competitive environment  Stop his contributions to etiology seem to be sociocultural rather than psychological or biological Bulimia Nervosa  Eating a larger amount of food typically more junk food and fruits and vegetables  Eating is experienced as out of control  Individual attempts to compensate for the binge eating and potential waking usually by purging techniques  These techniques include self-induced vomiting, using laxatives and diuretics (job that result in loss of fluids through greatly increased frequency of urination)  Women with bulimia who use laxatives are generally more impulsive than those who do not  Some fast for long periods of between binges and others exercise excessively  However rigorous exercising is usually more characteristic of anorexia nervosa  Activity levels increase at least a year prior to developing full-blown anorexia nervosa suggesting that excessive exercise maybe an early warning sign  Bulimia nervosa is typed into purging type and non-purging type – exercise or fasting in DSM-IV  Purging is not a particularly efficient method of reducing caloric intake  Vomiting reduces approximately 50% of the calories that were just consumed  Laxatives and related procedures have very little effect Medical Consequences  Chronic bulimia with purging has a number of medical consequences – one is salivary gland enlargement caused by repeated vomiting which in the face of chubby appearance  Repeated vomiting also made a road the dental enamel on the inner surface of the front teeth  May upset the chemical balance of bodily fluids including sodium and potassium levels – this condition is called electrolyte imbalance which can result in serious medical complications and unattended including cardiac arrhythmia and kidney failure both of which can be fatal  Young women with bulimia also develop more body fat than age and weight matched healthy controls  Intestinal problems resulting from laxative abuse are also potentially serious and they can include severe constipation or permanence: damage  Marks calluses on their fingers or the backs of their hands are caused by the friction of contact with the teeth and throat Associated Psychological Disorders  Anxiety and mood disorders  Particularly depression also commonly co-occur with eating disorders  Depression follows bulimia and maybe a reaction to it  High prevalence of borderline personality disorder in patients with bulimia  Substance-abuse commonly accompanies believe you nervosa  Eating disorders were associated with nicotine dependence in adolescent girls and with alcohol abuse in adult women  Binge purge types of eating disorders smoke the most and that’s smoking is related to impulse of personality traits  Bulimia may also be related to other behaviors suggesting poor and both control such as compulsive shoplifting  Bulimia seems related to anxiety disorders, mood disorder, substance use disorder, borderline personality and impulse control disorders Anorexia Nervosa  The overwhelming majority of individuals with bulimia are within 10% of the normal way  Both anorexia and bulimia are characterized by a morbid fear of gaining weight and losing control overheating  The major difference seems to be what it individually successfully losing weight  People with anorexia out of about their diets and their extraordinary control and they usually do not see themselves as having an illness  Bulimia patients are ashamed about the problem itself and the lack of control and they tend to be very secretive  Many individuals with bulimia have a history of anorexia  They have an intense fear of obesity  Commonly begins in an adolescent who is actually overweight or the procedures up to be  She then starts to diet that escalates into an obsessive preoccupation with thinking  Patients with anorexia nervosa have a tendency to over report their bodyweight  Severe and almost punishing exercise is common  Weight-loss is achieved through severe caloric restriction or by combining caloric restriction and purging  The DSM-IV specifies to subtypes of anorexia nervosa o In the restricting type individual diet to limit caloric intake o In the binge-eating/purging type they rely on purging  Unlike individuals with bulimia, binge eating/purging anorexics binge on relatively small amounts of food and purge more consistently  An individual with anorexia is never satisfied with his or her weight-loss  Staying the same weight from one day to the next or gaining any weight is likely to cause intense panic, anxiety and depression  Only continued weight loss every day for weeks on end is satisfactory  Another key criteria of anorexia is a marked disturbance and body image – the way a person sees and feels about her body  Some anorexic individuals show increased interest in cooking and food  Some become expert chefs preparing all the food for family and others for food in the rooms looking at it periodically Medical Consequences  Who the cessation of menstruation which is called amenorrhea occurs relatively often and bulimia  Medical signs and symptoms of anorexia include dry skin, brittle hair or nails, sensitivity to or intolerance of cool temperatures  Relatively common to see lanugo (downy hair on the lens and cheeks)  Cardiovascular problems such as chronically low blood pressure and heart rate can also result  If vomiting is part of the anorexia, electrolyte imbalance and result in cardiac and Katie problems can result like in bulimia Associated Psychological Disorders  Like bulimia anxiety disorders and disorders are often present in individuals with anorexia  Obsessive-compulsive disorder is one that seems to co-occur frequently  Unpleasant thoughts are focused on gaining weight and the individual engages in a variety of behaviors some of which are ritualistic to rid yourself of such thoughts  Substance abuse is also common Binge-Eating Disorder  Marked distress due to being cheating but they do not engage in extreme compensatory behaviors  Greater likelihood of occurring in males  Greater likelihood of remission and a better response to treatment of BED compare to other eating disorders  Often found in weight control programs  A disorder caused by a separate set of factors from obesity without to BED and is associated with more severe obesity  About half of individuals would BED tried dieting before binging and have started binging and then attempted diet  Those who begin binging first become more severely affected find BED and are more likely to have additional disorders  It is clear that individuals with BED have some the same concerns about shape and weight of people with anorexia and bulimia which distinguishes them from the individuals who are obese without BED Statistics  The overwhelming majority – 90 to 95% – of individuals with bulimia are women, most are white and middle the upper-middle-class  The 5 to 10% of cases that are male have a slightly later age of onset and a homosexual or bisexual orientation of used to be specific risk factor for meals especially for those who develop bulimia  Men with eating disorders a similar and most respect women  One place that men and women with eating disorders differ is an personality risk factors such as perfectionism  Men’s lower levels of these personality risk factors may help explain why bulimia is an overwhelmingly female disorder  Male athletes in sports that require wait regulations such as wrestling or another large group of males with eating disorders  The risk is much higher for females born after 1960s and for females born before 1960  Once bulimia develops it tends to be chronic if untreated  Strongest predictors of resistance or a history of childhood obesity and continuing over emphasis on the importance of being then  The same high percentage – 90 to 95% – of individuals with anorexia or female  Increase in rates of anorexia particularly in the 1960s and 1970s  Once anorexia develops its course seems more chronic than even bulimia and it is more resistant to treatment Cross-Cultural Considerations  Culturally specific nature of anorexia and bulimia  These disorders developed and immigrants who have recently moved to western countries  The surveillance of eating disorders among black and Asian North  American females is lower than among Caucasians but they are more frequent among aboriginal women  Black adolescent girls have left body dissatisfaction, fewer weight concerns, a more positive self image, and perceive themselves to be thinner than they actually are compared with Caucasian adolescent girls  Major risk factors for eating disorders and all groups include being overweight, being a higher social class and acculturating to the western majority  One culturally determined difference and criteria for eating disorders is that in traditional Chinese culture is been widely assumed that being slightly plump is highly valued with ideals of beauty focus on the face rather than the body  Therefore in this group acne was more often reported as a precipitant for anorexia nervosa then was fear of being fat  Patients said they refused to eat because the feeling of fullness or pain although it is possibly related food and take their skin conditions but beyond that thing that all criteria for anorexia  Miss Hong Kong beauty pageant found that winners were taller and thinner than the average Chinese woman with a curvaceous narrow waist and full hip body shape  This ideal matches depictions of beauty and classical Chinese literature any challenges the notion that this is valued at least in Hong Kong  In Japan the surveillance of anorexia nervosa I’m teenage girls is still lower than the rate in North America  In Canadian women, body dissatisfaction was related to concerns about the weight of the abdomen, hips, thighs and legs  In Indian woman body dissatisfaction was related to concerns about the weight of the face, neck, shoulders and chest  Patterns of physical development in girls and boys interact with cultural influences to create eating disorders  After puberty girls gain weight primarily in fact issue whereas boys develop muscle and lean tissue  As the ideal look in Western countries is tall and muscular for men and Ben and prepubertal for women, physical development brings boys and closer to the ideal and takes girls farther away Causes – Social  For young females in middle to upper-class competitive environments, self-worth, happiness and success are determined to a large extent by body measurements and percentage of body fat  Standards of desirable body sizes change much like fashion styles and clothes  The preferred shape during the 1960s and 70s was thinner and more tubular  Overweight men are 2 to 5 times more common as television characters been overweight women – the message from the media to be thin is clearly aimed at women  There’s a strong relationship between exposure to media images depicting the thin-ideal body and body image concerns and women  Girls who watched eight or more hours of TV per week reported significantly greater body satisfaction  The risk for developing eating disorders was directly related to the extent to which women internalize or buy in to the media messages  During the 1920s the ideal but nobody was similar in shape to be ideal today however this shape with achieved through fashion (the use of girdles rather than dieting)  Today standards are increasingly difficult to achieve because the size and weight of the average woman has increased over the years with improved nutrition  A second clear effect is the dramatic increase especially among women and dieting and exercise to achieve what made in fact be an impossible goal  Men rated their current size, their ideal size and the size they figured would be the most attractive to the opposite sex as approximately equal  They rated their ideal body weight as heavier than the weight female thought most attractive and men  Women however rated their current figures as much happier than the most attractive  Women are particularly critical of women tip size  Women’s judgment of ideal female body weight was less than the weight that meant thought was most attractive  Friendship cliques contributed significantly to the formation of individual body image concerns and eating behaviors  If your friends tend to use extreme dieting or other weight-loss techniques there’s a greater chance that you will too  Adolescent girls who dieted were 8x more likely to develop an eating disorder when you’re later than those who were not dieting  One of the reasons that attempts to lose weight may lead to eating disorders that weight reduction efforts and Allison girls are more likely to result in weight gain and weight loss!  Patient attempts to limit and control their dietary intake contributed to binge gratings but we’re not direct antecedents to binge eating episodes  Instead factors like negative effect may operate to trigger individual and cheating episodes among those who are currently restricting their dietary intake  Negative psychological impact of dieting are low self-esteem, food preoccupation and negative mood – a phenomenon they have labeled the false hope syndrome  This perspective asserts that people's faults hopes about self change attempts are initially strongly reinforced  Unfortunately the positive feelings and sense of control that people feel with their initial success at South change lead them to continue to pursue unrealistic or even impossible goals for weight loss but ultimately result in extreme disappointment and a decline in self-esteem Dietary Restraint  Those with eating disorders tend to display a strong preoccupation with food  Long-term diving can cause preoccupation with food – hoarding food, collecting recipes  Chronic dieters Also appear to remember information better when it pertains to feud  Possibility that chronic dieting causes a preoccupation with food and eating which in turn could contribute in cheating  Such disorders would be expected to occur where these pressures are particularly severe which is the case with ballet dancers  Similar results are apparent among athletes, particularly females suggestion mists, figure skaters and tennis players Family Influences  The typical anorexic family is eager to maintain harmony  To accomplish these goals family members often tonight or ignore conflicts or negative feelings and 10 to attribute their problems to other people at the expense of Frank communication among themselves  Mothers of girls with disordered eating seems to act as societies messengers and wanting their daughters to be thin  They were very likely to be dieting themselves and generally more perfectionistic and control mothers and that they were less satisfied with their families and family cohesion  Family preoccupation with appearance had a direct influence on body dissatisfaction and eating disorder symptoms  Educated and knowledgeable parents including psychologists and psychiatrists with full understanding of the disorder have recorded resorting to physical violence and moments of extreme frustration in an attempt to get their daughters to put some food in their mouse Biological Influences  Eating disorders run in families and the seem to have a genetic component  Study speculates that nonspecific personality traits such a emotional instability and poor impulse control might be inherited  A person might inherit a tendency to be emotionally responsive to specialists will like the vents and might eat and possibly in an attempt to relieve stress and anxiety  Perfectionistic traits with negative affect  This biological vulnerability might then interact with social and psychological factors to reduce an eating disorder  Low levels of serotoninergic activity are associated with impulsivity in general and then cheating specifically  Most drugs currently understudy as bulimia treatments target the serotonin system  Anorexics differ from most people who are starving because food lacks positive incentive value for them in terms of their desire to actually eat it  Phenomenon called “activity anorexia” where excessive physical activity can paradoxically cause a loss of appetite Psychological Dimensions  People with eating disorders have a diminished sense of personal control and a confidence in their own abilities and talents  They display more perfectionistic attitudes learned, perhaps from their families which may reflect attempts to exert control over important events in their life  Perfectionistic traits are crucial role in there eating disorders Individuals must first consider themselves overweight and also manifest low self-esteem  Perfectionism predicted eating disorder symptoms but only among women who were dissatisfied with their bodies  Bulimic women judged their body size to be larger than and their ideal weight to be less than  Women with bulimia judge their bodies were larger after they ate a chocolate bar and a soft drink whereas the judgment of woman and a control group were unaffected by snacks  Rather minor events related to eating me activate fear of gaining weight, further distortions in body image and corrected schemes such as purging  Substantial anxiety before and during snacks were theorizes as being relieved by purging  They suggests the state of relief strongly reinforces purging An Integrative Model  Individuals with eating disorders may have some of the same biological vulnerabilities and being highly responsive to stressful life events as individuals with anxiety disorders  Anxiety and mood disorders are also common in the families of individuals with eating disorders and negative emotions and mood intolerance seem to trigger binge eating in many patients  Drug and psychosocial treatments with proven effectiveness for anxiety disorders are also the treatment of choice for you disorders  We could conceptualize eating disorders as anxiety disorders focused exclusively on becoming overweight  Perhaps pre-existing personality characteristics such as a tendency to be overcontrolling or a tendency to act impulsively are important determinants of which disorder a girl develops – anorexia or bulimia respectively Drug Treatment  Drug treatments have generally not been found to be effective in the treatment of anorexia  Atypical antipsychotic medication olanzapine may be helpful in the treatment of anorexia and children  A side effect of olanzapine in the treatment of schizophrenia is waiting and this effect would be considered desirable and treating end and I see patients with anorexia  The drugs generally considered the most effective for bulimia (ex. Prozac) at the same antidepressant medications proven effective for disorders and anxiety disorders  In 2 studies one of tricyclic antidepressant drugs and the other of fluoxetine found an average reduction in binge eating and purging  Antidepressants are more effective than placebo in the short-term  Antidepressant drugs alone do not have substantial long-lasting effects on bulimia  Antidepressants show promise in enhancing the effects of psychosocial treatment Psychosocial Treatment - Bulimia  And cognitive behavioral treatment the first date is teaching the patient the physical consequences of binge eating and purging as well as the effectiveness of vomiting and laxative abuse for weight controlled  The adverse effects of diving are also described  Patients scheduled to eat small and manageable amounts of food five or six times per day with no more than a three hour interval between any plans meals and snacks which eliminates the alternating periods of over eating and dietary restriction which are hallmarks of bulimia  And later stages of treatment cognitive therapy focuses on altering dysfunctional thoughts and attitudes about body shape, weight and eating  Coping strategies for reducing the impulse to binge and purge are also developed including arranging activities of the individual will not spend time alone after eating during the early stages of treatment  Interpersonal psychotherapy (IPT) focuses on improving interpersonal functioning  IPT did as well as CBT at the one-year follow-up although CBT was more effective at the assessment immediately after treatment was completed  IPT does not concentrate directly on disorders eating patterns or dysfunctional attitudes about eating but rather on improving interpersonal functioning focus that may promote changes in eating habits and attitudes  CBT is the preferred psychological treatment for bulimia nervosa because it works significantly faster  Another variant of CBT is brief group psychoeducation for bulimia  The main goal of psychoeducation is to help bulimic individuals normalizer eating and reduce their body image disturbance  The goal is achieved by providing them with information relevant to bulimia and with useful strategies such as meal planning, problem-solving and self monitoring  The main differences from CTR that psychoeducation is briefer, is delivered and electrotype format and is not feeling to the unique needs of individual patients  The intervention is particularly affective for those with less severe bulimia  Combining drugs with psychosocial treatments might be still overall outcome at least in the short term  CBT remains the preferred treatment for bulimia Psychosocial Treatment – Binge-Eating Disorder  CBT treatment results look promising  Those who have stopped binge eating during CBT maintained a weight loss of approximately 4 kg over the follow-up period  Stopping binge eating is critical to sustaining weight loss in obese patients  In contrast to results with bulimia it appears that IPG is as effective as CBT for binge eating  Self-help procedures may also be useful in the treatment of BED – mailed a manual (a guided self-help in which therapists would meet patients periodically) Psychosocial Treatment – Anorexia  The most important initial goal is to restore the patients wait to a point that is at least within the low normal range  If bodyweight is below 85% of the average healthy bodyweight for a given individual or if we have been lost rapidly and the individual continues to refuse food inpatient treatment is recommended because of your medical complications particularly acute cardiac failure could occur if weight is not restored immediately  The weight-loss is been more gradual and seems to have stabilized wait restoration can be accomplished on an outpatient basis  Initial weight gain is a poor predictor of long-term outcome in anorexia  For restricting anorexics the focus of treatment must shift to their marked anxiety over becoming obese and losing control of eating as well as to their undue emphasis on thinness of this determinant of self-worth, happiness and success  In this regard effective treatments for restricting anorexics are similar to those for patients with bulimia  Importance of motivation to change in recovery from anorexia Every effort is made to include the family in order to accomplish two goals o First the nega
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