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

Agras, W. S., Crow, S. J., Halmi, K. A., Mitchell, J. E., Wilson, G. T., & Kraemer, H. C. (2000). Outcome predictors for the cognitive behavioral treatment of bulimia nervosa: Data from amultisite study. American Journal of Psychiatry, 157(8), 1302-1308.American Psychiatric Association (1994). Diagnostic and statistical manual (Fourth edition). Washington, D.C.: Author.Baker, C. W., Whisman, M. A., & Brownell, K. D. (2000). Studying intergenerational transmission of eating attitudes and behaviors: Methodological and conceptual questions. Health Psychology, 19(4), 376-381.Braet, C., & Van Winckel, M. (2000). Long-term follow-up of a cognitive behavioral treatment program for obese children. Behavior Therapy, 31(1), 55-74.Brownell, K. D., & Rodin, J. (1994). The dieting maelstrom: Is it possible and advisable to lose weight? American Psychologist, 49, 781-791.Daw, J. (2001). Eating disorders on the rise: A Capitol Hill briefing calls attention to eating disorders. APA Monitor on Psychology, 32(9), 21.DeAngelis, T. (2002a). A genetic link to anorexia. APA Monitor on Psychology, 33(3), 34-36.DeAngelis, T. (2002b). Further gene studies show promise. APA Monitor on Psychology, 33(3), 35.

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

Heatherton, T. F., Mahamedi, F., Striepe, M., Field, A. E., & Keel, P. (1997). A 10-year longitudinal study of body weight, dieting, and eating disorder symptoms. Journal of Abnormal Psychology, 106, 117-125.Kendler, K. S., MacClean, C., Neale, M. C., Kessler, R., Heath, A. C., & Eaves, L. (1991). The genetic epidemiology of bulimia nervosa. American Journal of Psychiatry, 148, 1627-1637.Killen, J. D., Taylor, C. B., Hayward. C., Wilson, D. M., Haydel, K. F., Hummer, L. S. et al., (1994). Pursuit of thinness and onset of eating disorder symptoms in a community sample of adolescent girls.: A three-year prospective analysis. International Journal of Eating Disorders, 16, 227-238.Maxmen, J. S., & Ward, N. G. (1995). Essential psychopathology and its treatment(2nd ed. rev. for DSM-IV). New York: W. W. Norton & Company.McCabe, M. P., & Ricciardelli, L. A. (2003). Body image and strategies to lose weight and increase muscle in boys and girls. Health Psychology, 22, 39-46.National Institute of Mental Health (1998). Summary of the NIMH workshop on research in eating disorders. [Online] Retrieved August 1, 2000, from: www.nimh.nih.gov/events/edsummary.cfmNewmark-Sztainer, D., Wall, M. M., Story, M., & Perry, C. L. (2003). Correlates of unhealthy weight-control behaviors amond adolescents: Implications for prevention programs. Health Psychology, 22 (1), 88-98.Ricciardelli, L. A., & McCabe, M. P. (2001). Psychometric evaluation of the Body Change Inventory: An assessment instrument for adolescent boys and girls. Eating Behaviors, 2, 1-15.

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

Wiseman, M. A., Gray, J. J., Mosimann, J. E., & Ahrens, A. H. (1992). Cultural expectations of thinness in women: An update. International Journal of Eating Disorders, 11, 85-89.