Chapter 10: Eating Disorders, Obesity, and Sleep Disorders

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1 Chapter 10: Eating Disorders, Obesity, and Sleep Disorders Rick Grieve, Ph.D. PSY 440 Western Kentucky University

2 Eating Disorders Becoming big concern Prevalence Rate Age 15-19; Age Over 8 million diagnosed with ED 90% young women 9% of girls had eating disorder Scary stats with precursors of ED

3 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

4 Anorexia Nervosa Distorted external and internal perceptions of the body Undue influence of body shape on self-evaluation Focus on one part of the body Denial of seriousness of current low body weight Overestimate of body width Amenorrhea Associated Features Inflexibility in thinking and behaving

5 Anorexia Nervosa Perfectionism View achievements in black and white terms Cognitive Difficulties Types of AN Restricting Type Binge-Eating/Purging Type Prevalence % for females % for adolescent females

6 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

7 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 years Recovery rates Long-term problems Etiology Genetics Gender additive model

8 Anorexia Nervosa Dieting Dysfunctional Beliefs About Appearance Societal Pressure Media Influence Sexual Abuse Chaotic Family Life Perfectionism Need for Control Early Maturation

9 Anorexia Nervosa Parental Influence Neurological Findings Treatment for AN Efficacy for tx is limited due to dearth of studies Goals of treatment Keep client alive Establish adequate nutrition Treat physical complications Correct abnormal eating habits

10 Anorexia Nervosa Change family interaction pattern Enhance self-control, identity, and autonomy Correct defects in affect/behavior regulation Starts w/hospitalization Low body weight/brain dysfunction connection Fed 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 feeding Involuntary hospitalization vs. compulsory treatment

11 Anorexia Nervosa Family Therapy Parents should not be responsible for client care Parents can see client after client begins to gain weight Focus is on re-establishing appropriate parent-child interactions Individual Therapy CBT Group Therapy Medication

12 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 period Feeling out of control while eating Objective vs. Subjective binges Recurring inappropriate compensatory behavior designed to prevent weight gain

13 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

14 Bulimia Nervosa Hunger Insomnia Prevalence Rates Associated 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

15 Bulimia Nervosa Excessive drive for symmetry and exactness Bulimia: 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

16 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

17 Bulimia Nervosa Medication Therapy CBT Components of CBT Two Phases: Break the Binge-Purge Cycle Focus on Broad Areas of Behavior and Attitudes Pretreatment variables associated with poor outcome Pretreatment variables associated with drop out

18 Bulimia Nervosa Interpersonal Therapy Group Therapy Family Therapy Combined Treatment A brief word on preventing Eating Disorders

19 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 % are obese

20 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

21 Sleep Disorders Sleep Dyssomnias Primary Insomnia Persistent difficulty in falling asleep, remaining asleep, or achieving restive sleep Lasts more than 1 month Associated Features Prevalence

22 Sleep Disorders Hypersomnia Pattern of excessive sleepiness during the day that continues for at least one month Difficulty awakening Sleep episodes during the day, almost every day Not accounted for by poor sleep the night before Associated Features Prevalence Rate

23 Sleep Disorders Narcolepsy Characterized by sudden, irresistible sleep episodes at all times of the day Must occur at least daily over the course of 3 months Needs to have one of the following: Cataplexy Intrusions of REM Sleep Associated Features

24 Sleep Disorders Sleep paralysis Hypnogogic hallucinations Prevalence rates Etiology Breathing-Related Sleep Disorders Obstructive Sleep Apnea Syndrome Repeated episodes of complete or partial obstruction of breathing during sleep Associated Features Prevalence Rates

25 Sleep Disorders Circadian Rhythm Disorder Circadian 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

26 Sleep Disorders Sleep Terror Disorder Recurrent episodes of sleep terror that result in abrupt awkenings Often found in children Prevalence rates Sleepwalking Disorder Repeated episodes in which the sleeper arises from bed and walks around the house while remaining fully asleep Associated Featuers Prevalence Rates

27 Sleep Disorders Treatment for Sleep Disorders Biological Medication Anxioytics Benzodiazepines Psychological CBT Relaxation Training Stress Management Sleep Hygiene Stimulus Control Rational Restructuring

28 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 a multisite study. American Journal of Psychiatry, 157(8), 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), Braet, C., & Van Winckel, M. (2000). Long-term follow-up of a cognitive behavioral treatment program for obese children. Behavior Therapy, 31(1), Brownell, K. D., & Rodin, J. (1994). The dieting maelstrom: Is it possible and advisable to lose weight? American Psychologist, 49, 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), DeAngelis, T. (2002b). Further gene studies show promise. APA Monitor on Psychology, 33(3), 35.

29 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), 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, 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, Ferguson, C. P., & Pigott, T. A. (2000). Anorexia and bulimia nervosa: Neurobiology and pharmacotherapy. Behavior Therapy, 31(2), 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, 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), 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, Harvard Medical School (2002). Treatment of bulimia and binge eating. Harvard Mental Health Letter, 19 (1), 1-4.

30 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, 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, 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, Maxmen, J. S., & Ward, N. G. (1995). Essential psychopathology and its treatment (2 nd 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, National Institute of Mental Health (1998). Summary of the NIMH workshop on research in eating disorders. [Online] Retrieved August 1, 2000, from: Newmark-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), 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.

31 References Shaw, H. E., & Stice, E. (2001). Body image and eating disturbances as risk factors for depression. The Prevention Researcher, 8(4), Spangler, D. L. (2002). Testing the cognitive model of eating disorders: The role of dysfunctional beliefs about appearance. Behavior Therapy, 33 (1), 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, 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 ). 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), 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),

32 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,

WEIGHT CONCERNS IN YOUNG GIRLS

WEIGHT CONCERNS IN YOUNG GIRLS CHAPTER 8 EATING AND SLEEP DISORDERS (PP. 268-311) 1 Overview Bulimia Nervosa Anorexia Nervosa Eating Disorders Binge Eating Disorder Stats Social Causes Bio Eating & Sleep Disorders Psy Insomnia Treat