Eating Disorder (Ch8) Bulimia nervosa eating disorder involving recurrent episodes of uncontrolled excessive (binge) eating followed

d by compensatory actions to remove the food (for example deliberate vomiting, laxative abuse, and excessive exercise) (the need to be thin but it goes a lot deeper than that) Hallmark: bingeing then find something to compensate for it, fear of weight gain Comorbid with OCD Impulse control problem; uncontrollable Uncontrollable bingeing for 2-ish hours Compensatory: purging, vomiting, exercising for hours, laxatives Gray-ish yellow enamel develops Comorbid with mood disorders and anxiety disorders and substance abuse like drugs and alcohol Health problems o Kidney failure o Electrolyte imbalance DSM Bulimia Nervosa Features include: Recurrent episodes of binge eating, characterized by an abnormally large intake of food within a 2-hour period, combined with a sense of lack of control over eating during these episodes Recurrent, inappropriate compensatory behavior to prevent weight gain, such as self-induced vomiting, misuse of laxative, fasting or excessive exercising On average, bingeing and inappropriate compensatory behaviors occur at least twice a week for at least 3 months Excessive preoccupation with body shape and weight Women young (18-21), high status, white, western Men young, homosexual males, high economic status Binge relatively brief episode of uncontrolled, excessive consumption, usually of food or alcohol Purging techniques in the eating disorder bulimia nervosa, the selfinduced vomiting or laxative abuse used to compensate for excessive food ingesting Anorexia nervosa eating disorder characterized by recurrent food refusal leading to dangerously low body weight

Hallmark: refusing to maintain body weight, restricting food, decrease body weight (15% below normal weight) Comorbid with Anxiety Disorder Its a fear of gaining weight. Some kind of phobia They dont recognize how it compares to normal population or severity of it BIG thing is restriction: looks like reduction in the amount of food you consume and/ or restricting to 500 less/day Anorexia nervosa is co-morbid with OCD (intrusive thoughts of, Im not good enoughto control these thoughts they starve themselves and they end up looking at it in a positive way), anxiety and depression Appetite is still there, but they ignore it Entirely about control! I cannot eat and is controlling what I do See health problems o Amenorrhea inability to have a regular menstruating cycle and you might not be able to have a child o Edema - Retaining fluids and swelling in your body o Brain Atrophy -brain going without something? o Electrolyte imbalance something o 50% of death is suicide

DSM Anorexia Nervosa Features include: Refusal to maintain body weight at or above a minimally normal level Intense fear of gaining weight Inappropriate evaluation of ones weight or shape, or denial of the seriousness of the current low body weight Amenorrhea Eating Disorder NOS (not otherwise specified) Purge, binge, below 15% of normal weight, restricting food Obesity excess of body fat resulting in a body mass index (a ratio of weight to height) of 30 or more Todays show: Ladys Statistics Found 75% of young women has disordered eating disorder 1 in 10 of females meet criteria for eating disorder o Of them 35% used unhealthy compensation (laxative and purging) Half of 35%, do so everyday

o 70% of them are skipping meals and pay attention to calories 50% of average normal weight tries to lose weight 400 calories is use to think in a day, 2000 calories to live. Going below will slow down metabolism, and may lead to depression symptoms

Bad habits about losing weight Diet pills Smoking Skipping meals Skipping meals slows down metabolism Biopsychosocial Model (its not just about losing weight) Social: media, o Family influence (very controlling family, successful family, high economic status, perfectionist, over protected, very strict, highly focus on success, lack of independence of autonomy) They have total control of eating, sleep, and go to bathroom o Words that we use influence Looks healthy: looks good o Magazine of a checklist of things to do and many reason why you are fat or many reasons for any other things o When they see this with no education, they live with it. Psychological dimensions o Anorexia vs. Bulimia Anorexia: rigid, control, well-planned, co-morbid with OCD Bulimia: loss of control, impulses, co-morbid with substance abuse and anxiety o Controlled vs. impulsive Anorexia: very good at control, very well plan and structured, fear of losing control Bulimia: already loss control o Emotional stability vs. emotional instability Anorexia: very good at controlling and hiding their emotions Bulimia: cannot control emotions, emotionally unstable, any little thing can throw them off o Uni-impulsive (impulsive about one thing) vs. multiimpulsive

Anorexia: uni-impulsive, inability to control their bad and self destructive thoughts, Im a bad person They control so much that they cant let go of controlling Bulimia: everything is impulsive, they can loss control and completely out of whack in different things Stable vs. unstable Anorexia: stable Bulimia: unstable Rigid vs. flexible (not rigid) Anorexia: safe foods, if not safe foods then its bad. Eat and dress like this, if not then its unsuccessful. Very strict pattern Bulimia: whenever they have the compulsive to purge you do it, no set strict pattern Moral vs. immoral Anorexia: have a strict moral code, hyper religious beliefs and behaviors, very strict political views, Bulimia: not as rigidly moral Both hate themselves, doesnt see severity of it

Binge eating disorder (BED) pattern of eating involving distressinducing binges not followed by purging behaviors; being considered as a new DSM diagnostic category (eat a lot of food that you usually wont eat and this is about 2 hour duration) Treatments Drug Treatments o Medication in psychology: we are altering neurotransmitter in the brain o Have different effect on behavior o SSRI (serotonin re-uptake): decrease levels of anxiety o Anorexia & Bulimia: not exposing them to fear stimulus Phobia of gaining weight Anxiety head on Psychological Treatments (strict behavior treatment) o Bulimia Nervosa Help with Compulsives Have a structured meal plan with normal size or a little smaller meal with more meals a day consistently throughout the day Prevent binging And let them know that they can be in control

Do things the same way at the same time and that can be highly effective because we like to look for patterns o Binge-eating disorder o Anorexia Nervosa Shows what people can eat Expose them to eating like show them people with Bulimia Try to increase the amount of food for them to eat to gain weight If you assign by calories, it can lead to excessive calorie counting If you have a strict cutoff, if they dont meet minimum and you will be a failure If not structured, then doesnt work Moles: unit of what you eating no specified amount but there are still a minimum. Eating enough or not enough Hospital and pump nutrients into them like 4000 calories a day Lead to depression o They are alone o They are forced to face fear o They are embarrassed Cognitive side o 70lbs to 100lbs they are not cured because they didnt do it themselves everything stays the same, and will do the same thing again after they get out of the hospital (no autonomy) doesnt fix the problem Gaining too much weight so quickly is a hard process and may kill you Accepting-commitment therapy o Similar to cognitive behavior therapy o Revolves on ideas with that kind of thought patterns If you this happens, something else is going to happen o Accepting the thoughts of what you think of and dont define yourself with that thought o Meta-cognition taking a step back and look at your thoughts and choose to accept if that is you or not, view your thoughts separately People with anxiety and eating disorders has a hard time do it

 They think things are bad, and its true o Cognitive style therapy? Nutritionist education : not enough to treat something Preventing eating disorders Being educated (educate little kids)

Sleeping Disorder (Ch8) Why do we sleep? For our body to physically recover Where subconscious talks to conscious mind Save energy and let the internal organs to do their thing Information processing theory: sleep to store information in memory and then prepare for the new day Reparative therapy: sleep to repair your body because you spend a lot of energy and calorie during the day Evolutionary: nighttime is dangerous for us to be out so sleep is developed to be at that time adaptive process No set Theory, but it was proven that we process information better with more sleep 5 stages of sleep:

Stage 1: you know youre awake and you know youre going to fall asleep nodding off ... transition between awake and sleep (5% of whole sleep cycle) Stage 2: fall asleep Stage 3: transition to deep sleep Stage 4: deep sleep Stage 5: REM sleep (lasts a minute to two minutes) similar level of almost being awake 20 minute nap: stage 2 and 3 so not too bad to wake up 1 hour nap: stage 4 and very deep sleep and hard to wake up Dreams happen 80% in REM and 20% in stage 4 Rapid eye movement (REM) sleep periodic intervals of sleep during which the eyes move rapidly from side to side, and dreams occur, but the body is inactive (like paralyzed) Two types: dyssomnia(problem with circadian ...not getting enough sleep or not enough sleep) and parasomnia Dyssomnia problem in getting to sleep or in obtaining sleep of sufficient quality Primary insomnia not enough sleep o Microsleep Primary hypersomnia too much sleep Narcolepsy random sleep

Breathing-related sleep disorders insomnia or hypersomnia due to breathing problems Circadian rhythm sleep disorders (sleep-wake schedule disorders) insomnia or hypersomnia due to sleep-wake schedule mismatch

Microsleep short, seconds-long period of sleep that occurs when someone has been deprived of sleep Primary insomnia difficulty in initiating, maintaining, or gaining from sleep; not related to other medical or psychological problems DSM Primary Insomnia Features include: Difficulty initiating or maintaining sleep, or non-restorative sleep, for at least 1 month The sleep disturbance (for associated daytime fatigue) causes clinically significant distress or impairment in functioning The sleep disturbance does not occur exclusively during the course of narcolepsy, a breathing-related sleep disorder, a circadian rhythm sleep disorder, or a parasomnia The disturbance does not occur exclusively during the course of another mental disorder The disturbance is not due to the direct physiological effects of a substance (eg. A drug abuse, a medication) or general medical condition Rebound Insomnia in a person with insomnia, the worsened sleep problems that can occur when medications are used to treat insomnia and then withdrawn Primary hypersomnia abnormal excessive sleep, A person with this condition falls asleep several times a day complaint of excessive sleepiness that is displayed as either prolonged sleep episodes or daytime sleep episodes DSM Hypersomnia Features include: Excessive sleepiness for at least 1 month (or less if recurrent) as evidenced by either prolonged sleep episodes or daytime sleep episodes that occur almost daily The excessive sleepiness causes clinically significant distress or impairment in functioning The excessive sleepiness is not better accounted for by insomnia, does not occur exclusively during the course of another sleep

disorder, and cannont be accounted for by an inadequate amount of sleep The disturbance does not occur exclusively during the course of another mental disorder The disturbance is not due to the direct physiological effectsof a substance or a general medical condition

Narcolepsy sleep disorder involving sudden and irresistible sleep attacks DSM Narcolepsy Features include: Irresistible attacks of refreshing sleep that occur daily over at least 3 months The presence of one or both of the following o Cataplexy (ie. Brieg episodes of sudden bilateral loss of muscle tone most often in association with intense muscle tone most often in association with inherence emotion o Recurrent intrusions of elements of rapid eye movement (REM) sleep into the transition between sleep and wakefulness, as manifested by either hynopompic or hypnagogic hallucinations or sleep paralysis at the beginning or end of sleep episodes The disturbance is not due to the direct physiological effect of a substance or another general medical condition Breathing-related sleep disorders sleep disruption leading to excessive sleepiness or insomnia, cause by a breathing problem such as interrupted (sleep apnea) or labor breathing (hyperventilation) DSM Breathing related sleep disorders Sleep disruption, leading to excessive sleepiness or insomnia, that is judged to be due to a sleep related breathing condition o Obstructive or central sleep apnea syndrome o Central alveolar hypoventilation syndrome The disruption is not better accounted for by another mental disorder and is not due to the direct physiological effects of a substance or another general medial condition Circadian rhythm sleep disorders (sleep-wake schedule disorders) sleep disturbance resulting in sleepiness or insomnia, caused by the bodys inability to synchronize its sleep patterns with the current pattern of day and night

DSM Circadian Rhythm Sleep Disorders (Formerly Sleep-Wake Schedule Disorder) A persistent or recurrent pattern of sleep disruption leading to excessive sleepiness or insomnia that is due to a mismatch between the sleep-wake schedule required by a persons environment and his or her circadian sleep-wake pattern The sleep disturbance causes clinically significant distress or impairment in functioning The disturbance does not occur exclusively during the course of another sleep disorder or other mental disorder The disturbance is not due to the direct physiological effects of a substance or a general medical condition Sleep Apnea Disorder involving brief periods when breathing ceases during sleep Parasomnia abnormal behavior such as a nightmare or sleepwalking that occurs during sleep Nightmare disorder (dream anxiety disorder) consistent nightmare throughout the night Sleep terror disorder sleep panic awakening Sleep walking disorder sleep walking (stage 4) Nightmare - Frightening and anxiety-provoking dream occurring during rapid eye movement sleep. The individual recalls the bad dream and recovers alertness and orientation quickly DSM Nightmare Disorder Repeated awakenings from the major sleep period or naps with detailed recall of extended and extremely frightening dreams, generally during the second half of the sleep period On awakening from the frightening dreams, the person rapidly becomes oriented and alert The dream experience, or the sleep disturbance resulting from the awakening the awaking, causes significant distress or impairment in functioning Nightmares do not occur exclusively during the course of another mental disorder and are not due to the direct physiological effects of a substance or a general medical condition Sleep Terror Episode of apparent awakening from sleep, accompanied by signs of panic and followed by disorientation and amnesia for the incident. Sleep terrors occur during non-rapid eye movement sleep and so do not involve frightening dreams DSM Sleep Terror Disorder

Recurrent episodes of abrupt awakening from sleep, usually occurring during the first third of the major sleep episode and beginning with a panicky scream Intense fear and signs of autonomic arousal, such as tachycardia, rapid breathing, and sweating, during each episode Relative unresponsiveness to efforts of others to comfort the person during the episode No detailed dream is recalled, and there is amnesia for the episode The episodes cause clinically significant distress or impairment in functioning The disturbance is not due to the direct physiological effects of a substance or a general medical condition

Sleepwalking parasomnia that involves leaving the bed during non rapid eye movement sleep DSM Sleepwalking Disorder Repeated episodes of rising from bed during sleep and walking about, usually occurring during the first third of the major sleep episode While sleepwalking, the person has a blank, staring face; is relatively unresponsive to the efforts of others to communicate; and can be awakened only with great difficulty On awakening (either from the sleepwalking episode or the next morning), the person has amnesia for the episode Within several minutes after awakening from the sleepwalking episode, there is no impairment of mental activity or behavior (although there may initially be a short period of confusion or disorientation) The sleepwalking causes clinically significant distress or impairment in functioning The disturbance is not due to the direct physiological effects of a substance or a general medical condition Somnambulism repeated sleepwalking that occurs during non-rapid eye movement sleep and so is not the acting out of a dream. The person is difficult to waken and does not recall the experience Treatment If its due to another mental illness some other treatments might be different If just insomnia or hypersomnia then find behavioral treatment have them go to bed and wake up. Use the bed for sleep and sex.

Medical treatment melatonin drossiness and makes you tired and sleep Environmental treatment behavioral treatment phase delay and phase advancement cycle and shift it amount of hours. Move regular sleep time early (phase advance) later (phase delay) its easier to fall asleep if later Preventing sleep disorders Having a normal sleep cycle sleep and wake up at the same time everyday Stimulants and caffeine avoid alcohol, coffee, tobacco or anything that has sudden burst of energy Exercise during the day and not at night because itll wake you up at night Things that he didnt go over. Polysomnographic (PSG) evaluation Assessment of sleep disorders in which a client sleeping in the lab is monitored for heart, muscle, respiration, brain wave, and other functions Actigraph small electronic device that is worn on the wrist like a watch and records body movements. The device can be used to record sleep- wake cycles. Sleep efficiency (SE) percentage of time actually spent sleeping of the total time spent in bed