Abnormal Psychology Psych 433
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This 12 page Class Notes was uploaded by Derek Schrick on Sunday March 13, 2016. The Class Notes belongs to Psych 433 at University of Missouri - Kansas City taught by K. Harry in Spring 2016. Since its upload, it has received 22 views. For similar materials see Abnormal Psychology in Psychlogy at University of Missouri - Kansas City.
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Date Created: 03/13/16
Chapter 8- Eating and Sleep- Wake Disorders Major types of eating disorders - Bulimia nervosa and anorexia nervosa - Disruptions in eating behavior - Fear of gaining weight - Binge-eating disorder - individuals may binge repeatedly and find it distressing, but they do not attempt to purge thefood - Sociocultural origins - Westernized views Major Types of Eating Disorders - Obesity - 70% of U.S. adults overweight - 35% obese - Rates are increasing - BMI versus weight - Health Risks Bulimia Nervosa - Binge eating - Excess amounts of food - Perceived as ‘out of control’ - Compensatory behaviors - Purging - Excessive exercise - Fasting - Belief that popularity and self-esteem are determined by weight and body shape Eating Disorders Bulimia Nervosa – Clinical Description - Subtypes - Purging (most common) - Vomiting, laxatives, or diuretics - Nonpurging - Exercise and/or fasting - 6-8% of Bulmics - Most are within 10% of normal weight Bulimia Nervosa - Medical consequences - Salivary gland enlargement - Erosion of dental enamel - Electrolyte imbalance - Kidney failure - Cardiac arrhythmia - Seizures Chapter 8- Eating and Sleep- Wake Disorders - Intestinal problems - Permanent colon damage - Hand calluses Bulimia Nervosa - Associated psychological disorders - Anxiety (80.6%) - Mood disorders (50-70%) - Substance abuse (36.8%) Anorexia Nervosa - “Overly-successful” weight loss - 15% below expected weight - Intense fears - Gaining weight - Losing control of eating - Relentless pursuit of thinness - Often begins with dieting Anorexia Nervosa - Subtypes - Restricting - Binge-eating-purging - Associated features - Body image disturbance - Pride in diet and control - Rarely seek treatment Anorexia Nervosa Anorexia Nervosa - Medical consequences - Amenorrhea - Dry skin - Brittle hair and nails - Sensitivity to cold temps - Lanugo - Cardiovascular problems - Electrolyte imbalance Anorexia Nervosa - Associated psychological disorders - Anxiety - OCD - Mood disorders (71%) - Substance abuse - Suicide Chapter 8- Eating and Sleep- Wake Disorders Binge-Eating Disorder - Marked distress because of binge eating but do not engage in extreme compensatory behaviors and therefore cannot be diagnosed with bulimia - Often found in weight-control programs 20% - 50% among candidates for bariatric surgery - Better response to treatment Binge-Eating Disorder Binge-Eating Disorder - Associated Features - Many are obese - Older - More psychopathology - vs. non-binging obese - Concerned about shape and weight Bulimia and Anorexia: Statistics - Bulimia - 90-95% female - Caucasian, middle to upper class - Onset = age 10 to 21 - Chronic, if untreated - Bulimia in men - 5-10% male - Caucasian, middle to upper class - Gay or bisexual - Athletes with weight regulations - Onset = older Bulimia and Anorexia: Statistics - Anorexia - More female than males - Caucasian, middle to upper class - Onset = age 13 to 18 - Chronic - Resistant to treatment Cross-Cultural Considerations - North American minority populations - Immigrants to western cultures - Increase in eating disorders - Increase in obesity - Cultural values - Standards for body image Chapter 8- Eating and Sleep- Wake Disorders Developmental Considerations - Developmental considerations - Adolescent onset - Weight gain - Interaction with social ideals Causes of Eating Disorders - Social dimensions - Cultural imperatives - Thinness = success, happiness - Ideal body size standards - Change rapidly - Media - Social and gender standards - Internal and perceived Causes of Eating Disorders Causes of Eating Disorders - Social dimensions - Dieting - Perceptions of fat - Social and peer groups - Dietary restraint Causes of Eating Disorders - Family influences - “Typical” family - Successful - Driven - Concerned about appearance - Maintains harmony - History of dieting, eating disorders - Mothers Causes of Eating Disorders - Biological dimensions - Heritability studies (.56) - Inherited tendency to be emotionally responsive to stress, eat impulsively - Perfectionism - Hypothalamus - Serotonin Causes of Eating Disorders - Psychological dimensions - Low sense of personal control - Low self-confidence Chapter 8- Eating and Sleep- Wake Disorders - Perfectionistic attitudes - Distorted body image - Preoccupation with food and appearance - Mood intolerance Treatment of Eating Disorders - Drug treatments of eating disorders - Anorexia - No demonstrated efficacy - Bulimia - Antidepressants - May enhance psychological treatment - No long-term efficacy Psychological Treatment of Bulimia - Cognitive-behavior therapy (CBT) - Treatment of choice - Target problem eating behaviors - Target dysfunctional thoughts - Interpersonal psychotherapy - Improve interpersonal functioning - Similarly effective, long-term - CBT may work quicker Psychological Treatment of Binge-eating Disorder - Cognitive-behavior therapy - Similar format to bulimia - Interpersonal psychotherapy - As effective as CBT - Medications - Prozac - No benefit - Meridia - Possible benefits Psychological Treatment of Anorexia Nervosa - Weight restoration - May require hospitalization - Target dysfunctional attitudes - Body shape - Control - Thinness = worth - Family involvement - Communication about eating/food - Attitudes about body shape Chapter 8- Eating and Sleep- Wake Disorders - Long-term prognosis - Poorer than bulimia Preventing Eating Disorders - Identify specific targets - Early weight concerns -Screening for at-risk groups - Provide education - Normal weight limits - Effects of calorie restriction - “Healthy Weight” Obesity—Statistics - Rapid increases in prevalence -U.S. adults - 1991 = 12% - 2000 = 30.5% - 2002 = 30.6% - 2004 = 32.2% - 2008 = 33.8% - 2010 = 35.7% - Developing nations Disordered Eating Patterns in Cases of Obesity - Night eating syndrome - Associated with obesity - 1/3 of daily calories consumed - Patients are awake - No binge eating Causes of Obesity - Spread of modernization - Inactive, sedentary lifestyle + high fat foods - Genetics - 30% of the cause - Biological factors - Initiation and maintenance of eating - Psychosocial factors - Impulse control, affect regulation, attitudes Obesity Treatment - Progression from least to most intrusive - Self-directed weight loss programs - Commercial self-help programs - Behavior modification programs Chapter 8- Eating and Sleep- Wake Disorders - Bariatric surgery - 15% of patients who have bariatric surgery fail to lose significant weight - Efficacy - Moderate for adults - Higher for children and adolescents - Family involvement Sleep–Wake Disorders: The Major Dyssomnias - Rapid eye movement (REM) sleep - Types of Sleep Disorders - Dyssomnias - Quantity - Quality - Sleep onset - Parasomnias - Abnormal behavioral - Physiological events - Polysomnographic (PSG) evaluation - Detailed history - Sleep hygiene & efficiency - Electrooculogram, eye movements - Electromyogram, muscle movements - Electrocardiogram, heart activity - Actigraph - Sleep efficiency (SE) Insomnia Disorder - Primary insomnia - Unrelated to any other condition - Rare - Microsleeps that last several seconds or longer - Statistics - Prevalence = 35% (year) older adults - Female : Male = 2:1 - More likely to report? - Frequently associated with: - Anxiety - Depression - Substance use disorder - Dementia of the Alzheimer’s type - Causes - Pain, physical discomfort - Delayed temperature rhythm Chapter 8- Eating and Sleep- Wake Disorders - Light, noise, temperature - Other sleep disorders - Apnea - Periodic limb movement disorder - Stress - Anxiety - Causes cultural and social expectations - Parents - Practices - Presence - Poor sleep habits - Sleeping pills - Rebound insomnia Hypersomnolence Disorders - Hypersomnolence disorders - Sleeping too much - Excessive sleepiness - Subjective experience as a problem - Unrelated to other condition - Rare - Facts and statistics - Family history - Associated with exposure to viral infections - Little research Narcolepsy - Narcolepsy - Daytime sleepiness - Cataplexy -Cataplexic attacks - REM sleep - Triggered by strong emotion - Sleep paralysis - Hypnagogic hallucinations Narcolepsy - Statistics - Prevalence = .03% to .16% - Female : Male = 1:1 - Typically improves over time - Daytime sleepiness persists without treatment Narcolepsy Breathing-Related Sleep Disorders - Breathing-related sleep disorders Chapter 8- Eating and Sleep- Wake Disorders - Daytime sleepiness - Disrupted sleep at night - Sleep apnea - Restricted air flow - Brief cessations of breathing Breathing-Related Sleep Disorders - Subtypes of sleep apnea - Obstructive sleep apnea hypopnea syndrome (OSA) - Central (CSA) - Sleep-related hypoventilation Breathing-Related Sleep Disorders Breathing-Related Sleep Disorders - Statistics - Obstructive sleep apnea = 10-20% - Female < Male - Associated with - Obesity - Increasing age Circadian Rhythm Sleep Disorder - Insomnia or hypersomnia - Inability to synchronize day and night - Suprachiasmatic nucleus - Brain’s biological clock -Stimulates melatonin Circadian Rhythm Sleep Disorder - Types - Jet lag - Shift work - Delayed sleep phase type - Advanced sleep phase type - Irregular sleep–wake type - Non-24 hour sleep–wake type Circadian Rhythm Sleep Disorder Circadian Rhythm Sleep Disorder Medical Treatment of Sleep Disorders - Insomnia - Benzodiazepines - Short-term solutions - Excessive sleepiness - Rebound insomnia - Dependence - Sleep-walking (Ambien) Chapter 8- Eating and Sleep- Wake Disorders - Hypersomnia/narcolepsy - Stimulants - Ritalin, amphetamine, modafrinil - Cataplexy - Antidepressants - Breathing-related sleep disorders - Weight loss - Mechanical devices - CPAP machine - Dental splint - Surgery Environmental Treatments for Dyssomnias - Circadian rhythm sleep disorders - Phase delays - Phase advances - Phototherapy Psychological Treatments for - Stimulus control - Improved sleep hygiene - Regular bedtime routine - Relaxation - Reduces stress - Modify unrealistic expectations about sleep - Combined medication/behavioral treatments Psychological Treatments for Dyssomnias Preventing Sleep Disorders - Improving sleep hygiene - Setting regular sleep and wake times Avoiding stimulants - Caffeine and nicotine - Educating parents about child’s sleep patterns Preventing Sleep Disorders Parasomnias and Their Treatment - Abnormal events during sleep or transition between sleep and waking - Types - REM sleep - Nightmares - NREM sleep - Sleepwalking - Sleep terrors Chapter 8- Eating and Sleep- Wake Disorders Dyssomnias The Parasomnias: Nightmare Disorder - REM sleep - Involves dreams: - Distressing & disturbing - Disrupt sleep, cause awakening - Interfere with functioning - More common in children The Parasomnias: Nightmare Disorder - Treatment - Antidepressants - Relaxation training Sleep Terror - More common in children - Piercing scream - Signs of elevated arousal (e.g., sweating) - Person looks extremely upset - Difficult to awaken - Little memory of the event - Prevalence - Children 6% - Adults 2% - More boys than girls Sleep Terror - Treatment - “Wait-and-see” posture - Scheduled awakenings Sleep Walking - Somnambulism - Non-REM sleep - Usually during first few hours of deep sleep - Person must leave the bed - Related Conditions - Nocturnal eating syndrome - Person eats while asleep The Parasomnias: Sleep Walking Disorder - Somnambulism - Non-REM sleep - First few hours of deep sleep - Person must leave the bed - More common in children 15-30% Chapter 8- Eating and Sleep- Wake Disorders - Difficult (not dangerous) to wake - Genetic component - Usually resolves on its own - Related to nocturnal eating syndrome - Person eats while asleep - Sexsomnia
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