CHAPTER 23 Eating and Sleeping Disorders

1Elsevier items and derived items © 2005 by Mosby, Inc.

CHAPTER 23 Eating and Sleeping Disorders

CHAPTER 23 Eating and Sleeping Disorders


Eating Disorders

Body Image- collection of perceptions, thoughts, feelings, and behaviors that relate to one’s body size and appearance

Body Image:Anxiety

Depression

Anorexia nervosa

Bulimia

obesity


Body Image

Early Europeans- large fleshy body= wealthpoor were thin because they could not afford food and worked hardModern society- high value on thinFear of obesity is prevalentChildren learn body image-

Boys imitating muscle men Girls dieting too look like a model


• An ongoing disturbance in behaviors associated with ingestion of food

• Criteria for diagnosis Problems interfere daily with the client’s quality of life Clients do not maintain normal body weight Distorted emphasis placed on body weight and shape Inappropriate eating behaviors

(Cont’d…)

Eating DisordersEating Disorders


Adolescents

Exercise

Skip meals

Take diet pills

vomit


The Quest for the Perfect Body


(…Cont’d)

• Anorexia nervosa, one of the most serious eating disorders, is a condition in which an individual refuses to maintain normal body weight because of intense fear of becoming fat.• Mania to be thin• 90-95% are female• 1 million males yearly• Seldom before puberty• Rare after 40 years old• Avg onset 17 yrs• High risk-

• Those with professions that focus on appearance• Children from dysfunctional or abusive families

Anorexia NervosaAnorexia Nervosa


Anorexia Nervosa

Personality factors associated:TenseAlertHyperactiveRigidYoungWomanThinks, talks and walks rapidlyAmbitious – drives to perfectionSensitiveInsecureSerious with a conscience that works overtime


contd

Neatness, self will and stubborness make her difficult to treatLack of warmth and friendliness allows her to make few friends

“relentless and successful pursuit of thinness that results in psychological and physiological disturbances”


Anorexia – clinical presentation

Quest for thinness in refusal to maintain body weight normSelf esteem depends highly on body shape and sizeWeigh selves 3-4 times a dayLooking in mirror for areas of excess fatLosing weight is a sign of controlDeny seriousness of their thinness


contdAnorexia is a life threatening disorder

Complications due to starvation or suicide

Death:Dehydration

Loss of critical muscle mass

Electrolyte imbalances

Suicide


contd

Little interest in sex

Inability to cope or solve problems exist

History :Anxiety

Depression

Substance abuse


(…Cont’d)

• Criteria for diagnosis of anorexia nervosa Refusal to maintain a body weight that is no more than 15% below

normal Though underweight, clients have an immense fear of becoming fat. Significance of body weight and shape is distorted; clients feel and

perceive selves as fat In a female past menarche, three missed menses

(Cont’d…)

Anorexia NervosaAnorexia Nervosa


Bulimia• Bulimia is a disorder of binge eating and the

use of inappropriate methods to prevent weight gain.

More common than anorexia nervosa

College age incidence 19% (women)Young

White

Middle class/upper class

Men 1 out 9 cases


Bulimia

Psychological profile:Anxiety

Drug use

Depression

Adolescents with chronic depression at higher risk for bulimia


(…Cont’d)

• Criteria for diagnosis of bulimia Recurring episodes of binge eating followed by inappropriate

behaviors to prevent weight gain Binges occur at least twice a week for at least 3 months. Excessive emphasis on body shape and weight in determining self-

esteem

• Untreated, eating disorders have a high mortality rate.(Cont’d…)



(…Cont’d)

• Obesity: Excessive body weight Mild obesity: 20% to 40% above normal Moderate obesity: 41% to 100% above normal Morbid obesity: more than 100% above normal

• Like others with eating disorders, obese persons lose control over their eating. • Eating patterns of obese persons do not pose an immediate threat, but chronic

obesity eventually results in severe physical and emotional problems.

(Cont’d…)



Binge EatingConsuming amounts larger than most than most individuals would eat in similar circumstances

Large amounts of carbs

5,000 calories :donuts, cakes, sweets

Lasts 1-2 hours followed by guild and wanting to rid the body of amount consumed


2 forms of Bulimia

Presence or absence of purging

Purging- attempt to rid body of unwanted foodVomitingDiureticsLaxativesEnemasSyrup of ipecac

Non Purging- does not purge after binging but goes through extremes to prevent weight gain- fasting and excessive exercise


BulimiaPersonality traits different than anorexia nervosa’s

Slightly older

More outgoing

Socially and sexually active

Distressed about her behaviors

Body weight is normal to above average• Other problems present

Substance abuse Self mutiliation hysteria


contd

View themselves as fat or thin

Fears of lifelong dieting

Perfectionism is important

Unrealistic expectations of selves

Failure= unable to reach goal due to weakness, inadequacy, unloveable

Life based on all-or-nothing principle


Clinical presentation- Bulimia

Essential feature- recurring episodes of binge eating

Ashamed and eat in secret

Episodes may be planned in advance

Must occur at least 2 x per week for at least 3 months

Trigger: stressful event or experience


Contd

Complications:Fluid and electrolyte imbalances

Cardiac or skeletal muscle wasting – ipecac

Death is rare • Underlying psychological problems are often more

severe than the anorexic (nervosa)


Obesity

Not consistently associated with mental health or behavioral problems

Linked to many physical and psychological problems that cause distress

Obesity- excess of body weight


Obesity

Mild- 20-40% over IBWModerate-41-100% over IBWSeverely-Morbidly- more than 100% above IBW

Too many calories consumed not enough calories burnedLoss of control over eating


ObesityFactors :

Neurochemical that help control appetite

Heredity

Lack of sufficient exercise

Faulty eating behaviors being in childhood

Eating helps relieve childhood stress

Lessening emotional pain by eating is called ‘Compulsive Eating’


Obesity

Clinical presentation

Ht weight history children >20% overweight should be assessed closely

Obtain thorough family history and childhood history


ObesitySociety disapproves:

Child becomes aware and diet and exercise (to excess) or continue to find more comfort in food

Adolscence-weight becomes important part of forming body image

Teens rebel against parental nagging

Teens may resort to unhealthy means

“cycle”


PicaPersistent eating of nonfood items that last for more than 1 month

ClayLaundry starchInsectsLeavesPebbles

Still enjoy foodOverwhelming need to eat nonfood itemCan be traced to vitamin, mineral or calorie deficiency


Rumination

Regurgitation and rechewing of food

Ejected from the mouth

Rechewed and swallowed

Death from malnutrition can result


(…Cont’d)

• Therapeutic goals Establish behaviors that promote health Assist clients in identifying and coping with the problem that led

to inappropriate eating

• Treatments and therapies for eating disorders require medical and mental health interventions.

(Cont’d…)



(…Cont’d)

• Short-term therapeutic goals Stabilize existing medical problems. Reestablish normal nutrition and eating patterns. Help client resolve the psychological and emotional issues that underlie their disordered

eating behaviors.

• Long-term therapeutic goals Teaching clients about good nutrition and help them develop appropriate eating habits.

• Mental health goals Assist clients in improving self-esteem and developing more effective coping

mechanisms.



• Normal sleep Bodily functions and metabolic rate slow. Muscles relax and body conserves energy. Renewal and repair of cells and tissues occurs. Brain activity important for learning, memory, and behavioral adaptation occurs. Dreaming allows humans to gain insights, solve problems, work through

emotional reactions, and prepare for the future.

• Sleeping disorder: a condition or problem that repeatedly disrupts an individual’s plan of sleep

(Cont’d…)

Sleep Disorders Sleep Disorders


(…Cont’d)

• Insomnia: A disorder of falling asleep or maintaining sound sleep• Often associated with increased physical and mental alertness at

night and sleepiness during the day• Often results in preoccupation with sleep problem and in

distress, which contributes to more anxiety about sleep and sets in motion a vicious cycle

(Cont’d…)



Sleep disorders

Polysomnogram- monitors electrophysical responses during sleep

Sleep labs


Sleep DisordersPrimary- r/t to abn functioning of sleep wake or timing mechanism

2 types dyssomnias and parasomniasDyssomnias- abnormal amt, quality or timing of sleep

• Insomnia

• Hypersomnia

• Narcolepsy

• Breathing related

• Circadian rhythm related


InsomniaDisorder of falling asleep or maintaining a sound sleep

Increased physical and mental alertness at night with sleepiness during the dayThey will become preoccupied and distressedCycle of anxiety over no sleep and no sleepChronic insomnia- continual negative perception anticipated sleep will be poor

• Decreased well being during waking hours• Lack of energy and motiviation• Decr. Attention span• Worsening of mood• 30-40% adults have problems with insomnia• More often in women• Begins in young adulthood or middle age


InsomniaPrimary hypersomniaExcessive sleepiness betw. 15 and 30 yrs Progresses over weeks or monthsBecomes chronic and stableProlonged sleep episodes or daytime sleeping that occurs for more than a monthImpairment of ADLsNightime sleep may be 8-12 hours difficulty waking, excessive sleepiness during the day

Difficult to meet social or business obligationsThought to be lazy or indifferent


NarcolepsyRepeated attacks of sleep

Apparent during adolescence

Pattern of sleepiness can be traced to childhood

Onset follows a change in the persons sleep wake schedule or stressful event

Episode is irresistable

Sleep is 10-20 minutes regardless of inpropriety


narcolepsyCataplexy- sudden episode of muscle weakness and loss of muscle tone lasts for seconds to minutes

Brought on by episodes of emotions

Inappropriate REM- during transition between sleep and wakefulness

Dreamlike hallucinations or paralysis of voluntary muscle occurs


ApneaObstructive sleep apnea-partially obstructed upper airway causes periods of apnea

Repeatedly awakens the individualLoud snoring followed by apnea lasting as long as 90 secsEvent ends with gasps, moans, mumbles, shakes, loud air gulping snoresExcessively sleepy during the day

Extremely overweight are at risk for this disorder


Pickwickian- apneic disorder based on weight

Circadian rhythm disorder- shift workers or frequently traveled

RLS-restless leg syndrome-prickling, tingling, itching or crawling occurs while falling asleep or during sleep

Nocturnal Myoclonus- repeated brief jerks in legs at beginning of sleep decrease in deeper REM, disturb normal sleep patterns


ParasomniasCharacterized by abnormal behavioral or physical events during sleep

Sleep walking- complex motor movement during sleep, rise from bed and walk around not resonsive to communication , remember little about the event

• First seen between ages 4 and 8yrs, peaks 12 yrs, usually disappears by adolescence

Sleep terrors-frightening dream, abrupt awakening, with panicky cry or scream and intense fear, symp response

Nightmares disorder- repeated frightening dream that lead to abrupt awakenings- symp. Response may be present, anxiety may linger


Nocturnal sleep related eating disorder

Binge eating during sleep

Rapid uncontrolled ingestion of food during partial or full awakening of sleep, variable recall of event


General Causes of Sleep Disorders

Medical conditionMental health conditionChemical substance useNeurological, cardiovascular or respiratory disorderPain, anxietyMoods-dpression, anxiety, adjustment, somatiform, personality disordersFlare ups of schizophreniaPrescribed medsInflammatory process etc.


(…Cont’d)

• Interventions for sleep disorders First step: teach prevention Teach client to establish and maintain a sleeping routine by preparing both

body and mind for sleep.

• Therapeutic interventions are aimed at promoting comfort, controlling physical disturbances and marinating a quiet, restful environment.

• Hypnotics should be utilized only when other methods of inducing sleep have failed.

(Cont’d…)


Documents

CHAPTER 23 Eating and Sleeping Disorders