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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. - PowerPoint PPT Presentation
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1Elsevier items and derived items © 2005 by Mosby, Inc.
CHAPTER 23 Eating and Sleeping Disorders
CHAPTER 23 Eating and Sleeping Disorders
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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
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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
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• 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
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Adolescents
Exercise
Skip meals
Take diet pills
vomit
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The Quest for the Perfect Body
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(…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
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Anorexia Nervosa
Personality factors associated:TenseAlertHyperactiveRigidYoungWomanThinks, talks and walks rapidlyAmbitious – drives to perfectionSensitiveInsecureSerious with a conscience that works overtime
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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”
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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
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contdAnorexia is a life threatening disorder
Complications due to starvation or suicide
Death:Dehydration
Loss of critical muscle mass
Electrolyte imbalances
Suicide
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contd
Little interest in sex
Inability to cope or solve problems exist
History :Anxiety
Depression
Substance abuse
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(…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
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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
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Bulimia
Psychological profile:Anxiety
Drug use
Depression
Adolescents with chronic depression at higher risk for bulimia
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(…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…)
Eating DisordersEating Disorders
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(…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…)
Eating DisordersEating Disorders
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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
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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
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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
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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
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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
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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)
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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
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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
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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’
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Obesity
Clinical presentation
Ht weight history children >20% overweight should be assessed closely
Obtain thorough family history and childhood history
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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”
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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
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Rumination
Regurgitation and rechewing of food
Ejected from the mouth
Rechewed and swallowed
Death from malnutrition can result
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(…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…)
Eating DisordersEating Disorders
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(…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.
Eating DisordersEating Disorders
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• 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
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(…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 Sleep Disorders
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Sleep disorders
Polysomnogram- monitors electrophysical responses during sleep
Sleep labs
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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.
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(…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…)
Sleep Disorders Sleep Disorders
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