Overview of Feeding, Eating, and Sleep-Wake Disorders

What does the DSM-5-TR describe as feeding and eating disorders?

A persistent disturbance of eating or eating-related behavior that results in altered consumption or absorption of food, significantly impairing physical health or psychosocial functioning.

What is Pica?

Pica involves persistent eating of non-nutritive, nonfood substances for at least one month, inappropriate for the person's developmental level, and not socially acceptable. It can lead to medical complications such as intestinal obstruction and lead poisoning.

At what age is Pica most commonly observed?

Pica is most common among children and has an elevated rate among pregnant women.

What are the key characteristics of Anorexia Nervosa?

Involves restriction of energy intake leading to significantly low body weight, an intense fear of gaining weight, and a disturbance in the way weight or shape is experienced.

What are the specifiers used in diagnosing Anorexia Nervosa?

Specifiers indicate type (restricting or binge-eating/purging), course (in partial or full remission), and severity based on body mass index.

What psychological conditions often co-occur with Anorexia Nervosa?

Anorexia Nervosa often co-occurs with depression and anxiety disorders, especially obsessive-compulsive disorder.

What are the medical complications associated with Anorexia Nervosa?

Medical complications are usually due to malnutrition and extreme weight loss, affecting nearly all major organ systems and can lead to death.

Why is Anorexia Nervosa considered difficult to treat?

Individuals often deny having an eating problem and resist treatment.

How does the prognosis for Anorexia Nervosa compare to Bulimia Nervosa?

The prognosis for Anorexia is generally poorer than for Bulimia, but long-term outcomes may be more similar than previously believed.

What were the recovery rates for Anorexia and Bulimia at the 9-year follow-up according to Eddy et al. (2017)?

31.4% of patients with Anorexia and 68.2% of patients with Bulimia had recovered.

What were the recovery rates for Anorexia and Bulimia at the 22-year follow-up according to Eddy et al. (2017)?

62.8% of patients with Anorexia and 68.2% of patients with Bulimia had recovered.

What are the initial treatment goals for Anorexia Nervosa?

To restore the person to a healthy weight and address physical complications.

What subsequent treatment goals are recommended for Anorexia Nervosa?

Increasing motivation for treatment, providing education about healthy nutrition, changing contributing beliefs and attitudes, treating psychological conditions, enlisting family support, and preventing relapse.

What role does family therapy play in the treatment of Anorexia Nervosa?

Family therapy may be provided when appropriate to support the individual in treatment.

What is cognitive behavior therapy (CBT) used for in treating anorexia nervosa?

CBT is a post-hospitalization intervention aimed at establishing regular eating patterns, eliminating body-checking, and replacing problematic thinking.

What is enhanced cognitive-behavior therapy (CBT-E) and how does it differ from traditional CBT?

CBT-E is a transdiagnostic treatment that focuses on the shared core psychopathology of eating disorders, offering personalized and flexible treatment.

What are the three phases of family-based treatment (FBT) for anorexia nervosa?

1) Parents manage the adolescent's nutritional rehabilitation and weight restoration,

2) control over eating is gradually returned to the adolescent, 3) developmental issues and healthy parent-child relationships are addressed.

What inconsistent findings exist regarding pharmacotherapy for anorexia nervosa?

Some studies suggest olanzapine may aid initial weight gain and fluoxetine may help with weight maintenance, but effectiveness varies, leading experts to recommend medications primarily for comorbid symptoms.

What characterizes bulimia nervosa?

Bulimia nervosa involves recurrent binge eating with a sense of lack of control, inappropriate compensatory behaviors, and self-evaluation excessively influenced by body shape and weight.

What are the diagnostic criteria for bulimia nervosa?

Binge eating and compensatory behaviors must occur at least once a week for three months or more.

What medical complications can arise from bulimia nervosa?

Complications include

1. dental erosion,

2. gastroesophageal reflux,

3. dehydration,

4. electrolyte imbalance,

5. heart arrhythmias, and

6. potentially death.

What treatments are commonly used for bulimia nervosa?

Treatment typically includes

1. nutritional rehabilitation plus CBT,

2. CBT-E,

3. interpersonal therapy (IPT), or

4. family-based treatment (FBT).

How do CBT, CBT-E, and IPT compare in treating bulimia nervosa?

CBT and CBT-E generally have comparable effects and are preferred over IPT, which takes longer to produce results.

What is the primary focus during the first phase of family-based treatment (FBT) for bulimia nervosa?

The focus is on disrupting the adolescent's binging, purging, and restrictive dieting while establishing healthy eating.

What is the role of anxiety in the context of bulimia nervosa?

Anxiety often co-occurs with bulimia nervosa and can sometimes precede the development of the eating disorder.

What is the relationship between bulimia nervosa and weight?

Most individuals with bulimia nervosa are within the normal weight range or overweight.

What are some common compensatory behaviors associated with bulimia nervosa?

Common behaviors include self-induced vomiting and excessive exercise.

How does the treatment approach for anorexia nervosa differ from that for bulimia nervosa?

While both may use CBT and FBT, anorexia treatment focuses on nutritional rehabilitation and weight restoration, whereas bulimia treatment emphasizes disrupting binging and purging behaviors.

What is a key assumption underlying cognitive behavior therapy for anorexia nervosa?

The assumption is that shape- and weight-related concerns lead to dietary restriction and extreme weight control methods.

What is the significance of the term 'transdiagnostic' in the context of CBT-E?

It refers to the approach that addresses shared psychopathological features across different eating disorders.

What are the potential consequences of purging behaviors in bulimia nervosa?

Purging can lead to dental problems, gastroesophageal reflux, dehydration, and serious electrolyte imbalances.

What is the importance of addressing developmental issues in family-based treatment for anorexia nervosa?

It helps establish age-appropriate independence for the adolescent and fosters healthy parent-child relationships.

What is the typical duration for the diagnosis of bulimia nervosa?

The behaviors must occur at least once a week for three months or more to meet diagnostic criteria.

What are the common characteristics of individuals with bulimia nervosa regarding their weight?

Most individuals are typically within the normal weight range or overweight.

What is the main goal of cognitive behavior therapy (CBT) in treating eating disorders?

To modify dysfunctional thoughts and behaviors related to eating, body image, and weight control.

What distinguishes the experience of symptoms in adolescents with bulimia from those with anorexia?

Adolescents with bulimia often experience their symptoms as ego-dystonic (feels wrong) and are motivated to change, leading to more collaborative treatment with parents.

Which SSRI has been found effective in treating bulimia nervosa?

Fluoxetine.

What is the effectiveness of combining cognitive behavior therapy (CBT) with antidepressants for bulimia treatment?

Research suggests that combined treatment is more effective than medication alone, but not consistently more effective than CBT alone.

What is the most effective version of cognitive behavior therapy for bulimia?

The enhanced version of cognitive behavior therapy (CBT-E).

What are the four stages of CBT-E for bulimia treatment?

1. Engaging the patient and creating a formulation of the eating problem;

2. Reviewing progress and identifying new problems;

3. Addressing overevaluation of shape and weight;

4. Identifying ways to maintain progress and reduce relapse risk.

What is the purpose of Stage 1 in CBT-E?

To engage the patient, create a formulation of the eating problem, establish self-monitoring, provide education about weight and eating, and establish a pattern of regular eating.

What does Stage 2 of CBT-E involve?

Reviewing the patient's progress, identifying new problems, and revising the formulation if necessary.

What is addressed in Stage 3 of CBT-E?

The patient's overevaluation of shape and weight, its origins, triggers for undesirable eating, clinical perfectionism, low self-esteem, and interpersonal problems.

What is the goal of Stage 4 in CBT-E?

To help the patient identify ways to maintain progress and reduce the risk of relapse.

What was the finding of Mitchell et al. (2008) regarding telepsychology versus face-to-face CBT for bulimia?

Both methods were equivalent in client acceptability and retention, but face-to-face CBT had slightly higher ratterm-46es of abstinence from binge eating and purging.

How do individuals with bulimia differ from those with anorexia in terms of distress and motivation?

Individuals with bulimia are more distressed by their symptoms and tend to be more motivated to change their eating behaviors.

What type of motivation has been confirmed to benefit treatment outcomes for individuals with bulimia?

Autonomous (intrinsic) motivation.

What did Sansfacon et al. (2018) study regarding motivation in eating disorders?

They compared the effects of autonomous (intrinsic) and controlled (extrinsic) motivation on reducing symptoms in individuals with bulimia, anorexia, or other eating disorders.

What is the primary focus of CBT-E in treating eating disorders?

It is based on the assumption that eating disorders share the same core psychopathology, specifically the excessive value placed on physical appearance and weight.

What is the significance of motivation in the treatment of bulimia nervosa?

Higher levels of autonomous motivation are associated with better treatment outcomes.

What are the common outcomes measured in studies comparing telepsychology and face-to-face interventions for bulimia?

Acceptability to clients, retention in treatment, rates of abstinence from binge eating and purging, and reductions in eating-disordered cognitions.

How does the treatment approach for bulimia differ from that for anorexia?

Treatment for bulimia is often more collaborative due to the patient's motivation to change, while anorexia may involve more resistance to treatment.

What is the role of parents in the treatment of adolescents with bulimia?

Parents work collaboratively with the adolescent to alter undesirable food-related behaviors.

What does research suggest about the effectiveness of CBT alone compared to combined treatment for bulimia?

Some studies indicate that combined treatment is most effective, while others show no significant difference compared to CBT alone.

What psychological issues are commonly addressed in CBT-E for bulimia?

Overevaluation of shape and weight, clinical perfectionism, low self-esteem, and interpersonal problems.

What is the significance of the findings from studies on telepsychology for bulimia treatment?

They suggest that telepsychology can be as effective as face-to-face interventions, although there may be slight differences in outcomes.

What type of motivation predicts a greater reduction in symptoms and lower dropout risk in treatment?

Higher levels of autonomous motivation.

What is required for a diagnosis of binge-eating disorder (BED)?

Recurrent episodes of binge eating involving larger amounts of food than most people would eat, along with a sense of lack of control during episodes.

What are the five characteristic symptoms for diagnosing binge-eating disorder?

Symptoms occur at least once a week for three months.

1) Eating more rapidly than usual;

2) Eating until uncomfortably full;

3) Eating large amounts when not feeling hungry;

4) Feeling alone due to embarrassment about binge eating;

5) Feeling disgusted, depressed, or guilty about binge eating.

What determines the symptom severity of binge-eating disorder?

The number of episodes each week.

In which gender is binge-eating disorder (BED) more common?

BED is two to three times more common in women than in men.

How does binge-eating disorder differ from bulimia nervosa?

Individuals with BED do not engage in recurrent inappropriate compensatory behaviors and usually have a better response to treatment.

What are the evidence-based treatments for binge-eating disorder?

Cognitive-behavior therapy-enhanced (CBT-E) and interpersonal therapy (IPT).

Which treatment has been found to be more effective for binge-eating disorder in some studies?

Cognitive-behavior therapy-enhanced (CBT-E).

What medications have been evaluated for treating binge-eating disorder?

SSRIs (fluoxetine, paroxetine, sertraline), topiramate, and lisdexamfetamine.

What is the general recommendation for treating individuals with BED who are overweight or obese?

Focus on binge-eating before or concurrently with weight loss.

What is enuresis and what are its diagnostic criteria?

1. repeated voiding of urine into bed or clothing,

2. occurring two or more times a week for at least three consecutive months,

3. causing significant distress or impaired functioning.

What age must a person be for a diagnosis of enuresis?

At least five years old or the equivalent developmental level.

What is the most common treatment for nocturnal enuresis?

The moisture alarm (bell-and-pad) that rings when a child begins to urinate while sleeping.

What medication can reduce or stop bedwetting in many cases?

Desmopressin, an antidiuretic hormone.

What is the risk associated with discontinuing desmopressin for bedwetting?

A high risk for relapse.

What do sleep-wake disorders involve according to the DSM-5-TR?

Dissatisfaction regarding the quality, timing, and amount of sleep, resulting in daytime distress and impairment.

What characterizes insomnia disorder?

Dissatisfaction with sleep quality or quantity associated with difficulty initiating sleep, maintaining sleep, or early-morning awakening with inability to return to sleep.

What are the diagnostic criteria for insomnia?

The sleep disturbance must occur at least three nights a week, be present for at least three months, occur despite sufficient opportunities for sleep, and cause significant distress or impaired functioning.

What are the three types of insomnia?

1. Sleep-onset insomnia: difficulty initially falling asleep.

2. Sleep maintenance insomnia: frequent or extended awakenings during the night.

3. Late insomnia: awakening in the early morning with an inability to return to sleep.

Which type of insomnia is the most common single type?

Sleep maintenance insomnia.

What is the most common overall presentation of insomnia?

A combination of sleep-onset, sleep maintenance, and late insomnia.

How do subjective reports of sleep compare to objective measures in insomnia?

Subjective reports usually overestimate sleep latencies, overestimate time spent awake during the night, and underestimate total amount of sleep time.

What is the nonpharmacological treatment-of-choice for insomnia?

A multi-component cognitive-behavioral intervention that includes stimulus control, sleep restriction, sleep-hygiene education, relaxation training, and/or cognitive therapy.

What is stimulus control in the context of insomnia treatment?

Strengthening the bedroom and bed as cues for sleep by going to bed only when tired and sleeping only in the bedroom.

What does sleep restriction involve?

Restricting the time allotted for sleep each night so that time spent in bed matches sleep requirements.

What characterizes narcolepsy?

Attacks of an irrepressible need to sleep causing sleep or daytime naps at least three times a week for three months or more.

What are the diagnostic requirements for narcolepsy?

Episodes of cataplexy, hypocretin deficiency, or a REM latency of 15 minutes or less as determined by nocturnal sleep polysomnography.

What are hypnagogic and hypnopompic hallucinations?

Hypnagogic hallucinations occur just before falling asleep, while hypnopompic hallucinations occur just after awakening.

What triggers cataplexy in narcolepsy?

Strong emotions.

What are some behavioral strategies for treating narcolepsy?

Establishing good sleep habits, taking daytime naps, and staying active.

What medications are used to improve alertness in narcolepsy?

Modafinil, armodafinil, amphetamines, and other psychostimulants.

What is the primary medication for treating cataplexy in narcolepsy?

Antidepressants such as venlafaxine, fluoxetine, and clomipramine.

What is sodium oxybate used for in narcolepsy treatment?

It improves deep sleep at night and reduces cataplexy and daytime sleepiness.

What are non-rapid eye movement sleep arousal disorders?

Disorders that include sleepwalking and sleep terrors, characterized by recurrent episodes of incomplete awakening from sleep.

What occurs during sleepwalking?

Getting out of bed during sleep and walking about, potentially including sleep-related eating or sexual behavior.

What characterizes sleep terror episodes?

Abrupt arousal from sleep starting with a panicky scream, accompanied by intense fear and autonomic arousal.

What is the memory recall like after a sleepwalking or sleep terror episode?

The person has little or no memory of the episode upon awakening.

What is nightmare disorder according to the DSM-5-TR?

Repeated occurrences of extended, extremely dysphoric dreams that usually involve efforts to avoid threats to survival, security, or physical integrity.

When do nightmares typically occur?

During rapid eye movement (REM) sleep in the second half of a major sleep period.

What is the typical response of a person when awakened from a nightmare?

The person is usually oriented and alert but may continue to experience a dysphoric mood.