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FEEDING AND EATING DISORDERS; ELIMINATION DISORDERS; SLEEP-WAKE DISORDERS; AND DISRUPTIVE, IMPULSE-CONTROL, AND CONDUCT DISORDERS CHAPTER 10 Copyright © 2014 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. EATING DISORDERS Copyright © 2014 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. EATING DISORDERS • Diagnosis for people who experience extreme disturbances in their everyday diet along with possible distress or concern about their body weight Copyright © 2014 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. ANOREXIA NERVOSA • Characterized by an inability to maintain normal weight, an intense fear of gaining weight, and distorted body perception Copyright © 2014 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. EFFECTS OF ANOREXIA NERVOSA • Bones, muscles, hair, and nails become weak and brittle • Develop low blood pressure, slowed breathing and pulse • Lethargic, sluggish, and fatigued • Gastrointestinal system functions abnormally • Heart and brain damage • Multiple organ failure Copyright © 2014 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. BULIMIA NERVOSA • Alternation between the extremes of eating large amounts of food in a short time • Compensating for the added calories either by: • Vomiting • Other extreme actions to avoid gaining weight Copyright © 2014 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. BULIMIA NERVOSA • Binge eating • Ingestion of large amounts of food during a short period of time • Lack of control over what or how much is eaten Copyright © 2014 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. BULIMIA NERVOSA • Purging: Eliminating food through unnatural methods • Vomiting • Administering enemas • Taking laxatives or diuretics • Nonpurging type - Trying to compensate by fasting or excessive exercise Copyright © 2014 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. EFFECTS OF BULIMIA NERVOSA • Ipecac syrup has toxic effects • Dental decay • Laxatives, diuretics, and diet pills also have toxic effects over time • Gastrointestinal damage may be permanent Copyright © 2014 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. BINGE-EATING DISORDER • The ingestion of large amounts of food during a short period of time, even after reaching a point of feeling full, and a lack of control over what or how much is • Binges occur at least twice a week for 6 months. • Significant weight gain can occur since there are no compensatory behaviors. Copyright © 2014 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. THEORIES AND TREATMENT OF EATING DISORDERS • Biological - Serotonin and dopamine receptor genes • SSRIs • Psychological • Cognitive-behavioral therapy • Exposure therapy • Holistically viewing their bodies in front of a mirror Copyright © 2014 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. FIGURE 10.1- COMPONENTS OF BODY IMAGE Copyright © 2014 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. THEORIES AND TREATMENT OF EATING DISORDERS • Sociocultural • Family component for clients • Maudsley model Copyright © 2014 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. AVOIDANT/RESTRICTIVE FOOD INTAKE DISORDER • Individuals show an apparent lack of interest in eating or food because they are concerned about the aversive consequences. • Food may be avoided based on its sensory characteristics: • Color, smell, texture, temperature, or taste. • As a result, significant weight loss occurs and psychosocial function is disturbed. Copyright © 2014 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. EATING DISORDERS ASSOCIATED WITH CHILDHOOD • A condition in which a person eats inedible substances, such as dirt or feces. • Significant medical consequences occur to due to lead poisoning or injury to the gastrointestinal tract Copyright © 2014 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. RUMINATION DISORDER • Rumination Disorder is an eating disorder in which the infant or child regurgitates food after it has been swallowed and then either spits it out or re-swallows it. • Five common disturbances include: • (1) delayed or absent development of feeding and eating skills, • (2) difficulty managing or tolerating food or drink • (3) reluctance to eat food based on taste, texture, and other sensory factors, • (4) lack of appetite or interest in food • (5) the use of feeding behaviors to comfort, self-soothe, or selfstimulate. Copyright © 2014 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. ELIMINATION DISORDERS • Elimination disorders are characterized by ageinappropriate incontinence and are generally • diagnosed in childhood. • Enuresis: bed wetting or urination in their clothing after the age of age when they should be toilet trained • Encopresis: child who is at least 4 years old repeatedly has bowel movements either in its clothes or in another inappropriate place. Copyright © 2014 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. SLEEP-WAKE DISORDERS Copyright © 2014 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. SLEEP-WAKE DISORDERS Copyright © 2014 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. DISRUPTIVE, IMPULSE-CONTROL, AND CONDUCT DISORDERS • This grouping of disorders includes diagnoses assigned to individuals who have difficulties regulating their emotions and behavior whose disorder violate the rights of others. Copyright © 2014 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. OPPOSITIONAL DEFIANT DISORDER • A disorder characterized by angry or irritable mood, argumentative or defiant behavior, and vindictiveness that results in significant family or school problems. • Oppositional defiant disorder typically becomes evident between ages 8 and 12. • Oppositional Defiant Disorder often progresses to conduct disorder. Copyright © 2014 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. INTERMITTENT EXPLOSIVE DISORDER • An impulse-control disorder involving an inability to hold back urges to express strong angry feelings and associated violent behaviors. • Angry outbursts, either verbal (temper tantrums, tirades, arguments) or physical, in which individuals become assaultive or destructive in ways that are out of proportion to any stress or provocation are common. • Treatment • SSRIs, mood stabilizers • Cognitive behavioral therapy Copyright © 2014 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. CONDUCT DISORDER • Individuals with conduct disorder violate the rights of others and society’s norms or laws. • Their delinquent behaviors include: • Aggression to people and animals (such as bullying and acts of animal cruelty) • Destruction of property • Deceitfulness or theft • Serious violations of rules (such as school truancy or running away from home). Copyright © 2014 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. IMPULSE-CONTROL DISORDERS • People with impulse-control disorders repeatedly engage in behaviors, often ones that are harmful, that they feel they cannot control. • After acting on their impulses, they experience a sense of pleasure or gratification, although later they may regret that they engaged in the behavior. Copyright © 2014 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. PYROMANIA • Impulse-control disorder involving the persistent and compelling urge to start fires. • To be diagnosed with pyromania, the individual must not set fires for monetary reasons or have other medical or psychiatric conditions • Reflect abnormalities in dopamine functioning. • Treatment • Cognitive-behavioral therapy Copyright © 2014 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. KLEPTOMANIA • Impulse-control disorder that involves the persistent urge to steal. • Don’t actually wish to have the object, or the money that it’s worth. Instead, they seek excitement from the act of stealing. • Researchers believe that these features of kleptomania also bear similarities to substance dependence. Copyright © 2014 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. KLEPTOMANIA • Symptoms • Insomnia, agitation, and irritability • Medication • Naltrexone • Cognitive behavioral treatments Copyright © 2014 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. EATING DISORDERS AND IMPULSE-CONTROL DISORDERS: THE BIO-PSYCHOSOCIAL PERSPECTIVE • Psychological approaches gave greater weight to psychodynamic theories. • Evidence-based treatment now seems virtually to mandate that clinicians use cognitive-behavioral treatment Copyright © 2014 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. • For more information on material covered in this chapter, visit our Web site: • http://www.mhhe.com/whitbourne7eupdate Copyright © 2014 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education.