1. Prevalence and characteristics of eating disorders (p. 527) Although nearly 50 percent of adolescent females and 20 percent of adolescent males report dieting to control their weight, the population of the United States is becoming heavier. Between 30 and 67 percent of normal-weight adolescent and college females believe they are overweight; their male age-peers also showed dissatisfaction with weight, wanting to be more muscular. Perceptions of ideal body weight and shape differed for males and females. More than 8 million Americans suffer from eating disorders, characterized by physically and/or psychologically harmful eating patterns; another 15 percent of young women having substantially disordered eating attitudes and behaviors.
   Anorexia nervosa is characterized by a refusal to maintain a body weight above the minimum normal weight for ones age and height; an intense fear of becoming obese that does not diminish with weight loss; body image distortion; and (in females) the absence of at least three consecutive menstrual cycles otherwise expected to occur. Prevalence is estimated as ranging from 0.5 to 1 percent of the female population. The restricting type loses weight through dieting or exercising; the binge-eating/purging type loses weight through self-induced vomiting, laxatives, or diuretics. There are serious physical complications, such as cardiac arrhythmias, low blood pressure, lethargy, and irreversible osteoporosis. As evidenced by the Internet, many women believe it is their right to refuse treatment. Comorbid disorders include obsessive-compulsive behaviors and certain personality characteristics. Approximately 44 to 50 percent of individuals treated for anorexia recover completely; mortality rate primarily from cardiac arrest or suicide ranges from 5 to 20 percent.
   Bulimia nervosa is characterized by recurrent episodes of binge eating high caloric foods at least twice a week for three months, during which the person loses control over eating. In the purging type, the individual regularly vomits or uses laxatives, diuretics, or enemas; in the nonpurging type, excessive exercise or fasting are used to compensate for binges. Prevalence rate is 3 percent of women in the Untied States; few males exhibit the disorder. Physical complications include erosion of tooth enamel, dehydration, swollen parotid glands, and lowered potassium, which can weaken the heart and cause arrhythmia and cardiac arrest. Comorbid mood disorders are common, as well as characteristics of borderline personality. Onset is generally later than for anorexia (late adolescence or early adulthood), and follow-up studies tend to find almost 70 to 75 percent remission.
   Binge-eating disorder, a diagnostic category provided for further study in DSM-IV-TR, involves consumption of large amounts of food over a short period of time, accompanying feeling of loss of control, and marked distress over the binges; but it lacks the compensatory behaviors of bulimia (e.g., vomiting). Females are one and one-half times more likely than males to have the disorder; prevalence rate estimates range from 0.7 to 5 percent. Although African American women are as likely as European American women to have the disorder, the former have fewer attitudinal concerns; prevalence rates for American Indian women are as high as 10 percent. Comorbid features include major depression, obsessive-compulsive personality disorder, and avoidant personality disorder. Onset is typically in late adolescence or early adulthood; although most individuals make a full recovery even without treatment, weight is likely to remain high.
   DSM-IV-TR includes the category eating disorder not otherwise specified, for those that do not meet all the criteria for anorexia or bulimia nervosa.
2. Etiology of eating disorders (p. 537) The etiology of eating disorders is believed to be determined by social, gender, psychological, familial, cultural, and biological factors. The social desirability of thinness in women in western culture plays a major role in causing eating disorder. Such disorders are rare in Asia. African Americans seem able to ignore the white media messages equating thinness with beauty and are more likely than white American women to be satisfied with their body shape and to feel that beauty stems from personality rather than thinness. White women in their twenties have especially high standards of thinness. Individuals with eating disorders often exhibit poor self-esteem, depression, and feelings of helplessness; anorexics are often described as perfectionistic, obedient, good students, excellent athletes, and model children, and the emphasis on weight allows them to have control over an aspect of their lives. Sexual abuse may be indirectly related to eating disorders. Genetic influences may play a part in a study of MZ and DZ twins, concordance rates were reported at 22.9 and 87 percent respectively.
3. Treatment of eating disorders (p. 546) Prevention programs in schools are aimed at reducing the incidence of eating disorders and disordered eating patterns. Initial treatment for anorexia focuses on weight gain (by feeding tube, contingent reinforcement for weight gain, or both). Cognitive-behavioral and family therapy sessions are common after weight gain, but relapse and continued obsession with weight are common. Bulimia is initially assessed for conditions that may have resulted from purging, including cardiac and gastrointestinal problems. The disorder is treated with psychotherapy, cognitive-behavioral treatment, and antidepressant medications; the combination of cognitive-behavioral therapy and medications appears to be best, although even with these approaches, only about 50 percent of those with the disorder recover fully. Treatments for anorexia and bulimia both involve interdisciplinary teams that include physicians and psychotherapists. Treatments for binge-eating disorder are similar to those for bulimia, including weight reduction strategies, although there are fewer physical complications for BED. Many of the therapies attempt to have clients identify the impact of societal messages regarding thinness and encourage development of healthier goals and values, develop normal eating patterns, a more positive body image, and healthier ways to deal with stress.
   Primary sleep disorders (p. 548) Primary sleep disorderscalled dyssominas involve difficulties in getting to or maintaining sleep. They can involve primary insomnia, primary hypersomnia, narcolepsy or breathe related disorders Circadian rhythm sleep disorder is a pattern of sleep disruption caused by the disruption of the biological sleep-wake cycle. Other primary sleep disorders calledparasomnias can include nightmare disorder, sleep terror disorder, sleepwalking disorder and parasomnias not otherwise specified
4. Etiology and treatment of sleep disorders (p. 555)Problems in sleep can result from factors such as subclinical anxiety and depression, environmental changes due to noise, light or other stimuli, and health and behavioral habits, in many cases the etiology is unknown. The etiology of parasomnias such as nightmare disorder, sleep terror and sleepwalking disorders is unknown. Treatments for dyssomnias can involve stimulant medications to combat excessive sleepiness or psychological techniques such as relaxation or stimulus control and change in habits. Parasomnias tend to resolve in adolescence or early adulthood and the etiology is unknown.