Chapter 14: Eating, Sleep, and Psychophysiological Disorders Overview

Anorexia involves a pervasive fear of becoming fat that results in excessive dieting and serious weight loss. Bulimia revolves around binge eating and purging. Depression is associated with both anorexia and bulimia. The disorders have been explained by suggesting that individuals with the disorders are reacting against a demanding and unpleasant family situation, taking the cultural preference for slimness to an extreme, suffering from a classically conditioned phobia for eating and fatness, exaggerating and overresponding to their perceived weight problem, or suffering from a hypothalamic malfunction which in some cases may be genetically determined. The psychodynamic and learning-based treatments have been somewhat effective; the tricyclic, serotonin specific reuptake inhibitors, and MAO drugs have received support as effective treatments, as have cognitive and interpersonal psychotherapies.

Stages of sleep are summarized as well as primary sleep disorders. Primary sleep disorders include dyssomnias (primary insomnia, primary hypersomnia, narcolepsy, breathing-related sleep disorder, and circadian rhythm disorder) and parasomnias (nightmare disorder, sleep terror disorder, and sleepwalking disorder).

Stress is the major psychological factor that contributes to physical disorders. After recognizing a stress, persons can cope with the stress or defend against it. If coping and defenses are not effective for reducing the stress, physiological responses are triggered that result in increased arousal, and increased physiological arousal may lead to physical disorders.

Coronary artery disease involves the build-up of fats inside the arteries which reduces blood flow. The Type A behavior pattern, and especially the hostility component of that pattern, is related to the development of coronary artery disease, increased arousal in challenging/stressful situations, and to the setting of higher personal goals. It may be that Type A/hostility and coronary artery disease are only correlated, and the relationship is due to a genetically determined high level of arousal which leads to both the behavior and the disease.

Essential hypertension is chronically elevated blood pressure for which there is not a known physical cause. It appears that stress leads to increased pressure.

Migraine and tension headaches are often attributed to stress, but thus far stress has been linked only to tension headaches.

Peptic ulcers are lesions on the digestive tract that stem from excessive acid or insufficient mucus. Stress leads to the production of excess acid, but this is most likely to occur in individuals who are genetically predisposed to the production of high levels of acid.

Individuals who are experiencing a high degree of stress are more likely to become physically ill because stress reduces immunocompetence. Cancer involves the abnormal reproduction of cells, which results in tumors. The process is often triggered by carcinogens and is more likely to occur if the immune system is suppressed and therefore less likely to destroy carcinogens. There is now evidence suggesting that persons who are depressed, lacking in hope, and who suppress emotion are at greater risk for cancer and may not survive as long once the disorder develops.