2. Describe the medical complications associated with bulimia and anorexia nervosa.
Ans – Anorexia Nervosa is an eating disorder which involves an intense and excessive fear of gaining weight as well as refusal to maintain a normal body weight. Even if the person has normal weight, they will relentlessly pursue the goal of being thin, no matter how much it affect their health. Most of them have distorted perception of their own bodies and thus, they pursue their goal of being thin, even if they have normal body.
As a result of Anorexia Nervosa, they starve themselves and this result in excessive drop in their weights. Thus, this eating disorder can result into many potential medical risks like –
Complications of Anorexia Nervosa
1) Constipation – Limiting food intake causes gastric immobility and intestine struggle to properly push food through digestive systems, resulting in uncomfortable stomach pain or extreme fullness.
2) Anemia – this occurs when there is lack of red blood cells in the bloodstream. To produce red blood cells body require adequate amount of Vitamin B12, iron etc. Now, if someone is restricting food intake, it can lead to anemia and inadequate oxygen transport throughout the body, which can further cause fatigue, weakness, headache, pale skin etc.
3) Dehydration can also happen as large percentage of dietary water also comes from solid foods. This can cause intense thirst, fatigue, confusion, dark-coloured urine.
4) Restricting food intake often result into electrolytic imbalances in the body such as sodium, potassium, calcium etc. which are essential for body’s balance and proper functioning.
Bulimia is an eating disorder in which a person engage in recurrent episodes of binge eating (huge amount of food being eaten in a short time) and then followed by some kind of compensatory behavior designed to prevent weight gain like self-induced vomiting, fasting, excessive exercise or misuse of laxatives. Similar to anorexics, bulimics perceive themselves as much heavier that they really are and this result in such kind of behavior.
Medical complications associated with Bulimia are –
1) Tooth Decay – self-induced vomiting, excess acid build up in mouth etc. increases rate by which teeth erode.
2) Gastric Rupture – binge eating episodes can result into tearing of stomach’s lining.
3) Digestive Problems – excessive dependence on laxatives can lead to disruption in body’s natural gastrointestinal functioning affecting bowel movement. Also, excessive acid can result into peptic ulcers.
4) Electrolytic Imbalance – due to compensatory behavior by bulimics, essential electrolytes like sodium, potassium, calcium, chloride etc. are removed from the body and if not replaced in proper time by adequate amount, can result into severe complications like hypovolemic shock, kidney failure, etc.
8. Describe the nature of REM and non-REM periods of sleep and how they relate to the parasomnias.
There are 4 stages of sleep, they are Non-REM Sleep Stage 1, 2, 3 and REM (rapid eye movement) Sleep. These stages progress cyclically from Non-REM Stage 1 through REM and then again begin from 1.
Stage 1 Non-REM is the first and lightest stage of NREM sleep. There are very slow eye movements and this stage can be easily disrupted causing awakenings or arousals. People may even experience abrupt jerks and sensation of falling. There is Thetha activity in the Brain in contrast to Alpha and Beta activity which are present during awake condition.
Stage 2 Non-REM is first actual stage of NREM sleep. There is no slow eye movements and awakening or arousal is not as easy as in the Stage 1. Brain waves slows down with specific bursts of rapid activity called sleep spindles intermixed with sleep structures called K complexes. These help in preventing awakening. As a result of all of this, body temperature decreases and hear rate slows down.
Stage 3 Non-REM is deep NREM sleep. It is believed to be most restorative stage of sleep. Awakening or arousal is highly difficult in this stage. It consists of delta waves which are slow waves.
REM period of sleep is short for Rapid Eye Movement period of sleep and is known as such because of rapid eye movements from side to side during this stage. This stage is also known as dreaming stage. Awakening and arousal occur easily. Also, brain waves are more active and consists of theta and beta activities which resemble waking restfulness. Some finding (Crick & Mitchision, 1995) suggest that this stage plays a crucial role in learning, allowing us to consolidate memories of the preceding day and to eliminate unnecessary memories and other mental clutter from our brains.
Coming to Parasomnias, they are any abnormal behavior that occurs at some point during sleep.
Non-REM Related Parasomnias – these can occur at any stage on Non-REM sleep.
1) Confusional arousals – people appear fully awake, but their thinking are not clear and somewhat hazy. Interestingly, they may respond to direct questions, but often their answers do not make sense or are blunt. People rarely remember what happened later.
2) Sleepwalking – people can complete various tasks ranging from as simple as closing a refrigerator doors to as complex as house cleaning. Many a times, sleepwalkers have no memory of the incidents afterward.
3) Night Terrors or Sleep Terrors.
4) Sleep eating
REM Related Parasomnias
1) Sleep Paralysis – A very unsettling experience where a person can find oneself awake and aware of what’s going around but unable to speak or move arms, legs or head. Some may experience that someone is present in the room which can be a frightening experience. It usually happens when someone is falling asleep or waking up.
2) REM Sleep Behavior Disorder (RBD) – In this, a person thrash around in bed or act some of the movements from the dream. As the years pass by, it can develop into a serious issue and can cause physical harm to sleeping partner.
3) Nightmare Disorder – frequent disruption of sleep on regular basis and prematurely waking up at night and unable to sleep afterwards due to anxiety etc.