Clinical pictures

Sleep disorders can very directly affect relatives. A typical example is the sleepless partner tossing and turning in bed, or constantly turning the light on. Relatives should avoid reacting in an irritable or angry way, even if that is sometimes difficult. Affected individuals in most cases suffer markedly and are tense due to their inability to sleep. Anger and blame do not help. If the situation lasts longer, separate beds can help prevent sleep deprivation.

Understanding for the situation and consideration for decreased daytime fitness and concentration bring temporary relief. In the long run, the affected individual must deal with the sleep disorder and seek help. Relatives can motivate them and show their support.

At the time of menopause, women go through a change in their hormonal balance and their fertility. Oestrogen and progesterone (sex hormones) production decreases. This leads on the one hand to shortened deep-sleep phases, and on the other hand to frequent night hot flashes. Both can severely impair sleep.

Internal restlessness and mood swings also develop frequently during menopause. The extensive internal and external changes of this life phase put many women under stress. All these circumstances can lead to sleep disorders. Age also plays a role. The body produces less melatonin sleep hormone and the depth of sleep decreases.

Not every change in eating behaviour reflects an eating disorder. For instance, decreased food intake can be a reaction to stress or sadness. Pathologically reduced food intake as part of anorexia is characterised by the following:

• Excessive preoccupation with the issue of eating.
• Eating behaviour displays a high level of self-control.
• Count calories incessantly and weigh themselves daily (even more than once).
• They eat slowly.
• They drink plenty of water to fill the stomach.
• They find excuses to avoid eating in the company of others or, when that is inevitable, to avoid eating (“I have eaten already”).
• Severe weight loss.
• Excessive sports activity.
• Consider themselves fat despite obvious underweight.
• Have difficulty concentrating, lose hair and have dry skin, and feel cold.
• Develop lanugo hair (new-born facial hair).

Binge eating is a mental disorder. This makes it difficult or downright impossible for affected individuals to control it without professional help. This is because the causes are multifactorial. Examples of causative factors include familial eating behaviour, familial conflicts, low self-esteem, a high body-mass index (BMI), or depression.

Cognitive behavioural therapy (CBT) has proved effective. The goals are to normalise the eating behaviour, to strengthen self-acceptance, and to recognise the triggers for binge episodes and find ways to deal with them.

Bulimia nervosa rarely has a single cause. In most cases it develops from the interplay of biological, psychological, familial, and/or sociocultural factors.

A biological example is genetic predisposition for an eating disorder. Familial influence refers to the attitude towards eating in the family. Examples include families in which frequent dieting occurs, or settings where excessive attention is paid to weight, physique, or appearance.

One of the psychological factors is almost always low self-esteem, which ill individuals try to offset by good looks. They frequently have a hard time dealing with feelings; depression is also frequent.

Societal influence also plays a role. Despite some opposite trends such as body positivity, mass media and social media are dominated by the beauty ideal of slimness. Affected individuals think that their urge to pursue this ideal makes them feel better.