O sentido na anorexia nervosa / Meaning in anorexia nervosa

A anorexia nervosa caracteriza-se pela manutenção voluntária de um peso corporal abaixo do esperado para a idade e altura, justificada pelo medo de engordar. No presente artigo, discutem-se hipóteses sobre os fatores envolvidos na vulnerabilidade psicológica para a anorexia nervosa. Mais especificamente, abordam-se perturbações na relação precoce com a figura materna e na estruturação matriarcal, tanto na polaridade receptiva (filho) como na polaridade ativa, provedora do autocuidado (mãe). Essas perturbações podem gerar dificuldades no estabelecimento do narcisismo saudável, o qual é responsável por um sentimento de continuidade da existência e de validade subjetiva. Tais falhas precoces favorecem a adesão onipotente a um ideal de magreza e autocontrole de forma compensatória. Discutem-se também as implicações que essas hipóteses trazem para o tratamento global da paciente e também para a abordagem psicoterápica.

Anorexia nervosa is characterized by a refusal to maintain a normal body weight for height and age, based on intense fear of becoming fat. We discuss a few hypothesis concerning psychological vulnerability for anorexia nervosa. We specifically describe problematic issues in the primary relationship between the girl and the mother figure. This experience of the mother archetype impairs both its receptive and active polarity (daughter). We suggest these initial problems interfere with the establishment of healthy narcissism and a basic sense of security and of inner validity that it provides. The anorexic patient seems to compensate this lack of solid narcissistic foundations with omnipotent weight control and rigid ideal of thinness. We also discuss implications of these ideas to patient treatment and psychotherapy.

O sentido na anorexia nervosa / Meaning in anorexia nervosa

A anorexia nervosa caracteriza-se pela manutenção voluntária de um peso corporal abaixo do esperado para a idade e altura, justificada pelo medo de engordar. No presente artigo, discutem-se hipóteses sobre os fatores envolvidos na vulnerabilidade psicológica para a anorexia nervosa. Mais especificamente, abordam-se perturbações na relação precoce com a figura materna e na estruturação matriarcal, tanto na polaridade receptiva (filho) como na polaridade ativa, provedora do autocuidado (mãe). Essas perturbações podem gerar dificuldades no estabelecimento do narcisismo saudável, o qual é responsável por um sentimento de continuidade da existência e de validade subjetiva. Tais falhas precoces favorecem a adesão onipotente a um ideal de magreza e autocontrole de forma compensatória. Discutem-se também as implicações que essas hipóteses trazem para o tratamento global da paciente e também para a abordagem psicoterápica. (AU)

Anorexia nervosa is characterized by a refusal to maintain a normal body weight for height and age, based on intense fear of becoming fat. We discuss a few hypothesis concerning psychological vulnerability for anorexia nervosa. We specifically describe problematic issues in the primary relationship between the girl and the mother figure. This experience of the mother archetype impairs both its receptive and active polarity (daughter). We suggest these initial problems interfere with the establishment of healthy narcissism and a basic sense of security and of inner validity that it provides. The anorexic patient seems to compensate this lack of solid narcissistic foundations with omnipotent weight control and rigid ideal of thinness. We also discuss implications of these ideas to patient treatment and psychotherapy. (AU)

Validation of the Portuguese version of the Questionnaire on Eating and Weight Patterns-Revised (QEWP-R) for the screening of binge eating disorder.

OBJECTIVE: The present paper describes the validation of the Questionnaire on Eating and Weight Patterns-Revised (QEWP-R) designed for the diagnosis of binge eating disorder (BED) and sub-clinical binge eating. METHODS: 89 overweight women seeking treatment for binge eating and/or obesity were assessed with the Portuguese version of the Questionnaire of Eating and Weight Patterns and were, subsequently, interviewed with the eating disorders module of the Structured Clinical Interview for DSM-IV (SCID-I/P). Rates of binge eating disorder and sub-clinical cases of binge eating obtained with the Questionnaire on Eating and Weight Patterns-Revised were then compared to those obtained with the Structured Clinical Interview for DSM-IV. RESULTS: In the identification of binge eating, irrespective of the presence of all criteria for binge eating disorder the QEWP-R Questionnaire on Eating and Weight Patterns-Revised yielded a sensitivity value of 0.88, a specificity value of 0.63 and a positive predictive value of 0.825. Rates for the identification of the full syndrome of binge eating disorder were: sensitivity value of 0.548, a specificity value of 0.8 and a positive predictive value of 0.793. CONCLUSIONS: The Questionnaire on Eating and Weight Patterns-Revised can be useful in a first-step screening procedure to identify probable cases of binge eating. It can be useful as a screening tool and as a first step of clinical assessment of patients seeking treatment for binge eating and/or obesity.

Validação da versão em português do Questionário sobre Padrões de Alimentação e Peso – Revisado (QEWP-R) para o rastreamento do transtorno da compulsão alimentar periódica / Validation of the portuguese version of the Questionnaire on Eating and Weight Patterns: revised (QEWP-R) for the screening of binge eating disorder

OBJECTIVE: The present paper describes the validation of the Questionnaire on Eating and Weight Patterns-Revised (QEWP-R) designed for the diagnosis of binge eating disorder (BED) and sub-clinical binge eating. METHODS: 89 overweight women seeking treatment for binge eating and/or obesity were assessed with the Portuguese version of the Questionnaire of Eating and Weight Patterns and were, subsequently, interviewed with the eating disorders module of the Structured Clinical Interview for DSM-IV (SCID-I/P). Rates of binge eating disorder and sub-clinical cases of binge eating obtained with the Questionnaire on Eating and Weight Patterns-Revised were then compared to those obtained with the Structured Clinical Interview for DSM-IV. RESULTS: In the identification of binge eating, irrespective of the presence of all criteria for binge eating disorder the QEWP-R Questionnaire on Eating and Weight Patterns-Revised yielded a sensitivity value of 0.88, a specificity value of 0.63 and a positive predictive value of 0.825. Rates for the identification of the full syndrome of binge eating disorder were: sensitivity value of 0.548, a specificity value of 0.8 and a positive predictive value of 0.793. CONCLUSIONS: The Questionnaire on Eating and Weight Patterns-Revised can be useful in a first-step screening procedure to identify probable cases of binge eating. It can be useful as a screening tool and as a first step of clinical assessment of patients seeking treatment for binge eating and/or obesity.

OBJETIVO: O presente artigo descreve a validação do Questionário sobre Padrões de Alimentação e Peso-Revisado (QEWP-R), instrumento criado para o diagnóstico do transtorno da compulsão alimentar periódica (TCAP) e de quadros subclínicos de compulsão alimentar. MÉTODOS: A amostra foi composta por 89 mulheres em busca de tratamento especializado para compulsão alimentar e/ou obesidade, que preencheram o Questionário sobre Padrões de Alimentação e Peso-Revisado e, posteriormente, foram entrevistadas com o módulo para transtornos alimentares da Entrevista Clínica Estruturada para o DSM-IV (SCID-I/P). As taxas de transtorno da compulsão alimentar periódica e de diagnósticos subclínicos obtidas pelo Questionário sobre Padrões de Alimentação e Peso-Revisado foram comparadas às obtidas pela Entrevista Clínica Estruturada para o DSM-IV. RESULTADOS: Na identificação de compulsão alimentar (independente da presença de todos os elementos necessários para o diagnóstico de transtorno da compulsão alimentar periódica), a versão em português do Questionário sobre Padrões de Alimentação e Peso-Revisado apresentou sensibilidade de 0,88, especificidade de 0,63 e valor preditivo positivo de 0,825. Já para o diagnóstico de transtorno da compulsão alimentar periódica, o questionário apresentou sensibilidade = 0,548, especificidade = 0,8 e valor preditivo positivo de 0,793. CONCLUSÕES: O Questionário sobre Padrões de Alimentação e Peso-Revisado, em sua versão para o português, mostrou ser um instrumento útil na detecção de prováveis casos de compulsão alimentar. Pode ser utilizado como escala de rastreamento ou ainda como primeiro passo na avaliação clínica de pacientes que procuram tratamento para compulsão alimentar e/ou obesidade.

Eating-disordered behaviors, body fat, and psychopathology in overweight and normal-weight children.

This study examined eating-disordered pathology in relation to psychopathology and adiposity in 162 non-treatment-seeking overweight (OW) and normal weight (NW) children, ages 6-13 years. Participants experienced objective or subjective binge eating (S/OBE; loss-of-control eating), objective overeating (OO), or no episodes (NE). OW children experienced significantly higher eating-disordered cognitions and behaviors than NW children and more behavior problems than NW children: 9.3% endorsed S/OBEs, 20.4% reported OOs, and 70.4% reported NEs. OW children reported S/OBEs more frequently than did NW children (p =.01), but similar percentages endorsed OOs. S/OBE children experienced greater eating-disordered cognitions (ps from <.05 to <.01) and had higher body fat (p <.05) than OOs or NEs. OOs are common in childhood, but S/OBEs are more prevalent in OW children and associated with increased adiposity and eating-disordered cognitions.

Comparison of assessments of children's eating-disordered behaviors by interview and questionnaire.

OBJECTIVE: In adults, interview methods may detect eating-disordered behaviors more accurately than self-report methods. However, no studies have investigated the relationships between interview and self-report assessments in children. We compared results from the Eating Disorder Examination adapted for Children (ChEDE) with the Adolescent version of the Questionnaire on Eating and Weight Patterns (QEWP-A) and with the Children's Eating Attitude Test (ChEAT) in a nontreatment sample of overweight and normal weight children. METHOD: The ChEDE, QEWP-A, and ChEAT were administered to 46 overweight (body mass index [BMI] at or above the 85th percentile) and 42 normal weight (BMI at the 15th-85th percentile) children, 10 +/- 1.8 years, recruited from the community. RESULTS: The ChEDE and QEWP-A were not concordant for the number or type of eating episodes that occurred in the past month. Compared with the ChEDE, the QEWP-A was reasonably specific, but it was not sensitive for the presence of objective (17 % sensitivity, 91% specificity) or subjective bulimic episodes (0 % sensitivity, 89 % specificity) during the past month. ChEDE and ChEAT global scores were significantly related (Kendall's tau = 0.286, p <.001), but specific items assessing guilt in relation to eating and preoccupation with food were not. DISCUSSION: Although self-report methods of eating disorder assessment in children may provide some general information regarding eating psychopathology in non-treatment-seeking children, they do not accurately reflect the results of a structured interview.

Etiologia dos transtornos alimentares: aspectos biológicos, psicológicos e sócio-culturais / Etiology of eating disorders: biological, psychological and sociocultural determinants

Os transtornos alimentares possuem uma etiologia multifatorial, composta de predisposições genéticas, socioculturais e vulnerabilidades biológicas e psicológicas. Entre os fatores predisponentes, destacam-se a história de transtorno alimentar e (ou) transtorno do humor na família, os padröes de interaçäo presentes no ambiente familiar, o contexto sociocultural, caracterizado pela extrema valorizaçäo do corpo magro, disfunções no metabolismo das monoaminas centrais e traços de personalidade. A dieta é o comportamento precursor que geralmente antecede a instalaçäo de um transtorno alimentar. Contudo, a presença isolada da dieta näo é suficiente para desencadear o transtorno alimentar, tornando-se necessária uma interaçäo entre os fatores de risco e outros eventos precipitantes. Por último, o curso transitório ou crônico de um transtorno alimentar está relacionado à persistência de distorções cognitivas, à ocorrência de eventos vitais significativos e a alterações secundárias ao estado de desnutriçäo

Binge-eating disorder in Brazilian women on a weight-loss program.

OBJECTIVE: To examine binge-eating disorder (BED) and its association with obesity, weight patterns, and psychopathology in a Brazilian sample of female participants of a weight-loss program in São Paulo, Brazil. RESEARCH METHODS AND PROCEDURES: Two hundred and seventeen overweight (body mass index >/= 25 kg/m(2)) women, ages 15 to 59 years, enrolled in the Weight Watchers Program were recruited for the study at a program branch meeting after completing the Questionnaire on Eating and Weight Patterns-Revised, Beck Depression Inventory, and the Toronto Alexithymia Scale-20. Participants were categorized into four groups: those who met questionnaire criteria for BED, those who met questionnaire criteria for bulimia nervosa (BN), those that reported binge eating but did not meet all the criteria for any eating disorder (BE), and those with no eating disorder symptoms (No ED). Groups were compared on measures of weight, depressive symptoms, and alexithymia. RESULTS: Binge eating was frequently reported by women in this study (BED, 16.1%; BN, 4.6%; BE, 22.6%). BED women had significantly higher body mass index, greater highest weight ever, and more frequent weight cycling than the No ED group. BED women also reported more depressive symptoms than BE and No ED women, and were more alexithymic than the No ED group. BE women presented more frequent weigh cycling and were also more depressed and alexithymic than the No ED group. DISCUSSION: BED is not uncommon in overweight Brazilian women, and similar to North American and European samples, it is associated with overweight and higher levels of psychopathology in this population.

Childhood obesity.

The prevalence of childhood obesity is rising, and pediatric obesity has become an important public health issue. It can be defined as BMI more than 95th percentile for age and sex, whereas overweight is defined as BMI more than 85th percentile. Using these cut points, more than one quarter of all children and adolescents are either overweight or obese. The recent increases in the prevalence of childhood obesity result from the interaction between a strong genetic predisposition that facilitates storage of fat, easy access to calorically dense foods, and the low levels of physical activity that characterize modern societies. Childhood obesity has pervasive psychosocial and medical consequences in the short term and the long term. Many of these consequences may not be apparent for decades, but the metabolic complications of obesity and the insidious effects of early psychosocial stigmatization are sometimes observed even in young children. For pediatric obesity, behavioral approaches seem moderately efficacious in younger children. Comprehensive programs generally include modification of dietary and activity habits and some degree of parental involvement. Medication for pediatric obesity cannot be recommended currently outside the context of clinical trials. Gastric bypass surgery is effective but should be considered a last resort for the child with life-threatening complications of obesity.

Loss of control over eating, adiposity, and psychopathology in overweight children.

OBJECTIVE: To investigate the relationship between loss of control over eating, adiposity, and psychological distress in a nontreatment sample of overweight children. METHOD: Based on self-reports of eating episodes, 112 overweight children, 6-10 years old, were categorized using the Questionnaire of Eating and Weight Patterns-Adolescent Version into those describing episodes of loss of control over eating (LC), and those with no loss of control (NoLC). Groups were compared on measures of adiposity, dieting, and eating behavior, and associated psychological distress. RESULTS: LC children (33.1%) were heavier and had greater amounts of body fat than NoLC children. They also had higher anxiety, more depressive symptoms, and more body dissatisfaction. 5.3% met questionnaire criteria for BED. Episodes of loss of control occurred infrequently, were often contextual, and involved usual meal foods. DISCUSSION: As in adults, overweight children reporting loss of control over eating have greater severity of obesity and more psychological distress than those with no such symptoms. It remains unknown whether children who endorse loss of control over eating before adolescence will be those who develop the greatest difficulties with binge eating or obesity in adulthood.

Questionário sobre Padrões de Alimentação e Peso - Revisado: um instrumento para avaliação do transtorno da compulsão alimentar periódica / Questionnaire of Eating and Weight Patterns - Revised: an instrument to assess binge eating desorder

O transtorno da compulsão alimentar periódica (binge eating disorder/BED) é uma terceira e nova categoria diagnóstica de transtorno alimentar, ainda em fase de pesquisa, incluída no Apêndice B do DSM-IV. Caracteriza-se por episódios recorrentes de compulsão alimentar (binge eating) na ausência de métodos de controle de peso extremados, característicos da bulimia nervosa. Neste artigo, são revisados os antecedentes que levaram à proposta de inclusão dessa categoria nas classificações diagnósticas oficiais e são delineados aspectos que requerem novos estudos. Enfatiza-se a importância da pesquisa na área e, para tanto, apresenta-se a versão em português do Questionário sobre Padrões de Alimentação e Peso - Revisado, único instrumento desenvolvido até o momento para o estudo e diagnóstico do transtorno da compulsão alimentar periódica. Expõe-se o método da tradução para o português em detalhes, assim como as adaptações necessárias. Por fim, indicam-se os possíveis usos do questionário

Questionario sobre padroes de alimentacao e peso-revisado: um instrumento para a avaliacao do transtorno da compulsao alimentar periodica

O transtorno da compulsao alimentar periodica (binge eating disorder/BED) e uma terceira e nova categoria diagnostica de transtorno alimentar, ainda em fase de pesquisa, incluida no apendiceB do DSM-IV. Caracteriza-se por episodios recorrentes de compulsao alimentar (binge eating) na ausencia de metodos de controle de peso extremados, caracteristicos da bulimia nervosa. Neste artigo, sao revisados os antecedentes que levaram a proposta de inclusao dessa categoria nas classificacoes diagnosticas oficiais e sao delineados aspectos que requerem novos estudos. Enfatiza-se a importancia da pesquisa na area e, para tanto, apresenta-se a versao em portugues do Questionario sobre Padroes de Alimentacao e Peso-Revisado, unico instrumento desenvolvido ate o momento para o estudo e diagnostico do transtorno da compulsao alimentar periodica. Expoe-se o metodo da traducao para o portugues em detalhes, assim como as adaptacoes necessarias. Por fim, indicam-se os possiveis usos do questionario.