Propiedades psicométricas del Cuestionario de Actitudes Socioculturales hacia la Apariencia (SATAQ-4) en adolescentes y jóvenes chilenos de ambos sexos / Psychometric properties of the Sociocultural Attitudes towards Appearance Questionnaire (SATAQ-4) in Chilean adolescents and youth of both sexes

Introducción: El Cuestionario de Actitudes Socioculturales hacia la Apariencia (versión 4) mide 5 factores, que son la presión social hacia la apariencia a partir de la familia, los medios de comunicación y los pares; así como también la internalización del ideal de delgadez y del ideal atlético/muscular. No se dispone actualmente de una versión chilena del instrumento. Objetivos: evaluar las propiedades psicométricas del instrumento en una muestra de adolescentes y adultos chilenos de ambos sexos, analizando su consistencia interna, así como también la validez de constructo y de criterio. Material y Métodos: por medio de un muestreo no probabilístico y empleando un diseño no experimental, transversal, se accedió a una muestre de 602 participantes de entre 15 y 29 años, a quienes se les administró el Cuestionario de Actitudes Socioculturales hacia la Apariencia-4 y un cuestionario sociodemográfico. Se realizó un análisis factorial confirmatorio, se analizó la validez de criterio, a partir de la comparación de medias de internalización del ideal de delgadez e internalización del ideal atlético/muscular según sexo utilizando t de Student; y se evaluó la consistencia interna de los factores con Alfa de Cronbach. Resultados: se confirmó el modelo de 5 factores. Además, las mujeres presentaron mayor internalización de delgadez, presión social familiar y presión de medios; en tanto que los hombres puntuaron más en internalización del ideal atlético/muscular. El instrumento arrojó adecuados valores de Alfa de Cronbach.Conclusiones: el Cuestionario de Actitudes Socioculturales hacia la Apariencia (versión 4) presenta adecuadas propiedades psicométricas para su utilización en Chile.(AU)

Introduction: The Sociocultural Attitudes towards Appearance Questionnaire (version 4) measures 5 factors,which are the social pressure towards appearance from thefamily, the media and peers; as well as the internalization ofthe thin ideal and the athletic/muscular ideal. There is currently no Chilean version of the instrument available.Objectives: to evaluate the psychometric properties of theinstrument in a sample of Chilean adolescents and adults ofboth sexes, analyzing its internal consistency, as well as itsconstruct and criterion validity.Material and Methods: by means of a non-probabilisticmethod and using a non-experimental and cross-sectional design, a sample of 602 participants between the ages of 15 and 29 was accessed, who were administered the SocioculturalAttitudes towards Appearance Questionnaire-4 and a sociodemographic questionnaire. A confirmatory factorial analysis was carried out, the validity of criteria was analyzed, fromthe comparison of means of internalization of the ideal ofthinness and internalization of the athletic/muscular ideal according to sex using Student’s t test; and the internal consistency of the factors was evaluated with Cronbach’s Alpha.Results: the 5 factor model proposed in the original version of the instrument was confirmed. In addition, womenpresented greater internalization of thinness, family socialpressure and pressure from the media; while men scoredhigher in internalization of the athletic/muscular ideal. The instrument yielded adequate values of Cronbach’s Alpha.Conclusions: the Sociocultural Attitudes towards AppearanceQuestionnaire (version 4) presents adequate psychometric properties for its use in Chile.(AU)

Obsesión por la delgadez y la musculatura en mujeres, un estudio transcultural: Comparación entre Chile y España

RESUMEN Es cada vez más frecuente la exposición de los adultos emergentes a prácticas socioculturales que afectan su salud mental, cumpliendo un papel importante en la manifestación de la obsesión por la delgadez y la musculatura. Por ello, el propósito del estudio fue comparar la obsesión por la delgadez y la musculatura entre mujeres adultas emergentes universitarias de Chile y España respecto a factores socio-culturales, satisfacción corporal y variables psicológicas vinculadas a la imagen corporal. De esta forma, la presente investigación se realizó desde un enfoque cuantitativo, con un diseño no experimental transversal, de alcance correlacional, con una muestra compuesta por 230 participantes (n chilenas= 155; n españolas= 75). Los resultados evidenciaron una diferencia significativa entre ambos grupos en la obsesión por la musculatura, siendo mayor en España. El modelo predictivo de obsesión por la delgadez estuvo compuesto por las variables de perfeccionismo, satisfacción corporal en forma negativa, presión social de la familia, de los medios de comunicación y nacionalidad española, explicando así el 45% de la varianza, mientras que el modelo explicativo para obsesión por la musculatura permite predecir un 16% de su varianza a partir de la nacionalidad española, la obsesión por la delgadez, la presión social de la familia y la actividad física regular. Finalmente, se plantea la necesidad de fomentar indagaciones futuras y profundizar más en las temáticas que permitan prevenir en las jóvenes mujeres con mayor riesgo de padecer alguna de estas problemáticas.

ABSTRACT Exposure of emerging adults to sociocultural practices that affect their mental health is more and more frequent, playing an important role in the manifestation of a drive for thinness and muscularity. The purpose of the study was to compare the drive for thinness and drive for muscularity, among emerging adult university women from Chile and Spain. We evaluated socio-cultural factors, body satisfaction and psychological variables linked to body image using a quantitative approach, with a non-experimental cross-sectional design. We used a correlational-causal scope, with a sample of 230 participants (n Chileans= 155; n Spanish= 75). The results evidenced a significant difference between the two groups in drive for muscularity, being higher in Spain. The predictive model of drive for thinness was made up of the variables of perfectionism, negative body satisfaction, social pressure from the family, the media and Spanish nationality, explaining 45% of the variance. The model for drive for muscularity predicted 16% of the variance based on Spanish nationality, drive for thinness, social pressure from the family and regular physical activity. Finally, there is a need to encourage future inquiries and delve deeper into the issues that allow young women at higher risk of suffering from any of these problems to be prevented.

Assumption of the Myths of Romantic Love: Its Relationship With Sex, Type of Sex-Affective Relationship, and Sexual Orientation.

Romantic love promotes and lays the foundation for the development of hegemonic affective sex relationships, guiding the normative ways of feeling and experiencing love. This way of conceiving love is an intrinsic part of women's subordination, and it entails a greater tolerance for situations of violence in sex-affective relationships in which the exercise of asymmetric power relations between men and women is legitimized. With the current advent of the postmodern stage, a wide variety of dissident (non-heterosexual) sexual orientations with heterosexual hegemony have been given greater visibility and legitimacy, and new ways of relating to sex affectively have emerged initially opposed to traditional romantic discourse, the fundamental pillar of monogamy. The aim of the present work was to study whether these different ways of linking us and understanding affective sex relations marked a significant difference with respect to the heterosexual monogamous hegemonic model in the assumption of the mythified ideas of romantic love. Therefore, we studied the relationship between sex, sexual orientation, and the type of sex-affective relationship (monogamous or non-monogamous by consensus) in the assumption of the myths of romantic love. For this purpose, an instrument that showed appropriate psychometric properties was created, and a cross-sectional study was carried out with a sample of 1,235 people who completed a self-administered online questionnaire. The results indicated that there were no significant differences according to sex, but there were differences in sexual orientation and type of relationship. It may be concluded that a person, regardless of sex, heterosexual or homosexual, monogamous or who has never had affective sex relations, will have a significantly greater probability of assuming the myths of romantic love than a person with a sexual orientation other than heterosexual or homosexual and who is in a non-monogamous consensual relationship.

Factores predictores asociados a conductas alimentarias de riesgo en universitarios chilenos / Predictive factors associated with risk eating behaviors in Chilean college students

Introducción: la adultez emergente en la universidad se caracteriza por una serie de cambios, dentro de los cuales se encuentran los relacionados con los hábitos alimentarios, siendo posible que se adquieran Conductas Alimentarias de Riesgo (CAR), las que se asocian a sintomatología de ansiedad, depresión y estrés, ante lo cual el apoyo social puede actuar como factor protector. Objetivo: identificar variables predictoras de CAR, evaluar la prevalencia de estas conductas, identificar las diferencias en CAR por sexo y orientación sexual y analizar la relación entre las variables estudiadas. Método: a una muestra de 601 participantes se le aplicaron los instrumentos: Cuestionario Breve de Conductas Alimentarias de Riesgo (CBCAR), Escala Multidimensional de Apoyo Social Percibido (MSPSS) y Escala abreviada de Depresión, Ansiedad y Estrés (DASS-21). Resultados: las variables predictoras de CAR fueron sexo, depresión y estrés, explicando el 17% de la varianza (R2 ajustado = 0,17). Además, las CAR se presentan mayormente en el sexo femenino, donde un 16,9% presenta riesgo alto de CAR, frente a un 8,7% del sexo masculino, siendo las diferencias estadísticamente significativas. También existen diferencias significativas en la prevalencia de estas conductas según la variable orientación sexual. Conclusiones: estos resultados destacan la alta prevalencia de las CAR, su comportamiento según variables sociodemográficas, además de la importancia de la prevención de sintomatología de depresión y estrés como una acción para prevenir las CAR en universitarios, enfatizando además la importancia de prestar particular atención al grupo femenino, por presentar mayor vulnerabilidad respecto a los problemas de alimentación. (AU)

Introduction: emerging adulthood in the university is characterized by a series of changes, among which are those related to eating behaviors, and it is possible that risky eating behaviors (REB) are acquired, which are associated with anxiety symptoms, depression and stress. Social support it can be a protective factor. Objective: identify predictors associated with REB and know the prevalence of these behaviors, analyze the relationship between the variables studied and identify differences by sex and sexual orientation. Method: A sample of 601 participants was studied, to whom the instruments were applied: Brief Questionnaire of Risky Eating Behaviors (CBCAR), Multidimensional Scale of Perceived Social Support (MSPSS) and Depression, Anxiety and Stress Scale (DASS- 21). Results: the variables sex, depression and stress were found as predictors of REB, explaining 17% of the variance (adjusted R2= 0,17). In addition, REB are mainly present in the female sex, where 16,9% have a high risk of REB, compared to 8,7% of the male sex, the differences being statistically significant. There are also significant differences in the prevalence of these behaviors according to the sexual orientation variable. Conclusion: these results highlight the importance of the prevention of depression and stress symptoms as an action that would allow preventing REB in university students, also emphasizing the importance of paying particular attention to the female group, as they present greater vulnerability with regard to eating problems. (AU)

Validación de la Escala de Reacciones ante Experiencias de Trato Desigual en Salud / Validating the Scale of Reactions to Experiences of Unequal Treatment in Health / Validação da Escala de Reações ante Experiências de Trato Desigual em Saúde

Resumen Introducción: este artículo tiene por objetivo estimar las propiedades psicométricas de la Escala de Reacciones ante Experiencias de Trato Desigual en Salud de Baeza-Rivera (2015) y establecer si existen diferencias estadísticamente significativas entre quienes se atienden en el sistema privado y público y la pertenencia o no a la etnia mapuche. Materiales y métodos: participaron 337 personas cuyo promedio de edad fue de 31 años, en su mayoría mujeres. El 57 % reportó ser usuario del sistema público de salud y el 32 % declaró su pertenencia a la etnia mapuche. Se realizó un análisis factorial exploratorio, análisis de confiabilidad y Anova factorial. Resultados: los hallazgos dan cuenta de un instrumento con adecuadas propiedades psicométricas, que puede usarse en población con características similares a la muestra empleada. Además, se observa que existen diferencias estadísticamente significativas en función del sistema de salud en que se atiende la persona y la pertenencia a la etnia mapuche. Conclusiones: el instrumento tiene adecuadas propiedades psicométricas que presenta dos factores relacionados, que sirve para ser utilizado en contextos de salud, lo que permite comprender los procesos de salud-enfermedad.

Abstract Introduction: This study aimed to estimate the psychometric properties of the Scale of Reactions to Experiences of Unequal Treatment in Health, from Baeza-Rivera (2015), and to determine any statistically significant differences between those using the private and public healthcare systems and those belonging to the Mapuche ethnic group. Materials and Methods: The Scale of Reactions to Experiences of Unequal Treatment in Health was used in 337 participants (mostly women) with a mean age of 31 years. Of these, 57% reportedly used the public healthcare system and 32% belonged to the Mapuche ethnic group. Subsequently, exploratory factor analysis and reliability analysis using Cronbach's alpha and factorial analysis of variance were conducted. Results: The findings demonstrated that this scale has ideal psychometric properties, such as reliability and factorial validity, and it can be used in a population with characteristics similar to those of the sample population used in this study. Additionally, statistically significant differences were observed between those using the healthcare systems and those belonging to the Mapuche ethnic group. Conclusions: This scale shows adequate psychometric properties, such as the two related factors reliability and factorial validity, and can be used in health-related contexts, thus allowing for an understanding of health-disease processes.

Resumo Introdução: este artigo tem por objetivo estimar as propriedades psicométricas da Escala de Reações ante Experiências de Trato Desigual em Saúde, de Baeza-Rivera (2015), e estabelecer se existem diferenças estatisticamente significativas entre quem se atendem no sistema privado e público e a pertença ou não à etnia mapuche. Materiais e métodos: participaram 337 pessoas cuja média de idade foi de 31 anos, em sua maioria mulheres, 57% reportou ser usuário do sistema público de saúde e 32% declarou pertencer à etnia mapuche. Se realizou análise fatorial exploratório, análise de confiabilidade e a Anova fatorial. Resultados: se conta com um instrumento com adequadas propriedades psicométricas, que pode ser utilizado em população com características similares à amostra utilizada. Adicionalmente, se observa que existem diferenças estatisticamente significativas em função do sistema de saúde em que se atende a pessoa e a pertença ou não a etnia mapuche. Conclusões: o instrumento tem adequadas propriedades psicométricas, apresenta dois fatores relacionados, e serve para ser utilizado em contextos de saúde, permitindo compreender os processos de saúde-doença.

Actitudes antiobesidad, sintomatología alimentaria y significados asociados a la obesidad en estudiantes universitarios vinculados al área de la salud / Anti-obesity attitudes, food symptomatology and meanings associated with obesity in students linked to the health area

INTRODUCCIÓN: las personas con obesidad suelen ser objeto de estigmas asociados al peso por parte de la población. Los estudiantes del área de la salud, al formar parte de la sociedad, también experimentan actitudes antiobesidad, lo que puede afectar a la calidad de la atención que ofrecen. OBJETIVOS: analizar las diferencias por sexo, en estudiantes universitarios vinculados al área de la salud, con respecto a las actitudes antiobesidad, la obsesión por la delgadez, la bulimia y la insatisfacción corporal, identificando las variables que permitan predecir las actitudes negativas respecto a la obesidad. Además, se exploraron los significados asociados a la malnutrición por exceso. MÉTODO: con un diseño no experimental transversal y un muestreo no probabilístico por conveniencia, se accedió a 212 participantes. Los instrumentos fueron: AFA, EDI-2 y redes semánticas naturales. RESULTADOS: las mujeres presentaron valores más altos que los hombres en todas las variables estudiadas (p < 0,05), excepto en la bulimia (p > 0,05). La obsesión por la delgadez fue el único predictor de las actitudes antiobesidad (R2 = 0,40). Los significados más prevalentes hacia las personas con obesidad fueron "enfermedad" y "aspectos psicológicos". CONCLUSIONES: la presencia de obsesión por la delgadez en estudiantes que trabajarán en el abordaje integral de la obesidad es un predisponente a experimentar actitudes antiobesidad. Dentro de los significados asociados al sobrepeso más prevalentes en este grupo están los aspectos psicológicos, antes que los conceptos relacionados con la alimentación y la actividad física. Todo esto puede tener un impacto negativo en la calidad de la atención que ofrezcan

INTRODUCTION: people with obesity are often subjected to weight-related stigma by the population. Career students linked to the approach to obesity, as part of society, also experience anti-obesity attitudes, which can affect the quality of care they will offer. OBJECTIVES: to analyze the differences by sex, in university students linked to the health area, in anti-obesity attitudes, drive for thinness, bulimia, and body dissatisfaction, identifying variables allowing to predict negative attitudes regarding obesity. In addition, the meanings associated with excess malnutrition were explored. METHOD: with a cross-sectional, non-experimental design and non-probabilistic, convenience sampling 212 participants were accessed. Instruments included: AFA, EDI-2, and natural semantic networks. RESULTS: women showed higher values than men in all the variables studied (p < 0.05) except bulimia (p > 0.05). Drive for thinness was the only predictor for anti-obesity attitudes (R2 = 0.40). The most prevalent meanings attached to people with obesity were "illness" and "psychological issues". CONCLUSIONS: the presence of drive for thinness in students who will work in the comprehensive approach to obesity is a predisposing factor to experiencing anti-obesity attitudes. Among the most prevalent meanings associated with overweight in this group are psychological issues, rather than concepts related to food and physical activity. All this can have a negative impact on the quality of the care they offer

[Anti-obesity attitudes, food symptomatology and meanings associated with obesity in students linked to the health area]. / Actitudes antiobesidad, sintomatología alimentaria y significados asociados a la obesidad en estudiantes universitarios vinculados al área de la salud.

INTRODUCTION: Introduction: people with obesity are often subjected to weight-related stigma by the population. Career students linked to the approach to obesity, as part of society, also experience anti-obesity attitudes, which can affect the quality of care they will offer. Objectives: to analyze the differences by sex, in university students linked to the health area, in anti-obesity attitudes, drive for thinness, bulimia, and body dissatisfaction, identifying variables allowing to predict negative attitudes regarding obesity. In addition, the meanings associated with excess malnutrition were explored. Method: with a cross-sectional, non-experimental design and non-probabilistic, convenience sampling 212 participants were accessed. Instruments included: AFA, EDI-2, and natural semantic networks. Results: women showed higher values than men in all the variables studied (p < 0.05) except bulimia (p > 0.05). Drive for thinness was the only predictor for anti-obesity attitudes (R2 = 0.40). The most prevalent meanings attached to people with obesity were "illness" and "psychological issues". Conclusions: the presence of drive for thinness in students who will work in the comprehensive approach to obesity is a predisposing factor to experiencing anti-obesity attitudes. Among the most prevalent meanings associated with overweight in this group are psychological issues, rather than concepts related to food and physical activity. All this can have a negative impact on the quality of the care they offer.

INTRODUCCIÓN: Introducción: las personas con obesidad suelen ser objeto de estigmas asociados al peso por parte de la población. Los estudiantes del área de la salud, al formar parte de la sociedad, también experimentan actitudes antiobesidad, lo que puede afectar a la calidad de la atención que ofrecen. Objetivos: analizar las diferencias por sexo, en estudiantes universitarios vinculados al área de la salud, con respecto a las actitudes antiobesidad, la obsesión por la delgadez, la bulimia y la insatisfacción corporal, identificando las variables que permitan predecir las actitudes negativas respecto a la obesidad. Además, se exploraron los significados asociados a la malnutrición por exceso. Método: con un diseño no experimental transversal y un muestreo no probabilístico por conveniencia, se accedió a 212 participantes. Los instrumentos fueron: AFA, EDI-2 y redes semánticas naturales. Resultados: las mujeres presentaron valores más altos que los hombres en todas las variables estudiadas (p < 0,05), excepto en la bulimia (p > 0,05). La obsesión por la delgadez fue el único predictor de las actitudes antiobesidad (R2 = 0,40). Los significados más prevalentes hacia las personas con obesidad fueron "enfermedad" y "aspectos psicológicos". Conclusiones: la presencia de obsesión por la delgadez en estudiantes que trabajarán en el abordaje integral de la obesidad es un predisponente a experimentar actitudes antiobesidad. Dentro de los significados asociados al sobrepeso más prevalentes en este grupo están los aspectos psicológicos, antes que los conceptos relacionados con la alimentación y la actividad física. Todo esto puede tener un impacto negativo en la calidad de la atención que ofrezcan.

Trastorno por atracón: una mirada integral a los factores psicosociales implicados en su desarrollo / Binge eating disorder: a comprehensive look at the psychosocial factors involved in its development

INTRODUCCIÓN: el Trastorno por Atracón (TA) es habitual en obesidad y en quienes buscan tratamiento para bajar de peso, aunque también puede presentarse en personas con peso normal. En el desarrollo y mantenimiento de este cuadro psicopatológico interfieren distintos factores psicológicos y sociales que es relevante tener en cuenta para su abordaje. OBJETIVO: este artículo tiene por objetivo proponer una perspectiva integral de esta problemática, que considera estos distintos elementos psicosociales implicados, considerando también las consecuencias que acarrea este problema. METODOLOGÍA: se realiza una revisión narrativa de antecedentes teóricos y empíricos a fin de generar un modelo comprehensivo de TA. RESULTADOS: para contextualizar, se comienza describiendo el TA y ofreciendo cifras de prevalencia, para posteriormente presentar factores de riesgo, la relación de la enfermedad con la salud mental y algunas de sus consecuencias. A partir de todo esto se presenta el modelo que sintetiza toda esta información. DISCUSIÓN: en el desarrollo de TA influyen factores internos y externos que es necesario tener presentes al momento de realizar diagnóstico e intervención para este trastorno. CONCLUSIÓN: es relevante que los distintos profesionales de la salud implicados en el abordaje de la obesidad y la nutrición en general, como médicos, nutricionistas y psicólogos, mantengan una mirada atenta al posible diagnóstico de TA, adoptando una comprensión compleja del fenómeno, a fin de favorecer la efectividad de su intervención

INTRODUCTION: Binge Eating Disorder is common in obesity and in those people seeking treatment to lose weight, although it can also occur in people with normal weight. There are different psycological and social factors that influence Binge Eating Disorder, and consequently it is relevant to analyse them for a proper treatment approach. OBJECTIVE: this article aims to propose a comprehensive perspective of this problem, considering not only the different psychosocial elements involved, but also the anlysis of the consequences of the Binge Eating Disorder. METHODS: a narrative review of theoretical and empirical background is carried out in order to generate a comprehensive model of Binge Eating Disorder. RESULTS: to contextualize, we begin by describing the Binge Eating Disorder and specifically prevalence figures, to later present risk factors, the relationship of the disease with mental health and some of its consequences. From all this, the model that synthesizes all this information is presented. DISCUSSION: Internal and external factors influence the development of Binge Eating Disorder that must be taken into account when making a diagnosis and intervention for this disorder. CONCLUSION: it is crucial that the different health professionals involved in tackling obesity and nutrition in general, such as doctors, nutritionists and psychologists, keep a close eye on the possible diagnosis of Binge Eating Disorder, adopting a complex understanding of the phenomenon in order to have an effective approach and treatment

Imagen corporal en función de sexo y estado nutricional: Asociación con la construcción del sí mismo y de los otros / Body image based on sex and nutritional status: Association with the construction of self and others

Resumen Tanto la distorsión como la insatisfacción con la imagen corporal (IC) son cruciales en el desarrollo de los trastornos alimentarios. Este estudio analiza la IC de jóvenes adultos en función del sexo y el estatus nutricional, así como su relación con la construcción del sí mismo y de los otros. Participaron 73 estudiantes universitarios (53% mujeres) de 18-28 años de edad (M = 21.96, DE = 2.04). La IC fue evaluada con Láminas de Modelos Anatómicos, y la construcción del sí mismo y de los otros con la Técnica de la Rejilla; además, el índice de masa corporal (IMC) fue calculado a partir del peso y la talla autoreportados. La distorsión corporal (DC) estuvo más presente en hombres vs. mujeres (p = .04), así como en los participantes normopeso vs. sobrepeso-obesidad (p = .01); contrariamente, la insatisfacción corporal fue más común en estos últimos (p = .03). En las mujeres, el IMC percibido correlacionó positivamente con aislamiento social, mientras que autodefinirse "como obesas" se asoció tanto con éste como con menor autoestima; no así en los hombres, en quienes dicha autodefinición solo correlacionó con aislamiento social. Aunque los hombres presentaron mayor DC, en las mujeres la IC se relacionó con más aspectos de su identidad.

Abstract Both distortion and dissatisfaction with body image are crucial in the development of eating disorders. This study analyzes body dissatisfaction (BD) of young adults based on sex and nutritional status, as well as their relation to the construction of the self and others. A total of 73 university students (53% women) aged 18-28 (M = 21.96, SD = 2.04) answered a BD assessment that includes Anatomical Models Sheets, and the construction of the self and the others with the Grid Technique; In addition, the body mass index (BMI) was calculated from self-reported weight and height. Men reported more body distortion vs. women (p = .04), as well as participants with normal weight vs. overweight-obesity (p = .01); conversely, BD was more common in the group with overweight-obesity (p = .03). In women, perceived BMI correlated positively with social isolation, while self-definition "as obese" was associated with BMI and with lower self-esteem; in men, self-definition only correlated with social isolation. Although men had higher body distortion, in women, BD was related to more aspects of their identity.

A Randomized Trial of Virtual Reality-Based Cue Exposure Second-Level Therapy and Cognitive Behavior Second-Level Therapy for Bulimia Nervosa and Binge-Eating Disorder: Outcome at Six-Month Followup.

This article reviews the 6-month followup data of a randomized, multicenter, parallel-group study conducted at five clinical sites in three European cities, which compared two second-level treatments for bulimia nervosa (BN) and binge eating disorder (BED): virtual reality-based cue exposure therapy (VR-CET) versus additional cognitive behavioral therapy (A-CBT). Post-treatment outcomes of this study were previously published and details of its design can be found at clinicaltrials.gov (identifier: NCT02237300). This article focuses on the evolution of symptoms assessed after 6 months of followup in a subgroup of 58 patients from the original study. In this study 64 patients with eating disorders (EDs) (35 with BN and 29 with BED), who still showed active episodes of binge eating by the end of a structured CBT program (first-level treatment), were randomly assigned to one of two second-level treatments (A-CBT or VR-CET). Frequency of binge and purge episodes, and attitudinal features of binge-related EDs (bulimia, drive for thinness, and body dissatisfaction) were assessed before starting the second-level treatment (n = 64), at the end (n = 64), and at 6-month followup (n = 58). Mixed between-within subject analyses of variance were used to compare outcomes of both second-level treatments over time. Although both treatment conditions showed statistically significant improvements at the end and after 6-month followup, obtained reductions were greater after VR-CET, regarding binge and purge episodes, as well as the decrease of self-reported tendency to engage in overeating episodes. Accordingly, abstinence from binge episodes were higher in VR-CET than A-CBT at followup (70 percent vs. 26 percent, respectively; χ2 = 11.711, p = 0.001). These results provide further support for the use of VR-CET as an effective second-level intervention for BN and BED treatment-resistant patients.

Testing virtual reality-based cue-exposure software: Which cue-elicited responses best discriminate between patients with eating disorders and healthy controls?

PURPOSE: Virtual reality (VR) technologies have been proposed as a new tool able to improve on in vivo exposure in patients with eating disorders. This study assessed the validity of a VR-based software for cue exposure therapy (CET) in people with bulimia nervosa (BN) and binge eating disorder (BED). METHODS: Fifty eight outpatients (33 BN and 25 BED) and 135 healthy participants were exposed to 10 craved virtual foods and a neutral cue in four experimental virtual environments (kitchen, dining room, bedroom, and cafeteria). After exposure to each VR scenario, food craving and anxiety were assessed. The frequency/severity of episodes of uncontrollable overeating was also assessed and body mass index was measured prior to the exposure. RESULTS: In both groups, craving and anxiety responses when exposed to the food-related virtual environments were significantly higher than in the neutral-cue virtual environment. However, craving and anxiety levels were higher in the clinical group. Furthermore, cue-elicited anxiety was better at discriminating between clinical and healthy groups than cue-elicited craving. CONCLUSIONS: This study provides evidence of the ability of food-related VR environments to provoke food craving and anxiety responses in BN and BED patients and highlights the need to consider both responses during treatment. The results support the use of VR-CET in the treatment of eating disorder patients characterized by binge-eating and people with high bulimic symptoms.

Emotional eating and cognitive conflicts as predictors of binge eating disorder in patients with obesity.

Background/Objectives: Binge Eating Disorder (BED) is often associated with obesity. In order to identify the variables that allow to better detect the presence of BED, people with overnutrition were compared with and without BED in the presence of cognitive conflicts, eating symptoms and anxious-depressive symptoms. The inclusion of cognitive conflicts had been relevant in bulimia studies but had not been investigated with respect to BED. Method: Two groups with obesity were evaluated, one without BED (OB, n = 54) and the other with BED (OB-BED, n = 48), using a social-demographic questionnaire as well as a semi-structured interview to assess BED, questionnaires (DASS-21, EDE-Q, EEQ) and the Repertory Grid Technique. Results: Overall, the OB-BED group presented more conflicts and more symptoms. The model that best differentiated between the groups included emotional eating and level of cognitive conflicts, correctly classifying 91.4% of the sample. Conclusion: These results highlight the role played by cognitive conflicts and emotional eating as differentiating elements between OB and OB-BED, with a high level of predictive accuracy.

Antecedentes/Objetivos: El trastorno por Atracón (TA) es un trastorno de la conducta alimentaria asociado frecuentemente con la obesidad. Con el objetivo de identificar las variables que permiten detectar mejor la presencia de TA se compararon personas con malnutrición por exceso con y sin TA respecto a la presencia de conflictos cognitivos, sintomatología alimentaria y sintomatología ansioso-depresiva. La inclusión de los conflictos cognitivos había resultado relevante en estudios con bulimia pero no habían sido investigados con respecto al TA. Método: Se evaluó a dos grupos con obesidad, uno sin TA (OB, n = 54) y otro con TA (OBTA, n = 48), utilizando un cuestionario sociodemográfico, una entrevista semiestructurada para evaluar TA, cuestionarios (DASS-21, EDE-Q, EEQ) y la Técnica de la Rejilla. Se realizaron análisis de comparación de grupos y de regresión logística. Resultados: El grupo OBTA presentó más conflictos y más sintomatología. El modelo que mejor diferenció entre los grupos incluyó la alimentación emocional y el nivel de conflictos cognitivos, clasificando correctamente al 91,4% de la muestra. Conclusiones: Estos resultados resaltan el rol que juegan los conflictos cognitivos y la alimentación emocional como aspectos diferenciadores entre OB y OBTA, con un alto nivel de precisión predictiva.

Emotional eating and cognitive conflicts as predictors of binge eating disorder in patients with obesity / Alimentación emocional y conflictos cognitivos como predictores del trastorno por atracón en pacientes con obesidad

Background/Objectives: Binge Eating Disorder (BED) is often associated with obesity. In order to identify the variables that allow to better detect the presence of BED, people with overnutrition were compared with and without BED in the presence of cognitive conflicts, eating symptoms and anxious-depressive symptoms. The inclusion of cognitive conflicts had been relevant in bulimia studies but had not been investigated with respect to BED. Method: Two groups with obesity were evaluated, one without BED (OB, n = 54) and the other with BED (OBBED, n = 48), using a social-demographic questionnaire as well as a semi-structured interview to assess BED, questionnaires (DASS-21, EDE-Q, EEQ) and the Repertory Grid Technique. Results: Overall, the OB-BED group presented more conflicts and more symptoms. The model that best differentiated between the groups included emotional eating and level of cognitive conflicts, correctly classifying 91.4% of the sample. Conclusion: These results highlight the role played by cognitive conflicts and emotional eating as differentiating elements between OB and OB-BED, with a high level of predictive accuracy (AU)

Antecedentes/Objetivos: El trastorno por Atracón (TA) es un trastorno de la conducta alimentaria asociado frecuentemente con la obesidad. Con el objetivo de identificar las variables que permiten detectar mejor la presencia de TA se compararon personas con malnutrición por exceso con y sin TA respecto a la presencia de conflictos cognitivos, sintomatología alimentaria y sintomatología ansioso-depresiva. La inclusión de los conflictos cognitivos había resultado relevante en estudios con bulimia pero no habían sido investigados con respecto al TA. Método: Se evaluó a dos grupos con obesidad, uno sin TA (OB, n = 54) y otro con TA (OBTA, n = 48), utilizando un cuestionario sociodemográfico, una entrevista semiestructurada para evaluar TA, cuestionarios (DASS-21, EDE-Q, EEQ) y la Técnica de la Rejilla. Se realizaron análisis de comparación de grupos y de regresión logística. Resultados: El grupo OBTA presentó más conflictos y más sintomatología. El modelo que mejor diferenció entre los grupos incluyó la alimentación emocional y el nivel de conflictos cognitivos, clasificando correctamente al 91,4% de la muestra. Conclusiones: Estos resultados resaltan el rol que juegan los conflictos cognitivos y la alimentación emocional como aspectos diferenciadores entre OB y OBTA, con un alto nivel de precisión predictiva (AU)

A Randomised Controlled Comparison of Second-Level Treatment Approaches for Treatment-Resistant Adults with Bulimia Nervosa and Binge Eating Disorder: Assessing the Benefits of Virtual Reality Cue Exposure Therapy.

A question that arises from the literature on therapy is whether second-level treatment is effective for patients with recurrent binge eating who fail first-level treatment. It has been shown that subjects who do not stop binge eating after an initial structured cognitive-behavioural treatment (CBT) programme benefit from additional CBT (A-CBT) sessions; however, it has been suggested that these resistant patients would benefit even more from cue exposure therapy (CET) targeting features associated with poor response (e.g. urge to binge in response to a cue and anxiety experienced in the presence of binge-related cues). We assessed the effectiveness of virtual reality-CET as a second-level treatment strategy for 64 patients with bulimia nervosa and binge eating disorder who had been treated with limited results after using a structured CBT programme, in comparison with A-CBT. The significant differences observed between the two groups at post-treatment in dimensional (behavioural and attitudinal features, anxiety, food craving) and categorical (abstinence rates) outcomes highlighted the superiority of virtual reality-CET over A-CBT. Copyright © 2017 John Wiley & Sons, Ltd and Eating Disorders Association.

Eating behavior style predicts craving and anxiety experienced in food-related virtual environments by patients with eating disorders and healthy controls.

Eating behavior style (emotional, restrictive, or external) has been proposed as an explanation for the differences in response to food-related cues between people who overeat and those who do not, and has been also considered a target for the treatment of eating disorders (EDs) characterized by lack of control over eating and weight-related (overweight/obesity) conditions. The aim of this study was to analyze the relationship between eating behavior style and psychophysiological responses (self-reported food craving and anxiety) to food-related virtual reality (VR) environments in outpatients with bulimia nervosa (BN) and binge eating disorder (BED) and to compare them with healthy participants. Fifty-eight outpatients and 135 healthy participants were exposed to palatable foods in four experimental everyday real-life VR environments (kitchen, dining room, bedroom and café). During exposure, cue-elicited food craving and anxiety were assessed. Participants also completed standardized instruments for the study purposes. ED patients reported significantly higher levels of craving and anxiety when exposed to the virtual food than healthy controls. Eating behavior styles showed strong associations with cue-elicited food craving and anxiety. In the healthy group, external eating was the only predictor of cue-elicited craving and anxiety. In participants with BN and BED, external and emotional eating were the best predictors of cue-elicited craving and anxiety, respectively.

Comparación entre personas con malnutrición por exceso, con y sin trastorno por atracón.

Introducción: si bien el Trastorno por Atracón es un trastorno de la conducta alimentaria que  no se da exclusivamente en personas obesas, es más común en este grupo que en sujetos con normopeso, sin embargo no todas las personas con malnutrición por exceso presentan Trastorno por Atracón. Objetivo: identificar el conocimiento actual respecto a las diferencias y semejanzas existentes entre personas con malnutrición por exceso con y sin Trastorno por Atracón.Método: para lograr el objetivo anterior, se realizó una revisión de artículos científicos en torno al tema.Resultados: primero se analizó la comorbilidad psicopatológica en obesidad y después se detectaron similitudes y diferencias entre los grupos de interés, tanto en sintomatología general, como así también en sintomatología de la conducta alimentaria. Además, se identificaron algunos aspectos controversiales, en que existe evidencia contradictoria respecto a la comparación intergrupal.Conclusión: de esta revisión se concluye que en el estudio de la obesidad se hace necesario conocer en mayor profundidad las características del subgrupo de pacientes que además presenta Trastorno por Atracón,  ya que estas personas poseen características distintivas cuyo conocimiento permitirá ofrecer tratamientos integrales más adecuados a las necesidades de los pacientes, lo que posibilitará, en consecuencia, diseñar intervenciones más eficaces.

Comparación entre personas con malnutrición por exceso, con y sin trastorno por atracón / Comparison between people with overnutrition, with and without binge eating disorder

Introducción: si bien el trastorno por atracón es un trastorno de la conducta alimentaria que no se da exclusivamente en personas obesas, es más común en este grupo que en sujetos con normopeso. Sin embargo, no todas las personas con malnutrición por exceso presentan trastorno por atracón. Objetivo: identificar el conocimiento actual respecto a las diferencias y semejanzas existentes entre personas con malnutrición por exceso, con y sin trastorno por atracón. Método: para lograr el objetivo anterior, se realizó una revisión de artículos científicos en torno al tema. Resultados: primero se analizó la comorbilidad psicopatológica en obesidad y después se detectaron similitudes y diferencias entre los grupos de interés, tanto en sintomatología general, como en sintomatología de la conducta alimentaria. Además, se identificaron algunos aspectos controversiales, en que existe evidencia contradictoria respecto a la comparación intergrupal. Conclusión: de esta revisión se concluye que en el estudio de la obesidad se hace necesario conocer en mayor profundidad las características del subgrupo de pacientes que además presenta trastorno por atracón, ya que estas personas poseen características distintivas cuyo conocimiento permitirá ofrecer tratamientos integrales más adecuados a las necesidades de los pacientes, lo que posibilitará, en consecuencia, diseñar intervenciones más eficaces (AU)

Introduction: Even though binge eating disorder is an eating disorder that does not occur exclusively in obese people, it is more common in this group than in subjects with normal weight. However, it has to be said that not all people with overnutrition have binge eating disorder. Objective: Identify current knowledge about the differences and similarities between people with overnutrition with and without binge eating disorder. Method: A review of scientific articles on the subject was conducted in order to achieve the above mentioned objective. Results: First, psychopathological comorbidity obesity was analyzed and then similarities and differences between the groups of interest were detected, both in general symptoms as well as in symptoms of eating behavior. Furthermore, controversial aspects were found since there is conflicting evidence regarding the intergroup comparison. Conclusion: This review concludes that within the study of obesity it is necessary to know in greater depth the characteristics of the subset of patients who also presents binge eating disorder, because these people have distinctive characteristics that can generate new knowledge that will provide more adequate comprehensive treatment needs of patients, which ultimately will enable to design more effective interventions (AU)