Mixed-method study of women's assessment and experience of childbirth care.

AIM: To examine women's evaluations of quality of care from their perspectives. BACKGROUND: Assessing women's satisfaction with the quality of care they receive during childbirth is an important component of care quality that should be analysed. Evidence suggests that childbirth experience has an important impact on women's health. Therefore, taking into account the perceptions of women about quality is a means to improve care. However, studies examining care quality in this setting remain scarce. DESIGN: Mixed-methods explanatory sequential design. METHODS: A national survey with a sample of 1082 participants, and 15 semi-structured interviews. Data collection occurred between January 2017 and January 2019. Quantitative data were obtained through a validated scale, the Quality from the Patient's Perspective-Intrapartal questionnaire, whose score can range from 1 (minimum satisfaction) to 4 (maximum satisfaction). Semi-structured interviews were conducted for qualitative data. Descriptive statistics, group comparison and qualitative content analysis were included in data analysis. RESULTS: The mean score on the QPP-I tool was high (3.13; SD 0.74). Variables that had the most influence on the experience were type of birth, type of perineal trauma, admission of the baby, time since birth, home-birth, parity and duration of labour. Data from the qualitative interviews identified five themes that explained women's experiences with the quality of care. Previous expectations influence the emotions they have regarding the experience. Relationships with professionals and their social skills are fundamental for the evaluation of quality. The separation of the newborn appears as a factor that worsens the appreciation of women. Good pain management and continuity of care by specialists are also named as key elements of the quality of care. CONCLUSION: Findings demonstrate that experience with childbirth care is of utmost importance for women. They also show the indisputable need to listen to their opinions and assessments when lines of improvement of quality are identified. IMPACT: This study provides information that can improve the care that women receive during their childbirths. Using their opinions will make them feel an active part of the system and in this way, we will be closer to achieve excellence in our services.

Attitudes towards change mediate the effect of dissociation on psychopathological outcome in the treatment of eating disorders.

OBJECTIVES: The study aimed to examine whether dissociation and attitudes towards change were associated with the psychopathology in patients with eating disorders (EDs) at 1-year follow-up. METHOD: The study included 110 females with anorexia nervosa and bulimia nervosa (48 and 62 respectively). At the beginning of the study and 1 year later, they were assessed by means of the following questionnaires: Dissociative Experiences Scale, Attitudes Towards Change (ACTA), State-Trait Anxiety Inventory, Rosenberg Self-Esteem Scale, Beck Depression Inventory, Eating Attitude Test, Bulimic Investigatory Test Edinburgh and Body Shape Questionnaire (BSQ). RESULTS: No statistically significant differences were found between both diagnostic groups regarding dissociation scores. The ACTA at baseline, specifically for patients in the contemplation stage, mediate the effect of dissociation on the psychopathological outcome. DISCUSSION: These findings suggest that dissociation might be a transdiagnostic feature related to the EDs outcome. The psychotherapeutic framework must take it into account, particularly in patients in the contemplation stage.

The Neuroendocrine and Metabolic Outcomes of Bariatric Surgery Depend on Presurgical Control over Eating.

BACKGROUND: The outcomes of bariatric surgery are very irregular and mostly unpredictable. The search for variables of predictive value is encouraged to help preventing therapeutic failures. OBJECTIVE: We aimed to confirm the hypothesis that preexisting eating behaviors could predict neuroendocrine and metabolic outcomes of gastric bypass surgery in morbidly obese subjects. METHODS: Twenty-one morbidly obese patients from the Bariatric Surgery Program of our hospital were selected according to the specific inclusion and exclusion criteria for this study. The subjects filled out a validated questionnaire to quantify the "loss-of-control" (LC) dimension of food craving and provided serum samples at the onset of the study and 1 year after gastric bypass surgery. Hematological, metabolic, and hormonal variables were studied by conventional clinical tests and enzyme immunoassays and checked for correlations with LC both before and after surgery. RESULTS: Those patients that had exhibited worse eating control at the beginning of the study experienced a better metabolic response 1 year after surgery in terms of reduction of serum insulin, HOMA1-IR, HOMA2-IR, and vitamin D1; all these variables were inversely correlated with presurgical LC. Serum brain-derived neurotrophic factor (BDNF) levels showed the same tendency; in fact, BDNF significantly decreased only in those patients with worse eating control. CONCLUSIONS: Problematic eating behaviors may predict a better response of insulin resistance and a specific reduction of serum BDNF in morbidly obese patients after gastric bypass surgery.

Paranoid Thinking and Wellbeing. The Role of Doubt in Pharmacological and Metacognitive Therapies.

INTRODUCTION: Pathological confidence in one's thoughts is a key mechanism of chronic paranoid thinking. For this reason, many of the current therapies focus on trying to reduce it. In fact, the way some antipsychotics (e.g., haloperidol) work seems to be through the induction of doubt. Because of the impact of these pathological thoughts on positive health, studying the well-being of people who experience paranoid thoughts is fundamental. The first objective of this research is to apply the Complete State Model of Health (CSMH) to a sample of patients characterized by the presence of paranoid thinking. Our second objective is to evaluate the impact of therapies based on reducing pathological confidence on patients' well-being. METHODS: Sixty participants with SCID-5 confirmed DSM-5 diagnosis related with paranoid thinking and without mood symptoms were recruited. In order to test the existence of a two continua model of mental health (CSMH), we conducted a parallel analysis and an exploratory factor analysis. To test our hypothesis regarding the partially mediating role of doubt between paranoid thinking and patients' well-being, we conducted a biased corrected bootstrapping procedure. RESULTS: As expected, two different unipolar dimensions emerged from the measures used to assess paranoid thinking and positive health (two continua model of mental health). When patients received metacognitive and pharmacological treatment, more paranoid thinking led to more doubt in all thoughts, which in turn affected well-being. The analyses carried out confirmed the partial mediating role of doubt. CONCLUSION: Despite the efficacy shown by both metacognitive therapies and antipsychotics, it seems that they not only reduce pathological confidence, but can also affect other thoughts not linked to delirium. This effect of generalization of doubt in all thoughts negatively affected patients' well-being and quality of life.

Quality of Childbirth Care in Women undergoing Labour: Satisfaction with Care Received and How It Changes over Time.

(1) Background: To evaluate women's satisfaction with the care received during childbirth undergoing labour and how this changes over time. (2) Methods: An observational, multicentre and longitudinal study in two public hospitals of Spain with a convenience sample of 248 women during the post-partum period. Satisfaction was evaluated using the Intrapartal-Specific Quality from the Patient's Perspective questionnaire. Socio-demographic and clinical variables were considered. A bivariate analysis evaluated the relationship between satisfaction and the recorded variables to compare the hypotheses, and also to know if there were any significant differences between the scores obtained at the various evaluated time points (three days, 15 days, one year postpartum). The multivariate analysis by binary logistic regression helped complete the study about the variables related to the level of satisfaction; (3) Results: The mean scores for satisfaction at each time point were high, and they lowered with time. The bivariate analysis showed an association between satisfaction and the following variables: 'mother's place of birth', 'level of education', 'type of labour onset', 'type of birth' and 'type of perineal trauma'. For the multivariate analysis, women who gave birth vaginally, began labour spontaneously and had an epidural were more satisfied than those who did not; (4) Conclusions: Women seemed to obtain good levels of satisfaction with the care they received. Even so, based on continuously improved quality, we proposed some improvement measures, particularly regarding the physical environment and the information offered to patients. It is important to know at what time experience while giving birth should be evaluated as scores can lower with time as part of its normal evolution.

Prevalence of orthorexia nervosa in university students and its relationship with psychopathological aspects of eating behaviour disorders.

INTRODUCTION: Orthorexia nervosa (ON) is characterized by an obsession with healthy eating, which may lead to severe physical, psychological and social disorders. It is particularly important to research this problem in populations that do not receive clinical care in order to improve early detection and treatment. OBJECTIVE: The aim of this study was to research the prevalence of ON in a population of Spanish university students and to analyze the possible associations between ON and psychological traits and behaviors that are common to ED. METHOD: A cross-sectional study with 454 students from the University of Castilla La Mancha, Spain. In total, 295 women and 159 men participated, aged between 18 and 41 years. The ORTO-11-ES questionnaire and the Eating Disorder Inventory (EDI-2) were used for this study. The chi squared test was used to compare the homogeneity among the different groups. RESULTS: The scores on the ORTO-11-ES suggested that 17% of students were at risk of ON. The scores on the EDI-2 for the group at risk of ON were significant, compared to the remaining individuals, regarding their drive for thinness (17.1% vs 2.1%), bulimia (2.6% vs 0%), body dissatisfaction (26.3% vs. 12.4%), perfectionism (14.5% vs 4.8%), interoceptive awareness (13.2% vs 1.3%), asceticism (15.8% vs 3.7%) and impulsiveness (9.2% vs 1.9%). DISCUSSION AND CONCLUSION: These findings suggest that many of the psychological and behavioral aspects of ED are shared by people who are at risk of ON. Future research should use longitudinal data, examining the temporal relationship among these variables or other underlying variables that may contribute to the concurrence of ED and ON.

Structural validation of ORTO-11-ES for the diagnosis of orthorexia nervosa, Spanish version.

PURPOSE: The ORTO-11-ES questionnaire is a tool to assess the pathological obsession displayed by some individuals regarding healthy eating. The aims of this study were (1) to confirm the factor structure of the Spanish version of ORTO-11-ES using confirmatory factor analysis (CFA) and (2) to examine the possible association between the ORTO-11-ES score, gender and body mass index (BMI). METHODS: The sample comprised 492 students from the University of Castilla la Mancha, Spain. Of these, 280 were women (56.9%). Participants were surveyed using the ORTO-11-ES questionnaire. RESULTS: The confirmatory factor analysis (CFA) supported the 11 elements and 3 domains of this tool as the better fitting model; for the Comparative Fit Index (CFI) and the Tucker-Lewis Index (TLI), the values were 0.94 and 0.91, respectively, and the Root Mean-Square Error of Approximation (RMSEA) was 0.058. The tendency towards orthorexic behavior is more associated with the female gender. The BMI had no influence on the tendency for ON. CONCLUSIONS: This study is the first attempt to confirm the three-factor structure of a Spanish version of the ORTO-15 questionnaire. These findings suggest that the ORTO-11-ES may be a valuable tool for identifying subjects with specific eating behavior patterns. This information may be useful for health professionals involved in the research, development and implementation of interventions catered to individuals suffering from this eating disorder. LEVEL OF EVIDENCE: Level V, descriptive cross-sectional study.

Adaptation and validation of the Spanish version of the ORTO-15 questionnaire for the diagnosis of orthorexia nervosa.

The aim of this study was the validation and analysis of the psychometric properties of a Spanish translation of the ORTO-15 questionnaire; an instrument designed to assess orthorexia nervosa behavior. Four hundred and fifty-four Spanish university students (65% women) aged between 18 and 51 years (M = 21.48 ± 0.31) completed the Spanish version of ORTO-15 and the Eating Disorders Inventory-2 (EDI-2). The Principal Component Analysis suggested a three-factor structure for the abbreviated 11-item version of the instrument. The internal consistency of the measurement was adequate (Cronbach's alpha = 0.80). The proposed test demonstrated a good predictive capacity at a threshold value of <25 (efficiency 84%, sensitivity 75% and specificity 84%). Our results support the psychometric properties of the proposed Spanish shortened-version of the ORTO-15 as being a reliable tool for assessing orthorexia nervosa. Its use is expected to greatly contribute to a better understanding of the impact of this disorder in Spain.

Cross-cultural adaptation and validation of the psychometric properties of the Quality from the Patient's Perspective I Questionnaire translated into Spanish.

OBJECTIVE: translate the questionnaire Quality from the Patient's Perspective-Intrapartal (QPP-I) into Spanish, carrying out a cross-cultural adaptation and validation of its validity and reliability DESIGN: observational multi-centre transversal study, with transcultural adaptation and validation of a scale. SETTING: the study was carried out in two public Spanish hospitals. PARTICIPANTS: 248 women in their postpartum period. METHODS: the instrument was translated and back translated. Validity was determined in different ways: by comparing the QPP-I with an instrument which had already been validated (the COMFORTS scale); by carrying out an exploratory factor analysis by means of a principal component analysis (PCA), and by studying the relationship between the QPP-I and sociodemographic variables (level of studies, age, place of birth of the mother), clinical variables (number of children, type of childbirth, use of epidural, gestational age), positive feelings (control, pride, safety, being paid attention to) and negative feelings (failure, feeling ignored) experienced during childbirth, as well as physical and mental state as assessed by the woman. Reliability was estimated from the internal consistency, with the Cronbach's alpha (α), and the test-retest, with the intraclass correlation coefficient (ICC). FINDINGS: eleven factors obtained an eigenvalue greater than the unit value in the PCA, explaining 70.5% of the total variance. A statistically significant association was found with the variables place of birth of the mother, level of studies, type of birth, positive and negative feelings during childbirth, and state of health of the mother. On comparing the QPP-I with the COMFORTS scale, the area under the received operating characteristic (ROC) curve was 0.824 (confidence interval of 95%, 0.764-0.884). For the total scale, the value of α was 0.96. The consistency ICC was 0.76 (CI 95%, 0.65-0.84) and the absolute agreement ICC was 0.76 (CI 95%, 0.66-0.84). KEY CONCLUSIONS: the QPP-I with 39 items distributed among 11 factors seems adequate to measure women's satisfaction with the care received during childbirth in our setting. IMPLICATIONS FOR PRACTICE: this tool can be used in both a clinical and a research setting for women to be able to evaluate the care they receive when they give birth. It is therefore a way of improving the care given to these users.

Influencia de la percepción de la crianza sobre la actitud hacia el cambio en los trastornos de la conducta alimentaria / Influence of parental rearing styles on attitude towards change in eating disorders

Resumen: Objetivo: Identificar la posible influencia de los «estilos de la crianza¼ con la «actitud hacia el cambio¼ en pacientes diagnosticadas de trastorno de la conducta alimentaria según criterios DSM-IV-TR (American Psychiatric Association -APA-, 1994). Método: Fueron incluidas 166 pacientes de las cuales 66 (39.8%) recibieron el diagnóstico de bulimia nerviosa, 49 (29.5%) de anorexia nerviosa y 51 (30.7%) de trastorno de la conducta alimentaria no especificado. Todas las pacientes completaron una batería de cuestionarios para evaluar las relaciones familiares (APGAR familiar), los recuerdos de su crianza y su actitud hacia el cambio (ACTA) al año de seguimiento. Resultados: En el análisis de regresión múltiple realizado, se observó que la «sobreprotección¼ percibida en la infancia se relacionaba con mayores puntuaciones en «precontemplación¼ y menores puntuaciones en «acción¼ y «mantenimiento¼ . Por otra parte, el «rechazo¼ percibido en la crianza se relacionaba con puntuaciones más elevadas en «precontemplación ¼, independientemente del grado de disfunción familiar existente. Por último, el «afecto¼ percibido se relacionaba directamente con puntuaciones superiores en la fase de «acción¼ . Conclusiones: Estos resultados nos muestran la importancia de la crianza en aspectos tan relevantes del tratamiento como la motivación ante el cambio.

Abstract: Objective: To evaluate the relationships between "parental rearing styles" and "attitude towards change" in eating disorders patients according to DSM-IV-TR (American Psychiatric Association -APA-, 1994). Methods: A total of 166 patients was evaluated: 66 (39.8%) patients met criteria for bulimia nervosa, 49 (29.5%) patients met criteria for anorexia nervosa and 51 (30.7%) patients met criteria for an eating disorder not otherwise specified. All the patients completed a set of self-administered questionnaires to evaluate their family relationships (APGAR familiar), their memories of parental upbringing and their attitudes towards change (ACTA) after one year treatment. Results: A multiple regression analysis was performed. "overprotection " perceived during childhood was related to higher scores in "pre-contemplation " and lower scores in "action " and "maintenance ". On the other hand, "rejection " during upbringing was related to higher scores in "pre-contemplation " at one year follow-up regardless of family dysfunction. Finally, "warm " perceived was related to higher scores in "action" . Conclusions: These results show the relevance of breeding in treatment important aspects in eating disorders patients.

Relación entre la percepción de la crianza y la psicopatología alimentaria / Parental rearing and eating psychopathology

Introducción. El objetivo de nuestro trabajo es identificar cómo los recuerdos de la crianza podrían influir en la expresión clínica de los trastornos de la conducta alimentaria (TCA). Metodología. Administramos una batería de cuestionarios de psicopatología general (BDI, STAI, RSE) y alimentaria (EAT, EDI-2, BITE, BSQ) a 196 pacientes diagnosticados de TCA y a 127 sujetos sanos reclutados de la Escuela de Enfermería. Todos completaron también un cuestionario sobre ‘Los recuerdos de mi crianza’ (EMBU) y una encuesta de variables familiares. Resultados. En relación al grupo control, los pacientes con un TCA percibían mayor rechazo, sobreprotección y menor afecto que los controles. En el grupo de pacientes, el favoritismo paterno, la sobreprotección materna e inversamente el afecto paterno se relacionaba con la ansiedad estado y rasgo. El afecto paterno, junto al rechazo, la sobreprotección y el favoritismo maternos, también se relacionaba inversamente con la autoestima. Respecto a la psicopatología alimentaria, el rechazo corporal se relacionaba inversamente con afecto paterno y favoritismo materno. La ineficacia, perfeccionismo y ascetismo del EDI con el rechazo global y el rechazo materno con la tendencia a la delgadez, conciencia interoceptiva e impulsividad. El afecto global con perfeccionismo. La subescala bulimia y las puntuaciones del BITE se relacionaban inversamente con sobreprotección paterna y afecto paterno y directamente con favoritismo paterno y rechazo global. Conclusiones. La percepción de la crianza difiere en los subtipos de TCA. Pacientes con bulimia o TCA no especificado recordaban mayor rechazo, menor afecto y mayor sobreprotección que pacientes con anorexia y controles

Introduction. The aim of this study was to identify the relationship between perceived rearing styles and the clinical expression of Eating Disorders (ED). Methods. One hundred and ninety-six patients diagnosed of an ED and 127 healthy student as controls selected from the Nursing College were evaluated for general psychopathology (STAI, BDI II, RSE), and for abnormal eating attitudes (EAT, EDI-II, BITE). The EMBU (‘my memories of upbringing’) was administered for the assessment of perceived parental rearing styles and we used a questionnaire to assess familial variables. Results. In relation to the control group, patients with ED perceived greater rejection, overprotection and less warmth than the controls. Patients who perceived greater paternal favoritism, maternal overprotection and low paternal emotional warmth, showed higher levels of anxiety. Paternal affection and maternal attitudes of rejection, overprotection and favoritism were related with lower selfesteem. Regarding abnormal eating attitudes, body dissatisfaction inversely correlated with paternal emotional care and maternal favoritism. The EDI subscales: ineffectiveness, perfectionism and ascetism were associated with parental rejection. Maternal rejection also related with drive for thinness, interoceptive awareness and impulse regulation. Perceived emotional warmth was related with perfectionism. Bulimia subscale and BITE scores were inversely associated with paternal overprotection and affection, and scored significantly higher in paternal favoritism and rejection from both parents. Conclusions. Perceived parental bonding is different in the various subtypes of EDs. Patients diagnosed of Bulimia Nervosa or Eating Disorders Not Otherwise Specified perceived greater rejection, less affection and a greater overprotection than Anorexia Nervosa patients and controls

Parental rearing and eating psychopathology.

INTRODUCTION: The aim of the study was to identify the relationship between perceived rearing styles and the clinical expression of Eating Disorders (ED). METHODS: One hundred and ninety-six patients diagnosed of an ED and 127 healthy student as controls selected from the Nursing College were evaluated for general psychopathology (STAI, BDI II, RSE), and for abnormal eating attitudes (EAT, EDI-II, BITE). The EMBU (‘my memories of upbringing’) was administered for the assessment of perceived parental rearing styles and was used a questionnaire to assess familial variables. RESULTS: In relation to the control group, patients with ED perceived greater rejection, overprotection and less warmth than the controls. Patients who perceived greater paternal favoritism, maternal overprotection and low paternal emotional warmth, showed higher levels of anxiety. Paternal affection and maternal attitudes of rejection, overprotection and favoritism were related to lower self-esteem. Regarding abnormal eating attitudes, body dissatisfaction inversely correlated with paternal emotional care and maternal favoritism. The EDI subscales: ineffectiveness, perfectionism and ascetism were associated to parental rejection. Maternal rejection also related with drive for thinness, interoceptive awareness and impulse regulation. Perceived emotional warmth was related with perfectionism. Bulimia subscale and BITE scores were inversely associated to paternal overprotection and affection, and scored significantly higher in paternal favoritism and rejection from both parents. CONCLUSIONS: Perceived parental bonding is different in the various subtypes of EDs. Patients diagnosed of Bulimia Nervosa or Eating Disorders Not Otherwise Specified perceived greater rejection, less affection and a greater overprotection than Anorexia Nervosa patients and controls.

The role of temperament and character in the outcome of depressive mood in eating disorders.

OBJECTIVES: The aims were to see which temperament and character dimensions were associated with depression, mainly with its outcome at two-year follow up in eating disorders (EDs). METHODS: Participants (N=151) were 44 Anorexia nervosa (AN), 55 Bulimia nervosa (BN) and 52 Eating disorders not otherwise specified (EDNOS) patients. The Beck Depression Inventory (BDI), State and Trait Anxiety Inventory (STAI), Rosenberg Self Esteem Questionnaire (RSE), Eating Disorder Inventory (EDI-2) and Temperament and Character Inventory (TCI) were administered. RESULTS: Depression at the beginning (t0) was severe in 22% of the cases. Harm Avoidance and Novelty Seeking had an effect on depressed mood at t0, mediated by Ineffectiveness. Responsibility (SD1) was associated with scores on the BDI at two-year follow up (ß=-0.37, 95% CI -2.6, -0.6, p<0.01). CONCLUSION: The evaluation of personality dimension in EDs has therapeutic and prognostic implications: To enhance self-efficacy and self-directness is crucial for good clinical outcome.

Influence of attitudes towards change and self-directness on dropout in eating disorders: a 2-year follow-up study.

OBJECTIVE: This study examined dropout-related factors at the Outpatient Eating Disorders Treatment Programme. METHOD: One hundred ninety-six eating disorders patients following DSM-IV diagnostic criteria that consecutively commenced treatment were recruited and followed up for a 2-year period. A total of 151 patients completed the whole assessment with a set of questionnaires evaluating eating and general psychopathology. The Attitudes towards Change in Eating Disorders questionnaire was used, and personality was evaluated using the Temperament and Character Inventory. During the follow-up period, patients were re-assessed. Two years later, 102 patients continued on treatment. RESULTS: Scores on Precontemplation at the beginning were predictors for dropout at 2-year follow-up. Character variables, as Responsibility, Integrity and Self-acceptance were protective factors to be at Precontemplation stage. DISCUSSION: The clinician's challenge is to help eating disorders patients to develop an unyielding sense of responsibility and self-acceptance, aimed to integrate the therapeutic choice into their own intrapersonal frame of goals.

Alteraciones psicopatológicas y hallazgos de neuroimagen con valor discriminante en los trastornos de la conducta alimentaria / Psychopathological alterations and neuroimaging findings with discriminant value in eating behavior disorders

Objetivos. Las dificultades en la delimitación diagnóstica de las pacientes con un Trastorno de la Conducta Alimentaria (TCA) ha favorecido la consideración de modelos multidimensionales. El objetivo del presente trabajo es identificar qué variables psicopatológicas y neurobiológicas podrían tener capacidad discriminante entre los distintos subtipos diagnósticos de TCA. Métodos. Seleccionamos 42 pacientes diagnosticadas de un TCA según criterios DSM-IV entre las que acudieron para recibir tratamiento en la Unidad de Trastornos Alimentarios del Hospital General de Ciudad Real: 11 Anorexia Restrictiva(AR), 10 Anorexia Purgativa (AP), 7 Bulimia no Purgativa (BNP), 14 Bulimia Purgativa (BP). Incluimos 12 controles sanos. En todas ellas realizamos un SPECT cerebral para medir el flujo sanguíneo regional cerebral (rCBF) en situación basal (reposo), otro tras estímulo visual neutro (vista del maren calma) y otro tras confrontarlos con su propia imagen corporal filmada dos semanas antes. Les administramos una batería de cuestionarios para evaluar psicopatología general y alimentaria. Resultados. Las pacientes con BNP presentaban menor psicopatología alimentaria y general, así mismo, a diferencia de las pacientes con AR y BP, no experimentaron incremento del rCBF al confrontarlas con su propia imagen corporal. Las variables discriminantes fueron: insatisfacción corporal, IMC, puntuaciones del BITE, puntuaciones sobre la silueta ideal, e hiperactivación temporal derecha al exponerlas a la propia imagen. Conclusiones. El subgrupo de pacientes diagnosticadas de BNP presentaba menor alteración emocional y menor respuesta emocional frente a su propia imagen que el resto de pacientes con TCA. Estas diferencias podrían tener implicaciones terapéuticas, pronósticas e incluso taxonómicas (AU)

Introduction. The difficulties encountered in regards to defining the diagnosis of patients with an Eating Behavior Disorder (EBD) have favored the use of multidimensional models. This study has aimed to identify which psychopathological and neurobiological variables could have a discriminating capacity regarding the different EBD diagnostic subtypes. Methods. A total of 42 patients with an EBD diagnosis (11 Restrictive Anorexia (R-AN), 10 Purgative Anorexia (P-AN), 7 Non-purgative Bulimia (NP-BN), 14 Purgative Bulimia (P-BN)), according to DSM-IV criteria, were selected from those who came for treatment in the Ciudad Real General Hospital Eating Disorder Unit. Twelve healthy controls were also included. All of the subject sunder went a brain SPECT to measure regional cerebral blood flow (rCBF) in baseline situation (rest). A second one was performed after a visual neutral stimulus (sight of a calm sea) and another one after confronting them with their own corporal image, filmed two weeks before. A battery of questionnaires was administered to evaluate general and eating psychopathology. Results. Patients with NP-BN showed less eating and general psychopathology. Furthermore, unlike patients with R-AN and P-BN, they did not experience an increase of the rCBF when confronted with their own body image. Discriminant variables were body dissatisfaction measured with the BSQ, BMI; BITE scores, ideal silhouette scores, and temporal right hyperactivation when they were shown their own body image. Conclusions. The subgroup of patients diagnosed with NP-BN showed less emotional alteration and less emotional response when they were shown their own body image than the rest of patients with EBD. These differences might have implications from the therapeutic, prognostic or even taxonomic viewpoint (AU)

Psychopathological alterations and neuroimaging findings with discriminant value in eating behavior disorders.

INTRODUCTION: The difficulties encountered in regards to defining the diagnosis of patients with an Eating Behavior Disorder (EBD) have favored the use of multidimensional models. This study has aimed to identify which psychopathological and neurobiological variables could have a discriminating capacity regarding the different EBD diagnostic subtypes. METHODS: A total of 42 patients with an EBD diagnosis (11 Restrictive Anorexia (R-AN), 10 Purgative Anorexia (P-AN), 7 Non-purgative Bulimia (NP-BN), 14 Purgative Bulimia (P-BN)), according to DSM-IV criteria, were selected from those who came for treatment in the Ciudad Real General Hospital Eating Disorder Unit. Twelve healthy controls were also included. All of the subjects underwent a brain SPECT to measure regional cerebral blood flow (rCBF) in baseline situation (rest). A second one was performed after a visual neutral stimulus (sight of a calm sea) and another one after confronting them with their own corporal image, filmed two weeks before. A battery of questionnaires was administered to evaluate general and eating psychopathology. RESULTS: Patients with NP-BN showed less eating and general psychopathology. Furthermore, unlike patients with R-AN and P-BN, they did not experience an increase of the rCBF when confronted with their own body image. Discriminant variables were body dissatisfaction measured with the BSQ, BMI; BITE scores, ideal silhouette scores, and temporal right hyperactivation when they were shown their own body image. CONCLUSIONS: The subgroup of patients diagnosed with NP-BN showed less emotional alteration and less emotional response when they were shown their own body image than the rest of patients with EBD. These differences might have implications from the therapeutic, prognostic or even taxonomic viewpoint.

Regional cerebral blood flow patterns of change following the own body image exposure in eating disorders: a longitudinal study.

OBJECTIVE: The aim of the present study is to see if the changes in the regional cerebral blood flow (rCBF) experienced by restrictive anorexia nervosa (AR) and bulimia nervosa (BN) patients, following the exposure to their own body image, persist at follow-up. METHODS: Three single photon emission computed tomography (SPECT) were performed on nine patients with a DSM-IV diagnosis of AR, 13 with BP, and 12 controls: at rest, following a neutral stimulus, and after exposure to their previously filmed whole body image. Body dissatisfaction was measured by means of the Body Dissatisfaction Questionnaire (BSQ). One year later the same assessment was repeated. RESULTS: Following the exposure to their own body image, BN showed an increase in body dissatisfaction, which was associated with the increase in the rCBF of the Right Temporal Area. Those changes persisted at follow-up. DISCUSSION: More specific long term therapies are needed for the treatment of the averse response showed by ED patients to their own body image exposure that is associated with the hyperactivation of the right temporal area when they are confronted with their whole body image.

Changes in regional cerebral blood flow after body image exposure in eating disorders.

Relationships of 'perceptual distortion' and 'cognitive evaluation' components of body image disturbances to brain activity were investigated. Changes in regional cerebral blood (rCBF) of nine patients with anorexia nervosa restrictive type (AN), 13 patients with bulimia nervosa purging type (BN) and 12 controls following three experiments with single photon emission computed tomography (SPECT) were compared: at rest, following a landscape video presentation (neutral stimulus), and after their filmed body image (positive stimulus) exposure. Body distortion was measured with the Silhouette test and body dissatisfaction with the Body Shape Questionnaire (BSQ). Patients with AN showed a hyperactivation of the left parietal and right superior frontal from neutral to positive stimulus. Patients with BN showed a hyperactivation of the right temporal and right occipital areas. Changes in BSQ responses were associated with changes in the right inferior frontal and right temporal rCBF, whereas changes in body distortion were related to the left parietal. The activation of the right temporal after the own body image exposure might be in accordance with the aversive events' response. Functional abnormalities in AN might be related to the storage of a distorted prototypical image of the body in the left parietal lobe.

Are there gender-specific pathways from early adolescence psychological distress symptoms toward the development of substance use and abnormal eating behavior?

The aim of the present longitudinal community study was to test whether psychological distress at 13 years of age predicted reported substance use problems in boys and abnormal eating behavior in girls 2 years later. The sample consisted of 500 male and 576 female students. The use of substances was evaluated using a semi-structured interview, psychological distress with the General Health Questionnaire (GHQ) and eating psychopathology with the Eating Attitudes Test (EAT-40), and the Bulimic Investigatory Test Edinburgh (BITE). Controlling the effect of initial substance use problems, psychological distress predicted later reported substance use problems in males. Girls with an initial score above the cut-off point on the GHQ were two times more likely to be at risk of having an eating disorder 2 years later. Therefore, psychological distress might take different developmental pathways in males and females, leading toward eating problems in the latter versus substance use in the former.

Role of dissociation in "false drug allergy".

OBJECTIVE: The aim of the present study was to analyze the influence of dissociation on the "false allergy" phenomenon. METHOD: Fifty-five individuals (11 males and 44 females) who consecutively presented for the study of their suspected drug allergy were assessed. RESULTS: After the challenge test, false allergy was found in 39.3% and placebo positive response in 12.5% of the patients. Seven patients (12.5%) scored above the cut-off point of 20 on the Dissociative Experiences Scale (DES), and 5 out of this group (71.4%) fit in the "false allergy" group. Pathological scores on the DES were associated with the diagnosis of "false allergy" (OR = 9.583, 95% CI = 1.002, 91.621). The effect of age, gender, and other psychopathological variables was controlled. CONCLUSIONS: High levels of dissociation might predispose to false drug allergy, which could complicate pharmacological treatment and therefore increase the patient's complaints and demands for medical attention.