Relações familiares na bulimia nervosa / Relaciones familiares en la bulimia nervosa / Family relationships in bulimia nervosa

RESUMO. Transtornos alimentares, como a bulimia, são psicopatologias de etiologia multifatorial que têm nas relações familiares um dos principais fatores desencadeadores e mantenedores dos sintomas. Este estudo teve por objetivo analisar as vivências das relações familiares na perspectiva de uma jovem diagnosticada com bulimia, de sua mãe e seu pai. Trata-se de um estudo de caso qualitativo, descritivo e transversal, cujo delineamento abarca a tríade pai-mãe-filha. Foram entrevistados três membros de uma família (pai, mãe e filha diagnosticada com bulimia). Os dados foram coletados por meio de roteiros de entrevista semiestruturada e analisados pela perspectiva do referencial teórico psicanalítico, a partir da construção de categorias temáticas. Os resultados mostraram que, assim como a filha, os pais também apresentaram fragilidades no seu desenvolvimento emocional, culminando em dificuldades no estabelecimento da diferenciação eu-outro nos membros da família. Essas dificuldades culminaram em vivências familiares de instabilidade, com vínculos de dependência impregnados por sensações paradoxais de invasão da intimidade e sentimentos de desamparo. Os resultados encontrados trazem avanços para o conhecimento da área, em especial no nível da compreensão das relações familiares no contexto da bulimia, e oferecem subsídios para o planejamento de ações e intervenções dos profissionais envolvidos na assistência a pacientes e familiares.

RESUMEN. Trastornos de la conducta alimentaria, como bulimia, son psicopatologías de etiología multifactorial que tienen las relaciones familiares como uno de los principales factores desencadenantes y mantenedores de los síntomas. Este estudio tuvo por objetivo analizar las vivencias de las relaciones familiares en la perspectiva de una joven diagnosticada con bulimia, de su madre y de su padre. Se trata de un estudio de caso cualitativo, descriptivo y transversal, con delineamiento compuesto por la tríada padre-madre-hija. Se entrevistaron a tres miembros de una familia (padre, madre e hija diagnosticada con bulimia). Los datos fueron recolectados por medio de guiones de entrevista semiestructurada y analizados por la perspectiva del referencial teórico psicoanalítico, a partir de la construcción de categorías temáticas. Los resultados mostraron que, al igual que la hija, los padres también presentaron fragilidades en su desarrollo emocional, culminando en dificultades en el establecimiento de la diferenciación yo-otro en esos miembros de la familia. Estas dificultades culminaron en vivencias familiares de inestabilidad, con vínculos de dependencia impregnados por sensaciones paradójales de invasión de la intimidad y sentimientos de desamparo. Los resultados encontrados contribuyen con avances en el conocimiento del área, en especial en el nivel de la comprensión de las relaciones familiares en el contexto de la bulimia, y ofrecen subsidios para acciones e intervenciones de los profesionales involucrados en la asistencia a pacientes y familiares.

ABSTRACT Eating disorders, such as bulimia, are psychopathologies of multifactorial etiology that have one of the primary triggerings and sustaining factors for symptoms in family relationships. This study aimed to analyze the experiences of family relationships from the perspective of a young woman diagnosed with bulimia, her mother and her father, who were interviewed. This is a qualitative, descriptive and cross-sectional case study whose design encompasses the father-mother-daughter triad. Data were collected through semi-structured interview scripts and analyzed from the perspective of the psychoanalytic theoretical framework, based on the construction of thematic categories. The results showed that, as the daughter, her parents also showed weaknesses in their emotional development, culminating in difficulties in establishing the self-other differentiation in these family members. These difficulties arose instability in family experiences, with dependence bonds permeated by paradoxical feelings of invasion of intimacy and helplessness. The results expand the knowledge of the field, especially in terms of understanding family relationships in the context of bulimia, and provide support for the actions and interventions planning of professionals involved in caring for patients and their families.

The influence of eating disorders on mothers' sensitivity and adaptation during feeding: a longitudinal observational study.

BACKGROUND: Parents with past and current eating disorders (ED) have been shown to report troubles nourishing their infants. This could increase the risk of infant feeding problems linked to maternal anxiety and depression. It is not clear how mothers' eating difficulties before pregnancy and at the time of birth can affect infant's feeding. We aimed to specify the impact of eating disorders on mothers' adaptation and sensitivity to their offspring during feeding, by comparing a population of mothers with eating disorders and controls. METHODS: Twenty-eight women agreed to participate in interviews and filmed mother-baby interactions. Pregnant women consulting at an obstetric unit for care follow-up were screened and tested for symptoms of eating disorders with the EDE-Q Questionnaire (Eating Disorders Examination Questionnaire) and the EDE Interview (Eating Disorders Examination Interview). Infant functional troubles and mothers' sensitivity were investigated through the Symptom Check List. Reciprocal adaptation during feeding with their new-borns was filmed and analysed with the Chatoor Infant Feeding Scale. Before pregnancy, two women suffered from anorexia, three suffered from bulimia, three had binge eating symptoms and two were diagnosed with EDNOS (Eating Disorders Not Otherwise Specified). RESULTS: Mothers suffering from ED tended to show more difficult interactive patterns in terms of dyadic reciprocity when feeding their babies compared with mothers with no symptoms of eating disorders. In the interviews, other than the behavioural data gathered, ED mothers expressed feeling more dissatisfaction and uneasiness during feeding. CONCLUSIONS: Pregnancy seems to be an useful period for interviewing women on eating disorders, allowing for the design and implementation of prevention programmes based on mothers' narratives and infant/mother observations and treatment.