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1.
Psychiatr Hung ; 34(4): 419-425, 2019.
Artigo em Húngaro | MEDLINE | ID: mdl-31767802

RESUMO

In the complex pathomechanism of eating disorders (especially that of bulimia nervosa and binge eating disorder) the traumatic experiences (sexual, physical, emotional abuse, neglect) often play an important role. The consequence of traumas can be the borderline personality disorder, or different disorders of the emotional regulation. These occur mainly in the multiimpulsive subtype of eating disorders with impulse control disorders. In relation to the trauma dissociative phenomena are frequent. In the diagnostics of eating disorders the history of traumatization is essential. Among the therapeutical possibilities the psychodynamic approach is important. Moreover, the newer methods based on cognitive behavioral therapy are effective, e.g., dialectic behavior therapy, integrative cognitive-analytic therapy, and other complex programs of trauma processing, such as the trauma-informed care.


Assuntos
Terapia Cognitivo-Comportamental , Transtornos da Alimentação e da Ingestão de Alimentos/psicologia , Transtornos da Alimentação e da Ingestão de Alimentos/terapia , Transtorno da Compulsão Alimentar/complicações , Transtorno da Compulsão Alimentar/psicologia , Transtorno da Compulsão Alimentar/terapia , Bulimia Nervosa/complicações , Bulimia Nervosa/psicologia , Bulimia Nervosa/terapia , Criança , Maus-Tratos Infantis/psicologia , Transtornos Dissociativos/complicações , Transtornos Dissociativos/psicologia , Transtornos Dissociativos/terapia , Transtornos da Alimentação e da Ingestão de Alimentos/complicações , Humanos
2.
Praxis (Bern 1994) ; 108(14): 917-921, 2019.
Artigo em Alemão | MEDLINE | ID: mdl-31662105

RESUMO

Cognitive Behavioral Therapy for Bulimia Nervosa Abstract. Abstract:: Cognitive behavioural therapy for eating disorders is an evidence-based effective method for the treatment of bulimia nervosa. It is based on a multifactorial and behavioal disorder model in which causes, triggering and maintaining conditions are considered and summarized in a behavioral analysis. Symptom-oriented standard procedures are used in the therapy process. Skills such as emotion regulation, interpersonal competence and cognitive techniques are taught. The low self-esteem and body dissatisfaction are of particular importance. Finally, personal goals are worked on with the patient, taking into account individual needs.


Assuntos
Bulimia Nervosa , Terapia Cognitivo-Comportamental , Bulimia Nervosa/psicologia , Bulimia Nervosa/terapia , Emoções , Humanos
3.
Psychiatr Danub ; 31(Suppl 3): 512-516, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31488782

RESUMO

BACKGROUND: Anorexia Nervosa (AN), Bulimia Nervosa (BN) and Binge Eating Disorder (BED) are severe psychiatric illnesses which represent the main expression of Feeding and Eating Disorders (FED). Clinicians agree that emotional and behavioural dysregulation play a crucial role in FED. Dysphoria could help us to better understand these components. Indeed, we define dysphoria as a generic state of dissatisfaction and emotional instability, without any specific features. Among the multitude of symptoms, we find that irritability, discontent, interpersonal resentment and surrender prevail. These dimensions correspond to the four subscales of Neapean Dysphoria Scale - Italian version (NDS-I). Dysphoria role in FED has not yet been investigated. Using this test, we can characterize dysphoria both in quantitative and qualitative terms. Accordingly, domain evaluation could discriminate these disorders allowing us to assess possible differential phenomenological expressions. AIMS: The aim of this paper is to understand in which way the dimensional spectrum that composes dysphoria differs between Anorexia Nervosa, Bulimia Nervosa and Binge Eating Disorders through an observational comparative study. SUBJECTS AND METHODS: The enrolled sample (30 patients) is represented by patients with a history of FED (AN, BN or BED). Patients were males and females between the ages of 13 and 45 with a good knowledge of Italian language. Patients with severe cognitive impairment (MMSE <19) and civil incapacitation were excluded. Patients were recruited from the Psychiatric Service of the Santa Maria della Misericordia Hospital in Perugia (PG), and other residential and semi residential structures specialized in FED treatment (FED specialized center at Palazzo Francisci in Todi (PG), Nido delle Rondini in Todi (PG), BED (Binge Eating Disorders) center in Città della Pieve (PG) and ambulatory services for FED in Umbertide (PG)). We administered them the Neapen Dysphoria Scale - Italian Version (NDS-I), a specific dimensional test for dysphoria. Starting from the dataset, with the aid of the statistical program SPSS 20, we have carried out a comparison between disorders groups selected and NDS-I total score and subscales (irritability, discontent, interpersonal resentment, surrender). For this we have used the Mann-Whitney U test, a nonparametric test with 2 independent samples, by setting a significance level p<0.05. CONCLUSIONS: This study allowed us to better understand and characterize the most common Eating Disorders. Beyond that, despite the small sample size, we found in our analysis statistically significant difference in the expression of various dysphoria dimension spectrum inside our 3 groups.


Assuntos
Emoções , Transtornos da Alimentação e da Ingestão de Alimentos/psicologia , Adolescente , Adulto , Anorexia Nervosa/psicologia , Transtorno da Compulsão Alimentar/psicologia , Bulimia Nervosa/psicologia , Feminino , Humanos , Itália , Masculino , Pessoa de Meia-Idade , Adulto Jovem
4.
Int J Clin Pract ; 73(11): e13401, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31397950

RESUMO

OBJECTIVE: While physical activity (PA) is known to have positive effects on psychological and physical health, little is understood about the association between non-compensatory PA (ie, not compulsive or intended to control weight or shape) and psychopathology among individuals with eating-disorder features. The present study explored associations between non-compensatory PA and psychopathology among adults categorised with bulimia nervosa (BN) and binge-eating disorder (BED). We further explored the association between compensatory PA and psychopathology among those who engaged in that form of "purging." METHOD: Participants were recruited through Mechanical Turk, an online recruitment platform. Individuals categorised with core features of BED (N = 138) and BN (N = 138) completed measures of eating-disorder psychopathology (Eating Disorder Examination - Questionnaire [EDE-Q] and Questionnaire on Eating and Weight Patterns - 5), depression (Patient Health Questionnaire - 2) and PA (both non-compensatory and compensatory, measured using the EDE-Q and Godin Leisure-Time Exercise Questionnaire). RESULTS: Engagement in non-compensatory PA was associated with lower frequency of binge-eating episodes, lower overvaluation of shape/weight and lower dissatisfaction with shape/weight (Ps < .05). Engagement in compensatory PA was related to greater frequency of binge-eating episodes and greater restraint (Ps < .05). DISCUSSION: Non-compensatory PA was associated with lower eating-disorder psychopathology. This suggests that PA is an important, though understudied, health behaviour among persons with features of BED and BN. Future research should examine the potential role of non-compensatory PA in interventions for individuals with core features of these eating disorders.


Assuntos
Transtorno da Compulsão Alimentar/psicologia , Bulimia Nervosa/psicologia , Exercício/psicologia , Comportamento Alimentar/psicologia , Adulto , Transtorno da Compulsão Alimentar/fisiopatologia , Peso Corporal , Bulimia/diagnóstico , Bulimia Nervosa/fisiopatologia , Depressão/psicologia , Feminino , Humanos , Masculino , Inquéritos e Questionários
5.
Int J Eat Disord ; 52(8): 941-949, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31184380

RESUMO

OBJECTIVE: Symptoms of eating disorders have been established as significant concurrent correlates with suicide ideation and behaviors in adolescent samples, but very few studies have examined eating disorder symptoms as prospective risk factors for suicide. The current study examined eating disorder symptoms as prospective risk factors for suicide ideation in an unselected community sample of adolescents. METHOD: Data were collected from 436 adolescents in middle and high school at baseline and 6- and 12-month follow-ups. Adolescents completed self-report measures assessing eating disorder symptoms and suicide ideation and behaviors at each time point during school hours. RESULTS: Regression analyses found that body dissatisfaction was a significant prospective predictor of suicide ideation severity at the 6- and 12-month follow-ups, symptoms of bulimia nervosa (binge-eating disorder and purging) predicted suicide ideation severity at the 12-month follow-up only, and symptoms of anorexia nervosa (drive for thinness and restricting) were not significant predictors of suicide ideation at either follow-up. Exploratory analyses found the same pattern of results for the sample of girls only, while no significant predictors were found for boys only. DISCUSSION: This is the first longitudinal study of disordered eating and suicide ideation in American adolescents. Symptoms of bulimia nervosa and body dissatisfaction seem to be true risk factors for suicidal ideation. The current study demonstrates the importance of disordered eating behaviors in the development of suicidal ideation in adolescents, particularly for adolescent girls.


Assuntos
Comportamento do Adolescente/psicologia , Bulimia Nervosa/psicologia , Ideação Suicida , Adolescente , Comportamento Alimentar/psicologia , Feminino , Humanos , Estudos Longitudinais , Masculino , Estudos Prospectivos , Análise de Regressão , Fatores de Risco
6.
Int J Eat Disord ; 52(8): 895-903, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31241208

RESUMO

OBJECTIVE: Abundant research points to the central role of body image disturbances in the occurrence of eating disorders (ED). While emotional arousal has been identified as a trigger for binge eating in bulimia nervosa (BN), empirical knowledge on the influence of emotions on body image in individuals with BN is scarce. The present study sought to experimentally examine effects of a positive and negative emotion induction on body dissatisfaction and selective attention towards negatively valenced body parts among people with BN. METHOD: In a randomized-controlled cross-over design, happiness and sadness were induced by film clips one-week apart in women with BN (n = 23) and non-ED controls (n = 26). After the emotion induction, participants looked at their body in a full-length mirror, while their attentional allocation was recorded with the help of a mobile eye tracker. Participants repeatedly rated their momentary body dissatisfaction. RESULTS: Induction of happiness led to a significant decrease in self-reported body dissatisfaction. Furthermore, attentional bias (higher gaze duration and frequency) towards the most disliked body part relative to the most liked body part was significantly greater in the sadness than happiness condition in BN. No significant effects of emotion induction on gaze duration and gaze frequency during mirror exposure were found for controls. DISCUSSION: In line with assumptions of current models on ED, findings support the notion that emotional state influences the body image of patients with BN.


Assuntos
/psicologia , Bulimia Nervosa/psicologia , Fixação Ocular , Felicidade , Tristeza , Adulto , Nível de Alerta , Viés de Atenção , Estudos Cross-Over , Feminino , Humanos , Filmes Cinematográficos , Autorrelato
7.
Int J Eat Disord ; 52(8): 962-967, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31215679

RESUMO

OBJECTIVE: We previously demonstrated that early improvements in access to emotion regulation strategies during the first 4 weeks of intensive cognitive behavior therapy (CBT)-based eating disorder (ED) treatment predicted a range of post-treatment outcomes. This follow-up article examines whether early improvements in access to emotion regulation strategies continue to predict good treatment outcomes at 6 months post-treatment. METHOD: Participants were 76 patients with bulimia nervosa or purging disorder who participated in the original study and the 6-month follow-up assessment. Hierarchical regression models were used to examine whether early improvements in emotion regulation strategies predicted 6-month follow-up outcomes. RESULTS: After controlling relevant covariates and rapid and substantial behavior change, greater early improvements in access to emotion regulation strategies during the first 4 weeks of intensive treatment predicted lower overall ED psychopathology and ED-related functional impairment 6 months after treatment. They did not predict abstinence from binge, vomit, and laxative use behaviors during the follow-up period. DISCUSSION: Individuals who learn early in treatment that they can use skills to more effectively regulate emotions have better treatment outcomes on some variables 6 months after treatment. Teaching emotion regulation skills in the first phase of CBT for ED may be beneficial, particularly for individuals with baseline difficulties.


Assuntos
Bulimia Nervosa/psicologia , Terapia Cognitivo-Comportamental , Adulto , Transtorno da Compulsão Alimentar/psicologia , Bulimia Nervosa/terapia , Feminino , Seguimentos , Humanos , Masculino , Desempenho Físico Funcional , Psicopatologia , Análise de Regressão , Fatores de Tempo , Resultado do Tratamento
8.
BMC Psychiatry ; 19(1): 134, 2019 05 06.
Artigo em Inglês | MEDLINE | ID: mdl-31060534

RESUMO

BACKGROUND: Mentalizing, the mental capacity to understand oneself and others in terms of mental states, has been found to be reduced in some mental disorders such as Borderline Personality Disorder (BPD). Some studies have suggested that Eating Disorders (EDs) may also be associated with impairments in mentalizing, but studies have not always yielded consistent results. This is the first study to systematically investigate mentalizing impairments in patients with Bulimia Nervosa (BN) compared with controls. In addition, we investigated whether impairments in mentalizing were related to BPD features, rather than BN per se, given the high comorbidity between BPD and BN. METHODS: Patients with BN (n = 53) and healthy controls (HCs; n = 87) completed a battery of measures assessing mentalizing including the Reflective Function Questionnaires (RFQ), the Object Relations Inventory (ORI; Differentiation-Relatedness Scales) and the Reading The Mind in The Eyes Test (RMET). RESULTS: Patients with BN scored significantly lower than HCs on all tests of mentalizing, with moderate to large between-group effect sizes. These differences were partially accounted for by BPD features as assessed with the Zanarini Rating Scale for Borderline Personality Disorder (ZAN-BPD), and partially by bulimic symptoms measured with the Eating Disorder Examination Questionnaire (EDE-Q). CONCLUSIONS: Patients with BN have significantly lower levels of mentalizing as assessed with a broad range of tests compared to HCs. These differences were related to both bulimic symptoms and BPD features. Although further research in larger samples is needed, if replicated, these findings suggest that poor mentalizing may be a significant factor in BN patients and should be addressed in treatment, regardless of the presence of BPD features.


Assuntos
Transtorno da Personalidade Borderline/complicações , Transtorno da Personalidade Borderline/psicologia , Bulimia Nervosa/complicações , Bulimia Nervosa/psicologia , Mentalização/fisiologia , Adolescente , Adulto , Transtorno da Personalidade Borderline/fisiopatologia , Bulimia Nervosa/fisiopatologia , Estudos de Casos e Controles , Comorbidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários , Adulto Jovem
9.
Eat Disord ; 27(2): 205-229, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31084429

RESUMO

Latinos are less likely to seek health care for eating disorders and more likely to drop out of treatment than members of other ethnic groups, highlighting existing challenges to engagement in traditional mental health care. This study explored the role of family in the treatment of adult Latinas with eating disorders through content analysis of family sessions adjunctive to cognitive behavioral therapy. This study yielded insight into the experiences of 10 Latinas with eating disorders (M age = 39.90 years) and 10 relatives (M age = 39.50) from the Promoviendo una Alimentación Saludable trial who were randomly selected to receive six family enhancement sessions. Data from 53 sessions were analyzed using a qualitative content analysis approach. Family intervention might serve as a valuable adjunct to conventional treatment by positively influencing social, family, and emotional support for Latinas with eating disorders.


Assuntos
Terapia Cognitivo-Comportamental , Terapia Familiar , Transtornos da Alimentação e da Ingestão de Alimentos/terapia , Hispano-Americanos/estatística & dados numéricos , Adulto , Transtorno da Compulsão Alimentar/psicologia , Bulimia Nervosa/psicologia , Transtornos da Alimentação e da Ingestão de Alimentos/etnologia , Feminino , Humanos
10.
Psychiatry Res ; 276: 269-277, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31125904

RESUMO

This study is an investigation of neuropsychological performance in patients with anorexia nervosa, bulimia nervosa, and binge eating disorder and hormonal secretion patterns for ghrelin, leptin, insulin, and glucose. An oral glucose tolerance test (OGTT) was performed in a cohort of n = 30 female patients suffering from eating disorders as well as n = 20 control females. All participants underwent the Wisconsin Card Sorting Test (WCST), the Trail Making Test (TMT), and a go/no-go task using food vs. neutral stimuli. Patients with anorexia nervosa differed from controls in their leptin response to the OGTT. While the four groups under investigation did not differ in neuropsychological performance, we found leptin responses to the OGTT to be associated with performance in the food-specific go/no-go task. These preliminary results may indicate a putative association between leptin concentrations and neuropsychological performance, particularly in measures of inhibitory control. Further studies investigating the role of leptin in impulsive behaviors in eating disorders would be useful.


Assuntos
Cognição/fisiologia , Transtornos da Alimentação e da Ingestão de Alimentos/sangue , Transtornos da Alimentação e da Ingestão de Alimentos/psicologia , Leptina/sangue , Adulto , Anorexia Nervosa/sangue , Anorexia Nervosa/psicologia , Transtorno da Compulsão Alimentar/sangue , Transtorno da Compulsão Alimentar/psicologia , Glicemia/análise , Bulimia Nervosa/sangue , Bulimia Nervosa/psicologia , Feminino , Alimentos , Grelina/sangue , Teste de Tolerância a Glucose , Humanos , Insulina/sangue , Análise e Desempenho de Tarefas , Adulto Jovem
11.
Int J Eat Disord ; 52(7): 834-845, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31002430

RESUMO

OBJECTIVE: To assess the long-term outcome and identify outcome predictors in a very large sample of inpatients treated for bulimia nervosa (BN). METHOD: Out of a total of 2,033 patients admitted consecutively to specialized treatment, 1,351 patients (mean age at treatment 25.94) were assessed for follow-up on average 11 (SD 6) years after admission. Also a very long-term (21 years) subsample (N = 147; mean age 25.92) was defined. Bivariate and logistic regression analyses identified predictors of poor outcome. RESULTS: For more than 70% of the patients follow-up information could be gathered. Severity of eating disorder (ED) and other symptoms decreased over time but remained higher than in healthy controls, using published normative data. Remission rate was 38% after 11 years and 42% in the subsample after 21 years. Out of the total sample of N = 2,033 patients, 49 had died (2.4%). Persistent BN was found in 14.2% and the most frequent crossover was to ED not otherwise specified. Predictors of poor outcome were fewer follow-up years, higher drive for thinness, higher age at treatment, and less global functioning. DISCUSSION: Based on clinical indicators, patients presented with a high level of ED and psychiatric symptomatology. With less than half of the patients remitted after 22 years, efforts are needed to improve treatment outcome.


Assuntos
Bulimia Nervosa/psicologia , Transtornos da Alimentação e da Ingestão de Alimentos/psicologia , Adulto , Feminino , Humanos , Pacientes Internados , Masculino , Resultado do Tratamento
12.
Psychiatry Res ; 275: 269-275, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30952070

RESUMO

The etiopathogenesis of eating disorders (EDs) is complex and still not well understood. Biological, psychological and environmental factors (e.g. childhood abuse) have all been considered to be involved in the onset and the persistence of EDs. The hypothalamic-pituitary-adrenal (HPA) axis is a relevant biological factor capable of influencing the onset and the course of EDs and not many information are available about the impact of a Cognitive Behavioral Therapy (CBT) on cortisol changes in EDs. The HPA-axis functioning has been evaluated before and after CBT in a group of patients with Anorexia Nervosa (n = 34) and Bulimia Nervosa (n = 35) according to the presence/absence of a history of sexual/physical abuse. At baseline, only patients reporting childhood abuse showed lower morning cortisol levels as compared with other patients of the same diagnostic group and Healthy Controls. After CBT, a variation of cortisol levels has been found only in patients without abuse, suggesting a role of childhood adversities in the persistence of HPA-axis alterations in Eating Disorders.


Assuntos
Sobreviventes Adultos de Maus-Tratos Infantis/psicologia , Anorexia Nervosa/metabolismo , Bulimia Nervosa/metabolismo , Terapia Cognitivo-Comportamental , Hidrocortisona/análise , Adulto , Anorexia Nervosa/psicologia , Anorexia Nervosa/terapia , Bulimia Nervosa/psicologia , Bulimia Nervosa/terapia , Criança , Transtornos da Alimentação e da Ingestão de Alimentos/metabolismo , Transtornos da Alimentação e da Ingestão de Alimentos/psicologia , Transtornos da Alimentação e da Ingestão de Alimentos/terapia , Feminino , Seguimentos , Humanos , Sistema Hipotálamo-Hipofisário , Masculino , Sistema Hipófise-Suprarrenal , Resultado do Tratamento
13.
Int J Eat Disord ; 52(6): 735-739, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30920683

RESUMO

BACKGROUND: Food insecurity occurs when access to food is limited by financial hardship. Yet, paradoxically, food insecurity is associated with overeating, with emerging evidence that it may be related to disordered eating. A recent report found that food insecurity was associated with binge-eating disorder (BED), but it is not yet known whether food insecurity is also associated with bulimia nervosa (BN). METHODS: Participants were 873 respondents recruited online who completed a battery of established measures and were categorized into three study groups: healthy-weight (HW), BED, and BN. Hierarchical logistic regressions evaluated the extent to which low and very low food security were associated with BN compared with HW and BED study groups. RESULTS: Low and very low food security were both associated with increased likelihood of BN group membership compared with HW but not BED. CONCLUSIONS: Our findings suggest that food insecurity is associated with BN and also suggest that food insecurity's association with BN is similar to that for BED. These findings highlight the need for greater clinical and research attention to associations between food insecurity and eating disorders that include binge eating to inform eating-disorder prevention and treatment.


Assuntos
Bulimia Nervosa/psicologia , Abastecimento de Alimentos/métodos , Adulto , Feminino , Humanos , Masculino , Estados Unidos
14.
Eat Behav ; 33: 49-54, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30903862

RESUMO

OBJECTIVE: Negative affect is a precipitant for binge eating in bulimia nervosa (BN). The purpose of the current study was to examine the effect of negative affect on food choices on a more granular level among individuals with BN using a computerized Food Choice Task. METHOD: Individuals with BN (n = 25) and healthy controls (HC, n = 21) participated in a computerized Food Choice Task following negative and neutral affect inductions, across two study sessions. During the task participants rated high and low-fat food items for Healthiness and Tastiness. Individuals then made a series of choices between a neutral-rated food and high and low-fat foods and were then given a snack based upon these choices. RESULTS: Overall negative affect score increased significantly for both the BN and HC groups following the negative affect induction. The group of individuals with BN, relative to the HC group, was less likely to choose high-fat foods (z = -2.763, p = 0.006), and these choices were not impacted by affect condition. Health ratings influenced food choices significantly more among individuals with BN than HC (z = 2.55, p = 0.01). DISCUSSION: Induction of negative affect was successful, yet was not related to an increase in proportion of high-fat food choices in the group of individuals with BN. The Food Choice Task captured dietary restriction in individuals with BN and results highlight the utility of this task as a probe to examine how the values of healthiness and tastiness impact food choice in individuals with BN.


Assuntos
Transtorno da Compulsão Alimentar/psicologia , Bulimia Nervosa/psicologia , Bulimia/psicologia , Comportamento de Escolha , Dieta/psicologia , Preferências Alimentares/psicologia , Adulto , Afeto , Comportamento Alimentar/psicologia , Feminino , Humanos , Paladar , Adulto Jovem
15.
Neuropsychopharmacology ; 44(7): 1265-1273, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30840983

RESUMO

Bulimia nervosa (BN) is characterized by dysregulated intake of food, which may indicate homeostatic imbalance. Critically important for homeostatic regulation is interoception, or the sensing and processing of body-relevant information. A well-documented link between avoidance of unpleasant body sensations and BN symptoms suggests that aversive interoceptive experiences may be particularly relevant to BN pathophysiology. This study examined whether individuals with a history of BN show aberrant neural processing of aversive interoceptive stimuli. Using a cued inspiratory breathing load paradigm, we compared women remitted from BN (RBN; n = 24; to reduce the confounding effects of active bulimic symptoms) and control women (CW; n = 25). During breathing load anticipation, the RBN group, relative to CW, showed increased activation in mid-insula, superior frontal gyrus, putamen, dorsal anterior cingulate, posterior cingulate, and amygdala. However, over the course of the aversive experience, neural activation in RBN relative to CW showed an aberrant decline in most of these regions. Exploratory analyses indicated that greater activation during breathing load anticipation was associated with past bulimic symptom severity and the duration of symptom remission. An exaggerated anticipatory response and an abnormally decreasing response during aversive homeostatic perturbations may promote hallmark bulimic behaviors-binge eating, dietary restriction, and purging. Our findings support a role for homeostatic instability in BN, and these altered patterns of brain activation may serve as novel targets for pharmacological, neuromodulatory, and behavioral interventions.


Assuntos
Antecipação Psicológica/fisiologia , Encéfalo/fisiopatologia , Bulimia Nervosa/fisiopatologia , Bulimia Nervosa/psicologia , Interocepção/fisiologia , Estresse Psicológico/fisiopatologia , Adulto , Mapeamento Encefálico , Bulimia Nervosa/complicações , Feminino , Humanos , Inalação , Imagem por Ressonância Magnética , Estresse Psicológico/complicações , Adulto Jovem
16.
Int J Eat Disord ; 52(5): 602-606, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30843609

RESUMO

OBJECTIVE: This case report describes the psychological treatment for bulimia nervosa of a 16-year old with co-occurring gender dysphoria. He reported restricting his food intake and purging for approximately 1 year prior to therapy commencing. METHOD: Ten sessions of cognitive behavioral therapy for eating disorders (CBT-T) were conducted with accommodations for gender-specific body dissatisfaction. RESULTS: The client eliminated binging and purging from the second treatment session and had maintained this at the 3-month follow-up. The quantity and variety of foods he was eating had increased and he no longer reported subjective binges. Improvements were also evident in his depression, anxiety and stress symptoms. DISCUSSION: This suggests that bulimia nervosa may be effectively treated with CBT-T in the context of gender dysphoria. Further research that investigates the generalizability of these outcomes would be beneficial.


Assuntos
Bulimia Nervosa/terapia , Terapia Cognitivo-Comportamental/métodos , Disforia de Gênero/psicologia , Psicoterapia/métodos , Adolescente , Bulimia Nervosa/psicologia , Humanos , Masculino , Resultado do Tratamento
17.
Curr Obes Rep ; 8(2): 112-127, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30827011

RESUMO

PURPOSE OF REVIEW: The purpose of this review was to examine different forms of disordered eating among individuals with excess weight, including their rates, correlates, and psychosocial treatments. RECENT FINDINGS: Binge eating/binge eating disorder, loss of control eating, emotional eating, and food addiction are all fairly prevalent among individuals with excess weight. They appear to share many of the same correlates, including broader eating disorder psychopathology, body/shape/weight concerns, depression, anxiety, and low self-esteem. Behavioral, cognitive-behavioral, and third-wave (e.g., acceptance, mindfulness) therapies appear effective in improving binge eating, loss of control eating, emotional eating, associated features (e.g., weight and shape concerns), and psychological distress (e.g., depression). Certain forms of disordered eating are elevated among individuals with excess weight, and psychosocial interventions have been found effective in improving symptomatology. Empirical research examining the efficacy of treatments for food addiction is lacking, and greatly needed given both its rate and controversy.


Assuntos
Transtornos da Alimentação e da Ingestão de Alimentos/epidemiologia , Transtornos da Alimentação e da Ingestão de Alimentos/psicologia , Ganho de Peso , Transtorno da Compulsão Alimentar/epidemiologia , Transtorno da Compulsão Alimentar/psicologia , Bulimia Nervosa/epidemiologia , Bulimia Nervosa/psicologia , Depressão/epidemiologia , Depressão/psicologia , Ingestão de Alimentos/psicologia , Feminino , Dependência de Alimentos/epidemiologia , Dependência de Alimentos/psicologia , Comportamentos Relacionados com a Saúde , Humanos , Masculino , Obesidade/epidemiologia , Obesidade/psicologia , Sobrepeso/epidemiologia , Sobrepeso/psicologia , Prevalência
18.
Eat Behav ; 33: 30-33, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30852343

RESUMO

PURPOSE: To examine the potential factor structure of the Eating Disorder Diagnostic Scale (EDDS) in a sample of individuals with bipolar disorder. METHOD: Exploratory common factor analyses were conducted in a sample of 1031 people with bipolar disorder as defined by the Structured Clinical Interview for DSM-IV-TR. RESULTS: Approximately 27% of participants had a comorbid eating disorder. Exploratory factor analysis yielded a 3 factor solution (i.e., shape/weight concerns; binge eating behaviors, compensatory behavior). CONCLUSIONS: The 3-factor solution of the EDDS in a bipolar disorder sample is consistent with major eating disorder symptom domains. Future research is necessary to replicate these findings in eating disorder samples with diverse comorbid psychopathology.


Assuntos
Anorexia Nervosa/psicologia , Transtorno da Compulsão Alimentar/psicologia , Transtorno Bipolar/psicologia , Bulimia Nervosa/psicologia , Comportamento Alimentar/psicologia , Adulto , Anorexia Nervosa/complicações , Anorexia Nervosa/epidemiologia , Transtorno da Compulsão Alimentar/complicações , Transtorno da Compulsão Alimentar/epidemiologia , Transtorno Bipolar/complicações , Bulimia Nervosa/complicações , Bulimia Nervosa/epidemiologia , Comorbidade , Manual Diagnóstico e Estatístico de Transtornos Mentais , Análise Fatorial , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Psicopatologia
19.
Eur Eat Disord Rev ; 27(3): 323-328, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30734406

RESUMO

This study evaluated the effects of two treatments for adolescent bulimia nervosa (BN), family-based treatment (FBT-BN), and cognitive behavioral therapy (CBT-A), on both attitudinal and behavioural outcomes at end-of-treatment. These associations were examined specifically relative to motivation for change in obsessive-compulsive (OC) features of eating disorder (ED) symptoms. Adolescents (N = 110) were randomly assigned to FBT-BN or CBT-A and completed assessments of eating pathology and OC-ED behaviour. Across both treatments, greater motivation for change in OC-ED behaviour was associated with improved attitudinal features of ED at end-of-treatment. Motivation for change did not demonstrate a direct or interaction effect on BN behavioural outcomes. Results suggest that adolescents with BN who are more motivated to change OC-ED behaviours at the start of treatment, FBT-BN or CBT-A, are more likely to demonstrate improvements in cognitions, but not behaviours associated with EDs, at treatment conclusion.


Assuntos
Bulimia Nervosa/psicologia , Bulimia Nervosa/terapia , Comportamento Compulsivo , Comportamento Obsessivo , Adolescente , Criança , Terapia Cognitivo-Comportamental , Terapia Familiar , Feminino , Humanos , Masculino , Motivação , Resultado do Tratamento
20.
Soc Psychiatry Psychiatr Epidemiol ; 54(7): 813-821, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30756148

RESUMO

BACKGROUND: Bulimia nervosa (BN) is associated with increased mortality. Frequent comorbidities of BN include substance use disorders, affective disorders and personality disorders (PD). These comorbidities may add an additional risk for mortality. METHODS: We investigated the influence of these psychiatric comorbidities on all-cause mortality with demographic and socioeconomic factors considered as confounders over an observation period from January 2007 to March 2016 for 1501 people with BN using anonymised health records data from the South London and Maudsley NHS Foundation Trust (SLaM), retrieved through its Clinical Records Interactive Search (CRIS) data resource. Mortality was ascertained through monthly linkages to the nationwide tracing system administered by the Office for National Statistics (ONS). We used Cox proportional hazards regression to calculate hazard ratios (HRs) with 95% confidence intervals (CIs). Multivariable analyses were also performed to estimate effects when controlling for confounding of age, sex, ethnicity, borough, marital status and deprivation score. RESULTS: A total of 18 patients with BN died during the observation period. The standardised mortality ratio (SMR) for our study cohort (against the population of England and Wales in 2012 as a standard) was 2.52 (95% CI 1.49-3.97). Cox regressions revealed significant associations of mortality with older age and male gender. Comorbid PD (HR: 3.36; 95% CI 1.05-10.73) was significantly associated with all-cause mortality, even after controlling for demographic and socioeconomic covariates. CONCLUSIONS: These results highlight increased mortality in patients with BN and the importance of recognising and treating PDs in patients with BN.


Assuntos
Bulimia Nervosa/mortalidade , Transtornos do Humor/mortalidade , Transtornos da Personalidade/mortalidade , Transtornos Relacionados ao Uso de Substâncias/mortalidade , Adulto , Idoso , Bulimia Nervosa/psicologia , Causas de Morte , Estudos de Coortes , Comorbidade , Inglaterra/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Transtornos do Humor/psicologia , Transtornos da Personalidade/psicologia , Modelos de Riscos Proporcionais , Fatores de Risco , Fatores Socioeconômicos , Transtornos Relacionados ao Uso de Substâncias/psicologia , País de Gales/epidemiologia
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