The aim of this study was to test for prospective relationships between personality factors measured in elementary school and drinking, smoking, and binge eating during the first year of middle school. Data were collected among adolescents drawn from 23 elementary schools and 15 middles schools in central Kentucky. In a two-wave study, 1,906 children completed questionnaire measures in the spring of 5th grade and the spring of 6th grade. After controlling for sex, pubertal status, and prior engagement in addictive behaviors, it was found that urgency at wave 1 predicted drinking, smoking, and binge eating at wave 2, and low conscientiousness at wave 1 predicted drinking and smoking at wave 2. Risky behaviors during the first year of middle school predict subsequent life problems and subsequent diagnosable addictive disorders. The finding that those behaviors can be predicted by personality factors measured in elementary school indicates the value, for risk researchers and prevention specialists, of focusing efforts on children prior to the onset of adolescence.

The current dissertation is comprised of two studies that examined the relationship between group dynamics, attachment anxiety, and post-treatment outcomes in a sample of women (N = 102) with binge eating disorder (BED) who received Group Psychodynamic Interpersonal Psychotherapy. The first study explored the relationship between the development of group cohesion, the individuals’ level of attachment anxiety, and frequency of binge eating, symptoms of depression, and self-esteem at post-treatment. The second study explored the relationship between the interpersonal learning, individuals’ level of attachment anxiety, and outcomes. Interpersonal learning was conceptualized as the convergence between multiple perspectives of group cohesion: one’s own and the group’s perception of one’s cohesion to the group. Parallel measures of individual self-rated cohesion (CQ-I) and mean group-rated cohesion (CQ-G) were developed based on the original Cohesion Questionnaire (CQ; Piper et al., 1983) for this study. Participants were assigned to homogeneous groups composed of either high or low attachment anxiety to assess the impact of pre-treatment attachment anxiety. Findings indicated significant growth in cohesion over time, and a significant convergence in multiple ratings of cohesion. These processes did not differ significantly based on level of attachment anxiety. Growth in cohesion was related to greater reductions in binge eating for those high in attachment anxiety, while the convergence in ratings of cohesion (i.e., interpersonal learning) was related to improvements in self-esteem for individuals in both attachment anxiety conditions. The findings support the importance of group interventions for BED that are sensitive to individuals’ attachment anxiety, and that emphasize cohesiveness, and interpersonal learning to improve outcomes.

[Truncated abstract] Eating disorders affect a significant proportion of adolescent and young adult women and a smaller proportion of children, men, and older individuals. They are associated with a range of physical, psychological, and social consequences that can have a profound and lasting impact on affected individuals. Eating disorder symptoms (e.g., marked weight and shape concern, strict dieting, binge eating, purging) are also associated with physiological and psychosocial morbidity, and are reported by up to half of adolescent girls and one-third of adolescent boys. If eating disorders are to be effectively prevented or treated, it is imperative that risk and maintaining factors for the conditions are identified. ... This thesis aimed to identify the variables and models that may best account for the development and maintenance of eating disorder symptoms, through two broad studies and six sub-studies. Study 1 focused on identifying predictors of cognitive (i.e., elevated weight and shape concern) and behavioural (i.e., binge eating) eating disorder symptoms in pre- to early-adolescent children followed over time. Prospective tests of the dual-pathway (Stice, 2001) and cognitive-behavioural (Fairburn, 2002; Fairburn, Cooper, & Shafran, 2003) models of eating pathology were also conducted, and a distinction was made between weight and shape concern and weight and shape over-evaluation. Low selfesteem, perceived media pressure to be thin, weight and shape over-evaluation, and maternal concern about child weight prospectively predicted increases in child weight and shape concern over time (Studies 1b and 1c), and weight and shape concern was the most robust predictor of increases in dietary restraint (Studies 1b and 1d). Dietary restraint and affect-related eating prospectively predicted binge eating onset (Studies 1a and 1d), and the dual-pathway and cognitive-behavioural models were both able to account for the development of binge eating over a two year period (Study 1d). Evidence was also provided for the relative superiority of the most recent, enhanced cognitivebehavioural model (Fairburn et al., 2003) over other available theoretical accounts. Study 2 focused more specifically on the role of mood intolerance in predicting and maintaining eating pathology in adults. In Study 2a, a new measure of mood intolerance was developed, revised, and evaluated. In Study 2b, the role of mood intolerance in cross-sectionally predicting binge eating and purging was examined within the framework of the enhanced cognitive-behavioural model. The importance of mood intolerance in accounting for eating disorder symptoms was confirmed, and additional support for the cognitive-behavioural model was provided. Collectively, the six empirical studies have provided new data regarding the relative importance of different variables in the development and maintenance of different eating disorder symptoms. They also provide initial insight into the relative validity of alternate theoretical models in this area. The results suggest that the most recent, enhanced cognitive-behavioural model may provide the best account of how eating disorder symptoms develop and are maintained, providing that the mood intolerance component of the model is specified.

A plethora of research has linked negative affect with binge eating in people with binge eating disorder (BED). Cognitive behavioural therapy (CBT) and interpersonal therapy (IPT) have not traditionally addressed emotional regulation deficits. Failure to address emotional aspects of binge eating may explain why some individuals do not respond to CBT or IPT, and why many of those who do respond relapse shortly after finishing treatment. Dialectical behaviour therapy (DBT) specifically targets the inability to accurately recognise and regulate affect. Preliminary investigations have shown that DBT may be efficacious in treating BED. However, it can take up to 10 months, and a shorter intervention targeting affect regulation and recognition may produce similar effects. Four studies evaluating a ten session emotion-focussed group psychoeducational intervention for BED were conducted. In the first, 25 women diagnosed with subthreshold or full syndrome BED (using DSM-IV-TR criteria) were treated. The second study tested whether the specific components of the intervention, or the treatment as a whole, was required to produce positive outcomes in women. Study three, examined the efficacy of the treatment programme with three men diagnosed with subthreshold or full syndrome BED (also using DSM-IV-TR criteria). The fourth study compared the women's and men's response to treatment. Following the intervention with women, binge abstinence rates, comparable to those of CBT and IPT, and various other positive changes to eating and general pathology, were observed. These effects were well-maintained up to one-year later. Overall, it was concluded that the whole treatment programme was necessary to produce the optimum outcome for BED in women. A positive outcome was measured in the men, although the effects were not as dramatic as those found in the women. Suggestions for improvements, and suggestions for further research, are discussed. The results provide support for the Affect Regulation Model of BED in women and men.

Binge eating disorder (BED) is characterized by compulsive consumption of food within a short time period accompanied by loss of control over eating. Recent literature provides the basis for consideration of BED as an addiction-like disorder. In this study, we aimed to determine the effects of Trace Amine-Associated Receptor 1 (TAAR1) agonism on maladaptive forms of feeding behaviors. TAAR1 is an intracellular receptor preferentially expressed in monoaminergic cells, and involved in reward and motivation. For this purpose, we trained male rats to self-administer either a sugary, highly palatable diet (Palatable rats) or a chow diet (Chow rats) for 1 hour/day under a Fixed Ratio 1 (FR1) schedule of reinforcement. Following escalation and stabilization of binge-like eating of palatable food, we tested the effects of the TAAR1 agonist RO5256390 on i) binge-like eating and eating rate in the FR1 schedule, ii) compulsive eating in a light/dark conflict test, iii) food reward using a conditioned place preference test, and lastly iv) food seeking behavior using a second-order schedule of reinforcement. Results showed that RO5256390 blocked binge-like eating, compulsive eating, food reward, and food seeking behavior selectively in Palatable rats without affecting Chow controls’ performance. Results provide evidence that TAAR1 may be a potential pharmacological target for Binge Eating Disorder. / 2018-06-16T00:00:00Z

O transtorno de compulsão periódica (TCAP) é uma categoria diagnóstica recente sendo considerada uma forma de transtorno alimentar sem outras especificações e seus critérios diagnósticos estão incluídos no apêndice B do DSMIV. As características essenciais deste transtorno são episódios recorrentes de compulsão alimentar periódica, na ausência de comportamentos compensatórios inadequados característicos da bulimia nervosa (vômitos auto-induzidos, uso de diuréticos e laxativos, exercícios físicos em excesso e jejum prolongado), associados com prejuízo no controle e sofrimento significativo relacionados aos ataques de hiperfagia. Medicações antidepressivas são efetivas, pelo menos a curto prazo, na supressão do comer compulsivo e na redução de psicopatologia associada.O Objetivo deste trabalho foi avaliar a efetividade e segurança da reboxetina, um inibidor seletivo da recaptação de noradrenalina, no tratamento de pacientes obesos com TCAP.Nove pacientes obesos ambulatoriais com índice de massa corpórea (IMC = calculado como o peso em kilogramas dividido pelo quadrado da altura em metros) entre 30-45 kg/m,2 com TCAP de acordo com o DSM-IV e sem nenhuma comorbidade psiquiátrica associada, foram selecionados e receberam reboxetina 8 mg/dia durante 12 semanas de tratamento. O número de dias com compulsão alimentar periódica por semana, a escala de compulsão alimentar periódica (ECAP), o peso, o IMC, a escala de Impressão Clínica Global - Severidade (CGI-S) e a escalade avaliação de qualidade de vida da Organização Mundial de Saúde - versão abreviada (WHOQOL-BREF) foram utilizados como medidas de eficácia. Na análise estatística dos dados foi utilizado o Teste t pareado para avaliar mudanças nos escores pré e pós-tratamento e uma análise por intenção de tratar foi utilizada incluindo na análise a última visita de cada sujeito no estudo. Cinco pacientes completaram o estudo e apresentaram uma remissão completa do TCAP ao final do tratamento. A média do número de dias com compulsão alimentar periódica por semana modificou-se significativamente de 4,6 ± 1,8 para 0,2 ± 0,6 ao final do estudo (p = 0,0002). A média dos escores da ECAP caiu de 32,3 ± 6,32 para 9,3 ± 6,8 (p = 0,0003). Houve também uma redução estatisticamente significativa do IMC de 36,5 ± 4,48 para 35,06 ± 4,49 (p = 0,01) e na CGI-S de 5,1 ± 0,92 para 1,4 ± 1,01 (p = 0,0002). Uma redução significativa do peso corporal (média = 4,24 kg) também foi observada entre o baseline e o final do estudo (p= 0,01). A qualidade de vida foi avaliada pela WHOQOL-BREF no pré e pós-tratamento e houve diferença com significância estatística nas duas questões de qualidade de vida geral (p= 0,02) e no domínio psicológico (p= 0,03). Nenhum evento adverso sério foi observado.A reboxetina pode ser um agente efetivo e bem tolerado no tratamento do TCAP em pacientes obesos. / Binge Eating Disorder (BED) is a recent diagnostic category considered a non-specified eating disorder whose diagnostic criteria are listed in Appendix B of DSM-IV. Its essential characteristics are recurrent episodes of binge eating and the absence of inadequate compensatory behavior that is characteristic of bulimia nervosa (self-induced vomits, use of laxative and diuretics, excessive exercise, and prolonged fasting), associated with loss of control and significant distress related to the episodes of hyperphagia. At least in the short term, antidepressants are effective in the suppression of compulsive eating and in the reduction of associated psychopathology.The aim of this study was to assess in an open clinical trial the effectiveness and safety of reboxetine, a selective noradrenaline reuptake inhibitor, in the treatment of obese patients with binge eating disorder.Nine obese outpatients with body mass index (the Body Mass Index [IMC] value equals a person's weight in kilograms divided by the square of the person's height in meters) between 30-45 kg/m2, with BED according to DSM-IV, and with no associated psychiatric co-morbidity, received reboxetine 8 mg/day during 12 weeks of treatment. The number of days of binge eating per week, the Binge Eating Scale (BES), body weight, BMI, the Clinical Global Impression- Severity (CGI-S) scale and the World Health Organization Quality of Life Assessment Scale (WHOQOL-BREF) were used to measure efficacy. Paired t-test was used in the data statistical analysis to evaluate changes in pre and posttreatmentscores; an intention-to-treatment analysis including the last visit of study participants was also used. Five patients completed the study and presented a complete remission of binge eating by the end of the treatment. Mean number of binge days per week showed a significant change, down from 4.6 ± 1.8 to 0.2 ± 0.6 at the end of the study (p = 0.0002). Mean scores of BES were down from 32.3 ± 6.32 to 9.3 ± 6.8 (p = 0.0003). Statistically significant decreases were found in BMI, from 36.5 ± 4.48 to 35.06 ± 4.49 (p = 0.01), in CGI-S, from 5.1 ± 0.92 to 1.4 ± 1.01 (p = 0.0002). Also, a significant decrease in body weight (mean = 4.24 kg) was seen between baseline and the end of the study (p= 0.01). The quality of life was evaluated with WHOQOLBREF in pre and posttreatment.It was showed a statistically significant improve on overall quality of life and general health (p= 0,02) and on psychological domain (p= 0,03). No severe side effects were observed.Reboxetine may be an effective and well-tolerated agent in the treatment of BED in obese patients.

Os Transtornos Alimentares (TA) são caracterizados por graves perturbações no comportamento alimentar, geralmente de início precoce e curso duradouro. Vários fatores estão associados a sua etiologia, como fatores familiares, socioculturais, biológicos e psicológicos. Alguns autores demonstraram existir correlação entre gravidade nos comportamentos alimentares inadequados, baixos níveis de assertividade, altos níveis de hostilidade autodirigida e dificuldade em expressar a raiva. Além disso, a raiva tem sido relacionada principalmente aos episódios de compulsão alimentar e métodos compensatórios. A literatura, já há algum tempo reconhece o papel central do afeto negativo na etiologia e manutenção da compulsão alimentar. A teoria da regulação do afeto pressupõe que os episódios de compulsão alimentar estão associados a uma dificuldade para regular as emoções de forma adaptada, configurando-os como uma estratégia inadequada para aliviar sofrimento e reduzir afetos intensos. Pesquisadores indicam que um terço das mulheres com compulsão alimentar, comem em resposta a emoções negativas, mais especificamente a raiva, depressão e ansiedade. A compulsão alimentar teria como função regular a experiência emocional, reduzindo a consciência da emoção. A raiva também tem sido associada a déficits em habilidades sociais. A literatura sugere que os indivíduos socialmente habilidosos são mais propensos a manejar com a emoção da raiva do que aqueles com déficits em habilidades sociais e resolução de problemas, e que muitos dos tratamentos efetivos para raiva e comportamento agressivo incluem o desenvolvimento dessas habilidades. Assim como elevados níveis de raiva estão associados a comportamentos alimentares disfuncionais, evidências apontam para a relação entre déficits em habilidades sociais e gravidade do comportamento alimentar. A literatura mostra que no tratamento da raiva, o treinamento de habilidades sociais tem sido bastante efetivo. Dessa forma, identificar de que forma a raiva se relaciona ao comportamento alimentar inadequado , bem como aos déficits em habilidades sociais se torna relevante para a criação de programas de intervenção que tenham como objetivo ensinar o indivíduo a manejar com a raiva e frustração, aumentando assim, a capacidade de resolução de problemas e diminuindo a ocorrência de comportamentos alimentares inadequados. Portanto, o objetivo desse estudo é avaliar as relações entre habilidades sociais e a raiva em pacientes com Bulimia Nervosa e Transtorno da Compulsão Alimentar Periódica. Em função das críticas ao uso de questionários de auto-informe em pesquisas, essa tese foi dividida em três estudos. O primeiro foi uma revisão sistemática da literatura que teve como propósito avaliar as relações entre níveis disfuncionais de raiva e compulsão alimentar em pacientes com bulimia nervosa e TCAP. O segundo estudo avaliou as relações entre níveis de habilidades sociais, raiva disfuncional e gravidade da compulsão alimentar em amostra clínica, através de questionários de autorrelato. E por fim, o terceiro estudo teve como objetivo identificar pensamentos automáticos e comportamentos associados a emoção da raiva através de entrevista estruturada, composta por cinco questões abertas. Os resultados de cada estudo serão discutidos, assim como sua implicação no tratamento dos TA / Eating Disorders (ED) are characterized by severe disturbances in eating behavior, usually with early and lasting progress. Several factors are associated with the etiology, such as family, social, cultural, biological and psychological factors. Some authors have demonstrated correlation between severity in inappropriate eating behaviors, low levels of assertiveness, high levels of self-directed hostility and difficulty expressing anger. In addition, the anger has been mainly related to binge eating and compensatory methods. The literature, for some time now recognizes the central role of negative affect in the etiology and maintenance of binge eating. The theory of affection regulation assumes that binge eating episodes are associated with a failure to regulate adapted form of emotions, setting them to an inadequate strategy to alleviate suffering and reduce intense affections. Researchers indicate that one third of women with binge eating, eat in response to negative emotions, specifically anger, depression and anxiety. Binge eating would regular function emotional experience, reducing the thrill of consciousness. Anger has also been linked to deficits in social skills. The literature suggests that socially skilled individuals are more likely to manage with the emotion of anger than those with deficits in social skills and problem solving, and that many effective treatments for anger and aggressive behavior include the development of these skills. As well as high levels of anger are associated with dysfunctional eating behaviors, evidence points to the relationship between deficits in social skills and severity of eating behavior. The literature shows that the treatment of anger, social skills training has been very effective. This can be proven with research showing the moderating role of empathy about anger as well as the importance of assertiveness. Thus, to identify how anger is related to inappropriate eating behavior, and the deficits in social skills is relevant to the creation of intervention programs that aim to teach the individual to manage with anger and frustration, thus increasing , problem-solving ability and reducing the occurrence of inappropriate eating behaviors. Therefore, the aim of this study is to evaluate the relationship between social skills and anger in patients with Bulimia Nervosa and Binge Eating Disorder. Depending on the criticism of the use of self-report questionnaires in research, this thesis was divided into three studies. The first was a systematic literature review that aimed to assess the relationship between dysfunctional levels of anger and binge eating in patients with bulimia nervosa and BED. The second study evaluated the relationship between levels of social skills, dysfunctional anger and severity of binge eating in clinical sample using self-report questionnaires. Finally, the third study aimed to identify automatic thoughts and behaviors associated with emotion of anger through a structured interview, consisting of five open questions. The results of each study will be discussed, as well as their involvement in the treatment of ED

Os Transtornos Alimentares (TA) são caracterizados por graves perturbações no comportamento alimentar, geralmente de início precoce e curso duradouro. Vários fatores estão associados a sua etiologia, como fatores familiares, socioculturais, biológicos e psicológicos. Alguns autores demonstraram existir correlação entre gravidade nos comportamentos alimentares inadequados, baixos níveis de assertividade, altos níveis de hostilidade autodirigida e dificuldade em expressar a raiva. Além disso, a raiva tem sido relacionada principalmente aos episódios de compulsão alimentar e métodos compensatórios. A literatura, já há algum tempo reconhece o papel central do afeto negativo na etiologia e manutenção da compulsão alimentar. A teoria da regulação do afeto pressupõe que os episódios de compulsão alimentar estão associados a uma dificuldade para regular as emoções de forma adaptada, configurando-os como uma estratégia inadequada para aliviar sofrimento e reduzir afetos intensos. Pesquisadores indicam que um terço das mulheres com compulsão alimentar, comem em resposta a emoções negativas, mais especificamente a raiva, depressão e ansiedade. A compulsão alimentar teria como função regular a experiência emocional, reduzindo a consciência da emoção. A raiva também tem sido associada a déficits em habilidades sociais. A literatura sugere que os indivíduos socialmente habilidosos são mais propensos a manejar com a emoção da raiva do que aqueles com déficits em habilidades sociais e resolução de problemas, e que muitos dos tratamentos efetivos para raiva e comportamento agressivo incluem o desenvolvimento dessas habilidades. Assim como elevados níveis de raiva estão associados a comportamentos alimentares disfuncionais, evidências apontam para a relação entre déficits em habilidades sociais e gravidade do comportamento alimentar. A literatura mostra que no tratamento da raiva, o treinamento de habilidades sociais tem sido bastante efetivo. Dessa forma, identificar de que forma a raiva se relaciona ao comportamento alimentar inadequado , bem como aos déficits em habilidades sociais se torna relevante para a criação de programas de intervenção que tenham como objetivo ensinar o indivíduo a manejar com a raiva e frustração, aumentando assim, a capacidade de resolução de problemas e diminuindo a ocorrência de comportamentos alimentares inadequados. Portanto, o objetivo desse estudo é avaliar as relações entre habilidades sociais e a raiva em pacientes com Bulimia Nervosa e Transtorno da Compulsão Alimentar Periódica. Em função das críticas ao uso de questionários de auto-informe em pesquisas, essa tese foi dividida em três estudos. O primeiro foi uma revisão sistemática da literatura que teve como propósito avaliar as relações entre níveis disfuncionais de raiva e compulsão alimentar em pacientes com bulimia nervosa e TCAP. O segundo estudo avaliou as relações entre níveis de habilidades sociais, raiva disfuncional e gravidade da compulsão alimentar em amostra clínica, através de questionários de autorrelato. E por fim, o terceiro estudo teve como objetivo identificar pensamentos automáticos e comportamentos associados a emoção da raiva através de entrevista estruturada, composta por cinco questões abertas. Os resultados de cada estudo serão discutidos, assim como sua implicação no tratamento dos TA / Eating Disorders (ED) are characterized by severe disturbances in eating behavior, usually with early and lasting progress. Several factors are associated with the etiology, such as family, social, cultural, biological and psychological factors. Some authors have demonstrated correlation between severity in inappropriate eating behaviors, low levels of assertiveness, high levels of self-directed hostility and difficulty expressing anger. In addition, the anger has been mainly related to binge eating and compensatory methods. The literature, for some time now recognizes the central role of negative affect in the etiology and maintenance of binge eating. The theory of affection regulation assumes that binge eating episodes are associated with a failure to regulate adapted form of emotions, setting them to an inadequate strategy to alleviate suffering and reduce intense affections. Researchers indicate that one third of women with binge eating, eat in response to negative emotions, specifically anger, depression and anxiety. Binge eating would regular function emotional experience, reducing the thrill of consciousness. Anger has also been linked to deficits in social skills. The literature suggests that socially skilled individuals are more likely to manage with the emotion of anger than those with deficits in social skills and problem solving, and that many effective treatments for anger and aggressive behavior include the development of these skills. As well as high levels of anger are associated with dysfunctional eating behaviors, evidence points to the relationship between deficits in social skills and severity of eating behavior. The literature shows that the treatment of anger, social skills training has been very effective. This can be proven with research showing the moderating role of empathy about anger as well as the importance of assertiveness. Thus, to identify how anger is related to inappropriate eating behavior, and the deficits in social skills is relevant to the creation of intervention programs that aim to teach the individual to manage with anger and frustration, thus increasing , problem-solving ability and reducing the occurrence of inappropriate eating behaviors. Therefore, the aim of this study is to evaluate the relationship between social skills and anger in patients with Bulimia Nervosa and Binge Eating Disorder. Depending on the criticism of the use of self-report questionnaires in research, this thesis was divided into three studies. The first was a systematic literature review that aimed to assess the relationship between dysfunctional levels of anger and binge eating in patients with bulimia nervosa and BED. The second study evaluated the relationship between levels of social skills, dysfunctional anger and severity of binge eating in clinical sample using self-report questionnaires. Finally, the third study aimed to identify automatic thoughts and behaviors associated with emotion of anger through a structured interview, consisting of five open questions. The results of each study will be discussed, as well as their involvement in the treatment of ED

O transtorno de compulsão periódica (TCAP) é uma categoria diagnóstica recente sendo considerada uma forma de transtorno alimentar sem outras especificações e seus critérios diagnósticos estão incluídos no apêndice B do DSMIV. As características essenciais deste transtorno são episódios recorrentes de compulsão alimentar periódica, na ausência de comportamentos compensatórios inadequados característicos da bulimia nervosa (vômitos auto-induzidos, uso de diuréticos e laxativos, exercícios físicos em excesso e jejum prolongado), associados com prejuízo no controle e sofrimento significativo relacionados aos ataques de hiperfagia. Medicações antidepressivas são efetivas, pelo menos a curto prazo, na supressão do comer compulsivo e na redução de psicopatologia associada.O Objetivo deste trabalho foi avaliar a efetividade e segurança da reboxetina, um inibidor seletivo da recaptação de noradrenalina, no tratamento de pacientes obesos com TCAP.Nove pacientes obesos ambulatoriais com índice de massa corpórea (IMC = calculado como o peso em kilogramas dividido pelo quadrado da altura em metros) entre 30-45 kg/m,2 com TCAP de acordo com o DSM-IV e sem nenhuma comorbidade psiquiátrica associada, foram selecionados e receberam reboxetina 8 mg/dia durante 12 semanas de tratamento. O número de dias com compulsão alimentar periódica por semana, a escala de compulsão alimentar periódica (ECAP), o peso, o IMC, a escala de Impressão Clínica Global - Severidade (CGI-S) e a escalade avaliação de qualidade de vida da Organização Mundial de Saúde - versão abreviada (WHOQOL-BREF) foram utilizados como medidas de eficácia. Na análise estatística dos dados foi utilizado o Teste t pareado para avaliar mudanças nos escores pré e pós-tratamento e uma análise por intenção de tratar foi utilizada incluindo na análise a última visita de cada sujeito no estudo. Cinco pacientes completaram o estudo e apresentaram uma remissão completa do TCAP ao final do tratamento. A média do número de dias com compulsão alimentar periódica por semana modificou-se significativamente de 4,6 ± 1,8 para 0,2 ± 0,6 ao final do estudo (p = 0,0002). A média dos escores da ECAP caiu de 32,3 ± 6,32 para 9,3 ± 6,8 (p = 0,0003). Houve também uma redução estatisticamente significativa do IMC de 36,5 ± 4,48 para 35,06 ± 4,49 (p = 0,01) e na CGI-S de 5,1 ± 0,92 para 1,4 ± 1,01 (p = 0,0002). Uma redução significativa do peso corporal (média = 4,24 kg) também foi observada entre o baseline e o final do estudo (p= 0,01). A qualidade de vida foi avaliada pela WHOQOL-BREF no pré e pós-tratamento e houve diferença com significância estatística nas duas questões de qualidade de vida geral (p= 0,02) e no domínio psicológico (p= 0,03). Nenhum evento adverso sério foi observado.A reboxetina pode ser um agente efetivo e bem tolerado no tratamento do TCAP em pacientes obesos. / Binge Eating Disorder (BED) is a recent diagnostic category considered a non-specified eating disorder whose diagnostic criteria are listed in Appendix B of DSM-IV. Its essential characteristics are recurrent episodes of binge eating and the absence of inadequate compensatory behavior that is characteristic of bulimia nervosa (self-induced vomits, use of laxative and diuretics, excessive exercise, and prolonged fasting), associated with loss of control and significant distress related to the episodes of hyperphagia. At least in the short term, antidepressants are effective in the suppression of compulsive eating and in the reduction of associated psychopathology.The aim of this study was to assess in an open clinical trial the effectiveness and safety of reboxetine, a selective noradrenaline reuptake inhibitor, in the treatment of obese patients with binge eating disorder.Nine obese outpatients with body mass index (the Body Mass Index [IMC] value equals a person's weight in kilograms divided by the square of the person's height in meters) between 30-45 kg/m2, with BED according to DSM-IV, and with no associated psychiatric co-morbidity, received reboxetine 8 mg/day during 12 weeks of treatment. The number of days of binge eating per week, the Binge Eating Scale (BES), body weight, BMI, the Clinical Global Impression- Severity (CGI-S) scale and the World Health Organization Quality of Life Assessment Scale (WHOQOL-BREF) were used to measure efficacy. Paired t-test was used in the data statistical analysis to evaluate changes in pre and posttreatmentscores; an intention-to-treatment analysis including the last visit of study participants was also used. Five patients completed the study and presented a complete remission of binge eating by the end of the treatment. Mean number of binge days per week showed a significant change, down from 4.6 ± 1.8 to 0.2 ± 0.6 at the end of the study (p = 0.0002). Mean scores of BES were down from 32.3 ± 6.32 to 9.3 ± 6.8 (p = 0.0003). Statistically significant decreases were found in BMI, from 36.5 ± 4.48 to 35.06 ± 4.49 (p = 0.01), in CGI-S, from 5.1 ± 0.92 to 1.4 ± 1.01 (p = 0.0002). Also, a significant decrease in body weight (mean = 4.24 kg) was seen between baseline and the end of the study (p= 0.01). The quality of life was evaluated with WHOQOLBREF in pre and posttreatment.It was showed a statistically significant improve on overall quality of life and general health (p= 0,02) and on psychological domain (p= 0,03). No severe side effects were observed.Reboxetine may be an effective and well-tolerated agent in the treatment of BED in obese patients.

O transtorno de compulsão periódica (TCAP) é uma categoria diagnóstica recente sendo considerada uma forma de transtorno alimentar sem outras especificações e seus critérios diagnósticos estão incluídos no apêndice B do DSMIV. As características essenciais deste transtorno são episódios recorrentes de compulsão alimentar periódica, na ausência de comportamentos compensatórios inadequados característicos da bulimia nervosa (vômitos auto-induzidos, uso de diuréticos e laxativos, exercícios físicos em excesso e jejum prolongado), associados com prejuízo no controle e sofrimento significativo relacionados aos ataques de hiperfagia. Medicações antidepressivas são efetivas, pelo menos a curto prazo, na supressão do comer compulsivo e na redução de psicopatologia associada.O Objetivo deste trabalho foi avaliar a efetividade e segurança da reboxetina, um inibidor seletivo da recaptação de noradrenalina, no tratamento de pacientes obesos com TCAP.Nove pacientes obesos ambulatoriais com índice de massa corpórea (IMC = calculado como o peso em kilogramas dividido pelo quadrado da altura em metros) entre 30-45 kg/m,2 com TCAP de acordo com o DSM-IV e sem nenhuma comorbidade psiquiátrica associada, foram selecionados e receberam reboxetina 8 mg/dia durante 12 semanas de tratamento. O número de dias com compulsão alimentar periódica por semana, a escala de compulsão alimentar periódica (ECAP), o peso, o IMC, a escala de Impressão Clínica Global - Severidade (CGI-S) e a escalade avaliação de qualidade de vida da Organização Mundial de Saúde - versão abreviada (WHOQOL-BREF) foram utilizados como medidas de eficácia. Na análise estatística dos dados foi utilizado o Teste t pareado para avaliar mudanças nos escores pré e pós-tratamento e uma análise por intenção de tratar foi utilizada incluindo na análise a última visita de cada sujeito no estudo. Cinco pacientes completaram o estudo e apresentaram uma remissão completa do TCAP ao final do tratamento. A média do número de dias com compulsão alimentar periódica por semana modificou-se significativamente de 4,6 ± 1,8 para 0,2 ± 0,6 ao final do estudo (p = 0,0002). A média dos escores da ECAP caiu de 32,3 ± 6,32 para 9,3 ± 6,8 (p = 0,0003). Houve também uma redução estatisticamente significativa do IMC de 36,5 ± 4,48 para 35,06 ± 4,49 (p = 0,01) e na CGI-S de 5,1 ± 0,92 para 1,4 ± 1,01 (p = 0,0002). Uma redução significativa do peso corporal (média = 4,24 kg) também foi observada entre o baseline e o final do estudo (p= 0,01). A qualidade de vida foi avaliada pela WHOQOL-BREF no pré e pós-tratamento e houve diferença com significância estatística nas duas questões de qualidade de vida geral (p= 0,02) e no domínio psicológico (p= 0,03). Nenhum evento adverso sério foi observado.A reboxetina pode ser um agente efetivo e bem tolerado no tratamento do TCAP em pacientes obesos. / Binge Eating Disorder (BED) is a recent diagnostic category considered a non-specified eating disorder whose diagnostic criteria are listed in Appendix B of DSM-IV. Its essential characteristics are recurrent episodes of binge eating and the absence of inadequate compensatory behavior that is characteristic of bulimia nervosa (self-induced vomits, use of laxative and diuretics, excessive exercise, and prolonged fasting), associated with loss of control and significant distress related to the episodes of hyperphagia. At least in the short term, antidepressants are effective in the suppression of compulsive eating and in the reduction of associated psychopathology.The aim of this study was to assess in an open clinical trial the effectiveness and safety of reboxetine, a selective noradrenaline reuptake inhibitor, in the treatment of obese patients with binge eating disorder.Nine obese outpatients with body mass index (the Body Mass Index [IMC] value equals a person's weight in kilograms divided by the square of the person's height in meters) between 30-45 kg/m2, with BED according to DSM-IV, and with no associated psychiatric co-morbidity, received reboxetine 8 mg/day during 12 weeks of treatment. The number of days of binge eating per week, the Binge Eating Scale (BES), body weight, BMI, the Clinical Global Impression- Severity (CGI-S) scale and the World Health Organization Quality of Life Assessment Scale (WHOQOL-BREF) were used to measure efficacy. Paired t-test was used in the data statistical analysis to evaluate changes in pre and posttreatmentscores; an intention-to-treatment analysis including the last visit of study participants was also used. Five patients completed the study and presented a complete remission of binge eating by the end of the treatment. Mean number of binge days per week showed a significant change, down from 4.6 ± 1.8 to 0.2 ± 0.6 at the end of the study (p = 0.0002). Mean scores of BES were down from 32.3 ± 6.32 to 9.3 ± 6.8 (p = 0.0003). Statistically significant decreases were found in BMI, from 36.5 ± 4.48 to 35.06 ± 4.49 (p = 0.01), in CGI-S, from 5.1 ± 0.92 to 1.4 ± 1.01 (p = 0.0002). Also, a significant decrease in body weight (mean = 4.24 kg) was seen between baseline and the end of the study (p= 0.01). The quality of life was evaluated with WHOQOLBREF in pre and posttreatment.It was showed a statistically significant improve on overall quality of life and general health (p= 0,02) and on psychological domain (p= 0,03). No severe side effects were observed.Reboxetine may be an effective and well-tolerated agent in the treatment of BED in obese patients.