This study examined the effectiveness of a systemic cybernetic counselling approach with 3 females with bulimia nervosa. Bulimia nervosa is a relatively recent diagnosed condition (1980). Thus, little is known about the efficacy of different treatment approaches. The systemic cybernetic counselling approach (White; de Shazer) which informs family therapy represents a potentially powerful form of treatment in that it allows a complex construction of the problem. The research design employed a multiple (3) single case study approach with embedded units of analyses. The 3 women, aged 17 to 27, were seen over a 2-3 month period for 4-8 one hour sessions. Predicted patterns of non-equivalent dependent variables were compared with empirically based patterns over time. Continuous (including pre-, post-treatment and long-term follow up) assessment of frequency of bingeing/purging was established as well as ratings on other dependent variables - psychometric measures (Eating Disorders Inventory, Beck Depression Inventory, Coopersmith Self Esteem Inventory), affective self reports and reports by others. Results show that all three clients eliminated bingeing/purging by post-treatment. Two clients maintained this improvement on all dependent measures at long-term follow up. The most marked improvements were associated with the least severe pre-treatment scores. In the case where the whole family attended counselling sessions, the number of sessions was reduced. On the basis of the results, systemic cybernetic counselling procedures hold promise for the successful treatment of bulimia nervosa.

A review of the literature reveals two significant gaps in existing psychological research into eating disorders. First, despite a clear association between dysfunctional family environment and eating psychopathology, little is known about factors that might mediate between the two. Second, cognitive-behavioural treatment is unexpectedly ineffective in anorexia nervosa or in some cases of bulimia nervosa. To fill these gaps, the present research investigated the role of core beliefs in the aetiology and treatment of eating disorders. Given their early origin, core beliefs may plausibly mediate between family environment and eating disorders. In addition, unhealthy core beliefs might explain the resistance to cognitive-behavioural treatment in some instances. The thesis first considers the relationship between unhealthy core beliefs and eating psychopathology in anorexic and bulimic women. This is followed by an examination of core beliefs as an outcome predictor in cognitive-behavioural treatment for eating disorders. Finally, the role of core beliefs as a mediator between dysfunctional family environment and eating disorders is investigated. The results demonstrate high levels of unhealthy core beliefs in both anorexic and bulimic women. These core beliefs also predict the level of symptom reduction following cognitive-behavioural treatment, but only in the bulimic women. While core beliefs play a perfect mediating role in the family interaction-eating disorders link in bulimia nervosa, this relationship is less clear-cut in anorexia nervosa.

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No description available.

VALE, Antonio Maia Olsen do. Comportamento alimentar anormal e práticas inadequadas para controle de peso entre adolescentes do sexo feminino de Fortaleza. 2002. 129 f . Dissertação (Mestrado em Saúde Pública)-Universidade Federal do Ceará, Fortaleza, 2002. / Submitted by denise santos (denise.santos@ufc.br) on 2011-10-31T12:52:21Z No. of bitstreams: 1 2002_dis_amovale.pdf: 372471 bytes, checksum: 8e09fd83f72ad8264a8ea6797d2f7be8 (MD5) / Approved for entry into archive by Eliene Nascimento(elienegvn@hotmail.com) on 2011-11-01T13:34:30Z (GMT) No. of bitstreams: 1 2002_dis_amovale.pdf: 372471 bytes, checksum: 8e09fd83f72ad8264a8ea6797d2f7be8 (MD5) / Made available in DSpace on 2011-11-01T13:34:30Z (GMT). No. of bitstreams: 1 2002_dis_amovale.pdf: 372471 bytes, checksum: 8e09fd83f72ad8264a8ea6797d2f7be8 (MD5) Previous issue date: 2002 / Objectives: characterize eating habits and possible risk factors associated with Eating Disorders, amongst female adolescents in Fortaleza-CE, Brazil. Methodology: transversal study, with 652 women between 14 and 20 years of age, students of the second year of Middle-level education. The Bulimic Investigatory Test Edinburgh (BITE), the Body Shape Questionnaire (BSQ) and the Eating Attitudes Test (EAT-26) were used. Results: 73.6% of the subjects are out of risk for development of an Eating Disorder, 25.2% are at risk and in 1.2% a strong possibility of eating disorder in course was found. The proportion of adolescents who showed risky habits was greater in private schools (p<0.05). According to the EAT-26, 9% of the sample showed a score (>=21) which characterizes them as being at risk and practicing pathological eating habits. The BSQ indicated that 36.2% of the adolescents showed concern with their body image (BI); of these, 61% (n=236) were concerned to a degree considered mild, 26.3% showed a moderate concern and 12.7% showed serious concern with BI. Students at public and private schools demonstrated a similar desire to be thin, but adolescents from private schools more frequently used inappropriate practices in order to reach that wish. Conclusion: Adolescents who demonstrate eating disorders in their clinical form, are a rare phenomenon in public and private schools in Fortaleza, whilst the symptoms of eating disorder, either isolated or in small groups, occur with relevant frequency amongst the population studied. / Objetivo: caracterizar práticas alimentares e os possíveis fatores de risco associados aos Transtornos Alimentares, entre estudantes adolescentes do sexo feminino de Fortaleza-CE. Métodos: estudo transversal, com 652 mulheres de 14 a 20 anos, estudantes do 2º ano do segundo grau. Foram utilizados o Bulimic Investigatory Test Edinburgh (BITE), o Body Shape Questionaire (BSQ) e o Eating Attitudes Test (EAT-26). Resultados: Das adolescentes, 73,6% estão fora de risco para o desenvolvimento de um Transtorno Alimentar, 25,2% delas estão em situação de risco e em 1,2% foram encontrados indicativos para a ocorrência de um transtorno alimentar. A proporção de adolescentes que apresentaram práticas de risco foi superior nas escolas particulares (p<0,05). Segundo o EAT-26, 9% da amostra apresentam uma pontuação (>=21) que caracteriza um estado de situação de risco, além de atitudes alimentares patológicas. O BSQ apontou que 36,2% das adolescentes apresentam preocupação com a imagem corporal; destas 61% tiveram uma preocupação considerada de grau leve, 26,3% apresentaram uma moderada preocupação e 12,7% apresentaram uma grave preocupação com a imagem corporal. A proporção de adolescentes que apresentam preocupação com a imagem corporal em colégios particulares (43%) foi superior à proporção das que estudam em colégios públicos (32,3%), ou seja, a ocorrência de adolescentes com alteração de imagem corporal é maior nos colégios particulares (p<0,05). As estudantes de colégios públicos e particulares demonstraram um desejo similar de serem magras, mas as adolescentes de colégios particulares usam de forma mais freqüente práticas inapropriadas para alcançar este desejo. Conclusão: Adolescentes que apresentam todos os critérios diagnósticos para caracterizar um transtorno alimentar são uma ocorrência rara em escolas públicas e privadas de Fortaleza, enquanto que os sintomas de transtorno alimentar, apresentando-se em pequena mas preocupante quantidade, ocorrem numa freqüência relevante entre a população estudada.

Ghrelin is a gut peptide produced by mainly stomach that induces appetite stimulatory actions. Obestatin is peptide derived from preproghrelin and was initially described to antagonize stimulatory effect of ghrelin on food intake. This work was undertaken to investigate the influence of postprandial status on plasma ghrelin and obestatin concentrations in patients with bulimia nervosa and healthy women. After overnight fasting, plasma ghrelin and obestatin were measured before and after consumption of soluble fiber alone or with glucose. I observed greater decrease of plasma ghrelin and obestatin after consumption of soluble fiber with glucose. I conclude that postprandial plasma ghrelin and obestatin levels are influenced by caloric content of the meal and depend on eating behavior.

Eating-disorder clients show low motivation, poor follow-through, and inordinate premature dropout rates in treatment. To date, little research has been conducted that might provide clinicians with an understanding of the critical factors that may aid clients' recovery. Such factors may be used by clinicians to better motivate clients to collaborate in treatment. The purpose of this study was to identify some of the critical factors that women with eating disorders believed were crucial in prompting or facilitating their recovery. Identification of these factors was accomplished through a systematic content analysis of semistructured interviews with recovered or recovering bulimics and anorexics. This study may contribute significantly to future research into the development of motivational supplements to eating disorder therapy (e.g., psychoeducational materials or therapy orientation programs). Of interest were what personal, interpersonal, or environmental factors anorexic and bulimic clients reported increased their motivation to recover, and prompted them to begin the recovery process, maintain recovery, and cope with the threat ofrelapse. Also, factors that subjects reported hindered their progress in recovery were examined. The anorexic and bulimic subjects reported social support as a critical factor across three stages of recovery, including beginning recovery, maintaining recovery, and coping with relapse. Being "tired" of the disorder and therapy were indicated to be relevant to beginning recovery. Improved self-esteem was deemed significant in helping subjects both maintain recovery and cope with the threat of relapse. Establishing healthy eating habits and attitudes was a necessary factor required to maintain recovery. Subjects shared that developing healthy ways to deal with emotions enabled them to deal successfully with the threat of relapse. Anorexic subjects reported that people and societal expectations, fear of becoming fat, incentive to numb emotions, and poor eating habits and attitudes impeded their recovery. Bulimic subjects indicated that people and societal expectations, incentive to numb emotions, lack of understanding, and poor eating habits and attitudes hindered their recovery.

Ziel: Das Ziel der explorativen Studie war es, erwachsene Patientinnen mit restriktiver bzw. bulimischer Anorexie oder Bulimie mit einer starken Inanspruchnahme von stationären Versorgungsleistungen, sogenannte Heavy User (HU), die eine vollstationäre Behandlung in der Klinik und Poliklinik für Psychiatrie, Psychosomatik und Psychotherapie des Universitätsklinikums Würzburg erhalten haben, zu beschreiben, soziodemographische sowie erkrankungsbezogene somatische und kognitive Charakteristika darzustellen und die Ergebnisse mit einer Kontrollgruppe aus Patientinnen mit dem gleichen Störungsbild, aber einer geringeren Inanspruchnahme medizinischer Versorgungsangebote, den Nicht-Heavy Usern (NHU), zu vergleichen. Teilnehmer und Methode: 23 anorektische bzw. bulimische Heavy User-Patientinnen, die sich im Zeitraum der Datenerhebung (1997-2008) zum mindestens dritten Mal in einer stationären Therapie aufgrund ihrer Essstörung befanden, und eine Vergleichsgruppe von 13 Nicht-Heavy User-Patientinnen mit höchstens einem stationären Voraufenthalt wurden in dieser Studie untersucht. Allgemein- und neurologischer Status sowie die Laborparameter zum Aufnahmezeitpunkt und die Auswertungen der kranialen CTs bzw. MRTs sowie der kognitiven Testverfahren zu Beginn der Therapie und vor der Entlassung wurden analysiert und miteinander verglichen. Ergebnisse und Schlußfolgerung: Die anorektischen und bulimischen Heavy User weisen viele auffällige somatische Befunde, von der Norm abweichende Laborparameter sowie im Falle der anorektischen Heavy User eine häufig bestehende Hirnatrophie auf. Darüber hinaus zeigen sie eine Reihe von kognitiven Defiziten in verschiedenen Bereichen. Am stärksten davon betroffen sind die restriktiv anorektischen Heavy User. Die Ausprägungen der untersuchten pathologischen Befunde unterscheiden sich jedoch nicht signifikant von denen der Nicht-Heavy User. Spezifische Eigenschaften der Heavy User, die es zulassen, sie von einem Nicht-Heavy User abzugrenzen, wurden nicht gefunden. Weitere Studien sind notwendig, um andere typische Merkmale der Heavy User zu eruieren, damit sie möglichst frühzeitig identifiziert und ihnen für sie geeignetere alternative Behandlungsmöglichkeiten angeboten werden können. / Objective: The objective of this explorative study was to describe female adult patients with restricting- respectively purging-type anorexia nervosa or bulimia nervosa with a high use of hospital services, so called heavy users, who received full inpatient treatment in the Clinics and Polyclinics for Psychiatry, Psychosomatics and Psychotherapy of the University Hospital of Würzburg, to show sociodemographic and disease-related somatic and cognitive characteristics and to compare the results with a control group of female patients with the same disorder, but a reduced demand of healthcare offerings, the non-heavy users. Patients and Methods: 23 anorectic respectively bulimic female heavy user patients, who were for at least the third time in inpatient treatment due to their eating disorder, and a comparison group of 13 female non-heavy user patients with a maximum of one inpatient prior stay were studied. General and neurological status, as well as the laboratory parameters at the time of exposure and the evaluation of the cranial CTs or MRTs plus the cognitive test methods at the beginning of the therapy and before discharge were analysed and compared with each other. Results and Conclusion: The anorectic and bulimic heavy users show a lot of noticeable somatic findings, laboratory parameters deviating from the norm and in case of the anorectic heavy users an often existing atrophy of the brain. Furthermore they present a series of cognitive deficits in various sectors. The most affected are the heavy users with restricting-type anorexia nervosa. The manifestations of the examined pathological findings are not significantly different from those of the non-heavy users. Specific characteristics of the heavy users which permit to differentiate them from a non-heavy user were not found. Further studies are necessary, to determine other typical features of heavy users, in order to identify them as early as possible and offer them more suitable alternative treatment options.

Eating disorders fall within the top nine health ailments affecting young people today. These illnesses such as Anorexia Nervosa, Bulimia Nervosa, and Eating Disorders Not Otherwise Specified affect a large number of people, particularly female adolescents. The disorders can further cause complications in one’s health, systemically and orally, sometimes resulting in death. The purpose of this paper is to closely examine published studies examining the link between eating disorders and oral health. Multiple studies have found that patients suffering from eating disorders are more likely to develop tooth erosion. Behaviors often found in eating disorder patients such as self-induced vomiting and ingestion of highly acidic diets can lead to such enamel loss, a condition that is irreversible. Other researchers disagree about whether eating disorders can lead to an increase in dental caries, with some finding amplification and others finding no significant results. Parotid gland swelling is another side effect of eating disorders but this complication often recedes once the unhealthy behavior is halted. Most studies have not yet found a link between these illnesses and increased periodontal disease. However, they do seem to lead to decreased unstimulated salivary flow rates. Furthermore, it also appears that the disorders lead to augmented levels of S. mutans and Lactobacilli. One’s oral mucosa can also be affected via angular cheilitis and oral candidiasis. Additionally, eating disorders may serve as a risk factor for bone and joint disorders such as osteoporosis and temporomandibular joint disorders, respectively. The illnesses may show effect outside the oral cavity through Russell’s sign on one’s knuckles and oral function may be impaired. With all these possible oral complications being some of the first to indicate the presence of an eating disorder, dentists may be integral to identifying and stopping the progression of the disease. However, it has been suggested that eating disorder patients may have greater dental anxiety keeping them from visiting the dentist in the first place, let alone divulging their disease to their dentist. Furthermore, oral health professionals may not be adequately prepared to notice the presence of an eating disorder. Dental schools must do more to teach future oral health professionals about eating disorders, especially in the clinic, as simple suggestions like avoiding brushing one’s teeth immediately after participating in self-induced vomiting may help to reduce the likelihood of enamel erosion. Through this analysis it was determined that while sufficient baseline research has been done, there is still a great deal more to learn about how eating disorders affect one’s oral health. There are multiple forms of diagnostic criteria that could possibly prevent patients from receiving the best treatment possible. Furthermore, more research needs to be done on disorders other than Anorexia Nervosa and Bulimia Nervosa as not every patient falls under these two categories. Since it has been shown that certain types of medication can decrease one’s salivary flow rate, future studies need to also consider any medication that patients may be on. In order to really aid those affected by eating disorders, men should be considered as future subjects too, since most studies have currently only focused on women. By completing more research on eating disorders and their consequences on oral health, health care professionals will be better able to serve those affected.

Este estudo tem como objetivo investigar a presença de disfunção temporomandibular (DTM) em pacientes previamente diagnosticados com transtorno alimentar (bulimia nervosa, anorexia nervosa ou anorexia nervosa purgativa), classificá-la em intra e extra-articular, investigar a possível correlação entre diagnósticos de transtorno alimentar e DTM e a correlação entre o tempo de duração do TA e o tempo de dor devido à DTM. O grupo estudado foi formado por 31 pacientes com transtorno alimentar (TA) composto quase pela totalidade (96,8%, 30/31) de mulheres, com idade média de 30,7 ± 6,7 (de 18 a 48 anos). Na primeira consulta, todos os participantes preencheram os questionários de saúde geral e o questionário de critérios diagnósticos em pesquisa da disfunção temporomandibular (RDC/TMD), foram entrevistados e examinados clinicamente para os sinais e sintomas de DTM. Os sinais clínicos contabilizados foram movimentos mandibulares, dor à palpação muscular e articular, sons articulares e dor espontânea contabilizada pela Escala Visual Analógica (EVA). Após o resumo de todas as variáveis do estudo, foram feitas as análises relacionadas à correlação dos dados obtidos. Para isso foram utilizados os seguintes testes: exato de Fisher, t-Student, Mann-Whitney,e teste de correlação de Pearson, conforme a natureza das variáveis. A significância estatística foi indicada para valores de p < 0,05. A maioria dos pacientes deste estudo, (83,9%, 26/31), foram diagnosticados com DTM, sendo 67,7% (21/31) intra-articular e 74,2% (23/31) extra-articular. Apresentaram os dois diagnósticos 54,8% (17/31) dos pacientes. A correlação entre o tempo do transtorno alimentar e o tempo de dor orofacial foi estatisticamente significativa, concluindo-se que quanto maior o tempo do TA, maior o tempo de dor orofacial caudada pela DTM. A correlação entre a classificação de DTM, intra e extra-articular, e os diagnósticos de TA, bulimia e anorexia nervosa, não foram significantes para este grupo estudado. / This study aims to investigate the presence of temporomandibular disorders (TMD) in patients previously diagnosed with eating disorders (bulimia nervosa , anorexia nervosa or purgative anorexia nervosa ), to categorize the TMD into intra- and extra articular and to investigate the possible correlation between eating disorders diagnoses and TMD as well as the correlation between the longevity of TA and the longevity of pain due to TMD. The study group consisted of 31 patients with eating disorders (ED) and was mainly composed by women ( 96.8 % , 30/31 ) with a mean age of 30.7 ± 6.7 ( 18-48 years) At the first visit all participants completed the general health questionnaire and the research diagnostic criteria for temporomandibular disorders questionnaire (RDC / TMD ), they were also interviewed and clinically examined for signs and symptoms of TMD. The recorded clinical signs were jaw movements , pain upon palpation of muscles and temporomandibular joints , joint sounds and spontaneous pain recorded by the Visual Analogic Scale (VAS ). After the summary of all study variables, the analyses related to the correlation of the data were made. The following tests were used: Fisher \'s exact test, t- Student , Mann -Whitney , and Pearson correlation test , according to the nature of the variables. Statistical significance was indicated for p values < 0.05. Most patients in this study ( 83.9 % , 26/31 ) were diagnosed with TMD, of which 67.7 % ( 21/31 ) presented intra -articular and 74.2 % ( 23/31 ) extra -articular .while 54.8 % ( 17/31 ) presented both diagnoses. The correlation between the duration of the eating disorder and the duration of orofacial pain due to TMD was statistically significant , it was concluded that the longer the TA , the longer the pain. The correlation between TMD classification , intra- and extra -articular , and TA diagnostics, bulimia and anorexia nervosa , was not significant for this studied group.