The diploma thesis is focusing on the topic of eating disorders in young men. The literature review summarizes the current information concerning eating disorders in this population. Eating and feeding disorders included in DSM - 5 are described. The thesis also focuses on orthorexia nervosa and muscle dysmorphia. A separate chapter deals with body image in men and its connection to eating disorders. The final chapter of the literary review section is focused on the possibilities of diagnostics and therapy. The empirical part of the work consists of a quantitative research conducted on a sample of 164 men aged 18-30 years. A questionnaire survey was carried out. Using Spearman's correlation coefficient, a significant correlation was found between the symptomatology of eating disorders and muscle dysmorphia. There was also a significant correlation between Body Mass Index and the symptoms of eating disorders and also between BMI and muscular dysmorphia. Data analysis revealed a positive correlation between the higher symptomatology of eating disorders and dissatisfaction with the amout of body fat. No significant relationship was found between the symptomatology of eating disorders and dissatisfaction with muscle mass. There was a significant correlation between Body Mass Index and dissatisfaction...

Während Leitlinien „Gold-Standards“ für die Psychotherapie bei bulimischen Essstörungen (Bulimia Nervosa und Binge-Eating-Störung) empfehlen, ist über psychotherapeutische Prozessfaktoren bei Essstörungen wenig bekannt. Ziel war es, mit Hilfe des etablierten Generic Model of Psychotherapy zur Systematisierung psychotherapeutischer Prozessfaktoren die aktuelle Literatur zum Einfluss dieser Faktoren auf den Therapieerfolg, operationalisiert als Symptomreduktion oder -remission, auf Basis einer systematischen Datenbanksuche zu sichten. Während der Einfluss des therapeutischen Settings nach bisheriger Forschungslage kaum Schlüsse hinsichtlich des Therapieerfolgs zulässt, konnte dieser durch spezifische Interventionen, frühe Symptomreduktionen und eine gute therapeutische Beziehung vorhergesagt werden. Weitere Forschung zu Prozessfaktoren bei bulimischen Essstörungen erscheint notwendig, um die praktische psychotherapeutische Arbeit zu unterstützen und Behandlungen effektiver gestalten zu können. / While guidelines recommend gold standards for psychotherapy in bulimic eating disorders (bulimia nervosa and binge eating disorder), less is known about psychotherapeutic process aspects. We aimed to summarize the current literature on the impact of process aspects on significant symptom reductions and/or abstinence as treatment outcome using the Generic Model of Psychotherapy. A systematic literature search was conducted. While effects of treatment settings can not yet be estimated, specific interventions, rapid response, and the therapeutic bond repeatedly predicted outcome. Process-outcome research in bulimic eating disorders will be necessary to support clinical practice and to enhance treatment efficacy.

Objective: Emerging prospective evidence from mixed samples, mostly covering short-term follow-up periods, suggests that childhood loss of control (LOC) eating predicts significant impairment in mental and physical health. This study sought to investigate the natural course of childhood LOC eating over the long term and in relation to binge eating disorder (BED) diagnosis, psychopathology, and body weight trajectory in the community. Method: A total of 60 children (8-13 years) with LOC eating within the past three months and 60 demographically-matched children without LOC history were assessed with the Eating Disorder Examination adapted for Children and self-report questionnaires over a 5.5 year follow-up period. Missing data were imputed. Results: Over follow-up, 38.3% of children showed persistent LOC eating, and 28.3% revealed an onset of LOC eating. Persistent LOC eating significantly predicted onset of partial-/full-syndrome BED at follow-up. Negative prognostic effects on eating disorder psychopathology, depressive symptoms, and body mass index were non-significant. Discussion: The results indicate a moderate stability of LOC eating over the long term. LOC eating, especially if stable, was suggested as a variable risk factor of clinically relevant eating disturbances. In contrast, a prognostic value for psychopathology and body mass index was not confirmed.

Die vorliegende Literatursichtung belegt, gerade im Lichte neuen Störungswissens und für neue diagnostische Kategorien, die Notwendigkeit, die Wirksamkeit bestehender Therapieformen zu erhöhen und/oder neue Behandlungen für Essstörungen, speziell für Bulimia Nervosa und Binge Eating-Störung, zu entwickeln. Ein wesentlicher Erkenntnisgewinn wird zudem von einer systematischen Analyse des therapeutischen Prozesses sowie von Moderatoren und Mediatoren erwartet. Darüber hinaus stellen die Dissemination evidenzbasierter Therapiemethoden in die Praxis und eine Überprüfung gestufter Behandlungsmodelle wichtige Aufgaben zukünftiger Forschung dar. / The consideration of existing literature, especially in light of new knowledge of eating disorders and new diagnostic categories, highlights the necessity to increase the efficacy of current forms of therapy, and to develop novel therapies for eating disorders. This pertains, in particular, to bulimia nervosa and binge eating disorder. A considerable gain in knowledge is to be expected from a systematic analysis of the therapeutic process as well as the moderators and mediators. Furthermore, dissemination of evidence-based treatment methods in practical settings and an examination of stepped care models are important avenues of future research.

Submitted by Suzana Dias (suzana.dias@famerp.br) on 2018-11-05T14:52:19Z No. of bitstreams: 1 SabrinaLiberatore_dissert.pdf: 576438 bytes, checksum: 784a87c03c876bd0617bd075a625192c (MD5) / Made available in DSpace on 2018-11-05T14:52:19Z (GMT). No. of bitstreams: 1 SabrinaLiberatore_dissert.pdf: 576438 bytes, checksum: 784a87c03c876bd0617bd075a625192c (MD5) Previous issue date: 2017-08-18 / Obesity is a chronic, multifactorial disease that involves psychological, genetic and environmental issues. Studies have been conducted to analyze the psychological profile of the patient who will undergo bariatric surgery. Objective: To characterize obesity patients, candidates for bariatric surgery and to identify lifestyle and the presence of symptoms of anxiety, depression and binge eating. Method: A retrospective study was carried out based on data from patients' charts in a private clinic in the interior of São Paulo, who were candidates for bariatric surgery, evaluated by psychology between January 2010 and December 2015. The psychological evaluation included a data questionnaire (BMI), the Beck Anxiety Inventory (BAI), the Beck Depression Inventory (BDI) and the Periodic Feed Compulsion Scale (ECAP). Results: 188 medical records were analyzed. Age ranged from 16 to 65 years (mean 34.7; SD: 11.3), 73% (n = 137) were female, 48.4% (n = 91) were married, and BMI ranged from 30 to 67 (mean 42.8; dp: 6.5). The BAI results indicated that 53% (n = 100) had minimal anxiety symptoms; of BDI that 52% (n = 97) presented symptoms of mild to severe depression; and ECAP, that 26% (n = 50) presented binge eating. Conclusion: Most of the patients were female, sedentary, young adults, with a history of family obesity and childhood obesity onset. Arterial Hypertension was the most common comorbidity among participants. Symptoms of anxiety and depression were present as well as binge eating. / Obesidade é uma doença crônica, multifatorial, que envolve questões psicológicas, genéticas e ambientais. Estudos têm sido realizados para analisar o perfil psicológico do paciente que será submetido à cirurgia bariátrica. Objetivo: Caracterizar pacientes com obesidade, candidatos à cirurgia bariátrica e identificar estilo de vida e a presença de sintomas de ansiedade, de depressão e de compulsão alimentar. Método: Estudo retrospectivo, realizado com base em dados de prontuários de pacientes em uma clínica particular do interior de São Paulo, candidatos à cirurgia bariátrica, avaliados pela psicologia, entre janeiro de 2010 e dezembro de 2015. A avaliação psicológica incluiu um questionário de dados pessoais, o Índice de Massa Corporal (IMC) fornecido pelo médico, o Inventário de Ansiedade de Beck (BAI), o Inventário de Depressão de Beck (BDI) e a Escala de Compulsão Alimentar Periódica (ECAP). Resultados: Foram analisados 188 prontuários. A idade variou de 16 a 65 anos (média 34,7; dp: 11,3), 73% (n=137) eram do sexo feminino, 48,4% (n=91) eram casados, e o IMC variou de 30 a 67 (média 42,8; dp: 6,5). Os resultados do BAI indicaram que 53% (n=100) tinham sintomas mínimos de ansiedade; do BDI que 52% (n=97) apresentaram sintomas de depressão de leve a severo; e do ECAP, que 26% (n=50) apresentaram compulsão alimentar. Conclusão: A maioria dos pacientes era do sexo feminino, sedentários, adultos jovens, com história de obesidade familiar e início da obesidade na infância. Hipertensão Arterial foi a comorbidade mais encontrada entre os participantes. Sintomas de ansiedade e depressão estiveram presentes, bem como compulsão alimentar.

A incidência global de obesidade tem aumentado nas últimas décadas e o consumo excessivo de alimentos industrializados ricos em açúcar e gordura está entre suas principais causas. Pesquisas recentes têm mostrado que estes alimentos desencadeiam mecanismos neurais e comportamentos semelhantes à adicção a drogas. Sabe-se que hábitos e preferências alimentares de adultos são adquiridos na infância, mas intervenções efetivas para prevenção da obesidade e suas comorbidades em crianças e adolescentes ainda constituem um desafio para a saúde pública. O objetivo do presente estudo foi avaliar os efeitos do consumo de dieta de cafeteria e retirada desta no comportamento alimentar, peso corporal, perfil lipídico, regularidade do ciclo estral, e comportamento de ansiedade e motivação. Ratas Wistar tiveram acesso limitado a itens alimentares de consumo humano de alta densidade energética por quatro semanas, ao final das quais foi realizada a retirada da dieta experimental de duas maneiras: para um grupo total e brusca, e para outro gradual durante uma semana. Após essa retirada, que simula dietas humanas de restrição, as ratas foram submetidas a testes comportamentais para avaliar ansiedade (labirinto em cruz elevado), e motivação para restabelecimento do acesso à dieta de cafeteria (modelo de restabelecimento). O grupo submetido à dieta de cafeteria apresentou maior consumo de gorduras totais e saturadas (p<0,05), e menor consumo de proteínas totais e fibras (p<0,05). Apesar disso, o consumo energético diário entre os grupos não atingiu diferença estatisticamente significativa, assim como o peso corporal das ratas. Após retirada da dieta de cafeteria, o consumo energético foi reduzido significativamente, porém, não acompanhado de perda de peso. Houve diferença significativa no perfil lipídico, sendo que ratas do grupo Cafeteria Sem Retirada tiveram os maiores valores de colesterol total e colesterol LDL (p<0,05). As ratas que sofreram retirada da dieta de cafeteria tiveram seus valores de colesterol similares às alimentadas somente com ração. A retirada completa da dieta de cafeteria e consequente diminuição do consumo energético foi responsável por irregularidade no ciclo estral das ratas. Os resultados no labirinto em cruz elevado não atingiram diferença estatisticamente significativa. O grupo Ração passou mais tempo no lado claro (p<0,05), conforme mostrado pelo teste de restabelecimento. A oferta limitada, de curto prazo, pós-desmame da dieta de cafeteria foi efetiva no desenvolvimento de compulsão alimentar em ratas adolescentes, porém sem evidências de vício alimentar. É provável que a obesidade seja condição necessária para o vício. Esperamos que os resultados deste estudo contribuam para o conhecimento da relação entre qualidade da dieta e comportamento alimentar e de adicção em ratas adolescentes. / The global incidence of obesity has steadily risen in the last decades and the excessive intake of industrialized food rich in sugar and fat is among its main causes. Recent researches have shown that these foods activate neural mechanism and behaviors similar to what is seen with drug addiction. It is known that adults eating habits and preferences are generally established during childhood, but effective preventive measures against obesity and its comorbities in children and adolescents are still a current public health challenge. The goal of the present study was to evaluate the effects of a cafeteria diet intake and withdrawal on eating behavior, body weight, lipid profile, estrous cycle regularity, and anxiety-like and motivational behavior. Female Wistar rats had limited access to energy-dense food items typically consumed by humans for four weeks, at the end of which, withdrawal from this diet occurred in one of two ways: for a group withdrawal was abrupt and total, and for another group, gradual for one week. After withdrawal, which attempts to mimic human restrictive dieting, we evaluated rats anxiety-like behavior through the elevated plus maze, and their motivation to reinstate access to the cafeteria diet through a reinstatement model. Daily energy intake between groups did not reach significant difference, as well as their body weight. Cafeteria fed rats did gain weight at a faster pace, and had a significant greater intake of total and saturated fat, and sodium (p<0.05); and a significantly lower intake of proteins and fibers (p<0.05). Groups that underwent withdrawal reduced their caloric intake significantly, but there was no weight loss. Rats with continuous access to cafeteria diet also had higher levels of total and LDL cholesterol (p<0.05), and rats from withdrawal groups had their cholesterol levels similar to chow-only animals. The total withdrawal of the cafeteria diet and resulting lower energy intake were also responsible for estrous cycle irregularities. There was no significant difference in rats performance in the EPM test. Chow only rats spent significantly more time in an aversive setting in order to gain access to an item from the cafeteria diet (p<0.05). The limited, short term, post-weaning offer of a cafeteria diet was effective in developing compulsive eating disorder, but without signs of food addiction. It is likely that obesity is precedent to the development of addiction. We expect that the results from this project contribute to the ongoing discussion and investigation on eating and addiction behavior in female adolescents rats.

A incidência global de obesidade tem aumentado nas últimas décadas e o consumo excessivo de alimentos industrializados ricos em açúcar e gordura está entre suas principais causas. Pesquisas recentes têm mostrado que estes alimentos desencadeiam mecanismos neurais e comportamentos semelhantes à adicção a drogas. Sabe-se que hábitos e preferências alimentares de adultos são adquiridos na infância, mas intervenções efetivas para prevenção da obesidade e suas comorbidades em crianças e adolescentes ainda constituem um desafio para a saúde pública. O objetivo do presente estudo foi avaliar os efeitos do consumo de dieta de cafeteria e retirada desta no comportamento alimentar, peso corporal, perfil lipídico, regularidade do ciclo estral, e comportamento de ansiedade e motivação. Ratas Wistar tiveram acesso limitado a itens alimentares de consumo humano de alta densidade energética por quatro semanas, ao final das quais foi realizada a retirada da dieta experimental de duas maneiras: para um grupo total e brusca, e para outro gradual durante uma semana. Após essa retirada, que simula dietas humanas de restrição, as ratas foram submetidas a testes comportamentais para avaliar ansiedade (labirinto em cruz elevado), e motivação para restabelecimento do acesso à dieta de cafeteria (modelo de restabelecimento). O grupo submetido à dieta de cafeteria apresentou maior consumo de gorduras totais e saturadas (p<0,05), e menor consumo de proteínas totais e fibras (p<0,05). Apesar disso, o consumo energético diário entre os grupos não atingiu diferença estatisticamente significativa, assim como o peso corporal das ratas. Após retirada da dieta de cafeteria, o consumo energético foi reduzido significativamente, porém, não acompanhado de perda de peso. Houve diferença significativa no perfil lipídico, sendo que ratas do grupo Cafeteria Sem Retirada tiveram os maiores valores de colesterol total e colesterol LDL (p<0,05). As ratas que sofreram retirada da dieta de cafeteria tiveram seus valores de colesterol similares às alimentadas somente com ração. A retirada completa da dieta de cafeteria e consequente diminuição do consumo energético foi responsável por irregularidade no ciclo estral das ratas. Os resultados no labirinto em cruz elevado não atingiram diferença estatisticamente significativa. O grupo Ração passou mais tempo no lado claro (p<0,05), conforme mostrado pelo teste de restabelecimento. A oferta limitada, de curto prazo, pós-desmame da dieta de cafeteria foi efetiva no desenvolvimento de compulsão alimentar em ratas adolescentes, porém sem evidências de vício alimentar. É provável que a obesidade seja condição necessária para o vício. Esperamos que os resultados deste estudo contribuam para o conhecimento da relação entre qualidade da dieta e comportamento alimentar e de adicção em ratas adolescentes. / The global incidence of obesity has steadily risen in the last decades and the excessive intake of industrialized food rich in sugar and fat is among its main causes. Recent researches have shown that these foods activate neural mechanism and behaviors similar to what is seen with drug addiction. It is known that adults eating habits and preferences are generally established during childhood, but effective preventive measures against obesity and its comorbities in children and adolescents are still a current public health challenge. The goal of the present study was to evaluate the effects of a cafeteria diet intake and withdrawal on eating behavior, body weight, lipid profile, estrous cycle regularity, and anxiety-like and motivational behavior. Female Wistar rats had limited access to energy-dense food items typically consumed by humans for four weeks, at the end of which, withdrawal from this diet occurred in one of two ways: for a group withdrawal was abrupt and total, and for another group, gradual for one week. After withdrawal, which attempts to mimic human restrictive dieting, we evaluated rats anxiety-like behavior through the elevated plus maze, and their motivation to reinstate access to the cafeteria diet through a reinstatement model. Daily energy intake between groups did not reach significant difference, as well as their body weight. Cafeteria fed rats did gain weight at a faster pace, and had a significant greater intake of total and saturated fat, and sodium (p<0.05); and a significantly lower intake of proteins and fibers (p<0.05). Groups that underwent withdrawal reduced their caloric intake significantly, but there was no weight loss. Rats with continuous access to cafeteria diet also had higher levels of total and LDL cholesterol (p<0.05), and rats from withdrawal groups had their cholesterol levels similar to chow-only animals. The total withdrawal of the cafeteria diet and resulting lower energy intake were also responsible for estrous cycle irregularities. There was no significant difference in rats performance in the EPM test. Chow only rats spent significantly more time in an aversive setting in order to gain access to an item from the cafeteria diet (p<0.05). The limited, short term, post-weaning offer of a cafeteria diet was effective in developing compulsive eating disorder, but without signs of food addiction. It is likely that obesity is precedent to the development of addiction. We expect that the results from this project contribute to the ongoing discussion and investigation on eating and addiction behavior in female adolescents rats.

Introduction: Eating disorders are serious psychiatric disorders that often require specialized care. Associated psychiatric comorbidity is frequent, with the most common comorbid conditions being anxiety and mood disorders. Eriksbergsgården in Örebro is one of Sweden’s specialized eating disorder treatment units.Aim: Primary aims were to describe clinical characteristics of the adult patient group at Eriksbergsgården and to evaluate treatment outcome and patient satisfaction at the one-year follow-up. An additional aim was to examine if factors such as psychiatric comorbidity affected treatment outcome.Methods: This study used data from Riksät and Stepwise, two large-scale Swedish registers for eating disorder treatment. Data for this study was registered into Stepwise and Riksät at Eriksbergsgården between August 2010 and December 2017 and 489 adult patients of both genders constituted the study group. Patient characteristics and DSM-IV axis I psychiatric comorbidity were assessed at the initial evaluation. At the one-year follow-up, treatment outcome and patient satisfaction were evaluated.Results: The most common diagnoses in this patient material were eating disorder not otherwise specified, 56.6 %, followed by bulimia nervosa, 26.4 %. At the initial evaluation, 62.0 % of the patients suffered from psychiatric comorbidity. Of the patients with initial comorbidity, 43.3 % were recovered at the one-year follow-up, compared to 62.8 % of the patients with no initial comorbidity, p=0.021.Conclusion: Our results confirm the previously known fact that psychiatric comorbidity among eating disorder patients is common. Also, the results identify psychiatric comorbidity as a possible factor to have negative effect on the treatment outcome.

Objective: Weight bias has strong associations with psychopathology in overweight and obese individuals. However, self-evaluative processes, as conceptualized in the process model of self-stigma, and implications for other health-related outcomes, remain to be clarified. Design and Methods: In a representative general population sample of N = 1158 overweight and obese individuals, the impact of core self-evaluation as a mediator between weight bias internalization and mental and global health outcomes as well as between weight bias internalization and health care utilization, was examined using structural equation modeling. Results: In overweight and obese individuals, greater weight bias internalization predicted lower core self-evaluation, which in turn predicted greater depression and anxiety, lower global health, and greater health care utilization. These mediational associations were largely stable in subsample analyses and after controlling for sociodemographic variables. Conclusions: The results show that overweight and obese individuals with internalized weight bias are at risk for impaired health, especially if they experience low core self-evaluation, making them a group with which to target for interventions to reduce self-stigma. Weight bias internalization did not represent a barrier to health care utilization, but predicted greater health care utilization in association with greater health impairments.

Objective: Childhood loss of control (LOC) eating and attention-deficit/hyperactivity disorder (ADHD) are highly comorbid conditions and present with disordered eating behaviors, such as overeating. This study sought to delineate shared and specific abnormalities in physiological, cognitive-motivational, and behavioral components of food-specific impulsivity in children with LOC eating and ADHD. Specifically, children’s reactivity and habituation to food and eating in the absence of hunger were examined. Methods: Within this community-based study, four groups of 8-13 year old children with LOC eating (n=24), ADHD (n=32), comorbid LOC eating/ADHD (n=9), and matched controls (n=34) received a standard laboratory test meal to establish satiety and were then exposed to their favorite snack food in a cue exposure/reactivity trial, while salivation and desire to eat were repeatedly assessed. Subsequently, they were offered a variety of snack foods ad libitum. Results: Children with LOC eating, ADHD, and LOC/ADHD did not differ from controls in salivary reactivity and habituation to food cues. Children with LOC eating and ADHD showed greater cue reactivity of the desire to eat than controls, but groups did not differ in its longer-term increments. At free access, only children with LOC/ADHD consumed significantly more energy than controls. Longer-term increments of desire to eat predicted greater energy intake beyond LOC/ADHD group status. Discussion: Desire to eat among children with comorbid LOC eating and ADHD was associated with overeating in the absence of hunger, which may contribute to excess weight gain. Delineation of the specific features of childhood LOC eating versus ADHD warrants further study.