An exploratory case study using multiple cases investigated the question "What is the meaning of stealing in eating disordered women?" Seven women diagnosed with bulimia nervosa participated in in-depth interviews about this experience. The findings of these interviews revealed commonalities and variations in the patterns and dynamics of both stealing and bulimia. Important information emerged about this experience regarding restrictive family patterns, participants' reactions to these restrictions through stealing and the parallel restrictions and reactions of the bulimic behaviours they later imposed upon themselves. These results add new and in-depth information to the few existing quantitative studies and clinical knowledge addressing stealing in bulimic women. Recommendations for future research and implications for clinical practice were presented. / Education, Faculty of / Educational and Counselling Psychology, and Special Education (ECPS), Department of / Graduate

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The emerging consensus among investigators seems to be that bulimia is a multidetermined disorder with a number of contributing factors, including biological components, sociocultural factor, personality, and family characteristics (Garfinkel & Garner, 1982). An etiological model was examined in this study integrating two important theoretical perspectives in the bulimia literature: the stress-coping perspective (Cattanach & Rodin, 1988) and the family systems perspective (Minuchin et al., 1978). Five latent variables: Family Characteristics, Coping Resources, Psychological Disturbance, Environmental Stressors, and Bulimia were represented by twelve measured variables. Structural Equation Modeling analysis allowed for the simultaneous examination of the hypothesized interrelationships between model variables. Findings confirmed a direct impact of psychological disturbances on bulimic symptoms. Hypothesized indirect relationships of family characteristics, coping resources and environmental stressors to bulimia were confirmed. Treatment implications as well as directions for future research were discussed.

Made available in DSpace on 2015-07-22T20:50:48Z (GMT). No. of bitstreams: 0 Previous issue date: 2010-07-28 / Objetivo: Verificar a prevalência de alterações vocais em adolescentes de 16 anos, estudantes da rede pública estadual da cidade de Recife-PE, com características de bulimia nervosa. Método: Para este estudo foram avaliados 216 adolescentes sendo 80 do gênero masculino e 136 do gênero feminino para identificar os que apresentavam características de bulimia nervosa foi utilizado o Teste de Investigação Bulímica (BITE) e a identificação dos sinais e sintomas vocais foi por meio de análises vocais subjetivas (Escala de GRBASI e Escala Analógica Visual- Escala Numérica EAV-EN) e objetiva (Voxmetria). Resultados: A prevalência de características de bulimia nervosa entre a população estudada foi de 70 indivíduos (32,4%), tendo percentual maior para o gênero feminino 52(74,3%) e menor para o masculino 18(25,7%). Quanto à análise vocal destes indivíduos com características de bulimia nervosa, na escala de GRBASI 19(27,1%) apresentaram vozes normais enquanto que 51(73,9%) mostraram alterações na voz (p<0,001); na EAV-EN 31(44,3%) apresentaram vozes no padrão normal e 39(56,5%) tinham alterações vocais (p<0,001), para o Voxmetria 37(53,6%) possuíam vozes normais e 33(47,1%) tinham algum tipo de alteração (p=0,381). Conclusão: Este estudo apresentou uma alta prevalência de adolescentes com características de bulimia nervosa das escolas públicas da cidade de Recife, com 16 anos de idade, além de encontrar neste grupo um alto percentual de sinais na voz, com isso se conclui a necessidade de que haja uma maior atenção aos riscos causados pelos transtornos alimentares nas vozes dos adolescentes. / Objective: To verify the prevalence of voice disorders in teenagers of 16 years old, students from public schools in the city of Recife-PE, with characteristics of bulimia nervosa. Method: For this study, 216 teenagers were rated with 80 males and 136 females to identify those that had characteristics of bulimia nervosa was used Bulimic Investigatory Test (BITE) and the identification of signs and symptoms vocal was by analysis subjective voice (Scale GRBASI and Visual Analog Scale-Scale Numerical- EN VAS) and objective (Voxmetria). Results: The prevalence of features of bulimia nervosa among the study population was 70 individuals (32.4%) and higher percentage for females 52 (74.3%) and lower for males 18 (25.7%). As for vocal analysis of these individuals with characteristics of bulimia nervosa, scale GRBASI 19 (27.1%) had normal voices while 51 (73.9%) showed changes in voice (p <0.001) in VAS-EN 31 (44.3%) had voices in the normal pattern and 39 (56.5%) had vocal changes (p <0.001) for Voxmetria 37 (53.6%) had normal voices and 33 (47.1%) had some type of change (p = 0.381). Conclusion: This study showed a high prevalence of teenagers with bulimia nervosa characteristics of public schools in the city of Recife, with 16 years of age, and find this group a high percentage of sings in her voice, it concludes with the need that there is greater attention to the risks posed by eating disorders in the voices of adolescents. / TEDE / BV UNIFESP: Teses e dissertações

Submitted by Fabio Sobreira Campos da Costa (fabio.sobreira@ufpe.br) on 2017-07-25T12:42:31Z No. of bitstreams: 2 license_rdf: 811 bytes, checksum: e39d27027a6cc9cb039ad269a5db8e34 (MD5) tese_tatiana_bertulino.pdf: 10443220 bytes, checksum: 79c9bf743bf865c2a6d7ee7c679ecadb (MD5) / Made available in DSpace on 2017-07-25T12:42:32Z (GMT). No. of bitstreams: 2 license_rdf: 811 bytes, checksum: e39d27027a6cc9cb039ad269a5db8e34 (MD5) tese_tatiana_bertulino.pdf: 10443220 bytes, checksum: 79c9bf743bf865c2a6d7ee7c679ecadb (MD5) Previous issue date: 2016-06-17 / Os adolescentes aprendem em nossa sociedade que uma das características do sucesso é o corpo magro. Esta pressão social pela magreza está mais presente nas adolescentes, criando o aumento da insatisfação corporal nesta população. A insatisfação com a própria imagem corporal é o cerne dos transtornos alimentares. Entre os transtornos alimentares destaca-se a bulimia nervosa, caracterizada pelos comportamentos de compulsão alimentar associado à purgação. O tratamento clínico recomendável para a bulimia nervosa é a terapia cognitivo-comportamental, realizado por um especialista em transtornos alimentares. Outras formas de intervenção nos pacientes com transtornos alimentares também são utilizadas, entre elas a psicoeducação. O objetivo deste estudo foi de avaliar as possíveis diferenças entre a intervenção psicoterápica do tipo cognitivocomportamental e a intervenção psicoeducativa em adolescentes diagnosticadas com bulimia nervosa. Foi realizado um ensaio clínico, constituído de 11 adolescentes do sexo feminino entre 13 a 19 anos com diagnóstico de bulimia nervosa. Para o diagnóstico utilizou-se a entrevista clínica diagnóstica: Levantamento sobre o Desenvolvimento e Bem – Estar de Crianças e Adolescentes (DAWBA). As adolescentes foram divididas em dois grupos: controle e experimental. No grupo controle, constituído de cinco adolescentes, o tratamento utilizado foi a terapia cognitivo-comportamental em grupo durante 13 encontros em 12 semanas. No grupo experimental, constituído de seis adolescentes, o tratamento utilizado foi a psicoeducação em grupo, em 13 encontros semanais. As medidas primárias de eficácia no estudo foram: diminuição dos sintomas de bulimia nervosa, diminuição dos sintomas de compulsão alimentar e diminuição da insatisfação corporal. Houve diminuição de sintomas de bulimia nervosa nos dois grupos, porém não se comprovou diferença significativa entre os grupos. Em relação a compulsão alimentar não houve modificação nos sintomas em nenhum dos grupos. A insatisfação corporal foi a variável que demonstrou melhora significativa quando os grupos foram analisados em conjunto, porém não houve diferença significativa entre os grupos. Na terapia cognitivocomportamental é aceitável que após o tratamento da bulimia nervosa, os pacientes ainda apresentem sintomas de transtorno alimentar, como a compulsão alimentar, pois o principal objetivo é que o sistema de manutenção das crenças que mantem a bulimia nervosa seja interrompido. A psicoeducação possui como foco o aumento da satisfação com a imagem corporal, o que de fato ocorreu no estudo. A psicoeducação não foca especificamente na melhora da bulimia nervosa e de seus sintomas, como a compulsão alimentar. Apesar de estudos anteriores terem encontrado melhora na relação alimentar dos participantes de psicoeducação, além da melhora nos sintomas da insatisfação corporal. Os dois tratamentos realizados na pesquisa demonstraram diminuição de sintomas, porém essa diminuição não foi significativa em nenhum dos grupos quando avaliados individualmente. É necessária a continuação da pesquisa, com o aumento da amostra e se possível com a análise qualitativa dos dados. A pesquisa demonstrou a possibilidade da utilização da psicoeducação, em um primeiro momento, em populações não crônicas. / Teenagers learn in our society that one of the characteristics of success is a thin body. This social pressure for thinness is more prevalent among the girls, causing increased body dissatisfaction in their group. Dissatisfaction with their own body image is the core of eating disorders. Among the eating disorders, bulimia nervosa stands out, characterized by binge eating behaviors associated with purging. The recommended medical treatment for bulimia nervosa is cognitive-behavioral therapy with a specialist in eating disorders. Other forms of intervention in patients with eating disorders are also used, including psychoeducation. The goal of this study was to evaluate possible differences between the psychotherapeutic intervention of cognitive-behavioral type and the psychoeducational intervention in female teenagers diagnosed with bulimia nervosa. A clinical trial was performed, consisting of 11 female teenagers between 13 and 19 years old, all of whom were diagnosed with bulimia nervosa. The clinical interview Development and Well-Being Assessment (DAWBA) was used for the diagnosis. The teenagers were split into two groups: control and experimental. In the control group, consisting of five teenagers, the treatment used was cognitive-behavioral group therapy for 13 meetings in 12 weeks. In the experimental group, consisting of six teenagers, the treatment used was group psychoeducation, in 13 weekly meetings. The primary effectiveness measures in the study were: reduction of the symptoms of bulimia nervosa, decreased symptoms of binge eating, and decreased body dissatisfaction. There was a reduction of the symptoms of bulimia nervosa in both groups; however, no significant difference was proved between them. Regarding binge eating, there was no change in symptoms in either group. Body dissatisfaction was the variable that showed most significant improvement when the groups were analyzed together, but once again there was no significant difference between groups. In cognitive-behavioral therapy, it is acceptable that after the treatment of bulimia nervosa, patients still present symptoms of eating disorders such as binge eating, because the main goal is that the system of beliefs which sustains bulimia nervosa is interrupted. Psychoeducation, on the other hand, focuses on increasing body image satisfaction, which actually happened in the study; psychoeducation does not focus specifically on the improvement of bulimia nervosa and its symptoms, though previous studies have found an improvement in the participants' relationship with food, besides an improvement in the symptoms of body dissatisfaction. Both treatments carried out in the research showed decreased symptoms, but this decrease was not significant in either group when assessed individually. Continued research, with a larger sample and qualitative data analysis, if possible, is required. The study has shown the possibility of using psychoeducation, at first, in nonchronic populations.

This investigation sought to identify anxiety responses to weight measurement, assessed by verbal report and cardiovascular reactivity CCR3 (systolic blood pressure, diastolic blood pressure, heart rate), which might differentiate females with either high or low self-reported bulimic behavior. Secondar i ly,, the study attempted to examine specific autonomic nervous system (ANS) arousal patterns of each group over time. The Bulimia Test (BULIT), Body Dissatisfaction Scale (BD), and a demographic questionnaire were administered to 105 undergraduate females at The University of North Texas. Based on BULIT scores, females were divided into high or low bulimic behavior groups. Of the 105 females screened, forty participated in the experiment which consisted of four phases: relaxation, anticipation of weight measurement, weight measurement, and recovery. Subjects had no prior knowledge of the weight stressor until presentation during the experiment. Results showed that subjects' notion of ideal weight was substantially lower than measured weight. During weight measurement, all subjects reported increased anxiety although the high group reported significantly more anxiety. Contrary to prediction, no significant group differences in CR were found when repeated measures multivariate analysis of variance (MANOVA) was performed. Orthogonal polynomial trend analysis was done with pooled groups, resulting in significant within-subject trends for all cardiovascular measures. There was also a significant group by time of measurement interaction for heart rate during the weight measurement phase. Correlational analyses failed to produce significant results between verbal report of anxiety and CR. There was, however, a significant correlation between BULIT and BD scores. It was concluded that heightened subjective anxiety during weight measurement could not be attributed to group differences in CR. Regarding ANS arousal patterns, mixed evidence of active and passive coping was seen. Nevertheless, both psychological and physiological measures supported an overvaluation of female thinness consistent with societal trends regardless of group membership. Implications of findings were discussed along with suggestions for future research.

Three groups were compared on a number of cognitive measures: 27 women who fulfilled operationalized DSM-III criteria for bulimia, 27 women who regularly binge-ate but did not fulfill the operationalized criteria for bulimia, and 27 control women who did not binge eat. Subjects were compared on measures of: 1) endorsement of rigid, perfectionistic beliefs; 2) confidence concerning their ability to argue effectively against such beliefs; 3) independent ratings of the effectiveness of their arguments; and 4) self-evaluations of the effectiveness of their arguments. These measures were assessed for two types of rigid, perfectionistic beliefs: those which concerned issues of eating, weight, and appearance (idiosyncratic beliefs) and those which concerned other personal issues (common beliefs). Bulimic women were found to endorse rigid, perfectionistic beliefs to a significantly greater extent than either comparison control group, giving especially high endorsements to beliefs concerning issues of eating, weight and appearance. Contrary to hypotheses, no differences were found between groups on their confidence ratings, ability to generate rational arguments, or evaluations of the effectiveness of their arguments for either idiosyncratic or common beliefs. However, a main effect of order of belief packet presentation was found which indicated that it was harder for women across groups to generate rational/effective arguments against the idiosyncratic belief statements, if they were somewhat fatigued by having had already argued against a number of common beliefs. This finding was interpreted as suggesting that factors, such as fatigue, which may impede concentration and affect the ability to think rationally about issues such as those described by the idiosyncratic belief statements. Overall these results lend partial support for cognitive-behavioral assumptions of bulimia and its correlates. The results support the assumption that bulimic women maintain a number of rigid, perfectionistic beliefs, especially concerning issues of eating, weight and appearance. Moreover, the results suggest that the assumption that bulimic individuals lack active cognitive coping strategies or are less able to respond to rigid, perfectionistic thoughts with strategies such as rational self-statements, needs to be refined. Implications of these findings for the assessment and treatment of bulimia were discussed. / Ph. D.

Abstract: The present study was designed to answer the following questions: (a) What is the level of awareness patients with Bulimia Nervosa (BN) and the professionals who work with them regarding the vocal health risks associated with self-induced vomiting? (b) Is the bulimic population at risk for under-referral for assessment and treatment of vocal pathology? (c) How do patients and professionals perceive the role of the Speech-Language Pathologist (SLP) in the treatment of eating disorder-related vocal pathology? Three original surveys were developed to address the research questions. There was one survey for individuals with a history of BN, one for SLPs, and one for other health care professionals involved in the care of bulimic individuals. There were 89 total participants in the present study. Thirty were respondents to the Health Care Providers Survey, 28 were respondents to the SLP Survey, and 31 were respondents to the Patient Survey. Results indicate a general lack of awareness concerning these risks and treatment options to address them on the part of patients and health care professionals and a lack of specific knowledge of how to recognize and treat individuals with BN on the part of SLPs. Results from all three groups supported the notion that the bulimic population is at risk for under-referral for treatment for voice disorders. Finally, results suggest that SLPs do in fact provide services to persons with BN, but that at present, patients and other health care professionals do not seem to perceive the SLP as having a role in management of care of this population. / text