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

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Made available in DSpace on 2019-03-29T23:54:15Z (GMT). No. of bitstreams: 0 Previous issue date: 2014-09-19 / This study had as an objective to analyze the approximations and distances between the biomedical and psychoanalytic perspectives about the body in anorexia and bulimia and its consequences, especially in an interdisciplinary clinical institutional program, the interdisciplinary program of nutrition in eating disorders and obesity (PRONUTRA). To achieve those results, we have based on the psychoanalytic theory, especially the Freudian contributions to make considerations about the biomedical and psychoanalytic rationalities, the eating disorders, institutional clinical and the construction of clinical cases. As these cases presents a complexity and accentuated gravity, PRONUTRA proposes an interdisciplinary intervention, where professionals, psychiatrists, nutritionists and psychologists, attempt to act in an integrated form in the care of the attended patients. However, in this scenario, biomedical knowledge is emphasized, and the subjective approach, referring to the psychic constitution of the subject, privileged in psychoanalytic listening, we deem necessary to discuss the possibilities of dialogue between these knowledges. In the construction of the clinical case, the singularity of the subject becomes relevant and this device offers important contributions to public health , especially to interventions and institutional clinical research, enabling strategies for case-by-case interventions. Accordingly, here we built a case of anorexia and other of bulimia, considering the constitution of the subject, the notion of orality, emphasizing the importance of life story that interweaves individual and the collective, and appear especially (in) controllable bodies. We emphasize the risk of reductionist visions that only consider the subject of the biomedicine, or only the subject of psychoanalysis, considering that even with epistemological and methodological differences, the subject and its modes of existence should be the main in researches and interventions in this area. Keywords: Psychoanalysis, biomedicine, body, anorexia, bulimia / Este trabalho teve como objetivo analisar as aproximações e distanciamentos entre as perspectivas biomédica e psicanalítica acerca do corpo na anorexia e na bulimia e seus desdobramentos, sobretudo, em um programa clínico-institucional interdisciplinar, o programa interdisciplinar de nutrição em transtornos alimentares e obesidade (PRONUTRA). Para trilhar este percurso, pautamo-nos no referencial psicanalítico, especialmente a partir das contribuições freudianas, para tecer considerações sobre as racionalidades biomédica e psicanalítica, os transtornos alimentares, a clínica-institucional e a construção de casos clínicos. Visto que tais quadros apresentam uma complexidade e gravidade acentuada, o PRONUTRA apresenta uma proposta de intervenção interdisciplinar, onde os profissionais envolvidos, psiquiatras, nutricionistas e psicólogos, procuram atuar de forma integrada no cuidado às pacientes atendidas. Porém, neste cenário, o saber biomédico ganha destaque e, ao abordar questões subjetivas, referentes à constituição psíquica do sujeito, privilegiadas na escuta psicanalítica, julgamos necessário discutir as possibilidades de interlocução entre esses saberes. A partir da construção do caso clínico, a singularidade do sujeito ganha relevância e esse dispositivo traz importantes contribuições para o campo da saúde coletiva, sobretudo no que diz respeito às intervenções e pesquisas clínico-institucionais, possibilitando a construção de estratégias de intervenção no caso a caso. Nesse sentido, aqui construímos um caso de anorexia e outro de bulimia, considerando questões pertinentes à constituição do sujeito, à noção de oralidade, destacando a importância da história de vida que entrelaça o singular e o coletivo e, sobretudo, aparecem em corpos (in)controláveis. Ressaltamos os riscos de visões reducionistas que ora vislumbram o sujeito da biomedicina, ora da psicanálise, apostando que, mesmo com diferenças epistemológicas e metodológicas, o sujeito e seus modos de existir devem ser o balizador de pesquisas e intervenções. Palavras-chave: Psicanálise, biomedicina, corpo, anorexia, bulimia.

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Thesis (Ph. D.) in Psychology--University of Maine, 2002. / Includes vita. Includes bibliographical references (leaves 146-170).

The role of dieting in the etiology and maintenance of bulimia nervosa remains unclear, and current treatments, which primarily aim to eliminate dieting behaviors, demonstrate limited efficacy. The purpose of this study was to conduct a randomized treatment trial to test whether healthy dieting maintains bulimic symptoms or effectively reduces this eating disturbance. Female participants (N=85) with full and subthreshold bulimia nervosa were randomly assigned to a 6-session healthy dieting intervention or waitlist condition and assessed through 3-month follow-up. Relative to control participants, intervention participants showed modest weight loss during treatment and demonstrated significant improvements in bulimic symptoms that persisted through follow-up. These preliminary results suggest that this intervention shows potential for the treatment for bulimia nervosa and may be worthy of future refinement and evaluation. Results also provide experimental evidence that dieting behaviors do not maintain bulimia nervosa, suggesting the need to reconsider maintenance models for this eating disorder. / text