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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

The present study was designed in an effort to address two general questions: (1) the primacy of social dysfunction in bulimia nervosa, and its potential as a risk factor in disease onset; and (2) the proximal antecedents of the binge eating episode in bulimic patients. Given the substantial clinical and empirical evidence of social impairment in this psychiatric group, as well as findings documenting the treatment effectiveness of Interpersonal Psychotherapy (a therapeutic program designed to exclusively address social disturbances) with bulimic patients, it has been speculated that difficulty with interpersonal relationships may be a predisposing factor in the development of bulimia. The present study sought to determine whether social problems could present as potential markers for later disturbances of eating in weight-preoccupied women. A comparison of bulimic patients with a group of restrained eaters and a group of unrestrained eaters on such features as social adjustment across domains of functioning, specific deficits in interpersonal transactions, and qualitative aspects of everyday social experiences was undertaken to determine whether deficits in the social sphere parallel the continuum of eating pathology. In support of previous research and consistent with predictions, bulimic subjects were found to display greater social maladjustment and interpersonal deficits, and to report more negative social interaction experiences than control subjects. Few dimensions of social dysfunction were found to differentiate restrained eaters from unrestrained eaters, thereby suggesting that bulimia nervosa and restrained eating are not continuous with regard to social problems. / Studies examining the proximal antecedents of binge eating episodes have suggested that negative affect reliably precedes binge eating, and as such, has been considered a precipitant to bulimic episodes. However, no previous empirical work has addressed the precursors of this negative mood state. The present study postulated an "interpersonal stress" model of the binge/purge episode which incorporates disturbances in social relatedness and negative interpersonal interaction as precipitants of the negative affect that characterizes the pre-binge state. The model was evaluated in a naturalistic investigation of social interaction experiences and eating behavior in a sample of clinical eating disorder patients. The interpersonal distress/negative affect/binging linkages postulated in the present study were supported, thus highlighting the significance of negative social interaction experiences in the elicitation of binge eating. The clinical implications of the present findings are substantial as they underscore the effectiveness of eating disorder treatment programs which consider interpersonal disturbances in their therapeutic interventions.