Submitted by Fabio Sobreira Campos da Costa (fabio.sobreira@ufpe.br) on 2016-07-22T12:19:51Z No. of bitstreams: 2 license_rdf: 1232 bytes, checksum: 66e71c371cc565284e70f40736c94386 (MD5) CAPA da dissertação COM CORRECOES DA BANCA ARQ unico 3 pdf.pdf: 2378442 bytes, checksum: 65fd4f0e4b5a3d33ed5be58bcd1d663e (MD5) / Made available in DSpace on 2016-07-22T12:19:51Z (GMT). No. of bitstreams: 2 license_rdf: 1232 bytes, checksum: 66e71c371cc565284e70f40736c94386 (MD5) CAPA da dissertação COM CORRECOES DA BANCA ARQ unico 3 pdf.pdf: 2378442 bytes, checksum: 65fd4f0e4b5a3d33ed5be58bcd1d663e (MD5) Previous issue date: 2016-02-03 / FACEPE / A adolescência é um período propenso ao desenvolvimento da insatisfação com o próprio corpo. A distorção da imagem corporal, em conjunto com a baixa autoestima, são os responsáveis pela busca incessante de emagrecimento, levando a comportamentos prejudiciais à saúde. Desta forma, são considerados fatores que podem desencadear sintomas de bulimia nervosa. Suas primeiras manifestações são na adolescência, podendo apresentar efeitos nocivos sobre a saúde bucal. Assim, este estudo teve como objetivo avaliar fluxo e pH salivar associados à presença de erosão dental em adolescentes com sintomas de bulimia nervosa. Tratou-se de um estudo descritivo e transversal com adolescentes de ambos os sexos, na faixa etária de 10 a 19 anos, estudantes de escolas públicas da rede estadual de educação do Estado de Pernambuco. Os instrumentos utilizados foram: questionário biodemográfico; Teste de Avaliação Bulímica de Edinburgh – BITE, em sua versão para adolescentes; uma ficha clínica odontológica para o preenchimento do Índice de Desgaste Dentário e um questionário de hábitos alimentares. A prevalência de sintomas de bulimia nervosa na população estudada foi de 44,0% de acordo com o Teste de Avaliação Bulímica de Edinburgh e deste total, 39,0% apresentaram escore médio e 5,0%, escore elevado. Em 57,7% dos adolescentes foi encontrada erosão dental. Apenas 14,9% e 2,7% da amostra apresentaram hipossalivação e pH salivar ácido, respectivamente. Houve associação significativa dos sintomas de bulimia nervosa com erosão dental, porém não foi verificado associação entre fluxo e pH salivar com erosão dental. Em relação ao grupo de dentes e faces, a presença de erosão concentrou-se nos dentes anteriores (incisivos centrais e laterais) nas faces linguais/palatinas, havendo associação com a presença de sintomas de bulimia nervosa. Após a análise dos dados pode-se concluir que a erosão dental está intimamente relacionada com a bulimia nervosa, assim como o consumo de refrigerantes e a frequência de escovação dental. O conhecimento dessas alterações por parte do cirurgião-dentista possibilitará o encaminhamento do adolescente a um tratamento integral, que envolve a participação de uma equipe multidisciplinar, evitando o agravo do transtorno e contribuindo com o diagnóstico precoce. / Adolescence is a period prone to the development of dissatisfaction with the body. The body image distortion along with low self-esteem are responsible for the relentless pursuit of weight loss, leading to unhealthy behaviors, and therefore factors that may trigger some symptoms of bulimia nervosa. These first manifestations are in adolescence and may have harmful effects on oral health. This study aimed to evaluate flow and salivary pH associated with the presence of dental erosion in adolescents with symptoms of bulimia nervosa. It was a descriptive, cross-sectional study with adolescents of both sexes, aged 10 to 19 years old, public state school students in Pernambuco. The instruments used were: a biodemographic questionnaire; Bulimic Investigatory Test Edinburgh - BITE, in its version for adolescents, a dental clinic file for filling the Tooth Wear Index and a questionnaire of food habits. The prevalence of symptoms of bulimia nervosa in the population studied was 44.0% according to the Bulimic Investigatory Test Edinburgh and of this total 39.0% had average score and 5.0% had a high score 5.0%. In 57.7% of teenagers found dental erosion. Only 14.9% and 2.7% had hyposalivation and salivary pH acid, respectively. There was a significant association of the symptoms of bulimia nervosa with dental erosion, but it has not been verified association between salivary flow and pH with dental erosion. Regarding the group of teeth and faces, the presence of erosion focused on anterior teeth (central incisors and lateral) on the lingual / palatal, having association with the presence of symptoms of bulimia nervosa. After analyzing the data, it can be concluded that dental erosion is closely related to bulimia nervosa, as well as soft drink consumption and frequency of tooth brushing. Knowledge of these changes on the part of the dentist may allow the teenager's referral to a full treatment, which involves the participation of a multidisciplinary team, avoiding the inconvenience of injury or even its appearance.

CoordenaÃÃo de AperfeiÃoamento de Pessoal de NÃvel Superior / 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 prÃticas alimentares e os possÃveis fatores de risco associados aos Transtornos Alimentares, entre estudantes adolescentes do sexo feminino de Fortaleza-CE. MÃtodos: estudo transversal, com 652 mulheres de 14 a 20 anos, estudantes do 2 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 situaÃÃo de risco e em 1,2% foram encontrados indicativos para a ocorrÃncia de um transtorno alimentar. A proporÃÃo de adolescentes que apresentaram prÃticas de risco foi superior nas escolas particulares (p<0,05). Segundo o EAT-26, 9% da amostra apresentam uma pontuaÃÃo (>=21) que caracteriza um estado de situaÃÃo de risco, alÃm de atitudes alimentares patolÃgicas. O BSQ apontou que 36,2% das adolescentes apresentam preocupaÃÃo com a imagem corporal; destas 61% tiveram uma preocupaÃÃo considerada de grau leve, 26,3% apresentaram uma moderada preocupaÃÃo e 12,7% apresentaram uma grave preocupaÃÃo com a imagem corporal. A proporÃÃo de adolescentes que apresentam preocupaÃÃo com a imagem corporal em colÃgios particulares (43%) foi superior à proporÃÃo das que estudam em colÃgios pÃblicos (32,3%), ou seja, a ocorrÃncia de adolescentes com alteraÃÃo de imagem corporal à maior nos colÃgios particulares (p<0,05). As estudantes de colÃgios pÃblicos e particulares demonstraram um desejo similar de serem magras, mas as adolescentes de colÃgios particulares usam de forma mais freqÃente prÃticas inapropriadas para alcanÃar este desejo. ConclusÃo: Adolescentes que apresentam todos os critÃrios diagnÃsticos para caracterizar um transtorno alimentar sÃo uma ocorrÃncia rara em escolas pÃblicas e privadas de Fortaleza, enquanto que os sintomas de transtorno alimentar, apresentando-se em pequena mas preocupante quantidade, ocorrem numa freqÃÃncia relevante entre a populaÃÃo estudada.

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.

Os transtornos alimentares (TA) são doenças graves de etiologia multifatorial, que cursam com alterações importantes no comportamento alimentar e complicações clínicas como desnutrição e distúrbios hidroeletrolíticos, além de comorbidades psiquiátricas. A hospitalização integral é uma modalidade terapêutica indicada quando o seguimento ambulatorial não atinge resultados satisfatórios associados à piora dos sintomas. O objetivo deste estudo foi descrever as características e resultados da hospitalização dos pacientes com TA atendidos pelo Grupo de Assistência em Transtornos Alimentares do Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto-USP. Dados antropométricos, bioquímicos e clínicos foram coletados a partir da revisão de prontuários dos pacientes internados durante o período de 1982 a 2011. Como resultado, observou-se que das 186 pessoas que receberam atendimento pelo serviço, 44,6% deles (n=83) necessitaram de no mínimo, uma internação durante o tratamento. A predominância foi do sexo feminino (95,2%), da raça branca (94%), solteira (76%) e sem filhos (78,3%). Cursavam o ensino médio (50,6%) com idade de 23,3±10,8 anos. O diagnóstico era de anorexia do tipo restritivo (AN-R) para 54,2% (n=45) deles, 31,3% (n=.26) apresentavam anorexia do subtipo compulsão periódica/purgativo (AN-CP) e 14,5% (n=12) tinham bulimia nervosa (BN). A média de internações foi de 1,9±3,9 vezes sendo que 73,5% (n=61) dos pacientes foram internados apenas uma vez, por 41,2±37,6 dias. Para aqueles que precisaram dessa modalidade de tratamento por mais de uma vez, a duração da hospitalização, considerando todas as internações, foi de 70,6±115,9 dias com extensa variação (3 a 804 dias). Não foi observada associação entre o número de internações com o Índice de Massa Corporal (IMC) e com o tempo de sintomas antes do diagnóstico. O IMC dos pacientes mudou significativamente (p<0,05) durante a internação (para o grupo com AN-R: de 13,5kg/m2 para 14,8kg/m2 ; para os com AN-CP: de 15,7kg/m2 para 16,9kg/m2 ; naqueles com BN: de 22,0kg/m2 para 21,0kg/m2 ). A amenorréia esteve presente em 69% (n=45) das mulheres, sendo mais frequente naquelas com AN-R (65,1%). Dos 23 pacientes (27,7%) que realizaram o exame de densitometria óssea, 44,4% (n=10) apresentam osteopenia e 29,7% (n=7) osteoporose. Os valores médios da maioria dos parâmetros bioquímicos avaliados estavam dentro da normalidade, com exceção do beta-caroteno, que encontrava-se elevado, tanto no início quanto no final da internação. A Nutrologia foi a enfermaria na qual a maioria das internações ocorreu (79,5%) e a necessidade de terapia nutricional foi a indicação mais frequente (62,3%). A via de administração de nutrientes preferencialmente utilizada foi a via oral (67,5%), apesar de ter sido observado aumento de 2,3 vezes na escolha da terapia nutricional enteral exclusiva nos pacientes que foram internados mais de uma vez. O acompanhamento multidisciplinar foi evidenciado, pois além do médico, houve a participação maciça de nutricionistas (87,9%) e psiquiatras (72,3%). Como conclusão, a hospitalização integral é uma modalidade bastante indicada no tratamento de pacientes com TA, mas sua duração é prolongada e requer a assistência de diversos profissionais. No entanto, quando indicada a partir de critérios bem estabelecidos proporciona melhora no estado nutricional. Futuros estudos são necessários para ampliar e aprofundar os resultados encontrados possibilitando o aprimoramento de condutas terapêuticas. / Eating disorders (ED) are serious diseases with multiple etiologies that course with major changes in eating behavior and clinical complications such as malnutrition and electrolyte disturbances, and also psychiatric comorbidities. Inpatient treatment is a modality of treatment used when the outpatient follow-up did not reach satisfactory results associated with worsening of clinical status. The aim of this study was to describe the characteristics and outcomes of the hospitalization in patients with ED who were treated by Assistance Group on Eating Disorders from the Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto - USP. Anthropometric, biochemical and clinical data were collected from the medical records of patients admitted between 1982 and 2011. It was observed that among 186 patients attended by the service, 44.6% (n = 83) required at least one inpatient treatment. Most patients were female (95.2%) and white (94%). The majority was single (76%), with no children 78.3%) and were high school students (50.6%). The mean age was 23.3± 10.8 years old. According to the diagnosis, 54.2% of patients had anorexia nervosa, restricting subtype (AN-R), 31.3% had anorexia nervosa binge-eating/purging subtype (AN-CP) and 14.5% had bulimia nervosa (BN). The mean age at admission was 23.3 ± 10.8 years (range 8-58 years), 73.5% of patients were hospitalized only once. The mean number of admissions was 1.9 ± 3.9 times and 73.5% (n=61) were hospitalized only once, during 41.2 ± 37.6 days. For those who needed this type of treatment more than once, the length of stay, considering all admissions, was 70.6 ± 115.9 days with extensive variation (3-804 days). No associations were observed between the number of hospitalizations and Body Mass Index (BMI) and duration of symptoms before diagnosis. The BMI of the patients changed significantly (p <0.05) during hospitalization (for the group with AN-R, from 13.5 kg/m2 to 14.8 kg/m2 ; for AN-CP: 15.7 kg/m2 to 16.9 kg/m2 , those with BN: from 22.0 kg/m2 to 21.0 kg/m2 ). Amenorrhea was present in 69% (n = 45) women, most frequently in those with AN-R (65.1%). According to exam of bone densitometry of 23 patients (27.7%), 44.4% (n=10) had osteopenia and 29.7% (n=7) had osteoporosis. The mean values of most biochemical parameters were within normal limits, except for beta- carotene, which was above the normal range, both in admission and discharge. The Nutrology was the infirmary where the majority of hospitalizations occurred (79.5%), nutritional support was the most frequent indication for hospitalization (62.3%). The route of administration of nutrients preferably used was oral (67.5%), although it has been observed an increase at 2.3 times on exclusively enteral feeding in patients admitted more than once. The multidisciplinary team reveals, besides the doctor, the massive presence of dietitians (87.9%) and extensive involvement of psychiatrists (72.3%). It is concluded that inpatient treatment is needed in patients with ED, often shows prolonged duration and requires the assistance of various professionals. However, when indicated based on criteria well established can provide improvement in nutritional status. Future studies are needed to broaden the results enabling the improvement of therapeutic approaches.

Bakgrund: Bulimia nervosa kännetecknas av perioder med hetsätning kombinerat med kräkning, användning av laxerande medel eller överdriven träning. Många patienter väljer att inte söka hjälp på grund av skam och skuld samt en rädsla för förändring. Psykologiska behandlingar som används är oftast kognitiv beteendeterapi på olika sätt. Sjuksköterskans främsta arbetsuppgift är att möta patienterna med lyhördhet och empati. Syfte: Syftet var att belysa patienter med bulimia nervosas upplevelser av psykologiska behandlingar. Metod: Studien var en allmän litteraturstudie där tio vetenskapliga artiklar samlades in och bearbetades. Resultat: De insamlade artiklarna resulterade i tre kategorier; tillit, motivation och lärande. Tillit till den som höll i de psykologiska behandlingarna var viktigt för att kunna öppna upp sig om sin sjukdom. De upplevde både förbättrad motivation till förändring men några uppgav även en försämrad motivation till förändring. Patienterna med bulimia nervosa upplevde ett lärande då de fick redskap för att hantera sin sjukdom genom de psykologiska behandlingarna. Konklusion: För patienter med bulimia nervosa var det viktigt att känna tillit till personalen för att bli motiverade till behandlingen och kunna lära sig hantera sin sjukdom för att lyckas gå vidare i sitt tillfrisknande. Det är viktigt att sjuksköterskan finns där för patienten. / Background: Bulimia nervosa is characterized by periods of binge eating combined with vomiting, using of laxatives or obsessive exercise. Patients choose not to get help because of shame and guilt and also a fear of change. Psychological treatments used for bulimia nervosa is primarily cognitive behavior therapy in different ways. As a nurse it is important to meet patients with sensitivity and empathy. Objective: The purpose was to illustrate patients with bulimia nervosas experiences of psychological treatments. Method: This study is an general literature study where ten scientific articles was collected and processed. Results: The collected articles resulted in three categories; trust, motivation and learning. Trust to those who held in those psychological treatments was important in order to open up about their illness. Patients experienced both improved motivation to make a change and some patients experienced worsen motivation to make a change. The psychological treatments gave patients the tools they needed to handle their illness. Conclusion: For the patients with bulimia nervosa it was important to feel trust to get motivated to the treatment and to be able to handle their illness and to move on with the recovery. It´s important for the nurse to be there for the patient.

Numerous studies have reported psychological benefits associated with the practice of values-based self-affirmation. However, there is little evidence regarding their clinical applicability. Many of the purported benefits of values-based self-affirmation are highly relevant to people with bulimia nervosa (BN). This study used a multiple case study design in order to investigate the effectiveness, underlying mechanisms and acceptability of a brief (three week) intervention focussing on the development and practice of values-based self-affirmations with people who have BN. Two participants were recruited from an Eating Disorders (ED) Service waiting list. They completed questionnaires measuring cognitions associated with ED, attitude towards change, self-esteem, self-compassion, body image acceptance, psychological flexibility, cognitive defusion, and SELF repertory grids over four time points. Following appointments qualitative data was collected, and on completion of the intervention participants were interviewed, regarding their experiences. Pre and post intervention behavioural measures of BN were also collected. The use of a personal values-based self-affirmation intervention was associated with reductions in behaviours associated with BN, enhanced attitude towards change and reduced discrepancy between self and ideal self. There was little convincing evidence that the intervention was associated with a reduction in cognitions associated with ED. A very small degree of change in a positive direction was observed in relation to self-esteem, self-compassion, body image acceptance, psychological flexibility and cognitive fusion. However, scores did not reflect Reliable Change in these processes. Overall, results appeared to be slightly better explained by theory underpinning Personal Construct Psychotherapy rather than Acceptance and Commitment Therapy. However, neither theoretical explanation fully accounted for the data. Participants generally found the intervention to be acceptable. The results add novel findings to the literature regarding the use of values-based self-affirmation within the treatment of BN. They suggest that a brief values-based self-affirmation intervention might be a useful adjunct to evidence based treatment of BN. However, the case study design that is utilised in this study limits the degree to which these results may be generalised and future research should explore this further.

Thesis advisor: Barbara E. Wolfe / The core defining features of bulimia nervosa (BN) are repeated binge eating episodes and compensatory purging behavior. The biobehavioral aspects of binge eating are complex and not fully understood. One area of recent interest is the role of the satiety-signaling peptide cholecystokinin (CCK). Previous research observed a blunted postprandial plasma CCK response in those with BN, therefore suggesting this may be a cause, consequence, or maintenance factor in binge eating. It is unknown whether this altered response is due to a state versus trait phenomenon, thus having implications in the development of clinical treatment strategies. To examine the nature of this altered response, this study assessed whether CCK normalizes following remission from BN (RBN). This biobehavioral study utilized a comparative design to prospectively evaluate the biological CCK response and the corresponding behavioral ratings of satiety and other eating-related sensations in individuals with BN (n=10), RBN (n =14), and healthy controls (CON, n=13). CCK and behavioral ratings were assessed at baseline, +15, +30, and +60 minutes following the ingestion of a standardized liquid test meal. The BN group's CCK response was blunted and approached significance (p =.052) when compared to the RBN and CON groups. As predicted the RBN and CON groups' CCK response did not significantly differ. This finding supports the premise that CCK may normalize following abstinence from binge and purge (vomit) episodes and that this is a state versus trait related phenomenon. A significant positive relationship between CCK response and ratings of satiety occurred in the RBN group only (r=.59, p<.05). A new and unanticipated finding in the BN group was a significant relationship (r=.86, p < .01, two-tailed) between their CCK response and urge to vomit. A greater urge to vomit was reported by those individuals who had increased CCK response. Therefore, it is unknown whether the normalization of CCK functioning is a protective or liability factor in the stabilization and recovery process. Replication studies utilizing a larger sample size are needed to understand the role of CCK in recovery and the subsequent development of novel treatment strategies for those suffering with BN. / Thesis (PhD) — Boston College, 2012. / Submitted to: Boston College. Connell School of Nursing. / Discipline: Nursing.

Binge eating is a harmful, maladaptive behavior associated with comorbid psychopathology. Theory posits that increases in maladaptive, transdiagnostic emotions following binge eating in individuals with BN may predict the experience of comorbid symptoms. The current study served as a laboratory test of the first part of this theory: whether state increases in maladaptive emotions occur following engagement in binge eating behavior in women with BN compared with healthy controls. Women (n = 51) were recruited from the community if they met DSM-5 criteria for BN or OSFED BN (of low frequency) (n = 21) or were free of lifetime disordered eating and current psychopathology (n = 30). Participants completed questionnaires assessing eating disorder symptoms (preoccupation with weight and shape, urge to vomit), state shame, and state negative affect before and after consuming a test meal in which they were instructed to binge. Women with BN endorsed significantly greater preoccupation with weight and shape and urge to vomit following test meal consumption compared with controls. Women with BN reported significant increases in state shame, but not state negative affect, following test meal consumption, compared with controls. Results are consistent with a model indicating binge eating precipitates increases in state shame among women with BN. Given shame’s status as a transdiagnostic risk factor, future work should clarify whether state shame following binge eating predicts increases in comorbid symptoms.

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 of relapse. 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.

Recent research indicates that 2% to 4% of the population meet diagnostic criteria for the newly proposed binge eating disorder, and that it is much more common (30%) among the treatment-seeking obese. Although recognized as a significant problem, binge eating disorder is l1l not well understood, and there is debate about whether binge eating disorder is a distinct disorder. It has been argued that binge eating disorder is simply a variant or milder form of bulimia nervosa and not a separate and distinct disorder. Researchers have begun to study this population in greater depth in order to assess the characteristics of individuals with binge eating disorder, the similarities and differences between individuals with binge eating disorder, bulimia nervosa, and obese individuals who do not engage in binge eating, and the effectiveness of various treatments for binge eating disorder. Previous reviews of the literature (using non-meta-analytic strategies) have examined these areas and have yielded inconsistent conclusions. Therefore, a more comprehensive, current, and empirical integration of the data was conducted. In total, 297 studies of individuals with binge eating disorder, bulimia nervosa and/or obese individuals who do not engage in binge eating were collected, coded, and statistically analyzed across studies (by calculating standardized mean difference effect sizes). The key characteristics of individuals with binge eating disorder were assessed, diagnostic groups were systematically compared, and treatment outcomes (from 19 studies) were evaluated. The results indicated that individuals with binge eating disorder have a number of differences from both bulimia nervosa and obese non binge eating individuals. However, the extent of these differences was not great, and there was a general trend for binge eating disorder individuals to fall between the two groups on most measures of disturbed eating and psychopathology. These findings tend to support the continuum/variant conceptualization of binge eating disorder rather than that of a distinct disorder. In addition, data from primary research studies on the treatment of binge eating disorder indicated that, overall, psychosocial interventions were helpful in decreasing binge eating and psychopathological symptoms, but were less effective at reducing weight. The clinical implications of these findings are discussed, as are suggestions for future research.