Eating disorders can lead to a negative impact on students' academic growth, nutrition and can cause death (Claude-Pierre, 1997; Manley, Rickson, & Standeven, 2000; Romeo, 1996). Early intervention by referring students to professional counseling might help counter these negative consequences. The teacher is in the position to assist students by providing health information, identifying those with problems, and intervening for a variety of dysfunctions that may include the eating disorders called anorexia nervosa and bulimia nervosa (Myers-Clark & Christopher, 2000). However teachers are in a difficult position to know when to address student concerns and judge what action to take (Ransley,1999). Teachers' engagement seems crucial (Smolak, Harris, Levine, & Shisslak, 2001) since eating disorders are being identified in younger children.The purpose of this study was to examine (a) the relationships of the theoretical constructs, attitude, subjective norm, and perceived behavioral control of the theory of planned behavior as predictors of behavioral intention (Ajzen & Fishbein, 1980) of middle school teachers to identify and refer suspected anorexia nervosa (AN) and/or bulimia nervosa (BN) students for professional help; and (b) the actual behavior of middle school teachers who reported having ever referred a student suspected of having AN and BN and those teachers who reported not having made such a referral. One hundred fourteen middle school teachers in Broward County, Florida volunteered to participate in the ex post facto research. Data were collected from a questionnaire. Multiple regression analysis revealed that the constructs of subjective norm (perception of what others think about one's performance of behavior combined with motivation to comply) and perceived behavioral control (perception regarding the extent of the difficulty of performing the behavior) were predictive of teachers' intent (likelihood of engaging in a behavior) to refer. However, the analysis revealed that attitude (overall positive or negative feeling with respect to performing the behavior) was not predictive of teachers' intent. Discriminant function analysis revealed that both intent and perceived behavioral control were predictive of group membership, either having referred a student suspected of having an eating disorder for counseling or not having made such a referral. Attitude and subjective norm were not predictive of group membership.

Orientador: Egberto Ribeiro Turato / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-26T23:55:56Z (GMT). No. of bitstreams: 1 GarciaJunior_Celso_D.pdf: 2283312 bytes, checksum: 66dc8e1447486f1382f2809c6b7a2a8a (MD5) Previous issue date: 2015 / Resumo: O presente estudo teve como objetivos compreender as experiências de vida dos genitores masculinos de pacientes adolescentes do sexo feminino em tratamento ambulatorial devido a um Transtorno Alimentar (TA) e entender como esses homens vivenciaram o impacto do TA de suas filhas em suas próprias vidas, desde o início da doença até o desenrolar do tratamento a que elas se submeteram no Grupo Interdisciplinar de Assistência e Estudos em Transtornos Alimentares (GETA) da UNICAMP. Foi utilizado o método clínico-qualitativo, através de entrevistas semidirigidas de questões abertas em uma amostra intencional que foi fechada pelo critério de saturação de informações. Doze indivíduos foram entrevistados individualmente no ambulatório de psiquiatria do Hospital das Clínicas da UNICAMP, onde as atividades do GETA são desenvolvidas. Cuidados éticos foram tomados seguindo as normas preconizadas pelo Conselho Nacional de Saúde. A técnica de tratamento de dados foi feita através da análise de conteúdo das entrevistas transcritas na íntegra e categorização. Os resultados foram submetidos à validação externa, por meio de discussão com os membros do Laboratório de Pesquisa Clínico-Qualitativa do Departamento de Psicologia Médica e Psiquiatria da UNICAMP e na apresentação em congressos nacionais e internacionais. Os resultados permitiram compreender que os entrevistados passaram pela infância e adolescência à deriva, devastados pelo trabalho infantil e buscavam desesperadamente pela atenção do pai distante afetivamente. Esses indivíduos mostraram-se com dificuldades em lidar adequadamente com situações de angústia e conflito e sentiam-se distantes de suas filhas. Os primeiros sintomas do TA foram minimizados pelos participantes. Com o agravamento do quadro, os pais vivenciaram sentimentos de tristeza, frustração, medo da morte da filha, culpa, impotência e desesperança. Os entrevistados foram capazes de reconhecer, com satisfação, os progressos obtidos a partir do tratamento e perceberam que, depois do TA, passaram a conversar mais com suas filhas. Aparentemente, o TA serviu como um caminho de aproximação na relação pai-filha. Nossos achados contribuíram na ampliação dos conhecimentos na área e podem ter aplicação na melhora da prática clínica no campo dos transtornos alimentares / Abstract: The present study aimed to understand life events reported by fathers of female adolescents with eating disorders (ED) in outpatient treatment and understand fathers¿ perceptions about the impact of having a daughter with an ED, since the symptoms onset. The Clinical-Qualitative method was used, through in-depth semi-structured interviews, using an intentional sample, closed by saturation criterion. Twelve participants were interviewed at the outpatient psychiatry unit of the Clinical Teaching Hospital at the State University of Campinas (UNICAMP), where Eating Disorders¿ Clinical and Research Program (GETA) activities are developed. Ethical procedures were taken following the ethical standards established by the National Council of Health. Data analysis was performed through the qualitative content analysis of the fully transcribed interviews and categorization. Peer-reviewers members from the Laboratory of Clinical-Qualitative Research (UNICAMP) validated the emerging categories, as also the attendees of national and international conferences where the results were presented. The findings made it possible to understand that the participants were adrift in their childhood and adolescence, devastated by child labor. They desperately sought attention without achieving a secure, affective contact with their affectively distant, hardworking father. These individuals showed difficulties in dealing adequately with situations of anguish and conflict. They felt distant from their daughters and had the sensation of impotence when faced with their daughter¿ problems. They minimized the early ED symptoms but feelings of sadness, frustration, fear of the daughter¿s death, self-guilty, powerlessness and helpless emerged, as the eating symptoms worsened. The fathers could recognize treatment benefits and perceived that they got able to improve the relationship with their daughter. Apparently, ED has functioned as a path to an improvement of the father-daughter relationship quality. Our findings can contribute to the expansion of knowledge in the area and may have application in improving clinical practice in the field of ED / Doutorado / Saude Mental / Doutor em Ciências Médicas

No description available.

Ätstörningar är ett ökande problem i samhället och orsakar personligt lidande. Individer som drabbats av ätstörningar kan få en påverkan på aktiviteter i vardagen. Vanor, motivation och utförande i aktiviteter påverkas negativt av sjukdomen. Syftet med studien var att kartlägga hur personers med ätstörningar tillfriskningsprocess kan stärkas genom delaktighet i aktivitet. Studiens design var en scoping review. Datainsamling gjordes genom sökningar i databaserna CINAHL with full text, AMED och Psychinfo. Sökningen av litteratur resulterade i nio artiklar och åtta artiklar från manuella sökningar, vilket mynnade ut i totalt 17 artiklar. Artiklarna var publicerade mellan år 2002-2020. Artiklarna analyserades genom en numerisk analys och en tematisk analys. Resultatet visade att personer med ätstörningars tillfriskningsprocess stärktes genom delaktighet i aktivitet. Delaktighet i aktivitet bidrog till en mer fungerande vardag och gav identitet och tillhörighet. Slutsatsen är att tillfriskningsprocessen från ätstörningar stärktes genom delaktighet i aktivitet samt bidrog till balanserade rutiner och struktur i vardagen. Delaktighet i aktivitet upplevdes meningsfullt och genererade glädje.

Bakgrund: Anorexia nervosa och bulimia nervosa är komplexa ätstörningar som medför stort lidande för patienterna. Patienterna drar sig bort från att söka vård då de bland annat inte har sjukdomsinsikt men även andra bidragande faktorer som medför olika känslor kring vårdupplevelsen. Syfte: Belysa upplevelsen av vården bland patienter med anorexia nervosa och bulimia nervosa. Metod: Litteraturöversikt där elva artiklar valdes ut, granskades och sammanställdes för att besvara syftet. Resultat: Upplevelsen av vården bland patienter med anorexia nervosa och bulimia nervosa redovisas via tre huvudteman; patienters upplevelse av att ta första steget till vård, att vara patient och att tillfriskna under vårdtiden. Under varje huvudtema tillkommer två subteman. Det framkom att det är en komplex vårdprocess som innerverar ett brett spektrum av känslor samt olika faktorer som medför både positiva och negativa känslor för berörd patientgrupp. Det föreligger även betydande faktorer i omvårdnaden som påverkar patientens relation till sjuksköterskan samt hur behandlingen, omvårdnaden och tillfrisknande sker. Konklusion: Att vårda patienter med anorexia nervosa och bulimia nervosa är komplext. Genom visat stöd, kommunikation, empati och en god relation mellan sjuksköterskan och patienten kan en adekvat vård utföras där patienten får en god vårdupplevelse. / Background: Anorexia nervosa and bulimia nervosa are complex eating disorders that cause suffering to patients. Patients tend to avoid seeking treatment because, among other things, they have no insight into the disease, but also other contributing factors that lead to different feelings about the care experience. Aim: To shed light on the experience of care among patients with anorexia nervosa and bulimia nervosa. Method: Literature review where eleven articles were selected, reviewed and compiled to answer the purpose. Findings: The experience of care among patients with anorexia nervosa and bulimia nervosa is reported via three main themes; patients' experience of taking the first step, patients' care experience and recovering during the care period. Under each main theme, two subthemes are added. It turned out that it is a complex care process that innervates a wide range of emotions as well as various contributes both positive and negative emotions for this group of patients. Conclusion: Caring for patients with anorexia nervosa and bulimia nervosa is complex.Through shown support, communication, empathy and a good relationship between the nurse and the patient, adequate care can be carried out where the patient gets a good care experience.

This study sought to examine risk and onset patterns in anorexia nervosa (AN), bulimia nervosa (BN), and binge eating disorder (BED). Women with AN (n=71), BN (n=66), BED (n=160) and non-psychiatric controls (n=323) were compared retrospectively on risk factors, symptom onset, and diagnostic migration. Eating disorder groups reported greater risk exposure than non-psychiatric controls. AN and BED differed on premorbid personality/behavioral problems, childhood obesity, and family overeating. Risk factors for BN were shared with AN and BED. Dieting was the most common onset symptom in AN, whereas binge eating was most common in BN and BED. Migration between AN and BED was rare, but more frequent between AN and BN and between BN and BED. AN and BED have distinct risk factors and onset patterns, while BN shares similar risk factors and onset patterns with both AN and BED. Results should inform future classification schemes and prevention programs.

The purpose of this study was to examine the degree to which several psychological and personality variables relate to anorexic and bulimic symptomatology in female undergraduates. Past research investigating the relationship between such variables and eating disorders has been contradictory for several reasons, including lack of theoretical bases, discrepant criteria, or combination of anorexia and bulimia nervosa. Recent investigators have concluded that it is important to examine subdiagnostic levels of eating pathology, especially within a college population. Thus, the present investigation used a female undergraduate sample in determining the extent to which several psychological factors--obsessiveness, dependency, over-controlled hostility, assertiveness, perceived control, and self-esteem--account for anorexic and bulimic symptomatology. Regression analyses revealed that anorexic symptoms were best explained by obsessiveness and then two measures of dependency, emotional reliance on another and autonomy. Bulimic symptoms were related most strongly to lack of social self-confidence (a dependency measure) and obsessiveness. Clinical implications and directions for future research are addressed.

Essstörungen sind prävalente psychische Störungen mit schwerwiegenden, oftmals langfristigen Auswirkungen auf die psychische und körperliche Gesundheit. Eine zunehmende Anzahl von klinischen Studien dokumentiert die Wirksamkeit verschiedener psychotherapeutischer Ansätze für spezifische Essstörungen. Im vorliegenden Themenheft 5 werden die Wirksamkeit von neuen Ansätzen zur Einzeltherapie und zur internet-basierten Rückfallprophylaxe, die Patientensicht auf die Therapie sowie die Relevanz von Faktoren des therapeutischen Prozesses bei verschiedenen Essstörungen beleuchtet. Weiterer Forschungsbedarf besteht insbesondere hinsichtlich des Prozesses und der Dissemination evidenzbasierter Psychotherapie für Essstörungen. / Eating disorders are prevalent psychiatric disorders with severe and longstanding 15 implications for mental and physical health. An increasing number of clinical studies documents the efficacy of certain psychotherapeutic approaches for specific eating disorders. This special issue addresses the efficacy of novel approaches in face-to-face individual therapy and Internet-based relapse prevention, patient views of treatment, and the relevance of therapeutic process factors for diverse eating disorders. Further research is particularly 20 warranted regarding the process and dissemination of evidence-based psychotherapy for eating disorders.

Avaliar a Qualidade de Vida (QV) de pacientes com Transtornos Alimentares (TA), verificar diferenças entre os subtipos de TA e identificar dimensões de QV mais prejudicadas. Métodos: O instrumento de QV da Organização Mundial de Saúde (WHOQOL-100) foi respondido por 69 mulheres com TA (Anorexia Nervosa AN=34; Bulimia Nervosa BN=26 e Transtorno Alimentar Não Especificado TANE=9) e por 69 mulheres saudáveis. Utilizou-se a Entrevista Clínica Estruturada para Transtornos do Eixo I do DSM-IV (SCID) para a realização dos diagnósticos psiquiátricos. Resultados: Pacientes com TA apresentaram piores escores na QV geral e em todos os domínios (físico, psicológico, relações sociais, meio ambiente, nível de independência e espiritualidade), tendo sido o psicológico aquele com maior prejuízo. Não foram encontradas diferenças entre os subtipos de TA quanto aos prejuízos de QV. As comorbidades psiquiátricas encontradas com maiores prevalências foram os Transtornos do Humor, os Relacionados ao Uso de Álcool e Outras Substâncias e os de Ansiedade. Pacientes com AN e comorbidade com o Transtorno de Pânico apresentaram QV mais prejudicada que pacientes com AN sem Pânico. A maioria dos pacientes apresentava múltiplas comorbidades e histórico de diversas tentativas de suicídio. Conclusões: Pacientes com TA apresentam significativo prejuízo de QV em todos os domínios, em especial no psicológico, provavelmente em função das peculiaridades da psicopatologia alimentar, sem diferenças entre os subtipos de TA. Pacientes com AN e comorbidade com Pânico devem ser avaliados com mais critério / Purpose: To assess quality of life in patients with eating disorders, verify differences among eating disorder subtypes, and identify the domains of quality of life most affected by eating disorders. Methods: The World Health Organization quality-of-life assessment instrument (WHOQOL-100) was completed by 69 women with eating disorders (34 with anorexia nervosa, 26 with bulimia nervosa, and 9 with eating disorder not otherwise specified) and 69 healthy women. The Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I) was used for the diagnosis of psychiatric disorders. Results: Patients with eating disorders reported lower (worse) total quality- of-life scores and lower scores on all quality-of-life domains (physical, psychological, social relationships, environment, level of independence, and spirituality) compared with healthy patients, with the psychological domain being the most impaired. No significant differences in impairment of quality of life were found among eating disorders subtypes. The most prevalent psychiatric comorbidities were mood disorders, alcohol or substance abuse- related disorders, and anxiety disorders. Patients with anorexia nervosa and comorbid panic disorder had greater impairment in quality of life than patients with anorexia nervosa but no panic disorder. Most patients had multiple comorbidities and history of suicide attempts. Conclusions: Patients with eating disorders experience significantly greater impairment in quality of life on all domains, especially on the psychological domain, compared with healthy patients, probably because of peculiarities in eating disorders psychopathology. No difference in quality of life impairment was observed among eating disorders subtypes. Patients with anorexia nervosa and comorbid panic disorder should be carefully evaluated

Transtornos Alimentares (TA) são transtornos mentais considerados graves. Dentre eles, Anorexia Nervosa e Bulimia Nervosa compartilham sintomas e características psicopatológicas como hábitos desregulados de alimentação, métodos extremos para controle do peso, e preocupações exageradas com a forma e o peso corporal. Os TA compartilham ainda sintomas comuns em outros transtornos psiquiátricos, como Depressão e Ansiedade. Pesquisas sobre o tema devem levar em conta este amplo espectro de sintomas. A meditação é uma prática que tem recebido crescente atenção de pesquisadores de diversas áreas de saúde. Dentro da área de Psiquiatria, a meditação mindfulness tem sido estudada como terapia complementar para diversos transtornos, sendo os mais pesquisados os transtornos de ansiedade, a depressão e a dependência química. Alguns programas baseados em mindfulness já demonstraram resultados positivos em pacientes com Compulsão Alimentar e Bulimia Nervosa. Este é um projeto que teve a intenção de desenvolver e mensurar os efeitos de uma nova intervenção baseada em meditação mindfulness para pacientes internados na Enfermaria de Comportamentos Alimentares (ECAL) do Instituto de Psiquiatria do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo. A hipótese primária foi que o treinamento em mindfulness diminuiria sintomas de ansiedade e depressão, em comparação com os pacientes que seguiram o tratamento usual da enfermaria. O projeto todo teve duração de três anos, sendo dividido em fase piloto, fase grupo controle e fase grupo intervenção. Cada fase aconteceu em diferentes períodos de tempo, para que um número adequado de indivíduos fosse alcançado para fins de pesquisa. Avaliações foram feitas sempre nos mesmos períodos para os três grupos: durante a primeira semana de internação e após 8 semanas, ou antes, se o paciente recebesse alta. Os resultados do grupo piloto foram positivos e ajudaram a delinear os exercícios que compuseram o programa aplicado na intervenção. A comparação dos resultados do grupo controle com o grupo intervenção apresentou significativa diferença para os índices de ansiedade (p < 0,01), depressão (p < 0,03), capacidade de agir com atenção (p < 0,01) e atitudes alimentares relacionadas a dietas (p < 0,04). Como previsto e em linha com outras pesquisas utilizando mindfulness para indivíduos com TA menos grave, este protocolo de oito sessões demonstrou efeito positivo e significativo apesar dos desafios de trabalhar com esta população neste contexto. Estes resultados dão suporte a novas pesquisas que poderão testá-los e compreender melhor a duração dos efeitos terapêuticos deste treinamento. Também, devem ser considerados aprimoramentos necessários, como refinamento dos exercícios, capacitação de outros terapeutas no protocolo e treinamento em mindfulness para outros profissionais envolvidos / Eating disorders (ED) are considered severe mental disorders. Anorexia Nervosa and Bulimia Nervosa are disorders that share symptoms and psychopathological characteristics such as deregulated feeding habits, extreme methods for weight control and exaggerated concerns about shape and weight. Eating Disorders also share common symptoms with other psychiatric disorders such as depression and anxiety. Research on eating disorders should take into account this wide spectrum of symptoms. Meditation is a practice that has received increasing attention from researchers in various areas of healthcare. Within the area of Psychiatry, mindfulness meditation has been studied as a complementary therapy for many disorders, and the most researched are anxiety, depression and addiction. Some mindfulness-based programs have already shown promising results in patients with Binge Eating Disorder and Bulimia Nervosa. This research project aimed to measure the effects of a mindfulness meditation intervention delivered to patients admitted to the Eating Disorders Ward at the Institute of Psychiatry in the Clinical Hospital for the Medical School, University of São Paulo. The primary hypothesis was that mindfulness training would lower symptoms measuring anxiety and depression compared to inpatients that received treatment as usual. The entire project was conducted during three years, with a pilot group phase, a control group phase and an intervention group phase. Each phase happened in different periods of time so the study could recruit a suitable number of participants. Assessments were made for all groups during the first week of admission and at eight weeks (or earlier if the patient were to be discharged). Pilot results were positive and helped delineate exercises that would be part of the main study intervention protocol. The final analysis comparing control and intervention group showed significant differences for measures in anxiety (p < 0.01), depression (p < 0.03), acting with awareness (p < 0.01) and dieting attitudes (p < 0.04). As hypothesized and in line with previous research with less severe eating disorders samples, this novel eight week program showed a positive and significant effect despite the challenges of working with this population and in this setting. These findings will inform future research which will need to replicate the findings, understand more about the durability of the effects and consider the resource allocation (eg staff training) needed to offer this promising intervention in this setting