Maladaptive interpersonal functioning is considered typical of eating disorders. The present thesis aimed to add to existing knowledge of interpersonal functioning in the eating disorders in terms of both symptomatology and treatment. In Study 1, relationships were found between eating disorder attitudes and several types of poor interpersonal functioning. These associations were present when controlling for depression and anxiety. Study 2 found that generalised interpersonal problems were more likely to be reported by women with bulimic disorders than comparison women, apart from problems with being too open, which were more likely to be reported by comparison women. In Study 3, individuals with self identified eating disorders were found to have poorer problem solving skills in specific interpersonal situations than healthy controls, generating less means to solve the problem, with these means being significantly less effective and less specific than those generated by healthy controls. In Study 4, the experience of an invalidating childhood environment was explored as a potential predictor of adult interpersonal problems in the eating disorders. Viewing the expression of emotions as a sign of weakness was a mediator of the relationship between having a more invalidating mother and adult eating concern in a nonclinical population. In Study 5, the interpersonal experiences of patients with bulimic disorders are explored using qualitative methodology. They report a range of problems characterised by social avoidance, social anxiety, non-assertiveness, and a difficulty with being genuine in relationships. In Study 6, patients reported their experiences of interpersonal psychotherapy for bulimic disorders. In general, they experienced the therapy as positive and beneficial. They express that it helped them address a range of interpersonal problems, and reduced but did not cure their eating disordered behaviours. Patients liked that therapy focused on both interpersonal relationships and eating. In Study 7, interpersonal psychotherapists discussed their perceptions of the modified therapy. They identified several factors as being related to outcome, such as the existence or willingness to build a support network, motivation to change, a clear interpersonal problem identified in the patient, level of depression, duration of the eating disorder and keeping therapy focused on the interpersonal. Results of these studies suggest that those with higher levels of eating disorder related attitudes and behaviours often have significant problems with interpersonal functioning. This thesis supports the use of interpersonal psychotherapy as a viable treatment approach to the eating disorders. It also supports the use of the modified version of the therapy, which addresses eating as well as interpersonal functioning.

Although previous research has shown a significant association between bulimia nervosa (BN) and drug use disorders (DUD), our knowledge of the underlying causes for this comorbidity remains limited. The purpose of the present study was to investigate possible influences on the comorbidity between BN and DUD. Subjects included 490 monozygotic and 354 dizygotic female twin pairs from the Virginia Adult Twin Study of Psychiatric and Substance Use Disorders. Multiple logistic regression analyses were used to test where putative shared correlates mediated the comorbidity between BN and DUD. Bivariate twin analyses were used to investigate the contribution of genes and environment to the correlation between BN and DUD. Regression analyses indicated a lifetime history of major depression, the personality trait of neuroticism, and childhood sexual abuse significantly mediated the associated between BN and DUD (using BN as the independent variable), while major depression, conduct disorder diagnosis, and childhood sexual abuse most significantly impacted the association when DUD was used as the independent variable. Bivariate twin analyses indicated there is additive genetic and nonshared environmental overlap between BN and DUD with genetic and unique environmental correlations of 0.39 and 0.10, respectively. Results show the reason for the association between BN and DUD is due mostly to overlapping genes with a smaller contribution from nonshared environmental influences. Major depression, the personality trait of neuroticism, and childhood sexual abuse are likely important shared correlates between BN and DUD.

Both eating disorders and smoking are significant problems for Black and White college women. Additionally, these two negative health behaviors frequently co-occur. This study aimed to investigate the relationship between these health behaviors using a multivariate model. Two models, one for full and one for partial mediation, were tested using Structural Equation Modeling. The Model for full mediation tested whether the relationship among general distress and smoking are fully mediated by body dissatisfaction, restraint, and binge eating. The model for partial mediation hypothesized that the relationships among general distress, and smoking are mediated by body dissatisfaction, restraint, and binge eating. Results indicated that there was not a significant difference between the full and partial model and therefore, the full model was retained as it is more parsimonious. In addition, a test of model invariance was conducted on the full mediation model to test form potential differences in Black and Whites. It was found that the structural model is invariant across these two groups. Results of this study may have important implications for future research as well as for treatment and preventative interventions.

En matière d’art-thérapies, si la littérature permet de relever les effets positifs de la pratique du théâtre en thérapie, elle reste peu référencée à une psychopathologie spécifique et/ou à des indications susceptibles de démontrer la relation supposée entre théâtre, psychologie et effets cathartiques. La médiation théâtrale a pourtant la particularité d’amener à un travail conjoint avec le corps, la voix, l’expression du regard et de l’émotion, référée à une palette de techniques éprouvées, à même de conduire à la construction de dispositifs spécifiques adoptés à tels ou tels symptômes et/ou pathologies. Dans ce contexte, un dispositif spécifique a été développé avec 30 personnes hospitalisées pour troubles des conduites alimentaires (TCA). Celui-ci s’étaye principalement sur le livre de Nathalie Sarraute Enfance ainsi que sur les techniques du travail de l’acteur. Une évaluation des représentations et des processus a été réalisée en procédure test/re-test avec une grille d’observation théâtrale et clinique. Les résultats permettent de voir, sur le plan artistique, clinique et statistique, que pour l’ensemble de ces personnes le théâtre aide à la construction et à l’affirmation de l’image de soi. Par ailleurs, il leur permet de ressentir, percevoir, de reconnaître et exprimer leurs émotions et de développer ainsi des stratégies de coping théâtral. Globalement, il se produit une certaine interpénétration : si le théâtre est une médiation pertinente pour les personnes TCA, elles apportent de leur côté une monstration symbolisante singulière et enrichissante aux différents dispositifs théâtraux. L’important est de créer, ou recréer, dans un aller-retour, le passage du corps au je(u) et du je(u) au corps par le biais de la catharsis, tant psychologique qu’esthétique et théâtrale des deux côtés de la scène. In fine, la catharsis apparaît comme le processus fondamental réunissant thérapies médiatisées et théâtre dans une démarche novatrice. / In art-therapy, although literature can raise the positive effects of Theatre practice in therapy, it is little referenced to a specific psychopathology and/ or indications which may demonstrate the hypothesised relationship between Theatre, psychology and cathartic effects. However, theatrical mediation is unique in that it joins together work with body, voice, gaze and emotional expression, referring to a range of proven techniques, and allowing the construction of specific devices adapted to such and such symptoms and/ or pathologies. In this context, a specific device was developed with 30 people hospitalised for eating disorders (ED). It is based mainly on the book “Childhood” by Nathalie Sarraute, and on the technical work of the Actor. An assessment of the shows and processes was conducted by following a test/ re-test procedure, with an observation grid including both theatrical and clinical aspects. The results allow us to see that for all involved, Theatre helps artistically, clinically and statistically in the construction and affirmation of self-image. Moreover, it allows them to feel, perceive, recognise and express their emotions and develop theatrical coping strategies.Overall, there is some inter-penetration: if Theatre is a mediation relevant to people with ED, they bring their own particularly symbolising and uniquely enriching monstration to said various theatrical devices. The key is to create, or recreate through an exchange, the journey between body and JE(u) (I/play) and JE(u) (I/play) to the body through psychological, aesthetical and theatrical catharsis on both sides of the stage. In fine, catharsis appears as the fundamental process uniting mediated therapies and Theatre in an innovative approach.

This diploma thesis deals with eating disorders, their causes and displays. It is based on the assumption that former patients are able to assess what was the main cause of their problems. The theoretical part defines particular eating disorders, their history, risk factors of their emergence, diagnosis, epidemiology and health complications accompanying this diseases. The practical part focuses on obtaining information by friendly interview with open questions. The qualitative research includes case studies of six women, four of them are over the age of 20 years and two of them over the age of 40 years. The main objective was to discover how they were affected by the school environment in relation to her own body and what attitude do they have to the prospective prevention programs at our schools. The part with recommendations tries to enlarge already existing prevention programs at schools. There are some proposals for cooperation between schools and professional institutions, workshops with patients and some suggestions to lessons of Health education. Further there are mentioned some projects focused on interpersonal relationships and healthy lifestyle. Finally, there are some suggestions focused on education of teachers and parents of students in the prevention of ED.

Este estudo tem por objetivos identificar as representações sociais da equipe de enfermagem acerca da anorexia e bulimia nervosa e dos indivíduos portadores desses transtornos, bem como correlacionar essas representações com as intervenções realizadas no cotidiano do trabalho desses profissionais em um hospital psiquiátrico. Para realizá-lo, foram feitas entrevistas semi-estruturadas, individuais, junto a 12 componentes da equipe de enfermagem de um hospital universitário. A teoria moscoviciana de representação social foi adotada como referencial teórico-metodológico e os dados submetidos à análise de conteúdo segundo Bardin. Dessa análise emergiram temas como sintomas físicos e psíquicos além dos fatores psicossociais, que constituíram a categoria “A Construção do conhecimento". A construção desse conhecimento mostrou-se ancorada essencialmente em um discurso médico – científico veiculado na instituição, numa interface com o conhecimento prático que a vivência cotidiana possibilita. Já a outra categoria delineou-se a partir do “Campo das Ações/ Sentimentos", constituída por temas como controle/limite, onde o sofrimento psíquico do trabalhador é mais evidente, principalmente na iminência do suicídio. Por outro lado, é por meio de temas como a escuta, o vínculo de confiança e o cuidar individualizado que os profissionais conseguem expressar o prazer no trabalho / This study intends to identify the social representations of nursing staff about anorexia and bulimia nervosa and about carries of these eating disorders as long as to correlate these representations with the interventions made in the se professionals daily life, inside of a psychiatric hospital. Semi-structured, and individuals interviews were made with twelve members of the nursing staff of a university hospital. The moscovician theory of social representation was adopted as referential-methodological referential and the data were submitted for content analysis in Bardin’ s point of view. From this analysis emerged themes as physical and psychic symptoms, besides psychosocial factors, which constituted the category “knowledge Construction". The construction of knowledge seemed to be anchored essentially on a medical-scientific lecture diffused in the institution, in a interface with the pratic knowledge which the daily life provides. On the other side, the other category was outlined from “Actions / Feelings Field", constituted by themes as control / limit, where the worker’ s psychic suffering is more evident, mostly in imminence of suicide. By other way, is by themes as the listening, confidence link and individually care that professionals care express their pleasure on work

La experiencia de ser diagnosticada con anorexia y bulimia representa una tensión y ambigüedad en torno al cuerpo femenino y a la salud. Nos encontramos actualmente en una sociedad donde la delgadez es altamente valorada a través de las interacciones cotidianas y en los medios; pero que a su vez puede ser patologizada por asociarse a prácticas alimentarias y acciones consideradas atípicas desde el discurso biomédico. Esta tesis explora, desde un enfoque antropológico, cuáles son las narrativas y prácticas en torno al cuerpo femenino y a la salud presentes en 6 mujeres jóvenes diagnosticadas con anorexia y bulimia. Estas narrativas son relatos que buscan explicar y dar sentido a la experiencia subjetiva de vivir con determinada condición, las cuales producen significados de acuerdo a sus vivencias y marcos de interpretación. Esta investigación fue de carácter cualitativo con enfoque etnográfico. Las narrativas de las mujeres con anorexia y bulimia se triangularon con la observación participante a terapias de una clínica privada para reconstruir su experiencia cotidiana en ambos espacios, y también con la observación a medios con los que ellas han interactuado (programas de televisión y páginas web Pro Anorexia). Los hallazgos de esta investigación se han organizado en tres secciones de acuerdo a los contextos y actores con los cuales interactuaron las jóvenes diagnosticadas. En primer lugar, se explicarán las narrativas del control del cuerpo femenino que estuvieron presentes a lo largo de su vida previo a su tratamiento. En esta etapa, los cuerpos de las jóvenes se ven sujetos a constante control, vigilancia y experiencias de violencia de género en diversos espacios y desde distintos actores. En el marco de estas experiencias, surgieron diversos significados sobre la delgadez y el cuerpo femenino que llevaron a desarrollar prácticas alimentarias y purgativas para bajar de peso como una búsqueda del propio control del cuerpo. Asimismo, en este contexto, también surgen las primeras miradas patologizantes de estas prácticas y estrategias que tenían como objetivo la delgadez. Posteriormente, se procederá explicar las narrativas y discursos sobre la delgadez y anorexia presente en los medios de comunicación. Se analizarán la accesibilidad y búsqueda de información para bajar de peso; y también las prácticas relacionadas con la elaboración de sus primeros diagnósticos y la patologización sus prácticas alimentarias a partir de programas de televisión. Finalmente, se estudiarán las narrativas de y sobre los entornos terapéuticos. De este modo se hará un contraste entre las narrativas de las jóvenes, lo relatado desde los terapeutas y lo observado en terapias. Se analizarán los imaginarios en torno a una persona con anorexia, las motivaciones o decisiones para ingresar a un tratamiento terapéutico biomédico como las sensaciones de malestar y tensiones con el entorno; la práctica terapéutica como búsqueda de normalización a partir de la alimentación, medicación y terapias; y las diversas narrativas de recuperación que surgen desde las informantes y los terapeutas / Tesis

En esta investigación se aborda la problemática de la bulimia nerviosa desde la construcción de representaciones e identificaciones en la experiencia de mujeres con bulimia de sectores medios de Lima. Los estudios sobre bulimia han estado tradicionalmente anclados en el paradigma biomédico y en la psicología. Dichas disciplinas han prescindido de factores como el contexto y los entornos de socialización que condicionan y afectan de modo transversal la experiencia corporal de los sujetos. Al aproximarse al tema desde el marco de la sociología se busca poner en evidencia el impacto de dimensiones, elementos de riesgo y predisposición en un contexto de “culto narcisista” al cuerpo propio de nuestro tiempo. Utilizando un enfoque biográfico para recoger las narrativas que tienen los sujetos sobre su propia experiencia, a través de entrevistas e historias de vida; y analizando los hallazgos desde un marco teórico de la sociología del cuerpo en relación con subjetividades y el surgimiento de identificaciones. Se encontró que son los grupos de pares los que reinterpretan valores y representaciones idealizadas sobre el cuerpo femenino y los transmiten de manera más efectiva y cercana, reforzando mutuamente entre compañeras prácticas cotidianas y naturalizadas de estilización y cuidado del cuerpo, hasta llegar a prácticas consideradas propias de los desórdenes alimenticios, en un intento por obtener posicionamiento en su entorno y perspectivas de éxito en la vida privada y pública hacia el futuro / Tesis

Made available in DSpace on 2016-04-29T13:18:11Z (GMT). No. of bitstreams: 1 tese_66181.pdf: 563798 bytes, checksum: fc2b3c496aea4079fd2bae4d37cf195b (MD5) Previous issue date: 2001-02-23 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / This work was based on the Skinnerian model of selection by consequences and on the biobehavioral model of activity anorexia, in order to interpret the so called anorexia and bulimia nervosa, emphasizing the multiple determination of such eating disorder. The present study aimed at investigating the variables involved in the origin and maintenance of the eating disorders of four participants treated at an outpatient program for eating disorders of a university hospital (PROATA UNIFESP). The relationships between physical activity and eating restrictions (dieting), which are considered a risk for anorexia, as well as the acting contingencies probably involved on the maintenance of the eating disorders were investigated. The results indicated a probable relationship between exercising and feeding restrictions at the origin of the patients referred eating disorders, and allowed for the identification of the acting contingencies involved in their maintenance / Este trabalho está baseado no modelo Skinneriano de seleção por conseqüências e no modelo biocomportamental de anorexia induzida por atividade física com o objetivo de interpretar as chamadas anorexia e bulimia nervosa, enfatizando a múltipla determinação na constituição destes transtornos. O presente estudo teve por objetivo a investigação das variáveis envolvidas no desencadeamento e manutenção dos problemas alimentares descritos por quatro participantes recebidas para tratamento no Programa de Orientação e Assistência aos Transtornos Alimentares (PROATA- UNIFESP). Indícios da relação entre atividade física e restrição alimentar, considerada fator de risco para desenvolvimento de anorexia, e contingências atuais provavelmente envolvidas na manutenção de problemas com alimentação foram investigadas. Os resultados confirmam o possível envolvimento da relação entre exercícios e restrição alimentar na origem das dificuldades alimentares referidas pelas participantes, e permitem a identificação de contingências de reforçamento atuais possivelmente envolvidas na manutenção destas alterações

Submitted by Filipe dos Santos (fsantos@pucsp.br) on 2017-09-13T11:40:51Z No. of bitstreams: 1 Patricia Gipsztejn Jacobsohn.pdf: 1052909 bytes, checksum: f0653b758f54649c69f5a61c419eea19 (MD5) / Made available in DSpace on 2017-09-13T11:40:51Z (GMT). No. of bitstreams: 1 Patricia Gipsztejn Jacobsohn.pdf: 1052909 bytes, checksum: f0653b758f54649c69f5a61c419eea19 (MD5) Previous issue date: 2017-09-01 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPES / Fundação de Amparo à Pesquisa do Estado de São Paulo - FAPESP / This research aims at investigating aspects of the clinical practice of analysts who work with patients with anorexias and bulimias. It also aims at investigating the specificities and issues of particular relevance in the analyst's encounter with his/her patient; countertransference issues arising in the encounter of this analytical duo; checking if it is possible to correlate these countertransference aspects with the difficulty in attendance and bond with these patients; if there is a difficulty in these services, which mobilizes personally and which issues involved in the professional choice of these analysts to deal with this type of patient; raising personal questions of these analysts (such as history of eating disorder in their personal or family histories) and correlate this issue with professional choice; and also investigating whether the way the analyst deals with questions about his/her own body and how he conducts his/her food life influence his clinical practice. A theoretical research was carried out, with bibliographical revisions referring to the proposed theme and the concepts that are articulated to the work. Semi-open interviews were also carried out with 5 (five) female analysts who study and work with patients with anorexias and bulimias / Esta pesquisa busca investigar aspectos da prática clínica de analistas que trabalham com pacientes com anorexias e bulimias. Tem por objetivo investigar as especificidades e questões de pertinência particular no encontro do analista com seu paciente; levantar aspectos contratransferenciais surgidos no encontro desta dupla analítica; verificar se é possível correlacionar esses aspectos contratransferenciais à dificuldade no atendimento e vínculo com esses pacientes; verificar se existe uma dificuldade nesses atendimentos, o que mobiliza pessoalmente e quais as questões envolvidas na escolha profissional desses analistas em lidar com esse tipo de paciente; levantar dados pessoais desses analistas (como histórico de transtorno alimentar em suas histórias pessoais ou familiares) e correlacioná-los à escolha profissional; e, ainda, investigar se a forma com que a o analista lida com questões relativas ao seu próprio corpo e como conduz sua vida alimentar influenciam sua prática clínica. Foi feita uma pesquisa teórica, com revisões bibliográficas referente à temática proposta e aos conceitos que se articulam ao trabalho, e também foram realizadas entrevistas semi-abertas com 5 (cinco) analistas mulheres que estudam e trabalham com pacientes com anorexias e bulimias