Introduction: Eating disorders were previously regarded as a Western culture-bound syndrome affecting only young Western women. However they have been described in the UK and in across the world. Research has highlighted the prevalence of disordered eating among South Asian females. However little is known about the process of how this comes about, and little qualitative research has been conducted in this area. This research aimed to understand the issues relating to the development and maintenance of eating disorders among South Asian females and their help seeking behavior, as well as the barriers to accessing treatment. Methods: Three main studies were carried out; two systematic reviews, a review of prevalence (study 1), a qualitative review (study 2) and a qualitative study (study 3). For study 1, the review was planned and reported with reference to MOOSE guidelines (Stroup et al 2000) for systematic reviews of observational studies. For study 2, the quality of the studies was appraised in accordance with Critical Appraisal Skills Programme Criteria (CASP 2013), qualitative research check list. For both reviews, a systematic literature search was conducted across four data basis, Psychinfo, Medline, CINAL and EMBASE. All articles were screened against inclusion/exclusion criteria. The data extracted from the selected studies was tabulated in a way that demonstrated the methodological robustness and cultural quality of each study was also reported. For the qualitative study (study 3), semi-structured interviews were carried out with three groups of participants, ten South Asian females with eating disorders, seven parents and siblings and eighteen health care professionals. Results: For study 1, thirteen studies were initially selected. Overall, these studies reported higher prevalence of Bulimia among Asian females in the UK compared to Caucasian females. Studies conducted in Pakistan and India reported a lower prevalence rate of diagnosable eating disorders than reported in Western countries. In study 2, three studies were selected. They identified important themes; cultural conflict and controlling families. In study 3, two overarching themes were identified with corresponding sub-themes; development and maintenance of eating disorders in the context of family and cultural conflict; barriers and facilitators to accessing treatment. Conclusions: Reviewed prevalence study findings highlighted a need to consider the adaptation of measuring tools, as eating disorders may present differently in different cultures, and diagnostic criteria based on Western norms may not always be appropriate. There was a lack of qualitative studies and those available were of poor quality. The main aetiology and maintenance of Eating Disorders reported by South Asian females were focused on conflict with family and culture. Seeking treatment was difficult for these women due to stigma, shame, issues of confidentiality and lack of training and understanding in cultural competence among health care professionals.

This short film visualizes the experiences of seven Scripps students who have or have had eating disorders, using interview audio and projected imagery to critique existing media portrayals of eating disorders, as well as humanizing those who actually suffer from them.

Os transtornos alimentares são definidos como desvios do comportamento alimentar que podem levar à caquexia ou à obesidade, entre outros problemas físicos e incapacidades. Corresponde aos diagnósticos de Anorexia Nervosa (AN), Bulimia Nervosa (BN) e o Transtorno de Compulsão Alimentar Periódica (TCAP). Este estudo objetivou avaliar a prevalência e a severidade de desgaste dentário de pacientes atendidos pelo GRATA (Grupo de Assistência aos Transtornos Alimentares) do Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto - USP (HCFMRP - USP). A amostra foi composta por 30 pacientes com transtornos alimentares atendidos no GRATA. O instrumento de coleta de dados utilizado foi um questionário com perguntas estruturadas dividido em duas etapas: a primeira contendo informações relacionadas à identificação dos pacientes; a segunda parte para identificar hábitos presentes na rotina diária dos pacientes, abrangendo questões sobre cuidados com higiene bucal, hábitos bucais e alimentares, a fim de detectar as associações com os diferentes graus de desgaste dentário, utilizando o índice IDD adaptado. Procedeu-se a análise estatística por meio de freqüências absolutas e relativas. O teste de Mann Whitney (p<0,05) foi utilizado para amostras independentes. Verificou-se neste estudo que todos os pacientes portadores de transtornos alimentares apresentaram algum grau de desgaste dentário, sendo que a superfície dentária mais acometida foi à superfície oclusal/incisal com uma severidade de desgaste dentário em dentina correspondendo a 66,7%. Com relação à superfície vestibular observou-se que 13,3% apresentaram desgaste dentário grau 4. Na superfície lingual apresentou uma prevalência de desgaste dentário com comprometimento pulpar de 13,4%. O fator ranger e apertar os dentes apresentou-se uma associação significativa com o desgaste dentário na superfície oclusal (p= 0,02 e p= 0,01 respectivamente). Assim, concluiu-se que pacientes portadores de transtornos alimentares podem apresentar desgaste dentário em diferentes graus. O cirurgião-dentista pode contribuir no diagnóstico, na prevenção e no tratamento de alterações dentárias, proporcionando benefícios à saúde bucal e geral destes pacientes. / Eating disorders are defined as deviations in eating habits that may lead to cachexy or obesity, besides other physical problems and inabilities. It corresponds to diagnoses of Anorexia, Bulimia and Binge Eating Disorder. This study evaluated the prevalence and severity of tooth wear in patients assisted at GRATA (Group of Assistance to Eating Disorders) of the Clinics Hospital of Ribeirão Preto Medical School - USP (HCFMRP-USP). The sample included 30 patients with eating disorders assisted at GRATA. Data were collected with aid of a questionnaire containing structured questions, divided into two sections; the first contained information related to patient identification, and the second aimed to identify habits in the daily routine of patients, including questions on oral hygiene, oral and feeding habits, to investigate the association with different degrees of tooth wear, using the adapted tooth wear index (TWI). The results were statistically analyzed by absolute and relative frequencies. The Mann Whitney test for independent samples was applied (p<0.05). All patients with eating disorders in this study presented some degree of tooth wear; the occlusal/incisal tooth aspect was the most affected, with severity of tooth wear in dentine corresponding to 66.7%. Concerning the buccal aspect, 13.3% exhibited some tooth wear degree 4. The lingual surface presented prevalence of tooth wear with pulp involvement of 13.4%. The habit of tooth clenching and grinding had significant association with tooth wear on the occlusal aspect (p=0.02 and p=0.01, respectively). Thus, it was concluded that patients with eating disorders may present tooth wear of different degrees. The dentist may contribute with diagnosis, prevention and treatment of tooth alterations, providing benefits to the oral and general health of these patients.

Resumo: O presente estudo teve por objetivo estimar a prevalência de comportamentos sugestivos de transtornos alimentares entre estudantes universitárias de todos os anos dos cursos de Medicina, Enfermagem e Nutrição da Faculdade de Medicina de Botucatu-UNESP. Foram também investigadas as associações desses comportamentos com características sócio-demográficas, curso, auto-avaliação de desempenho escolar, índice de massa corporal, auto-imagem corporal, e realização de tratamento psiquiátrico atual ou prévio. Método: Foi utilizado formulário estruturado para investigar aspectos sócio-demográficos, auto-avaliação de desempenho escolar, informações sobre realização prévia de tratamento psiquiátrico, uso e tempo de uso de psicofármacos. Para avaliar alterações no comportamento alimentar foram utilizados o Teste de Atitudes Alimentares (EAT-26) e o Teste de Investigação Bulímica de Edimburgo (BITE). Na análise univariada foram utilizados o teste do Qui-quadrado, o teste de Goodman para contrastes entre e dentro de proporções multinomiais. Posteriormente, foi realizada a análise multivariada através de regressão logística para controle de possíveis variáveis confundidoras. Resultados e Conclusões: Responderam o questionário 76,7% da população alvo, totalizando 468 alunas. A idade média foi 21,6 anos (DP±2,05); 98,7% eram solteiras; 64,1% residiam com amigos; seus pais tinham alto nível de escolaridade, 85,5% dos pais e 81,8% das mães com nível escolar acima ou equivalente ao nível médio completo; sendo a média de renda per capita das famílias de 3,9 salários mínimos. A maioria das alunas (81,8%) considerou seu desempenho acadêmico "bom ou excelente", 84,4% nunca haviam... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: This study aimed at estimating the prevalence of behaviors suggesting eating disorders among university students of all years in the Medicine, Nursing and Nutrition Programs of the Botucatu School of Medicine - UNESP. The associations of such behaviors with socio-demographic characteristics, academic program, self-evaluation of school performance, body mass index, body self-image and the existence of current or previous psychiatric treatment were also investigated. Method: A structured form was used in order to investigate socio-demographic aspects, self-evaluation of school performance, information concerning the existence of previous psychiatric treatment and the use and period of use of psychiatric drugs. In order to study alterations in dietary behavior, the Eating Attitudes Test (EAT-26) and the Bulimic Investigation Test of Edinburgh (BITE) were used. For univariate analysis, the Chi-square test and Goodman's contrast test among and within multinomial proportions were used. Later, multivariate analysis was performed by means of logistic regression in order to control possible confusing variables. Results and Conclusions: 76.7% of the target population answered the questionnaire, which totaled 468 students whose mean age was 21.6 years (DP±2.05); 98.7% were single; 64.1% shared a place of residence with friends; their parents were highly educated, 85.5% of their fathers and 81.8% of their mothers had graduated from high school or had attended college; their families' mean per capita income was of 3.9 minimum salaries. Most of the students (81.8%) considered their academic performance to be "good or excellent", 84.4% had never undergone psychiatric treatment. According to the Eating Attitudes Test (EAT-26), 93 students (19.9%) were identified as presenting a Abstract possible eating disorder, and 184 students (39.3%) were observed to exhibit abnormal eating patterns as shown by the Bulimic Investigation Test of Edinburgh (BITE). / Orientador: Ana Teresa de Abreu Ramos Cerqueira / Coorientador: Maria Cristina Pereira Lima / Banca: Albina Rodrigues Torres / Banca: Jair Lício Ferreira Santos / Mestre

Submitted by Haroudo Xavier Filho (haroudo.xavierfo@ufpe.br) on 2016-03-02T19:04:17Z No. of bitstreams: 2 license_rdf: 1232 bytes, checksum: 66e71c371cc565284e70f40736c94386 (MD5) Dayzene - Dissertação de mestrado.pdf: 1828584 bytes, checksum: 8e90c2f0693fdf9ad20b442adcc269c2 (MD5) / Made available in DSpace on 2016-03-02T19:04:17Z (GMT). No. of bitstreams: 2 license_rdf: 1232 bytes, checksum: 66e71c371cc565284e70f40736c94386 (MD5) Dayzene - Dissertação de mestrado.pdf: 1828584 bytes, checksum: 8e90c2f0693fdf9ad20b442adcc269c2 (MD5) Previous issue date: 2015-03-12 / CAPES / Introdução: Os transtornos alimentares e as cefaleias primárias, migrânea e cefaleia do tipo tensional, acometem frequentemente a população infantil e adolescente. Essas condições clínicas parecem compartilhar mecanismos fisiopatológicos semelhantes, relacionados à alteração no metabolismo de neurotransmissores. A associação entre cefaleia e transtorno alimentar foi observada em estudos conduzidos com populações específicas de mulheres adultas. No entanto, não existem pesquisas que evidenciem essa relação na adolescência. Objetivo: Investigar a associação entre as cefaleias primárias (migrânea e cefaleia do tipo tensional) e os sintomas de transtornos alimentares nos adolescentes. Métodos: Tratou-se de um estudo transversal e analítico realizado com 607 adolescentes, sendo 388 meninas (63,9%), com idade variando entre 11 e 18 anos, média de idade de 13,9 anos (IC 95%: 13,7; 14,0), estudantes de escolas públicas estaduais de Recife. Para o rastreamento dos transtornos alimentares foram utilizados dois questionários autoaplicáveis: o Teste de Atitudes Alimentares-26 (EAT-26) e o Teste de Investigação Bulímica de Edimburgo (BITE). A presença e a caracterização da cefaleia foram verificadas por meio de um questionário, baseado nos critérios diagnóstico da Sociedade Internacional de Cefaleia (ICHD-III, versão beta). Resultados: A migrânea esteve presente em 454/607 (74,8%) adolescentes, mostrando associação estatisticamente significativa com o gênero [309/388 (79,6%) meninas vs. 145/219 (66,2%) meninos, p<0,001; 2]. De acordo com o EAT-26, 157/607 (25,9%) adolescentes apresentaram sintomas indicativos de transtornos alimentares, sendo observada diferença estatisticamente significativa entre os gêneros [111/388 (28,6%) meninas e 46/219 (21,0%) meninos, p=0,04; 2]. De acordo com a escala BITE, 221/607 (36,4%) adolescentes apresentaram sintomas indicativos de bulimia nervosa, havendo diferença entre os gêneros [162/388 (41,8%) meninas vs. 59/219 (26,9%) meninos, p<0,001; X2]. Quanto à faixa etária, foi observada uma maior frequência das queixas de migrânea e dos sintomas de bulimia nervosa rastreados pela escala BITE nos adolescentes de 14 a 18 anos, enquanto que os sintomas de transtornos alimentares rastreados pelo Teste de Atitudes Alimentares foram mais evidentes entre os adolescentes de 11 a 13 anos. Houve associação estatisticamente significativa entre a migrânea e os sintomas de transtornos alimentares rastreados pelo EAT-26 [127/454 (28,0%) dos estudantes com migrânea apresentavam EAT positivo, em comparação a 30/153 (19,6%) dos estudantes sem migrânea, p=0,041; 2] e pelo BITE [178/454 (39,2%) estudantes migranosos apresentaram bulimia nervosa, em comparação a 43/153 (28,1%) estudantes sem migrânea, p=0,014; 2]. Na análise multivariada dos possíveis fatores explicativos da bulimia nervosa, meninas migranosas apresentaram 43,7% de chance para desenvolver bulimia nervosa [gênero feminino (ORajustada=1,85; IC 95%: 1,28; 2,66, p<0,001) e migrânea (ORajustada=1,51; IC 95%: 1,0; 2,26, p=0,048]. Conclusão: Migrânea está associada aos sintomas de transtornos alimentares em adolescentes do gênero feminino. / Background: Eating disorders and primary headaches, migraine and tension-type headache, often affect the infant and adolescent population. Those clinical conditions seem to share similar pathophysiological mechanisms, related to changes in neurotransmitter metabolism. The association between headache and eating disorder was observed in studies conducted with specific populations of adult women. However, there are no studies that demonstrate this relation in adolescence. Aims: The aim of this study was to investigate the association between primary headaches (migraine and tension-type headache) and symptoms of eating disorders in adolescents. Methods: We carried out a cross-sectional and analytical study with 607 adolescents (388 girls, 63.9% sample), aged between 11 and 18 years, mean age of 13.9 years (95% CI: 13.7; 14.0), students from state public schools in Recife. For tracing of eating disorders were used two self-reported questionnaires: the Eating Attitudes Test-26 (EAT-26) and the Bulimic Investigatory Test of Edinburgh (BITE). The presence and characterization of headache were verified using a questionnaire based on the diagnostic criteria of the International Headache Society (ICHD-III). Results: Migraine was present on 454/607 (74.8%) adolescents, showing a statistically significant association with gender [309/388 (79.6%) girls vs. 145/219 (66.2%) boys, p<0.001; 2]. According to EAT-26, 157/607 (25.9%) adolescents had symptoms indicative of eating disorders, with significant difference between genders [111/388 (28.6%) girls and 46/219 (21.0%) boys, p=0.04; 2]. According to BITE, 221/607 (36.4%) adolescents had symptoms indicative of bulimia nervosa, with significant difference between genders [162/388 (41.8%) girls vs. 59/219 (26.9%) boys, p<0.001; 2]. In relation to age, a higher frequency of complaints of migraine and of symptoms of bulimia nervosa traced by the Bulimic Test scale in adolescents aged 14 to 18 years was observed, while the symptoms of eating disorders traced by the Eating Attitudes Test were more evident among adolescents aged 11 to 13 years. There was statistically association between migraine and symptoms of eating disorders traced by the EAT-26 [127/454 (28.0%) students with migraine had positive EAT, compared to 30/153 (19.6%) students without migraine, p=0.041] and by the Bulimic Test [178/454 (39.2%) students migraineurs had symptoms of bulimia nervosa, compared to 43/153 (28.1%) students without migraine, p=0.014]. In the multivariate analysis, migraine girls has 43.7% chance of developing bulimia nervosa [gender female (ORadjusted=1.85; 95% CI: 1.28 to 2.66, p<0.001) and migraine (ORadjusted=1.51; 95% CI: 1.0 to 2.26, p=0.048)]. Conclusion: Migraine is associated to symptoms of eating disorders in female adolescents.

A alimentação é um objeto de estudo de extrema complexidade que envolve várias áreas do saber científico, entre elas a sociologia, a antropologia, a psicologia e a nutrição que se dedicam a investigar este instigante fenômeno. Até o momento, sabe-se que ela assume função social e afetiva entre os seres. O caráter simbólico dos alimentos se insere no contexto das relações sociais, sendo a família um importante instrumento de transmissão de rituais e de regras dietéticas. Do ponto de vista afetivo, a alimentação, primeiramente pela amamentação, é considerada o primeiro elo entre a mãe e o bebê e este processo acontece naturalmente quando existe uma relação harmoniosa entre a dupla. Considerando os estudos sobre as heranças psíquicas, em especial aquelas advindas de elementos transgeracionais, o objetivo desta pesquisa foi compreender o significado e as experiências emocionais da alimentação para as mães com filhas portadoras de transtornos alimentares. O percurso teórico baseou-se na pesquisa qualitativa, descritiva e exploratória. Participaram do estudo cinco mães de jovens com transtornos alimentares que frequentaram o grupo de apoio psicológico aos familiares do Grupo de Assistência em Transtornos Alimentares do Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto (GRATA-HCFMRP-USP) no ano de 2008. Como instrumento de coleta de dados foi utilizado um roteiro semiestruturado, sendo as entrevistas audiogravadas e transcritas na íntegra. A partir da análise dos dados emergiram aspectos relacionados à alimentação e seu caráter socioculturais e emocionaisl com os seguintes temas: a alimentação materna, a alimentação e o afeto e a alimentação após o transtorno alimentar da filha. Observou-se que vivências destas mães com a própria alimentação influenciaram seus desejos, a manutenção de tradições alimentares ou a transformação dessas, assim como a construção dos vínculos com suas filhas. As recordações infantis trouxeram lembranças da família e da organização da rotina alimentar considerando como personagens fundamentais deste processo suas avós e suas mães, caracterizando a presença de, pelo menos, duas gerações responsáveis pela transmissão dos hábitos, costumes alimentares e sentimentos. Ficou evidente que as necessidades alimentares destas mães não se basearam somente no caráter nutritivo dos alimentos, mas também buscaram afeto, cuidado e atenção. Elas ensaiaram tentativas de modificar as tradições e os costumes herdados com a finalidade de vivenciar outra maneira de receber e oferecer o alimento. Contudo, observou-se que os significados que a alimentação assumiu para estas mães estavam pautados nas referências e valores transmitidos por suas próprias mães. Todas apresentaram alguma restrição alimentar, seja pela dificuldade financeira familiar ou pela resistência em ingerir determinados alimentos durante a infância. Diante desses resultados, pode-se pensar que as dificuldades das mães referentes à alimentação e aos vínculos construídos a partir da relação com suas próprias mães tenderam a se repetir com as filhas, sugerindo a existência de uma herança que as antecede e atravessou gerações. Sem a pretensão de encontrar ou apontar culpados ou vítimas que justifiquem a existência da herança transgeracional nos transtornos alimentares, outros ou novos estudos serão necessários para ampliar os conhecimentos sobre este fenômeno que muitas vezes impede o viver criativo. / Feeding is a very complex object of study that involves many scientific areas, including sociology, anthropology, psychology and nutrition that investigate this interesting phenomenon. Up until now, it is known that it assumes a social and affective function among people. The symbolic quality of foods is inserted in the social relation context, considering the family a very important instrument to teach rituals and dietetic rules. From the affective point of view, feeding, first having breast feeding, is considered the first link between the mother and the baby, and this process happens naturally when there is a harmonious relation between both. Considering the studies about psychic heritage, specially the one that comes from transgenerational elements, the goal of this research was to understand the meaning and the emotional experiences of feeding of mothers who have daughters with eating disorders. The theory was based on qualitative, descriptive and exploratory research. Five mothers of young people who suffer from eating disorders took part in this study and they attended meetings to have psychological support at Grupo de Assistência em Transtornos Alimentares do Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto (GRATA-HCFMRP-USP) during the year of 2008. A semi-structured guide was used as an instrument to collect the data, and the interviews were recorded and written out verbatim. From the data analysis some aspects related to feeding and its social-psychocultural quality appeared with the following themes: breast feeding, feeding and affection, and feeding after a daughter\'s eating disorder. It was seen that these mothers\' life experiences considering their own feeding influenced their wishes, the keeping of feeding traditions or the change in them as well as the building of bonds between them and their daughters. The childhood memories brought up family memories and also memories of feeding routine having their grandmothers and their mothers as very important characters in this process, showing that at least two generations are responsible for transmitting eating habits and feelings. It was evident that these mothers\' nutritional necessities were not only based on the foods nutritional qualities, but also sought for affection, care and attention. They tried to change traditions and customs they inherited so they could try another way to give and receive food. However, it was seen that the meanings and importance of feeding to these mothers were related to the values taught by their own mothers. All of them presented some feeding restriction because of family financial difficulty or because of some resistance to the idea of eating certain kinds of food during childhood. According to these results, it is thought that the difficulties these mothers have concerning feeding and the bonds built from the relation to their own mothers tended to be repeated with their daughters. This suggests the existence of heritage that preceded them and crossed generations. There is no pretension to find or point victims or anyone to blame who could justify the existence of transgenerational heritage of feeding disorders, other studies are needed to increase the knowledge about this phenomenon that many times impede a creative living.

Fundamentando-se nas perspectivas teóricas da análise do discurso de linha francesa e da psicanálise lacaniana, busca-se investigar o significante corpo em uma paciente anoréxica. Considerando-se que o caráter primordial do significante se exerce em relação ao sujeito, buscamos compreender o sujeito anoréxico através da investigação do significante corpo. O material analisado foi constituído por uma entrevista semi-estruturada, realizada com uma paciente diagnosticada como anoréxica, em tratamento no Hospital das Clínicas de Ribeirão Preto da Faculdade de Medicina da Universidade de São Paulo. De acordo com os referenciais teóricos, a análise dos dados foi qualitativa e obedeceu ao paradigma indiciário. A análise da entrevista permitiu-nos observar que o significante \"corpo\" atrelou-se aos significantes \"peso\" e \"alimentação\" em uma mesma cadeia: como \"a única coisa que eu consigo controlar na minha vida\". O significante corpo constituiu, para o sujeito, a via encontrada na busca por sua alteridade. Desse modo, essa cadeia significante veio compor a ordem da identidade e da alteridade, sob a égide do (sem)controle. Concluímos que a queixa muda da anoréxica, enunciada sob o comportamento da recusa alimentar, era dirigida ao Outro como uma tentativa de alcançar sua alteridade. / Basing theoretical perspectives of analysis on the discourse of the Lacanian and the French line of psychoanalysis, the body signifier of an anorexic patient was investigated. Remembering that the primordial character of the signifier exerts an influence on the subject, we attempted to understand the anorexic individual through an investigation of body signifiers. The analyzed material was formed from a semi-structured interview of a patient diagnosed as anorexic, who was being treated in the Teaching Hospital das Clínicas, University of São Paulo, Ribeirão Preto. According to theoretical references, data analysis was qualitative and followed the indicated paradigm. Analysis of the interview allowed us to observe that the body signifier was linked to the ?weight? and ?feeding? signifiers in a single chain, as ?the only thing that I can control in my life?. The body signifier constituted, for the individual, the way the patient found to identify her alterity. Thus, this signifier chain established the order of the identity and alterity, by the support of (lack of)control. In conclusion, the silent complaint of anorexia, confirmed by the behavior of refusing to eat, is directed at the ?Big Other? in an attempt to attain alterity.

O profissional nutricionista é capacitado para atuar em áreas do conhecimento em que a alimentação e a nutrição se apresentam fundamentais para a promoção, manutenção e recuperação da saúde. Entre essas, estão os transtornos alimentares (TA), quadros psicopatológicos graves e atuais, cuja etiologia é bastante complexa e multifatorial. No âmbito da alimentação, apresentam importantes alterações do comportamento, variando desde restrições até compulsões alimentares. O tratamento deve ser multiprofissional e interdisciplinar, sendo o nutricionista o profissional qualificado para implementar a avaliação e orientação nutricionais. No entanto, não há estudos na literatura que abordem o papel desse profissional na equipe de tratamento, direcionando as ações de nutrição nesse contexto. Sendo assim, o objetivo deste estudo, de natureza qualitativa, foi identificar o perfil e a atuação do nutricionista que desenvolve essa atividade. Foram entrevistados seis nutricionistas inseridos em serviços especializados das regiões Sul e Sudeste do Brasil: GRATA-HCFMRP-USP em Ribeirão Preto, AMBULIM-HCFMSP-USP e PROATA-UNIFESP em São Paulo, GOTA-IEDE e Psiquiatria da Santa Casa de Misericórdia no Rio de Janeiro e GEATA-CEAPIA de Porto Alegre. Como instrumento de coleta de dados foi utilizado um roteiro semiestruturado, sendo que as entrevistas foram áudiogravadas, realizadas na cidade de origem do serviço e transcritas na íntegra. Os temas que emergiram foram: o nutricionista, a função, o fazer e o trabalho em equipe. Os participantes, apenas um do sexo masculino, tem de 29 a 52 anos de idade, de cinco a 34 anos de formação e trabalham, em sua maioria, voluntariamente no serviço há sete anos, em média. Todos fizeram curso de especialização na modalidade de lato sensu e/ou stricto sensu. A maioria já se interessava pela temática antes dessa atuação e sente-se valorizada pelo profissional ser essencial na equipe. Porém, é preciso desenvolver-se emocionalmente para a relação com o paciente a fim de compreender que os sintomas alimentares são consequências de conflitos intensos e abrangentes. Para isso, devem apresentar postura acolhedora, contudo firme. As principais dificuldades se referem às orientações quanto às modificações necessárias para melhorar a relação que o paciente estabelece com os alimentos e com o peso, ter uma abordagem psiconutricional e saber lidar com a frustração e impotência, sentimentos que comumente emergem nessa atividade. O trabalho em equipe foi caracterizado como algo que oferece segurança e respeito. Há boa comunicação entre os integrantes, o que proporciona crescimento e aprendizagem, apesar das dificuldades relativas à falta de estrutura física adequada e à inserção de novos profissionais sem experiência na área. Para todos eles, os conhecimentos adquiridos durante a graduação foram insuficientes para subsidiar essa atuação sendo necessário, o aprimoramento através de cursos de pós-graduação. Os resultados sugerem que os profissionais mostraram-se engajados nos serviços e realizados com essa conquista e atuação, apesar das limitações do cotidiano. Os desafios impostos para o campo da nutrição no contexto dos TA são inúmeros, mas apontam para a possibilidade de apreender diferentes olhares e perspectivas na direção do diálogo interdisciplinar, tendo por intuito romper a formação tecnicista tradicional e promover a integralidade do cuidado em saúde. / The nutritionist professional is able to act in areas of knowledge where the food and nutrition are fundamental to the promotion, maintenance and recovery of health. Among these are the eating disorders (ED),serious and current psychopathologic cases, which etiology is multifactor and very complex. In the realm of food field show important changes in behavior, ranging from restrictions to food compulsions. Treatment should be multidisciplinary and interdisciplinary, being the professional nutritionist the one qualified to implement evaluation and nutritional guidance. However, there areno studies in the literature that address the role of the professional treatment team, directing the actions of nutrition in this context. Therefore, the objective of this study, of qualitative nature, was to identify the profile and performance of the nutritionist who develops this activity. We interviewed six nutritionists inserted in specialized regions of South and Southeast of Brazil: GRATAHCFMRP- USP in Ribeirão Preto, USP AMBULIM-HCFMSP-and-PROATA UNIFESP, São Paulo, GOTA-IEDE and Psychiatry, Santa Casa de Misericordia in Rio de Janeiro and AEE-CEAP in Porto Alegre. As data collection instrument it was used a semi structured script, and the interviews were audio recorded, performed in the city of origin of the service and transcribed in full. The themes that emerged were: the nutritionist, the role, doing and teamwork. The participants, only one male, 29 to 52 years of age, from 5 to 34 years of training and work, mostly on a voluntary service, for seven years on average. All have current expertise in the modality lato senso and/or strict senso. Most of them had been interested in the subject before that performance and feel grateful when the professional is essential in the team. However, we need to develop ourselves emotionally to the relationship with the patient to understand that food is a symptom of intense and comprehensive conflict. This will provide friendly attitude, yet firm. The main difficulties relate to the guidance on the changes necessary to improve the relationship that the patient establishes with food and weight, have a psyco-nutritional approach and knowing how to deal with frustration and incapacity, feelings that commonly arise in this activity. Team work was characterized as something that provides security and respect. There is good communication between members, which provides growth and learning, despite the difficulties on the lack of adequate physical infrastructure and the insertion of new professionals with experience in the area. For all the knowledge acquired during the studies was insufficient to support such action is necessary, the improvement through post-graduate. The results suggest that professionals seemed to be engaged in services and carried out with this achievement and performance, despite the limitations of everyday life. The challenges for the field of nutrition in the context of the TA are numerous, but indicate to the possibility of understanding different views and perspectives in the direction of interdisciplinary dialogue, with the aim to break the traditional technical training and promote the integration of health care.

The objective of this thesis is to critically examine the diagnostic divisions of eating disorders as proposed within the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). I focus on Anorexia Nervosa, Bulimia Nervosa, Binge Eating Disorder, and Other Specified Feeding or Eating Disorder (OSFED), although there were several new categories issued in 2013. Using person-centered ethnographic interviews, focus groups, participant observation, and autoethnography, I collected qualitative data to highlight how disordered eaters perceive themselves and their behaviors in relation to their diagnoses. I recruited participants in Boston, MA from Eating Disorders Anonymous (EDA), a decentralized network of support groups for disordered eaters. Subjects in my study, as well as from EDA at large, have a wide variety of diagnoses. Building off anthropologies of the pathological body, embodiment, medicalization and neuroanthropology, I highlight how predominant scripts of mental illness in both popular media and science shape the ways that disordered eaters understand their pathological behaviors. I also examine the historical and contemporary evolution of eating disorder theory within the psychological literature, offering a reflexive approach to the theoretical foundations within the field. Interweaving psychological literature reviews with ethnographic data, I demonstrate that disordered eaters do not fit as straightforwardly into diagnostic categories as presumed. Instead, findings indicate that individuals express different combinations of symptoms that range across diagnostic divisions.

The purpose of the study is to articulate the phenomenology of the anorexic body. In order to describe the complex meaning of the anorexic body, the present research adopts the qualitative and exploratory approach of Seidman's (1991) in-depth phenomenologically based interviewing method. This involves a series of three separate interviews, with three research participants who have had personal experience of anorexia. The method of data analysis used is essentially on editing style of analysis (Miller and Crabtree, 1992) and is based on a hybrid of the grounded theory approach of Glaser and Strauss (1967) and Heidegger's (1927) ontological hermeneutics to form what Addison (1992) calls grounded interpretive research. Anorexic embodiment is conceptualised as precipitating a fundamental disturbance between the interactions of embodied consciousness and the world. The body is no longer taken-for-granted, and becomes an object for scrutiny. As an object, the body is experienced as a thing exterior to the self, and this awareness contributes to the sense of qisorder which permeates anorexic embodiment. Bodily intentionality is frustrated when the sphere of bodily actions and habitual acts become circumscribed. The character of lived temporality and lived spatiality are also effected with the anorexic's focus on the now, ushering in a spatiality of the here. These findings indicate that anorexic embodiment is experienced primarily as a disruption of the 'lived body' rather than that of the biological body. The prevailing discourses of anorexic embodiment are shown to be split between the naturalized discourses that provide a model of the body that is biologically determined and ahistorical, and the denaturalized discourses that provide a model of the body that is culturally constructed and lacks embodied givenness. It is argued that Merleau-Ponty's phenomenology of the body offers a renaturalization of the body that overcomes the nature/culture dichotomy of the naturalized and denaturalized discourses, thereby providing a solid foundation that more directly addresses the phenomenology of the anorexic body. The theoretical and treatment implications of Merleau-Ponty's renaturalization of the anorexic body are highlighted, and suggestions for further research are presented.