Introduction: Weight dissatisfaction and misperception are widespread problems in the United States as are unhealthy weight loss practices. These negative body image issues can lead to eating disorders which have serious health and quality of life consequences. Objective: To evaluate the extent to which the prevalence of distorted body image and unhealthy dieting tactics exist in adults in the US and how these are related. Methods: Data from NHANES 2000-20006 on adults aged 20-59 was used. Weight perception was assessed with the physical exam measurements of weight status and the weight history questionnaire item asking if the person considered him or herself to be underweight, normal weight or overweight. Weight loss techniques were assessed with the weight history questionnaire items asking what methods they used if they tried to lose weight. Respondents were classified as having a weight perception discord if their perception was greater than actual weight status, and as having a concord in all other cases. Results: The total sample was 6,022. 10% had a perception discord and 15% used unhealthy weight loss practices. After adjustment, a significant relationship between a perception discord and behaviors was not found--this held true for both men and women. Discussion and Conclusion: Our results were similar overall to past studies; our inability to find a relationship could have been hampered by stigma associated with the subject matter. There are clearly other factors related to the adoption of unhealthy weight loss behaviors, which need to be determined.

Subjects rated 12 female body shapes with respect to their physical attractiveness, and the extent to which they would be expected to possess various personality characteristics. The shapes were varied using 3 levels of overall weight and 4 levels of body shapeliness. The sample was modified to control for socioeconomic factors and results are based on 297 undergraduates from Caucasian, African American, and Hispanic racial backgrounds. Loglinear analyses revealed that men and women, regardless of racial background, rated shapely underweight females as most physically attractive, sexy, and ideal for a woman, followed by normal weight figures of similar proportion. African Americans, women in particular, judged the shapely normal weight figures more favorably than the other subjects. Multidimensional scaling and subsequent frequency analyses showed that those figures judged as most attractive, sexy, and ideal were also expected to be fairly emotionally stable, and most successful and interpersonally competitive, but least faithful, kind, and family-oriented. Overweight female shapes, while rated as least physically attractive, sexy, and emotionally stable, were expected to be most family-oriented, kind, and faithful. Shapely normal weight figures were judged to be attractive and sexy, and were assumed to possess a moderate amount of the personality traits in question. The results suggest that Caucasian and Hispanic subjects prefer shapely underweight women, while African Americans, particularly women, find shapely underweight and shapely normal weight women to be physically appealing. African American women also rate shapely normal weight women favorably with respect to personality traits. This perceptual difference may help inoculate them from developing eating disturbances and account for the low prevalence rate of eating disorders in African Americans compared to women of other racial backgrounds. It is suggested that future research identify those beliefs, values or behaviors that seem to inoculate African American women from developing eating disorders. Once identified, mental health professionals may facilitate their development in those women who are likely to have eating problems.

1 Filozofická fakulta Univerzity Karlovy v Praze, Katedra psychologie Název práce: Využití terapeutické techniky video konfrontace v léčbě poruchy příjmu potravy Název práce v angličtině:Video confrontation in the treatment of eating disorders Autor práce: Mgr.Milena Adámková Ségard, Ph.D. Vedoucí práce: Doc. PhDr. Slávka Fraňková, DrSc. Rok odevzdání: 2012 Abstrakt anglicky The goal of this pilot study is to search for a specific influence of the video confrontation technique when used as a therapy for a patient with eating disorder. For the method a questionnaire was chosen which includes semantic differentials and separate sentences. The respondents were selected based on availability. The 26 respondents included in this research were all women diagnosed with anorexia nervosa or bulimia nervosa. All were hospitalized in an eating disorder unit. The outcome of the study confirmed that video confrontation resulted in the patients describing the picture of their own body less ungainly and they were less ashamed about their own body. The outcome of the study confirmed that video confrontation resulted in the patients with anorexia nervosa describing the picture of their own body as more elegant, attractive, but also more worthless, more ugly and ungainly. In the case of patients with bulimia nervosa a...

Thesis advisor: Stephen J. Pope / The aim of this dissertation is to expand a contemporary multidimensional discourse on the nature of eating disorders to encompass also a moral dimension. Eating disorders are complex phenomena which include biomedical, psychological, and sociocultural components. This dissertation brings the psychosocial literature on eating disorders and body dissatisfaction into dialogue with contemporary studies in Thomistic moral theology, and argues that such a multidisciplinary dialogue can illuminate new insights both for the study of eating disorders and for recent efforts to recover Thomistic moral theology in a contemporary context. Beginning empirically, the dissertation examines recent evidence showing that exposure to &ldquo;thin-ideal images&rdquo; in the mass media is positively correlated with an increase in body dissatisfaction and eating disorder symptomatology. Socioculturally, the explanation for this phenomenon is called &ldquo;thin-ideal internalization,&rdquo; and basically measures the extent to which individuals &ldquo;buy into&rdquo; the validity of images using ultra-thin female models as a paradigm of beauty. Women who have a high level of internalization desire to conform to a thin-ideal, and behave accordingly, even when they are rationally aware of the unrealistic and unhealthy nature of such an ideal. Turning to Thomas Aquinas' moral theology, the dissertation argues that thin-ideal internalization is a form of connatural knowledge, an affective form of knowing (<italic>per modum inclinationis</italic> or <italic>ex instinctu</italic>) which is at the very basis of Aquinas' moral theology, both in explaining the operation of habits and in explaining the role of grace in the moral life through charity and the gifts of the Holy Spirit. This dissertation argues that Aquinas' theory of connatural knowledge provides a relevant and constructive contribution to the study of eating disorders, especially on the relationship between body dissatisfaction and eating disorder symptamatology. Additionally, the incorporation of the psychosocial literature on eating disorders into Thomistic moral theology provide a valuable contribution to Thomistic moral theology in the effort to understand the role of the affections in moral deliberation, the development of habits, and the importance of Christian practices in the moral life. / Thesis (PhD) — Boston College, 2011. / Submitted to: Boston College. Graduate School of Arts and Sciences. / Discipline: Theology.

Thesis advisor: Barbara E. Wolfe / Despite the chronicity and less than optimal outcomes of inpatient treatment (IPT) for anorexia nervosa (AN), treatment guidelines continue to reflect the common notion of one-size-fits-all and the process of weight restoration continues to be poorly understood. Weight restoration, a primary goal of IPT for AN, does not occur in isolation but rather reflects an adaptation process within internal and external environments. It is unknown whether or not there are unique patterns of change in body weight that are associated with factors identified in the existing literature as being predictors of weight gain. The purpose of this study was to explore the extent to which patterns of change in body weight existed among individuals during IPT for AN, and the relationship with factors identified in the existing literature as being predictors of weight gain (i.e., age at time of admission, admission caloric intake, percent of ideal body weight [IBW] at time of admission, body weight at time of discharge, body mass index [BMI] at time of discharge). Individuals who were diagnosed with AN and admitted to the inpatient unit of an eating disorder treatment facility in the Northeast between January 1, 2012 to December 31, 2015 were included in this retrospective, exploratory study (N = 500). Group-based trajectory modeling (GBTM) was used to identify distinct trajectories of change in body weight, and to determine the risk of being in a particular trajectory. Four distinct trajectories were identified: weight gain (n = 197), weight loss (n = 177), weight plateau (n = 82), and weight fluctuate (n = 44) groups. Significant predictors of trajectories were age, history of prior IPT for AN, admission caloric intake, body weight at time of admission and discharge, and length of stay. Results from this study suggest that a further understanding of patterns of change in body weight among individuals with AN, will help guide assessment and treatment interventions and consequently influence outcomes. Additionally, there is an opportunity to update treatment guidelines and recommendations for AN. / Thesis (PhD) — Boston College, 2016. / Submitted to: Boston College. Connell School of Nursing. / Discipline: Nursing.

Os transtornos alimentares (TAs) são caracterizados como graves perturbações no comportamento alimentar, que podem resultar em prejuízos biológicos, psicológicos e sociais. A prevalência é substancialmente maior no sexo feminino e os sintomas eclodem predominantemente na adolescência, coincidindo com a transição psicossocial que marca essa etapa do ciclo vital e a intensificação das vivências sexuais. Sob a ótica da psicanálise, os TAs podem ser compreendidos como respostas somáticas a estados de tensão emocional desencadeados por processos mentais que não puderam ser simbolizados. Essa dificuldade de simbolização parece estar relacionada à impossibilidade da adolescente se individuar, o que necessitaria da assunção de um corpo e uma mente de mulher adulta. A fusão psíquica e decorrente angústia de separação em relação à figura materna também estão relacionadas com as representações inconscientes da feminilidade: a irrupção da sexualidade na adolescência leva a menina a vivenciar um luto pela perda do corpo infantil que, assim como os pais da infância, está sendo deixado para trás. Partindo-se da hipótese de que o sintoma da recusa alimentar pode ser considerado como uma defesa inconsciente utilizada para obliterar o processo de separação-individuação, que é parte inerente ao desenvolvimento emocional, o presente estudo teve por objetivo investigar o desenvolvimento da sexualidade e da feminilidade em mulheres que desenvolveram TAs, na perspectiva das pacientes, de suas mães e de seus pais, buscando estabelecer relações entre esses aspectos fundamentais da constituição subjetiva e os sintomas que caracterizam o quadro psicopatológico. Trata-se de um estudo de caso coletivo, descritivo e transversal, com enfoque qualitativo. As participantes eram adolescentes e jovens adultas com TAs, vinculadas ao Grupo de Assistência em Transtornos Alimentares (GRATA) do Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (HC-FMRP-USP), e seus respectivos pais (casal parental, entrevistados em separado), totalizando sete tríades edípicas. Os instrumentos utilizados para a coleta dos dados foram: roteiro de entrevista semiestruturada, aplicada individualmente com cada membro da tríade; diário de campo, elaborado pela pesquisadora após as entrevistas; e Critério de Classificação Econômica Brasil/2015. As entrevistas foram gravadas em áudio para posterior transcrição e análise temática. Os dados foram interpretados com o apoio do referencial teórico da psicossomática psicanalítica de Joyce McDougall. Os resultados demonstraram que a dinâmica psíquica das tríades era marcada por fusão entre mãe e filha, e distanciamento afetivo do pai. A feminilidade era vivenciada tanto pelas filhas quanto pelas mães como equivalente à vulnerabilidade, tornando-se fonte de angústias. Para os genitores do sexo masculino, a feminilidade das filhas foi vivenciada como ameaçadora, suscitando afastamento entre pai e filha na época da puberdade. Evidenciou-se dificuldades, por parte das filhas, no acesso à genitalidade, que guarda relação com a dificuldade no processo de individuação e separação em relação aos pais da infância. Os achados proporcionam insumos para a prática clínica no que concerne à articulação entre as vivências relacionadas à sexualidade/feminilidade e a precipitação e manutenção dos sintomas de TAs, proporcionando uma compreensão mais abrangente dos aspectos psicológicos por parte dos profissionais envolvidos na assistência, prevenção e promoção de saúde na adolescência. / Eating disorders (ED) are characterized by severe disturbances in eating behavior, which may result in biological, psychological and social prejudices. Prevalence is significantly higher in female gender and symptoms start mainly during adolescence, coinciding with the psychosocial transition that marks this stage of vital cycle and the intensification of sexual experiences. From the perspective of psychoanalysis, ED can be understood as somatic responses to emotional tension triggered by mental processes that could not be symbolized. This difficulty of symbolization seems to be related to the adolescent\'s impossibility to individuate, which would require an adult´s woman body and mind. Psychic fusion and the resulting anxiety from separation of the mother figure is also related to the unconscious representations of femininity: the eruption of sexuality in adolescence leads the girl to grieve for her child body, and also her child\'s parents, which are being left behind. Starting from the premise that the symptom of food refusal may be regarded as an unconscious defense used to obliterate the process of separation-individuation, which is an inherent part of emotional development, the present study aimed to investigate the development of sexuality and femininity in women who developed ED, from the perspective of patients, their mothers and their fathers, seeking to establish links between these fundamental aspects of subjective constitution and the symptoms that characterize the psychopathological condition. It is a collective case study, descriptive and cross-sectional, with qualitative approach. Participants were female adolescents and young adults with ED, linked to the Group of Assistance on Eating Disorders (GRATA), from the Clinics Hospital of the Faculty of Medicine of Ribeirão Preto, University of São Paulo (HC-FMRP -USP), and their parents (parental couple, interviewed separately), totalizing seven oedipal triads. The instruments used for data collection were: semi-structured interviews, applied individually with each member of the triad consisting of daughter-mother-father; field diary, prepared by the researcher during data collection; and Brazilian Economic Classification Criterion/2015. Interviews were audio-recorded for later transcription and thematic analysis. Data was be interpreted with the support of the theoretical framework of Joyce McDougall´s psychoanalytic psychosomatic. Results showed that the triads´ psychic dynamic included mother-daughter fusion, and father´s detachment. Mothers and daughters perceived femininity as equivalent to vulnerability and source of distress. Fathers were frightened by their daughters´ femininity, which made them distance themselves. Daughters´ difficulties regarding reaching genitality was evident, and was associated with difficulties of individuation and separation from the parents from childhood. This study provides input into clinical practice with regard to the relationship between the experiences related to sexuality/femininity and symptoms of ED, providing a more comprehensive understanding of the psychological aspects related to sexuality by the professionals involved in care, prevention and health promotion in adolescence.

A literatura aponta que casos de transtornos alimentares em homens têm uma menor incidência do que em mulheres e que, até os anos 80, questões relacionadas à imagem corporal eram vistas como uma preocupação feminina, porém estudos recentes demonstram que os homens também estão sofrendo com preocupações relativas à corporeidade e isso se reflete no comportamento alimentar, na prática de exercícios físicos e na adesão às dietas. Apesar disso, quadros clínicos de homens com anorexia e/ou bulimia nervosas ainda são pouco conhecidos e apresentam uma enorme complexidade diagnóstica. O objetivo deste estudo foi investigar o modo singular como portadores de anorexia e/ou bulimia nervosas vivenciam o corpo e a imagem corporal e como os acompanhantes/familiares e os profissionais de saúde percebem a problemática desses rapazes em relação à corporeidade, visando compreender essa singularidade e qual a sua influência na evolução desses transtornos alimentares e no tratamento. Trata-se de uma pesquisa com abordagem qualitativa, priorizando um enfoque exploratório, conduzida segundo o método de estudo de caso. O estudo compreende três casos e a população do universo de cada caso é composta por: paciente, seus respectivos acompanhantes/familiares (que o acompanharam durante tratamento) e profissionais de saúde responsáveis diretos pela assistência em cada caso (psicólogo, nutricionista, médico nutrólogo e psiquiatra). O contexto da investigação é de um serviço especializado na assistência em transtornos alimentares. Para a coleta de dados a pesquisadora utilizou três fontes: (1) consulta aos prontuários dos participantes (pacientes), visando obter informações clínicas que complementarão as informações obtidas com os profissionais; (2) entrevistas individuais semi-estruturadas com os participantes (pacientes, acompanhantes e profissionais de saúde) e (3) diário de campo. Primeiramente foi realizada análise de cada caso separadamente, as entrevistas foram submetidas à análise de conteúdo na modalidade temática, o que proporcionou conhecer como profissionais de saúde e familiares percebem a forma com que o paciente vivencia sua corporeidade, bem como a ótica do próprio paciente. Em seguida, o material coligido a partir das entrevistas, prontuário e diário de campo foi triangulado e submetido à interpretação, seguindo as proposições da teoria psicanalítica, inspirando-se principalmente no trabalho de Winnicott. Os resultados da análise dos casos sugeriram que estes rapazes não foram capazes de lidar com emoções primitivas e consequentemente, não foram capazes de desenvolver a capacidade de pensá-las e elaborá-las, expandindo essas emoções impensáveis para o corpo. Dessa forma, conclui-se que esses rapazes usam o corpo como uma fortaleza que os protege da vivência de sentimentos tão angustiantes, como invasão, desamparo e solidão. (FAPESP). / Literature shows that cases of males with eating disorders are in less incidence than females and that until the eighties issues related to body and body image were seen as a female concern. However, current studies present that males are also suffering due to worries regarding corporeity and it reflects on the eating habits, on the practice of physical exercises and on diet habits. In spite of it, clinical cases of males who develop anorexia and/or bulimia nervosa still are scarcely known and have an enormous diagnostic complexity. The aim of this study was to investigate the singular way of how males with eating disorders (anorexia nervosa, bulimia nervosa) experience body and body image and how family and health professionals perceive the troubles of these males with regards to their corporeity, intending to understand this singularity and its influence in the development of an eating disorder and in the treatment. It is a qualitative, exploratory research, carried out according to the case study methodology. This study comprehends 3 cases and the population of each case is composed by: patient and his respective family (who have followed the patient throughout the illness and treatment) and health professionals (responsible for the assistance to the patient: nutritionist, psychologist, psychiatrist, nutrologist). It was carried out in the eating disorders service of the Hospital das Clínicas da FMRP-USP (Faculdade de Medicina de Ribeirão Preto - Universidade de São Paulo - USP). The data was collected from 3 sources: (1) consultation to the medical reports of the patients, in order to obtain clinical and socio - demographic information, (2) individual interview with the participants (patients, family and professionals), (3) diary (where I wrote feelings and impressions I had throughout the research process and interviews). Firstly each case was analyzed separately; the interviews were transcribed literarily and submitted for theme-based content analysis. After that, the data collected from the interviews, medical reports and diary were interpreted mainly according to the psychoanalytic approach of Winnicott. The results of the analysis of the cases suggested that these males were not able to deal with primitive emotions inside themselves and consequently, not able to develop the skill to think about them and elaborate these emotions, expanding these unthinkable feelings to their body. In this manner these males use their body as a fort to protect them from overwhelming feelings such as invasion, abandonment and solitude. (FAPESP).

O acolhimento é um dispositivo técnico e político que visa garantir à população um atendimento em saúde usuário-centrado e com elevada resolutividade em suas ações. O vínculo entre profissional e usuário é a relação que possibilita que a autonomia e a cidadania sejam estimuladas, na participação ativa do usuário no serviço e na construção de saberes sobre saúde. No entanto, visto a relação conflituosa que se estabelece entre anoréxicos e bulímicos, e os profissionais de saúde que tratam desses pacientes, este estudo teve por objetivo avaliar como é o processo de acolhimento dos usuários do Grupo de Assistência em Transtornos Alimentares do Hospital das Clínicas da Faculdade de Medicina - Campus USP (GRATA-HCFMRP-USP) e como se dá o vínculo entre os profissionais e os usuários, ambos inseridos nesse serviço. Através da Avaliação Qualitativa de Quarta Geração, que tem como base teórica o Construtivismo, e como ferramenta metodológica o Círculo Hermenêutico-Dialético de Guba e Lincoln, foram entrevistados 16 usuários e 7 profissionais do serviço. O Círculo Hermenêutico-Dialético teve a finalidade de fazer emergir construções sobre os significados do acolhimento e do vínculo, que foram negociados entre os participantes da pesquisa. Os dados foram analisados pelas construções conjuntas emergidas, dos pontos consensuais e divergentes levantados nas entrevistas, e também por meio de análises de documentos e das observações no serviço. Os dados mostraram que há alguns elementos que são essenciais para que o acolhimento aconteça e para que o vínculo se estabeleça, são eles: integralidade no serviço, intersetorialidade, interdisciplinaridade, formação profissional, vínculo e humanização do atendimento. Respectivamente, o GRATA mostrou ser um grupo que busca a integralidade em seu atendimento, no entanto essa integralidade pode ser prejudicada pelo excessivo emprego do modelo biomédico na atuação de alguns profissionais; a articulação intersetorial com os vários profissionais e setores de saúde mostrou-se fundamental ao serviço, apesar do HCFMRP-USP apresentar algumas deficiências quanto a estrutura física e organizacional; há uma trabalho interdisciplinar consistente na equipe, prejudicado apenas por algumas sobrecargas de funções e excessivo emprego de uma visão biomédica de alguns; as atividades de capacitação e supervisão mostraram-se fundamentais ao trabalho, podendo ser estendidas aos outros profissionais do HCFMRP-USP; os vínculos entre profissional e usuário mostraram-se consistentes e promissores de espaços dialógicos, no entanto prejudicados por fatores como a falta de salas, a inabilidade da escuta qualificada por alguns profissionais ou a rotatividade de profissionais; a relação entre os usuários mostrou-se um recurso de enfrentamento ao transtorno, porém, algumas vezes, prejudiciais ao tratamento, sendo que atividades que poderiam ser oferecidas pelo serviço foram citadas como redutoras dos danos causados por essas más relações; o GRATA, enfim, foi considerado um serviço que busca um atendimento usuário-centrado com considerada resolutividade, com procedimentos que priorizam a dimensão humana do sujeito atendido, apesar de algumas limitações e deficiências vistas. / The user embracement is a technical and political way aiming to guarantee the population a type of health assistance with high resolution. The attachment between the health professional and the patient is the relationship which makes possible that the autonomy and the citizenship are stimulated by an active participation of the user in the service and in the health knowledge construction. However, due to the conflicting relationship usually established between the anorexic and bulimic patients with the health professionals dealing with them, this investigation had the purpose to access how the user embracement process is in the Assistance Group of Eating Disorders of the University Hospital of the Ribeirão Preto Medical School (GRATA-HCFMRP-USP), and how the attachment between users and health professional is established. By means of the Fourth Generation Evaluation, which is based in the theoretical framework of the Constructivism and uses Guba and Lincoln\"s Hermeneutic-Dialectic Circle as methodological tool, 16 patients and 7 health professionals were interviewed. The Hermeneutic-Dialetic Circle was employed with the purpose of allowing the appearance of constructions about the meaning of the user embracement and of the attachment, which are negotiated among the research participants. The data were analyzed by the emerged constructions, the consensual and divergent aspects raised in the interviews and also by analysis of the documents and observations available in the service. The data disclosed that some elements are essential for the establishment of the user embracement and the attachment: service integrality, intersectoriality, interdisciplinary approach, degree of professional education, attachment and humanization of the health assistance process. Respectively, the GRATA showed to be a group seeking an integral patient assistance, although this integrality can be affected by the exceeding use of the biomedical model of some professionals; the sectorial articulation with the various professionals and health departments was fundamental to the service, despite some deficiencies of the HCFMRP-USP regarding its physical and structural organization; there is a consistent interdisciplinary aspect within the service, however influenced by function overload and excess use of the biomedical approach in some health professionals; the training and supervision activities were considered fundamental, which could also be extended to other professionals of the HCFMRP-USP; the attachments between the professionals and the patients were consistent and revealed some potentiality for dialogic spaces, despite being prejudiced by the lack of enough rooms, inability of some professionals for an adequate listening of the patient, and the professionals\" turnover; the relationship among the patients was considered an useful resource for facing the problem, even though it sometimes influenced the treatment negatively, considering that activities which could be offered by the service were supposed to attenuate the harm imposed by these relationships; the GRATA, in the end, was regarded as a service seeking a model of assistance centered in the patient, having a considerable degree of resolution and tending to adopt procedures that highlight the patient human dimension, despite the occurrence of some limitations and deficiencies.

O objetivo deste estudo foi avaliar a imagem corporal, os comportamentos alimentares e o autoconceito de pré-adolescentes com sobrepeso, obesos e não-obesos. Trata-se de um estudo com delineamento de comparação de grupos e amostra de conveniência. Participaram do mesmo, dois grupos com sobrepeso e obesos e não-obesos constituídos, respectivamente, por 54 pré-adolescentes com sobrepeso e obesos e 50 não-obesos, de escolas da rede pública da cidade de Ribeirão Preto - SP. O grupo com sobrepeso e obesos caracterizou-se por 29 meninas e 25 meninos, e o grupo dos não-obesos foi constituído de 28 meninas e 22 meninos, tendo estes sido avaliados por dois instrumentos: EBBIT- Teste de Comportamento Alimentar e Imagem Corporal de Pré- Adolescentes e Escala Infantil Piers-Harris de Autoconceito. O que sinto e penso sobre mim mesmo. Foram medidos seus pesos e alturas, a fim de se obter o Índice de Massa Corporal para a idade e o gênero. A análise dos dados se deu por meio dos resultados descritivos e resultados comparativos, utilizando-se o teste estatístico não-paramétrico Mann-Whitney, comparando-se os grupos entre si e os gêneros (p<=0,05). Os resultados mostraram que os pré-adolescentes obesos estão mais insatisfeitos com seus corpos e apresentam mais sinais de restrição alimentar que os pré-adolescentes não-obesos. Apesar disso, ao comparar meninas não-obesas com meninos não-obesos, verificou-se maior insatisfação naquelas que nestes, indicando que a pressão sociocultural para um corpo magro tende a ser maior no sexo feminino, e, por isso, há maior insatisfação apresentada nesse grupo, apesar dessas meninas possuírem o peso dentro dos parâmetros de normalidade. Nenhum dos grupos apresentou indícios significativos de vii desordens no comportamento alimentar. Quanto à avaliação do autoconceito, o grupo com sobrepeso e obesos não diferiu do grupo dos não-obesos de um modo geral, mostrando que, apesar de estarem com o peso acima do esperado, eles se avaliam com características físicas e atributos pessoais positivos. Observou diferença ao avaliar meninas não-obesas e meninos não-obesos, com relação ao escore total do autoconceito, ao status intelectual acadêmico e ao comportamento, indicando que elas apresentaram um autoconceito, um status intelectual acadêmico e um comportamento inferior aos dos meninos não obesos. No que diz respeito à popularidade e à aparência física e atributos pessoais - subescalas avaliadas na escala de autoconceito - também não se confirmaram diferenças. A diferença encontrada esteve na avaliação da felicidade e satisfação, na qual as meninas obesas mostraram-se menos felizes e satisfeitas que os meninos obesos e as meninas não-obesas. Quanto à ansiedade, os meninos obesos mostraram-se mais ansiosos que os meninos não-obesos e menos ansiosos que as meninas obesas. O comportamento foi avaliado com índice melhor nos meninos não-obesos, que nos meninos obesos. Portanto, este estudo mostrou que os pré-adolescentes obesos estão mais insatisfeitos com suas imagens corporais e tendem a apresentar mais comportamentos de restrição alimentar quando comparados com os pré-adolescentes não-obesos. Por outro lado, parte dos resultados obtidos minimizou a concepção de que pré-adolescentes obesos têm problemas comportamentais, baixa auto-estima, baixo rendimento escolar e competência social. / This study aimed to assess the body image, eating behaviors and self-concept of overweight, obese and non-obese preadolescents. We carried out a group comparison study with a convenience sample. Two groups participated: overweight, obese and nonobese, which included, respectively, 54 overweight and obese and 50 non-obese preadolescents from public schools in Ribeirão Preto-SP, Brazil. The overweight and obese group consisted of 29 girls and 25 boys, and the non-obese group of 28 girls and 22 boys, who were assessed through two instruments: EBBIT Preadolescent Eating Behaviors and Body Image Test and the Piers-Harris Children\'s Self-Concept Scale What I feel and think about myself. Weight and height were measured to obtain the Body Mass Index (BMI) for their age and gender. Data were analyzed through descriptive and comparative results, using Mann-Whitneys non-parametric statistical test for intergroup and gender comparison (p<=0,05). Results showed that obese preadolescents are more dissatisfied about their bodies and present more signs of eating restrictions than non-obese preadolescents. Nevertheless, when comparing non-obese boys with girls, we found greater dissatisfaction among girls than boys. None of the groups presented significant eating behavior disorder rates. As to the assessment of their self-concept, in general, we found no difference between the overweight and obese and the non-obese group, showing that, although their weight exceeds expected levels, they assess their physical characteristics and personal attributes positively. Total self-concept scores, intellectual academic status and behavior differed between non-obese girls and boys, indicating that they presented a self-concept, an academic intellectual status and a behavior inferior to that of non-obese boys.. With respect to popularity, physical appearance and personal attributes subscales assessed on the Self-Concept Scale -, no differences were confirmed either. We found differences for happiness and satisfaction assessment, in which obese girls showed to be less happy and satisfied than obese boys and non-obese girls. What anxiety is concerned, obese boys showed to be more anxious than non-obese boys and less anxious than obese girls. Non-obese boys behaviors were assessed better than that of obese boys. Therefore, this study showed that obese preadolescents are more dissatisfied with their body images and tend to present more food restriction behaviors in comparison with non-obese pre-adolescents. On the other hand, part of the obtained results minimized the conception that obese preadolescents have behavioral problems, low self-esteem, low school results and social competence.

Pacientes com transtornos alimentares freqüentemente apresentam comorbidades com outros transtornos psiquiátricos, em especial com os transtornos de humor. Apesar de estudos recentes sugerirem uma íntima relação com o transtorno bipolar, o estudo do espectro bipolar em suas formas abrangentes ainda não foi realizado nesta população. O presente trabalho estudou, em pacientes com transtornos alimentares atendidos em serviço terciário, a ocorrência do espectro bipolar e os correlatos de impulsividade, imagem corporal, sintomas de humor ao longo da vida, adequação social e qualidade de vida. Avaliou sessenta e nove pacientes com diagnóstico de anorexia nervosa, bulimia nervosa ou transtorno alimentar sem outra especificação e, como grupo comparativo, sessenta e nove mulheres sem diagnóstico de transtornos alimentares ou transtorno bipolar. A avaliação foi constituída pela Entrevista Clínica Estruturada para Transtornos do Eixo I do DSM IV, avaliação clínica dos critérios de Zurich para diagnóstico do espectro bipolar, a Escala de Impulsividade de Barrat, o Questionário de Imagem Corporal, a Escala de Auto-avaliação de Hipomania, a Entrevista Clínica Estruturada para o Espectro do Humor, Escala de Hamilton para Avaliação de Depressão, Escala de Young para Avaliação de Mania, a Escala de Adequação Social e a Escala de Avaliação da Qualidade de Vida. As comparações das médias das variáveis contínuas foram realizadas por meio dos testes de Kruskal- Wallis e Mann-Whitney. A associação entre as variáveis categóricas e os grupos foi descrita através de tabelas de contingência e analisadas através do teste Chi- Quadrado de Pearson ou Exato de Fisher. A análise multivariada pelo método de stepwise foi realizada para verificar o efeito das variáveis sobre a imagem corporal, adequação social e qualidade de vida. O nível de significância alfa foi estabelecido em 5%. Os resultados mostraram que 68,1% das pacientes apresentaram comorbidade com espectro bipolar e isto esteve associado à maior renda familiar, proporção de pessoas casadas, comorbidade com uso de substâncias e mais sintomas maníacos/hipomaníacos ao longo da vida. Tanto o grupo com e sem comorbidade com espectro bipolar apresentaram maiores níveis de gravidade em todos os desfechos avaliados em relação ao grupo comparativo. No grupo de pacientes com comorbidade com espectro bipolar a qualidade de vida, impulsividade e comportamento suicida influenciaram a imagem corporal. Estes resultados mostraram que o espectro bipolar é uma comorbidade comum em pacientes com transtornos alimentares e está associado a correlatos de importância clínica, notadamente a comorbidade com uso de substâncias. Devido ao padrão de semelhança entre os grupos com e sem comorbidade com o espectro bipolar em relação a diversos desfechos avaliados a identificação da comorbidade pode ser difícil. Entretanto, o diagnóstico preciso e a identificação criteriosa de correlatos clínicos pode contribuir para futuros avanços no tratamento destas condições / Eating disorder patients often have comorbidities with other psychiatric disorders, especially with mood disorders. Although recent studies suggest an intimate relationship with bipolar disorder, the study of bipolar spectrum broader definition has not been done in this population. This work studied the occurrence of bipolar spectrum and correlates of impulsivity, body image, mood symptoms throughout life, social adjustment and quality of life in eating disorders patients of a tertiary service. Sixty-nine female patients diagnosed with anorexia nervosa, bulimia nervosa or eating disorder not otherwise specified and, as a comparative group, sixty-nine women without a diagnosis of eating disorder or bipolar disorder were evaluated. The evaluation comprised the Structured Clinical Interview for DSM IV Axis I Disorders, clinical criteria for diagnosis of Zurich bipolar spectrum, Barratt Impulsiveness Scale, the Body Shape Questionnaire, the Hypomania Checklist-32, the Structured Clinical Interview for Mood Spectrum, Hamilton Depression Rating Scale, Young Mania Rating Scale, Social Adjustment Scale and the World Health Organizations Quality of Life Questionnaire. Kruskall-Wallis and Mann-Whitney tests compared means of continuous variables. The association between categorical variables and the groups were described using contingency tables and analyzed using the chi-squared or Fisher exact test. Multivariate analysis using the stepwise method was performed to verify the effect of variables on body image, social adjustment and quality of life. The level of significance alpha was set at 5%. The results showed that 68,1% of patients had comorbidity with bipolar spectrum and this was associated with higher family income, proportion of married people, comorbidity with substance use and more manic/hypomanic symptoms throughout life. The groups with or without comorbidity with bipolar spectrum showed more severity in all outcomes compared with the comparison group. In patients with comorbid bipolar spectrum, quality of life, impulsivity and suicidal behavior influenced the body image. These results showed that the bipolar spectrum is a common comorbidity in patients with eating disorders and is associated with correlates of clinical importance, notably the comorbidity with substance use. Due to the pattern of similarity between the groups with and without comorbid bipolar spectrum in relation to various outcomes evaluated the identification of comorbidity can be difficult. However, the precise diagnosis and careful identification of clinical correlates may contribute to future advances in treating these conditions