While cognitive-behavioral therapy (CBT) is the most well-established treatment for binge-eating disorder (BED), little is known about process factors influencing its outcome. The present study sought to explore the assessment of therapist adherence, its course over treatment, and its associations with patient and therapist characteristics, and the therapeutic alliance. In a prospective multicenter randomized-controlled trial comparing CBT to internet-based guided self-help (INTERBED-study), therapist adherence using the newly developed Adherence Control Form (ACF) was determined by trained raters in randomly selected 418 audio-taped CBT sessions of 89 patients (25% of all sessions). Observer-rated therapeutic alliance, interview-based and self-reported patient and therapist characteristics were assessed. Three-level multilevel modeling was applied. The ACF showed adequate psychometric properties. Therapist adherence was excellent. While significant between-therapist variability in therapist adherence was found, within-therapist variability was non-significant. Patient and therapist characteristics did not predict the therapist adherence. The therapist adherence positively predicted the therapeutic alliance. The ACF demonstrated its utility to assess therapist adherence in CBT for BED. The excellent levels of therapist adherence point to the internal validity of the CBT within the INTERBED-study serving as a prerequisite for empirical comparisons between treatments. Variability between therapists should be addressed in therapist trainings and dissemination trials.

L’addiction à l’alimentation (AA) est un concept ancien, mais encore sujet de controverses qui toucherait 18 à 24 % des obèses. Dans cette thèse, nous nous sommes intéressés aux intrications entre régulations du comportement alimentaire, addiction et AA, afin de mieux comprendre les mécanismes liés à la désinhibition de la prise alimentaire. Notre travail a conduit à plusieurs résultats : 1) Une revue de la littérature a permis de montrer l’existence d’interaction étroite entre les niveaux de régulation du comportement alimentaire et comment AA pourrait en être un exemple de dérégulation. 2) Une étude de cohorte a permis de démontrer l’existence de caractéristiques cliniques communes entre addictions et AA et celle d’un probable transfert d’addiction de la nicotine vers l’alimentation. 3) Sur le plan expérimental, nous avons montré qu’il existe des perturbations des ondes P300 et N200, dans l’obésité et la désinhibition alimentaire, proches de celles observées dans les addictions. 4) Enfin, nos résultats suggèrent le rôle potentiel de la ghréline comme marqueur de risque de trouble du comportement alimentaire. Ce travail ouvre des perspectives sur le plan expérimental, avec la suggestion de groupes contrôles plus pertinents ; cliniques, avec la création d’un potentiel test de dépistage rapide ; thérapeutiques, avec la mise en place d’un essai thérapeutique par tDCS / Food addiction (FA) is an old concept, but still subject to controversy. It affects 18 to 24% of obese people. In this thesis, we are interested in overlaps between food behavior regulation, addiction and FA, in order to better understand the mechanisms linked to food intake disinhibition. Our work leads to several results: 1) A review of the literature has shown the existence of close interaction between eating behavior regulation levels and how FA could be an example of their disturbance. 2) A cohort study demonstrated the existence of common clinical features between addiction and FA and a probable addiction transfer from nicotine to food. 3) From an experimental point of view, we have shown that there are disturbances of P300 and N200 ERP, in obesity and food disinhibition, close to those observed in addictions. 4) Finally, our results suggest the potential role of ghrelin as a marker for eating disorders increased risk. This work opens experimental perspectives, with the suggestion of more relevant control groups; clinical perspectives, with the creation of a screening tool; therapeutics perspectives, with the establishment of a therapeutic trial by tDCS

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This is a qualitative study which purpose is to examine the experiences of the recovery process after a treatment for eating disorders.                                                          The questions we have decided to examine are; how did the women adapt to a healthier life after treatment, what are the women's perceived experiences of the aspects related to identity and identity work, and what external social influence was seen as important for their adjustment process to a healthier life? Methods: We have used computer-supported and semi-structured interviews. There were a total of nine women who took part in the study.                                                                                                                     Results: Majority of these women have been recovered from their eating disorders, but some still have major or minor problems. They found it rather difficult to adjust their life's without an eating disorder. Conclusions: Increased self-awarness led to greater control over the eating disorder. The women could begin to confer the new features that they identified with. The social network is described as having been a major factor in the recovery process.

Eating disorders and disordered eating habits and behaviors were measured using the Eating Disorders Inventory-3 Referral Form (EDI-3 RF). The sample consisted of 159 elite, collegiate student athletes, males and females, aged 18 to 22. Five sports were represented, including basketball, gymnastics, soccer, swimming & diving, and volleyball. Overall, findings support the position that athletes, as a distinct population, and specifically female athletes and those that participate in lean sports, are at an increased risk for disordered eating behaviors and diagnosable eating disorders. Of the 159 total athletes that completed the questionnaire, 33% (n=53) of the athletes sampled met one or more referral criteria based on reported behavior in the 3 months prior. A total of 37 athletes were referred to professional healthcare providers for meeting criteria of disordered eating behavior according the the Eating Disorder Inventory-3 Referral Form.

Eating disorders are serious psychological disorders associated with debilitating lifestyle, multiple health problems and high rates of suicidality and mortality. Despite extensive research, the aetiology of eating disorders still remains unclear. Amongst the identified risk factors for eating disorders, stress has been frequently studied. The purpose of the present study was to explore the possibility that tail-pinch administered to rats could provide an animal model of stress-induced eating disturbances in humans, and whether environmental enrichment might ameliorate the effects of stress. In Experiment 1, we compared eating behaviours of rats that were reared in either enriched or standard environments and later exposed to tail-pinch and allowed to eat when food deprived. The study showed that a single exposure to tail-pinch induced eating disturbances in most of the rats. When rats were not food deprived, but were conditioned to eating when placed in test chamber, tail-pinch suppressed eating in all rats, but significantly more for rats reared under standard than in enriched conditions. Experiment 2 used a between-subjects design in which rats were reared in either a standard or enriched environment, and were either exposed to tail-pinch or not exposed during sessions in which they were not food deprived and allowed to eat. Tail-pinch suppressed the food intake of rats reared in enriched but not standard environments. Although this finding appeared to contradict results of Experiment 1, analysis of body weight revealed that exposure to tail pinch suppressed increases in weight gain across sessions more for rats reared in standard than enriched environments. The suppression of food intake during test sessions for enriched but not standard rats exposed to tail-pinch was attributed to differences in contextual conditioning and discrimination of the test chamber from home cages. Overall, results of the present study suggest that rats reared in enriched environments were more resilient to the effects of tail-pinch as a stressor. Implications of these findings for the understanding of human eating disorders are discussed.

Orientador: Wilza Carla Spiri / Resumo: Introdução: A prevalência da obesidade vem aumentando entre adultos em todo o mundo e está associada com aumento do risco de morbimortalidade, bem como redução da expectativa de vida com resultados negativos de saúde. Também associa-se a outras patologias como transtorno de ansiedade, comportamento compulsivo e desequilíbrio no comportamento do sono. Apesar da obesidade ser considerada uma patologia previnível, ainda existem grandes dificuldades associadas com a perda de peso e a sua manutenção através da modificação do estilo de vida no cenário atual, mostrando a necessidade de investigação de fatores que abordem não só o peso, mas também patologias e/ou sintomas associados. A terapia floral faz parte de um campo emergente de terapias vibracionais, e suas essências, feitas a partir de plantas silvestres, flores e árvores do campo, atuam harmonizando as emoções, e não tratando de condições físicas. Neste contexto, aparece como uma alternativa para o alivio do comportamento ansioso dos indivíduos, pois não há incompatibilidade com outros métodos de tratamento, e pode ser indicada a um grande número de pessoas em qualquer etapa da vida. Objetivo: Identificar se o tratamento com terapia floral altera o grau de ansiedade de indivíduos com sobrepeso ou obesidade, com consequente melhora no padrão de sono, redução nos sintomas de compulsão alimentar, redução na frequência cardíaca de repouso e melhora nos níveis de pressão arterial. Métodos: Ensaio Clínico Randomizado, paralelo, co... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Introduction: The prevalence of obesity is increasing among adults worldwide and is associated with an increased risk of morbidity and mortality, as well as a reduction in life expectancy with negative health outcomes. It is also associated with other pathologies such as anxiety disorder, compulsive behavior and imbalance in sleep behavior. Although obesity is considered a predictable pathology, there are still great difficulties associated with weight loss and its maintenance by modifying lifestyle in the current scenario, showing the need to investigate factors that address not only weight but also pathologies and / or associated symptoms. Floral therapy is part of an emerging field of vibrational therapies, and its essences, made from wild plants, flowers and field trees, work by harmonizing emotions, not by treating physical conditions. In this context, it appears as an alternative for the relief of the anxious behavior of individuals, as there is no incompatibility with other treatment methods, and can be indicated to a large number of people at any stage of life. Objective: To identify whether treatment with floral therapy changes the degree of anxiety of overweight or obese individuals, with consequent improvement in sleep pattern, reduction in binge eating symptoms, reduction in resting heart rate and improvement in blood pressure levels. Methods: Randomized, parallel, two-arm, double-blind, placebo-controlled, four-week clinical trial conducted at a public stitution ... (Complete abstract click electronic access below) / Doutor

Está bem estabelecido que o Transtorno Alimentar (TA), uma patologia predominantemente compulsiva, e o Transtorno de Déficit de Atenção/Hiperatividade (TDAH), uma patologia predominantemente impulsiva, coocorrem em uma frequência maior do que esperado ao acaso. A avaliação fenotípica e o estudo detalhado de pacientes que apresentam ambas as patologias (TA-TDAH) oferecem a oportunidade de compreender melhor o tipo de interação entre esses dois traços comportamentais, fundamentais no entendimento das patologias dos comportamentos aditivos. Este é um estudo transversal com 63 mulheres com diagnóstico atual de Anorexia Nervosa (AN) ou Bulimia Nervosa (BN) recrutadas do Programa de Transtorno Alimentar do Hospital de Clínicas de Porto Alegre e 254 mulheres com diagnóstico de TDAH provenientes do Programa de Déficit de Atenção e Hiperatividade do mesmo hospital, entre os anos de 2002 e 2016. A coocorrência TA-TDAH foi diagnosticada em ambos os grupos através de entrevista clínica e instrumentos validados. A partir destes achados, o grupo TA-TDAH foi comparado em termos de perfil demográfico, sintomatologia clínica e comorbidades psiquiátricas, com sua contraparte com TDAH e sem TA e com TA sem TDAH. Nossos resultados mostraram que os indivíduos com TA-TDAH apresentam aumento da prevalência de transtorno de ansiedade generalizada e transtorno obsessivo compulsivo quando comparado ao grupo com TDAH. Ainda, o grupo de TATDAH apresenta aumento das taxas de comorbidades com uso de substâncias psicoativas (SPA) e uso de bebida alcoólica quando comparados com ambos os grupos, TA e TDAH. Este aumento excedeu o efeito meramente aditivo encontrado no padrão para as comorbidades inicialmente descritas, demonstrando um padrão sinérgico, resultante provavelmente da interação entre os comportamentos compulsivos e impulsivos. Se considerando a avaliação de funcionalidade, o grupo TDAH-TA apresentou piores escores nas áreas de lazer quando comparado ao grupo TDAH e nas áreas de finanças e cognição quando comparado ao grupo com TA. Estes resultados são relevantes clinicamente pois demonstram que a coocorrência de TA e TDAH está associada ao desenvolvimento de um perfil clínico mais severo, que provavelmente exija uma abordagem diferenciada para este tipo de paciente. / It is well established that an Eating Disorder is a predominantly compulsive pathology, and that the Attention Deficit Hyperactivity Disorder (ADHD) is a predominantly impulsive pathology, which occur at a frequency deemed higher than what one would expect for events occurring at random. The phenotype assessment and the detailed study of patients diagnosed with both pathologies provide us with the opportunity to better understand the type of interaction between these two behavioral traits, which are essential to the understanding of the pathologies related to addictive behaviors. This is a cross-sectional study involving 63 women who have been currently diagnosed with Anorexia Nervosa (AN) or Bulimia Nervosa (BN), recruited from the Eating Disorder Program at Hospital das Clínicas de Porto Alegre, was well as 254 women diagnosed with ADHD from the Attention Deficit Hyperactivity Disorder Program at the same hospital, carried out between 2002 and 2016. From clinical interviews and the use of validated instruments, we have been able to attest the co-occurrence of Eating Disorders and ADHD in both groups. Then, from these findings, a comparison was made in terms of demographics, clinical symptomatology and psychiatric comorbidities: the group diagnosed with an Eating Disorder and ADHD with the group diagnosed with ADHD without an Eating Disorder and the group with an Eating Disorder without ADHD. Our results have shown that individuals with an Eating Disorder and ADHD have presented higher numbers of generalized anxiety disorder and obsessive-compulsive disorder, when compared to the group diagnosed solely with ADHD. Moreover, the group diagnosed with an Eating Disorder and ADHD presented an increase in comorbidity rates with the use of psychotropic drugs and alcohol, when compared to the groups diagnosed solely with an Eating Disorder or ADHD. This increase has exceeded the purely addictive effect found in the patterns related to the comorbidities initially described, showing a synergistic pattern, most likely resulting from the interaction between compulsive and impulsive behaviors. When taking into account the assessment of functionality, the group diagnosed with an Eating Disorder and ADHD presented the lowest numbers in leisurely areas, when compared to the group diagnosed solely with ADHD, and the lowest number in financial and cognitive areas, when compared to the group diagnosed solely with an Eating Disorder. These results are relevant from a clinical standpoint, since they demonstrated that the co-occurrence of an Eating Disorder and ADHD is linked to the development of a more serious clinical profile, which will likely demand a unique approach towards these patients.

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Cognitive behaviour therapy and interpersonal psychotherapy are the leading treatments for eating disorders. Little is understood regarding their mechanisms of action. The research described in this thesis investigated the purported mechanisms of action of two transdiagnostic versions of these treatments; enhanced cognitive behaviour therapy (CBT-E) and interpersonal psychotherapy for eating disorders (IPT-ED). A series of mediation studies were embedded within a randomised controlled trial comparing CBT-E and IPT-ED in a transdiagnostic sample of patients with eating disorders. An analytic strategy using multilevel and structural equation modelling was used to assess for statistical mediation. Three of the key purported mediators of action of CBT-E (regularity of eating, frequency of weighing, and frequency of shape checking) and the key purported mediator of IPT-ED (interpersonal problem severity) were studied. Only regularity of eating demonstrated a strong case for being a mediator of the effect of CBT-E (on frequency of binge eating). The findings were inconclusive regarding other putative mediators of the effect of CBT-E, and for interpersonal problem severity being a mediator of the effect of IPT-ED. Limitations of the research included the non-optimal choice of measures and non-optimal timing of measurements for establishing temporal precedence. Future research should investigate the mediating role of both cognitive (e.g. interpretation of weight) and behavioural processes (e.g. frequency of weighing) in CBT-E, and the role of interpersonal functioning in CBT-E and IPT-ED. Research should use daily, or session by session measurement to better assess the temporal relationship between the purported mediator/s and the outcome/s. Experimental designs comparing dismantled versions of treatment would also help determine the relative effects that different treatment procedures have on treatment outcome/s.