The present work has been implemented as a literature study aimed to investigate the prevalence, possibly causes and consequences of an eating disorder. In today's modern society individuals are living with a constant reminder from the media about how a person should look and act to blend into the social norms and expectations of the modern society. This literature review has been analysed on the basis of concepts such as identity, gender identity and gender. In addition previous research has been analysed in terms of themes, history, possible causes/risk factors, media, body image and control, depression, shame and guilt as well as culture. The above themes were analysed on the basis of behaviouristic theory and role theory. The conclusion of the present work is that an eating disorder is 10 times more common in girls than boys. Furthermore present work has shown that Anorexia Nervosa, Bulimia Nervosa and UNS previously existed even though it was not documented as a medical condition. Another conclusion is medias exposure of the stereotypical body image which contributes to an increased development of the medical conditions mentioned above.

Anorexia nervosa und unipolare Affektive Störungen stellen häufige und schwerwiegende kinder- und jugendpsychiatrische Störungsbilder dar, deren Pathogenese bislang nicht vollständig entschlüsselt ist. Verschiedene Studien zeigen bei erwachsenen Patienten gravierende Auffälligkeiten in den kognitiven Funktionen. Dahingegen scheinen bei adoleszenten Patienten lediglich leichtere Einschränkungen in den kognitiven Funktionen vorzuliegen. Die Prävalenz der Anorexia nervosa und unipolaren Affektiven Störung ist mit Beginn der Adoleszenz deutlich erhöht. Es ist anzunehmen, dass kognitive Dysfunktionen, die sich bereits in diesem Alter abzeichnen, den weiteren Krankheitsverlauf bis in das Erwachsenenalter, die Behandlungsergebnisse und die Prognose maßgeblich beeinträchtigen könnten. Zudem ist von einem höheren Chronifizierungsrisiko auszugehen. In der vorliegenden Arbeit wurden daher kognitive Funktionen bei adoleszenten Patientinnen mit Anorexia nervosa sowie Patienten mit unipolaren Affektiven Störungen untersucht. Die Überprüfung der kognitiven Funktionen bei Patientinnen mit Anorexia nervosa erfolgte vor und nach Gewichtszunahme. Weiterhin wurden zugrundeliegende biologische Mechanismen überprüft. Zudem wurde die Spezifität kognitiver Dysfunktionen für beide Störungsbilder untersucht und bei Patienten mit unipolaren Affektiven Störungen geschlechtsbezogene Unterschiede exploriert. Insgesamt gingen 47 Patientinnen mit Anorexia nervosa (mittleres Alter 16,3 + 1,6 Jahre), 39 Patienten mit unipolaren Affektiven Störungen (mittleres Alter 15,5 + 1,3 Jahre) sowie 78 Kontrollprobanden (mittleres Alter 16,5 + 1,3 Jahre) in die Untersuchung ein. Sämtliche Studienteilnehmer durchliefen eine neuropsychologische Testbatterie, bestehend aus Verfahren zur Überprüfung der kognitiven Flexibilität sowie visuellen und psychomotorischen Verarbeitungsgeschwindigkeit. Neben einem Intelligenzscreening wurden zudem das Ausmaß der depressiven Symptomatik sowie die allgemeine psychische Belastung erfasst. Die Ergebnisse legen nahe, dass bei adoleszenten Patientinnen mit Anorexia nervosa, sowohl im akut untergewichtigen Zustand als auch nach Gewichtszunahme, lediglich milde Beeinträchtigungen in den kognitiven Funktionen vorliegen. Im akut untergewichtigen Zustand offenbarten sich deutliche Zusammenhänge zwischen dem appetitregulierenden Peptid Agouti-related Protein und kognitiver Flexibilität, nicht jedoch zwischen Agouti-related Protein und visueller oder psychomotorischer Verarbeitungsgeschwindigkeit. Bei dem Vergleich von Anorexia nervosa und unipolaren Affektiven Störungen prädizierte die Zugehörigkeit zu der Patientengruppe Anorexia nervosa ein Risiko für das Vorliegen kognitiver Dysfunktionen. Es zeigte sich zudem, dass adoleszente Patienten mit unipolaren Affektiven Störungen lediglich in der psychomotorischen Verarbeitungsgeschwindigkeit tendenziell schwächere Leistungen offenbarten als gesunde Kontrollprobanden. Es ergab sich jedoch ein genereller geschlechtsbezogener Vorteil für weibliche Probanden in der visuellen und psychomotorischen Verarbeitungsgeschwindigkeit. Die vorliegenden Befunde unterstreichen die Notwendigkeit der Überprüfung kognitiver Funktionen bei adoleszenten Patienten mit Anorexia nervosa sowie unipolaren Affektiven Störungen in der klinischen Routinediagnostik. Die Patienten könnten von spezifischen Therapieprogrammen profitieren, die Beeinträchtigungen in den kognitiven Funktionen mildern bzw. präventiv behandeln. / Anorexia nervosa and unipolar affective disorders are common and severe psychiatric disorders whose pathogenesis is not fully understood so far. Several studies have revealed serious impairments in cognitive functions among adult patients whereas recent research in adolescent patients shows only subtle cognitive dysfunctions. The prevalence in both disorders increases with the beginning of adolescence. Cognitive impairments that occur during adolescence may exacerbate the course of disease. Early cognitive deficits may also hinder treatment efforts and prognosis to a greater extent than during adulthood. Moreover, there is a higher risk for chronification. In the present study cognitive functions in adolescent patients with anorexia nervosa and unipolar affective disorders were examined. Cognitive functions in patients with anorexia nervosa were assessed before and after weight gain. Furthermore, the underlying biological mechanisms were explored. Moreover, the specificity for these psychiatric diagnoses as well as gender differences in patients with unipolar affective disorders were investigated. 47 patients with anorexia nervosa (mean age 16.3 + 1.6), 39 patients with unipolar affective disorders (mean age 15.5 + 1.3) and 78 healthy adolescents (mean age 16.5 + 1.3) participated in this study. Each of them completed a battery of neuropsychological tests for cognitive functions including tests for assessing cognitive flexibility as well as visual and psychomotor processing speed. Moreover, intelligence, depressive symptoms and psychological stress were explored. The findings revealed only subtle cognitive impairments in adolescent patients with anorexia nervosa, both in underweight condition and after weight gain. Besides, the results showed an association between cognitive flexibility and plasma agouti-related protein levels in female adolescent patients with acute anorexia nervosa, but not for visual or psychomotor speed and plasma agouti-related protein levels. Comparing anorexia nervosa and unipolar affective disorders, the results suggested a higher risk for cognitive dysfunctions when belonging to the anorexia nervosa group. Furthermore, the results only revealed a slightly weaker performance in psychomotor processing speed in adolescent patients with unipolar affective disorders compared to healthy adolescents. Moreover, female subjects generally displayed a better performance in visual and psychomotor processing speed. The present findings underlie the necessity of exploring cognitive functions in adolescent patients with anorexia nervosa and unipolar affective disorders within routine clinical diagnostic. Patients may benefit from specific therapy programs to reduce or prevent cognitive dysfunctions.

Anorexia nervosa (AN) is a serious disorder with long-term consequences for those afflicted. No evidence-based care is available for adults with full or subthreshold AN. The thesis research investigated aspects of emotion and cognition relevant to the maintenance of AN that might inform psychological treatment. In addition, the effectiveness of a recent psychotherapy model of AN was investigated. Study I investigated alexithymia and emotional awareness and their associations with depression, anxiety, and perfectionism among patients with AN compared with a control group. The AN group exhibited the same level of emotional awareness as did the control group and the same level of alexithymia when controlling for depression and anxiety. Alexithymia and emotional awareness were not associated, despite representing an overlapping construct. The results of the present study indicate that those with AN can trust their emotional awareness. Study II explored implicit pro-thin and anti-fat attitudes (towards the self and others), striving for thinness (loosely corresponding to positive reinforcement), and avoidance of fatness (loosely corresponding to negative reinforcement). The AN and the control groups were found to have equally strong implicit pro-thin and striving for thinness attitudes. The AN group exhibited stronger implicit anti-fat and avoidance of fatness attitudes (loosely corresponding to negative reinforcement) than did the control group. There was no association between implicit and explicit measures. The results are in line with the over-evaluation of weight and shape as a core feature of eating disorders. Study III compared the effectiveness of Acceptance and Commitment Therapy (ACT) and treatment as usual (TAU) for adults with AN after day-care. Follow-up measures indicated no difference in improvement or deterioration between the two groups. The level of perfectionism was reduced in the ACT group relative to the TAU group. The study was compromised by a lower inflow of patients than anticipated and by a high drop-out rate, and thus fails to provide evidence of a difference between the two groups. The present thesis demonstrates that emotional awareness is intact in those with AN and that implicit attitudes concerning weight and shape reflect the explicit attitudes, although without association. The treatment study indicates that, when designing treatment, it is important to consider the ambivalence to treatment among those suffering from AN, which is reflected in the high drop-out rate in the present study.

Diss. (sammanfattning) Stockholm : Karol. inst., 2006. / Härtill 4 uppsatser.

Thesis (Ph. D.)--University of California, San Diego and San Diego State University, 2006. / Vita. Includes bibliographical references (leaves 90-96).

M. Diac. (Spelterapie) / Text in Afrikaans with summaries in Afrikaans and English / Anorexia nervosa is ‘n komplekse eetversteuring wat hoofsaaklik voorkom onder adolessente meisies regoor die wêreld. Anorexia nervosa word geklassifiseer as ‘n versteuring wat ten spyte van literatuur steeds nie ten volle verstaan of begryp kan word nie, weens die kompleksiteit daarvan. Hierdie kompleksitieit het ‘n tekort aan insig en begrip van ander tot gevolg wat weerstand by die adolessent wek. Die terapeutiese proses met hierdie individue word sodoende negatief beïnvloed en lei tot beperkte groei en verandering. In die betrokke studie is die ervaringswêreld van die adolessent wat lei aan anorexia nervosa nagevors met die doel om lig te bring op hierdie komplekse, tog hedendaagse verskynsel. Na die uitvoering van ongestruktureerde onderhoudvoering met adolessente meisies wat lei aan anorexia nervosa, is verskeie temas, konsepte en kategorieë geïdentifiseer en bespreek aan die hand van Gestalt terapeutiese konsepte. / Anorexia nervosa is a complex eating disorder that mainly affects adolescent girls all over the world. Anorexia nervosa is classified as a disorder that, despite existing literature, cannot be fully understood or comprehended, due to the complexity of the disorder. The complexity of Anorexia nervosa makes it difficult for people to understand these individuals, which causes resistance to occur within the adolescents. The resistance then complicates the therapeutic process, which can lead to inefficient growth and change in therapy. In this study, the experience of adolescent girls that suffer from anorexia nervosa is researched with the aim of shedding some light on this complex, though common, issue. After interviewing adolescents that suffer from anorexia nervosa, certain themes, concepts and categories were identified and explained by the hand of Gestalt therapeutic concepts. / Social Work

A proposta deste estudo foi avaliar alguns parâmetros clínicos (sensibilidade dental, IMC, condição periodontal, índice de erosão e a qualidade de vida) de pacientes com bulimia e anorexia nervosa purgativa, antes e depois da reabilitação oral. Também houve a pretensão de auxiliar esses pacientes, através da devolução da função e da estética, na motivação para o controle do transtorno alimentar, avaliada por meio da classificação da gravidade da doença. A casuística foi composta por 30 pacientes, com idade acima de 18 anos, ambos os gêneros, sendo que 20 receberam tratamento de reabilitação oral e foram classificados como grupo A1, e 10 (grupo A2) não continuaram o tratamento. Os pacientes, inicialmente, responderam à ficha de anamnese e a dois questionários, um para mensurar o impacto da saúde bucal na qualidade de vida (OHIP-14) e outro para avaliação apenas da qualidade de vida (WHOQOL-100). Foi avaliada presença de cáries, de erosão ácida, sensibilidade, condição periodontal e demais alterações da saúde bucal. Os pacientes do grupo A1 responderam novamente aos questionários após 30 dias do término do tratamento. Para análise dos dados foram utilizados os testes: t-Student, Wilcoxon, exato de Fisher e McNemar. As análises foram processadas no software estatístico IBM SPSS Statistics 20, e a significância estatística foi verificada para valores de p< 0,05 (5%). O transtorno alimentar que prevaleceu foi a bulimia nervosa (83,3%), o restante dos pacientes tinha o diagnóstico de anorexia nervosa purgativa. A média de idade dos pacientes foi de 30,67 anos, com média de idade de início do TA de 20,1 anos ±5,1 anos. A média do número de dentes cariados no grupo A2 foi bem maior do que o grupo A1, tendo pacientes com até 10 dentes cariados, mostrando que a condição de saúde bucal desses pacientes era pior. No grupo A1, antes do tratamento de reabilitação oral, 60 % dos pacientes necessitavam de raspagem e polimento, remoção de excesso de restaurações e orientação de higiene bucal, 35% apresentaram índice médio ou alto de erosão ácida, 80% relatavam sensibilidade e 95% praticavam a indução de vômitos após as refeições. Após o tratamento de reabilitação oral, apenas 50% dos pacientes relatou sensibilidade e 35% parou de vomitar, sendo que a classificação de gravidade da doença melhorou para esse grupo. Já no grupo A2, considera-se quanto à classificação da doença, 30% leve, 10% grave e 50% extrema. Através dos dois instrumentos o grupo A1 apresentou melhora na qualidade de vida após o tratamento de reabilitação oral, com diferenças significantes quando comparado ao grupo A2 através do WHOQOL-100 nos domínios 1 (p=0,009), 2 (p=0,013), e 3 (p=0,02). O tratamento de reabilitação oral influenciou na melhora da sensibilidade dental, na diminuição da frequência de vômitos autoinduzidos e na melhora da qualidade de vida de pacientes com Anorexia nervosa purgativa e Bulimia nervosa. / The purpose of this study was to evaluate some clinical parameters (dental sensibility, BMI, periodontal condition, erosion index and quality of life) of patients with bulimia and purgative anorexia nervosa, before and after mouth rehabilitation. There was also the intention to help these patients, through the return of function and aesthetics, in the motivation for the control of eating disorder, evaluated through the classification of the severity of the disease. The sample consisted of 30 patients, aged over 18 years, both genders, 20 of whom received full mouth rehabilitation treatment and were classified as A1, and 10 (group A2) did not continue treatment. Patients initially responded to the anamnesis form and two questionnaires, one to measure the impact of oral health on OHIP-14 quality of life and another to assess WHOQOL-100 quality of life only. The presence of cavities, acid erosion, sensitivity, periodontal condition and other changes in oral health were evaluated. Patients in group A1 responded to the questionnaires again 30 days after the end of treatment. To analyze the data, the following tests were used: t-Student, Wilcoxon, Fisher exact and McNemar. The analyzes were processed in the statistical software SPSS Statistics 20, and the statistical significance was verified for values of p <0.05 (5%). The prevailing eating disorder was bulimia nervosa (83.3%), the rest of the patients had a diagnosis of purgative anorexia nervosa. The mean age of the patients was 30.67 years, mean age at onset of TA was 20.1 years ± 5.1 years. The mean number of decayed teeth in the A2 group was much higher than the A1 group, with patients with up to 10 decayed teeth, showing that the oral health status of these patients was worse. In the A1 group, 60% of the patients required scaling and polishing, removal of excess restorations and orientation of oral hygiene, 35% presented medium or high acid erosion index, 80% reported sensitivity and 95% inducing vomiting after meals. After the mouth rehabilitation treatment, only 50% of the patients reported sensitivity and 35% stopped vomiting, and the severity rating of the disease improved for this group. In group A2, 30% are considered mild, 10% severe and 50% extreme, regarding the classification of the disease. The A1 group presented improvement in the quality of life after mouth rehabilitation treatment, with significant differences when compared to the A2 group through the WHOQOL-100 in domains 1 (p = 0.009), 2 (p = 0.013), and 3 (p = 0.02). Mouth rehabilitation treatment may influence the improvement of dental sensitivity, the reduction of the frequency of self-induced vomiting and the improvement of the quality of life of patients with purgative anorexia and bulimia nervosa.

INTRODUÇÂO: Embora seja um evento freqüente, não existe um consenso de quais fatores estariam envolvidos no abandono do tratamento para transtornos alimentares. O presente estudo teve por objetivo a identificação de fatores de risco para o abandono do tratamento hospitalar para anorexia nervosa e bulimia nervosa. Aspectos prévios a hospitalização, aspectos clínicos presentes no ato da internação e fatores relacionados ao período do tratamento hospitalar de pacientes que abandonaram e completaram o tratamento foram comparados MÉTODOS: Foi executado um estudo de caráter retrospectivo, do tipo caso-controle, com o abandono do tratamento sendo considerada a condição de interesse. Prontuários de pacientes do sexo feminino admitidas em uma enfermaria especializada no tratamento de anorexia e bulimia nervosas entre os anos de 2005 e 2010 foram revisados. RESULTADOS: Do total de 259 internações e 178 pacientes, foram sujeitos da pesquisa 103 mulheres, das quais 83 completaram o tratamento e 20 o abandonaram, resultando em uma taxa de abandono do tratamento de 19,42%. Para o tratamento estatístico dos dados, foi realizada análise univariada, com posterior análise multivariada das variáveis consideradas significantes, através de regressão logística do tipo passo a passo com seleção para trás. Na análise univariada, afastamento profissional devido à gravidade da doença, existência de relacionamento afetivo, IMC mais baixo na admissão, internações motivadas por baixo peso, diagnóstico de anorexia nervosa e presença de comportamentos purgativos (presente em todas as pacientes que abandonaram o tratamento) foram considerados como fatores relacionados ao abandono do tratamento. Após a condução da regressão logística, encontramos que pacientes que no momento da internação estavam afastadas do emprego devido à gravidade da doença, mantinham um relacionamento amoroso e foram hospitalizadas devido ao baixo peso foram mais propensas a abandonar o tratamento. CONCLUSÕES: Na presente amostra, o abandono do tratamento foi influenciado por fatores sociodemográficos (licença médica e existência de relacionamento amoroso), por variáveis diagnósticas (diagnóstico de anorexia nervosa e presença de sintomas purgativos) e aspectos da gravidade dos sintomas (IMC mais baixo e internação motivada por baixo peso). Tais resultados nos remetem ao caráter egosintônico dos transtornos alimentares, especialmente da anorexia nervosa, além de trazer um paradoxo: pacientes que na admissão apresentavam quadros mais grave do transtorno (com menor peso e impossibilitadas de exercer funções laborais) foram mais propensas a abandonar o tratamento. Embora apresente diversas limitações, principalmente em função do desenho retrospectivo, a presente pesquisa é o primeiro estudo sobre o abandono do tratamento hospitalar para transtornos alimentares realizada no Brasil. Sugere-se a execução de investigações com delineamento prospectivo que confirmem ou refutem os resultados aqui encontrados / INTRODUCTION: Although is a frequent event, there is no consensus on what factors would be involved in the dropout of treatment for eating disorders. This study aimed to identify risk factors for the dropout of an inpatient treatment for anorexia nervosa and bulimia nervosa. Aspects previous to the hospitalization, clinical features present at the admission and factors related to the period of the inpatient treatment of patients who dropped out and completed treatment were compared. METHODS: We performed a retrospective study, case-control, with the dropout of the treatment being considered the interest condition. Medical records of female patients admitted to a specialized ward in treating anorexia nervosa and bulimia nervosa between the years 2005 and 2010 were reviewed. RESULTS: A total of 259 admissions and 178 patients, research subjects were 103 women, of which 83 completed treatment and 20 dropped out, resulting in a dropout rate of treatment of 19.42%. For the statistical treatment of the data was performed univariate analysis with subsequent multivariate logistic regression with backward stepwise selection analysis of the variables considered significant. In univariate analysis, professional removal due to illness severity, existence of affective relationship, lower BMI at admission, admissions motivated by low weight, diagnosis of anorexia nervosa and existence of purging behaviors (present in all patients who dropped out the treatment) were considered as factors related to dropout treatment. After conducting the logistic regression, we found that patients at admission who were removed from the job due to the illness severity, maintained a romantic relationship and were hospitalized due to low weight were more likely to dropout the treatment. CONCLUSIONS: In this sample, the dropout of treatment was influenced by sociodemographic factors (professional removal due to illness severity and existence of a romantic relationship), for diagnostic variables (diagnosis of anorexia nervosa and purging symptoms) and aspects of symptom severity (lower BMI and hospitalization motivated by low weight). These results lead us to the egosyntonic character of eating disorders, especially anorexia nervosa, and bring a paradox: patients that on admission showed more severe symptoms of the Eating Disorder (with lower weight and disabled to work) were more likely to dropout of the treatment. Although it has several limitations, mainly due to the retrospective design, the present research is the first study of dropout of inpatient treatment for eating disorders held in Brazil. It is suggested to run with prospective investigations to confirm or refute our findings

Os transtornos alimentares (TA) são quadros psiquiátricos graves, de etiologia multifatorial e a influência genética parece exercer importante papel. Três genes são candidatos em potencial para o desenvolvimento desses quadros e são investigados: o gene do receptor 5-hidroxitriptamina (5-HT2A), o do Fator Neurotrófico Derivado do Cérebro (BDNF) e do receptor ? do estrogênio (ER?). O objetivo deste estudo foi identificar a presença de polimorfismos (SNPs) desses genes em pacientes e ex-pacientes com TA (grupo de pacientes-GP) e em mulheres jovens saudáveis (grupo controle-GC) e foi realizado junto ao Grupo de Assistência em Transtornos Alimentares do Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto-USP. Coletaram-se os dados: idade, peso e altura para cálculo do índice de massa corporal (IMC) e aplicou-se o Eating Atitudes Test (EAT-26) para excluir possível caso de doença no GC (<21pontos). Os SNPs foram determinados pela técnica de reação em cadeia da polimerase (PCR). Para análises estatísticas, utilizou-se o Statistical Package for Social Sciences (SPSS, 20.0), nas variáveis contínuas (IMC e idade) usou-se o teste ANOVA, na variável dicotômica (presença ou não de SNPs), teste qui-quadrado e regressão logística binária (pa ). Como resultados, foram coletados dados de 29 indivíduos do GP e 78 do GC. A idade foi de 26,37±7,00 anos no GP e 28,65±6,67 anos no GC (p=0,274), o IMC foi de 20,83±4,47kg/m2 no GP e 21,56±1,67kg/m2 no GC (p=0,294), e o EAT-26 foi de 30,34±18,83 pontos no GP e 7,83±4,94 pontos no GC (p=0,000). Calcularam-se as frequências alélicas e genotípicas dos genes e foi feita análise que unia genótipos que possuíam alelos de risco para cada gene. No gene 5HT2A 75,8% do GP e 38,4% do GC apresentaram-se os genótipos com o alelo de risco (GA e AA) (pX2 =0,253; OR=1,964; IC95%=0,748-5,156 e pa =0,552). No do BDNF, encontraram-se frequências de 96,5% no GP e 96,1% no GC com os genótipos com alelo de risco, MM e MV (pX2 =1,00; OR=1,120; IC95%=0,112-11,221 e pa =0,362 ). No gene do ER?, para o SNP presente no éxon 5 (1082 G->A), as frequências dos genótipos de risco GA e AA foram de 6,8% no GP e 8,9% no GC (pX2 =1,00; OR=0,751; IC95%=0,147-3,841 e pa =0,883), e o SNP situado no éxon 8 (1730 A->G), as frequências dos genótipos de risco AG e AA foram de 65,5% no GP e 83,3% no GC (pX2 =0,064; OR=0,380; IC95%=0,144-1,002 e pa =0,399). Todas as análises não apresentaram diferença estatística significativa para a presença dos alelos de risco que podem contribuir para o desenvolvimento de TA. Concluiu-se que a heterogeneidade da população brasileira, a baixa incidência da doença e a amostra limitada do GP podem ter influenciado para as semelhanças entre os grupos. Futuros estudos, utilizando marcadores genéticos de etnias e amostras maiores, devem prosseguir na linha promissora da investigação etiológica. / Eating disorders (ED) are serious psychiatric conditions with multifactorial etiology, it seems genetic influence has an important role. Three genes were investigated: the receptor 5-hydroxitriptamine (5-HT2A), the Brain-Derived Neurotrophic Factor (BDNF) and the Estrogen Receptor ? (ER?). This study aims at identifying the presence of polymorphisms (SNPs) in patients or in ex-patients with ED (Group of patients - GP) and in wealthy women (Control Group - CG). The study was conducted with the Eating Disorders Assistence Group at Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto-USP. To calculate the Body Mass Index (BMI), we collected data referring to age, weight and height, we applied the Eating Attitudes Test (EAT-26) to exclude a possible occurrence of disease in the CG (<21 points). The polymerase chain reaction (PCR) was used to determine SNPs. For the statistical analysis we used the Statistical Package for Social Sciences (SPSS, 20.0): for the continuous variables (BMI and age), the ANOVA and for the dichotomous variable (presence or not of SNPs), Chi-square test and Binary logistic regression (pa ). There were 29 individuals of the GP and 78 of the CG. The age was 26,37±7,00 in the GP and 28,65±6,67 in the CG (p=0,274), the BMI was 20,83±4,47Kg/m2 in the GP and 21,56±1,67Kg/m2 in the CG (p=0,294), and the EAT-26 was 30,34±18,83 points in the GP e 7,83±4,94 points in the CG (p=0,000). We calculated the allelic and genotypic frequencies in the genes of the studied groups and afterwards we did an analysis that joined genotypes with risk alleles for each gene. The genes 5HT2A 75,8% of GP and 38,4% of the CG presented the genotype with risk allele (GA and AA) (pX2 =0,253; OR=1,964; IC95%=0,748-5,156 e pa =0,552). In the BDNF we found frequencies of 96,5% in the GP and 96,1% in the CG with genotypes with risk allele, MM and MV (pX2 =1,00); OR=1,120; IC95%=0,112-11,221 e pa =0,362). Regarding the gene ER?, for the SNP present in the exon 5 (1082 G->A), the frequency of risk genotypes GA and AA were of 6,8% in the GP and of 8,9% in the CG (pX2 =1,00; OR=0,751; IC95%=0,147-3,841 and pa =0,883), and for the SNP located in the exon 8 (1730 A->G), the frequency of risk genotypes AG and AA were of 65,5% in the GP and 83,3% in the CG (pX2 =0,064; OR=0,380; IC95%=0,144-1,002 e pa =0,399). There were no significant differences between the studied groups for the presence of risk alleles that may contribute to the development of ED. We concluded that heterogeneity of Brazilian population, the low incidence of the disease in it and the limited sample of GP may have influenced the similarities between the groups. Future studies using genetic markers of ethnicity and a wider sampling may contribute to the promising trend of etiologic investigation.

Os transtornos alimentares (TA) vêm sendo descritos atualmente como uma síndrome que atinge principalmente adolescentes e adultos jovens do sexo feminino e apresenta etiologia multifatorial, envolvendo fatores biológicos, genéticos, psicológicos, sócio-culturais e familiares. As relações familiares apresentam características muito particulares nesses casos. São relatados na literatura um grande número de casos onde as relações das mães com as pacientes apresentam características de simbiose e por vezes dificuldades de individuação. O contato com estas mães por um grupo de apoio aos familiares de pacientes com TA (GRATA-HCFMRP-USP), bem como a constatação de que desde muito antes do aparecimento do sintoma, suas filhas já apresentavam algumas diferenças marcantes, conduziram-nos a pensar que alguma compreensão a respeito do quadro pudesse vir da investigação de um período precoce do desenvolvimento das filhas. O objetivo deste estudo foi portanto, conhecer como as mães experienciaram o processo de cuidar de suas filhas desde a gestação até os 2 (dois) anos de idade, incluindo a questão alimentar como forte elo entre um bebê e sua mãe, procurando investigar a influência que estas vivências tiveram (ou não) no aparecimento futuro da doença. Foram entrevistadas 7 (sete) mães de pacientes com TA em atendimento ambulatorial no GRATA- HCFMRP-USP. As entrevistas foram semi-estruturadas e áudio-gravadas e em seguida transcritas na íntegra. As questões norteadoras foram previamente estabelecidas levando-se em conta os seguintes temas: gravidez, parto, pós-parto/puerpério, amamentação/ alimenta-ção e características da filha. Os dados foram analisados baseandose nos preceitos da teoria psicanalítica como proposto por Klein e por Winnicott. Encontramos relatos de muito sofrimento e impotência, com grande dificuldade de ?reverie? por parte das mães. Por outro lado, as crianças foram descritas como intensamente vorazes, o que nos sugere que também teriam muita dificuldade em assimilar o cuidado oferecido por suas mães. Parece ter ocorrido um encontro entre uma mãe com dificuldades em oferecer continência psíquica às condições básicas de sua filha e uma criança com dificuldades em receber seus cuidados. Essa dinâmica relacional pode ter sido um importante fator de influência das vicissitudes vinculares ulteriores. O sintoma alimentar, portanto, poderia ser entendido como uma tentativa da filha de retomar essa relação complexa e sofrida, a partir de uma equação simbólica na qual o alimento, transformado em equivalente simbólico da função materna internalizada de forma ambivalente, deve ser evitado ou eliminado. / Eating Disorders (ED) have been described as a syndrome that affects mainly female teenagers and young adults and that has a multifactorial aetiology involving organic, genetic, psychological, social and family factors. Family relationship presents with very particular characteristics in those cases. A high number of cases in which mother-daughter relationships presented symbiotic features and sometimes difficulties of individuation have been reported. The contact with mothers, which was established by a support group for relatives of patients with ED (GRATA-HCFMRP-USP), along with the realization that much before the first symptoms, their daughters already presented remarkable differences, made us consider that some understanding about the picture could come from the investigation of an early period of daughter s development. Therefore, the purpose of this study was to know how mothers experienced the process of raising their daughters from pregnancy to their second year of age, including the eating issue as a strong link between a baby and his mother and trying to analyze the influences of those experiences over the future development of the disease. Seven mothers of ED outclinic patients of GRATAHCFMRP- USP were interviewed. The interviews were semi-structered and were recorded and transcribed entirely. The main questions were previously established and concerned the following themes: pregnancy, partum, post partum, breastfeeding/feeding and characteristics of the daughter. Data was analyzed based on the psychoanalysis theory as proposed by Klein and Winnicott. We found descriptions of deep suffering and impotence, with mothers facing difficulty to reverie. On the other hand, children were described as intensively voracious, what suggests that they might have difficulty in assimilating the care provided by their mothers. It looks like a meeting between a mother with difficulties to provide care and a child with difficulties to receive it. This relational dynamics may have been an important factor that influenced the difficulties of the posterior relationship. Therefore, the eating symptom would be an attempt from the daughter to restart this complex and suffering relationship, from a symbolic equation where the very much desired food, transformed into a symbolical equivalent of the maternal function internalized in an ambivalent way, must be avoided or eliminated.