O controlo do corpo… O controlo da vida autonomia em adolescentes com anorexia nervosa

Dissertação de Mestrado apresentada no Instituto Superior de Psicologia Aplicada para obtenção de grau de Mestre na especialidade de Psicologia Clínica

Psicomotricidade na anorexia nervosa : Unidade de Internamento/Ligação de Pedopsiquiatria no Hospital Dona Estefânia

O presente relatório descreve as atividades de estágio desenvolvidas no âmbito do Ramo de Aprofundamento de Competências Profissionais (RACP) do Mestrado de Reabilitação Psicomotora, que decorreu na Unidade de Internamento/ligação de Pedopsiquiatria integrada no Hospital Dona Estefânia do Centro Hospitalar Lisboa Central. O objetivo do estágio centrou-se na implementação da intervenção psicomotora em saúde mental na pedopsiquiatria deste serviço, no qual se acompanharam oito casos com Perturbação do Comportamento Alimentar (PCA), nomeadamente com Anorexia Nervosa (AN). O relatório integra um enquadramento teórico que inclui a revisão bibliográfica da saúde mental em Portugal e a terapia psicomotora em saúde mental, especificamente na prática com PCA e AN. Este relatório agrega também o enquadramento da prática profissional que aborda a organização das atividades desenvolvidas, a caracterização da população atendida e de dois estudos de caso. No período de estágio foi permitido à aluna incluir-se numa equipa multidisciplinar, onde foi possível desenvolver as suas competências pessoais e profissionais. Conclui-se que os objetivos de estágio foram alcançados, na medida em que se verificou que a intervenção psicomotora nesta unidade foi fundamental para a evolução dos casos seguidos em internamento/ligação e, posteriormente, existiu a oportunidade de alargar a terapia a outras perturbações além da PCA.

Nutritional approach of inpatients with anorexia nervosa

Anorexia nervosa (AN) is the most prevalent of eating disorders in children and adolescents, and its treatment is long and complex, involving a multidisciplinary team. Nutritional rehabilitation and restoration of a healthy body weight is one of the central goals in the initial stages of inpatient treatment. However, current recommendations on initial energy requirements for these patients are inconsistent, with a clear lack of controlled studies, available scientific evidence and global consensus on the most effective and safe refeeding practices in hospitalized adolescents with anorexia nervosa (AN). Conservative refeeding recommendations have been classically established in order to prevent the refeeding syndrome. Nevertheless, various works have recently appeared advocating a higher initial caloric intake, without observing more complications or refeeding syndrome, and allowing a shorter average stay. We present our experience in the treatment of restricting AN with a conservative progressive treatment. We have obtained good results with this approach, which was well tolerated by patients, with no observing complications. As a consequence, the medical team could establish a pact about the therapeutic goals with the patients in an easier way.

An exploratory evaluation of the family meal intervention for adolescent anorexia nervosa

Although weight restoration is a crucial factor in the recovery of anorexia nervosa (AN), there is scarce evidence regarding which components of treatment promote it. In this paper, the author reports on an effort to utilize research methods in her own practice, with the goal of evaluating if the family meal intervention (FMI) had a positive effect on increasing weight gain or on improving other general outcome measures. Twenty-three AN adolescents aged 12-20 years were randomly assigned to two forms of outpatient family therapy (with [FTFM] and without [FT]) using the FMI, and treated for a 6-month duration. Their outcome was compared at the end of treatment (EOT) and at a 6-month posttreatment follow-up (FU). The main outcome measure was weight recovery; secondary outcome measures were the Morgan Russell Global Assessment Schedule (MRHAS), amenorrhea, general psychological symptoms, and eating disorder symptoms. The majority of the patients in both groups improved significantly at EOT, and these changes were sustained through FU. Given its primarily clinical nature, findings of this investigation project preclude any conclusion. Although the FMI did not appear to convey specific benefits in causing weight gain, clinical observation suggests the value of a flexible stance in implementation of the FMI for the severely undernourished patient with greater psychopathology.

An interpretative phenomenological analysis of participation in a pro-anorexia Internet site and its relationship to disordered eating

Pro-anorexia Internet sites aim to promote, support and discuss anorexia nervosa. Media coverage has raised concerns that sites may increase the level of eating disorders. This research examines the meaning of participation in a pro-anorexia Internet site and its relationship with disordered eating by using an interpretative phenomenological analysis of fifteen separate message ‘threads’ followed over a six-week period. Four themes were identified: (1) tips and techniques; (2) ‘ana’ v. anorexia nervosa; (3) social support; and (4) need for anorexia. Findings suggest participation was multi-purpose, providing a coping function in relation to weight loss, and the contribution of sites to increased levels of eating disorders is not inevitable.

Quando a magreza torna-se um ideal masculino: um estudo socioantropologico sobre a anorexia e a bulimia em homens

Esta dissertação pretende discutir o surgimento de casos de anorexia nervosa e bulimia nervosa em homens e sua relação com: a - as questões socioculturais ligadas ao culto à magreza e seus desdobramentos (como a noção de estilo de vida); e b - as discussões sobre masculinidades, experiências corporais e subjetivas desses sujeitos. Seu principal objetivo é compreender como estes transtornos alimentares, tidos como distúrbios de ordem psiquiátrica pela literatura biomédica, não estão restritos somente ao feminino, sugerindo também implicações ligadas ao processo de elaboração do saber médico, seus campos de pesquisa e atuação. A metodologia empregada foi a realização de entrevistas via MSN Messenger, com 20 homens entre 13 e 30 anos, que declaram passar ou ter passado por algum tipo de experiência envolvendo a anorexia e/ou bulimia.

Anorexia: um sintoma contemporâneo

Esta dissertação propõe investigar o sintoma anoréxico na estrutura neurótica como um sintoma contemporâneo em consequência da baixa operatividade da função paterna e da incidência avassaladora do Desejo Materno. A pesquisa foi iniciada por um levantamento histórico-bibliográfico do jejum e da recusa alimentar ao longo da história, até o estabelecimento da anorexia como uma psicopatologia. Para dar sustentação ao eixo central desta Dissertação, a pesquisa explora o conceito de pai na Obra de Freud e no ensino de Lacan, investigando a baixa operatividade desta função e seus efeitos na formação do sintoma. O conceito de pulsão é explorado com o objetivo de compreender a anorexia como uma invasão pulsional no corpo decorrente da precária sustentação da armadura simbólica que a lei paterna insere. Deste modo, esta Dissertação expõe duas hipóteses centrais: a anorexia como uma manobra de separação, operação que a função paterna não inscreve devidamente e desta forma um recurso diante da hegemonia materna; e a anorexia como estragos que apontam a invasão da mortífera pulsão no corpo, decorrentes da presença avassaladora do Outro materno e da inconsistência da função paterna

Nada sabe tan bien como sentirse delgado: un análisis de herramientas virtuales presentes en páginas web relacionadas con la anorexia nerviosa

En esta investigación se exploran distintas herramientas usadas por comunidades virtuales en Internet para la creación, difusión y defensa de sus ideas en contra de comunidades rivales y algunas veces la sociedad. El caso de estudio particular en que se ha centrado este trabajo es el de distintos grupos relacionados con la anorexia nerviosa y sus usos de la imagen de los nombres e imagen de usuario. La metodología de investigación usada es cualitativa y experimental.

Inside anorexia : the experiences of girls and their families

An accessible resource for anyone who wants a better understanding of anorexia nervosa. An informative guide for health professionals as well as for people with anorexia and their families.

Looking after well siblings of adolescent girls with anorexia : an important parental role

Background Research has suggested that well siblings of children with chronic and life-threatening illnesses are at risk for negative outcomes and that parents’ responses to the illnesses can influence the adaptation of well siblings. Yet, parents’ efforts to look after well siblings in the context of illness are rarely considered in literature about sibling adaptation. The importance of attending to the needs of well siblings was a major theme to emerge from a qualitative analysis of the experiences of parents of adolescent girls with anorexia nervosa.

Methods In-depth interviews were conducted with 24 parents of adolescent girls with anorexia and analysed using grounded theory method.

Results The data indicated that parents viewed caring for well siblings in the context of anorexia as an important role and responsibility. Parents reported making conscious and active efforts to look after well siblings by: maintaining normality; compensating for changes to routines; protecting siblings; providing emotional support; and managing the consequences.

Conclusions This paper provides a picture of the actions parents take to help well siblings adapt to anorexia in the family. Further research is needed to develop and expand this understanding to families experiencing a wide range of chronic and life-threatening illnesses. The findings underline the importance of clinical attention and further research into the critical parental role of caring for well siblings.

Parents dealing with anorexia : actions and meanings

This paper examines parents’ actions in response to anorexia nervosa, and how these are shaped by the ways they construct or understand the eating disorder. The findings indicate that parents try to influence their daughters by searching for help, providing practical support, avoiding confrontation, complying with special requirements, persuading, explaining, and pressuring, using ploys and force, providing emotional support, and mediating interactions. Parents’ actions are influenced by how they construct anorexia, such as whether they see it as an eating issue, an illness, a psychological problem, a choice, or a mystery. Understanding parents’ actions and constructions can help clinicians develop collaborative partnerships with parents.

Support for parents of children with anorexia : what parents want

Parents' encounters with health professionals can influence their ability to cope with having a daughter with anorexia nervosa. Using qualitative analysis of in-depth interviews with 24 parents, we examine the question “What support do parents of teenage girls with anorexia want from clinicians?” The analysis shows that parents wanted clinicians to include them in treatment, support and guide them in their daughters' care, and demonstrate positive attitudes toward them. The implications for clinicians are discussed, including being sensitive to parents' vulnerability, ensuring congruence between clinicians' and parents' expectations about treatment, and strengthening formal channels of communication.

The paradox of virtue : (re)thinking deviance, anorexia and schooling

In this paper we posit a radical retheorization of anorexia as a form of deviance. We examine how the disciplinary practices and moral technologies typical of contemporary secondary schooling signify and enter into the articulation of three ‘virtue discourses’ (discipline, achievement and healthism), and tease out how these ‘virtue discourses’ play into the formation of the ‘anorexic’ subject. Informed by Foucauldian theory, our analysis draws on our life history interview study with teenage girls diagnosed with anorexia nervosa and their parents. We argue that anorexia can be understood not as a form of deviance but as a ‘paradox of virtue’ involving zealous compliance with and taking up of socially and culturally sanctioned ‘virtue discourses’ that are immanent in schooling and wider society.

Anorexia: a Failure in the Work of Melancholia

The self-reproach against their own bodies seen in patients with eating disorders has led us to posit the existence of failures in the work of melancholia. Defined by Freud in 1915, this process of melancholia is aimed at repairing a loss felt as unbearable by the ego and that triggers off a violent struggle with ambivalent feelings toward the lost object. The resulting hatred is aimed at the shadow of the object that falls on the ego. Especially in anorexia nervosa, there seems to be a regressive movement that goes beyond this.

Anorexia: a failure in the work of melancholia

The self-reproach against their own bodies seen in patients with eating disorders has led us to posit the existence of failures in the work of melancholia. Defined by Freud in 1915, this process of melancholia is aimed at repairing a loss felt as unbearable by the ego and that triggers off a violent struggle with ambivalent feelings toward the lost object. The resulting hatred is aimed at the shadow of the object that falls on the ego. Especially in anorexia nervosa, there seems to be a regressive movement that goes beyond this.