Recension systématique et critique des études portant sur l'utilisation de la variable motivationnelle dans les inerventions auprès d'adolescent(e)s atteint(e)s d'anorexie mentale

Essai doctoral présenté à la Faculté des arts et des sciences en vue de l'obtention du grade de Doctorat (D.Psy) en psychologie option psychologie clinique.

Predictors of Attitudes toward Cosmetic Surgery among U.S. and Colombian College Women: The Roles of Eating Behaviors and Demographic Variables

Cross-cultural studies on eating behaviors and related constructs can identify cultural and social factors that contribute to eating disorder symptomatology. Eating disorders (EDs) are a major cause for concern in the U.S., and recent studies in Colombia have shown growing rates among their female population. In addition, cosmetic surgery procedures have been increasing rapidly in both the U.S. and Colombia, and preliminary research suggests a positive relation between disordered eating and endorsement of plastic surgery. In samples of college women from Colombia and the U.S., we investigated patterns of association between disordered eating variables and cosmetic surgery acceptance. Our approach utilized separate analyses for various subcomponents of disordered eating (to determine their unique associations with cosmetic surgery acceptance) while adjusting for potentially relevant covariates and examining cross-cultural patterns. Participants were students at an urban, public college in the U.S. (n=163) and an urban, private college in Colombia (n=179). Overall, our findings suggested that participants from Colombia with greater disordered eating were more likely to endorse cosmetic surgery for social reasons, while those from the U.S. were more likely to consider undergoing cosmetic surgery for personal reasons. Differing findings between the two samples may be due to cultural and social factors, which we delineate. These findings also have potential implications for presurgical counseling of cosmetic surgery candidates.

Autocuidados e automedicação na temática da obstipação

Atualmente, consideram-se os autocuidados como a primeira forma de prevenção e tratamento de doenças. Através de alterações no estilo de vida e da automedicação é possível obter enormes benefícios, não só na saúde mas também na economia do próprio país. Para que estas medidas sejam eficazes e seguras, é essencial garantir a formação e informação da sociedade, sendo os profissionais de saúde os principais intervenientes neste processo. Assim, o farmacêutico deve intervir junto da população, não só na promoção da saúde, como também no incentivo ao uso racional dos medicamentos. São diversas as situações passíveis de automedicação e são igualmente vários os casos de utilização incorreta de medicamentos neste contexto. Assim, optou-se por destacar a automedicação na obstipação com recurso não só a Medidas Não Farmacológicas, como também à utilização de laxantes. A obstipação é um conjunto de sintomas associado a determinada causa. Fatores desencadeantes podem ser de origem patológica ou de origem comportamental, destacando-se o stress, polimedicação e hábitos de consumo. Os laxantes são normalmente utilizados no tratamento da obstipação, no entanto, temse conhecimento que podem ser indevidamente usados para outros fins, nomeadamente em contexto de distúrbios alimentares. A dependência destes medicamentos é elevada quando utilizados de forma incorreta, por tempo prolongado e em elevada frequência. Deste modo, o presente estudo tem como principais objetivos percecionar quais as possíveis causas da obstipação; avaliar a utilização de laxantes; identificar que tipo de intervenção é feita pelo farmacêutico nesta temática; avaliar qual o grau de conhecimento da sociedade relativamente à obstipação e ao uso de laxantes e elaborar o Protocolo de Intervenção Farmacêutica na obstipação. Trata-se de um estudo descritivo e transversal que se baseou na realização de um questionário de resposta fechada a utentes da Farmácia Damaia. Foram inquiridos 300 voluntários, de ambos os géneros, com idades compreendidas entre os 1-88 anos (45,15 ± 20,16 anos), após consentimento de participação. O questionário abordou diversas áreas, nomeadamente estilo de vida, rotinas e hábitos defecatórios e xvi utilização de laxantes. Os dados foram tratados no programa Microsoft Excel® 2007 e posteriormente analisados. Através do estudo foi possível percecionar que são várias as falhas existentes ao nível dos conhecimentos da população, nomeadamente em relação aos princípios básicos do funcionamento intestinal. Este estudo também demonstrou que existem lacunas nos conhecimentos acerca dos tipos de obstipação e na utilização de laxantes. Torna-se percetível que é fundamental o processo de instrução da população em relação a esta e outras temáticas relacionadas com a saúde. Assim, o farmacêutico deve tornar-se mais pró-ativo e intervir nesta área, para benefício de toda a sociedade.

Perfectionism as a transdiagnostic process: a clinical review

Perfectionism is a risk and maintaining factor for eating disorders, anxiety disorders and depression. The objective of this paper is to review the four bodies of evidence supporting the notion that perfectionism is a transdiagnostic process. First, a review of the literature was conducted that demonstrates the elevation of perfectionism across numerous anxiety disorders, depression, and eating disorders compared to healthy controls. Data is presented that shows perfectionism increases vulnerability for eating disorders, and that it maintains obsessive–compulsive disorder, social anxiety and depression as it predicts treatment outcome in these disorders. Second, evidence is examined showing that elevated perfectionism is associated with co-occurrence of psychopathology. Third, the different conceptualisations of perfectionism are reviewed, including a cognitive-behavioural conceptualisation of clinical perfectionism that can be utilised to understand this transdiagnostic process. Fourth, evidence that treatment of perfectionism results in reductions in anxiety, depression and eating pathology is reviewed. Finally,the importance of clinicians considering the routine assessment and treatment of perfectionism is outlined.

A case of anxiety disorder not otherwise specified (ADNOS): a transdiagnostic approach

The transdiagnostic approach to eating disorders has led to significant benefit for the research and treatment of "eating disorder not otherwise specified" (EDNOS). There is currently almost no research on "anxiety disorder not otherwise specified (ADNOS)." This case report describes a transdiagnostic approach to the treatment of ADNOS, using a modular framework. The treatment was successful in the short term but not in the longer term. It is concluded that increasing the evidence base for transdiagnostic treatment of anxiety disorders is a clinical and research priority.

An experimental analysis of body checking

The relationship between repeated body checking and its impact on body size estimation and body dissatisfaction is of interest for two reasons. First, it has importance in theoretical accounts of the maintenance of eating disorders and, second, body checking is targeted in cognitive-behavioural treatment. The aim of this study was to determine the impact of manipulating body checking on body size estimation and body dissatisfaction. Sixty women were randomly assigned either to repeatedly scrutinize their bodies in a critical way in the mirror ("high body checking") or to refrain from body checking but to examine the whole of their bodies in a neutral way ("low body checking"). Body dissatisfaction, feelings of fatness and the strength of a particular self-critical thought increased immediately after the manipulation among those in the high body checking condition. Feelings of fatness decreased among those in the low body checking condition. These changes were short-lived. The manipulation did not effect estimations of body size or the discrepancy between estimations of body size and desired body size. The implications of these findings for understanding the influence of body checking on the maintenance of body dissatisfaction are considered. (c) 2006 Elsevier Ltd. All rights reserved.

The interpretation of symptoms of starvation/severe dietary restraint in eating disorder patients

The aims of the study were to test the hypotheses that some symptoms of starvation/severe dietary restraint are interpreted by patients with eating disorders in terms or control. Sixty-nine women satisfying the Diagnostic and Statistical Manual of Mental Disorders - IV edition (DSM-IV) criteria for a clinical eating disorder and 107 controls participated in the Study. All the participants completed an ambiguous scenarios paradigm, the Eating Disorder Lamination Questionnaire (EDE-Q) and the Beck Depression Inventory (BDI). Significantly more eating disorder patients than non clinical participants interpreted the starvation/dietary restraint symptoms of hunger, heightened satiety, and dizziness in terms of control. The data give further Support to the recent cognitive-behavioural theory of eating disorders suggesting that eating disorder patients interpret some starvation/dietary restraint symptoms in terms of control.

A preliminary evaluation of cognitive-behaviour therapy for clinical perfectionism: a case series

Objective: The construct of 'clinical perfectionism' has been developed in response to criticisms that other approaches have failed to yield advances in the treatment of the type of self-oriented perfectionism that poses a clinical problem. The primary aim of this study was to conduct a preliminary investigation into the efficacy of a theory-driven, cognitive-behavioural intervention for 'clinical perfectionism'. Design. A multiple baseline single case series design was used. Method: A specific, 10-session cognitive-behavioural intervention to address clinical perfectionism in eating disorders was adapted to allow its use in nine patients referred with a range of axis I disorders and clinical perfectionism. Results: The intervention led to clinically significant improvements in self-referential perfectionism from pretreatment to follow-up for six of the nine participants on two perfectionism measures and for three of the nine participants on the measure of clinical perfectionism. Statistically significant improvements from pre- to post-intervention for the group as a whole were found on all three measures. The improvements were maintained at follow-up. Conclusions: The finding that clinical perfectionism is improved in the majority of participants is particularly encouraging given that perfectionism has traditionally been viewed as a personality characteristic resistant to change. These preliminary findings warrant replication in a larger study.

History of eating disorder in mothers of children with early onset eating disorder or disturbance

The literature suggests that there is significant familial aggregation of eating disorders. A specific association has also been reported between childhood feeding problems and maternal eating disorder. This study investigates whether subgroups of children with early onset eating disturbance are distinguished by maternal eating disorder history. The mothers of 66 children with either anorexia nervosa (AN), food avoidance emotional disorder (FAED) or selective eating (SE) were interviewed to ascertain eating disorder history. Seventeen per cent of mothers reported a history of eating disorder, compared with 3%–5% reported for community samples. A history of eating disorder was reported by 5.9% of mothers of children with SE, 12.9% of mothers of children with AN and 33.3% of mothers of children with FAED. The findings, based on this small sample, suggest that children with FAED are especially likely to have grown up in a dysfunctional food environment.

Biased interpretation in perfectionism and its modification

Perfectionism is a transdiagnostic construct associated with a range of diagnoses, including depression, eating disorders and obsessive compulsive disorder. Treatments that directly target perfectionist cognitions have been shown to successfully reduce associated pathologies. However, the way in which they do this is not clear. We set out to assess the role of one candidate mechanism of action, namely the cognitive process of interpretation of ambiguity. In one experiment we looked for associations between biased interpretation and perfectionism. In a second, we manipulated interpretations, thereby providing a strong test of their aetiological significance. Results from the first experiment confirmed the presence of biased interpretation in perfectionism and demonstrated that these are highly specific to perfection relevant information, rather than reflecting general negativity. The second experiment succeeded in manipulating these perfection relevant interpretations and demonstrated that one consequence of doing so is a change in perfectionist behaviour. Together, these data experimentally demonstrate that biased interpretation of perfection relevant ambiguity contributes to the maintenance of perfectionism, but that it is also possible to reverse this. Clinical implications include the identification of one likely mechanism of therapeutic change within existing treatments, as well as identification of an appropriate evidence based focus for future treatment development. Targeting underlying functional mechanisms, such as biased interpretation, has the potential to offer transdiagnostic benefits.

Neural effects of cannabinoid CB1 neutral antagonist tetrahydrocannabivarin (THCv) on food reward and aversion in healthy volunteers

Disturbances in the regulation of reward and aversion in the brain may underlie disorders such as obesity and eating disorders. We previously showed that the cannabis receptor subtype (CB1) inverse agonist rimonabant, an antiobesity drug withdrawn due to depressogenic side effects, diminished neural reward responses yet increased aversive responses (Horder et al., 2010). Unlike rimonabant, tetrahydrocannabivarin is a neutral CB1 receptor antagonist (Pertwee, 2005) and may therefore produce different modulations of the neural reward system. We hypothesized that tetrahydrocannabivarin would, unlike rimonabant, leave intact neural reward responses but augment aversive responses. Methods: We used a within-subject, double-blind design. Twenty healthy volunteers received a single dose of tetrahydrocannabivarin (10mg) and placebo in randomized order on 2 separate occasions. We measured the neural response to rewarding (sight and/or flavor of chocolate) and aversive stimuli (picture of moldy strawberries and/or a less pleasant strawberry taste) using functional magnetic resonance imaging. Volunteers rated pleasantness, intensity, and wanting for each stimulus. Results: There were no significant differences between groups in subjective ratings. However, tetrahydrocannabivarin increased responses to chocolate stimuli in the midbrain, anterior cingulate cortex, caudate, and putamen. Tetrahydrocannabivarin also increased responses to aversive stimuli in the amygdala, insula, mid orbitofrontal cortex, caudate, and putamen. Conclusions: Our findings are the first to show that treatment with the CB1 neutral antagonist tetrahydrocannabivarin increases neural responding to rewarding and aversive stimuli. This effect profile suggests therapeutic activity in obesity, perhaps with a lowered risk of depressive side effects. Keywords: reward, THCv, obesity, fMRI, cannabinoid

Psychometric evaluation of the Disordered Eating Attitude Scale (DEAS). English version

Eating attitudes are defined as beliefs, thoughts, feelings, behaviors and relationship with food They could influence people`s food choices and their health status Objective This study aimed to adapt from Portuguese to English the Disordered Eating Attitude Scale (DEAS) and evaluate its validity and reliability. The original scale in Portuguese was translated and adapted into English and was applied to female university students of University of Minnesota USA (n = 224). Internal consistency was determined (Cronbach`s Alpha). Convergent validity was assessed by correlations between Eating Attitude Test-26 (EAT-26) and Restrain Scale (RS). Reliability was evaluated applying twice the scale to a sub-sample (n = 30). The scale was back translated into Portuguese and compared with the original version and discrepancies were not found. The internal consistency was .76 The DEAS total score was significantly associated with EAT-26 (r = 0.65) and RS (r = 0 69) scores The correlation between test-retest was r = 09 The English version of DEAS showed appropriate internal consistency, convergent validity and test-retest reliability and will be useful to assess eating attitudes in different population groups in English spoken countries. (C) 2010 Elsevier Ltd. All rights reserved

Changing attitudes, beliefs and feelings towards food in bulimic patients

Eating attitudes are defined as beliefs. thoughts, feelings and behaviors towards food. Bulimia nervosa (BN) is ail eating disorder, in which the eating, attitudes are Seriously disturbed. Studies that evaluated nutritional aspects of BN focus mainly oil food intake, dietary restriction and binge eating. while the follow-up Studies evaluate mainly clinical symptoms. The objective of this study was to evaluate eating attitudes of patients with BN. during and after cognitive-behavioral intervention. Thirty nine (39) BN female patients received cognitive behavioral treatment with a Multidisciplinary team and had eating attitudes assessed by a questionnaire developed for this research. Frequencies of the attitudes assessed were compared at baseline. after 12 weeks and 24 weeks of treatment. After treatment, patients had less distorted beliefs about food, less guilty after eating ""forbidden"" foods and they felt more tranquil while caring outside home. Other negative behaviors, as dietary restriction, the desire of not cat, being angry when feeling hungry and using the food to relive stress. persisted. Eating attitudes of patients with BN are hard to be changed in a short-term. More attention to this disease`s component and new approaches to treatment are needed in order to have a better recovery.

Clinical significance of lifetime panic disorder in the course of bipolar disorder type I

Objectives: The aim of the study was to analyze the impact of lifetime panic disorder (PD) diagnosis in a sample of patients with bipolar disorder type I (BPI), evaluating clinical and demographic variables. Methods: Ninety-five outpatients from the Bipolar Disorder Research Program at the Institute of Psychiatry of the University of Sao Paulo Medical School were enrolled. Twenty-seven BPI patients with PD were compared to 68 BPI patients without any anxiety disorders regarding clinical and demographic variables. Results: Compared to BPI patients without any anxiety disorders, patients with BPI + PD presented significantly higher number of mood episodes (18.9 +/- 13.8 vs 8.5 +/- 7.8; P < .001), depressive episodes (10.8 +/- 8.2 vs 4.6 +/- 4,8; P = .001), and manic episodes (7.4 +/- 7.3 vs 3.6 +/- 3.6; P = .008). Patients with BPI + PD had more frequently a depressive episode as their first one compared to BPI patients without anxiety disorders (94.1% vs 57.5%; P = .011). Patients with BPI + PD had more comorbidity with lifetime diagnosis of drug abuse or dependence (33.3% vs 8.8%; P = .010) and eating disorders (29.6% vs 6.0%; P = .004). Conclusions: The higher number of mood episodes in general presented by patients with BPI + PD when compared with BPI patients without any anxiety disorders, along with the higher frequencies of drug misuse and eating disorders, indicates that PD comorbidity is associated with a poorer Course and outcome of BPI. The higher frequency of depression as the onset mood episode and the higher number of manic episodes in the group with PD may have important treatment implications and should be further investigated. (C) 2009 Elsevier Inc. All rights reserved.