RESUMEN
Personality variables have long been implicated in the onset and maintenance of eating disorders, as well as in symptom divergence between anorexia nervosa and bulimia nervosa. Clinical observations are broadly supported by the data, with restricting anorexia nervosa associated with higher levels of constraint and Persistence, and binge-purge behaviors linked to the tendency to take impulsive action when emotionally distressed. Considerable heterogeneity is found within diagnostic categories, however, suggesting that different personality structures may predispose individuals to develop disordered eating through alternative pathways.
Asunto(s)
Anorexia Nerviosa/fisiopatología , Bulimia Nerviosa/fisiopatología , Conducta Impulsiva/fisiología , Perfeccionismo , Trastornos de la Personalidad/fisiopatología , HumanosRESUMEN
Significant progress has been achieved in the development and evaluation of evidence-based psychological treatments for eating disorders over the past 25 years. Cognitive behavioral therapy is currently the treatment of choice for bulimia nervosa and binge-eating disorder, and existing evidence supports the use of a specific form of family therapy for adolescents with anorexia nervosa. Important challenges remain. Even the most effective interventions for bulimia nervosa and binge-eating disorder fail to help a substantial number of patients. A priority must be the extension and adaptation of these treatments to a broader range of eating disorders (eating disorder not otherwise specified), to adolescents, who have been largely overlooked in clinical research, and to chronic, treatment-resistant cases of anorexia nervosa. The article highlights current conceptual and clinical innovations designed to improve on existing therapeutic efficacy. The problems of increasing the dissemination of evidence-based treatments that are unavailable in most clinical service settings are discussed.
Asunto(s)
Terapia Cognitivo-Conductual/métodos , Terapia Familiar/métodos , Trastornos de Alimentación y de la Ingestión de Alimentos/terapia , Generalización Psicológica , Humanos , Autoeficacia , Resultado del TratamientoRESUMEN
There are compelling reasons to examine personality variables in the eating disorder (ED) field but many impediments to the collection of useful data. In addition to the conceptual and methodological difficulties associated with personality assessment in the general case, the EDs present a number of special problems. These include patients' young age at onset and evaluation, the "state" effects of semi-starvation and chaotic eating, denial and distortion in self-report, the instability of ED subtypes, and the intrusion of eating and weight concerns into a wide range of apparently unrelated domains. Although there is substantial support for the clinical view that personality variables are linked to anorexia nervosa (AN) and bulimia nervosa (BN), the identification of stable traits and Axis II disorders in individual patients should be deferred until after the initial phase of treatment.
RESUMEN
The Food Phobia Survey (FPS) is a recently developed clinical instrument designed to identify foods that are avoided out of fear or guilt by eating disordered individuals. The measure has potential utility in clinical settings for several purposes: the assessment of current food selection and food-related concerns; the construction of individual hierarchies for graded exposure; and the evaluation of treatment outcomes with reference to fear and avoidance of food items. It is comprised of 180 commonly eaten foods rated on three dimensions: fear/guilt, appeal in the absence of weight concern, and frequency of consumption. Dieting and non-dieting college women were compared to provide preliminary data on the FPS from a non-clinical population. The FPS yielded findings convergent with other data on forbidden foods and discriminated between dieters and non-dieters. For both groups, the perception that foods were fattening was correlated with increased fear/guilt, with dieters showing significantly greater increases in ratings of fear/guilt and number of feared foods with increments in the perceived 'fatteningness' of food items.
Asunto(s)
Dieta Reductora , Trastornos de Alimentación y de la Ingestión de Alimentos/psicología , Alimentos/clasificación , Encuestas y Cuestionarios/normas , Adulto , Análisis de Varianza , Anorexia Nerviosa/psicología , Bulimia/psicología , Ingestión de Energía , Conducta Alimentaria , Femenino , Preferencias Alimentarias , Humanos , Percepción , Psicometría , Reproducibilidad de los ResultadosRESUMEN
OBJECTIVE: Anorexia nervosa (AN) is associated with serious medical morbidity and has the highest mortality rate of all psychiatric disorders. The National Institutes of Health (NIH) Workshop on Overcoming Barriers to Treatment Research in Anorexia Nervosa convened on September 26-27, 2002 to address the dearth of treatment research in this area. The goals of this workshop were to discuss the stages of illness and illness severity, pharmacologic interventions, psychological interventions, and methodologic considerations. METHOD: The program consisted of a series of brief presentations by moderators, each followed by a discussion of the topic by workshop participants, facilitated by the session chair. RESULTS: This report summarizes the major discussions of these sessions and concludes with a set of recommendations related to the development of treatment research in AN based on these findings. DISCUSSION: It is crucial that treatment research in this area be prioritized.