Pain and temporomandibular disorders in patients with eating disorders

Abstract Orofacial pain and temporomandibular dysfunction may cause chronic facial pain, which may interfere with the emotional state and food intake of patients with eating disorders (ED), such as anorexia nervosa (AN) and bulimia nervosa (BN). Sixty-four patients were assigned to four groups: Group A (AN - restricting subtype): 07; Group B (AN - purging subtype ): 19; Group C (BN): 16; and Group D (control): 22. Complaints of pain are more prevalent in individuals with eating disorders (p<0.004). There are differences between the presence of myofascial pain and the number of hospitalizations (p = 0.046) and the presence of sore throat (p=0.05). There was a higher prevalence of masticatory myofascial pain and complaints of pain in other parts of the body in ED patients; however, there was no difference between ED subgroups. There was no difference in the number of self-induced vomiting between ED patients with and without myofascial pain.

Anorexia e bulimia – corpo perfeito versus morte / Anorexia and bulimia – perfect body versus death

A anorexia nervosa e a bulimia nervosa são transtornos alimentares (TA) de difícil tratamento e de alta morbidade. OPrograma de Transtornos Alimentares (AMBULIM) do IPq-FMUSP caracteriza-se como o primeiro centro brasileiro multidisciplinarpara o tratamento, ensino e pesquisa da área. O atendimento embasa-se em ações multidisciplinares envolvendo,essencialmente, o acompanhamento médico, nutricional e psicológico. A atividade física merece atenção, poishá evidências da associação da dependência ao exercício com os TA. Observamos um processo lento e gradativo, como comprometimento da saúde física, emocional e social desse paciente, com uma recusa mórbida em ganhar peso. Suascrenças pessoais, muitas vezes, embasam-se no fato de que “ser magro(a)”, “estar magro(a)” é a chave para o seu sucessopessoal, afetivo e social. A expectativa de corpo difundida na sociedade contemporânea, caracterizada por uma noção deperfeição ligada à magreza, acaba por influenciar a imagem corporal, elemento essencial na etiologia dos TA. A mídia,por sua vez, oferece instruções explícitas sobre como atingir o ideal de beleza, promovendo a crença de que as pessoaspodem, e de fato devem, controlar sua forma e peso corporais. O trabalho desenvolvido pelo profissional da saúde com opaciente que desenvolve TA é intenso e repleto de desafios, devendo ir além da intervenção assistencial. É esperado quepossa compartilhar seus conhecimentos com a população e informá-la acerca dos riscos e formas de cuidados, evitando,assim, que o TA seja um dos caminhos trilhado por muitos jovens.

Nervous anorexia and nervous bulimia are food disturbances (FD) of difficult treatment and of rise morbidity. The Programof Food Disturbances (Ambulim) of IPq-FMUSP is the first multidisciplinary Brazilian center for the treatment, teachingand research of the area. The service is based on multidisciplinary actions integrating essentially medical, nutritional andpsychological assistance. Physical activity is considered, since there are evidences of the association of dependence toexercise with FD. We observe a slow and gradual process leading to physical, emotional and social health worsening of apatient, with a morbid refusal to gaining weight. Her personal beliefs very often are based on the fact that “to be thin”, “staythin” is the key for her personal, affective and social success. The expectation about the body spread in the contemporarysociety, characterized by a notion of perfection connected to slimness, influences the physical image, essential element theetiology of FD. The media, by their turn, offer explicit instructions about how to reach the ideal of beauty, promoting thebelief that persons can, and in fact have to, to control his physical condition and weight. The work developed by a healthprofessional with a patient who develops FD is intense and full with challenges, and must go beyond health care. It is expectedthat professionals could share their knowledge with the population, warning it about the risks and care modalitiesin order to prevent FDs to be a life style choice for young people.