Dificultades interpersonales en los trastornos alimentarios: un modelo psiconeurobiológico explicativo/comprensivo / Interpersonal difficulties in eating disorders: an explanatory/ comprehensive psychoneurobiological model

RESUMEN: Antecedentes: Los trastornos alimentarios (TCA) presentan entre sus síntomas disfunciones psicosociales como ansiedad social, alexitimia y falta de asertividad. Objetivo: Se propone un modelo explicativo/comprensivo que integra aspectos de psiconeurobiología y comportamiento útil para la clínica. Método: Se evaluó una revisión de la literatura en Medline / PubMed, SciELO y bases de datos de textos especializados con criterios de calidad. Fueron seleccionados conceptos centrales para construir una coherencia que permitiera la lectura psiconeurobiológica del fenómeno y su aplicación clínica. Resultados: Cuatro factores fueron dispuestos a significar: 1- sistema de alarma; 2- sistema de recompensa 3- cerebro social; 4-mecanismos de control (inhibición/excitación). Se dispusieron mostrando la complejidad de su interacción psicofisiológica. Se sugiere que la ingesta de alimentos podría funcionar como una forma primaria de equilibrio cuando hay fallas en alguno de los sistemas expuestos. Conclusión: Se presenta un modelo de integración psiconeurobiológico útil para explicar la dificultad interpersonal en TCA. Esta forma de comprensión facilita: la conexión entre las investigaciones emergentes en TCA y DI; la toma de decisiones clínicas y orientan el pronóstico y las alternativas de tratamiento.

ABSTRACT Background: Eating disorders (ED) are characterized by psychosocial disfunctions, like social anxiety, alexithymia and lack of assertiveness. Objective: To propose a comprehensive integrative model including neurobiology and behavior aspects. Method: A literature review on Medline/PubMed, SciELO and specialized texts databases were assessed against quality criteria. Core concepts were extracted and coherence articulated. Results: Four factors were disposed to meaning: alarm and reward system with social brain and control (inhibition/excitation) mechanisms. They were articulate in a complex psychophysiological interplay. They were associated with social behaviours achieved/not achieved during development. Food intake could operate like a pathological balance to psychopathological effects Conclusion: An explanatory/comprehensive psychoneurobiological model to understand social function in ED is proposed. This form of understanding facilitates: the connection between emerging research in eating disorders and ID; clinical decision-making and guide the prognosis and treatment alternatives.

Abuso sexual infantil y adolescente y su relación con trastornos alimentarios / Child and adolescent sexual abuse and its relationship with eating disorders

ANTECEDENTES: El antecedente de abuso sexual (AS) en la infancia o adolescencia en los trastornos alimentarios (TCA) está documentado en la experiencia clínica y en la literatura. Sin embargo, las complejas relaciones entre ambas condiciones no han sido sistematizadas. OBJETIVO: Describir la relación clínica y neurobiológica entre AS y TCA. MÉTODO: Se analizó exhaustivamente la literatura especializada en textos y artículos incluidos en Medline/PubMed, SciELO. Se perfilaron los conceptos centrales y se redactó la información buscando didáctica cohesión incluyendo un caso clínico ilustrativo. RESULTADOS: Aunque el AS es un factor inespecífico para el desarrollo de trastornos mentales, constituye un fenómeno significativo predisponente, desencadenante y perpetuante para la emergencia de un TCA, principalmente bulimia nerviosa. Se describen los factores de riesgo, mediadores, predictores, protectores y de resiliencia. Ambas condiciones poseen correlatos neurobiológicos y clínicos análogos (síntomas nucleares y funciones adaptativas). Existen disfunciones similares en los circuitos de recompensa y regulación emocional, con alteraciones estructurales distintas en áreas prefrontales. CONCLUSIONES: Existe contundente evidencia de la co-existencia de AS en los TCA. No obstante, es necesario continuar desarrollando modelos de investigación que integren realmente los procesos genéticos, hormonales, neurotransmisores, de personalidad y socioculturales de riesgo.

BACKGROUND: A history of childhood sexual abuse (SA) or adolescence in eating disorders (ED) is documented in clinical experience and in the literature. However, the complex relationships between both conditions have not been systematized. OBJECTIVE: To describe the clinical and neurobiological relationship between SA and ED. METHOD: The specialized literature in texts and articles included in Medline/PubMed, SciELO was thoroughly analysed. Central concepts were outlined and information was written seeking didactic cohesion, including an illustrative clinical case. RESULTS: Although SA is a nonspecific factor for the development of mental disorders, it constitutes a significant predisposing, triggering and perpetuating phenomenon for the emergence of ED, mainly bulimia nervosa. Risk, mediator, predictor, protective and resilience factors are described. Both specific conditions show analogous neurobiological and clinical correlates (core symptoms and adaptive functions). Similar dysfunctions exist in reward and emotional regulation circuits, with limited structural disturbances in prefrontal areas. CONCLUSIONS: There is strong evidence of the coexistence of SA in ED. However, it is necessary to develop research models that truly integrate genetic, hormonal, neurotransmitter, personality and sociocultural risk processes.

The delusional dimension of anorexia nervosa: phenomenological, neurobiological and clinical perspectives

Abstract Background Delusional characteristics have been largely ignored in patients suffering from anorexia nervosa (AN). Objectives To review the literature on delusional features in AN from phenomenological, neurobiological, and clinical viewpoints. Methods Data were obtained through searches of Medline, PubMed, SciELO and Cochrane Library. Results Distorted beliefs in AN may range from an overvalued idea to an overt delusion, involving affective, personality and/or psychotic disorders. Studies confirm alterations in monoaminergic systems. It has also been seen a decreased integration of visual/proprioceptive information, and alterations in neural networks involved in body processing. It is known that body image distortion may present "delusional proportions" as a consequence of great concern about body. Concomitantly, "embodied defence hypothesis" has been proposed. Restrictive AN exhibits higher levels of delusionality, and a particular delusional type of AN has been suggested, associated with a worse long-term outcome. Low doses of atypical antipsychotics are recommended combined with cognitive techniques. Discussion Delusional thinking in AN is likely a dynamic and dimensional phenomenon that can vary, both in nature and/or severity, whereas high insight levels, before and after refeeding, result in positive outcomes. Neurobiological research on this topic must be encouraged, since clinical and phenomenological approaches are comparatively more frequently reported.

Trastornos alimentarios en mujeres adultas (maduras) / Eating disorders in adult (mature) women

Resumen Antecedentes: Existe evidencia de un creciente número de mujeres en la mediana edad que sufren trastornos de la conducta alimentaria (TCA). Objetivo: Describir las mujeres en la adultez mediana con TCA, en relación a sus características epidemiológicas, etiopatogénicas, clínicas, evolutivas y terapéuticas. Método: Se realizó una búsqueda bibliográfica exhaustiva utilizando las bases de datos electrónicas MEDLINE/PubMed, SciELO y la Biblioteca Cochrane, además de textos de consulta especializados, desde 1984 hasta la actualidad (2017). Resultados: Las características clínicas y la mayoría de los factores de riesgo (biológico, psicológico, sociocultural) son similares a los encontrados en mujeres más jóvenes, pudiendo ser más probablemente la continuación de un TCA previo o un inicio tardío de la patología. Las variables más distintivas y relevantes para las mujeres de mediana edad son la menopausia y la ansiedad relacionada al envejecimiento, quienes parecen ser menos proclives a desarrollar anorexia nerviosa y bulimia nerviosa, sino más bien trastorno por atracones y otros TCA no especificados y especificados subumbrales. Es muy frecuente la depresión y las comorbilidades físicas sistémicas. El manejo terapéutico es multidisciplinario y la falta de adherencia implica un desenlace crónico. Conclusiones: Los médicos deben tener presentes el mayor riesgo de TCA en mujeres perimenopáusicas, cuando los cambios en la apariencia física pueden ser drásticos, inesperados y no deseados y deben esmerarse en explorar esta posibilidad en la práctica clínica diaria.

Background: There is evidence of an increasing number of middle-aged women suffering from eating disorders (ED). Objective: To describe women in adulthood with eating disorders, in relation to their epidemiological, aetiopathogenic, clinical, evolutionary and therapeutic characteristics. Method: A comprehensive literature search was carried out using the electronic databases MEDLINE/PubMed, SciELO and the Cochrane Library, as well as specialized consultation texts, from 1984 to present (2017). Results: Clinical characteristics and most of the risk factors (biological, psychological, sociocultural) are similar to those found in younger women, and may be more likely the continuation of a previous ED or a late onset of the pathology. The most distinctive and relevant variables for middle-aged women are menopause and anxiety related to aging, who seem to be less likely to develop anorexia nervosa and bulimia nervosa, but rather binge eating disorder and other unspecified and specified threshold EDs. Depression and systemic physical comorbidities are very common. The therapeutic management is multidisciplinary and the lack of adherence implies a chronic outcome. Conclusions: Physicians should bear in mind the increased risk of EDs in peri-menopausal women, when changes in physical appearance can be drastic, unexpected and undesirable, and should strive to explore this possibility in their daily clinical practise.

Influencia de factores socioculturales en la imagen corporal desde la perspectiva de mujeres adolescentes / Influence of sociocultural factors on body image from the perspective of adolescent girls

Resumen: La imagen corporal es un tópico relevante en el desarrollo de la identidad durante la adolescencia, donde los factores sociales son decisivos en la determinación de las expectativas individuales. Este estudio describe y analiza la percepción que mujeres adolescentes tienen acerca de la influencia de los aspectos socioculturales en su imagen corporal. El enfoque de investigación fue cualitativo, exploratorio y descriptivo, basado en la teoría fundamentada. Se entrevistó a cinco mujeres adolescentes de entre 16 y 18 años de edad. Los resultados muestran que existe una experiencia de la imagen corporal caracterizada por sentimientos ambivalentes y diferentes grados de insatisfacción corporal. En general, las participantes sobrevaloran la importancia del aspecto físico y, específicamente, la delgadez es considerada signo de atractivo, éxito y perfección; prototipo estético que favorece la insatisfacción corporal. Los parámetros socioculturales percibidos como más influyentes fueron los medios masivos de comunicación, especialmente las redes sociales digitales, que superan a los pares y a la familia. Se concluye que el fortalecimiento de la capacidad de juicio crítico para discernir entre los ideales corporales y los cuerpos reales podría favorecer la prevención de problemas alimentarios en las mujeres adolescentes.

Abstract: Body image is a relevant topic in the development of identity during the adolescence, where social factors are significant in determining individual expectations. This study aims to describe and analyze the perception that female adolescents have about the influence of sociocultural factors on their own body image. This research has a qualitative, exploratory and descriptive approach based on the Grounded Theory. Five adolescent girls aged between 16 and 18 years were interviewed. Results show that body image is characterized by ambivalent feelings and different degrees of body dissatisfaction. In general, participants overvalue physical aspects, for instance, thinness is believed as a sign of attractiveness, success and perfection, prototype linked to body dissatisfaction. The more influential sociocultural parameters were mass media, especially online social networks, peers and family. It is concluded that strengthening critical judgment skills to distinguish between the ideal body and the real body could enhance the prevention of eating disturbances in adolescent women.

Vivencias y significados en torno a la imagen corporal en varones chilenos / Experiencies and perceptions on body image in Chilean males

Resumen: La imagen corporal (IC) es fundamental en el desarrollo de la identidad; sin embargo, en la población masculina la evidencia empírica es escasa. El propósito de este estudio es describir las vivencias y significados asociados a la construcción de la IC en varones, a partir de una aproximación metodológica cualitativa. Participaron 16 varones de entre 15 y 25 años de edad. Los datos fueron recolectados mediante entrevistas semiestructuradas y se formaron dos grupos focales, ambos analizados por medio de codificación abierta. Los significados y procesos asociados a la IC se clasificaron en tres categorías: Cuidado de la apariencia física, Ideal estético, Autoconcepto e IC. Los participantes percibieron diferencias en su preocupación y cuidado de la apariencia física respecto a las mujeres, los varones homosexuales o los varones de generaciones previas. En la construcción de la IC destaca el papel de la motivación por resultar atractivo al sexo opuesto, con énfasis en el incremento del desarrollo muscular. No obstante, la insatisfacción corporal no representa un tópico particularmente relevante en los participantes, dado que hacen una valoración práctica de su imagen, lo que podría ser un indicador de una nueva relación con su propia masculinidad e IC que es necesario explorar.

Abstract: Body image (BI) is a core feature for identity development; nevertheless amongst male population there is scarce empirical evidence. The aim of this study was to describe the experiences and meanings associated to the construction of BI in male, based on a methodological-qualitative approach. Participated 16 young men aged 15 to 25 years. Data were collected by semi-structured interviews and two focus groups, both analised by open codification. Meanings and procedures related to BI were classified in the following categories: physical appearance care, beauty ideal, self-concept and BI. Participants perceived differences in their physical appearance care compared with women, homosexuals and men of previous generations. In BI construction it is highlighted the drive for being attractive to the opposite sex by the increase of the muscle development. However body dissatisfaction do not represent a relevant topic for participants, since they display a pragmatic value of their BI, which may be an index of a new relationship with their own masculinity and BI that must be explored.

Funcionamiento psicosocial en pacientes agudos y crónicos no psiquiátricos en régimen hospitalario: depresión, alexitimia y falta de asertividad / Psychosocial functioning in non-psychiatric acute and chronic inpatients: depression, alexithymia and lack of assertiveness

Background: Depression, alexithymia, and lack of assertiveness interfere with individual psychosocial functioning and may result in longer hospitalization stay and poorer therapeutic results. Aim: To analyze the psychosocial functioning in acute and chronic patients and its association with psychological, clinical and sociodemographic variables. Material and Methods: We performed a cross-sectional study that included 80 inpatients of both sexes with organic pathology, aged between 18 to 70 years old, without any current psychiatric disorder. Clinical and sociodemographic data were collected from a semi-structured interview and hospital records. Beck Depression Inventory-IA, Toronto Alexithymia Scale-20 and Rathus Assertiveness Scale were administered. Results: Fifty five percent of patients had some degree of depression, 33% alexithymia and 34% lack of assertiveness. The levels of depression, alexithymia and lack of assertiveness in chronic patients were significantly higher than those observed in acute patients. Women and participants older than 60 years exhibited the highest degrees of depression. Alexithymia and lack of assertiveness were associated with a lower educational level. A negative significant correlation between alexithymia and assertiveness scores was observed among acute patients. Conclusions: Participants with chronic diseases had a lower psychosocial functioning. Less educated patients showed more alexithymic and less assertive features. We emphasized the need of a better management of these aspects by the health team, since social functioning might interfere with the outcome of physical illnesses.

Trastorno dismórfico corporal: aspectos clínicos, dimensiones nosológicas y controversias con la anorexia nerviosa / Body dysmorphic disorder: clinical aspects, nosological dimensions and controversies with anorexia nervosa

There is strong evidence about the co-existence of body dysmorphic disorder (BDD) and eating disorders (ED), particularly with anorexia nervosa (AN). An exhaustive review of the specialised literature regarding these disorders was carried out. The results show that their co-occurrence implies a more complex diagnosis and treatment, a more severe clinical symptomatology and a worse prognosis and outcome. Both disorders display common similarities, differences and comorbidities, which allow authors to classify them in different nosological spectra (somatomorphic, anxious, obsessive-compulsive, affective and psychotic). Their crossover involves higher levels of body dissatisfaction and body image distortion, depression, suicidal tendency, personality disorders, substance use/abuse, obsessive-compulsive disorder, social phobia, alexithymia and childhood abuse or neglect background. Treatment including cognitive-behavioral psychotherapy and selective reuptake serotonin inhibitors are effective for both, BDD and ED; nevertheless, plastic surgery could exacerbate BDD. Clinical traits of BDD must be systematically detected in patients suffering from ED and vice versa.

Trastornos de la imagen corporal: anorexia nerviosa versus anorexia inversa (trastorno dismórfico muscular) / Body image disorders: anorexia nervosa versus reverse anorexia (muscle dysmorphia)

Resumen Introducción Entre los trastornos relacionados con la imagen corporal, la anorexia nerviosa (AN) en el sexo femenino y el trastorno dismórfico muscular (TDM) en el masculino surgen como los más representativos. Objetivo Analizar descriptivamente la relación entre las características clínicas de la AN y el TDM. Método Se realizó una búsqueda bibliográfica sobre la relación entre AN y TDM mediante las bases de datos Medline/PubMed, SciELO y textos especializados. Resultados Existen similitudes y diferencias entre ambos trastornos. Se inician en la adolescencia, muestran gran traslape diagnóstico, uso/abuso de fármacos, similares comorbilidades, mejoría con inhibidores selectivos de la recaptura de serotonina, psicoterapia cognitivo-conductual y se focalizan en la imagen corporal, pero en la AN se persigue la delgadez, mientras que en el TDM, el desarrollo muscular. Desde la perspectiva psicosocial, estos trastornos de la imagen corporal surgen debido a las presiones socioculturales occidentales relacionadas con los estereotipos de rol de género, que enfatizan una silueta esbelta femenina versus una masculina vigorosa. La clasificación nosológica del TDM ha sido controvertida, siendo actualmente incluida en el DSM-5 en el espectro obsesivo-compulsivo. Conclusiones Ambos trastornos implican una insatisfacción corporal con diversos grados de distorsión de la imagen corporal, alcanzando aun dimensiones delirantes. Se requieren futuras investigaciones que puedan fundamentar nuevas categorizaciones de estos desórdenes, clarificadoras de su esencia.

Abstract Background Among body image disorders, anorexia nervosa (AN) in females and muscle dysmorphia (MD) in males, emerge as the more representative. Objective To describe the relationship of clinical characteristics between AN and MD. Method A review of specialised textbooks and the available literature in Medline/PubMed and SciELO was made. Results There are similarities and differences between both disorders. They begin in adolescence, show a great diagnostic crossover, use/abuse of pharmacological drugs, similar co-morbidities, improvement with selective serotonin reuptake inhibitors and behavioural-cognitive psychotherapy, they are focused in body image, but AN pursuits thinness while MD muscle development. From a psychosocial perspective, body image disorders come out due to western socio-cultural pressures related to gender role stereotypes, which emphasise a slim feminine figure versus a vigorous masculine one. The nosological classification of MD is controversial and it has been including within the obsessive-compulsive spectrum of the DSM-5. Conclusions Both disorders imply body dissatisfaction with different degrees of body image distortion, even reaching delusional dimensions. Future studies are required which can lay the foundations of new categorisations of these disorders that better clarify their essence.

Ascetismo y espiritualidad en la anorexia nerviosa: Un análisis psicosocial histórico / Asceticism and spirituality in anorexia nervosa: A historical psychosocial analysis

Introducción: El ascetismo se relaciona profundamente con la espiritualidad y las prácticas de ayuno que han sido observadas en la anorexia nerviosa (AN) a lo largo de la historia.Objetivo:Se realiza un análisis psicosocial de la espiritualidad y el ascetismo en el contexto histórico de la AN, desde la Edad Media hasta el siglo XXI, comparando la anorexia santa con la anorexia contemporánea. Se describen casos ilustrativos ad hoc.Método: Se realizó una búsqueda bibliográfica de la evidencia sobre el ascetismo y la espiritualidad en la AN y su desarrollo histórico mediante las bases de datos Medline/PubMed y textos de consulta especializados.Resultados: Desde una perspectiva histórica, el ascetismo de las santas medievales (anorexia santa) y de las anoréxicas modernas, exhiben rasgos comunes, aunque orientados a distintas metas: espiritualidad versus apariencia mundana, respectivamente. El puritanismo contemporáneo y la AN comparten rasgos distintivos de la ética protestante, principalmente autodisciplina, autocontrol, abnegación, racionalidad, eficiencia y obtención de logros. El ascetismo se relaciona significativamente con sentimientos rabiosos, rasgos de inmadurez y conductas purgativas.Discusión y conclusión: Muchas mujeres místicas medievales mostraron características similares con la AN actual, sin embargo, mientras el ascetismo en las santas se orientaba al logro del encuentro divino, la motivación por adelgazar en las jóvenes anoréxicas contemporáneas se relaciona más bien con ideales estéticos socioculturales. La ocurrencia atemporal de la esencia patogénica del síndrome anoréxico sugiere que factores como edad, personalidad y/o entorno psicosocial lo modelan patoplásticamente.

Background: Asceticism is deeply related to spirituality and fasting practices that have been observed in anorexia nervosa (AN) through the history.Objective: A psychosocial analysis of spirituality and asceticism within the historical context of the AN is made, from Middle Ages to XXI century, comparing the holy anorexia and the contemporary AN. Ad hoc illustrative cases are described.Method: Medline/Pubmed, data bases and specialized textbooks were used to look for evidence on asceticism and spirituality in AN and its historical development.Results: From a historical point of view, asceticism of medieval saints (holy anorexia) and that of modern anorectics, display common features; nevertheless, it is oriented to different goals: spirituality versus worldly appearance, respectively. Contemporary Puritanism and AN share distinctive characteristics of protestant ethics, mainly self-discipline, self-control, self-sacrifice, rationality, efficiency and goals achievement. Asceticism is significantly related to angry feelings, inmaturity features and purging.Discussion and conclusion: Many medieval mystical women showed similar characteristics with present AN, nevertheless, while asceticism in saints were oriented to achieve the divine encounter, drive for thinness in contemporary young anorectics is rather related to sociocultural aesthetic ideals. The atemporal occurrence of the pathogenic essence of the anorectic syndrome suggests that factors like age, personality and/or psychosocial environment pathoplastically model it.

Estudio multicéntrico para la validación de la versión en español del Eating Disorder Diagnostic Scale / Validation of the Spanish version of the Eating Disorders Diagnostic Scale

Background: The Eating Disorders Diagnostic Scale (EDDS) is a self-administered low cost psychometric instrument with excellent levels of temporal reliability and validity. Aim: To adapt and validate the EDDS in Chile. Material and Methods: Thefactorial structure, internal consistency and test-retest reliability ofthe Spanish-language version of the EDDS was analyzed in a sample of1964 university and high school students. The concurrent validity was tested in a sample of 50 primary care patients with ED and 59 controls, comparing its results with those of a structured psychiatric interview (CIDI). Results: The EDDS showed a high internal consistency, moderate test-retest reliability, an appropriate factorial structure (in women) and an excellent convergent validity. Also, the diagnosis of ED obtained with the EDDS is moderately consistent with the structured psychiatric interview. Conclusions: The Spanish-language version of the EDDS showed a satisfactory psychometric behavior and a good capacity for detecting ED, according to the DSM criterion.

Dismorfia muscular, imagen corporal y conductas alimentarias en dos poblaciones masculinas / Muscle dysmorphia, body image and eating behaviors in two male populations

Background: Muscle dysmorphia or vigorexia is a disorder in which a person becomes obsessed with the idea that he or she is not muscular enough. Aim: To assess physical exercise, eating behaviors and the presence of muscle dysmorphia among weightlifters and medical students. Subjects and Methods: Cross sectional evaluation of 88 male weightlifters aged 27 ± 7 years and 84 male medical students aged 22 ± 1 year was made. Eating behaviors were evaluated using the Eating Attitudes Test (EAT-40) and the Eating Disorders Inventory (EDI). The perception of body image was assessed using the Graduate Hannover Scale (GHS). Results: Prevalence of muscle dysmorphia among weightlifters was 13.6 percent. Both groups did not differ in body dissatisfaction. Interest in appearance among weightlifters was significantly higher than in students and ranged significantly higher in EAT-40 and EDI (p < 0.001). Other sports were practiced with the same frequency by weightlifters and students. Weightlifters expended more time than students exercising to improve their appearance (p < 0.005). Forty two percent of weightlifters with muscle dysmorphia displayed abuse of anabolics and 67 percent used other substances to improve their performance (p < 0.005). Conclusions: The presence of muscle dysmorphia among weightlifters was confirmed. They were dissatisfied with their body image and more concerned with their physical appearance than those without muscle dysmorphia and/or students. Their anabolic abuse rate was high. Our findings were similar to those reported in the international literature.

Factores psicosociales de los trastornos alimentarios / Psychosocial factors of eating disorders

Es interesante comprender desde un punto de vista sociocultural y psicológico el trasfondo de los trastornos de la conducta alimentaria, anorexia y bulimia, problemas que aquejan principalmente a adolescentes y mujeres.

La imagen corporal en los trastornos de la conducta alimentaria / Body image and eating disorders

En este artículo se revisa el concepto y la percepción de la imagen corporal de sí mismo, aspecto importante en el diagnóstico de trastornos de la conducta alimentaria, como anorexia nerviosa o bulimia.

Consumo de alcohol y trastornos de la conducta alimentaria: evidencia, similitudes e implicancias / Alcohol consumption and eating disorders: evidence, similarities and implications

Antecedentes. Existe una contundente evidencia que apoya la co-ocurrencia entre trastornos de la conducta alimentaria y abuso de alcohol y otras sustancias. Método. Se revisa la literatura especializada disponible acerca de la asociación entre ambas patologías, la presencia de abuso de alcohol en familiares de pacientes con desórdenes alimentarios y las hipótesis que las relacionan etiopatogénicamente, considerando sus similitudes y diferencias. Resultados. El 27% de las pacientes con trastornos alimentarios presenta dependencia a alcohol. El abuso y/o dependencia de alcohol oscila entre el 0% al 6% en la anorexia nerviosa restrictiva, 10% y 28% cuando se demuestra la presencia de rasgos bulímicos, y hasta 50% en las pacientes bulímicas. Entre el 15% al 56% de las pacientes alcohólicas presenta un trastorno alimentario: 1,4% a 10% anorexia nerviosa, 10% comer compulsivo o trastorno por comilonas, pero principalmente bulímico, entre 6,2% a 50%. Abuso de alcohol parental se observa hasta en el 50% de pacientes bulímicas y sólo hasta el 7% de pacientes anorécticas. Conclusiones. Las referencias publicadas claramente sugieren una comorbilidad entre trastornos de la conducta alimentaria y abuso de drogas, incluido el alcohol, cuya relación aún permanece oscura. Más del 30% de los pacientes con trastornos alimentarios puede exhibir un problema de abuso de sustancias concurrente, particularmente los pacientes portadores de bulimia nerviosa. La coexistencia de ambos desórdenes posee implicancias clínicas, terapéuticas y pronósticas.

Detección de trastornos del hábito del comer en una población estudiantil de la V región / Detection of eating behavior disorders in a school population of V region

Los jóvenes adolescentes en edad escolar han sido consideradas como una población de alto riesgo para desarrollar eventualmente un trastorno del hábito del comer, sea éste anoréctico y/o bulímico. A 570 estudiantes de sexo femenino de III y IV año de enseñanza media de la V Región y a 30 pacientes con diagnóstico de desorden alimentario, se les administró el Test de Actitudes Alimentarias (EAT40), resultando un subgrupo denominado potencialmente patológico (n: 103), que representó el 18,1 por ciento de la muestra estudiantil y que obtuvo puntajes en el rango patológico del EAT40. Del análisis factorial del EAT40 emergió una útil subescala abreviada: el EAT22. Se comparan los hallazgos más relevantes entre los grupos, confrontándolos con la literatura especializada y se sugieren medidas preventivas apropiadas