A randomized controlled trial to prevent obesity among Latino paediatric patients.

BACKGROUND: Obesity disproportionately affects Latino youth. Community clinics are an important resource, yet there is little evidence for the efficacy of clinic-based approaches in this population. OBJECTIVE: The purpose of this study was to test the efficacy of a clinic-based intervention to lower body mass index (BMI) and improve body composition among overweight Latino children. METHODS: A randomized trial (2 group × 3 repeated measures) was conducted among 297 randomly sampled, overweight paediatric patients (5-10 years old) and their parents. The 12-month family-based culturally tailored behavioural intervention (Luces de Cambio) was based on the 'traffic light' concepts to address behaviour change and was delivered by clinic health educators and mid-level providers. The primary study outcome was child BMI (kg m-2 ) assessed at baseline, 6-month (n = 191) and 12-month (n = 201) post-baseline. A subsample of the children was examined for overall and site-specific adiposity using dual-energy X-ray absorptiometry (n = 79). RESULTS: There were no significant intervention effects on child BMI (p > 0.05); however, intervention children showed significantly (p < 0.05) lower total and trunk per cent fat compared with the usual care condition. CONCLUSIONS: The Luces intervention did not reduce child BMI, yet small but significant reductions were observed for child per cent body fat. Further research is needed to identify and reduce barriers to recruitment and participation among Latino families.

La mujer moderna y el comprar compulsivo / Modern woman and compulsive buying

Resumen Introducción: El comprar compulsivo (CC) ha sido observado principalmente en mujeres modernas (hasta 95%) en nuestra sociedad occidental. Objetivo: Describir analíticamente la relación entre el CC y factores biopsicosociales que favorecen su desarrollo. Método: Se realizó una búsqueda bibliográfica sobre la relación entre CC y factores biopsicosociales mediante las bases de datos Medline/PubMed, SciELO y textos especializados. Resultados: El CC es un trastorno del control de los impulsos (a menudo dentro de un patrón multiimpulsivo), con severa interferencia en el funcionamiento psicosocial y financiero, que emerge en un contexto postmoderno, con una significativa asociación con los cambios de identidad de género en el sexo femenino, con comorbilidades, principalmente, trastornos de ansiedad, del ánimo, alimentarios, uso/abuso de sustancias y de personalidad (obsesivo-compulsivo, evitativo, limítrofe). Habitualmente es desencadenado por afectos negativos (angustia, tristeza, ira, frustración, soledad), baja autoestima, estímulos externos favorecidos por el sistema de mercado, valoración de la aprobación social por el consumo y/o satisfacción hedonista. El tratamiento combinado de psicoterapia cognitivo-conductual, psicoeducación y fármacos ISRS parece ser más efectivo. Conclusiones: La evidencia muestra que el CC correspondería a un fenómeno biopsicosocial, más prevalente en mujeres, en un trasfondo histórico sociocultural postmoderno, que sobrepasa la autonomía, igualdad y competencia en ámbitos masculinos logrados por la mujer actual, convirtiéndose en un trastorno del espectro impulsivo incluido en la CIE-10.

Background: Compulsive buying (CB) has been observed mainly in modern women (up to 95%) in our Western society. Objective: To describe analytically the relationship between CB and biopsychosocial factors that encourage its development. Method: A review of specialised textbooks and the available literature in Medline/PubMed and SciELO on the relationship between CB and biopsychosocial factors was conducted. Results: CB is an impulse control disorder (ojien within a multi-impulsive pattern), with severe interference in psychosocial and financial functioning, which emerges in a postmodern context, with a significant association with changes in the female gender identity, with comorbidities mainly anxiety, mood, eating disorders, use/abuse of substances and personality (obsessive-compulsive, avoidant, borderline). It is usually triggered by negative affects (anguish, sadness, anger, frustration, loneliness), low self-esteem, external stimuli reinforced by the marketing system, value of social approval for consumption and/or hedonistic satisfaction. The combined treatment of cognitive-behavioural psychotherapy, psychoeducation and SSRI drugs seems to be more effective. Conclusions: The evidence shows that CB could be considered as a biopsychosocial phenomenon, more prevalent in women, in a postmodern socio-cultural historical background, that exceeds the autonomy, equality and competence in masculine domains achieved by the current woman, becoming a psychopathological disorder within the impulsive spectrum that has been included in the ICD-10.

Estado actual de los trastornos somatomorfos y conversivos en niños y adolescentes / Current state of somatoform and conversion disorders in children and adolescents

Introducción: Los trastornos somatomorfos (TS) y conversivos (TC) han aumentado su incidencia durante las dos últimas décadas en niños y adolescentes, aunque ambos son habitualmente subdiagnosticados. Objetivo: Efectuar una puesta al día de la evidencia sobre TS y TC en niños y adolescentes. Método: Se realizó una búsqueda bibliográfica mediante las bases de datos Medline/PubMed, SciELO y textos especializados. Resultados: Existe una alta intercurrencia con trastornos afectivos y ansiosos y se han identificado algunos factores de riesgo, especialmente mayor vulnerabilidad al estrés, disfunción familiar, sobreprotección parental y limitada mentalización de los síntomas físicos (alexitimia), que también perpetuan la sintomatología. Desde la perspectiva etiopatogénica se han invocado hipótesis psicodinámicas, psicosomáticas, traumático-ambientales y biológicas. Los pacientes con TS y TC frecuentemente son mujeres, presentan rasgos más introvertidos de personalidad, más eventos vitales estresantes y défictis ejecutivos. Las convulsiones psicógenas no epilépticas se relacionan con más comorbilidades psiquiátricas y peor pronóstico. Las psicoterapias cognitivo-conductual y la hipnoterapia-psicodinámica combinadas con fármacos inhibidores de la recaptura de serotonina han demostrado ser eficaces en el tratamiento. Conclusiones: Los TS y TC en poblaciones infanto juveniles se observan en contextos médicos y psiquiátricos. Su reconocimiento es difícil debido a su etiología multifactorial, la falta de consenso diagnóstico yla escasa experiencia clínica, implicando un verdadero desafío terapéutico, por lo que es indispensable realizar futuras investigaciones en este tópico. Su manejo en la atención primaria parece apropiado, pero en casos más complejos es necesaria su derivación al especialista.

Background: Somatoform (SD) and conversion (CD) disorders have increased their incidence during the last two decades in children and adolescents, although both are currently underdiagnosed. Objective: To review the evidence on SD and CD in children and adolescents. Method: A review ofspecialised textbooks and the available literature in Medline/PubMed and SciELO was made. Results: There is a high intercurrence with affective and anxiety disorders and some riskfactors have been identified, especially higher vulnerability to stress, family disfunction, parental overprotection, and limited mentalization of physical symptoms (alexithymia), which at the same time, perpetuate the symptomatology. From an ethiopathogenicperspective, psychodynamic, psychosomatic, traumatic-environmental and biological hypothesis have been invoked. Patients with SD and CD are frequently females, show more introversive personality features, more stressful life events and executive deficits. Psychogenic non-epileptic seizures are related with more psychiatric co-morbidities and worse outcome. Cognitive-behavioural psychotherapy and psychodynamic-hypnotherapy combined with selective serotonin reuptake inhibitors have been effective. Conclusions: SD and CD in child and adolescent populations have been observed in medical and psychiatric contexts. Their recognition is difficult due to their multifactorial ethiology, the lack of diagnosis consensus and the scarce clinical experience, involving a true therapeutic challenge; therefore, it is imperative to carry out future researches on this issue. Their management in primary care seems suitable, but in more complex cases the referral to the specialist is necessary.

Molecular characterization of the Israeli B. bigemina vaccine strain and field isolates.

The present study demonstrated the genetic character of the Israeli Babesia bigemina vaccine strain and field isolates, based on rap-1a and rap-1c gene sequences. The RAP-1a of blood-derived Israeli B. bigemina field isolates shared 100% amino acid sequence identity. However, comparison of RAP-1c from various Israeli B. bigemina field isolates revealed that the total sequence identity among the field isolates ranged from 98.2 to 100%. High identity was observed when RAP-1a sequences from the Israeli vaccine strain and field isolates were compared with RAP-1a from Egypt, Syria, Mexico and South Africa, while, the Israeli RAP-1c sequences showed the highest identity to the Mexican isolate JG-29 and to the PR isolate from Puerto-Rico. Based on sequence variations between the rap-1a of the vaccine strain and that of the field isolate, and between the rap-1c of the vaccine strain and that of the field isolates, nPCR-RFLP procedures were developed that enable, for the first time differentiation between the Israeli B. bigemina vaccine strain and field-infection isolates. These assays could serve as fast and sensitive methods for detection and differentiation between Israeli B. bigemina vaccine strains and field isolates, as well as for epidemiological investigations.

Significados sobre la experiencia de hospitalización en pacientes adolescentes diagnosticados con anorexia nerviosa / Meanings about the experience of hospitalization in adolescent patients diagnosed with anorexia nervosa

Introduction: The psychiatric hospitalization of children and adolescents suffering from anorexia nervosa (AN) has important implications in their developmental stage, but its impact has been scarcely reported, particularly from the subjective individual experience. Objective: To describe the experiencing meanings constructed by anorectic children and adolescents about their hospitalization process. Method: A qualitative descriptive study based on the Grounded Theory was conducted. The sample was intentionally composed by6 patients (5 females and 1 male) with and without previous hospitalization background. A semi-structured in-depth interview was applied. The data were transcribed and analysed by using open coding and triangulation of specialists. Results: Four categories are described: (A) Impressions on mental health professionals and psychiatric hospitalization units before inpatient treatment: reported experiences were negative, influencing future interventions; (B) Impressions and experiences at admission: anguish, sadness and fear (symptomatology impairment, abuse and weight gain); (C) Therapeutic effects of hospitalization: emphasis in therapeutic alliance and symptoms remission and (D) Critical assessment concerning psychiatric hospitalizations during the adolescence: reinforcement of individual capabilities for the disorder management, benefits of the isolation from family issues, development illness awareness. Conclusion: Hospitalization in AN is a positive therapeutic resource in certain cases. Improvement process was facilitated by constructive dialogues throw the acknowledgement of the patient particular affective needs and the institutional plasticity in offering appropriate tools for their experiencing, emphasising the relevance of therapeutic alliance.

Introducción: La hospitalización psiquiátrica en anorexia nerviosa (AN) infanto-juvenil posee importantes implicancias en el vivenciar de su etapa del desarrollo, pero su impacto ha sido escasamente reportado, particularmente desde la experiencia individual subjetiva. Objetivo: Describir los significados experienciales construidos por niños y adolescentes anorécticos en torno a su proceso de hospitalización. Método: Estudio cualitativo descriptivo basado en la Grounded Theory. La muestra se constituyó intencionadamente por un total de 6 pacientes (5 mujeres y 1 hombre) con y sin antecedentes de hospitalización psiquiátrica. Se utilizó la entrevista en profundidad semi-estructurada, analizando los datos mediante triangulación de especialistas y codificación abierta. Resultados: Se describen cuatro categorías: (A) Impresiones sobre los profesionales de la salud mental y las unidades de hospitalización psiquiátrica previas a la internación: las vivencias informadas fueron negativas, influyendo en futuras intervenciones; (B) Impresiones y experiencias al momento del ingreso: angustia, tristeza y temor (empeoramiento sintomático, maltrato y aumento ponderal); (C) Efectos terapéuticos de la hospitalización: énfasis en la alianza terapéutica y en la remisión sintomática y (D) Apreciación crítica sobre las hospitalizaciones psiquiátricas durante la adolescencia: fortalecimiento de habilidades individuales para el manejo del trastorno, beneficio del distanciamiento de las problemáticas familiares, desarrollo de consciencia de enfermedad. Conclusión: La hospitalización en AN es un recurso terapéutico positivo en determinados casos. El proceso de mejoría se facilitó estableciendo diálogos constructivos mediante el reconocimiento de las necesidades afectivas particulares del paciente y la plasticidad de la institución para ofrecerle herramientas atingentes a su vivenciar, enfatizando la relevancia de la alianza terapéutica.

Alexitimia y depresión: evidencia, controversias e implicancias / Alexithymia and depression: evidence, controversies and implications

Background: Several researches have demonstrated the relationship between alexithymia and depression. Some authors support the hypothesis that alexithymia measured by TAS-20 and BVAQ may be a personality trait and others point out that it would be a confrontation mechanism against stressful life events. Objective: To describe the concept of alexithymia, the evidence on its relationship with depression and its correlates within the context of various biopsychosocial aspects. Method: Medline/Pubmed and SciELO databases were used to look for evidence on alexithymia and depression. Results: The higher level of alexithymia, the higher severity of anxiety and depressive symptoms and a worse response to antidepressant treatment. Alexithymia is a risk factor for the development of psychopathological disorders (panic, eating disorders, substance abuse). In the acute phase of a major depressive disorder, alexithymia rates reached 46% and its prevalence was eight times higher in depressive patients than in a general population. Obssesive personality traits were significant predictors of alexithymia and in turn, a triggering and/or perpetuating factor and a prognosis index of psychosomatic illness in the development and maintenance of pain, mainly within a context of a negative affective state like depression. Conclusions: Alexithymia is significantly associated to depression. Future longitudinal studies are required to determine if both conditions are different phenomena or affective and cognitive variants of a unique psychopathological disorder.

Antecedentes: Numerosas investigaciones han demostrado la relación entre alexitimia y depresión. Algunos autores apoyan la hipótesis de que la alexitimia, evaluada por la TAS-20 y el BVAQ, puede ser un rasgo de personalidad y otros señalan que sería un mecanismo de afrontamiento ante eventos vitales estresantes. Objetivo: Describir el concepto de alexitimia y la evidencia de su relación con la depresión y su correlación con diversos aspectos biopsicosociales. Método: Se realizó una búsqueda bibliográfica de evidencia sobre alexitimia y depresión mediante las bases de datos Medline/PubMed, SciELO y textos especializados. Resultados: A mayor nivel de alexitimia, mayor severidad de síntomas ansiosos y depresivos y peor respuesta a antidepresivos. La alexitimia es un factor de riesgo para el desarrollo de trastornos psicopatológicos (pánico, conducta alimentaria, abuso de sustancias). En la fase aguda de un trastorno depresivo mayor, la tasa de alexitimia alcanzó un 46%, siendo su prevalencia ocho veces superior entre depresivos que en la población general. Los rasgos obsesivos de personalidad fueron predictores significativos de alexitimia, siendo ésta además un factor desencadenante y/o perpetuante e índice pronóstico de enfermedades psicosomáticas, favoreciendo el desarrollo y mantención del dolor, principalmente en el contexto de un afecto negativo como la depresión. Conclusiones: La alexitimia se encuentra significativamente asociada a la depresión. Se requieren futuros estudios longitudinales para determinar si ambas condiciones corresponden a fenómenos distintos o a variantes afectivas y cognitivas de un mismo desorden psicopatológico.

Differentiation between Israeli B. bovis vaccine strain and field isolates.

The present study demonstrated for the first time the ability to distinguish between the Israeli Babesia bovis vaccine strain and field isolates. The existence of an additional EcoRI restriction site in the rhoptry-associated protein-1 (rap-1) gene, which is unique to the Israeli vaccine strain, and the abolition of one of the HaeIII restriction sites in the rap-1 gene of the vaccine strain enabled distinction between the Israeli B. bovis vaccine strain and field isolates, and this was the basis for polymerase chain reaction (PCR)-restriction fragment length polymorphism (RFLP) development. ClustalW sequence alignment of RAP-1-deduced amino acids of the Israeli B. bovis strains and of field isolates showed that the total sequence identity among the RAP-1 amino acid sequences ranged from 97.5% to 100%. However, comparison between amino acids of RAP-1 of the Israeli vaccine strain and of field isolates, on the one hand, and B. bovis strains from Argentina, Mexico, Brazil, and USA, on the other hand, revealed 90% identity. The PCR-RFLP assay offered the great advantage of being able to distinguish between vaccine and field isolates in mixtures and provide new insight into the molecular epidemiology of B. bovis infections in Israel.

Trastornos alimentarios maternos y su influencia en la conducta alimentaria de sus hijas(os) / Maternal eating disorders and their influence on eating behavior of the children: a review of the literature

Background: There is conclusive evidence about the influence of mothers with eating disorders (ED) on their children. Objective: To describe different aspects about mothers with ED and its implications in the feeding, growing and development in their children. Method: A review of specialized textbooks and the available literature in PubMed was made. Results: Mothers with previous or present ED show restrictive eating patterns, a deficient affective bond with their own mothers, exhibit more psychiatric comorbidities, mainly depression and anxiety; in addition, feelings of guilt and shame, early cessation of breastfeeding, high control of food consumption of their children, and/or pressure them to eat, irregular mealtimes, unbalanced and monotonous meals, proneness to slimness, a critical attitude about the body shape of their daughters. Breastfeeding implies a critical period for the irruption or relapse of an ED due to the adjustment to the characteristic body shape changes during pregnancy. Conclusions: There is a particular relationship between a maternal ED and its occurrence in their children, and it can be considered a risk factor for its development.

Antecedentes: Existe concluyente evidencia de la influencia de madres con trastornos de la conducta alimentaria (TCA) en sus hijas (os). Objetivo: Analizar descriptivamente los diversos aspectos de madres con historia de TCA y sus implicancias en la nutrición, crecimiento y desarrollo de sus hijas (os). Método: Se efectuó una revisión de la literatura disponible en PubMed y textos de consulta especializados. Resultados: Las madres con TCA previo o actual muestran patrones alimentarios restrictivos, un vínculo afectivo deficitario con sus propias madres, exhiben más comorbilidades psiquiátricas, principalmente depresión y ansiedad; además sentimientos de culpa y vergüenza, cese precoz de la lactancia, elevado control del consumo de alimentos de sus hijas (os) y/o presión para comer, horarios irregulares de comidas, dieta desequilibrada y monótona, preferencia por la delgadez y actitud crítica sobre la silueta corporal de sus hijas (os). La lactancia representa un período crítico para la irrupción o recaída de un TCA por la adaptación que implican los cambios característicos de su figura corporal durante el embarazo. Conclusiones: Existe una particular relación entre la presencia de un TCA materno y su ocurrencia en hijas (os), considerándose un factor de riesgo para su desarrollo.

Perfeccionismo e insatisfacción corporal en los trastornos de la conducta alimentaria / Perfectionism and body dissatisfaction in eating disorders

Background: There is an important relationship between perfectionism (P), body dissatisfaction (BD) and eating disorders (ED). Objective: To describe the evidence about P and/or BD within the clinical course of ED. Method: A review of specialized textbooks and the available literature in PubMed was made. Two descriptive case reports are analyzed. Results: Socially prescribed and self-oriented dimensions of P were related to ED attitudes and specially restrictive behaviors, mediating and moderating the association between BD and ED. BD and P are intrapersonal risk factors in the development of an ED. BD shares about 10% of genetic variability with P and both increase the appearance comparative assessment, mainly within a higher western acculturation, drive for thinness, a maladaptative stress response, a low self-esteem, the severity of the disorder, depressive symptomatology, sports that emphasize a slim body shape, comorbidities (personality, anxiety and/or affective disorders), alexithymia and lack of assertiveness. Conclusions: According to the evidence, BD and P, although unspecific, are core characteristics of ED as predisposing, triggering and/or perpetuating factors that significantly influence its treatment and outcome.

Antecedentes: Existe una importante relación entre el perfeccionismo (P), la insatisfacción corporal (IC) y los trastornos de la conducta alimentaria (TCA). Objetivo: Se analiza descriptivamente la evidencia sobre la relación entre P e IC en el curso clínico de los TCA. Método: Se efectuó una revisión de la literatura disponible en PubMed y textos de consulta especializados. Se analizan dos casos clínicos ilustrativos. Resultados: El Pen sus dimensiones socialmente prescrito y auto-orientado se asoció con actitudes y conductas de TCA, especialmente restrictivas, mediando y moderando la relación entre la IC y el TCA. La IC y el P son factores de riesgo intrapersonal para el desarrollo de TCA. La IC comparte alrededor del 10% de la variabilidad genética con el P y ambos favorecen la evaluación comparativa de la apariencia, principalmente con una mayor aculturación occidental, la motivación por la delgadez, la respuesta maladaptativa al estrés, la baja autoestima, la severidad del desorden, la sintomatología depresiva, los deportes que acentúan la silueta corporal esbelta, las comorbilidades (trastornos de personalidad, de ansiedad, afectivos), la alexitimia y la falta de asertividad. Conclusiones: De acuerdo a la evidencia, la IC y el P, aunque inespecíficas, son características nucleares de los TCA como factores predisponentes, desencadenantes y perpetuantes, que influyen significativamente en su tratamiento y desenlace.

[Maternal eating disorders and their influence on eating behavior of the children: a review of the literature]. / Trastornos alimentarios maternos y su influencia en la conducta alimentaria de sus hijas(os).

BACKGROUND: There is conclusive evidence about the influence of mothers with eating disorders (ED) on their children. OBJECTIVE: To describe different aspects about mothers with ED and its implications in the feeding, growing and development in their children. METHOD: A review of specialized textbooks and the available literature in PubMed was made. RESULTS: Mothers with previous or present ED show restrictive eating patterns, a deficient affective bond with their own mothers, exhibit more psychiatric comorbidities, mainly depression and anxiety; in addition, feelings of guilt and shame, early cessation of breastfeeding, high control of food consumption of their children, and/or pressure them to eat, irregular mealtimes, unbalanced and monotonous meals, proneness to slimness, a critical attitude about the body shape of their daughters. Breastfeeding implies a critical period for the irruption or relapse of an ED due to the adjustment to the characteristic body shape changes during pregnancy. CONCLUSIONS: There is a particular relationship between a maternal ED and its occurrence in their children, and it can be considered a risk factor for its development.

Facilitadores de la alianza terapéutica en la anorexia nerviosa: una mirada desde la diada terapeuta-paciente / Facilitators of therapeutic alliance in anorexia nervosa: a look from the therapist-patient dyad

Antecedentes: En el contexto terapéutico de pacientes con anorexia nerviosa, es relevante el establecimiento de la alianza terapéutica (AT). Objetivo: Describir los aspectos identificados como facilitadores del logro de una AT positiva desde la perspectiva de pacientes con anorexia nerviosa y sus respectivas terapeutas. Método: Estudio exploratorio, descriptivo-relacional realizado con metodología cualitativa, cuyo análisis de datos se basó en la Grounded Theory, incluyéndose a dos pacientes anorécticas con sus respectivas terapeutas. Resultados: Las pacientes y sus terapeutas valoraron los siguientes parámetros, respectivamente: 1. Ambiente emocional: la incondicionalidad, el interés genuino y la confianza versus el no enjuiciamiento y mayor disponibilidad; 2. Conductas y actitudes deseables (en la terapeuta): flexibilidad, libertad para hablar y la disponibilidad, (en las pacientes): la necesidad de cambiar y tener recursos; 3. Técnicas valoradas: terapia centrada en recursos (o capacidades), co-participación con el tratamiento, conocer testimonios de otras pacientes, hablar libremente con empatía, chequear constantemente el tratamiento y responsabilizar a la paciente de su terapia. Surge un modelo de facilitadores de la AT que incluye subsistema paciente, subsistema terapeuta, atmósfera relacional y espacio terapéutico con sus características particulares. Conclusiones: La generación de una buena AT es un factor destacable en el éxito del proceso terapéutico que implica una relación consciente y una aceptación recíproca, integrada por las influencias de la díada terapeuta/paciente.

Background: The settlement of a therapeutic alliance (TA) is relevant within the therapeutic context of patients suffering from anorexia nervosa. Objective: To describe the aspects identified as facilitators in order to achieve a positive therapeutic alliance from the perspective of anorexic patients and their a positive therapeutic alliance from the perspective of anorexic patients and their therapists. Method: It was an exploratory, relational-descriptive and qualitative study and its data analysis was based in the Grounded Theory, including two anorectic patients and their in the Grounded Theory, including two anorectic patients and their therapists. Results: Both, patients and therapists valued the following parameters, respectively: 1. Emotional environment: unconditional genuine interest and confidence versus non judgment and higher availability; 2. Desirable behaviors and attitudes (in the therapist): flexibility, freedom of speech and availability, (in patients): to change and to have resources; 3. Valued techniques: centered in resources, co-participation in the treatment, to know testimonies of other patients versus focalization in skills, emphatic freedom of speech, to check the treatment constantly and to make the patient responsible of her therapy. A model of TA facilitators emerges that includes patient subsystem, therapist subsystem, relational atmosphere and therapeutic space with their particular characteristics. Conclusions: The generation of a good TA is a remarkable factor in the success of the therapeutic process that implies a conscious relationship and a reciprocal acceptation integrated by the influences of the therapist/patient dyad.

[Evolutionary perspective of eating disorders]. / Perspectiva evolucionista de los trastornos de la conducta alimentaria.

BACKGROUND: Evolutionary theory has contributed with physiological, psychological and behavioral explanations to the comprehension and treatment of eating disorders (ED). The aim of this review is to analyze the relationship between ED and the attachment theory and natural selection based hypotheses (famine flight, reproductive suppression and intrasexual competition). Insecure attachment is characteristic of ED and significantly interferes in the individuation developmental process. Maternal attachment is usually ambivalent; mainly avoidant in anorexics and anxious in bulimics. Anorexic syndrome evokes ancestral adaptive mechanisms to face food scarcity, status achievement and threat of group exclusion. Suppression of reproductive capacity in anorexics, favored by family dynamics, represents a self-sacrifice to obtain the benefit of its members through genetic altruism. Feminine intrasexual competence is related to nubile features in order to attract and retain high quality and long-term partners. Therefore, from an evolutionary perspective, ED symptomatology may be described as a self-destructive adaptive state of lack of control, in response to a particular genetic phenotype plasticity, environmental factors and cognitive processes.

Espiritualidad y ascetismo en la anorexia nerviosa / Spirituality and asceticism in anorexia nervosa

Background: Spirituality and asceticism are relevant characteristics of patients suffering from anorexia nervosa (AN). Objective: To describe the evidence on spirituality and asceticism in AN. Method: Medline/Pubmed databases were used to look for evidence on spirituality and asceticism in AN. Results: From an historical point of view, asceticism of medieval saints ("holy anorexia") and that of the modern anorexics, display common features; nevertheless, the former wanted to reach sacredness and the latest seek thinness, so valuable socioculturally. Contemporary Protestantism and AANshare distinctive characteristics of protestant ethics, mainly self-discipline, self-control, self-sacrifice, rationality, efficiency and goals achievement. Although asceticism has been significantly correlated to worse outcome, more treatment dropouts, perfectionism, immaturity and purgative behaviors, is also associated to creative and adaptative skills and its connection to spiritual and religious proneness may help the improvement of psychopathological and/or behavioral symptoms in AN. Conclusions: Spirituality may stimulate the motivation, contention and increase therapeutic adherence in patients suffering from AN. It should be considered as a helpful and eventually routine therapeutic tool in the treatment of anorexic patients.

Antecedentes: La espiritualidad y el ascetismo son características relevantes en las pacientes con anorexia nerviosa (AN). Objetivo: Describir la evidencia acerca de la espiritualidad y el ascetismo en la AN. Método: Se realizó una búsqueda bibliográfica de evidencia sobre la espiritualidad y el ascetismo en la AN mediante las bases de datos Medline/PubMed. Resultados: Desde una perspectiva histórica, el ascetismo de las santas medievales ("anorexia santa") y de las anoréxicas modernas, exhibe rasgos comunes; sin embargo, el objetivo de las primeras era alcanzar la santidad y las últimas ambicionan la delgadez, tan valorada socioculturalmente. El Protestantismo contemporáneo y la AN comparten rasgos distintivos de la ética protestante, principalmente autodisciplina, autocontrol, abnegación, racionalidad, eficiencia y obtención de logros. Aunque el ascetismo se ha correlacionado significativamente con peor pronóstico, abandono del tratamiento, perfeccionismo, inmadurez y conductas purgativas, su conexión con la tendencia espiritual y religiosidad implica una capacidad creativa y de adaptación, que puede favorecer la mejoría de los síntomas psicopatológicos y/o conductuales de la AN. Conclusiones: La espiritualidad puede estimular la motivación, la contención y aumentar la adherencia al tratamiento de las pacientes con AN. Debería ser considerada como una herramienta terapéutica útil y eventualmente rutinaria en el tratamiento de las pacientes portadoras de AN.

Perspectiva evolucionista de los trastornos de la conducta alimentaria / Evolutionary perspective of eating disorders

Background: Evolutionary theory has contributed with physiological, psychological and behavioral explanations to the comprehension and treatment of eating disorders (ED). The aim of this review is to analyze the relationship between ED and the attachment theory and natural selection based hypotheses (famine flight, reproductive suppression and intrasexual competition). Insecure attachment is characteristic of ED and significantly interferes in the individuation developmental process. Maternal attachment is usually ambivalent; mainly avoidant in anorexics and anxious in bulimics. Anorexic syndrome evokes ancestral adaptive mechanisms to face food scarcity, status achievement and threat of group exclusion. Suppression of reproductive capacity in anorexics, favored by family dynamics, represents a self-sacrifice to obtain the benefit of its members through genetic altruism. Feminine intrasexual competence is related to nubile features in order to attract and retain high quality and long-term partners. Therefore, from an evolutionary perspective, ED symptomatology may be described as a self-destructive adaptive state of lack of control, in response to a particular genetic phenotype plasticity, environmental factors and cognitive processes.

Sentimientos de ineficacia personal en los trastornos de la conducta alimentaria / Ineffectiveness in eating disorders

Antecedentes: El sentimiento de ineficacia personal es una de las características clínicas nucleares en los trastornos de la conducta alimentaria (TCA). Objetivo: Describir la evidencia acerca del sentimiento de ineficacia personal en pacientes portadoras de anorexia nerviosa y/o bulimia nerviosa. Método: Se realizó una búsqueda bibliográfica mediante las bases de datos Medline/PubMed de evidencia sobre la ineficacia en los TCA. Resultados: El "paralizante sentimiento de ineficacia personal", descrito por Bruch (1973) en pacientes anorécticas, relacionado con un déficit en el sentido del self debido a distorsiones tempranas en el vínculo madre-hija, aún es un concepto válido en la práctica clínica cotidiana. Aunque la ineficacia es también característica del trastorno depresivo, en los TCA se relaciona principalmente, con motivación por la delgadez, perfeccionismo, timidez, falta de asertividad y consciencia interoceptiva (alexitimia), abuso de laxantes y sustancias, dieta, ejercicio físico, sintomatología obsesivo-compulsiva, baja autoestima, insatisfacción corporal, estrés y con la severidad del TCA. Conclusiones: Existe una fuerte evidencia que apoya la existencia de un sentimiento de ineficacia personal, tanto en poblaciones no clínicas en riesgo para desarrollar TCA, como también en pacientes anorécticas y/o bulímicas. Puede considerarse un factor predisponente, perpetuante y pronóstico de un TCA. Sin embargo, su presencia en trastornos depresivos cuestiona su especificidad en los TCA.

Background: The sense of personal ineffectiveness is one of the core clinical characteristics in eating disorders (ED). Objective: To describe the evidence on the sense of personal ineffectiveness in patients suffering from anorexia nervosa and/or bulimia nervosa. Method: Medline/Pubmed databases were used to look for evidence on ineffectiveness in ED. Results: The "paralyzing sense of personal ineffectiveness" described by Bruch (1973) in anorexic patients, related to a deficit in the sense of self, due to early distortions in mother-child attachment, is still a valid concept in everyday clinical practice. Although ineffectiveness is also a characteristic of a depressive disorder, in ED it is related mainly to drive for thinness, perfectionism, shyness, lack of assertiveness and interoceptive awareness (alexythimia), laxative and substance abuse, diet, physical exercise, obsessive-compulsive symptomatology, low self-esteem, body dissatisfaction, stress and severity of ED. Conclusions: There is strong evidence supporting the sense of ineffectiveness, both in non clinical populations at risk to develop ED and also in anorexic and/or bulimic patients. It may be considered as a predisposing, perpetuating and prognosis factor of an ED. Nevertheless, ineffectiveness as a feature of depressive disorder questions its exclusiveness to ED.

Expresión emocional en los trastornos de la conducta alimentaria: alexitimia y asertividad / Emotional expression in eating disorders: alexithymia and assertiveness

Antecedentes: La alexitimia y falta de asertividad son características comunes en los trastornos alimentarios (TCA) e interfieren en la expresión emocional. Objetivo: Determinar presencia de alexitimia y asertividad en subtipos de TCA. Método: A108 mujeres con TCA (28 anorécticas, 36 con TCA no especificados (TCANE) y 44 bulímicas) se les aplicó el Test de Actitudes Alimentarias (EAT-40), el Inventario de Desórdenes Alimentarios (EDI), las Escalas de Alexitimia de Toronto (TAS-20) y de Asertividad de Rathus (RAS). Resultados: Todos los subgrupos alcanzaron puntajes en rango de alexitimia, especialmente las anorécticas (57,1%) siendo el más alto (52,9 ± 14,3), aunque no estadísticamente significativo (NS). Las bulímicas mostraron mayor dificultad para discriminar señales emocionales (23,3 ± 8,7) y las anorécticas pensamientos más orientados hacia detalles externos (15,1 ± 7,1) (NS). Las bulímicas alcanzaron puntajes negativos (-0,6 ± 25,8) en RAS, principalmente más conductas sumisas y dependientes (-2,6 ± 7,4) (NS). En subgrupos bulímico (r = 0,795; p < 0,001) y TCANE (r = 0,623; p < 0,001), a menor nivel de consciencia interoceptiva, hubo mayor dificultad para discriminar señales emocionales. A mayor desconfianza interpersonal en subgrupos anoréctico (r = 0,617;p = 0,001) y con TCANE (r = 0,590; p < 0,001), hubo mayor dificultad en expresar verbalmente emociones; con una mayor dificultad en discriminar señales emocionales se observó más conductas deficitarias en las bulímicas (r = -0,715; p < 0,001; r = 0,707; p < 0,001) y sentimientos de ineficacia personal en las anorécticas (r = 0,593; p = 0,001). Conclusiones: Se verificó la presencia de alexitimia y falta de asertividad en todos los subgrupos de TCA. Las más alexitímicas fueron las anorécticas y las menos asertivas, las bulímicas, que mostraron mayor dificultad para identificar sentimientos y las anorécticas para describirlos.

Background: Alexithymia and lack of assertiveness are common characteristics eating disorders disorders (ED) and interfere in emotional expression. Aim: To assess the presence ofalexithymia and assertiveness in different subtypes of ED. Method: The Eating Attitudes Test (EAT-40), the Eating Disorders Inventory (EDI), the Toronto Alexithymia Scale (TAS-20) and Rathus Assertiveness Schedule) (RAS) were administered to 108 ED patients (28 anorectics, 36 with ED not otherwise specified (EDNOS) and 44 bulimics). Results: All the subgroups scored within the pathological range of alexithymia, especially anorexics (57.1%), the highest (52.9 ± 14.3), although not statistically significant (NS). Bulimics showed more difficulty to discriminate emotional signals (23.3 ± 8.7) and anorexics more thoughts oriented to external details (15.1 ± 7.1) (NS). Bulimics scored negative in RAS (-0.6 ± 25.8), mainly exhibiting more submissive and dependant behaviors (-2.6 ± 7.4) (NS). In bulimic (r = 0.795; p < 0.001) and EDNOS (r = 0.623; p < 0.001) subgroups, the lower interoceptive consciousness, the more difficulty to discriminate emotional signals were observed. The higher interpersonal distrust in anorexic (r = 0.617;p = 0.001) and EDNOS subgroups (r = 0.590;p < 0.001), the more difficulty to express emotions verbally; the more difficulty to discriminate emotional signals, the more deficit behaviors in bulimics (r = -0.715; p < 0.001; r = 0.707; p < 0.001) and ineffectiveness in anorexics (r = 0.593; p = 0.001) were observed. Conclusions: The presence of alexithymia and lack of assertiveness in all the ED subgroups were verified. The most alexiyhimic were the anorexics and bulimics were less assertive and showed more difficulty to identify emotions and anorexics to describe them.

Insatisfacción corporal en los trastornos de la conducta alimentaria: un estudio comparativo / Body dissatisfaction in eating disorders: a comparative study

Background: Body dissatisfaction (BD) is considered as a predisposing, triggering, perpetuating and/or prognosis factor of eating disorders (ED). Objective: To compare the presence of BD and psychopathological and/or behavioural features between female subjects with and without ED. Method: Comparatively the EatingAttitudes Test (EAT-40), the Eating Disorder Inventory (EDI) and the Body Shape Questionnaire (BSQ) were administered to 52 ED female patients and to 51 female students without ED. Results: Patients reached significantly higher rates than female students without ED on BSQ, EAT-40, EDI and subscales (p = < 0.001), except perfectionism (p = 0.015). BD assessed by EDI (17 versus 4; p < 0.001) y el BSQ (152 versus 58.5; p < 0.001) scored significantly higher in patients, mainly in anorexics on EAT-40, BSQ, BD, ineffectiveness and perfectionism (p < 0.001); bulimics on global EDI, drive for thinness, interoceptive awareness, bulimia, maturity fears and interpersonal distrust (p < 0,001). The OR of BD (EDI) was 1.17 versus BSQ (OR = 1.05) (p < 0.001). The EAT global score was directly and significantly correlated to BSQ (r = 0.672; p < 0.001) in patients and to BD (EDI) (r = 0.639; p < 0.001) in female students without ED. Conclusions: BD is prevalent in an extreme degree within all the subtypes of ED. Anorexics exhibited a higher BD as well as ineffectiveness and perfectionism. A higher BD is positively related to a higher ED symptomatology. The risk of developing an ED in a young woman that exhibits some degree of BD is very high.

Antecedentes: La insatisfacción corporal (IC) es considerada factor predisponente, desencadenante, perpetuante y pronóstico de los trastornos alimentarios (TCA). Objetivos: Comparar la presencia de IC y características psicopatológicas/conductuales entre mujeres con y sin TCA. Método: A 52 pacientes con TCA y 51 estudiantes sin TCA, se les aplicó comparativamente el Test de Actitudes Alimentarias (EAT-40), el Inventario de Desórdenes Alimentarios (EDI) y el Cuestionario de Silueta Corporal (BSQ). Resultados: Las pacientes alcanzaron puntajes significativamente más elevados que las estudiantes en el BSQ, EAT-40, EDIy sub escalas (p = < 0,001), excepto perfeccionismo (p = 0,015). La IC medida por el EDI (17 versus 4; p < 0,001) y el BSQ (152 versus 58,5; p < 0,001) arrojó puntajes significativamente más altos en las pacientes, principalmente las anorécticas en el EAT-40, BSQ, IC, sentimientos de inutilidad personal y perfeccionismo (p < 0,001); las bulímicas en el EDI global, motivación por la delgadez, consciencia interoceptiva, bulimia, temor a la madurez y desconfianza interpersonal (p < 0,001). El ítem IC del EDI mostró un OR de 1,17, versus el BSQ (OR= 1,05) (p < 0,001). El puntaje global del EAT-40 se correlacionó directa y significativamente con el BSQ (r = 0,672; p < 0,001) en las pacientes y estudiantes con el ítem IC del EDI (r = 0,639; p < 0,001). Conclusiones: La IC está presente en grado extremo en todos los subtipos de TCA. Las anorécticas mostraron mayor IC acompañada de sentimientos de inutilidad personal y perfeccionismo. Una mayor IC se relaciona positivamente con una mayor sintomatología compatible con TCA. El riesgo de padecerlo de una joven que exhibe algún grado de IC es altísimo.

Funcionamiento psicosocial en los trastornos de la conducta alimentaria: Ansiedad social, alexitimia y falta de asertividad / Psychosocial functioning in eating disorders: Social anxiety, alexithymia and lack of assertiveness

Existe una gran cantidad de información concluyente sobre el déficit del funcionamiento psicosocial en las pacientes con trastornos de la conducta alimentaria (TCA). Objetivo: Describir la evidencia acerca de la influencia de la ansiedad social, la alexitimia y la falta de asertividad como factores predisponentes, desencadenantes y perpetuantes de la sintomatología de los TCA y el deterioro de las conductas y/o actitudes sociales de pacientes portadoras de anorexia nerviosa y/o bulimia nerviosa. Método: Revisión exhaustiva de la literatura especializada nacional e internacional. Resultados: La ansiedad social que puede manifestarse como fobia social (evitación del contacto interpersonal), la alexitimia (dificultad para identificar y/o expresar sentimientos y sensaciones) que puede asociarse principalmente a la depresión y la falta de asertividad (discapacidad en la competencia social para confrontar los eventos comunicacionales) alcanzan cifras de prevalencia significativamente más altas en las pacientes alimentarias comparadas con sujetos controles. Conclusiones: La evidencia apoya la interferencia significativa en las habilidades sociales, en el manejo terapéutico y en el desenlace de las pacientes con TCA relacionada con estas comorbilidades. Es imperativo su identificación y abordaje clínico precoz para prevenir la aparición de los TCA.

There is a great conclusive amount of information about the deficit of psychosocial functioning in eating disordered patients. Objective: To describe the evidence on the influence of social anxiety, alexithymia and lack of assertiveness as predisposing, triggering and perpetuating factors of eating disorders (ED) symptomatology and the impairment of social behaviors and/or attitudes in patients suffering from anorexia nervosa and/or bulimia nervosa. Method: An exhaustive review of the national and international specialized literature was made. Results: Social anxiety that may become a social phobia (avoidance of interpersonal contact), alexithymia (difficulty to identify and/or express feelings and sensations) that may be associated to depression and lack of assertiveness (discapacity in social competence to confront communicational events) reach significatively higher prevalence rates in eating disordered patients compared to control subjects. Conclusions: The evidence supports the significant interference in social skills, in the therapeutic management and in the outcome of eating disordered patients related to these comorbidities. It is imperative its early identification and clinical approach in order to prevent the emergence of ED.