APID, Firenze, 24 marzo 2012 · dysmorphia, and emetophobia.. Eat Disord. 2011;19(2):145-55...
Transcript of APID, Firenze, 24 marzo 2012 · dysmorphia, and emetophobia.. Eat Disord. 2011;19(2):145-55...
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D i s t u r b i d e l l ’ a l i m e n t a z i o n e e
i m m a g i n e d e l c o r p o
APID, Firenze, 24 marzo 2012
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1 •
nominare i disturbi del l ’a l imentazione
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DSM: pro l i fera t ion of d iagnost ic categor ies
DSM-I (1952)
DSM-II (1968)
DSM-III (1980)
DSM-III-R(1987)
DSM-IIV-TR (2000)
0
100
200
300
400
n° diagnosi
DSM I
DSM II
DSM III
DSM III-R
DSM IV-TR
1952 1968 1980 1987 2000
106 182 265 292 350+
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DC:0-3R
DC:0-3R
Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood. Revised edition,
Zero to Three, 2005
•
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GOS criteria
Lask B, Bryant-Waugh R, editors.
Eating Disorders in Childhood and Adolescence
London: Routledge; 2007
3rd Edition.
•
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New syndromes? V a n d e r e y c k e n W , 2 0 1 1 ( a
Vandereycken W
Media hype, diagnostic fad or genuine disorder? Professionals' opinions about night eating syndrome, orthorexia, muscle dysmorphia, and emetophobia..
Eat Disord. 2011;19(2):145-55
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Many "new" syndromes have been proposed for inclusion in the DSM-V:
Night Eating Syndrome
Orthorexia
Muscle Dysmorphia
Emetophobia
…
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28/05/12" massimo cuzzolaro"università la sapienza dsnpee"
7"
PS•EAD !
An increasing number of cases of eating disorders in the
postoperative period are being reported.
Segal A, Kinoshita Kussunoki D, Larino MA
Post-surgical refusal to eat: anorexia
nervosa, bulimia nervosa or a new eating disorder? A case series.
Obes Surg 2004;14(3):353-60
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A broad spectrum of ...
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Eating Disorders Obesity
Weight-related Disorders or
Non-homeostatic Eating Disorders
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2 •
immagine del corpo
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Eating disorders!
Body image disturbances!
Un fenomeno del Novecento …
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Pierre Bonnier (1905)
“ Noi sappiamo di occupare un certo nostro luogo, ed è grazie a questo schema che ci orientiamo oggettivamente nel mondo e soggettivamente riguardo alla localizzazione delle diverse parti del nostro proprio corpo ” (Bonnier, 1905)
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Schema corporeo
schema corporeo rappresentazione del corpo • topografica • spaziale • dinamica
che permette di orientarsi continuamente rispetto all’ambiente esterno e alle varie parti del proprio corpo.
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Aschematie
Le aschematie (disturbi dello schema corporeo) sono definite:
• negative quando manca la consapevolezza di parti del corpo (p.e.
autotopoagnosia, sindrome di Gerstmann, emisomatoagnosia etc.)
• positive quando vi è l’illusione dell’esistenza di parti del corpo in realtà
mancanti (p.e. arto fantasma)
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Ambroise Paré (1551)
“... dopo un’amputazione, per lungo tempo, alcuni pazienti dicono
di sentire ancora dolore nella parte amputata …”
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“ ... il quadro mentale che ci facciamo
del nostro corpo, vale a dire il modo in
cui il corpo appare a noi stessi … ”
Paul Schilder (1935)
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Immagine del corpo • componenti
costrutto psicologico complesso al quale contribuiscono componenti : - senso-percettive (size estimation) - cognitive - affettive - comportamentali - relazionali
Wood et al. 1996 Stormer & Thompson 1996 Cash & Pruzinsky, 1990 e 2002
giudizio di valore (body image satisfaction)
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BUT: predictive validity for sex … (Cuzzolaro M et al, 2006)
BUT•A Global Severity Index
13-15 16-17
18-39
40-65> 65
13-15
16-17 18-39
40-65
> 65
0
0,2
0,4
0,6
0,8
1
1,2
1,4
1,6
0 1 2 3 4 5 6
Age
GS
I M
F
The discriminant functions concerning differences between males and females are highly significant above all in the 13-39-age range.
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… and for age (Cuzzolaro M et al, 2006)
BUT•A Global Severity Index
13-15 16-17
18-39
40-65> 65
13-15
16-17 18-39
40-65
> 65
0
0,2
0,4
0,6
0,8
1
1,2
1,4
1,6
0 1 2 3 4 5 6
Age
GS
I M
F
In males there were no significant differences among the different age groups
The females under 40 had significantly higher scores compared to the others
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Anoressie, Bulimie e punteggi BUT (Cuzzolaro M et al, 2006)
0
0,5
1
1,5
2
2,5
3
3,5
4
GSI WP BIC A CSM D
BN•PAN•BPAN•Rcut-off
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Body Uneasiness Test Global Severity Index by BMI (Marano G et al, 2007)
0
1
2
3
4
5
1 2 3 4 5 6 7 8 9 10
BMI 30-35 (n = 566)
BMI 35-40 (n = 441)
BMI > 40 (n = 578)
Deciles
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Means and standard deviations of BUT scores in BED and non-BED obese patients (Cuzzolaro M et al, 2008)
Males Females BUT-A scores
BE D N = 7 0
NON-BED N=70 t
BED N=89
NON–BED N=89 t
M 2.11 1.33 2.83 1.97 Global Severity Index SD 1.07 0.93
4.32 *** 0.98 1.19
5.22 ***
M 2.57 1.73 3.17 2.45 Weight Phobia
SD 1.22 1.08 4.04 *** 1.13 1.36
3.84 **
M 3.02 2.06 3.71 2.79 Body Image Concerns
SD 1.43 1.44 3.72 ** 1.10 1.44
4.78 ***
M 1.68 0.76 2.66 1.47 Avoidance
SD 1.32 0.85 4.63 *** 1.28 1.33
6.12 ***
M 0.95 0.67 1.47 1.11 Compulsive Self Monitoring
SD 0.87 0.64 2.03 * 1.06 1.04
2.29 *
Depersonalization M 1.48 0.79 3.65 ** 2.32 1.32 5.23 ***
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Eating disorders and body image disturbance
disorderedeating
body imagedisturbance
AnorexiaNervosa
BulimiaNervosa
Binge EatingDisorder
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Disturbi neurologici (schema corporeo)
Anoressia nervosa Bulimia nervosa
Obesità
Ipocondria
Dismorfofobia
Psicopatologia dell’immagine del corpo
Depersonalizzazione
Condizioni sfiguranti
imm
agin
e ne
gativ
a de
l cor
po
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Dismorfofobia
Nel 1886 Enrico Morselli descrisse una nuova forma di disturbo mentale che propose di chiamare dismorfofobia.
La definì come caratterizzata dalla penosa
sensazione di essere portatore di una imperfezione o di una deformità dell’aspetto che agli altri, invece, appare normale.
La dismorfofobia non è, però, una fobia. È un rovello
ossessivo; oppure, altre volte, un franco delirio che riguarda il proprio sembiante. A. Dürer
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BDD e BUT
Cuzzolaro M, Giorgini L e Cardi V Identità e immagine corporea. Il disturbo di dismorfismo corporeo.
In: Gentile MG, editor.
Aggiornamenti in nutrizione clinica. N° 16
Fidenza: Mattioli; 2008. p. 71-85
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BUT • A Body Dysmorphic Disorder vs. controls
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BUT • A Body Dysmorphic Disorder vs. controls
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BDD e chirurgia estetica
L’ interesse per il disturbo di dismorfismo corporeo è molto aumentato negli ultimi trent’anni.
Un motivo è stato la grande diffusione degli
interventi di chirurgia estetica, pericolosamente richiesti da chi soffre di questo disturbo.
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10 February 2009�Alicia Douvall: addicted to cosmetic surgery (a
"I'm on a quest for change …”.
“My philosophy is: if it can be changed, it will be”.
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Identità e immagine del corpo
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Posé comme représentant de
soi, il [le corps] devient
affirmation personnelle, mise en
évidence d’une esthétique et
d’une morale de la présence.
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le corps inachevé (David Le Breton, 1999)
... corps brouillon
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Le corps est soumis à un design parfois radical ... (D. Le Breton, 2002)
Il n’est plus question
de se contenter du
corps que l’on a,
mais d’en modifier
les assises pour le
completer ...
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• body building
• régimes alimentaires
• cosmétiques
• prises de produits comme le DHEA
• gymnastiques de toute sortes
• marques corporelles
• chirurgie esthétique
• transexualisme
• body art
• etc.
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3 •
danza-movimento-terapia e
disturbi del l ’a l imentazione
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DMT e DA: uno s tudio i ta l iano C a r r a r o A e t a l , 1 9 9 8 ( a
Carraro A, Cognolato S, Bernardis AL
Evaluation of a programme of adapted physical activity for Eating Disorder patients.
Eat Weight Disord. 1998;3(3):110-4
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The importance of work focused on body experience in the therapy of Eating Disorders is widely acknowledged.
Even so, few researches have been devoted to this aspect.
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DMT e DA: uno s tudio i ta l iano C a r r a r o A e t a l , 1 9 9 8 ( b
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This paper describes the employment of adapted physical activity as part of a residential cure programme for 96 eating disorder patients.
The wide variety of working tools includes both individual and group activities:
• movement exercise
• adapted sports
• dancing
• expressive activities
• relaxation.
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DMT e DA: uno s tudio i ta l iano C a r r a r o A e t a l , 1 9 9 8 ( c
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The following are used to evaluate results:
• individual and group talks
• specific observation scales
• video recordings of some meetings.
The observations indicate that controlled physical activities
can be usefully integrated into an ED cure project.
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DMT e DA: uno s tudio tedesco L a u m e r U e t a l , 1 9 9 7 ( a
Laumer U, Bauer M, Fichter M, Milz H
Therapeutic effects of the Feldenkrais method "awareness through movement" in patients with eating disorders.
Psychother Psychosom Med Psychol. 1997;47(5):170-80
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Based on
the movement-pedagogical concept of Feldenkrais and
the findings-of disturbed body perception by eating disordered patients
this research aimed at studying
the therapeutical effects
of the Feldenkrais Method
"Awareness through Movement”
with eating disorder patients.
The Feldenkrais Method is
a somatic educational system
designed by
Moshé Feldenkrais (1904–1984).
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DMT e DA: uno s tudio tedesco L a u m e r U e t a l , 1 9 9 7 ( b
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15 eating disordered patients treated at the Roseneck hospital for behavioural medicine rated-by means of a questionnaire consisting of scales of
• the Body Cathexis Scale (BCS)
• the Body Parts Satisfaction Scale (BPSS)
• the questionnaire for body perception (Fragebogen zum Korpererleben; FKE)
• the Emotion inventory (Emotionalitatsinventar; EMI-B)
• the Anorexia-Nervosa-Inventory for Self-rating (ANIS)
• the Eating Disorder Inventory-2 (EDI).
before and after participating in a nine hour course of the Feldenkrais Method.
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The participants of the Feldenkrais-course showed
• increasing contentment with regard to problematic zones of their body and their own health
• as well as concerning acceptance and familiarity with their own body.
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The outcome points to the therapeutical effectiveness
of the Feldenkrais Method
with eating-disorder patients
within a multimodal treatment program.