Obstáculos en el tratamiento de los Trastornos Alimentarios: Propuestas para superarlos

Autores/as

DOI:

https://doi.org/10.33898/rdp.v31i115.352

Palabras clave:

trastornos alimentarios, obstáculos, cronicidad, resistencia, comorbilidad

Resumen

Los Trastornos de la Conducta Alimentaria (TCA) conforman un conjunto de cuadros complejos, en muchos casos discapacitantes y que tienden en un alto porcentaje a la cronicidad (Klump, Bulik, Kaye, Treasure y Tyson, 2009), con altas tasas de mortalidad y suicidio (Fichter y Quadflieg, 2016; Hoang, Goldacre y James, 2014). Diversas fuentes informan que en la actualidad contamos con suficiente evidencia de las pocas oportunidades en la mayoría de los pacientes con TCA para lograr una recuperación plena en sus tratamientos (Murray, 2019). Necesitamos mejorar nuestras intervenciones terapéuticas y un punto fundamental en esa dirección es conocer con más profundidad cuáles son los obstáculos que se presentan y cómo abordarlos.
En el presente trabajo nos enfocaremos en barreras que son particularmente significativas durante el proceso de la intervención terapéutica: la cronicidad, que tiene fundamental importancia respecto de la naturaleza del trastorno y alimenta fuertemente las creencias negativas (no sólo del paciente) respecto a la expectativa de posibles logros terapéuticos; la elevada comorbilidad, que hace particularmente difícil en muchos casos la elaboración de un diagnóstico preciso y, por consiguiente, de un adecuado diseño de tratamiento; y la Resistencia que presenta un conjunto de mecanismos que dificultan los procesos de cambio.

Citas

Ali, K., Farrer, L., Fassnacht, D. B., Gulliver, A., Bauer, S. y Griffiths, K. M. (2017). Perceived barriers and facilitators towards help-seeking for eating disorders: A systematic review. International Journal of Eating Disorders, 50(1), 9-21. https://doi.org/10.1002/eat.22598

American Psychiatric Association (2013). The diagnostic and statistical manual of mental disorders, (5th ed.). Arlington, VA: American Psychiatric Association.

Braun, D. L., Sunday, S. R. y Halmi, K. A. (1994). Psychiatric comorbidity in patients with eating disorders. Psychological Medicine, 24(4), 859-867. https://doi.org/10.1017/S0033291700028956

Brenes, G. A., Ingram, C. W. y Danhauer, S. C. (2011). Benefits and challenges of conducting psychotherapy by telephone. Professional Psychology: Research and Practice, 42(6), 543-549. https://doi.org/10.1037/a0026135

Brownley, K. A., Berkman, N. D., Peat, C. M., Lohr, K. N., Cullen, K. E., Bann, C. M., y Bulik, C. M. (2016). Binge-eating disorder in adults: a systematic review and meta-analysis. Annals of Internal Medicine, 165(6), 409-420. https://doi.org/10.7326/M15-2455

Bulik, C. M., Sullivan, P. F., Fear, J. L. y Pickering, A. (1997). Predictors of the development of bulimia nervosa in women with anorexia nervosa. Journal of Nervous and Mental Diseases, 185(11), 704-707.

Cachelin, F. M., Rebeck, R., Veisel, C. y Striegel-Moore, R. H. (2001). Barriers to treatment for eating disorders among ethnically diverse women. International Journal of Eating Disorders, 30(3),269-278. https://doi.org/10.1002/eat.1084

Cachelin, F. M. y Striegel-Moore, R. H. (2006). Help seeking and barriers to treatment in a community sample of Mexican American and European American women with eating disorders. International Journal of Eating Disorders, 39(2),154-161. https://doi.org/10.1002/eat.20213

Cesa, G., Manzoni, G., Bacchetta, M., Castelnouvo, G., Conti, S., Gaggioli, A., … Riva, G. (2013). Virtual Reality for Enhancing the Cognitive Behavioural Treatment of Obesity with Binge Eating Disorder: Randomized Controlled Study with One-Year Follow-up. Journal of medical internet research, 15(6), e113. https://doi.org/10.2196/jmir.2441

Chambless, D. L. y Hollon, S. D. (1998). Defining empirically supported therapies. Journal of Consulting and Clinical Psychology, 66(1), 7-18. https://psycnet.apa.org/doi/10.1037/0022-006X.66.1.7

Cruzat Mandich, C., Diaz Castrillón, F., Kirszman, D., Aspillaga Hesse, C. y Behar Astudillo, R. (2013). Cambio terapéutico en el tratamiento de los trastornos alimentarios: Contenidos, factores facilitadores y obstaculizadores. Revista Mexicana de Trastornos Alimentarios, 4(2), 102-115.

Fairburn, C. G., Cooper Z. D. P., Doll, H. A., O’Connor, M. E., Bohn, K. D. P., Hawker, D. M., … Palmer, R. L. (2009). Transdiagnostic cognitive-behavioral therapy for patients with eating disorders: a two-site trial with 60-week follow-up. American Journal of Psychiatry, 166(3), 311-319. https://doi.org/10.1176/appi.ajp.2008.08040608

Fairburn, C. G. y Cooper, Z. (2011). Eating disorders, DSM-5 and clinical reality. The British journal of psychiatry, 198(1), 8-10. https://doi.org/10.1192/bjp.bp.110.083881

Ferrer-García, M., Gutiérrez-Maldonado, J., Pla-Sanjuanelo, J., Vilalta-Abella, F., Riva, G., Clerici, M., … Dakanalis, A. (2017). A Randomised Controlled Comparison of Second-Level Treatment Approaches for Treatment-Resistant Adults with Bulimia Nervosa and Binge Eating Disorder: Assessing the Benefits of Virtual Reality Cue Exposure Therapy. European Eating Disorders Review, 25(6), 479-490. https://doi.org/10.1002/erv.2538

Ferrer-García, M., Pla-Sanjuanelo, J., Dakanalis, A., Vilalta-Abella, F., Riva, G., Fernandez-Aranda, F., … Gutiérrez-Maldonado, J. (2019). A Randomized Trial of Virtual Reality-Based Cue Exposure Second-Level Therapy and Cognitive Behavior Second-Level Therapy for Bulimia Nervosa and Binge-Eating Disorder: Outcome at Six-Month. Cyberpsychology, Behavior, and Social Networking, 22(1), 60-68. https://doi.org/10.1089/cyber.2017.0675

Fichter, M. M. y Quadflieg, N. (2016). Mortality in eating disorders e Results of a large prospective clinical longitudinal study. International Journal of Eating Disorders, 49(4), 391-401. https://doi.org/10.1002/eat.22501

Halmi, K. A. (1992). Psychobiology and treatment of anorexia nervosa and bulimia nervosa. Washington, DC: American Psychiatric Press.

Hart, L. M., Granillo, M. T., Jorm, A. F. y Paxton, S. J. (2011). Unmet need for treatment in the eating disorders: a systematic review of eating disorder specific treatment seeking among community cases. Clinical psychology review, 31(5), 727-735. https://doi.org/10.1016/j.cpr.2011.03.004

Hilbert, A., Hoek, H. W. y Schmidt, R. (2017). Evidence-based clinical guidelines for eating disorders: International comparison. Current Opinion in Psychiatry, 30(6), 423-437. https://doi.org/10.1097/YCO.0000000000000360

Herzog, D. B., Keller, M. B., Lavori, P. W., Kenny, G.M. y Sacks, N. R. (1992). The prevalence of personality disorders in 210 women with eating disorders. Journal of Clinical Psychiatry, 53(5), 147-52.

Hoang, U., Goldacre, M. y James, A. (2014). Mortality following hospital discharge with a diagnosis or eating disorder: national record linkage study, Englan, 2001-2009. International Journal of Eating Disorders, 47(5),507-15. https://doi.org/10.1002/eat.22249

Innes, N. T., Clough, B. A. y Casey, L. M. (2017). Assessing treatment barriers in eating disorders: A systematic review. Eating Disorders: The Journal of Treatment & Prevention, 25(1), 1-21. https://doi.org/10.1080/10640266.2016.1207455

Johnson, C. y Wonderlich, S. A. (1992). Personality characteristics as a risk factor in the development of eating disorders. En J. H. Crowther, D. L. Tennenbaum, S. E. Hobfoll y M. A. P. Stephens (Eds.), Series in applied psychology: Social issues and questions. The etiology of bulimia nervosa: The individual and familial context (pp. 179-196). Londres, Reino Unido: Hemisphere Publishing.

Kanbur, N. y Harrison, A. (2016). Co-occurrence of Substance Use and Eating Disorders: An Approach to the Adolescent Patient in the Context of Family Centered Care. A Literature Review. Substance Use & Misuse, 51(7), 853-860. https://doi.org/10.3109/10826084.2016.1155614

Kästner, D., Buchholz, I., Weigel, A., Brunner, R., Voderholzer, U., Gumz, A. y Löwe, B. (2019). Facilitators and barriers in anorexia nervosa treatment initiation (FABIANA): study protocol for a mixed-methods and multicentre study. BJPsych Open, 5(6), e92, 1-9. https://doi.org/10.1192/bjo.2019.77

Kazdin, A. E., Fitzsimmons‐Craft, E. E. y Wilfley, D. E. (2017). Addressing critical gaps in the treatment of eating disorders. International Journal of Eating Disorders, 50(3), 170-189. https://doi.org/10.1002/eat.22670

Kirszman, D. y Salgueiro, M. (2002). El enemigo en el espejo: de la insatisfacción corporal al trastorno alimentario. Madrid, España: TEA.

Kirszman, D. y Salgueiro, M. (2015). Imagen Corporal. Dimensiones mediadoras en la psicopatología y modalidades de intervención. Revista Mexicana de Trastornos Alimentarios, 6(2), 129-136. http://dx.doi.org/10.1016/j.rmta.2015.10.004

Klump, K. L., Bulik, C. M., Kaye, W. H., Treasure, J. y Tyson, E. (2009). Academy for eating disorders position paper: Eating disorders are serious mental illnesses. International Journal of Eating Disorders, 42(2), 97-103. http://dx.doi.org/10.1002/eat.20589

Linardon, J., Wade, T. D., de la Piedad Garcia, X. y Brennan, L. (2017) The efficacy of cognitive-behavioral therapy for eating disorders: A systematic review and meta-analysis. Journal of Consulting and Clinical Psychology, 85(11), 1080-1094. https://doi.org/10.1037/ccp0000245

Marco, J. H., Perpiñá, C. y Botella, C. (2014). Tratamiento de la imagen corporal en los trastornos alimentarios y cambio clínicamente significativo. Anales de Psicología/Annals of Psychology, 30(2), 422-430. http://dx.doi.org/10.6018/analesps.30.2.151291

Mc Elroy, S. L., Crow, S., Blom, T. J., Biernacka, J. M., Winham, S. J., Geske, J., … Frye, M. A. (2016). Prevalence and correlates of DSM-5 eating disorders inpatients with bipolar disorder. Journal of Affective Disorders, 191, 216-221. https://doi.org/10.1016/j.jad.2015.11.010

Manzoni, G., Cesa, G., Bacchetta, M., Castelnuovo, G., Conti, S., Gaggioli, A., … Riva, G. (2016). Virtual Reality-Enhanced Cognitive-Behavioral Therapy for Morbid Obesity: A Randomized Controlled Study with 1 Year Follow-Up. Cyberpsychology, Behavior, and Social Networking, 19(2), 134-140. https://doi.org/10.1089/cyber.2015.0208

Murray, S. B. (2019). Updates in the treatment of eating disorders in 2018: A year in review in eating disorders: The Journal of Treatment & Prevention. Eating disorders, 27(1), 6-17. https://doi.org/10.1080/10640266.2019.1567155

Mojtabai, R., Olfson, M. y Mechanic, D. (2002). Perceived need and help-seeking in adults with mood, anxiety, or substance use disorders. Archives of general psychiatry, 59(1), 77-84. https://doi.org/10.1001/archpsyc.59.1.77

Olmsted, M. P., MacDonald, D. E., McFarlane, T., Trottier, K. y Colton, P. (2015). Predictors of rapid relapse in bulimia nervosa. International Journal of Eating Disorders, 48(3), 337-340. https://doi.org/10.1002/eat.22380

Organización Mundial de la Salud (2018). Clasificación Internacional de las Enfermedades (CIE-11). Ginebra, Suiza: OMS.

Powers, P. S., Coovert, D. L., Brightwell, D. R. y Stevens, B. A. (1988). Other psychiatric disorders among bulimic patients. Comprehensive psychiatry, 29(5), 503-508. https://doi.org/10.1016/0010-440X(88)90066-1

Riva, G., Wiederhold, B. K. y Mantovani, F. (2019). Neuroscience of Virtual Reality: From Virtual Exposure to Embodied Medicine. Cyberpsychology, Behavior, and Social Networking, 22(1), 82-96. https://doi.org/10.1089/cyber.2017.29099.gri

Salgueiro, M. C. y Kirszman, D. (2012). Intervención Multinivel en el Tratamiento de los Trastornos de la Conducta Alimentaria: El rol de la familia. Revista Argentina de Clínica Psicológica, 21(2), 161-172.

Smink, F. R., van Hoeken, D. y Hoek, H. W. (2013). Epidemiology, course, and outcome of eating disorders. Current opinion in psychiatry, 26(6), 543-548. https://doi.org/10.1097/YCO.0b013e328365a24f

Speranza, M., Corcos, M., Godart, N., Loas, G., Guilbaud, O., Jeammet, P. y Flament, M. (2001). Obsessive compulsive disorders in eating disorders. Eating Behaviors, 2, 193-207. https://doi.org/10.1016/S1471-0153(01)00035-6

Steinhausen, H. C. (2002). The outcome of anorexia nervosa in the 20th century. American Journal of Psychiatry, 159(8), 1284-1293. https://doi.org/10.1176/appi.ajp.159.8.1284

Striegel-Moore, R. H. y Smolak, L. E. (2001). Eating disorders: Innovative directions in research and practice. Washington, DC: American Psychological Association. https://psycnet.apa.org/doi/10.1037/10403-000

Thompson-Brenner, H., Eddy, K. T., Franko, D. L., Dorer, D. J., Vashchenko, M., Kass, A. E. y Herzog, D. B. (2008). A personality classification system for eating disorders: a longitudinal study. Comprehensive Psychiatry, 49(6), 551-560. https://doi.org/10.1016/j.comppsych.2008.04.002

Thompson, C. y Park, S. (2016). Barriers to access and utilization of eating disorder treatment among women. Archives of Womes’s Mental Health, 19, 753-760. https://doi.org/10.1007/s00737-016-0618-4.

Tierney, S. y Fox, J. R. (2009). Chronic anorexia nervosa: A Delphi study to explore practitioners’ views. International Journal of Eating Disorders, 42(1), 62-67. https://doi.org/10.1002/eat.20557

Vanheusden, K., Mulder, C. L, van der Ende, J., van Lenthe, F. J., Mackenbach, J. P. y Verhulst, F. C.(2008). Young adults face major barriers to seeking help from mental health services. Patient Education and Counseling, 73(1), 97-104. https://doi.org/10.1016/j.pec.2008.05.006

Verkes, R. J., Pijl, H., Meinders, A. E. y Van Kempen, G. M. (1996). Borderline personality, impulsiveness, and platelet monoamine measures in bulimia nervosa and recurrent suicidal behavior. Biological Psychiatry, 40(3), 173-80. https://doi.org/10.1016/0006-3223(95)00384-3

Yager, J., Landsverk, J. y Edelstein, C. K. (1989). Help seeking and satisfaction with care in 641 women with eating disorders. I. Patterns of utilization, attributed change, and perceived efficacy of treatment. The Journal of nervous and mental disease, 177(10), 632-637. https://doi.org/10.1097/00005053-198910000-00006

Zanarini, M. C., Frankenburg, F. R., Pope, H. G., Hudson, J. I., Yurgelun-Todd, D. y Cicchetti, C. J. (1990). Axis II comorbidity of normal-weight bulimia. Comprehensive Psychiatry, 31(1), 20-24. https://doi.org/10.1016/0010-440X(90)90050-3

Publicado

2020-03-01

Cómo citar

Kirszman, D. (2020). Obstáculos en el tratamiento de los Trastornos Alimentarios: Propuestas para superarlos. Revista De Psicoterapia, 31(115), 5-15. https://doi.org/10.33898/rdp.v31i115.352