A question that arises from the literature on therapy is whether second-level treatment is effective for patients with recurrent binge eating who fail first-level treatment. It has been shown that subjects who do not stop binge eating after an initial structured cognitive-behavioural treatment (CBT) programme benefit from additional CBT (A-CBT) sessions; however, it has been suggested that these resistant patients would benefit even more from cue exposure therapy (CET) targeting features associated with poor response (e.g. urge to binge in response to a cue and anxiety experienced in the presence of binge-related cues). We assessed the effectiveness of virtual reality-CET as a second-level treatment strategy for 64 patients with bulimia nervosa and binge eating disorder who had been treated with limited results after using a structured CBT programme, in comparison with A-CBT. The significant differences observed between the two groups at post-treatment in dimensional (behavioural and attitudinal features, anxiety, food craving) and categorical (abstinence rates) outcomes highlighted the superiority of virtual reality-CET over A-CBT. Copyright © 2017 John Wiley & Sons, Ltd and Eating Disorders Association.

This article reviews the 6-month followup data of a randomized, multicenter, parallel-group study conducted at five clinical sites in three European cities, which compared two second-level treatments for bulimia nervosa (BN) and binge eating disorder (BED): virtual reality-based cue exposure therapy (VR-CET) versus additional cognitive behavioral therapy (A-CBT). Post-treatment outcomes of this study were previously published and details of its design can be found at clinicaltrials.gov (identifier: NCT02237300). This article focuses on the evolution of symptoms assessed after 6 months of followup in a subgroup of 58 patients from the original study. In this study 64 patients with eating disorders (EDs) (35 with BN and 29 with BED), who still showed active episodes of binge eating by the end of a structured CBT program (first-level treatment), were randomly assigned to one of two second-level treatments (A-CBT or VR-CET). Frequency of binge and purge episodes, and attitudinal features of binge-related EDs (bulimia, drive for thinness, and body dissatisfaction) were assessed before starting the second-level treatment (n = 64), at the end (n = 64), and at 6-month followup (n = 58). Mixed between-within subject analyses of variance were used to compare outcomes of both second-level treatments over time. Although both treatment conditions showed statistically significant improvements at the end and after 6-month followup, obtained reductions were greater after VR-CET, regarding binge and purge episodes, as well as the decrease of self-reported tendency to engage in overeating episodes. Accordingly, abstinence from binge episodes were higher in VR-CET than A-CBT at followup (70 percent vs. 26 percent, respectively; χ = 11.711, p = 0.001). These results provide further support for the use of VR-CET as an effective second-level intervention for BN and BED treatment-resistant patients.

Eating behavior style (emotional, restrictive, or external) has been proposed as an explanation for the differences in response to food-related cues between people who overeat and those who do not, and has been also considered a target for the treatment of eating disorders (EDs) characterized by lack of control over eating and weight-related (overweight/obesity) conditions. The aim of this study was to analyze the relationship between eating behavior style and psychophysiological responses (self-reported food craving and anxiety) to food-related virtual reality (VR) environments in outpatients with bulimia nervosa (BN) and binge eating disorder (BED) and to compare them with healthy participants. Fifty-eight outpatients and 135 healthy participants were exposed to palatable foods in four experimental everyday real-life VR environments (kitchen, dining room, bedroom and café). During exposure, cue-elicited food craving and anxiety were assessed. Participants also completed standardized instruments for the study purposes. ED patients reported significantly higher levels of craving and anxiety when exposed to the virtual food than healthy controls. Eating behavior styles showed strong associations with cue-elicited food craving and anxiety. In the healthy group, external eating was the only predictor of cue-elicited craving and anxiety. In participants with BN and BED, external and emotional eating were the best predictors of cue-elicited craving and anxiety, respectively.

This study provides evidence of the ability of food-related VR environments to provoke food craving and anxiety responses in BN and BED patients and highlights the need to consider both responses during treatment. The results support the use of VR-CET in the treatment of eating disorder patients characterized by binge-eating and people with high bulimic symptoms.

Background/Objectives: Binge Eating Disorder (BED) is often associated with obesity. In order to identify the variables that allow to better detect the presence of BED, people with overnutrition were compared with and without BED in the presence of cognitive conflicts, eating symptoms and anxious-depressive symptoms. The inclusion of cognitive conflicts had been relevant in bulimia studies but had not been investigated with respect to BED. Method: Two groups with obesity were evaluated, one without BED (OB, n = 54) and the other with BED (OB-BED, n = 48), using a social-demographic questionnaire as well as a semi-structured interview to assess BED, questionnaires (DASS-21, EDE-Q, EEQ) and the Repertory Grid Technique. Results: Overall, the OB-BED group presented more conflicts and more symptoms. The model that best differentiated between the groups included emotional eating and level of cognitive conflicts, correctly classifying 91.4% of the sample. Conclusion: These results highlight the role played by cognitive conflicts and emotional eating as differentiating elements between OB and OB-BED, with a high level of predictive accuracy.

Introducción: si bien el Trastorno por Atracón es un trastorno de la conducta alimentaria que  no se da exclusivamente en personas obesas, es más común en este grupo que en sujetos con normopeso, sin embargo no todas las personas con malnutrición por exceso presentan Trastorno por Atracón. Objetivo: identificar el conocimiento actual respecto a las diferencias y semejanzas existentes entre personas con malnutrición por exceso con y sin Trastorno por Atracón.Método: para lograr el objetivo anterior, se realizó una revisión de artículos científicos en torno al tema.Resultados: primero se analizó la comorbilidad psicopatológica en obesidad y después se detectaron similitudes y diferencias entre los grupos de interés, tanto en sintomatología general, como así también en sintomatología de la conducta alimentaria. Además, se identificaron algunos aspectos controversiales, en que existe evidencia contradictoria respecto a la comparación intergrupal.Conclusión: de esta revisión se concluye que en el estudio de la obesidad se hace necesario conocer en mayor profundidad las características del subgrupo de pacientes que además presenta Trastorno por Atracón,  ya que estas personas poseen características distintivas cuyo conocimiento permitirá ofrecer tratamientos integrales más adecuados a las necesidades de los pacientes, lo que posibilitará, en consecuencia, diseñar intervenciones más eficaces.

Durante 2019 Chile fue protagonista de masivas manifestaciones ciudadanas motivadas por desigualdades históricas. El objetivo del estudio fue comparar la percepción de adultos emergentes y adultos chilenos sobre la protesta social y su relación con salud mental y bienestar social. 771 personas respondieron una encuesta en línea sobre las variables de estudio. Los resultados indican que los adultos sobre 30 años presentan mayor interés en la política y ambos grupos manifiestan un rechazo transversal al uso de violencia en protestas ciudadanas. Además, los adultos emergentes lideraron en anomia y afecto negativo, mientras que los adultos presentan mayor bienestar social y satisfacción con la vida. La protesta social chilena ha tenido consecuencias políticas y socioemocionales, las cuales permanecen hasta la actualidad.

Both distortion and dissatisfaction with body image are crucial in the development of eating disorders. This study analyzes body dissatisfaction (BD) of young adults based on sex and nutritional status, as well as their relation to the construction of the self and others. A total of 73 university students (53% women) aged 18-28 (M = 21.96, SD = 2.04) answered a BD assessment that includes Anatomical Models Sheets, and the construction of the self and the others with the Grid Technique; In addition, the body mass index (BMI) was calculated from self-reported weight and height. Men reported more body distortion vs. women (p = .04), as well as participants with normal weight vs. overweight-obesity (p = .01); conversely, BD was more common in the group with overweight-obesity (p = .03). In women, perceived BMI correlated positively with social isolation, while self-definition "as obese" was associated with BMI and with lower self-esteem; in men, self-definition only correlated with social isolation. Although men had higher body distortion, in women, BD was related to more aspects of their identity. Resumen Tanto la distorsión como la insatisfacción con la imagen corporal (IC) son cruciales en el desarrollo de los trastornos alimentarios. Este estudio analiza la IC de jóvenes adultos en función del sexo y el estatus nutricional, así como su relación con la construcción del sí mismo y de los otros. Participaron 73 estudiantes universitarios (53% mujeres) de 18-28 años de edad (M = 21.96, DE = 2.04). La IC fue evaluada con Láminas de Modelos Anatómicos, y la construcción del sí mismo y de los otros con la Técnica de la Rejilla; además, el índice de masa corporal (IMC) fue calculado a partir del peso y la talla autoreportados. La distorsión corporal (DC) estuvo más presente en hombres vs. mujeres (p = .04), así como en los participantes normopeso vs. sobrepeso-obesidad (p = .01); contrariamente, la insatisfacción corporal fue más común en estos últimos (p = .03). En las mujeres, el IMC percibido correlacionó positivamente con aislamiento social, mientras que autodefinirse “como obesas” se asoció tanto con éste como con menor autoestima; no así en los hombres, en quienes dicha autodefinición solo correlacionó con aislamiento social. Aunque los hombres presentaron mayor DC, en las mujeres la IC se relacionó con más aspectos de su identidad.