Gender, Phenotypical Differentation and Therapy Response for Bulimia Nervosa

Abstract

The present PhD thesis is a compilation of four empirical studies and one review that try to better understand the clinical presentation of Bulimia Nervosa (BN) by investigating three important aspects: (1) gender differences in eating disorder (ED) symptomatology, associated traits and therapy outcome (study 1 and study 2), (2) phenomenology and boundaries of BN-purging, BN-non-purging and BED diagnoses (study 3) and (3) new technological approaches for the treatment of EDs with bulimic symptomatology (study 4 and study 5).

In the first study, 60 male and 60 female ED patients were compared to 120 healthy controls to find out similarities and differences in ED clinical features, psychopathology and personality traits by gender. The goal of the second study was to examine the efficacy of CBT treatment delivered in a group for BN male individuals compared with BN female individuals. In the third study, 34 females suffering from binge eating disorder (BED), 34 BN purging and 34 BN non-purging were compared to explore similarities and differences on clinical, psychopathological and personality variables. The forth study was a book chapter-review of ED interventions (specifically BN and BED) through new technologies. In the last study, an effectiveness analysis of an Internet-based therapy program (IBT) for BN was compared to a waiting list (WL).

Results regards to gender showed important clinical similarities between male and female ED participants. However, specific aspects related to shape or thinness were differently considered by them. Taking into account treatment response, results indicated that CBT treatment for BN was beneficial for both male and females ED patients. Moreover, the differences found in personality traits by gender appeared to be more related to gender differences in the general population rather than to ED per se.

Regards to BED, BN purging and BN non-purging spectrum, a linear trend in general psychopathology was observed between disorders showing a continuum were BNpurging represented the most severe disorder and BED the least severe. And obesity was a clinical variable strongly associated with BED. And finally, regards to Internet programs data suggested that the IBT program was useful for BN patient when compared to a waiting list.

All the studies presented in this dissertation have been published in international and national journals. Studies:

1) "Do men with eating disorders differ from women in clinics, psychopathology and personality?" Authors: Núñez- avarro, A.; Agüera, Z.; Krug, I.; Jimenez-Murcia, S.; Sánchez, I.; Araguz, N; Gorwood, P.; Granero, R.; Penelo, E.; Karwautz, A.; Moragas, L; Saldaña, S; Treasure, J.; Menchón, J.M. and Fernández-Aranda, F. (2012) European Eating Disorders Review 20 (1) 23-31.

2) “Male eating disorders and therapy: a controlled pilot study with one year follow-up” Authors: Fernández-Aranda, F.; Krug, I.; Jiménez-Murcia, S.; Granero, R.; N úñez, A.; Penelo, E.; Solano, R. and Treasure, J. (2009) J. Behav. Ther. & Exp. Psychiat. 40 (3) 479–486.

3) “Differentiating purging and nonpurging bulimia nervosa and binge eating disorder” Authors: úñez- avarro, A., Jiménez-Murcia, S., Álvarez-Moya, E., Villarejo, C., Sánchez, I.; Masuet, C., Granero, R., Penelo, E., Krug, I., Tinahones, FJ. Bulik, C. and Fernández-Aranda, F. (2011) International Journal of Eating Disorders 44(6)488-496.

4) “Nuevas tecnologías en el tratamiento de los trastornos de la alimentación” Authors: Fernández Aranda, F.; Martínez, C.; N úñez, A., Álvarez, E. y Jiménez-Murcia, S. (2007) Cuadernos de Medicina Psicosomática y Psiquiatría de enlace, 82, 7-16.

5) “Internet-based cognitive-behavioral therapy for bulimia nervosa: a controlled study” Authors: Fernández-Aranda, F.; Núñez, A.; Martínez, C.; Krug, I.; Cappozzo, M.; Carrard, I.; Rouget, P.; Jiménez-Murcia, S.; Granero, R.; Penelo, E.; Santamaría, J. and Lam, T. (2009) Cyberpsychology & behavior 12 (1) 37-41.

Aquesta tesi doctoral és un recull de quatre estudis empírics (format article) i una revisió que tenen com objectiu comprendre en major profunditat tres aspectes específics de la Bulímia Nerviosa (BN): (1) diferències de gènere en la simptomatologia, trets associats i resposta a la teràpia (2) fenomenologia i límits entre la BN-purgativa, BNno-purgativa y Trastorn per Afartament (TA) i (3) enfocament terapèutic basat en noves tecnologies.

A la primera àrea d'investigació, els resultats suggereixen que la presentació clínica entre homes i dones amb TCA es força similar. No obstant això, algunes especificitats de gènere deuen tenir-se en compte: desig de primesa (dones) versus desig de musculatura (homes). Al segon estudi, el tractament amb teràpia cognitiu-conductual (TCC) per a la BN es va trobar beneficiós tant per a dones com per a homes, tots dos sexes van presentar una resposta similar i positiva al tractament. Considerant la segona línia d'investigació, es va observar una tendència lineal en la psicopatologia general dels trastorns estudiats, mostrant un continu on la BN-purgativa era la de major gravetat i TA el de menor. A més l'obesitat va aparèixer fortament associada amb el TA, molt més que amb qualsevol de les formes de la BN. Finalment, en l'última línia d'investigació, es van revisar les potents possibilitats de les noves tecnologies com a intervencions específiques per a la simptomatologia bulímica. I les persones que van participar en el programa online van mostrar una disminució significativa tant en els índexs psicopatològics com en la gravetat de les conductes bulímiques. Quatre dels estudis presentats han estat publicats en revistes científiques internacionals i el cinquè en una revista científica nacional