Intervención Psicoterapéutica Integrada y Transdiagnóstica en los Trastornos de la Conducta Alimentaria
DOI:
https://doi.org/10.33898/rdp.v29i110.248Palabras clave:
transdiagnóstico, trastornos de la conducta alimentaria, tratamiento, síntomas inespecíficos, migraciónResumen
Los trastornos de la conducta alimentaria (TCA) presentan características psicopatológicas específicas para su entidad y otras inespecíficas que también pueden encontrarse en otros síndromes o trastornos psiquiátricos. Esta característica ocurre también a través de todas sus categorías diagnósticas en la que la migración de una a otra es habitual. La intolerancia a la incertidumbre, la hipersensibilidad a la crítica, la emocionalidad negativa, el perfeccionismo, la rigidez cognitiva o la impulsividad influyen en la gravedad del cuadro y en su evolución posterior son algunos de esos síntomas o rasgos considerados transdiagnósticos.
Esto pudiera explicar en parte el hecho de que los tratamientos actuales empíricamente validados no obtienen una mejoría suficiente en una gran parte de los trastornos alimentarios. En los últimos años han surgido nuevas técnicas psicoterapéuticas adaptadas de la ya existentes o aplicadas a esta patología enfocadas al manejo no sólo de los síntomas que caracterizan a un TCA sino también enfocadas al tratamiento de esos síntomas concurrentes.
En este artículo mostramos una revisión de dichas propuestas terapéuticas acompañado de una reflexión sobre la aplicación práctica de un modelo integrado y transdiagnóstico en nuestro medio.
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American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders (5th). Arlington, VA: American Psychiatric Publishing.
Abbate-Daga, G., Buzzichelli, S., Marzola, E., Amianto, F. y Fassino, S. (2012). Effectiveness of cognitive remediation therapy (CRT) in anorexia nervosa: a case series. Journal of Clinical and Experimental Neuropsychology, 34(10), 1009–1015. http://doi.org/10.1080/13803395.2012.704900
Agüera, Z., Sánchez, I., Granero, R., Riesco, N., Steward, T., Martín-Romera, V., Jiménez-Murcia, S., Romero, X., Caroleo, M., Segura-García, C., Mechon, J. M. y Fernández-Aranda, F. (2017). Short-Term Treatment Outcomes and Dropout Risk in Men and Women with Eating Disorders. European Eating Disorders Review, 25(4), 293–301. http://doi.org/10.1002/erv.2519
Atiye, M., Miettunen, J. y Raevuori-Helkamaa, A. (2015). A meta-analysis of temperament in eating disorders. European Eating Disorders Review, 23(2), 139–146. http://doi.org/10.1002/erv.2342
Barlow, D. H. (Ed.). (2007). Emotional Disorders: A unified transdiagnostic protocol. En Clinical Handbook of Psychological Disorders: A Step-by-Step Treatment Manual. New York, NY: Guildford. http://doi.org/10.4088/JCP.09bk05278
Berg, K. C. y Wonderlich, S. A. (2013). Emerging psychological treatments in the field of eating disorders. Current Psychiatry Reports, 15(11). http://doi.org/10.1007/s11920-013-0407-y
Brown, M., Robinson, L., Campione, G. C., Wuensch, K., Hildebrandt, T. y Micali, N. (2017). Intolerance of Uncertainty in Eating Disorders: A Systematic Review and Meta-Analysis. European Eating Disorders Review, 25(5), 329–343. http://doi.org/10.1002/erv.2523
Cano, T. R., Fernandez, L. B., Saenz, B. M., Moreno, L. R. y Leal, F. V. (2016). Perfectionism, a transdiagnostic construct in eating disorders. European Psychiatry, 33. http://doi.org/10.1016/j.eurpsy.2016.01.1562
Currin L, Schmidt, U., Treasure, J. y Jick, H. (2005). Time trends in eating disorder incidence. The British Journal Psychiatry, 186(2), 132–135.
Fairburn, C. G., Bailey-Straebler, S., Basden, S., Doll, H. A., Jones, R., Murphy, R., O'Connor, M. E., y Cooper, Z. (2015). A transdiagnostic comparison of enhanced cognitive behaviour therapy (CBT-E) and interpersonal psychotherapy in the treatment of eating disorders. Behaviour Research and Therapy 70, 64-71. http://doi.org/10.1016/j.brat.2015.04.010
Fairburn, C. G., Cooper, Z., & Shafran, R. (2003). Cognitive behaviour therapy for eating disorders: A ‘transdiagnostic’ theory and treatment. Behaviour Research and Therapy, 41(5), 509-528. http://doi.org/10.1016/S0005-7967(02)00088-8
Fairburn, C. G., Cooper, Z., Shafran, R. y Wilson, Terence, G. (2008). Eating Disorders - a Transdiagnostic Protocol. En David H. Barlow (Ed.), Clinical Handbook of Psychological Disorders, New York, NY: Guildford. http://doi.org/10.1056/NEJM199908193410816
Fulton, J., Lavender, J., Tull, M., Klein, A., Muehlenkamp, J. y Gratz, K. (2012). The relationship between anxiety sensitivity and disordered eating: The mediating role of experiential avoidance. Eating Behaviors, 13(2), 166–169. http://doi.org/10.1016/J.EATBEH.2011.12.003
Gómez Del Barrio, A., Vellisca Gonzalez, M. Y., González Gómez, J., Latorre Marín, J. I., Carral-Fernández, L., Orejudo Hernandez, S., Madrazo, R-H., y Moreno Malfaz, L. (2017). Characteristics of patients in an eating disorder sample who dropped out: 2-year follow-up. Eating and Weight Disorders, 1–9. http://doi.org/10.1007/s40519-017-0416-7
Goss, K. y Allan, S. (2012). An Introduction to Compassion-Focused Therapy for Eating Disorders (CFT-E). En J. Fox y K. Goss (Eds.), Eating and its Disorders (pp. 303-314). http://doi.org/10.1002/9781118328910.ch20
Guideline, C. (2017). National Institute for Health and Care Excellence Eating Disorders: recognition and treatment, (May). Recuperado de: https://www.nice.org.uk/guidance/ng69/evidence/full-guideline-pdf-161214767896
Hilbert, A., Pike, K., Goldschmidt, A., Wilfley, D., Fairburn, C., Dohm, F-A., Walsh, T. y Striegel Weissman, R. (2014). Risk factors across the eating disorders. Psychiatry Research 220(1), 500-506. http://doi.org/10.1016/j.psychres.2014.05.054
Hill, L., Peck, S. K., Wierenga, C. E. y Kaye, W. H. (2016). Applying neurobiology to the treatment of adults with anorexia nervosa. Journal of Eating Disorders, 4(1), 1–14. http://doi.org/10.1186/s40337-016-0119-x
Knowles, L., Anokhina, A. y Serpell, L. (2013). Motivational interventions in the eating disorders: What is the evidence? International Journal of Eating Disorders, 46(2), 97–107. http://doi.org/10.1002/eat.22053
Lester, R. J. (2017). Self-governance, psychotherapy, and the subject of managed care: Internal Family Systems therapy and the multiple self in a US eating-disorders treatment center. American Ethnologist, 44(1), 23–35. http://doi.org/10.1111/amet.12423
Mallorquí-Bagué, N., Vintró-Alcaraz, C., Sánchez, I., Riesco, N., Agüera, Z., Granero, R., Jiménez-Múrcia, S., Mechón, J. M., Treasure, J. y Fernández-Aranda, F. (2018). Emotion Regulation as a Transdiagnostic Feature Among Eating Disorders : Cross-sectional and Longitudinal Approach. European Eating Disorders Review, 26(1), 53–61. http://doi.org/10.1002/erv.2570
Mcintosh, V., Jordan, J., Carter, J. D., Luty, S. E., Carter, F. A., McKenzie, J. M., Frampton, C. M. y Joyce, P. (2016). Assessing the distinctiveness of psychotherapies and examining change over treatment for anorexia nervosa with cognitive‐behavior therapy, interpersonal psychotherapy, and specialist supportive clinical management. International Journal of Eating Disorders, 49(10), 958–962. http://doi.org/10.1002/eat.22555
Schmidt, U., Renwick, B., Lose, A., Kenyon, M., Dejong, H., Broadbent, H., Loomes, R., Watson, C., Ghelani, S., Serpell, L., Richards, L., Johnson-Sabine, E., Bougton, N., Whitehead, L., Beecham, J., Treasure, J. L. y Landau, S. (2013). The MOSAIC study - comparison of the Maudsley Model of Treatment for Adults with Anorexia Nervosa (MANTRA) with Specialist Supportive Clinical Management (SSCM) in outpatients with anorexia nervosa or eating disorder not otherwise specified, anorexia nerv. Trials, 14(1), 160. http://doi.org/10.1186/1745-6215-14-160
Thompson-Brenner, H., Boswell, J. F., Espel-Huynh, H., Brooks, G. y Lowe, M. R. (2018). Implementation of transdiagnostic treatment for emotional disorders in residential eating disorder programs: A preliminary pre-post evaluation. Psychotherapy Research : Journal of the Society for Psychotherapy Research, 1–17. http://doi.org/10.1080/10503307.2018.1446563
Treasure, J., Cardi, V., Leppanen, J. y Turton, R. (2015). New treatment approaches for severe and enduring eating disorders. Physiology and Behavior, 152, 456–465. http://doi.org/10.1016/j.physbeh.2015.06.007
Treasure, J., Claudino, A. M. y Zucker, N. (2010). Eating disorders. The Lancet, 375(9714), 583–593. http://doi.org/10.1016/S0140-6736(09)61748-7
Treasure, J., Leslie, M., Chami, R. y Fernández-Aranda, F. (2018). Are trans diagnostic models of eating disorders fit for purpose? A consideration of the evidence for food addiction. European Eating Disorders Review. http://doi.org/10.1002/erv.2578
Vall, E. y Wade, T. D. (2015). Predictors of treatment outcome in individuals with eating disorders: A systematic review and meta-analysis. International Journal of Eating Disorders, 48(7), 946–971. http://doi.org/10.1002/eat.22411
Waller, G. (2016). Treatment Protocols for Eating Disorders: Clinicians’ Attitudes, Concerns, Adherence and Difficulties Delivering Evidence-Based Psychological Interventions. Current Psychiatry Reports, 18(4), 1–8. http://doi.org/10.1007/s11920-016-0679-0