ABSTRACT Background: Eating disorders (ED) are characterized by psychosocial disfunctions, like social anxiety, alexithymia and lack of assertiveness. Objective: To propose a comprehensive integrative model including neurobiology and behavior aspects. Method: A literature review on Medline/PubMed, SciELO and specialized texts databases were assessed against quality criteria. Core concepts were extracted and coherence articulated. Results: Four factors were disposed to meaning: alarm and reward system with social brain and control (inhibition/excitation) mechanisms. They were articulate in a complex psychophysiological interplay. They were associated with social behaviours achieved/not achieved during development. Food intake could operate like a pathological balance to psychopathological effects Conclusion: An explanatory/comprehensive psychoneurobiological model to understand social function in ED is proposed. This form of understanding facilitates: the connection between emerging research in eating disorders and ID; clinical decision-making and guide the prognosis and treatment alternatives.

RESUMEN: Antecedentes: Los trastornos alimentarios (TCA) presentan entre sus síntomas disfunciones psicosociales como ansiedad social, alexitimia y falta de asertividad. Objetivo: Se propone un modelo explicativo/comprensivo que integra aspectos de psiconeurobiología y comportamiento útil para la clínica. Método: Se evaluó una revisión de la literatura en Medline / PubMed, SciELO y bases de datos de textos especializados con criterios de calidad. Fueron seleccionados conceptos centrales para construir una coherencia que permitiera la lectura psiconeurobiológica del fenómeno y su aplicación clínica. Resultados: Cuatro factores fueron dispuestos a significar: 1- sistema de alarma; 2- sistema de recompensa 3- cerebro social; 4-mecanismos de control (inhibición/excitación). Se dispusieron mostrando la complejidad de su interacción psicofisiológica. Se sugiere que la ingesta de alimentos podría funcionar como una forma primaria de equilibrio cuando hay fallas en alguno de los sistemas expuestos. Conclusión: Se presenta un modelo de integración psiconeurobiológico útil para explicar la dificultad interpersonal en TCA. Esta forma de comprensión facilita: la conexión entre las investigaciones emergentes en TCA y DI; la toma de decisiones clínicas y orientan el pronóstico y las alternativas de tratamiento.

Background: A history of childhood sexual abuse (SA) or adolescence in eating disorders (ED) is documented in clinical experience and in the literature. However, the complex relationships between both conditions have not been systematized. Objective: To describe the clinical and neurobiological relationship between SA and ED. Method: The specialized literature in texts and articles included in Medline/PubMed, SciELO was thoroughly analysed. Central concepts were outlined and information was written seeking didactic cohesion, including an illustrative clinical case. Results: Although SA is a nonspecific factor for the development of mental disorders, it constitutes a significant predisposing, triggering and perpetuating phenomenon for the emergence of ED, mainly bulimia nervosa. Risk, mediator, predictor, protective and resilience factors are described. Both specific conditions show analogous neurobiological and clinical correlates (core symptoms and adaptive functions). Similar dysfunctions exist in reward and emotional regulation circuits, with limited structural disturbances in prefrontal areas. Conclusions: There is strong evidence of the coexistence of SA in ED. However, it is necessary to develop research models that truly integrate genetic, hormonal, neurotransmitter, personality and sociocultural risk processes.

Resumen Antecedentes: El antecedente de abuso sexual (AS) en la infancia o adolescencia en los trastornos alimentarios (TCA) está documentado en la experiencia clínica y en la literatura. Sin embargo, las complejas relaciones entre ambas condiciones no han sido sistematizadas. Objetivo: Describir la relación clínica y neurobiológica entre AS y TCA. Método: Se analizó exhaustivamente la literatura especializada en textos y artículos incluidos en Medline/PubMed, SciELO. Se perfilaron los conceptos centrales y se redactó la información buscando didáctica cohesión incluyendo un caso clínico ilustrativo. Resultados: Aunque el AS es un factor inespecífico para el desarrollo de trastornos mentales, constituye un fenómeno significativo predisponente, desencadenante y perpetuante para la emergencia de un TCA, principalmente bulimia nerviosa. Se describen los factores de riesgo, mediadores, predictores, protectores y de resiliencia. Ambas condiciones poseen correlatos neurobiológicos y clínicos análogos (síntomas nucleares y funciones adaptativas). Existen disfunciones similares en los circuitos de recompensa y regulación emocional, con alteraciones estructurales distintas en áreas prefrontales. Conclusiones: Existe contundente evidencia de la co-existencia de AS en los TCA. No obstante, es necesario continuar desarrollando modelos de investigación que integren realmente los procesos genéticos, hormonales, neurotransmisores, de personalidad y socioculturales de riesgo.

Abstract: Obesity (OB) and feeding and eating disorders (FED) are complex and prevalent pathologies in adolescents. OB has been shown to be a risk factor for developing binge eating disorder and buli mia nervosa, and vice versa, these FED also develop OB. However, obese adolescents may present atypical or sub-threshold criteria for FED. The objective of this review is to describe the epidemio logical, clinical, and therapeutic relationship between FED and OB in adolescents, with emphasis on the urgent need for research and collaboration among professionals in the fields of mental health and nutrition.

Resumen: La obesidad (OB) y los trastornos alimentarios y de la ingestión de alimentos (TAI) son patologías complejas y prevalentes en adolescentes. Se ha demostrado que la OB es un factor de riesgo para el trastorno por atracón y bulimia nerviosa, y viceversa, también los TAI desarrollan OB. Es importante considerar que los adolescentes obesos pueden exhibir criterios atípicos o sub-umbrales de TAI. El objetivo de la presente revisión es describir la relación epidemiológica, clínica y terapéutica entre TAI y OB en adolescentes, con énfasis en la urgente necesidad de investigación y colaboración entre los profesionales de los ámbitos de salud mental y nutricional.

Abstract Background Delusional characteristics have been largely ignored in patients suffering from anorexia nervosa (AN). Objectives To review the literature on delusional features in AN from phenomenological, neurobiological, and clinical viewpoints. Methods Data were obtained through searches of Medline, PubMed, SciELO and Cochrane Library. Results Distorted beliefs in AN may range from an overvalued idea to an overt delusion, involving affective, personality and/or psychotic disorders. Studies confirm alterations in monoaminergic systems. It has also been seen a decreased integration of visual/proprioceptive information, and alterations in neural networks involved in body processing. It is known that body image distortion may present “delusional proportions” as a consequence of great concern about body. Concomitantly, “embodied defence hypothesis” has been proposed. Restrictive AN exhibits higher levels of delusionality, and a particular delusional type of AN has been suggested, associated with a worse long-term outcome. Low doses of atypical antipsychotics are recommended combined with cognitive techniques. Discussion Delusional thinking in AN is likely a dynamic and dimensional phenomenon that can vary, both in nature and/or severity, whereas high insight levels, before and after refeeding, result in positive outcomes. Neurobiological research on this topic must be encouraged, since clinical and phenomenological approaches are comparatively more frequently reported.

Background: There is evidence of an increasing number of middle-aged women suffering from eating disorders (ED). Objective: To describe women in adulthood with eating disorders, in relation to their epidemiological, aetiopathogenic, clinical, evolutionary and therapeutic characteristics. Method: A comprehensive literature search was carried out using the electronic databases MEDLINE/PubMed, SciELO and the Cochrane Library, as well as specialized consultation texts, from 1984 to present (2017). Results: Clinical characteristics and most of the risk factors (biological, psychological, sociocultural) are similar to those found in younger women, and may be more likely the continuation of a previous ED or a late onset of the pathology. The most distinctive and relevant variables for middle-aged women are menopause and anxiety related to aging, who seem to be less likely to develop anorexia nervosa and bulimia nervosa, but rather binge eating disorder and other unspecified and specified threshold EDs. Depression and systemic physical comorbidities are very common. The therapeutic management is multidisciplinary and the lack of adherence implies a chronic outcome. Conclusions: Physicians should bear in mind the increased risk of EDs in peri-menopausal women, when changes in physical appearance can be drastic, unexpected and undesirable, and should strive to explore this possibility in their daily clinical practise.

Resumen Antecedentes: Existe evidencia de un creciente número de mujeres en la mediana edad que sufren trastornos de la conducta alimentaria (TCA). Objetivo: Describir las mujeres en la adultez mediana con TCA, en relación a sus características epidemiológicas, etiopatogénicas, clínicas, evolutivas y terapéuticas. Método: Se realizó una búsqueda bibliográfica exhaustiva utilizando las bases de datos electrónicas MEDLINE/PubMed, SciELO y la Biblioteca Cochrane, además de textos de consulta especializados, desde 1984 hasta la actualidad (2017). Resultados: Las características clínicas y la mayoría de los factores de riesgo (biológico, psicológico, sociocultural) son similares a los encontrados en mujeres más jóvenes, pudiendo ser más probablemente la continuación de un TCA previo o un inicio tardío de la patología. Las variables más distintivas y relevantes para las mujeres de mediana edad son la menopausia y la ansiedad relacionada al envejecimiento, quienes parecen ser menos proclives a desarrollar anorexia nerviosa y bulimia nerviosa, sino más bien trastorno por atracones y otros TCA no especificados y especificados subumbrales. Es muy frecuente la depresión y las comorbilidades físicas sistémicas. El manejo terapéutico es multidisciplinario y la falta de adherencia implica un desenlace crónico. Conclusiones: Los médicos deben tener presentes el mayor riesgo de TCA en mujeres perimenopáusicas, cuando los cambios en la apariencia física pueden ser drásticos, inesperados y no deseados y deben esmerarse en explorar esta posibilidad en la práctica clínica diaria.

Abstract: Body image (BI) is a core feature for identity development; nevertheless amongst male population there is scarce empirical evidence. The aim of this study was to describe the experiences and meanings associated to the construction of BI in male, based on a methodological-qualitative approach. Participated 16 young men aged 15 to 25 years. Data were collected by semi-structured interviews and two focus groups, both analised by open codification. Meanings and procedures related to BI were classified in the following categories: physical appearance care, beauty ideal, self-concept and BI. Participants perceived differences in their physical appearance care compared with women, homosexuals and men of previous generations. In BI construction it is highlighted the drive for being attractive to the opposite sex by the increase of the muscle development. However body dissatisfaction do not represent a relevant topic for participants, since they display a pragmatic value of their BI, which may be an index of a new relationship with their own masculinity and BI that must be explored.

Resumen: La imagen corporal (IC) es fundamental en el desarrollo de la identidad; sin embargo, en la población masculina la evidencia empírica es escasa. El propósito de este estudio es describir las vivencias y significados asociados a la construcción de la IC en varones, a partir de una aproximación metodológica cualitativa. Participaron 16 varones de entre 15 y 25 años de edad. Los datos fueron recolectados mediante entrevistas semiestructuradas y se formaron dos grupos focales, ambos analizados por medio de codificación abierta. Los significados y procesos asociados a la IC se clasificaron en tres categorías: Cuidado de la apariencia física, Ideal estético, Autoconcepto e IC. Los participantes percibieron diferencias en su preocupación y cuidado de la apariencia física respecto a las mujeres, los varones homosexuales o los varones de generaciones previas. En la construcción de la IC destaca el papel de la motivación por resultar atractivo al sexo opuesto, con énfasis en el incremento del desarrollo muscular. No obstante, la insatisfacción corporal no representa un tópico particularmente relevante en los participantes, dado que hacen una valoración práctica de su imagen, lo que podría ser un indicador de una nueva relación con su propia masculinidad e IC que es necesario explorar.

Abstract: Body image is a relevant topic in the development of identity during the adolescence, where social factors are significant in determining individual expectations. This study aims to describe and analyze the perception that female adolescents have about the influence of sociocultural factors on their own body image. This research has a qualitative, exploratory and descriptive approach based on the Grounded Theory. Five adolescent girls aged between 16 and 18 years were interviewed. Results show that body image is characterized by ambivalent feelings and different degrees of body dissatisfaction. In general, participants overvalue physical aspects, for instance, thinness is believed as a sign of attractiveness, success and perfection, prototype linked to body dissatisfaction. The more influential sociocultural parameters were mass media, especially online social networks, peers and family. It is concluded that strengthening critical judgment skills to distinguish between the ideal body and the real body could enhance the prevention of eating disturbances in adolescent women.

Resumen: La imagen corporal es un tópico relevante en el desarrollo de la identidad durante la adolescencia, donde los factores sociales son decisivos en la determinación de las expectativas individuales. Este estudio describe y analiza la percepción que mujeres adolescentes tienen acerca de la influencia de los aspectos socioculturales en su imagen corporal. El enfoque de investigación fue cualitativo, exploratorio y descriptivo, basado en la teoría fundamentada. Se entrevistó a cinco mujeres adolescentes de entre 16 y 18 años de edad. Los resultados muestran que existe una experiencia de la imagen corporal caracterizada por sentimientos ambivalentes y diferentes grados de insatisfacción corporal. En general, las participantes sobrevaloran la importancia del aspecto físico y, específicamente, la delgadez es considerada signo de atractivo, éxito y perfección; prototipo estético que favorece la insatisfacción corporal. Los parámetros socioculturales percibidos como más influyentes fueron los medios masivos de comunicación, especialmente las redes sociales digitales, que superan a los pares y a la familia. Se concluye que el fortalecimiento de la capacidad de juicio crítico para discernir entre los ideales corporales y los cuerpos reales podría favorecer la prevención de problemas alimentarios en las mujeres adolescentes.

Background: Depression, alexithymia, and lack of assertiveness interfere with individual psychosocial functioning and may result in longer hospitalization stay and poorer therapeutic results. Aim: To analyze the psychosocial functioning in acute and chronic patients and its association with psychological, clinical and sociodemographic variables. Material and Methods: We performed a cross-sectional study that included 80 inpatients of both sexes with organic pathology, aged between 18 to 70 years old, without any current psychiatric disorder. Clinical and sociodemographic data were collected from a semi-structured interview and hospital records. Beck Depression Inventory-IA, Toronto Alexithymia Scale-20 and Rathus Assertiveness Scale were administered. Results: Fifty five percent of patients had some degree of depression, 33% alexithymia and 34% lack of assertiveness. The levels of depression, alexithymia and lack of assertiveness in chronic patients were significantly higher than those observed in acute patients. Women and participants older than 60 years exhibited the highest degrees of depression. Alexithymia and lack of assertiveness were associated with a lower educational level. A negative significant correlation between alexithymia and assertiveness scores was observed among acute patients. Conclusions: Participants with chronic diseases had a lower psychosocial functioning. Less educated patients showed more alexithymic and less assertive features. We emphasized the need of a better management of these aspects by the health team, since social functioning might interfere with the outcome of physical illnesses.

There is strong evidence about the co-existence of body dysmorphic disorder (BDD) and eating disorders (ED), particularly with anorexia nervosa (AN). An exhaustive review of the specialised literature regarding these disorders was carried out. The results show that their co-occurrence implies a more complex diagnosis and treatment, a more severe clinical symptomatology and a worse prognosis and outcome. Both disorders display common similarities, differences and comorbidities, which allow authors to classify them in different nosological spectra (somatomorphic, anxious, obsessive-compulsive, affective and psychotic). Their crossover involves higher levels of body dissatisfaction and body image distortion, depression, suicidal tendency, personality disorders, substance use/abuse, obsessive-compulsive disorder, social phobia, alexithymia and childhood abuse or neglect background. Treatment including cognitive-behavioral psychotherapy and selective reuptake serotonin inhibitors are effective for both, BDD and ED; nevertheless, plastic surgery could exacerbate BDD. Clinical traits of BDD must be systematically detected in patients suffering from ED and vice versa.

Abstract Background Among body image disorders, anorexia nervosa (AN) in females and muscle dysmorphia (MD) in males, emerge as the more representative. Objective To describe the relationship of clinical characteristics between AN and MD. Method A review of specialised textbooks and the available literature in Medline/PubMed and SciELO was made. Results There are similarities and differences between both disorders. They begin in adolescence, show a great diagnostic crossover, use/abuse of pharmacological drugs, similar co-morbidities, improvement with selective serotonin reuptake inhibitors and behavioural-cognitive psychotherapy, they are focused in body image, but AN pursuits thinness while MD muscle development. From a psychosocial perspective, body image disorders come out due to western socio-cultural pressures related to gender role stereotypes, which emphasise a slim feminine figure versus a vigorous masculine one. The nosological classification of MD is controversial and it has been including within the obsessive-compulsive spectrum of the DSM-5. Conclusions Both disorders imply body dissatisfaction with different degrees of body image distortion, even reaching delusional dimensions. Future studies are required which can lay the foundations of new categorisations of these disorders that better clarify their essence.

Resumen Introducción Entre los trastornos relacionados con la imagen corporal, la anorexia nerviosa (AN) en el sexo femenino y el trastorno dismórfico muscular (TDM) en el masculino surgen como los más representativos. Objetivo Analizar descriptivamente la relación entre las características clínicas de la AN y el TDM. Método Se realizó una búsqueda bibliográfica sobre la relación entre AN y TDM mediante las bases de datos Medline/PubMed, SciELO y textos especializados. Resultados Existen similitudes y diferencias entre ambos trastornos. Se inician en la adolescencia, muestran gran traslape diagnóstico, uso/abuso de fármacos, similares comorbilidades, mejoría con inhibidores selectivos de la recaptura de serotonina, psicoterapia cognitivo-conductual y se focalizan en la imagen corporal, pero en la AN se persigue la delgadez, mientras que en el TDM, el desarrollo muscular. Desde la perspectiva psicosocial, estos trastornos de la imagen corporal surgen debido a las presiones socioculturales occidentales relacionadas con los estereotipos de rol de género, que enfatizan una silueta esbelta femenina versus una masculina vigorosa. La clasificación nosológica del TDM ha sido controvertida, siendo actualmente incluida en el DSM-5 en el espectro obsesivo-compulsivo. Conclusiones Ambos trastornos implican una insatisfacción corporal con diversos grados de distorsión de la imagen corporal, alcanzando aun dimensiones delirantes. Se requieren futuras investigaciones que puedan fundamentar nuevas categorizaciones de estos desórdenes, clarificadoras de su esencia.

Background: Asceticism is deeply related to spirituality and fasting practices that have been observed in anorexia nervosa (AN) through the history.Objective: A psychosocial analysis of spirituality and asceticism within the historical context of the AN is made, from Middle Ages to XXI century, comparing the holy anorexia and the contemporary AN. Ad hoc illustrative cases are described.Method: Medline/Pubmed, data bases and specialized textbooks were used to look for evidence on asceticism and spirituality in AN and its historical development.Results: From a historical point of view, asceticism of medieval saints (holy anorexia) and that of modern anorectics, display common features; nevertheless, it is oriented to different goals: spirituality versus worldly appearance, respectively. Contemporary Puritanism and AN share distinctive characteristics of protestant ethics, mainly self-discipline, self-control, self-sacrifice, rationality, efficiency and goals achievement. Asceticism is significantly related to angry feelings, inmaturity features and purging.Discussion and conclusion: Many medieval mystical women showed similar characteristics with present AN, nevertheless, while asceticism in saints were oriented to achieve the divine encounter, drive for thinness in contemporary young anorectics is rather related to sociocultural aesthetic ideals. The atemporal occurrence of the pathogenic essence of the anorectic syndrome suggests that factors like age, personality and/or psychosocial environment pathoplastically model it.

Introducción: El ascetismo se relaciona profundamente con la espiritualidad y las prácticas de ayuno que han sido observadas en la anorexia nerviosa (AN) a lo largo de la historia.Objetivo:Se realiza un análisis psicosocial de la espiritualidad y el ascetismo en el contexto histórico de la AN, desde la Edad Media hasta el siglo XXI, comparando la anorexia santa con la anorexia contemporánea. Se describen casos ilustrativos ad hoc.Método: Se realizó una búsqueda bibliográfica de la evidencia sobre el ascetismo y la espiritualidad en la AN y su desarrollo histórico mediante las bases de datos Medline/PubMed y textos de consulta especializados.Resultados: Desde una perspectiva histórica, el ascetismo de las santas medievales (anorexia santa) y de las anoréxicas modernas, exhiben rasgos comunes, aunque orientados a distintas metas: espiritualidad versus apariencia mundana, respectivamente. El puritanismo contemporáneo y la AN comparten rasgos distintivos de la ética protestante, principalmente autodisciplina, autocontrol, abnegación, racionalidad, eficiencia y obtención de logros. El ascetismo se relaciona significativamente con sentimientos rabiosos, rasgos de inmadurez y conductas purgativas.Discusión y conclusión: Muchas mujeres místicas medievales mostraron características similares con la AN actual, sin embargo, mientras el ascetismo en las santas se orientaba al logro del encuentro divino, la motivación por adelgazar en las jóvenes anoréxicas contemporáneas se relaciona más bien con ideales estéticos socioculturales. La ocurrencia atemporal de la esencia patogénica del síndrome anoréxico sugiere que factores como edad, personalidad y/o entorno psicosocial lo modelan patoplásticamente.

Background: The Eating Disorders Diagnostic Scale (EDDS) is a self-administered low cost psychometric instrument with excellent levels of temporal reliability and validity. Aim: To adapt and validate the EDDS in Chile. Material and Methods: Thefactorial structure, internal consistency and test-retest reliability ofthe Spanish-language version of the EDDS was analyzed in a sample of1964 university and high school students. The concurrent validity was tested in a sample of 50 primary care patients with ED and 59 controls, comparing its results with those of a structured psychiatric interview (CIDI). Results: The EDDS showed a high internal consistency, moderate test-retest reliability, an appropriate factorial structure (in women) and an excellent convergent validity. Also, the diagnosis of ED obtained with the EDDS is moderately consistent with the structured psychiatric interview. Conclusions: The Spanish-language version of the EDDS showed a satisfactory psychometric behavior and a good capacity for detecting ED, according to the DSM criterion.

Background: Muscle dysmorphia or vigorexia is a disorder in which a person becomes obsessed with the idea that he or she is not muscular enough. Aim: To assess physical exercise, eating behaviors and the presence of muscle dysmorphia among weightlifters and medical students. Subjects and Methods: Cross sectional evaluation of 88 male weightlifters aged 27 ± 7 years and 84 male medical students aged 22 ± 1 year was made. Eating behaviors were evaluated using the Eating Attitudes Test (EAT-40) and the Eating Disorders Inventory (EDI). The perception of body image was assessed using the Graduate Hannover Scale (GHS). Results: Prevalence of muscle dysmorphia among weightlifters was 13.6%. Both groups did not differ in body dissatisfaction. Interest in appearance among weightlifters was significantly higher than in students and ranged significantly higher in EAT-40 and EDI (p < 0.001). Other sports were practiced with the same frequency by weightlifters and students. Weightlifters expended more time than students exercising to improve their appearance (p < 0.005). Forty two percent of weightlifters with muscle dysmorphia displayed abuse of anabolics and 67% used other substances to improve their performance (p < 0.005). Conclusions: The presence of muscle dysmorphia among weightlifters was confirmed. They were dissatisfied with their body image and more concerned with their physical appearance than those without muscle dysmorphia and/or students. Their anabolic abuse rate was high. Our findings were similar to those reported in the international literature.

Background. There is substantial evidence that supports the co-occurrence between eating disorders and drug and alcohol problems. Method. A review of the specialized literature available is made about the relationship between both pathologies, the presence of alcohol abuse among relatives of eating disordered patients and the hypothesis that correlate them from an etiopathogenic point of view. The similarities and differences between these types of disorders are also discussed. Results. 27% of eating disordered patients has alcohol dependence. Alcohol abuse and/or dependence is seen between 0% and 6% in restrictive anorexia, 10% to 28% when the presence of bulimic traits are demonstrated and in approximately 50% of bulimic patients. From 15% to 56% of alcoholic patients develop an eating disorder: 1,4% a 10% anorexia nervosa, 10% compulsive overeating or binge eating disorder, but mainly a bulimic disorder, between 6.2% to 50%. 50% of parental alcohol abuse has been noted in bulimic patients and just 7% in anorectic patients. Conclusions. The published references suggest a clear co-morbidity between eating disorders and alcohol and drug abuse, and its relationship still remains unclear. More than 30% with eating disorders may have concurrent substance abuse problems, particularly patients with bulimia nervosa. The co-existence of both disorders involves clinical, therapeutic and outcome implications

Antecedentes. Existe una contundente evidencia que apoya la co-ocurrencia entre trastornos de la conducta alimentaria y abuso de alcohol y otras sustancias. Método. Se revisa la literatura especializada disponible acerca de la asociación entre ambas patologías, la presencia de abuso de alcohol en familiares de pacientes con desórdenes alimentarios y las hipótesis que las relacionan etiopatogénicamente, considerando sus similitudes y diferencias. Resultados. El 27% de las pacientes con trastornos alimentarios presenta dependencia a alcohol. El abuso y/o dependencia de alcohol oscila entre el 0% al 6% en la anorexia nerviosa restrictiva, 10% y 28% cuando se demuestra la presencia de rasgos bulímicos, y hasta 50% en las pacientes bulímicas. Entre el 15% al 56% de las pacientes alcohólicas presenta un trastorno alimentario: 1,4% a 10% anorexia nerviosa, 10% comer compulsivo o trastorno por comilonas, pero principalmente bulímico, entre 6,2% a 50%. Abuso de alcohol parental se observa hasta en el 50% de pacientes bulímicas y sólo hasta el 7% de pacientes anorécticas. Conclusiones. Las referencias publicadas claramente sugieren una comorbilidad entre trastornos de la conducta alimentaria y abuso de drogas, incluido el alcohol, cuya relación aún permanece oscura. Más del 30% de los pacientes con trastornos alimentarios puede exhibir un problema de abuso de sustancias concurrente, particularmente los pacientes portadores de bulimia nerviosa. La coexistencia de ambos desórdenes posee implicancias clínicas, terapéuticas y pronósticas

Background. Although anorexigens are not widely used in psychiatry, psychiatrists frequently prescribe psychotropics to patients already being treated with appetite suppressants, involving significant interactions between them and other medications which may cause irreversible and even fatal complications. Aim. To describe the main anorexigen agents available in Chile along with their classifications, characteristics, pharmacokinetics, indications, contraindications, adverse effects and interactions. Material and methods. Current specialized literature on the subject is reviewed. Results. Appetite suppressants are just one component of integral treatment in obese patients with results improving when the patient's eating habits are modified. Anorexigens have a high potential for abuse, dependence, tolerance and deprivation syndrome. Their foremost side effects affect cardiovascular, gastrointestinal and central nervous systems. The most widely used in Chile between 1997 and 1998 were phentermine, diethylpropion, phenproporex and dexfenfluramine. Discussion. Anorexigens are generally prescribed to treat obesity. They must be used only under close medical supervision and are recommended for a short-term use. They have significant interactions with MAOIs, SSRIs, decongestants, antitussives, antihistamines, general anaesthetics, alcohol and illegal substances, and other drugs metabolised through cytocrome P450. The danger of serotoninergic syndrome is emphasized. Chile, Argentina and Brazil are among the countries with the highest rates of stimulants consumption

Antecedentes. Los anorexígenos generalmente no suelen ser de manejo habitual en la práctica clínica psiquiátrica. Sin embargo, es frecuente indicar una amplia gama de psicofármacos a pacientes a los cuales se les ha prescrito medicamentos supresores del apetito por otros profesionales. Esta combinación farmacológica implica una serie de aspectos a considerar en relación a las indicaciones, efectos adversos y fundamentalmente las interacciones propias de los agentes anorexígenos que en algunos casos pueden llegar a provocar complicaciones irreversibles y fatales. Objetivo. Puesta al día de los principales fármacos anorexígenos disponibles en Chile describiendo su clasificación, características, farmacocinética, indicaciones, contraindicaciones, efectos adversos e interacciones. Material y métodos. Revisión actualizada de la literatura especializada. Resultados. Los anorexígenos son coadyuvantes en el tratamiento integral de pacientes obesos. El resultado del tratamiento es mejor si se acompaña de una recuperación de los hábitos alimentarios. Poseen un alto potencial de abuso, dependencia, tolerancia y síndrome de privación. Sus principales efectos son cardiovasculares, gastrointestinales y en el sistema nervioso central. Los más utilizados en Chile entre 1997 y 1998 fueron fentermina, dietilpropión, fenproporex y dexfenfluramina. Discusión. La principal indicación de los anorexígenos es la obesidad. Deben ser prescritos exclusivamente por médicos. Se recomienda su indicación a corto plazo. Poseen importantes interacciones a considerar con IMAOs, ISRSs, descongestionantes, antitusígenos, antialérgicos, anestésicos generales, sustancias ilícitas, alcohol y otras drogas metabolizadas por el citocromo P450. Se enfatiza la posibilidad de la producción del síndrome serotoninérgico. Chile, Argentina y Brasil se encuentran entre los principales países consumidores de estimulantes