Publication: Factores psicosociales en la adolescencia y riesgo de desarrollo de trastornos de la conducta alimentaria
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2018-11-26
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Abstract
La adolescencia ha sido definida tradicionalmente por la Organización Mundial de la Salud (OMS) como el período comprendido entre los 10 y 19 años de edad (1). Se trata de un periodo de transición asociado a una serie de cambios biopsicosociales existiendo una considerable variabilidad individual durante el proceso, encontrando como variables moduladoras de esta variabilidad tanto las de carácter individual, como es el género; como contextuales, considerando aquí el nivel educacional o sociocultural del individuo (2). Existe cierto consenso generalizado en situar el inicio de la adolescencia con la pubertad, fenómeno clínico y fisiológico objetivable definido por los cambios físicos y fisiológicos que se desarrollan en el individuo (3). Además los diferentes investigadores de la psicología evolutiva señalan la diferencia entre los términos pubertad y adolescencia, contribuyendo así a la comprensión de la adolescencia como un proceso y no como un producto o estado (4). Los TCA se manifiestan como una alteración en el consumo de alimentos con el consecuente deterioro de la salud física y psicológica de la persona (5). En general, los TCA influyen significativamente en los aspectos psicológicos, físicos y sociales de la vida cotidiana de los individuos afectados y, debido a su carácter crónico, suponen un enorme coste sanitario y personal (6). Los TCA representan hoy en día una categoría claramente establecida dentro de las clasificaciones internacionales de las enfermedades mentales y los criterios clínicos se encuentran bien definidos tanto en la Clasificación Estadística Internacional de Enfermedades y otros Problemas de Salud (CIE-10) de la Organización Mundial de la Salud (OMS, 1992) (7) como en el Manual Diagnóstico y Estadístico de los Trastornos Mentales de la American Psychiatric Association (APA, 2014) (8). La AN es un TCA que se manifiesta como un deseo irrefrenable de estar delgado, acompañado de la práctica voluntaria de procedimientos para conseguirlo: dieta restrictiva y/o conductas purgativas. A pesar de la pérdida de peso progresiva, las personas afectadas continúan presentando un intenso temor a llegar a ser obsesas (9). Presentan una distorsión de la imagen corporal, con un control extremo de la dieta, la figura y el peso; y persisten en conductas de evitación hacia la comida con acciones compensatorias para contrarrestar lo que ingieren (hiperactividad física desmesurada, vómitos autoinducidos, abuso de laxantes, uso de diuréticos, etc.) (10). No suelen tener conciencia de enfermedad ni del riesgo que corren por su conducta, centrando exclusivamente su atención en la pérdida ponderal, lo que les causa estados nutricionales carenciales que comportan riesgos vitales (11)...
Adolescence constitutes a highly variant process regarding biological, psychological and social growth and development, within the temporal boundaries of this period. Besides, the process may be asynchronous in different aspects (biological, emotional, intellectual and social) and not occur as a continuity, but present frequent periods of regression related to vital stressor. A significant extension of this period related to an earlier puberty occurs and it has been proved throughout the 20th century (improvement in the hygienic conditions, nutrition and child care) and especially due to the delay observed in the achievement of personal independency and the possibility of acquiring adulthood roles (6). Adolescence has traditionally been defined by the World Health Organization (WHO) as an age period comprised between 10 and 19 years (9). As mentioned previously, adolescence is a period of transition related to a series of biopsychosocial changes there being a noteworthy individual variability over the process, being both the individual nature and the gender those modulated variables responsible of this variability; as much as contextual variables, considering the educational and sociocultural level of the individual. There is a certain generalized agreement on setting the beginning of adolescence with puberty, which is a determined clinic and physiological event defined by the physiological changes that will develop within the individual (7). Furthermore, several researches of developmental psychology point the difference between terms as puberty and adolescence, contributing therefore, to the understanding of adolescence as a process and not as product or state (8). EDs expound themselves as a disorder in food consumption leading to physical and psychological health deterioration in the person (162). Generally, EDs have a significant influence over the affected individuals regarding psychological, physical and social aspects of daily life, and they suppose huge healthcare and personal costs due to their chronic character (161). Nowadays, EDs are well classified into a clear category within the international rankings of mental diseases and their clinical judgment are well defined in both the International Statistical Classification of Diseases and Related Health Problems (CIE-10) of the World Health Organization (WHO, 1992) (163) and the Diagnostic and Statistical Manual of Mental Disorders of the American Psychiatric Association (APA, 2014) (8). AN is an ED which appears as an uncontrollable desire of being slim, along with the voluntarily practice of procedures to succeed: restrictive diet and/or purging behaviors. Despite of progressive weight loss, the affected people keep on feeling a powerful fear to be overweight (173). Further, they suffer a distortion of body shape, an extreme diet, shape and weight care and persist in food avoidance behaviors and compensatory efforts to counteract what they ingest (excessive physical hyperactivity, self-induced vomiting, laxative abuse, diuretic use, etc.) (174). They are not usually aware of their disease or the risk that their behavior implies, focusing attention exclusively on weight loss which brings on them nutritional deficiencies which represent vital risks (175)...
Adolescence constitutes a highly variant process regarding biological, psychological and social growth and development, within the temporal boundaries of this period. Besides, the process may be asynchronous in different aspects (biological, emotional, intellectual and social) and not occur as a continuity, but present frequent periods of regression related to vital stressor. A significant extension of this period related to an earlier puberty occurs and it has been proved throughout the 20th century (improvement in the hygienic conditions, nutrition and child care) and especially due to the delay observed in the achievement of personal independency and the possibility of acquiring adulthood roles (6). Adolescence has traditionally been defined by the World Health Organization (WHO) as an age period comprised between 10 and 19 years (9). As mentioned previously, adolescence is a period of transition related to a series of biopsychosocial changes there being a noteworthy individual variability over the process, being both the individual nature and the gender those modulated variables responsible of this variability; as much as contextual variables, considering the educational and sociocultural level of the individual. There is a certain generalized agreement on setting the beginning of adolescence with puberty, which is a determined clinic and physiological event defined by the physiological changes that will develop within the individual (7). Furthermore, several researches of developmental psychology point the difference between terms as puberty and adolescence, contributing therefore, to the understanding of adolescence as a process and not as product or state (8). EDs expound themselves as a disorder in food consumption leading to physical and psychological health deterioration in the person (162). Generally, EDs have a significant influence over the affected individuals regarding psychological, physical and social aspects of daily life, and they suppose huge healthcare and personal costs due to their chronic character (161). Nowadays, EDs are well classified into a clear category within the international rankings of mental diseases and their clinical judgment are well defined in both the International Statistical Classification of Diseases and Related Health Problems (CIE-10) of the World Health Organization (WHO, 1992) (163) and the Diagnostic and Statistical Manual of Mental Disorders of the American Psychiatric Association (APA, 2014) (8). AN is an ED which appears as an uncontrollable desire of being slim, along with the voluntarily practice of procedures to succeed: restrictive diet and/or purging behaviors. Despite of progressive weight loss, the affected people keep on feeling a powerful fear to be overweight (173). Further, they suffer a distortion of body shape, an extreme diet, shape and weight care and persist in food avoidance behaviors and compensatory efforts to counteract what they ingest (excessive physical hyperactivity, self-induced vomiting, laxative abuse, diuretic use, etc.) (174). They are not usually aware of their disease or the risk that their behavior implies, focusing attention exclusively on weight loss which brings on them nutritional deficiencies which represent vital risks (175)...