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Összefoglaló. Bevezetés: Az asthma bronchialéban szenvedő fiatalok egészségmagatartására lényeges hatást gyakorol a virtuális világ (például a Facebook). Ezt gyakran kötődési hiányállapotaik kompenzálására használják. Célkitűzés: Az asthmás gyermekek közösségimédia-használatának vizsgálata egészséges kontrollcsoporttal összehasonlítva. Módszer: A vizsgálatban 250 fő, 10–18 éves asthmás, valamint 250 fő, 10–18 éves egészséges gyermek vett részt. Velük a Facebook Használati Kérdőív, a Ten Item Personality Inventory, a Rosenberg Önértékelési Skála, a Beck Gyermekdepresszió Kérdőív, valamint a Gyermek Multidimenzionális Szorongás Skála került felvételre. Eredmények: Az asthmás gyermekek kevesebb aktív időt töltenek a Facebookkal, mint az egészségesek (pKövetkeztetés: Az asthmás gyermekek életében a közösségi média igen jelentős szerepet tölt be. Mivel a 10–18 éves korosztály vulnerábilis ennek addiktív hatásaira, a pszichoedukáció és a prevenció alapvető volna. Orv Hetil. 2022; 163(15): 593–598. Summary. Introduction: The health behavior of patients with asthma bronchiale can be influenced by the virtual world (e.g., Facebook). It is often used to compensate their attachment deficits. Objective: In this study, the use of social media is analyzed among asthmatic children compared to a healthy control group. Method: 250 asthmatic and 250 healthy children were interviewed from the age of 10 to 18. The Facebook Intensity Scale, the Ten Item Personality Inventory, the Rosenberg Self-Esteem Scale, the short version of the Beck Depression Inventory and the Multidimensional Anxiety Scale for Children were used in the study. Results: Asthmatic children’s social media time was significantly lower compared to that of healthy children (pConclusion: Social media plays a very important role in the life of asthmatic children. The psychoeducation and prevention is of basic importance, because the age group of 10–18-year-old children is vulnerable to the addictive effect of social media. Orv Hetil. 2022; 163(15): 593–598.

A Covid-19-pandémia során több pszichiátriai kórkép vált gyakoribbá, a többi között az evészavarok esetében is. Növekedett az anorexia nervosa és a bulimia nervosa, valamint egyéb evészavartünetek incidenciája. Emellett súlyosbodtak a tünetek és nagyobb lett a relapszus aránya is. Mindezek hátterében a következő tényezők szerepelhetnek: megváltozott az étel elérhetősége; fokozódott a félelem az elhízástól, hangsúlyossá vált a közösségi média és egyes internetes oldalak szerepe az izoláció következtében, kifejezettebb lett a társas összehasonlítás; korlátozottak voltak a sportolási lehetőségek; növekedett a stresszkeltő életesemények hatása, például a családi feszültségeké. A pandémia mentális következményei a táplálkozási magatartás terén is a pszichoedukáció, az elsődleges és másodlagos prevenció fontosságára hívják fel a figyelmet.

Összefoglaló. A divatiparra vonatkozó egészségvédelmi szabályozások hiányosak. A karcsúság elérését célzó szociokulturális nyomás a divatiparon belül fokozott, a divatmodelleket gyakran késztetik kórosan alacsony testsúly elérésére, ami pszichológiai abúzusnak felel meg. Ezért a modellek közt az evészavarok prevalenciája magasabb az átlagpopulációhoz képest. A divatvilág veszélyei között ezeken túl a szexuális abúzus, a financiális visszaélések, illetve a fiatalkorúak foglalkoztatásával kapcsolatos szabályozatlanság említendő. A kockázatok csökkentése érdekében fontos volna nemzetközi szabályozásokat bevezetni a divatszakmában. Az erre irányuló kezdeményezések először 2006-ban jelentek meg Spanyolországban: a modellek foglalkoztatásának feltétele volt az egészséges tápláltsági állapot alsó határától minimálisan elmaradó testtömegindex (18,0) elérése. Később Franciaországban az evészavarok gyakoriságának mérséklésére törvénybe foglalták a modellek kötelező egészségügyi vizsgálatát, illetve az utólagosan módosított divatfotók megjelölését. E szabályozások azonban könnyen kijátszhatók. A törvényhozás mellett különböző szervezetek alkottak olyan irányelveket, amelyek a modellek egészségvédelmét szolgálták. Ezek az iránymutatások elsősorban a biztonságos munkavégzésre, a fiatalkorúak foglalkoztatásának korlátozására és az emberi méltóság megtartására irányulnak. A divatszakmában előforduló feszültségek vezettek továbbá olyan nonprofit szervezetek megalakulásához, amelyek a modellek érdekvédelméért dolgoznak. A divatmodellek egészségvédelmét célzó jogi szabályozás a mai kultúrában domináns karcsúságideál megváltoztatását is szolgálná, mert a szociális tanulás révén a divatot követő átlagnépesség utánozza a modelleket. A divatmodellek egészségének védelme tehát népegészségügyi vonatkozással is bír. Orv Hetil. 2021; 162(23): 905–910. Summary. The fashion industry is lacking sufficient health protective regulations. There is an increased sociocultural pressure to be thin. Fashion models are often forced to reach abnormally low body weight, which can be regarded as psychological abuse. This leads to a higher prevalence of eating disorders among models compared with the general population. Some of the other dangers associated with the fashion industry are sexual harassment, financial exploitation, and unregulated minor labour force. To reduce these risks, it is crucial to introduce international regulations in the fashion industry. The first initiative for such regulations took place in Spain in 2006 when the condition for models’ employment was for their body mass index (BMI) not to drop below 18.0, which is close to the low end of healthy BMI. Later in France, to decrease the prevalence of eating disorders, a legislation on compulsory medical examination for models was made. Also, retouching of photos had to be disclosed. Regulations like these, however, can easily be eluded. Different organisations implemented guidelines, such as establishing safe working conditions, limiting underage labour force, and maintaining dignity to protect models’ health. Tension within the fashion industry led to the formation of non-profit organisations seeking the protection of models’ interest. Regulations protecting models’ health in the fashion industry would encourage society to adjust its predominant ideal for thinness. Just as the general population tends to follow fashion trends portrayed by fashion models, so would they likely imitate the new look of models. Hence, the protection of models’ health goes beyond the fashion industry. It has public health implications as well. Orv Hetil. 2021; 162(23): 905–910.

Purpose The aim of our study was validating Eating Disorder Inventory (EDI) among pregnant women, who are vulnerable to eating disorders (EDs). Methods In 2012–2013, 1146 women (aged 18–47 years) completed a questionnaire including EDI during the first 3 days after delivery. We checked factorial validity of three diagnostic subscales of EDI with confirmative factor analysis and internal validity by Cronbach’s alpha and item-total correlation. We also tested discriminative validity by comparing average of the three subscale of EDI in case of ED and non-ED groups. Results When applying the EDI to pregnant women, it seems necessary to exclude five items on three diagnostic subscales: on the Drive for Thinness subscale, 4 items remain (out of 7); on the Bulimia subscale, 6 items remain (out of 7); the Body Dissatisfaction subscale decreases from 9 to 8 items. Cronbach’s alpha and item-total correlation values meet the requirements defined by Garner et al. The internal consistency of the EDI has proved to be appropriate, indicating that it is a reliable screening tool. Conclusions Thinking, attitudes, and behaviors connected to eating, along with the relation to altering body weight change during pregnancy. Vomiting usually accompanies pregnancy; body weight gain within wide limits is also regarded as normal during pregnancy. These behaviors and changes are not feasible to use for measuring ED symptoms. These aspects cannot be neglected when screening eating disorders in pregnant women. Level of evidence Level IV evidence obtained from multiple time series with or without an intervention.

Objective The aim of this study was to measure how orthorexic tendencies relate to age, self-esteem, and spirituality. We conducted the study on a sample of Hungarian adults performing regular fitness activity. Method 175 participants completed a four-part online survey: demographics and training habits, the Rosenberg Self-Esteem Scale, the Eating Habits Questionnaire-Revised (EHQ-R), and one of the Spiritual Awareness questionnaire’s subscale. We performed univariate linear regression to assess the predictor role of age on orthorexic tendencies. Mediation analysis was conducted to determine the effect of self-esteem on orthorexic tendencies and the mediator role of spiritual attitudes. Results Age negatively correlated with EHQ-R, and there were no gender differences. Lower self-esteem was a predictor for orthorexic tendencies with the total effect of ß = -0.3046 (p Discussion Among frequent exercisers, strict dieting is likely to originate from a lack of self-esteem due to perfectionist standards, social comparison, and the aspiration of being in control. In case self-esteem is achieved through spiritual approaches, individuals may experience positive changes in their attitudes toward eating and their bodies as well. In the future, it is important to confirm whether the EHQ-R indicates diagnostic boundaries. Level of evidence Level V, descriptive cross-sectional study.

Background and aimsThere are contradictory findings on time changes in the prevalence of eating disorders (EDs). The first epidemiological studies in Hungary were carried out in the late 1980s. The objective of the present study was to follow the changes in the prevalence of EDs in medical students after a period of 22 years.MethodsA questionnaire survey was conducted in 1989 and in 2010. The sample comprised medical students: 538 subjects (248 males and 290 females) in 1989 and 969 subjects (261 males and 708 females) in 2010. The questionnaire contained sociodemographic and anthropometric items, the Eating Behaviour Severity Scale, the General Health Questionnaire, the Anorexia Nervosa Inventory for Self-Rating, and the Eating Disorder Inventory (EDI). In the second wave, three subscales of the EDI-2 and the SCOFF questionnaire were added.ResultsCurrent and desired body mass index were significantly higher in the second study. Binge eating at least once a week was reported less frequently (2.7% vs 6.8% in males, 6.1% vs 13% in females) in 2010. The proportion of subclinical anorexia nervosa was higher among females in 2011 (2.5% vs 0.3%,P< 0.01). Among males, the proportion of counterregulatory behaviours increased significantly (from 8.9 to 14.6%).Discussion and conclusionsThe increase of the proportion of subclinical anorexia nervosa and that of male EDs may relate to the importance of the changes in the sociocultural background. Further representative studies are proposed in other countries of Central and Eastern Europe among medical students and in the general population.

In this theoretical study, certain characteristics of orthorexia nervosa (ON) are assessed. As a type of disordered eating, ON is characterized as pathological healthy eating obsession. By reviewing previous literature, four orthorexic traits are investigated whether they meet the conditions of becoming adaptive drivers of human behavior. First, learned neophobia to avoid “improper” foods is considered as an advantageous strategy, secondly, ON being a cohesive force based on common beliefs and its religious, virtuous characteristics is adaptive as well. The third orthorexic trait in the form of physiological consequences (refeeding syndrome, malnutrition) suggests that ON is rather a nonadaptive health behavior, along with the fourth characteristic, namely, the psychological disturbances that health anxiety may induce. To conclude, ON can be viewed as an inherently useful tool to protect one’s health by diet, but also as a phenomenon which has extreme forms causing health problems. The exact etiologies are unexplored, therefore, the psychological, social and cultural drivers of extreme healthy eating are important to understand for future improvements. In order to establish the criteria and therapeutic guidelines, it would be beneficial to collect narrative data and experiences from individuals with orthorexic tendencies.

Introduction: The health behavior of patients with asthma bronchiale can be influenced by the virtual world (es., Facebook). It is often used to compensate their attachment deficits. Objective: In this study, the use of social media is analyzed among asthmatic children compared to a healthy control group. Method: 250 asthmatic and 250 healthy children were interviewed from the age of 10 to 18. The Facebook Intensity Scale, the Ten Item Personality Inventory, the Rosenberg Self-Esteem Scale, the short version of the Beck Depression Inventory and the Multidimensional Anxiety Scale for Children were used in the study. Results: Asthmatic children's social media time was significantly lower compared to that of healthy children (p0.001). However, their feeling of being part of the Facebook community is the main motivation to use it (p0.001). Higher scores of anxiety and depression, and the lower self-esteem compared to the healthy control group can be detected among asthmatic children (p0.001). The increased use of Facebook can be shown in both groups of girls. The increased use of Facebook among girls is in connection with a higher score of depression and anxiety (p0.05). Conclusion: Social media plays a very important role in the life of asthmatic children. The psychoeducation and prevention is of basic importance, because the age group of 10-18-year-old children is vulnerable to the addictive effect of social media.Összefoglaló. Bevezetés: Az asthma bronchialéban szenvedő fiatalok egészségmagatartására lényeges hatást gyakorol a virtuális világ (például a Facebook). Ezt gyakran kötődési hiányállapotaik kompenzálására használják. Célkitűzés: Az asthmás gyermekek közösségimédia-használatának vizsgálata egészséges kontrollcsoporttal összehasonlítva. Módszer: A vizsgálatban 250 fő, 10–18 éves asthmás, valamint 250 fő, 10–18 éves egészséges gyermek vett részt. Velük a Facebook Használati Kérdőív, a Ten Item Personality Inventory, a Rosenberg Önértékelési Skála, a Beck Gyermekdepresszió Kérdőív, valamint a Gyermek Multidimenzionális Szorongás Skála került felvételre. Eredmények: Az asthmás gyermekek kevesebb aktív időt töltenek a Facebookkal, mint az egészségesek (p0,001), mégis ők érzik azt, hogy ez a platform inkább az életük része (p0,001). Az asthmásokat magasabb depressziószint és szorongás, valamint alacsonyabb önértékelés jellemzi (p0,001). Mindkét csoport esetében a lányok használják gyakrabban a Facebookot. A lányok között a Facebook fokozott használata együtt jár a magasabb depressziószinttel és szorongással. Következtetés: Az asthmás gyermekek életében a közösségi média igen jelentős szerepet tölt be. Mivel a 10–18 éves korosztály vulnerábilis ennek addiktív hatásaira, a pszichoedukáció és a prevenció alapvető volna. Orv Hetil. 2022; 163(15): 593–598.

In eating disorders, the denial of the illness is a central phenomenon. In the most severe forms of anorexia, compulsory treatment may be necessary. The professional acceptance of involuntary treatment is controversial due to the fact that the autonomy of the patient is juxtaposed with the obligation of the health care practitioner to save lives. This paper discusses the major practical and ethical considerations surrounding this controversy. In addition, case vignettes are used to illustrate various strategies to diminish client resistance and enhance motivation toward treatment. Involving the family is nearly always essential for the treatment of patients with eating disorders. In some cases, parental consultation (i.e., treatment without the client) can also be an option. Home visits, though rarely used, can reframe the therapeutic relationship and provide information about family functioning. In general, a lower level of treatment coercion can be achieved through transparent client-parent and client-therapist communication.

Összefoglaló. A divatiparra vonatkozó egészségvédelmi szabályozások hiányosak. A karcsúság elérését célzó szociokulturális nyomás a divatiparon belül fokozott, a divatmodelleket gyakran késztetik kórosan alacsony testsúly elérésére, ami pszichológiai abúzusnak felel meg. Ezért a modellek közt az evészavarok prevalenciája magasabb az átlagpopulációhoz képest. A divatvilág veszélyei között ezeken túl a szexuális abúzus, a financiális visszaélések, illetve a fiatalkorúak foglalkoztatásával kapcsolatos szabályozatlanság említendő. A kockázatok csökkentése érdekében fontos volna nemzetközi szabályozásokat bevezetni a divatszakmában. Az erre irányuló kezdeményezések először 2006-ban jelentek meg Spanyolországban: a modellek foglalkoztatásának feltétele volt az egészséges tápláltsági állapot alsó határától minimálisan elmaradó testtömegindex (18,0) elérése. Később Franciaországban az evészavarok gyakoriságának mérséklésére törvénybe foglalták a modellek kötelező egészségügyi vizsgálatát, illetve az utólagosan módosított divatfotók megjelölését. E szabályozások azonban könnyen kijátszhatók. A törvényhozás mellett különböző szervezetek alkottak olyan irányelveket, amelyek a modellek egészségvédelmét szolgálták. Ezek az iránymutatások elsősorban a biztonságos munkavégzésre, a fiatalkorúak foglalkoztatásának korlátozására és az emberi méltóság megtartására irányulnak. A divatszakmában előforduló feszültségek vezettek továbbá olyan nonprofit szervezetek megalakulásához, amelyek a modellek érdekvédelméért dolgoznak. A divatmodellek egészségvédelmét célzó jogi szabályozás a mai kultúrában domináns karcsúságideál megváltoztatását is szolgálná, mert a szociális tanulás révén a divatot követő átlagnépesség utánozza a modelleket. A divatmodellek egészségének védelme tehát népegészségügyi vonatkozással is bír. Orv Hetil. 2021; 162(23): 905-910. Summary. The fashion industry is lacking sufficient health protective regulations. There is an increased sociocultural pressure to be thin. Fashion models are often forced to reach abnormally low body weight, which can be regarded as psychological abuse. This leads to a higher prevalence of eating disorders among models compared with the general population. Some of the other dangers associated with the fashion industry are sexual harassment, financial exploitation, and unregulated minor labour force. To reduce these risks, it is crucial to introduce international regulations in the fashion industry. The first initiative for such regulations took place in Spain in 2006 when the condition for models' employment was for their body mass index (BMI) not to drop below 18.0, which is close to the low end of healthy BMI. Later in France, to decrease the prevalence of eating disorders, a legislation on compulsory medical examination for models was made. Also, retouching of photos had to be disclosed. Regulations like these, however, can easily be eluded. Different organisations implemented guidelines, such as establishing safe working conditions, limiting underage labour force, and maintaining dignity to protect models' health. Tension within the fashion industry led to the formation of non-profit organisations seeking the protection of models' interest. Regulations protecting models' health in the fashion industry would encourage society to adjust its predominant ideal for thinness. Just as the general population tends to follow fashion trends portrayed by fashion models, so would they likely imitate the new look of models. Hence, the protection of models' health goes beyond the fashion industry. It has public health implications as well. Orv Hetil. 2021; 162(23): 905-910.

Confinement during the COVID-19 pandemic is expected to have a serious and complex impact on the mental health of patients with an eating disorder (ED) and of patients with obesity. The present manuscript has the following aims: (1) to analyse the psychometric properties of the COVID Isolation Eating Scale (CIES), (2) to explore changes that occurred due to confinement in eating symptomatology; and (3) to explore the general acceptation of the use of telemedicine during confinement. The sample comprised 121 participants (87 ED patients and 34 patients with obesity) recruited from six different centres. Confirmatory Factor Analyses (CFA) tested the rational-theoretical structure of the CIES. Adequate goodness-of-fit was obtained for the confirmatory factor analysis, and Cronbach alpha values ranged from good to excellent. Regarding the effects of confinement, positive and negative impacts of the confinement depends of the eating disorder subtype. Patients with anorexia nervosa (AN) and with obesity endorsed a positive response to treatment during confinement, no significant changes were found in bulimia nervosa (BN) patients, whereas Other Specified Feeding or Eating Disorder (OSFED) patients endorsed an increase in eating symptomatology and in psychopathology. Furthermore, AN patients expressed the greatest dissatisfaction and accommodation difficulty with remote therapy when compared with the previously provided face-to-face therapy. The present study provides empirical evidence on the psychometric robustness of the CIES tool and shows that a negative confinement impact was associated with ED subtype, whereas OSFED patients showed the highest impairment in eating symptomatology and in psychopathology., This manuscript and research was supported by grants from the Ministeriode Economía y Competitividad (PSI2015-68701-R), Instituto de Salud Carlos III (ISCIII) (FIS PI14/00290/ INT19/00046nd PI17/01167) and co-funded by FEDER funds/European Regional Development Fund (ERDF), a way to build Europe. CIBERobn, CIBERsam and CIBERDEM are all initiatives of ISCIII. GMB is supported by a postdoctoral grant from FUNCIVA. This initiative is supported by Generalitat de Catalunya. LM is supported by a postdoctoral grant of the mexican institution Consejo Nacional de Ciencia y Tecnología (CONACYT). PPM was supported, in part, by a Portuguese Foundation for Science and Technology grant (POCI-01-0145-FEDER-028145). The funders had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Abstract: The present study aims at overviewing the different stages of the education of medical psychology in Hungary. In the perspective of the achievements of cognitive and affective neuroscience as well as developmental psychology, we intend to define the roots of doctor-patient relationship, certain determining factors of diagnosis forming and therapy efficiency as well as the essential components of empathy. We attest to the fact that the current psychosomatic medicine with its evidence-based achievements is a valid component and constitutive pillar of everyday medical care. The integrated university level instruction of medical psychology and behavioral sciences aims at consolidating this perspective. We also emphasize that the ill body hinders adequate psychological functioning and mental disorders provide risk factors concerning somatic illnesses. Through spreading health psychology perspective, we support the concept that in everyday medical care, health protection and the development of health conscious behavior relies on responsible, informed and committed decision-making patients as well as on similarly educated extended medical care teams. Orv Hetil. 2018; 159(36): 1455–1464.

In the complex pathomechanism of eating disorders (especially that of bulimia nervosa and binge eating disorder) the traumatic experiences (sexual, physical, emotional abuse, neglect) often play an important role. The consequence of traumas can be the borderline personality disorder, or different disorders of the emotional regulation. These occur mainly in the multiimpulsive subtype of eating disorders with impulse control disorders. In relation to the trauma dissociative phenomena are frequent. In the diagnostics of eating disorders the history of traumatization is essential. Among the therapeutical possibilities the psychodynamic approach is important. Moreover, the newer methods based on cognitive behavioral therapy are effective, e.g., dialectic behavior therapy, integrative cognitive-analytic therapy, and other complex programs of trauma processing, such as the trauma-informed care.

Common gynecological complications of various eating disorders include infertility, unwanted pregnancy, miscarriage, sexual dysfunction and complications in the treatment of gynecological cancers. Women with eating disorders typically see their gynecologists because of menstrual and other endocrine disorders or unexplained gastrointestinal symptoms, and often report on psychological symptoms (anxiety, depression or decreased libido). In spite of anovulation, menstruation may occur and ovulation without menstruation may be possible, which may lead to an increased incidence of unwanted pregnancies in case of prior or current eating disorders. Ovulation induction due to anovulation associated with weight loss or inappropriate dietary habits, or pregnancy with amenorrhoea may be a significant risk among women with unrecognized eating disorders. In such cases, the primary care is the change of dietary lifestyle and only secondary care is the ovulation induction. The prevalence of eating disorders is high among women who approach infertility clinics. If an eating disorder is confirmed prior to infertility treatment, the patient should be informed of the possible consequences and referred to the necessary psychological support. Such a multidisciplinary approach would allow successful infertility treatments without complications.

Background and purpose Attachment theory provides an integrative perspective about the interplay between cognitive, affective, behavioral and interpersonal processes and is relevant for understanding irritable bowel syndrome (IBS) and panic disorder (PD). The aim of the present study was to examine the adult attachment style and parental bonding of IBS and PD patients. Methods In a cross-sectional questionnaire-based study, 65 PD and 65 IBS patients with clinical diagnosis participated. Measures were Attachment Style Questionnaire, Experiences in Close Relationships Scale - Revised, and Parental Bonding Instrument. Results The frequencies of insecure attachment (80.0% vs. 63.1%) and paternal neglect (35.4% vs. 16.9%) were higher in IBS than in PD (χ2 (1)=4.571, p=0.033, and χ2 (3)=7.831, p=0.050, respectively). The frequency of secure attachment was significantly higher for optimal paternal bonding than with suboptimal paternal bonding (75.0% vs. 21.9%, χ2 (1)=19.408, p

Eating disorders are psychosomatic disorders affecting primarily women, and influence reproductive functions as well. They have an impact on ovarial cyclem fertility, course of pregnancy, process of delivery, post partum period. Moreover, some data show that they can influence the adult health status. Extensive research from the last three decades call the attention to the fact that besides the classical eating disorders (anorexia nervosa and bulimia nervosa) the newer types (e.g., orthorexia nervosa), and subclinical disorders also occur in a subgroup of pregnant women. For this reason it is of key importance that the personnel working in the territory of obstetrics and gynecology have a solid knowledge about the symptoms, screening and therapeutical opportunities, and outcome of these disorders. The review summarizes the recent research data about the relationship of eating disorders and pregnancy.

Háttér és célkitűzés A kiégés a segítő foglalkozásúak gyakori szindrómája, mely az egyéni terheken túl az egészségügyi ellátó rendszer nehézségeihez vezet. Megelőzése alapvető fontosságú egyéni és szervezeti szinten egyaránt. Áttekintő tanulmányunkban a kiégés megelőzésének újabb módszereit összegezzük. Módszer Az utóbbi évtized irodalmi adatainak áttekintése. Elsősorban az újabb eljárásokat bemutató és hatékonyságot elemző kutatásokra támaszkodtunk (például az „e-mental health” terén végzett vizsgálatokra). Eredmények Az elsődleges, másodlagos és harmadlagos prevencióban gyakran alkalmaznak hagyományos módszereket (például relaxációkat, kognitív-viselkedésterápiás elemeket). Az újabb eljárások között említendők a stresszmenedzsment programjai, a mindfulness alkalmazása. A legmodernebb eszközök az új információs technológiák, amelyekkel egyre több prevenciós program él. Az új prevenciós stratégiák között ki kell emelni a prevenciós eszközök személyre szabott alkalmazását, valamint a szervezeti kultúra fejlesztését célzó programokat, amelyek egészségpolitikai lépések szükségességére is felhívják a figyelmet. Következtetés A kiégés megelőzése a munkalélektanban és a segítő foglalkozások terén lényeges feladat a szakemberek védelme és az ellátás minősége, valamint az egészségügyi gazdaságosság szempontjából. A prevenciót szolgáló programok hatékonysága jó, bár még kevés randomizált, kontrollált vizsgálat készült.

The present study aims at overviewing the different stages of the education of medical psychology in Hungary. In the perspective of the achievements of cognitive and affective neuroscience as well as developmental psychology, we intend to define the roots of doctor-patient relationship, certain determining factors of diagnosis forming and therapy efficiency as well as the essential components of empathy. We attest to the fact that the current psychosomatic medicine with its evidence-based achievements is a valid component and constitutive pillar of everyday medical care. The integrated university level instruction of medical psychology and behavioral sciences aims at consolidating this perspective. We also emphasize that the ill body hinders adequate psychological functioning and mental disorders provide risk factors concerning somatic illnesses. Through spreading health psychology perspective, we support the concept that in everyday medical care, health protection and the development of health conscious behavior relies on responsible, informed and committed decision-making patients as well as on similarly educated extended medical care teams. Orv Hetil. 2018; 159(36): 1455-1464.Absztrakt: A tanulmány az orvosi pszichológia több évtizedes hazai fejlődésének főbb állomásait, fontosabb fogalmait és alkalmazási területeit mutatja be. A kognitív, valamint az affektív idegtudomány és a fejlődéslélektan modern ismereteinek segítségével felvázolja az orvos és a beteg közt alakuló kötődés és bizalom kettős, evolúciós és kulturális eredetét, a diagnózis és a terápia eredményességét meghatározó tényezőket, valamint az empátia lényegét. Bemutatjuk, hogy a pszichoszomatikus orvoslás napjainkra a mindennapi ellátás részévé vált, tudományosan igazolt eredményeinek felhasználása immár a hatékony gyógyítás alappillére. Az orvosi pszichológia és a magatartástudományok integrált oktatása már az egyetemi évek során ennek a szemléletnek a meghonosítására törekszik. Hangsúlyozza továbbá, hogy a beteg test hátráltatja a lelki funkciók kiteljesedését, a lelki betegség pedig testi betegségek komoly kockázati tényezője. Az egészségpszichológiai gondolkodásmód térhódításának példáján érzékeltetjük, hogy a sikeres egészségügyi ellátás az egészség megőrzésében, az egészségmagatartás fejlesztésében érdekelt, autonóm, önmagukért felelősséget vállaló, tájékozott, megfelelő döntések meghozatalában elkötelezett személyeket és a segítségükre lévő, hasonló képességekkel rendelkező gyógyító személyzetet feltételez. Orv Hetil. 2018; 159(36): 1455–1464.

There are two notable eating behaviors that are not far from having their own category as a mental disorder: the purging disorder, that is already among the DSM-5 non-specific eating disorders, and orthorexia nervosa, when a person is fixating too much on healthy foods. Our purpose is to describe how these can be observed in recreational juice cleanse camps, which are very popular today as an alternative health trend.The first author recorded her data during multisited ethnographic observations in two Hungarian juice cleanse camps. Based on the diary logs, notes and interviews collected, we will present the motives of eating anomalies that the participants had shown.The main motive of the camp is "detoxification". The lack of solid food, drastically low calorie intake and lots of physical activity will bring an inevitable change in the body, that is interpreted as toxins leaving the body. Participants have also included deliberate use of laxatives in their everyday routines, with which they associate positive connotations and are linked to the spiritual processes of "letting it go" and "renewal" in the spirit of a holistic approach. The use of symbols in the physiological processes was highly noticeable. Rapid weight loss due to diuresis, the desire for "clean" meals, and "self-rewarding" borrowed from the esoteric-self-help culture are also common motives. Due to the refeeding complications, so far two deaths have been reported by camp organizers.Both purging disorder and orthorexia nervosa can be well-identified in our observations. This shows that also in the non-clinical environment, there is an institutionalization of eating habits that are dangerous to the health. This "detox" is not only physiologically harmful, but it is not proved to provide long-term help in mental health either. As a solution, we advocate developing an appropriate health communication plan for misconceptions about healthy lifestyle and eating, and also a promotion of psychotherapeutic opportunities. Orv Hetil. 2018; 159(28): 1153-1157.Absztrakt: Bevezetés és célkitűzés: A kórképpé minősítés előszobájában két, említésre méltó evési viselkedés is van: a DSM-5-ben nemspecifikus evészavarként feltüntetett purgálózavar és az egészségesétel-függőségnek fordított orthorexia nervosa. Célunk annak leírása, hogy ezek miként figyelhetők meg a léböjttáborokban, amelyek alternatív egészségmegőrző trendként igen népszerűek napjainkban. Módszer: Az első szerző két országos léböjttáborban többterepű etnográfiai megfigyeléssel rögzítette adatait. A gyűjtése során készült terepnapló, jegyzetek és interjúk alapján mutatjuk be az evészavartünetek motívumait. Eredmények: A tábor legfőbb motívuma a „méregtelenítés”. A szilárd táplálék nélkülözése s ezáltal igen alacsony kalóriabevitel és fizikai aktivitás során bekövetkező gyors testi változásokat a mérgek távozásának tudják be. A léböjttábor résztvevői beiktatták mindennapos rutinjukba a szándékos hashajtást is, amelyhez pozitív konnotációk társulnak, és a holisztikus szemlélet jegyében az „elengedés” és „megújulás” lelki folyamataihoz kötik. A szimbólumok használata az élettani folyamatokkal kapcsolatban erősen észlelhető volt. A vízvesztésből adódó gyors fogyás lendülete, a tiszta étkezés iránti vágy és az ezoterikus-önsegítő kultúrából kölcsönzött „önjutalmazás” is gyakori motívumok. Az újratáplálásból adódó komplikációk miatt eddig két halálesetet tartanak számon a táborszervezők. Következtetések: Mind a purgálózavarra, mind az orthorexia nervosára találhatók jól beazonosítható leírások. Ez azt mutatja, hogy a klinikumon kívüli környezetben is komoly a valószínűsége olyan evési magatartások intézményesítésének, amelyek az egészségre veszélyesek. A „méregtelenítés” ugyanis nemcsak fiziológiailag lehet káros, de hosszú távú mentális segítségnyújtásra sincs bizonyíték. Megoldásként javasoljuk az egészséges életmódról és étkezésről szóló tévhitekre irányuló megfelelő egészségkommunikációs terv kidolgozását és a pszichoterápiás lehetőségek népszerűsítését. Orv Hetil. 2018; 159(28): 1153–1157.

Attachment theory provides an integrative perspective about the interplay between cognitive, affective, behavioral and interpersonal processes and is relevant for understanding irritable bowel syndrome (IBS) and panic disorder (PD). The aim of the present study was to examine the adult attachment style and parental bonding of IBS and PD patients.In a cross-sectional questionnaire-based study, 65 PD and 65 IBS patients with clinical diagnosis participated. Measures were Attachment Style Questionnaire, Experiences in Close Relationships Scale - Revised, and Parental Bonding Instrument.The frequencies of insecure attachment (80.0% vs. 63.1%) and paternal neglect (35.4% vs. 16.9%) were higher in IBS than in PD (χ2 (1)=4.571, p=0.033, and χ2 (3)=7.831, p=0.050, respectively). The frequency of secure attachment was significantly higher for optimal paternal bonding than with suboptimal paternal bonding (75.0% vs. 21.9%, χ2 (1)=19.408, p0.001). According to the results of multiple binary logistic analysis, optimal paternal bonding predicted secure attachment after adjusting for the background variables (OR=9.26, p=0.001).A high frequency of insecure attachment was present in both groups, especially in IBS. With regard to maternal bonding, IBS and PD groups showed similar patterns, while an apparent difference was observed for paternal bonding. These highlighted the developmental similarities of these two, symptomatically different disorders. While optimal maternal bonding did not predict adult attachment security, paternal bonding did thus replete with therapeutic implications. Attachment functions, like responsiveness, attunement and affection modulation were apparent in the psychotherapist-patient relationship as well.A kötődéselméletek kognitív, érzelmi, viselkedéses és társas szinten egyaránt perspektívát kínálnak az irritábilis bél szindróma (IBS) és a pánikzavar (PD) megértésében. Kutatásunk célja a felnőttkori kötődési stílus és a szülői bánásmód vizsgálata volt IBS-sel és pánikzavarral küzdő betegek körében.A keresztmetszeti kérdőíves kutatásban 65 IBS- és 65 PD-beteg vett részt, mindannyian klinikai diagnózissal rendelkező betegek. Mérőeszközök: Kötődési Stílus Kérdőív, Közeli Kapcsolati Tapasztalatok Skála és Szülői Bánásmód Kérdőív.A bizonytalan kötődés (80,0 vs. 63,1%) és a szülői elhanyagolás (35,4 vs. 16,9%) gyakorisága egyaránt magasabb volt az IBS-csoportban, mint a pánikbetegeknél (χ2 (1)=4,571, p=0,033; χ2 (3)=7,831, p=0,050). A biztonságos kötődés szignifikánsan gyakrabban fordult elő optimális, mint szuboptimális apai bánásmód esetében (75,0% vs. 21,9%; χ2 (1)=19,408, p0,001). A többváltozós bináris logisztikus regresszió elemzés eredményei szerint az optimális apai bánásmód a háttérváltozók kontrollja mellett is szignifikánsan előre jelzi a biztonságos kötődést (OR=9,26, p=0,001).Mindkét csoportban nagy gyakoriságú volt a bizonytalan kötődés, különösen IBS-ben. Az anyai bánásmód tekintetében hasonló mintázat mutatkozott, míg az apai bánásmód esetében eltérő. Ez jelzi a fejlődéspszichológiai hasonlóságokat a tünetek tekintetében különböző két kórképnél. Míg az anyai bánásmód nem jelezte előre a felnőtt kötődési biztonságot, az apai bánásmód kimutatható összefüggést mutatott azzal, pszichoterápiás implikációkat kínálva fel. Olyan kötődési funkciók, mint a válaszkészség, az egymásra hangolódás és az érzelemszabályozás fontos szerepet játszanak a terapeuta-beteg kapcsolatban is.

The importance of eating disorders is increasing in the psychiatric practice, underlined by the epidemiological data and the severity of these disorders. In the treatment several approaches can be found, and some of these are controversial. Following the rules of evidence-based medicine an increasing number of guidelines were published. Eating disorders are prevalent and often show a serious course, the guidelines summarizing the recent knowledge in the literature are very useful for the therapists. The present guideline aims to help the everyday practice. It overviews the principles of the treatment of eating disordered patients, the steps of diagnostics, and the therapeutical methods. Many basic and practical techniques are also presented. It discusses the skills which are necessary for the treatment of eating disorders, and the therapeutical traps as well.

The slimness ideal plays an important role in the sociocultural background of eating disorders. The risk of anorexia nervosa and bulimia nervosa is high among fashion models, because in the beauty industry the thin body is a professional requirement. The first author of the present self-case report had anorexia nervosa from her age of 15 years, between 2006 and 2013. However, she was employed as a fashion model between 2008 and 2013. The pressure to maintain the slimness was intensive; the contract included the breast-waist-hip circumference as well. The case report is illustrated by excerpts of the personal diary. Although a regulation was brought in by which models with a body mass index lower than 18 cannot be employed in the fashion industry, the agents pressed her to drink water to reach the necessary limit. The agents often criticized the models’ body in a rough manner and force them to be slim. This pressure is an everyday phenomenon in the fashion industry, and is harmful for the physical and mental health of the models. The impact of fashion industry representatives on models is can be regarded as a form of psychological abuse, although the models (and the parents, if the models are minors) accept this way of life. This is a subconscious collusion among the model agencies, the parents and the models. Because of the risk of psychological abuse, an international regulation is recommended in the employment of fashion models.

Objective The ProYouth programme focuses on the promotion of mental health and the prevention of eating disorders (EDs) among young people. The aim of our study was to explore whether the programme can address individuals who are at risk for developing 2EDs. Method This study is designed as an online cross-sectional survey (n = 664, 12.2% men, 87.8% women, mean age: 24.9 years, SD = 5.4 years, range: 18–40 years). Measures included demographic data, self-reported weight and height, the Patient Health Questionnaire for Depression and Anxiety, Short Evaluation of Eating Disorders, Weight Concerns Scale and previous/current treatment for EDs. Results In terms of severity of EDs, 22.9% (n = 152) of the screened participants were symptom free, 48.8% (n = 324) had considerable concerns about their weight, 11.1% (n = 74) were slightly impaired, 15.1% (n = 100) had severe impairment and 2.1% (n = 14) of participants are currently under treatment for EDs. In total, 56.3% of users (n = 374) registered in the programme. According to our results, those who had considerable concerns about their weight and individuals who were severely impaired registered with a greater odds to the programme than those who were symptom free [odds ratio (OR) = 1.64, p = .021 and OR = 1.90, p = .023, respectively]. Furthermore, those who previously received treatment for their ED registered to the programme with greater odds than those who did not (OR = 2.40, p = .017). Conclusion ProYouth successfully addressed those who have elevated concerns about their weight and who also registered with greater odds to the programme than those who were symptom free regarding EDs. The screening results show that there is a greater need for specialized care targeting EDs in Hungary than what is currently available. Copyright © 2015 John Wiley & Sons, Ltd and Eating Disorders Association.

a b s t r a c t Muscle dysmorphia (MD) is a body image disturbance characterized by a pathological preoccupation with muscularity. The study aimed to differentiate the levels of risk for MD among weightlifters and to define a tentative cut-off score for the Muscle Appearance Satisfaction Scale (MASS) for the identification of high risk MD cases. Hungarian male weightlifters (n = 304) completed the MASS, the Exercise Addiction Inventory, and specific exercise and body image related questions. For the differentiation of MD, factor mixture modeling was performed, resulting in three independent groups: low-, moderate-, and high risk MD groups. The estimated prevalence of high risk MD in this sample of weightlifters was 15.1%. To determine a cut-off score for the MASS, sensitivity and specificity analyses were performed and a cut-off point of 63 was suggested. The proposed cut-off score for the MASS can be useful for the early detection of high risk MD.

The risk of eating disorders is high in populations who are exposed to slimness ideal, so among fashion models. The present qualitative study evaluates the risk factors of eating disorders in a group of fashion models with semistructured interview. Moreover, the aim of the study was to examine the impact of professional requirements on the health of models.The study group was internationally heterogeneous. The models were involved by personal professional relationship. A semistructured questionnaire was used by e-mail containing anthropometric data and different aspects of the model profession.29 female and three male models, three agents, two designers, three fotographers, one personal trainer and one stylist answered the questionnaire. Transient bulimic symptoms were reported by six female models (21%). Moreover, five female models fulfilled the DSM-5 criteria of anorexia nervosa or bulimia nervosa. Four of them were anorexic (body mass index: 13.9-15.3), one was bulimic. The symptoms of three persons began before the model career, those of two models after it. 17 models reported that the model profession intensively increased the bodily preoccupations.The study corroborates the effect of the model profession on the increase of the risk for eating disorders. In the case of the models, whose eating disorder began after stepping into the model profession, the role of the representants of the fashion industry can be suggested as a form of psychological abuse. As the models or in the case of underages their parents accepted the strong requirement of slimness, an unconscious collusion is probable. Our date highlight the health impact of cultural ideals, and call the attention to prevention strategies.

One of the territories of dental psychosomatics is the link between personality characterisctics and dental status. The aim of the present study was to survey the relationship between temperament and character factors and dental status in police students. It can be hypothesized, that some temperament factors can increase the risk for dental health problems. After dental screening 792 police students completed the Temperament and Character Inventory (TCI) devised by Cloninger. 57.5% of students rated their own teeth as being in good or very good condition, and only 2.8% as bad condition. In persons rating their dental status as “good”, the average DMFT was 9.23±5.01 (mean±S.D.). In students assessing their own oral health as bad, TCI results showed that a higher percentage of students displayed extravagance, impulsiveness, disorderliness than the overall population. Among the students with good self-assessment but bad teeth, there was a higher percentage of students displaying passivity, low assertiveness, and introversion. The temperament and character factors may have negative consequences for students in an institution which exposes them to high stress level. It may be useful to screen these students using subjective health questionnaires in order to permit more effective efforts to positive health behaviour.

Prejudice against obese people has been widely confirmed in scientific papers. Therefore, recent studies have increasingly focused on investigating the individual and cultural factors related to attitudes towards obesity. Since there have been no comparative studies involving Gypsy people, our present research aimed at exploring the possible discrepancies in children's attitudes towards obese children between Gypsy and Hungarian cultures. Our survey included 247 children aged 9-16 (108 boys and 139 girls), of which 136 considered themselves Hungarian (55.1 %), while 111 children (44.9 %) claimed themselves as Gypsy. The subjects were asked to rank six male and six female figure drawings according to their preference. Each sequence of figure drawings included a healthy child, an obese child, and four drawings depicted children with disabilities. According to our results, the drawings portraying the healthy child figure were rated most preferable and those portraying the obese child figure the least preferable amongst the subjects regardless of gender and origin. However, the obese girl figures and boy figures were rated significantly more positively by Gypsy children than Hungarian children. Our results suggest that there is a difference in attitude towards obesity among Gypsy and Hungarian children. Therefore, it is worthwhile to further explore this phenomenon.

To review the literature on the prevalence, risk groups and risk factors of the alleged eating disorder orthorexia nervosa. We searched Medline and Pubmed using several key terms relating to orthorexia nervosa (ON) and checked the reference list of the articles that we found. Attention was given to methodological problems in these studies, such as the use of non-validated assessment instruments, small sample size and sample characteristics, which make generalization of the results impossible. Eleven studies were found. The average prevalence rate for orthorexia was 6.9 % for the general population and 35–57.8 % for high-risk groups (healthcare professionals, artists). Dieticians and other healthcare professionals are at high risk of ON. Risk factors include obsessive–compulsive features, eating-related disturbances and higher socioeconomic status. Relevant clinical experience, published literature and research data have increased in the last few years. The definition and diagnostic criteria of ON remain unclear. Further studies are needed to clarify appropriate diagnostic methods and the place of ON among psychopathological categories.

A korabban jellegzetesen női betegsegkent emlegetett anorexia nervosa egyre gyakrabban fordul elő ferfiak kozott is. A tanulmany attekinti a Peter Pan-szindromanak is nevezett ferfi anorexia jellemzőit. Kozottuk az egyik fontos sajatossag a posztadoleszcencia jelensege. Magyarorszagon eddig ket kozlemeny jelent meg, amely anorexias ferfiak pszichoterapias folyamatat ismertette. A jelen tanulmany egy mozaikcsaladban elő, 19 eves anorexias ferfibeteg tiz ulesből allo csaladterapias folyamatat ismerteti. Harom honapos utankovetes tunetmentesseget igazolt. A terapias eredmeny elereseben a csaladi hierarchiaviszonyok ujrarendeződese fontos szerepet jatszott. A sikeres terapia arra hivja fel a figyelmet, hogy az anorexiaban a csaladterapia fontos szerepet jatszik, ezt nemzetkozi adatok is megerősitik. Ma egyre fontosabba valik a posztadoleszcencia szerepe a csaladi diszfunkciok kozott. Ennek kezelese, a szeparacio-individuacio folyamatanak erősitese a terapia lenyeges celkitűzesei koze tartozik.

Az anorexia nervosa kialakulasara vonatkozoan ma a komplex, multidimenzionalis megkozeliteseket ajanljak. Emellett tobb olyan elmelet is ismeretes, mely a korkepet egy szelektiv szemszogből vizsgalja, ilyen az evolucios pszichologiai magyarazat is. Az evolucios pszichologia az utobbi ket evtizedben bontakozott ki, kepviselői arra a kerdesre keresik a valaszt, hogy az evolucio soran kialakult tulelesi mechanizmusok milyen mertekben befolyasoljak a mai ember lelki műkodeset. Az anorexia nervosa evolucios ertelmezese egy lehetseges adaptiv strategiat lat a korkep hattereben. Az evolucios megkozelites provokativ elkepzelesnek indult, mara azonban egyre elfogadottabba valnak az egyes evolucios elmeletek (peldaul a reproduktiv szuppresszio, szulői manipulacio). Ugyanakkor az ősi adaptiv mechanizmusok szerepe kevesbe tanulmanyozott es alig ismert. Az ultimativ okok keresese helyett inkabb a proximativ megkozelitest helyezik előterbe. A jelen tanulmany celja a figyelemfelkeltes mellett ezen ujfajta ertelmezes bem...

The aim of this study was to assess the caries experience of Hungarian police students and to evaluate its relationship with nutrition, oral hygiene habits, behavioural and social factors. This representative cross-sectional epidemiological survey was conducted in a dental office of the Miskolc Law Enforcement Secondary School in Hungary in 2008. Altogether 792 Hungarian police student volunteers (male/female ratio was 90.3/9.7%, age: 20.4 ± 1.3 years, mean ± SD) participated in the study. Caries experience was measured using World Health Organization criteria and a validated questionnaire was used to collect social and oral health behaviour data. The DMFT number was 10.3 ± 5.7 (mean ± SD). Significant relationships were found between the DMFT value and the education of fathers, frequency of dental attendance, and use of dental floss (p < 0.05). D and T components of caries prevalence showed significant relationships with the frequency of dental attendance, while from the components the FT value showed statistically significant relationships with the education of fathers and the MT component with the use of dental floss (p < 0.05). Based on the results of this survey, strategies aiming at effective caries-preventive programmes should be established in police student populations ensuring the official basic requirements on their health condition and suitability for subsequent service. The published information can be used as a base for new strategies, and allows the evaluation of the effects of a carefully planned and implemented health care system.

Limited studies have evaluated the psychometric properties of the Muscle Appearance Satisfaction Scale (MASS), a measure of muscle dysmorphia, in different cultures and languages. The aims were to examine the psychometric properties of the Hungarian version of the MASS (MASS-HU), and to investigate its relationship with self-esteem and exercise-related variables. Two independent samples of male weight lifters (ns = 289 and 43), and a sample of undergraduates (n = 240) completed the MASS, Eating Disorder Inventory, and Rosenberg Self-esteem Scale. Exploratory factor analysis supported the original five-factor structure of the MASS only in the weight lifter sample. The MASS-HU had excellent scale score reliability and good test–retest reliability. The construct validity of the MASS-HU was tested with multivariate regression analyses which indicated an inverse relationship between self-esteem and muscle dysmorphia. The 18-item MASS-HU was found to be a useful measure for the assessment of muscle dysmorphia among male weight lifters.

Elmeleti hatter: Az eveszavarok kialakulasaban a szociokulturalis tenyezők is szerepet jatszanak. Ezek kozvetett, kulonboző szinteken megmutatkozo befolyast gyakorolnak a testsulyszabalyozasra. A tomegtajekoztatas kiemelkedő jelentősegű az ertekek es normak kozvetiteseben. A manapsag oly nepszerű karcsu női testideal, divatos fogyokurak, megjelenessel kapcsolatos elvarasok is gyakran a media altal jutnak el az egyes szemelyekhez. Celkitűzes: A vizsgalat celja a magazinolvasasi szokasok es az eveszavarok, illetve az eveszavarokhoz vezető tunetek kapcsolatanak vizsgalata volt. Modszer: A keresztmetszeti, kerdőives vizsgalat resztvevői altalanos es kozepiskolas lanyok, valamint egyetemi hallgatonők voltak (n = 193). Alkalmazott merőeszkozok: a magazinolvasasi szokasokat felmerő kerdessor, Megjelenessel Kapcsolatos Szociokulturalis Attitűdok Kerdőiv (SATAQ-3), Testi Attitűdok Tesztje (BAT), Evesi Zavar Kerdőiv (EDI), valamint a SCOFF kerdőiv. A vizsgalat kereteben magyar nyelvre forditottuk a Vonzosagrol Alko...