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CHESTIONARUL SCHEMELOR COGNITIVE
______________________________________________________________
CHESTIONARUL SCHEMELOR COGNITIVE YOUNG - FORMA
SCURTĂ 3 (YSQ-S3)
Copyright © Daniel David

INTRODUCERE
J. Young (2003) introduce termenul de scheme dezadaptative timpurii úi le defineúte ca
fiind teme largi cu privire la sine úi propriile relaĠii cu ceilalĠi ce se dezvoltă în copilărie, se
elaborează pe parcursul vieĠii úi sunt disfuncĠionale într-o anumită măsură.
Caracteristicile acestor scheme dezadaptative timpurii sunt următoarele:
ƒ Se dezvoltă în copilărie, ca rezultat al interacĠiunii dintre temperamentul înnăscut
úi experienĠele negative de zi cu zi ce apar în relaĠia copilului cu persoanele
apropiate;
ƒ Sunt responsabile pentru generarea unui distres emoĠional puternic, conduc la
consecinĠe defavorabile persoanei sau celor din jurul său;
ƒ Împiedică dezvoltarea autonomiei, exprimării proprii, acceptării úi a bunei
interrelaĠionări;
ƒ Sunt convingeri bazale, pattern-uri adânc înrădăcinate, teme centrale ale sinelui
úi auto-perpetuate;
ƒ Sunt activate de evenimentele cotidiene congruente cu scheme sau de o stare
biologică.
Pentru evaluarea acestor scheme, Young úi colaboratorii săi (Young úi Brown, 1990,
2001, apud Young, 2003) au dezvoltat Chestionarul Schemelor. Primele forme ale
chestionarului sunt YSQ – L2 (Chestionarul Schemelor Cognitive Young, forma lungă 2) úi
YSQ- S2 (Chestionarul Schemelor Cognitive Young, forma scurtă 2). YSQ – L2 are 205 itemi
úi măsoară 16 dintre schemele cognitive dezadaptative: Emotional deprivation (ED),
Abandonment/Instability (AB), Distrust/Abuse (MA), Social Isolation (SI), Deficiency/Shame
(DS), Approval Seeking/Recognition Seeking (AS), Failure (FA), Dependence/Incompetence
(DI), Vulnerability to harm and illness (SS), Emotional Inhibition (EI), Unrealistic standards
(US), Entitlement/Grandiosity (ET), Insufficient Self-Control (IS). Este de preferat a fi folosită
cu scop clinic, deoarece pune în evidenĠă fiecare schemă úi oferă mai multe informaĠii utile.
Forma scurtă YSQ- S2 este compusă din 75 de itemi distribuiĠi pe subscale: Ed, Ab,
Ma, Si, Ds, Fa, Di, Vh, Em, Sb, Ss, Ei, Us, Et, Is. Este frecvent folosită în cercetare deoarece
poate fi completată într-un timp mai scurt.
Recent, Young úi Brown (2001) au revizuit ambele forme ale chestionarului
schemelor cognitive, rezultând YSQ – L3 úi YSQ – S3. YSQ – L3 are 232 itemi úi măsoară
toate cele optsprezece scheme dezadaptative. YSQ - S3 are 114 itemi úi măsoară 18 scheme
cognitive disfuncĠionale.

1
CHESTIONARUL SCHEMELOR COGNITIVE
______________________________________________________________

CE MĂSOARĂ TESTUL?
Au fost identificate optsprezece scheme dezadaptative grupate în cinci categorii sau
domenii.
I. SEPARARE ùI RESPINGERE – se referă la convingerea, presupunerea că nu vor fi
satisfăcute nevoile de securitate, siguranĠă, îngrijire, empatie, acceptare úi respect. Acest
prim domeniu este compus din cinci scheme:
1. Deprivare EmoĠională (Emotional Deprivation - ED) – ceilalĠi nu ne oferă dragostea,
protecĠia úi înĠelegerea de care avem nevoie. Există trei forme majore de deprivare
emoĠională: a) deprivarea de îngrijire (absenĠa atenĠiei, afecĠiunii úi căldurii sufleteúti). b)
deprivarea de înĠelegere (absenĠa empatiei) c) deprivarea de protecĠie (absenĠa
direcĠionării, îndrumării, ghidării)
2. Abandon / Instabilitate (Abandonment/Instability - AB) – sentimentul că cei apropiaĠi
nu vor putea să ne ofere susĠinerea emoĠională de care avem nevoie, pentru că aceútia la
rândul lor, sunt instabili emoĠional, nu sunt prezenĠi când avem nevoie de ei sau ne vor
părăsi pentru altcineva.
3. Neîncredere / Abuz (Distrust/Abuse - MA) – convingerea că, într-un final, ceilalĠi ne vor
răni intenĠionat, că ne înúeală, abuzează de noi, ne fac să suferim, ne umilesc sau ne
mint.
4. Izolare socială / Înstrăinare (Social Isolation - SI) – senzaĠia de izolare socială, că
suntem diferiĠi de alĠii úi că nu putem face parte dintr-un grup.
5. Defect / Ruúine ( Deficiency/Shame - DS) – sentimentul că suntem fără valoare, că
suntem răi, nedoriĠi, inferiori sau incapabili în anumite aspecte importante ale vieĠii, iar
dacă ceilalĠi vor vedea acest lucru, nu ne vor mai fi iubi. Persoanele care interiorizează
această schemă sunt sensibile la critică, sunt foarte conútiente de ele însele, se compară
cu ceilalĠi, nu se simt în siguranĠă în prezenĠa celorlalĠi, au sentimentul de ruúine legat de
propriul “handicap”.

II. AUTONOMIE ùI PERFORMANğĂ - al doilea domeniu este cel al slabei autonomii úi

performanĠei scăzute úi se referă la perceperea propriei incapacităĠi de a supravieĠui úi
funcĠiona independent. Acestui domeniu îi aparĠin următoarele scheme:
6. Eúec (Failure - FA) – convingerea că nu eúti capabil să faci ceva bine, că inevitabil vei
greúi, vei eúua în domenii importante ale vieĠii (úcoală, carieră, sport), că eúti prost, că ai
un statut social scăzut, úi mai puĠin succes decât ceilalĠi de aceeaúi vârstă.
7. DependenĠă / IncompetenĠă (Dependence/Incompetence - DI) – convingerea că
suntem incapabili să ne îndeplinim bine responsabilităĠile zilnice fără un sprijin
considerabil din partea celorlalĠi. Apare senzaĠia constantă de neputinĠă.
8. Vulnerabilitate la rău úi boală (Vulnerability to harm and illness - VH) – frica
exagerată de catastrofe iminente ce ni se pot întâmpla oricând úi pe care nu le putem
preveni. Această frică poate apărea în legătură cu diferite boli (infarct miocardic), cu

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diferite probleme emoĠionale grave (teama de a nu înnebuni) sau alte catastrofe externe
(prăbuúirea avionului).
9. ProtecĠionism / Ego infantil (Enmeshment/Underdeveloped Self - EM) – o relaĠie
emoĠională úi de apropiere exagerată faĠă de persoane relevante (deseori părinĠi), relaĠie
care împiedică dezvoltarea propriei identităĠi individuale úi sociale. Persoana are
convingerea că nu va putea trăi fără cealaltă, nu va putea fi fericită dacă nu va avea
sprijinul acesteia.

III. DEFICIENğA LIMITELOR - al treilea domeniu conĠine scheme cu privire la limite defectuoase
úi constă în incapacitatea de a stabili sau stabilirea inexactă a limitelor interne, a
responsabilităĠilor faĠă de ceilalĠi, a scopurilor pe termen lung. Apar dificultăĠi în respectarea
drepturilor celorlalĠi, în stabilirea úi atingerea unor scopuri personale realiste. Din acest
domeniu fac parte două scheme:
10. Revendicare / Grandomanie (Entitlement/Grandiosity - ET) – convingerea că suntem
superiori altor oameni, deci revendicăm drepturi úi privilegii speciale. Regula reciprocităĠii
nu funcĠionează în acest caz. Revendicăm dreptul de a face ce vrem, indiferent dacă
ceea ce dorim este ancorat în realitate sau nu, indiferent care sunt consecinĠele pentru
celălalt. Un sentiment exagerat al superiorităĠii, care se manifestă cu scopul de a obĠine
control úi putere.
11. Autocontrol / Auto-disciplină insuficientă (Insufficient Self-Control - IS) – dificultatea
de a se controla, disciplina în obĠinerea scopurilor, control insuficient al emoĠiilor úi
impulsurilor, toleranĠă scăzută la frustrare, dorinĠa excesivă de menĠinere a confortului, de
evitarea a situaĠiilor neplăcute.
IV. DEPENDENğA DE ALğII - al patrulea domeniu este caracterizat prin focalizarea
excesivă pe satisfacerea dorinĠelor, nevoilor altora în detrimentul satisfacerii propriilor dorinĠe
úi nevoi, cu scopul obĠinerii dragostei úi aprobării celor din jur. Schemele componente ale
acestui domeniu sunt:
12. Subjugarea (Subjugation - SB) – controlul excesiv asupra celorlalĠi. Are două forme
principale: subjugarea nevoilor (propriile preferinĠe, decizii úi dorinĠe sunt reprimate,
ignorate) úi subjugarea emoĠiilor (exprimarea emoĠiilor, în special a furiei este reprimată).
13. Auto-sacrificiul (Self-Sacrifice -SS) – fixarea excesivă, asupra satisfacerii nevoilor
zilnice ale celorlalĠi în detrimentul satisfacerii propriile nevoi, pentru a evita sentimentul de
a fi egoist, pentru a menĠine relaĠia cu persoana pe care crede că trebuie să o ajute.
14. Căutarea Aprobării / Recunoaúterii (Approval Seeking/Recognition Seeking - AS) –
căutarea exagerată a aprobării, recunoaúterii sau atenĠiei celorlalĠi, fapt ce împiedică
dezvoltarea identităĠii de sine. Stima de sine este dependentă în principal, de reacĠia
celorlalĠi.
V. HIPERVIGILENğĂ ùI INHIBIğIE - al cincilea domeniu este reprezentat de
hipervigilenĠă úi inhibiĠie. Sentimentele, impulsurile, alegerile spontane nu sunt exprimate

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iar persoana nu crede că are dreptul de a fi fericită, relaxată. Sănătatea, relaĠiile apropiate au,
prin urmare, de suferit. Schemele celui de al cincilea domeniu sunt:
15. Negativism / Pasivitate (Negativity/Passivity - NP) – aspectele negative ale vieĠii sunt
exagerat conturate, subliniate, maximizate, în timp ce evenimentele sau aspectele
pozitive, optimiste, plăcute sunt minimalizate.
16. InhibiĠie EmoĠională (Emotional Inhibition - EI) – inhibarea acĠiunilor, sentimentelor,
comunicării spontane pentru a evita dezaprobarea celorlalĠi, sentimentul de ruúine úi de
pierdere a controlului asupra propriilor impulsuri. Cele mai întâlnite forme de inhibiĠie
sunt: a) inhibarea furiei úi agresivităĠii, b) inhibarea impulsurilor pozitive, c) dificultate în
exprimarea vulnerabilităĠii sau în comunicarea propriilor sentimente, d) excesiva invocare
a raĠionalităĠii úi eliminarea emoĠionalului.
17. Standarde Nerealiste / Hipercriticism (Unrealistic Standards/Hypercriticism - US) –
convingerea că trebuie să atingem niúte standarde interiorizate de comportament úi
performanĠă foarte ridicate, cu scopul de a evita critica. Aceste standarde nerealiste pot
apărea sub forma perfecĠionismului, atenĠiei deosebite la detalii, reguli rigide de tipul
“trebuie”, nemulĠumirea că nu a realizat cât de mult ar fi vrut/ar fi trebuit să realizeze.
18. Penalizarea (Punishment - PU) – convingerea că oamenii ar trebui aspru criticaĠi úi
pedepsiĠi pentru greúelile lor. Implică tendinĠa de a se înfuria, de a fi intolerant, punitiv úi
nerăbdător cu acei oameni (inclusiv cu propria persoană) ce nu ne satisfac propriile
noastre expectanĠe sau standarde. Greúelile sunt uitate cu greutate, úi nu se Ġine seama
de natura failibilă a omului.

DESCRIEREA ITEMILOR
Cei 114 itemi sunt astfel repartizaĠi pe subscale după cum urmează:
1. Deprivare EmoĠională (ED): 1,25, 49, 73, 96;
2. Abandon/Instabilitate (AB): 2, 26, 50, 74, 97;
3. Neîncredere/Abuz (MA): 3, 27, 51, 75, 98;
4. Izolare Socială/Înstrăinare (SI): 4, 28, 52, 76, 99;
5. Defect/Ruúine (DS): 5, 29, 53, 77, 100;
6. Eúec (FA): 9, 33, 57, 81, 103;
7. DependenĠă/IncompetenĠă (DI): 10,34, 58, 82, 104;
8. Vulnerabilitate la rău úi boală (VH): 11, 35, 59, 83, 105;
9. ProtecĠionism/Ego infantil (EM): 12, 36, 60, 84, 106;
10. Revendicare/Grandomanie (ET): 20, 44, 68, 92, 113;
11. Autocontrol/Auto-disciplină insuficientă (IS): 21, 45, 69, 93, 114
12. Subjugare (SB): 13, 37, 61, 85, 107;
13. Auto-sacrificiu (SS): 17, 41, 65, 89, 110;
14. Căutarea Aprobării/Recunoaúterii (AS): 16, 14, 22, 30, 38, 46, 54, 62, 70, 78, 86, 94, 101,
108;
15. Negativism/Pasivitate (NP): 7, 15, 23, 31, 39, 47, 55, 63, 71, 79, 87;

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16. InhibiĠie EmoĠională (EI): 18, 42, 66, 90, 111;
17. Standarde nerealiste/Hipercriticism (US): 19, 43, 67,91, 112;
18. Penalizare (PU): 8, 16, 24, 32, 40, 48, 56, 64, 72, 80, 88, 95, 102, 109.

ADMINISTRAREA ùI COTAREA
x Administrarea
În scop clinic, clientul/pacientul este rugat să completeze acest chestionar ca úi temă
de casă, după prima sau a doua întâlnire. În scop de cercetare, instrumentul poate fi
administrat atât individual, cât úi colectiv. RespondenĠii vor evalua fiecare item pe o scală
Lickert de 6 puncte unde: 1 = total neadevărat în ceea ce mă priveúte, 2 = de cele mai multe
ori neadevărat în ceea ce mă priveúte, 3 = mai degrabă fals decât adevărat, 4 = mai degrabă
adevărat decât fals, 5 = de cele mai multe ori adevărat în ce mă priveúte, 6 = mă descrie
perfect). Durata medie de completare a chestionarului este de 25 de minute.
Unele persoane pot rememora traume puternice atunci când completează
chestionarul úi, datorită interferenĠei emoĠionale, durata completării poate fi mai lungă.
Psihologul poate să ceară acestor persoane să completeze un număr de întrebări pe
săptămână. AlĠii vor evita să-úi administreze chestionarul, vor lăsa întrebări fără răspuns,
deoarece încearcă să evite expunerea la schemele dezadaptative proprii. Dacă aceste
persoane vor continua să evite completarea chestionarului, psihologul nu va insista, ci va
discuta motivele pentru care nu fac acest lucru (evită completarea chestionarului).
x Cotarea răspunsurilor
Itemii sunt grupaĠi în funcĠie de scheme. Pe foaia de cotare, după fiecare item, apare
un cod de două litere indicând schema măsurată. De obicei, nu se înregistrează scorul total
sau media scorului pentru fiecare schemă, ci se reĠin itemii cu scorurile cele mai mari (5 sau
6). Scorurile mari indică/oferă informaĠii relevante despre convingerile, schemele persoanei.
Psihologul/Terapeutul poate revedea rezultatele împreună cu clientul, punând întrebări despre
itemii la care s-au înregistrat scoruri ridicate. Se va discuta despre schemele evidenĠiate prin
obĠinerea de scoruri ridicate la anumiĠi itemi apoi îl va învăĠa numele fiecărei scheme înalt
cotate úi semnificaĠia ei.

Fidelitate chestionarului
Pentru stabilirea fidelităĠii scalei, au fost incluúi în studiu, 160 de subiecĠi, tineri úi
maturi. Administrarea instrumentului s-a făcut atât colectiv cât úi individual.
Chestionarul are o fidelitate foarte bună, obĠinându-se un Į Cronbach = .96. Au fost
de asemenea calculaĠi coeficienĠii Į Cronbach pentru subscale (între .68 - .90) aceútia
susĠinând o bună fidelitate a subscalelor (Tabel 1).

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Tabel 1 CoeficienĠii Į Cronbach pentru subscale
Subscale Coeficeint Į Cronbach
Deprivare emoĠională (ED) .86
Abandon (AB) .83
Neîncredere /Abuz (MA) .84
Izolare Socială / Înstrăinare (SI) .80
Defect / Ruúine (DS) .85
Eúec (FA) .88
DependenĠă / IncompetenĠă (DI) .81
ProtecĠionism / Ego infantil (EM) .68
Vulnerabilitate la rău úi boală (VH) .84
Subjugare (SB) .76
Auto-sacrificiu (SS) .82
InhibiĠie EmoĠională (EI) .71
Standarde nerealiste / Hipercriticism (US) .75
Revendicare / Grandomanie (ET) .76
Autocontrol / Auto-disciplină insuficientă (IS) .68
Căutarea Aprobării / Recunoaúterii (AS) .88
Negativism / Pasivitate (NP) .90
Penalizare (PU) .86

FIDELITATE ùU VALIDITATE
Validitatea chestionarului
La validarea pe populaĠia românească a chestionarului au participat 160 de subiecĠi;
108 femei úi 52 bărbaĠi, cu vârsta medie de 30 de ani. În acest proces s-au folosit
chestionarele STAI-X1 úi STAI-X2 pentru măsurarea anxietăĠii, SPIN úi ATQ. După
întocmirea etalonului pentru YSQ – S3 au fost eliminaĠi subiecĠii care au obĠinut scoruri medii,
pentru fiecare subscală. S-au realizat apoi comparaĠii între subiecĠii ce au înregistrat scoruri
mici úi subiecĠii cu scoruri mari atât pentru nivelul anxietăĠii ca stare cât úi ca trăsătură.
Pentru anxietatea ca stare, nu se obĠin diferenĠe semnificative între cele două grupuri,
excepĠie făcând schemele Us (t=2.55, p= .014) úi Pu (t=2.31, p=.025). Persoanele ce îúi
fixează standarde foarte înalte, uneori nerealiste, fiind foarte critice cu ele însele (m2, s.d.2)
înregistrează o stare de anxietate mai ridicată decât persoanele opuse lor (m2=48,
s.d.2=2.98; m1=46.06, s.d.1 = 2.64). De asemenea, starea de anxietate creúte úi atunci când
suntem intoleranĠi faĠă de propriile greúeli dar úi faĠă de greúelile celor din jur (m2= 48.07,
s.d.= 3.90; m1= 45.95, s.d.=2.77).
Spre deosebire de anxietatea ca stare, nivelul anxietăĠii ca trăsătură este puternic
influenĠat de tăria credinĠei în aproape toate schemele cognitive dezadaptative descrise de
Young. Rezultatele sunt prezentate în tabelul de mai jos.

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Tabel 2 Rezultate privind anxietatea ca trăsătură
Scheme t p m s.d.
Ed 2.03 .046 m1 = 47.94 s.d.1= 6.08
m2 = 50.91 s.d.2= 6.28
Ab 2.81 .007 m1 = 47.67 s.d.1= 5.38
m2 = 51.77 s.d.2= 6.26
Ma 2.59 .012 m1 = 47.26 s.d.1= 5.46
m2 = 50.95 s.d.2= 6.10
Si 1.98 .050 m1 = 47.82 s.d.1= 5.56
m2 = 50.75 s.d.2= 5.90
Ds 3.32 .002 m1 = 47.71 s.d.1= 5.15
m2 = 51.90 s.d.2= 6.54
Fa 3.05 .004 m1 = 47.14 s.d.1= 4.93
m2 = 52.10 s.d.2= 7.30
Ei 2.28 .026 m1 = 46.53 s.d.1= 4.41
m2 = 49.90 s.d.2= 7.08
As 3.27 .002 m1 = 46.52 s.d.1= 4.73
m2 = 51.18 s.d.2= 6.30
Np 3.47 .001 m1 = 45.88 s.d.1= 5.97
m2 = 52.30 s.d.2= 6.88
Pu 2.14 .036 m1 = 47.13 s.d.1= 5.67
m2 = 50.50 s.d.2= 7.08
Vh 4.33 .000 m1 = 46.24 s.d.1= 5.18
m2 = 52.64 s.d.2= 7.03
Em 2.28 .026 m1 = 47.12 s.d.1= 5.24
m2 = 50.74 s.d.2= 6.92
Ss 2.42 .019 m1 = 47.14 s.d.1= 4.68
m2 = 50.84 s.d.2= 6.51

* m1 úi s.d.1 reprezintă media úi abaterea standard eúantionului ce înregistrează scoruri

scăzute la chestionarul schemelor, iar m2 úi s.d.2 reprezintă media úi abaterea standard
eúantionului ce înregistrează scoruri ridicate la chestionarul schemelor
CredinĠa în schemele cognitive dezadaptative diferenĠiază prin urmare persoanele
anxioase de cele non-anxioase. ExpectanĠa că nu vor fi satisfăcute nevoile de securitate,
siguranĠă, îngrijire, empatie, acceptare úi respect va conduce la dezvoltarea anxietăĠii ca
trăsătură. De asemenea, schema ce se referă la frica exagerată de catastrofe iminente ce pot
să ni se întâmple oricând úi nu le putem preveni creúte nivelul de anxietate. Convingerea că
cel puĠin una dintre persoanele implicate într-o relaĠie nu va putea trăi fără cealaltă, nu va
putea fi fericită dacă nu va avea sprijinul acesteia susĠine o frică perpetuă de a fi respins.
Blamarea de sine, convingerea că nu este capabil să facă ceva bine, că inevitabil va greúi, va
eúua în autorealizare va fi însoĠită tot timpul de anxietate de performanĠă. Aceasta poate fi
însă întreĠinută úi de căutarea exagerată a aprobării, recunoaúterii sau atenĠiei celorlalĠi.
Atunci când sentimentele, impulsurile, alegerile spontane sunt împiedicate a se exprima,
persoana nu-úi rezervă dreptul de a fi relaxat, trăind o continuă stare de anxietate.
Al doilea instrument utilizat în validarea chestionarului YSQ-S3 este Inventarul de
Fobie Socială (SPIN – Social Phobia Inventory), adaptat pe populaĠia românească de Chereji
(2003). SPIN conĠine 17 itemi evaluaĠi pe o scală de la 0 la 4. Ei măsoară frica, evitarea úi
disconfortul fiziologic. CorelaĠia test-retest variază între .78 - .89 iar Į Cronbach între .82 -
.94. Subscalele YSQ-S3 dovedesc o bună validitate predictivă. Utilizând analiza de regresie

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lineară simplă, putem concluziona că dezvoltarea unei fobii sociale poate fi prezisă în procent
de 28% pe baza subscalei Sb (p=.000), 24% pe baza subscalei Vh (p=.000) úi Np (p=.000);
22% din varianĠa fobiei sociale ar putea fi explicată de Ma (p=.000), 20% de Em (p=.000);
scorul obĠinut la subscala Fa (p=.000) poate prezice apariĠia unei fobii sociale în procent de
19%, iar scorurile subscalelor Si (p=.000), Ds (p=.000) úi Di (p=.000) în procent de 17%; 13%
din varianĠa fobiei sociale ar putea fi prezisă scorul subscalelor Ed (p=.000), Ab (p=.000)úi
respectiv As (p=.000); procente mai mici sunt înregistrate pentru Is (p=.001) – 9%, Ei (p=.009)
úi Pu (p=.009) – 5%, Et (p=.026)- 3%.
Al treilea instrument utilizat pentru validare a fost ATQ – The Automatic Thoughts
Questionnaire, elaborat de Hollan úi Kendel, în 1980. ATQ este un chestionar format din 30
de itemi în care subiectul este solicitat să marcheze pe o scală de la 1 la 5 cât de frecvent
experienĠiază o serie de gânduri negative. ATQ are o consistenĠă internă bună, Į Cronbach
este de .96 úi de asemenea o bună validitate (corelează puternic cu BDI úi MMPI-D). Se obĠin
corelaĠii semnificative între subscalele YSQ-S3 úi ATQ (Chestionarul gândurilor automate).
Cu cât credinĠa în schemele dezadaptative este mai mare, cu atât frecvenĠa gândurilor
automate este mai mare. CoeficienĠii de corelaĠie sunt prezentaĠi în tabelul de mai jos.

Tabel 3 CoeficienĠi de corelaĠie YSQ-S3 – ATQ

Ed Ab Ma Si Ds Di Ei Us
ATQ 44* 51* 54* 70* 74* 49* 33* 18**
Et Is As Np Pu Vh Em Sb
ATQ 43* 45* 28** 63* 34* 55* 43* 49*
* p< 0.01
** p < 0.05
În concluzie, YAQ-S3 are o bună validitate pe populaĠia românească; poate discrimina între
scoruri mici úi socruri mari la anxietate, poate prezice fobia socială úi corelează puternic cu
ATQ.
ETALONAREA CHESTIONARULUI
Pe baza rezultatelor obĠinute s-au întocmit următoarele etaloane pentru subscalele
YSQ-S3 (N=160).
Ed Ab Ma Si Fa
Scăzut 0-5 0-6 0-8 0-6 0-5
Mediu 5-7 6-8 8-11 6-8 5-8
Ridicat 7-12 8-12 11-15 8-11 8-10
Foarte 12-30 12-30 15-30 11-30 10-30
ridicat
m=9,43, m=9,97, m=11,97, m=9,35, m=8,73,
s.d=5,37 s.d=5,23 s.d=5,49 s.d=4,57 s.d=4,27
Ds Ei US Et Di
Scăzut 0-5 0-8 0-13 0-11 0-6
Mediu 5-7 8-10 13-17 11-14 6-8
Ridicat 7-30 10-14 17-20 14-19 8-11
Foarte 14-30 20-30 19-30 11-30
ridicat
m=7, s.d=3,55 m=11,38, m=16,56, m=14,97, m=8,93,
s.d=4,73 s.d=5,28 s.d=5,52 s.d=4,28

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Is Vh Em Sb
Scăzut 0-9 0-5 0-6 0-6
Mediu 9-12 5-6 6-9 6-8
Ridicat 12-17 6-10 9-12 8-11
Foarte 17-30 10-30 12-30 11-30
ridicat
m=12,76, m=8,19, m=9,76, m=9,03,
s.d=4,57 s.d=4,58 s.d=4,57 s.d=4,04
SS AS Np Pu
Scăzut 0-14 0-26 0-16 0-29
Mediu 14-18 26-35 16-21 29-36
Ridicat 18-22 35-43 21-31 36-46
Foarte 22-30 43-84 31-66 46-84
ridicat
m=18,14, m=36,23, m=24,76, m=37,76,
s.d=5,32 s.d=13,24 s.d=11,19 s.d=11,92

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CHESTIONARUL SCHEMELOR COGNITIVE
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BIBLIOGRAFIE SELECTIVĂ
1. Anastasi, A. (1988). Psychological testing, New York, Macmillan Publishing Company.
2. Chereji, S (2003). CogniĠie úi fobie socială, Lucrare de licenĠă nepublicată, Oradea.
3. Pitariu, H & Albu, M. (1996). Psihologia personalului I. Măsurarea úi interpretarea
diferenĠelor individuale, Cluj Napoca, Editura Presa Universitară Clujeană.
4. Radu, I & colab. (1993). Metodologie psihologică úi analiza datelor, Cluj Napoca, Editura
Sincron.
5. Trif, S. (2006). The Romanian Version of Young Schema Questionnaire – Short Form
(YSQ-S3). Journal of Cognitive and Behavioral Psychotherapies, vol.6, no.2.
6. Young, E.J., Klosko, S. J. & Weishaar, E. M. (2003). Schema Therapy. A Practitioner’s
Guide, New York, The Guiford Press.

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CHESTIONARUL SCHEMELOR COGNITIVE
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YSQ-S3

InstrucĠiuni: lista de mai jos cuprinde afirmaĠii folosite de o persoana pentru a se descrie pe
sine. Vă rugăm citiĠi cu atenĠie fiecare afirmaĠie úi decideĠi cât de bine vă descrie pe dvs..
Când nu sunteĠi sigur/ă, răspundeĠi în funcĠie de ceea ce simĠiĠi úi nu în funcĠie de ceea ce
credeĠi că este adevărat. AlegeĠi valoarea dintre 1 úi 6 care credeĠi că vă descrie cel mai bine
si scrieĠi numărul în locul din faĠa afirmaĠiei.

1 – total neadevărat în ceea ce mă priveúte

2 – de cele mai multe ori neadevărat în ceea ce mă priveúte
3 - mai degrabă fals decât adevărat în ceea ce mă priveúte
4 – mai degrabă adevărat decât fals în ceea ce mă priveúte
5 – de cele mai multe ori adevărat în ceea ce mă priveúte
6 – mă descrie perfect

1___ În general nu am avut pe cineva care să se îngrijească de mine, căreia (căruia) să-i
împărtăúesc din viaĠa mea, sau căreia (căruia) să-i pese mult de tot ceea ce se întâmpla cu
mine.
2___ M-am agăĠat de cei apropiaĠi mie pentru că m-am temut că mă vor părăsi.
3__ Simt că oamenii vor profita de mine.
4___ Nu-mi găsesc locul nicăieri.
5___ Nici o femeie/bărbat pe care o/îl doresc nu mă poate iubi odată ce îmi va vedea
defectele.
6___Este important pentru mine să fiu plăcut(ă) de aproape toată lumea pe care o útiu.
7___Chiar si când lucrurile par să meargă bine, eu cred că este doar temporar.
8___Dacă fac o greúeală, merit să fiu pedepsit(ă).
9___ Aproape orice din activităĠile mele de la úcoala sau la serviciu nu este atât de bine făcut
ca a celorlalĠi.
10___ Nu mă simt capabil(ă) să mă descurc singur(ă) în fiecare zi a vieĠii mele.
11___Nu pot scăpa de sentimentul ca ceva rău este pe cale sa se întâmple.
12___Nu am fost în stare sa mă despart de părinĠii mei în felul in care o fac ceilalĠi de vârsta
mea.
13___Cred că dacă fac ceea ce cred, dau numai de necazuri.
14___Mă schimb in funcĠie de oamenii cu care sunt pentru ca ei să mă placă mai mult.
15___Dacă uneori se întâmpla ceva bun, mi-e teama că ceva rău va urma.
16___Dacă nu fac tot ce pot, pot sa mă aútept să pierd.
17___Sunt genul care de obicei sfârúeúte prin a avea grija de cei apropiaĠi mie.
18___Sunt prea conútiincios (conútiincioasă) să arăt sentimente pozitive faĠă de ceilalĠi
(afecĠiune, preocupare).
19___Trebuie să fiu cel mai bun în tot ce fac; nu accept sa fiu al doilea dintre cei mai buni.
20___Am probleme când trebuie sa accept „nu” ca răspuns când vreau ceva de la ceilalĠi.
21___Nu mă pot motiva să îndeplinesc sarcini plictisitoare úi de rutina.
22___Încerc sa mă adaptez.
23___Nu poĠi fi totdeauna atent; ceva rău va apărea întotdeauna.
24___Nu există nici o scuză dacă fac o greúeală.
25___ În general oamenii nu au fost lângă mine ca să îmi ofere căldură, sprijin úi dragoste.
26___ Am atâta nevoie de ceilalĠi încât mă îngrijorez că îi voi pierde.
27__ Simt că nu trebuie să las garda jos în prezenĠa altor oameni pentru că altfel mă vor răni
intenĠionat.
28___ Sunt fundamental diferit(ă) de ceilalĠi oameni.
29___ Nici unul din cei pe care îi doresc eu nu va putea sa stea lângă mine odată ce mă va
cunoaúte cu adevărat.
30___Stima mea se bazează mai ales pe felul cum mă vad ceilalĠi.
31___Oricât de mult aú munci, mi-e teama că aú putea să fiu falit(ă) financiar.
32___Oamenii care nu-úi cunosc limitele îndeajuns ar trebui pedepsiĠi în vreun fel.
33___Sunt incompetent(ă) când este vorba de realizări.
34___Mă gândesc la mine ca úi la o persoană dependentă când este vorba de viaĠa de zi cu
zi.

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CHESTIONARUL SCHEMELOR COGNITIVE
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35___Simt că un dezastru (natural, chimic, medical sau criminal) se poate întâmpla în orice
moment.
36___PărinĠii mei úi cu mine tindem să ne implicăm în viaĠa úi problemele celuilalt.
37___Simt că nu am altă posibilitate decât să îndeplinesc dorinĠele altora, altfel mă vor
respinge.
38___Să am bani úi să útiu lume bună mă face sa fiu mai valoros(valoroasă).
39___Mă îngrijorez de faptul că o decizie greúită poate duce la dezastru.
40___In general nu accept scuzele altora. Ei nu sunt doritori să accepte responsabilităĠi úi să
suporte consecinĠele.
41___Sunt o persoană bună deoarece mă gândesc la alĠii mai mult decât la mine.
42___Mi se pare jenant să-mi exprim sentimentele altora.
43___Încerc să fac tot ce pot; nu mă mulĠumesc cu suficient.
44___Sunt deosebit(ă) úi nu trebuie să accept restricĠii puse de ceilalĠi.
45___Daca nu îmi pot atinge un scop devin repede frustrat(ă) úi renunĠ.
46___Petrec mult timp pentru aspectul fizic, pentru ca oamenii sa mă valorifice.
47___Sunt obsedat(ă) des de deciziile minore deoarece consecinĠele unei greúeli par
serioase.
48___Dacă nu îmi fac treaba ar trebui să sufăr consecinĠele.
49___ Foarte mult timp din viaĠa mea nu am simĠit că sunt special(ă) pentru cineva.
50___ Mă tem că oamenii de care mă simt apropiat(ă) mă vor părăsi sau abandona.
51__ Este doar o problemă de timp ca cineva să ajungă să mă trădeze (să mă înúele).
52___ Locul meu nu e aici; sunt singuratic(ă).
53___ Nu merit dragostea, atenĠia úi respectul celorlalĠi.
54___Realizările sunt mai valoroase pentru mine dacă oamenii le observă.
55___Mă simt mai bine pretinzând că lucrurile nu-mi vor merge bine, ca să nu mă simt rău
dacă lucrurile nu merg bine.
56___Mă gândesc des la greúelile pe care le fac úi sunt furios(ă) pe mine.
57___ Majoritatea celorlalĠi sunt mai capabili decât mine în domeniile profesionale úi în
realizări.
58___ Sunt mai puĠin capabil decât majoritatea oamenilor.
59___Mă tem ca o sa fiu atacat(ă).
60___Este foarte greu pentru mine úi părinĠii mei să păstram detalii intime despre celalalt fără
să ne simĠim vinovaĠi úi înúelaĠi.
61___In relaĠii, las pe cealaltă persoana sa aibă un cuvânt de spus.
62___Sunt atât de preocupat(ă) să mă adaptez, încât uneori uit cine sunt eu.
63___Mă concentrez mai ales asupra evenimentelor úi situaĠiilor de viată negative.
64___Când oamenii fac ceva rău am probleme să aplic expresia: „Iartă si uita”.
65___Sunt atât de ocupat(ă) să mă ocup de oamenii de care îmi pasă, încât am puĠin timp
pentru mine.
66___Mi se pare greu să arăt căldura úi spontaneitate.
67___Trebuie sa-mi îndeplinesc toate responsabilităĠile.
68___Detest să fiu constrâns sau reĠinut din ceea ce vreau eu sa fac.
69___Nu sacrific satisfacĠia imediată pentru obĠinerea unui scop îndepărtat.
70___Mi se pare greu să-mi fixez propriile scopuri fără să mă gândesc cum ceilalĠi vor
răspunde alegerilor mele.
71___Tind să fiu pesimist(ă).
72___Port pică chiar dacă persoana s-a scuzat.
73___ În cea mai mare parte a timpului nu am avut pe cineva care să mă asculte într-adevăr,
care să mă înĠeleagă, sau care să investească în mine sentimente adevărate.
74___ Când simt că cineva la care Ġin se îndepărtează de mine, devin disperat(ă).
75___ Sunt destul de suspicios (suspicioasă) în privinĠa motivelor altora.
76___ Mă simt străin(ă) de ceilalĠi oameni.
77___ Simt că nu pot fi iubit(ă).
78___Când mă uit la deciziile din viaĠa mea îmi dau seama că le-am făcut pe majoritatea cu
gândul la aprobarea de către ceilalĠi.
79___Oamenii apropiaĠi mie, mă consideră îngrijorat(ă).
80___Mă supăr când cred că cineva a renunĠat prea repede.
81___ Nu sunt atât de talentat cum sunt ceilalĠi la munca.
82___Judecata mea nu poate fi bună in toate situaĠiile de zi cu zi.
83___Mă tem ca o sa-mi pierd toĠi banii úi o sa devin un(o) nevoiaú(ă).

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CHESTIONARUL SCHEMELOR COGNITIVE
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84___Simt des că daca părinĠii mei trăiesc prin mine, nu mai am viaĠa mea pe cont propriu.
85___Întotdeauna îi las pe ceilalĠi să ia decizii pentru mine, deci nu útiu ce vreau pentru mine.
86___Chiar dacă nu îmi place cineva tot vrea ca el(ea) să mă placă.
87___Dacă oamenii se entuziasmează de ceva, mă simt inconfortabil úi simt că i-aú avertiza
că ceva merge greúit.
88___Mă enervez când oamenii se scuză úi îi învinuiesc pe ceilalĠi pentru problemele lor.
89___Întotdeauna am fost genul care a ascultat problemele altora.
90___Mă controlez atât de mult că oamenii cred ca nu am emoĠii.
91___Simt ca este o presiune constantă asupra mea să îndeplinesc úi să realizez diferite
lucruri.
92___Simt că nu trebuie să urmez regulile normale úi convenĠiile pe care ceilalĠi le fac.
93___Nu mă pot forĠa să fac lucruri care nu îmi plac, chiar când útiu că este pentru binele
meu.
94___Când nu primesc multă atenĠie din partea altora mă simt puĠin important(ă).
95___Nu contează de ce fac o greúeala; când fac ceva greúit trebuie sa plătesc.
96___ Rar am avut o persoană care să mă sfătuiască sau care să mă îndrume când nu am
útiut ce să fac.
97__ Câteodată sunt atât de îngrijorat(ă) că oamenii mă părăsesc încât îi îndepărtez eu de
mine.
98___ De obicei sunt vigilent(ă) faĠă de motivele pe care oamenii le au.
99___ Întotdeauna mă simt înafara grupului.
100___ Am prea multe defecte de neacceptat în foarte multe aspecte pentru a mă lăsa
cunoscut(ă) altora.
101___ Caut recunoaútere úi admiraĠie atunci când îmi spun părerea la o întâlnire sau
întrunire. .
102___Mă lupt cu mine însumi (însămi) pentru lucrurile în care am eúuat.
103___ Nu sunt atât de inteligent(ă) ca úi ceilalĠi când este vorba de scoală sau serviciu.
104___Nu am încredere in capacitatea mea de a rezolva toate problemele care apar.
105___Mă tem ca am o boala grava, deúi nu a fost diagnosticat nimic grav de către doctor.
106___Simt des că nu am o identitate separată de a părinĠilor mei sau de a partenerului
(partenerei) meu (mele).
107___Am o mulĠime de probleme când cer sa-mi fie respectate drepturile úi să-mi fie luate în
seamă sentimentele.
108___Complimente úi recompensări multe mă fac sa mă simt valoros (valoroasă).
109___Sunt o persoană rea care merită să fie pedepsită.
110___CeilalĠi oameni mă cunosc ca făcând prea mult pentru alĠii úi nu destul pentru mine.
111___Oamenii mă vad inflexibil(ă) din punct de vedere emoĠional.
112___Nu pot să-mi cer scuze pentru greúelile mele.
113___Simt că ceea ce am de oferit are mai mare valoare decât contribuĠiile altora.
114___Rar am fost în stare să mă bazez pe propriile mele hotărâri.

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CHESTIONARUL SCHEMELOR COGNITIVE
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YSQ-S3 – FIùA DE COTARE

Deprivare EmoĠională (ED)

1 _____ 25 _____ 49 _____ 73 _____ 96 _____ Total_____

Abandon (AB)
2 _____ 26 _____ 50 _____ 74 _____ 97 _____ Total ____

Neîncredere / Abuz (MA)

3 _____ 27 _____ 51 _____ 75 _____ 98 _____ Total ____

Izolare Socială / Înstrăinare (SI)

4 _____ 28 _____ 52 _____ 76 _____ 99 _____ Total ____

Defect / Ruúine (DS)

5 _____ 29 _____ 53 _____ 77 _____ 100 _____Total ____

Eúec (FA)
9 _____ 33 _____ 57 _____ 81 _____ 103 _____Total____

DependenĠă / IncompetenĠă (DI)

10 _____ 34 _____ 58 _____ 82 _____ 104 _____Total ____

Vulnerabilitate la rău úi boală (VH)

11 _____ 35 _____ 59 _____ 83 _____ 105 _____Total ____

ProtecĠionism / Ego infantil (EM)

12 _____ 36 _____ 60 _____ 84 _____ 106 _____Total____

Subjugarea (SB)
13 _____ 37 _____ 61 _____ 85 _____ 107 _____Total ____

Auto-sacrificiu (SS)
17 _____ 41 _____ 65 _____ 89 _____ 110 _____Total ____

InhibiĠie emoĠională (EI)

18 _____ 42 _____ 66 _____ 90 _____ 111 _____Total____

Standarde Nerealiste / Hipercriticism (US)

19 _____ 43 _____ 67 _____ 91 _____ 112 _____Total____

Revendicare / Grandomanie (ET)

20 _____ 44 _____ 68 _____ 92 _____ 113 _____Total ___

Autocontrol / auto-disciplină insuficientă (IS)

21 _____ 45 _____ 69 _____ 93 _____ 114 _____Total____

Căutarea aprobării / Recunoaúterii (AS)

6 _____ 14 _____ 22 _____ 30 _____ 38 _____46 _____
54 _____ 62 _____ 70 _____ 78 _____ 86 _____94 _____
101 _____ 108 _____ Total _____

Negativism / Pasivitate (NP)

7 _____ 15 _____ 23 _____ 31 _____ 39 _____47_____
55 _____ 63 _____ 71 _____ 79 _____ 87 _____ Total _____

Penalizarea (PU)
8 _____ 16 _____ 24 _____ 32 _____ 40 _____48 _____
56 _____ 64 _____ 72 _____ 80 _____ 88 _____95 _____
102 _____ 109 _____ Total _____

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SCALA DE ATITUDINI DISFUNCğIONALE, FORMA A

SCALA DE ATITUDINI DISFUNCğIONALE, FORMA A

(DYSFUNCTIONAL ATTITUDES SCALE, FORM A)
Copyright © Daniel David (pentru versiunea în limba română)

INTRODUCERE
Depresia clinică este o condiĠie diferită de stările de tristeĠe care survin uneori în viaĠa
fiecăruia dintre noi. Conform DSM IV-R (2000), persoanele afectate de depresie clinică se
simt triste úi fără speranĠă săptămâni de-a rândul. De cele mai multe ori, acestea îúi pierd
interesul în lucrurile care înainte le făceau plăcere úi au probleme cu somnul úi alimentaĠia.
Totodată, le vine greu să depună efortul de a găsi soluĠii la problemele pe care le au, iar
uneori nu se pot concentra suficient nici măcar pentru activităĠile cotidiene. De regulă,
persoanele deprimate petrec multe ore gândindu-se la sinucidere, moarte sau la faptul că le-
ar fi mai bine dacă nu ar mai exista. Aceste simptome sunt asemănătoare cu cele întâlnite la
persoanele care trec prin situaĠii de doliu, însă în cazul depresiei clinice fie lipsesc
evenimentele de pierdere, fie manifestările durează cu mult mai mult decât ar fi normal în
astfel de situaĠii. Manifestările menĠionate produc dificultăĠi majore de adaptare, tulburarea
depresivă majoră constituind úi una dintre cauzele importante de deces, în asociere cu ideaĠia
suicidară.
Printre cele mai eficiente metode de tratament în tulburarea depresivă majoră se
numără intervenĠiile cognitiv-comportamentale. Elementul central care diferenĠiază abordările
cognitiv-comportamentale de celelalte abordări psihoterapeutice este conceptualizarea
cognitivă a problemelor psihice. Conceptualizarea cognitivă oferă cadrul de interpretare úi
explicare a modului în care au apărut úi s-au menĠinut problemele pacientului. Terapiile
cognitiv-comportamentale pleacă de la asumpĠia că emoĠiile úi problemele emoĠionale ale
oamenilor provin din modul în care aceútia interpretează úi gândesc asupra situaĠiilor de viaĠă
(Ellis, 1994; Beck, 1995).
Perspectiva lui Aaron Beck asupra depresiei (Beck, 1967; Beck, Rush, Emery úi
Shaw, 1979) porneúte de la asumpĠia că depresivii au scheme de sine biasate negativ, care
filtrează informaĠia pozitivă în avantajul aspectelor negative. O schemă cognitivă este o
structură de cunoútinĠe care interacĠionează cu informaĠiile noi, orientând selectiv atenĠia,
expectanĠele, interpretările úi reactualizarea din memorie (Williams,Watts, MacLeod úi
Mathews, 1997). Aspectele relevante asociate cu sinele se structurează o dată cu experienĠa
personală; în timp, anumite elemente centrale sunt interrelaĠionate cu un număr mare de
informaĠii, devenind astfel mai accesibile. Astfel, ele ajung să ghideze modul în care sunt
interpretate situaĠiile ambigue, precum úi codarea úi reactualizarea din memorie a informaĠiei
încărcate emoĠional (Williams úi colab., 1997). În timp ce schemele se prezintă ca structuri
cognitive existente în mintea persoanei, credinĠele centrale (i.e., „core beliefs”) sunt
conĠinuturile specifice ale schemelor respective (Beck, 1964).

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SCALA DE ATITUDINI DISFUNCğIONALE, FORMA A
În cadrul teoriei cognitive asupra depresiei (Beck úi colab., 1979) schemele de tip
depresiv úi credinĠele centrale constituie structuri latente, care pot fi activate de evenimentele
de viaĠă stresante. O dată activate, aceste structuri cognitive susĠin generarea de gânduri
automate. Modelul cognitiv al lui A. Beck postulează faptul că depresivii gândesc mai negativ
despre sine, lume úi viitor decât persoanele neafectate de această tulburare. Această
perspectivă negativă asupra vieĠii – exprimată în sintagma „triadă cognitivă negativă” stă în
spatele simptomelor specifice tulburării depresive majore (Beck, 1967, 1976, 1987). O dată
activate, schemele disfuncĠionale produc erori sistematice în gândire. Câteva dintre
distorsiunile tipice în cazul persoanelor cu depresie sunt:
(1) Gândirea de tip „ totul sau nimic” – tendinĠa de a gândi în termeni extremi sau
absolutiúti.
(2) InferenĠa arbitrară - tendinĠa de a trage concluzii negative în absenĠa unor date care
să le susĠină.
(3) Abstractizarea selectivă - tendinĠa de a se focaliza pe detalii negative fără a acorda
importanĠă unor aspecte semnificative ale unei situaĠii/probleme.
(4) Maximizare / Minimizare – tendinĠa de a exagera importanĠa evenimentelor negative
úi de a minimiza semnificaĠia evenimentelor pozitive.
(5) Etichetarea úi generalizarea excesivă - tendinĠa de a trage concluzii negative globale
pe baza unui singur exemplu/fapt sau a unui incident/caz izolat, ignorând aspectele
care ar putea sugera o concluzie alternativă.

Atitudinile disfuncĠionale reflectă conĠinutul schemelor cognitive stabile (Beck, Brown,

Steer, úi Weissman, 1991). O serie de studii anterioare (Dent úi Teasdale, 1988; Marton,
Churchard úi Kutcher, 1993; Weich, Churchill úi Lewis, 2003) au demonstrat că atitudinile
disfuncĠionale se asociază cu prezenĠa simptomatologiei de tip depresiv.

CE MĂSOARĂ SCALA?
Scala de atitudini disfuncĠionale (DAS - Weissman, 1979; Weissman úi Beck, 1978)
este un instrument care permite evaluarea atitudinilor ce pot constitui o predispoziĠie pentru
instalarea depresiei.
Forma iniĠială a scalei avea 100 de itemi, transformată ulterior în două forme paralele
a 40 de itemi fiecare (DAS-A úi DAS-B). Utilizând un lot clinic cu tulburări de anxietate úi
afective de 2.023 de subiecĠi, Beck, Brown, Steer úi Weissman (1991) au arătat că structura
factorială a formei originale includea nouă factori principali: (1) vulnerabilitate, (2) aprobare,
(3) perfecĠionism, (4) nevoia de a-i mulĠumi pe ceilalĠi, (5) evitarea slăbiciunilor, (6) controlul
emoĠiilor, (7) dezaprobarea, (8) cerinĠele absolutiste úi (9) nevoia de a-i impresiona pe ceilalĠi.
Analizele factoriale efectuate pe cele două forme paralele relevă structuri diferite, în
funcĠie de populaĠia Ġintă. Astfel, Cane, Olinger, Gotlib úi Kuiper (1986) au analizat forma A a
DAS folosind un grup nonclinic de 664 de studenĠi úi au găsit doi factori pe care i-au numit
„evaluarea performanĠelor” (peformance evaluation) úi „aprobare din partea celorlalĠi”

2
SCALA DE ATITUDINI DISFUNCğIONALE, FORMA A
(approval by others). Un an mai devreme, în 1985, Oliver úi Baumgart au administrat ambele
forme ale DAS unui grup de 275 de persoane format din personal medical úi soĠii/soĠiile
acestora úi au constatat o lipsă de echivalenĠă factorială între cele două forme ale scalei. În
1984, Parker, Bradshaw úi Blignault au aplicat ambele forme ale scalei pe două grupe (117 úi
126 subiecĠi) de pacienĠi ai unor medici de familie úi au identificat patru factori: „stimă de sine
externalizată” (externalized self-esteem), „stimă de sine anaclitică ” (anaclitic self-esteem),
„incertitudine” (tentativeness) úi „nevoia de aprobare” (need for approval). Rezultatele
obĠinute utilizând loturi de persoane în vârstă indică faptul că tendinĠele identificate la
persoanele tinere nu persistă la această grupă de vârstă. Mai mult, structurii factoriale
obĠinute pe loturile de vârstnici îi lipseúte consistenĠa, fiind relevaĠi în aceeaúi măsură unul,
doi sau chiar trei factori (Floyd, Scogin úi Chaplin, 2004).

DESCRIEREA ITEMILOR
Cei 40 de itemi ai scalei sunt formulaĠi ca afirmaĠii care stau, în general, la baza
gândirii idiosincratice tipic depresive. Răspunsul la fiecare item oferă informaĠii referitoare la
atitudinile disfuncĠionale ale persoanei, care funcĠionează ca scheme prin intermediul cărora
persoana îúi construieúte realitatea (Weissman úi Beck, 1978).
Spre exemplu, itemul 4 - „Dacă nu reuúesc să fac totul bine de fiecare dată, nu voi fi
respectat de ceilalĠi” reflectă o atitudine disfuncĠională úi este evaluat pe o scală Lickert de la
1-7, unde:
1 = sunt cu totul de acord
2 = sunt în mare măsură de acord
3 = sunt întrucâtva de acord
4 = sunt neutru
5 = sunt întrucâtva în dezacord
6 = sunt în mare măsură în dezacord
7 = sunt în dezacord total

Scala DAS-A, indică măsura în care atitudinile disfuncĠionale sunt considerate ca fiind
proprii gândirii subiectului: cu cât scorul total este mai mare, cu atât nivelul atitudinilor
disfuncĠionale este mai mare.

ADMINISTRARE ùI COTARE
Scala se administrează în varianta creion-hârtie, atât individual, cât úi în grup. În
cazul administrării în grup, este indicat ca grupurile să nu fie mai mari de 15 persoane. Se
recomandă administrarea individuală ori de câte ori este posibil. Când grupul este mai mare
de 15 persoane, numărul examinatorilor trebuie să crească, păstrându-se raportul de un
examinator la maximum 15 persoane evaluate.

3
SCALA DE ATITUDINI DISFUNCğIONALE, FORMA A

Materiale necesare
ƒ Scala cu instrucĠiunile de completare;
ƒ Foaia de răspuns;
ƒ Instrument de scris.

CondiĠii de administrare
ƒ Mediu securizant úi ferit de zgomote;
ƒ Persoana examinată să fie motivată pentru completarea scalei úi odihnită;
ƒ Mobilier úi iluminare adecvate, care să permită subiectului examinat
completarea în condiĠii bune a foii de răspuns;
ƒ În cazul aplicării în grup, sala trebuie să fie suficient de mare pentru a oferi
confort persoanelor examinate.

InstrucĠiuni de aplicare
Scala se administrează fără limită de timp.
După ce materialele úi condiĠiile necesare pentru administrarea scalei sunt asigurate,
persoanei examinate i se spune:
Acest chestionar cuprinde o serie de atitudini úi convingeri pe care unele
persoane le au în diverse situaĠii. CitiĠi cu atenĠie fiecare afirmaĠie úi decideĠi în ce
măsură sunteĠi sau nu de acord cu ea. UtilizaĠi pentru fiecare afirmaĠie, din scala
prezentată mai jos, cifra care corespunde în cea mai mare măsură modului în care
gândiĠi. AlegeĠi un singur răspuns pentru fiecare afirmaĠie în parte. Deoarece oamenii
sunt diferiĠi, nu există răspunsuri corecte sau greúite. Pentru a vă asigura că o anumită
atitudine vă caracterizează, aveĠi în vedere modul în care gândiĠi în cea mai mare parte
a timpului (în general).

Cotarea răspunsurilor
Fiecare item al DAS-A este cotat pe o scală Lickert de la 1 la 7.
Variantele de răspuns sunt:
1 = sunt cu totul de acord
2 = sunt în mare măsură de acord
3 = sunt întrucâtva de acord
4 = sunt neutru
5 = sunt întrucâtva în dezacord
6 = sunt în mare măsură în dezacord
7 = sunt în dezacord total
În funcĠie de conĠinut, itemii sunt cotaĠi direct sau invers.
Următorii itemi sunt cotaĠi ca fiind adaptativi dacă răspunsul merge spre aprobare sau
acord total (itemi cotaĠi direct):

4
SCALA DE ATITUDINI DISFUNCğIONALE, FORMA A
Forma A: itemii
2 29
6 30
12 35
17 37
24 40

CeilalĠi itemi ai scalei sunt cotaĠi în direcĠia inversă:

7 = sunt cu totul de acord
6 = sunt în mare măsură de acord
5 = sunt întrucâtva de acord
4 = sunt neutru
3 = sunt întrucâtva în dezacord
2 = sunt în mare măsură în dezacord
1 = sunt în dezacord total

Itemii care au fost omiúi se cotează cu zero. Dacă subiectul omite să dea răspunsuri
la un număr mare de itemi, atunci testul nu se ia în considerare. Scorul maxim posibil este
280 (7x40 itemi), iar scorul minim posibil este 40 (1x40 itemi). Cu cât scorul total este mai
mare, cu atât nivelul atitudinilor disfuncĠionale este mai mare.

FIDELITATE ùI VALIDITATE
Fidelitate

Fidelitatea unui test psihologic se referă la acordul sau stabilitatea aúteptată a

măsurilor analoge. Dacă un instrument este fidel, atunci rezultatele obĠinute în condiĠii
similare prezintă o anumită stabilitate în timp (Dempster úi Brainerd, 1995).
Fidelitatea unui instrument de măsurare este cel mai adesea exprimată pe baza
consistenĠei interne úi a stabilităĠii în timp a rezultatelor (Anastasi, 1988).
ConsistenĠa internă a unei scale se referă la măsura în care toĠi itemii scalei măsoară
aceeaúi variabilă. Stabilitatea rezultatelor testării ne indică în ce măsură la aplicări diferite în
timp un subiect obĠine rezultate similare la un test sau scală.
Într-un studiu pe populaĠie de limbă engleză, Weissman úi Beck (1978) găsesc un
coeficient de fidelitate (Alfa Cronbach) de 0.89 pentru ambele forme úi o corelaĠie de 0.81
între DAS-A úi DAS-B.
Fidelitatea DAS-A a fost estimată prin calculul coeficientului de consistenĠă internă
Alfa Cronbach. Eúantionul utilizat a fost de 682 subiecĠi, valoarea Alfa obĠinută fiind de .86
(Tabelul 1). Această valoare indică o consistenĠă internă bună, ceea ce exprimă faptul că
itemii testului evaluează acelaúi construct descris de Beck (1976)– atitudinile disfuncĠionale
asociate cu depresia.

5
SCALA DE ATITUDINI DISFUNCğIONALE, FORMA A
Tabelul 1. Statistici descriptive úi indicii Alfa Cronbach de consistenĠă internă pentru scorurile
la DAS-A

DAS-A Adults (vârsta cuprinsă între 15-73 ani, m=34.42 )

Femei BărbaĠi SubiecĠi lipsă Total
date sex
Scor total M 131.32 136.50 93.87 125.92
A.S. 24.11 24.16 27.09 28.87
N 398 163 121 682
D .81 .79 .84 .86

Validitate
Validitatea este o caracteristică a unui test (sau scală) care arată măsura în care
acesta măsoară ceea ce se spune că măsoară. Altfel spus, validitatea se referă la măsura în
care inferenĠele pe care le facem pornind de la rezultatele obĠinute la un test sunt corecte
(Messick, 1995).
Validitatea de conĠinut se referă la examinarea sistematică a itemilor testului/scalei
pentru a vedea dacă ei acoperă un eúantion reprezentativ al domeniului pe care dorim să îl
măsurăm. În elaborarea celor două forme ale DAS (A úi B) s-a pornit de la formularea a 100
de itemi pornind de la teoria lui A. Beck asupra depresiei úi a distorsiunilor cognitive
subiacente (Beck, 1967; Beck úi colab, 1979). Scala a fost astfel concepută încât itemii săi să
acopere diferitele categorii de atitudini disfuncĠionale. Spre exemplu, un item de tipul „Dacă o
persoană pe care o iubesc nu mă iubeúte, înseamnă că sunt un nimeni” se referă la
etichetare úi generalizare excesivă. Ulterior unor studii de analiză factorială, cei 100 de itemi
au stat la baza elaborării celor două forme paralele, A úi B.

Validitatea de construct se referă la măsura în care testul/scala reflectă constructul pe

care îl măsoară. În cazul testelor utilizate pentru măsurare, validarea relativă la criteriu este o
componentă a validării relative la constructul măsurat (Albu, 1998). Ea apreciază „gradul în
care rezultatele furnizate de test corelează cu rezultatele altui instrument de evaluare despre
care se presupune că măsoară acelaúi construct sau unul similar” (Haynes, apud Silva,
1993).
Într-un studiu efectuat pe populaĠie românească (Macavei, 2006 – lucrare
nepublicată) s-a încercat determinarea măsurii în care atitudinile disfuncĠionale (măsurate cu
DAS-A) se asociază cu anumite emoĠii úi cogniĠii specifice, conform modului teoretic propus
de Aaron Beck (Beck, 1967; Beck úi colab, 1979). AsumpĠia de bază a modelului amintit este
că la baza problemelor de tip emoĠional úi comportamental stau distorsiunile cognitive
(atitudinile úi schemele dezadaptative). Atunci când cineva deĠine credinĠe adaptative despre
sine, lume úi viitor va trăi emoĠii pozitive sau negative, însă nu va trăi emoĠii invalidante.
Astfel, dacă asumpĠiile modelului sunt corecte, ne aúteptăm să găsim:

6
SCALA DE ATITUDINI DISFUNCğIONALE, FORMA A
1. o asociere pozitiv între atitudinile disfuncĠionale úi anxietate úi depresie ca sindrom
ă
(manifestări de ordin emoĠional, comportamental, fiziologic, cognitiv);
2. o asociere pozitivă între atitudinile disfuncĠionale úi emoĠiile negative;
3. o asociere pozitivă între atitudinile disfuncĠionale măsurate cu DAS-A úi alte credinĠe
dezadaptative;
4. o asociere negativă între atitudinile disfuncĠionale úi acceptarea necondiĠionată a
propriei persoane;

La studiu au participat în total 701 subiecĠi; o parte dintre aceútia au fost studenĠi
recompensaĠi pentru participare prin recunoaúterea unor activităĠi de profil prevăzute în
curricula úcolară. CeilalĠi subiecĠi au fost incluúi în studiu pe bază de voluntariat, în urma unor
anunĠuri publice. Pentru participarea persoanelor cu vârste sub 18 ani s-a cerut acordul unui
părinte sau tutore legal. Datele statistice oferite mai jos reflectă úi faptul că unii dintre
participanĠii la studiu au omis sau refuzat să ofere informaĠii complete vizând nivelul
educaĠional, vârsta, statutul marital etc.

Tabelul 2. Date statistice privind subiecĠii incluúi în studiu

Nivel educaĠional N = 701 100 %

ùcoală primară = 22 (3.1 %)

ùcoală profesională = 28 (4.0 %)
Liceu = 222 (31.7 %)
ùcoală postliceală = 60 (8.6 %)
Facultate = 346 (49.3 %)
Studii postuniveristare = 19 (2.7 %)
Altceva = 4 (0.6 %)
Vârsta N = 695 Sex N = 574
Date lipsă N=6 Date lipsă N=127
M= 34.42 Min.= 15 BărbaĠi = 169
Max.= 73 Femei = 405

Statut marital N = 567

Date lipsă N=134
Căsătorit = 326
Necăsătorit = 241

Instrumentele utilizate au fost:

Scala de atitudini disfuncĠionale – DAS-A (Dysfunctional Attitudes Scale – form A -
Weissman, 1979; Weissman úi Beck, 1978) este un instrument de 40 de itemi care permite
evaluarea prezenĠei atitudinilor/credinĠelor disfuncĠionale associate simptomatologiei de tip
depresiv.
Inventarul de depresie Beck – BDI (Beck Depression Inventory - Beck, Rush, Shaw,
úi Emery, 1979) conĠine 21 de itemi úi a fost utilizat pentru identificarea prezenĠei

7
SCALA DE ATITUDINI DISFUNCğIONALE, FORMA A
simptomatologiei de tip depresiv, exprimată prin emoĠii, comportamente, credinĠe úi
manifestări fiziologice specifice.
Scala de atitudini úi convingeri 2 – ABS2 (Attitudes and Beliefs Scale 2 -DiGiuseppe,
Leaf, Exner, úi Robin, 1988) este formată din 72 de itemi úi este un instrument valid pentru
identificarea prezenĠei credinĠelor iraĠionale úi raĠionale centrale teoriei raĠional-emotive úi
comportamentale. Varianta în limba română a scalei prezintă proprietăĠi psihometrice bune
(Macavei, 2002).
Chestionarul de acceptare necondiĠionată a propriei persoane – USAQ
(Unconditional Self-Acceptance Questionnaire - Chamberlain úi Haaga, 2001) este format din
20 de itemi úi măsoară acceptarea necondiĠionată a propriei persoane, ca factor protectiv
care previne declanúarea anumitor forme de psihopatologie la contactul cu situaĠiile negative
de viaĠă.
Profilul distresului emoĠional – PDE (Profile of Emotional Distress- Opriú úi Macavei,
2005) este un instrument de 26 de itemi care măsoară prezenĠa emoĠiilor negative funcĠionale
úi disfuncĠionale (ca anxietatea, îngrijorarea, deprimarea, tristeĠea); utilizează principiul de
construcĠie al Profilului dispoziĠiilor afective, forma scurtă (DiLorenzo, Bovbjerg, Montgomery,
Valdimarsdottir, úi Jacobsen, 1999) úi se bazează pe teoria lui Albert Ellis asupra distresului
emoĠional (Ellis, 1994). Instrumentul are proprietăĠi psihometrice bune (Opriú úi Macavei, sub
tipar).
Profilul dispoziĠiilor afective – forma scurtă – POMS-SV (Profile of Mood States—
Short Version - Shacham 1983) este un instrument de 47 de itemi care măsoară emoĠiile
positive úi negative.
Chestionarul gândurilor automate –ATQ (Automatic Thoughts Questionnaire - Hollon
úi Kendall, 1980) conĠine 30 de itemi care reflectă gândirea e tip depresiv.
State and Trait Anxiety Inventory – STAI-X1 úi STAI-X2 (Inventarul de anxietate ca
stare úi trăsătură - Spielberger, 1983). ) este alcătuit din 2 scale de autoevaluare a câte 20 de
itemi fiecare pentru măsurarea a două aspecte distincte privind anxietatea. Starea de
anxietate (A-stare) úi anxietatea ca trăsătură (A-trăsătură).

Procedura de lucru a implicat în prima fază solicitarea consimĠământului de

participare la studiu, după care subiecĠii au fost completat individual câte un pachet conĠinând
instrumentele menĠionate anterior, fără limită de timp.
Rezultatele arată că prezenĠa atitudinilor disfuncĠionale se asociază pozitiv cu alte
distorsiuni cognitive (ex. gânduri automate negative, credinĠele iraĠionale), cu emoĠii negative,
cu anxietate úi depresie. De asemenea, există o asociere negativă între atitudinile
disfuncĠionale pe de o parte úi acceptarea necondiĠionată a propriei persoane úi emoĠiile
pozitive pe de altă parte.

8
SCALA DE ATITUDINI DISFUNCğIONALE, FORMA A
Tabelul 3. CorelaĠii (r-Person) între scorurile la DAS-A úi scorurile la alte instrumente de
evaluare a cogniĠiilor úi emoĠiilor funcĠionale/disfuncĠionale.

DAS-A
1 PDE – scor total (N= 539) .26
2 PDE – tristeĠe (N= 555) .21
3 PDE – deprimare (N = 555) .27
4 PDE – anxietate (N= 554) .25
5 PDE – îngrijorare (N= 558) .19
6 PDE – emoĠii negative funcĠionale (N= 551) .22
7 PDE – emoĠii negative disfuncĠionale (N= 548) .28
8 BDI (N= 230) .50
9 USAQ (N= 234) -.69
10 ATQ (N= 231) .52
11 ABS2 – IB (N= 220) .77
12 POMS-VS – scor total (N= 215) .47
13 POMS-VS – emoĠii negative (N= 220) .45
14 POMS-VS – emoĠii pozitive (N= 230) -.36
15 STAI X1 .45
16 STAI X2 .55
* toate corelaĠiile sunt semnificative la p.05

Pentru a evalua capacitatea DAS-A de a discrimina între persoane cu un nivel ridicat

úi scăzut al emoĠiilor negative, au fost create grupe extreme prin adăugarea úi scăderea 1
A.S. la úi de la medie. În tabelul 4, grupul „mediu” include scorurile aflate între cele două
extreme.

Tabelul 4. Statistică descriptivă pentru scalele utilizate la crearea grupelor extreme

Instrument m A.S. N Grupul Grupul
cu cu
scoruri scoruri
scăzute ridicate
PDE- scor total 49.80 18.77 782  31 ! 69
PDE – scala de depresie 12.71 6.28 811 6 ! 19
POMS-VS scor total 50.05 29.61 224  20 ! 80

Pentru toate modalităĠile de evaluare a emoĠiilor negative, diferenĠele între grupele

extreme au fost semnificative (tabelul 5). Luând în considerare numărul relativ mic de
subiecĠi, rezultatele obĠinute reprezintă un argument în plus pentru validitatea versiunii în
limba română a DAS-A.

9
SCALA DE ATITUDINI DISFUNCğIONALE, FORMA A
Tabelul 5. ComparaĠii între grupe extreme la DAS-A.

DAS-A
Grupul m A.S. N F
PDE- scor total Ridicat 144.03 24.01 60 F(2,536) =
PDE – scala de Mediu 132.23 23.93 422 11.27,
depresie
Scăzut 123.14 24.67 57 p.05
(toate
grupele)
PDE- scor total Ridicat 146.02 22.86 60 F(2, 552) =
PDE – scala de 10.37,
depresie Mediu 131.01 24.21 460 p.05
Scăzut 132.03 23.32 35 (toate
grupele)
PDE- scor total Ridicat 139.49 25.95 35 F(2, 212)=
17.36,
Mediu 109.97 31.34 151 p.05
Scăzut 98.17 31.02 29 (toate
grupele)

În concluzie, datele disponibile până în acest moment sugerează că varianta în limba

română a DAS-A are proprietăĠi psihometrice bune, asemănătoare variantei originale, în
limba engleză. Datorită limitelor studiilor existente până în acest moment, până la investigaĠii
viitoare, se impune prudenĠă în utilizarea DAS-A, varianta în limba română.

ETALONARE
Cotele sau clasele stabilite asupra grupului de referinĠă constituie etalonul sau tabelul
de norme. Cotele brute capătă semnificaĠie numai dacă sunt raportate la etalon. Pentru
construcĠia etaloanelor am utilizat 701 subiecĠi.
Etalonul a fost construit pe cinci clase normalizate. Prima clasă include 6.7% din
subiecĠi, cei cu cel mai scăzut nivel de acceptare necondiĠionată a propriei persoane. A doua
clasă, în sens ascendent al acceptării necondiĠionate, include următorii 24.2% dintre subiecĠi,
a treia clasă include următorii 38.2%, a patra clasă include următorii 24.2%, iar a cincea clasă
include ultimii 6.7% dintre subiecĠi, cei cu cel mai înalt nivel de acceptare necondiĠionată a
propriei persoane.
Întrucât nu există diferenĠe semnificative în funcĠie de sex (t = 2.30, p ! .05).,
etaloanele sunt valabile atât pentru femei, cât úi pentru bărbaĠi

10
SCALA DE ATITUDINI DISFUNCğIONALE, FORMA A

DAS-A (N= 682)

Clase Descriere Scoruri
I Nivel foarte scăzut al atitudinilor disfuncĠionale d 79
II Nivel scăzut al atitudinilor disfuncĠionale 80-112
III Nivel mediu al atitudinilor disfuncĠionale 113-142
IV Nivel ridicat al atitudinilor disfuncĠionale 143-169
V Nivel foarte ridicat al atitudinilor disfuncĠionale t 170

11
SCALA DE ATITUDINI DISFUNCğIONALE, FORMA A

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Weissman, A.N. (1979). The Dysfunctional Attitude Scale: A validation study. Dissertation
Abstracts International, 40, 1389B-1390B. (University Microfilms No. 79-19, 533).
Weissman, A.N., úi Beck, A.T. (1978, November). Development and validation of the
Dysfunctional Attitude Scale : A preliminary investigation. Paper presented at the
meeting of the Association for the Advancement of Behavior Therapy, Chicago.
Williams, J.M.G., Watts, F.N., MacLeod, C., úi Mathews, A. (1997). Cognitive Psychology and
Emotional Disorders. Chichester, England: Wiley.

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 SCALA DE ATITUDINI DISFUNCğIONALE, FORMA A

SCALA DE ATITUDINI DISFUNCğIONALE, FORMA A (DYSFUNCTIONAL

ATTITUDES SCALE, FORM A)

Nume úi prenume:
___________________________________________Data:_____________

InstrucĠiuni:
Acest chestionar cuprinde o serie de atitudini úi convingeri pe care unele
persoane le au în diverse situaĠii. CitiĠi cu atenĠie fiecare afirmaĠie úi decideĠi în ce
măsură sunteĠi sau nu de acord cu ea. UtilizaĠi pentru fiecare afirmaĠie, din scala
prezentată mai jos, cifra care corespunde în cea mai mare măsură modului în care
gândiĠi. AlegeĠi un singur răspuns pentru fiecare afirmaĠie în parte. Deoarece oamenii
sunt diferiĠi, nu există răspunsuri corecte sau greúite. Pentru a vă asigura că o anumită
atitudine vă caracterizează, aveĠi în vedere modul în care gândiĠi în cea mai mare parte
a timpului (în general).
1 2 3 4 5 6 7
Sunt cu Sunt în Sunt Sunt Sunt în Sunt în
totul de mare întrucâtva Sunt întrucâtva mare dezacord
acord măsură de de acord neutru în măsură în total
acord dezacord dezacord
Nr. AfirmaĠii Răspuns
01 Este dificil să fii fericit/ă dacă nu eúti prezentabil/ă, inteligent/ă, bogat/ă, úi creativ/ă.
02 Fericirea depinde în mai mare măsură de atitudinea mea faĠă de mine, decât de ce
simt alĠii faĠă de mine.
03 Oamenii mă vor aprecia probabil în mai mică măsură, dacă voi comite o greúeală.
04 Dacă nu reuúesc să fac totul bine de fiecare dată, nu voi fi respectat de ceilalĠi.
05 Chiar úi asumarea unui risc minor este un lucru nesăbuit, deoarece pierderile pe care
le antrenează pot fi dezastruoase.
06 PoĠi câútiga respectul altei persoane, chiar dacă nu eúti deosebit de talentat într-un
domeniu oarecare.
07 Nu pot fi fericit/ă decât dacă sunt admirat/ă de majoritatea persoanelor pe care le
cunosc.
08 A cere ajutorul cuiva este un semn de slăbiciune.
09 Dacă nu mă descurc la fel de bine ca alĠii, înseamnă că sunt o persoană inferioară.
10 Dacă eúuez la locul de muncă, înseamnă că sunt un ratat.
11 Dacă nu poĠi face un lucru ca lumea, atunci nici nu merită să te apuci de el.
12 Este în regulă să fac greúeli, deoarece pot învăĠa din ele.
13 Dacă cineva nu este de acord cu mine, asta înseamnă probabil că nu mă
simpatizează.
14 Dacă eúuez parĠial, este la fel de rău ca úi când aú fi un om ratat.
15 Dacă alĠii află cum eúti în realitate, te vor aprecia în mai mică măsură.
16 Dacă o persoană pe care o iubesc nu mă iubeúte, înseamnă că sunt un nimeni.

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SCALA DE ATITUDINI DISFUNCğIONALE, FORMA A

17 O activitate îĠi poate oferi plăcere indiferent de rezultatul ei.

18 Înainte de a se apuca de ceva, omul trebuie să útie că are sorĠi de izbândă.
19 Valoarea mea ca persoană depinde în mare măsură de părerea celorlalĠi despre
mine.
20 Dacă nu îmi fixez aspiraĠii înalte, voi deveni o persoană „de mâna a doua”.
21 Pentru a fi o persoană valoroasă, trebuie să fiu cu adevărat excepĠional/ă în cel puĠin
un domeniu important.
22 Oamenii care au idei bune sunt mai valoroúi decât ceilalĠi.
23 Dacă fac o greúeală este normal să fiu supărat.
24 Părerea mea despre mine este mai importantă decât ceea ce cred alĠii despre mine.
25 Dacă vreau să fiu o persoană bună, morală úi valoroasă, trebuie să ajut pe oricine are
nevoie de ajutor.
26 Dacă pun o întrebare las impresia că sunt o persoană inferioară.
27 Este groaznic să fii dezaprobat de persoanele importante pentru tine.
28 Dacă nu ai pe cine să te sprijini, eúti condamnat la tristeĠe.
29 Pot realiza lucruri importante chiar dacă nu mă hărĠuiesc ca pe un sclav.
30 Este posibil ca cineva să fie dojenit fără ca asta să îl supere.
31 Nu pot avea încredere ceilalĠi, deoarece m-ar putea trata cu cruzime.
32 Nu poĠi fi fericit, dacă ceilalĠi nu te plac.
33 Este mai bine să renunĠi la propriul tău interes, pentru a face pe plac celor din jur.
34 Fericirea mea depinde în mai mare măsură de alĠii decât de mine.
35 Nu am nevoie de aprobarea celorlalĠi pentru a fi fericit.
36 Dacă eviĠi problemele, acestea dispar de la sine.
37 Pot fi fericit, chiar dacă pierd multe din părĠile bune ale vieĠii.
38 Este foarte important ce cred alĠii despre mine.
39 Izolarea de ceilalĠi duce la nefericire.
40 Pot fi fericit, chiar dacă nimeni nu mă iubeúte.

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PROFILUL DISTRESULUI EMOğIONAL (PDE)

PROFILUL DISTRESULUI EMOğIONAL (PDE)

Copyright © Daniel David (pentru versiunea în limba română)

INTRODUCERE
Ceea ce experienĠiem ca mulĠumire, tristeĠe, îngrijorare, bucurie, furie, frică sau regret
rezultă din combinaĠia inedită dintre felul în care gândim, modul în care ne comportăm úi
modificările biofiziologice care au loc în corpul nostru atunci când ne confruntăm cu o situaĠie
de viaĠă. EmoĠiile reprezintă aúadar variabile dependente sau etichete cu care noi descriem o
suită de modificări survenite la mai multe nivele (David, Holdevici, Szamoskozi, úi Băban,
2000). În procesul apariĠiei unei emoĠii, intensitatea acesteia va fi determinată de nivelul
activării fiziologice, pe când calitatea ei (ex., faptul că o numim „frică” úi nu „tristeĠe”) va
rezulta din specificul componentelor cognitive implicate (Singer úi Schachter, 1962; David úi
colab., 2000).
Deúi la nivelul simĠului comun afectivitatea este resimĠită ca un conglomerat de trăiri
aflate într-o complexă interacĠiune, cercetătorii au arătat că întreaga varietate de emoĠii
resimĠite se reduce la câteva dimensiuni de bază. Astfel, în urma mai multor studii, Watson úi
Tellegen (1985) au concluzionat că afectul are o structură ce cuprinde două dimensiuni
necorelate între ele: emoĠiile pozitive úi emoĠiile negative. EmoĠiile pozitive sunt indicate de
măsura în care o persoană experienĠiază plăcere úi mulĠumire, în timp ce emoĠiile negative
sunt indicate de gradul de neplăcere experienĠiată (distresul psihologic).
Pe baza unei vaste experienĠe clinice, Albert Ellis (1962, 1994) a formulat modelul
binar al distresului (David, Schnur úi Belloiu, 2002), împărĠind pentru prima dată emoĠiile
negative în două categorii – emoĠii negative funcĠionale úi emoĠii negative disfuncĠionale.
FuncĠionalitatea sau disfuncĠionalitatea unei emoĠii negative este dată de: 1) experienĠa
subiectivă asociată emoĠiei, (2) credinĠele asociate úi (3) consecinĠele comportamentale ale
emoĠiei respective (Ellis úi DiGiuseppe, 1993). Această categorizare se bazează pe
diferenĠele calitative care există între emoĠii cu aceeaúi valenĠă – diferenĠă dată în principal de
credinĠele subiacente acestora - úi nu pe variaĠiile în intensitate (Ellis 1994; Ellis úi Harper,
1975). Altfel spus, o intensitate mai mare a „tristeĠei” nu se numeúte „deprimare”, diferenĠa
dintre cele două trăiri emoĠionale fiind dată de credinĠele specifice care le determină (ex.,
credinĠe raĠionale pentru emoĠiile negative funcĠionale úi credinĠe iraĠionale pentru emoĠiile
negative disfuncĠionale).
DiferenĠele la nivel subiectiv între emoĠiile negative funcĠionale úi emoĠiile negative
disfuncĠionale au fost investigate în mai multe studii; rezultatele indică existenĠa unor
diferenĠe cantitative úi calitative între cele două tipuri de emoĠii (Kassinove, Eckhardt úi
Endes, 1993; David, Schnur úi Birk, 2004; Opriú úi Macavei, 2005).
Profilul Distresului EmoĠional (PDE) este un instrument elaborat pentru a servi la
evaluarea dimensiunii subiective a emoĠiilor negative funcĠionale úi disfuncĠionale.

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PROFILUL DISTRESULUI EMO ğIONAL (PDE)

CE MĂSOARĂ SCALA?
Profilul Distresului EmoĠional (PDE) este o scală cu 26 de itemi care măsoară emoĠiile
negative disfuncĠionale úi emoĠiile negative funcĠionale din categoriile „frică” úi
„tristeĠe/deprimare”.
Scala permite atât calcularea unui scor general de distres, cât úi a scorurilor separate
pentru „frică funcĠională”, „frică disfuncĠională”, „tristeĠe/deprimare funcĠională” úi
„tristeĠe/deprimare disfuncĠională”.
Scala a fost concepută în 2005 (Opriú úi Macavei, 2005) pornind de la itemii Profilului
Distresului EmoĠional, varianta scurtă (Profile of Mood Disorders, Short Version - DiLorenzo,
Bovbjerg, Montgomery, Valdimarsdottir, úi Jacobsen, 1999). Acestor itemi li s-au adăugat
cuvinte care descriu emoĠii identificate cu ajutorul unui dicĠionar de sinonime. Cei 26 de itemi
care formează varianta finală a scalei au rezultat în urma unei validări cu experĠi úi a mai
multor studii experimentale menite să stabilească relevanĠa lor úi subscalele în care se
încadrează.
EficienĠa instrumentului este sporită de faptul că permite atât estimarea unei valori
globale a distresului, cât úi calcularea unor scoruri separate pentru emoĠiile negative
funcĠionale úi disfuncĠionale, precum úi pentru „frică funcĠională”, „frică disfuncĠională”,
„tristeĠe/deprimare funcĠională” úi „tristeĠe/deprimare disfuncĠională”. Comparativ cu alte scale,
PDE conĠine un număr relativ mic de itemi formulaĠi într-un limbaj accesibil, fiind uúor de
administrat úi cotat.

DESCRIEREA ITEMILOR
PDE conĠine 26 de adjective care descriu emoĠii negative (Anexă). Cei 26 de itemi se
grupează în úase subscale:
(1) 6 itemi reprezintă emoĠii negative funcĠionale din categoria „tristeĠe/deprimare”.
(2) 8 itemi reprezintă emoĠii negative disfuncĠionale din categoria „tristeĠe/deprimare”.
(3) 6 itemi reprezintă emoĠii negative funcĠionale din categoria „frică”.
(4) 6 itemi reprezintă emoĠii negative disfuncĠionale din categoria „frică”.
(5) 12 itemi reprezintă emoĠii negative funcĠionale (categoriile „tristeĠe/deprimare” úi
„frică”).
(6) 14 itemi reprezintă emoĠii negative disfuncĠionale (categoriile „tristeĠe/deprimare” úi
„frică”).

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 PROFILUL DISTRESULUI EMOğIONAL (PDE)

Tabelul 1. DistribuĠia itemilor PDE pe subscale.

TristeĠe/Deprimare Frică
FuncĠionale DisfuncĠionale FuncĠionale DisfuncĠionale
trist item 2 nefolositor item 5 preocupat item 10 anxios item 8
mâhnit item 15 deprimat item 12 îngrijorat item 6 îngrozit item 16
amărât item 7 deznădăjduit item 26 neliniútit item 24 panicat item 20
melancolic item 3 fără speranĠă item 4 încordat item 14 înspăimântat item 11
necăjit item 13 depresiv item 9 alarmat item 19 înfricoúat item 25
supărat item 21 distrus item 22 tensionat item 1 nervos item 17
îndurerat item 18
disperat item 23

PosibilităĠile de răspuns ale subiecĠilor la fiecare din cei 26 de itemi sunt:

DELOC FOARTE MEDIU MULT FOARTE
PUğIN MULT

Nici itemii scalei úi nici variantele de răspuns nu sunt numerotate, eliminând astfel
posibilitatea de biasare a răspunsurilor ca urmare a valorii numerice ataúate.

ADMINISTRARE ùI COTARE
Scala se administrează în varianta creion-hârtie, atât individual (úi în varianta
autoadministrare), cât úi în grup. Se preferă administrarea individuală, ori de câte ori este
posibil. În cazul administrării în grup, este indicat ca grupurile să nu fie mai mari de 15
persoane. Când grupul este mai mare de 15 persoane, numărul examinatorilor trebuie să
crească, păstrându-se raportul de un examinator la maximum 15 persoane evaluate.
Materiale necesare
ƒ Scala cu instrucĠiunile de completare úi itemii;
ƒ Instrument de scris.

CondiĠii de administrare
ƒ Mediu securizant úi ferit de zgomote;
ƒ Persoana examinată să fie motivată pentru completarea scalei úi odihnită;
ƒ Mobilier úi iluminare adecvate, care să permită subiectului examinat
completarea în condiĠii bune a scalei;
ƒ În cazul aplicării în grup, sala trebuie să fie suficient de mare pentru a oferi
confort persoanelor examinate.

InstrucĠiuni de aplicare
Scala se administrează fără limită de timp.

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PROFILUL DISTRESULUI EMOğIONAL (PDE)

După ce materialele úi condiĠiile necesare pentru administrarea scalei sunt asigurate,

persoanei examinate i se spune:
Mai jos v prezentăm o listă de cuvinte care descriu emoĠiile pe care oamenii le
ă
au în diverse situaĠii. CitiĠi cu atenĠie fiecare cuvânt, apoi încercuiĠi varianta/marcaĠi
varianta care corespunde cel mai bine întrebării: CUM V-AğI SIMğIT ÎN ULTIMELE
DOUĂ SĂPTĂMÂNI?
Această instrucĠiune apare úi pe lista cu itemii, subiectul putând să o recitească ori de
câte ori doreúte pe parcursul evaluării.
În plus, persoana examinată este încurajată să întrebe examinatorul dacă nu înĠelege
sensul vreunui item. Examinatorul va răspunde la astfel de întrebări prin înúirarea listei de
adjective din categoria în care se găseúte itemul cu probleme (a se vedea Tabelul 1). Spre
exemplu, dacă subiectul întreabă „Ce înseamnă anxios?”, examinatorul va răspunde „Acest
cuvânt are un sens apropiat de al cuvintelor „îngrozit”, „panicat”, înspăimântat”, „înfricoúat”,
„nervos””. Printr-un astfel de răspuns standard, se încearcă (1) evitarea răspunsurilor la
întâmplare, (2) evitarea lipsei răspunsurilor la mai mulĠi itemi, precum úi (3) evitarea sugerării
unor răspunsuri în funcĠie de expectanĠele úi/sau cunoútinĠele examinatorului (ex. „Anxios
înseamnă înfricoúat, panicat, preocupat, supărat”).
SubiecĠii sunt rugaĠi să îúi evalueze emoĠiile pe o scală cu cinci variante (deloc, foarte
puĠin, mediu, mult, foarte mult) úi să coloreze cerculeĠul din dreptul variantei de răspuns
alese, încercând să nu omită nici unul din cei 26 de itemi.
Ex. Răspunsul subiectului la itemul „Tensionat (ă)” este „Foarte puĠin”.

DELOC FOARTE MEDIU MULT FOARTE

PUğIN MULT
Tensionat
( ă)
Pentru a corespunde cerinĠelor diferitelor situaĠii úi studii, instrucĠiunile se pot referi la
diverse intervale de timp (de la „două săptămâni”, cum apare în instrucĠiunile standard, la „în
acest moment” sau „în cursul săptămânii trecute”).
PDE este recomandat atât pentru evaluarea distresului în cazul subiecĠilor adulĠi fără
psihopatologie, cât úi în cazul subiecĠilor adulĠi cu diferite forme de psihopatologie (excepĠie
condiĠiile medicale care afectează capacitatea de introspecĠie asupra propriilor stări
emoĠionale).

Cotarea răspunsurilor
Cotarea pentru cei 26 de itemi se face direct, însumând răspunsurile la fiecare item,
alocându-se de la 1 la 5 puncte după cum urmează: Deloc = 1, Foarte puĠin = 2, Mediu = 3,
Mult = 4, Foarte mult = 5.

4
PROFILUL DISTRESULUI EMOğIONAL (PDE)

Pe lângă scorul global de distres – obĠinut prin însumarea scorurilor la cei 26 de

itemi, se mai pot calcula scoruri pe cele 6 subscale, prin însumarea scorurilor la itemii care le
compun (a se vedea Tabelul 1).

FIDELITATE ùI VALIDITATE
Fidelitate
Fidelitatea unui test psihologic se referă la acordul sau stabilitatea aúteptată a
măsurilor analoge. Dacă un instrument este fidel, atunci rezultatele obĠinute în condiĠii
similare prezintă o anumită stabilitate în timp (Dempster úi Brainerd, 1995).
Fidelitatea unui instrument de măsurare este cel mai adesea exprimată pe baza
consistenĠei interne úi a stabilităĠii în timp a rezultatelor (Anastasi, 1988).
ConsistenĠa internă a unei scale se referă la măsura în care toĠi itemii scalei măsoară
aceeaúi variabilă. Stabilitatea rezultatelor testării ne indică în ce măsură la aplicări diferite în
timp un subiect obĠine rezultate similare la un test sau scală.
Fidelitatea PDE a fost estimată prin calculul coeficientului de consistenĠă internă Alfa
Cronbach. Eúantionul utilizat a fost de 745 subiecĠi, valorile Alfa pentru scorurile globale úi
scorurile pe scale fiind cuprinse între .75 úi .94 (Tabelul 2). Aceste valori indică o foarte bună
consistenĠă internă, ceea ce exprimă faptul că itemii testului evaluează acelaúi construct –
distresul emoĠional. Cei mai mici indici de consistenĠă internă se înregistrează în cazul scalei
de „frică” (între .75 úi .81), fiind totuúi suficient de mari pentru a indica o fidelitate acceptabilă.

Tabelul 2. Statistici descriptive úi indicii Alfa de consistenĠă internă pentru scalele PDE

Scala PDE AdulĠi (vârsta cuprinsă între 15-73; m=32.81)

Femei BărbaĠi Lipsă date Total
sex
Scor total M 51.37 48.87 49.11 50.59
S.D. 17.60 15.49 10-06 16.94
N 482 212 9 703
D .94 .93 .85 .94
TristeĠe/Deprimare M 12.64 11.81 11.50 12.37
funcĠional
S.D. 4.96 4.48 3.39 4.81
N 496 223 12 731
D .87 .83 .60 .85
TristeĠe/Deprimare M 13.03 12.65 14.00 12.93
disfuncĠional
S.D. 5.90 5.30 4.91 5.70
N 494 222 12 728
D .88 .86 .79 .87

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PROFILUL DISTRESULUI EMOğIONAL (PDE)

Frică funcĠional M 15.40 14.71 15.00 15.19

S.D. 4.72 4.29 4.28 4.60
N 503 223 12 738
D .81 .78 .78 .80
Frică disfuncĠional M 10.40 9.80 9.53 10.21
S.D. 4.12 3.45 2.06 3.91
N 498 219 13 730
D .82 .75 .20 .80
Total funcĠional M 28.02 26.57 26.50 27.56
S.D. 8.94 7.92 5.81 8.62
N 495 220 10 725
D .89 .87 .75 .89
Total disfuncĠional M 23.42 22.30 23.75 23.09
S.D. 9.49 8.10 5.92 9.05
N 490 216 12 718
D .91 .89 .74 .91

Validitate
Validitatea este o caracteristică a unui test (sau scală) care arată măsura în care
acesta măsoară ceea ce se spune că măsoară. Altfel spus, validitatea se referă la măsura în
care inferenĠele pe care le facem pornind de la rezultatele obĠinute la un test sunt corecte
(Messick, 1995).
Validitatea de conĠinut se referă la examinarea sistematică a itemilor testului/scalei
pentru a vedea dacă ei acoperă un eúantion reprezentativ al domeniului pe care dorim să îl
măsurăm. În elaborarea PDE s-a pornit de la POMS-SV (Shacham, 1983), de unde au fost
extraúi itemi pentru subscalele de anxietate úi depresie. AlĠi itemi au fost selectaĠi din varianta
lungă a POMS (McNair, Lorr, úi Droppelman, 1971). Folosindu-se un dicĠionar de sinonime,
itemilor deja construiĠi li s-au adăugat alĠii astfel încât s-a ajuns la o listă de 41 de adjective
care descriu emoĠii. În selecĠia adjectivelor s-a Ġinut cont de principiile teoriei raĠional-emotive
úi comportamentale, care subliniază distincĠia dintre emoĠiile negative funcĠionale úi
disfuncĠionale. Cei 41 de itemi au fost ulterior clasificaĠi în cele două categorii (emoĠii
funcĠionale úi disfuncĠionale) de 3 experĠi în psihoterapie raĠional-emotivă úi comportamentală
de la AsociaĠia de Psihoterapii Cognitive úi Comportamentale din România. Cei 26 de itemi
care compun varianta finală a scalei sunt cei care au întrunit consensul interevaluatori.
Aúadar, PDE a fost astfel construit încât conĠinutul său reflectă principii teoriei
raĠional-emotive úi comportamentale, iar forma sa este asemănătoare altor teste similare deja
existente úi care úi-au dovedit utilitatea.

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PROFILUL DISTRESULUI EMO ğIONAL (PDE)

Validitatea de construct se referă la măsura în care testul/scala reflectă constructul pe

care îl măsoară. În cazul testelor utilizate pentru măsurare, validarea relativă la criteriu este o
componentă a validării relative la constructul măsurat (Albu, 1998). Ea apreciază „gradul în
care rezultatele furnizate de test corelează cu rezultatele altui instrument de evaluare despre
care se presupune că măsoară acelaúi construct sau unul similar” (Haynes, apud Silva,
1993).
Într-un studiu efectuat pe populaĠie românească (Macavei, 2006 – lucrare
nepublicată) s-a încercat determinarea măsurii în care emoĠiile negative funcĠionale úi
disfuncĠionale (măsurate cu PDE) se asociază cu anumite cogniĠii conform modului teoretic
propus de Albert Ellis (teoria raĠional-emotivă úi comportamentală). AsumpĠia de bază a
modelului amintit este că la baza problemelor de tip emoĠional úi comportamental stau
credinĠele dezadaptrative úi iraĠionale despre sine, lume úi viaĠă. Atunci când cineva deĠine
credinĠe adaptative despre sine, ceilalĠi úi viaĠă úi se poate considera o fiinĠă valoroasă
indiferent de comportamentele sale va trăi emoĠii pozitive sau negative (conform dinamicii
dintre evenimentele de viaĠă úi scopurile sale), însă nu va trăi emoĠii
invalidante/disfuncĠionale. Întrucât persoanele cuprinse în studiu nu au probleme de
intensitate clinică (altfel spus emoĠiile negative trăite de ele nu apar ca parte a unui tablou
clinic invalidant) este mai dificil de evidenĠiat dinamica diferită a emoĠiilor negative funcĠionale
úi disfuncĠionale. Studiul de faĠă pune în evidenĠă:
1. asocierea pozitivă dintre distresul emoĠional úi distorsiunile cognitive (credinĠele
dezadaptative, de tip iraĠional);
2. asocierea pozitivă dintre distresul emoĠional úi anxietate úi depresie (evaluate ca úi
complexe de manifestări cognitive, comportamentale, fiziologice úi subiective).
La studiu au participat în total 701 subiecĠi; o parte dintre aceútia au fost studenĠi
recompensaĠi pentru participare prin recunoaúterea unor activităĠi de profil prevăzute în
curricula úcolară. CeilalĠi subiecĠi au fost incluúi în studiu pe bază de voliuntariat, în urma unor
anunĠuri publice. Pentru participarea persoanelor cu vârste sub 18 ani s-a cerut acordul unui
părinte sau tutore legal. Datele statistice oferite mai jos reflectă úi faptul că unii dintre
participanĠii la studiu au omis sau refuzat să ofere informaĠii complete vizând nivelul
educaĠional, vârsta, statutul marital etc.

Tabelul 3. Date statistice privind subiecĠii incluúi în studiu

Nivel educaĠional N = 701 100 %

ùcoală primară = 22 (3.1 %)

ùcoală profesională = 28 (4.0 %)
Liceu = 222 (31.7 %)
ùcoală postliceală = 60 (8.6 %)
Facultate = 346 (49.3 %)
Studii postuniveristare = 19 (2.7 %)
Altceva = 4 (0.6 %)
Vârsta N = 695 Sex N = 574

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PROFILUL DISTRESULUI EMOğIONAL (PDE)

Date lipsă N=6 Date lipsă N=127

M= 34.42 Min.= 15 BărbaĠi = 169

Max.= 73 Femei = 405

Statut marital N = 567

Date lipsă N=134
Căsătorit = 326
Necăsătorit = 241

Instumentele utilizate au fost:

Scala de atitudini disfuncĠionale – DAS-A (Dysfunctional Attitudes Scale – form A -
Weissman, 1979; Weissman úi Beck, 1978) este un instrument de 40 de itemi care permite
evaluarea prezenĠei atitudinilor/credinĠelor disfuncĠionale associate simptomatologiei de tip
depresiv.
Inventarul de depresie Beck – BDI (Beck Depression Inventory - Beck, Rush, Shaw,
úi Emery, 1979) conĠine 21 de itemi úi a fost utilizat pentru identificarea prezenĠei
simptomatologiei de tip depresiv, exprimată prin emoĠii, comportamente, credinĠe úi
manifestări fiziologice specifice.
Scala de atitudini úi convingeri 2 – ABS2 (Attitudes and Beliefs Scale 2 -DiGiuseppe,
Leaf, Exner, úi Robin, 1988) este formată din 72 de itemi úi este un instrument valid pentru
identificarea prezenĠei credinĠelor iraĠionale úi raĠionale centrale teoriei raĠional-emotive úi
comportamentale. Varianta în limba română a scalei prezintă proprietăĠi psihometrice bune
(Macavei, 2002).
Chestionarul de acceptare necondiĠionată a propriei persoane – USAQ
(Unconditional Self-Acceptance Questionnaire - Chamberlain úi Haaga, 2001) este format din
20 de itemi úi măsoară acceptarea necondiĠionată a propriei persoane, ca factor protectiv
care previne declanúarea anumitor forme de psihopatologie la contactul cu situaĠiile negative
de viaĠă.
Profilul distresului emoĠional – PDE (Profile of Emotional Distress- Opriú úi Macavei,
2005) este un instrument de 26 de itemi care măsoară prezenĠa emoĠiilor negative funcĠionale
úi disfuncĠionale (ca anxietatea, îngrijorarea, deprimarea, tristeĠea); utilizează principiul de
construcĠie al Profilului dispoziĠiilor afective, forma scurtă (DiLorenzo, Bovbjerg, Montgomery,
Valdimarsdottir, úi Jacobsen, 1999) úi se bazează pe teoria lui Albert Ellis asupra distresului
emoĠional (Ellis, 1994).
Profilul dispoziĠiilor afective – forma scurtă – POMS-SV (Profile of Mood States—
Short Version - Shacham 1983) este un instrument de 47 de itemi care măsoară emoĠiile
positive úi negative.
Chestionarul gândurilor automate –ATQ (Automatic Thoughts Questionnaire - Hollon
úi Kendall, 1980) conĠine 30 de itemi care reflectă gândirea e tip depresiv.
State and Trait Anxiety Inventory – STAI-X1 úi STAI-X2 (Inventarul de anxietate ca
stare úi trăsătură - Spielberger, 1983). ) este alcătuit din 2 scale de autoevaluare a câte 20 de

8
 PROFILUL DISTRESULUI EMOğIONAL (PDE)

itemi fiecare pentru măsurarea a două aspecte distincte privind anxietatea. Starea de
anxietate (A-stare) úi anxietatea ca trăsătură (A-trăsătură).

Procedura de lucru a implicat în prima fază solicitarea consimĠământului de

participare la studiu, după care subiecĠii au fost completat individual câte un pachet conĠinând
instrumentele menĠionate anterior, fără limită de timp.
Rezultatele obĠinute pun în evidenĠă relaĠia pozitivă dintre emoĠiile negative
disfuncĠionale úi distorsiunile cognitive. Este de remarcat că, deúi nu se poate vorbi de
probleme emoĠionale în cazul lotului utilizat, corelaĠiile emoĠiilor negative disfuncĠionale (END)
cu distorsiunile cognitive (DC) sunt sistematic uúor mai mari decât corelaĠiile dintre emoĠiile
negative funcĠionale (ENF) úi aceleaúi distorsiuni cognitive (DC-END .28, .49, .30 versus
DC-ENF .22, .44, .22). Mai mult, credinĠele raĠionale úi acceptarea necondiĠionată a propriei
persoane se asociază negativ cu distresul emoĠional – evaluat ca úi combinaĠie de emoĠii
funcĠionale úi disfuncĠionale; deúi corelaĠiile nu sunt mari, direcĠia acestora sugerează rolul de
posibili factori protectivi al respectivelor cogniĠii.
De asemenea, scorurile obĠinute confirmă (1) asocierea pozitivă dintre distresul
emoĠional úi distorsiunile cognitive (credinĠele dezadaptative, de tip iraĠional) úi (2) asocierea
pozitivă dintre distresul emoĠional úi anxietate úi depresie (evaluate ca úi complexe de
manifestări cognitive, comportamentale, fiziologice úi subiective).

Tabelul 4. CorelaĠii între scorurile la PDE úi scorurile la alte instrumente de evaluare a

cogniĠiilor úi emoĠiilor funcĠionale úi disfuncĠionale.

PDE PDE– PDE – PDE – PDE – emoĠii PDE – PDE –

– tristeĠe îngrijorare emoĠii negative anxietate depresie
scor negative disfuncĠionale
total funcĠionale
BDI . 56* .50* .40* .50* -.57* .50* .57*
N 173 174 176 174 174 175 175
DAS-A .26* .21* .19* .22* .28* .25* .27*
N 539 555 558 551 548 554 555
ATQ .48* .43* .40* .44* .49* .46* .49*
N 112 117 118 116 116 117 118
ABS2- .27* .23* .18* .22* .30* .28* .30*
IB 330 344 348 342 336 342 342
N
ABS2- -.26* -.21* -.21 -.23* -.27* -.25* -.26*
RB 326 340 344 338 334 338 340
N
POMS .74* .70* .70* .73* .71* .67* .70*
– TOT 106 108 110 108 107 108 109
N
POMS- .75* .72* .71* .75* .72* .68* .71*
NEG 110 112 114 112 111 112 113
N
POMS- -.46* -.43* -.44* -.45* -.45* -.42* -.45*
POZ 112 115 116 114 114 115 116

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 PROFILUL DISTRESULUI EMO ğIONAL (PDE)

N
STAI – .58* .55* .59* .60* .54* .55* .51*
X1 115 118 119 117 117 118 119
N
STAI- .47* .43* .42* .44* .48* .44* .48*
X2 98 101 102 100 100 101 102
N
USAQ -.19* -.15 -.20* -.18* -.18* -.14 -.20*
N 115 118 119 117 117 118 119
* corelaĠiile sunt semnificative la p.05

În concluzie, datele disponibile până în acest moment sugerează că PDE are

proprietăĠi psihometrice bune úi poate fi utilizat pentru evaluarea distresului pentru populaĠia
nonclinică. Datorită limitelor studiilor existente până în acest moment, până la investigaĠii
viitoare, se impune prudenĠă în utilizarea PDE.

Etalonare
Pentru scorul total la PDE úi scorul la PDE - emoĠii negative disfuncĠionale nu există
diferenĠe semnificative în funcĠie de sex, etaloanele fiind valabile atât pentru femei, cât úi
pentru bărbaĠi (vezi Tabelul 5). Pentru scorul la PDE- emoĠii negative funcĠionale există
diferenĠe în funcĠie de sex, etaloanele separate reflectând această diferenĠă.

Tabelul 5. Date descriptive úi pragurile de semnificaĠie pentru comparaĠiile pe scale în funcĠie

de sex.

SEX N Media A.S. t p

Total PDE masculin 212 48.87 15.49 -1.78 ! .05
feminin 482 51.37 17.60
Depresie/tristeĠe masculin 223 11.81 4.48 -2.13 .05
FuncĠional
feminin 496 12.64 4.96
Depresie/tristeĠe masculin 222 12.65 5.30 -.82 !.05
DisfuncĠional
feminin 494 13.03 5.90
Frică FuncĠional masculin 223 14.71 4.29 -1.88 ! .05
feminin 503 15.40 4.72
Frică DisfuncĠional masculin 219 9.80 3.45 -1.88 ! .05
feminin 498 10.40 4.12
Total FuncĠional masculin 220 26.57 7.92 -2.06  .05
feminin 495 28.02 8.94
Total DisfuncĠional masculin 216 22.30 8.10 -1.50 !.05
feminin 490 23.42 9.49

PDE total, N=782

Clase Descriere Cote
I Nivel foarte scăzut de distres d 28
II Nivel scăzut de distres 29-39

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PROFILUL DISTRESULUI EMOğIONAL (PDE)

III Nivel mediu de distres 40-56

IV Nivel ridicat de distres 57-86
V Nivel foarte ridicat de distres t 87

PDE disfuncĠional, N=799

Clase Descriere Cote
I Nivel foarte scăzut de emoĠii negative d 14
disfuncĠionale
II Nivel scăzut de emoĠii negative disfuncĠionale 15-17
III Nivel mediu de emoĠii negative disfuncĠionale 18-25
IV Nivel ridicat de emoĠii negative disfuncĠionale 26-42
V Nivel foarte ridicat de emoĠii negative t 43
disfuncĠionale

PDE funcĠional – Femei, N=546

Clase Descriere Cote
I Nivel foarte scăzut de emoĠii negative funcĠionale d 15
II Nivel scăzut de emoĠii negative funcĠionale 16-22
III Nivel mediu de emoĠii negative funcĠionale 23-31
IV Nivel ridicat de emoĠii negative funcĠionale 32-43
V Nivel foarte ridicat de emoĠii negative funcĠionale t 44

PDE funcĠional – BărbaĠi, N=249

Clase Descriere Cote
I Nivel foarte scăzut de emoĠii negative funcĠionale d 14
II Nivel scăzut de emoĠii negative funcĠionale 15-22
III Nivel mediu de emoĠii negative funcĠionale 23-30
IV Nivel ridicat de emoĠii negative funcĠionale 31-43
V Nivel foarte ridicat de emoĠii negative funcĠionale t 44

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PROFILUL DISTRESULUI EMOğIONAL (PDE)

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Anastasi, A. (1988). Psychological Testing. 6th edition. New York: Macmillan.
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David, D., Holdevici, I., Szamoskozi, ù., úi Băban, A. (2000). Psihoterapie úi hipnoterapie
cognitiv-comportamentală. Editura Risoprin: Cluj-Napoca.
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David, D., Schnur, J., úi Birk, J. (2004). Functional and dysfunctional feelings in Ellis’ cognitive
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DiGiuseppe, R., Leaf, R., Exner, T. úi Robin, M.W. (1988). The development of a measure of
rational/irrational thinking. Paper presented at the World Congress of Behavior
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DiLorenzo, T., Bovbjerg, D., Montgomery, G., Valdimarsdottir, H., úi Jacobsen, P. (1999) The
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Ellis, A., úi Harper, R.A. (1975). A new guide to rational living (rev. ed.). Hollywood, CA:
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“Inappropriate” Emotions in Rational-Emotive Therapy. Journal of Cognitive
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McNair, D.M., Lorr, M., úi Droppelman, L.F. (1971). EITS Manual for the Profile of Mood
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Messick, S. (1995). Validity of Psychological Assessment. American Psychologist, 50, 741-

749.
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negative emotions; An empirical analysis. Journal of Cognitive and Behavioral
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Schachter, S., úi Singer, J.E. (1962). Cognitive, social and physiological determinants of
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Consulting Psychologists Press.
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Weissman, A.N. (1979). The Dysfunctional Attitude Scale: A validation study. Dissertation
Abstracts International, 40, 1389B-1390B. (University Microfilms No. 79-19, 533).
Weissman, A.N., úi Beck, A.T. (1978, November). Development and validation of the
Dysfunctional Attitude Scale : A preliminary investigation. Paper presented at the
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SCALA DE ATITUDINI ùI CONVINGERI (ABS II)

SCALA DE ATITUDINI ùI CONVINGERI (Attitudes and Beliefs Scale-II) (ABS-II)

Copyright © Daniel David (pentru versiunea în limba română)

INTRODUCERE. PARADIGMA RAğIONAL – EMOTIVĂ ùI COMPORTAMENTALĂ

Între formele de terapie cognitiv-comportamentală (CBT), terapia raĠional-emotivă úi
comportamentală (REBT) ocupă un loc privilegiat, atât datorită rădăcinilor istorice care o plasează la
originea celei mai influente abordări terapeutice cunoscute până în prezent - CBT- cât úi din perspectiva
solidei sale ancorări în practică. În opinia întemeietorului său, Dr. Albert Ellis, relaĠia dintre REBT úi CBT
este una de incluziune; astfel, forma generală de REBT se suprapune peste ceea ce astăzi numim CBT,
pe lângă aceasta mai existând úi aúa numitul REBT “elegant”, având ca finalitate modificarea perspectivei
filozofice asupra vieĠii úi, deci, flexibilizarea personalităĠii pacientului/clientului (Ellis, apud Weinrach,
1996). În 1955, Albert Ellis elabora o metodă terapeutică pe care o numeúte “raĠională”, datorită
accentului pus pe identificarea úi modificarea trăsăturilor iraĠionale úi ilogice ale gândirii clienĠilor săi. Deúi
accentul cade pe componenta cognitivă, încă de la început Ellis adopta un ”eclecticism” metodologic,
folosind o gamă largă de tehnici emotive úi comportamentale, care s-a diversificat úi îmbogăĠit în timp.
Această caracteristică duce, în 1970, la schimbarea denumirii din terapie raĠională (RT) în terapie raĠional-
emotivă (RET). Ulterior, în 1993, la insistenĠele psihologilor interesaĠi de dezvoltarea úi eficientizarea
tehnicii, numele acesteia va deveni “terapia raĠional-emotivă úi comportamentală (REBT)”, reflectând
paleta largă de tehnici utilizate în reducerea distresului pacienĠilor (Ellis & Dryden, 1997; Weinrach, 1996).
Se poate spune deci, că de-a lungul a mai bine de trei decenii REBT a cunoscut o evoluĠie
ascendentă, rezultat al optimizării úi perfecĠionării constante prin efortul mai multor generaĠii de practicieni
úi cercetători (DiGiuseppe, 1996).
În general, terapia cognitiv-comportamentală consideră problemele psihologice ca fiind răspunsuri
dezadaptative învăĠate, susĠinute de cogniĠii disfuncĠionale. În consecinĠă, se accentuează necesitatea
identificării úi modificării cogniĠiilor dezadaptative úi înlocuirea comportamentelor disfuncĠionale (Ellis &
Dryden, 1997).
Conform teoriei avansate de Albert Ellis (pentru detalii vezi Ellis & Dryden, 1997), la baza
tulburărilor emoĠionale stă tendinĠa individului de a face evaluări absolutiste úi rigide ale evenimentelor
percepute. Aceste evaluări iau adesea forma lingvistica a lui “trebuie cu necesitate”, “este obligatoriu”,
“este absolut necesar”, (demandigness – DEM -). Din aceste cogniĠii absolutiste centrale derivă apoi un
nucleu de credinĠe iraĠionale (IB):
x convingeri catastrofice (un eveniment care a avut loc deúi “nu trebuia să aibă loc” este evaluat ca
fiind mai mult de 100% negativ), (awfulizing –AWF -);
x toleranĠa scăzută la frustrare (o persoana crede că nu poate fi deloc fericită dacă apare ceva ce
“nu trebuia să apară în nici un caz”), (low frustration tolerance – LFT -);

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SCALA DE ATITUDINI ùI CONVINGERI (ABS II)

x deprecierea úi evaluarea globală (ex. etichetarea globală a propriei persoane, a celorlalĠi, sau a
vieĠii ca fiind “mizerabile”, dacă lucrurile nu merg aúa cum trebuie), (self-downing and/or global
evaluation – SD/GE -).
Aceste procese se leagă între ele, fiind “feĠe diferite ale aceleiaúi monede” (Ellis & Dryden, 1997).
PredispoziĠia spre patologie este data de patern-urile de gândire absolutistă vis a vis de sine,
ceilalĠi úi viaĠă. Conform acestei teorii, dacă o persoană deĠine un patern de gândire absolutistă, iar viaĠa îi
confirmă aceste aúteptări iraĠionale (caz rar!), atunci persoana trăieúte emoĠii pozitive (deúi în viitor este
vulnerabilă la distres). Dacă, însă, aúteptările persoanei sunt infirmate de condiĠiile de viaĠă (ceea ce este
cu atât mai probabil cu cât persoanele sunt mai iraĠionale), se dezvoltă reacĠii emoĠionale negative
blocante/dezadaptative ca stări depresive, anxietatea, sentimentele de culpa úi/sau agresivitatea. Pe de
alta parte, prezenĠa credinĠelor raĠionale (flexibile), de genul “Mi-as dori ca lucrurile să decurgă astfel, dar
nu e obligatoriu să se întâmple chiar aúa”, chiar în condiĠiile unor condiĠii de viaĠă adverse, generează
emoĠii negative adaptative, stenice.
Aúadar, credinĠele iraĠionale:
- sunt cogniĠii evaluative (adică relevante pentru scopurile individului), cu semnificaĠie personală, de
natură absolutistă, dogmatică;
- generează emoĠii negative dezadaptative;
- sunt iraĠionale deoarece sunt rigide úi blochează atingerea scopurilor.
Corespondentele raĠionale ale lor:
- sunt cogniĠiile evaluative cu semnificaĠie personală, de natură preferenĠială, nonabsolutistă;
- duc la emoĠii pozitive sau negative adaptative;
- sunt raĠionale deoarece sunt flexibile si nu se interpun în calea atingerii scopurilor individului. (Ellis
& Dryden, 1997).
Pe scurt, o credinĠă iraĠională se defineúte prin faptul că este incorectă din punct de vedere logic,
este incongruentă cu realitatea obiectivă úi blochează atingerea scopurilor individului. Prin contrast,
credinĠele raĠionale se bazează pe realitatea empirică, facilitează atingerea scopurilor persoanei úi
respectă principiile logicii (Maultsby apud DiGiuseppe, 1996).
În esenĠă, ideile care fundamentează această teorie, reflectându-se úi în intervenĠia terapeutică,
pot fi sintetizate astfel (Walen, apud Weinrach, 1996):

(1) CogniĠiile sunt cel mai important determinant al emoĠiilor la oameni;

(2) Gândirea disfuncĠională este cauza principală a distresului emoĠional; mare parte din
psihopatologie este rezultatul gândirii disfuncĠionale;
(3) Dacă tulburările emoĠionale sunt cauzate de menĠinerea unor credinĠe iraĠionale, modalitatea
optimă de a înlătura distresul este modificarea acestor credinĠe;
(4) Printre factorii etiologici ai gândirii iraĠionale úi psihopatologiei se numără influenĠe genetice úi
de mediu;

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SCALA DE ATITUDINI ùI CONVINGERI (ABS II)

(5) REBT pune accent mai ales pe rolul evenimentelor din prezent (mai degrabă decât trecut) în
generarea psihopatologiei, în special deoarece oamenii îúi întreĠin tulburările prin perpetuarea
unui mod disfuncĠional de gândire;
(6) CredinĠele iraĠionale pot fi schimbate, deúi modificarea acestora implică efort úi perseverenĠă
din partea individului.
ABS II evaluează convingerile iraĠionale úi raĠionale descrise în teoria lui Albert Ellis. Scala
a fost concepută de către DiGiuseppe, Leaf, Exner si Robin în 1988 úi este o măsură validă a
constructelor centrale în REBT (DiGiuseppe, Robin, Leaf, & Gormon, 1989).
EficienĠa instrumentului este sporită de faptul că permite calcularea unor scoruri separate pe
diferite tipuri de credinĠe iraĠionale, precum úi estimarea unor valori globale de raĠionalitate / iraĠionalitate.
Mai mult, comparativ cu alte teste clinice, conĠine un număr relativ mic de itemi (72) formulaĠi într-un limbaj
accesibil, fiind uúor de administrat úi cotat; în situaĠiile în care nu este posibilă administrarea integrală,
scala permite selectarea itemilor care evaluează doar un anumit tip de credinĠe iraĠionale, putându-se
calcula un scor individual pentru aceútia.
În concluzie, ABS II este unul dintre cele mai eficiente instrumente de evaluarea a credinĠelor
iraĠionale / raĠionale, disponibile la ora actuala.

PREZENTAREA SCALEI ABS II

Scala ABS II cuprinde 72 de itemi (de la 5-76) dispuúi într-o matrice (4x3x2) alcătuită din trei
factori:
(1) primul factor se referă “procese cognitive” úi are patru nivele, reprezentând patru
procese de gândire iraĠională:
- imperativul “trebuie” (DEM)
- deprecierea úi evaluarea globală (SD/GE)
- toleranĠă scăzută la frustrare (LFT)
- gândirea catastrofică (AWF);
(2) cel de-al doilea factor se numeúte “arii de conĠinut” (content / context) úi are trei nivele sau
teme majore, reprezentând convingeri legate de aprobare, realizare úi confort;
(3) cel de-al treilea factor se numeúte “mod de frazare” (irrationality / rationality) úi are două
nivele, reprezentând modul de formulare a itemilor: iraĠional / raĠional.
Fiecare item este rezultanta celor 3 factori menĠionaĠi anterior. De exemplu, itemul 6: “Daca oameni
importanĠi pentru mine nu mă plac, înseamnă că sunt o persoană lipsită de valoare” este:
- frazat iraĠional (IR);
- are un conĠinut care se refera la aprobare;
- vizează procesul cognitiv de autoevaluare (SD/GE).
PosibilităĠile de răspuns ale subiecĠilor vizează atitudinea lor faĠă de conĠinutul itemilor, pe o scală în 5
trepte:

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SCALA DE ATITUDINI ùI CONVINGERI (ABS II)

A – puternic împotriva
B – parĠial împotriva
C – neutru
D – parĠial de acord
E – puternic de acord
Cotarea se face pentru 36 dintre itemi direct úi pentru 36 invers (vezi anexa 3)
Cotare directă: A=0, B=1, C=2, D=3, E=4
Cotare inversă: A=4, B=3, C=2, D=1, E=0
Altfel spus, itemii cotaĠi direct sunt cei formulaĠi iraĠional, pe când cei cotaĠi invers sunt formulaĠi
raĠional. Rezultă ca un scor global (Total) mic înseamnă credinĠe iraĠionale puĠine, iar un scor mare
credinĠe iraĠionale multe. Deci, scorul global arată nivelul de cogniĠii iraĠionale pe care le utilizează o
persoană. În platforma CAS, cotarea se face automat.
Scorurile se pot calcula úi separat, pentru iraĠionalitate úi raĠionalitate. În plus, se pot calcula
diferite scoruri rezultate din combinaĠii pe scale úi subscale.
Scorul pentru fiecare subscală se realizează prin însumarea scorurilor itemilor care o compun.
Numărul minim de puncte ce poate fi realizat este zero (adică la toĠi itemii direcĠi = frazaĠi iraĠional s-a
răspuns cu “puternic împotrivă” úi la toĠi itemii inverúi = frazaĠi raĠional s-a răspuns cu “puternic de acord”).
Numărul maxim de puncte, cota maximă de iraĠionalitate este 288 (72 itemi x 4 puncte).
Utilizând doar factorul “procese cognitive” (ca úi factor de varianĠă), rezultă 4 subscale:
DEM – 18 itemi (9 direcĠi úi 9 inverúi);
SD/GE – 18 itemi (9 direcĠi úi 9 inverúi);
LFT – 18 itemi (9 direcĠi úi 9 inverúi);
AWF - 18 itemi (9 direcĠi úi 9 inverúi).
Aúadar, scorurile luate în discuĠie în această lucrare ca úi măsură a credinĠelor subiecĠilor sunt:
(1) Total (măsură a iraĠionalităĠii);
(2) IB (credinĠe iraĠionale);
(3) RB (credinĠe raĠionale);
(4) DEM (imperativul “trebuie”);
(5) SD/GE (autodeprecierea/evaluarea globală)
(6) LFT (toleranĠa scăzută la frustrare);
(7) AWF (gândirea catastrofică).

INVESTIGAREA INDICATORILOR PSIHOMETRICI

Totalul subiecĠilor cuprinúi în studiul de stabilirea a indicatorilor psihometrici sunt în număr de
381, dintre care: 369 de persoane sunt elevi de liceu, studenĠi si angajaĠi cu studii medii si superioare din
diferite întreprinderi (muncitori, informaticieni, secretare, funcĠionari), iar 12 persoane sunt pacienĠi ai
spitalelor de psihiatrie din Cluj-Napoca.

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SCALA DE ATITUDINI ùI CONVINGERI (ABS II)

Un număr de 350 de persoane, 167 de bărbaĠi úi 183 de femei, cu vârste cuprinse între 16 úi 49
de ani (m=20,11) au format lotul utilizat în estimarea consistenĠei interne a scalei. ToĠi subiecĠii au fost
voluntari, grupul fiind eterogen din punct de vedere ocupaĠional si al nivelului educaĠional (cuprinzând de
la elevi de liceu la persoane cu studii postuniversitare). Aceútia au completat ABS II, în grup úi fără limită
de timp. SubiecĠii au primit instrucĠiunea de a răspunde cât mai sincer la afirmaĠiile prezentate în
chestionar, specificându-se că nu există răspunsuri bune sau rele. Testarea s-a făcut în varianta hârtie -
creion.
Dintre cele 350 de persoane, 104 au completat si Inventarul de Depresie Beck (BDI), varianta
scurtă (13 itemi). Testul a fost administrat în aceeaúi manieră, imediat după completarea ABS II.
Alte 19 persoane, cu vârste cuprinse între 17 si 51 de ani au completat ABS II, precum si BDI,
varianta lungă (21itemi). Testele au fost administrate individual, fără limită de timp, în varianta hârtie -
creion, întâi ABS II iar apoi BDI.
Aceste 19 persoane au fost astfel selectate încât să aibă un scor scăzut la BDI (9 sau mai mic),
conform standardelor recomandate pentru ”formarea” unui lot nondepresiv (Solomon, Haaga, Brody, Kirk
& Friedman, 1998).
Un alt grup de 12 persoane a fost format din pacienĠi ai spitalelor de psihiatrie din Cluj-Napoca (ex. Clinica
de Ergoterapie), diagnosticaĠi cu depresie (episod depresiv major sau reacĠii depresive cu simptome
specifice episodului depresiv major). SubiecĠii au completat ABS II precum si BDI, varianta lungă
(21itemi). Testele au fost administrate individual, fără limită de timp, în varianta hârtie-creion, întâi ABS II
iar apoi BDI. ToĠi subiecĠii au înregistrat un scor de 16 sau mai mare la BDI, ceea ce indică prezenĠa
depresiei de nivel clinic. Deci, s-a lucrat cu un lot normal, neselecĠionat (N=350 persoane) la care s-a
adăugat un lot cu depresie cu scoruri foarte scăzute la BDI (N=19 persoane) úi un lot clinic, cu scor mare
la BDI (N=12 persoane).

REZULTATE
Rezultatele obĠinute pe populaĠia nonclinică (N=350) arată că:
(1) Nu se constată diferenĠe semnificative în funcĠie de vârstă sau sex;

Tabelul 1. ComparaĠii pe scale, în funcĠie de vârstă úi sex (N=350).

Scala Scala ComparaĠii în funcĠie de
Vârstă (adulĠi/adolescenĠi) Sex (M/F)
DEM t=-.89 / p=0.36 t=.07 / p=0.93
SD/GE t=-.68 / p=0.49 t=1.17 /p=0.23
AWF t=-1.67/p=0.09 t=.68 / p=0.49
LFT t=.48 / p=0.63 t=-1.55/p=0.12

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SCALA DE ATITUDINI ùI CONVINGERI (ABS II)

(2) Scorurile la cele patru subscale ale testului (DEM, LFT, SD, AWF) corelează (corelaĠie liniara)
puternic între ele (toate valorile p<0.01) si cu scorul total, constituind o nouă dovadă în sprijinul ideii
conform căreia toate credinĠele iraĠionale sunt relaĠionate din punct de vedere psihologic (DiGiuseppe et
al., 1989);

Tabelul 2. CorelaĠiile între scorurile subscalelor si scorul total (N=350).

AWF DEM SD LFT Total
AWF 1.000
DEM .492 1.000
SD .547 .277 1.000
LFT .606 .559 .417 1.000
Total .824 .701 .723 .812 1.000
Toate corelaĠiile sunt semnificative la p<.01.

(3) În tabelul 3 sunt prezentate comparativ mediile si abaterile standard pentru lotul românesc si
un lot american format din studenĠi (DiGiuseppe et al., 1989). După cum se observă, valorile obĠinute pe
populaĠia de limba română sunt mai mari, însă această diferenĠă ar putea fi explicată de numărul diferit de
subiecĠi din cele două loturi, precum úi de componenta diferită a acestora (studenĠi pentru lotul american,
elevi, studenĠi úi alte categorii de adulĠi pentru lotul românesc);

Tabelul 3. Mediile (m) úi abaterile standard (SD) pentru un lot românesc úi unul american
Scale Lotul românesc (N=350) Lotul american (N=764)
Total m=113.02 (SD=27.683) m=84.88 (SD=36.73)
AWF m=28.95 (SD=8.66) m=21.18 (SD=10.80)
DEM m=32.44 (SD=7.67) m=24.43 (SD=9.90)
SD m=20.06 (SD=9.99) m=12.82 (SD=10.80)
LFT m=31.56 (SD=8.92) m=26.80 (SD=10.80)

(4) Etalonul pentru scorul total, construit în baza datelor obĠinute pe populaĠie nonclinică (N=350) este
prezentat mai jos.
- IraĠionalitate foarte scăzută 0-91
- IraĠionalitate scăzută 92-107
- IraĠionalitate medie 108-121

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SCALA DE ATITUDINI ùI CONVINGERI (ABS II)

- IraĠionalitate ridicată 122-127

- IraĠionalitate foarte ridicată 136-288

ConsistenĠa internă a scalei. Puterea de discriminare

Studiile psihometrice efectuate pe populaĠie americană indică o consistenĠă internă adecvată utilizării
instrumentului; astfel coeficienĠii alfa pentru cele patru procese úi trei subscale de conĠinut variază între
.92 si .86. Majoritatea subscalelor discriminează între grupurile clinice si cele de control (fără
psihopatologie) (DiGiuseppe et al., 1989).

Fidelitatea test - retest

Studiile pilot anterioare efectuate pe populaĠie românească indică o fidelitate test-retest úi o consistenĠă
internă adecvate: r = .7340 (N=80); alpha Cronbach =.8654 (N=80) (Niculas, 2000).
Datele obĠinute în urma acestui studiului efectuat pe un eúantion de 350 vorbitori de limba română indică
valori comparabile cu cele obĠinute în investigaĠia iniĠială efectuată pe populaĠie americană, adecvate
utilizării în condiĠii bune a scalei.

Tabelul 4. CoeficienĠii alpha Cronbach pentru scalele testului si scorul total (N=350)
Scale Coeficient alpha Număr de itemi
Cronbach
Total .8792 72 itemi
AWF .6795 18 itemi
DEM .6063 18 itemi
SD .7924 18 itemi
LFT .7221 18 itemi

Validitatea discriminativă
Itemii în limba engleză ai scalei au fost concepuĠi, în baza unei definiĠii anterior formulate, de o
echipa de experĠi (terapeuĠi în cadrul Institutului de Terapie RaĠional Emotivă din New York); constructul
de credinĠe iraĠionale úi raĠionale a fost examinat cu succes în numeroase cercetări (Ellis & Dryden, 1997).
Varianta finală a instrumentului conĠine doar acei itemi care au întrunit acordul tuturor experĠilor convocaĠi.
Analiza factorială efectuată asupra scalei relevă existenĠa unui factor general úi a altor trei factori, numiĠi
de autori raĠionalitate, confort úi iraĠionalitate. Studiile de validare efectuate pe populaĠie americană indică
faptul că majoritatea subscalelor discriminează între loturile clinice úi cele de control (fără psihopatologie)
(DiGiuseppe et al., 1989).
În studiul pe populaĠia românească, dintre cele 350 de persoane care au completat scala ABS II,
104 au primit, de asemenea, BDI, varianta scurta (13 itemi). Pe baza rezultatelor la BDI, au fost selectate

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SCALA DE ATITUDINI ùI CONVINGERI (ABS II)

două grupe extreme (N=15 si N=17), utilizând formula m+_1SD, care au fost ulterior comparate în funcĠie
de scorurile la ABS2. DiferenĠele constatate sunt semnificative la pragul de .004 (t=3.102).

Capacitatea discriminativă
Am efectuat comparaĠii între un lot de persoane cu diagnostic clinic de depresie (N=12) úi un grup
de control, constituit din subiecĠi care nu au avut niciodată un diagnostic psihiatric (N=19). Aceste 19
persoane au fost astfel selectate încât să aibă un scor scăzut la BDI (9 sau mai mic), conform
standardelor recomandate pentru formarea unui lot nondepresiv (Solomon et al., 1998). Rezultatele
obĠinute sunt sintetizate în tabelul 5.

Tabelul 5. ComparaĠii între mediile la ABS II ale unui grup de subiecĠi depresivi (N=12)
si ale unui grup de control (N=19)
Scala t p
Total 6.850 .0001
DEM 4.017 .0004
LFT 3.756 .0008
SD 6.186 .0001
AWF 5.578 .0001
IB 7.165 .0001
RB 3.187 .0034

Deúi grupele de subiecĠi cu care s-a lucrat sunt mici, datele obĠinute constituie un argument în
plus, arătând ca ABS II este un instrument care discriminează între grupe de populaĠie cu nivele diferite
ale simptomatologiei depresive, precum úi între persoane cu depresie clinică úi subiecĠi fără
psihopatologie.
Studiile efectuate pe populaĠie americană indică faptul ca scorurile la ABS II corelează puternic cu
rezultatele obĠinute la alte teste (pentru detalii privind aceste instrumente vezi DiGiuseppe et al., 1989) ca:
forma scurta a BDI (Beck & Beck,1972), the General Health Questionnaire (Goldberg, 1972), the General
Psychological Well Being Scale (DuPue, 1988), The Spielberger Trait Anger Scale úi The Spielberger
Trait Anxiety Scale (DiGiuseppe et al., 1989).
Din datele obtinute pe populatie românească rezultă că majoritatea subscalelor ABS II corelează
cu forma scurta a Inventarului de Depresie Beck (BDI).

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SCALA DE ATITUDINI ùI CONVINGERI (ABS II)

CONCLUZII
In concluzie, propriet ăĠilepsihometrice adecvate, comparabile cu cele găsite în studii similare
efectuate pe populaĠie americană, permit utilizarea în condiĠii bune a variantei româneúti a ABS II. Totuúi,
recomandăm prudenĠa în extinderea concluziilor la categorii de vârstă úi socio-profesionale
nereprezentate în eúantionul utilizat. Dincolo de validitatea unui instrument, care este un proces continuu,
expertiza clinică a utilizatorului testului îúi are importanĠa ei de netăgăduit. În faza actuală a adaptării
scalei pe populaĠia românească s-a putut oferi etalonul numai pentru scorul global. În perspectivă odată
cu progresul cercetărilor, vor fi oferite úi etaloane pentru fiecare dintre cele 4 subscale.

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SCALA DE ATITUDINI ùI CONVINGERI (ABS II)

BIBLIOGRAFIE SELECTIVA

1. DiGiuseppe, R. (1996). The nature of irrational and rational beliefs: Progress in Rational Emotive
Behavior Therapy. Journal of Rational – Emotive & Cognitive Behavior Therapy, 14, 5-28.
2. DiGiuseppe, R., Leaf, R, Exner, T., & Robin, M.V. (1988). The development of a measure of
rational/irrational thinking. Paper presented at the World Congress of Behavior Therapy, Edinburg,
Scotland.
3. DiGiuseppe, R., Robin, M.W., Leaf, R. & Gormon, B. (1989). A discriminative validation and factor
analysis of a measure of rational /irrational beliefs. Paper presented at the World Congress of Cognitive
Therapy, Oxford, UK.
4. Ellis, A. & Dryden, W. (1997). The Practice of Rational Emotive Behavior Therapy.London: Springer
Publis hing Company.
5. Niculas F. (2000). Relatia convingeri irationale – strategii de coping. Lucrare de diploma/License
Dissertation. Oradea State University, Oradea.
6. Solomon A., Haaga, D.A.F., Brody C., Kirk, L., & Friedman, D.G. (1998). Priming irrational beliefs in
recovered - depressed people. Journal of Abnormal Psychology, 107, 440-449.
7. Weinrach, S.G. (1996). Nine experts describe the essence of Rational-Emotive Therapy while standing
on one foot. Journal of Counseling and Development, 74, 626- 632. Primit spre publicare în 15 Martie,
2002 / Received March 15, 2002 Acceptat pentru publicare în 23 Iunie, 2002 / Accepted (final revision)
June 23, 2002

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SCALA DE ATITUDINI ùI CONVINGERI (ABS II)

SCALA DE ATITUDINI ùI CONVINGERI II - ABS II

CitiĠi cu atenĠie următoarele afirmaĠii. AlegeĠi apoi, pentru fiecare afirmaĠie, unul dintre următoarele
răspunsuri care corespunde cel mai bine atitudini dv. fata de situaĠiile descrise.

A. dacă sunteĠi PUTERNIC ÎMPOTRIVĂ

B. dacă sunteĠi PARğIAL ÎMPOTRIVĂ
C. dacă sunteĠi NEUTRU
D. dacă sunteĠi PARğIAL DE ACORD
E. dacă sunteĠi PUTERNIC DE ACORD

Nu lăsaĠi ca răspunsul dv. la un item să influenĠeze răspunsul dv. la un alt item. Nu

există răspunsuri corecte sau incorecte; suntem interesaĠi doar de atitudinile manifestate într-o
serie de situaĠii descrise mai jos. NotaĠi pe foaia de răspuns, pentru fiecare afirmaĠie în parte, litera
care corespunde răspunsului ales de dumneavoastră.
Itemii 1 – 4 sunt itemi „de încălzire”. Ei pot lipsi din aplicarea scalei.

5. Este insuportabil să mă simt tensionat sau nervos, úi nu pot tolera stările acestea atunci când le am.
6. Dacă oameni importanĠi pentru mine nu mă plac, înseamnă că sunt o persoană lipsită de valoare.
7. Este dezamăgitor să nu fiu plăcut de oameni importanĠi pentru mine, dar útiu că asta este doar
neplăcut, nu ceva îngrozitor.
8. Atunci când mă simt tensionat, nervos sau inconfortabil, mă gândesc că asta arată ce om lipsit de
valoare sunt.
9. Dacă oameni importanĠi pentru mine nu mă plac, este din cauză că sunt o persoană nesuferită.
10. Este insuportabil să eúuez în lucrurile importante, úi nu suport să nu le duc la bun sfârúit.
11. Este regretabil că există necazuri în viaĠa mea, dar înĠeleg că a avea parte de necazuri este
dezamăgitor dar nu îngrozitor.
12. Va fi un dezastru dacă nu îndeplinesc bine lucrurile importante.
13. Îmi doresc foarte mult să fiu plăcut de anumite persoane, dar înĠeleg că nu trebuie neapărat ca
acestea să mă placă.
14. Când oameni importanĠi pentru mine nu mă plac, nu înseamnă că n-am valoare ca persoană.
15. Trebuie în mod absolut să fac bine lucrurile importante, úi nu voi accepta să nu le fac astfel.
16. Nu îmi face plăcere să mă simt inconfortabil, tensionat sau nervos, dar pot suporta stările acestea
atunci când apar.
17. Atunci când nu reuúesc într-o sarcină importantă, mă pot accepta pe mine însumi cu greúelile úi
limitele mele, úi nu mă condamn pentru eúec.
18. Este îngrozitor úi dezastruos să ai performanĠe slabe în sarcini importante.
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SCALA DE ATITUDINI ùI CONVINGERI (ABS II)

19. Pot suporta ca oameni importanĠi pentru mine să nu mă placă sau să nu fie de acord cu mine.
20. Sunt o persoană bună, valoroasă úi mă pot accepta pe mine însumi chiar dacă eúuez în unele sarcini
importante pentru mine.
21. Atunci când viaĠa mi se pare grea úi mă simt inconfortabil, înĠeleg că a te simĠi inconfortabil sau
tensionat nu este îngrozitor ci doar neplăcut, iar viaĠa merge înainte.
22. Nu pot suferi să fiu tensionat sau nervos úi cred că aceste stări sunt de nesuportat.
23. Dacă nu îndeplinesc bine sarcinile foarte importante pentru mine, este din cauză că sunt o persoana
incapabilă úi lipsită de valoare.
24. Nu vreau să eúuez în sarcinile importante pentru mine, dar înĠeleg că nu este absolut obligatoriu să le
îndeplinesc perfect doar pentru că vreau eu asta.
25. Este neplăcut să fii tensionat, dar pot suporta o astfel de senzaĠie de neplăcere.
26. Este insuportabil pentru mine să nu mă placă oameni pe care eu îi socotesc importanĠi.
27. Este îngrozitor să nu fiu plăcut de oamenii importanĠi pentru mine, úi este un dezastru dacă ei nu mă
plac.
28. Nu suport să nu îndeplinesc bine sarcinile importante pentru mine.
29. Este important să fiu plăcut de anumiĠi oameni, dar înĠeleg că ei nu trebuie să mă placă numai pentru
că vreau eu asta.
30. Sunt dezamăgit dacă nu îndeplinesc bine sarcinile importante pentru mine, dar nu consider că este
îngrozitor sau că este cel mai rău lucru cu putinĠă.
31. Am valoare ca persoană, chiar dacă nu îndeplinesc întotdeauna bine îndatoririle pe care le socotesc
importante.
32. Chiar úi atunci când mă simt tensionat, nervos sau inconfortabil, útiu că sunt la fel de valoros ca úi
ceilalĠi.
33. Este esenĠial úi absolut necesar să îndeplinesc bine sarcinile importante pentru mine.
34. Uneori cred că certurile úi nemulĠumirile mele cotidiene sunt îngrozitoare úi sunt cea mai rea parte din
viaĠa mea.
35. Este important să ai o viaĠă plăcută în cea mai mare parte a timpului; totuúi, înĠeleg că nu este absolut
obligatoriu să am o viaĠă plăcută numai pentru că vreau eu asta.
36. Mă simt dezamăgit dacă nu sunt plăcut de unii oameni pe care eu îi plac, dar înĠeleg că dacă ei nu mă
plac este doar regretabil, nu úi îngrozitor.
37. Trebuie cu necesitate să fiu plăcut de oamenii pe care îi socotesc importanĠi úi nu pot accepta să nu
fiu plăcut de ei.
38. Dacă nu voi reuúi în ceea ce fac, atât de bine cât mi-aú dori, aceasta va fi doar o dezamăgire úi ceva
regretabil.
39. Nu pot accepta să nu îndeplinesc bine sarcinile importante, iar eúecul este insuportabil.
40. Dacă cineva pe care îl socotesc important nu este de acord cu mine sau mă respinge, îmi dau seama
că pot accepta úi suporta acest fapt.

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SCALA DE ATITUDINI ù I CONVINGERI (ABS II)

41. Vreau să îndeplinesc bine unele lucruri, dar nu este absolut obligatoriu să iasă bine numai pentru că
îmi doresc eu asta.
42. Dacă nu realizez perfect lucrurile importante pentru mine e un dezastru.

43. Trebuie să am o viaĠă plăcută úi confortabilă aproape tot timpul, úi nu pot accepta viaĠa atunci când

aceasta este plină de necazuri úi eúecuri.

44. Dacă sunt respins de cineva pe care eu îl/o plac, pot să mă accept pe mine însumi úi să îmi recunosc

valoarea ca fiinĠă umană.

45. Atunci când mă simt tensionat sau nervos, consider că este neplăcut dar nu îngrozitor.

46. Este neplăcut să nu îmi îndeplinesc bine sarcinile importante, dar pot suporta disconfortul de a fi făcut

lucrurile mai puĠin bine decât mi-ar fi plăcut mie.

47. Nu pot suferi cearta în viaĠa mea.

48. Vreau să fiu plăcut úi acceptat de oamenii pe care îi plac, dar înĠeleg că nu este obligatoriu ca ei să

mă placă doar pentru că vreau eu asta.

49. Este îngrozitor să te cerĠi, úi este un dezastru să fii certat.

50. Nu pot suporta să nu fiu plăcut de oameni pe care îi socotesc importanĠi.

51. Este de dorit să fiu plăcut de anumiĠi oameni, dar înĠeleg că este doar regretabil dacă aceútia nu mă

plac.
52. Este absolut esenĠial să fii plăcut de oamenii importanĠi pentru tine, úi nu pot accepta ca aceútia să nu

mă placă.
53. Cred că este îngrozitor să trăieúti în tensiune, nervozitate sau nemulĠumire, úi este cel mai rău lucru

care mi s-ar putea întâmpla.

54. Mă supăr dacă nu îmi îndeplinesc bine sarcinile importante, dar pot suporta această supărare.

55. Vreau să îmi îndeplinesc bine sarcinile importante, dar înĠeleg că nu este absolut obligatoriu să

reuúesc în aceste sarcini numai pentru că îmi doresc eu asta.

56. Trebuie cu necesitate să am o viaĠă plăcută úi nu voi accepta să am problemele.

57. Dacă nu sunt plăcut de unii oameni importanĠi pentru mine, îmi dau seama că pot suporta faptul că ei

nu mă plac.
58. Este neplăcut să fii certat, dar pot suporta aceasta nemulĠumire.

59. Este îngrozitor să fiu respins de oamenii care trebuie să mă placă.

60. Atunci când mă cert úi / sau când viaĠa mea este neplăcută, cred că sunt o persoana fără valoare.

61. Sunt nemulĠumit că nu îmi îndeplinesc bine unele sarcini, dar útiu că pot suporta nemulĠumirea.

62. Aú fi o persoană lipsită de valoare dacă aú obĠine rezultate slabe la sarcinile foarte importante pentru

mine.
63. Trebuie cu necesitate să fiu plăcut úi acceptat de persoanele care vreau să mă placă, úi nu pot

accepta ca ele să nu mă placă.

64. Atunci când mă simt tensionat, nervos sau inconfortabil, înĠeleg că nu e obligatoriu să mă simt bine

numai pentru că aúa vreau eu.

13
SCALA DE ATITUDINI ùI CONVINGERI (ABS II)

65. Voi fi o persoană cu valoare dacă continui să am eúecuri la serviciu, la úcoală sau în alte activităĠi
importante pentru mine.
66. Atunci când oamenii pe care eu îi plac mă resping sau nu mă plac, înseamnă că sunt o persoană rea
úi fără de valoare.
67. Când oamenii care vreau eu să mă placă nu sunt de acord cu mine sau mă resping, nu pot suporta
aceasta situaĠie.
68. Atunci când în viaĠa mea există disconfort úi cearta, am tendinĠa să cred că nu sunt o persoană bună.
69. Când am necazuri, îmi dau seama că necazurile sunt parte a vieĠii úi că nu este obligatoriu ca ele să
dispară doar pentru că aúa vreau eu.
70. InĠeleg că nereuúita în sarcinile importante pentru mine este o dezamăgire úi nu ceva îngrozitor.
71. Nu trebuie úi nu pot accepta să mă simt tensionat, nervos sau inconfortabil.
72. Chiar dacă oamenii care vreau eu să mă placă nu sunt de acord cu mine, útiu că rămân în continuare
o persoană valoroasă.
73. Chiar úi atunci când viata mea este dificilă, înĠeleg că sunt o persoană la fel de bună ca oricare alta.
74. Trebuie să am succes în activităĠile pe care le consider importante, úi nu voi accepta altceva decât
succesul.
75. Dacă cei iubiĠi sau prietenii mă resping, acest lucru nu este doar neplăcut, ci este cel mai rău lucru
care mi s-ar putea întâmpla mie.
76. Atunci când viaĠa mea devine dezagreabilă, înĠeleg că sunt în continuare o persoană bună, chiar dacă
mă simt inconfortabil.

Note:
1. Itemii scalei sunt formulaĠi din raĠiuni de simplificare a exprimării la genul masculin.
2. Itemii 1-4 pot fi adăugaĠi de către clinician în funcĠie de interesul clinic urmărit. Aceútia: (a) sunt itemi de ” încălzire”;
(b) nu se iau in calcul la cotarea scalei, dar pot oferi informaĠii utile psihologului.

14
SCALA DE ATITUDINI ùI CONVINGERI (ABS II)

ANEXA 2
Scala de Atitudini úi Convingeri II – ABS II
Foaie de răspuns
Nume úi prenume: _________________________________
Data:__________
Vârsta:_________
Nivel de studii:______________________________
Sex:___ M___F

Pentru fiecare dintre afirmaĠiile de mai jos, marcaĠi cu un “X” spaĠiul corespunzător răspunsului ales:
A. dacă sunteĠi PUTERNIC ÎMPOTRIVĂ
B. dacă sunteĠi PARğIAL ÎMPOTRIVĂ
C. dacă sunteĠi NEUTRU
D. dacă sunteĠi PARğIAL DE ACORD
E. dacă sunteĠi PUTERNIC DE ACORD

ABCDE
5. __
6. __
7. __
8. __
9. __
ABCDE
10. __
11. __
12. __
13. __
14. __
ABCDE
15. __
16. __
17. __
18. __
19. __
ABCDE
20. __
21. __
22. __
15
SCALA DE ATITUDINI ùI CONVINGERI (ABS II)

23. __
24. __
ABCDE
25. __
26. __
27. __
28. __
29. __
ABCDE
30. __
31. __
32. __
33. __
34. __
ABCDE
35. __
36. __
37. __
38. __
39. __
ABCDE
40. __
41. __
42. __
43. __
44. __
ABCDE
45. __
46. __
47. __
48. __
49. __
ABCDE
50. __
51. __
52. __
53. __
54. __
16
SCALA DE ATITUDINI ùI CONVINGERI (ABS II)

ABCDE
55. __
56. __
57. __
58. __
59. __
ABCDE
60. __
61. __
62. __
63. __
64. __
ABCDE
65. __
66. __
67. __
68. __
69. __
ABCDE
70. __
71. __
72. __
73. __
74. __
ABCDE
75. __
76. __

17
SCALA DE ATITUDINI ùI CONVINGERI (ABS II)

ANEXA 3
Scala de Atitudini úi Convingeri II – ABS II

Codurile itemilor pentru cotare sunt:

Item RaĠionalitate ®/ ConĠinut Proces
IraĠionalitate (IR)
5 IR CONFORT LFT
6 IR APROBARE SD/GE
7 R APROBARE AWF
8 IR CONFORT SD/GE
9 IR APROBARE SD/GE
10 IR REALIZARE LFT
11 R CONFORT AWF
12 IR REALIZARE AWF
13 R APROBARE DEM
14 R APROBARE SD/GE
15 IR REALIZARE DEM
16 R CONFORT LFT
17 R REALIZARE SD/GE
18 IR REALIZARE AWF
19 R APROBARE LFT
20 R REALIZARE SD/GE
21 R CONFORT AWF
22 IR CONFORT LFT
23 IR REALIZARE SD/GE
24 R REALIZARE DEM
25 R CONFORT LFT
26 IR APROBARE LFT
27 IR APROBARE AWF
28 IR REALIZARE LFT
29 R APROBARE DEM
30 R REALIZARE AWF
31 R REALIZARE SD/GE
32 R CONFORT SD/GE
33 IR REALIZARE DEM
34 IR CONFORT AWF
35 R CONFORT DEM
36 R APROBARE AWF
37 IR APROBARE DEM
38 R REALIZARE AWF
39 IR REALIZARE LFT
40 R APROBARE LFT
41 R REALIZARE DEM
42 IR REALIZARE AWF
43 IR CONFORT DEM
44 R APROBARE SD/GE
45 R CONFORT AWF
46 R REALIZARE LFT
47 IR CONFORT LFT
48 R APROBARE DEM
18
SCALA DE ATITUDINI ù I CONVINGERI (ABS II)

49 IR CONFORT AWF
50 IR APROBARE LFT
51 R APROBARE AWF
52 IR APROBARE DEM
53 IR CONFORT AWF
54 R REALIZARE LFT
55 R REALIZARE DEM
56 IR CONFORT DEM
57 R APROBARE LFT
58 R CONFORT LFT
59 IR APROBARE AWF
60 IR CONFORT SD/GE
61 R REALIZARE LFT
62 IR REALIZARE SD/GE
63 IR APROBARE DEM
64 R CONFORT DEM
65 IR REALIZARE SD/GE
66 IR APROBARE SD/GE
67 IR APROBARE LFT
68 IR CONFORT SD/GE
69 R CONFORT DEM
70 R REALIZARE AWF
71 IR CONFORT DEM
72 R APROBARE SD/GE
73 R CONFORT SD/GE
74 IR REALIZARE DEM
75 IR APROBARE AWF
76 R CONFORT SD/GE

19
CHESTIONARUL DE ACCEPTARE NECONDIğIONATĂ A PROPRIEI PERSOANE
_____________________________________________________________________________
CHESTIONARUL DE ACCEPTARE NECONDIğIONATĂ A PROPRIEI
PERSOANE (UNCONDITIONAL SELF ACCEPTANCE
QUESTIONNAIRE - USAQ)
Copyright © Daniel David (pentru adaptarea în limba română)

INTRODUCERE
Stima de sine este reprezentarea în termeni de judecăĠi de valoare pe care fiecare o are
despre propria persoană úi este o componentă a schemei cognitive referitoare la sine. Ideea
conform căreia stima de sine face parte dintre factorii care se asociază cu sănătatea psihică este
parte integrantă a psihologiei de simĠ comun, de unde a pătruns úi în útiinĠă (Dawes, 1996).
Astfel, se consideră că o stimă de sine scăzută, apărută ca urmare a unor probleme din trecut, se
asociază cu prezenĠa simptomelor specifice depresiei (Beck, Steer, Epstein úi Brown, 1990;
Tarlow úi Haaga, 1996). Pe de altă parte, o stimă de sine ridicată ar duce la consecinĠe psiho-
comportamentale pozitive (Mecca, Smelser, úi Vasconcellos, 1989). Există însă o categorie tot
mai largă de studii care arată că úi o stimă de sine prea ridicată poate avea efecte negative
asupra sănătăĠii mentale. Astfel, o stimă de sine prea ridicată duce adesea la comportamente
agresive, anti-sociale, persoanele din această categorie fiind predispuse la acte de violenĠă
(Baumeister, Smart úi Boden, 1996). Totodată, cei cu stimă de sine ridicată acceptă mai greu
feedback-ul nefavorabil (Shrauger úi Lund, 1975) úi sunt mai vulnerabili la critică (Schlenker,
Soraci úi McCarthy, 1976). În concluzie, se pare că atât o stimă de sine prea ridicată, cât úi o
stimă de sine foarte scăzută afectează negativ funcĠionarea psihică a individului (Chamberlain úi
Haaga, 2001).
Încercând să explice acest paradox, Ellis (1962, 1994), propune ideea conform căreia
prezenĠa oricărui nivel al stimei de sine reflectă prezenĠa procesului de evaluare globală a
propriei persoane, care este iraĠional úi deci dezadaptativ. IraĠionalitatea procesului de evaluare
globală constă în imposibilitatea de a stabili în mod realist valoarea unei fiinĠe umane. Altfel spus,
deúi unele dintre performanĠele mele sunt scăzute este iraĠional să mă etichetez ca
„neperformant/ă”, deoarece aceasta ar însemna că toate comportamentele mele prezente,
trecute úi viitoare sunt neperformante, ceea ce este imposibil. Cu toate acestea, suntem tentaĠi ca
atunci când comportamentele noastre sunt performante să ne evaluăm pozitiv úi să experienĠiem
trăiri afective pozitive, iar atunci când comportamentele noastre sunt neperformante să ne
evaluăm negativ úi să experienĠiem trăiri afective negative disfuncĠionale. Deúi iraĠionale úi
dezadaptative, aceste evaluări sunt învăĠate úi încurajate social, ele fiind sursa sentimentului de
bine atunci când avem reuúite. Însă atunci când comportamentele noastre sunt neperformante,

1
CHESTIONARUL DE ACCEPTARE NECONDIğIONATĂ A PROPRIEI PERSOANE
_____________________________________________________________________________
tot ele ne produc suferinĠă emoĠională. Varianta raĠională este de a înlocui conceptul de stimă de
sine cu cel de acceptare necondiĠionată a propriei persoane (unconditional self-acceptance -
USA) care este logic corect úi mai pragmatic (Ellis, 1994; Rogers, 1961).
În această variantă, noi ne evaluăm comportamentele úi nu persoana noastră, care este
acceptată necondiĠionat indiferent de performanĠă, căci este prea complexă úi în continuă
schimbare pentru a fi evaluată global, pornind doar de la un eúantion de comportamente concrete
în situaĠii concrete. Mai mult, autoevaluarea (în special compararea propriei valori cu cea a altora)
tinde să consume mult timp úi să ne distragă de la alte scopuri personale, mult mai utile:
încercarea de a dobândi fericirea, căutarea úi dobândirea lucrurile pe care le dorim cu adevărat în
viaĠă. Astfel, atunci când am un eúec voi spune că am avut un comportament neperformant nu
că sunt neperformant/ă ca persoană. Această filozofie se regăseúte în marile religii ale lumii; spre
exemplu în Creútinism ea este foarte bine reflectată de formula „pedepsim păcatul dar îl iertăm
pe păcătos!” (David, 2003). În concluzie, acceptarea necondiĠionată a propriei persoane se referă
la faptul că individul „se acceptă în totalitate úi necondiĠionat, indiferent dacă se comportă
inteligent, corect, sau competent úi indiferent dacă oamenii îl aprobă, îl respectă sau îl iubesc”
(Ellis, 1977, pp. 101). Acceptarea necondiĠionată se poate referi (1) la propria persoană, (2) la cei
din jur úi (3) la condiĠiile de viaĠă.
Datele empirice (Chamberlain úi Haaga, 2001; David, Schnur úi Belloiu, 2002) arată că
implementarea acestui mod de evaluare în viaĠa de zi cu zi este un factor protectiv faĠă de
evenimentele stresante. Cercetările sugerează (Chamberlain úi Haaga, 2001) că atunci când sunt
învăĠaĠi această „filosofie de viaĠă validată empiric”, cei mai mulĠi oameni o asimilează mai uúor
astfel: când au performanĠe pozitive se evaluează pozitiv (în termenii stimei de sine), iar când au
performanĠe negative îúi evaluează comportamentul fără a-úi evalua persoana (în termenii
acceptării necondiĠionate) aceasta ducând la emoĠii negative funcĠionale (ex. tristeĠe) nu
disfuncĠionale (ex. depresie). Aceasta este o modalitate pragmatică de a aproxima atitudinea
raĠională în viaĠa reală.

CE MĂSOARĂ CHESTIONARUL?
Chestionarul cuprinde 20 de itemi care măsoară acceptarea necondiĠionată a propriei
persoane. Acesta a fost conceput în 2001, de către Chamberlain úi Haaga úi se bazează pe
teoria lui Albert Ellis asupra acceptării necondiĠionate, itemii reflectând diferitele aspecte ale
acestui concept multifaĠetat, central teoriei raĠional-emotive úi comportamentale.
Scala permite calcularea unui scor global, unde valorile mari reflectă nivele crescute de
acceptare necondiĠionată a propriei persoane.

2
CHESTIONARUL DE ACCEPTARE NECONDIğIONATĂ A PROPRIEI PERSOANE
_____________________________________________________________________________
DESCRIEREA ITEMILOR
USAQ cuprinde 20 de itemi, dintre care 9 itemi sunt astfel formulaĠi încât reflectă nivele
crescute de acceptare necondiĠionată a propriei persoane (ex., „Mă simt valoros, chiar dacă nu
reuúesc să ating anumite scopuri importante pentru mine.”), iar 11 itemi sunt formulaĠi astfel încât
reflectă o acceptare necondiĠionată scăzută (ex. „Ca să mă simt o persoană valoroasă trebuie să
fiu iubit de persoanele importante pentru mine.” ).
PosibilităĠile de răspuns pentru fiecare item merg de la „Aproape întotdeauna fals”, până
la „Aproape întotdeauna adevărat”.

Aproape De obicei Mai des La fel de Mai des De obicei Aproape

întotdeauna fals fals decât des adevărat adevărat întotdeauna
fals adevărat adevărat úi decât fals adevărat
fals
1 2 3 4 5 6 7

ADMINISTRARE ùI COTARE
Scala se administrează în varianta creion-hârtie, atât individual (úi în varianta
autoadministrare), cât úi în grup. Se preferă administrarea individuală, ori de câte ori este posibil.
În cazul administrării în grup, este indicat ca grupurile să nu fie mai mari de 15 persoane. Când
grupul este mai mare de 15 persoane, numărul examinatorilor trebuie să crească, păstrându-se
raportul de un examinator la maximum 15 persoane evaluate.
Materiale necesare
ƒ Itemii scalei úi instrucĠiunile de completare;
ƒ Foaia de răspuns;
ƒ Instrument de scris.
CondiĠii de administrare
ƒ Mediu securizant úi ferit de zgomote;
ƒ Persoana examinată să fie motivată pentru completarea scalei úi odihnită;
ƒ Mobilier úi iluminare adecvate, care să permită subiectului examinat
completarea în condiĠii bune a scalei;
ƒ În cazul aplicării în grup, sala trebuie să fie suficient de mare pentru a oferi
confort persoanelor examinate.

InstrucĠiuni de aplicare
Scala se administrează fără limită de timp.
După ce materialele úi condiĠiile necesare pentru administrarea scalei sunt asigurate,
persoanei examinate i se spune:

3
CHESTIONARUL DE ACCEPTARE NECONDIğIONATĂ A PROPRIEI PERSOANE
_____________________________________________________________________________
Vă rugăm indicaĠi cât de des simĠiĠi că afirmaĠiile de mai jos sunt adevărate sau
false pentru dumneavoastră. Pentru fiecare afirmaĠie, notaĠi numărul corespunzător (de la
1 la 7) pe linia din stânga acesteia, folosind scala de mai jos.
Această instrucĠiune apare úi pe lista cu itemii, subiectul putând să o recitească ori de
câte ori doreúte pe parcursul evaluării.

Ex. Răspunsul subiectului la itemul 1 – „Faptul că sunt lăudat mă face să mă simt mai
valoros ca persoană” este 5 - „Mai des adevărat decât fals”.

___5___ 1. Faptul că sunt lăudat mă face să mă simt mai valoros ca persoană.

ă
Cotarea r spunsurilor

Cotarea pentru 9 itemi se face direct (itemii 2, 3, 5, 8, 11, 16, 17, 18, 20), iar pentru 11
itemi invers (itemii 1, 4, 6, 7, 9, 10, 12, 13, 14, 15, 19).
Scorul total se obĠine însumând răspunsurile la fiecare dintre cei 20 de itemi, alocându-se
de la 1 la 7 puncte după cum urmează:

Pentru itemii cotaĠi direct: Pentru itemii cotaĠi invers:

Aproape întotdeauna fals = 1,
De obicei fals = 2,
Mai des fals decât adevărat = 3,
La fel de des adevărat úi fals = 4,
Mai des adevărat decât fals = 5,
De obicei adevărat = 6,
Aproape întotdeauna adevărat = 7.
Aproape întotdeauna fals = 7,
De obicei fals = 6,
Mai des fals decât adevărat = 5,
La fel de des adevărat úi fals = 4,
Mai des adevărat decât fals = 3,
De obicei adevărat = 2,
Aproape întotdeauna adevărat = 1.

Scorul total reflectă nivelul de acceptare necondiĠionată a propriei persoane. Scorurile

mari indică o acceptare necondiĠionată a propriei persoane ridicată, în timp ce scorurile scăzute
indică o acceptare necondiĠionată scăzută. Scorurile posibile variază între valorile de 20 (scor
minim) –140 (scor maxim).

FIDELITATE ùI VALIDITATE
Fidelitate

Fidelitatea unui test psihologic se referă la acordul sau stabilitatea aúteptată a măsurilor
analoge. Dacă un instrument este fidel, atunci rezultatele obĠinute în condiĠii similare prezintă o
anumită stabilitate în timp (Dempster úi Brainerd, 1995).

4
CHESTIONARUL DE ACCEPTARE NECONDIğIONATĂ A PROPRIEI PERSOANE
_____________________________________________________________________________
Fidelitatea unui instrument de măsurare este cel mai adesea exprimată pe baza
consistenĠei interne úi a stabilităĠii în timp a rezultatelor (Anastasi, 1988).
ConsistenĠa internă a unei scale se referă la măsura în care toĠi itemii scalei măsoară
aceeaúi variabilă. Stabilitatea rezultatelor testării ne indică în ce măsură la aplicări diferite în timp
un subiect obĠine rezultate similare la un test sau scală.

Fidelitatea USAQ a fost estimată prin calculul coeficientului de consistenĠă internă Alfa
Cronbach. Eúantionul utilizat a fost de 437 subiecĠi, valoarea Alfa obĠinută fiind de .73 (Tabelul 1).
Această valoare indică o consistenĠă internă bună, ceea ce exprimă faptul că itemii testului
evaluează acelaúi construct – acceptarea necondiĠionată a propriei persoane. Studiile de
fidelitate efectuate pe populaĠie americană indică un indice Alfa Cronbach de .72 (similar celui
obĠinut de noi pe populaĠie românească) (Chamberlain úi Haaga, 2001). Valoarea medie a
coeficientului obĠinut este în concordanĠă cu definiĠia constructului de acceptare necondiĠionată a
propriei persoane, care este multifaĠetat – implicând convingeri legate de caracteristicile propriului
comportament (ex. inteligent, corect, competent) úi de atitudinea persoanelor semnificative (ex.
aprobare, respect, iubire), reunite sub conceptul mai general al valorii intrinseci a fiinĠei umane.

Tabelul 1. Statistici descriptive úi indicii Alfa de consistenĠă internă pentru scorurile la USAQ

USAQ AdulĠi (vârsta cuprinsă între 18-74; m=28.99)

Femei BărbaĠi SubiecĠi lipsă Total
date sex
Scor total M 87.53 87.56 97.75 90.43
S.D. 13.43 12.02 15.06 14.41
N 235 78 124 437
D .68 .57 .82 .73

Tabelul 2. Date descriptive referitoare la nivelul educaĠional al subiecĠilor.

Nivel educaĠional N = 442 (437
valide)
ùcoală generală= 5 1.1 %
ùcoală profesională= 10 2.3 %
Liceu = 83 18.8 %
ùcoală postliceală= 17 3,8 %
Facultate= 308 69.7 %

5
CHESTIONARUL DE ACCEPTARE NECONDIğIONATĂ A PROPRIEI PERSOANE
_____________________________________________________________________________
Master sau doctorat= 14 3.2 %
Altceva= 5 1.1 %

Validitate

Validitatea este o caracteristică a unui test (sau scală) care arată măsura în care acesta
măsoară ceea ce se spune că măsoară. Altfel spus, validitatea se referă la măsura în care
inferenĠele pe care le facem pornind de la rezultatele obĠinute la un test sunt corecte (Messick,
1995).
Validitatea de conĠinut se referă la examinarea sistematică a itemilor testului/scalei
pentru a vedea dacă ei acoperă un eúantion reprezentativ al domeniului pe care dorim să îl
măsurăm. În elaborarea USAQ, Chamberlain úi Haaga (2001) au pornit de la definiĠia acceptării
necondiĠionate a propriei persoane care reflectă faptul că individul „se acceptă în totalitate úi
necondiĠionat, indiferent dacă se comportă inteligent, corect, sau competent úi indiferent dacă
oamenii îl aprobă, îl respectă sau îl iubesc” (Ellis, 1977, pp. 101). Chestionarul a fost astfel
conceput încât itemii lui să acopere diferitele faĠete ale conceptului de acceptare necondiĠionată
astfel definit. Spre exemplu, un item de tipul „Simt că sunt o persoană valoroasă chiar úi atunci
când alĠi oameni mă dezaprobă” se referă la aprobarea din partea celorlalĠi, în timp ce afirmaĠia
„Ca să mă simt o persoană valoroasă trebuie să fiu iubit de persoanele importante pentru mine”
face trimitere la iubirea celorlalĠi. În acelaúi fel, itemul „Cred că a fi bun în multe domenii, te face o
persoană bună în general” se referă la competenĠă, iar o afirmaĠie de tipul „Cred că sunt valoros
prin simplul fapt că sunt o fiinĠă umană” exprimă ideea subiacentă întregului chestionar conform
căreia toĠi oamenii sunt valoroúi prin simplul fapt că sunt oameni, indiferent de comportamentele
lor.
Validitatea de construct se referă la măsura în care testul/scala reflectă constructul pe
care îl măsoară. În cazul testelor utilizate pentru măsurare, validarea relativă la criteriu este o
componentă a validării relative la constructul măsurat (Albu, 1998). Ea apreciază „gradul în care
rezultatele furnizate de test corelează cu rezultatele altui instrument de evaluare despre care se
presupune că măsoară acelaúi construct sau unul similar” (Haynes, apud Silva, 1993).

Într-un studiu efectuat pe populaĠie românească (Macavei, 2006 – lucrare nepublicată) s-

a încercat determinarea măsurii în care acceptarea necondiĠionată a propriei persoane (măsurată
cu USAQ) se asociază cu anumite emoĠii úi cogniĠii conform modului teoretic propus de Albert
Ellis (teoria raĠional-emotivă úi comportamentală). AsumpĠia de bază a modelului amintit este că
la baza problemelor de tip emoĠional úi comportamental stă dificultatea persoanei de a se
accepta necondiĠionat úi de a accepta necondiĠionat oamenii din jurul său úi condiĠiile de viaĠă.
Atunci când cineva deĠine credinĠe adaptative despre sine, ceilalĠi úi viaĠă úi se poate considera o

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CHESTIONARUL DE ACCEPTARE NECONDIğIONATĂ A PROPRIEI PERSOANE
_____________________________________________________________________________
fiin valoroasă indiferent de comportamentele sale va trăi emoĠii pozitive sau negative (conform
Ġă
dinamicii dintre evenimentele de viaĠă úi scopurile sale), însă nu va trăi emoĠii invalidante. Astfel,
dacă asumpĠiile modelului sunt corecte, ne aúteptăm să găsim:
1. o asociere pozitivă între acceptarea necondiĠionată a propriei persoane úi credinĠele
adaptative, de tip raĠional;
2. o asociere negativă între acceptarea necondiĠionată a propriei persoane úi credinĠele
dezadaptative, de tip iraĠional;
3. o asociere negativă între acceptarea necondiĠionată a propriei persoane úi emoĠiile de
tip disfuncĠional;
4. o asociere negativă între acceptarea necondiĠionată a propriei persoane úi anxietate úi
depresie ca sindrom (manifestări de ordin emoĠional, comportamental, fiziologic,
cognitiv);
5. lipsa unei asocieri între acceptarea necondiĠionată a propriei persoane úi emoĠiile
pozitive úi negative de tip funcĠional.

La studiu au participat în total 701 subiecĠi; o parte dintre aceútia au fost studenĠi
recompensaĠi pentru participare prin recunoaúterea unor activităĠi de profil prevăzute în curricula
úcolară. CeilalĠi subiecĠi au fost incluúi în studiu pe bază de voluntariat, în urma unor anunĠuri
publice. Pentru participarea persoanelor cu vârste sub 18 ani s-a cerut acordul unui părinte sau
tutore legal. Datele statistice oferite mai jos reflectă úi faptul că unii dintre participanĠii la studiu au
omis sau refuzat să ofere informaĠii complete vizând nivelul educaĠional, vârsta, statutul marital
etc.
Tabelul 3. Date statistice privind subiecĠii incluúi în studiu

Nivel educaĠional N = 701 100 %

ùcoală primară = 22 (3.1 %)

ùcoală profesională = 28 (4.0 %)
Liceu = 222 (31.7 %)
ùcoală postliceală = 60 (8.6 %)
Facultate = 346 (49.3 %)
Studii postuniveristare = 19 (2.7 %)
Altceva = 4 (0.6 %)
Vârsta N = 695 Sex N = 574
Date lipsă N=6 Date lipsă N=127
M= 34.42 Min.= 15 BărbaĠi = 169
Max.= 73 Femei = 405
Statut marital N = 567
Date lipsă N=134
Căsătorit = 326
Necăsătorit = 241

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CHESTIONARUL DE ACCEPTARE NECONDIğIONATĂ A PROPRIEI PERSOANE
_____________________________________________________________________________
Instrumentele utilizate au fost:
Scala de atitudini disfuncĠionale – DAS-A (Dysfunctional Attitudes Scale – form A -
Weissman, 1979; Weissman úi Beck, 1978) este un instrument de 40 de itemi care permite
evaluarea prezenĠei atitudinilor/credinĠelor disfuncĠionale associate simptomatologiei de tip
depresiv.
Inventarul de depresie Beck – BDI (Beck Depression Inventory - Beck, Rush, Shaw, úi
Emery, 1979) conĠine 21 de itemi úi a fost utilizat pentru identificarea prezenĠei simptomatologiei
de tip depresiv, exprimată prin emoĠii, comportamente, credinĠe úi manifestări fiziologice
specifice.
Scala de atitudini úi convingeri 2 – ABS2 (Attitudes and Beliefs Scale 2 -DiGiuseppe,
Leaf, Exner, úi Robin, 1988) este formată din 72 de itemi úi este un instrument valid pentru
identificarea prezenĠei credinĠelor iraĠionale úi raĠionale centrale teoriei raĠional-emotive úi
comportamentale. Varianta în limba română a scalei prezintă proprietăĠi psihometrice bune
(Macavei, 2002).
Chestionarul de acceptare necondiĠionată a propriei persoane – USAQ (Unconditional
Self-Acceptance Questionnaire - Chamberlain úi Haaga, 2001) este format din 20 de itemi úi
măsoară acceptarea necondiĠionată a propriei persoane, ca factor protectiv care previne
declanúarea anumitor forme de psihopatologie la contactul cu situaĠiile negative de viaĠă.
Profilul distresului emoĠional – PDE (Profile of Emotional Distress- Opriú úi Macavei,
2005) este un instrument de 26 de itemi care măsoară prezenĠa emoĠiilor negative funcĠionale úi
disfuncĠionale (ca anxietatea, îngrijorarea, deprimarea, tristeĠea); utilizează principiul de
construcĠie al Profilului dispoziĠiilor afective, forma scurtă (DiLorenzo, Bovbjerg, Montgomery,
Valdimarsdottir, úi Jacobsen, 1999) úi se bazează pe teoria lui Albert Ellis asupra distresului
emoĠional (Ellis, 1994).
Profilul dispoziĠiilor afective – forma scurtă – POMS-SV (Profile of Mood States—Short
Version - Shacham 1983) este un instrument de 47 de itemi care măsoară emoĠiile positive úi
negative.
Chestionarul gândurilor automate –ATQ (Automatic Thoughts Questionnaire - Hollon úi
Kendall, 1980) conĠine 30 de itemi care reflectă gândirea e tip depresiv.
State and Trait Anxiety Inventory – STAI-X1 úi STAI-X2 (Inventarul de anxietate ca stare
úi trăsătură - Spielberger, 1983). ) este alcătuit din 2 scale de autoevaluare a câte 20 de itemi
fiecare pentru măsurarea a două aspecte distincte privind anxietatea. Starea de anxietate (A-
stare) úi anxietatea ca trăsătură (A-trăsătură).

Procedura de lucru a implicat în prima fază solicitarea consimĠământului de participare la

studiu, după care subiecĠii au completat individual câte un pachet conĠinând instrumentele
menĠionate anterior, fără limită de timp.

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CHESTIONARUL DE ACCEPTARE NECONDIğIONATĂ A PROPRIEI PERSOANE
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Rezultatele arată că acceptarea necondiĠionată a propriei persoane se asociază pozitiv
cu credinĠele raĠionale, fără însă a se suprapune peste acest concept. Conform teoriei raĠional-
emotive úi comportamentale, acceptarea necondiĠionată este un concept care se referă atât la
varianta funcĠională a evaluării globale negative, cât úi la o atitudine mai generală faĠă de sine,
lume úi viaĠă. Totodată, acceptarea necondiĠionată a propriei persoane se asociază negativ cu (1)
credinĠele dezadaptative de diverse tipuri (inferenĠe, evaluări, scheme cognitive) úi cu (2) emoĠiile
de tip disfuncĠional. Indicii de corelaĠie obĠinuĠi evidenĠiază úi distincĠia dintre problemele
emoĠionale (care implică aspecte diverse de tip afectiv, cognitiv, comportamental úi fiziologic) úi
emoĠiile (ca trăiri afective distincte). Astfel, o persoană poate trăi emoĠii negative, fără ca acestea
aibă în subiacent distorsiuni cognitive sau să devină probleme emoĠionale (cu implicaĠii de ordin
comportamental, fiziologic), aspect reflectat de gradul de asociere diferit între scorurile la PDE úi
USAQ pe de o parte úi STAI/BDI úi USAQ pe de alta.

Tabelul 4. CorelaĠii între scorurile la USAQ úi scorurile la alte instrumente de evaluare a

cogniĠiilor úi emoĠiilor funcĠionale úi disfuncĠionale.

USAQ
1 PDE – scor total (N= 115) -.19*
2 PDE – subscala de tristeĠe (N= 118) -.15
3 PDE – subscala de depresie (N = 119) -.20*
4 PDE – subscala de anxietate (N= 118) -.14
5 PDE – subscala de îngrijorare (N= 119) -.20*
6 PDE – emoĠii negative funcĠionale (N= 117) -.18*
7 PDE – emoĠii negative disfuncĠionale (N= 117) -.18*
8 BDI (N= 235) -.37*
9 DAS-A (N=234) -.69*
10 ATQ (N= 236) -.40*
11 ABS2 – IB (N= 224) -.55*
12 ABS2 - RB (N=225) .43*
13 POMS-VS – scor total (N= 220) -.36*
14 POMS-VS – emoĠii negative (N= 225) -.35*
15 POMS-VS – emoĠii pozitive (N= 236) .27*
16 STAI X1 (N= 236) -.35*
17 STAI X2 (N= 207) -.48*
* corelaĠiile sunt semnificative la pd.05

În concluzie, datele disponibile până în acest moment sugerează că varianta în limba

română a USAQ are proprietăĠi psihometrice bune, asemănătoare variantei originale, în limba

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CHESTIONARUL DE ACCEPTARE NECONDIğIONATĂ A PROPRIEI PERSOANE
_____________________________________________________________________________
engleză.Datorită limitelor studiilor existente până în acest moment, până la investigaĠii viitoare,
se impune o anumită prudenĠă în utilizarea USAQ, varianta în limba română.

Etalonare

Cotele sau clasele stabilite asupra grupului de referinĠă constituie etalonul sau tabelul de
norme. Cotele brute capătă semnificaĠie numai dacă sunt raportate la etalon. Pentru construcĠia
etaloanelor am utilizat 437 de subiecĠi (vezi úi studiul de fidelitate).
Etalonul a fost construit pe cinci clase normalizate. Prima clasă include 6.7% din subiecĠi,
cei cu cel mai scăzut nivel de acceptare necondiĠionată a propriei persoane. A doua clasă, în
sens ascendent al acceptării necondiĠionate, include următorii 24.2% dintre subiecĠi, a treia clasă
include următorii 38.2%, a patra clasă include următorii 24.2%, iar a cincea clasă include ultimii
6.7% dintre subiecĠi, cei cu cel mai înalt nivel de acceptare necondiĠionată a propriei persoane.
Întrucât nu există diferenĠe semnificative în funcĠie de sex, etaloanele sunt valabile atât
pentru femei, cât úi pentru bărbaĠi (vezi Tabelul 5).

Tabelul 5 . Date descriptive úi pragul de semnificaĠie pentru comparaĠii în funcĠie de sex.

SEX N Media A.S. t p

Total USAQ masculin 78 87.56 12.02 .01 .98
feminin 235 87.53 13.43

USAQ (N=437)
Clase Descriere Cote
I Acceptare necondiĠionată a propriei persoane d 70
foarte scăzută
II Acceptare necondiĠionată a propriei persoane 71-83
scăzută
III Acceptare necondiĠionată a propriei persoane 84-98
medie
IV Acceptare necondiĠionată a propriei persoane 99-113
ridicată
V Acceptare necondiĠionată a propriei persoane t 114
foarte ridicată

Punctul critic de decizie (cutoff point) reprezintă media plus o abatere standard (90.43 +
14.41 = 104.84) úi indică scorul de la care se poate considera că persoana prezintă o tendinĠă
crescută de acceptare necondiĠionată a propriei persoane, ceea ce – conform literaturii de
specialitate - poate constitui un factor protectiv care previne declanúarea anumitor forme de
psihopatologie la contactul cu situaĠiile negative de viaĠă.

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CHESTIONARUL DE ACCEPTARE NECONDIğIONATĂ A PROPRIEI PERSOANE
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BIBLIOGRAFIE
Albu, M. (1998). Construirea úi utilizarea testelor psihologice. Cluj-Napoca: Editura Clusium.
Anastasi, A. (1988). Psychological Testing. 6th edition. New York: Macmillan.
Baumeister, R.F., Smart, L., úi Boden J.M. (1996). Relation of threatened egotism to violence and
aggression: The dark side of high self-esteem.Psychological Review, 103, 5–33.
Beck, A.T., Rush, A.J., Shaw, B.F. úi Emery, G. (1979). Cognitive therapy of depression. Guilford
Press: New York.
Beck, A.T., Steer, R.A., Epstein, N., úi Brown, G. (1990). Beck Self-Concept Test. Psychological
Assessment, 2, 191–197.
Chamberlain, J.M., úi Haaga, D.A.F. (2001). Unconditional self-acceptance and psychological
health. Journal of Rational-Emotive & Cognitive-Behavior Therapy, 19 (3), 163-176.
David, D. (2003). Castele de nisip. Bucureúti: Editura Tritonic.
David, D., Schnur J., úi Belloiu A. (2002). Another search for the “hot” cognitions: Appraisal,
irrational beliefs, attributions, and their relation to emotion. Journal of Rational-Emotive
and Cognitive-Behavior Therapy, 2, 93-131.
Dawes, R.M. (1996). House of cards. Psychology and psychotherapy built on myth. The Free
Press: New York.
Dempster, F.N., úi Brainerd, C.J. (1995). Inference and inhibition in cognition. San Diego, CA:
Academic Press.
DiGiuseppe, R., Leaf, R., Exner, T. úi Robin, M.W. (1988). The development of a measure of
rational/irrational thinking. Paper presented at the World Congress of Behavior Therapy,
Edinburgh, Scotland.
DiLorenzo, T., Bovbjerg, D., Montgomery, G., Valdimarsdottir, H., úi Jacobsen, P. (1999) The
application of a shortened version of the profile of mood states in a sample of breast
cancer chemotherapy patients. British Journal of Health Psychology, 4, 315–325.
Ellis, A. (1962). Reason and emotion in psychotherapy. New York: Lyle Stuart.
Ellis, A. (1977). Psychotherapy and the value of a human being. În A. Ellis úi R. Grieger (Eds.),
Handbook of rational-emotive therapy (pp. 99-112). New-York: Springer.
Ellis, A. (1994). Reason and emotion in psychotherapy (re. ed.). Secaucus, NJ: Birscj Lane.
Hollon, S.D., úi Kendall, P.C. (1980). Cognitive self-statements in depression: Development of an
automatic thoughts questionnaire. Cognitive Therapy and Research, 4, 383-395.
Macavei, B. (2002). A Romania adaptation of the Attitudes and Beliefs Scale 2. Romanian
Journal of Cognitive and Behavioral Psychotherapies, 2, 105-122.
Mecca, A., Smelser, N.J., úi Vasconcellos, J. Eds. (1989).The Social Importance of Self-
Esteem. University of California Press: Berkeley.
Messick, S. (1995). Validity of Psychological Assessment. American Psychologist, 50, 741-749.

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Opris, D., úi Macavei, B. (2005). The distinction between functional and dysfunctional negative
emotions; An empirical analysis. Journal of Cognitive and Behavioral Psychotherapies, 5,
181-195.
Rogers, C.R. (1961). On becoming a person. Houghton Mifflin: Boston.
Schlenker, B.R., Soraci, S., úi McCarthy, B. (1976). Self-esteem and group performance as
determinants of egocentric perceptions in cooperative groups. Human Relations, 29,
1163–1176.
Shacham, N. (1983) A shortened version of the profile of mood states. Journal of Personality
Assessment, 47, 305–306.
Shrauger, J.S., úi Lund, A.K. (1975). Self-evaluation and reactions to evaluations from others.
Journal of Personality, 43, 94–108.
Silva, F. (1993). Psychometric Foundations and Behavioral Assessment. Sage Publications.
Spielberger, C.D. (1983). Manual for the State-Trait Anxiety Inventory (STAI). PaloAlto, CA:
Consulting Psychologists Press.
Tarlow, E.M., úi Haaga, D.A.F. (1996). Negative self-concept: Specificity to depressive symptoms
and relation to positive and negative affectivity. Journal of Research in Personality, 30,
120–127.
Weissman, A.N. (1979). The Dysfunctional Attitude Scale: A validation study. Dissertation
Abstracts International, 40, 1389B-1390B. (University Microfilms No. 79-19, 533).
Weissman, A.N., úi Beck, A.T. (1978, November). Development and validation of the
Dysfunctional Attitude Scale : A preliminary investigation. Paper presented at the
meeting of the Association for the Advancement of Behavior Therapy, Chicago.

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CHESTIONARUL DE ACCEPTARE NECONDIğIONATĂ A PROPRIEI PERSOANE
_____________________________________________________________________________

CHESTIONARUL DE ACCEPTARE NECONDIğIONATĂ A PROPRIEI

PERSOANE (UNCONDITIONAL SELF ACCEPTANCE
QUESTIONNAIRE - USAQ)

InstrucĠiuni:
Vă rugăm indicaĠi cât de des simĠiĠi că afirmaĠiile de mai jos sunt adevărate sau
false pentru dumneavoastră. Pentru fiecare afirmaĠie, notaĠi numărul corespunzător (de
la 1 la 7) pe linia din stânga acesteia, folosind scala de mai jos:

Aproape De obicei Mai des La fel de Mai des De obicei Aproape

întotdeauna fals fals decât des adevărat adevărat întotdeauna
fals adevărat adevărat úi decât fals adevărat
fals
1 2 3 4 5 6 7

_______ 1. Faptul că sunt lăudat mă face să mă simt mai valoros ca persoană.

_______ 2. Mă simt valoros, chiar dacă nu reuúesc să ating anumite scopuri importante
pentru mine.
_______ 3. Atunci când primesc un comentariu negativ, îl consider o oportunitate de a-mi
îmbunătăĠi comportamentul sau performanĠa.
_______ 4. Simt că unii oameni sunt mai valoroúi decât alĠii.
_______ 5. Să faci o greúeală poate fi dezamăgitor, dar nu schimbă ceea ce simt faĠă de
mine în general.
_______ 6. Uneori mă surprind gândindu-mă dacă sunt o persoană bună sau rea.
_______ 7. Ca să mă simt o persoană valoroasă trebuie să fiu iubit de persoanele
importante pentru mine.
_______ 8. Îmi fixez scopuri în speranĠa că mă vor face fericit (sau mai fericit).
_______ 9. Cred că a fi bun în multe domenii, te face o persoană bună în general.
_______ 10. Sentimentul valorii mele depinde în mare măsură de rezultatul comparaĠiei cu
alte persoane.

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CHESTIONARUL DE ACCEPTARE NECONDIğIONATĂ A PROPRIEI PERSOANE
_____________________________________________________________________________
_______ 11. Cred că sunt valoros prin simplul fapt că sunt o fiinĠă umană.
_______ 12. Atunci când primesc un comentariu negativ mi-e greu să fiu deschis la ceea ce
se spune despre mine.
_______ 13. Îmi stabilesc scopuri care sper să îmi dovedească valoarea.
_______ 14. Nepriceperea la anumite lucruri mă face să mă apreciez ca fiind mai puĠin
valoros.
_______ 15. Cred că oamenii care au succes în ceea ce fac sunt oameni foarte valoroúi.
_______ 16. Cred că cel mai bun lucru în a fi lăudat este că mă face conútient de forĠele
mele.
_______ 17. Simt că sunt o persoană valoroasă chiar úi atunci când alĠi oameni mă
dezaprobă.
_______ 18. Evit să mă compar cu alĠi oameni pentru a decide dacă sunt sau nu o persoană
valoroasă.
_______ 19. Atunci când sunt criticat sau atunci când nu reuúesc în ceva am o părere mai
proastă despre mine ca persoană.
_______ 20. Nu cred că este o idee bună să îmi judec valoarea ca persoană.

14
 PDSQ
Chestionarul de screening
şi diagnostic psihiatric
Manual
—
Adaptarea ºi standardizarea PDSQ
pe populaþia din România

AUTORI

Mark Zimmerman, M.D.

–
Amalia Ciuca (coordonator)
Monica Albu
Descrierea CIP a Bibliotecii Naţionale a României
ZIMMERMAN, MARK
PDSQ : chestionarul de screening şi diagnostic psihiatric : manual : adaptarea şi standardizarea PDSQ pe
populaţia din România / Mark Zimmerman, Amalia Ciuca, Monica Albu. - Cluj-Napoca : Editura ASCR, 2010
Bibliogr.
ISBN 978-606-8244-04-4

I. Ciuca, Amalia
II. Albu, Monica

303:616.89

Ediţia în limba engleză

The Psychiatric Diagnostic Screening Questionnaire. Manual, Mark Zimmerman, M.D.

Published by WPS – WESTERN PSYCHOLOGICAL SERVICES
12031 Wilshire Boulevard
Los Angeles, CA 90025-1251
Copyright © 2001 by Mark Zimmerman, M.D. Translated and reprinted by permission of the publisher,
Western Psychological Services. Not to be reproduced in any form without written permission of Western
Psychological Services, 12031 Wilshire Boulevard, Los Angeles, California 90025, U.S.A. All rights reserved.

Copyright © 2001 Mark Zimmerman, M.D. Tradus şi reprintat cu permisiunea editurii Western
Psychological Services. Reproducerea integrală sau parţială în orice tip de format este interzisă fără acordul
prealabil în scris al Western Psychological Services, 12031 Wilshire Boulevard, Los Angeles, California
90025, U.S.A. Toate drepturile rezervate.

Ediţia în limba română

PDSQ – Chestionarul de screening şi diagnostic psihiatric. Manual.

Adaptarea şi standardizarea PDSQ pe populaţia din România
Coordonatorul ediţiei româneşti|Amalia Ciuca
Traducere din limba engleză|Dafina Ionuţiu
Coperta|Carolina Banc
Paginaţie şi prepress|Kitty Bojan
Lectura|Diana Breaz
Editor|Diana Breaz

Tipar|S.C. Cognitrom S.R.L., Cluj-Napoca

Pentru comenzi:
Tel.: 0264‑581499
www.cognitrom.ro
office@cognitrom.ro
 
 
Copyright © 2010 S.C. COGNITROM S.R.L.

Toate drepturile rezervate. Reproducerea integrală sau parţială a textului şi stocarea sa într-o bază de date,
fără acordul prealabil în scris al COGNITROM, sunt interzise şi se pedepsesc conform legii.
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Š™’˜•ž•ȱŗȱȬȱ—›˜žŒŽ›Žȱ ŗŗ
ŽœŒ›’Ž›ŽȱŽ—Ž›Š•©ȱ ŗŗ
˜Š•’©ô’ȱŽȱž’•’£Š›Žȱó’ȱ•’–’Žȱȱ ŗŘ

Š™’˜•ž•ȱŘȱȬȱ–’—’œ›Š›ŽŠȱœŒŠ•Ž’ȱ ŗř
–’—’œ›Š›Žȱó’ȱŒ˜Š›Žȱ ŗř
˜Š›ŽŠȱœŒŠ•Ž’ȱ ŗř

Š™’˜•ž•ȱřȱȬȱ—Ž›™›ŽŠ›ŽŠȱ›Ž£ž•ŠŽ•˜›ȱ ȱ Řŗ
©œ™ž—œž›’•Žȱ’œ˜›œ’˜—ŠŽȱ Řŗ
Œ˜›ž•ȱ˜Š•ȱ•ŠȱœŒŠ•Šȱȱ ȱ ŘŘ
ž‹œŒŠ•Ž•Žȱȱ ȱ Řř
Ž•ŽŒŠ›ŽŠȱ™ž—ŒŽ•˜›ȱŽȱœŽŒô’ž—Žȱ™Ž—›žȱœŒ›ŽŽ—’—Ȭž•ȱɗȱœŒ˜™ȱ’Š—˜œ’Œȱ ŘŚ
’•’£Š›ŽŠȱ̎¡’‹’•©ȱŠȱ™ž—ŒŽ•˜›ȱŽȱœŽŒô’ž—Žȱ ŘŚ
ž•‹ž›Š›ŽŠȱŽ™›Žœ’Ÿ©ȱ–Š“˜›©ȱ Řś
ž’Œ’ž•ȱ Řś
ž•‹ž›Š›ŽŠȱŽȱœ›Žœȱ™˜œĴ›Šž–Š’Œȱ Řś
ž•’–’ŠȦ•’–Ž—Šô’ŠȱŒ˜–™ž•œ’Ÿ©ȱ ŘŜ
ž•‹ž›Š›ŽŠȱ˜‹œŽœ’ŸȬŒ˜–™ž•œ’Ÿ©ȱ ŘŜ
ž•‹ž›Š›ŽŠȱŽȱ™Š—’Œ©ȱ Řŝ
ž•‹ž›©›’•Žȱ™œ’‘˜’ŒŽȱ Řŝ
˜›Š˜‹’Šȱ ŘŞ
˜‹’Šȱœ˜Œ’Š•©ȱ ŘŞ
‹ž£ž•ȦŽ™Ž—Ž—ôŠȱŽȱŠ•Œ˜˜•ȱ Řş
‹ž£ž•ȦŽ™Ž—Ž—ôŠȱŽȱ–Ž’ŒŠ–Ž—Žȱ Řş
ž•‹ž›Š›ŽŠȱŽȱŠ—¡’ŽŠŽȱŽ—Ž›Š•’£Š©ȱ řŖ
ž•‹ž›Š›ŽŠȱŽȱœ˜–Š’£Š›Žȱ řŗ
™˜‘˜—›’Šȱ řŗ
¡Ž–™•ŽȱŽȱŒŠ£ž›’ȱ ȱ řŘ
Š£ž•ȱŗDZȱȬ•ȱȱ řŘ
Š£ž•ȱŘDZȱȬ•ȱ
ȱ řś
Š£ž•ȱřDZȱȬ›Šȱȱ řŜ

Š™’˜•ž•ȱŚȱȬȱ˜—œ›žŒô’ŠȱœŒŠ•Ž’ȱó’ȱ™›˜™›’Ž©ô’•ŽȱœŠ•Žȱ™œ’‘˜–Ž›’ŒŽȱȱ řş
Œ˜™ž›’•ŽȱŒŠ›ŽȱŠžȱ–˜’ŸŠȱŒ˜—œ›žŒô’ŠȱœŒŠ•Ž’ȱȱ ȱ řş
™ŽŒ’ęŒŠ›ŽŠȱŒ›’Ž›’’•˜›ȱ’Š—˜œ’ŒŽȱ řş
ŒŒŽ™Š›ŽŠȱ’Š—˜œ’ŒŽ•˜›ȱŽ›’ŸŠŽȱ’—ȱ’—Ž›Ÿ’ž›’•ŽȱœŠ—Š›’£ŠŽȱ ŚŖ
 ›ŽŒŸŽ—ôŽ•ŽȱŒ›ŽœŒžŽȱŽȱŒ˜–˜›‹’’ŠŽȱó’ȱ—’ŸŽ•ž•ȱœŒ©£žȱŽȱ›ŽŒž—˜ŠóŽ›Žȱ
ŠȱŒ˜–˜›‹’’©ô’’ȱ ŚŖ
›Žœ’ž—ŽŠȱ’–™ž•ž’ȱó’ȱŒ˜—œ›¦—Ž›’•Žȱœ’œŽ–ž•ž’ȱ–Ž’ŒŠ•ȱ ŚǾ
˜—ô’—žž›’•ŽȱœŒŠ•Ž’ȱȱ ȱ Śŗ
ž‹œŒŠ•Ž•Žȱȱ ŚŘ
ž›ŠŠȱœ’–™˜–Ž•˜›ȱó’ȱ›Ž™Ž›Ž•ŽȱŽ–™˜›Š•Žȱ ŚŘ
—Ž•’’‹’•’ŠŽŠȱ’Ž–’•˜›ȱȱ Śř
Š›’Œ’™Š—ô’ȱȱ Śř
—œ›ž–Ž—Žȱȱ ŚŚ
Ž£ž•ŠŽȱ ŚŚ
’Ž•’ŠŽŠȱó’ȱŸŠ•’’ŠŽŠȱœŒŠ•Ž’ȱ ȱ Śŝ
›’Ž›’’•Žȱ™Ž—›žȱ–˜’ęŒŠ›ŽŠȱœž‹œŒŠ•Ž•˜›ȱó’ȱŠȱ’Ž–’•˜›ȱ Śŝ
Š›’Œ’™Š—ô’ȱ Śŝ
—œ›ž–Ž—Žȱ Śŝ
˜—œ’œŽ—ôŠȱ’—Ž›—©ȱó’ȱꍎ•’ŠŽŠȱŽœȬ›ŽŽœȱȱ Śş
Š•’’ŠŽŠȱ’œŒ›’–’—Š’Ÿ©ȱó’ȱŸŠ•’’ŠŽŠȱŒ˜—ŸŽ›Ž—©ȱ ȱ śŘ
Š•’’ŠŽŠȱŽȱŒ›’Ž›’žȱ śŚ
Šę—Š›ŽŠȱœŒŠ•Ž’ȱȱ™Žȱ‹Š£Šȱ›Ž£ž•ŠŽ•˜›ȱœž’’•˜›ȱŽȱŸŠ•’’ŠŽȱó’ȱꍎ•’ŠŽȱ śŜ
Ž£ž–Šȱ śŜ

Š™’˜•ž•ȱśȱȬȱŽ›˜›–Š—ôŠȱœŒŠ•Ž’ȱ•ŠȱœŒ›ŽŽ—’—Ȭž•ȱɗȱœŒ˜™ȱ’Š—˜œ’Œȱ ȱ śŝ
Š›ŠŒŽ›’œ’Œ’•ŽȱŒ•’—’ŒŽȱŠ•Žȱ™Š›’Œ’™Š—ô’•˜›ȱ•Šȱœž’ž•ȱŽȱœŒ›ŽŽ—’—ȱ ȱ śŝ
ŠŽȱœŠ’œ’ŒŽȱŒŠ›ŽȱŽœŒ›’žȱ™Ž›˜›–Š—ôŠȱž—ž’ȱŽœȱ ȱ śş
ŠŽȱœŠ’œ’ŒŽȱ•ŽŠŽȱŽȱ™Ž›˜›–Š—ôŠȱœŒŠ•Ž’ȱȱ ȱ ŜŘ
˜—œ’Ž›Šô’’ȱŽ—Ž›Š•Žȱ•ŽŠŽȱŽȱœŒ›ŽŽ—’—Ȭž•ȱɗȱœŒ˜™ȱ’Š—˜œ’Œȱ ȱ ŜŘ
ž—ŒŽ•ŽȱŽȱœŽŒô’ž—Žȱ ŜŘ
Š•ó’’ȱ™˜£’’Ÿ’ȱɗȱ–Ž’ž•ȱ™œ’‘’Š›’ŒȱŒ•’—’Œȱ Ŝř
—Ž¡ŠȱȱȬȱŽ–’’ȱŒ›’’Œ’ȱŠ’ȱœŒŠ•Ž’ȱȱ ȱ Ŝś
—Ž¡ŠȱȱȬȱ˜’ęŒŠ›ŽŠȱœŒŠ•Ž’ȱȱ ȱ Ŝŝ
—Ž¡ŠȱȱȬȱ›’Ž›’’•Žȱ™›’Ÿ’—ȱ–˜’ęŒŠ›ŽŠȱœŒŠ•Ž’ȱȱ ŝŝ
ŽŽ›’—ôŽȱ‹’‹•’˜›ŠęŒŽȱȱ ŝŝ

ȱȱȬȱ
Š™Š›ŽŠȱó’ȱœŠ—Š›’£Š›ŽŠȱȱ™Žȱ™˜™ž•Šô’Šȱ’—ȱ˜–¦—’Šȱȱ
Ȭȱ–Š•’ŠȱŠ›’Šȱǰȱȱ˜—’ŒŠȱȱ
ŗǯȱ‹’ŽŒ’Ÿž•ȱœž’ž•ž’ȱ ȱ Şř
ŘǯȱŠ›’Œ’™Š—ô’ȱ ȱ Şř
řǯȱ›˜ŒŽž›Šȱ ȱ Şř
ŚǯȱŠŽȱŽœ™›ŽȱŽóŠ—’˜—ž•ȱ˜•˜œ’ȱ•Šȱ—˜›–Š›ŽȦŽŠ•˜—Š›Žȱ ȱ Şś
śǯȱŠ›ŠŒŽ›’œ’Œ’ȱ™œ’‘˜–Ž›’ŒŽȱȱ Şŝ
śǯŗǯȱ’Ž•’ŠŽŠȱ Şŝ
śǯŘǯȱŠ•’’ŠŽŠȱ ŞŞ
śǯŘǯŗǯȱŠ•’’ŠŽŠȱŒ˜—ŸŽ›Ž—©ȱó’ȱ’œŒ›’–’—Š’Ÿ©ȱ ŞŞ
śǯŘǯŘǯȱŠ•’’ŠŽŠȱŽȱŒ›’Ž›’žȱ şŖ
ŜǯȱŠŽȱœŠ’œ’ŒŽȱ•ŽŠŽȱŽȱ™Ž›˜›–Š—ôŠȱœŒŠ•Ž’ȱȱȱ şř
ŝǯȱ—Ž›™›ŽŠ›ŽŠȱœŒ˜›ž›’•˜›ȱ˜‹ô’—žŽȱ™›’—ȱŠ™•’ŒŠ›ŽŠȱȱ ȱ şŜ
ŝǯŗǯȱŒ˜›ž•ȱ˜Š•ȱ•ŠȱœŒŠ•ŠȱȱȮȱ˜ȱŒ•’—’Œȱ şŜ
ŝǯŘǯȱŒ˜›ž•ȱ˜Š•ȱ•ŠȱœŒŠ•ŠȱȱȮȱ˜ȱ—˜—ȬŒ•’—’Œȱ şŝ
ŝǯřǯȱž‹œŒŠ•Ž•Žȱȱ ŗŖŖ
ŽŽ›’—ôŽȱ‹’‹•’˜›ŠęŒŽȱȱ ŗŖŗ
 ’œŠȱꐞ›’•˜›ȱ

Š›ŽŠȱ
’ž›ŠȱŗǯȱŠ’Žž•ȱŽœž•ž’ȱȱó’ȱ’óŠȱŽȱœž–Š›’£Š›ŽȱŒ˜–™•ŽŠŽȱ ŗś
’ž›ŠȱŘǯȱ’óŠȱŽȱœž–Š›’£Š›Žȱ™Ž—›žȱŠ£ž•ȱŗȱǻȬ•ȱǼȱ řř
’ž›Šȱřǯȱȱ’óŠȱŽȱœž–Š›’£Š›Žȱ™Ž—›žȱŠ£ž•ȱŘȱǻȬ•ȱ
Ǽȱ řŚ
’ž›ŠȱŚǯȱ’óŠȱŽȱœž–Š›’£Š›Žȱ™Ž—›žȱŠ£ž•ȱřȱǻȬ›ŠȱǼȱ řŝ
’ž›Šȱśǯȱž—Œô’’•Žȱȱ™Ž—›žȱœž‹œŒŠ•Ž•Žȱȱ Ŝŗ

Š›ŽŠȱŠȱȬŠ
’ž›Šȱŗǯȱ›˜ŒŽœž•ȱŽȱ›ŠžŒŽ›Žȱó’ȱŠŠ™Š›ŽȱŠȱŒ‘Žœ’˜—Š›ž•ž’ȱȱ Şś
’ž›ŠȱŘǯȱž—Œô’’•Žȱȱ™Ž—›žȱœž‹œŒŠ•Ž•Žȱȱȱ şŜ

’œŠȱŠ‹Ž•Ž•˜›

Š›ŽŠȱ
Š‹Ž•ž•ȱŗȱȬȱž‹œŒŠ•Ž•Žȱȱ ŗŘ
Š‹Ž•ž•ȱŘȱȬȱŠ•˜›’•Žȱ™ž—ŒŽ•˜›ȱŽȱœŽŒô’ž—Žȱ›ŽŒ˜–Š—ŠŽȱ™Ž—›žȱŠȱęȱž’•’£ŠŽȱɗȱ
™›ŠŒ’ŒŠȱŒ•’—’Œ©ȱó’ȱŒŠ›ŠŒŽ›’œ’Œ’•ŽȱŠœ˜Œ’ŠŽȱ ŘŘ
Š‹Ž•ž•ȱřȱȬȱŠ›ŠŒŽ›’œ’Œ’ȱŽ–˜›ŠęŒŽȱó’ȱŒ•’—’ŒŽȱŠ•Žȱ™ŠŒ’Ž—ô’•˜›ȱ›ŠŠô’ȱɗȱž—’©ô’ȱ
™œ’‘’Š›’ŒŽȱŠ–‹ž•Š˜›’’ȱŒŠ›ŽȱŠžȱ™Š›’Œ’™Šȱ•Šȱœž’’•ŽȱŽȱꍎ•’ŠŽȱó’ȱ
ŸŠ•’’ŠŽȱŠ•ŽȱœŒŠ•Ž’ȱȱ ŚŜ
Š‹Ž•ž•ȱŚȱȬȱ’Ž•’ŠŽŠȱœŒ˜›ž›’•˜›ȱ•Šȱœž‹œŒŠ•Ž•Žȱȱ˜‹ô’—žŽȱŽȱ™ŠŒ’Ž—ô’’ȱ
™œ’‘’Š›’Œ’ȱ›ŠŠô’ȱŠ–‹ž•Š˜›’žȱ Śş
Š‹Ž•ž•ȱśȱȬȱ’Ž•’ŠŽŠȱó’ȱŸŠ•’’ŠŽŠȱœŒ˜›ž›’•˜›ȱ•Šȱ’Ž–’’ȱœŒŠ•Ž’ȱȱ˜‹ô’—žŽ
ȱŽȱ™ŠŒ’Ž—ô’’ȱ™œ’‘’Š›’Œ’ȱ›ŠŠô’ȱŠ–‹ž•Š˜›’žȱ śŖ
Š‹Ž•ž•ȱŜȱȬȱ˜›Ž•Šô’’•Žȱ’—›ŽȱœŒ˜›ž›’•Žȱ•Šȱœž‹œŒŠ•Ž•Žȱȱó’ȱ–©œž›©˜›’ȱŠ•ŽȱŠ•˜›ȱ
œ’—›˜Š–Žȱȱ śŗ
Š‹Ž•ž•ȱŝȱȬȱŽ’ŠȱœŒ˜›ž›’•˜›ȱ•Šȱœž‹œŒŠ•Ž•Žȱȱ•Šȱ™ŠŒ’Ž—ô’’ȱŒžȱó’ȱ©›©ȱ’Š—˜œ’ŒŽȱ
Šœ˜Œ’ŠŽȱ śř
Š‹Ž•ž•ȱŞȱȬȱŽ›˜›–Š—ôŠȱœž‹œŒŠ•Ž•˜›ȱȱ›Š™˜›Š©ȱ•ŠȱŒ›’Ž›’’•ŽȱŽȱ–˜’ęŒŠ›Žȱ śŚ
Š‹Ž•ž•ȱşȱȬȱŽ›˜›–Š—ôŠȱ’Ž–’•˜›ȱȱ›Š™˜›Š©ȱ•ŠȱŒ›’Ž›’’•ŽȱŽȱ–˜’ęŒŠ›Žȱ śś
Š‹Ž•ž•ȱŗŖȱȬȱŠ›ŠŒŽ›’œ’Œ’ȱŽ–˜›ŠęŒŽȱó’ȱŒ•’—’ŒŽȱŠ•Žȱ™ŠŒ’Ž—ô’•˜›ȱ™œ’‘’Š›’Œ’ȱ
›ŠŠô’ȱŠ–‹ž•Š˜›’žǰȱŒŠ›ŽȱŠžȱ™Š›’Œ’™Šȱ•Šȱœž’ž•ȱŒŠ›ŽȱŽ¡Š–’—ŽŠ£©ȱ
™Ž›˜›–Š—ôŠȱœŒŠ•Ž’ȱȱɗȱœŒ›ŽŽ—’—ȱ śŞ
Š‹Ž•ž•ȱŗŗȱȬȱŽ—œ’‹’•’ŠŽŠȱó’ȱœ™ŽŒ’ęŒ’ŠŽŠȱœž‹œŒŠ•Ž•˜›ȱȱ•Šȱ’Ž›’ŽȱŸŠ•˜›’ȱ
Š•Žȱ™ž—ŒŽ•˜›ȱŽȱœŽŒô’ž—Žȱ śş
Š‹Ž•ž•ȱŗŘȱȬȱŠ•˜›’•Žȱ™›Ž’Œ’ŸŽȱ™˜£’’ŸŽȱó’ȱ—ŽŠ’ŸŽȱŠ•Žȱœž‹œŒŠ•Ž•˜›ȱȱ•Šȱ
’Ž›’ŽȱŸŠ•˜›’ȱŠ•Žȱ™ž—ŒŽ•˜›ȱŽȱœŽŒô’ž—Žȱ ŜŖ

Š›ŽŠȱŠȱȬŠ
Š‹Ž•ž•ȱŗȱȬȱŠ›ŠŒŽ›’œ’Œ’•ŽȱŽ–˜›ŠęŒŽȱó’ȱŒ•’—’ŒŽȱ ŞŚ
Š‹Ž•ž•ȱŘȱȬȱȱ˜–™Š›Š›ŽŠȱ–Ž’’•˜›ȱœŒ˜›ž›’•˜›ȱɗ›ŽȱœŽ¡Žȱɗȱ•˜ž•ȱŒ•’—’Œȱ ŞŜ
Š‹Ž•ž•ȱřȱȬȱ˜–™Š›Š›ŽŠȱ–Ž’’•˜›ȱœŒ˜›ž›’•˜›ȱɗ›ŽȱœŽ¡Žȱɗȱ•˜ž•ȱ—˜—ȬŒ•’—’Œȱ ŞŜ


 Š‹Ž•ž•ȱŚȱȬȱ˜—œ’œŽ—ôŠȱ’—Ž›—©ȱó’ȱꍎ•’ŠŽŠȱŽœȬ›ŽŽœȱŠȱœž‹œŒŠ•Ž•˜›ȱȱ
ǻ•˜ȱŒ•’—’ŒǼȱ Şŝ
Š‹Ž•ž•ȱśȱȬȱ’Ž•’ŠŽŠȱó’ȱŸŠ•’’ŠŽŠȱœŒ˜›ž›’•˜›ȱ•Šȱ’Ž–’’ȱœŒŠ•Ž’ȱȱ ŞŞ
Š‹Ž•ž•ȱŜȱȬȱ˜›Ž•Šô’’•Žȱ’—›ŽȱœŒ˜›ž›’•Žȱ•Šȱœž‹œŒŠ•Ž•Žȱȱó’ȱ–©œž›©˜›’ȱŠ•ŽȱŠ•˜›ȱ
ž•‹ž›©›’ȱǻƽŗŞřǼȱ Şş
Š‹Ž•ž•ȱŝȱȬȱ˜–™Š›Š›ŽŠȱ–Ž’’•˜›ȱœŒ˜›ž›’•˜›ȱ•Šȱœž‹œŒŠ•Ž•Žȱȱɗ›Žȱ™ŠŒ’Ž—ô’’ȱŒžȱ
ó’ȱ©›©ȱ’Š—˜œ’ŒŽȱŠœ˜Œ’ŠŽȱ şŖ
Š‹Ž•ž•ȱŞȱȬȱ˜–™Š›Š›ŽŠȱ–Ž’’•˜›ȱœŒ˜›ž›’•˜›ȱ•Šȱœž‹œŒŠ•Ž•Žȱȱɗ›Žȱ™˜™ž•Šô’Šȱ
Œ•’—’Œ©ȱó’ȱŒŽŠȱ—˜—ȬŒ•’—’Œ©ȱ şŗ
Š‹Ž•ž•ȱşȱȬȱ›˜ŒŽ—Š“Ž•Žȱ’Ž–’•˜›ȱ‹’Šô’ȱŽȱ™ŠŒ’Ž—ô’’ȱŒžȱó’ȱ©›©ȱ’Š—˜œ’ŒŽȱŠœ˜Œ’ŠŽȱ
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Š‹Ž•ž•ȱŗŖȱȬȱŽ—œ’‹’•’ŠŽŠȱó’ȱœ™ŽŒ’ęŒ’ŠŽŠȱœž‹œŒŠ•Ž•˜›ȱȱ•Šȱ’Ž›’ŽȱŸŠ•˜›’ȱŠ•Žȱ
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™œ’‘’Š›’Œȱ ǻǼȱ ŽœŽȱ ž—ȱ ’—œ›ž–Ž—ȱ Žȱ
Šž˜ŽŸŠ•žŠ›Žȱ Œ˜—ŒŽ™žȱ ™Ž—›žȱ Šȱ ŽŽŒŠȱ ŒŽ•Žȱ
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Œ˜›ž•ȱ ˜Š•ȱ •Šȱ œŒŠ•Šȱ ȱ œŽȱ ‹Š£ŽŠ£©ȱ
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›ŽŒŸŽ—ôŠȱ ›ŽŒŸŽ—ôŠȱ
Š•˜Š›ŽŠȱ Š•˜Š›ŽŠȱ Žœ’–Š©ȱŠȱ Žœ’–Š©ȱŠȱ
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™ŠŒ’Ž—ô’ǯȱ
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C—›Ž‹©›’•Žȱ œž™•’–Ž—Š›Žȱ Š›ȱ ›Ž‹ž’ȱ ™žœŽȱ
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Šȱ ęȱ •ŽŠ©ȱ Žȱ ž—ȱ ’Š—˜œ’Œȱ œ™ŽŒ’ęŒǰȱ Œ˜—˜›–ȱ
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C—ȱœž’ž•ȱ—˜œ›žȱŽȱŸŠ•’’ŠŽǰȱɗȱŒŠ›ŽȱŠžȱ˜œȱ
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›©œ™ž—œȱŠę›–Š’Ÿȱ•Šȱž—ž•ȱœŠžȱ–Š’ȱ–ž•ô’ȱ’Ž–’ȱŽȱ
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ŒŠ›Žȱ Šžȱ ˜‹ô’—žȱ œŒ˜›ž•ȱ Ŗȱ —žȱ œžŽ›ŽŠžȱ Žȱ ŠŒŽŠœ©ȱ
ŠŽŒô’ž—Žǯȱ C—ȱ ˜Š•ǰȱ ŞǰŚƖȱ ’—›Žȱ ™ŠŒ’Ž—ô’ȱ Šžȱ ˜œȱ
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ŗŚƖǯ
Ž—›žȱ Šȱ ’Ž›Ž—ô’Šȱ ɗ›Žȱ œŒ‘’£˜›Ž—’Žǰȱ
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ž•‹ž›Š›ŽŠȱ ™œ’‘˜’Œ©ȱ ©›©ȱ Š•©ȱ œ™ŽŒ’ęŒŠô’Žȱ
ó’ȱ ž•‹ž›Š›ŽŠȱ Ž™›Žœ’Ÿ©ȱ –Š“˜›©ǰȱ ŽŸŠ•žŠ›ŽŠȱ
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›Ž‹ž’Žȱ œ©ȱ ŽŽ›–’—Žȱ Œ›˜—’Œ’ŠŽŠȱ ‘Š•žŒ’—Šô’’•˜›ȱ
ó’ȦœŠžȱ Šȱ Ž•’›ž•ž’ǯȱ ŠŒ©ȱ Ž¡’œ©ȱ œ’–™˜–Žȱ
œ™ŽŒ’ęŒŽȱ ž•‹ž›©›’•˜›ȱ ŠŽŒ’ŸŽǰȱ ŽŸŠ•žŠ›ŽŠȱ ›Ž‹ž’Žȱ
œ©ȱ Š‹˜›Ž£Žȱ ›Ž•Šô’Šȱ Ž–™˜›Š•©ȱ ’—›Žȱ ŠŒŽœŽŠȱ ó’ȱ
œ’–™˜–Ž•Žȱ ™œ’‘˜’ŒŽǯȱ Žȱ ŠœŽ–Ž—ŽŠǰȱ ›Ž‹ž’Žȱ
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Šȱ ŠŸŽŠȱ ž—ȱ ŠŠŒȱ Žȱ ™Š—’Œ©ǯȱ Ž–’’ȱ ŜşŠȱ Ȯȱ Ŝş‘ȱ Š’ȱ
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Š˜›Š˜‹’Ž’Dzȱ’Ž–’’ȱŜŞȱó’ȱŝŖȱŽŽ›–’—©ȱŒŠ›ŠŒŽ›ž•ȱ
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˜ȱœ’žŠô’ŽȱɗȱŒ’žŠȱŠ—¡’Ž©ô’’ȱœŠžȱɗȱŒŠ£ž•ȱɗȱŒŠ›Žȱ
ŠŒŽœŠȱŠ›Žȱž—ȱɗœ˜ô’˜›ǯ
C—ȱ œž’ž•ȱ —˜œ›žȱ Žȱ ŸŠ•’’ŠŽǰȱ ɗȱ ŒŠ›Žȱ Šžȱ
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ŞŞƖȱ ’—›Žȱ ™ŠŒ’Ž—ô’’ȱ œžŽ›’—ȱ Žȱ Š˜›Š˜‹’Žȱ Šžȱ
›©œ™ž—œȱ Šę›–Š’Ÿȱ •Šȱ ™Š›žȱ œŠžȱ –Š’ȱ –ž•ô’ȱ ’Ž–’ȱ
’—ȱ œž‹œŒŠ•Šȱ Žȱ ŽŸŠ•žŠ›Žȱ Šȱ Š˜›Š˜‹’Ž’ǰȱ ɗȱ ’–™ȱ

ŒŽȱşŞƖȱ’—›ŽȱŒŽ’ȱŒŠ›ŽȱŠžȱ˜‹ô’—žȱž—ȱœŒ˜›ȱ–Š’ȱ–’Œȱ
Žȱ ™Š›žȱ —žȱ ™›Ž£Ž—Šžȱ ŠŒŽœȱ œ’—›˜–ǯȱ C—ȱ ˜Š•ǰȱ
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Œžȱ ž•‹ž›Š›Žȱ Žȱ ™Š—’Œ©ȱ Œžȱ Š˜›Š˜‹’Žǰȱ Œ˜—˜›–ȱ
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ŒŠ›Žȱ Šžȱ ™ž—ŒŠȱ ™Š›žȱ œŠžȱ –Š’ȱ –ž•ô’ȱ ’Ž–’ȱ ™Žȱ
ŠŒŽŠœ©ȱœž‹œŒŠ•©ȱŠȱ˜œȱŽȱřŜƖǯ
ŸŠ•žŠ›ŽŠȱœž™•’–Ž—Š›©ȱ›Ž‹ž’Žȱœ©ȱœŠ‹’•ŽŠœŒ©ȱ
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ŽŸ’Š›ŽŠȱ Šœ˜Œ’Š©ȱ ˜‹’Ž’ȱ œ˜Œ’Š•Žȱ Š˜›Š©ȱ ›’Œ’’ȱ
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Œ˜—Š–’—Š›Žȱ œŠžȱ ŽŸ’Š›ŽŠȱ £‹˜›ž•ž’ȱ Œžȱ ŠŸ’˜—ž•ȱ
Šœ˜Œ’Š©ȱ ˜‹’Ž’ȱ œ™ŽŒ’ęŒŽȱ Š˜›Š©ȱ ›’Œ’’ȱ Žȱ
™›©‹žó’›ŽǼǯ
Šȱ ó’ȱ ɗȱ ŒŠ£ž•ȱ œž‹œŒŠ•Ž’ȱ ž•‹ž›Š›Žȱ Žȱ ™Š—’Œ©ǰȱ
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Š•ȱ œž‹œŒŠ•Ž’ȱ ˜›Š˜‹’Žȱ ŽœŽȱ ž—ȱ ’Ž–ȱ Œ›’’ŒDzȱ ž—ȱ
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™Ž—›žȱ Šȱ œŠ‹’•’ȱ ŒŠ›Žȱ œž—ȱ œ’žŠô’’•Žȱ ɗȱ ŒŠ›Žȱ
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ŸŠ•žŠ›ŽŠȱ œž™•’–Ž—Š›©ȱ ›Ž‹ž’Žȱ œ©ȱ –©œ˜Š›Žȱ ó’ȱ
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ŽŸ’©›’’ȱŠ˜›Š˜‹’ŒŽǯ
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ŗşŞŗǼȱ ó’ȱ Ȭž•ȱ Šžȱ ˜œȱ ŠŒŒŽ™ŠŽǰȱ ɗȱ Œ’žŠȱ

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Žȱœ›Žœȱ™˜œĴ›Šž–Š’ŒȱǻŗŗǰşƖǼǯ
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şşŚȱ Žȱ ™ŠŒ’Ž—ô’ȱ ›ŠŠô’ȱ ɗȱ œŽŒô’’•Žȱ Š–‹ž•Š˜›’’ȱ
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Ž—›žȱ śŗŝȱ ›Žœ™˜—Ž—ô’ȱ ŽŸŠ•žŠ›ŽŠȱ ’Š—˜œ’Œ©ȱ
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Ž—›žȱ Šȱ Ž¡Š–’—Šȱ ŸŠ•’’ŠŽŠȱ Œ˜—Œž›Ž—©ȱ
Šȱ œž‹œŒŠ•Ž•˜›ȱ ǰȱ Řřŝȱ ’—›Žȱ ŒŽ’ȱ ŝřŘȱ Žȱ

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ž›–©˜Š›Ž•Žȱ’—œ›ž–Ž—ŽDZ
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ǻŽ•ȬŠŽȱ Š—’Šȱ —ŸŽ—˜›¢ǰȱ Dzȱ
‘žŠ›ǰȱ Œ‘Ž›£Ž›ǰȱ ˜—Ž›ȱ ó’ȱ ’ Šœ‹Š››˜ǰȱ
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›ǯȱŽȱ Œ˜›ž•ȱ Œ˜›ž•ȱ ›ǯȱŽȱ Œ˜›ž•ȱ Œ˜›ž•ȱ

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ȱŠŽ•Žȱ™Š›žȱŒ›’Ž›’’ȱœž—ȱ™›Ž£Ž—ŠŽȱɗȱ—Ž¡Šȱǯ

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Œžȱ ž—ȱ Š—ž–’ȱ ’Š—˜œ’Œȱ Šžȱ ˜‹ô’—žȱ œŒ˜›ž›’ȱ
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’™˜–Š—’Žǯ ž•‹ž›Š›Žȱ ’œ’–’Œ©ȱ ǻŗȱ ’Ž–Ǽǰȱ Š—’ŽȦ
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Š•’’ŠŽŠȱ Žȱ Œ›’Ž›’žȱ •Šȱ —’ŸŽ•ȱ Žȱ ’Ž–ȱ Šȱ
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›©œ™ž—œž›’•˜›ȱ Šę›–Š’ŸŽȱ •Šȱ ŠŒŽ•ȱ ’Ž–ȱ Š•Žȱ
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ŗŖŖȱ ǻŞşǰřƖǼȱ Šžȱ ›©œ™ž—œȱ Šę›–Š’Ÿȱ –Š’ȱ ›ŽŒŸŽ—ȱ
›Žœ™˜—Ž—ô’’ȱ ’Š—˜œ’ŒŠô’ȱ Œžȱ ž•‹ž›Š›ŽŠȱ
ŽŸŠ•žŠ©ȱ Žȱ ŠŒŽ•ȱ ’Ž–ǰȱ ŽŒ¦ȱ ŒŽ’ȱ ŒŠ›Žȱ —žȱ Šžȱ ˜œȱ
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ǻž—ȱ ’Š—˜œ’Œȱ Ȭȱ Šž¡’•’Š›ǰȱ ŒŠ›Žǰȱ Žȱ
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›Š–Ž›ǰȱŗşŞśDzȱ
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ŽœœŽ•ȱ ó’ȱ ’––Ž›–Š—ǰȱ
Šȱ ˜œȱ Žȱ ž•‹ž›Š›Žȱ Ž™›Žœ’Ÿ©ȱ –Š“˜›©ǰȱ ž•‹ž›Š›Žȱ
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Š•ȱ ŠŒŽœ˜›ȱ ŠŽȱ œŠ’œ’ŒŽȱ ǻ
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Š‹Ž•ž•ȱŗŗ
Ž—œ’‹’•’ŠŽŠȱó’ȱœ™ŽŒ’ęŒ’ŠŽŠȱœž‹œŒŠ•Ž•˜›ȱȱ•Šȱ’Ž›’ŽȱŸŠ•˜›’ȱŠ•Žȱ™ž—ŒŽ•˜›ȱŽȱœŽŒô’ž—Ž

Ž—£’’Ÿ’ŠŽŠȦ™ŽŒ’ęŒ’ŠŽ‹ȱǻƖǼ
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ž•’–’ŽȦ ‹ž£Ȧ Ž™Ž—Ž—ô© ž•‹ž›Š›Žȱ
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Œ˜›ȱ   Œ˜–™ž•œ’Ÿ©  Žȱ™Š—’Œ© ˜‹’Ž œ˜Œ’Š•© ŽȱŠ•Œ˜˜• –Ž’ŒŠ–Ž—Ž  œ˜–Š’£Š›Ž ™˜‘˜—›’Ž ™œ’‘˜’ŒŽ
ŗ ŗŖŖȦś şŝȦřś şŜȦśŜ ŞşȦŝŖ şşȦřŞ şśȦśŗ şŜȦŚŖ ŞśȦŞŖ ŞśȦŞŝ şşȦŖŞ şśȦřř şŗȦŜś ŝśȦŝŚ
Ř ŗŖŖȦŗŖ şŝȦŚŝ şŜȦŝŘ ŝŜȦŞř şŝȦśŖ şśȦŜŗ şŜȦśŖ ŝşȦŞś ŞŖȦşŗ şşȦŗř ŞŜȦśř şŗȦŝŚ śşȦşŖ
ř ŗŖŖȦŗŞ şŝȦśŚ şŜȦŝŝ ŜŚȦşŘ şśȦŜŗ şŚȦŜş şřȦśŞ ŜşȦşŘ ŜŖȦşś şşȦŗş śşȦŝŚ şŗȦŞŗ řŚȦşŜ
Ś ŗŖŖȦŘś şśȦśŝ şŜȦŞŖ śŞȦşś şŗȦŜş ŞŞȦŝś şŗȦŜř ŜŖȦşŜ śŖȦşŝ şşȦŘř řŜȦŞş śśȦŞş ŗŜȦşş
ś şşȦřŚ şŘȦŜŘ şŜȦŞř ŚřȦşŝ ŞśȦŝŝ ŞŘȦŞř ŞśȦŜş ŚŘȦşŞ ŚśȦşŞ şŝȦřŘ ŗŞȦşŞ śśȦşŜ ŖȦşş
Ŝ şşȦŚŘ ŞŜȦŜŚ şŘȦŞś ŘŚȦşŞ ŝşȦŞŚ ŝŗȦŞŞ ŞŘȦŝŜ ŘřȦşş řŖȦşş şśȦŚŗ ŖȦşş
ŝ şŞȦśŘ ŞŚȦŜş ŞŞȦŞş ŗŗȦŗŖŖ ŜŝȦşŖ śŚȦşŚ ŝŝȦŞŖ şŖȦśŖ
Ş şśȦŜř ŞŖȦŝŘ ŜŝȦşř ŚśȦşś ŚŗȦşŝ ŝřȦŞŚ ŞŘȦśŞ
ş şŖȦŜŝ ŝŝȦŝŜ ŘşȦşŝ ŘşȦşŞ ŜśȦŞŜ ŜŝȦŝŗ
ŗŖ ŞŗȦŝř ŝŖȦŞŗ ŞȦşş ŗşȦşş śŝȦşŖ ŚŚȦŞř
ŗŗ ŝŖȦŝŞ śŞȦŞŜ ŜȦŗŖŖ ŚşȦşŘ
ŗŘ ŜřȦŞŚ śśȦşŖ řŚȦşŜ
ŗř śřȦŞş ŚŚȦşŚ ŗŞȦşŞ
ŗŚ ŚřȦşŘ řŗȦşŜ ŗŖȦşş
ŗś řŗȦşŚ ŗŚȦşş ŚȦŗŖŖ
ŗŜ ŘŘȦşŝ
ŗŝ ŗřȦşş
ŗŞ ŞȦşş
ŗş ŘȦŗŖŖ
ŘŖ ŖȦŗŖŖ
Řŗ ŖȦŗŖŖ

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 Š‹Ž•ž•ȱŗŘ
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œž‹œŒŠ•Ž•˜›ȱ ȱ ó’ȱ ’Ž–’’ȱ ŠŒŽœ˜›Šȱ Šžȱ ˜‹ô’—žȱ
™Ž›˜›–Š—ôŽȱ ‹ž—Žǯȱ —Š•’£Ž•Žȱ ™œ’‘˜–Ž›’ŒŽȱ Šžȱ
Š›©ŠȱŒ©ȱž—Ž•Žȱœž‹œŒŠ•Žȱó’ȱž—’’ȱ’Ž–’ȱ—žȱŠžȱ˜‹ô’—žȱ
™Ž›˜›–Š—ôŽȱ˜™’–Žǰȱ—ŽŒŽœ’¦—ǰȱŠœŽ•ǰȱ›ŽŸ’£ž’›’ǯȱ
C—ȱŠŒŽœŽȱŒŠ£ž›’ǰȱŠȱ˜œȱ’–™˜›Š—ȱœ©ȱęŽȱ©œ’ȱž—ȱ
ŽŒ‘’•’‹›žȱɗ›ŽȱŒŽ›’—ôŽ•ŽȱŽ–™’›’ŒŽȱó’ȱŒ˜—œ’Ž›Šô’’•Žȱ
Ž˜›Ž’ŒŽǯȱ Žȱ ˜‹’ŒŽ’ǰȱ Šžȱ ˜œȱ ›Žœ™ŽŒŠŽȱ ›Ž™Ž›Ž•Žȱ
’—’ô’Š•Žǰȱ’Š›ȱœŒŠ•ŠȱȱŠȱ˜œȱ–˜’ęŒŠ©ȱɗȱŸ’›žŽŠȱ
™›˜™›’Ž©ô’•˜›ȱ™œ’‘˜–Ž›’ŒŽȱŠ•Žȱœž‹œŒŠ•Ž•˜›ȱó’ȱŠ•Žȱ
’Ž–’•˜›ǯȱžȱ˜ŠŽȱŠŒŽœŽŠǰȱž—Ž˜›’ǰȱ›Ž£ž•ŠŽ•ŽȱŠžȱ
œžŽ›ŠȱŒ©ȱœž—ȱ —ŽŒŽœŠ›Žȱ –˜’ęŒ©›’ǰȱŠ›ȱŠŒŽœŽŠȱ
—žȱ Šžȱ ˜œȱ ŽŽŒžŠŽȱ Œžȱ œŒ˜™ž•ȱ Žȱ Šȱ ›Žœ™ŽŒŠȱ
Œ›’Ž›’’•Žȱ ǯȱ —’Œ’™¦—ȱ ›ŽŠ•’£Š›ŽŠȱ ž—˜›ȱ
œž’’ȱ Ÿ’’˜Š›Žȱ ŒŠ›Žȱ œ©ȱ ’—ŸŽœ’‘Ž£Žȱ ™Ž›˜›–Š—ôŠȱ
’—œ›ž–Ž—ž•ž’ȱ ɗȱ Šȱ ’Ž—’ęŒŠȱ ’Š—˜œ’ŒŽ•Žǰȱ Šžȱ
˜œȱŠ©žŠô’ȱ’Ž–’ȱ—˜’ȱŒŠ›Žȱœ©ȱŽŸŠ•žŽ£ŽȱŒ›’Ž›’’•Žȱ

Ȭǯȱ ž™©ȱ –˜’ęŒ©›’•Žȱ ŠžœŽȱ œŒŠ•Ž’ȱ ǰȱ
Šȱ ˜œȱ ›Ž™ŽŠȱ Š¦ȱ œž’ž•ȱ Šœž™›Šȱ ’—Ž•’’‹’•’©ô’’ȱ
’Ž–’•˜›ǰȱŒ¦ȱó’ȱœž’ž•ȱŽȱ’—ŸŽœ’Š›ŽȱŠȱꍎ•’©ô’’ȱ
ó’ȱŠȱŸŠ•’’©ô’’ǯ
ž’ž•ȱ›Ž™•’ŒŠ’Ÿ
Ž£ž•ŠŽ•Žȱ œž’ž•ž’ȱ ›Ž™•’ŒŠ’Ÿȱ ǻŒŠ›Žȱ Šȱ ˜œȱ
–Š’ȱ Ž¡’—œȱ ŽŒ¦ȱ œž’ž•ȱ ’—’ô’Š•Ǽȱ Šžȱ ’—’ŒŠȱ ’—ȱ
—˜žȱŠ™ž•ȱŒ©ȱœŒŠ•ŠȱȱŽœŽȱž—ȱ’—œ›ž–Ž—ȱꍎ•ȱ
ó’ȱŸŠ•’ȱŒŠ›Žȱ™˜ŠŽȱęȱɗŒ˜›™˜›Šȱɗȱ™›ŠŒ’ŒŠȱŒ•’—’Œ©ȱ
Žȱ ›ž’—©ȱ ’—ȱ ž—’©ô’•Žȱ Š–‹ž•Š˜›’’ǯȱ Š’ȱ –ž•ȱ
ŽŒ¦ȱ Š¦ǰȱ ŽœŽȱ ŽŸ’Ž—ȱ Š™ž•ȱ Œ©ȱ –˜’ęŒ©›’•Žȱ
ŒŠ›ŽȱŠžȱ˜œȱ©ŒžŽȱɗȱ‹Š£Šȱ›Ž£ž•ŠŽ•˜›ȱœž’ž•ž’ȱ
’—’ô’Š•ȱ Šžȱ ɖ‹ž—©©ô’ȱ ™›˜™›’Ž©ô’•Žȱ ™œ’‘˜–Ž›’ŒŽȱ
Š•Žȱ œŒŠ•Ž’ǯȱ ˜ŠŽȱ ŒŽ•Žȱ ŗśȱ œž‹œŒŠ•Žȱ Šžȱ ›ŽŒžȱ Žȱ
Œ›’Ž›’’•Žȱ Žȱ –˜’ęŒŠ›Žȱ ɗȱ ™›˜ŒŽ—ȱ Žȱ ŝŚǰŝƖȱ ɗȱ
œž’ž•ȱ’—’ô’Š•ǰȱ’Š›ȱŠŒŽœȱ™›˜ŒŽ—ȱŠȱŒ›ŽœŒžȱ•ŠȱŞśǰřƖȱ
ɗȱœž’ž•ȱ›Ž™•’ŒŠ’ŸǯȱŠȱ—’ŸŽ•ȱŽȱ’Ž–’ǰȱ™›˜ŒŽ—ž•ȱ
’Ž–’•˜›ȱŒŠ›ŽȱŠžȱ›ŽŒžȱŽȱ˜ŠŽȱŒŽ•Žȱ™Š›žȱŒ›’Ž›’’ȱ
Žȱ–˜’ęŒŠ›ŽȱŠȱŒ›ŽœŒžȱŽȱ•ŠȱŞřǰŖƖȱ•ŠȱŞşǰŘƖǯ
 ȱ
›’Ž›’’•Žȱ™›’Ÿ’—ȱ–˜’ęŒŠ›ŽŠȱœŒŠ•Ž’ȱ

›’Ž›’’•ŽȱŽȱ–˜’ęŒŠ›ŽȱŠȱœž‹œŒŠ•Ž•˜›
ŒŠ•Šȱ—ŽŒŽœ’©ȱ–˜’ęŒŠ›Žȱǻ’ǯŽǯȱ—žȱ›ŽŒŽȱŽȱŒ›’Ž›’žǼǰȱŠŒ©DZ
ŗǯȱ •™‘Šȱ›˜—‹ŠŒ‘ȱǀŖǰŞŖǯ
Řǯȱ ˜ŽęŒ’Ž—ž•ȱŽȱꍎ•’ŠŽȱŽœȬ›ŽŽœȱǀŖǰŞŖǯ
řǯȱ ˜›Ž•Šô’Šȱ’—›Žȱœž‹œŒŠ•Šȱȱó’ȱ˜ȱŠ•©ȱ–©œž›©˜Š›ŽȱŠȱŠŒŽ•ž’Šó’ȱŒ˜—œ›žŒȱǀŖǰśŖǯ
Śǯȱ ˜›Ž•Šô’Šȱ’—›Žȱœž‹œŒŠ•Šȱȱó’ȱ˜ȱŠ•©ȱ–©œž›©˜Š›ŽȱŠȱŠŒŽ•ž’Šó’ȱŒ˜—œ›žŒȱ—žȱŽœŽȱŒžȱŒŽ•ȱ™žô’—ȱŖǰŘŖȱ–Š’ȱ
–Š›ŽȱŽŒ¦ȱ–Ž’ŠȱŒ˜›Ž•Šô’’•˜›ȱ’—›ŽȱŠŒŽŠȱœž‹œŒŠ•©ȱȱó’ȱœŒŠ•ŽȱŒŠ›Žȱ–©œ˜Š›©ȱŒ˜—œ›žŒŽȱ’Ž›’Žǯ
śǯȱ Ž’ŠȱœŒ˜›ž›’•˜›ȱœž‹œŒŠ•Ž’ȱ—žȱŽœŽȱœŽ–—’ęŒŠ’Ÿȱ–Š’ȱ–Š›Žȱ•Šȱ™ŠŒ’Ž—ô’’ȱ’Š—˜œ’ŒŠô’ȱŒžȱŠŒŽŠȱž•‹ž›Š›Žȱ
Œ˜—˜›–ȱȬȱŽŒ¦ȱ•Šȱ™ŠŒ’Ž—ô’’ȱ©›©ȱŠŒŽ•ȱ’Š—˜œ’Œǯ

›’Ž›’’•ŽȱŽȱ–˜’ęŒŠ›ŽȱŠȱ’Ž–’•˜›
Ž–ž•ȱ—ŽŒŽœ’©ȱ–˜’ęŒŠ›Žȱǻ’ǯŽǯȱ—žȱ›ŽŒŽȱŽȱŒ›’Ž›’žǼǰȱŠŒ©DZ
ŗǯȱ ˜›Ž•Šô’Šȱ’Ž–ž•ž’ȱŒžȱœŒ˜›ž•ȱ˜Š•ȱŠ•ȱœž‹œŒŠ•Ž’ȱ’—ȱŒŠ›Žȱ™›˜Ÿ’—ŽȱŠŒŽ•ȱ’Ž–ȱǀŖǰřŖǯ
Řǯȱ ˜›Ž•Šô’ŠȱŠ“žœŠ©ȱ’—›Žȱ’Ž–ȱó’ȱœž‹œŒŠ•Šȱ’—ȱŒŠ›Žȱ™›˜Ÿ’—Žȱ—žȱŽœŽȱŒžȱŒŽ•ȱ™žô’—ȱŖǰŘŖȱ–Š’ȱ–Š›ŽȱŽŒ¦ȱ–Ž’Šȱ
Œ˜›Ž•Šô’’•˜›ȱ’—›ŽȱŠŒŽ•ȱ’Ž–ȱó’ȱŠ•Žȱœž‹œŒŠ•Žǯ
řǯȱ Ž–ž•ȱŠ›Žȱ˜ȱ›ŽŒŸŽ—ô©ȱ›Ž•Š’Ÿ©ȱŠȱ›©œ™ž—œž›’•˜›ȱ™˜£’’ŸŽȱŽȱŒŽ•ȱ™žô’—ȱśƖȱó’ȱ—žȱ˜‹ô’—Žȱ˜ȱꍎ•’ŠŽȱŽœȬ›ŽŽœȱ
ǻ”Š™™ŠǼȱǃŖǰśŖǯ
Śǯȱ Ž–ž•ȱ—žȱ™›’–ŽóŽǰȱœŽ–—’ęŒŠ’Ÿȱ–Š’ȱ›ŽŒŸŽ—ǰȱ›©œ™ž—œž›’ȱŠę›–Š’ŸŽȱ’—ȱ™Š›ŽŠȱ™ŠŒ’Ž—ô’•˜›ȱ’Š—˜œ’ŒŠô’ȱ
Œžȱž•‹ž›Š›ŽŠȱ›Žœ™ŽŒ’Ÿ©ȱŽŒ¦ȱ’—ȱ™Š›ŽŠȱ™ŠŒ’Ž—ô’•˜›ȱ©›©ȱŠŒŽ•ȱ’Š—˜œ’ŒȱŒ˜—˜›–ȱȬǯ


 ŽŽ›’—ôŽȱ‹’‹•’˜›ŠęŒŽ

–Ž›’ŒŠ—ȱ œ¢Œ‘’Š›’Œȱ œœ˜Œ’Š’˜—ǯȱ ǻŗşŞŝǼǯȱ ’Š—˜œ’Œȱ ˜‘Ž—ǰȱ ǯȱ ǻŗşŞŞǼǯȱ Š’œ’ŒŠ•ȱ ™˜ Ž›ȱ Š—Š•¢œ’œȱ ˜›ȱ ‘Žȱ
Š—ȱ œŠ’œ’ŒŠ•ȱ –Š—žŠ•ȱ ˜ȱ –Ž—Š•ȱ ’œ˜›Ž›œȱ ǻŽŸǯȱ ř›ȱ ‹Ž‘ŠŸ’˜›Š•ȱ œŒ’Ž—ŒŽœȱ ǻؗȱ ŽǯǼǯȱ Š‘ Š‘ǰȱ DZȱ
ŽǯǼǯȱŠœ‘’—˜—ǰȱDZȱž‘˜›ǯ ›•‹Šž–ǯ
–Ž›’ŒŠ—ȱ œ¢Œ‘’Š›’Œȱ œœ˜Œ’Š’˜—ǯȱ ǻŗşşŚǼǯȱ ’Š—˜œ’Œȱ ˜›’—Šǰȱ ǯȱ ǯȱ ǻŗşşřǼǯȱ ‘Šȱ ’œȱ Œ˜ŽĜŒ’Ž—ȱ Š•™‘Šǵȱ —ȱ
Š—ȱ œŠ’œ’ŒŠ•ȱ –Š—žŠ•ȱ ˜ȱ –Ž—Š•ȱ ’œ˜›Ž›œȱ ǻŚ‘ȱ ŽǯǼǯȱ Ž¡Š–’—Š’˜—ȱ˜ȱ‘Ž˜›¢ȱŠ—ȱŠ™™•’ŒŠ’˜—œǯȱ˜ž›—Š•ȱ˜ȱ
Šœ‘’—˜—ǰȱDZȱž‘˜›ǯ ™™•’Žȱœ¢Œ‘˜•˜¢ǰȱŝŞǰȱşŞȬŗŖŚǯ
Š•ŽœœŠ›’—’ǰȱ ǯȱ ǯǰȱ ’—”•ŽœŽ’—ǰȱ ǯǰȱ ǭȱ ›Š—Šǰȱ ǯȱ ǯȱ ˜›¢Ž••ǰȱǯǰȱ—’Œ˜Ĵǰȱǯǰȱ—›ŽŠœŽ—ǰȱǯȱǯǰȱ Ž••Ž›ǰȱǯȱ
ǻŗşŞřǼǯȱ ‘Žȱ ™›Ž’Œ’ŸŽȱ ™˜ Ž›ȱ ˜ȱ ’Š—˜œ’Œȱ Žœœȱ ǯǰȱ •Š¢˜—ǰȱ ǯȱ ǯǰȱ
’›œŒ‘Ž•ǰȱ ǯȱ ǯǰȱ Žȱ Š•ȱ ǻŗşŞŞǼǯȱ
Š—ȱ‘ŽȱŽěŽŒȱ˜ȱ™›ŽŸŠ•Ž—ŒŽȱ˜ȱ’••—Žœœǯȱ›Œ‘’ŸŽœȱ˜ȱ Ž™›Žœœ’˜—ȱŠ—ȱ™Š—’ŒȱŠĴŠŒ”œDZȱ‘Žȱœ’—’ęŒŠ—ŒŽȱ˜ȱ
Ž—Ž›Š•ȱœ¢Œ‘’Š›¢ǰȱŚŖǰȱśŜşȬśŝřǯ ˜ŸŽ›•Š™ȱŠœȱ›ŽĚŽŒȱ’—ȱ˜••˜ Ȭž™ȱŠ—ȱŠ–’•¢ȱœž¢ȱ
Š›•˜ ǰȱ ǯȱ
ǯǰȱ ŠŒ‘ǰȱ ǯȱ ǯȱ ǭȱ ›ŠŒŽ¢ǰȱ ǯȱ ǯȱ ǻŗşşŞǼǯȱ ŠŠǯȱ–Ž›’ŒŠ—ȱ˜ž›—Š•ȱ˜ȱœ¢Œ‘’Š›¢ǰȱŗŚśǰȱŘşřȬřŖŖǯ
‘Žȱ —Šž›Žȱ Š—ȱ ŽŸŽ•˜™–Ž—ȱ ˜ȱ Š—¡’Ž¢ȱ Š—ȱ ˜›¢Ž••ǰȱ ǯǰȱ ǭȱ ˜¢Žœǰȱ ǯȱ ǻŗşŞŞǼǯȱ •ŠŒŽ‹˜ȱ ›Žœ™˜—œŽȱ ’—ȱ
Ž™›Žœœ’˜—DZȱŠŒ”ȱ˜ȱ‘Žȱžž›Žǯȱ—ȱǯȱ ǯȱ˜ž‘ȱǭȱǯȱ ™Š—’Œȱ’œ˜›Ž›ǯȱ–Ž›’ŒŠ—ȱ˜ž›—Š•ȱ˜ȱœ¢Œ‘’Š›¢ǰȱŗŚśǰȱ
ǯȱŽž‹Ž’œȱǻœǯǼǰȱ‘ŽȱœŒ’Ž—ŒŽȱ˜ȱŒ•’—’ŒŠ•ȱ™œ¢Œ‘˜•˜¢DZȱ ŗŗřŞȬŗŗŚŖǯ
ŒŒ˜–™•’œ‘–Ž—œȱŠ—ȱžž›Žȱ’›ŽŒ’˜—œȱǻ™™ǯȱşśȬŗŘŖǼǯȱ ›˜—‹ŠŒ‘ǰȱǯȱǯȱǻŗşşŖǼǯȱœœŽ—’Š•œȱ˜ȱœ¢Œ‘˜•˜’ŒŠ•ȱŽœ’—ǯȱ
Šœ‘’—˜—ǰȱ DZȱ –Ž›’ŒŠ—ȱ œ¢Œ‘˜•˜’ŒŠ•ȱ Ž ȱ˜›”DZȱ
Š›™Ž›ȱ˜••’—œǯ
œœ˜Œ’Š’˜—ǯ Ž™žŽǰȱ ǯȱǯǰȱ ›Šžœœǰȱ ǯǰȱ ™˜˜—ǰȱ ǯȱ ǯǰȱ ǭȱ›‹’œ’ǰȱ ǯȱ
Š›•˜ ǰȱ ǯȱ
ǯǰȱ ’Š›˜ǰȱ ǯȱ ǯǰȱ Ž›–’•¢ŽŠǰȱ ǯǰȱ ǭȱ ǻŗşŞşǼǯȱ Ž—Ž›Š•ȱŽ‘ŠŸ’˜›ȱ—ŸŽ—˜›¢ȱ’Ž—’ęŒŠ’˜—ȱ
•Š—Œ‘Š›ǰȱ ǯȱ ǯȱ ǻŗşŞŜǼǯȱ ˜Ȭ–˜›‹’’¢ȱ Š—ȱ ˜ȱ ž—’™˜•Š›ȱ Š—ȱ ‹’™˜•Š›ȱ ŠěŽŒ’ŸŽȱ Œ˜—’’˜—œȱ ’—ȱ
Ž™›Žœœ’˜—ȱ Š–˜—ȱ ‘Žȱ Š—¡’Ž¢ȱ ’œ˜›Ž›œDZȱ œœžŽœȱ Šȱ —˜—Œ•’—’ŒŠ•ȱ ž—’ŸŽ›œ’¢ȱ ™˜™ž•Š’˜—ǯȱ ˜ž›—Š•ȱ ˜ȱ
’—ȱ’Š—˜œ’œȱŠ—ȱŒ•Šœœ’ęŒŠ’˜—ǯȱ˜ž›—Š•ȱ˜ȱŽ›Ÿ˜žœȱ ‹—˜›–Š•ȱœ¢Œ‘˜•˜¢ǰȱşŞǰȱŗŗŝȬŗŘŜǯ
Š—ȱŽ—Š•ȱ’œŽŠœŽǰȱŗŝŚǰȱŜřȬŝŘǯ Žž’ĴŽ›ǰȱ ǯǰȱ ħ”Ž—ǰȱ
ǯǰȱ Š›œœŽ—ǰȱ ǯǰȱ Š—Œ‘Š’”ǰȱǯǰȱ
ŽŒ”ǰȱǯȱǯǰȱ›˜ —ǰȱ ǯǰȱ™œŽ’—ǰȱǯǰȱǭȱŽŽ›ǰȱǯȱǻŗşŞŞǼǯȱ ǭȱ ›ŠŠ’–ŠŠǰȱǯȱǻŗşŞşǼǯȱ˜–˜›‹’’¢ȱŠ–˜ž—ȱ‘Žȱ
—ȱ ’—ŸŽ—˜›¢ȱ ˜›ȱ –ŽŠœž›’—ȱ Œ•’—’ŒŠ•ȱ Š—¡’Ž¢DZȱ Š—¡’Ž¢ȱ’œ˜›Ž›œǯȱ˜ž›—Š•ȱ˜ȱ—¡’Ž¢ȱ’œ˜›Ž›œǰȱřǰȱ
œ¢Œ‘˜–Ž›’Œȱ™›˜™Ž›’Žœǯȱ˜ž›—Š•ȱ˜ȱ˜—œž•’—ȱŠ—ȱ śŝȬŜŞǯ
•’—’ŒŠ•ȱœ¢Œ‘˜•˜¢ǰȱśŜǰȱŞşřȬŞşŝǯ ’›œǰȱ ǯȱ ǯǰȱ ™’£Ž›ǰȱ ǯȱ ǯȱ ’‹‹˜—ǰȱ ǯǰȱ ǭȱ ’••’Š–œǰȱ
ŽŒ”ǰȱǯȱǯǰȱžœ‘ǰȱǯȱǯǰȱ‘Š ǰȱǯȱǯǰȱǭȱ–Ž›¢ǰȱ ǯȱǻŗşŝşǼǯȱ ǯȱ ǯȱ ǯȱ ǻŗşşŝǼǯȱ ›žŒž›Žȱ •’—’ŒŠ•ȱ —Ž›Ÿ’Ž ȱ ˜›ȱ
˜—’’ŸŽȱ‘Ž›Š™¢ȱ˜ȱŽ™›Žœœ’˜—ǯȱŽ ȱ˜›”DZȱ ž’•˜›ȱ Ȭȱ¡’œȱȱ’œ˜›Ž›œȱǻǼǯȱŠœ‘’—˜—ǰȱDZȱ
›Žœœǯ –Ž›’ŒŠ—ȱœ¢Œ‘’Š›’Œȱœœ˜Œ’Š’˜—ǯ
ŽŒ”–Š—ǰȱ
ǯȱǯǰȱǭȱžŽŽ›ǰȱǯȱǯȱǻŗşşŝǼǯȱŽŠŠ‹’•’¢ȱ˜ȱ •ŽŒ‘Ž›ǰȱ ǯǰȱ •ŽŒ‘Ž›ǰȱ ǯǰȱ ǭȱ Š—Ž›ǰȱ ǯȱ ǻŗşŞŞǼǯȱ •’—’ŒŠ•ȱ
œŽ•Ȭ›Ž™˜›ȱ Œ•’—’ŒŠ•ȱ ˜žŒ˜–Žȱ –ŽŠœž›Žœǯȱ ˜ž›—Š•ȱ ˜ȱ Ž™’Ž–’˜•˜¢ǯȱŽ ȱ˜›”DZȱ’••’Š–œȱǭȱ’•”’—œǯ
•’—’ŒŠ•ȱœ¢Œ‘˜•˜¢ǰȱśřǰȱŝŞśȬŝŞşǯ ˜Šǰȱ ǯȱ ǯǰȱ ’œǰȱ ǯȱ ǯǰȱ Š—Œžǰȱ ǯȱ ǯǰȱ ǭȱ ˜‘‹Šž–ǰȱ
›˜ —ǰȱ ǯȱ ǯǰȱ ǭȱ Š›•˜ ǰȱ ǯȱ
ǯȱ ǻŗşşŘǼǯȱ ˜–˜›‹’’¢ȱ ǯȱ ǯȱ ǻŗşşřǼǯȱ Ž•’Š‹’•’¢ȱ Š—ȱ ŸŠ•’’¢ȱ ˜ȱ Šȱ ‹›’Žȱ
Š–˜—ȱ Š—¡’Ž¢ȱ ’œ˜›Ž›œDZȱ –™•’ŒŠ’˜—œȱ ˜›ȱ ’—œ›ž–Ž—ȱ ˜›ȱ ŠœœŽœœ’—ȱ ™˜œȬ›Šž–Š’Œȱ œ›Žœœȱ
›ŽŠ–Ž—ȱ Š—ȱ Ȭǯȱ ˜ž›—Š•ȱ ˜ȱ ˜—œž•’—ȱ Š—ȱ ’œ˜›Ž›ǯȱ˜ž›—Š•ȱ˜ȱ›Šž–Š’Œȱ›ŽœœǰȱŜǰȱŚśşȬŚŝřǯ
•’—’ŒŠ•ȱœ¢Œ‘˜•˜¢ǰȱŜŖǰȱŞřśȬŞŚŚǯ Š›—Ž›ǰȱ ǯȱ ǯǰȱ •–œŽŠǰȱ ǯȱ ǯǰȱ ǭȱ ˜•’Ÿ¢ǰȱ ǯȱ
žŒ‘Ž›ǰȱ ǯȱ ǯǰȱ ›Š‘Š–ǰȱ ǯȱ ǯǰȱ ’••’Š–œǰȱ ǯȱ ǯȱ ǭȱ ǻŗşŞřǼǯȱ ŽŸŽ•˜™–Ž—ȱ Š—ȱ ŸŠ•’Š’˜—ȱ ˜ȱ Šȱ
Ž—Ȭ˜›Š‘ǰȱǯȱǯȱǻŗşşŖǼǯȱŽŸŽ•˜™–Ž—ȱŠ—ȱžœŽȱ˜ȱ‘Žȱ –ž•’’–Ž—œ’˜—Š•ȱ ŽŠ’—ȱ ’œ˜›Ž›ȱ ’—ŸŽ—˜›¢ȱ
ȬŘȱ ˜—Ž—ȱ ŒŠ•Žœǯȱ ’——ŽŠ™˜•’œDZȱ —’ŸŽ›œ’¢ȱ ˜›ȱ Š—˜›Ž¡’Šȱ —Ž›Ÿ˜œŠȱ Š—ȱ ‹ž•’–’Šǯȱ —Ž›—Š’˜—Š•ȱ
˜ȱ’——Žœ˜Šȱ›Žœœǯ ˜ž›—Š•ȱ˜ȱŠ’—ȱ’œ˜›Ž›œǰȱŘǰȱŗśȬřŚǯ
Š–™‹Ž••ǰȱ ǯȱ ǯǰȱ ǭȱ ’œ”Žǰȱ ǯȱ ǯȱ ǻŗşśşǼǯȱ ˜—ŸŽ›Ž—ȱ ˜’œ–Š—ǰȱǯȱǯǰȱ ˜•Ž—‹Ž›ǰȱǯǰȱŠœ’•Žǰȱǯȱ ǯǰȱǭȱ Ž••Ž›ǰȱ
Š—ȱ ’œŒ›’–’—Š—ȱ ŸŠ•’Š’˜—ȱ ‹¢ȱ ‘Žȱ –ž•’›Š’ȱ ǯȱ ǯȱ ǻŗşşśǼǯȱ ˜–˜›‹’’¢ȱ ˜ȱ Š—¡’Ž¢ȱ ’œ˜›Ž›œȱ
–ž•’Ȭ–Ž‘˜ȱ –Š›’¡ǯȱ œ¢Œ‘˜•˜’ŒŠ•ȱ ž••Ž’—ǰȱ śŜǰȱ ’—ȱ –ž•’ŒŽ—Ž›ȱ Š—¡’Ž¢ȱ œž¢ǯȱ ˜–™›Ž‘Ž—œ’ŸŽȱ
ŞŗȬŗŖśǯ œ¢Œ‘’Š›¢ǰȱřŜǰȱřŖřȬřŗŗǯ
ŠœœŠ—˜ǰȱ ǯȱ ǯǰȱ Ž›ž’ǰȱ ǯǰȱ ǭȱ žœŽĴ’ǰȱ ǯȱ ǻŗşşŖǼǯȱ ˜•œ˜—ǰȱǯȱǯǰȱȂ
Š›ŠǰȱǯȱǯǰȱǭȱŒ‘Š›£ǰȱ
ǯȱǯȱǻŗşşŖǼǯȱ
˜–˜›‹’’¢ȱ’—ȱ™Š—’Œȱ’œ˜›Ž›ǯȱœ¢Œ‘’Š›’Œȱ——Š•œǰȱ Ž•’Š‹’•’¢ǰȱ ŸŠ•’’¢ǰȱ Š—ȱ ™›Ž•’–’—Š›¢ȱ —˜›–Š’ŸŽȱ
ŘŖǰȱśŗŝȬśŘŗǯ ŠŠȱ˜›ȱ‘Žȱ—ŸŽ—˜›¢ȱ˜ȱ’Š—˜œŽȱŽ™›Žœœ’˜—ȱ’—ȱ
Šȱ Œ˜••ŽŽȱ ™˜™ž•Š’˜—ǯȱ œ¢Œ‘˜•˜’ŒŠ•ȱ œœŽœœ–Ž—ǰȱ Řǰȱ
ŘŗŘȬŘŗśǯ


 ›ŽŽ—ǰȱ ǯȱ ǯǰȱ ’—¢ǰȱ ǯȱ ǯǰȱ ›ŠŒŽǰȱ ǯȱ ǯǰȱ ǭȱ •ŽœŽ›ǰȱ ǯȱ Š›”˜ ’£ǰȱ ǯȱ ǯǰȱ ˜›Š—ǰȱ ǯȱ ǯǰȱ ˜Œœ’œǰȱ ǯȱ
ǯǰȱ ǭȱ
ǯȱ ǻŗşŞşǼǯȱ ž•’™•Žȱ ’Š—˜œŽœȱ ’—ȱ ™˜œĴ›Šž–Š’Œȱ ›Š—ŒŽœǰȱǯȱǯȱǻŗşŞşǼǯȱ›ŽŸŠ•Ž—ŒŽȱŠ—ȱŒ˜–˜›‹’’¢ȱ
œ›Žœœȱ’œ˜›Ž›ǯȱ‘Žȱ›˜•Žȱ˜ȱ Š›ȱœ›Žœœ˜›œǯȱ˜ž›—Š•ȱ ˜ȱ ¢œ‘¢–’Œȱ ’œ˜›Ž›ȱ Š–˜—ȱ ™œ¢Œ‘’Š›’Œȱ
˜ȱŽ›Ÿ˜žœȱŠ—ȱŽ—Š•ȱ’œŽŠœŽǰȱŗŝŝǰȱřŘşȬřřśǯ ˜ž™Š’Ž—œǯȱ˜ž›—Š•ȱ˜ȱ쎌’ŸŽȱ’œ˜›Ž›œǰȱŘŚǰȱŜřȬŝŗǯ
›’—Ž›ǰȱ ǯȱ ǯǰȱ Š¢Ž œ”’ǰȱ ǯȱ ǯǰȱ žœ‘•’—ǰȱ ǯȱ ǯǰȱ ǭȱ Š›”œǰȱǯȱǯǰȱǭȱŠ‘Ž œǰȱǯȱǯȱǻŗşŝşǼǯȱ›’ŽȱœŠ—Š›ȱ
›ŽŽ—•Š—ǰȱǯȱǻŗşŞŗǼǯȱŽ•ŽŒ’˜—ȱŠ—ȱ’—Ž›™›ŽŠ’˜—ȱ œŽ•Ȭ›Š’—ȱ˜›ȱ™‘˜‹’Œȱ™Š’Ž—œǯȱŽ‘ŠŸ’˜ž›ȱŽœŽŠ›Œ‘ȱ
˜ȱ ’Š—˜œ’Œȱ Žœœȱ Š—ȱ ™›˜ŒŽž›ŽœDZȱ ›’—Œ’™•Žœȱ Š—ȱ‘Ž›Š™¢ǰȱŗŝǰȱŘŜřȬŘŜŝǯ
Š—ȱ Š™™•’ŒŠ’˜—œǯȱ ——Š•œȱ ˜ȱ —Ž›—Š•ȱ Ž’Œ’—Žǰȱ şŚǰȱ ŠœŽ›ǰȱ ǯȱ ǯǰȱ ǭȱ •˜—’—Ž›ǰȱ ǯȱ ǯȱ ǻŗşşŖǼǯȱ ˜–˜›‹’’¢ȱ
śśřȬŜŖŖǯ ˜ȱ –˜˜ȱ Š—ȱ Š—¡’Ž¢ȱ ’œ˜›Ž›œǯȱ Šœ‘’—˜—ǰȱ DZȱ
›ž—‘Šžœǰȱ ǯȱ ǻŗşŞŞǼǯȱ •’—’ŒŠ•ȱ Š—ȱ ™œ¢Œ‘˜‹’˜•˜’ŒŠ•ȱ –Ž›’ŒŠ—ȱœ¢Œ‘’Š›’Œȱœœ˜Œ’Š’˜—ǯ
Œ‘Š›ŠŒŽ›’œ’Œœȱ ˜ȱ œ’–ž•Š—Ž˜žœȱ ™Š—’Œȱ ’œ˜›Ž›ȱ Šžœ—Ž›ǰȱ ǯǰȱ ǭȱ ›Š–Ž›ǰȱ ǯȱ ǻŗşŞśǼǯȱ ™¢Ž–’˜•˜¢DZȱ —ȱ
Š—ȱ –Š“˜›ȱ Ž™›Žœœ’˜—ǯȱ –Ž›’ŒŠ—ȱ ˜ž›—Š•ȱ ˜ȱ ’—›˜žŒ˜›¢ȱŽ¡ǯȱ‘’•ŠŽ•™‘’ŠDZȱǯǯȱŠž—Ž›œǯ
œ¢Œ‘’Š›¢ǰȱŗŚśǰȱŗŘŗŚȬŗŘŘŗǯ Ž¢Ž›ǰȱǯȱǯǰȱ’••Ž›ǰȱǯȱǯǰȱŽ£Ž›ǰȱǯȱǯǰȱǭȱ˜›”˜ŸŽŒǰȱ

œ’Š˜ǰȱ ǯȱ
ǯǰȱ Š›”˜ǰȱ ǯȱ ǯǰȱ ǭȱ ˜ĴŽ›ǰȱ ǯȱ ǯȱ ǻŗşŞşǼǯȱ ǯȱ ǯȱ ǻŗşşŖǼǯȱ ŽŸŽ•˜™–Ž—ȱ Š—ȱ ŸŠ•’Š’˜—ȱ ˜ȱ
’Š—˜œ’—ȱ ’Š—˜œŽœDZȱ ŽŒŽ’ŸŽ›ȱ ˜™Ž›Š’—ȱ ‘Žȱ Ž——ȱ ŠŽȱ ˜››¢ȱ žŽœ’˜——Š’›Žǯȱ Ž‘ŠŸ’˜ž›ȱ
Œ‘Š›ŠŒŽ›’œ’Œȱ–Ž‘˜œȱŠ—ȱ™œ¢Œ‘’Š›¢ǯȱ›Œ‘’ŸŽœȱ˜ȱ ŽœŽŠ›Œ‘ȱŠ—ȱ‘Ž›Š™¢ǰȱŘŞǰȱŚŞŝȬŚşśǯ
Ž—Ž›Š•ȱœ¢Œ‘’Š›¢ǰȱŚŜǰȱŜŜŚȬŜŜŝǯ Ž££’Œ‘ǰȱ ǯǯǰȱ Š‹›ŽŠǰȱ
ǯǰȱ ǭȱ ˜ě–Š—ǰȱ ǯǯȱ ǻŗşŞŝǼǯȱ

Ž••Ž›ǰȱ ǯȱ ǯǰȱ
•Ž›–Š—ǰȱ ǯȱ ǰȱ ŠŸ˜›’ǰȱ ǯȱ ǯǰȱ ˜›¢Ž••ǰȱ ž•’Š¡’Š•ȱŒ‘Š›ŠŒŽ›’£Š’˜—ȱ˜ȱŽ™›Žœœ’ŸŽȱ™Š’Ž—œǯȱ
ǯǰȱ —’Œ˜Ĵǰȱ ǯǰȱ ǭȱ Š¢•˜›ǰȱ ǯȱ ǻŗşŞŚǼǯȱ ˜—ȬŽ›–ȱ ˜ž›—Š•ȱ˜ȱŽ›Ÿ˜žœȱŠ—ȱŽ—Š•ȱ’œŽŠœŽǰȱŗŝśǰȱřřşȬřŚŜǯ
˜žŒ˜–Žœȱ˜ȱŽ™’œ˜Žœȱ˜ȱ–Š“˜›ȱŽ™›Žœœ’˜—ǯȱ˜ž›—Š•ȱ
ǯǰȱǭȱ˜ě–Š—ǰȱ ǯȱǯǰȱǭȱ
Š•Ž¢ǰȱ
˜ȱ–Ž›’ŒŠ—ȱŽ’ŒŠ•ȱœœ˜Œ’Š’˜—ǰȱŘśŘǰȱŝŞŞȬŝşŘǯ
Ž••—Ž›ǰȱ ǯȱ ǻŗşŞśǼǯȱ ¢–™˜–ȬŠ’—ȱ Žœǯȱ —ȱ ǯȱ
Ž££’Œ‘ǰȱǯȱǯǰȱŠ‹›ŽŠǰȱ
ǯȱǻŗşŞşǼǯȱȬȱ’œ˜›Ž›œȱ’—ȱŠȱ•Š›ŽȱœŠ–™•Žȱ˜ȱ
™œ¢Œ‘’Š›’Œȱ ™Š’Ž—œDZȱ ›ŽšžŽ—Œ¢ȱ Š—ȱ œ™ŽŒ’ęŒ’¢ȱ
Š›˜›’žœȱ ǭȱ ǯȱ ǯȱ Š—ȱ ǻœǼǯȱ œœŽœœ–Ž—ȱ ˜ȱ ˜ȱ ’Š—˜œŽœǯȱ –Ž›’ŒŠ—ȱ ˜ž›—Š•ȱ ˜ȱ œ¢Œ‘’Š›¢ǰȱ ŗŚŜǰȱ
Ž™›Žœœ’˜—ǯȱŽ ȱ˜›”DZȱ™›’—Ž›ȬŽ›•Šǯ ŘŗŘȬŘŗşǯ

ŽœœŽ•ǰȱ ǯȱ ǯǰȱ ǭȱ ’––Ž›–Š—ǰȱ ǯȱ ǻŗşşřǼǯȱ Ž™˜›’—ȱ
Ž››˜›œȱ ’—ȱ œž’Žœȱ ˜ȱ ‘Žȱ ’Š—˜œ’Œȱ ™Ž›˜›–Š—ŒŽȱ
˜ȱ œŽ•ȬŠ–’—’œŽ›Žȱ šžŽœ’˜——Š’›ŽœDZȱ ¡Ž—ȱ ˜ȱ
‘Žȱ™›˜‹•Ž–ǰȱ›ŽŒ˜––Ž—Š’˜—œȱ˜›ȱœŠ—Š›’£Žȱ
ǯǰȱǭȱŠ›•˜ ǰȱǯȱǻŗşşŘǼǯȱŽę—’’˜—ȱ˜ȱœŽŒ˜—Š›¢ȱ
™›ŽœŽ—Š’˜—ȱ ˜ȱ ›Žœž•œǰȱ Š—ȱ ’–™•’ŒŠ’˜—œȱ ˜›ȱ ‘Žȱ
™ŽŽ›ȱ ›ŽŸ’Ž ȱ ™›˜ŒŽœœǯȱ œ¢Œ‘˜•˜’ŒŠ•ȱ œœŽœœ–Ž—ǰȱ śǰȱ
řşśȬřşşǯ
Žœœ•Ž›ǰȱ ǯȱ ǯǰȱ Œ ˜—Š•Žǰȱ
ǯȱ ǯǰȱ ‘Š˜ǰȱ ǯǰȱ Ž•œ˜—ǰȱ ˜œœ–Š—ǰȱ ǯȱ ǭȱ ˜–˜£Šǰȱ ǯȱ ǻŗşŞşǼǯȱ Š¡’–’£’—ȱ
ǯǯǰȱ
ž‘Žœǰȱ ǯǰȱ œ‘Ž•–Š—ǰȱ ǯǰȱ Žȱ Š•ǯȱ ǻŗşşŚǼǯȱ
’Ž’–Žȱ Š—ȱ ŗŘȬ–˜—‘ȱ ™›ŽŸŠ•Ž—ŒŽȱ ˜ȱ ȬȬȱ
™œ¢Œ‘’Š›’Œȱ ’œ˜›Ž›œȱ ’—ȱ ‘Žȱ —’Žȱ ŠŽœǯȱ
’••˜—ǰȱ ǯȱ ǻŗşşŚǼǯȱ Š—žŠ•ȱ ˜›ȱ ‘Žȱ ’••˜—ȱ •’—’ŒŠ•ȱ
ž•’Š¡’Š•ȱ —ŸŽ—˜›¢Ȭȱ ǻȬǼǯȱ ’——ŽŠ™˜•’œǰȱ
DZȱŠ’˜—Š•ȱ˜–™žŽ›ȱ¢œŽ–œǯ
˜›Šœǰȱ
Ž™›Žœœ’˜—DZȱ쎌œȱ˜—ȱ˜–˜›‹’’¢ȱŠ—ȱ˜žŒ˜–Žȱ
’—ȱŠ—¡’Ž¢ȱ’œ˜›Ž›œǯȱœ¢Œ‘˜™‘Š›–ŠŒ˜•˜¢ȱž••Ž’—ǰȱ
ŘŞǰȱŘŝȬřřǯ
’Š—˜œ’Œȱ’—˜›–Š’˜—ȱ›˜–ȱ‘ŽȱŽ¡Š–Ž‘Šœ˜—Žȱ
œž™™›Žœœ’˜—ȱŽœǯȱ›Œ‘’ŸŽœȱ˜ȱ Ž—Ž›Š•ȱœ¢Œ‘’Š›¢ǰȱŚŜǰȱ
ŜśřȬŜŜŖǯ
›Œ‘’ŸŽœȱ˜ȱ Ž—Ž›Š•ȱœ¢Œ‘’Š›¢ǰȱśŗǰȱŞȬŗşǯ ž›™‘¢ǰȱǯȱǯǰȱŽ› ’Œ”ǰȱǯȱǯȱŽ’—œŽ’—ǰȱǯȱǯǰȱ˜›žœǰȱ

˜Ž—’œ‹Ž›ǰȱ
ǯȱ ǯǰȱ
Š™•Š—ǰȱ ǯȱ ǯǰȱ ’•–˜›Žǰȱ ǯȱ ǯǰȱ ǯȱ ǯǰȱ ž–Š—ǰȱ ǯȱ
ǯǰȱ ǭȱ
•Ž›–Š—ǰȱ ǯȱ ǯȱ ǻŗşŞŝǼǯȱ
ǭȱ˜˜™Ž›ǰȱǯȱǯȱǻŗşŞśǼǯȱ‘Žȱ›Ž•Š’˜—œ‘’™ȱ‹Ž ŽŽ—ȱ Ž›˜›–Š—ŒŽȱ ˜ȱ œŒ›ŽŽ—’—ȱ Š—ȱ ’Š—˜œ’Œȱ Žœœǯȱ
œ¢—›˜–Žȱ Š—ȱ ™Ž›œ˜—Š•’¢ȱ ’œ˜›Ž›ȱ ’—ȱ ȬDZȱ ›Œ‘’ŸŽœȱ˜ȱ Ž—Ž›Š•ȱœ¢Œ‘’Š›¢ǰȱŚŚǰȱśśŖȬśśśǯ
¡™Ž›’Ž—ŒŽȱ ’‘ȱŘŚŜŘȱ™Š’Ž—œǯȱ–Ž›’ŒŠ—ȱ˜ž›—Š•ȱ˜ȱ ˜¢Žœǰȱ ǯǰȱ Ž’Œ‘ǰȱ ǯǰȱ ‘›’œ’Š—œŽ—ǰȱ ǯǰȱ žŽ•£Ž›ǰȱ ǯǰȱ
œ¢Œ‘’Š›¢ǰȱŗŚŘǰȱŘŖŝȬŘŗŘǯ ˜‘•ǰȱ ǯǰȱ ǭȱ ˜›¢Ž••ǰȱ ǯǯȱ ǻŗşşŖǼǯȱ žŒ˜–Žȱ ˜ȱ

ž‘—Ž›ǰȱ ǯǰȱ ǭȱ Ž’Ž•ǰȱ
ǯȱ ǯȱ ǻŗşşřǼǯȱ œ¢Œ‘˜–Ž›’œŒ‘Žȱ ™Š—’Œȱ’œ˜›Ž›ǯȱ›Œ‘’ŸŽœȱ˜ȱ Ž—Ž›Š•ȱœ¢Œ‘’Š›¢ǰȱŚŝǰȱ
ž—ȱ ’Š—˜œ’Œ‘Žȱ ’Ž—œŒ‘ŠĞŽ—ȱ Ž’—Ž›ȱ ŞŖşȬŞŗŞǯ
ŽžŒ‘œ™›ŠŒ‘’Ž—ȱ Ž›œ’˜—ȱ Žœȱ —ŸŽ—˜›¢ȱ ˜ȱ
ǯȱǻŗşşŚǼǯȱœ¢Œ‘˜–Ž›’Œȱ
’Š—˜œŽȱ Ž™›Žœœ’˜—ȱ ǻǼǯȱ ǽœ¢Œ‘˜–Ž›’Œȱ Š—ȱ
’••ǯ
’Š—˜œ’Œȱ Œ‘Š›ŠŒŽ›’œ’Œœȱ ˜ȱ Šȱ Ž›–Š—Ȭ•Š—žŠŽȱ
ž——Š••¢ǰȱǯȱǯǰȱǭȱŽ›—œŽ’—ǰȱǯȱ
‘Ž˜›¢ȱǻř›ȱŽǯǼǯȱŽ ȱ˜›”DZȱŒ ›Š Ȭ
‘–Ž›ǰȱǯǰȱǭȱŽ˜ž£ŠǰȱǯȱǻŗşŞśǼǯȱȱœŒ›ŽŽ—’—ȱŽœȱ˜›ȱ
ŸŽ›œ’˜—ȱ˜ȱ‘ŽȱǾǯȱ’Š—˜œ’ŒŠǰȱřşǰȱŘŘşȬřŘŗǯ œ˜–Š’£Š’˜—ȱ’œ˜›Ž›ȱǻ‘¢œŽ›’ŠǼǯȱ–Ž›’ŒŠ—ȱ˜ž›—Š•ȱ
ŽŠ›¢ǰȱ ǯȱ ǯȱ ǻŗşŞřǼǯȱ ȱ ‹›’Žȱ ŸŽ›œ’˜—ȱ ˜ȱ ‘Žȱ ŽŠ›ȱ ˜ȱ ˜ȱœ¢Œ‘’Š›¢ǰȱŗŗŚŘǰȱŗŗŚŜȬŗŗŚşǯ
ŽŠ’ŸŽȱ ŸŠ•žŠ’˜—ȱ ŒŠ•Žǯȱ Ž›œ˜—Š•’¢ȱ Š—ȱ ˜Œ’Š•ȱ ’•˜ œ”¢ǰȱ ǯȱ ǻŗşŜŝǼǯȱ ’–Ž—œ’˜—œȱ ˜ȱ ‘¢™˜Œ‘˜—›’Šœ’œǯȱ
œ¢Œ‘˜•˜¢ȱž••Ž’—ǰȱşǰȱřŝŗȬřŝśǯ ›’’œ‘ȱ˜ž›—Š•ȱ˜ȱœ¢Œ‘’Š›¢ǰȱŗŗřǰȱŞşȬşřǯ
ŽœœŽ›ǰȱ ǯȱ ǯǰȱ ž‹’—ǰȱ ǯȱ ǯǰȱ ŽŒ”—˜•ǰȱ ǯȱ ǯǰȱ ’Ĥ’—ǰȱ ˜‹’—œǰȱ ǯȱ ǯǰȱ
Ž•£Ž›ǰȱ ǯȱ ǯǰȱ ›˜ž‘Š—ǰȱ ǯǰȱ ǭȱ ŠŒ•’ěǰȱ
ǯǰȱ  ’—œ˜—ǰȱ ǯȱ ǯǰȱ ¢’Š›ǰȱ ǯȱ ǯǰȱ Žȱ Š•ǯȱ ǻŗşŞŞǼǯȱ
ǯȱǯȱǻŗşŞŗǼǯȱŠ’˜—Š•ȱ—œ’žŽȱ˜ȱŽ—Š•ȱ
ŽŠ•‘ȱ
ŽŒ˜—Š›¢ȱ Ž™›Žœœ’˜—ȱ ’—ȱ ™Š—’Œȱ ’œ˜›Ž›ȱ Š—ȱ ’Š—˜œ’Œȱ —Ž›Ÿ’Ž ȱ Œ‘Žž•ŽDZȱ œȱ ‘’œ˜›¢ǰȱ
Š˜›Š™‘˜‹’Šǯȱ ›Œ‘’ŸŽœȱ ˜ȱ Ž—Ž›Š•ȱ œ¢Œ‘’Š›¢ǰȱ Śśǯȱ Œ‘Š›ŠŒŽ›’œ’Œœǰȱ Š—ȱ ŸŠ•’’¢ǯȱ ›Œ‘’ŸŽœȱ ˜ȱ Ž—Ž›Š•ȱ
ŚřŝȬȱŚŚřǯ œ¢Œ‘’Š›¢ǰȱřŞǰȱřŞŗȬřŞşǯȱ
’ŸŽœ•Ž¢ǰȱǯȱǯȱǻŗşşŞǼǯȱžŽœ’˜—œȱ˜›ȱŠȱ›Š–Ž ˜›”ȱ˜›ȱ ˜‹’—œǰȱǯȱǯǰȱ˜Œ”ŽǰȱǯȱǯǰȱǭȱŽ’Ž›ǰȱǯȱǯȱǻŗşşŖǼǯȱ—ȱ
Š—ȱŽ–™’›’ŒŠ••¢ȱ‹ŠœŽȱŒ•Šœœ’ęŒŠ’˜—ȱ˜ȱ™Ž›œ˜—Š•’¢ȱ ˜ŸŽ›Ÿ’Ž ȱ ˜ȱ ™œ¢Œ‘’Š›’Œȱ ’œ˜›Žœȱ ’—ȱ–Ž›’ŒŠǯȱ —ȱ
’œ˜›Ž›ǯȱ Š—Š’Š—ȱ ˜ž›—Š•ȱ ˜ȱ œ¢Œ‘’Š›¢ǰȱ Śřǰȱ
ŗřŝȬŗŚŝǯ
˜›Š—Ž›ǰȱ ǯȱ ǯȱ ǻŗşşŖǼǯȱ ‘Žȱ ’–™ŠŒȱ ˜ȱ Ȭȱ ˜—ȱ
’Š—˜œ’Œȱ ™›ŠŒ’ŒŽȱ ’—ȱ Šȱ ž—’ŸŽ›œ’¢ȱ ‘˜œ™’Š•ǯȱ
›Œ‘’ŸŽœȱȱ Ž—Ž›Š•ȱœ¢Œ‘’Š›¢ǰȱŚŝǰȱŜŝŘȬŜŝśǯ
ǯȱ ǯȱ ˜‹’—œȱ ǭȱ ǯȱ ǯȱ Ž’Ž›ȱ ǻœǯǼǰȱ œ¢Œ‘’Š›’Œȱ
’œ˜›Ž›œȱ ’—ȱ –Ž›’ŒŠDZȱ ‘Žȱ ™’Ž–’˜•˜’Œȱ ŠŒ‘–Ž—ȱ
ž¢ǯȱŽ ȱ˜›”DZȱ›ŽŽȱ›Žœœǯ


Š‹œ‘’—ǰȱǯȱǻŗşşŗǼǯȱ˜–˜›‹’’¢DZȱȱŒŽ—›Š•ȱŒ˜—ŒŽ›—ȱ˜ȱ ’••’Š–œǰȱǯȱǯȱǯǰȱ ’‹‹˜—ǰȱǯǰȱ’›œǰȱǯȱǯǰȱ™’£Ž›ǰȱǯȱǯǰȱ
™œ¢Œ‘’Š›¢ȱ ’—ȱ ‘Žȱ ŗşşŖœǯȱ
˜œ™’Š•ȱ Š—ȱ ˜––ž—’¢ȱ ŠŸ’œǰȱǯǰȱ˜›žœǰȱǯǰȱŽǯȱŠ•ǯȱǻŗşşŘǼǯȱ‘Žȱ›žŒž›Žȱ
œ¢Œ‘’Š›¢ǰȱŚŘǰȱřŚśǯ •’—’ŒŠ•ȱ—Ž›Ÿ’Ž ȱ˜›ȱȬȬȱǻǼǯȱ›Œ‘’ŸŽœȱ
ŠŒ”ŽĴǰȱ ǯȱ ǻŗşşŘǼǯȱ ȱ ™›’–Ž›ȱ ˜—ȱ ‘Žȱ ™›ŽŒ’œ’˜—ȱ Š—ȱ ˜ȱ Ž—Ž›Š•ȱœ¢Œ‘’Š›¢ǰȱŚşǰȱŜřŖȬŜřŜǯ
ŠŒŒž›ŠŒ¢ȱ˜ȱ‘ŽȱŒ•’—’ŒŠ•ȱŽ¡Š–’—Š’˜—ǯȱ˜ž›—Š•ȱ˜ȱ‘Žȱ ’––Ž›–Š—ǰȱ ǯȱ ǻŗşŞřǼǯȱ Ž•Ȭ›Ž™˜›ȱ Ž™›Žœœ’˜—ȱ œŒŠ•Žȱ
–Ž›’ŒŠ—ȱŽ’ŒŠ•ȱœœ˜Œ’Š’˜—ǰȱŘŜŝǰȱŘŜřŞȬŘŜŚŚǯ ǻ•ŽĴŽ›Ǽǯȱ›Œ‘’ŸŽœȱ˜ȱ Ž—Ž›Š•ȱœ¢Œ‘’Š›¢ǰȱŚŖǰȱŗŖřśǯ
Š—Ž›œ˜—ǰȱ ǯȱ ǯǰȱ ’Š›˜ǰȱ ǯȱ ǯǰȱ Š™ŽŽǰȱ ǯȱ ǯǰȱ ǭȱ ’––Ž›–Š—ǰȱ ǯȱ ǻŗşşŚǼǯȱ —Ž›Ÿ’Ž ȱ ž’Žȱ ˜›ȱ ŽŸŠ•žŠ’—ȱ
Š›•˜ ǰȱ ǯȱ
ǯȱ ǻŗşşŖǼǯȱ ¢—›˜–Žȱ Œ˜–˜›‹’’¢ȱ Ȭȱ ™œ¢Œ‘’Š›’Œȱ ’œ˜›Ž›œȱ Š—ȱ –Ž—Š•ȱ œŠžœȱ
’—ȱ ™Š’Ž—œȱ ’Š—˜œŽȱ  ’‘ȱ Šȱ ȬȬȱ Š—¡’Ž¢ȱ Ž¡Š–’—Š’˜—ǯȱŠœȱ ›ŽŽ— ’Œ‘ǰȱDZȱœ¢Œ‘ȱ›˜žŒœȱ
’œ˜›Ž›ǯȱ ˜ž›—Š•ȱ ˜ȱ ‹—˜›–Š•ȱ œ¢Œ‘˜•˜¢ǰȱ şşǰȱ ›Žœœǯ
řŖŞȬřŗŘǯ ’––Ž›–Š—ǰȱ ǯǰȱ ǭȱ ˜›¢Ž••ǰȱ ǯȱ ǻŗşŞŝǼǯȱ —ŸŽ—˜›¢ȱ ˜ȱ
Š—Ž›œ˜—ǰȱǯȱǰȱ˜›Š—ǰȱǯȱǯȱ ˜Œœ’œǰȱǯȱ
ǯǰȱǭȱ›Š—ŒŽœǰȱ ’Š—˜œŽȱ Ž™›Žœœ’˜—ȱ ǻǼDZȱ ȱ œŽ•Ȭ›Ž™˜›ȱ œŒŠ•Žȱ
ǯȱ ǯȱ ǻŗşşŖǼǯȱ ¢—›˜–Žȱ Œ˜–˜›‹’’¢ȱ ’—ȱ ™Š’Ž—œȱ ˜ȱ’Š—˜œŽȱ–Š“˜›ȱŽ™›Žœœ’ŸŽȱ’œ˜›Ž›ǯȱ˜ž›—Š•ȱ˜ȱ
 ’‘ȱ–Š“˜›ȱŽ™›Žœœ’˜—ȱ˜›ȱ¢œ‘¢–’ŠDZȱ›ŽŸŠ•Ž—ŒŽȱ ˜—œž•’—ȱŠ—ȱ•’—’ŒŠ•ȱœ¢Œ‘˜•˜¢ǰȱśśǰȱśśȬśşǯ
Š—ȱ Ž–™˜›Š•ȱ ›Ž•Š’˜—œ‘’™œǯȱ –Ž›’ŒŠ—ȱ ˜ž›—Š•ȱ ˜ȱ ’––Ž›–Š—ǰȱ ǯǰȱ ǭȱ ˜›¢Ž••ǰȱ ǯȱ ǻŗşŞŞǼǯȱ ‘Žȱ ŸŠ•’’¢ȱ
œ¢Œ‘’Š›¢ǰȱŗŚŝǰȱŗŖŘśȬŗŖŘŞǯ ˜ȱœŽ•Ȭ›Ž™˜›ȱšžŽœ’˜——Š’›Žȱ˜›ȱ’Š—˜œ’—ȱ–Š“˜›ȱ
Œ‘ Š•‹Ž›ǰȱ ǯȱ ǯǰȱ Š›•˜ ǰȱ ǯȱ
ǯǰȱ •Ž›ǰȱ ǯȱ ǯǰȱ ǭȱ Ž™›Žœœ’ŸŽȱ’œ˜›Ž›ǯȱ›Œ‘’ŸŽœȱ˜ȱ Ž—Ž›Š•ȱœ¢Œ‘’Š›¢ǰȱ

˜ Š›ǰȱ ǯȱ ǯȱ ǻŗşşŘǼǯȱ ˜–™Š›’œ˜—ȱ ˜ȱ ‹ž•’–’Œœǰȱ ŚśǰȱŝřŞȬŝŚŖǯ
˜‹ŽœŽȱ‹’—ŽȱŽŠŽ›œǰȱœ˜Œ’Š•ȱ™‘˜‹’ŒœǰȱŠ—ȱ’—’Ÿ’žŠ•œȱ ’––Ž›–Š—ǰȱǯǰȱ ǭȱ ˜›¢Ž••ǰȱǯȱǻŗşşŚǼǯȱ Œ›ŽŽ—’—ȱ˜›ȱ
 ’‘ȱ ™Š—’Œȱ ’œ˜›Ž›ȱ ˜—ȱ Œ˜–˜›‹’’¢ȱ ŠŒ›˜œœȱ –Š“˜›ȱ Ž™›Žœœ’ŸŽȱ ’œ˜›Ž›ȱ ’—ȱ ‘Žȱ Œ˜––ž—’¢DZȱ ȱ
ȬȬȱŠ—¡’Ž¢ȱ’œ˜›Ž›œǯȱ˜ž›—Š•ȱ˜ȱ‹—˜›–Š•ȱ Œ˜–™Š›’œ˜—ȱ˜ȱ–ŽŠœž›Žœǯȱœ¢Œ‘˜•˜’ŒŠ•ȱœœŽœœ–Ž—ǰȱ
œ¢Œ‘˜•˜¢ǰȱŗŖŗǰȱŜŝśȬŜŞŗǯ ŜǰȱŝŗȬŝŚǯ
Ž•£Ž›ǰȱ ǯȱ ǯȱ ǻŗşŝŗǼǯȱ ’Œ‘’Š—ȱ•Œ˜‘˜•’œ–ȱ Œ›ŽŽ—’—ȱ ’––Ž›–Š—ǰȱ ǯǰȱ ǭȱ ˜›¢Ž••ǰȱ ǯǰȱ ˜›Ž—‘Š•ǰȱ ǯǰȱ ǭȱ
ŽœDZȱ‘ŽȱšžŽœȱ˜›ȱŠȱ—Ž ȱ’Š—˜œ’Œȱ’—œ›ž–Ž—ǯȱ ’•œ˜—ǰȱǯȱǻŗşŞŜǼǯȱȱœŽ•Ȭ›Ž™˜›ȱœŒŠ•Žȱ˜ȱ’Š—˜œŽȱ
–Ž›’ŒŠ—ȱ˜ž›—Š•ȱ˜ȱœ¢Œ‘’Š›¢ǰȱŗŘŝǰȱŗŜśřȬŗŜśŞǯ –Š“˜›ȱ Ž™›Žœœ’˜—ȱ ’œ˜›Ž›ǯȱ ›Œ‘’ŸŽœȱ ˜ȱ Ž—Ž›Š•ȱ
‘žŠ›ǰȱ ǯǰȱŒ‘Ž›£Ž›ǰȱǯǰȱ˜—Ž›ǰȱǯȱǯǰȱǭȱ’ Šœ‹Š››˜ǰȱ œ¢Œ‘’Š›¢ǰȱŚřǰȱŗŖŝŜȬŗŖŞŗǯ
ǯȱ ǻŗşşŘǼǯȱ ŽŸŽ•˜™–Ž—ǰȱ žœŽǰȱ Š—ȱ ŠŒ˜›ȱ Š—Š•¢œ’œȱ ’––Ž›–Š—ǰȱǯǰȱŠ›‹Ž›ǰȱǯȱǯǰȱ
Š›ž—ǰȱǯǰȱžœ‘ǰȱǯȱǯǰȱ
˜ȱœŽ•Ȭ›Ž™˜›ȱ’—ŸŽ—˜›¢ȱ˜›ȱ–Š—’Šǯȱ˜–™›Ž‘Ž—œ’ŸŽȱ ǭȱ ž£–Š—ǰȱǯȱǯȱǻŗşşŚǼǯȱŒ›ŽŽ—’—ȱ˜›ȱ™œ¢Œ‘’Š›’Œȱ
œ¢Œ‘’Š›¢ǰȱřřǰȱřŘśȬřřŗǯ ’œ˜›Ž›œȱ ’—ȱ –Ž’ŒŠ•ȱ ™Š’Ž—œDZȱ ȱ ŽŠœ’‹’•’¢ȱ Š—ȱ
’Ž›•Žœǰȱ ǯȱ ǯǰȱ ‘Ž—ǰȱ ǯȱ ǯǰȱ ŒŠ›•Š—ǰȱ ǯȱ ǯǰȱ ǭȱ Š¢•˜›ǰȱ ™Š’Ž—ȱŠŒŒŽ™Š—ŒŽȱœž¢ǯȱŽ’ŒŠ•ȱŒŠ›ŽǰȱřŘǰȱŜŖřȬŜŖŞǯ
ǯȱǯȱǻŗşŞřǼǯȱ˜œĴ›Šž–Š’Œȱœ›ŽœœȱŠ—ȱŒ˜—Œž››Ž—ȱ ’––Ž›–Š—ǰȱǯǰȱǭȱ’œ‘ǰȱǯȱǯȱǻŗşşśǼǯȱ‘ŽȱDZȱ
™œ¢Œ‘’Š›’Œȱ’••—ŽœœDZȱȱ™›Ž•’–’—Š›¢ȱ›Ž™˜›ǯȱ–Ž›’ŒŠ—ȱ Šȱ‹›˜Š‹ŠœŽȱœŽ•Ȭ›Ž™˜›ȱœŒ›ŽŽ—’—ȱšžŽœ’˜——Š’›Žǯȱ
˜ž›—Š•ȱ˜ȱœ¢Œ‘’Š›¢ǰȱŗŚŖǰȱŗŗŝŝȬŗŗŝşǯ ›’–Š›¢ȱœ¢Œ‘’Š›¢ǰȱŘǰȱŘŗȬŘŜǯ
”’——Ž›ǰȱ
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˜œ™’Š•ȱœ¢Œ‘’Š›¢ǰȱ
›Œ‘’ŸŽœȱ˜ȱ Ž—Ž›Š•ȱœ¢Œ‘’Š›¢ǰȱřśǰȱŝŝřȬŝŞŘǯ ŗŜǰȱřŞŞȬřşŜǯ
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˜ȱ ȱ DZȱ ‘Žȱ 
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›’–Š›¢ȱ Š›Žȱ ŸŠ•žŠ’˜—ȱ ˜ȱ Ž—Š•ȱ ’œ˜›Ž›œǯȱ Œ•’—’ŒŠ•ȱ Œ˜››Ž•ŠŽœǯȱ ˜–™›Ž‘Ž—œ’ŸŽȱ œ¢Œ‘’Š›¢ǰȱ řşǰȱ
Š’Ž—ȱ
ŽŠ•‘ȱ žŽœ’˜——Š’›Žǯȱ ˜ž›—Š•ȱ ˜ȱ ‘Žȱ ŘŜśȬŘŝŖǯ
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ǯǰȱ Š›–Ž›ǰȱ ǯǰȱ ˜—Ž›•’Œ‘ǰȱ ǯǰȱ ǭȱ –’‘ǰȱ –’œœŽǵȱ˜–™›Ž‘Ž—œ’ŸŽȱœ¢Œ‘’Š›¢ǰȱŚŖǰȱŗŞŘȬŗşŗǯ
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ȱ™Žȱ™˜™ž•Šô’Šȱ’—ȱ˜–¦—’Š

–Š•’ŠȱŠ›’ŠȱȱǻŒ˜˜›˜—Š˜›Ǽ

ȱ˜—’ŒŠȱ
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™Žȱ™˜™ž•Šô’Šȱ’—ȱ˜–¦—’Šȱ
ŗǯȱ‹’ŽŒ’Ÿž•ȱœž’ž•ž’
ž’ž•ȱ Žȱ Šô©ȱ Š›Žȱ ŒŠȱ ˜‹’ŽŒ’Ÿȱ ™›’—Œ’™Š•ȱ
ŠŠ™Š›ŽŠǰȱ ŸŠ•’Š›ŽŠȱ ó’ȱ Œ›ŽŠ›ŽŠȱ Žȱ ŽŠ•˜Š—Žȱ
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Š›Š–ž›Žóǰȱ Šó’ǰȱ
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C—ȱ Š‹Ž•ž•ȱ ŗȱ œž—ȱ ™›Ž£Ž—ŠŽȱ ŠŽ•Žȱ Ž–˜›ŠęŒŽȱ
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›’–Šȱ Š£©ǰȱ ŠŒŽŽŠȱ Šȱ ›ŠžŒŽ›’’ȱ ’—ȱ •’–‹Šȱ
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›ǯȱó’ȱǻƖǼ ›ǯȱó’ȱǻƖǼ
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ȱȱȱȱȱŽ–Ž’ ŘŖŗȱǻśŜǰśǼ ŝŝŞȱǻŜřǰŝǼ
ȱȱȱȱȱ©›‹Šô’ ŗśśȱǻŚřǰśǼ ŚŚŝȱǻřŜǰřǼ
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ȱȱȱȱȱŗŖȱŠ—’ ŗŝȱǻŚǰŞǼ ŞşȱǻŝǰřǼ
ȱȱȱȱȱŗŘȱŠ—’ ŗŖŞȱǻřŖǰřǼ ŚřŚȱǻřśǰŚǼ
ȱȱȱȱȱŗŜȱŠ—’ ŜŗȱǻŗŝǰŗǼ ŚŚŞȱǻřŜǰŜǼ
ȱȱȱȱȱǁȱŗŜȱŠ—’ řȱǻŖǰŞǼ ŗŞřȱǻŗŚǰşǼ

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ȱȱȱȱȱȱ©žŸ řŝȱǻŗŖǰŚǼ ŗŖŜȱǻŞǰŝǼ
ȱȱȱȱȱȱŽŒ©œ©˜›’ ŞŞȱǻŘŚǰŝǼ řřŗȱǻŘŝǼ

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ȱȱȱȱȱ˜–©ȱȱȱȱȱ ŘȱǻŖǰŜǼ şȱǻŖǰŝǼ

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˜ô’ȱ ˜™Ž›Š˜›’’ȱ ǻ™Ž›œ˜Š—Ž•Žȱ ŒŠ›Žȱ Šžȱ
Š–’—’œ›ŠȱŒ‘Žœ’˜—Š›ž•ȱǼȱŠžȱ˜œȱ’—œ›ž’ô’ȱ
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C—ȱ œŽŒô’ž—’•Žȱ ž›–©˜Š›Žȱ œž—ȱ ™›Ž£Ž—ŠŽȱ
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ŠŒŽœž’ȱŽ—ȱŽȱž•‹ž›Š›Žǯ
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ó’ȱ ŒŽ•Ž•Š•Žȱ œž‹œŒŠ•Žȱ ǻŸŽ£’ȱ Š‹Ž•ž•ȱ śǼǯȱ C—ȱ ŒŠ£ž•ȱ
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ŖǰŜŗǰȱ ’Š›ȱ –Ž’Šȱ Œ˜›Ž•Šô’Ž’ȱ ’Ž–ȦŒŽ•Ž•Š•Žȱ œž‹œŒŠ•Žȱ
Šȱ˜œȱŽȱŖǰŘŖǯ
Ž—›žȱ Šȱ Ž¡Š–’—Šȱ ŸŠ•’’ŠŽŠȱ Œ˜—Œž›Ž—©ȱ
Šȱ œž‹œŒŠ•Ž•˜›ȱ ǰȱ ŗŞřȱ ’—›Žȱ ŒŽ’ȱ řśŜȱ Žȱ
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ŗǯȱ ž‹œŒŠ•Šȱ ž•’–’Žȱ Šȱ —ŸŽ—Š›ž•ž’ȱ ž•‹žȬ
›©›’•˜›ȱ Žȱ Œ˜–™˜›Š–Ž—ȱ Š•’–Ž—Š›ȱ ǻŠ’—ȱ
’œ˜›Ž›ȱ—ŸŽ—˜›¢ǰȱȬřDzȱ Š›—Ž›ǰȱŘŖŖŚǼǯ
˜›Ž•Šô’Š
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Š•ŽȱŠŒŽ•Ž’Šó’ȱž•‹ž›©›’Œ Š•ŽȱŠ•˜›ȱž•‹ž›©›’
ŖǰŜŚŠDzȱŖǰśś‹ Ŗǰřř
Ȭ ŖǰŘŝ
ŖǰŜŗŒ Ŗǰŗş
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Ȭ ŖǰŘŚ
Ȭ ŖǰŗŞ
Ȭ ŖǰŘŘ
Ŗǰŝŗ 
ŖǰŘŞ
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Ȭ ŖǰŖŘ
Ŗǰśŗ DzȱŖǰŚř
Ž 
ŖǰŘŞ
Ȭ Ŗǰŗş
Ȭ Ŗǰŗŝ
Řǯȱ —ŸŽ—Š›ž•ȱŽȱŽ™›Žœ’ŽȱŽŒ”ȱǻŽŒ”ȱŽ™›Žœœ’˜—ȱ
—ŸŽ—˜›¢ǰȱ Dzȱ ŽŒ”ǰȱ žœ‘ǰȱ ‘Š ȱ ó’ȱ
–Ž›¢ǰȱ ŗşŝşǼȱ ó’ȱ œž‹œŒŠ•Šȱ Žȱ Ž™›Žœ’Žȱ
’—ȱ ŒŠ›ž•ȱ œŒŠ•Ž’ȱ ȱ ǻ˜Ÿ’‹˜—ȱ ó’ȱ
˜Ÿ’‹˜—ǰȱŗşşśǼǯ
řǯȱ ž‹œŒŠ•Šȱ ȬȬȱ ǻŠ—¡’ŽŠŽŠȱ ŒŠȱ
›©œ©ž›©ȱ ɗȱ œ’žŠô’’ȱ Žȱ ŽŸŠ•žŠ›Žȱ œ˜Œ’Š•©Ǽȱ
’—ȱ ŒŠ›ž•ȱ œŒŠ•Ž•˜›ȱ ȱ ǻ—•Ž›ǰȱ •ŽĴǰȱȱ
ŘŖŖŘDzȱ’Œ•ŽŠǰȱ•‹žǰȱ’žŒŠǰȱŘŖŖşǼǯ
Śǯȱ ž‹œŒŠ•Šȱ ȬȬȱ ǻŠ—¡’ŽŠŽŠȱ ŒŠȱ
›©œ©ž›©ȱ ɗȱ œ’žŠô’’ȱ Žȱ ›ž’—©ȱ £’•—’Œ©ȱ
Ȯȱ Š—¡’ŽŠŽŠȱ Ž—Ž›Š•’£Š©Ǽȱ ’—ȱ ŒŠ›ž•ȱ
œŒŠ•Ž•˜›ȱ ȱ ǻ—•Ž›ȱ ó’ȱ Œ˜•Š‹ǯȱ ŗşşŗDzȱ
’Œ•ŽŠȱ ó’ȱ Œ˜•Š‹ǯȱ ŘŖŖşǼȱ ó’ȱ œž‹œŒŠ•Šȱ Žȱ
Š—¡’ŽŠŽȱ ’—ȱ ŒŠ›ž•ȱ œŒŠ•Ž’ȱ ȱ
ǻ˜Ÿ’‹˜—ȱó’ȱ˜Ÿ’‹˜—ǰȱŗşşśǼǯ
śǯȱ —ŸŽ—Š›ž•ȱ Žȱ ™Ž›œ˜—Š•’ŠŽȱ Ȭ
ȱ ǻ˜›Š—Ž›ǰȱ ŘŖŖŗǼǯȱ ŸŠ•žŽŠ£©ȱ ŒŽ•Žȱ ŗŖȱ
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Ȭǯ
Ŝǯȱ ‘Žœ’˜—Š›Ž•Žȱ Žȱ ŽŸŠ•žŠ›Žȱ Šȱ Œ˜™’—ž•ž’DZȱ
ȱ ȱ Ȭȱ Œ˜™’—ȱ Œ˜—’’ŸȬŽ–˜ô’˜—Š•ȱ ǻ Š›Ȭ
—Žœ”¢ȱ ó’ȱ Œ˜•Š‹ǯǰȱ ŘŖŖśǼȱ ó’ȱ ȱ Ȯȱ Œ˜™’—ȱ

 Œ˜–™˜›Š–Ž—Š•ȱǻ˜——’Ž›ǰȱ
˜‹˜••ǰȱž—ŠȬ Œ˜—ŸŽ›Ž—©ȱó’ȱ’œŒ›’–’—Š’Ÿ©ȱŠȱ˜œȱ–Š’ȱ–Š›ŽȱŽȱ
‘Š˜˜ǰȱ
ž•œ’£Ž›ǰȱ˜‘—œ˜—ǰȱŗşşŞǼǯ ŖǰŘŖȱɗȱŒŠ£ž•ȱžž›˜›ȱœž‹œŒŠ•Ž•˜›ǯ
ž™©ȱ Œž–ȱ œŽȱ ™˜ŠŽȱ ˜‹œŽ›ŸŠȱ ɗȱ Š‹Ž•ž•ȱ
Ŝǰȱ œŒ˜›ž›’•Žȱ •Šȱ œž‹œŒŠ•Ž•Žȱ ȱ Šžȱ Œ˜›Ž•Šȱ
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™žŽ›—’ŒȱŒžȱœŒŠ•ŠȱŒŠ›ŽȱŠȱŽŸŠ•žŠȱŠŒŽŽŠó’ȱž•‹ž›Š›Žȱ
ŽŒ¦ȱ Œžȱ œŒŠ•Ž•Žȱ ŒŠ›Žȱ Šžȱ ŽŸŠ•žŠȱ Š•Žȱ ž•‹ž›©›’ǯȱ
Žȱ Ž¡Ž–™•žǰȱ œž‹œŒŠ•Šȱ ž•’–’ŽȦ•’–Ž—Šô’Žȱ
Œ˜–™ž•œ’Ÿ©ȱ Šȱ Œ˜›Ž•Šȱ –Š’ȱ ™žŽ›—’Œȱ Œžȱ œž‹œŒŠ•Šȱ
ž•’–’Žȱ ’—ȱ ŒŠ›ž•ȱ —ŸŽ—Š›ž•ž’ȱ ž•‹ž›©›’•˜›ȱ Žȱ
Œ˜–™˜›Š–Ž—ȱ Š•’–Ž—Š›ȱ ǻ›ƽŖǰŜŗǰȱ ™ǀŖǰŖŖŗǼȱ ŽŒ¦ȱ
Œžȱ Š•Žȱ œŒŠ•Žȱ ŒŠ›Žȱ –©œ˜Š›©ȱ Œ˜—œ›žŒŽȱ ’Ž›’Žǰȱ
Œž–ȱŠ›ȱęȱȱǻŽ™›Žœ’Žǰȱ›ƽŖǰŗŞǼȱœŠžȱȬȬȱ
ǻŠ—¡’ŽŠŽŠȱ ŒŠȱ ›©œ©ž›©ȱ ɗȱ œ’žŠô’’ȱ Žȱ ŽŸŠ•žŠ›Žȱ
œ˜Œ’Š•©ǰȱ ›ƽŖǰŘŗǼǯȱ ˜ŠŽȱ Œ˜›Ž•Šô’’•Žȱ œž‹œŒŠ•Ž•˜›ȱ
ȱ Œžȱ œŒŠ•Ž•Žȱ Žȱ ŸŠ•’’ŠŽȱ Œ˜—ŸŽ›Ž—©ȱ Šžȱ
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ŒžȱȬȬȱǻŠ—¡’ŽŠŽŠȱŒŠȱ›©œ©ž›©ȱɗȱœ’žŠô’’ȱ
Žȱ ›ž’—©ȱ £’•—’Œ©Ǽǰȱ Šȱ ˜œȱ Žȱ ›ƽŖǰŚřǯȱ C—ȱ –˜ȱ Œ•Š›ȱ
ɗœ©ǰȱ ’Ž›Ž—ôŠȱ ’—›Žȱ Œ˜ŽęŒ’Ž—ô’’ȱ Žȱ ŸŠ•’’ŠŽȱ
ž™©ȱŒž–ȱœŽȱ™˜ŠŽȱ˜‹œŽ›ŸŠȱɗœ©ȱó’ȱ’—ȱŠ‹Ž•ž•ȱ
Ŝǰȱ—žȱœȬŠȱ›Žžó’ȱŒŽ›ŒŽŠ›ŽŠȱŸŠ•’’©ô’’ȱŒ˜—ŸŽ›Ž—Žȱ
™Ž—›žȱ ˜ŠŽȱ œž‹œŒŠ•Ž•Žȱ ’—ȱ ǰȱ ŠœŠȱ Š˜›’©ȱ
Š™ž•ž’ȱ Œ©ǰȱ ɗȱ ™›Ž£Ž—ǰȱ —žȱ Ž¡’œ©ȱ –©œž›©˜›’ȱ
ŸŠ•’ŠŽȱ ™Žȱ ™˜™ž•Šô’Šȱ ›˜–¦—ŽŠœŒ©ȱ ™Ž—›žȱ ˜ŠŽȱ
ž•‹ž›©›’•Žȱ Žȱ ™Žȱ Š¡Šȱ ǯȱ Žȱ ™›˜™ž—Ž–ȱ ɗœ©ȱ œ©ȱ
Œ˜–™•Ž©–ȱŠŒŽœȱŠœ™ŽŒȱŠ•ȱŸŠ•’’©ô’’ȱŒ˜—ŸŽ›Ž—Žȱ
ó’ȱ ’œŒ›’–’—Š’ŸŽȱ ž’•’£¦—ȱ ŒŠȱ ’—œ›ž–Ž—ȱ Žȱ
Œ˜–™Š›Šô’Žȱ Ȭž•ȱ ǻ’›œǰȱ ™’£Ž›ǰȱ ’‹‹˜—ȱ ó’ȱ
’••’Š–œǰȱ ŗşşŝDzȱ ŸŽ›œ’ž—ŽŠȱ ɗȱ •’–‹Šȱ ›˜–¦—©ȱ ȱ Ȯȱ
ŠŸ’ȱ ó’ȱ Œ˜•Š‹ǯǰȱ ŘŖŖŝǼǰȱ –Š’ȱ ™›ŽŒ’œȱ Ȭǰȱ
ŸŽ›œ’ž—ŽŠȱ™Ž—›žȱ™ŠŒ’Ž—ô’ǯ
śǯŘǯŘǯȱŠ•’’ŠŽŠȱŽȱŒ›’Ž›’ž
Š•’’ŠŽŠȱŽȱŒ›’Ž›’žȱŠȱœž‹œŒŠ•Ž•˜›ȱȱŠȱ
˜œȱ›ŽŠ•’£Š©ȱ™›’—DZ
Šǯȱ ŸŽ›’ęŒŠ›ŽŠȱ ŒŠ™ŠŒ’©ô’’ȱ œž‹œŒŠ•Ž•˜›ȱ Žȱ Šȱ
’Ž›Ž—ô’Šȱ ɗ›Žȱ ™˜™ž•Šô’Šȱ Œ•’—’Œ©ȱ ó’ȱ ŒŽŠȱ
—˜—ȬŒ•’—’Œ©Dz

Š‹Ž•ž•ȱŝ
˜–™Š›Š›ŽŠȱ–Ž’’•˜›ȱœŒ˜›ž›’•˜›ȱ•Šȱœž‹œŒŠ•Ž•Žȱȱɗ›Žȱ™ŠŒ’Ž—ô’’ȱŒžȱó’ȱ©›©ȱ’Š—˜œ’ŒŽȱŠœ˜Œ’ŠŽ

˜ȱŒ•’—’ŒȱǻƽřśŜǼ
ŠŒ’Ž—ô’ȱŒžȱŠŒŽ•ȱ ŠŒ’Ž—ô’ȱ©›©ȱ
˜–™Š›Šô’Šȱ’—Ž›Ȭ›ž™ž›’
’Š—˜œ’Œ ŠŒŽ•ȱ’Š—˜œ’Œ
›ǯȱŒŽ•˜›
ž‹œŒŠ•Šȱ ȱŒžȱ – Ƴ – Ƴ  ™
’Š—˜œ’Œ
ž•‹ž›Š›ŽȱŽ™›Žœ’Ÿ©ȱ–Š“˜›© ŗřŘ ŗŗǰŞŖ řǰŖŜ ŜǰŜ ŚǰŘŝ ŗŘǰřŗ ŖǰŖŖŖ
ž•‹ž›Š›ŽȱŽȱœ›Žœȱ
řŗ ŗŘǰŘŖ ŚǰŘş řǰş ŚǰŚŚ şǯǰşś ŖǰŖŖŖ
™˜œĴ›Šž–Š’Œ
ž•’–’ŽȦ•’–Ž—Šô’Žȱ
ŗř ŞǰŗŖ Řśř ŗǰś ŘǰŘŜ ŗŖǰŘř ŖǰŖŖŖ
Œ˜–™ž•œ’Ÿ©
ž•‹ž›Š›Žȱ˜‹œŽœ’ŸȬ
řŘ śǰŗŖ ŘǰŖŘ ŗǰŝ ŗǰŝŜ ŗŘǰŘř ŖǰŖŖŖ
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˜‹’Žȱœ˜Œ’Š•© ŜŜ ŝǰśŖ Řǰŗŗ ŘǰŘ Řǰřś ŗŜǰŜŝ ŖǰŖŖŖ
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ŚŖ ŚǰŝŖ ŗǰŜś Ŗǰş ŗǰřŗ ŗŜǰŞŞ ŖǰŖŖŖ
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ŝś şǰŘŖ ŗǰŝŘ ŚǰŞ řǰŘş ŗŗǰŘŖ ŖǰŖŖŖ
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™˜‘˜—›’Ž ŘŚ ŚǰŚŖ ŗǰśř ŗǰř ŗǰŜŝ ŞǰŝŖ ŖǰŖŖŖ

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 ‹ǯȱ ŸŽ›’ęŒŠ›ŽŠȱ ŒŠ™ŠŒ’©ô’’ȱ œž‹œŒŠ•Ž•˜›ȱ Žȱ
Šȱ ’œŒ›’–’—Šȱ ɗ›Žȱ ŒŽ’ȱ Œžȱ ž—ȱ Š—ž–’ȱ
’Š—˜œ’Œȱó’ȱŒŽ’ȱ©›©ȱŠŒŽ•ȱ’Š—˜œ’ŒǯȱŒŽœȱ
•žŒ›žȱ Šȱ ˜œȱ Š—Š•’£Šȱ ™›’—ȱ Œ˜–™Š›Š›ŽŠȱ
œŒ˜›ž›’•˜›ȱ –Ž’’ȱ •Šȱ œž‹œŒŠ•Ž•Žȱ ŒŠ›Žȱ
ŽŸŠ•žŽŠ£©ȱ ž—ȱ ’Š—˜œ’Œȱ œ™ŽŒ’ęŒȱ ɗ›Žȱ
›Žœ™˜—Ž—ô’’ȱ Œžȱ ŠŒŽ•ȱ ’Š—˜œ’Œȱ Œ˜—˜›–ȱ
ȱȱó’ȱŒŽ’ȱ©›©ȱž—ȱŠœŽ•ȱŽȱ’Š—˜œ’Œǯȱ
Žȱ Ž¡Ž–™•žǰȱ œȬŠžȱ Œ˜–™Š›Šȱ ›Ž£ž•ŠŽ•Žȱ
˜‹ô’—žŽȱ •Šȱ œž‹œŒŠ•Šȱ ž•‹ž›Š›Žȱ Žȱ œ›Žœȱ
™˜œĴ›Šž–Š’Œȱɗ›Žȱ›Žœ™˜—Ž—ô’’ȱŒžȱŠŒŽŠœ©ȱ
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ꎌŠ›Žȱ œž‹œŒŠ•©ȱ ǰȱ —ž–©›ž•ȱ Žȱ
™ŠŒ’Ž—ô’ȱ Œžȱ ž—ȱ ’Š—˜œ’Œȱ Œ˜›Žœ™˜—Ž—ȱ
ŽœŽȱ ›ŽŒžȱ ɗȱ Š‹Ž•ž•ȱ ŝǰȱ ɖ™›Žž—©ȱ Œžȱ
–Ž’Šȱ œŒ˜›ž›’•˜›ȱ •Šȱ œž‹œŒŠ•Šȱ ›Žœ™ŽŒ’Ÿ©ȱ
™Ž—›žȱꎌŠ›Žȱ›ž™ǯ
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™ŠŒ’Ž—ô’’ȱ Œžȱ ž—ȱ Š—ž–’ȱ ’Š—˜œ’Œȱ Šžȱ ˜‹ô’—žȱ
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Žȱ ™˜ŠŽȱ Œ˜—Œ•ž£’˜—Šȱ ŠóŠŠ›ȱ Œ©ȱ œž‹œŒŠ•Ž•Žȱ
ȱ ›ŽžóŽœŒȱ œ©ȱ ’œŒ›’–’—Ž£Žȱ ˜Š›Žȱ ‹’—Žȱ Š¦ȱ
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ŒŽ’ȱ©›©ȱŠŒŽ•ȱ’Š—˜œ’Œǯȱ
Š•’’ŠŽŠȱ Žȱ Œ›’Ž›’žȱ •Šȱ —’ŸŽ•ȱ Žȱ ’Ž–ȱ
Šȱ ˜œȱ Š—Š•’£Š©ȱ ™›’—ȱ Œ˜–™Š›Š›ŽŠȱ ›ŽŒŸŽ—ôŽ’ȱ
›©œ™ž—œž›’•˜›ȱ Šę›–Š’ŸŽȱ •Šȱ ŠŒŽ•ȱ ’Ž–ȱ Š•Žȱ
›Žœ™˜—Ž—ô’•˜›ȱŒŠ›Žȱ™›Ž£’—©ȱó’ȱŠ•ŽȱŒŽ•˜›ȱŒŠ›Žȱ—žȱ
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Œ˜–™ž•œ’Ÿ©ȱŠ›ȱ›Ž‹ž’ȱœ©ȱęŽȱ–Š’ȱ›ŽŒŸŽ—ȱœ’–™˜–ž•ȱ
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ŠŒŽŠœ©ȱ ž•‹ž›Š›Žȱ ɗȱ Œ˜–™Š›Šô’Žȱ Œžȱ ŒŽ’ȱ ŒŠ›Žȱ —žȱ
™›Ž£’—©ȱ ž•‹ž›Š›Žȱ ˜‹œŽœ’ŸȬŒ˜–™ž•œ’Ÿ©ǯȱ Šȱ ˜ô’ȱ
’Ž–’’ȱ ȱ Šžȱ ›©œ™ž—œȱ Šę›–Š’Ÿȱ –Š’ȱ ›ŽŒŸŽ—ȱ
›Žœ™˜—Ž—ô’’ȱ’Š—˜œ’ŒŠô’ȱŒžȱž•‹ž›Š›ŽŠȱŽœŒ›’œ©ȱ
Žȱ œž‹œŒŠ•Šȱ ’—ȱ ŒŠ›Žȱ ŠŒŽȱ ™Š›Žȱ ŠŒŽ•ȱ ’Ž–ǰȱ ŽŒ¦ȱ
ŒŽ’ȱ ŒŠ›Žȱ —žȱ Šžȱ ™›’–’ȱ ŠŒŽœȱ ’Š—˜œ’Œǯȱ ’—›Žȱ
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Šę›–Š’Ÿȱ–Š’ȱ›ŽŒŸŽ—ȱ›Žœ™˜—Ž—ô’’ȱ’Š—˜œ’ŒŠô’ȱ
Œžȱ ž•‹ž›Š›ŽŠȱ •Šȱ ŒŠ›Žȱ œŽȱ ›ŽŽ›©ȱ ŠŒŽ•ȱ ’Ž–ǰȱ ŽŒ¦ȱ

Š‹Ž•ž•ȱŞ
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˜ȱŒ•’—’Œ ˜ȱ—˜—Œ•’—’Œ ˜–™Š›Šô’Šȱ’—Ž›Ȭ›ž™ž›’


ž‹œŒŠ•Šȱ – Ƴ – Ƴ  ™
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ž•‹ž›Š›ŽȱŽȱœ›Žœȱ™˜œĴ›Šž–Š’Œ řřŞ ŚǰŜŝ śǰŖř ŗǰśŞ ŘǰŜŝ ŗŖǰŞŜ ŖǰŖŖŖ
ž•’–’ŽȦ•’–Ž—Šô’ŽȱŒ˜–™ž•œ’Ÿ© řśŗ ŗǰŝś Řǰśş ŗǰŗŗ ŗǰşŗ ŚǰŘş ŖǰŖŖŖ
ž•‹ž›Š›Žȱ˜‹œŽœ’ŸȬŒ˜–™ž•œ’Ÿ© řśŖ Řǰŗş ŘǰŗŞ ŖǰŞş ŗǰŚř ŗŖǰśŗ ŖǰŖŖŖ
ž•‹ž›Š›ŽȱŽȱ™Š—’Œ© řśŖ řǰŘŗ ŘǰŞş ŖǰŜŝ ŗǰśŗ ŗśǰŞŗ ŖǰŖŖŖ
ž•‹ž›©›’ȱ™œ’‘˜’ŒŽ řśŖ ŗǰřŖ ŗǰśş ŖǰŚŝ ŖǰşŘ şǰřŜ ŖǰŖŖŖ
˜›Š˜‹’Ž řŚŞ ŗǰśś ŗǰŜř Ŗǰřř ŖǰŞŜ ŗřǰŚś ŖǰŖŖŖ
˜‹’Žȱœ˜Œ’Š•© řŚŜ řǰŗŞ Řǰşś ŗǰŘŖ ŘǰŖŞ ŗŗǰŝŚ ŖǰŖŖŖ
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‹ž£ȦŽ™Ž—Ž—ô©ȱŽȱ ŖǰŖŖŖ
řśŗ ŗǰŚś ŗǰŞŝ ŖǰŘś ŖǰŞř ŗŗǰŝŚ
–Ž’ŒŠ–Ž—Ž
ž•‹ž›Š›ŽȱŽȱŠ—¡’ŽŠŽȱ ŖǰŖŖŖ
řŚş śǰŞŝ řǰśś ŘǰśŞ řǰŖř ŗśǰŝŝ
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ž•‹ž›Š›ŽȱŽȱœ˜–Š’£Š›Ž řŚŝ ŗǰşř ŗǰśŝ ŖǰŜŜ ŗǰŖŜ ŗŚǰŘŖ ŖǰŖŖŖ
™˜‘˜—›’Ž řŚş ŗǰśŘ ŗǰŞř Ŗǰřř ŖǰŞş ŗŗǰŝŗ ŖǰŖŖŖ

ŽŽ—©DZȱ–ȱƽȱ–Ž’ŠǰȱʍȱƽȱŠ‹ŠŽ›ŽŠȱœŠ—Š›Dzȱ™ȱƽȱ™›Šž•ȱŽȱœŽ–—’ęŒŠô’Žǯ
˜©ǯȱŠ˜›’©ȱŠŽ•˜›ȱ•’™œ©ǰȱ–©›’–ŽŠȱŽóŠ—’˜Š—Ž•˜›ȱŒ•’—’ŒŽȱ˜•˜œ’Žȱ™Ž—›žȱŽŽŒžŠ›ŽŠȱŒ˜–™Š›Šô’’•˜›ȱŠȱ̞ŒžŠȱɗȱž—Œô’ŽȱŽȱ
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 Š‹Ž•ž•ȱş
›˜ŒŽ—Š“Ž•Žȱ’Ž–’•˜›ȱ‹’Šô’ȱŽȱ™ŠŒ’Ž—ô’’ȱŒžȱó’ȱ©›©ȱ’Š—˜œ’ŒŽȱŠœ˜Œ’ŠŽȱꎌ©›ž’ȱ’Ž–

›ǯȱ ƖȱŒŽ•˜›ȱŒŠ›Žȱ ƖȱŒŽ•˜›ȱŒŠ›ŽȱŠžȱ ›ǯȱ ƖȱŒŽ•˜›ȱŒŠ›Žȱ ƖȱŒŽ•˜›ȱŒŠ›ŽȱŠžȱ ›ǯȱ ƖȱŒŽ•˜›ȱŒŠ›Žȱ ƖȱŒŽ•˜›ȱŒŠ›ŽȱŠžȱ

’Ž– Šžȱ‹’Šȱ ‹’Šȱ’Ž–ž•ǰȱ ’Ž– Šžȱ‹’Šȱ ‹’Šȱ’Ž–ž•ǰȱ ’Ž– Šžȱ‹’Šȱ ‹’Šȱ’Ž–ž•ǰȱ
’Ž–ž•ȱó’ȱŠžȱ Š›ȱ—žȱŠžȱ ’Ž–ž•ȱó’ȱŠžȱ Š›ȱ—žȱŠžȱ ’Ž–ž•ȱó’ȱŠžȱ Š›ȱ—žȱŠžȱ
’Š—˜œ’Œ ’Š—˜œ’Œ ’Š—˜œ’Œ ’Š—˜œ’Œ ’Š—˜œ’Œ ’Š—˜œ’Œ
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ŗǯ şŝ ŝř Śŝǯ şŚ řŖ ŞŖǯ ŜŚ ŗŖ
Řǯȱ ŞŚ Śś ŚŞǯ ŞŚ ŘŜ Şŗǯ ŝş ŗş
řǯȱ ŞŘ śŝ Śşǯ şŝ ŘŜ ŞŘǯ ŝś ŗŜ
Śǯ ŝŜ řŞ śŖǯ şŚ řŞ Şřǯ ŝŚ ŗŚ
śǯ ŜŞ řş śŗǯ ŞŚ ŘŜ ŞŚǯ ŝř Ş
Ŝǯ ŗŝ ŘŘ śŘǯ şŗ ŗŝ Şśǯ śş ŗŘ
ŝǯ ŝř řş śřǯ Şŗ ŗř ‹ž£ȦŽ™Ž—Ž—ô©ȱŽȱ–Ž’ŒŠ–Ž—Ž
Şǯ Řř Řř ž•‹ž›Š›ŽȱŽȱ™Š—’Œ© ŞŜǯ şŖ Řŝ
şǯ ŞŘ śŖ śŚǯ Şŗ řŖ Şŝǯ Şř ŗŝ
ŗŖǯ Şŝ śŚ śśǯ Şś ŘŘ ŞŞǯ ŝś Ş
ŗŗǯ śŖ Řś śŜǯ Şş řŗ Şşǯ ŞŖ Řŝ
ŗŘǯ śś Řŝ śŝǯ ŞŖ ŘŘ şŖǯ ŝŞ ŗŚ
ŗřǯ Śş ŗř śŞǯ Şś ŗş şŗǯ ŜŞ ŝ
ŗŚǯ Ŝŝ řŞ śşǯ Şś ŗş ž•‹ž›Š›ŽȱŽȱŠ—¡’ŽŠŽȱŽ—Ž›Š•’£Š©
ŗśǯ Ŝř Řř ŜŖǯ ŝś ŗş şŘǯ şŗ śś
ŗŜǯ ŚŜ ŗś Ŝŗǯ ŜŚ ŗŘ şřǯ şś śŞ
ŗŝǯ ŚŚ ŗś ž•‹ž›©›’ȱ™œ’‘˜’ŒŽ şŚǯ şř ŚŚ
ŗŞǯ řş ŗŚ ŜŘǯ řş ŗŚ şśǯ şŘ Śś
ŗşǯ řř ŗŗ Ŝřǯ řř ŗŗ şŜǯ şŘ śŗ
ŘŖǯ Řř ŝ ŜŚǯ Řř ŝ şŝǯ şś śŝ
Řŗǯ Řř Ş Ŝśǯ Řř Ş şŞǯ şŘ Śř
›Žœȱ™˜œĴ›Šž–Š’Œ ŜŜǯ Şŝ řŝ şşǯ şŗ Śş
ŘŘǯ Şŝ řŝ Ŝŝǯ ŝŚ řŖ ŗŖŖǯ şŘ Śř
Řřǯ ŝŚ řŖ ˜›Š˜‹’Ž ŗŖŗǯ şŘ řş
ŘŚǯ ŞŚ Řś ŜŞǯ şŝ řŗ ž•‹ž›Š›ŽȱŽȱœ˜–Š’£Š›Ž
Řśǯ Şŝ ŘŞ Ŝşǯ ŗŖŘǯ Şŗ Śś
ŘŜǯ ŞŚ Řŝ Š Ŝŗ ŗŘ ŗŖřǯ ŝś śř
Řŝǯ ŞŚ Řŝ ‹ǯ Ŝř ŗś ŗŖŚǯ ŝś ŘŞ
ŘŞǯ Şŗ řŘ Œǯ ŗř Ŗ ŗŖśǯ ŜŖ Řś
Řşǯ Şŗ řŗ ǯ řŞ ř ŗŖŜǯ śŜ ŘŜ
řŖǯ Şŗ ŘŘ Žǯ Śś ŗś ™˜‘˜—›’Ž
řŗǯ Şŝ Řś ǯ řś Ř ŗŖŝǯ ŞŞ řş
řŘǯ Şŝ ŗŞ ǯ śś ŗŞ ŗŖŞǯ Şř ŘŜ
řřǯ ŝŚ ŘŘ ‘ǯ ŘŘ Ş ŗŖşǯ şŘ ŘŚ
řŚǯ ŝŚ ŗŝ ŝŖǯ şŞ Řś ŗŗŖǯ ŞŞ ŗş
řśǯ ŝŝ ŘŜ ŝŗǯ şř řŖ ŗŗŗǯ ŞŞ Řř
řŜǯ ŝŝ ŘŚ ˜‹’Žȱœ˜Œ’Š•©
ž•’–’Ž ŝŘǯ ŞŞ řŞ
řŝǯ Şś ŘŜ ŝřǯ şŗ řŝ
řŞǯ ŝŝ ŗŞ ŝŚǯ şŜ řś
řşǯ ŝŝ ŘŘ ŝśǯ ŞŞ Řř
ŚŖǯ Şś ŗŞ ŝŜǯ ŞŞ řŖ
Śŗǯ şŘ ŝ ŝŝǯ
ŚŘǯ ŝŝ ŗŗ Šǯ ŝŖ Řŗ
Śřǯ şŘ ŗś ‹ǯ řř ŗŖ
ŚŚǯ Şś ŗŖ Œǯ ŘŜ ŗŖ
Śśǯ śŚ ŝ ǯ Řś Ş
ŚŜǯ Şś ŗŝ Žǯ Ŝř ŘŘ
ǯ śŗ ŘŘ
ǯ řş ŗŖ
‘ǯ Ŝŗ ŗŜ
ŝŞǯ Şś Řŗ
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Ž—œ’‹’•’ŠŽŠȱó’ȱœ™ŽŒ’ęŒ’ŠŽŠȱœž‹œŒŠ•Ž•˜›ȱȱ
•Šȱ’Ž›’ŽȱŸŠ•˜›’ȱŠ•Žȱ™ž—ŒŽ•˜›ȱŽȱœŽŒô’ž—Ž

Ž—œ’‹’•’ŠŽȱŠȦ™ŽŒ’ęŒ’ŠŽȱ‹ȱǻƖǼ
ž—ŒȱŽȱ ˜›ŠȬ ˜‹’Šȱ ‹ž£ȱ ‹ž£ȱ
  ž•’–’Ž  Š—’Œ©  ˜–Š’£Š›Ž ™˜‘˜—›ǯ œ’‘˜’ŒŽ
œŽŒô’ž—Ž ˜‹’Š œ˜Œ’Š•© Š•Œ˜˜• –Ž’Œǯ
ŗ ŗŖŖȦŜ şŝȦřś ŗŖŖȦŚş şŝȦřŘ ŗŖŖȦřŚ ŗŖŖȦřş şŞȦřŞ şŖȦŝŘ şŝȦśŞ şşȦŗŝ şŝȦŘś şŘȦśŖ ŞŖȦśŗ
Ř ŗŖŖȦŞ şřȦŚś şŘȦŜŞ şŗȦśř şŜȦŚŜ ŗŖŖȦśś şŞȦŚŞ ŞŚȦŞŖ şŘȦŝř şşȦŘř ŞŝȦŚŝ şŘȦŜŜ ŜŘȦŝŚ
ř ŗŖŖȦŗř şŖȦśŜ şŘȦŞŖ ŞŝȦŝŗ şřȦŜŖ ŗŖŖȦŜř şŝȦśŞ ŝŞȦŞŞ şŖȦŞŜ şŝȦŘş ŝŘȦŝŝ ŞŞȦŝŜ ŚŜȦşŗ
Ś ŗŖŖȦŘŗ şŖȦŜŖ şŘȦŞŚ ŞŗȦŞř şŖȦŝŘ şśȦŞś şśȦŝŜ ŝŖȦşŘ ŞŖȦşŜ şŝȦřŞ śŜȦşŗ ŞřȦŞś řřȦşŞ
ś ŗŖŖȦřŜ şŖȦŜŜ şŘȦŞŞ ŜşȦşŗ ŞŞȦŞř ŝŘȦşŗ şŗȦŞř ŜŘȦşŚ ŜŘȦşŞ şŝȦŚŚ ŚŗȦşŜ ŞřȦşŗ ŘŗȦŗŖŖ
Ŝ şşȦŚŝ ŞŝȦŜŞ ŞśȦşŘ śŖȦşŝ ŝŚȦŞŞ ŚřȦşř ŞŜȦŞŞ ŚŗȦşŝ śŖȦşş şśȦśŘ ŝȦŗŖŖ
ŝ şŝȦśş ŞŝȦŝŗ ŞśȦşś řŚȦşŞ ŜŚȦşŘ ŘŗȦşś ŝŜȦşŘ şśȦŜŘ
Ş şŚȦŜŞ ŞŗȦŝŚ ŞśȦşŝ řŜȦşř ŗŗȦşŞ śŞȦşŜ şřȦŝś
ş ŞşȦŝś ŝŝȦŞŗ śŚȦşŞ śȦşş ŘŜȦŗŖŖ ŞŚȦŞŚ
ŗŖ ŝŜȦŞŘ ŝŚȦŞś řŗȦşŞ ŖȦŗŖŖ ŗśȦŗŖŖ ŜŞȦşř
ŗŗ ŜŚȦŞŚ ŜŞȦŞŞ ŖȦŗŖŖ ŜȦŗŖŖ
ŗŘ ŚşȦŞŜ śŞȦşŘ ŖȦŗŖŖ
ŗř řŝȦŞŝ śŘȦşś ŖȦŗŖŖ
ŗŚ ŘŜȦşŗ ŚśȦşŝ ŖȦŗŖŖ
ŗś ŘŖȦşŘ ŘŜȦşŞ ŖȦŗŖŖ
ŗŜ ŗřȦşŚ
ŗŝ şȦşŜ
ŗŞ ŚȦşş
ŗş řȦşş
ŘŖ ŗȦŗŖŖ
Řŗ ŖȦŗŖŖ

ȱŠȱǮŽŸ©›Šô’’ȱ™˜£’’Ÿ’ȄȱœŠžȱ™›˜ŒŽ—ž•ȱ’—ȱŒŠ£ž›’•Žȱ›ŽŠ•ŽȱŒŠ›ŽȱŠžȱ˜œȱŒ˜›ŽŒȱ’Ž—’ęŒŠŽǯȱ
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ǮŽŸ©›Šô’’ȱ—ŽŠ’Ÿ’ȄȱœŠžȱ™›˜ŒŽ—ž•ȱ’—ȱŒŠ£ž›’•ŽȱŒŠ›Žȱ—žȱ™›Ž£’—©ȱž•‹ž›Š›ŽŠȱ›Žœ™ŽŒ’Ÿ©ǰȱŒŠ›ŽȱŠžȱ˜œȱŒ˜›ŽŒȱ’Ž—’ęŒŠŽȱŒŠȱ—ŽŠŸ¦—ȱŠŒŽ•ȱ’Š—˜œ’Œǯ

ŽŽ—©DZȱȱȮȱž•‹ž›Š›ŽȱŽ™›Žœ’Ÿ©ȱ–Š“˜›©DzȱȱȮȱž•‹ž›Š›ŽȱŽȱœ›Žœȱ™˜œĴ›Šž–Š’ŒDzȱȱȮȱž•‹ž›Š›Žȱ˜‹œŽœ’ŸȬŒ˜–™ž•œ’Ÿ©Dzȱ ȱȮȱž•‹ž›Š›ŽȱŽȱŠ—¡’ŽŠŽȱŽ—Ž›Š•’£Š©ǯ
 Š‹Ž•ž•ȱŗŗ
Š•˜›’•Žȱ™›Ž’Œ’ŸŽȱ™˜£’’ŸŽȱó’ȱ—ŽŠ’ŸŽȱŠ•Žȱœž‹œŒŠ•Ž•˜›ȱȱ
•Šȱ’Ž›’ŽȱŸŠ•˜›’ȱŠ•Žȱ™ž—ŒŽ•˜›ȱŽȱœŽŒô’ž—Ž

Š•˜Š›Žȱ™›Ž’Œ’Ÿ©ȱ™˜£’’Ÿ©ŠȦ—ŽŠ’Ÿ©‹ȱǻƖǼ
ž—ŒȱŽȱ ˜›ŠȬ ˜‹’Šȱ ‹ž£ȱ ‹ž£ȱ
  ž•’–’Ž  Š—’Œ©  ˜–Š’£Š›Ž ™˜‘˜—›ǯ œ’‘˜’ŒŽ
œŽŒô’ž—Ž ˜‹’Š œ˜Œ’Š•© Š•Œ˜˜• –Ž’Œǯ
ŗ řşȦŗŖŖ ŗřȦşş ŝȦŗŖŖ ŗřȦşş řřȦŗŖŖ ŘŜȦŗŖŖ ŘŝȦşş ŚşȦşŜ ŘřȦşş řŖȦşŞ ŗŘȦşŞ ŗŘȦşş ŘśȦşŘ
Ř ŚŖȦŗŖŖ ŗśȦşŞ ŗŖȦŗŖŖ ŗŜȦşŞŖ řŝȦşŞ řŘȦŗŖŖ řŗȦşş śŜȦşŚ řŗȦşş řŘȦşŞ ŗŚȦşŝ ŗŝȦşş řřȦşŖ
ř ŚŗȦŗŖŖ ŗŝȦşŞ ŗśȦŗŖŖ ŘřȦşŞ ŚŜȦşŝ řŝȦŗŖŖ řśȦşŞ ŜŜȦşř ŚŜȦşŞ řŚȦşŝ ŘŚȦşŜ ŘŗȦşş śŗȦŞŞ
Ś ŚŚȦŗŖŖ ŗşȦşŞ ŗŞȦŗŖŖ řřȦşŝ śŞȦşŝ śŜȦşŞ ŚŞȦşŞ ŝŚȦşŗ ŝŗȦşŝ řŝȦşŞ řşȦşś ŘşȦşş ŝŜȦŞŝ
ś ŚşȦŗŖŖ ŘŗȦşŞ ŘřȦŗŖŖ ŚřȦşŜ ŝŞȦşŝ ŜřȦşř śśȦşŝ ŝŝȦŞş ŞŗȦşś ŚŖȦşŞ ŚŞȦşŚ ŚŘȦşş şŘȦŞś
Ŝ śřȦşş ŘŘȦşŞ řŖȦşş ŜŘȦşś şŘȦşř śŝȦŞŞ ŜřȦşŜ ŞŖȦŞŚ ŞřȦşŚ ŚŚȦşŞ ŝśȦŞř
ŝ śşȦşŝ ŘřȦşŞ ŚŘȦşş ŜśȦşř şŚȦşŖ śŖȦŞś ŜşȦşŚ śŗȦşŞ
Ş ŜŚȦşś ŘŚȦşŝ śŘȦşş şŜȦŞŚ śŚȦŞř ŝşȦşŖ ŜřȦşŞ
ş ŜŞȦşŘ ŘşȦşŝ ŚŝȦşŞ ŜŖȦŞř ŗŖŖȦŞś ŝŚȦşś
ŗŖ ŝřȦŞŜ řřȦşŝ řřȦşŝ ȬȦŞŘ ŗŖŖȦŞř şŜȦşŗ
ŗŗ ŝŗȦŝş řŜȦşŜ ȬȦŞŘ ŗŖŖȦŞŗ
ŗŘ ŜŞȦŝŚ ŚŘȦşś ȬȱȦŞŗ
ŗř ŜŚȦŜş śŖȦşś ȬȦŞŗ
ŗŚ ŜśȦŜŝ ŜŚȦşś ȬȦŞŗ
ŗś ŜŖȦŜś śřȦşř ȬȦŞŗ
ŗŜ śşȦŜŚ
ŗŝ ŜŖȦŜř
ŗŞ ŜřȦŜř
ŗş ŜŝȦŜř
ŘŖ ŗŖŖȦŜŘ
Řŗ ȬȦŜŘ

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›˜ŒŽ—ž•ȱ™Ž›œ˜Š—Ž•˜›ȱŒŠ›ŽȱɗŽ™•’—ŽœŒȱŒ›’Ž›’’•Žȱ™Ž—›žȱž—ȱŠ—ž–’ȱ’Š—˜œ’Œȱ’—›Žȱ˜ŠŽȱŒŠ£ž›’•Žȱ’Ž—’ęŒŠŽȱŽȱœž‹œŒŠ•©ǯȱ
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Ž—›žȱœŒ˜›ž›’•ŽȱŗŖȱó’ȱŗŗȱŠ•Žȱœž‹œŒŠ•Ž’ȱ˜›Š˜‹’ŽǰȱŸŠ•˜Š›ŽŠȱ™›Ž’Œ’Ÿ©ȱ™˜£’’Ÿ©ȱ—žȱŠȱ™žžȱęȱŒŠ•Œž•Š©ǰȱŽ˜Š›ŽŒŽȱ—’Œ’ž—ȱ™ŠŒ’Ž—ȱ—žȱŠȱ˜‹ô’—žȱŠŒŽœŽȱœŒ˜›ž›’ǯ
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 ’ž›ŠȱŘǯȱž—Œô’’•Žȱȱ™Ž—›žȱœž‹œŒŠ•Ž•Žȱ
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˜ȱ–Ž’ŽȱŽȱŖǰŞŞȱó’ȱŸŠ›’’—ȱɗ›ŽȱŖǰŝśȱó’ȱŖǰşśȱǻ–ž•ȱ
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ŝǯȱ—Ž›™›ŽŠ›ŽŠȱœŒ˜›ž›’•˜›ȱ˜‹ô’—žŽȱ™›’—ȱ
Š™•’ŒŠ›ŽŠȱ
ŝǯŗǯȱŒ˜›ž•ȱ˜Š•ȱ•ŠȱœŒŠ•ŠȱȱȮȱ˜ȱŒ•’—’Œ
Œ˜›ž•ȱ ˜Š•ȱ •Šȱ œŒŠ•Šȱ ȱ œŽȱ ‹Š£ŽŠ£©ȱ
™Žȱ —ž–©›ž•ȱ ˜Š•ȱ Žȱ œ’–™˜–Žȱ ™œ’‘’Š›’ŒŽȱ
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C—ȱ ŒŠ£ž•ȱ ŠŒŽœŽ’ȱ œŒŠ•Žǰȱ ŠŒŽœȱ •žŒ›žȱ ɗœŽŠ–—Šȱ

Œ©ȱ ’—Ž›™›ŽŠ›ŽŠȱ œŒ˜›ž•ž’ȱ œŽȱ ›ŽŠ•’£ŽŠ£©ȱ ™›’—ȱ
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Š•ȱ’œž—Œô’˜—Š•’©ô’’ȱŠœ˜Œ’ŠŽȱ™ŽȱŒŠ›Žȱ™ŠŒ’Ž—ž•ȱ•Žȱ
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–Ž’Šȱ śŖȱ ó’ȱ Š‹ŠŽ›ŽŠȱ œŠ—Š›ȱ ŗŖǯȱ 󊍊›ǰȱ
œŒ˜›ž›’•Žȱ ˜Š•Žȱ Œž™›’—œŽȱ ɗ›Žȱ ŚŖȱ ó’ȱ ŜŖȱ œŽȱ ŠĚ©ȱ
ɗȱ ŒŠ›ž•ȱ ’—Ž›ŸŠ•ž•ž’ȱ –Ž’žǯȱ ŠŒ’Ž—ô’’ȱ ŒŠ›Žȱ
Šžȱ ˜‹ô’—žȱ œŒ˜›ž›’ȱ Œžȱ Œ˜Žȱ ȱ Œž™›’—œŽȱ ɗȱ ŠŒŽœȱ
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Œžȱ Š•Žȱ ™Ž›œ˜Š—Žȱ ŒŠ›Žȱ Šžȱ ˜œȱ ŽŸŠ•žŠŽȱ ɗȱ ŒŠ›ž•ȱ
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™ŠŒ’Ž—ô’ǯȱȱ
Œ˜›ž›’•Žȱ ˜Š•Žȱ Žȱ ŝŖȱ ó’ȱ ŒŽ•Žȱ ™ŽœŽȱ ŠŒŽŠœ©ȱ
ŸŠ•˜Š›Žȱœž—ȱŽ¡›Ž–ȱŽȱŒ›ŽœŒžŽǯȱC—ȱŠ‹œŽ—ôŠȱŠ•˜›ȱ
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Éó’ȱ Ž¡ŠŽ›Ž£Žȱ œ’–™˜–Ž•Žǯȱ ŒŽœȱ •žŒ›žȱ œŽȱ ™˜ŠŽȱ
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•ŽŠ•Žǰȱ ™Ž—›žȱ Šœ’ž›Š›ŽŠȱ ž—˜›ȱ œŽ›Ÿ’Œ’’ǰȱ ™Ž—›žȱ
˜‹ô’—Ž›ŽŠȱž—˜›ȱŒ˜–™Ž—œŠô’’ȱœŠžȱ™Ž—›žȱŠ•ȱ–˜’Ÿȱ
ŒŠ›Žȱ ™˜ŠŽȱ ›Ž’Žó’ȱ ’—ȱ ’œŒžô’’•Žȱ Œžȱ ™ŠŒ’Ž—ž•ȱ œŠžȱ
’—ȱŠ•Žȱœž›œŽȱŽȱ’—˜›–Š›Žȱ’œ™˜—’‹’•Žǯ
Œ˜›ž›’•Žȱ ˜Š•Žȱ •Šȱ ȱ œž‹ȱ ŚŖȱ ’—’Œ©ȱ
Š™ž•ȱ Œ©ȱ ™ŠŒ’Ž—ž•ȱ Šȱ ›Š™˜›Šȱ ž—ȱ —ž–©›ȱ ›Ž•Š’Ÿȱ
›Žžœȱ ’—›Žȱ œ’–™˜–Ž•Žȱ ™›Ž£Ž—ŠŽȱ ɗȱ –˜ȱ
’™’Œȱ Žȱ ŒŽ’ȱ ŒŠ›Žȱ ŠŒŒŽœŽŠ£©ȱ œŽ›Ÿ’Œ’’•Žȱ ™œ’‘’Š›’ŒŽȱ
Š–‹ž•Š˜›’’ǯȱŒŽœȱ •žŒ›žȱ œžŽ›ŽŠ£©ȱ Œ©ȱ ™ŠŒ’Ž—ž•ȱ
Š›ȱ ‹Ž—ŽęŒ’Šȱ –Š’ȱ Ž›Š‹©ȱ Žȱ ™Žȱ ž›–Šȱ ž—ž’ȱ ™•Š—ȱ
Žȱ ›ŠŠ–Ž—ȱ Žȱ œŒž›©ȱ ž›Š©ǰȱ ô’—’ȱ ó’ȱ ˜ŒŠ•’£Šȱ
™Žȱœ’–™˜–ǯȱœŽȱ˜Š›Žȱ—Ž˜‹’ó—ž’ȱŒŠȱ˜ȱ™Ž›œ˜Š—©ȱ
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œŽȱ ’–™˜›Š—ȱ œ©ȱ ô’—Ž–ȱ Œ˜—ȱ Žȱ Š™ž•ȱ Œ©ǰȱ
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œŒŠ•Ž’ȱ ȱ ›ŽĚŽŒ©ǰȱ Žȱ ˜‹’ŒŽ’ǰȱ ɗȱ –˜ȱ ŠŒž›Šȱ
—’ŸŽ•ž•ȱ™œ’‘˜™Š˜•˜’Ž’ȱœŠžȱŠ•ȱ’œž—Œô’˜—Š•’©ô’’ȱ
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ž—ȱ™ŠŒ’Ž—ȱɕȱ›Žœ’–Žǯȱ󊍊›ǰȱ—žȱ—Žȱ™žŽ–ȱ‹Š£Šȱ
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ŒŠȱ꒗ȱ˜Š›ŽȱŽ›Š—“Š—Žǰȱɗȱ’–™ȱŒŽǰȱ™Ž—›žȱŠ•ô’ȱ
™ŠŒ’Ž—ô’ǰȱ ŠŒŽœŽŠȱ ™˜ȱ ęȱ Šœ˜Œ’ŠŽȱ Œžȱ ž—ȱ ’œ›Žœȱ
™žŽ›—’ŒǯȱŽȱŽȱŠ•©ȱ™Š›ŽǰȱŒŽ’ȱŒŠ›Žȱ›Š™˜›ŽŠ£©ȱž—ȱ
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Œžȱ ˜ŠŽȱ ŠŒŽœŽŠǰȱ ž—ȱ —’ŸŽ•ȱ Œ›ŽœŒžȱ Š•ȱ ’œ›Žœž•ž’ȱ
˜Œ–Š’ȱ’—ȱŒŠž£ŠȱŠŒŽœ˜›ȱœ’–™˜–Žǯ
C—ȱ Š‹Ž•ž•ȱ ŗŘȱ œž—ȱ ™›Ž£Ž—ŠŽȱ Œ˜Ž•Žȱ ȱ
Œ˜›Žœ™ž—£©˜Š›Žȱ ’ŸŽ›œŽ•˜›ȱ Œ˜Žȱ ‹›žŽȱ ™˜œ’‹’•Žȱ
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ŝǯŘǯȱŒ˜›ž•ȱ˜Š•ȱ•ŠȱœŒŠ•ŠȱȱȮȱ˜ȱ—˜—ȬŒ•’—’Œ
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œŒ˜›ž•ȱ˜Š•ȱ•ŠȱœŒŠ•ŠȱȱœŽȱ‹Š£ŽŠ£©ȱ™Žȱ—ž–©›ž•ȱ
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ꎌŠ›Žȱ ›Žœ™˜—Ž—ǯȱ C—ȱ ŒŠ£ž•ȱ ™Ž›œ˜Š—Ž•˜›ȱ ’—ȱ
™˜™ž•Šô’Šȱ Ž—Ž›Š•©ǰȱ ’—Ž›™›ŽŠ›ŽŠȱ œŒ˜›ž•ž’ȱ ˜Š•ȱ
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œ’–™˜–Ž•˜›ȱ ŽœŒ›’œŽȱ Žȱ ›Žœ™˜—Ž—ȱ Œžȱ ŒŽ•Žȱ Š•Žȱ
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Œ˜›ž•ȱ˜Š•ȱ•ŠȱœŒŠ•ŠȱȱŽœŽȱŽ¡™›’–Šȱœž‹ȱ
˜›–Šȱ ž—Ž’ȱ Œ˜Žȱ œŠ—Š›ȱ ǯȱ ˜Ž•Žȱ ȱ Šžȱ –Ž’Šȱ
śŖȱ ó’ȱ Š‹ŠŽ›ŽŠȱ œŠ—Š›ȱ ŗŖǯȱ 󊍊›ǰȱ ™Ž—›žȱ Œ©ȱ
’œŒž©–ȱ Žœ™›Žȱ ˜ȱ ™˜™ž•Šô’Žȱ —˜›–Š•©ǰȱ œŒ˜›ž›’•Žȱ
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’—Ž›ŸŠ•ž•ž’ȱ –Ž’žǯȱ Ž›œ˜Š—Ž•Žȱ ŒŠ›Žȱ Šžȱ ˜‹ô’—žȱ
œŒ˜›ž›’ȱ Œžȱ Œ˜Žȱ ȱ Œž™›’—œŽȱ ɗȱ ŠŒŽœȱ ’—Ž›ŸŠ•ȱ Šžȱ
›Š™˜›Šȱ Ž¡™Ž›’Ž—ô’Ž›ŽŠȱ ž—ž’ȱ —ž–©›ȱ –Ž’žȱ
Žȱ œ’–™˜–Žȱ ™œ’‘’Š›’ŒŽȱ ɗȱ Œ˜–™Š›Šô’Žȱ Œžȱ Š•Žȱ
™Ž›œ˜Š—Žȱ’—ȱ™˜™ž•Šô’ŠȱŽ—Ž›Š•©ǯȱȱ
Œ˜›ž›’•Žȱ ˜Š•Žȱ Œž™›’—œŽȱ ɗ›Žȱ ŜŖȱ ó’ȱ ŝŖȱ
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œŽȱ™˜œ’‹’•ȱŒŠȱŠŒŽœŽȱ™Ž›œ˜Š—Žȱœ©ȱŠ’‹©ȱ™›˜‹•Ž–Žȱ
Žȱ œ©—©ŠŽȱ –Ž—Š•©ȱ ó’ȱ œž—ȱ ›ŽŒ˜–Š—ŠŽȱ
’—ŸŽœ’Šô’’ȱœž™•’–Ž—Š›Žǰȱ™Ž—›žȱŠȱœŽȱœŠ‹’•’ȱŠŒ©ȱ
ŽœŽȱ œŠžȱ —žȱ ŒŠ£ž•ȱ ž—Ž’ȱ ™›˜‹•Ž–Žȱ Žȱ œ©—©ŠŽȱ
–Ž—Š•©ȱ’Š—˜œ’ŒŠ‹’•ŽȱŒ•’—’Œǯȱȱ
Œ˜›ž›’•Žȱ ˜Š•Žȱ Žȱ ŝŖȱ ó’ȱ ŒŽ•Žȱ ™ŽœŽȱ ŠŒŽŠœ©ȱ
ŸŠ•˜Š›Žȱ œž—ȱ œŒ˜›ž›’ȱ –Š›’ǯȱ C—ȱ ŠœŽ•ȱ Žȱ ŒŠ£ž›’ȱ
œŽȱ ›ŽŒ˜–Š—©ǰȱ ɗȱ –˜ȱ ŽŸ’Ž—ǰȱ ’—ŸŽœ’Šô’’ȱ
œž™•’–Ž—Š›ŽǰȱŽ˜Š›ŽŒŽȱ™›Ž£Ž—ôŠȱž—˜›ȱ™›˜‹•Ž–Žȱ
Žȱ œ©—©ŠŽȱ –Ž—Š•©ȱ ’Š—˜œ’ŒŠ‹’•Žȱ Œ•’—’Œȱ ŽœŽȱ
Žœž•ȱŽȱ™›˜‹Š‹’•©ǯ
C—ȱ Š‹Ž•ž•ȱ ŗřȱ œž—ȱ ™›Ž£Ž—ŠŽȱ Œ˜Ž•Žȱ ȱ
Œ˜›Žœ™ž—£©˜Š›Žȱ ’ŸŽ›œŽ•˜›ȱ Œ˜Žȱ ‹›žŽȱ ™˜œ’‹’•Žȱ
˜‹ô’—žŽȱɗȱž›–ŠȱŠ™•’Œ©›’’ȱǯȱŒŽœŽŠȱŠ™Š›ȱɗȱ
–˜ȱœŽ™Š›Šǰȱ™Ž—›žȱ‹©›‹Šô’ȱó’ȱŽ–Ž’ǰȱŽ˜Š›ŽŒŽȱŠžȱ

 Š‹Ž•ž•ȱŗŘ Š‹Ž•ž•ȱŗř
›Š—œ˜›–Š›ŽŠȱŒ˜Ž•˜›ȱ‹›žŽȱɗȱŒ˜Žȱȱ™Ž—›žȱ ›Š—œ˜›–Š›ŽŠȱŒ˜Ž•˜›ȱ‹›žŽȱɗȱŒ˜Žȱȱ™Ž—›žȱ
ŽóŠ—’˜—ž•ȱŒ•’—’Œ ‹©›‹Šô’ȱó’ȱŽ–Ž’ǰȱ•˜ž•ȱ—˜—ȬŒ•’—’Œ

Œ˜›ȱ‹›ž ˜Šȱ ©›‹Šô’ Ž–Ž’ȱ

ǁşŗ ǁȱŝś Œ˜›ȱ‹›ž ˜Šȱ Œ˜›ȱ‹›ž ˜Šȱ
şŖȬşŗ ŝś ǁŜŚ ǁŞŜ ǁŝŞ ǁşŜ
ŝşȬŞŖ ŝŖ ŜŚ ŞŜ ŝŞ şŜ
ŝŞ Ŝş śŞ ŞŘ ŝŝ şś
ŝśȬŝŜ ŜŞ śŝ Şŗ ŝś şŚ
ŝřȬŝŚ Ŝŝ śŗ ŝŜ Ŝş şŖ
ŝŗȬŝŘ ŜŜ Śş ŝś Ŝś Şŝ
ŜşȬŝŖ Ŝś ŚŜ ŝř ŜŘȬŜř Şś
ŜŝȬŜŞ ŜŚ Śś ŝŘ Ŝŗ ŞŚ
ŜśȬŜŜ Ŝř Śř ŝŗ śŞȬśş ŞŘ
ŜřȬŜŚ ŜŘ řş ŜŞ śŝ Şŗ
ŜŗȬŜŘ Ŝŗ řŝ Ŝŝ śśȬśŜ ŞŖ
śşȬŜŖ ŜŖ řŜ ŜŜ śŚ ŝş
śŝȬśŞ śş řŚ Ŝś śř ŝŞ
śŚȬśŜ śŞ řř ŜŚ śŗȬśŘ ŝŝ
śŘȬśř śŝ řŗȬřŘ Ŝř śŖ ŝŜ
śŖȬśŗ śŜ řŖ ŜŘ ŚŞȬŚş ŝś
ŚŞȬŚş śś Řş Ŝŗ Śŝ ŝŚ
ŚŜȬŚŝ śŚ ŘŝȬŘŞ ŜŖ ŚŜ ŝř
ŚŚȬŚś śř ŘŜ śş ŚŚȬŚś ŝŘ
ŚŘȬŚř śŘ ŘŚȬŘś śŞ Śř ŝŗ
ŚŖȬŚŗ śŗ Řř śŝ ŚŗȬŚŘ ŝŖ
řŞȬřş śŖ ŘŘ śŜ ŚŖ Ŝş
řŜȬřŝ Śş ŘŖȬŘŗ śś řŞȬřş ŜŞ
řŚȬřś ŚŞ ŗş śŚ řŝ Ŝŝ
řŘȬřř Śŝ ŗŝȬŗŞ śř řŜ ŜŜ
řŖȬřŗ ŚŜ ŗŜ śŘ řŚȬřś Ŝś
ŘŞȬŘş Śś ŗś śŗ řř ŜŚ
ŘśȬŘŝ ŚŚ ŗřȬŗŚ śŖ řŗȬřŘ Ŝř
ŘřȬŘŚ Śř ŗŘ Śş řŖ ŜŘ
ŘŗȬŘŘ ŚŘ ŗŖȬŗŗ ŚŞ Řş Ŝŗ
ŗşȬŘŖ Śŗ ş Śŝ ŘŝȬŘŞ ŜŖ
ŗŝȬŗŞ ŚŖ Ş ŚŜ ŘŜ śş
ŗśȬŗŜ řş ŜȬŝ Śś ŘŚȬŘś śŞ
ŗřȬŗŚ řŞ ś ŚŚ Řř śŝ
ŗŗȬŗŘ řŝ řȬŚ Śř ŘŘ śŜ
şȬŗŖ řŜ Ř ŚŘ ŘŖȬŘŗ śś
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ş Śŝ
Ş ŚŜ
ŜȬŝ Śś
ś ŚŚ
řȬŚ Śř
Ř ŚŘ
ŗ Śŗ
Ŗ ŚŖ


 Š‹Ž•ž•ȱŗŚ
Š•˜›’•Žȱ™ž—ŒŽ•˜›ȱŽȱœŽŒô’ž—Žȱ›ŽŒ˜–Š—ŠŽȱ™Ž—›žȱŠȱęȱž’•’£ŠŽȱɗȱ™›ŠŒ’ŒŠȱŒ•’—’Œ©ȱ
ó’ȱŒŠ›ŠŒŽ›’œ’Œ’•ŽȱŠœ˜Œ’ŠŽ

ž—Œž•ȱŽȱ Ž—œ’‹’•’ŠŽ ™ŽŒ’ęŒ’ŠŽ Š•˜Š›ŽŠȱ Š•˜Š›ŽŠȱ ›ŽŒŸŽ—ôŠȱŽœ’–Š©ȱ ›ŽŒŸŽ—ôŠȱŽœ’–Š©ȱŠȱ

œŽŒô’ž—Žȱ ǻƖǼ ǻƖǼ ™›Ž’Œ’Ÿ© ™›Ž’Œ’Ÿ©ȱ ŠȱŠ™Š›’ô’Ž’ȱ•Šȱ Š™Š›’ô’Ž’ȱɗȱ™˜™ž•Šô’Šȱ
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 SACS
Scala de abordare strategicã
a coping-ului

AUTORI
Ozana Budău
Monica Albu
Descrierea CIP a Bibliotecii Naįionale a României
BUDàU, OZANA
SACS : scala de abordare strategicâ a copingului / Ozana Budâu, Monica Albu.
- Cluj-Napoca : Editura ASCR, 2010
Bibliogr.
ISBN 978-606-8244-05-1

I. Albu, Monica

303

SACS – Scala de abordare strategicâ a coping-ului

Coperta|Carolina Banc
Paginaįie ĩi prepress|Diana Breaz
Lectura| Diana Breaz

Editor|Diana Breaz

Tipar | S.C. Cognitrom S.R.L., Cluj-Napoca

Pentru comenzi:
Tel.: 0264̂581499
www.cognitrom.ro
office@cognitrom.ro









Copyright © 2010 S.C. COGNITROM S.R.L.

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4
 CUPRINS

Capitolul 1 Introducere 7
Fundamentare teoreticâ 8
Conceptul de individualism în studiile despre coping 9
Modelul multiaxial al coping-ului 10
Capitolul 2 Descrierea SACS 12
Semnificaįia subscalelor SACS 12
Descrierea itemilor SACS 13
Administrarea SACS 15
Instrucįiuni pentru completarea SACS 15
Populaįiile pentru care poate fi folosit SACS 15
Cotare SACS 15
Utilizarea SACS în scop ĩtiinįific 15
Utilizarea SACS în prevenįie, dezvoltare personalâ, 16
evaluare psihologicâ
Capitolul 3 Adaptarea ĩi standardizarea Scalei de abordare strategicâ a 17
coping-ului (SACS) pe populaįia din România
Obiectiv 17
Participanįi 17
Procedura de adaptare a scalei SACS pe populaįia din 18
România
Procedurâ 20
Instrumente 20
Capitolul 4 Caracteristici psihometrice ale SACS 23
Fidelitatea scalei de abordare strategicâ a coping-ului SACS 23
Consistenįa internâ: ơ Cronbach 23
Coeficienįii test-retest 24
Validitatea scalelor SACS 25
Analiza corelaįiilor între subscalele SACS 26
Analiza factorialâ 27
Analiza factorialâ a itemilor din SACS, în eĩantionul non- 29
clinic
SACS ĩi COPE 29
SACS ĩi Chestionarul de coping cognitiv-emoįional(CERQ) 30
Validitatea de criteriu 31
Comparaįie între sexe, în cadrul eĩantioanelor 32
SACS ĩi alte dimensiuni ale psiho-patologiei (PDSQ) 33
(Chestionarul de screening ĩi diagnostic psihiatric)

5
 Capitolul 5 Etalonarea SACS 35
Interpretarea scorurilor la subscalele SACS 35
Date despre eĩantionul folosit la etalonare 35
Etalonarea 38
Utilizarea cotelor T 38
Utilizarea intervalelor de încredere ale scorurilor reale 39
Interpretarea celor nouâ subscale SACS 40
Concluzii 41
Bibliografie 43
Anexa 1 45
Anexa 2 46
Anexa 3 48


6
 Capitolul 1
Introducere
Scala strategicâ de abordare a coping-ului,
SACS, este un instrument care evalueazâ
dimensiunea comportamentalâ a coping-ului,
luând în considerare ĩi aspectele sociale ale
strategiilor prin care cineva face faįâ situaįiilor
stresante. Mai precis, SACS surprinde
strategiile de coping ale persoanelor acolo
unde acestea se manifestâ cu precâdere, în
context social.
SACS este construit de câtre Stevan E.
Hobfoll, Carla L. Dunahoo, Jeannine Monnier,
Michael R. Hulsizer ĩi Robert Johnson1 în 1993
(revizuit, apoi, în 1998), având la bazâ modelul
multiaxial al coping-ului (Monnier ĩi colab.,
1998), într-o încercare de a evalua coping-ul în
cadrul unui context mult mai echilibrat, care
permite înįelegerea atât a perspectivei
individualiste2, cât ĩi a celei comunitare.
Perspectiva individualistâ considerâ coping-ul
activ drept una dintre cele mai „sanogene”

1 Autorii Stevan E. Hobfoll, Carla L. Dunahoo, Jeannine
Monnier, Michael R. Hulsizer ĩi Robert Johnson
exploreazâ în articolele There’s more than rugged
individualism in coping. Part 1: Even the lone ranger had
tonto ĩi Part 2: Construct Validity and Further Model Testing,
publicate în „Anxiety, Stress, and Coping”, Vol 11, pp.
137-165, pp.247-272 (1998 OPA) rolul comportamentelor
de coping ca râspuns al oamenilor în situaįii stresante,
luând în considerare aspectele sociale ale coping-ului ĩi
prezentând versiunea finalâ a chestionarului de evaluare
SACS.
2 Perspectiva individualistâ presupune abordarea directâ
a problemei ĩi atingerea scopurilor personale.
strategii de a face faįâ situaįiilor stresante, în
timp ce ignorâ coping-ul social sau îl descrie
drept o modalitate pasivâ sau ineficientâ de a
rezolva o situaįie problematicâ (Endler ĩi
Parker, 1990). Perspectiva comunitarâ ia în
considerare aspectele prosociale ĩi antisociale
ale coping-ului ĩi descrie strategii de coping
care sunt influenįate ĩi/sau influenįeazâ
contextul social (de exemplu, o persoanâ poate
sâ amâne sau sâ nu se angajeze într-o acįiune
directâ de rezolvare a problemei, dacâ acea
acįiune este perceputâ ca fiind cauzatoare de
distres pentru o altâ persoanâ).
Strategiile de coping activ-pasive se
referâ la faptul câ o persoanâ poate fie sâ se
confrunte direct sau activ cu cauzele situaįiei
stresante, fie sâ evite, sâ evadeze sau sâ se
retragâ din faįa situaįiei stresante.
Scala SACS evalueazâ strategii de coping
comportamental pe urmâtoarele dimensiuni:
activ-pasivâ, prosocial-antisocialâ, direct-indi-
rectâ. În prezent, SACS include nouâ subscale:
Acįiune asertivâ, Relaįionare socialâ, Câutarea
suportului social, Acįiune prudentâ, Acįiune
instinctivâ, Evitare, Acįiune indirectâ, Acįiune
antisocialâ, Acįiune agresivâ. Ea se compune din
52 de itemi evaluaįi pe o scalâ Likert în 5
puncte, unde 1 înseamnâ Nu este deloc ceea ce aĩ
face, iar 5 înseamnâ Categoric, e ceea ce aĩ face.
SACS poate sâ fie administrat în
populaįia normalâ ĩi clinicâ, în cazul adulįilor,
7
cu vârste peste 18 ani, poate sâ fie utilizat
pentru a mâsura comportamentele de coping,
în general, ale unei persoane, dar ĩi strategiile
specifice de coping, raportate la un eveniment
specific.
Fundamentare teoreticâ
Coping-ul joacâ un rol important în
influenįarea stârii de bine psihologice ĩi fizice
a oamenilor, atunci când aceĩtia se confruntâ
cu evenimente de viaįâ negative sau stresante
(Aspinwall ĩi Taylor, 1997).
Coping-ul3 a fost conceptualizat, în
general, drept adresarea unei acįiuni direct spre
problemâ sau drept acįiuni ĩi cogniįii care
influenįeazâ sensul situaįiei problematice ĩi
reacįiile emoįionale ale oamenilor la stres
(Endler ĩi Parker, 1990; Lazarus ĩi Folkman,
1984).
În literatura de specialitate, se face
distincįie între douâ funcįii principale ale
coping-ului:
x coping centrat pe problemâ4, care cuprinde
toate strategiile de coping care se
adreseazâ direct problemei;
x coping centrat pe emoįie, care include
strategiile de coping care au ca įintâ
reglarea emoįiilor asociate problemei
(Compas, 1988);

3 O definiįie general acceptatâ a coping-ului este aceea
oferitâ de Lazarus, care considerâ coping-ul drept
„eforturile unei persoane de a face faįâ cerinįelor
(condiįii de vâtâmare, ameninįare sau diferite provocâri)
care sunt evaluate (sau percepute) ca depâĩind sau
suprasolicitând propriile resurse” (Lazarus, Folkman,
1984, p.225).
4 În general, strategiile de coping centrate pe problemâ
sunt considerate a fi mai folositoare decât strategiile de
coping centrate pe emoįie (Thoits, 1991).

8
precum ĩi între douâ dimensiuni, care
transcend clasificarea prezentatâ mai sus,
ĩi anume:
x coping cognitiv (gândurile în legâ-
turâ cu problema sau cu propria
persoanâ);
x coping comportamental (compor-
tamentele în legâturâ cu problema
sau cu propria persoanâ).
Majoritatea scalelor de coping existente la
ora actualâ sunt alcâtuite dintr-un amestec de
strategii de coping cognitiv ĩi comportamental.
În ultimii 20 de ani, a apârut, însâ, un
interes crescut cu privire la componentele
sociale ale coping-ului. Mai mult, Coyne ĩi
Smith (1991) au sugerat câ interacįiunea
socialâ stâ la baza coping-ului ĩi câ reprezintâ
o axâ principalâ în funcįie de care strategiile de
coping pot fi articulate. Eckenrode (1991) a
propus ideea câ modul în care oamenii
reacįioneazâ la stres poate fi influenįat de
mediul lor social, care poate sâ faciliteze sau sâ
împiedice un râspuns eficient.
Dimensiunea socialâ a coping-ului nu a
fost ignoratâ cu desâvârĩire. Existâ o serie de
instrumente care includ subscale care mâsoarâ
variabile precum Câutarea suportului social
(Amirkhan, 1990; Carver, Scheier ĩi Weintraub,
1989; Lazarus ĩi Folkman, 1984). Însâ aceasta a
fost asociatâ, mai probabil, cu strategiile
evitative ĩi emoįionale ale coping-ului, care, la
rândul lor, se asociazâ cu distres emoįional ĩi
cu psihopatologie crescutâ (Amirkhan, 1990;
Coyne ĩi Smith, 1991; Endler ĩi Parker,1990).
O discrepanįâ interesantâ apare, în
literatura de specialiate, între urmâtoarele
douâ variabile sociale: strategiile de coping
Suportul social perceput ĩi Câutarea suportului
social, în care prima este consideratâ a avea, în
general, efecte pozitive (Folkman, Moskowitz
2004). Sarason, Sarason ĩi Shearin (Monnier ĩi
colab, 1998) explicâ acest fenomen prin faptul
câ Suportul social perceput este considerat a fi
Astfel, persoanele care se percep ca fiind
sprijinite social au un distres emoįional mai
scâzut, iar cele care cautâ suportul social
recurg la aceastâ strategie din cauza unei
adaptâri ineficiente la problemâ.
Discrepanįa dintre eficienįa Suportului
social perceput ĩi ineficienįa Câutârii suportului
social a fost explicatâ ĩi de Riger (1993).
Autoarea afirmâ câ teoriile ĩi modelele
occidentale ale coping-ului au tendinįa de a
favoriza strategiile individualiste ale coping-
ului (precum Suportul social perceput,
conceptualizat drept variabilâ a Sinelui), în
timp ce Câutarea suportului social este
consideratâ a fi o strategie care nu are în
vedere adresarea directâ a problemei, ci doar o
ameliorare pasivâ a distresului emoįional
(Endler ĩi Parker, 1990).
Conceptul de individualism
în studiile despre coping
Individualismul „sever”5, afirmâ Riger
(1993) instigâ Omul împotriva Celorlalįi, într-
o luptâ pe viaįâ ĩi pe moarte, în care
capacitatea de a râmâne în control ĩi de a
acįiona în vederea atingerii scopurilor
personale sunt considerate extrem de
importante ĩi eficiente.
Monnier (1998) atrage atenįia, într-o serie
de articole din anii 90, câ, prin favorizarea
acestei perspective individualiste a „Câlâre-
įului singuratic împotriva Celorlaįi”, este

5 Stevan E. Hobfoll, Carla L. Dunahoo, Jeannine Monnier,
Michael R. Hulsizer, Robert Johnson (1998). There’s more
than rugged individualism in coping. Part 1: Even the lone
ranger had tonto, Anxiety, Stress, and Coping, Vol 11, pp.
137-165.
mai mult o dimensiune sau o caracteristicâ a
Sinelui, decât o dimensiune legatâ de context.
posibil sâ se fi omis influenįa diferenįelor de
gen ĩi etnice asupra coping-ului.
Studiile despre coping au promovat
imaginea omului autonom, independent,
încrezâtor în sine ĩi capabil de afirmare de sine
(Riger, 1993), care apeleazâ cel mai frecvent la
strategii de coping active, focalizate pe
problemâ. Faptul câ strategiile active, directe
ar putea avea efecte antisociale sau câ i-ar
afecta negativ pe ceilalįi a fost, în general,
ignorat (Lane ĩi Hobfoll, 1992).
Teorile actuale ale coping-ului, afirmâ
Monnier (1998), nu iau în considerare, în mod
adecvat, dimensiunea socialâ a coping-ului.
Astfel, strategia de a apela la ceilalįi
pentru ajutor este consideratâ coping
comportamental pasiv sau dependent (prin
care se evitâ confruntarea cu problema).
Endler ĩi Parker (1990) au clasificat itemi
precum: A vizita un prieten ĩi A petrece timpul cu
o persoanâ specialâ mai mult drept strategii de
coping pasiv-evitativ, în loc de strategii active
(acįiuni concrete care urmâresc înlâturarea
stresorului), legate de rezolvarea problemei
respective. Apoi, abordarea individualistâ
minimalizeazâ influenįa mediului social.
Aspecte sociale, precum: nevoia de a menįine
relaįii sociale, starea de bine a grupului,
sacrificarea binelui personal pentru binele
familiei sau al grupului nu sunt incluse în
conceptualizârile coping-ului.
Mai mult, perspectiva individualistâ a
influenįat în mod major evaluarea diferenįelor
de coping între femei ĩi bârbaįi.
În literatura de specialitate despre coping
se susįine câ alternativele majore la acįiune
sunt fie evitarea, fie încercarea de a reduce
emoįiile negative (Lazarus ĩi Folkman, 1984).
Acestea sunt considerate a fi râspunsuri la
stres „tipic feminine” ĩi cel mai puternic
9
relaįionate cu distres psihologic. Mai mult,
cercetâtorii au descoperit câ bârbaįii recurg
mai degrabâ la un coping activ, la acįiuni care
sâ modifice datele problemei, în timp ce
femeile recurg la un coping pasiv, prin evitare
sau prin modificarea propriului râspuns
emoįional la stres (Billings ĩi Moos, 1984;
Endler ĩi Parker, 1990; Stone ĩi Neale, 1984).
Hobfoll ĩi colab. (1998) argumenteazâ
împreunâ cu Riger (1993) câ, deoarece
modelele teoretice care stau la baza acestor
studii provin dintr-o perspectivâ indivi-
dualistâ, strategiile pe care femeile le-ar utiliza,
adesea, nu sunt evaluate în complexitatea lor.
Mai mult, Thoits (1991) adaugâ câ strategiile
de coping ale bârbaįilor ĩi ale femeilor ar fi
diferite datoritâ abordârii mult mai „sociale” a
problemelor de câtre femei.
Accentul individualist a limitat, de
asemenea, atenįia acordatâ diferenįelor etnice,
de clase sociale ĩi culturale. Triandis,
McCusker ĩi Hui (1990) au sugerat câ, în timp
ce individualismul este o caracteristicâ predo-
minantâ a contextului social în cultura vesticâ,
perspectiva comunitarâ, socialâ reprezintâ o
caracteristicâ specificâ culturilor non-vestice ĩi
este consecventâ cu modul de a privi lumea al
culturilor africane, americano-africane sau
latino-americane (Jackson ĩi Meadows, 1991).
Aceastâ viziune a lumii presupune câ succesul
va fi atins prin acįiunea grupului, preįuind
nevoilor grupului ĩi prin grija faįâ de ceilalįi.
Aĩadar, motivând câ teoriile actuale ale
coping-ului nu iau în considerare coping-ul
comportamental în contextul social, acolo
unde acesta se manifestâ, Hobfoll ĩi colab.
(1998) au creat, pentru a umple acest gol, Scala
de abordare strategicâ a coping-ului, SACS.
10
Modelul multiaxial al coping-ului
Hobfoll ĩi colab. (1998) au creat modelul
multiaxial al coping-ului, cu scopul de a
explica ĩi de a evalua coping-ul în cadrul unui
context mult mai echilibrat, care permite
înįelegerea atât a aspectelor individualiste, cât
ĩi a celor comunitare.
Într-o primâ fazâ, autorii au propus
modelul biaxial al coping-ului (Hobfoll ĩi
colab., 1998) care cuprindea dimensiunea
activ-pasivâ ĩi dimensiunea prosocial-
antisocialâ a coping-ului.
Perspectiva comunitarâ, în baza câreia a
fost construit modelul respectiv, sugereazâ câ
strategiile active ĩi prosociale ar reprezenta
abordarea cea mai eficientâ a situaįiilor
problematice, mai ales când mai multe
persoane sunt implicate. Deoarece situaįiile
stresante cele mai intense sunt de naturâ
interpersonalâ sau implicâ soluįii care
presupun interacįiunea cu ceilalįi, utilizarea
strategiilor activ-prosociale este, în mod
evident, importantâ (Coyne ĩi Smith, 1991).
În timpul procedurii de testare ĩi validare
a modelului, autorii au arâtat câ bârbaįii ĩi
femeile nu prezintâ diferenįe în ceea ce
priveĩte dimensiunea activ-pasivâ a coping-
ului. Totuĩi, atunci când femeile recurg la o
strategie activâ, acestea au o atitudine
prosocialâ, atât prin Câutarea suportului social,
cât ĩi prin Relaįionarea socialâ (de
exempluformând coaliįii pentru a aborda o
problemâ). Spre deosebire de femei, bârbaįii,
atunci când recurg la strategii active, se
comportâ, de multe ori, agresiv ĩi chiar
antisocial (de exemplu, „atacându-i” pe
ceilalįi, pentru a-ĩi atinge scopurile).
Aceste rezultate au fost interpretate ca
fiind o ilustrare a faptului câ bârbaįii tind sâ fie
mai individualiĩti decât femeile, câteodatâ pe
socoteala celorlalįi din comunitate.
 Pe de altâ parte, femeile tind sâ fie mai
puįin individualiste, sacrificându-ĩi, probabil,
unele dintre scopurile lor, în favoarea îngrijirii
celorlalįi (Hobfoll ĩi London, 1986; Kessler,
McLeod ĩi Wethington, 1985). Mai mult, studii
preliminare de testare a modelului (Hobfoll ĩi
colab. 1994) au arâtat câ un coping prosocial ĩi
activ se asociazâ mai frecvent cu o capacitate
de control mai mare ĩi cu un distres psihologic
mai scâzut, atunci când este utilizat, atât de
femei, cât ĩi de bâbrbaįi.
Un numâr de teoreticieni au asociat
coping-ul activ cu cel social. Coyne ĩi Gotlieb
(1996) au propus ideea câ o mare parte din
strategiile de coping sunt orientate spre
menįinerea stârii de bine a membrilor unui
grup ĩi spre menįinerea relaįiilor sociale.
Natura asociativâ beneficâ a copingului social
ĩi activ a fost ilustratâ de Holahan ĩi Moos
(Hobfoll ĩi colab., 1994), care au descoperit câ
persoanele care aveau un comportament de
coping activ, dar apelau ĩi la sprijin social,
dovedeau o rezistenįâ mai crescutâ la stres.
Pentru a dezvolta ĩi mai mult modelul
biaxial al coping-ului, autorii au adâugat o
nouâ dimensiune, aceea a abordârii indirecte a
problemelor. Perspectiva comunitarâ sugerea-
zâ câ, chiar ĩi în cazul unor strategii active,
comportamentul poate fi direct sau indirect.
De exemplu, în societatea japonezâ, este
neadecvat, din punct de vedere social, sâ îįi
faci de râs rivalul în afaceri. Aĩadar, a
manipula mediul de afaceri în mod indirect,
astfel ca afacerea ta sâ fie în avantaj, fârâ ca
firma rivalâ sâ îĩi piardâ reputaįia, este o
obiĩnuinįâ (Weisz, Rothbaum ĩi Blackburn,
1984). Aceste „manipulâri” presupun eforturi
mari ĩi un comportament orientat spre scop,
dar acestea au loc în spatele scenei, indirect.
De asemenea, în societatea africano-
americanâ, acįiunile oamenilor tind sâ fie
direcįionate, mai degrabâ, indirect, spre
modificarea mediilor ĩi a contextelor, pentru a
îmbunâtâįi starea de bine a celorlalįi, decât
direct, spre ceilalįi oameni (Dressler, 1985).
Autorii au revizuit, în concluzie, modelul,
transformându-l într-un model triaxial alcâtuit
din urmâtoarele dimensiuni: activ-pasivâ, care
descrie eforturile pe care le fac oamenii pentru
a rezolva probleme sau pentru a le evita,
prosocial-antisocialâ, care descrie eforturile pe
care le fac oamenii pentru a-ĩi atinge scopurile,
luând sau neluând în considerare binele ĩi
interesele celorlalįi, percepuįi drept compe-
titori sau obstacole; direct-indirectâ, care descrie
eforturile fâcute de oameni pentru a-ĩi atinge
scopurile, manipulând contextul ĩi acįionând
„în spatele scenei”, versus o abordare
transparentâ a problemei.
11
 Capitolul 2
Descrierea SACS
SACS este un chestionar de autoevaluare,
care mâsoarâ strategiile de coping compor-
tamental6 active, pasive, prosociale, antisociale,
directe, indirecte ale adulįilor peste 18 ani. Mai
precis, cu ajutorul acestui chestionar se poate
evalua cum reacįioneazâ oamenii comporta-
mental, în general, atunci când se confruntâ cu
o problemâ/situaįie stresantâ.
Strategiile evaluate se referâ, mai
degrabâ, la tendinįa generalâ de a aborda
probleme, apelând la un set specific de
comportamente. Aceastâ tendinįâ este destul
de stabilâ în timp.
Se ĩtie, însâ, din literatura de specialitate
despre coping câ, în anumite situaįii, oamenii
folosesc strategii de coping specifice, care se
pot deosebi de strategiile pe care le-ar folosi în
alte situaįii sau de strategiile pe care le-ar
folosi în general. Capacitatea oamenilor de a
utiliza sistematic diverse strategii de coping în
situaįii diferite descrie natura flexibilâ a
coping-ului ĩi are valoare adaptativâ (Lester,
Smart ĩi Baum, 1994). Aceste aspecte trebuie
tratate cu atenįie în cadrul procesului
evaluativ.

6 SACS mâsoarâ strategiile comportamentale ale
oamenilor în faįa evenimentelor stresante ĩi nu modul în
care îĩi regleazâ emoįiile (Hobfoll ĩi colab., 1998).
12
Semnificaįia subscalelor SACS
SACS distinge nouâ strategii de coping
comportamental.
Acestea sunt:
Acįiune asertivâ, prin care abordaįi
situaįia în mod ferm, spontan, sincer ĩi direct,
fârâ sâ vâ retrageįi din faįa problemelor ĩi prin
care vâ urmâriįi interesele, fârâ a le face râu
celorlalįi (dimensiunea activ-pasivâ).
Relaįionare socialâ, prin care vâ alâturaįi
celorlalįi pentru a face faįâ situaįiei împreunâ
sau prin care îi ajutaįi pe ceilalįi, luând în
considerare ĩi nevoile acestora (dimensiunea
prosocial-antisocialâ).
Câutarea suportului social, prin care
apelaįi la ceilalįi pentru ajutor ĩi sprijin
emoįional ĩi prin care vâ sfâtuiįi cu familia ĩi
prietenii în legâturâ cu ce aveįi de fâcut
(dimensiunea prosocial-antisocialâ).
Acįiune prudentâ, prin care vâ luaįi toate
mâsurile de precauįie înainte de a acįiona ĩi
prin care vâ evaluaįi atent opįiunile, pentru a
vâ proteja de orice pericol (dimensiunea
prosocial-antisocialâ.
Acįiune instinctivâ, prin care vâ bazaįi
pe intuiįia dumneavoastrâ ĩi prin care
reacįionaįi în funcįie de impulsuri de moment,
pentru a rezolva problemele (dimensiunea
prosocial-antisocialâ).
Evitare, prin care vâ angajaįi în alte
activitâįi, ca sâ nu vâ mai ocupaįi de problemâ,
prin care vâ retrageįi sau aĩteptaįi ca lucrurile
sâ se rezolve de la sine (dimensiunea activ-
pasivâ).
Acįiune indirectâ, prin care manipulaįi
situaįia pentru a-i face pe ceilalįi sâ creadâ câ
ei deįin controlul, în timp ce dumneavoastrâ
rezolvaįi problema, în mod netransparent, „în
spatele scenei” (dimensiunea direct-indirectâ).
Acįiune antisocialâ, prin care vâ urmâriįi
interesele, chiar dacâ le faceįi râu celorlalįi
(dimensiunea prosocial-antisocialâ).
Acįiune agresivâ, prin care acįionaįi
decisiv, rapid, pentru a-i lua pe ceilalįi prin
surprindere ĩi pentru a prelua controlul
(dimensiunea prosocial-antisocialâ).
Descrierea itemilor din SACS
Chestionarul cuprinde 52 de itemi care se
referâ la modul în care reacįioneazâ o
persoanâ, în general, (ceea ce face o persoanâ)
atunci când se confruntâ cu o situaįie sau o
problemâ stresantâ. Itemii sunt împârįiįi pe
nouâ subscale, astfel încât fiecare subscalâ
SACS conįine între 4 ĩi 9 itemi.
Mai jos, se regâsesc numele subscalelor
cu itemii corespunzâtori. Numerele corespund
numârului pe care îl are itemul în chestionarul
propriu-zis.
1. Acįiune asertivâ
1. Nu renunįaįi, chiar ĩi atunci când
situaįia pare a fi cea mai gravâ, pentru câ
adesea lucrurile se pot schimba.
10. Treceįi mai departe, la alte lucruri,
deoarece sunt puįine speranįe ca astfel de
situaįii sâ se îmbunâtâįeascâ. (-)
15. Vâ retrageįi ĩi evitaįi problema, pânâ
când aceasta trece de la sine. (-)
25. Probabil câ vâ simįiįi râu, dar nu
puteįi face mare lucru într-o astfel de
situaįie. (-)
26. Vâ strâduiįi mai mult; vâ dedicaįi
trup ĩi suflet.
33. Ieĩiįi din situaįie, deoarece, de obicei,
când apar probleme înseamnâ câ va fi ĩi
mai râu.(-)
50. Sunteįi asertiv(â) ĩi vâ urmâriįi
interesele.
51. Sunteįi puternic(â) ĩi categoric(â), dar
evitaįi sâ le faceįi râu celorlalįi.
52. Abordaįi situaįia direct ĩi nu vâ
retrageįi din faįa problemelor.
2. Relaįionare socialâ
17. Vâ alâturaįi celorlaįi pentru a face faįâ
situaįiei împreunâ.
23. Încercaįi sâ îi ajutaįi pe ceilalįi
implicaįi, deoarece, de obicei, sâ fii
altruist ajutâ la rezolvarea unor probleme
de genul acesta.
24. Vâ gândiįi atent la ceea ce simt ceilalįi,
înainte de a decide ce e de fâcut.
30. Încercaįi din greu sâ veniįi în
întâmpinarea dorinįelor celorlalįi, întru-
cât acest lucru ar ajuta în aceastâ situaįie.
41.Încercaįi sâ satisfaceįi nevoile celorlalįi
implicaįi.
3. Câutarea suportului social
2. Vâ consultaįi cu prietenii despre ceea
ce ar face ei.
9. Vâ consultaįi cu membrii familiei
despre ceea ce ar face ei.
13. Apelaįi la alįii pentru ajutor.
18. Vâ bazaįi pe dumneavoastrâ, dar, în
acelaĩi timp, ĩi pe cei care vâ sunt
apropiaįi.
28. Mergeįi la cineva pentru sprijin
emoįional.
38. Vorbiįi cu ceilalįi ca sâ scâpaįi de
frustrâri.
13
 46. Vâ întrebaįi prietenii sau familia
despre opinia lor în legâturâ cu planul
dumneavoastrâ de acįiune.
4. Acįiune prudentâ
12. Sunteįi foarte prudent(â) ĩi vâ
evaluaįi foarte atent opįiunile (mai bine
sâ fiįi în siguranįâ, decât sâ vâ parâ râu).
14. Mergeįi înainte, dar nu vâ folosiįi
toate resursele, pânâ când nu ĩtiįi exact
cu ce vâ confruntaįi.
29. Acįionaįi foarte prudent, deoarece ar
putea exista interese ascunse.
40. Împârįiįi problema în bucâįi mai mici
ĩi vâ ocupaįi de ele pe rând.
43. Faceįi ceva care sâ vâ ajute sâ vâ
calmaįi ĩi, abia dupâ aceea, începeįi sâ
rezolvaįi problema.
5. Acįiune instinctivâ
5. Vâ bazaįi pe dumneavoastrâ ĩi pe
forįele proprii, deoarece consideraįi câ nu
este o idee bunâ sâ depindeįi de ceilalįi.
6. Aveįi încredere în instinctele, nu în
gândurile dumneavoastrâ.
11. Vâ bazaįi pe reacįiile dumneavoastrâ
de moment.
35. Vâ bazaįi pe intuiįia dumneavoastrâ.
42. Vâ urmaįi primul impuls, deoarece,
de obicei, lucrurile se rezolvâ cel mai bine
în felul acesta.
48. Vâ bazaįi pe propria judecatâ,
deoarece sunteįi singurul/singura care
ĩtie ce este cel mai bine pentru
dumneavoastrâ.
6. Evitare
7. Evitaįi sâ vâ ocupaįi de problemâ,
deoarece consideraįi câ, adesea, astfel de
lucruri dispar de la sine.
14
20. Faceįi ceva care vâ ajutâ sâ nu vâ mai
gândiįi la problemâ.
22. Vâ retrageįi ĩi lâsaįi lucrurile sâ se
limpezeascâ.
27. Staįi pe loc, deoarece este mai bine sâ
aĩteptaįi ca situaįia sâ se limpezeascâ
înainte de a acįiona.
32. Dacâ lucrurile nu se înrâutâįesc,
evitaįi întreaga situaįie.
47. Vâ concentraįi pe altceva ĩi lâsaįi
situaįia sâ se rezolve de la sine.
7. Acįiune indirectâ
4. Încercaįi sâ deįineįi controlul, dar îi
lâsaįi pe ceilalįi sâ creadâ în continuare câ
ei hotârâsc.
21. Ceilalįi au nevoie sâ simtâ câ ei
controleazâ lucrurile, aĩa câ trebuie sâ îi
„fentaįi” pentru a le termina.
34. Îi lâsaįi pe ceilalįi sâ creadâ câ ei
controleazâ situaįia, dar įineįi bine
hâįurile în mâini.
37. Câteodatâ, singura dumneavoastrâ
opįiune, este sâ fiįi un pic manipulativ(â)
ĩi sâ îi „fentaįi” pe oameni.
8. Acįiune antisocialâ
16. Ripostaįi ĩi îi prindeįi pe ceilalįi cu
garda jos.
19. Vâ apâraįi interesele, chiar dacâ
aceasta înseamnâ sâ îi râniįi pe ceilalįi
implicaįi.
36. Vâ arâtaįi imediat autoritatea.
39. Acįionaįi repede pentru a-i dezavan-
taja pe ceilalįi.
44. Câutaįi slâbiciunile celorlalįi ĩi le
folosiįi în avantajul dumneavoastrâ.
 9. Acįiune agresivâ
3. Acįionaįi rapid, deoarece consideraįi câ
este mai bine sâ vâ aruncaįi chiar în
mijlocul problemei.
8. Pregâtiįi un atac decisiv; sunteįi
agresiv(â).
31. Acįionaįi agresiv, deoarece adesea,
dacâ îl prindeįi pe celâlalt cu garda jos,
lucrurile se vor rezolva în favoarea
dumneavoastrâ.
45. Luaįi taurul de coarne ĩi adoptaįi o
atitudine de preluare a controlului.
49. Sunteįi ferm(â) ĩi râmâneįi pe poziįii.
(-) = itemii cotaįi negativ
Administrarea SACS
SACS poate fi administrat atât individual,
cât ĩi în grup, în versiune creion-hârtie ĩi în
versiune computerizatâ.
Locul în care va fi completat chestionarul
trebuie sâ ofere condiįii bune, pentru ca
persoanele testate sâ se poatâ concentra: fârâ
perturbâri, fârâ zgomote deranjante, cu luminâ
suficientâ, iar, în cazul în care este administrat
unui grup, repartizarea sâ se facâ astfel încât sâ
existe spaįiu suficient pentru a se completa
totul în liniĩte ĩi într-un cadru privat. De
regulâ, completarea SACS dureazâ 7 minute.
Instrucįiuni pentru completarea
SACS
SACS poate fi folosit pentru a evalua
strategiile de coping în mod general.
Chestionarul include urmâtoarele ins-
trucįiuni:
Descrieįi cum reacįionaįi, în general, atunci
când vâ confruntaįi cu o problemâ/situaįie
stresantâ. Indicaįi râspunsul dumneavoastrâ,
încercuind o variantâ de la „1” la „5”, în care „1”
înseamnâ „Nu e deloc ceea ce aĩ face”, iar „5”,
„Categoric (foarte mult), e ceea ce aĩ face”. Se va
explica, în mod clar, faptul câ, prin
completarea acestui chestionar, se urmâresc
punctele de vedere ale fiecârei persoane ĩi câ
nu existâ râspunsuri corecte sau greĩite.
Cotare SACS
Fiecare persoanâ evaluatâ prin SACS
indicâ pe o scalâ de cinci puncte, unde 1
înseamnâ „Nu e deloc ceea ce aĩ face”, iar 5
înseamnâ „Categoric (foarte mult), e ceea ce aĩ
face”, în ce mâsurâ foloseĩte comportamentul
descris de fiecare item.
Pentru a obįine scorul unei subscale se
calculeazâ suma cotelor itemilor incluĩi în
scalâ (adunare simplâ). Acesta poate varia, de
exemplu, în cazul subscalei Relaįionare socialâ
de la 5 (strategia nu este folositâ niciodatâ) la
25 (strategia este folositâ foarte des). Dintre
itemii care compun o subscalâ, nu poate „lipsi”
râspunsul la mai mult de unu. În acest caz,
scorul „lipsâ” va fi înlocuit cu media celorlalte
scoruri.
Populaįiile pentru care poate fi
folosit SACS
SACS poate fi utilizat în cazul
persoanelor adulte fârâ diagnostic psihiatric ĩi
al pacienįilor adulįi cu diagnostic psihiatric.
Utilizarea SACS în scop ĩtiinįific
Modelul multiaxial al coping-ului ĩi
instrumentul de evaluare SACS (Hobfoll ĩi
colab., 1994, 1998) au fost create tocmai pentru
a aduce luminâ în ceea ce priveĩte
dimensiunea socialâ a coping-ului, raportatâ
atât la sexe, cât ĩi la etnii diferite. Cercetârile
realizate cu ajutorul instru-mentului de
15
evaluare SACS au arâtat câ, spre deosebire de
studii ulterioare pe coping, bârbaįii ĩi femeile
nu prezintâ diferenįe semnificative în ce
priveĩte coping-ul activ. S-a gâsit, în schimb,
câ femeile sunt mai prosociale decât bârbaįii ĩi
câ bârbaįii sunt mai antisociali decât femeile.
Aceste rezultate sunt în concordanįâ cu
rezultatele obįinute în studii fâcute pe
diferenįe de gen, care descriu coping-ul la
femei ĩi la bârbaįi ca fiind diferit mai mult pe
dimensiunea socialâ, decât pe aceea a acįiunii.
(Hobfoll ĩi London, 1986; Kessler ĩi colab.,
1985)
Autorii cred câ aceste date ar putea
reprezenta un fundament pentru construirea
unui produs secundar (un model teoretic ĩi un
instrument de evaluare) care sâ descrie mai
detaliat aspectele sociale ale coping-ului (pro ĩi
anti sociale) ĩi care ar permite, astfel, femeilor
sâ îĩi descrie mai adecvat comportamentele de
coping (Monnier ĩi colab., 1998).
Un alt aspect relevant pentru cercetare
este posibilitatea de a dezvâlui aspecte sociale
ascunse, neasumate, ale coping-ului activ ĩi ale
celui emoįional, evaluate de teste de coping,
precum COPE (Carver, Scheier ĩi Weintraub,
1998). O astfel de comparaįie ar putea sâ arate
câ ceea ce este considerat a fi coping activ
pozitiv poate sâ însemne altceva atunci când
are o laturâ antisocialâ. La fel, atunci când
coping-ul emoįional are o nuanįâ prosocialâ,
s-ar putea înįelege mai bine de ce aceastâ
abordare a fost preferatâ în anumite situaįii,
chiar dacâ poate avea consecinįe potenįial
negative pentru persoana care foloseĩte o astfel
de strategie (Triandis ĩi colab., 1990).
Cercetâri ulterioare în aceste direcįii ar fi
relevante pentru a evalua caracterul funcįional
sau disfuncįional ale unor combinaįii de
strategii de coping, precum ĩi a identifica
posibile diferenįe de coping, din punct de
vedere etnic.
16
Utilizarea SACS în prevenįie,
dezvoltare personalâ,
evaluare psihologicâ
Un aspect important în cadrul evaluârii
psihologice ĩi al psihodiagnosticului este
identificarea unor factori de risc ĩi de protecįie,
asociaįi cu dezvoltarea ĩi menįinerea
problemelor emoįionale ĩi de comportament.
Rezultatele studiilor efectuate de câtre Hobfoll
ĩi colab. (1998), coroborate cu alte cercetâri din
literatura de specialite, aratâ câ, într-adevâr, se
pot identifica strategii de coping care se
asociazâ mai frecvent atât cu condiįii de
psihopatologie, cât ĩi cu distres emoįional
scâzut.
Alte studii au arâtat câ strategiile de
coping active ĩi prosociale au tins sâ se
asocieze mai des cu consecinįe emoįionale
pozitive, cu niveluri scâzute de anxietate ĩi
depresie, în timp ce coping-ul antisocial s-a
asociat cu niveluri crescute de furie, iar cel
evitativ cu un nivel mai crescut de anxietate ĩi
de depresie (Hobfoll ĩi colab., 2001).
De aceea, înainte de stabilirea unui plan
de prevenįie, dezvoltare personalâ sau de
intervenįie, este important sâ se poatâ afla ce
tip de coping utilizeazâ o persoanâ, cât de
frecvent utilizeazâ anumite strategii, cât timp.
Strategiile de coping nu sunt adaptative sau
dezadaptative „in abstractio” (Folkman,
Moskowitz, 2004). Funcįionalitatea acestora
depinde de caracteristicile stresorului, de
contextul în care apar, de frecvenįa ĩi de
durata utilizârii lor.
Astfel, cu SACS se pot surprinde
informaįii contextualizate, care, coroborate cu
alte informaįii ĩi date obįinute prin interviuri
semi-structutate ĩi administrâri de teste
psihologice, pot sprijini luarea unor decizii de
prevenįie, dezvoltare, intervenįie comporta-
mentalâ, cognitivâ ĩi emoįionalâ.
 Capitolul 3

Adaptarea ĩi standardizarea Scalei de abordare strategicâ a coping-ului

(SACS) pe populaįia din România

Obiectiv Ƴ=15,20), cu diagnostic de tulburâri specifice

Studiile de faįâ au ca obiectiv principal
adaptarea ĩi standardizarea Scalei de abordare
strategicâ a coping-ului (SACS) pe populaįia din
România. Prin urmare, au fost efectuate o serie
de studii de fidelitate ĩi validitate pe diverse
categorii de participanįi, atât din populaįia
generalâ, cât ĩi din grupuri clinice.
Participanįi
La studiu au participat 554 de persoane,
din care:
Eĩantionul clinic a fost format din 111
persoane (50 de bârbaįi, 61 de femei), cu vârsta
cuprinsâ între 20 ĩi 81 de ani (m=46,53;
Axei 1 (DSM-4).
Eĩantionul non-clinic a fost format din
443 de persoane (189 de bârbaįi, 254 de femei),
cu vârsta cuprinsâ între 18 ĩi 80 de ani
(m=29,95; Ƴ=13,23).
Participanįii au provenit din zone urbane
ĩi rurale din Cluj, Oradea, Hunedoara, Baia-
Mare, Satu-Mare, Bacâu, Iaĩi. Peste 80% dintre
participanįi au cel puįin liceul absolvit.
47 de subiecįi din eĩantionul extras din
populaįia generalâ au participat ĩi la faza de
retest, la un interval de douâ luni, dupâ prima
administrare.
Datele demografice, mediile ĩi abaterile
standard ale vârstei participanįilor sunt
prezentate în Tabelul 1.

Tabelul 1. Date demografice, mediile ĩi abaterile standard ale vârstei participanįilor

Eĩantion Frecvenįa Vârsta (în ani)

Total Bârbaįi Femei Interval m ǻ

Clinic 111 50 61 20-81 46,53 15,20

Nonclinic 443 189 254 18-80 29,95 13,23

17
 Procedura de adaptare a scalei SACS
pe populaįia din România
Procedura de adaptare a scalei SACS a
constat în trei faze: 1. Traducerea scalei din
limba englezâ în limba românâ ĩi
retroversiunea (retraducerea variantei obįinute
în limba românâ în limba englezâ); 2. Un
studiu pilot, cu scopul de a verifica itemii
traduĩi; 3. Determinarea caracteristicilor
psihometrice (fidelitate ĩi validitate) ale
versiunii în limba românâ. Primele douâ faze
ale procesului de adaptare sunt prezentate în
Figura 1. Ele au fost conforme recomandârilor
generale privind procedeele de traducere ĩi
adaptare a scalelor.
Prima fazâ, aceea a traducerii din limba
englezâ în limba românâ ĩi retroversiunea a
fost finalizatâ într-o sâptâmânâ. Traducâtorul
este o persoanâ care vorbeĩte fluent limba
englezâ, având ca limbâ maternâ limba
românâ. Traducerea a vizat gâsirea în limba
românâ a echivalenįelor conceptuale ale
cuvintelor sau ale frazelor, ĩi nu traducerea
cuvânt cu cuvânt (ad litteram). S-a evitat
utilizarea termenilor tehnici sau prea ĩtiinįifici,
precum ĩi formulârile academice. Prima formâ
tradusâ a scalei SACS a fost supusâ analizei, în
cadrul unei discuįii panel, care a inclus
traducâtorul, 3 psihologi atestaįi ĩi un
specialist în filologie ĩi lingvisticâ. S-au sugerat
alternative pentru unele formulâri neadecvate
ĩi au fost operate modificârile necesare. În
urma discuįiilor ĩi a analizei traducerilor, s-a
obįinut prima variantâ a scalei SACS în limba
românâ.
Aceastâ versiune iniįialâ a fâcut subiectul
retroversiunii (traducerea din limba românâ în
limba englezâ) de câtre un alt traducâtor,
fluent în limba englezâ ĩi cu background în
18
psihologie ĩi filologie, care nu cunoĩtea scala
SACS originalâ. Similar cu traducerea iniįialâ,
accentul a câzut asupra echivalenįei culturale
ĩi conceptuale în limba românâ. Rezultatul
retroversiunii a fost analizat de câtre experįii
implicaįi în studiu, dupâ care s-a stabilit
versiunea preliminarâ a scalei SACS, care,
apoi, a fost testatâ în cadrul unui studiu pilot
efectuat în faza a doua a procesului de
adaptare. Studiul pilot a inclus 40 de
participanįi, dintre care 35 au fost persoane cu
vârste cuprinse între 18 ĩi 50 de ani, iar 5,
psihologi. S-au verificat compre-hensiunea
instrucįiunilor ĩi a itemilor.
Operatorii (psihologi atestaįi) au fost
instruiįi în legâturâ cu modalitatea de
administrare a SACS, pentru a diminua
posibilele influenįe apârute în timpul
completârii râspunsurilor la itemi. Totodatâ,
au fost rugaįi sâ îĩi noteze problemele care au
apârut pe parcursul administrârii.
Administrarea s-a realizat în universitâįi
ĩi la locul de muncâ al participanįilor, atât în
zone rurale, cât ĩi urbane. În funcįie de
situaįie, administrarea s-a realizat individual
sau în grup, cu consimįâmântul verbal al
fiecârui participant la testare.
Experįii implicaįi în faza 1 a adaptârii au
analizat problemele apârute în timpul
studiului pilot ĩi au fâcut câteva modificâri la
nivel de itemi, în cazul unor expresii
metaforice folosite în versiunea originalâ,
pentru a surprinde sensul acestora cât mai clar
ĩi mai congruent cu limba vorbitâ.
Varianta finalâ obįinutâ în urma
introducerii tuturor modificârilor a fost
utilizatâ, apoi, pentru studiile de validare ĩi de
standardizare în limba românâ.
 Traducereaȱînȱlimbaȱromân©ȱ(unȱ
traduc©torȱfamiliarizatȱcuȱterminologia)ȱ
Expresii neadecvate
ale traducerii

Discuôieȱpanelȱ(traduc©torul,ȱ3ȱpsihologiȱ Retraducereaȱ
atestaôi,ȱexpertȱfilolog)ȱ expresiilorȱneadecvateȱ
Expresii adecvate
ale traducerii

Versiuneaȱiniôial©ȱtradus©ȱaȱSACS

Retroversiuneaȱ(unȱtraduc©torȱcareȱnuȱaȱ
participatȱlaȱtraducereaȱînȱlimbaȱromân©)ȱ
Itemi
ƺȱcuȱaccentȱpeȱechivalenôaȱconceptual©ȱóiȱ problematici
cultural©ȱaȱtermenilorȱ Reformulareaȱitemilorȱ
problematiciȱ
Itemi adecvaįi
Studiuȱpilotȱ(40ȱdeȱpersoane,ȱlotȱ
nonclinic,ȱóiȱ5ȱpsihologi)ȱ

Formaȱfinal©ȱaȱversiuniiȱscaleiȱSACSȱînȱ
limbaȱromân©ȱ

Figura 1. Procesul de traducere ĩi adaptare a scalei SACS pe populaįia din România

19
 Procedurâ
Participanįii au fost rugaįi sâ completeze
chestionarele, individual sau în grupuri de
aproximativ 15-20 persoane, dupâ ce ĩi-au dat
consimįâmântul în mod oficial.
Douâ luni mai târziu, unui numâr de 47
de participanįi din eĩantionul de adulįi din
populaįia generalâ i s-a administrat din nou
SACS, în condiįii similare. Acest eĩantion a
fost utilizat pentru a evalua fidelitatea test-
retest.
Administrarea s-a realizat în universitâįi,
la locul de muncâ al participanįilor, în clinici
de psihiatrie, atât în zone rurale, cât ĩi urbane,
de câtre psihologi atestaįi, care au fost instruiįi
în prealabil în legâturâ cu modalitatea de
administrare a SACS, pentru a diminua
posibilele influenįe apârute în timpul comple-
târii testelor.
Instrumente
Subiecįii au râspuns la întrebâri
referitoare la datele lor demografice (vârstâ,
sex, ani de ĩcolarizare, etnie) ĩi au completat
SACS. Unii dintre ei au râspuns ĩi la
Chestionarul CERQ (Chestionarul de Coping
Cognitiv Emoįional) (Garnefski ĩi colab., 2002),
Chestionarul PDSQ (Chestionarul de Screening ĩi
Diagnostic Psihiatric) (Zimmerman, 2002),
Chestionarul COPE (Coping Orientations to
Problems Experienced) (Carver, Scheier ĩi
Weintraub, 1989).
CERQ (Chestionar de Coping
Cognitiv Emoįional)
CERQ este un chestionar multidi-
mensional, construit pentru a identifica
exclusiv strategiile de coping cognitiv, pe care
cineva le foloseĩte dupâ ce a trâit anumite
evenimente sau situaįii negative. În opoziįie cu
20
alte chestionare de coping, care nu fac o
distincįie explicitâ între gândurile unei
persoane ĩi activitatea sa realâ, chestionarul
prezent se referâ în mod exclusiv la gândurile
unei persoane dupâ ce a trâit o experienįâ
negativâ. CERQ este un chestionar de auto-
evaluare format din 36 de itemi ĩi mâsoarâ
nouâ strategii de coping: Autoculpabilizarea,
Acceptarea, Ruminarea, Refocalizarea pozi-
tivâ, Refocalizarea pe planificare, Reevaluarea
pozitivâ, Punerea în perspectivâ, Catas-
trofarea, Culpabilizarea celorlalįi.
În continuare, vâ vom prezenta o
descriere sumarâ a strategiilor mâsurate de
subscalele din CERQ.
Autoculpabilizarea este o strategie de
coping cognitiv care presupune apariįia unor
gânduri potrivit cârora întreaga respon-
sabilitate pentru situaįia trâitâ aparįine
propriei persoane, vina este atribuitâ sieĩi ĩi
apar preocupâri legate de gânduri care se
referâ la greĩelile pe care persoana le face.
Acceptarea se referâ la acele gânduri
datoritâ cârora ne resemnâm faįâ de ceea ce s-a
întâmplat ĩi acceptâm situaįia, gândindu-ne câ
aceasta nu mai poate fi schimbatâ ĩi câ viaįa
continuâ.
Ruminarea se referâ la situaįia în care ne
gândim în continuu ĩi/sau suntem mereu
preocupaįi excesiv de sentimentele ĩi gându-
rile pe care le asociem unui eveniment negativ.
Refocalizarea pozitivâ apare atunci când ne
gândim la alte lucruri mai plâcute, în loc sâ ne
gâdim la evenimentul negativ trâit. Un scor
ridicat indicâ utilizarea frecventâ a acestei
strategii.
Refocalizarea pe planificare apare atunci
când ne gândim la paĩii pe care trebuie sâ îi
urmâm, pentru a face faįâ unui eveniment
negativ sau atunci când ne gândim la un plan
prin care sâ schimbâm o situaįie.
 Reevaluarea pozitivâ apare atunci când
asociem mental o semnificaįie pozitivâ unui
eveniment negativ în termenii dezvoltârii
personale, gândindu-ne câ evenimentul ne va
face mai puternici, câutând aspectele pozitive
ale acestuia.
Punerea în perspectivâ se referâ la acele
gânduri prin care se reduce nivelul de
gravitate al evenimentului, prin comparaįie cu
alte evenimente ĩi se pune accentul pe faptul
câ existâ ĩi lucruri mai grave în lume.
Catastrofarea apare atunci când ne gândim
în mod recurent la cât de teribil a fost
evenimentul trâit ĩi la faptul câ este cel mai
crunt/groaznic lucru care se putea întampla,
câ este mult mai grav decât ceea ce li s-a
întâmplat altora.
Culpabilizarea celorlalįi apare atunci când
îi învinovâįim pe ceilalįi pentru ceea ce ni s-a
întâmplat, atunci când îi facem pe ceilalįi
responsabili pentru ceea ce s-a întâmplat
ĩi/sau atunci când ne gândim la greĩelile pe
care le-au facut ceilalįi în aceastâ privinįâ.
Chestionarul COPE
COPE (Carver ĩi colab., 1989) investi-
gheazâ modurile diferite în care oamenii fac
faįâ stresului. COPE a fost elaborat de Carver,
Scheier ĩi Weintraub, în 1989. Instrumentul
integreazâ modelul stresului elaborat de
Lazarus în 1984, care vizeazâ 14 forme de
coping, cu un caracter preponderent activ sau
pasiv. Chestionarul cuprinde 53 de afirmaįii,
fiecare formâ de coping fiind evaluatâ prin
patru itemi. Excepįie face coping-ul prin
recurgere la alcool-medicamente, mâsurat
printr-un singur item. Râspunsurile se
plaseazâ pe o scalâ de la unu la patru, în care
cifra unu reprezintâ ,,de obicei nu fac acest
lucru'', iar cifra patru ,,deseori fac acest lucru”.
COPE a fost citat drept unul dintre cele mai
valide instrumente din punct de vedere
teoretic ĩi metodologic. (Schwarzer ĩi
Schwarzer, 1996).
Cinci scale evalueazâ aspecte conceptuale
distincte ale coping-ului centrat pe problemâ
(Coping activ, Planificare, Eliminarea activitâįilor
concurente, Reįinerea de la acįiune, Câutarea
suportului social instrumental); cinci scale
evalueazâ aspecte ale coping-ului centrat pe
emoįie (Câutarea suportului social emoįional,
Reinterpretarea pozitivâ, Acceptarea, Negarea,
Orientarea spre religie); patru scale evalueazâ
strategii de coping mai puįin funcįionale
(Descârcare emoįionalâ, Pasivitate comportamen-
talâ, Pasivitate mentalâ, Recurgerea la alcool-
medicamente).
În continuare, vâ vom prezenta pe scurt
scalele din COPE.
Coping-ul activ vizeazâ acįiunile concrete
care urmâresc înlâturarea stresorului.
Planificarea se referâ la orientarea gândirii
spre paĩii ĩi modalitâįile de acįiune.
Eliminarea activitâįilor concurente evaluea-
zâ tendinįa persoanelor de a evita distragerea
de la situaįia problematicâ pentru a se
concentra mai mult asupra soluįionârii ei.
Reįinerea de la acįiune este o formâ de
coping pasiv pânâ când circumstanįele vor
permite acįiunea.
Câutarea suportului social instrumental
identificâ în ce mâsurâ persoana tinde sâ
solicite sfaturi, informaįii, în acįiunile de
ameliorare a situaįiei ĩi este o formâ de coping
centrat pe problemâ.
Câutarea suportului social emoįional iden-
tificâ în ce mâsurâ persoana tine sâ solicite
înįelegere, compasiune, suport moral de la
prieteni, rude, pentru a diminua distresul ĩi
este o formâ de coping focalizat pe emoįii.
Reinterpretarea pozitivâ identificâ tendinįa
unei persoane de a extrage un beneficiu chiar
dintr-o situaįie indezirabilâ sau cu consecinįe
nefaste.
21
 Acceptarea vizeazâ fie acceptarea factoru-
lui ameninįâtor în vederea acįionârii asupra
lui, fie acceptarea faptului câ nu se poate face
nimic pentru a ameliora situaįia.
Negarea se referâ la refuzul de a crede câ
stresorul existâ.
Descârcarea emoįionalâ pune în evidenįâ
tendinįa persoanei de a-ĩi reduce nivelul
distresului prin exprimarea afectelor ĩi a
emoįiilor negative.
Orientarea spre religie se referâ la mâsura
în care subiectul apeleazâ în momente
nesigure la ajutorul din partea divinitâįii.
Pasivitatea mentalâ identificâ tactica
folositâ în scopul de a evita confruntarea cu
problema ĩi are loc prin imersia în alte
activitâįi.
Pasivitatea comportamentalâ evalueazâ
tendinįa de râspuns la stres prin reducerea
efortului sau chiar prin abandonarea angajârii
în înlâturarea stresorului.
Recurgerea la alcool-medicamente identificâ
propensiunea de a apela la medicaįie
anxioliticâ sau la alcool pentru ameliorarea
distresului psihic.
22
PDSQ (Chestionar de Screening ĩi
Diagnostic Psihiatric)
PDSQ este un instrument de autoe-
valuare conceput pentru a detecta cele mai
frecvent întâlnite tulburâri de pe axa I a DSM-
IV (Manual de Diagnostic ĩi Statisticâ a
Tulburârilor Mentale, Ediįia a patra, Asociaįia
Americanâ de Psihiatrie, 1994) în unitâįile
spitaliceĩti destinate problemelor de sânâtate
mentalâ. Scala cuprinde 125 de întrebâri cu
râspunsuri da/nu (111 itemi numerotaįi,
dintre care doi sunt formaįi din mai multe
pârįi). Itemii din PDSQ sunt grupaįi în 13
subscale din domeniile urmâtoare: tulburare
depresivâ majorâ, tulburare de stres
posttraumatic, bulimie nervoasâ, tulburare
obsesiv-compulsivâ, tulburare de panicâ,
psihozâ, agorafobie, fobie socialâ, abuz
/dependenįâ de alcool, abuz/dependenįâ de
droguri, tulburare de anxietate generalizatâ,
tulburare de somatizare ĩi ipohondrie.
 Capitolul 4
Caracteristici psihometrice ale SACS
Acest capitol trateazâ diferite aspecte ale
structurii interne, ale fidelitâįii ĩi ale validitâįii
SACS.
Fidelitatea scalei de abordare
strategicâ a coping-ului SACS
Fidelitatea unui instrument de mâsurâ
este cel mai adesea exprimatâ pe baza
consistenįei interne ĩi a stabilitâįii în timp a
rezultatelor. Consistenįa internâ a unui test se
referâ la mâsura în care toįi itemii sâi mâsoarâ
aceeaĩi variabilâ. Stabilitatea rezultatelor
testârii ne indicâ în ce mâsurâ, la aplicâri
diferite în timp, un subiect obįine rezultate
similare la un test psihologic.
Consistenįa internâ: ơ Cronbach
Consistenįa internâ oferâ informaįii
legate de consistenįa râspunsurilor la itemii
testului. Acest coeficient indicâ gradul de
omogenitate a râspunsurilor la itemii scalei sau
mâsura în care toįi itemii scalei evalueazâ
acelaĩi lucru. Coeficientul ơ Cronbach este un
index corelaįional care ia valori între 0 (nu
existâ consistenįâ) ĩi 1 (consistenįâ foarte
mare). Consistenįa internâ a testului, mâsuratâ
prin ơ Cronbach este prezentatâ în Tabelul 2,
pentru fiecare eĩantion în parte, sex ĩi scalâ.
Valorile coeficienįilor ơ Cronbach variazâ
în eĩantionul non-clinic între 0,52 ĩi 0,79
(Tabelul 2). Subscala Acįiune indirectâ are
coeficientul fidelitâįii interne 0,31 în eĩantionul
clinic, dar aceasta este un lucru obiĩnuit pentru
subscalele cu itemi puįini (4 itemi), aĩadar,
valoarea coeficientului ar trebui sâ fie
relevantâ.
Una dintre caracteristicile psihometrice,
conform literaturii de specialitate (Folkman,
Moskowitz, 2004), a scalelor de coping este câ
nu au, în general, valori ale consistenįei
interne mai mari de 0,80. Utilizarea unei
strategii de coping este suficientâ pentru
reducerea distresului emoįional; aceasta are
drept consecinįâ diminuarea nevoii de a utiliza
alte strategii de coping, fie din aceeaĩi
categorie, fie alte categorii. (Billings ĩi Moos,
1981, p.145).
23
 Tabelul 2. Consistenįa internâ a subscalelor (coeficientul ơ Cronbach)

Subscala Nr. Eĩantionul non-clinic Eĩantionul clinic

de Bârbaįi Femei Bârbaįi Femei
itemi (N=189) (N=254) (N=50) (N=61)
Acįiune asertivâ 9 0,52 0,63 0,52 0,49
Relaįionare socialâ 5 0,68 0,77 0,77 0,77
Câutarea suportului social 7 0,79 0,78 0,73 0,81
Acįiune prudentâ 5 0,57 0,63 0,66 0,61
Acįiune instinctivâ 6 0,65 0,76 0,64 0,74
Evitare 6 0,70 0,77 0,62 0,79
Acįiune indirectâ 4 0,72 0,78 0,31 0,70
Acįiune antisocialâ 5 0,70 0,77 0,38 0,70
Acįiune agresivâ 5 0,62 0,61 0,32 0,70

În general, scalele din SACS au o
consistenįâ internâ mai bunâ în eĩantionul
non-clinic decât în cel clinic.
Coeficienįii test-retest
Prin evaluarea aceleiaĩi persoane la
momente de timp diferite, se obįin informaįii
despre stabilitatea scorurilor în timp. Astfel, se
poate vedea dacâ scalele ajutâ la luarea unor
decizii sau la realizarea unui profil al
strategiilor de coping în baza unor strategii de
abordare a problemelor, relativ stabile.
Coeficientul test-retest este un astfel de
indicator al stabilitâįii în timp a rezultatelor.
Un test fidel mâsoarâ stabil un construct care
nu se modificâ în timp.
Cele douâ administrâri ale scalei SACS
s - au realizat la un interval de 2 luni ĩi au
inclus un numâr de 47 de adulįi (cu vârste
cuprinse între 19 ĩi 53 de ani).
Valorile coeficienįilor test-retest variazâ
între 0,40 ĩi 0,78, arâtând o stabilitate bunâ a
rezultatelor în timp. Mediile scorurilor
subscalelor nu diferâ semnificativ între cele
douâ momente de evaluare, în afarâ de Acįiune
indirectâ (Vezi Tabelul 3). Deĩi strategiile de
coping evaluate se referâ la o tendinįâ de
abordare generalâ a situaįiilor stresante,
trebuie luatâ în calcul ĩi capacitatea
persoanelor de a utiliza diverse strategii în
situaįii diferite, care ar putea influenįa evaluâri
generale ale stilului de coping, la anumite
intervale de timp (Lester ĩi colab., 1994).

24
 Tabelul 3. Compararea mediilor scorurilor subscalelor între test ĩi retest,
folosind testul t pentru eĩantioane perechi

Scala Test Retest t(46) p

m Ƴ m Ƴ
Acįiune asertivâ 31,95 5,18 31,85 4,48 0,141 0,888
Relaįionare socialâ 16,31 3,73 16,93 3,10 1,229 0,225
Câutarea suportului social 22,47 5,94 22,87 4,99 0,578 0,566
Acįiune prudentâ 16,43 2,96 16,95 3,26 1,279 0,207
Acįiune instinctivâ 18,87 4,30 18,37 3,87 1,269 0,211
Evitare 14,25 4,47 14,21 4,13 0,067 0,947
Acįiune indirectâ 10,35 3,36 11,75 3,13 2,813 0,007
Acįiune antisocialâ 12,12 3,82 13,02 3,28 1,594 0,118
Acįiune agresivâ 13,66 3,37 13,68 3,08 0,041 0,968

Tabelul 4. Coeficienįii de corelaįie liniarâ între scorurile la test ĩi cele la retest

Scala r p

Acįiune asertivâ 0,450 0,001

Relaįionare socialâ 0,482 0,001
Câutarea suportului social 0,636 0,000
Acįiune prudentâ 0,594 0,000
Acįiune instinctivâ 0,783 0,000
Evitare 0,485 0,001
Acįiune indirectâ 0,441 0,002
Acįiune antisocialâ 0,409 0,004
Acįiune agresivâ 0,397 0,005

Rezultatele obįinute sunt asemânâtoare Validitatea scalelor SACS

celor obįinute pentru versiunea originalâ a
testului (Monnier ĩi colab., 1998). Coeficienįii
test-retest ai versiunii americane a SACS
variazâ între 0,46 ĩi 0,68. Stabilitatea în timp a
rezultatelor obįinute prin evaluarea strategiilor
de coping este bunâ sau chiar mai bunâ decât
aceea care se obįine, de obicei, prin evaluarea
trâsâturilor de personalitate (Compas ĩi colab.,
1988).
Validitatea de construct
Validitatea de construct reprezintâ
mâsura în care se poate susįine câ testul
mâsoarâ o variabilâ specificâ. Altfel spus,
testul mâsoarâ ceea ce îĩi propune sâ mâsoare.
Constructele pe care scala SACS le evalueazâ
se referâ la strategiile de coping compor-
tamental ale unei persoane atunci când se con-
fruntâ cu o situaįie sau cu un eveniment
stresant.

25
 Analiza corelaįiilor între subscalele
SACS
Pentru a examina în ce mâsurâ cele nouâ
subscale SACS sunt interrelaįionate, s-au
calculat coeficienįii de corelaįie Pearson pentru
un eĩantion de 257 de persoane din eĩantionul
non-clinic.

Tabelul 5. Coeficienįii de corelaįie Pearson între cele nouâ subscale SACS (N=257)

Subscala 1 2 3 4 5 6 7 8 9
Acįiune asertivâ 0,15* 0,06 0,13* -0,25 -0,57* 0,07 0,08 0,34**
Relaįionare socialâ 0,45** 0,44** -0,20** 0,12 0,13 -0,02 -0,07
Câutarea 0,33** -0,06 0,05 0,08 0,00 -0,08
suportului social
Acįiune prudentâ 0,18** 0,11 0,25** 0,07 0,13*
Acįiune 0,27** 0,40** 0,41** 0,42**
instinctivâ
Evitare 0,16* 0,09 -0,08
Acįiune indirectâ 0,60** 0,47**
Acįiune 0,60**
antisocialâ
Acįiune agresivâ
**Corelaįia este semnificativâ la pŭ0,01, *Corelaįia este semnificativâ la pŭ0,05, iar 1 (Acįiune asertivâ), 2 (Relaįionare socialâ),
3 (Câutarea suportului social), 4 (Acįiune prudentâ), 5 (Acįiune instinctivâ), 6 (Evitare), 7 (Acįiune indirectâ), 8 (Acįiune
antisocialâ), 9 (Acįiune agresivâ).
Observaįie. Pentru unele perechi de subscale, numârul persoanelor pe baza cârora s-a calculat coeficientul de corelaįie
este mai mic decât 257, din cauza omiterii unor râspunsuri.

În general, corelaįiile variazâ între valori
moderate ĩi mari.
Tabelul 5 aratâ faptul câ scalele care
descriu aceeaĩi dimensiune (de exemplu,
subscalele Relaįionare socialâ, Câutarea
suportului social, Acįiune prudentâ care descriu
dimensiunea prosocialâ a SACS) coreleazâ mai
bine între ele decât cu cele aflate pe alte
dimensiuni, descriind, de fapt, profilul
multifactorial al scalei.
Scalele prosociale (Câutarea suportului
social ĩi Relaįionare socialâ) coreleazâ negativ
(dar nesemnificativ) cu scalele antisociale
(Acįiune antisocialâ ĩi Acįiune agresivâ).
Scala Acįiune asertivâ coreleazâ negativ
semnificativ cu scala Evitare.
Totodatâ, apar corelaįii pozitive, semni-
ficative între scalele considerate de autori ca
fiind caracteristice unei anumite dimensiuni:
coreleazâ pozitiv semnificativ, la pŭ0,01,
Acįiune antisocialâ ĩi Acįiune agresivâ (0,60), iar
Relaįionare socialâ coreleazâ pozitiv semni-
ficativ, la pŭ0,01, cu Câutarea suportului social
(0,45) ĩi Acįiune prudentâ (0,44). Este interesant
faptul câ apare o corelaįie pozitivâ moderatâ,
dar semnificativâ, atât între subscalele Acįiune
asertivâ ĩi Acįiune agresivâ, cât ĩi între
subscalele Acįiune asertivâ ĩi Relaįionare socialâ.
Acest lucru este în concordanįâ cu ipotezele
autorilor versiunii originale conform cârora
coping-ul activ-asertiv poate sâ se manifeste
atât prosocial, cât ĩi antisocial, în funcįie de
context ĩi de caracteristicile stresorului.

26
 Apoi, este interesant faptul câ subscala
Acįiune indirectâ coreleazâ pozitiv semnificativ
cu scalele Acįiune antisocialâ, Acįiune agresivâ,
Acįiune prudentâ. Dimensiunea direct-indirectâ
a coping-ului pare a se asocia atât cu aspectele
prosociale, cât ĩi cu cele antisociale ale coping-
ului, ipotezâ susįinutâ de autori în versiunea
originalâ (Monnier ĩi colab., 1998), dar
neconfirmatâ de datele obįinute de aceĩtia.
Rezultatele obįinute pe eĩantionul
românesc aratâ câ o abordare indirectâ a
situaįiei problematice poate sâ se asocieze cu o
atitudine prosocialâ, în acord cu ipotezele
autorilor americani, conform literaturii de
specialitate cu privire la cultura non
occidentalâ (Dressler, 1985), dar ĩi cu o
atitudine antisocialâ. Aceasta din urmâ se
poate interpreta prin faptul câ, în general,
acįiunea indirectâ („în spatele scenei”) poate fi
asociatâ atât cu intenįii antisociale, cât ĩi cu
intenįii prosociale.
Astfel, în general, putem concluziona câ
multidimensionalitatea SACS este susįinutâ de
intercorelaįiile subscalelor sale.
Analiza factorialâ
Ne-am pus întrebarea dacâ strategiile de
coping ale participanįilor exprimâ, într-adevâr,
modelul multiaxial al coping-ului.
S-a fâcut analiza factorialâ asupra scalelor
din SACS prin metoda Componentelor principale
ĩi a rotaįiei Varimax, pe sexe, în eĩantionul
clinic ĩi în cel non-clinic (Vezi Anexa 1).
Eĩantionul non-clinic, Femei
Au fost extraĩi 3 factori, care acoperâ
69,21% din varianįa totalâ (F1: 30,56%;
F2:19,91%; F3:18,74%).
Eĩantionul non-clinic, Bârbaįi
Au fost extraĩi 3 factori, care acoperâ
69,48% din varianįa totalâ (F1: 24,75%;
F2:23,77%; F3:20,96%).
Eĩantionul clinic, Femei
Au fost extraĩi 3 factori, care acoperâ
74,46% din varianįa totalâ (F1: 29,25%;
F2:27,49%; F3:17,72%).
Eĩantionul clinic, Bârbaįi
Au fost extraĩi 3 factori, care acoperâ
69,21% din varianįa totalâ (F1: 27,56%;
F2:23,84%; F3:16,74%).
În eĩantionul non-clinic, pentru ambele
sexe ĩi în eĩantionul clinic pentru femei,
structura factorialâ pentru scalele din SACS
este identicâ. Au saturaįii mari în acelaĩi
factor:
x
scalele Relaįionare socialâ, Câutarea
suportului social ĩi Acįiune prudentâ (toate
au saturaįie pozitivâ);
x
scalele Acįiune instinctivâ, Acįiune indirectâ,
Acįiune antisocialâ ĩi Acįiune agresivâ (toate
au saturaįie pozitivâ);
x scalele Acįiune asertivâ ĩi Evitare (au
saturaįii de semn opus).
Rezultatele sunt similare celor obįinute
de Hobfoll ĩi colab. (1998), care, au identificat 3
factori care explicâ 66,6% din varianįâ: un
factor activ-antisocial (Acįiune agresivâ, Acįiune
antisocialâ, Acįiune instinctivâ), un factor activ-
prosocial (Relaįionare socialâ, Câutarea suportului
social, Acįiune prudentâ), un factor activ-pasiv
(Acįiune asertivâ ĩi Evitare). Acįiune indirectâ are
saturaįii mari pe factorul activ-antisocial.În
urma Analizei componentelor principale, reies, în
mod categoric, imagini similiare între
rezultatele din studiul american din 1998
(Monnier ĩi colab., 1998) ĩi cel românesc (Vezi
Tabelul 6). În toate eĩantioanele, factorii extraĩi
explicâ peste 60% din varianįâ.
Coping-ul activ versus coping-ul pasiv
reprezintâ o dimensiune validâ a coping-ului.
Singura excepįie apare în cazul eĩantionului
clinic, bârbaįi, unde Evitare are saturaįii mari
în factorul activ-prosocial. Studii ulterioare pe
27
populaįii clinice ar trebui realizate pentru a
vedea dacâ aceastâ excepįie este confirmatâ ĩi
în alte populaįii.
Coping-ul prosocial ĩi cel antisocial au
avut saturaįii mari în factori diferiįi. Aceasta
sugereazâ faptul câ oamenii pot sâ utilizeze fie
coping-ul prosocial, fie pe cel antisocial, fie
ambele strategii sau niciuna dintre aceste
strategii.
Rezultatele aratâ, aĩadar, existenįa unui
model multifactorial, în care scalele nu se
exclud exhaustiv reciproc. Rezultatele
autorilor americani (faptul câ scalele active-
antisociale ĩi active-prosociale vor avea
saturaįii în factori diferiįi ĩi nu într-un factor
comun antisocial-prosocial), precum ĩi
rezultatele obįinute pe eĩantioanele româneĩti
confirmâ una dintre tendinįele caracteristice
instrumentelor de evaluare a coping-ului. Deĩi
o scalâ multifactorialâ ar trebui sâ aibâ scale
care sunt independente unele de celelalte,
acest lucru poate sâ nu fie valabil în cazul
evaluârii coping-ului. (Folkman, Moskowitz,
2004) Aceasta se datoreazâ faptului câ, deĩi,
din punct de vedere teoretic se poate face o
distincįie clarâ între concepte, din punct de
vedere practic, aceastâ distincįie nu mai este
atât de evidentâ ĩi tipuri diferite de coping se
manifestâ împreunâ. Mai mult, strategiile de
coping nu se exclud reciproc în mod exhaustiv,
astfel dimensiunile antisociale ĩi prosociale se
pot manifesta la aceeaĩi persoanâ, dar în
situaįii, contexte ĩi relaįii diferite. Astfel,
afirmâ Folkman (2004, pag. 753), „a urmâri ca
subscalele sâ nu coreleze pentru a obįine o
puritate statisticâ, eliminând, de exemplu,
itemi care coreleazâ inter factori, ar putea avea
drept consecinįâ o diminuare a validitâįii
instrumentului.”
Aĩadar, aceste rezultate sunt, în general,
consecvente cu modelul teoretic propus.
S-ar pârea câ strategiile antisociale sunt
mult mai instinctive decât cele prosociale, care
sunt mai prudente. Aceasta ar susįine teoriile
conform cârora comportamentul prosocial
implicâ o abordare mult mai precautâ a
problemelor, întrucât presupune luarea în
considerare a nevoilor celorlaįi (Triandis ĩi
colab., 1990; Weisz ĩi colab., 1984).

Tabelul 6. Saturaįiile subscalelor din SACS în factorii extraĩi, versiunea americanâ

(Monnier ĩi colab., 1998)

Subscale SACS Factor activ-antisocial Factor activ-prosocial Factor activ-pasiv

Acįiune asertivâ 0,04 0,08 0,89*
Relaįionare socialâ -0,14 0,83* -0,11
Acįiune agresivâ 0,73* -0,01 0,35
Câutarea suportului social -0,28 0,73* 0,05
Acįiune prudentâ 0,34 0,69* 0,22
Evitare -0,07 -0,00 -0,82*
Acįiune antisocialâ 0,83* -0,22 -0,18
Acįiune instinctivâ 0,64* -0,14 0,24
Acįiune indirectâ 0,62* 0,37 -0,30
Varianįa reprezentatâ 26,5 21,6 18,5
Legendâ: * = saturaįie cel puįin egalâ cu 0,4.

28
 Analiza factorialâ a itemilor din
SACS, în eĩantionul non-clinic
Au fost extraĩi 14 factori, care acoperâ
66,515% din varianįa totalâ, vezi Anexa 2:
F1:8,579%; F2:7,569%; F3:6,023%;
F4:5,878%; F5:5,585%; F6:5,372%; F7:4,988%;
F8:3,948%; F9:3,853%; F10:3,370%; F11:3,284%;
F12:2,947%; F13:2,805%; F14:2,316%.
S-a urmârit dacâ itemii care fac parte din
aceeaĩi subscalâ au cea mai mare saturaįie în
acelaĩi factor.
Itemii din subscalele Câutarea suportului
social ĩi Evitare îndeplinesc aceastâ condiįie.
Pentru subscala Relaįionare socialâ, un singur
item are cea mai mare saturaįie în alt factor
decât restul itemilor, iar pentru subscalele
Acįiune instinctivâ, Acįiune prudentâ, Acįiune
indirectâ ĩi Acįiune antisocialâ, doi itemi au cea
mai mare saturaįie în alt factor decât restul
itemilor. Aĩadar devierile de la structura
aĩteptatâ teoretic sunt relativ mici.
În cazul subscalelor Acįiune agresivâ,
Acįiune antisocialâ, Acįiune instinctivâ, Acįiune
indirectâ ĩi Acįiune asertivâ, itemi care fac parte
din douâ subscale au saturaįii mari în acelaĩi
factor, în urmâtoarele combinaįii: itemi din
scalele Acįiune agresivâ ĩi Acįiune antisocialâ,
itemi din scalele Acįiune agresivâ ĩi Acįiune
instinctivâ, itemi din scalele Acįiune antisocialâ
ĩi Acįiune indirectâ, itemi din scalele Acįiune
asertivâ ĩi Acįiune agresivâ.
O explicaįie posibilâ ar fi câ distincįia
dintre concepte la nivel teoretic nu mai este
atât de evidentâ la nivel practic, deoarece mai
multe stiluri de coping se pot manifesta
împreuna. În acest caz, itemii „devianįi” fac
parte din subscalele care mâsoarâ copingul
activ-antisocial, între care s-au gâsit corelaįii
moderate ĩi ridicate.
Structura variantei româneĩti a SACS se
suprapune într-o mare mâsurâ peste structura
teoreticâ propusâ de Hobfoll ĩi colab. (1998) în
cazul adulįilor din populaįia generalâ.
Structura sa mai eterogenâ indicâ necesitatea
unor studii suplimentare, eventual cu un
numâr mai mare de participanįi.
SACS ĩi COPE
Pentru a determina mâsura în care scalele
SACS se suprapun cu alte mâsurâtori ale
copingului, s-a administrat COPE simultan cu
SACS unui grup de 25 de adulįi din populaįia
generalâ, cu vârsta cuprinsâ între 18 ĩi 24 de
ani.
COPE include 14 scale, însâ doar 8 vor fi
luate în considerare aici Ŧ cele care se referâ în
mod special la coping activ versus coping
pasiv ĩi la coping social. Acestea sunt: Coping-
ul activ, Planificarea, Reįinerea de la acįiune,
Câutarea suportului social instrumental, Câutarea
suportului emoįional, Pasivitatea comportamen-
talâ, Negarea ĩi Pasivitatea mentalâ.
S-au calculat coeficienįii de corelaįie
liniarâ Pearson între aceste scale ĩi subscalele
din SACS. Rezultatele sunt prezentate în
tabelul 7.
Coping-ul activ din COPE a corelat pozitiv
semnificativ cu subscalele Acįiune asertivâ,
Relaįionare socialâ ĩi Acįiune indirectâ din SACS.
Scala Planificare din COPE a corelat
pozitiv semnificativ cu subscalele Acįiune
asertivâ, Relaįionare socialâ ĩi Acįiune prudentâ.
Scala Reįinerea de la acįiune a corelat
pozitiv semnificativ cu subscala Acįiune
prudentâ din SACS.
Scala Câutarea suportului social instru-
mental din COPE a corelat pozitiv semnificativ
cu subscalele Acįiune asertivâ, Relaįionare
socialâ, Acįiune prudentâ, Acįiune indirectâ din
COPE.
29
 Pasivitatea comportamentalâ din COPE a
corelat pozitiv semnificativ cu subscalele
Evitare ĩi Acįiune prudentâ din SACS.
Subcala Evitare a mai corelat pozitiv
semnificativ cu scalele Negare (0,57*) ĩi
Pasivitate mentalâ (0,61*).
În general, componentele active (Coping
activ, Planificare, Câutarea suportului social
instrumental), respectiv cele pasive (Pasivitate
comportamentalâ, Negare) ale chestionarului
COPE s-au asociat cu componentele active
(Acįiune asertivâ), respectiv pasive (Evitare) ale
scalei SACS. Mai mult, subscalele prosociale
ale SACS (Relaįionare socialâ, Acįiune prudentâ)
s-au asociat cu componentele active ale
chestionarului COPE (Coping activ, Planificare
ĩi Câutarea suportului social instrumental). Face
excepįie subscala Acįiune prudentâ, care nu
coreleazâ cu Coping activ. Este interesant de
observat câ Acįiune indirectâ s-a asociat cu
scalele Coping activ ĩi Câutarea suportului social
instrumental, ceea ce este în concordanįâ cu
prezumįiile autorilor versiunii originale, ĩi
anume faptul câ dimensiunea indirectâ a
coping-ului are o componentâ activâ,
presupune investirea de eforturi pentru
atingerea scopurilor. În studiul original de
validare, dimensiunea indirectâ s-a asociat cu
strategia activâ de planificare din COPE, ceea
ce ar susįine faptul câ dimensiunea indirectâ
nu este pasivâ, ci poate fi proactivâ (Weisz ĩi
colab., 1984).

Tabelul 7. Coeficienįii de corelaįie liniarâ între scalele COPE ĩi scalele SACS

COPE SACS
1 2 3 4 5 6 7 8 9
Coping activ 0,49* 0,48* 0,24 0,13 -0,16 -0,16 0,42* -0,30 -0,07

Planificare 0,46* 0,50* 0,15 0,41* -0,22 -0,18 0,09 -0,14 0,03

Reįinerea de la 0,00 0,39 0,35 0,55** -0,17 0,10 0,07 -0,04 -0,09
acįiune
Câutarea suportului 0,53* 0,58** 0,38 0,67** -0,18 -0,14 0,41* -0,16 -0,29
social instrumental
Câutarea suportului 0,21 0,30 0,33 0,23 -0,21 -0,06 0,11 -0,05 0,03
social emoįional
Pasivitatea 0,01 0,10 -0,21 0,49* 0,10 0,49* 0,42 0,33 0,30
comportamentalâ
**Corelaįia este semnificativâ la pŭ0,01, *Corelaįia este semnificativâ la pŭ0,05, iar 1 (Acįiune asertivâ), 2 (Relaįionare socialâ),
3 (Câutarea suportului social), 4 (Acįiune prudentâ), 5 (Acįiune instinctivâ), 6 (Evitare), 7 (Acįiune indirectâ), 8 (Acįiune
antisocialâ), 9 (Acįiune agresivâ)

SACS ĩi Chestionarul de coping CERQ este un chestionar care, spre

cognitiv-emoįional (CERQ) deosebire de alte chestionare de coping
existente, îĩi propune evaluarea exclusivâ a
Pentru a determina mâsura în care strategiilor de coping cognitiv-emoįional pe
subscalele SACS se suprapun cu alte care o persoanâ le foloseĩte dupâ ce trâieĩte un
mâsurâtori ale copingului, s-a administrat eveniment negativ.
Chestionarul de coping cognitiv-emoįional (CERQ) SACS este un instrument care evalueazâ
simultan cu SACS unui grup de 105 adulįi din dimensiunea comportamentalâ a coping-ului.
populaįia generalâ.
30
 Deĩi cele douâ instrumente mâsoarâ
acelaĩi construct (strategiile de coping), acestea
įintesc dimensiuni diferite ale constructului:
dimensiunea comportamentalâ (SACS) ĩi
dimensiunea cognitivâ (CERQ).
S-a fâcut analiza factorialâ asupra scalelor
din cele douâ instrumente, prin metoda
Componentelor principale ĩi rotaįie Varimax.
Eĩantionul a fost format din 105 persoane
(43 de bârbaįi, 60 de femei ĩi 2 persoane care
nu au completat rubrica „sex”), cu vârsta
cuprinsâ între 20 ĩi 67 de ani (m=38,21;
Ƴ=12,50).
Au fost extraĩi 6 factori, care acoperâ
68,98% din varianįa totalâ (F1: 13,78%;
F2:12,63%; F3:12,35%; F4: 10,83%; F5:10,80%;
F6:8,58%)

Tabelul 8. Saturaįiile factorilor extraĩi pentru subscalele din SACS ĩi scalele din CERQ

Scala Factor
F1 F2 F3 F4 F5 F6
Acįiune asertivâ 0,179 0,120 0,079 0,871 0,011 0,002
Relaįionare socialâ 0,061 0,851 0,109 0,004 0,063 0,001
Câutarea suportului social 0,068 0,837 -0,012 0,196 -0,033 0,005
Acįiune prudentâ -0,029 0,754 0,093 -0,234 0,064 -0,054
Acįiune instinctivâ 0,244 0,087 0,520 -0,437 0,028 -0,347
Evitare -0,005 0,111 0,106 -0,851 -0,060 -0,139
Acįiune indirectâ -0,018 0,156 0,750 -0,115 0,010 -0,015
Acįiune antisocialâ -0,002 -0,192 0,846 -0,040 0,072 0,057
Acįiune agresivâ 0,129 0,268 0,718 0,233 0,062 -0,085
Autoculpabilizare 0,017 -0,025 0,136 0,113 0,841 0,014
Acceptare 0,228 0,223 -0,141 0,051 0,659 0,063
Ruminare 0,176 -0,042 0,102 -0,099 0,746 0,110
Refocalizare pozitivâ 0,662 -0,034 0,194 0,140 -0,087 0,159
Refocalizare pe planificare 0,818 -0,050 -0,056 -0,008 0,174 0,009
Reevaluare pozitivâ 0,851 0,072 -0,049 0,006 0,128 -0,117
Punerea în perspectivâ 0,662 0,137 0,088 0,038 0,225 0,086
Catastrofarea 0,087 -0,172 0,087 0,261 0,344 0,710
Culpabilizarea celorlalįi 0,061 0,079 -0,122 -0,004 -0,009 0,908

Subscalele din SACS au saturaįii mari în 1. verificarea capacitâįilor subscalelor de a

alįi factori decât cei în care au saturaįii mari discrimina între populaįia clinicâ ĩi non-
scalele din CERQ (tabelul 8), ceea ce înseamnâ clinicâ; între populaįia masculinâ ĩi
câ scalele din cele douâ instrumente mâsoarâ femininâ, în funcįie de teoriile din
aspecte diferite ale copingului. literatura de specialitate;
2. analiza corelaįiilor dintre scorurile la SACS
Validitatea de criteriu ĩi la alte instrumente de mâsurare a
anumitor condiįii psihopatologice.
Evaluarea validitâįii de criteriu a sub-
scalelor SACS a fost realizatâ prin:

31
 Pentru a stabili validitatea unui test,
proprietâįile sale discriminative sunt foarte
importante. Atunci când se aĩteaptâ ca scale
specifice sâ aibâ medii mai mari în populaįii
specifice, acest lucru ar trebui sâ se reflecte în
diferenįe între mediile scorurilor.
Conform literaturii referitoare la SACS
(Dunahoo ĩi colab., 1998) este de aĩteptat ca
bârbaįii sâ utilizeze mai mult decât femeile
strategii de coping antisocial ĩi acįiuni
agresive, în timp ce femeile sâ utilizeze mai
mult strategii de coping prosocial. Între bârbaįi
ĩi femei nu ar trebui sâ aparâ deosebiri în
privinįa dimensiunii activ-pasiv.
În tabelele 9 ĩi 10 se aratâ comparaįiile
între mediile scorurilor la subscalele SACS,
pentru grupul de femei ĩi grupul de bârbaįi,
din eĩantionul de adulįi din populaįia generalâ
ĩi din eĩantionul din populaįia clinicâ.
Comparaįie între sexe, în cadrul
eĩantioanelor
Pentru fiecare eĩantion s-au comparat
mediile scalelor între bârbaįi ĩi femei, folosind
testul t pentru eĩantioane independente.

Eĩantion clinic
Tabelul 9. Compararea mediilor scorurilor subscalelor între sexe, în eĩantionul clinic

Subcala Bârbaįi Femei t g.l. p

(N=50) (N=61)
m Ƴ m Ƴ
Acįiune asertivâ 30,70 5,79 29,49 5,32 1,143 109 0,255
Relaįionare socialâ 17,24 4,90 17,41 4,96 0,180 109 0,857
Câutarea suportului social 22,24 6,44 22,67 7,06 0,334 109 0,739
Acįiune prudentâ 17,72 4,51 17,44 4,04 0,342 109 0,733
Acįiune instinctivâ 20,82 4,72 20,48 5,30 0,358 109 0,721
Evitare 18,10 5,11 18,05 5,94 0,048 109 0,962
Acįiune indirectâ 9,86 3,06 11,08 3,94 1,793 109 0,076
Acįiune antisocialâ 11,22 3,55 11,97 4,55 0,949 109 0,345
Acįiune agresivâ 13,34 3,46 14,16 4,81 1,047 107 0,298

În populaįia clinicâ, mediile scorurilor posibilele diferenįe între coping-ul folosit de

subscalelor nu diferâ semnificativ, la pragul bârbaįi ĩi de femei.
p=0,05, între bârbaįi ĩi femei. O posibilâ Rezultatele aratâ, însâ, diferenįe semnifi-
explicaįie ar fi faptul câ severitatea simpto- cative în ce priveĩte coping-ul între bârbaįi ĩi
melor în populaįia clinicâ diminueazâ femei în cadrul eĩantionului non clinic.

32
 Eĩantion non-clinic
Tabel 10. Compararea mediilor scorurilor subscalelor între sexe, în eĩantionul non-clinic

Subcala Bârbaįi Femei t(270) g.l. p

(N=144) (N=195)
m Ƴ m Ƴ
Acįiune asertivâ 32,99 4,42 33,28 5,38 0,555 333 0,579
Relaįionare socialâ 15,77 3,65 16,00 3,94 0,546 337 0,586
Câutarea suportului social 19,88 5,61 22,32 5,78 3,904 337 0,000
Acįiune prudentâ 16,83 3,64 17,09 3,40 0,673 337 0,501
Acįiune instinctivâ 19,26 4,27 18,92 4,58 0,683 337 0,495
Evitare 13,75 4,39 13,58 4,58 0,345 337 0,731
Acįiune indirectâ 11,55 3,74 10,13 3,70 3,465 337 0,001
Acįiune antisocialâ 13,20 4,28 11,47 4,21 3,710 337 0,000
Acįiune agresivâ 14,28 3,79 12,96 3,46 3,349 337 0,001

În eĩantionul non-clinic mediile scoru-
rilor subscalelor diferâ semnificativ, la pragul
p=0,001, între bârbaįi ĩi femei, pentru
subscalele Câutarea suportului social (media
scorurilor este mai mare pentru femei), Acįiune
indirectâ (media scorurilor este mai mare
pentru bârbaįi), Acįiune antisocialâ (media
scorurilor este mai mare pentru bârbaįi) ĩi
Acįiune agresivâ (media scorurilor este mai
mare pentru bârbaįi). Aĩadar, femeile
utilizeazâ mai mult strategii prosociale, iar
bârbaįii folosesc mai ales strategii antisociale.
Nu s-au raportat diferenįe semnificative
pentru subscalele Acįiune asertivâ ĩi Evitare,
care evalueazâ dimensiunea activ-pasiv a
copingului, ceea ce corespunde datelor
obįinute de autori în studiile originale de
validare (Monnier ĩi colab., 1998). În studiul
original de validare (Dunahoo ĩi colab., 1998),
au fost gâsite diferenįe semnificative ale
mediilor scorurilor între bârbaįi ĩi femei, la
subscalele Relaįionare socialâ (media a fost mai
mare pentru femei), Câutarea suportului social
(media a fost mai mare pentru femei), Acįiune
indirectâ (media a fost mai mare pentru
bârbaįi), Acįiune antisocialâ (media a fost mai
mare pentru bârbaįi) ĩi Acįiune agresivâ (media
a fost mai mare pentru bârbaįi).
În baza acestor rezultate, scalele SACS
dovedesc câ au proprietâįi discriminative în
acord cu asumpįiile autorilor versiunii
americane.
SACS ĩi alte dimensiuni ale psiho-
patologiei (PDSQ) (Chestionarul de
screening ĩi diagnostic psihiatric)
Pentru a stabili dacâ strategiile de coping
se asociazâ mai frecvent cu scoruri mari pe
diferite dimensiuni ale psihopatologiei, s-au
administrat SACS ĩi Chestionarul de screening ĩi
diagnostic psihiatric (PDSQ) în rândul unui
eĩantion extras din populaįia clinicâ. Grupul
clinic a fost alcâtuit din 111 pacienįi psihiatrici
Coeficienįii de corelaįie sunt prezentaįi în
Tabelul 11, pentru lotul clinic.

Tabelul 11. Coeficienįii de corelaįie liniarâ între subscalele SACS ĩi subscalele din PDSQ

33
 Subscale PDSQ Subscala SACS
1 2 3 4 5 6 7 8 9
Tulburare depresivâ -0,177* -0,065 -0,078 0,078 0,003 0,192* 0,045 0,170* 0,099
majorâ
Stres posttraumatic -0,071 0,043 0,009 0,055 0,002 0,152 0,055 0,070 0,013
Mâncat compulsiv -0,112 -0,071 -0,046 -0,017 -0,008 -0,089 -0,023 -0,055 -0,010
Tulburare obsesiv – -0,052 0,105 -0,031 0,264* 0,160 0,254* -0,002 -0,005 -0,009
compulsivâ
Tulburare de panicâ -0,100 0,052 -0,042 0,179* 0,016 0,242* -0,011 -0,009 0,025
Psihozâ -0,030 -0,137 -0,181* -0,007 0,094 0,268* -0,004 0,075 0,089
Agorafobie -0,099 -0,064 -0,068 0,074 0,039 0,187* 0,007 0,052 0,114
Fobie socialâ -0,205* -0,031 -0,106 -0,004 -0,009 0,223* 0,012 0,059 0,032
Dependenįâ/Abuz de 0,128 0,060 0,056 0,198* 0,074 0,065 -0,049 -0,059 -0,054
alcool
Dependenįâ/Abuz de -0,067 -0,023 -0,026 -0,076 0,133 0,150 -0,006 0,132 0,178*
medicamente
Anxietate -0,111 0,082 0,066 0,166 0,041 0,223* 0,142 0,091 0,184*
generalizatâ
Tulburare de -0,269* 0,037 0,003 0,110 -0,078 0,172* 0,000 0,003 -0,043
somatizare
Ipohondrie -0,165 -0,061 -0,085 0,210* 0,084 0,295* -0,004 0,062 0,090
**Corelaįia este semnificativâ la pŭ0,01, *Corelaįia este semnificativâ la pŭ0,05, iar 1 (Acįiune asertivâ), 2 (Relaįionare socialâ),
3 (Câutarea suportului social), 4 (Acįiune prudentâ), 5 (Acįiune instinctivâ), 6 (Evitare), 7 (Acįiune indirectâ), 8 (Acįiune
antisocialâ), 9 (Acįiune agresivâ).

În cazul grupului clinic, scala Evitare a anxietate ale PDSQ.

corelat semnificativ cu mai multe dimensiuni
psihopatologice (vezi Tabel 11). În acelaĩi
timp, strategia adaptativâ Acįiune asertivâ a
corelat negativ semnificativ cu Tulburarea
depresivâ majorâ, Fobia socialâ ĩi Tulburarea de
somatizare. Strategiile de coping social au
corelat negativ cu scalele de depresie ĩi
Aceste date susįin faptul câ anumite
strategii de coping se asociazâ mai frecvent cu
anumite condiįii psihopatologice ĩi câ un
coping asertiv, prosocial ar reprezenta un
aspect important al sânâtâįii mentale (Monnier
ĩi colab., 1998; Folkman, Moskowitz, 2004).

34
 Capitolul 5


Etalonarea SACS

Interpretarea scorurilor la subscalele
SACS
Pentru toate subscalele SACS este valabil
urmâtorul fapt: cu cât scorul este mai mare la o
anumitâ subscalâ, cu atât persoana în cauzâ
utilizeazâ în mai mare mâsurâ acea strategie
de coping comportamental.
Date despre eĩantionul folosit la
etalonare
Adulįi din populaįia generalâ
Pentru acest eĩantion, chestionarele au
fost aplicate în perioada februarie-octombrie
2010 unor adulįi din populaįia generalâ.
Participanįii au fost preponderent din mediul
urban, din judeįele Cluj, Bihor, Maramureĩ,
Iaĩi, Bacâu. Completarea chestionarelor s-a
realizat pe bazâ de voluntariat. Au fost reįinuįi
în eĩantionul utilizat la etalonare numai
participanįii care au râspuns la toįi itemii din
SACS. Eĩantionul final a constat din 339 de
adulįi cu vârsta între 18 ĩi 80 ani, dintre care
144 au fost bârbaįi ĩi 195 femei. Media de
vârstâ a fost de 30,02 de ani, iar abaterea
standard a fost 13,21. Dintre persoanele care au
oferit informaįii referitoare la nivelul de
educaįie, peste 60% au cel puįin liceul absolvit.
Tabelul 12 oferâ o descriere a
eĩantionului extras din populaįia generalâ,
folosit pentru etalonare.
Din cauza existenįei diferenįelor între
sexe la mai multe subscale din SACS (vezi
tabelul 10), etaloanele au fost construite pe
sexe.
Pentru a decide dacâ este necesarâ
construirea etaloanelor pe grupe de vârstâ, s-
au calculat coeficienįii de corelaįie liniarâ între
scorurile subscalelor din SACS ĩi vârstâ
(tabelul 13).

Tabel 12. Structura eĩantionului de subiecįi

N Vârsta
minim maxim m Ƴ
Bârbaįi 144 18 75 29,40 12,42
Femei 195 18 80 30,48 13,79
Total 339 18 80 30,02 13,21

35
 Tabelul 13. Corelaįiile liniare între scorurile subscalelor ĩi vârstâ, pe sexe

Subscala Bârbaįi Femei

(N=144) (N=195)
r p r p
Acįiune asertivâ -0,157 0,060 -0,062 0,389
Relaįionare socialâ -0,197 0,018 -0,136 0,058
Câutarea suportului social -0,227 0,006 -0,089 0,216
Acįiune prudentâ -0,214 0,010 -0,159 0,027
Acįiune instinctivâ 0,259 0,002 -0,068 0,342
Evitare 0,190 0,023 -0,009 0,896
Acįiune indirectâ -0,085 0,309 -0,187 0,009
Acįiune antisocialâ -0,009 0,913 -0,170 0,018
Acįiune agresivâ 0,066 0,434 -0,122 0,089

Pentru ambele sexe, existâ mai multe ani Ŧ 40 de ani ĩi 41 de ani – 80 de ani, atunci,
subscale care coreleazâ liniar cu vârsta, pentru ambele sexe, existâ mai multe subscale
semnificativ la pragul p=0,05. ale câror medii ale scorurilor diferâ semni-
Dacâ se formeazâ grupele de vârstâ 18 ficativ între grupele de vârstâ (tabelul 14).

Tabelul 14. Compararea mediilor subscalelor din SACS între grupele de vârstâ 18-40 de ani ĩi 41-75 de ani

Bârbaįi
Subscala 18-40 de ani 41-75 de ani t(270) g.l. p
(N=116) (N=28)
m Ƴ m Ƴ
Acįiune asertivâ 33,39 4,25 31,32 4,78 2,253 142 0,026
Relaįionare socialâ 16,16 3,36 14,18 4,38 2,626 142 0,010
Câutarea suportului social 20,64 5,49 16,71 5,05 3,447 142 0,001
Acįiune prudentâ 17,28 3,36 14,96 4,19 3,121 142 0,002
Acįiune instinctivâ 18,84 4,27 21,00 3,88 2,448 142 0,016
Evitare 13,28 4,17 15,68 4,85 2,641 142 0,009
Acįiune indirectâ 11,67 3,82 11,04 3,37 0,808 142 0,420
Acįiune antisocialâ 13,16 4,24 13,39 4,52 0,263 142 0,793
Acįiune agresivâ 14,17 3,65 14,75 4,39 0,722 142 0,471

36
 Femei
Subscala 18-40 de ani 41-80 de ani t(270) g.l. p
(N=152) (N=43)
m Ƴ m Ƴ
Acįiune asertivâ 33,38 5,29 32,95 5,74 0,453 193 0,651
Relaįionare socialâ 16,28 3,70 15,02 4,64 1,851 193 0,066
Câutarea suportului social 22,64 5,85 21,21 5,44 1,435 193 0,153
Acįiune prudentâ 17,28 3,36 16,44 3,48 1,425 193 0,156
Acįiune instinctivâ 19,15 4,34 18,12 5,33 1,310 193 0,192
Evitare 13,53 4,68 13,77 4,25 0,304 193 0,761
Acįiune indirectâ 10,47 3,82 8,95 3,03 2,395 193 0,018
Acįiune antisocialâ 11,88 4,32 10,05 3,48 2,548 193 0,012
Acįiune agresivâ 13,22 3,62 12,02 2,65 2,404 91 0,018

Dar numârul de subiecįi redus nu a subscalele Câutarea suportului social (media

permis construirea etaloanelor pentru grupa
de vârstâ 41-80 de ani. Din acest motiv, s-au
construit etaloane numai pentru grupa de
vârstâ 18-40 de ani.
Ĩi pentru grupa de vârstâ 18-40 de ani
mediile scorurilor diferâ semnificativ, la
pragul p=0,05, între bârbaįi ĩi femei, pentru
scorurilor este mai mare pentru femei), Acįiune
indirectâ (media scorurilor este mai mare
pentru bârbaįi), Acįiune antisocialâ (media
scorurilor este mai mare pentru bârbaįi) ĩi
Acįiune indirectâ (media scorurilor este mai
mare pentru bârbaįi) (tabelul 15).

Tabelul 15. Compararea mediilor scorurilor subscalelor între sexe, pentru grupa de vârstâ 18-40 de ani

Subscala Bârbaįi Femei t(270) g.l. p

(N=116) (N=152)
m Ƴ m Ƴ
Acįiune asertivâ 33,39 4,25 33,38 5,29 0,022 266 0,983
Relaįionare socialâ 16,16 3,36 16,28 3,70 0,276 266 0,782
Câutarea suportului social 20,64 5,49 22,64 5,85 2,848 266 0,005
Acįiune prudentâ 17,28 3,36 17,28 3,36 0,020 266 0,984
Acįiune instinctivâ 18,84 4,27 19,15 4,34 0,593 266 0,554
Evitare 13,28 4,17 13,53 4,68 0,439 266 0,661
Acįiune indirectâ 11,67 3,82 10,47 3,82 2,561 266 0,011
Acįiune antisocialâ 13,16 4,24 11,88 4,32 2,421 266 0,016
Acįiune agresivâ 14,17 3,65 13,22 3,62 2,121 266 0,035

37
 Etalonarea
S-au fâcut etaloane separate pentru
femeile ĩi bârbaįii care aparįin populaįiei
generale cu vârsta cuprinsâ între 18 ĩi 40 de
ani. Etaloanele se regâsesc la sfârĩitul acestui
capitol, în Anexa 3.
În secįiunea „Interpretarea scorurilor la
subscalele din SACS”, care se gâseĩte în cadrul
acestui capitol, ne vom referi la interpretarea
scorurilor ĩi la semnificaįia practicâ a
subscalelor SACS.
Pentru interpretarea scorului obįinut de
un subiect la o subscalâ din SACS se
transformâ acesta în cotâ T, utilizând formula:
T 50  10 x V m
unde:
T reprezintâ cota T corespunzâtoare
scorului x;
m ĩi Ƴ sunt media ĩi abaterea standard
pentru scorurile subscalei corespunzâtoare
sexului subiectului.
În Anexa 3, pentru fiecare subscalâ din
SACS existâ câte un tabel care conįine cotele T
corespunzâtoare tuturor scorurilor brute
posibile ĩi intervalele de încredere ale
scorurilor reale, pentru probabilitatea P=0,95.
Cotele T au fost determinate utilizându-se
mediile ĩi abaterile standard ale scorurilor
subscalelor care se gâsesc în tabelul 15.
Scorul real al unei persoane la un test este
media scorurilor pe care le-ar obįine persoana
respectivâ, dacâ i s-ar administra testul de o
infinitate de ori, în condiįii diferite. El este
interpretat ca fiind scorul pe care l-ar obįine
subiectul dacâ testul ar fi perfect ĩi ar fi
administrat în condiįii ideale.
Evident, scorul real al unei persoane la
38
un test nu poate fi cunoscut. Dar, ĩtiind scorul
pe care l-a obįinut persoana respectivâ la o
administrare a testului, se poate determina, cu
o probabilitate P aleasâ (de obicei, P=0,95),
intervalul în care existâ ĩanse de 100xP% sâ se
gâseascâ scorul real. Acest interval se numeĩte
interval de încredere al scorului real corespun-
zâtor probabilitâįii P.
Dacâ x este scorul obįinut de o persoanâ
la test ĩi se alege P=0,95, atunci intervalul de
încredere al scorului real este (x-1,96ƳE,
x+1,96ƳE), unde ƳE este eroarea standard de
mâsurâ a testului în populaįie.
ƳE se calculeazâ cu ajutorul coeficientului
de fidelitate al testului, Ʊ2, ĩi al abaterii
standard a scorurilor testului în eĩantionul de
subiecįi extras din populaįie, Ƴ, folosind
V E V 1 U 2
formula:
Intervalul de încredere al scorului real are
o lungime micâ, permiįând o localizare mai
precisâ a scorului real, atunci când eroarea
standard de mâsurâ a testului în populaįie este
micâ, ceea ce se întâmplâ doar dacâ testul are o
fidelitate mare (Ʊ2 este mare) ĩi scorurile sale în
eĩantionul extras din populaįie variazâ puįin (Ƴ
este mic).
Utilizarea cotelor T
Cotele T servesc la interpretarea
scorurilor subiectului la o subscalâ, prin
raportarea acestora la rezultatele obįinute de
persoanele din eĩantionul extras din populaįia
din care subiectul face parte (având în vedere
sexul sâu).
Cotele T mai mari decât 60 sunt
considerate „mari”, iar cele mai mici decât 40
sunt considerate „mici”. Cele cuprinse în
intervalul [40, 60] sunt considerate „medii”.
 Utilizarea intervalelor de încredere
ale scorurilor reale
Intervalele de încredere ale scorurilor
reale permit compararea persoanelor între ele.
Se poate considera câ douâ persoane se
deosebesc una de alta în ceea ce priveĩte
constructul mâsurat de o subscalâ, doar dacâ
intervalele de încredere ale scorurilor reale
corespunzâtoare cotelor brute ale acestor
persoane la subscalâ sunt disjuncte (nu au
porįiuni comune). Atunci când intervalele de
încredere ale scorurilor reale pentru douâ per-
soane se intersecteazâ, existâ posibilitatea ca
scorurile reale sâ se afle în porįiunea comunâ,
fiind egale, sau chiar într-o relaįie de ordine
opusâ celei în care se gâsesc scorurile obįinute
la subscalâ de câtre cele douâ persoane.
Instrucįiuni de utilizare a etaloanelor ĩi
a intervalelor de încredere
Atunci când folosiįi tabelele de transfor-
mare a scorurilor brute în cote T, selectaįi din
Anexa 3 tabelul potrivit, în funcįie de subscalâ.
Identificaįi cota T corespunzâtoare scorului
brut, prin localizarea în tabel a coloanei
potrivite corespunzâtoare sexului subiectului.
Urmaįi aceeaĩi procedurâ pentru toate
subscalele.
În funcįie de cota T corespunzâtoare
scorului brut obįinut, se poate evalua dacâ
acest scor este „mic/scâzut”, „mediu”,
„mare/ridicat”.
De exemplu, un bârbat în vârstâ de 30 de
ani a obįinut un scor brut de 21 la subscala
Acįiune asertivâ. Consultând tabelul de
conversie a scorurilor brute în cote T, consta-
tâm câ scorul 21 are drept corespondent cota T
de 20,85, deci o cotâ T mai micâ de 40. În acest
caz, un scor 21 pentru Acįiune asertivâ
intrâ la categoria „scâzut”. Aceasta înseamnâ –
comparativ cu grupul sâu de vârstâ ĩi de sex –
câ acest bârbat foloseĩte în mod redus strategia
de coping comportamental Acįiune asertivâ.
Selectaįi din Anexa 3 tabelul potrivit în
funcįie de subscalâ. Identificaįi intervalul de
încredere corespuzâtor scorului brut, prin
localizarea în tabel a coloanei potrivite în
funcįie de sexul subiectului. Urmaįi aceastâ
procedurâ pentru toate subscalele.
Exemplu:
O persoanâ de sex masculin de 28 de ani
a obįinut un scor brut de 34 la subscala Acįiune
asertivâ. Un alt bârbat de 37 de ani, a obįinut la
aceeaĩi subscalâ un scor de 37. Se poate afirma
câ primul bârbat foloseĩte mai puįin frecvent
strategii de coping asertiv decât cel ce-al doilea
bârbat?
Din Anexa 3 se citesc intervalele de
încredere ale scorurilor reale corespunzâtoare
probabilitâįii P=0,95.
x Pentru scorul 34: [29, 39]
x Pentru scorul 37: [32, 42]
Intervalele au o porįiune comunâ,
intervalul [32, 39]. Scorurile reale ale celor
douâ persoane se pot afla în acest interval,
fiind posibil ca scorul real al primei persoane
sâ fie mai mic, mai mare sau egal cu scorul real
al celei de-a doua persoane. În consecinįâ, nu
se poate afirma câ cel de-al doilea bârbat este
mai asertiv decât primul, chiar dacâ primul
bârbat are un un scor brut mai mic decât cel
de-al doilea.
Interpretarea scorurilor la subscalele
SACS
În cazul tuturor strategiilor de coping
comportamental, scorurile ridicate indicâ
utilizarea frecventâ a respectivei strategii, în
39
timp ce scorurile scâzute se referâ la utilizarea
mai redusâ a aceleiaĩi strategii.
O strategie de coping nu este funcįionalâ
sau disfuncįionalâ în sine, conteazâ frecvenįa
cu care este utilizatâ, perioada de timp ĩi
nivelul de control perceput asupra stresorului
în cauzâ. Totodatâ, interpretarea fâcutâ pe
baza scorurilor trebuie sâ fie personalizatâ în
funcįie de natura stresorului, severitatea
perceputâ a acestuia, de istoricul personal al
respondentului, de contextul ĩi de problemele
curente ale acestuia.
Interpretarea celor nouâ subscale
SACS
Acįiune asertivâ este o strategie de
coping comportamental prin care persoana
abordeazâ situaįia/problema stresantâ în mod
ferm, sincer ĩi direct. Aceasta exprimâ deschis
ceea ce simte, ce gândeĩte ĩi acįioneazâ în
consecinįâ, în concordanįâ cu propriile dorinįe
ĩi planuri. Îĩi urmâreĩte ferm interesele, fârâ a
le face râu celorlalįi.
Studiile (Folkman, Moskowitz, 2004)
aratâ câ aceasta este, în general, o strategie de
coping comportamental-funcįionalâ. Un scor
ridicat la aceastâ strategie se asociazâ, în
general, cu distres emoįional scâzut, iar un
scor scâzut se poate asocia cu probleme
emoįionale sau cu simptome psihopatologice.
Relaįionare socialâ este o strategie de
coping comportamental prin care persoana se
alâturâ altor oameni pentru a face faįâ
împreunâ situaįiei/problemei stresante. Ea se
implicâ în rezolvarea problemei împreunâ cu
ceilalįi, luând în considerare ĩi nevoile
acestora. Un scor ridicat indicâ utilizarea
frecventâ a acestei strategii. Un scor scâzut
40
indicâ o utilizare mai puįin frecventâ a acestei
strategii. În general, aratâ câ utilizarea
frecventâ a aceastei strategii poate avea efecte
pozitive asupra stârii emoįionale de bine
(Hobfoll ĩi colab., 2001).
Câutarea suportului social este o
strategie de coping comportamental prin care
persoana apeleazâ la alte persoane pentru
ajutor, sfaturi, informaįii ĩi sprijin emoįional,
în vederea ameliorârii sau a rezolvârii situaįiei
stresante. Ea se sfâtuieĩte cu familia ĩi cu
prietenii în legâturâ cu ceea ce are de fâcut. Un
scor ridicat indicâ utilizarea frecventâ a acestei
strategii. Un scor scâzut indicâ o utilizare mai
puįin frecventâ a acestei strategii. În general,
studiile (Monnier ĩi colab., 1998 ĩi Hobfoll ĩi
colab., 2001) aratâ câ un scor ridicat pentru
Câutarea suportului social poate fi asociat unui
nivel crescut al stârii emoįionale de bine.
Acįiune prudentâ este o strategie de
coping comportamental prin care persoana îĩi
evalueazâ atent opįiunile înainte de a acįiona
ĩi îĩi ia toate mâsurile de precauįie pentru a se
proteja de orice pericol. O acįiune prudentâ
poate implica ĩi o atentâ considerare a nevoilor
ĩi a sentimentelor celorlalįi, înainte de a trece
la acįiune. Un scor ridicat indicâ utilizarea
frecventâ a acestei strategii. Un scor scâzut
indicâ o utilizare mai puįin frecventâ a acestei
strategii.
Acįiune instinctivâ este o strategie de
coping comportamental prin care persoana
abordeazâ problema/situaįia stresantâ, bazân-
du-se, în primul rând, pe propriile intuiįii.
Aceasta reacįioneazâ impulsiv, aruncându-se
cu capul înainte, fârâ sâ se gândeascâ prea
mult la consecinįe. O acįiune instinctivâ poate
implica o mai slabâ considerare a celorlalįi ĩi a
nevoilor acestora. Un scor ridicat indicâ
utilizarea frecventâ a acestei strategii. Un scor
scâzut indicâ o utilizare mai puįin frecventâ a
acestei strategii.
Evitare este o strategie de coping
comportamental prin care persoana se
angajeazâ în alte activitâįi, pentru a nu se
confrunta cu problema/situaįia stresantâ.
Persoana reduce efortul sau abandoneazâ
angajarea în atingerea scopului sau în
înlâturarea stresorului. Aceasta se retrage sau
aĩteaptâ ca lucrurile sâ se rezolve de la sine.
Un scor ridicat indicâ utilizarea frecventâ a
acestei strategii. Un scor scâzut indicâ o
utilizare mai puįin frecventâ a acestei strategii.
Studiile (Folkma, Moskowitz, 2004) aratâ câ
evitarea este o strategie de coping disfunc-
įionalâ. Un scor ridicat la aceastâ strategie se
asociazâ, în general, cu distres emoįional
ridicat ĩi cu simptome psihopatologice.
Acįiune indirectâ este o strategie de
coping comportamental prin care persoana
preferâ sâ abordeze problema stresantâ în
mod „netransparent”, în spatele scenei. O
acįiune indirectâ implicâ influenįarea sau
manipularea mediului, a contextului sau a
altor persoane în vederea ameliorârii situaįiei
stresante. Abordarea indirectâ a stresorului
poate implica atât luarea în considerare, cât ĩi
neluarea în considerare a nevoilor celorlalįi.
Un scor ridicat indicâ utilizarea frecventâ a
acestei strategii. Un scor scâzut indicâ o
utilizare mai puįin frecventâ a acestei strategii.
Acįiune antisocialâ este o strategie de
coping comportamental prin care persoana
abordeazâ probleme/situaįii stresante, urmâ-
rindu-ĩi, în primul rând, propriile interese,
chiar dacâ acįiunile acesteia au consecinįe
negative asupra celorlalįi. Un scor ridicat
indicâ utilizarea frecventâ a acestei strategii.
Un scor scâzut indicâ o utilizare mai puįin
frecventâ a acestei strategii.
Acįiune agresivâ este o strategie de
coping comportamental prin care persoana
abordeazâ problemele/situaįiile stresante
rapid, decisiv, pentru a-i surprinde pe ceilalįi
cu garda jos. O acįiune agresivâ implicâ
intenįia de preluare a controlului cu orice preį,
dominarea ĩi dezarmarea celorlalįi. Un scor
ridicat indicâ utilizarea frecventâ a acestei
strategii. Un scor scâzut indicâ o utilizare mai
puįin frecventâ a acestei strategii.
CONCLUZII
Scala SACS evalueazâ râspunsurile
comportamentale ale persoanelor atunci când
se confruntâ cu situaįii sau probleme stresante.
Instrumentul este construit pornind de la
modelul multiaxial al coping-ului, creat de
Hobfoll ĩi colab. (1998) pentru a surprinde
diferenįele între bârbaįi ĩi femei, în ceea ce
priveĩte coping-ul, fârâ sâ favorizeze a priori
unul dintre sexe. Acest obiectiv a fost atins
prin adâugarea unei dimensiuni social-comu-
nitare.
Analiza factorialâ confirmâ o dimensiune
activ-pasivâ, o dimensiune activ-prosocialâ ĩi o
dimensiune activ-antisocialâ, pe care a avut
saturaįii mari ĩi subscala Acįiune indirectâ. Deĩi
o scalâ multifactorialâ ar trebui sâ aibâ
subscale care sunt independente unele faįâ de
celelalte, acest lucru nu este foarte posibil în
cazul instrumentelor de evaluare a coping-
ului. Strategiile de coping nu se exclud
reciproc în mod exhaustiv, dimensiunile
antisociale ĩi prosociale se pot manifesta la
aceeaĩi persoanâ, dar în situaįii, contexte ĩi
relaįii diferite.
Conform modelului teoretic, dimensi-
unea indirectâ ar trebui sâ se asocieze atât cu
41
coping-ul prosocial, cât ĩi cu cel antisocial.
Analiza factorialâ nu confirmâ, însâ, acest
lucru. Aceasta distinge dimensiunea indirectâ
de cea activ-pasivâ, dar o asociazâ doar cu
coping-ul activ-antisocial. Credem noi, însâ, câ
apelarea la un mod de abordare a problemei
direct sau indirect este dependentâ de situaįie.
Rezultatele referitoare la dimensiunea
indirect-directâ nu sunt foarte semnificative.
Aceasta se poate explica prin faptul câ scala
conįine o singurâ subscalâ care descrie aceastâ
dimensiune ĩi are o colecįie de itemi limitatâ.
Studii ulterioare sunt necesare în aceastâ
direcįie.
În concordanįâ cu studii anterioare pe
diferenįe de gen, care sugereazâ câ strategiile
de coping ale femeilor se diferenįiazâ de cele
ale bârbaįilor, în special prin tendinįa lor de a
utiliza strategii de adaptare de naturâ socialâ
(Kessler ĩi colab., 1985; Thoits, 1991), studiul
nostru aratâ câ femeile au tendinįa sâ fie mai
prosociale, iar bârbaįii mai antisociali. Datele
noastre aratâ câ femeile ĩi bârbaįii nu sunt
diferiįi în ceea ce priveĩte dimensiunea activ-
pasivâ.
Rezultatele referitoare la sex sunt
consistente cu predicįiile noastre. Rezultatele
noastre aratâ câ atât bârbaįii, cât ĩi femeile
utilizeazâ deseori strategii active atunci când
se confruntâ cu stresori, dar câ bârbaįii vor
acįiona mai probabil într-un mod în care poate
fi ostil faįâ de ceilalįi, în timp ce femeile vor
aborda problemele într-un mod care
presupune ĩi câutarea sprijinului celorlalįi sau
relaįionarea cu ceilalįi pentru a face faįâ.
Cele mai importante teorii ale perso-
nalitâįii descriu coping-ul social, activ ca fiind
un element important al sânâtâįii mentale
(Monnier ĩi colab., 1998).
42
O tendinįâ activâ, prosocialâ s-a asociat
mai frecvent cu niveluri scâzute de
psihopatologie, iar o tendinįâ evitativâ s-a
asociat mai frecvent cu niveluri crescute de
anxietate ĩi de depresie.
S-a evitat identificarea „in abstractio” a
celor nouâ tipuri de strategii, ca fiind
adaptative sau dezadaptative, deoarece
funcįionalitatea acestora poate fi influenįatâ de
caracteristicile persoanei care le utilizeazâ, de
mediul ĩi de relaįiile sociale în care aceasta
trâieĩte ĩi se manifestâ, de gradul de
controlabilitate al situaįiei. Strategiile de
coping nu sunt în sine bune sau rele (Lazarus
ĩi Folkman, 1984). Calitâįile adaptative ale
strategiilor de coping trebuie interpretate în
contexte cât mai specifice. Informaįiile oferite
de SACS pot sâ aducâ o valoare suplimentarâ
oricârui program de intervenįie, prevenįie sau
dezvoltare personalâ, deoarece surprind
strategiile de coping mult mai nuanįat, în
mediul social în care aceste strategii sunt, de
fapt, puse în practicâ. Acestea, apoi, pot fi
modificate, schimbate sau învâįate, în funcįie
de nevoile ĩi de scopurile personale.
Surprinderea dimensiunii sociale com-
portamentale a coping-ului aduce, astfel, o
valoare adâugatâ teoriei despre coping
raportat la diferenįe de gen.
Studiul nostru de standardizare aratâ câ
scala SACS este un instrument fidel ĩi valid
pentru evaluarea dimensiunii comportamen-
tale a coping-ului pe populaįia româneascâ.
Studii viitoare sunt necesare pentru a
clarifica relaįia dintre coping-ul indirect ĩi
anumite condiįii psihopatologice, între
anumite strategii de coping ĩi trâsâturile de
personalitate.
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 ANEXA 1

Saturaįiile scalelor din SACS în factorii extraĩi

Scala Eĩantion non-clinic Eĩantion clinic

Bârbaįi Femei Bârbaįi Femei

F1 F2 F3 F1 F2 F3 F1 F2 F3 F1 F2 F3

Acįiune asertivâ 0,043 0,110 -0,924 0,198 0,190 0,858 -0,150 0,087 0,904 0,416 0,188 -0,689

Relaįionare socialâ 0,843 0,078 0,049 0,045 0,828 -0,079 0,563 -0,316 0,504 0,045 0,923 0,010

Câutarea suportului 0,832 0,068 0,044 -0,077 0,714 0,037 0,739 -0,114 -0,147 -0,088 0,903 -0,090
social

Acįiune prudentâ 0,751 0,050 0,155 0,244 0,713 0,113 0,755 0,068 0,275 0,255 0,707 0,266

Acįiune instinctivâ 0,036 0,545 0,477 0,735 0,120 -0,202 0,420 0,504 0,426 0,732 -0,128 0,357

Evitare 0,331 0,093 0,822 0,159 0,109 -0,894 0,747 0,129 -0,177 0,033 0,244 0,891

Acįiune indirectâ 0,172 0,830 0,060 0,793 0,149 -0,039 0,521 0,570 0,199 0,662 0,435 -0,261

Acįiune antisocialâ -0,130 0,829 0,268 0,878 -0,050 0,055 -0,005 0,823 -0,231 0,830 0,065 -0,162

Acįiune agresivâ 0,317 0,656 -0,315 0,823 0,000 0,293 -0,138 0,865 0,180 0,849 0,054 -0,160

45
46
ANEXA 2
ȱ
Saturaįiile itemilor în cei 14 factori extraĩi

Subscala Item F1 F2 F3 F4 F5 F6 F7 F8 F9 F10 F11 F12 F13 F14

Acįiune 1 -0,158 0,058 0,075 -0,121 0,307 0,146 0,047 0,178 0,063 0,075 -0,059 0,004 0,669 -0,113
asertivâ 10 -0,627 -0,151 0,057 -0,092 0,166 -0,222 -0,116 -0,326 0,017 -0,007 -0,091 0,143 0,021 0,014
15 -0,736 0,154 0,122 -0,143 -0,029 0,084 -0,138 0,154 -0,047 0,064 0,138 -0,034 0,152 0,022
25 -0,347 -0,136 0,078 -0,231 0,037 -0,109 -0,303 0,142 0,035 -0,038 -0,455 -0,165 -0,162 0,115
26 -0,245 0,060 -0,169 0,129 0,291 0,441 0,204 0,175 0,293 0,007 0,113 -0,005 -0,011 0,161
33 -0,510 0,073 -0,076 0,001 0,055 -0,036 -0,048 0,029 -0,085 -0,076 -0,037 -0,158 0,222 -0,614
50 -0,081 0,129 0,374 -0,151 0,645 -0,084 0,115 -0,010 0,038 -0,105 -0,084 -0,115 -0,063 -0,091
51 -0,032 0,068 -0,066 0,006 0,718 0,223 -0,059 -0,019 0,018 0,199 0,091 0,117 0,039 0,016
52 -0,199 -0,042 0,017 0,107 0,614 0,062 0,046 0,172 0,183 0,030 -0,077 -0,047 0,255 0,149
Relaįionare 17 0,008 0,473 -0,170 0,186 0,218 0,375 -0,018 -0,064 -0,059 0,213 0,060 -0,029 -0,109 -0,013
socialâ 23 0,071 0,087 -0,048 0,115 0,139 0,811 0,037 0,108 0,058 0,067 0,156 0,081 -0,145 0,009
24 0,100 0,161 -0,033 0,153 0,106 0,590 -0,015 -0,191 0,369 -0,000 0,175 0,018 -0,002 -0,225
30 0,067 0,135 0,094 -0,030 -0,030 0,746 -0,014 0,042 -0,004 0,011 -0,013 0,055 0,229 0,120
41 -0,014 0,290 -0,009 -0,034 0,006 0,601 -0,180 0,166 0,288 0,046 -0,315 0,026 0,078 -0,090
Câutarea 2 0,004 0,726 0,049 -0,102 -0,014 -0,026 0,004 -0,070 0,061 0,049 -0,021 -0,026 0,288 -0,135
suportului 9 -0,035 0,557 0,002 -0,178 0,062 0,084 -0,038 0,178 0,158 0,126 0,064 -0,250 -0,412 -0,137
social 13 -0,061 0,660 0,195 0,065 0,069 0,086 0,009 -0,354 0,045 -0,141 0,020 0,129 -0,007 -0,042
18 -0,089 0,571 -0,231 0,227 0,028 0,157 -0,014 0,077 0,152 0,240 0,207 -0,098 0,083 0,259
28 0,079 0,634 0,192 -0,218 -0,076 0,065 0,154 -0,100 0,163 -0,156 0,049 0,240 0,118 0,031
38 0,128 0,713 0,050 0,011 0,073 0,157 0,022 -0,020 -0,101 -0,134 -0,015 0,299 -0,023 0,032
46 -0,095 0,776 -0,136 0,039 0,006 0,137 -0,033 0,138 0,059 0,059 0,072 -0,068 -0,148 0,035
Acįiune 12 -0,019 0,202 -0,177 -0,048 0,246 -0,001 -0,151 0,225 0,516 0,068 0,440 0,124 -0,063 -0,001
prudentâ 14 -0,072 0,104 0,042 0,046 0,075 0,098 -0,84 0,120 0,102 0,062 0,750 0,105 -0,064 0,035
29 0,133 0,034 0,287 0,010 0,107 0,220 -0,083 -0,037 0,665 0,068 0,054 -0,150 0,029 0,103
40 -0,192 0,188 -0,022 0,017 0,046 0,237 0,110 0,048 0,609 0,004 0,066 0,330 0,070 0,011
 43 0,215 0,155 0,037 0,017 0,127 0,096 0,052 0,006 0,127 0,207 0,239 0,688 -0,002 0,043
Acįiune 5 -0,024 -0,247 0,146 0,054 0,224 0,129 0,029 0,635 0,060 0,191 0,093 -0,016 0,069 0,045
instinctivâ 6 0,060 -0,079 0,099 0,686 -0,167 0,078 -0,009 0,080 0,094 0,225 0,211 -0,208 0,030 -0,111
11 0,204 -0,063 0,152 0,736 0,038 0,114 0,137 0,041 -0,084 0,033 -0,025 0,108 0,010 -0,002
35 0,173 -0,071 0,164 0,743 0,148 0,092 0,022 0,115 0,070 0,013 0,058 0,054 -0,222 0,013
42 0,054 0,147 -0,024 0,757 0,118 -0,051 0,259 0,056 -0,019 0,029 -0,063 0,040 0,072 0,140
48 0,145 -0,050 0,014 0,291 0,431 0,009 0,033 0,577 0,017 -0,018 0,108 0,039 0,058 -0,065
Evitare 7 0,614 -0,011 -0,118 0,300 -0,039 -0,071 0,007 -0,200 -0,108 0,088 0,029 -0,158 0,229 -0,026
20 0,401 0,198 0,180 0,157 -0,169 0,159 0,044 0,267 0,145 -0,176 0,155 0,356 0,057 0,118
22 0,733 -0,057 -0,096 0,060 0,007 0,018 0,017 0,014 -0,070 0,021 -0,125 0,316 -0,228 0,011
27 0,722 -0,044 -0,046 -0,025 -0,048 0,087 0,012 0,051 0,077 -0,090 0,069 0,136 -0,012 0,095
32 0,711 0,010 0,175 0,090 0,047 0,061 0,024 -0,107 0,096 0,137 -0,003 -0,140 0,084 0,186
47 0,596 0,152 0,112 0,096 -0,255 -0,101 -0,083 0,120 -0,178 0,119 0,059 0,061 -0,017 -0,245
Acįiune 4 -0,021 -0,012 0,188 0,164 0,045 0,114 0,030 0,110 -0,061 0,781 0,154 0,046 0,108 -0,014
indirectâ 21 0,112 0,028 0,493 0,191 0,052 -0,018 0,297 0,147 0,315 0,236 -0,222 0,020 0,037 0,255
34 0,192 0,008 0,327 0,074 0,136 -0,003 0,247 0,100 0,240 0,655 -0,087 0,111 -0,122 0,096
37 -0,086 0,075 0,732 0,110 0,038 0,047 0,183 0,127 0,034 0,187 -0,019 -0,017 0,020 -0,069
Acįiune 16 0,078 -0,031 0,153 0,060 0,125 0,046 0,713 0,072 0,023 0,172 -0,008 0,028 -0,233 0,122
antisocialâ 19 0,128 -0,142 0,288 0,059 0,210 -0,138 0,306 0,078 0,075 0,143 0,312 -0,322 -0,118 0,145
36 -0,177 0,023 0,495 0,232 0,102 0,128 0,145 0,419 -0,077 0,023 0,192 -0,059 -0,171 -0,115
39 0,046 0,033 0,517 0,145 0,086 -0,010 0,438 0,108 0,044 -0,128 0,011 -0,099 0,124 0,370
44 -0,035 -0,064 0,760 0,059 0,037 -0,103 0,224 -0,067 -0,002 0,150 0,037 0,116 0,051 0,043
Acįiune 3 -0,284 0,034 0,249 0,303 0,119 0,020 -0,082 0,009 -0,382 0,169 0,116 -0,135 0,242 0,303
agresivâ 8 0,063 0,051 0,159 0,149 -0,069 -0,002 0,775 0,092 -0,012 0,021 -0,001 0,080 0,125 -0,139
31 0,055 0,015 0,418 0,100 -0,011 -0,069 0,706 0,026 -0,052 -0,022 -0,051 -0,054 0,103 0,054
45 -0,284 0,212 0,213 0,089 0,294 0,053 0,201 0,454 0,092 0,128 -0,141 0,119 0,177 0,093
49 -0,038 0,027 0,064 0,157 0,759 0,035 -0,004 0,302 0,017 -0,000 0,162 0,054 0,023 -0,046

47
 ANEXA 3

SACS - Tabele cu etaloane

Modul de utilizare/sau interpretare a etaloanelor este explicat în Capitolul 5.

Paginile urmâtoare enumerâ etaloanele pentru urmâtoarele grupuri, respectiv:

48
Adulįi din populaįia generalâ, cu vârsta între 18-40 ani: bârbaįi ĩi femei

INTERVALELE DE ÎNCREDERE ALE SCORURILOR REALE

CORESPUNZàTOARE PROBABILITàĭII P=0,95

Scala Acįiune asertivâ

Scor Cota T Interval de încredere
(P=0,95)
Bârbaįi Femei Bârbaįi Femei
9 -7,39 3,91 [9, 14] [9, 14]
10 -5,04 5,80 [9, 15] [9, 15]
11 -2,68 7,69 [9, 16] [9, 16]
12 -0,33 9,58 [9, 17] [9, 17]
13 2,02 11,47 [9, 18] [9, 18]
14 4,38 13,36 [9, 19] [9, 19]
15 6,73 15,26 [10, 20] [10, 20]
16 9,08 17,15 [11, 21] [11, 21]
17 11,44 19,04 [12, 22] [12, 22]
18 13,79 20,93 [13, 23] [13, 23]
19 16,14 22,82 [14, 24] [14, 24]
20 18,49 24,71 [15, 25] [15, 25]
21 20,85 26,60 [16, 26] [16, 26]
22 23,20 28,49 [17, 27] [17, 27]
23 25,55 30,38 [18, 28] [18, 28]
24 27,91 32,27 [19, 29] [19, 29]
25 30,26 34,16 [20, 30] [20, 30]
26 32,61 36,05 [21, 31] [21, 31]
27 34,96 37,94 [22, 32] [22, 32]
28 37,32 39,83 [23, 33] [23, 33]
29 39,67 41,72 [24, 34] [24, 34]
30 42,02 43,61 [25, 35] [25, 35]
31 44,38 45,50 [26, 36] [26, 36]
32 46,73 47,39 [27, 37] [27, 37]
33 49,08 49,28 [28, 38] [28, 38]
34 51,44 51,17 [29, 39] [29, 39]
35 53,79 53,06 [30, 40] [30, 40]
36 56,14 54,95 [31, 41] [31, 41]
37 58,49 56,84 [32, 42] [32, 42]
38 60,85 58,73 [33, 43] [33, 43]
39 63,20 60,62 [34, 44] [34, 44]
40 65,55 62,51 [35, 45] [35, 45]
41 67,91 64,40 [36, 45] [36, 45]
42 70,26 66,29 [37, 45] [37, 45]
43 72,61 68,19 [38, 45] [38, 45]
44 74,96 70,08 [39, 45] [39, 45]
45 77,32 71,97 [40, 45] [40, 45]

49
 Scala Relaįionare socialâ
Scor Cota T Interval de încredere
(P=0,95)
Bârbaįi Femei Bârbaįi Femei
5 16,79 19,51 [5, 8] [5, 8]
6 19,76 22,22 [5, 9] [5, 9]
7 22,74 24,92 [5, 10] [5, 10]
8 25,71 27,62 [5, 11] [5, 11]
9 28,69 30,32 [6, 12] [6, 12]
10 31,67 33,03 [7, 13] [7, 13]
11 34,64 35,73 [8, 14] [8, 14]
12 37,62 38,43 [9, 15] [9, 15]
13 40,60 41,14 [10, 16] [10, 16]
14 43,57 43,84 [11, 17] [11, 17]
15 46,55 46,54 [12, 18] [12, 18]
16 49,52 49,24 [13, 19] [13, 19]
17 52,50 51,95 [14, 20] [14, 20]
18 55,48 54,65 [15, 21] [15, 21]
19 58,45 57,35 [16, 22] [16, 22]
20 61,43 60,05 [17, 23] [17, 23]
21 64,40 62,76 [18, 24] [18, 24]
22 67,38 65,46 [19, 25] [19, 25]
23 70,36 68,16 [20, 25] [20, 25]
24 73,33 70,86 [21, 25] [21, 25]
25 76,31 73,57 [22, 25] [22, 25]

50
 Scala Câutarea suportului social
Scor Cota T Interval de încredere
(P=0,95)
Bârbaįi Femei Bârbaįi Femei
7 25,15 23,26 [7, 11] [7, 11]
8 26,98 24,97 [7, 12] [7, 12]
9 28,80 26,68 [7, 13] [7, 13]
10 30,62 28,39 [7, 14] [7, 14]
11 32,44 30,10 [7, 15] [7, 15]
12 34,26 31,81 [8, 16] [8, 16]
13 36,08 33,52 [9, 17] [9, 17]
14 37,91 35,23 [10, 18] [10, 18]
15 39,73 36,94 [11, 19] [11, 19]
16 41,55 38,65 [12, 20] [12, 20]
17 43,37 40,36 [13, 21] [13, 21]
18 45,19 42,07 [14, 22] [14, 22]
19 47,01 43,78 [15, 23] [15, 23]
20 48,83 45,49 [16, 24] [16, 24]
21 50,66 47,20 [17, 25] [17, 25]
22 52,48 48,91 [18, 26] [18, 26]
23 54,30 50,62 [19, 27] [19, 27]
24 56,12 52,32 [20, 28] [20, 28]
25 57,94 54,03 [21, 29] [21, 29]
26 59,76 55,74 [22, 30] [22, 30]
27 61,58 57,45 [23, 31] [23, 31]
28 63,41 59,16 [24, 32] [24, 32]
29 65,23 60,87 [25, 33] [25, 33]
30 67,05 62,58 [26, 34] [26, 34]
31 68,87 64,29 [27, 35] [27, 35]
32 70,69 66,00 [28, 35] [28, 35]
33 72,51 67,71 [29, 35] [29, 35]
34 74,34 69,42 [30, 35] [30, 35]
35 76,16 71,13 [31, 35] [31, 35]

51
 Scala Acįiune prudentâ
Scor Cota T Interval de încredere
(P=0,95)
Bârbaįi Femei Bârbaįi Femei
5 13,45 13,45 [5, 9] [5, 8]
6 16,43 16,43 [5, 10] [5, 9]
7 19,40 19,40 [5, 11] [5, 10]
8 22,38 22,38 [5, 12] [5, 11]
9 25,36 25,36 [5, 13] [6, 12]
10 28,33 28,33 [6, 14] [7, 13]
11 31,31 31,31 [7, 15] [8, 14]
12 34,29 34,29 [8, 16] [9, 15]
13 37,26 37,26 [9, 17] [10, 16]
14 40,24 40,24 [10, 18] [11, 17]
15 43,21 43,21 [11, 19] [12, 18]
16 46,19 46,19 [12, 20] [13, 19]
17 49,17 49,17 [13, 21] [14, 20]
18 52,14 52,14 [14, 22] [15, 21]
19 55,12 55,12 [15, 23] [16, 22]
20 58,10 58,10 [16, 24] [17, 23]
21 61,07 61,07 [17, 25] [18, 24]
22 64,05 64,05 [18, 25] [19, 25]
23 67,02 67,02 [19, 25] [20, 25]
24 70,00 70,00 [20, 25] [21, 25]
25 72,98 72,98 [21, 25] [22, 25]

52
 Scala Acįiune instinctivâ
Scor Cota T Interval de încredere
(P=0,95)
Bârbaįi Femei Bârbaįi Femei
6 19,93 19,70 [6, 10] [6, 10]
7 22,27 22,00 [6, 11] [6, 11]
8 24,61 24,31 [6, 12] [6, 12]
9 26,96 26,61 [6, 13] [6, 13]
10 29,30 28,92 [6, 14] [6, 14]
11 31,64 31,22 [7, 15] [7, 15]
12 33,98 33,53 [8, 16] [8, 16]
13 36,32 35,83 [9, 17] [9, 17]
14 38,67 38,13 [10, 18] [10, 18]
15 41,01 40,44 [11, 19] [11, 19]
16 43,35 42,74 [12, 20] [12, 20]
17 45,69 45,05 [13, 21] [13, 21]
18 48,03 47,35 [14, 22] [14, 22]
19 50,37 49,65 [15, 23] [15, 23]
20 52,72 51,96 [16, 24] [16, 24]
21 55,06 54,26 [17, 25] [17, 25]
22 57,40 56,57 [18, 26] [18, 26]
23 59,74 58,87 [19, 27] [19, 27]
24 62,08 61,18 [20, 28] [20, 28]
25 64,43 63,48 [21, 29] [21, 29]
26 66,77 65,78 [22, 30] [22, 30]
27 69,11 68,09 [23, 30] [23, 30]
28 71,45 70,39 [24, 30] [24, 30]
29 73,79 72,70 [25, 30] [25, 30]
30 76,14 75,00 [26, 30] [26, 30]

53
 Scala Evitare
Scor Cota T Interval de încredere
(P=0,95)
Bârbaįi Femei Bârbaįi Femei
6 32,54 33,91 [6, 10] [6, 10]
7 34,94 36,05 [6, 11] [6, 11]
8 37,34 38,18 [6, 12] [6, 12]
9 39,74 40,32 [6, 13] [6, 13]
10 42,13 42,46 [6, 14] [6, 14]
11 44,53 44,59 [7, 15] [7, 15]
12 46,93 46,73 [8, 16] [8, 16]
13 49,33 48,87 [9, 17] [9, 17]
14 51,73 51,00 [10, 18] [10, 18]
15 54,12 53,14 [11, 19] [11, 19]
16 56,52 55,28 [12, 20] [12, 20]
17 58,92 57,41 [13, 21] [13, 21]
18 61,32 59,55 [14, 22] [14, 22]
19 63,72 61,69 [15, 23] [15, 23]
20 66,12 63,82 [16, 24] [16, 24]
21 68,51 65,96 [17, 25] [17, 25]
22 70,91 68,10 [18, 26] [18, 26]
23 73,31 70,24 [19, 27] [19, 27]
24 75,71 72,37 [20, 28] [20, 28]
25 78,11 74,51 [21, 29] [21, 29]
26 80,50 76,65 [22, 30] [22, 30]
27 82,90 78,78 [23, 30] [23, 30]
28 85,30 80,92 [24, 30] [24, 30]
29 87,70 83,06 [25, 30] [25, 30]
30 90,10 85,19 [26, 30] [26, 30]

54
 Scala Acįiune indirectâ
Scor Cota T Interval de încredere
(P=0,95)
Bârbaįi Femei Bârbaįi Femei
4 29,92 33,06 [4, 7] [4, 7]
5 32,54 35,68 [4, 8] [4, 8]
6 35,16 38,30 [4, 9] [4, 9]
7 37,77 40,92 [4, 10] [4, 10]
8 40,39 43,53 [5, 11] [5, 11]
9 43,01 46,15 [6, 12] [6, 12]
10 45,63 48,77 [7, 13] [7, 13]
11 48,25 51,39 [8, 14] [8, 14]
12 50,86 54,01 [9, 15] [9, 15]
13 53,48 56,62 [10, 16] [10, 16]
14 56,10 59,24 [11, 17] [11, 17]
15 58,72 61,86 [12, 18] [12, 18]
16 61,34 64,48 [13, 19] [13, 19]
17 63,95 67,09 [14, 20] [14, 20]
18 66,57 69,71 [15, 20] [15, 20]
19 69,19 72,33 [16, 20] [16, 20]
20 71,81 74,95 [17, 20] [17, 20]

55
 Scala Acįiune antisocialâ
Scor Cota T Interval de încredere
(P=0,95)
Bârbaįi Femei Bârbaįi Femei
5 30,75 34,07 [5, 9] [5, 8]
6 33,11 36,39 [5, 10] [5, 9]
7 35,47 38,70 [5, 11] [5, 10]
8 37,83 41,02 [5, 12] [5, 11]
9 40,19 43,33 [5, 13] [6, 12]
10 42,55 45,65 [6, 14] [7, 13]
11 44,91 47,96 [7, 15] [8, 14]
12 47,26 50,28 [8, 16] [9, 15]
13 49,62 52,59 [9, 17] [10, 16]
14 51,98 54,91 [10, 18] [11, 17]
15 54,34 57,22 [11, 19] [12, 18]
16 56,70 59,54 [12, 20] [13, 19]
17 59,06 61,85 [13, 21] [14, 20]
18 61,42 64,17 [14, 22] [15, 21]
19 63,77 66,48 [15, 23] [16, 22]
20 66,13 68,80 [16, 24] [17, 23]
21 68,49 71,11 [17, 25] [18, 24]
22 70,85 73,43 [18, 25] [19, 25]
23 73,21 75,74 [19, 25] [20, 25]
24 75,57 78,06 [20, 25] [21, 25]
25 77,92 80,37 [21, 25] [22, 25]

56
 Scala Acįiune agresivâ
Scor Cota T Interval de încredere
(P=0,95)
Bârbaįi Femei Bârbaįi Femei
5 24,88 27,29 [5, 9] [5, 9]
6 27,62 30,06 [5, 10] [5, 10]
7 30,36 32,82 [5, 11] [5, 11]
8 33,10 35,58 [5, 12] [5, 12]
9 35,84 38,34 [5, 13] [5, 13]
10 38,58 41,10 [6, 14] [6, 14]
11 41,32 43,87 [7, 15] [7, 15]
12 44,05 46,63 [8, 16] [8, 16]
13 46,79 49,39 [9, 17] [9, 17]
14 49,53 52,15 [10, 18] [10, 18]
15 52,27 54,92 [11, 19] [11, 19]
16 55,01 57,68 [12, 20] [12, 20]
17 57,75 60,44 [13, 21] [13, 21]
18 60,49 63,20 [14, 22] [14, 22]
19 63,23 65,97 [15, 23] [15, 23]
20 65,97 68,73 [16, 24] [16, 24]
21 68,71 71,49 [17, 25] [17, 25]
22 71,45 74,25 [18, 25] [18, 25]
23 74,19 77,02 [19, 25] [19, 25]
24 76,93 79,78 [20, 25] [20, 25]
25 79,67 82,54 [21, 25] [21, 25]

57
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Š™’˜•ž•ȱŘǯȱŽœŒ›’Ž›ŽŠȱȱ ŗŗ
Ž–—’ęŒŠô’ŠȱœŒŠ•Ž•˜›ȱȱ ŗŗ
ŽœŒ›’Ž›ŽŠȱ’Ž–’•˜›ȱȱ ŗŗ
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Š™’˜•ž•ȱŚǯȱ›˜™›’Ž©ô’ȱ™œ’‘˜–Ž›’ŒŽȱŠ•Žȱȱ ŗŝ
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Žȱ —ŽŸ˜’Šȱ Ž—Ž›Š•ȱ ˜–’—Š—©ȱ Žȱ Šȱ ŠŸŽŠȱ ž—ȱ ’—ȱŽ—ȱ˜œŒ‘ȱó’ȱžž›˜›ȱŒŽ•˜›•Š•Žȱ󌘕’ȱŒŠ›ŽȱŠžȱ
Œ‘Žœ’˜—Š›ȱ ŒŠ›Žȱ œ©ȱ ™˜Š©ȱ –©œž›Šȱ œ›ŠŽ’’•Žȱ ™Š›’Œ’™Šȱ •Šȱ œž’ž•ȱ —˜œ›žǰȱ ›ž™ž•ȱ ħ—ŽŽœȱ
Žȱ Œ˜™’—ȱ Œ˜—’’Ÿȱ Š•Žȱ ˜Š–Ž—’•˜›ȱ œŽ™Š›Šȱ Žȱ
Šœ™ŽŒŽ•Žȱ Œ˜–™˜›Š–Ž—Š•Žȱ Š•Žȱ Œ˜™’—Ȭž•ž’ǯȱ
ȱó’ȱ–Š—žŠ•ž•ȱŒ˜›Žœ™ž—£©˜›ȱœž—ȱ›Ž£ž•Šž•ȱ
ž—ž’ȱ™›˜’ŽŒȱŒŠ›ŽȱŠȱɗŒŽ™žȱŠŒž–ȱ›Ž’ȱŠ—’ȱó’ȱŠ›ȱŠŸŽŠȱ
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Šœ’œŠȱ ó’ȱ Šžȱ Œ›Ž£žȱ ɗȱ —˜’ȱ ™Žȱ ˜Š©ȱ ™Ž›’˜ŠŠȱ ɗȱ
’—ȱ Ž’Ž—ȱ ǻ˜œŠȱ ˜•’Œ•’—’Œ©ȱ Ž•Ž›œ–ŠǼǰȱ •˜Œž•ȱ
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Žȱ ŸŠ•’Š›Žǯȱ 󊍊›ǰȱ •Žȱ œ˜•’Œ’©–ȱ ŒŽ•˜›ȱ ŒŠ›Žȱ Ÿ˜›ȱ
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ŒŠ›ŽȱŠžȱŽ™©ó’ǰȱ˜ŠŽǰȱŖǰśşǯȱ’—ž›ŠȱŽŸ’Ž›ŽȱŽȱ•Šȱ
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˜›Ž•Šô’’ȱɗ›ŽȱœŒŠ•Ž•Žȱ
Ž—›žȱ Šȱ Ž¡Š–’—Šȱ ɗȱ ŒŽȱ –©œž›©ȱ ŒŽ•Žȱ —˜ž©ȱ
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ǻŽóŠ—’˜Š—Žȱ
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ž‹œŒŠ•Ž ›ȱŗȬŘ  –ȱǻǼ –ȱǻǼ
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™Ž›œ™ŽŒ’Ÿ©
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ŒŽ•˜›•Š•ô’

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ś ȱŖǰřŜȘȘȘ ȱŖǰřŞȘȘȘ Ŗǰŗŗ ȱŖǰřŘȘȘȘ ȱŖǰŚŖȘȘȘ ȱŖǰśŝȘȘȘ Ȭ
ŠŠœ›˜Š›Žȱ
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ŽŸ’Š›Žǯ
ȱó’ȱśȬŠŒ˜›ȱŽ›œ˜—Š•’¢ȱŽœȱǻȬǼ
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ɗȱ ŠŒŽ•Šó’ȱ ’–™ȱ Œžȱ Ȭǯȱ ȱ –©œ˜Š›©ȱ
ŒŽ’ȱ Œ’—Œ’ȱ ŠŒ˜›’ȱ Žȱ ™Ž›œ˜—Š•’ŠŽDZȱ —Žž›˜’Œ’œ–ǰȱ
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•Šȱ –˜ž•ȱ Ž—Ž›Š•ǰȱ ŠŒŽœȱ Œ˜—ŒŽ™ȱ œŽȱ œž™›Š™ž—Žȱ
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 Ŗǰŗş ŘǰşŘ řǰŝş řǰŜŗ ŚǰŖŗ Śǰŗŗ ŚǰŘś řǰşŞ ŚǰŖŜ řǰŞř
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ŠŠœ›˜Š›Ž – śǰŜŜ śǰŞŞ Ŝǰŝŝ Ŝǰşř śǰŜŝ ŜǰŜŘ ŜǰŚŘ ŝǰŜŘ Şǰŝŝ ŞǰŚŘ
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••Š—ǰȱ ǯǰȱ ǭȱ ’•‹Ž›ǰȱ ǯȱ ǻŗşşśǼǯȱ ȱ œ˜Œ’Š•ȱ Œ˜–™Š›’œ˜—ȱ Š›—Žœ”’ǰȱ ǯǰȱ ŸŠ—ȱ Ž—ȱ ˜––Ž›ǰȱ ǯǰȱ ›ŠŠħǰȱ ǯǰȱ
œŒŠ•ŽDZȱ ™œ¢Œ‘˜–Ž›’Œȱ ™›˜™Ž›’Žœȱ Š—ȱ Ž•Š’˜—œ‘’™ȱ ŽŽ›œǰȱ ǯǰȱ ŽŽ›œŽŽǰȱ ǯǰȱ ǭȱ —œŽ’—ǰȱ ǯȱ ǻŘŖŖ؊Ǽǯȱ
˜ȱ ™œ¢Œ‘˜™Š‘˜•˜¢ǯȱ Ž›œ˜—Š•’¢ȱ Š—ȱ —’Ÿ’žŠ•ȱ ‘Žȱ ›Ž•Š’˜—œ‘’™ȱ ‹Ž ŽŽ—ȱ Œ˜—’’ŸŽȱ Ž–˜’˜—ȱ
’쎛Ž—ŒŽœǰȱŗşǰȱŘşřȬŘşşǯ ›Žž•Š’˜—ȱ œ›ŠŽ’Žœȱ Š—ȱ Ž–˜’˜—Š•ȱ ™›˜‹•Ž–œǯȱ
—Ž›œ˜—ǰȱ ǯȱ ǯǰȱ ’••Ž›ǰȱ ǯȱ ǯǰȱ ’Ž›ǰȱ ǯȱ ǯǰȱ ’••ǰȱ ž›˜™ŽŠ—ȱ˜ž›—Š•ȱ˜ȱŽ›œ˜—Š•’¢ǰȱŗŜǰȱŚŖřȬŚŘŖǯ
ǯȱ ǯǰȱ ǭȱ Ž’”’Žœǰȱ ǯȱ ǻŗşşŚǼǯȱ Ž‘ŠŸ’˜›Š•ȱ Š—ȱ Š›—Žœ”’ǰȱ ǯǰȱ ›ŠŠħǰȱ ǯȱ ǭȱ ™’—‘˜ŸŽ—ǰȱ ‘ǯȱ ǻŘŖŖŗŠǼǯȱ
Œ‘Š›ŠŒŽ›˜•˜’ŒŠ•ȱ œ¢•Žœȱ Šœȱ ™›Ž’Œ˜›œȱ ˜ȱ ŽŠ’ŸŽȱ•’ŽȱŽŸŽ—œǰȱŒ˜—’’ŸŽȱŽ–˜’˜—ȱ›Žž•Š’˜—ȱ
Ž™›Žœœ’˜—ȱ Š—ȱ •˜—Ž•’—ŽœœDZȱ ›ŽŸ’Ž ǰȱ ›Žę—Ž–Ž—ǰȱ Š—ȱ Ž™›Žœœ’˜—ǯȱ Ž›œ˜—Š•’¢ȱ Š—ȱ —’Ÿ’žŠ•ȱ
Š—ȱŽœǯȱ˜ž›—Š•ȱ˜ȱŽ›œ˜—Š•’¢ȱŠ—ȱ˜Œ’Š•ȱœ¢Œ‘˜•˜¢ǰȱ ’쎛Ž—ŒŽœǰȱřŖǰȱŗřŗŗȬŗřŘŝǯ
ŜŜǰȱśŚşȬśśŞǯ Š›—Žœ”’ǰȱ ǯǰȱ ›ŠŠħǰȱ ǯȱ ǭȱ ™’—‘˜ŸŽ—ǰȱ ‘ǯȱ ǻŘŖŖŗ‹Ǽǯȱ
››’—Ž••ǰȱ ǯȱ ǯǰȱ ǭȱ ĴŽ–Šǰȱ ǯȱ
ǯȱ ǯȱ ǻŗşŞŜǼǯȱ Ȭ ‘Žȱ ›Ž•Š’˜—œ‘’™ȱ ‹Ž ŽŽ—ȱ Œ˜—’’ŸŽȱ Œ˜™’—ȱ
şŖǯȱ Š—žŠ•ȱ ˜›ȱ Šȱ –ž•’’–Ž—œ’˜—Š•ȱ ’—’ŒŠ˜›ȱ œ›ŠŽ’Žœȱ Š—ȱ œ¢–™˜–œȱ ˜ȱ Ž™›Žœœ’˜—ǰȱ Š—¡’Ž¢ȱ
˜ȱ œ¢Œ‘˜™Š‘˜•˜¢ȱ ǻ
Š—•Ž’’—ȱ ‹ħȱ ŽŽ—ȱ Š—ȱ œž’Œ’Š•’¢ȱ ǻŽȱ ›Ž•Š’Žȱ žœœŽ—ȱ Œ˜—’’ŽŸŽȱ
–ž•’’–Ž—œ’˜—Ž•Žȱ™œ¢Œ‘˜™Š‘˜•˜’ŽȬ’—’ŒŠ˜›Ǽǯȱ’œœŽǰȱ Œ˜™’—œ›ŠŽ’Žº—ȱ Ž—ȱ œ¢–™˜–Ž—ȱ ŸŠ—ȱ Ž™›Žœœ’Žǰȱ
‘ŽȱŽ‘Ž›•Š—œDZȱ ŽœȱǭȱŽ’•’—Ž›ǯ Š—œȱ Ž—ȱ œžÊŒ’Š•’Ž’Ǽǯȱ Ž›Šȱ Ž—ȱ Ž£˜—‘Ž’ǰȱ Řşǰȱ
›’—”ǰȱǯǯǰȱŽœŠŸŠŽǰȱǯǯǰȱ
ŽŽ›œŽ–Šǰȱǯ
ǯǰȱŽ¢ǰȱǯȱ ŗŜŜȬŗŝŜǯ
ǭȱ ˜œŽǰȱ ǯǯȱ ǻŗşŞŘǼǯȱ Œ›ŽŽ—’—ȱ Žœœȱ ˜›ȱ Ž›’Š›’Œȱ Š›—Žœ”’ǰȱ ǯǰȱ ›ŠŠħǰȱ ǯȱ ǭȱ ™’—‘˜ŸŽ—ǰȱ ‘ǯȱ ǻŘŖŖ؋Ǽǯȱ
Ž™›Žœœ’˜—ǯȱ•’—’ŒŠ•ȱ Ž›˜—˜•˜’œǰȱŗǰȱřŝȬŚřǯ Š—žŠ•ȱ ˜›ȱ ‘Žȱ žœŽȱ ˜ȱ ‘Žȱ ˜—’’ŸŽȱ –˜’˜—ȱ
Š›ŸŽ›ǰȱǯȱǯǰȱŒ‘Ž’Ž›ǰȱǯȱǯǰȱǭȱŽ’—›Šž‹ǰȱǯȱ ǯȱǻŗşŞşǼǯȱ Žž•Š’˜—ȱ žŽœ’˜——Š’›ŽDZȱ žŒ‘ȱ Ž›œ’˜—ȱ
œœŽœœ’—ȱ Œ˜™’—ȱ œ›ŠŽ’ŽœDZȱ Šȱ ‘Ž˜›Ž’ŒŠ••¢ȱ ǻ
Š—•Ž’’—ȱ Ÿ˜˜›ȱ ‘Žȱ Ž‹›ž’”ȱ ŸŠ—ȱ Žȱ ˜—’’ŸŽȱ
‹ŠœŽȱ Š™™›˜ŠŒ‘ǯȱ ˜ž›—Š•ȱ ˜ȱ Ž›œ˜—Š•’¢ȱ Š—ȱ ˜Œ’Š•ȱ –˜’˜—ȱ Žž•Š’˜—ȱ žŽœ’˜——Š’›ŽǼǯȱ Ž’Ž›˜›™ǰȱ
œ¢Œ‘˜•˜¢ǰȱśŜǰȱŘŜŝȬŘŞřǯ ‘ŽȱŽ‘Ž›•Š—œDZȱ
˜–™Šœǰȱ ǯǯǰȱ ˜——˜›Ȭ–’‘ǰȱ ǯ ǯǰȱ Š•£–Š—ǰȱ
ǯǰȱ Š›—Žœ”’ǰȱ ǯǰȱ ŽŽ›œŽŽǰȱ ǯǰȱ ›ŠŠħǰȱ ǯǰȱ Š—ȱ Ž—ȱ

Š›’—ȱ ‘˜–œŽ—ǰȱ ǯȱ ǭȱ Šœ ˜›‘ǰȱ ǯǯȱ ˜––Ž›ǰȱ ǯǰȱ ǭȱ ŽŽ›œǰȱ ǯȱ ǻŘŖŖ،Ǽǯȱ ˜—’’ŸŽȱ
ǻŘŖŖŗǼǯȱ˜™’—ȱ ’‘ȱœ›Žœœȱž›’—ȱ‘’•‘˜˜ȱŠ—ȱ Œ˜™’—ȱ œ›ŠŽ’Žœȱ Š—ȱ œ¢–™˜–œȱ ˜ȱ Ž™›Žœœ’˜—ȱ
˜•ŽœŒŽ—ŒŽDZȱ ™›˜‹•Ž–œǰȱ ™›˜›Žœœȱ Š—ȱ ™˜Ž—’Š•ȱ Š—ȱ Š—¡’Ž¢DZȱ Šȱ Œ˜–™Š›’œ˜—ȱ ‹Ž ŽŽ—ȱ Š˜•ŽœŒŽ—œȱ
’—ȱ‘Ž˜›¢ȱŠ—ȱ›ŽœŽŠ›Œ‘ǯȱœ¢Œ‘˜•˜’ŒŠ•ȱž••Ž’—ǰȱŗŘŝǰȱ Š—ȱŠž•œǯȱ˜ž›—Š•ȱ˜ȱ˜•ŽœŒŽ—ŒŽǰȱŘśǰȱŜŖřȬŜŗŗǯ
ŞŝȬŗŘŝǯ Š›—Žœ”’ǰȱ ǯǰȱ ŽŽ›œǰȱ ǯȱ ǰȱ ›ŠŠħǰȱ ǯǰȱ ŽŽ›œŽŽǰȱ ǯȱ ǭȱ
˜–™Šœǰȱ ǯȱ ǯǰȱ ›˜œŠ—ǰȱ ǯȱ ǯǰȱ ǭȱ ›Š—ǰȱ ǯȱ ǯȱ ǻŗşşřǼǯȱ Š—ȱ Ž—ȱ ˜––Ž›ǰȱ ǯȱ ǻŘŖŖřǼǯȱ ˜—’’ŸŽȱ Ž–˜’˜—ȱ
˜•ŽœŒŽ—ȱ œ›Žœœȱ Š—ȱ Œ˜™’—DZȱ –™•’ŒŠ’˜—œȱ ˜›ȱ ›Žž•Š’˜—ȱ œ›ŠŽ’Žœȱ Š—ȱ Ž™›Žœœ’ŸŽȱ œ¢–™˜–œDZȱ
™œ¢Œ‘˜™Š‘˜•˜¢ȱ ž›’—ȱ Š˜•ŽœŒŽ—ŒŽǯȱ ˜ž›—Š•ȱ ˜ȱ ’쎛Ž—ŒŽœȱ ‹Ž ŽŽ—ȱ –Š•Žœȱ Š—ȱ Ž–Š•Žœǯȱ
˜•ŽœŒŽ—ŒŽǰȱŗŜǰȱřřŗȬřŚşǯ Ž›œ˜—Š•’¢ȱŠ—ȱ—’Ÿ’žŠ•ȱ’쎛Ž—ŒŽœǰȱŘśǰȱŜŖřȬŜŗŗǯ
Ž›˜Š’œǰȱǯȱǯȱǻŗşŝŝǼǯȱȬşŖDZȱ–’—’œ›Š’˜—ǰȱŒ˜›’—ȱ
˜Ž”œ›Šǰȱ
ǯǯǰȱ ›–Ž•ǰȱ ǯȱ ǭȱ Žȱ ›ž¢ǰȱ ǯȱ ǻŗşşŜǼǯȱ
Š—ȱ ›˜ŒŽž›Žœȱ Š—žŠ•Ȭȱ ˜›ȱ ‘Žȱ ǻŽŸ’œŽǼŽ›œ’˜—ǯȱ ȱ Ž›œ˜—Š•’¢ȱ žŽœ’˜—Š’›ŽœDZȱ Š—žŠ•ȱ ǻȱ
Š•’–˜›ŽDZȱ ˜‘—ȱ
˜™”’—œȱ —’ŸŽ›œ’¢ȱ Œ‘˜˜•ȱ ˜ȱ Ž›œ˜˜—•ħ”‘Ž’œȱ Ÿ›ŠŽ—•ħœŽ—DZȱ
Š—•Ž’’—Ǽǯȱ ’œœŽDZȱ
Ž’Œ’—Žǰȱ•’—’ŒŠ•ȱœ¢Œ‘˜–Ž›’ŒœȱŽœŽŠ›Œ‘ȱ—’ǯ  ŽœȱǭȱŽ’•’—Ž›ǯ
—•Ž›ǰȱǯȱǯȱǭȱŠ›”Ž›ǰȱǯȱǯȱǯȱǻŗşşŖǼǯȱž•’’–Ž—œ’˜—Š•ȱ
˜•Š‘Š—ǰȱ ǯȱ ǯǰȱ ˜˜œǰȱ ǯȱ
ǯǰȱ ǭȱ Œ‘ŠŽěŽ›ǰȱ ǯȱ ǯȱ
ŠœœŽœœ–Ž—ȱ˜ȱŒ˜™’—DZȱŠȱŒ›’’ŒŠ•ȱŽŸŠ•žŠ’˜—ǯȱ˜ž›—Š•ȱ ǻŗşşŜǼǯȱ ˜™’—ǰȱ œ›Žœœȱ ›Žœ’œŠ—ŒŽȱ Š—ȱ ›˜ ‘DZȱ
˜ȱŽ›œ˜—Š•’¢ȱŠ—ȱ˜Œ’Š•ȱœ¢Œ‘˜•˜¢ǰȱśŞǰȱŞŚŚȬŞśŚǯ ˜—ŒŽ™žŠ•’£’—ȱ ŠŠ™’ŸŽȱ ž—Œ’˜—’—ǯȱ —DZȱ ǯȱ
˜•”–Š—ǰȱǯǰȱǭȱŠ£Š›žœǰȱǯȱǯȱǻŗşŞŞǼǯȱŠ—žŠ•ȱ˜ȱ‘ŽȱŠ¢œȱ Ž’—Ž›ȱǭȱǯǯȱ—•Ž›ȱǻœǼǯȱ
Š—‹˜˜”ȱ˜ȱŒ˜™’—ǯȱ
˜ȱ ˜™’—ȱ žŽœ’˜——Š’›Žǯȱ Š•˜ȱ •˜DZȱ ˜—œž•’—ȱ Ž ȱ˜›”DZȱ˜‘—ȱ’•Ž¢ȱǭȱ˜—œǰȱ—Œǯ
œ¢Œ‘˜•˜’œœȱ›Žœœǯ ›ŠŠħǰȱ ǯǰȱ Š›—Žœ”’ǰȱ ǯȱ ǭȱ ŸŠ—ȱ Ž› Ž—ǰȱ ǯȱ ǻŘŖŖřǼǯȱ
ȬȬȬȬȬȬǰȱ ǯǰȱ ˜˜—ǰȱ ǯȱ ǭȱ ›ŠŠħǰȱ ǯȱ ǻŘŖŖřǼǯȱ Ž•Š’˜—œ‘’™œȱ ˜—’’ŸŽȱŒ˜™’—ȱŠ—ȱŠ—¡’Ž¢ȱœ¢–™˜–œȱŠ–˜—ȱ
‹Ž ŽŽ—ȱ Œ˜—’’ŸŽȱ œ›ŠŽ’Žœȱ ˜ȱ Š˜•ŽœŒŽ—œȱ Š—ȱ ™Ž˜™•Žȱ ‘˜ȱœŽŽ”ȱ‘Ž•™ȱ˜›ȱŽŠ›ȱ˜ȱĚ¢’—ǯȱŸ’Š’˜—ǰȱ
Ž™›Žœœ’ŸŽȱ œ¢–™˜–Š˜•˜¢ȱ ŠŒ›˜œœȱ ’쎛Ž—ȱ ™ŠŒŽǰȱŠ—ȱ—Ÿ’›˜—–Ž—Š•ȱŽ’Œ’—ŽǰȱŝŚǰȱŘŝřȬŘŝŝǯ
¢™Žœȱ˜ȱ•’ŽȱŽŸŽ—œǯȱ˜ž›—Š•ȱ˜ȱ˜ž‘ȱŠ—ȱ˜•ŽœŒŽ—ŒŽǰȱ ›ŠŠħǰȱ ǯǰȱ Š›—Žœ”’ǰȱ ǯǰȱ ’•Žǰȱ ǯǯȱ Žǰȱ ħ”œ›Šǰȱ ǯǰȱ
řŘǰŚŖŗȬŚŖŞǯ Ž‹‘Š›ǰȱ ǯǰȱ ŠŽœǰȱ ǯǰȱ ǭȱ ˜Žœǰȱ ǯȱ Ž›ȱ ǻŘŖŖřǼǯȱ
ŽŠ’ŸŽȱ•’ŽȱŽŸŽ—œȱŠ—ȱŽ™›Žœœ’ŸŽȱœ¢–™˜–œȱ’—ȱ


 •ŠŽȱ Š˜•ŽœŒŽ—ŒŽDZȱ ‹˜—’—ȱ Š—ȱ Œ˜—’’ŸŽȱ Œ˜™’—ȱ Œ‘ Š›£Ž›ǰȱ ǯȱ ǻŗşşřǼǯȱ ŽŠœž›Ž–Ž—ȱ ˜ȱ ™Ž›ŒŽ’ŸŽȱ œŽ•Ȭ
Šœȱ Ÿž•—Ž›Š‹’•’¢ȱ ŠŒ˜›œǵȱ ˜ž›—Š•ȱ ˜ȱ ˜ž‘ȱ Š—ȱ ŽĜŒŠŒ¢ǯȱœ¢Œ‘˜–Ž›’ŒȱœŒŠ•Žœȱ˜›ȱŒ›˜œœŒž•ž›Š•ȱ›ŽœŽŠ›Œ‘ǯȱ
˜•ŽœŒŽ—ŒŽǰȱřŘǰȱŗŞśȬŗşřǯ Ž›•’—ǰȱ Ž›–Š—¢DZȱ›Ž’Žȱ—’ŸŽ›œ’§ȱŽ›•’—ǯ

›ŠŠħǰȱ ǯǰȱ ›ž¢–‹˜˜–ǰȱ ǯǰȱ ǭȱ Š›—Žœ”’ǰȱ ǯȱ ǻŘŖŖŘǼǯȱ ™’›’˜ǰȱ ǯǰȱ Š›”ǰȱ ǯȱ ǯǰȱ ǭȱ ’••’Š–œǰȱ ǯȱ ǻŗşŞŞǼǯȱ
˜—’’ŸŽȱ Œ˜™’—ȱ Š—ȱ Ž™›Žœœ’ŸŽȱ œ¢–™˜–œȱ ’—ȱ ŽŸŽ•˜™–Ž—ȱ ˜ȱ Šȱ ‹›’Žȱ Œ˜™’—ȱ Œ‘ŽŒ”•’œȱ ˜›ȱ žœŽȱ
‘ŽȱŽ•Ž›•¢DZȱȱ•˜—’ž’—Š•ȱœž¢ǯȱ’—ȱǭȱŽ—Š•ȱ  ’‘ȱ ™Ž’Š›’Œȱ ™˜™ž•Š’˜—œǯȱ ˜ž›—Š•ȱ ˜ȱ Ž’Š›’Œȱ

ŽŠ•‘ǰȱŜǰȱŘŝśȬŘŞŗǯ œ¢Œ‘˜•˜¢ǰȱŗřǰȱśśśȬśŝŚǯ
Š£Š›žœǰȱǯȱǭȱ˜•”–Š—ǰȱǯȱǻŗşŞŚǼǯȱ›ŽœœǰȱŠ™™›Š’œŠ•ȱŠ—ȱ
Œ˜™’—ǯȱŽ ȱ˜›”DZȱ™›’—Ž›ǯ
˜—ŠǰȱǯǰȱǭȱŠ£Š›žœǰȱǯȱǯȱǻŗşşŗǼǯȱ›ŽœœȱŠ—ȱŒ˜™’—DZȱŠ—ȱ
Š—‘˜•˜¢ǯȱŽ ȱ˜›”DZȱ˜•ž–‹’Šȱ—’ŸŽ›œ’¢ȱ›Žœœǯ
ǯǰȱ ǭȱĝŽŒ”ǰȱ ǯȱ ǻŗşşŖǼǯȱ •Š–’—ȱ ˜‘Ž›œȱ ˜›ȱ
˜•Ž—Ȭ
ž••’ŸŠ—ǰȱǯȱǯȱǯǰȱ’œ‘˜™ǰȱǯȱǯǰǭȱ’Ÿ’”ǰȱǯȱǻŗşşśǼǯȱ‘Žȱ
Š’—ȱ ŠŠœ›˜™‘’£’—ȱ ŒŠ•ŽDZȱ ŽŸŽ•˜™–Ž—ȱ Š—ȱ
ŸŠ•’Š’˜—ǯȱœ¢Œ‘˜•˜’ŒŠ•ȱœœŽœœ–Ž—ǰȱŝǰȱśŘŚȬśřŘǯ
Ž——Ž—ǰȱ
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ŖǰśŝȬŖǰŜŝ ŖǰŚşȬŖǰŜŘ
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›ž™ȱŗȱȬȱ˜•ŽœŒŽ—ô’ǰȱ ›ž™ȱŘȱȬȱž•ô’ȱ’—ȱ™˜™ž•Šô’ŠȱŽ—Ž›Š•©ǰȱ ›ž™ȱřȱȬȱŠŒ’Ž—ô’ȱŒžȱ’Š—˜œ’Œȱ™œ’‘’Š›’Œǯ

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˜ŠŽȱ ŒŽ•Žȱ ›Ž’ȱ ›ž™ž›’ǯȱ C—ȱ ŒŠ£ž•ȱ Š˜•ŽœŒŽ—ô’•˜›ǰȱ
ŠŒŽœŽŠȱŠžȱ˜œȱ™›Ž£Ž—Žȱɗ›ŽȱŽŽŸŠ•žŠ›Žȱ™˜£’’Ÿ©ȱó’ȱ
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ŽŽŸŠ•žŠ›Žȱ ™˜£’’Ÿ©ȱ ó’ȱ Ž˜ŒŠ•’£Š›Žȱ ™Žȱ ™•Š—’ęŒŠ›Žȱ
Š™Š›Žȱ ŒŽ•ȱ –Š’ȱ ›ŽŒŸŽ—ȱ ŒŠȱ ŠŸ¦—ȱ ˜ȱ ŸŠ•˜Š›Žȱ –Š›Žȱ
œŠžȱ˜Š›Žȱ–Š›Žǰȱɗȱ˜ŠŽȱŒŽ•Žȱ›Ž’ȱ›ž™ž›’ǯȱŒŽœȱ
›Ž£ž•Šȱ›Ž™›˜žŒŽȱŠŒŽ•Šó’ȱŽ—˜–Ž—ȱ’Ž—’ęŒŠȱó’ȱ
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Œ˜•Š‹ǯǰȱ ŘŖŖŘǼǯȱ Žȱ Žȱ Š•©ȱ ™Š›Žǰȱ Ž•ȱ ›ŽĚŽŒ©ȱ ›Ž•Šô’Šȱ
œ›É—œ©ȱ ’—›Žȱ ŒŽ•Žȱ ˜ž©ȱ œŒŠ•Žǰȱ ŠóŠȱ Œž–ȱ Šȱ ˜œȱ
›ŽĚŽŒŠ©ȱ ó’ȱ ɗȱ œ›žŒž›Šȱ ŠŒ˜›’Š•©ȱ Šȱ œŒŠ•Ž’ǰȱ ɗȱ
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–Š›’ȱ œŠžȱ ˜Š›Žȱ –Š›’ȱ ɗ›Žȱ œŒŠ•Žȱ œȬŠžȱ ˜‹ô’—žȱ ɗȱ
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Œ˜ŽęŒ’Ž—ô’•˜›ȱ Žȱ Œ˜›Ž•Šô’Žȱ ǻŒŠ•Œž•Š©ȱ ɗ›Žȱ ŒŽ•Žȱ
řȱ›ž™ž›’Ǽȱ ŽœŽȱ Žȱ ŖǰŘŚȱ ǻɗ›Žȱ ȬŖǰŗŖȱ Ȯȱ ŖǰŜŝǼǯȱ ŠŒ©ȱ
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ǻȬŖǰŗŖȱ Ȯȱ ŖǰŚśǼǯȱ ŒŽœŽȱ ŸŠ•˜›’ȱ œž—ȱ ŽŠ•Žȱ œŠžȱ –Š’ȱ
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œž™•’–Ž—Š›Žǰȱ Žȱ •Šȱ ž—ȱ —ž–©›ȱ –Š’ȱ –Š›Žȱ Žȱ
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›˜™›’Ž©ô’ȱ’œŒ›’–’—Š’ŸŽ
Ž—›žȱ Šȱ œŠ‹’•’ȱ ŸŠ•’’ŠŽŠȱ ž—ž’ȱ Žœǰȱ
™›˜™›’Ž©ô’•Žȱ œŠ•Žȱ ’œŒ›’–’—Š’ŸŽȱ œž—ȱ ˜Š›Žȱ
’–™˜›Š—Žǯȱ ’Œ©ȱ Šž—Œ’ȱ Œ¦—ȱ œŽȱ ŠóŽŠ™©ȱ
ŒŠȱ œŒŠ•Žȱ œ™ŽŒ’ęŒŽȱ œ©ȱ Š’‹©ȱ –Ž’’ȱ –Š’ȱ –Š›’ȱ ɗȱ
™˜™ž•Šô’’ȱ œ™ŽŒ’ęŒŽǰȱ ŠŒŽœȱ •žŒ›žȱ Š›ȱ ›Ž‹ž’ȱ œ©ȱ œŽȱ
›ŽĚŽŒŽȱ ɗȱ ’Ž›Ž—ôŽȱ ɗ›Žȱ –Ž’’•Žȱ œŒ˜›ž›’•˜›ǯȱ C—ȱ
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ŒŠ£ž•ȱ œŒŠ•Ž•˜›ȱ ȱ œŽȱ ™›Žœž™ž—Žȱ Œ©ȱ ™ŠŒ’Ž—ô’’ȱ
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ž’•’£Š›ŽŠȱ œ›ŠŽ’’•˜›ȱ Žȱ Œ˜™’—ȱ Œ˜—’’Ÿȱ œ©ȱ œŽȱ
–˜’ęŒŽǰȱ ž—Ž•Žȱ œ›ŠŽ’’ȱ Žȱ Œ˜™’—ȱ ꒗ȱ –Š’ȱ
›ŽŒŸŽ—ȱ ž’•’£ŠŽȱ ǻ Š›—Žœ”’ȱ ó’ȱ Œ˜•Š‹ǯǰȱ ŘŖŖŘǼǯȱ C—ȱ
ŒŠ™’˜•ž•ȱ ž›–©˜›ǰȱ ŒŠ›Žȱ ›ŠŽŠ£©ȱ œŠ—Š›’£Š›ŽŠȱ
ǰȱ ©œ’–ȱ ž—ȱ Š‹Ž•ȱ ǻŠ‹Ž•ž•ȱ ŗśǼȱ ɗȱ ŒŠ›Žȱ œž—ȱ
™›Ž£Ž—ŠŽȱ’Ž›Ž—ôŽ•Žȱ’—›Žȱ–Ž’’ȱ™Žȱ›ž™ŽȱŽȱ
Ÿ¦›œ©ȱó’ȱ™ŽȱœŽ¡Žǯ
óŠȱ Œž–ȱ œŽȱ ™˜ŠŽȱ Œ˜—œŠŠǰȱ ™ŠŒ’Ž—ô’’ȱ Œžȱ
’Š—˜œ’Œȱ ™œ’‘’Š›’Œȱ Šžȱ œŒ˜›ž›’ȱ –Š’ȱ –Š›’ȱ •Šȱ
Š™›˜Š™Žȱ˜ŠŽȱœŒŠ•Ž•Žȱǰȱž—ȱŠœ™ŽŒȱŒ˜—œŠŠȱ
ó’ȱɗȱŒŠ£ž•ȱŸŠ›’Š—Ž’ȱ˜›’’—Š•ŽȱŠȱœŒŠ•Ž’ȱǻ Š›—Žœ”’ȱ
ó’ȱŒ˜•Š‹ǯǰȱŘŖŖŘǼǯȱŽȱŽȱŠ•©ȱ™Š›ŽǰȱŠóŠȱŒž–ȱ’—’Œ©ȱ
ŠŽ•Žȱ ’—ȱ Š‹Ž•ž•ȱ ŗśǰȱ ɗȱ ŒŠ›ž•ȱ ›ž™ž•ž’ȱ Žȱ
Šž•ô’ȱ ’—ȱ ™˜™ž•Šô’Šȱ Ž—Ž›Š•©ǰȱ Ž–Ž’•Žȱ Šžȱ ŠŸžȱ
œŒ˜›ž›’ȱ –Š’ȱ –Š›’ȱ ™Žȱ ˜ŠŽȱ œŒŠ•Ž•Žȱ ǻŒžȱ Ž¡ŒŽ™ô’Šȱ

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ŒŠ•© 󊗝’˜—  Ž’Šȱ ‹ŠŽ›Žȱ  ™

Œ•’—’Œȱ œŠ—Š›
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Š¦ȱ Šȱ Šœ™ŽŒŽ•˜›ȱ ’—’Ÿ’žŠ•’œŽǰȱ Œ¦ȱ ó’ȱ Šȱ ŒŽ•˜›ȱ

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ž‹œŒŠ•ŽȱŽȱŒ˜™’—ȱǻǼ
ž‹œŒŠ•Žȱ ǻŗǼ ǻŘǼ ǻřǼ ǻŚǼ ǻśǼ ǻŜǼ ǻŝǼ ǻŞǼ ǻşǼ
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 Š‹Ž•ž•ȱŗŘ
Šž›Šô’’•ŽȱŠŒ˜›’Š•Žȱ™Ž—›žȱœž‹œŒŠ•Ž•Žȱȱó’ȱ

ŒŠ•Šȱȱ ŠŒ˜›ȱ
ȱ ŗ Ř ř Ś ś Ŝ
Œô’ž—ŽȱŠœŽ›’Ÿ© ȱŖǰŗŝş ȱŖǰŗŘŖ ȱŖǰŖŝş ȱŖǰŞŝŗ ȱŖǰŖŗŗ ȱŖǰŖŖŘ
Ž•Šô’˜—Š›Žȱœ˜Œ’Š•© ȱŖǰŖŜŗ ȱŖǰŞśŗ ȱŖǰŗŖş ȱŖǰŖŖŚ ȱŖǰŖŜř ȱŖǰŖŖŗ
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Ÿ’Š›Ž ȬŖǰŖŖś ȱŖǰŗŗŗ ȱŖǰŗŖŜ ȬŖǰŞśŗ ȬŖǰŖŜŖ ȬŖǰŗřş
Œô’ž—Žȱ’—’›ŽŒ© ȬŖǰŖŗŞ ȱŖǰŗśŜ ȱŖǰŝśŖ ȬŖǰŗŗś ȱŖǰŖŗŖ ȬŖǰŖŗś
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ŒŒŽ™Š›Ž ȱŖǰŘŘŞ ȱŖǰŘŘř ȬŖǰŗŚŗ ȱŖǰŖśŗ ȱŖǰŜśş ȱŖǰŖŜř
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ž•™Š‹’•’£Š›ŽŠȱŒŽ•˜›•Š•ô’ ȱŖǰŖŜŗ ȱŖǰŖŝş ȬŖǰŗŘŘ ȱŖǰŖŖŚ ȬŖǰŖŖş ȱŖǰşŖŞ

’—Ž›œ˜Œ’Š•Žǯȱ—ȱœŒ˜›ȱ–Š›Žȱ™Žȱž—Šȱ’—›ŽȱœŒŠ•Ž•Žȱ ŘDZŗŘǰŜřƖDzȱ řDZŗŘǰřśƖDzȱ ŚDZȱ ŗŖǰŞřƖDzȱ śDZŗŖǰŞŖƖDzȱ

ȱ ɗœŽŠ–—©ȱ Œ©ȱ ™Ž›œ˜Š—Šȱ ˜•˜œŽóŽȱ –Š’ȱ –ž•ȱ
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C—ȱ ž›–Šȱ Š—Š•’£Ž’ǰȱ œȬŠžȱ Ž¡›Šœȱ Ŝȱ ŠŒ˜›’ȱ ŒŠ›Žȱ
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Œ©ȱ ŒŽ•Žȱ ˜ž©ȱ ’—œ›ž–Ž—Žȱ –©œ˜Š›©ȱ •žŒ›ž›’ȱ
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ȱ –©œ˜Š›©ȱ ’–Ž—œ’ž—ŽŠȱ Œ˜–™˜›Š–Ž—Š•©ȱ
Šȱ Œ˜™’—Ȭž•ž’ǯȱ C—ȱ Š‹Ž•ž•ȱ ŗŘȱ œž—ȱ ™›Ž£Ž—ŠŽȱ
›Ž£ž•ŠŽ•ŽȱŠ—Š•’£Ž’ȱŠŒ˜›’Š•Žǯȱ
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ŒŽ•˜›ȱ Œ’—Œ’ȱ œž™›ŠŠŒ˜›’ȱ Š’ȱ –˜Ž•ž•ž’ȱ ’ȱ


’ŸŽȱ ǻ¡›ŠŸŽ›œ’ž—Žǰȱ Š‹’•’ŠŽȱ Ž–˜ô’˜—Š•©ǰȱ
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–Š’ȱŠŒŒŽ—žŠ©ǯȱ
˜ŽęŒ’Ž—ô’’ȱ Žȱ Œ˜›Ž•Šô’Žȱ œž—ȱ ™›Ž£Ž—Šô’ȱ
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›Ž£ž•ŠŽ•Žȱ —˜Š‹’•Žȱ œŽȱ —ž–©›©ȱ Š‹’•’ŠŽŠȱ
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ȬŘŗ ȬŘŗ ȬŘŗ

—¡’ŽŠŽȱ ›Žœȱ Ž™›Žœ’Ž
ž‹œŒŠ•Žȱ ž•ô’ȱ ž•ô’ȱ ž•ô’ȱ
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ž•™Š‹’•’£Š›ŽŠȱŒŽ•˜›•Š•ô’ ȱŖǰŘŜȘȘ ȱŖǰŘřȘȘ ȱŖǰŘşȘȘ

ȱ ȘDZȱ™ǀŖǰŖśDzȱȘȘDZȱ™ǀŖǰŖŗǯ


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ŒŒŽ™Š›Ž ȱŖǰŗŚȘȘȘ ŖǰŗŖȘȘ ȱŖǰŗŖȘȘ ŖǰŗŘȘȘȘ ŖǰŖşȘ ŖǰŖŞȘ ŖǰŗŘȘȘȘ ȱŖǰŗŝȘȘȘ ȱŖǰŖř ȱŖǰŖś ȱŖǰŗśȘȘȘ ȱŖǰŗŗȘȘ ȱŖǰŗŖȘȘ
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Š‹Ž•ž•ȱŗŜ
˜›Ž•Šô’’ȱɗ›Žȱȱó’ȱǰȱɗȱŒŠ£ž•ȱ•˜ž•ž’ȱŒ•’—’Œȱǻ™ŠŒ’Ž—ô’ȱ™œ’‘’Š›’Œ’Ǽ

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Descrierea CIP a Bibliotecii Naţionale a României
Garner, David M.
EDI-3: Inventarul tulburărilor de comportament alimentar-3: Manual de specialitate:
adaptarea şi standardizarea EDI-3 pe populaţia din România / David M. Garner; adapt.:
Ştefania Miclea (coord.), Oltea-Daniela Joja, Monica Albu. - Cluj-Napoca: Editura ASCR, 2010
ISBN 978-606-8244-09-9

I. Miclea, Ştefania (coord.)

II. Joja, Oltea-Daniela
III. Albu, Monica

159.9:612.394

Ediţia în limba engleză

David M. Garner, PhD

Eating Disorder Inventory-3 (EDI-3). Professional Manual.

Copyright © 1984, 1991, 2004 by Psychological Assessment Resources, Inc. 16204 N. Florida
Avenue, Lutz, Florida 33549, SUA. All rights reserved. May not be reproduced in whole or in
part in any form or by any means without written permission of Psychological Assessment
Resources, Inc.

Ediţia în limba română

David M. Garner, PhD

EDI-3. Inventarul tulburărilor de comportament alimentar-3. Manual de specialitate
Adaptarea şi standardizarea EDI-3 pe populaţia din România

Referenţi ştiinţifici | prof.dr. Adriana Băban, prof.dr. Mircea Miclea

Coordonatorul ediţiei în limba română |Ştefania Miclea

Traducerea din limba engleză| Emma Moldovan, Livia Apostol
Coperta|Carolina Banc
Paginaţie şi prepress|Kitty Bojan
Lectura comparativă cu originalul|Ştefania Miclea
Lectura|Diana Breaz, Monica Albu
Tipar|S.C. Cognitrom S.R.L., Cluj-Napoca
Editor|Diana Breaz

Pentru comenzi
Tel.: 0264‑581499
www.cognitrom.ro
office@cognitrom.ro

Copyright © 2010 S.C. COGNITROM S.R.L.

Toate drepturile rezervate. Reproducerea integrală sau parţială a textului, stocarea într-o bază de
date sau transmiterea în orice formă sau prin orice mijloace, electronic, mecanic, prin fotocopiere,
înregistrare sau prin mijloace de altă natură, fără acordul prealabil în scris al COGNITROM, sunt
interzise şi se pedepsesc conform legii.
 Cuprins

Mulţumiri 11
Locuri clinice 13
Statele Unite 13
La nivel internaţional 13

Locurile de unde s-au colectat datele 13

Locuri nonclinice 14

Capitolul 1 - Introducere

Prezentare generală a EDI‑3 15

Rezumatul caracteristicilor principalele ale EDI‑3 17
Caracteristici adiţionale ale EDI‑3 18
EDI‑3 LS  18
EDI‑3 FT 18
Scopul EDI‑3 18
Prezentare generală a tulburărilor de comportament alimentar 19
Diagnoza şi definiţia subtipurilor: relevanţa pentru EDI‑3 20
Incidenţa şi prevalenţa 20
Observaţii cu privire la gen 21
Observaţii cu privire la dezvoltare 21
S‑au schimbat tulburările de comportament alimentar de‑a lungul timpului?  21
Evoluţia şi efectele tratamentului 21
Rezumat 22

Capitolul 2 - Construcţia EDI-3

Scopurile şi motivul revizuirii EDI‑3 23

Originea EDI: modelul continuumului tulburărilor de comportament alimentar 24
Construcţia inventarelor EDI şi EDI‑2: validitatea de conţinut 27
Selecţia itemilor: analiza itemilor şi consistenţa internă 27
Evaluarea validităţii scalelor 27
Construcţia inventarului EDI‑3: itemi şi scale 28
Reorganizarea scalelor EDI‑3 28
Descrierea şi conţinutul scalelor şi ale scalelor compozite ale EDI‑3 28
Scalele de Risc de tulburare de comportament alimentar 28
Scala Dorinţa de a fi slab (DS) 29
Scala Bulimie (B) 29
Scala Nemulţumire faţă de corp (NC) 29
Scala Stimă de sine scăzută (SSS) 30
Scala Alienare personală (AP) 30
Scala Nesiguranţă interpersonală (NI) 30
Scala Alienare interpersonală (AI) 31
Scala Deficite interoceptive (DI) 31
 Scala Dezechilibru emoţional (DE) 31
Scala Perfecţionism (P) 32
Scala Ascetism (A) 32
Scala Frica de maturitate (FM) 33
Scale compozite 33
Scala compozită Risc de tulburare de comportament alimentar (SCRTCA) 33
Scala compozită Ineficacitate (SCI) 33
Scala compozită Probleme interpersonale (SCPI) 34
Scala compozită Probleme emoţionale (SCPE) 34
Scala compozită Control exagerat (SCCE) 34
Scala compozită Neadaptare psihologică generală (SCNPG) 34
Scala Inconsecvenţă (IN) 35
Scala Raritate (R) 35
Scala Impresie negativă (ING) 35
Sistemul de cotare al EDI‑3 35

Capitolul 3 - Administrare şi cotare

Imagine de ansamblu 41
Materiale 41
Broşura cu itemi, Formularul de răspuns, Foaia de profil ale EDI‑3 41
EDI‑3 FT 41
EDI‑3 LS 41
Populaţii ţintă 41
Aplicaţii pentru evaluarea clinică a tulburărilor de comportament alimentar 42
Aplicaţii la procesul terapeutic 42
Aplicaţii în contexte nonclinice 42
Aplicaţii în cercetare 42
Competenţe profesionale 43
Stabilirea relaţiei cu pacientul şi administrarea EDI‑3 43
Cotarea EDI‑3 44
Verificarea Broşurii cu itemi şi a Formularului de răspuns EDI‑3 completate 44
Proceduri de cotare 44
Calculul scorurilor scalelor 44
Calculul scorurilor compozite 44
Calcularea scorurilor la Scalele de validitate 49
Trasarea profilului pe baza scalelor şi a scalelor compozite  52
Administrarea EDI‑3 FT 52
Cotarea EDI‑3 FT 53
Verificarea Formularului de răspuns EDI‑3 FT completat 53
Decizia recomandării unui consult de specialitate 53
Stabilirea trimiterii la un consult de specialitate pe baza criteriului exclusiv al IMC 56
Stabilirea trimiterii la un consult de specialitate pe baza valorii IMC‑ului şi a scorurilor
totale brute obţinute la scalele DS şi B 56
Stabilirea trimiterii la un consult de specialitate exclusiv pe baza simptomelor
comportamentale 56
Administrarea instrumentului EDI‑3 LS 57

Capitolul 4 - Interpretare

Prezentare generală a metodelor de evaluare a tulburărilor de comportament alimentar 59

Prezentare generală a procesului de interpretare 59
Factori care au o influenţă semnificativă asupra interpretării 61
Motivaţia pentru tratament 61
Sugestii pentru interpretarea EDI‑3 62
Creşterea motivaţiei pentru procesul de evaluare 62
Afecţiuni psihologice secundare pierderii în greutate sau înfometării 63
Afecţiuni psihologice, ca efect secundar al unor pattern‑uri haotice de alimentaţie 64
Stabilitatea constructelor EDI în timp 65
Variabilitatea în timp a simptomatologiei tulburărilor de comportament alimentar 65
Prezentare generală a metodelor de evaluare 66
Interviu clinic 66
Interviu semistructurat 66
Instrumente de autoevaluare 67
Observaţie comportamentală şi automonitorizare 68
Evaluarea generală a psihopatologiei 68
Structura interviului de evaluare 68
Greutatea corporală şi istoricul greutăţii corporale 68
Preocuparea exagerată faţă de greutatea şi de forma corpului 69
Comportamentul alimentar restrictiv, provocarea vărsăturilor şi alte comportamente extreme de
control al greutăţii 70
Alimentaţia compulsivă 70
Complicaţii medicale ale tulburărilor de comportament alimentar 71
Interpretările profilului EDI‑3 72
Utilizarea instrucţiunilor de interpretare şi a tabelelor 72
Scalele de Risc de tulburare de comportament alimentar şi scala compozită 73
Scala Dorinţa de a fi slab (DS) 73
Indicatori de interpretare 75
Scala Bulimie (B) 76
Indicatori de interpretare 77
Scala Nemulţumire faţă de corp (NC) 78
Indicatori de interpretare 79
Scala compozită Riscul de tulburare de comportament alimentar (SCRTCA) 81
Indicatori de interpretare 82
Scale psihologice şi scale compozite  83
Scala Stimă de sine scăzută (SSS) 83
Scala Alienare personală (AP) 84
Scala compozită Ineficacitate (SCI) 84
Indicatori de interpretare 85
Scala Nesiguranţă interpersonală (NI) 86
Scala Alienare interpersonală (AI) 87
Scala compozită Probleme interpersonale (SCPI) 88
Indicatori de interpretare 89
Scala Deficite interoceptive (DI) 89
Scala Dezechilibru emoţional (DE) 91
Clusterul de itemi Risc pentru abuz de substanţe (RAS) 93
Scala compozită Probleme emoţionale (SCPE) 94
Scala Perfecţionism (P) 95
Indicatori de interpretare 96
Scala Ascetism (A) 98
Indicatori de interpretare 99
Scala compozită Control exagerat (SCCE) 99
Scala Frica de maturitate (FM) 100
Indicatori de interpretare 101
Scala compozită Neadaptare psihologică generală (SCNPG) 102
Indicatori ai stilului de răspuns 103
Scala Inconsecvenţă (IN) 103
Scala Raritate (R) 103
Scala Impresie negativă (ING) 103
Scoruri mari la toate scalele (variaţie mică între scale) 103
Scoruri mici la toate scalele 104
Scoruri la scale relative unele la altele în profilurile individuale 104
Exemple de cazuri 104
Cazul 1: Frica de maturitate psiho‑biologică în adolescenţă 104
Sumarul interpretativ al testării iniţiale 105
Sumarul interpretativ al celei de‑a doua testări 109
Sumarul interpretativ al celei de‑a treia testări 110
Cazul 2. Bulimia nervoasă cu un istoric de abuz fizic şi sexual 110
Sumarul interpretativ al testării iniţiale 112
Cazul 3: Ineficacitate/alienare interpersonală la o femeie de 42 de ani 114
Sumarul interpretativ al testării iniţiale 116
Cazul 4. Tulburare de alimentaţie compulsivă la o femeie adultă 116
Sumarul interpretativ al testării iniţiale 118
Cazul 5: Băiat de 16 ani cu Anorexie nervoasă 119
Sumarul interpretativ al testării 121
Interpretarea EDI‑3 FT 121
Greutate corporală scăzută comparativ cu etaloanele în funcţie de vârstă şi sex 121
Îngrijorări exagerate referitoare la alimentaţie şi greutate corporală 122
Întrebări referitoare la comportament 124
Screeningul tulburărilor de comportament alimentar 126
Screening versus identificarea cazurilor 126
Screeningul tulburărilor de comportament alimentar la atleţi 127
Rezultatul tratamentului: evaluarea unei game largi de aspecte ale rezultatelor 129
Sensibilitatea EDI la schimbările clinice în urma tratamentului 130
Stabilitatea în timp a schimbării pe perioada de follow‑up 130
Rezultate comparative prin utilizarea EDI 131
Predictori ai răspunsului la tratament prin utilizarea EDI 132
Perfecţionismul persistă după recuperare 134
Schimbări în EDI‑3: pre‑tratament şi post‑tratament 135
Programul TIZ de la RCC (programul de spitalizare parţială) 135
Programul TAS de la RCC 136

Capitolul 5 - Standardizarea şi construirea etaloanelor

Standardizarea 143
Selecţia eşantioanelor 143
Descrierea eşantioanelor folosite la etalonare 143
Proceduri de etalonare 143
Obţinerea cotelor T ajustate în funcţie de vârstă  143
Obţinerea cotelor T 144
Obţinerea cotelor T compozite 144
Intervalele de încredere 144

Capitolul 6 - Fidelitate şi validitate

Fidelitatea 149
Consistenţa internă 149
Erori standard de măsurare (ESM) şi intervale de încredere (IC) 150
Stabilitatea test‑retest 150
Validitatea 154
Dovezi bazate pe structura internă 154
Studii de intercorelaţie 154
Analiza factorială a versiunilor anterioare ale EDI 154
Analiza factorială exploratorie a itemilor scalei compozite EDI‑3 Risc de tulburare de
comportament alimentar  154
Analiza factorială exploratorie a itemilor Scalei Psihologice EDI‑3 156
Analiza factorială confirmatorie a Scalelor psihologice EDI‑3 158
Dovezi bazate pe relaţiile cu alte variabile (externe) 165
Corelaţii cu EDI‑2 165
Dovezi obţinute pe baza performanţelor persoanelor de sex masculin cu tulburări de
comportament alimentar 176
Dovezi obţinute pe baza performanţelor persoanelor de sex masculin şi feminin fără
tulburări de comportament alimentar 176
Bibliografie 181
Anexe 193

Capitolul 7 - Studiul de adaptare şi standardizare a Inventarului tulburărilor de comportament

alimentar – 3 (EDI-3) pe populaţia din România

Obiectivul studiului 243

Participanţi 243
Procedura 243
Procedura iniţială  243
Procedura de validare şi standardizare 244
Date de etalonare 244
Caracteristici psihometrice 246
Fidelitatea 246
Fidelitatea test‑retest 246
Consistenţa internă 247
Validitatea 247
Validitatea de criteriu 247
Validitatea de construct 254
Concluzii 256
Cotarea şi interpretarea scorurilor la scalele EDI‑3 256
Cotarea 256
Transformarea cotelor brute în cote T şi în centile 256
Calcularea scorurilor la scalele de validitate 257
Utilizarea intervalelor de încredere ale cotelor T  257
Utilizarea foilor de profil 258
Utilizarea EDI-3 FT 258
Utilizarea EDI‑3 LS 258
Bibliografie 259
Anexe 261
 Mulţumiri
Inventarul tulburărilor de comportament
alimentar (EDI) a fost construit în forma sa
originală acum mai bine de 20 de ani, cu scopul
de testa „modelul continuumului” al anorexiei
nervoase propus de către Nylander (1971). Acest
model s‑a bazat pe observaţia că majoritatea
elevelor din Suedia au declarat că „se simt grase”
şi că aproape 10% dintre acestea au menţionat cel
puţin trei „simptome de anorexie” referitoare la
greutatea corporală. Conform acestui punct de
vedere, anorexia nervoasă reprezintă stadiul final
al unui proces continuu care începe cu restricţie
alimentară liber consimţită şi avansează către o
restricţie alimentară mai severă, asociată cu o
pierdere progresivă a gradului de conştientizare.
Diferenţa dintre cazurile uşoare sau moderate şi
cele în care se stabileşte un diagnostic complet este
mai degrabă cantitativă decât calitativă. Concluzia
studiilor efectuate mai demult este că acest
continuum al preocupărilor legate de alimentaţie
şi greutate nu este paralel cu continuumurile
constructelor psihologice observate frecvent la
pacienţii cu anorexie nervoasă şi bulimie (Garner,
Olmsted şi Garfinkel, 1984). Definirea severităţii
în termenii unui singur sistem de identificare a
simptomelor împiedică înţelegerea semnificaţiei
diferenţelor dintre subgrupuri.
Validitatea ipotezei continuumului nu
a fost stabilită, unii cercetători interpretând
rezultatele în favoarea ideii că tulburările de
comportament alimentar sunt la extremitatea
unui continuum al unei alimentaţii dezorganizate
(Dancyger şi Garfinkel, 1995; Fitzgibbon,
Sanchez‑Johnsen şi Martinovich, 2003; Löwe,
Gleaves, DiSimone‑Weiss şi colab., 1998; Stice,
Killen, Hayward şi Taylor, 1998b; Stice, Ziemba,
Margolis şi Flick, 1996; Tylka şi Subich, 1999), iar
alţii concluzionând că există diferenţe calitative
între cazurile adevărate şi variantele subclinice
(Gleaves, Löwe, Snow, Green şi Murphy‑Eberenz,
2000; Laessle, Tuschl, Waadt şi Pirke, 1989; Prather
şi Williamson, 1998; Ruderman şi Besbeas, 1992).
Controversa iniţială nu a fost soluţionată şi încă
prezintă interes (Lindeman, Stark şi Jkeskivaara,
2001; Tylka şi Subich, 2002).
EDI a depăşit cu mult intenţia iniţială şi a
devenit tot mai important în literatura în continuă
dezvoltare privind tulburările de comportament
alimentar. Potrivit omului de ştiinţă suedez
Theander (2004), există aproximativ 11.600 de
articole despre tulburările de comportament
alimentar publicate pe parcursul a 18 ani, între
1983 şi 2000, iar EDI a fost citat în circa 5%, 9%
şi 17% dintre publicaţii în perioade succesive
de câte 6 ani (adică în intervalele 1983‑1988,
1989‑1994, 1995‑2000).
Aceasta este, mai degrabă, o modalitate de
a‑mi prezenta pe îndelete recunoştinţa faţă de
numeroşi cercetători care au avut încrede în EDI
de‑a lungul anilor, utilizând acest instrument
pentru a evalua factorii de risc, a testa modele
etiologice, a măsura rezultate şi a face predicţii
asupra răspunsului la tratament. Tot mai multe
dovezi în acest domeniu s‑au îndreptat de la
speculaţiile privind caracterul plurideterminat
al tulburărilor de comportament alimentar
către conturarea unor factori specifici genetici
şi de mediu care influenţează vulnerabilitatea
şi determină răspunsul la tratament. EDI şi‑a
îndeplinit scopul urmărit pe parcursul acestor
cercetări şi, să sperăm, EDI‑3 va extinde baza
existentă de cunoştinţe. Cu toate acestea, EDI
este, înainte de toate, un instrument clinic, iar
semnificaţia unei cercetări care utilizează acest
instrument este de a facilita o mai bună înţelegere
a persoanelor cu tulburări de comportament
alimentar, prin oferirea unui suport pentru
diferitele teme psihologice prezente în grupurile
de diagnostic eterogene.
EDI‑3 constituie prima revizuire substanţială
a acestui test în aproape 15 ani. Întâi, trebuie
să‑i mulţumesc fiului meu, Kyle, şi fiicei mele,
Sarah, pentru răbdarea şi sacrificiul lor timp
de mai multe luni, când proiectul EDI‑3 m‑a
împiedicat să le fiu aproape. Sunt recunoscător,
mai ales, soţiei mele, Maureen Garner, PhD,
întrucât EDI‑3 (şi EDI‑2) nu ar fi fost posibile fără
aptitudinile sale profesionale extraordinare în
privinţa analizei datelor, a înţelegerii aspectelor
conceptuale relevante în cazul tulburărilor de
11
comportament alimentar, fără abilităţile ei clinice
deosebite şi fără atenţia şi strădania cu care a
făcut corectura textului.
Manualul profesional al EDI‑3 reflectă
contribuţiile însumate ale mai multor persoane
de‑a lungul anilor, inclusiv colegi de cercetare şi
din domeniul clinic, personal de suport pentru
pacienţi, precum şi pacienţi şi participanţi din
comunitate care s‑au oferit voluntari. Sunt
îndatorat lui James Schuerger, PhD, pentru
încurajările din timpul pregătirii mele iniţiale în
psihometrie. Sunt, de asemenea, recunoscător,
lui Marion Olmsted, PhD, şi lui Janet Plovy, PhD,
pentru sprijinul lor în construcţia setului inţial
de itemi şi pentru rafinarea scalelor originale,
acum mai bine de 20 de ani, la Universitatea
din Toronto. Am avut de câştigat şi în urma
discuţiilor avute cu Paul Garfinkel, MD, Harvey
Moldofsky, MD, Donald Coscina, PhD, Alan
Kaplan, MD, Padraig Darby, MD, şi Wendi
Rockert de la Universitatea din Toronto, dar şi cu
cadrele didactice şi colegii din alte părţi, precum
Arnold Andersen, MD, Hilde Bruch, MD, Pierre
Beumont, MD, Arthur Crisp, MD, Amy Dennis,
PhD, Christopher Fairburn, MD, Craig Johnson,
PhD, James Mitchell, MD, Pauline Powers, MD,
Gerald Russell, MD, Michael Strober, PhD,
Stephen Touyz, PhD, Susan Wooley, PhD, şi, mai
ales, lui Kelly Vitousek, PhD. Apreciez sprijinul
pe care mi l-au acordat Lionel Rosen, MD,
Christine Shafer, MD, James Bender, DO, Peggy
Parker, PhD, şi Mary Lohr, în timpul în care am
fost la Universitatea de stat Michigan.
Doresc să‑mi exprim recunoştinţa faţă de
multe persoane din America de Nord, Europa
şi Australia, care au contribuit cu amabilitate la
baza de date necesară standardizării şi validării
EDI‑3. Datele au provenit din Indiana, de la
Dorothy Espelage, PhD, Roberta Sherman, PhD
şi Ron Thompson, PhD; din Maryland, de la
Angela Guarda, MD, Janelle Coughlin, PhD,
şi Leslie Heinberg, PhD; din Michigan, de la
Lionel Rosen, MD şi Christine Shafer, MD; din
Ohio, de la Diann Ackard, PhD; din Wisconsin,
de la Pamela Bean, PhD şi Ted Weltzin, MD; din
Australia, de la Sarah Maguire, PhD, şi Pierre
Beumont, MD; din Canada, de la Howard Steiger,
PhD; din Italia, de la Riccardo Dalle Grave,
MD; din Olanda, de la Tatjana van Strein, PhD
şi din Suedia, de la Birgitta Edlund, PhD, Claes
Norring, PhD, şi Barbro Thurfjell, PhD.
Îmbunătăţirea EDI‑3 ar fi fost imposibilă fără
eforturile pline de devotament ale personalului
clinic de bază de la Centrul Clinic River, printre
12
care Amy Hanson‑Akins, LISW, Julie Desai,
MA, LLP, Sharon Donatelli, LISW, Maureen
Garner, PhD, Katie Gorman, Dawn Karchner,
Denise Litterer, PhD, Lori Rokicki, PhD, Meggan
Schneider, Pat Wiley, DT, şi ale personalului
administrativ condus de Arline Soncrant şi care
este format din Denise Baker, Sarah Garner, Kim
Kross, Kris Partridge, Sylvia Kaczmarek, Olga
Mack şi Heather Smith. Îmi exprim mulţumiri
faţă de Declan Berry, PhD, Christina Magana,
PhD, Linda Myerholtz, PhD, şi Jennifer Yarab,
PhD, pentru sprijinul adus în calitate de foşti
studenţi sau ca membri ai personalului. Sunt
recunoscător pentru ajutorul primit de la Diane
Best, Karen Paulk şi Keith Paulk, precum şi pentru
sprijinul profesional, care nu poate fi cuantificat,
din partea lui Harriet Adams, PhD, JD, Riccardo
Dalle Grave, MD, Susan Hanson, MD, şi Stevie
Kim.
Mai multe persoane au avut o contribuţie
extraordinară la revizuirea EDI‑3. Îi sunt
recunoscător lui Arline Soncrant, pentru sprijinul
şi îndrumarea statornice, precum şi lui Dan
Mock, pentru talentul său tehnic remarcabil. Julie
Desai, MA, s‑a dedicat managementului clinic şi
colectării stăruitoare a datelor clinice. Elizabeth
Soll, PhD, a contribuit cu multă sârguinţă la
analiza statistică a datelor pentru standardizare
şi, alături de Priska Volgger, PhD, a adunat şi
a revizuit bibliografia. John Garner a muncit
neobosit la organizarea noilor cercetări şi la
editarea textului şi a tabelelor în diferite etape ale
proiectului.
În încheiere, aş dori să‑mi exprim mulţumirile
faţă de personalul de la Psychological
Assessment Resources, Inc. Îi sunt recunoscător
lui R. Bob Smith, III, PhD, pentru ajutorul şi
încrederea arătate faţă de multiplele reluări ale
EDI‑3, pe parcursul ultimilor 20 de ani. Îi sunt
îndatorat Melissei Messer, MHS, pentru suportul
tehnic, Lisei L. Doelling, pentru sugestiile
editoriale excepţionale, lui Becky Haines,
pentru cunoştinţele sale tipografice şi lui Travis
White, PhD, pentru organizarea şi supervizarea
personalului implicat în proiect. În cele din urmă,
doresc să‑mi exprim adânca preţuire faţă de dr.
Mark F. Ledbetter, Senior Project Director, pentru
abilitatea analitică şi intuiţia clinică extraordinare
în toate etapele proiectului. Încurajarea,
îndrumarea şi rigoarea sa conceptuală au jucat
un rol decisiv în finalizarea proiectului.
David M. Garner, PhD
Noiembrie, 2004
 Locurile de unde s-au colectat datele
Toate seturile de date provin din arhivă şi au
fost obţinute în urma unei cercetări generale a
autorului Manualului profesional EDI‑3 asupra
datelor care urmau să fie utilizate, cu precădere,
pentru actualizarea inventarului EDI‑2.
Locuri clinice
Statele Unite
Indiana: Datele au fost furnizate de către
dr. Dorothy Espelage, dr. Roberta Sherman
şi dr. Ron Thompson, de la un centru de
tratament ambulatoriu la Spitalul Bloomington
din Bloomington, Indiana. Eşantionul a fost
alcătuit din 257 de adulţi şi 31 de adolescenţi,
pacienţi îndrumaţi pentru evaluare şi tratament
ambulatoriu de către clinicieni specializaţi în
tratamentul tulburărilor de comportament
alimentar.
Maryland: Datele au fost furnizate de către
Angela Guarda, MD, dr. Janelle Coughlin şi dr.
Leslie Heinberg, în cadrul programului pentru
pacienţi internaţi, derulat de Spitalul Johns
Hopkins din Baltimore, Maryland. Eşantionul a
fost format din 106 adulţi şi 35 de adolescenţi,
pacienţi beneficiind de tratament în cadrul
unui centru de asistenţă terţiară, specializat în
tulburări de comportament alimentar.
Michigan: Datele au fost furnizate de către
Lionel Rosen, MD, şi Christine Shafer, MD,
din cadrul Departamentului de Psihiatrie al
Universităţii de stat Michigan, East Lansing,
Michigan. Eşantionul a constat din 100 de
adulţi şi 16 adolescenţi, pacienţi îndrumaţi
spre evaluare şi tratament ambulatoriu de către
clinicieni specializaţi în tratamentul tulburărilor
de comportament alimentar.
Ohio: Acest set de date provine de la Centrul
Clinic River din Sylvania, Ohio, care asigură
spitalizare şi tratament ambulatoriu parţiale
pentru adulţi, precum şi tratament în regim
sanatorial şi ambulatoriu pentru adolescenţi.
Datele din acest loc au cuprins 240 de adulţi şi
136 de adolescenţi şi sunt descrise mai detaliat
în seţiunea despre rezultatele tratamentului a
acestui Manual de specialitate.
Wisconsin: Datele au fost furnizate de
către dr. Pamela Bean şi Ted Weltzin, MD, de
la Spitalul Memorial Rogers din Oconomowoc,
Wisconsin. Eşantionul a cuprins 170 de adulţi şi
101 adolescenţi, pacienţi beneficiind de tratament
într‑un centru terţiar cu regim sanatorial,
specializat în tulburări de comportament
alimentar.
La nivel internaţional
Australia: Datele au fost furnizate de către
Sarah Maguire, PhD, şi Pierre Beumont, MD, de
la Universitatea din Sydney, New South Wales,
Australia. Eşantionul a fost alcătuit din 106
adulţi şi 35 de adolescenţi, pacienţi beneficiind
de tratament într‑un centru terţiar specializat în
tulburări de comportament alimentar.
Canada: Datele au fost furnizate de către
Howard Steiger, PhD, în cadrul Programului
pentru tulburări de comportament alimentar
de la Centrul de cercetare al spitalului Douglas,
Borough of Verdun, Montreal, Quebec. Eşantionul
a fost format din 97 de pacienţi adulţi, care au
fost iniţial diagnosticaţi cu bulimie nervoasă şi
au primit tratament pe perioada internării sau
ambulator.
Italia: Datele au fost furnizate de către
Riccardo Dalle Grave, MD, de la Unitatea de
reabilitare nutriţională din Villa Garda, Italia.
Eşantionul a fost alcătuit din 103 pacienţi
adulţi beneficiind de tratament într‑un centru
terţiar specializat în tulburări de comportament
alimentar.
Olanda: Datele au fost furnizate de către
Tatjana van Strien, PhD, de la Departamentul de
psihologie clinică şi personalitate, Universitatea
din Nijmegen, şi au fost obţinute de la pacienţi
înregistraţi la mai multe clinici olandeze
specializate în tulburări de comportament
alimentar.
13
 Locuri nonclinice
Olanda: Datele au fost furnizate de către
Tatjana van Strien, PhD, de la Departamentul de
psihologie clinică şi personalitate, Universitatea
din Nijmegen, Nijmegen, Olanda.
Cincinnati şi Bowling Green, Ohio: Datele
au fost furnizate de către Diann Ackard, PhD,
provenind dintr‑un studiu efectuat pe studenţi
de la Universitatea din Cincinnati.
14
Suedia 1: Datele au fost furnizate de către
dr. Claes Norring, Centrul Naţional pentru
tulburările de comportament alimentar, Orebro,
Suedia. Eşantionul a fost format din 963 de femei
şi 784 de bărbaţi, cu vârste cuprinse între 13 şi 33
de ani.
Suedia 2: Datele a fost furnizate de către
dr. Birgitta Edlund şi dr. Barbro Thurfjell,
Universitatea Uppsala, Departamentul de Ştiinţe
ale Sănătăţii Publice şi Asistenţei, Secţia Ştiinţe
ale Asistenţei, Uppsala, Suedia.
 1
Introducere
Prezentare generală a EDI‑3
Inventarul tulburărilor de comportament
alimentar‑3 (EDI‑3) este o ediţie revizuită a
celui mai folosit instrument de autoevaluare
a trăsăturilor sau a constructelor psihologice
care s‑au dovedit a fi relevante din punct
de vedere clinic la persoanele cu tulburări
de comportament alimentar. EDI‑3 este un
instrument de măsură standardizat şi uşor
de aplicat, care furnizează scoruri şi profiluri
obiective, utile în conceptualizarea cazurilor şi
pentru planul de tratament al persoanelor care
au sau se presupune că ar avea o tulburare de
comportament alimentar. De asemenea, este
un instrument valoros de cercetare, având ca
scop evaluarea domeniilor de psihopatologie
care prezintă interes pentru testarea teoriilor,
identificarea subgrupurilor relevante de pacienţi
şi evaluarea rezultatelor tratamentului.
Aşa cum se arată în Figura 1.1, frecvenţa
menţionărilor referitoare la EDI în literatură a
crescut substanţial de la prima sa publicare, din
1983. EDI‑3 este o revizuire a versiunii originale,
care a fost folosită mai bine de 20 de ani (EDI;
Garner, Olmsted şi Polivy, 1983). Ansamblul
original de itemi, împreună cu itemii proveniţi din
revizuirea din 1991 (EDI‑2; Garner), a fost păstrat
cu grijă, astfel încât clinicienii şi cercetătorii să
poată continua compararea datelor colectate
anterior, cu datele provenite din EDI‑3 revizuit.
EDI‑3 a fost îmbunătăţit cu scopul de a furniza
scale pentru măsurarea constructelor care sunt
mai potrivite cu domeniile psihologice identificate
de către teoriile moderne ca fiind relevante
pentru etiologia, menţinerea sau variaţiile
simptomelor de bază la indivizii cu tulburări de
comportament alimentar. Rafinarea conceptuală
şi îmbunătăţirea proprietăţilor psihometrice
ale EDI‑3 reprezintă un progres semnificativ în
evaluarea psihologică din domeniul tulburărilor
de comportament alimentar.
EDI‑3 este destinat, în primul rând,
adolescenţilor mari, cu vârste începând de la 13
ani, şi femeilor adulte; totuşi, ansamblul de itemi
a fost folosit şi pentru adolescenţii cu vârste
cuprinse între 11 şi 12 ani. EDI‑3 este format
din 91 de itemi provenind din EDI‑2, organizaţi
în 12 scale de bază. Acestea sunt constituite din
trei scale specifice de tulburări de comportament
alimentar şi nouă scale psihologice generale care
sunt foarte relevante, dar nu specifice, pentru
tulburările de comportament alimentar. EDI‑3
aduce în plus 6 scale compozite: una care este
specifică tulburărilor de comportament alimentar
(adică Riscul de tulburare de comportament
alimentar) şi alte cinci care sunt constructe
psihologice integrative generale (Ineficacitate,
Probleme interpersonale, Probleme emoţionale,
Control exagerat, Neadaptare psihologică generală).
Cele 6 scale compozite ale EDI‑3 sunt prezentate
în Tabelul 1.1, împreună cu scalele EDI‑3 care
sunt folosite la formarea fiecărei scale compozite.
Unele dintre scalele EDI‑3 rămân în aceeaşi
formă ca în EDI şi EDI‑2 originale, pe când altele
au fost îmbunătăţite sau create cu scopul de a
îmbunătăţi calităţile psihometrice şi conţinutul
conceptual ale scalelor şi ale instrumentului în
întregime. Tabelul 1.2 prezintă scalele EDI‑3 şi
subscalele EDI‑2 pentru o comparaţie facilă a
gradului de suprapunere a itemilor între cele
două instrumente. Revizuirea EDI‑3 este bazată
pe un eşantion mare de pacienţi cu tulburări de
comportament alimentar, provenind din mai
multe centre de tratament din Statele Unite,
Canada, Europa şi Australia. Au fost create noi
etaloane pe un eşantion clinic din diferite locuri
din Statele Unite, iar eşantioanele non‑clinice
corespunzătoare au provenit din Statele Unite şi
din Europa.
15
 140

120

100

80

60
Număr de citări

40

20

0
1983 1985 1987 1989 1991 1993 1995 1997 1999 2001 2003

An

Figura 1.1. Frecvenţa citărilor în literatură, referitoare la Inventarul tulburărilor de

comportament alimentar

Tabelul 1.1
Scalele EDI-3 şi scalele compozite asociate ale acestora

Scala Scala compozită

Dorinţa de a fi slab (DS)
Bulimie (B) Scala compozită Risc de tulburare de comportament
Nemulţumire faţă de corp (NC) alimentar (SCRTCA)

Stimă de sine scăzută (SSS)

Alienare personală (AP) Scala compozită Ineficacitate (SCI)

Nesiguranţă interpersonală (NI)

Alienare interpersonală (AI) Scala compozită Probleme interpersonale (SCPI)

Deficite interoceptive (DI)

Dezechilibru emoţional (DE) Scala compozită Probleme emoţionale (SCPE)

Perfecţionism (P)
Ascetism (A) Scala compozită Control exagerat (SCCE)

Stimă de sine scăzută (SSS)

Alienare personală (AP)
Nesiguranţă interpersonală (NI)
Alienare interpersonală (AI)
Deficite interoceptive (DI)
Scala compozită Neadaptare psihologică generală (SCNPG)
Dezechilibru emoţional (DE)
Perfecţionism (P)
Ascetism (A)
Frica de maturitate (FM)

16
 Tabelul 1.2
Diferenţe între EDI-2 şi EDI-3

Scala EDI-3/Scala compozită/Indicator al stilului

Subscala EDI-2 Diferenţa
de răspuns
Scala Riscului de tulburare de comportament
alimentar
Dorinţa de a fi slab (DS) Dorinţa de a fi slab (DS) Niciuna
Bulimie (B) Bulimie (B) 1 item de la CI
Nemulţumire legată de corp (NC) Nemulţumire faţă de corp (NC) 1 item de la CI

Ineficaciate (I)
Nesiguranţă socială (NS)a
Neîncredere interpersonală (NI)
Conştiinţă interoceptivă (CI)
Reglarea impulsurilor (RI)a
Perfecţionism (P)
Ascetism (A)a
Frica de maturitate (FM)
Scala psihologică
Stimă de sine scăzută (SSS) 5 itemi de la I
Alienare personală (AP) 4 itemi de la I; 3 de la NS
Nesiguranţă interpersonală (NI) 4 itemi de la NI; 3 de la NS
Alienare interpersonală (AI) 3 itemi de la NI; 3 de la AI; 1 de la NS
Deficite interoceptive (DI) 8 itemi de la CI; 1 de la AI
Dezechilibru emoţional (DE) 8 itemi de la RI
Perfecţionism (P) Niciuna
Ascetism (A) 7 itemi de la A
Frica de maturitate (FM) Niciuna

Scala compozităb
Scala compozită Risc de tulburare de comportament
alimentar (SCRTCA)
Scala compozită Ineficacitate (SCI)
Scala compozită Probleme interpersonale (SCPI)
Scala compozită Probleme emoţionale (SCPE)
Scala compozită Control exagerat (SCCE)
Scala compozită Neadaptare psihologică generală
(SCNPG)

Indicatorul stilului de răspunsb

Inconsecvenţă (IN)
Raritate (R)
Impresie negativă (ING)

Notă. Itemul 71 din EDI-2 este inclus în Broşura cu itemi EDI-3, dar nu este cotat în EDI-3.
a
Aceste scale nu apar în varianta originală EDI. bScalele compozite şi indicatorii stilului de răspuns sunt nou introduse în
EDI‑3.

Rezumatul caracteristicilor principalele ale asupra utilizării extinse a EDI în domeniul

EDI‑3
• Evaluează aspectele psihologice relevante
conceptual pentru înţelegerea şi tratarea
tulburărilor de comportament alimentar.
• Uşor de administrat şi cotat, EDI‑3 aduce
în plus 12 scoruri la scale care nu se
suprapun şi 6 scoruri la scale compozite
care pot fi utilizate pentru crearea de
profiluri semnificative din punct de vedere
clinic. Profilurile pot fi asociate planurilor
de tratament, intervenţiilor specifice şi
monitorizării tratamentului.
• Este destinat pentru aplicarea atât în
cercetare, cât şi în scop clinic.
• Manualul de specialitate oferă o privire de
ansamblu asupra proprietăţilor psihometrice
ale EDI‑3 şi o revizuire a literaturii relevante
tulburărilor de comportament alimentar.
• Oferă formulare noi şi uşor de folosit
pentru cote T şi pentru profilul bazat pe
centile, care includ seturi de itemi critici ce
permit dezvoltarea unui tablou clinic mai
semnificativ.
• Include ghiduri clinice de interpretare, cu
exemple de cazuri.
• Propune un sistem nou de cotare care
îmbunătăţeşte proprietăţile psihometrice ale
EDI‑3.
• Indicii de fidelitate şi validitate sunt excelenţi.
• Utilizează eşantioane extinse de
standardizare din mai multe locuri clinice
din SUA, împărţite în patru subgrupuri
diferite de diagnostic, care au fost utilizate
pentru crearea de etaloane actualizate.
• Utilizează eşantioane clinice extinse,
internaţionale, pentru comparaţii.

17
• Utilizează eşantioane non‑clinice din mai
multe locuri la nivel internaţional şi din SUA,
pentru comparaţii.
• Discriminează între grupurile clinice şi
non‑clinice.
• În profilul de interpretare sunt incluşi itemi
critici, care permit dezvoltarea unui tablou
clinic mai semnificativ.
• Datele se pot aplica în situaţiile de asistenţă
medicală primară.
Caracteristici adiţionale ale EDI‑3
• EDI‑3 SP este un program de cotare pe
calculator care generează un profil clinic
individual şi detaliat şi un raport cu cotele
obţinute pentru fiecare client.
• EDI‑3 are un sistem îmbunătăţit de cotare.
EDI‑3 foloseşte un sistem de cotare de la 0
la 4, care menţine integritatea conceptuală a
sistemului original, îmbunătăţeşte fidelitatea
anumitor scale şi are avantajul unui interval
mai mare de scoruri.
• EDI‑3 LS este o listă de simptome care
contribuie la strângerea sistematică de date
referitoare la simptome, pentru a stabili
dacă sunt îndeplinite toate criteriile de
diagnostic conform Manualului de diagnostic
şi statistică a tulburărilor mentale, ediţia a 4‑a,
revizuită (DSM‑IV‑TR; American Psychiatric
Association, 2000).
• EDI‑3 FT este un formular de trimitere care
poate fi administrat în licee, facultăţi, cluburi
sportive sau alte locuri non‑clinice, cu scopul
de a stabili dacă un individ ar trebui trimis la
un consult de specialitate.
EDI‑3 LS
EDI‑3 LS este un inventar independent
şi structurat de autoevaluare a simptomelor.
Acest formular uşor de completat oferă date
despre frecvenţa simptomelor (ex. alimentaţia
compulsivă, provocarea vărsăturilor, tipuri de
activitate fizică efectuată, folosirea laxativelor, a
pastilelor de slăbit şi a diureticelor), precum şi
informaţii privind greutatea, istoricul greutăţii
şi al ciclului menstrual. Informaţii detaliate
cu privire la categoriile de simptome evaluate
de EDI‑3 LS sunt necesare pentru a determina
dacă pacienţii îndeplinesc criteriile precise de
diagnostic pentru o tulburare de comportament
alimentar.
18
EDI‑3 FT
EDI‑3 FT este un formular de trimitere al
EDI‑3 şi include trei scale care formează Scala
compozită Risc de tulburare de comportament
alimentar (SCRTCA) (adică Dorinţa de a fi slab
[DS], Bulimie [B], Nemulţumire faţă de corp [NC]).
În plus faţă de cele 25 de întrebări ale EDI‑3,
acest scurt formular de autoevaluare include
întrebări legate de indicatorii comportamentali,
care sunt folosite pentru a identifica indivizii cu
posibile tulburări de comportament alimentar
sau cu o posibilă patologie. Indicaţiile pentru
trimitere se bazează pe informaţii provenite din
întrebările din EDI‑3 şi pe valorile indicelui de
masă corporală (IMC) al persoanei şi sunt folosite
pentru a identifica indivizii care prezintă riscul să
dezvolte o tulburare de comportament alimentar.
Scopul EDI‑3
EDI‑3 nu este menit să pună un diagnostic
de tulburare de comportament alimentar.
Mai degrabă, are ca scop evaluarea trăsăturilor
psihologice sau a clusterilor de simptome relevante
pentru dezvoltarea şi menţinerea tulburărilor
de comportament alimentar. Profilul psihologic
oferit de EDI‑3 este o sursă bogată de informaţii
pentru generarea sau confirmarea impresiilor
clinice care sunt mai mult decât simple
diagnostice. Este, de asemenea, un instrument
valoros în elaborarea planurilor de tratament şi
în evaluarea efectului tratamentului în domenii
psihologice de bază.
Subgrupurile de diagnostic al tulburărilor
de comportament alimentar au fost formate
bazându‑se, în principal, pe greutatea corporală şi
pe manifestări ale comportamentului alimentar,
precum alimentaţia compulsivă şi provocarea
vărsăturilor; cu toate acestea, eterogenitatea
extraordinară a caracteristicilor psihologice din
cadrul fiecărui subgrup de diagnostic (Garner,
Garner şi Rosen, 1993) subliniază beneficiul
clinic al evaluării pacienţilor din perspectiva
unui spectru larg de variabile psihosociale
semnificative. Această variaţie în descrierea
pacientului reprezintă punctul conceptual central
al EDI‑3. Pentru a înţelege mai bine aplicaţiile
EDI‑3, este util să trecem în revistă câteva
principii fundamentale referitoare la înţelegerea
şi clasificarea tulburărilor de comportament
alimentar.
Scopul EDI‑3 este de a oferi o măsură
cuprinzătoare a prezenţei şi a intensităţii
trăsăturilor psihologice sau ale clusterilor de
simptome care sunt relevante din punct de vedere
 Individual

Urmarea unei diete

pentru a creşte
Familial Agenţi stresori autocontrolul şi Înfometare
respectul de sine

Sociocultural

Factori predispozanţi Factori favorizanţi Factori de menţinere

Figura 1.2. Tulburările de comportament alimentar, plurideterminate de trei clase de factori predispozanţi sau
de risc. Din Patogeneza anorexiei nervoase (Pathogenesis of Anorexia Nervosa) de D.M. Garner, 1993, The Lancet,
341, p. 1632. Copyright 1993, Elsevier. Reprodus cu permisiunea autorului.

clinic într‑o evaluare cuprinzătoare a persoanelor
cu tulburări de comportament alimentar. Acest
fapt este în concordanţă cu concepţia asupra
tulburărilor de comportament ca având un
caracter multideterminat şi eterogen (Garner,
1993a; Garner şi Garfinkel, 1980). În consecinţă,
aceste tulburări reprezintă traiectorii comune
finale care rezultă din interacţiunea a trei clase
mari de factori de risc, după cum apare ilustrat
în Figura 1.2.
Factorii de risc culturali (sau sociali),
individuali (adică de dezvoltare, psihologici,
biologici) şi factorii de risc familiali se combină în
moduri diferite, ducând la dezvoltarea tulburări-
lor de comportament alimentar. Tematica
factorilor de risc va fi dezbătută mai pe larg în
capitolul 4; în orice caz, factorii predispozanţi
includ: a) a fi femeie; (b) a trăi în societatea
occidentală; (c) a fi adolescent(ă) sau adult tânăr;
(d) stima de sine scăzută; (e) perfecţionismul;
(f) depresia şi (g) antecedente familiale de orice
tip de tulburare de comportament alimentar,
obezitate, depresie sau abuz de substanţe.
Factorii favorizanţi importanţi cuprind: (a)
restricţie alimentară pentru scăderea în greutate;
(b) presiuni la locul de muncă sau în timpul liber
pentru a fi slab(ă); (c) comentarii critice referitoare
la greutatea şi conformaţia corporală şi (d) abuz
sexual. Factorii de menţinere importanţi sunt
efectele psihologice, emoţionale şi fizice ale
înfometării.
Prezentare generală a tulburărilor de
comportament alimentar
Tulburările de comportament alimentar
se regăsesc în terminologia psihiatrică de
mulţi ani; totuşi, doar în ultimele două decenii
acestea au suscitat un larg interes pentru
psihologie, psihiatrie şi specialităţile asociate
(Theander, 2004). Un motiv al acestui interes este
recunoaşterea consecinţelor importante asupra
sănătăţii ale tulburărilor de comportament
alimentar. Anorexia nervoasă este considerată
a fi cea de‑a treia boală cronică ce apare la fete
cu vârste cuprinse între 15 şi 19 ani (Lucas,
Beard, O’Fallon şi Kurland, 1991). Aceasta este
asociată cu complicaţii medicale importante,
iar rata mortalităţii depăşeşte de douăsprezece
ori incidenţa presupusă a morţii din alte cauze
în rândul femeilor cu vârste cuprinse între 15
şi 24 de ani (Sullivan, 1995). Rata mortalităţii
pentru bulimia nervoasă este mult mai scăzută,
rămânând, însă, semnificativă (Keel, Mitchell,
Davis şi Crow, 2002; Nielsen, 2003).

19
Diagnoza şi definiţia subtipurilor: relevanţa
pentru EDI‑3
Sistemele existente de diagnoză, Manualul
de diagnoză şi statistică a tulburărilor mentale,
ediţia a patra revizuită (DSM‑IV‑TR; Asociaţia
Americană de Psihiatrie, 2000) şi ICD‑10
Clasificarea tulburărilor mentale şi comportamentale:
descrieri clinice şi ghiduri de diagnostic (Organizaţia
Mondială a Sănătăţii [OMS], 1992), au definit
două tulburări principale de comportament
alimentar, Anorexia nervoasă (AN) şi Bulimia
nervoasă (BN), precum şi un grup divers de
pacienţi cu tulburări clasificate la categoria
de Tulburări de comportament alimentar fără altă
specificaţie (TCAFAS). Pacienţii cu AN au fost
împărţiţi în două subtipuri: Restrictiv (AN‑R) şi
Comportament alimentar compulsiv/vărsături
(AN‑AC/V)1. Criteriile de diagnostic pentru
cele două tulburări principale de comportament
alimentar şi pentru grupul de TCAFAS vor fi
discutate în continuare, în capitolul 4; totuşi,
punctele pertinente majore pentru evaluarea cu
EDI‑3 pot fi rezumate pe scurt.
Asocierea dintre anumite simptome şi
subgrupurile de diagnostic şi anumiţi clusteri
de simptome sau profiluri clinice a fost, uneori,
mai degrabă generalizată la întreg grupul de
diagnostic, decât folosită pentru a sublinia
asemănările remarcabile dintre subgrupuri în
ceea ce priveşte o gamă largă de dimensiuni
demografice, clinice şi psihologice. De exemplu,
pacienţii care au un comportament alimentar
compulsiv şi îşi provoacă vărsături (atât în
cazul AN, cât şi BN) tind să manifeste un nivel
mai ridicat de impulsivitate, o funcţionare
deficitară la nivel social/sexual, abuz de anumite
substanţe şi probleme generale de control al
impulsurilor. Spre deosebire de aceştia, pacienţii
cu AN‑R sunt descrişi ca fiind perfecţionişti,
obsesiv‑compulsivi, timizi, introvertiţi, sensi-
bili în relaţiile inter‑personale şi stoici. Cu toate
acestea, subliniind în mod exagerat diferenţele
semnificative dintre grupuri în privinţa acestor
variabile nu se evidenţiază faptul că mulţi
pacienţi nu sunt în concordanţă cu acest profil.
Mai mult decât atât, cercetările arată că aceste
trăsături impulsive şi compulsive pot apărea
la acelaşi pacient, indiferent de subgrupul de
diagnostic (Steiger, Israel, Gauvin, Ng Ying Kin şi
1
Termenul de binge‑eating a fost tradus prin cel de
„comportament alimentar compulsiv”, deşi, la origine,
acesta semnifică ingerarea unei cantităţi mari de alimente,
într‑un interval scurt de timp, cu pierderea controlului
asupra comportamentului alimentar. În text, termenul apare
fie sub forma „comportament alimentar compulsiv”, fie ca
„alimentaţie compulsivă” (n.t.).
20
Young, 2003). Cel puţin în scopuri clinice, pentru
a deduce tipologiile psihologice este mai rentabil
să se evalueze direct dimensiunile psihologice
importante decât a se baza pe categoriile de
diagnostic.
În acelaşi timp, în fiecare grup de diagnostic
există o extraordinară eterogenitate în privinţa
valorilor fiecăreia dintre variabilele demografice,
clinice şi psihologice (Garner, Garner şi colab.,
1993). EDI‑3 este construit pentru a evalua
domenii psihologice care au atât aplicaţii clinice,
cât şi ştiinţifice, întrucât acestea sunt relevante
conceptual pentru înţelegerea şi tratamentul
tulburărilor de comportament alimentar.
Este dovedit faptul că, în diferite momente,
pacienţii se încadrează în grupuri diferite de
diagnostic, indiferent dacă au fost sau nu trataţi.
(Eddy şi colab., 2002; Russell, 1979). Cu toate
că variabile precum comportamentul alimentar
şi greutatea, care determină apartenenţa la un
grup de diagnostic, ajustează anumite aspecte
ale tratamentului, deplasarea între grupurile de
diagnostic pare să reflecte mai degrabă o fază a
evoluţiei unei tulburări decât un subtip disctinct.
DSM‑IV‑TR include în categoria TCAFAS, un
subtip de diagnostic extins şi eterogen, indivizii
care prezintă tulburări de comportament
alimentar semnificative din punct de vedere
clinic, dar care nu întrunesc toate criteriile de
diagnostic pentru AN sau BN. Din păcate,
termenul „fără altă specificaţie” ar putea fi
interpretat ca implicând existenţa unor probleme
de comportament alimentar nesemnificative din
punct de vedere clinic. Această presupunere este
incorectă, pentru că tabloul clinic pentru mulţi
dintre indivizii cu tulburări de comportament
alimentar care fac parte din această categorie
poate fi la fel de complicat şi de grav ca şi cel al
celor două tulburări principale de comportament
alimentar (Walsh şi Garner, 1997).
Incidenţa şi prevalenţa
Rata de incidenţă este definită ca fiind
numărul de cazuri noi apărute într‑un an în
rândul populaţiei, în timp ce rata de prevalenţă
se referă la numărul efectiv de cazuri din rândul
populaţiei într‑un anumit moment. Estimând
incidenţa pe baza datelor furnizate de medicii de
familie, rata este de 8,1 la 100.000 de persoane pe
an pentru AN şi 11,5 la 100.000 de persoane pe
an pentru BN (Hoek şi colab., 1995). Estimările
prevalenţei pentru tulburările de comportament
alimentar variază considerabil, în funcţie de
metodele folosite şi de modurile în care este
definită tulburarea. Metodele autoevaluative
au ca rezultat, de regulă, o rată mai crescută a
prevalenţei faţă de metodele bazate pe interviu.
Spre deosebire de acestea, datele provenite din
studiile epidemiologice au dus la concluzia că
criteriile de diagnostic actuale ar putea fi prea
restrictive, datorită faptului că mulţi dintre cei
care nu se încadrează într‑un anumit diagnostic
au aceeaşi morbiditate psihiatrică ca şi cei cu
sindrom complet (Sullivan, Bulik şi Kendler,
1998).
Observaţii cu privire la gen
Studiile epidemiologice au arătat constant că
tulburările de comportament alimentar sunt mai
frecvente în rândul femeilor decât al bărbaţilor.
În eşantioanele clinice, doar 5% până la 10%
dintre pacienţi sunt bărbaţi (Hoek şi colab., 1995).
Studiile realizate în Statele Unite sugerează că
incidenţa anorexiei nervoase în rândul bărbaţilor
poate ajunge doar până la 0,02% pe an, iar
prevalenţa bulimiei nervoase în rândul bărbaţilor
este între 0,1% şi 0,5%. Diferenţele dintre
frecvenţele pe sexe sunt, în general, atribuite
factorilor culturali; totuşi, când aceste tulburări
apar la bărbaţi, manifestările clinice sunt foarte
asemănătoare cu cele observate în cazul femeilor
(Andersen, 1990).
Observaţii cu privire la dezvoltare
Începând cu cele dintâi descrieri, s‑a
convenit că AN este, înainte de toate, o tulburare
a adolescenţei şi că psihopatologia de bază se
asociază adesea cu conflicte care apar odată cu
schimbările puberale în conformaţia corpului.
Theander (1996) a analizat chestiunea vârstei
de debut şi a stabilit că vârsta medie de debut
este de aproximativ 17 ani, iar în aproximativ
30% dintre cazuri debutul este la 14 ani sau
mai devreme. Anumite biasări în procesul de
selecţie evidenţiază, în unităţile de tratament
pediatrice, vârsta de debut mai redusă. Theander
centralizează datele referitoare la distribuţia
vârstei de debut, afirmând că: (a) există
câţiva pacienţi cu o vârstă timpurie de debut
(vârste cuprinse între 7 şi 10 ani); (b) numărul
cazurilor creşte brusc la vârstele de 11 şi 12
ani; (c) în majoritatea cazurilor, tulburările de
comportament alimentar se dezvoltă la vârsta
adolescenţei (vârste cuprinse între 13 şi 19
ani); (d)  există o diminuare treptată în privinţa
frecvenţei cazurilor cu debut la vârstele cuprinse
între 20 şi 30 de ani şi (e) există doar câteva cazuri
cu un debut după 30 de ani. Unii cercetători au
arătat că vârsta de debut tinde să fie puţin mai
redusă în cazul bărbaţilor faţă de acela al femeilor;
totuşi, acest aspect rămâne controversat.
S‑au schimbat tulburările de comportament
alimentar de‑a lungul timpului?
S‑a dovedit faptul că tulburările de
comportament alimentar se pot manifesta
diferit, în funcţie de importanţa pe care, la un
moment dat, mediul cultural o acordă restricţiei
alimentare. Cultura nu a fost identificată ca fiind
un factor relevant în manifestarea tulburărilor de
comportament alimentar atunci când autorul a
consultat primul său pacient, în urmă cu 30 de
ani; acest concept a fost promovat cu prudenţă
(Garner şi Garfinkel, 1978, 1980; Garner,
Garfinkel, Schwartz şi Thompson, 1980). Casper
(1983) a sugerat că ar fi existat o schimbare
istorică în psihopatologia anorexiei nervoase, de
la relatările timpurii despre „motivele ascetice”,
la teme motivaţionale mai moderne, referitoare la
„dorinţa de a fi slab” şi „teama de a se îngrăşa”.
Russel (1985) a dezvoltat această observaţie,
notând că BN a devenit parte a terminologiei de
diagnostic datorită presiunilor crescânde asupra
femeilor de a urma o dietă, astfel încât să atingă
standarde nerealiste de supleţe şi frumuseţe.
Acest punct de vedere se sprijină pe o serie
de rapoarte care indică faptul că tulburările de
comportament alimentar pot avea o „evoluţie”
mai precoce în anumite ţări asiatice. Lee, Ho şi
Hsu (1993) au identificat în China un subgrup
de pacienţi cu AN, cu „fobie faţă de absenţa
grăsimii”, care se disting prin scoruri mici la
subscalele EDI „Dorinţa de a fi slab” şi „Bulimie”,
dar care prezintă o psihopatologie semnificativă,
măsurată cu ajutorul altor subscale EDI (Lee, Lee
şi Leung, 1998) şi care obţin rezultate intermediare
mai bune (Lee, Chan şi Hsu, 2003).
Evoluţia şi efectele tratamentului
În ultimii ani au avut loc progrese majore
în ceea ce priveşte tratamentul anorexiei şi
cel al bulimiei nervoase. Deşi există variaţii
considerabile între rezultatele cercetărilor,
aproximativ 70% dintre adolescenţii cu AN se
recuperează în urma tulburării de comportament
alimentar. Evoluţia în cazul acestor pacienţi
poate fi dificilă şi un procent însemnat (20% până
la 30%) rămân disfuncţionali din punctul de
vedere al adaptării psihologice şi al funcţionării
sociale (Patton, Coffey şi Sawyer, 2003;
Steinhausen, Boyadjieva, Griogoroiu‑Serbanescu
şi Neumarker, 2003; Strober, Freeman şi Morrell,
1997). Studiile de follow‑up pe termen lung
21
în cazul adulţilor cu AN indică rezultate mai
puţin favorabile, cu o rată de recuperare de
aproximativ 50%; totuşi, aşa cum s‑a menţionat,
există variaţii semnificative în ceea ce priveşte
rezultatele studiilor de follow‑up (Steinhausen,
2002). Mai mult, există o diversitate extraordinară
privind efectele tratamentului în diferite centre,
sugerându‑se că elementele unui tratament
eficient există, însă acestea nu sunt bine precizate
sau aplicate consecvent.
Există mai multe dovezi în favoarea
unui tratament eficient pentru BN, în sensul
recuperării a 70% dintre pacienţi pe parcursul
a 3 luni de terapie cognitiv‑comportamentală
validată empiric, desfăşurată în regim
ambulatoriu (Fairburn şi colab., 1995). Cu
toate acestea, studii recente au scos în evidenţă
caracterul fluctuant al simptomelor, de‑a lungul
perioadei de follow‑up, pentru mulţi pacienţi
care au probleme psihologice şi interpersonale
generalizate (Fichter şi Quadflieg, 1997; Keel,
Mitchell, Miller, Davis şi Crow, 1999; Wilson,
Fairburn, Agras, Walsh şi Kraemer, 2002). Acest
lucru nu poate fi atribuit doar distorsionării
rezultatelor, cauzată de selecţia cazurilor în
care s‑a solicitat tratamentul, deoarece studii
prospective efectuate asupra unor comunităţi
reprezentative indică faptul că funcţionarea
psihosocială deficitară şi inadaptarea psihologică
afectează un subgrup semnificativ de pacienţi
cu AN (Wentz, Gillberg, Gillberg şi Rastam,
2001) şi cu BN (Fairburn şi colab., 2003). Chiar
şi printre aceia care se recuperează în urma AN,
s‑a dovedit că există o frecvenţă mare a celor la
care se menţin perfecţionismul, obsesionalitatea
şi funcţionarea socială deficitară (Patton şi colab.,
2003; Steinhausen şi colab., 2003), precum şi un
risc crescut pentru apariţia unei game extinse
de probleme fizice şi de sănătate mintală, la
începutul perioadei adulte (Johnson Cohen,
Kasen şi Brook, 2002).
22
Rezumat
Scopul principal al EDI‑3 este evaluarea
clinică a simptomatologiei asociate cu tulburările
de comportament alimentar. Acesta are avantajul
de a fi standardizat şi economic şi nu necesită
un intervievator calificat. Poate fi completat
într‑un timp relativ scurt şi poate fi administrat
în grup. O parte semnificativă a literaturii
arată că subscalele EDI măsoară dimensiuni
clinice relevante ale experienţelor pacienţilor cu
tulburări de comportament alimentar. Subscalele
originale s‑au dovedit a avea un conţinut adecvat
şi o bună validitate de criteriu, convergentă
şi discriminantă. Cercetările din ultimele
două decenii au arătat că EDI este sensibil la
modificările de natură clinică şi că ar putea juca
un rol valoros în evaluările clinice ale pacienţilor
cu tulburări de comportament alimentar sau ale
celor suspecţi de tulburări de comportament
alimentar. EDI‑3 a fost îmbunătăţit semnificativ
pentru a oferi scale şi scale compozite pentru
măsurarea constructelor celor mai concordante
cu domeniile psihologice identificate de teoriile
moderne ca fiind relevante pentru tulburările de
comportament alimentar.
EDI‑3 nu ar trebui să fie considerat
drept o selecţie exhaustivă de caracteristici
psihopatologice ale tulburărilor de comporta-
ment alimentar. EDI‑3, ca orice alt instrument
de autoevaluare, poate fi criticat ca având un
potenţial de distorsiune care îl face vulnerabil,
din cauza distorsionărilor cauzate de stilul de
răspuns, a furnizării de informaţii incorecte, a
unei atitudini defensive şi a negării. Interviurile
structurate au avantajul de a permite o apreciere
mai detaliată a unor psihopatologii specifice şi de
a oferi posibilitatea de investigare şi clarificare
a semnificaţiei anumitor răspunsuri. Pe de altă
parte, interviurile structurate durează mult,
necesită intervievatori calificaţi şi pot fi nepractice
în multe situaţii. Instrumentele de autoevaluare
şi cele pe bază de interviu oferă diferite avantaje
şi dezavantaje. Ambele ar trebui luate în
considerare într‑o evaluare comprehensivă a
simptomatologiei tulburărilor de comportament
alimentar.
 2
Construcţia EDI-3
Scopurile şi motivul revizuirii EDI‑3
Scopul principal în elaborarea variantei
originale EDI (Garner, Olmsted şi Polivy, 1983) şi
a EDI‑2 (Garner, 1991) a fost acela de a construi
un instrument standardizat de autoevaluare a
trăsăturilor psihologice relevante din punct de
vedere clinic pentru persoanele care suferă de tul-
burări de comportament alimentar. Construcţia
instrumentului a avut la bază asumpţia
fundamentală conform căreia caracteristicile
psihologice care cauzează şi menţin tulburările
comportamentului alimentar variază în populaţia
clinică eterogenă. S‑a presupus că înţelegerea
acestor caracteristici va ajuta la înţelegerea şi
tratarea tulburărilor de comportament alimentar.
La fel ca instrumentele care îl precedă, EDI‑3
a fost realizat folosind o abordare care a vizat
validitatea de construct, ce pune accentul atât
pe metodele raţionale, cât şi pe cele empirice de
construcţie a scalelor. Constructele au fost alese
în urma unei treceri în revistă a principalelor
teorii din literatura de specialitate, iar scalele
au fost elaborate de către psihologi clinicieni
cu experienţă, care au definit operaţional aceste
constructe. Scalele şi scalele compozite incluse
în varianta finală a EDI‑3 au suportul empiric şi
stabilitatea necesare. Descrierea paşilor iterativi
ai validării de construct pentru EDI şi EDI‑2 va fi
detaliată pe parcursul acestui manual.
Motivul pentru care s‑a considerat necesară
revizuirea EDI‑2 s‑a bazat pe câteva obiective
relaţionate între ele, prezentate pe scurt în
continuare.
1. Versiunile precedente ale EDI nu conţineau
etaloane pentru pacienţii adolescenţi cu
tulburări de comportament alimentar. În
plus, eşantioanele relativ mici din populaţia
clinică adultă au făcut ca sfera evaluării
psihometrice a subscalelor EDI, în ceea ce
priveşte variabilele demografice, diagnostice,
clinice şi externe care corelază între ele, să
fie limitată. Astfel, pentru a remedia aceste
neajunsuri, EDI‑3 a fost validat pe eşantioane
suficient de mari de adulţi şi adolescenţi cu
tulburări de comportament alimentar.
2. Prin revizuirea EDI‑3 sunt abordate şi
punctele slabe ale celor trei subscale
provizorii din EDI‑2 (Ascetism, Reglarea
impulsului, Nesiguranţă socială). Aceste
subscale conţin itemi care se referă la
constructe semnificative din punct de vedere
teoretic; cu toate acestea, mărimea mică a
eşantionului nu a permis o analiză riguroasă
a stabilităţii itemilor şi a structurii scalelor. În
cadrul EDI‑3, aceşti itemi sunt organizaţi, cu
ajutorul metodelor raţionale şi empirice, în
subscale semnificative din punct de vedere
teoretic.
3. Varianta originală a EDI se baza pe
constructe relevante în perioada în care
acesta a fost realizat. Între timp, dezvoltarea
la nivel teoretic a dus la rafinarea domeniilor
psihologice considerate cele mai relevante
pentru tulburările de comportament alimen-
tar. Dimensiunile psihologice măsurate de
EDI şi EDI‑2 au fost transpuse în constructe
mai semnificative, care reflectă progresele
la nivel conceptual făcute în domeniul
tulburărilor de comportament alimentar.
4. Eşantioanele folosite la etalonarea EDI‑3 au
fost selectate din diferite centre de tratament
de pe teritoriul S.U.A., iar eşantioanele
folosite la comparaţii au fost obţinute din
mai multe centre din Canada, Europa şi
Australia. Aceasta constituie o diferenţă între
EDI‑3 şi versiunile sale precedente, pentru
validarea cărora s‑au selectat eşantioane din
două regiuni geografice din Midwestern
(zona centrală şi de vest) S.U.A. şi din
Ontario, Canada.
23
5. Sistemul de cotare de la 0 la 3 puncte folosit
în varianta originală a EDI a fost contestat în
literatura de specialitate, deoarece la itemi
se răspundea pe o scală Likert cu 6 puncte,
însă intervalul era redus (de ex., 000123) prin
neluarea în considerare a scorurilor itemilor
aflate în extrema „non‑simptomatică”.
În EDI‑3 se foloseşte un sistem de cotare
cu puncte de la 0 la 4, care constituie un
compromis între creşterea variabilităţii scalei
şi susţinerea teoretică a sistemului de cotare
de la 0 la 3.
6. Deşi este binecunoscut faptul că mulţi
pacienţi cu tulburări de comportament
alimentar nu sunt motivaţi atunci când încep
tratamentul, versiunile iniţiale ale EDI nu
includeau scale de validitate sau „scale care
să identifice răspunsurile distorsionate”.
Aceste scale ar fi putut ajuta psihologii
clinicieni să determine posibilitatea obţinerii
unui profil care să poată fi interpretat.
În EDI‑3 au fost incluse scale menite să
atenţioneze psihologii clincieni în legătură
cu pattern‑urile de răspuns care sugerează o
posibilă distorsionare în răspunsurile la test.
Originea EDI: modelul continuumului
tulburărilor de comportament alimentar
Unul dintre scopurile principale în
construcţia variantei originale EDI a fost acela
de a testa „modelul continuumului” anorexiei
nervoase (AN) propus de Nylander (1971).
Modelul are la bază observaţia faptului că
majoritatea elevelor de liceu din Suedia au
declarat că „se simt grase” şi aproape 10% dintre
acestea au raportat cel puţin trei „simptome de
anorexie” în asociere cu pierderea în greutate.
Fires (1974) a ajuns la aceeaşi concluzie în urma
studiului efectuat la o clinică de fertilitate,
asupra femeilor care prezentau amenoree
secundară. Potrivit acestei teorii, AN reprezintă
stadiul final al unui proces continuu, care
începe cu restricţie alimentară liber consimţită
şi avansează cu diete tot mai stricte însoţite de
o pierdere progresivă a discernământului. Astfel,
diferenţele dintre cazurile uşoare sau subclinice
şi cele care primesc un diagnostic complet
sunt mai degrabă cantitative decât calitative.
Perspectiva continuităţii a fost contestată de
către teoreticienii care considerau că există
diferenţe calitative între adevăratele cazuri de
AN şi cazurile subclinice. Crisp (1970) a subliniat
semnificaţia unică a „fobiei de îngrăşare” în
AN, ca fiind o retragere din faţa conflictelor care
24
apar în procesul de maturizare, pe parcursul
dezvoltării adolescenţilor. În mod similar, Bruch
(1973) a sugerat că AN se deosebeşte de formele
mai uşoare ale tulburărilor de comportament
alimentar prin deficite esenţiale la nivelul
percepţiei propriului corp, al „sentimentelor de
eficacitate” şi al „conştiinţei interoceptive”.
Interesul pentru acest subiect al autorilor
Garner şi Garfinkel (1980) a fost stimulat de
criticile aduse rezultatelor lor, conform cărora
există o prevalenţă a AN şi a cazurilor subclinice
mai mare decât cea aşteptată, printre elevii la
şcolile de balet. Rezultatele obţinute de aceştia,
în urma aplicării Testului de Atitudini faţă de
Alimentaţie (Eating Attitudes Test, Garner, 1993b,
1997), au indicat că elevii de la şcolile de balet
pot fi plasaţi pe un continuum al preocupărilor
faţă de alimentaţie, la capătul patologic al acestui
continuum situându‑se aceia diagnosticaţi cu
AN. EDI a fost creat pentru a testa „ipoteza
continuumului” la femeile „preocupate de
greutate” – categorie definită cu ajutorul
scorurilor la subscala Dorinţa de a fi slab –, la
fel ca în cazul pacienţilor cu AN selectaţi din
eşantioanele nonclinice. S‑a presupus că femeile
preocupate de greutate vor avea niveluri
similare de psihopatologie în ceea ce priveşte
alte constructe considerate relevante pentru
dezvoltarea sau menţinerea tulburărilor de
comportament alimentar (definite operaţional
prin subscalele psihologice ale EDI). Femeile
preocupate de greutate, din rândul studentelor
la diferite facultăţi sau la balet, au fost definite
operaţional ca având scoruri egale sau superioare
scorului mediu (m=15) al pacienţilor cu AN la
subscala Dorinţa de a fi slab (Garner, Olmsted şi
Garfinkel, 1983; Garner şi colab., 1984). După
cum se observă şi în Figura 2.1, femeile care
sunt preocupate de greutate, cele nepreocupate
de greutate şi cele cu AN au fost comparate
din punctul de vedere al rezultatelor la toate
subscalele EDI. Femeile din grupul preocupat
de greutate au fost, practic, identice cu cele
din grupul cu AN, în ceea ce priveşte scorurile
la subscalele Dorinţa de a fi slab, Perfecţionism şi
Frica de maturitate. Folosind analiza de clusteri
în scopul unei examinări mai atente a grupului
preocupat de greutate, s‑au evidenţiat două
subgrupuri semnificative, care au format doi
clusteri separaţi. În Figura 2.2 este ilustrat grupul
celor 35 de femei preocupate de greutate, împărţit
în cei doi clusteri. Primul cluster este compus din
11 femei preocupate de greutate, ale căror scoruri
la toate subscalele EDI au fost egale sau mai mari
decât ale femeilor cu AN. Al doilea cluster este
format din 24 de femei preocupate de greutate,
 AN
PG
NPG

DS B NC I P NI AI FM

Figura 2.1. Comparaţie între grupurile formate din persoane cu anorexie nervoasă, persoane preocupate de
greutate şi nepreocupate de greutate, la subscalele EDI. Notă: AN = Anorexie nervoasă; PG = Preocupate de
greutate; NPG = Nepreocupate de greutate; DS = Dorinţa de a fi slab; B = Bulimie; NC = Nemulţumire faţă de corp;
I = Ineficacitate; P = Perfecţionism; NI = Neîncredere interpersonală; AI = Alienare interpersonală; FM = Frica de
maturitate.

AN
PG1
PG2

DS B NC I P NI AI FM
Figura 2.2. Comparaţie între grupul format din persoane cu anorexie nervoasă şi două subgrupuri preocupate
de greutate, la subscalele EDI. Notă: AN = Anorexie nervoasă; PG1 = primul cluster de persoane preocupate de
greutate (n = 11); PG2 = al doilea cluster de persoane preocupate de greutate (n = 24); DS = Dorinţa de a fi slab;
B = Bulimie; NC = Nemulţumire faţă corp; I = Ineficacitate; P = Perfecţionism; NI = Neîncredere interpersonală; AI =
Alienare interpersonală; FM = Frica de maturitate

25
care au avut scoruri ridicate la subscalele Dorinţa
de a fi slab, Nemulţumire faţă de corp şi Perfecţionism.
Aceste femei au avut scoruri mult mai scăzute la
celelalte subscale, cu excepţia a două dintre ele
(adică Ineficacitate, Neîncredere interpersonală), la
care au înregistrat scoruri semnificativ mai mici,
comparabile cu cele ale unui eşantion de studente
din populaţia nonclinică.
Acelaşi pattern al rezultatelor a apărut şi în
cazul unui eşantion de studente din populaţia
nonclinică, care declaraseră într‑un chestionar
că şi‑au provocat vărsături (Olmsted şi Garner,
1986). Concluzia care reiese din aceste studii
este că acest continuum al preocupărilor legate
de alimentaţie şi de greutate nu este paralel
cu continuum‑urile constructelor psihologice
observate, în mod curent, la pacienţii cu AN. De
asemenea, definirea severităţii prin identificarea
unui singur simptom poate duce la pierderea
din vedere a unor diferenţe semnificative între
subgrupuri. Rezultatele acestor studii timpurii
rămân ca fundamente ale concepţiei care a stat la
baza elaborării EDI, EDI‑2 şi EDI‑3. O abordare
multidimensională a evaluării oferă informaţii
despre pacienţi, care sunt la fel de semnificative
pentru cei cu un diagnostic de tulburare de
comportament alimentar, ca şi pentru cei care
prezintă forme subclinice ale acesteia.
În literatura de specialitate este în continuare
prezentă dezbaterea dintre cele două puncte de
vedere asupra tulburărilor de comportament
alimentar, conform cărora acestea fie sunt
entităţi distincte de diagnostic, fie reprezintă o
extremitate pe un continuum al pattern‑urilor
de alimentaţie disfuncţională. Unii cercetători
au interpretat rezultatele lor ca fiind o dovadă a
situării tulburărilor de comportament alimentar
la o extremitate a unui continuum al alimentaţiei
disfuncţionale (Dancyger şi Garfinkel, 1995;
Fitzgibbon şi colab., 2003; Löwe, Gleaves şi
Murphy‑Eberenz, 1998; Stice, Killen, Hayward şi
Taylor, 1998a, 1998b; Stice şi colab., 1996; Tylka şi
Subich, 1999), în timp ce alţii au concluzionat că
există diferenţe de ordin calitativ între cazurile
clinice şi variantele lor subclinice (Gleaves şi
colab., 2000; Laessle şi colab., 1989; Prather
şi Williamson, 1998; Ruderman şi Besbeas,
1992). O examinare atentă a cercetărilor asupra
continuumului arată că rezultatele pot face
subiectul unor interpretări multiple, în funcţie de
definiţia continuităţii şi de tipurile variabilelor
evaluate (Garner, Olmsted şi Garfinkel, 1983;
Garner şi colab., 1984; Lindeman şi colab., 2001;
Tylka şi Subich, 2002). Într‑un studiu efectuat
pe 265 de femei, precum şi pe un eşantion clinic
de dimensiuni reduse, Lindeman şi colab. au
26
constatat o creştere liniară în cazul tulburărilor
psihologice de la normalitate la formele uşoare ale
tulburărilor de comportament alimentar, însă s‑a
constatat o creştere bruscă şi neliniară a acestora
în cazul femeilor care prezentau simptome
mai grave ale tulburărilor de comportament
alimentar. Acest fapt confirmă observaţiile
timpurii conform cărora „continuitatea” este,
în mod normal, o caracteristică atribuită unei
singure variabile; cu toate acestea, majoritatea
studiilor iau, de fapt, în considerare relaţia
dintre două sau mai multe variabile. Lindeman
şi colab. sugerează că semantica ar putea juca un
rol important în lipsa consensului din dezbaterea
privind „ipoteza continuumului”. Exprimarea
rezultatelor în termeni de grad de liniaritate între
alimentaţie şi variabilele psihologice ar putea
duce la interpretări mai puţin ambigue.
Care sunt implicaţiile practice ale rezultatelor
obţinute până acum? În primul rând, indiferent
de felul în care sunt conceptualizate tulburările
de comportament alimentar, este important să
se recunoască eterogenitatea cazurilor în ceea
ce priveşte severitatea simptomelor. În al doilea
rând, identificarea unor tipologii psihologice
semnificative, mai ales prin intermediul
folosirii constructelor descrise în literatura de
specialitate, poate duce la o caracterizare mai
bună a pacienţilor şi la o îmbunătăţire în luarea
de decizii clinice. În al treilea rând, cercetările
care evaluează constructe psihologice legate, la
nivel teoretic, de tulburările de comportament
alimentar, pot furniza informaţii valoroase în
legătură cu etiologia, prognosticul în cazul
unor forme de tratament diferite, predictorii
recidivelor, variabilele biologice intercorelate şi
diferenţele de ordin cultural.
În concluzie, inventarul EDI a fost elaborat
iniţial ca un instrument care să fie util din punct
de vedere psihometric în clarificarea ideii că
tulburările de comportament alimentar trebuie să
fie considerate: a) entităţi distincte sau b) extreme
ale unui continuum care reflectă pattern‑uri
disfuncţionale de comportament alimentar şi
psihopatologie. Dezbaterea iniţială nu a fost încă
încheiată şi prezintă, în continuare, interes; cu
toate acestea, inventarul EDI şi‑a depăşit cu mult
scopul iniţial.
 Construcţia inventarelor EDI şi EDI‑2:
validitatea de conţinut
Construcţia itemilor şi a scalelor versiunii
iniţiale, cu 64 de itemi, a EDI a început în anul
1981. Metodele folosite pentru construcţia
acestei versiuni rămân fidele abordării clasice a
construcţiei de teste recomandată de Campbell şi
Fiske (1959). Această metodă pune pe primul loc
scalele care măsoară constructe relativ omogene
sau atribute centrale, bazându‑se cel mai mult
pe parametrii specifici ai itemilor, cum sunt
capacitatea de a discrimina între eşantioanele
clinice şi cele nonclinice şi pe omogenitatea ite-
milor din fiecare scală. În EDI‑2 au fost introduşi
itemi suplimentari, care se refereau la constructe
care păreau promiţătoare, în baza cercetărilor
psihologice nou apărute; totuşi, dimensiunea
redusă a eşantionului clinic a limitat posibilitatea
evaluării empirice a scalelor şi a legăturilor cu
variabile externe.
Constructele pe baza cărora au fost elaborate
scalele au fost alese în urma trecerii în revistă a
teoriilor principale din literatura de specialitate.
Itemii au fost creaţi de către psihologi clinicieni
cu experienţă, care au încercat să surprindă
conţinuturile relevante pentru domeniul
constructului vizat. Prima condiţie pentru
păstrarea itemilor a fost validitatea de conţinut.
Itemii au fost reţinuţi în varianta finală a scalelor
doar în cazul în care conţinutul lor a fost considerat
reprezentativ pentru sfera constructului. Această
strategie este diferită de construcţia scalelor pe
baza unor metode empirice, prin care itemii
pot fi păstraţi doar pe baza caracteristicilor lor
psihometrice. Itemii au fost verificaţi şi editaţi
de către autor pentru a obţine un stil şi o formă
de exprimare uniforme. Versiunea iniţială a EDI
a constat în 146 de itemi destinaţi să măsoare
11 constructe. Itemii preliminari au fost testaţi
într‑un studiu pilot, pe un număr restrâns de
pacienţi aflaţi sub tratament într‑un centru de
asistenţă terţiară, specializat în tulburări de
comportament alimentar. Câţiva itemi, care au
fost consideraţi neclari, au fost modificaţi în
urma feedback‑ului primit de la pacienţi.
Selecţia itemilor: analiza itemilor şi
consistenţa internă
Pentru a determina care dintre itemii iniţiali
vor fi incluşi în varianta originală a EDI, au
fost folosite mai multe proceduri, printre care:
a) itemii trebuiau să discrimineze între eşantionul
subiecţilor cu tulburări de comportament
alimentar şi cel din populaţia non‑clinică;
b)  corelaţia itemilor cu scorul scalei din care
făceau parte trebuia să fie mai ridicată decât cu
oricare altă scală; c) s‑au considerat dezirabile
situaţiile în care, pentru eşantioanele cu tulburări
de comportament alimentar, coeficientul de
corelaţie dintre un item şi scorul total al scalei
din care acesta provenea a fost mai mare decât
0,40. Au fost reţinuţi trei itemi a căror corelaţie
dintre item şi scorul total al scalei a fost mai mică
de 0,40, pentru că aveau un conţinut semnificativ
şi un impact minim asupra fidelităţii scalei.
Valoarea medie a corelaţiilor dintre itemi şi scorul
total a scalei a fost de 0,63, indicând, în general,
o varianţă comună substanţială între itemi
în cadrul scalelor (Garner, Olmsted şi Polivy,
1983). Pentru a fi incluse în varianta originală a
EDI, scalele trebuiau să îndeplinească criteriul
consistenţei interne de a avea un coeficient alpha
(α; Cronbach, 1951) mai mare de 0,80 în cazul
eşantioanelor cu tulburări de comportament
alimentar. Verificarea omogenităţii scalelor a fost
repetată pe un al doilea eşantion de pacienţi cu
tulburări de comportament alimentar şi pe unul
de control din populaţia nonclinică (Garner,
Olmsted şi Polivy, 1983).
Evaluarea validităţii scalelor
Înainte de publicare, au fost efectuate şi alte
analize pentru a stabili validitatea convergentă,
discriminativă şi relativă la un criteriu extern
a subscalelor EDI. Aceste analize au inclus:
a) corelaţii acceptabile între scorurile la subscale
obţinute de către pacienţii cu tulburări de
comportament alimentar şi evaluările făcute de
clinicieni acestor pacienţi, în ceea ce priveşte
dimensiunile măsurate de EDI; b) diferenţe
semnificative între media scorurilor eşantionului
cu tulburări de comportament alimentar şi cea a
eşantionului nonclinic, la toate subscalele; c) medii
similare ale scorurilor la subscale pentru un grup
restrâns de pacienţi cu AN recuperaţi şi un grup
de femei din populaţia non‑clinică; d) diferenţe
semnificative între pacienţii cu AN – tipul
Restrictiv (AN‑R) şi AN – tipul Comportament
alimentar compulsiv/vărsături (AN‑AC/V) la
subscala Bulimie şi e) pattern‑ul de corelaţii dintre
subscalele EDI, precum şi corelaţiile subscalelor
EDI cu alte măsurători care au grade diferite de
suprapunere conceptuală aduc anumite dovezi
în legătură cu validitatea convergentă şi cea
discriminativă pentru subscalele EDI reţinute.
Trei dintre cele 11 constructe originale au fost
scoase din versiunea iniţială EDI, deoarece
subscalele nu au îndeplinit criteriile de fidelitate
şi validitate necesare pentru a fi incluse.
27
 Construcţia inventarului EDI‑3: itemi şi
scale
De la apariţia variantei originale EDI, în 1983,
s‑au făcut progrese importante în tratamentul
şi înţelegerea tulburărilor de comportament
alimentar. Unele dintre constructele considerate
importante în managementul clinic au rezistat,
în timp ce altele au fost revizuite sau au primit
tot mai puţină susţinere. Revizuirea EDI‑3 a fost
ghidată atât de evoluţia modelelor teoretice în
domeniu, cât şi de evaluarea constructelor clinice
care stau la baza subscalelor variantei iniţiale
EDI.
Demersul care a urmat în procesul de
validare de construct a EDI‑3 a pus accentul
pe aplicarea secvenţială a metodelor raţionale
şi a celor empirice. Primul pas din acest proces
a constat în examinarea relaţiei dintre itemi,
prin aplicarea analizei factoriale exploratorii
(AFE) la eşantioanele folosite la etalonare şi
la subgrupurile de diagnostic. Prin analiza de
itemi şi prin aplicarea procedurilor AFE, au fost
evidenţiaţi câţiva clusteri de itemi care formează
constructe unitare şi conforme cu structura
subscalelor EDI‑2. Totuşi, aceste procedee au
avut ca rezultat şi alte configuraţii alternative de
scale, semnificative din punct de vedere teoretic,
precum şi alţi clusteri.
Aceste rezultate au dus la acceptarea unora
dintre scale sau a unor clusteri de itemi pentru
construcţia EDI‑3 care să aibă capacitatea de
a evalua un domeniu mai restrâns şi mai bine
definit din punct de vedere conceptual, decât
în cazul subscalelor din EDI‑2. Un rezultat
opus s‑a obţinut cu scalele compozite, care au
lărgit domeniul de analiză conceptuală prin
selectarea informaţiilor din întreg spectrul
domeniului constructului care prezenta interes.
Există avantaje şi dezavantaje, de ordin practic
şi psihometric, asociate cu ambele extreme ale
procedurilor de selecţie a itemilor utilizate în
definirea unui construct.
Identificarea unor constructe mai distincte
sau mai „pure”, bazată, în principal, pe
omogenitatea itemilor, are avantajul potenţial
de a optimiza discriminarea relevantă între
subgrupurile de pacienţi cu tulburări de
comportament alimentar. Totuşi, există mai
multe dezavantaje în cazul acestei abordări. În
primul rând, clusterii de itemi „prototipici” ar
putea să nu cuprindă informaţii provenite din tot
spectrul unui construct multidimensional. Acest
fapt ar duce la construcţia unor scale care nu
reuşesc să facă diferenţierile dezirabile (adică fac
interpretări fals‑negative), deoarece conţinutul
28
itemilor este prea specific în raport cu sensul mai
larg al constructului la care se referă. În al doilea
rând, presupunând că itemii sunt comparabili
din punctul de vedere al calităţii, scalele cu mai
puţini itemi sunt, în general, mai puţin fidele
decât scalele cu un număr mai crescut de itemi.
De aceea, construcţia unor scale compozite, care
să conţină itemi apaţinând întregului spectru al
domeniilor dominante, dar multidimensionale,
ale constructelor, permite o diferenţiere mai
acurată a caracteristicilor sau a sindroamelor
clinice legate de o anumită formă relevantă de
psihopatologie.
Reorganizarea scalelor EDI‑3
Descrierea şi conţinutul scalelor şi ale
scalelor compozite ale EDI‑3
Există 12 scale de bază şi şase scale
compozite ale EDI‑3, acestea din urmă fiind
obţinute prin însumarea cotelor T la două sau
mai multe scale. Trei dintre scalele de bază (adică
Dorinţa de a fi slab [DS], Bulimie [B], Nemulţumire
faţă de corp [NC]) sunt etichetate drept scale de
Risc de tulburare de comportament alimentar2, iar
cercetările au arătat că obţinerea de scoruri
ridicate la aceste scale îi situează pe respondenţi
în sfera de risc crescut pentru dezvoltarea unei
tulburări de comportament alimentar. Celelalte
nouă scale (adică Stimă de sine scăzută [SSE],
Alienare personală [AP], Nesiguranţă interpersonală
[NI], Alienare interpersonală [AI], Deficite
interoceptive [DI], Dezechilibru emoţional [DE],
Ascetism [A], Frica de maturitate [FM]) evaluează
constructe psihologice relevante din punct de
vedere conceptual pentru evoluţia şi menţinerea
tulburărilor de comportament alimentar. EDI‑3
prezintă şi trei „clusteri de itemi” care oferă
informaţii suplimentare în legătură cu câteva
domenii specifice de interes.
Scalele de Risc de tulburare de comportament
alimentar
Relaţiile dintre itemii scalei compozite
Risc de tulburare de comportament alimentar au
fost investigate cu ajutorul analizei factoriale
exploratorii, iar argumentele teoretice care stau la
baza EDI‑3 şi semnificaţia factorilor au fost luate
în considerare. După cum este descris în detaliu
în Capitolul 6, relaţiile de fond dintre itemi
2
Cele trei scale formează scala compozită Risc de tulburare de
comportament alimentar.
pentru fiecare dintre cele trei grupuri folosite la
etalonare au fost cel mai bine explicate în urma
unei soluţii cu trei factori a analizei factoriale
pentru itemii scalei compozite Risc de tulburare de
comportament alimentar. În majoritatea cazurilor,
itemii au avut saturaţie maximă în cadrul scalei
în care au fost distribuiţi. Cu toate acestea, au
existat şi câteva excepţii de la acest tipar, iar
distribuirea finală a itemilor a fost făcută pe baza
unor considerente legate de conţinut şi pe baza
altor dovezi, precum consistenţa factorilor între
grupurile clinice.
Scala Dorinţa de a fi slab (DS)
Descrierea scalei. Constructul „dorinţa de
a fi slab” a fost descris ca fiind una dintre
caracteristicile de bază ale tulburărilor de
comportament alimentar şi a fost considerat un
criteriu esenţial de diagnostic, conform multor
sisteme de clasificare. Cei şapte itemi ai acestei
scale evaluează: a) dorinţa puternică de a fi
mai slab/ă, b) preocuparea legată de diete, c)
preocuparea legată de greutate şi d) frica intensă
de a nu se îngrăşa.
Relaţia cu EDI‑2. Subscala Dorinţa de fi slab
din EDI‑3 este identică cu cea din EDI‑2.
Rezumatul cercetărilor. Studiile prospective
au arătat că scala DS este un bun predictor
pentru alimentaţia compulsivă şi pentru apariţia
tulburărilor de comportament alimentar la
adolescenţi şi la adulţi. De asemenea, este un
bun predictor al apariţiei bulimiei nervoase
la studenţi, după o perioadă de 10 ani. Are
o stabilitate foarte bună, dovedită în studii
de test‑retest la 1 an şi la 10 ani. Fetele care se
dezvoltă devreme şi care au o greutate corporală
mai mare tind să aibă scoruri mai crescute la scala
DS. În plus, scorul la scala DS prezice cu mare
acurateţe severitatea simptomelor tulburării de
comportament alimentar la evaluarea ulterioară
(follow‑up).
Scala Bulimie (B)
Descrierea scalei. Scala B evaluează tendinţa
de a se gândi la şi a se angaja în episoade de
alimentaţie excesivă şi necontrolată (adică
alimentaţie compulsivă). Cei opt itemi ai acestei
scale evaluează preocuparea în legătură cu
alimentaţia compulsivă şi mâncatul ca răspuns
la starea de supărare. Prezenţa episoadelor de
alimentaţie compulsivă este una dintre trăsăturile
definitorii ale BN şi diferenţiază AN‑R (tipul
restrictiv) de AN‑AC/V (tipul caracterizat prin
comportament alimentar compulsiv/vărsături).
Cercetările au arătat că alimentaţia compulsivă
este frecvent întâlnită la persoanele care nu
îndeplinesc toate criteriile pentru un diagnostic
precis de tulburare de comportament alimentar;
cu toate acestea, de cele mai multe ori, episoadele
severe de alimentaţie compulsivă sunt asociate
cu o suferinţă emoţională evidentă.
Relaţia cu EDI‑2. Subscalele Bulimie din
EDI‑2 şi EDI‑3 coincid, cu excepţia adăugării
itemului 64 din subscala Conştiinţă interoceptivă
din EDI‑2 (adică: „Mă îngrijorez că, atunci când
sunt supărat(ă), voi începe să mănânc.”). Acest
item a fost adăugat scalei B din EDI‑3, întrucât
se potriveşte din punct de vedere conceptual, iar
corelaţia itemului cu scorul total al scalei B este
foarte bună. Corelaţia dintre scala B din EDI‑3
şi subscala Bulimie din EDI‑2, pentru grupul de
adulţi din eşantionul utilizat pentru etalonare,
sugerează posibilitatea ca adăugarea acestui item
să fi lărgit sfera conceptuală evaluată de scala B
din EDI‑3 (a se vedea Capitolul 6).
Rezumatul cercetărilor. Scala B diferenţiază
foarte bine pacienţii cu AN‑AC/V şi BN
de pacienţii cu AN‑R. S‑a dovedit că are o
bună stabilitate în timp şi că prezice debutul
problemelor de alimentaţie.
Scala Nemulţumire faţă de corp (NC)
Descrierea scalei. Scala NC este formată din
10 itemi care evaluează nemulţumirea faţă de
forma şi de dimensiunile unor zone ale corpului,
aspecte ce constituie un motiv deosebit de
preocupare pentru persoanele care au tulburări
de comportament alimentar (cu alte cuvinte, este
vorba de burtă, şolduri, coapse, fese). Având în
vedere faptul că nemulţumirea faţă de propriul
corp este specifică tinerelor femei din cultura
occidentală, nu se poate trage concluzia că
numai acest construct cauzează tulburările de
comportament alimentar; totuşi, el reprezintă
un factor de risc responsabil pentru debutul
şi menţinerea unor comportamente extreme
de control al greutăţii, care duc la tulburări de
comportament alimentar în cazul persoanelor
care sunt, de altfel, vulnerabile.
Relaţia cu EDI‑2. Subscalele Nemulţumire
faţă de corp din EDI‑2 şi din EDI‑3 sunt identice,
cu excepţia adăugării itemului 47 din subscala
Conştiinţă interoceptivă din EDI‑2. Itemul 47
evaluează senzaţia de balonare după o masă
normală, o caracteristică des întâlnită la
persoanele care sunt nemulţumite de propria
greutate. Acest item a fost adăugat, întrucât se
potriveşte din punct de vedere conceptual şi are
o corelaţie medie cu scorul total la scala NC. Între
29
scala NC din EDI‑3 şi scala Nemulţumire faţă de
corp din EDI‑2 există o corelaţie ridicată (a se
vedea Capitolul 6).
Rezumatul cercetărilor. Scorul la scala NC
este influenţat de greutatea sau de indicele de
masă corporală al persoanei; cu cât individul
are o greutate mai mare, cu atât scorurile brute
la scala NC sunt mai mari. Rezultatele la această
scală se mai asociază şi cu niveluri mai scăzute
de expresivitate emoţională, cu existenţa unui
istoric de tachinare din partea celorlalţi, cu
comparaţii frecvente legate de aspectul fizic şi cu
internalizarea valorilor sociale.
Scalele psihologice
La fel ca în cazul scalelor de Risc de tulburare
de comportament alimentar, relaţiile dintre itemii
care compun Scalele psihologice au fost examinate
folosind analiza factorială exploratorie (AFE).
Argumentele teoretice care stau la baza EDI‑3
şi semnificaţia factorilor au fost, de asemenea,
luate în considerare. După cum este descris în
detaliu în Capitolul 6, relaţiile fundamentale
dintre itemii Scalelor psihologice, pentru fiecare
dintre cele trei eşantioane folosite la etalonare,
au fost cel mai bine explicate de o soluţie cu 8
factori a AFE. În majoritatea cazurilor, itemii au
avut saturaţie maximă în cadrul scalei în care au
fost distribuiţi. Au existat şi câteva excepţii de la
acest pattern, iar distribuirea finală a itemilor a
fost făcută pe baza unor considerente legate de
conţinut şi pe baza altor dovezi psihometrice,
cum ar fi corelaţiile dintre itemi şi scorul total al
scalei din care fac parte.
Scala Stimă de sine scăzută (SSS)
Scala SSS măsoară conceptul primar de
autoevaluare în termeni negativi. Cinci dintre
cei şase itemi ai scalei se referă la constructe
saturate emoţional, legate de sentimente de
nesiguranţă, de neadecvare, de ineficienţă şi
de auto‑devalorizare. Celălalt item măsoară
percepţia individului referitoare la incapacitatea
de a‑şi atinge propriile standarde. Majoritatea
teoriilor consideră că stima de sine scăzută
joacă un rol important în apariţia şi menţinerea
tulburărilor de comportament alimentar.
Relaţia cu EDI‑2. Scala Stimă de sine scăzută
din EDI‑3 corelează semnificativ cu subscala
Ineficienţă din EDI‑2 (a se vedea Capitolul 6),
sugerând un nivel ridicat de suprapunere a
scalelor.
Rezumatul cercetărilor. Dat fiind gradul mare
de suprapunere a scalelor, cercetările asupra
30
subscalei de Ineficienţă din EDI‑2 sunt valabile
şi în cazul scalei Stimă de sine scăzută din EDI‑3.
S‑a constatat că scorurile brute ridicate la scala
de Ineficienţă prezic debutul tulburărilor de
comportament alimentar şi se asociază cu
rezultate slabe în urma tratamentului.
Scala Alienare personală (AP)
Scala Alienare personală se suprapune din
punct de vedere conceptual cu scala Stimă de
sine scăzută, dar măsoară un domeniu mai larg,
reflectând caracteristici precum un sentiment
generalizat de deprivare emoţională, singurătate
şi o capacitate scăzută de înţelegere a propriei
persoane. Cei şapte itemi ai scalei AP se referă
la conţinuturi care reflectă sentimente de izolare
faţă de restul persoanelor, de înfrângere sau
de nerecunoaştere a meritelor de către ceilalţi.
Itemii scalei AP măsoară, de asemenea, şi dorinţa
respondentului de a fi altcineva, precum şi un
sentiment general de lipsă a controlului asupra
evenimentelor din propria viaţă.
Relaţia cu EDI‑2. Scala AP este compusă din
patru itemi proveniţi din subscala Ineficienţă şi trei
itemi din subscala Nesiguranţă socială din EDI‑2.
După cum era de aşteptat, scala AP corelează
puternic cu ambele subscale din EDI‑2 (a se
vedea Capitolul 6), sugerând un nivel crescut de
suprapunere conceptuală între aceste scale.
Rezumatul cercetărilor. Nu există cercetări
publicate care să vizeze scala AP; totuşi,
patternul de corelaţii prezentat în Capitolul 6
sugerează că această scală corelează cel mai
bine cu măsurători externe ale somatizării, ale
sensibilităţii, ale ostilităţii, ale stimei de sine
scăzute şi ale depresiei.
Scala Nesiguranţă interpersonală (NI)
Scala Nesiguranţă interpersonală este formată
din şapte itemi care evaluează stările de
disconfort, de nelinişte şi de reticenţă în situaţii
sociale. Aceasta se concentrează mai ales pe
dificultăţi în exprimarea propriilor gânduri şi
emoţii faţă de ceilalţi. Conţinutul itemilor acestei
scale îşi propune să evalueze şi tendinţa de
retragere şi izolare socială.
Relaţia cu EDI‑2. Scala Nesiguranţă
interpersonală a EDI‑3 este compusă din patru
itemi proveniţi din subscala Neîncredere
interpersonală şi trei itemi din subscala Nesiguranţă
socială ale EDI‑2. Scala NI corelează puternic cu
ambele subscale din EDI‑2 (a se vedea Capitolul
6), sugerând un nivel crescut de suprapunere
conceptuală între aceste scale.
 Rezumatul cercetărilor. Nu există cercetări
publicate care să vizeze scala Nesiguranţă
interpersonală. Totuşi, patternul de corelaţii
prezentat în Capitolul 6 indică faptul că această
scală corelează cu scalele Inventarului Clinic
Multiaxial Millon – II (Millon Clinical Multiaxial
Inventory–II, Millon, 1987), sugerând un stil
evitant şi pasiv de interacţiune interpersonală.
Scala Alienare interpersonală (AI)
Cei şapte itemi ai scalei Alienare interpersonală
evaluează dezamăgirea, distanţarea, înstrăinarea
şi lipsa de încredere în relaţiile interpersonale. De
asemenea, itemii măsoară tendinţa de a se simţi
prins în capcană în relaţii, precum şi impresia că
ceilalţi nu oferă suficientă afecţiune şi înţelegere.
Un scor ridicat la scala AI indică o incapacitate
fundamentală în formarea ataşamentului
interpersonal.
Relaţia cu EDI‑2. Scala Alienare interpersonală
a EDI‑3 este compusă din trei itemi proveniţi
din subscala Neîncredere interpersonală, doi itemi
din subscala Nesiguranţă socială şi doi itemi
din subscala Reglarea impulsului din EDI‑2.
Scala AI corelează moderat spre puternic cu
aceste subscale, sugerând un nivel crescut de
suprapunere conceptuală între acestea (a se
vedea Capitolul 6).
Rezumatul cercetărilor. Nu există cercetări
publicate care să vizeze scala de Alienare
interpersonală. Totuşi, patternul de corelaţii
prezentat în Capitolul 6 indică faptul că această
scală corelează cu măsurători externe sugerând
un stil de interacţiune interpersonală emotiv şi
pasiv.
Scala Deficite interoceptive (DI)
Scala Deficite interoceptive este formată din
nouă itemi care măsoară starea de confuzie
asociată cu abilitatea de a recunoaşte şi a
răspunde în mod adecvat la stările emoţionale.
În cadrul scalei DI au fost identificaţi doi clusteri.
În primul rând, există un cluster numit Frica de
emoţii, care identifică o stare de distres atunci
când emoţiile sunt prea puternice sau sunt
scăpate de sub control. În al doilea rând, clusterul
numit Confuzie în legătură cu emoţiile evidenţiază
dificultăţi în recunoaşterea adecvată a stărilor
emoţionale. Confuzia şi lipsa de încredere cu
privire la funcţionarea din punct de vedere fizic
şi emoţional au fost, în mod repetat, recunoscute
ca fiind caracteristici importante ale persoanelor
care suferă de tulburări ale comportamentului
alimentar.
Gruparea itemilor în clusteri. Analiza factorială
exploratorie iniţială a itemilor subscalelor psiho-
logice din EDI‑2 a oferit suficiente argumente în
favoarea păstrării structurii originale a subscalei
Conştiinţă interoceptivă din EDI‑2, excepţie făcând
cei doi itemi care au saturaţie mai mare în scalele
Bulimie şi Nemulţumire faţă de corp. Evaluarea
acestor itemi în funcţie de fidelitate şi analiza de
itemi justifică adăugarea itemului 77 din subscala
Reglarea impulsului (adică „Nu pot să îmi scot
din cap gândurile ciudate.”). Analiza factorială
exploratorie efectuată asupra celor nouă itemi
care formează scala Deficite interoceptive indică
existenţa unui construct unidimensional
dominant; totuşi, obţinerea forţată a unei soluţii
cu doi factori sprijină, într‑o oarecare măsură,
clusterul „de control”, care este format din doi
itemi („Mi-e greu să-mi controlez sentimentele.”
şi „Mă înspăimânt atunci când sentimentele mele
sunt prea puternice”). Restul itemilor au saturaţii
mari în clusterul care se referă la „confuzia
internă”.
Relaţia cu EDI‑2. Scala Deficite interoceptive a
EDI‑3 este compusă din opt itemi proveniţi din
subscala Conştiinţă interoceptivă şi un item din
subscala Reglarea impulsului din EDI‑2. Scala
DI corelează puternic cu subscala Conştiinţă
interoceptivă din varianta originală EDI‑2 (a se
vedea Capitolul 6).
Rezumatul cercetărilor. Datorită faptului că
scala Deficite interoceptive din EDI‑3 şi subscala
Conştiinţă inetroceptivă din EDI‑2 sunt foarte
asemănătoare, este posibil ca rezultatele
cercetărilor care au utilizat scala iniţială să poată
fi extrapolate şi la noua scală. Un scor ridicat la
subscala Conştiinţă interoceptivă constituie un
factor de risc pentru manifestarea unei tulburări
de comportament alimentar şi prezice rezultate
nesatisfăcătoare în urma tratamentului. Scala
Deficite interoceptive are corelaţii relativ mari
cu măsurători externe ale anxietăţii, depresiei,
sensibilităţii şi stimei de sine scăzute (a se vedea
Capitolul 6).
Scala Dezechilibru emoţional (DE)
Scala Dezechilibru emoţional este compusă
din opt itemi prin care se evaluează tendinţa
spre instabilitate dispoziţională, impulsivitate,
nechibzuinţă, furie şi comportamente
auto‑distructive. Această scală conţine un
cluster format din doi itemi. Aceşti doi itemi
se referă la posibile probleme legate de abuzul
de substanţe: unul pentru alcool şi unul pentru
medicamente. Tendinţele către o autoreglare
deficitară a impulsului şi către lipsa de toleranţă
31
la schimbările de dispoziţie au fost identificate
printre semnele unui prognostic defavorabil
în tulburările de comportament alimentar.
Itemii din scala DE evaluează anumite atribute
emoţionale caracteristice unui subgrup de
pacienţi cu tulburări ale comportamentului
alimentar consideraţi deosebit de rezistenţi la
tratament.
Relaţia cu EDI‑2. Cei opt itemi ai scalei
Dezechilibru emoţional provin din rândul celor
unsprezece itemi ai subscalei Reglarea impulsului
din EDI‑2. Scala DE corelează puternic cu
subscala Reglarea impulsului din EDI‑2 (a se vedea
Capitolul 6).
Rezumatul cercetărilor. Din cauză că scala
Dezechilibru emoţional din EDI‑3 nu este identică
cu subscala Reglarea impulsului din EDI‑2,
rezultatele obţinute cu aceasta din urmă nu pot
fi generalizate la cazul scalei din EDI‑3. Scala
Dezechilbru emoţional corelează relativ puternic cu
măsurători externe ale ostilităţii, ale utilizării de
droguri şi ale depresiei (a se vedea Capitolul 6).
Scala Perfecţionism (P)
Scala Perfecţionism conţine şase itemi prin
care se stabileşte măsura în care o persoană
pune preţ pe atigerea unor scopuri măreţe şi pe
standarde de reuşită personală deosebit de înalte.
Conţinutul itemilor acestei scale se încadrează
în două domenii de conţinut. Primul este
„perfecţionismul orientat către sine” şi reflectă
standarde personale riguroase de performanţă.
Al doilea este „perfecţionismul prescris social”
şi se referă la cerinţe pentru performanţă
provenite din presiunea exercitată de către
părinţi şi de către profesori. Cercetările au arătat
că perfecţionismul poate sta la baza eforturilor
necontenite de control al greutăţii, precum şi a
eforturilor nerealiste depuse în alte domenii.
Perfecţionismul a fost identificat ca fiind o
caracteristică esenţială în apariţia şi menţinerea
tulburărilor de comportament alimentar.
Gruparea itemilor în clusteri. Pe baza analizei
factoriale exploratorii a itemilor din scala
Perfecţionism au fost identificaţi doi factori sau
doi clusteri formaţi din itemi cu valori proprii
mai mari decât 1. Primul cluster este format din
trei itemi şi se referă la conţinuturile specifice
pentru „perfecţionismul orientat către sine”.
Cel de‑al doilea cluster, format din trei itemi
se potriveşte cu domeniul de conţinut specific
pentru „perfecţionismul prescris social”.
Relaţia cu EDI‑2. Subscala Perfecţionism din
EDI‑2 şi cea din EDI‑3 sunt identice.
32
Rezumatul cercetărilor. De mulţi ani se
consideră că perfecţionismul este implicat
în evoluţia şi menţinerea tulburărilor de
comportament alimentar. Acesta pare a fi o
trăsătură de personalitate care precedă instalarea
tulburării şi persistă după recuperare. Conform
anumitor studii, perfecţionismul constituie
un semn pentru un prognostic defavorabil.
Unele cercetări au arătat că ar putea exista o
distincţie semnificativă între cele două tipuri de
perfecţionism: „perfecţionismul orientat către
sine” şi „perfecţionismul prescris social”.
Scala Ascetism (A)
Scala Ascetism este formată din şapte itemi
care evaluează tendinţa de a căuta virtutea
prin urmărirea unor idealuri spirituale, precum
autodisciplina, negarea de sine, autoreţinerea,
sacrificiul de sine şi controlul nevoilor corpului.
Motivaţia de tip ascetic pentru pierderea în
greutate era des întâlnită în literatura timpurie
despre AN şi continuă să fie o temă importantă
în anumite cazuri. Ascetismul poate fi exprimat
prin restricţie alimentară ca o formă de purificare,
greutatea scăzută poate fi considerată o virtute,
iar postul – un act de penitenţă. Respingerea
alimentelor şi abţinerea de la mâncare pot face
parte dintr‑o temă mai generală, de renunţare
la gratificările de ordin fizic. Conceptul de
ascetism poate avea fie conotaţii pozitive, de
obţinere a virtuţii prin autocontrol, fie conotaţii
negative (de exemplu, vină şi ruşine) faţă de
experienţele plăcute. Ascetismul s‑ar putea
manifesta prin deprivarea intenţionată de somn,
auto‑provocarea durerii prin tăierea sau înţeparea
pielii până la sângerare, provocarea vărsăturilor,
stat în picioare perioade îndelungate, activitate
fizică cu scopul de a ispăşi o pedeapsă şi
evitarea, în general, a oricărei plăceri. În ultimele
decenii, unii clinicieni au observat o schimbare
în psihopatologia tulburărilor de comportament
alimentar, constând în înlocuirea motivaţiei de
„tip ascetic” de a slăbi cu cea de tip „dorinţă de a
slăbi” ca tema motivaţională cel mai des întâlnită.
Relaţia cu EDI‑2. Singura diferenţă dintre
subscalele Ascetism din EDI‑2 şi din EDI‑3 este
aceea că itemul 71 („Aş face orice ca să simt
plăcere.”) nu are saturaţie semnificativă în
niciuna dintre scale. În consecinţă, el a fost inclus
în EDI‑3, dar nu se cotează.
Rezumatul cercetărilor. Scala Ascetism a
demonstrat un nivel ridicat de validitate
discriminativă în diferenţierea pacienţilor cu
BN de cei din grupul de control (Schoemaker,
Verbraak, Breteler şi van der Staak, 1997). Scala
A din EDI‑3 corelează puternic cu subscala
Ascetism din EDI‑2 (a se vedea Capitolul 6),
permiţând utilizarea, cu precauţie, a acestor scale
ca echivalente. Scala Ascetism din EDI‑3 corelează
cu măsurători externe ale agorafobiei, anxietăţii,
sensibilităţii şi depresiei (a se vedea Capitolul 6).
Scala Frica de maturitate (FM)
Scala FM este formată din opt itemi care
evaluează dorinţa de retragere în atmosfera
sigură a copilăriei. Acest construct este considerat
un factor central de menţinere a patologiei
într‑un subgrup de pacienţi adolescenţi, a căror
restricţie alimentară şi pierdere în greutate sunt
funcţionale, deoarece oferă mijloacele de a reveni
la o înfăţişare şi un echilibru hormonal specifice
pubertăţii. În acest fel, ei se pot retrage din faţa
agitaţiei, a conflictelor şi pot evita expectanţele
legate de dezvoltare, specifice vârstei adulte.
Frica de a se dezvolta poate stimula apariţia
altor temeri şi expectanţe legate de schimbările
de rol, faţă de care adolescenţii, părinţii sau şi
unii şi ceilalţi nu se simt pregătiţi să le facă faţă.
Doi itemi din această scală (adică itemii 3 şi 39)
sunt destinaţi să fie interpretaţi din perspectiva
adultului, atunci când priveşte înapoi către
perioada copilăriei (de ex., „Îmi doresc să mă
pot întoarce la siguranţa copilăriei.”); din acest
motiv, aceşti itemi nu sunt potriviţi pentru copii.
Relaţia cu EDI‑2. Subscala Frica de maturitate
din EDI‑2 este identică cu scala FM din EDI‑3.
Rezumatul cercetărilor. Scala Frica de maturitate
din EDI‑3 pare să reprezinte una dintre cele mai
stabile trăsături măsurate de acest instrument,
prin faptul că înregistrează o descreştere, la fel
de mare ca alte subscale din EDI, pe parcursul
tratamentului şi la follow‑up (Fernández‑Aranda
şi colab., 1998; Garner şi colab., 1990; Garner,
Rockert şi colab., 1993; Lee şi colab., 2003; Rø,
Martinsen, Hoffert şi Rosenvinge, 2003). Nu
toate studiile au avut aceleaşi rezultate (Carter,
Blackmore, Sutandar‑Pinnock şi Woodside, 2004)
şi s‑a constatat că scorurile la subscala FM se
asociază cu rezultate slabe în urma tratamentului
(Fassino şi colab., 2001). Două studii au sugerat
că un nivel ridicat al expresivităţii emoţionale
(EE) în familia de provenienţă ar putea prezice
modificări la finalul tratamentului sau la
follow‑up (Hedlund, Fichter, Quadflieg şi Brandl,
2003; Moulds şi colab., 2000).
Scale compozite
Scala compozită Risc de tulburare de
comportament alimentar (SCRTCA)
Scorul SCRTCA este obţinut prin însumarea
cotelor T la scalele DS, B şi NC. El oferă o măsură
globală a acestor constructe, fiecare dintre scale
contribuind într‑o măsură egală la valoarea lui.
Scorul SCRTCA poate fi folosit pentru screening
sau pentru a obţine un scor unic care să reflecte
nivelul preocupărilor legate de alimentaţie.
Justificarea combinării acestor scale în varianta
originală a EDI, pe eşantioane din populaţia
non‑clinică, provine din cercetări care au folosit
analiza factorială (Welch, Hall şi Walkey, 1988).
Într‑un studiu prospectiv pe o durată de 5
ani asupra unor nou‑născuţi şi a mamelor lor,
scoruri ridicate ale mamelor la subscalele Dorinţa
de a fi slab, Bulimie şi Nemulţumire faţă de corp ale
inventarului EDI au prezis apariţia tulburărilor
de comportament alimentar în copilăria timpurie
(Stice, Agras şi Hammer, 1999). Scalele de
„preocupări pentru alimentaţie” din inventarul
EDI au fost folosite în cadrul unor studii
transversale pentru a identifica alte variabile
care ar putea juca un rol important în apariţia
tulburărilor de comportament alimentar. De
exemplu, Engstrom şi Norring (2002) au folosit
subscala Dorinţa de a fi slab, pentru a studia un
eşantion de elevi de liceu din Suedia, între anii
1993 şi 1998. Ei au constatat prezenţa unei asocieri
dintre factorii de risc şi cei socio‑demografici,
cum ar fi exerciţii fizice exagerate, hărţuirea,
a trăi singur şi părăsirea timpurie a familiei.
Studiile care s‑au ocupat de factorii de risc au
mai utilizat şi alte subscale EDI, ca măsurători
ale altor constructe psihologice despre care se
considera că ar contribui la evoluţia tulburărilor
de comportament alimentar.
Davis, Shuster, Blackmore şi Fox (2004) au
operaţionalizat „preocuparea pentru greutate”
prin suma scorurilor la subscalele Dorinţa de a fi
slab, Bulimie, Nemulţumire faţă de corp din EDI‑2.
S‑a confirmat, astfel, ipoteza conform căreia
atenţia acordată, în cadrul familiei, înfăţişării
fizice duce la preocupare pentru greutate
numai în cazul femeilor cu o vulnerabilitate
psihologică, indicată prin scoruri relativ ridicate
ale neuroticismului.
Scala compozită Ineficacitate (SCI)
Scorul acestei scale este calculat prin
adunarea cotelor T la scalele SSS şi AP. Aceste
două scale corelează puternic, atât în cazul
33
populaţiei clinice, cât şi al celei non‑clinice,
iar combinarea lor îmbunătăţeşte, în general,
fidelitatea. Scala compozită de Ineficacitate
cuprinde toţi itemii subscalei de Ineficacitate
din EDI‑2 şi trei itemi, cu corelaţii inter‑itemi
foarte bune, din subscala Nesiguranţă socială din
EDI‑2. Valorile mari ale acestui scor indică atât o
evaluare a propriei persoane în termeni negativi,
cât şi sentimentul de vid emoţional, care reflectă
un deficit fundamental în identitatea personală.
Scala compozită Probleme interpersonale
(SCPI)
Scorul SCPI constă în suma cotelor T la
scalele NI şi AI. Aceste două scale corelează
doar moderat între ele. Toţi itemii subscalei
Neîncredere interpersonală din EDI‑2 au saturaţii
mari fie în scala NI, fie în AI, iar aceasta este una
dintre cele mai predictive subscale ale EDI‑2,
în ceea ce priveşte răspunsul nesatisfăcător la
tratament. O valoare crescută a scorului SCPI
indică faptul că respondentul are convingerea
că relaţiile sociale sunt tensionate, nesigure,
dezamăgitoare, nesatisfăcătoare şi, în general, de
proastă calitate. Multe persoane cu tulburări de
comportament alimentar sunt descrise ca având
sentimente de nesiguranţă, îndoială şi o lipsă
generală de încredere în relaţiile sociale. Scorul
SCPI indică existenţa unor probleme severe la
nivelul abilităţii de a forma ataşamente; acest
fapt are nenumărate implicaţii în ceea ce priveşte
relaţia terapeutică. Problemele interpersonale
contribuie la menţinerea simptomelor tulbu-
rărilor de comportament alimentar la multe
dintre persoanele afectate şi constituie un scop
important al tratamentului.
Scala compozită Probleme emoţionale (SCPE)
Scorul SCPE se calculează însumând cotele
T la scalele DI şi DE. Aceste două scale corelează
moderat între ele. Scorul SCPE reflectă deficite
severe în modalitatea indivizilor de a interpreta
stimulii emoţionali şi de a răspunde la ei. Acei
pacienţi cu tulburări de comportament alimentar
care au dificultăţi în a‑şi înţelege propriile
stări emoţionale şi cu tendinţa de a reacţiona
impulsiv, cu furie, prin modificări de dispoziţie
afectivă sau prin abuz de substanţe, pot ridica
probleme serioase în terapie. Dificultatea cu care
un individ îşi identifică şi îşi tolerează stările de
dispoziţie afectivă poate fi un factor important
de menţinere a unei tulburări de comportament
alimentar şi se constituie într‑un element central
în terapie.
34
Scala compozită Control exagerat (SCCE)
Acest scor se calculează însumând cotele
T la scalele A şi P. Împreună, aceste scale
reflectă încercarea de a atinge perfecţiunea prin
auto‑negare şi suferinţă. Perfecţionismul, însoţit
de auto‑sacrificiu extrem şi de controlul nevoilor
corpului, îşi găseşte originile istorice în predicile
asceţilor religioşi, care erau adepţii stabilirii de
scopuri de puritate şi spirituale care erau, adesea,
nocive pentru corp. Scorul compozit poate avea
semnificaţii diferite în cadrul unui diagnostic de
tulburare de comportament alimentar; de obicei,
însă, denotă existenţa unor constructe definitorii
pentru pacient, care sunt extrem de rezistente la
schimbare datorită asocierii lor cu virtutea.
Scala compozită Neadaptare psihologică
generală (SCNPG)
Scorul SCNPG este format din suma cotelor
T la toate cele nouă scale psihologice ale EDI‑3.
Unele analize factoriale pe populaţii nonclinice
au sugerat existenţa a doi factori importanţi:
unul legat de preocuparea pentru alimentaţie
şi celălalt legat de o neadaptare psihologică
generală. Se poate spune că adunarea scorurilor
tuturor scalelor psihologice într‑un singur scor
compozit ar putea fi înşelătoare, deoarece vine
în contradicţie cu obiectivele unei evaluări
multidimensionale; cu toate acestea, acest scor
ar putea avea o valoare empirică prin predicţia
rezultatelor tratamentului, sugerând un set
de răspunsuri la testare sau indicând niveluri
deosebit de ridicate de psihopatologie.
Indicatori ai Stilului de răspuns
În cadrul inventarului EDI‑3 au fost incluse
trei scale de validitate sau de stil de răspuns
(adică Inconsecvenţă (IN), Raritate (R) şi Impresie
negativă (ING). Aceste scale au fost construite
pentru a stabili probabilitatea ca scorurile la
EDI‑3 să poată fi interpretate. Pentru a stabili
intervale calitative de clasificare pentru scalele
de validitate, au fost determinate distribuţiile
de frecvenţă şi procentajele cumulate pentru
cele două eşantioane folosite la etalonare din
populaţia S.U.A (a se vedea Tabelele 2.1 până la
2.6). Intervalele pentru clasificarea calitativă au
fost stabilite pe baza distribuţiei scorurilor brute
ale celor două eşantioane. În general, răspunsurile
care corespund centilelor de la 1 până la 94 sunt
clasificate ca fiind Tipice; cele care corespund
centilelor de la 95 la 98 sunt considerate Atipice;
în timp ce răspunsurile care corespund centilului de 2%) printre participanţii din eşantionul de
99 sau peste acesta sunt clasificate ca fiind Foarte standardizare. Itemii care fac parte din scala R
atipice (a se vedea Tabelele 2.7 până la 2.9). sunt prezentaţi în Tabelul 2.11.

Scala Inconsecvenţă (IN) Scala Impresie negativă (ING)

Această scală indică măsura în care
respondentul dă răspunsuri contradictorii la
itemi care au un conţinut similar. De exemplu, un
individ care încercuieşte Întotdeauna ca răspuns la
itemul 2 („Cred că burta mea este prea mare”) şi,
în acelaşi timp, încercuieşte Întotdeauna la itemul
12 („Cred că burta mea are mărimea potrivită”)
nu este consecvent în felul de a răspunde.
Perechile de itemi din care este compusă scala IN
sunt prezentate în Tabelul 2.10.
Scala Raritate (R)
Această scală indică măsura în care
respondentul oferă răspunsuri în direcţia unei
simptomatologii severe, la itemi la care acest
fapt constituie o raritate (în general, mai puţin
Tabelul 2.1
Scala Inconsecvenţă (IN): eşantionul clinic de
adulţi din SUA
Scala Impresie negativă evaluează gradul în
care respondentul are tendinţa de a răspunde la
itemi în direcţia unei simptomatologii extreme.
Scala ING ia în considerare toţi itemii care se
cotează ai EDI‑3; itemul 71 nu se cotează.
Sistemul de cotare al EDI‑3
Opţiunile de răspuns la itemii din EDI‑3 sunt
pe o scală cu 6 puncte, cu alegerea obligatorie
a unei variante, iar respondentul trebuie să
stabilească pentru fiecare item în parte dacă
i se potriveşte: Întotdeauna, De obicei, Adesea,
Câteodată, Rar sau Niciodată. Aşa cum este indicat
în Tabelul 2.12, fiecărui item îi este atribuit un
scor de la 0 la 4. Răspunsurile extreme care indică
prezenţa simptomatologiei sau a patologiei
(fie Întotdeauna, fie Niciodată, depinzând de
cotarea directă sau inversă a itemului) primesc
scorul 4. Răspunsul imediat alăturat (De obicei

Scor brut Frecvenţa % cumulate Tabelul 2.2

0 2 0 Scala Inconsecvenţă (IN): eşantionul clinic de
1 7 1 adolescenţi din SUA
2 24 4
3 44 9 Scor brut Frecvenţa % cumulate
4 72 18 0 4 1
5 99 29 1 6 3
6 108 42 2 6 5
7 92 53 3 15 10
8 93 64 4 24 19
9 78 73 5 23 26
10 61 80 6 27 35
11 51 86 7 35 47
12 29 89 8 33 58
13 27 93 9 24 67
14 19 95 10 24 75
15 13 96 11 16 80
16 8 97 12 18 86
17 8 98 13 6 88
18 4 99 14 11 92
19 1 99 15 8 95
20 5 99 16 3 96
21 1 >99 17 6 98
22 1 >99 18 2 98
23 1 >99 19 2 99
24 1 >99 20 1 99
25 0 >99 21 2 >99
Notă. N = 983. Notă. N = 335.

35
 Tabelul 2.3 Tabelul 2.4
Scala Raritate (R): eşantionul clinic Scala Raritate (R): eşantionul clinic de
de adulţi din SUA adolescenţi din SUA

Scor brut Frecvenţa % cumulate Scor brut Frecvenţa % cumulate

0 774 79 0 231 69
1 140 93 1 61 87
2 43 97 2 25 95
3 18 99 3 10 98
4 6 >99 4 3 99
5 2 >99 5 2 99
6 2 >99
Notă. N = 983. 7 1 >99
Notă. N = 335.

Tabelul 2.5
Scala Impresie negativă (ING): eşantionul clinic de adulţi din SUA

Scor brut Frecvenţa % cumulate Scor brut Frecvenţa % cumulate

0 33 3 32 14 87
1 31 7 33 9 87
2 31 10 34 8 88
3 24 12 35 13 90
4 30 15 36 9 91
5 36 19 37 10 92
6 29 22 38 6 92
7 34 25 39 5 93
8 36 29 40 10 94
9 28 32 41 7 94
10 30 35 42 6 95
11 24 37 43 2 95
12 26 40 44 5 96
13 27 43 45 6 96
14 33 46 46 5 97
15 25 49 47 3 97
16 22 51 48 3 97
17 28 54 49 4 98
18 44 58 50 5 98
19 17 60 51 2 99
20 20 62 52 1 99
21 30 65 53 3 99
22 23 67 54 1 99
23 36 71 55 1 99
24 24 73 56 4 >99
25 24 76 57 0 >99
26 18 78 58 1 >99
27 18 79 59 0 >99
28 12 81 60 1 >99
29 11 82 61 1 >99
30 22 84 62 0 >99
31 11 85 63 1 >99

Notă. N = 983.

36
 Tabelul 2.6
Scala Impresie negativă (ING): eşantionul clinic de adolescenţi din SUA

Scor brut Frecvenţa % cumulate Scor brut Frecvenţa % cumulate

0 10 3 36 3 91
1 21 9 37 1 91
2 15 14 38 1 92
3 12 17 39 2 92
4 13 21 40 2 93
5 11 24 41 1 93
6 16 29 42 0 93
7 12 33 43 2 94
8 7 35 44 3 95
9 12 39 45 2 95
10 7 41 46 1 96
11 13 44 47 2 96
12 4 46 48 2 97
13 11 49 49 1 97
14 9 52 50 0 97
15 11 55 51 1 97
16 9 58 52 2 98
17 12 61 53 2 99
18 10 64 54 1 99
19 8 67 55 1 99
20 4 68 56 0 99
21 8 70 57 0 99
22 6 72 58 1 99
23 6 74 59 0 99
24 3 75 60 0 99
25 7 77 61 0 99
26 5 78 62 0 99
27 4 79 63 0 99
28 9 82 64 0 99
29 2 83 65 0 99
30 5 84 66 0 99
31 7 86 67 0 99
32 1 87 68 0 99
33 5 88 69 1 >99
34 4 89 70 0 >99
35 3 90 71 1 >99

Notă. N = 335.

Tabelul 2.7 Tabelul 2.8

Scala Inconsecvenţă (IN): clasificări descriptive Scala Raritate (R): clasificări descriptive

Intervalul scorului brut Clasificarea Intervalul scorului brut Clasificarea

0-15 Tipică 0-2 Tipică
16-19 Atipică 3-4 Atipică
20-40 Foarte atipică 5-10 Foarte atipică

37
 Tabelul 2.9
Scala Impresie negativă (ING): clasificări descriptive

Intervalul scorului brut Clasificarea

0-44 Tipică
45-54 Atipică
55-90 Foarte atipică

Tabelul 2.10
Scala Inconsecvenţă (IN): perechile de itemi

Perechile de itemi
2. Cred că burta mea este prea mare.
9. Cred că am coapsele prea mari.
10. Simt că sunt o persoană ineficientă.
17. Am încredere în ceilalţi.
21. Sunt confuz(ă) în legătură cu ceea ce simt.
30. Mă aflu în relaţii apropiate cu ceilalţi.
31. Îmi place forma feselor mele.
34. Am dificultăţi în a-mi exprima emoţiile faţă de
ceilalţi.
37. Am încredere în mine.
45. Cred că şoldurile mele sunt prea mari.
12. Cred că burta mea are mărimea potrivită.
55. Cred că am coapsele de mărime potrivită.
50. Simt că sunt o persoană valoroasă.
65. Mă vor dezamăgi, până la urmă, chiar şi oamenii pe
care îi plac.
26. Pot să disting clar ce emoţie simt.
54. Mai bine ţin oamenii la distanţă (mă incomodează
dacă se apropie prea mult de mine).
59. Cred că fesele mele sunt prea mari.
57. Îmi este uşor să vorbesc despre gândurile şi
sentimentele mele.
41. Am o părere proastă despre mine.
62. Cred că şoldurile mele au mărimea potrivită.

sau Rar) primeşte scorul 3, următorul răspuns
adiacent (Adesea sau Câteodată) primeşte scorul 2,
următorul (Câteodată sau Adesea) primeşte scorul
1, iar următoarele două răspunsuri în direcţia
opusă unei manifestări patologice primesc scorul
0. Punctajul scalei este calculat prin simpla
însumare a tuturor scorurilor itemilor scalei
respective.
Aşa cum se poate vedea din Tabelul 2.13,
variantele anterioare ale EDI foloseau o scală de
6 puncte, cu alegerea obligatorie a unei variante,
iar adverbelor Întotdeauna, De obicei, Adesea,
Câteodată, Rar şi Niciodată li se atribuiau scorurile
3, 2, 1, 0, 0, 0, în cazul întrebărilor care reflectau
un nivel crescut de psihopatologie (ele erau cotate
invers, atunci când conţinutul itemilor reflecta
un nivel scăzut de psihopatologie). Majoritatea
analizelor factoriale efectuate pentru EDI,
incluzând eşantioane clinice, susţin structura
cu opt factori a versiunii originale compusă din
64 de itemi (Eberenz şi Gleaves, 1994; Espelage
şi colab., 2003; Lee, Lee, Leung şi Yu, 1997;
Machado, Goncalves, Martins şi Soares, 2001;
Raciti şi Norcross, 1987; Welch, Hall şi Norring,
1990). Cu toate acestea, procedura tradiţională
de cotare determină o asimetrie puternică a
datelor culese din populaţia nonclinică, fapt ce
încalcă presupunerile necesare pentru unele
proceduri statistice parametrice. După cum era
de aşteptat, atunci când EDI a fost administrat
unor subiecţi din populaţia nonclinică, au fost
găsiţi mai puţini factori (Bennett şi Stevens,
1997; Phelps şi Wilczenski, 1993; Welch şi
colab., 1988), iar acest fapt i‑a determinat pe
unii cercetători să recomande utilizarea unor
scoruri „netransformate” pentru itemi (adică,
de la 1 la 6), pentru a îmbunătăţi consistenţa
internă a scalelor în cazul populaţiei nonclinice
(Schoemaker, van Strien şi van der Staak, 1994;
van Strien şi Ouwens, 2003). Totuşi, utilizarea
unor scoruri „netransformate” nu a îmbunătăţit,
neapărat, integritatea factorială (Lee şi colab.).
Argumentul pentru sistemul de cotare de
la 0 la 4, preferat celui de la 1 la 6, are atât un
caracter raţional‑teoretic, cât şi unul empiric;
acesta se bazează pe ipoteza conform căreia scala
de măsură a itemilor din EDI este continuă numai
pentru răspunsurile care primesc valori între 1 şi
4. Cele două răspunsuri care corespund absenţei
simptomelor nu ar trebui luate în considerare

38
 Tabelul 2.11 Tabelul 2.12
Scala Raritate (R): itemi Sitemul de cotare pentru EDI-3

Item Itemi cotaţi Itemi cotaţi

Răspuns
17. Am încredere în ceilalţi. direct invers
23. Comunic uşor cu alte persoane. Întotdeauna 4 0
30. Mă aflu în relaţii apropiate cu ceilalţi. De obicei 3 0
39. Sunt fericit(ă) că nu mai sunt copil. Adesea 2 1
48. Simt că oamenii sunt cei mai fericiţi atunci când Câteodată 1 2
sunt copii. Rar 0 3
70. Spun lucruri la primul impuls, pe care regret că Niciodată 0 4
le-am spus.
80. Cred că oamenii îmi oferă încrederea pe care o
merit. Tabelul 2.13
Sistemul de cotare pentru
88. Suferinţa te face o persoană mai bună.
versiunile EDI
89. Ştiu că oamenii mă iubesc.
90. Simt nevoia de a-i face rău cuiva.
Itemi cotaţi Itemi cotaţi
Răspuns
direct invers
Întotdeauna 3 0
De obicei 2 0
în calculul scorului total al scalei ce reflectă Adesea 1 0
psihopatologia. Nu este nici intuitiv, nici logic Câteodată 0 1
ca un respondent să primească punctaje diferite
Rar 0 2
pentru variantele de răspuns Rareori şi Niciodată,
Niciodată 0 3
indicând absenţa simptomelor la un anumit item.
În cazul unui sistem de cotare de la 1 la 6, este
posibil ca trei răspunsuri care nu reflectă prezenţa
unei simptomatologii să primească aceeaşi
pondere (2 + 2 + 2 = 6) ca unul dintre răspunsurile romantice ar avea o fidelitate redusă şi o structură
extreme care indică simptomatologia. factorială slabă, dacă ar fi aplicat pe un lot de
EDI a fost construit pentru a oferi un profil copii de grădiniţă, deoarece constructele nu
psihologic al indivizilor din populaţia clinică. sunt relevante pentru aceştia. Cu toate acestea,
Valorile mai scăzute ale fidelităţii constatate frecvenţa cu care EDI a fost utilizat pentru a testa
la eşantioanele din populaţia nonclinică erau aspecte teoretice în populaţia nonclinică a făcut
de aşteptat, deoarece majoritatea distribuţiilor ca unii cercetători să adopte sistemul de cotare de
itemilor au o asimetrie negativă (adică există la 1 la 6. Pentru EDI‑3 a fost ales sitemul de cotare
efectul de podea – floor effect), precum şi din de la 0 la 4, pentru că păstrează valoarea euristică
cauza constructelor clinice care au o relevanţă a sistemului iniţial de cotare şi, în plus, lărgeşte
scăzută pentru majoritatea indivizilor dintr‑un intervalul de scoruri, îmbunătăţind calităţile
eşantion nonclinic. În mod similar, un test psihometrice ale instrumentului, în primul rând
legat de comportamentul în situaţii de întâlniri pentru populaţia nonclinică.

39
 3
Administrare şi cotare
Imagine de ansamblu
Pe lângă broşura cu itemi din EDI‑3, care
cuprinde atât itemii din primul EDI (itemii
1‑64), cât şi itemii scalelor provizorii din EDI‑2
(itemii 65‑91) şi lista de simptome EDI‑3 LS, care
conţine aceiaşi itemi ca EDI‑2 LS, s‑a construit un
nou instrument de trimitere – EDI‑3 FT. Acest
capitol conţine informaţii referitoare la aspecte
profesionale, precum şi informaţii cu privire la
administrarea şi cotarea fiecărui formular EDI‑3.
Materiale
Broşura cu itemi, Formularul de răspuns, Foaia
de profil ale EDI‑3
Pentru administrarea şi cotarea EDI‑3 este
nevoie de Broşura cu itemi, de Formularul de
răspuns şi de Foaia de profil ale EDI‑3. Prima
pagină a Broşurii cu itemi conţine întrebări care
vizează obţinerea de informaţii demografice şi
caracteristici fizice. Întrebările marcate cu un
asterisc conţin informaţii necesare pentru a pune
un diagostic de tulburare a comportamentului
alimentar, folosind criteriile DSM‑IV‑TR.
Celelalte pagini ale Broşurii conţin itemii de la 1
la 91. Formularul de răspuns se utilizează de către
respondent pentru a‑şi înregistra răspunsurile la
întrebările din chestionar. Fişa de cotare şi Fişa de
centralizare a rezultatelor sunt folosite de evaluator
pentru a calcula scorurile scalelor de validitate,
scorurile brute la scale, cotele T şi centilele.
EDI‑3 FT
EDI‑3 FT a fost construit sub forma unui
formular de trimitere la medicul specialist, cu
scopul de a ajuta la identificarea indivizilor
cu un risc crescut de a dezvolta tulburări de
comportament alimentar. FT este format din 4
pagini care cuprind Formularul de răspuns, Fişa
de cotare şi Formularul de trimitere. Formularul de
răspuns cuprinde două secţiuni cu un total de
39 de itemi/întrebări. Fişa de cotare şi Formularul
de trimitere sunt folosite pentru a decide dacă
sunt întrunite criteriile de trimitere la un medic
specialist. Ultima pagină a broşurii cuprinde un
tabel pentru calculul indicelui de masă corporală
al persoanei.
EDI‑3 LS
EDI‑3 LS a fost elaborat ca o listă de simptome,
care poate fi folosită în unităţile clinice sau în alte
circumstanţe, acolo unde este nevoie de obţinerea
unor informaţii detaliate în legătură cu anumite
simptome specifice şi cu frecvenţa apariţiei
acestora. EDI‑3 LS este o broşură de 4 pagini şi
conţine nouă secţiuni de întrebări referitoare
la diferite simptome (cum ar fi, episoadele de
alimentaţie compulsivă, vărsături).
Înainte de a administra oricare dintre
componentele EDI‑3, este important ca
utilizatorii să se familiarizeze cu informaţiile din
acest capitol. Mai precis, utilizatorii trebuie să
aibă o înţelegere aprofundată a caracteristicilor
psihometrice, a aplicabilităţii clinice şi de
cercetare, precum şi a limitelor EDI‑3.
Populaţii ţintă
EDI‑3 a fost construit pentru a veni în
sprijinul evaluării clinice a persoanelor cu
tulburări de comportament alimentar. EDI‑3
furnizează etaloane pentru femei cu vârsta
cuprinsă între 13 şi 53 de ani. Toate protocoalele
pentru etalonare au fost colectate în cadrul a
diferite unităţi de internare sau ambulatorii. Sunt
oferite etaloane pentru următoarele categorii de
diagnostic DSM‑IV‑TR: (a) Anorexia nervoasă
de tip restrictiv (AN‑R); (b) Anorexia nervoasă
41
de tip Comportament alimentar compulsiv/
vărsături (AN‑AC/V); (c) Bulimia nervoasă (BN)
şi (d) Tulburări de comportament alimentar fără
altă specificaţie (TCAFAS).
Este obligatoriu ca evaluatorul să fie extrem
de precaut atunci când administrează oricare
dintre componentele EDI‑3 persoanelor a
căror limbă maternă nu este engleza. Datorită
diferenţelor culturale şi lingvistice, răspunsurile
date de aceste persoane pot avea o validitate
discutabilă şi ar trebui revăzute pentru a
se asigura că respondentul a înţeles fiecare
item în parte, înainte de a cota şi interpreta
răspunsurile. Potrivit analizelor nivelului de
citire Flesch‑Kincaid (Microsoft Word, 2002 –
versiunea [10.4109.3501] SP‑2), întrebările din
Broşura cu itemi EDI‑3 sunt scrise la un nivel de
citire corespunzător clasei a patra, în timp ce
EDI‑3 FT şi EDI‑3 LS sunt scrise la nivelul clasei
a şasea.
Aplicaţii pentru evaluarea clinică a
tulburărilor de comportament alimentar
EDI‑3 a fost construit şi standardizat pentru
evaluarea clinică a persoanelor cu tulburări de
comportament alimentar. Fiind un instrument
de evaluare clinică, EDI‑3 este menit să ofere
informaţii utile pentru înţelegerea pacientului,
pentru planificarea tratamentului şi pentru
evaluarea progresului. EDI‑3 oferă posibilitatea
întocmirii unui profil al pacientului, care
poate fi comparat cu eşantioane de pacienţi cu
tulburări de comportament alimentar. Acest tip
de informaţie este deosebit de relevant pentru
cazurile particulare, deoarece se ştie că pacienţii
diferă mult în ceea ce priveşte dimensiunile
psihologice evaluate de EDI‑3. Atunci când este
administrat la momente diferite în timp, EDI‑3
poate oferi informaţii preţioase în legătură
cu starea clinică şi cu răspunsul la tratament.
Chiar dacă oferă informaţii relevante pentru
scopurile sus‑amintite, este important de ştiut că
instrumentul nu a fost elaborat pentru a oferi o
evaluare exhaustivă a psihopatologiei prezente în
cazul pacienţilor cu tulburări de comportament
alimentar.
Versiunea originală EDI a fost construită
şi standardizată pentru utilizare în scop clinic
la pacienţi cu vârste începând de la 18 ani şi au
existat foarte puţine informaţii despre calităţile
sale psihometrice în cazul pacienţilor cu tulburări
de comportament alimentar mai tineri. EDI‑3
este prima versiune a instrumentului care a fost
standardizată pe un eşantion de adolescenţi cu
tulburări de comportament alimentar; totuşi,
42
acest eşantion a fost constituit dintr‑un număr
relativ redus de adolescenţi. Din acest motiv, nu
există date suficiente pentru a face inferenţe pe
baza profilurilor la acest test, în ceea ce priveşte
pacienţii de 12 ani sau mai tineri.
Aplicaţii la procesul terapeutic
EDI‑3 poate fi utilizat pentru a oferi informaţii
valoroase din punct de vedere clinic pentru
conceptualizarea cazului şi pentru planificarea
tratamentului. De exemplu, terapeutul ar
trebui să fie pregătit să se confrunte cu posibile
dificultăţi în stabilirea unei relaţii terapeutice
puternice şi bazată pe încredere cu un pacient
care are scoruri foarte ridicate la scalele AI şi
DE, la începutul terapiei. Există un risc crescut
ca un pacient cu un asemenea profil să adopte
comportamente impulsive sau necooperante şi
să renunţe prematur la tratament. Ar putea fi
util ca, la începutul tratamentului, să se discute
împreună cu pacientul Foaia de profil EDI‑3,
pentru a facilita colaborarea în planificarea
tratamentului. Unii pacienţi cu tulburări de
comportament alimentar încep tratamentul cu
o motivaţie scăzută de a se schimba. O metodă
neameninţătoare de a‑l implica în procesul de
identificare a propriilor probleme este aceea de
a‑l ruga pe pacient să analizeze şi să comenteze
împreună cu terapeutul Foaia de profil.
Aplicaţii în contexte nonclinice
În cadrul contextelor nonclinice, EDI‑3 FT oferă
o modalitate eficientă de identificare a indivizilor
care prezintă riscul de a dezvolta tulburări ale
comportamentului alimentar. În general, este
bine să se administreze EDI‑3 FT în cadrul unui
proces de screening în şcoli, în programe sportive
şi în alte instituţii, pentru a identifica persoanele
care prezintă simptome specifice tulburărilor de
comportament alimentar.
Aplicaţii în cercetare
EDI‑3 se dovedeşte a fi un instrument util,
cu diferite aplicaţii în cercetare. Acesta oferă
informaţii descriptive, care permit compararea
eşantioanelor din unităţi de cercetare diferite.
A fost utilizat atât pentru a măsura rezultatele
tratamentului, cât şi ca un indicator al
prognosticului în studii asupra tratamentului.
De asemenea, EDI‑3 a mai fost utilizat în studii
prospective, pentru a urmări funcţionarea
psihologică a subiecţilor cu risc de a dezvolta
tulburări de comportament alimentar. EDI‑3
poate fi folosit pentru selecţia sau definirea
grupurilor‑criteriu în studii asupra unor
constructe, precum nemulţumirea faţă de corp,
preocuparea pentru greutatea corporală şi
perfecţionismul.
Competenţe profesionale
Atât EDI‑3, cât şi EDI‑3 LS sunt instrumente
avansate de autoevaluare, iar modalităţile de
administrare şi cotare sunt clare. Nu este necesar
ca evaluatorii să aibă studii de psihologie,
însă ei trebuie să ştie cum se administrează
instrumentele de autoevaluare, individual
sau în grup. Evaluatorii trebuie să cunoască
instrucţiunile din acest manual de specialitate,
precum şi indicaţiile general acceptate privind
utilizarea şi interpretarea testelor, aşa cum
sunt cele descrise în Standardele pentru testarea
educaţională şi psihologică (Standards for Educational
and Psychological Testing – American Educational
Research Association, American Psychological
Association şi National Council of Measurement
in Education, 1999).
Toţi evaluatorii trebuie supervizaţi de
o persoană calificată, cum ar fi un psiholog
autorizat, care să se asigure că se respectă
procedeele clinice pentru obţinerea unor rezultate
la testare acurate, fidele şi valide. Interpretarea
rezultatelor poate fi făcută doar de către
persoane cu calificare profesională, cu pregătire
recunoscută în ceea ce priveşte metodele de
evaluare, care deţin cunoştinţe de statistică
şi psihometrie şi au experienţă în domeniul
tulburărilor de comportament alimentar. Pentru
a stabili un diagnostic şi a lua decizii legate de
screening, este nevoie de integrarea informaţiilor
provenite din mai multe surse, rezultatele la acest
inventar nefiind suficiente.
Menţionăm că, pentru administrarea şi
interpretarea EDI‑3 FT, competenţele profesionale
sunt mai reduse decât în cazul EDI‑3 şi al
EDI‑3 LS, deoarece scopul acestui instrument este
acela de a oferi un număr limitat de interpretări
şi de a oferi asistenţă pentru recomandarea unui
consult de specialitate. Acesta poate fi utilizat de
către consilieri şcolari sau de alte persoane care
sunt calificate să facă trimiteri către specialişti în
sănătate mentală.
Utilizatorii ar trebui să încredinţeze
rezultatele la test doar unor persoane calificate să
le interpreteze şi să se asigure că vor fi folosite
doar în mod adecvat. Analiza şi interpretarea
scorurilor împreună cu respondenţii trebuie
făcute folosind un limbaj de interfaţă, deoarece
EDI‑3 conţine termeni de specialitate, care pot fi
înţeleşi greşit. Toţi itemii, toate etaloanele şi alte
materiale necesare pentru testare ale EDI‑3 sunt
protejate de legislaţia dreptului de autor şi nu
pot fi reproduse sub nicio formă şi prin niciun
mijloc, fără permisiunea prealabilă a editorului,
Psychological Assessment Resources, Inc.
Stabilirea relaţiei cu pacientul şi
administrarea EDI‑3
Instrucţiunile de completare a EDI‑3 sunt
cuprinse în Broşura cu itemi. Se recomandă
folosirea următoarelor instrucţiuni şi condiţii de
testare:
1. EDI‑3 trebuie prezentat ca fiind un instru-
ment de evaluare a atitudinilor, emoţiilor şi
comportamentelor respondentului, asociate
cu alimentaţia şi cu alte aspecte generale.
2. Respondenţii trebuie să fie informaţi că nu
există răspunsuri corecte sau greşite şi că nu
există o limită de timp pentru a răspunde la
întrebări. Majoritatea adulţilor tineri sunt
capabili să completeze EDI‑3 în cel mult 20
de minute.
3. Se recomandă oferirea de asigurări şi
încurajarea unei atitudini pozitive faţă de
situaţia de testare, prin menţionarea faptului
că EDI‑3 este un instrument standardizat, la
care au răspuns mii de persoane.
4. Cel mai indicat este ca administrarea testului
să aibă loc într‑un cadru privat. Acesta
trebuie completat în prezenţa personalului
calificat sau sub supravegherea directă a
unui personal calificat. Dacă este administrat
în grup, respondenţii trebuie sfătuiţi să nu
se consulte între ei atunci când răspund la
întrebări.
5. EDI‑3 nu este destinat interpretărilor
idiosincrasice ale itemilor, aşadar
respondenţilor trebuie să li se ofere
oportunitatea de a pune întrebări, iar
examinatorul trebuie să ofere clarificările
necesare referitoare la itemi.
6. Respondenţii trebuie să fie informaţi că
este important să răspundă la toţi itemii. Ei
trebuie încurajaţi să exprime orice îngrijorări
sau dificultăţi în a răspunde la itemi.
43
 Cotarea EDI-3
Verificarea Broşuriicuitemi şi a Formularului
derăspunsEDI-3 completate
Utilizarea optimă a EDI‑3 necesită
completarea unui număr de întrebări de pe
coperta Broşurii cu itemi. Completarea acestor
întrebări este deosebit de importantă pentru
adunarea de informaţii referitoare la istoricul
respondentului în ceea ce priveşte greutatea.
Vârsta, sexul şi diagnosticul sunt vitale în alegerea
eşantioanelor potrivite pentru a face comparaţii.
După ce Formularul de răspuns a fost
completat de către respondent, persoana care a
administrat EDI‑3 trebuie să se uite peste acesta
pentru a vedea dacă respondentul nu a omis să
răspundă la anumiţi itemi sau dacă există itemi
cu răspunsuri multiple. În acest caz, respondenţii
sunt instruiţi să răspundă la itemii pe care i-au
omis sau să aleagă un singur răspuns la itemii
la care au dat iniţial mai multe răspunsuri. Un
protocol este invalid, dacă conţine mai multe
răspunsuri lipsă sau care nu pot fi cotate. De
exemplu, scorurile la scale nu trebuie calculate
atunci când mai mult de un item din acea scală
a fost omis. Atunci când lipseşte răspunsul la
un singur item, examinatorul are posibilitatea
să calculeze scorul scalei pe baza mediei cotelor
itemilor completaţi; totuşi, scorul final la această
scală va fi interpretat cu prudenţă, deoarece nu
există studii de validitate a scorurilor bazate pe
date incomplete. În plus, scorul compozit nu ar
trebui calculat atunci când în compoziţia lui intră
o scală care a fost invalidată.
Proceduri de cotare
Calculul scorurilor scalelor
Primul pas în calcularea scorurilor la scale
este ruperea benzii perforate din partea dreaptă
a Formularului de răspuns EDI‑3 şi deschiderea
acestuia.
Numele clientului, data şi scorurile la itemi
apar imprimate pe Fişa de cotare EDI‑3, care se
află sub Formularul de răspuns. În continuare, se
calculează scorul la fiecare dintre cele 12 scale.
Începeţi cu scala DS, însumând scorul fiecărui
item al acestei scale. Treceţi rezultatul în spaţiul
special prevăzut pentru scala DS în partea de jos
a Fişei de cotare. Repetaţi procedura pentru fiecare
dintre celelalte 11 scale (B, NC, SSS, AP, NI, AI,
DI, DE, P, A, FM), aşa cum se poate vedea şi în
Figura 3.1.
44
În continuare, transferaţi scorurile brute ale
scalelor în spaţiile prevăzute pentru acestea pe
Fişa de centralizare a rezultatelor (a se vedea Figura
3.2). După transferarea tuturor scorurilor brute,
consultaţi anexa corespunzătoare eşantionului
(cum ar fi, Populaţie clinică adultă din S.U.A.
[Anexa A], Populaţie clinică adultă - Componenţă
internaţională [Anexa B], Populaţie clinică
adolescenţi S.U.A. [Anexa C]) şi găsiţi Tabelul
1 pentru a transforma scorurile brute în cote T
pentru scalele de Risc de tulburare de comportament
alimentar (adică DS, B, NC). Începeţi prin a găsi
scorul brut obţinut la scala DS şi apoi, pentru a
găsi cota T, urmăriţi pe orizontală în tabel până
la coloana corespunzătoare pentru scala DS
(denumită „DS”), în funcţie de grupul diagnostic
(adică AN-R, AN-AC/V, BN, TCAFAS). Treceţi
cota T în spaţiul destinat acesteia pe Fişa de
centralizare a rezultatelor. Repetaţi aceeaşi
procedură în cazul scalelor B şi NC. Consultaţi,
apoi, Tabelul 2 al aceleiaşi anexe şi repetaţi
procedura pentru a găsi cotele T corespunzătoare
fiecărui scor brut al Scalelor psihologice. Pentru a
face transformarea scorurilor brute ale scalelor
de Risc de tulburare de comportament alimentar şi ale
Scalelor psihologice în centile, consultaţi Tabelele 3
şi 4 din aceeaşi anexă.
Tabelul 3.1 cuprinde itemii fiecărei scale,
intervalul posibil al scorurilor şi direcţia de
cotare pentru fiecare item din EDI‑3. Pentru
profesioniştii care s-au familiarizat cu versiunile
anterioare ale EDI, tabelul furnizează şi
repartizarea itemilor în scalele EDI‑2. În fine,
în Tabelul 3.1 sunt identificaţi cei cinci clusteri
experimentali derivaţi din EDI‑3. Aceşti clusteri
(adică Frica de emoţii, Confuzie în legătură cu
emoţiile, Risc pentru abuz de substanţe, Perfecţionism
orientat către sine, Perfecţionism prescris social) au
fost generaţi în urma analizelor logice şi empirice
şi sunt discutaţi în Capitolul 4.
Calculul scorurilor compozite
Pentru a calcula scorurile compozite, adunaţi
cotele T ale celor trei scale de Risc de tulburare
de comportament alimentar (adică DS, B şi NC) şi
scrieţi rezultatul în spaţiul prevăzut pentru suma
cotelor T ale SCRTCA, pe Fişa de centralizare a
rezultatelor. Calculaţi apoi suma cotelor T pentru
fiecare scor compozit psihologic (adică SCI,
SCPI, SCPE, SCCE, SCNPG). Scalele care compun
fiecare scală compozită sunt listate sub scorul
compozit, pe Fişa de centralizare a rezultatelor.
După ce aţi calculat şi înregistrat suma cotelor
T, consultaţi Tabelul 5 din anexa corespunzătoare
(cum ar fi, Eşantion clinic de adulţi din SUA
Fiecare afi rmaţie corespunde unei scale anume. Adunaţi scorurile afi rmaţiilor pentru fi ecare scală şi treceţi
rezultatul în spaţiul corespunzător.

Model A 11/1/04
Nume şi prenume _________________________________________ Data completării __________________

Î = ÎNTOTDeaUNa O = De OBICeI a = aDeSea C = CÂTeODaTĂ R = RaR N = NICIODaTĂ

1. DS 0 0 1 2 3 4 19. NC 0 0 1 2 3 4 37. SSS 0 0 1 2 3 4 55. NC 0 0 1 2 3 4 73. NI 0 0 1 2 3 4

2. NC 4 3 2 1 0 0 20. AP
3. FM 4 3 2 1 0 0 21. DI
4. B 4 3 2 1 0 0 22. FM
5. B 4 3 2 1 0 0 23. NI
6. FM 4 3 2 1 0 0 24. AP
7. DS 4 3 2 1 0 0 25. DS
8. DI 4 3 2 1 0 0 26. DI
9. NC 4 3 2 1 0 0 27. SSS 4 3 2 1 0 0 45. NC
10. SSS 4 3 2 1 0 0 28. B
11. DS 4 3 2 1 0 0 29. P
12. NC 0 0 1 2 3 4 30. AI
13. P 4 3 2 1 0 0 31. NC
14. FM 4 3 2 1 0 0 32. DS
15. NI 0 0 1 2 3 4 33. DI
16. DS 4 3 2 1 0 0 34. NI
17. AI 0 0 1 2 3 4R 35. FM
18. AP 4 3 2 1 0 0 36. P
0 0 1 2 3 4 38. B 4 3 2 1 0 0 56. AP 4 3 2 1 0 0 74. AI 4 3 2 1 0 0
4 3 2 1 0 0 39. FM 0 0 1 2 3 4R 57. NI 0 0 1 2 3 4 75. A 4 3 2 1 0 0
0 0 1 2 3 4 40. DI 4 3 2 1 0 0 58. FM 0 0 1 2 3 4 76. AI 0 0 1 2 3 4
0 0 1 2 3 4R 41. SSS 4 3 2 1 0 0 59. NC 4 3 2 1 0 0 77. DI 4 3 2 1 0 0
4 3 2 1 0 0 42. SSS 0 0 1 2 3 4 60. DI 4 3 2 1 0 0 78. A 4 3 2 1 0 0
4 3 2 1 0 0 43. P 4 3 2 1 0 0 61. B 4 3 2 1 0 0 79. DE 4 3 2 1 0 0
0 0 1 2 3 4 44. DI 4 3 2 1 0 0 62. NC 0 0 1 2 3 4 80. AP 0 0 1 2 3 4R
4 3 2 1 0 0 63. P 4 3 2 1 0 0 81. DE 4 3 2 1 0 0
4 3 2 1 0 0 46. B 4 3 2 1 0 0 64. B 4 3 2 1 0 0 82. A 4 3 2 1 0 0
4 3 2 1 0 0 47. NC 4 3 2 1 0 0 65. AI 4 3 2 1 0 0 83. DE 4 3 2 1 0 0
0 0 1 2 3 4R 48. FM 4R 3 2 1 0 0 66. A 4 3 2 1 0 0 84. AP 4 3 2 1 0 0
0 0 1 2 3 4 49. DS 4 3 2 1 0 0 67. DE 4 3 2 1 0 0 85. DE 4 3 2 1 0 0
4 3 2 1 0 0 50. SSS 0 0 1 2 3 4 68. A 4 3 2 1 0 0 86. A 4 3 2 1 0 0
4 3 2 1 0 0 51. DI 4 3 2 1 0 0 69. NI 0 0 1 2 3 4 87. NI 4 3 2 1 0 0
4 3 2 1 0 0 52. P 4 3 2 1 0 0 70. DE 4R 3 2 1 0 0 88. A 4R 3 2 1 0 0
4 3 2 1 0 0 53. B 4 3 2 1 0 0 71. 89. AI 0 0 1 2 3 4R
4 3 2 1 0 0 54. AI 4 3 2 1 0 0 72. DE 4 3 2 1 0 0 90. DE 4R 3 2 1 0 0
91. AP 0 0 1 2 3 4

16 11 18 14 15 12 15 16 19 11 15 12
_____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____
DS B NC SSS AP NI AI DI DE P A FM

Psychological Assessment Resources, Inc.  16204 N. Florida Avenue  Lutz, FL 33549  1.800.331.8378  www.parinc.com
Copyright © 1984, 1991, 2004 by Psychological Assessment Resources, Inc.
Toate drepturile rezervate. Nicio parte a acestei publicaţii nu poate fi reprodusă sau transmisă sub nicio formă (electronic sau mecanic, incluzând fotocopierea sau orice
alt sistem de copiere), fără permisiunea prealabilă a Psychological Assessment Resources, Inc. Conţine itemii versiunii originale EDI, construiţi de către Garner, Olmsted
si Polivy (19840. Acest formular este tiparit cu cerneala indigo pe hârtie albă. Orice altă variantă este neautorizată.

Figura 3.1. Model de Fişă de cotare EDI-3 pentru un adult

 Scorul Scalei Inconsecvenţă a răspunsurilor (IN)
1. Treceţi scorul fi ecărui item referitor la Inconsecvenţă (IN) în căsuţa
corespunzătoare de mai jos.
2. Scădeţi numărul cel mai mic din numărul cel mai mare şi treceţi
rezultatul în coloana Total.
3. Adunaţi numerele din coloana Total pentru a obţine Scorul de
Inconsecvenţă. Apoi, utilizând tabelul cu scoruri de mai jos, încercuiţi
categoria corespunzătoare scorului.

Item Scor Item Scor Total

Lot non-clinic: 2. 0 12. 1 = 1
9. 55. =
P adulţi din SUa adulţi străini adolescenţi din SUa 2 1 1
10. 3 50. 2 = 1
Lot clinic:
17. 2 65. 4 = 2
P aN-R aN-aC/v BN TCaFaS
21. 3 26. 2 = 1
30. 1 54. 2 = 1
Scala de Risc de tulburare de comportament alimentar şi scala
compozită 31. 1 59. 3 = 2
Cotă 34. 2 57. 3 = 1
Scală Scor brut T Centil 37. 0 41. 4 = 4
Dorinţa de a fi slab (DS) 16 48 38 45. 3 62. 1 = 2
Bulimie (B) 11 69 93
Scorul de Inconsecvenţă 16
Nemulţumire faţă de corp (NC) 18 44 36 Interval scoruri Categorie
Suma Cotă
Scală compozită cotelor T T Centil 0‑15 Tipic

Scală compozită Risc de tulburare de 16‑19 Atipic

comportament alimentar (SCRTCA) 161 54 65 20‑40 Foarte atipic
[DS+B+NC]

Scala psihologică şi scala compozită Scorul Scalei Raritate (R)

Cotă 1. Număraţi itemii aparţinând scalei Raritate, care au scorul 4. (Notă:

Scală Scor brut T Centil Aceşti itemi sunt marcaţi prin litera R alături de cifra 4 pe Fişa de co‑
tare.)
Stimă de sine scăzută (SSS) 14 52 54 2. Treceţi numărul acestora în spaţiul de mai jos corespunzător Scorului
de Raritate.
Alienare personală (AP) 15 52 59 3. Utilizând tabelul cu scoruri de mai jos, încercuiţi categoria corespun‑
Nesiguranţă interpersonală (NI) 12 51 53 zătoare scorului.
Alienare interpersonală (AI) 15 59 80 Scorul de Raritate 0
Defi cite interoceptive (DI) 16 49 47 Interval scoruri Categorie
Dezechilibru emoţional (DE) 19 69 95 0‑2 Tipic
Perfecţionism (P) 11 45 33 3‑4 Atipic
Ascetism (A) 15 54 66 5‑10 Foarte atipic
Frica de maturitate (FM) 12 52 62
Suma Cotă Scorul Scalei Impresie negativă (ING)
Scor compozit cotelor T T Centil
1. Număraţi itemii care au fost cotaţi cu 4.
Scală compozită Inefi cacitate (SCI) (Notă: Aceşti itemi sunt marcaţi prin căsuţele de o culoare mai închisă
[SSS+AP] 104 52 55 de pe Fişa de cotare.)
2. Treceţi numărul acestora în spaţiul de mai jos corespunzător scorului de
Scală compozită Probleme interpersonale
(SCPI) [NI+AI] 110 55 68 Impresie negativă.
3. Utilizând tabelul cu scoruri de mai jos, încercuiţi categoria corespun‑
Scală compozită Probleme emoţionale zătoare scorului.
(SCPE) [DI+DE]
118 60 81
Scorul de Impresie negativă 7
Scală compozită Control exagerat (SCCE)
[P+A]
99 49 45 Interval scoruri Categorie

Scor compozit Neadaptare 0‑44 Tipic

psihologică generală (SCNPG)
483 54 66
45‑54 Atipic
[SSS+AP+NI+AI+DI+DE+P+A+FM]
55‑90 Foarte atipic

Figura 3.2. Model de Fişă de centralizare a rezultatelor pentru un adult, utilizând grupul cu
46 diagnostic de anorexie nervoasă de tip restrictiv (AN-R)
 Tabelul 3.1
Itemii scalelor din EDI-3, subscalele corespondente din EDI-2 şi direcţia de cotare

Numărul Subscala
Scala/Item Cotare
itemului EDI-2
Scala Dorinţa de a fi slab (DS)
1. Mănânc dulciuri şi carbohidraţi (pâine, paste făinoase, produse de patiserie
DS 001234
etc.), fără să mă neliniştească acest lucru.
7. Mă gândesc să fac o cură de slăbire. DS 432100
11. Mi-e frică să nu mă îngraş după ce mănânc. DS 432100
16. Sunt îngrozit(ă) că aş putea să mă îngraş. DS 432100
25. Dau o importanţă mare sau exagerată greutăţii corporale. DS 432100
32. Sunt preocupat(ă) de dorinţa de a fi mai slab(ă). DS 432100
49. Dacă mă îngraş cu un kilogram sau două, mă îngrijorez că mă voi îngrăşa
DS 432100
în continuare.
Scala Bulimie (B)
4. Mănânc când sunt supărat(ă). B 432100
5. Mă îndop cu mâncare. B 432100
28. Am continuat să mănânc compulsiv atunci când simţeam că nu mă pot
B 432100
opri.
38. Mă gândesc să mă îndop cu mâncare. B 432100
46. Mănânc moderat în faţa altora şi mă îndop cu mâncare când rămân
B 432100
singur(ă).
53. Mă gândesc să încerc să vomit ca să slăbesc. B 432100
61. Mănânc sau beau pe ascuns. B 432100
64. Mă îngrijorez că, atunci când sunt supărat(ă), voi începe să mănânc. CI 432100
Scala Nemulţumire faţă de corp (NC)
2. Cred că burta mea este prea mare. NC 432100
9. Cred că am coapsele prea mari. NC 432100
12. Cred că burta mea are mărimea potrivită. NC 001234
19. Sunt mulţumit(ă) de forma corpului meu. NC 001234
31. Îmi place forma feselor mele. NC 001234
45. Cred că şoldurile mele sunt prea mari. NC 432100
47. Mă simt umflat(ă) după ce mănânc o masă normală. CI 432100
55. Cred că am coapsele de mărime potrivită. NC 001234
59. Cred că fesele mele sunt prea mari. NC 432100
62. Cred că şoldurile mele au mărimea potrivită. NC 001234
Scala Stimă de sine scăzută (SSS)
10. Simt că sunt o persoană ineficientă. SSS 432100
27. Mă simt nelalocul meu. SSS 432100
37. Am încredere în mine. SSS 001234
41. Am o părere proastă despre mine. SSS 432100
42. Mă simt în stare să îmi ating standardele. SSS 001234
50. Simt că sunt o persoană valoroasă. SSS 001234
Scala Alienare personală (AP)
18. Mă simt singur(ă) pe lume. I 432100
20. Am sentimentul de control asupra lucrurilor din viaţa mea. I 001234
24. Mi-aş dori să fiu altcineva. I 432100
56. Am un sentiment de gol interior. I 432100
80. Cred că oamenii îmi oferă încrederea pe care o merit. NS 001234
84. Simt că ies în pierdere pe toate planurile. NS 432100
91. Mă cunosc destul de bine. NS 001234

47
 Tabelul 3.1 (continuare)
Itemii scalelor din EDI-3, subscalele corespondente din EDI-2 şi direcţia de cotare

Numărul Subscala
Scala/Item Cotare
itemului EDI-2
Scala Nesiguranţă interpersonală (NI)
15. Vorbesc uşor despre sentimentele mele. NI 001234
23. Comunic uşor cu alte persoane. NI 001234
34. Am dificultăţi în a-mi exprima emoţiile faţă de ceilalţi. NI 432100
57. Îmi este uşor să vorbesc despre gândurile şi sentimentele mele. NI 001234
69. Mă simt în largul meu când sunt într-un grup. NS 001234
73. Sunt comunicativ(ă) cu aproape toată lumea. NS 001234
87. Prefer să-mi petrec timpul de unul/una singur(ă), decât cu ceilalţi. NS 432100
Scala Alienare interpersonală (AI)
17. Am încredere în ceilalţi. NI 001234
30. Mă aflu în relaţii apropiate cu ceilalţi. NI 001234
54. Mai bine ţin oamenii la distanţă (mă incomodează dacă se apropie prea
NI 432100
mult de mine).
65. Mă vor dezamăgi, până la urmă, chiar şi oamenii pe care îi plac. RI 432100
74. Mă simt prins(ă) în relaţii ca într-o capcană. RI 432100
76. Oamenii înţeleg problemele mele reale. RI 001234
89. Ştiu că oamenii mă iubesc. NS 001234
Scala Deficite interoceptive (DI)
8. Mă înspăimânt atunci când sentimentele mele sunt prea puternice. a CI 432100
21. Sunt confuz(ă) în legătură cu ceea ce simt. b CI 432100
26. Pot să disting clar ce emoţie simt. b CI 001234
33. Nu ştiu ce se întâmplă în interiorul corpului meu. b CI 432100
40. Nu-mi dau seama dacă mi-e foame sau nu. b CI 432100
44. Mi-e greu să-mi controlez sentimentele. a CI 432100
51. Când mă supără ceva, nu ştiu dacă sunt trist(ă), înspăimântat(ă) sau furios/ CI
432100
furioasă. b
60. Am sentimente pe care nu le prea pot distinge. b CI 432100
77. Nu reuşesc să-mi scot din minte gânduri ciudate. b RI 432100
Scala Dezechilibru emoţional (DE)
67. Alţi oameni ar putea spune că sunt instabil(ă) emoţional. RI 432100
70. Spun lucruri la primul impuls, pe care regret că le-am spus. RI 432100
72. Trebuie să am grijă cu tendinţa mea de a abuza de medicamente. c RI 432100
79. Sunt predispus(ă) la izbucniri de furie sau de mânie. RI 432100
81. Trebuie să am grijă cu tendinţa mea de a abuza de alcool. c RI 432100
83. Ceilalţi ar spune că mă enervez uşor. RI 432100
85. Am schimbări evidente de dispoziţie emoţională. RI 432100
90. Simt nevoia de a-i face rău cuiva. RI 432100
Scala Perfecţionism (P)
13. În familia mea, doar performanţele deosebite sunt suficient de bune. e P 432100
29. Copil fiind, am încercat din greu să nu îmi dezamăgesc părinţii şi
P 432100
profesorii. e
36. Urăsc să nu fiu cel/cea mai bun(ă) în tot ceea ce fac. d P 432100
43. Părinţii mei s-au aşteptat să fiu cel/cea mai bun(ă). e P 432100
52. Simt că trebuie să fac lucrurile perfect sau să nu le fac deloc. d P 432100
63. Îmi fixez scopuri foarte măreţe. d P 432100
Scala Ascetism (A)
66. Mi-e ruşine de slăbiciunile mele omeneşti. A 432100

48
 Tabelul 3.1 (continuare)
Itemii scalelor din EDI-3, subscalele corespondente din EDI-2 şi direcţia de cotare

Numărul Subscala
Scala/Item Cotare
itemului EDI-2
68. Vreau să am control total asupra poftelor şi pornirilor corpului meu. A 432100
75. Faptul că mă abţin, mă face să mă simt mai puternic(ă) din punct de vedere A 432100
spiritual.
78. A mânca de plăcere este un semn de slăbiciune morală. A 432100
82. Cred că a te relaxa este doar pierdere de vreme. A 432100
86. Sunt jenat(ă) de poftele şi de pornirile corpului meu. A 432100
88. Suferinţa te face o persoană mai bună. A 432100
Scala Frica de maturitate (FM)
3. Îmi doresc să mă pot întoarce la siguranţa copilăriei. FM 432100
6. Îmi doresc să fiu mai tânăr(ă). FM 432100
14. Cea mai fericită perioadă din viaţă este atunci când eşti copil. FM 432100
22. Aş dori să fiu mai degrabă adult decât copil. FM 001234
35. Cerinţele vârstei adulte sunt prea mari. FM 432100
39. Sunt fericit(ă) că nu mai sunt copil. FM 001234
48. Simt că oamenii sunt cei mai fericiţi atunci când sunt copii. FM 432100
58. Cei mai buni ani din viaţa ta sunt atunci când devii adult. FM 001234

Notă. Pentru subscalele EDI-2: DS = Dorinţa de a fi slab; B = Bulimie; NC = Nemulţumire faţă de corp; I = Ineficienţă; P = Perfecţionism;
NI= Neîncredere interpersonală; CI = Conştiinţă interoceptivă; FM = Frica de maturitate; A = Ascetism; RI = Reglarea impulsurilor; NS
= Nesiguranţă interpersonală.
a
Clusterul Frică de emoţii. b Clusterul Confuzie în legătură cu emoţiile. c
Clusterul Risc pentru abuz de substanţe. d
Clusterul
Perfecţionism orientat către sine. e Clusterul Perfecţionism prescris social.

[Anexa A], Eşantion clinic internaţional [Anexa
B], Eşantion clinic de adolescenţi din SUA [Anexa
C]) pentru a găsi scorul SCNPG. Mai întâi,
localizaţi valoarea obţinută ca sumă a cotelor T
pentru grupul de diagnostic corespunzător, apoi
urmăriţi pe orizontală în tabel, pentru a găsi
cota T şi centilul corespunzător pentru SCNPG.
Treceţi cota T şi centilul în spaţiile destinate
acestora, pe Fişa de centralizare a rezultatelor.
Repetaţi aceeaşi procedură în cazul fiecărui scor
compozit psihologic, folosind tabelele 6 şi 7 din
aceeaşi anexă (a se vedea Figura 3.2).
Calcularea scorurilor la Scalele de validitate
Pentru a cota scala de Inconsecvenţă (IN),
copiaţi de pe Fişa de cotare scorul fiecărui item
al acestei scale, în căsuţa de perechi de itemi
corespunzătoare de pe Fişa de centralizare a
rezultatelor. Apoi, scădeţi numărul mai mic din
numărul mai mare şi treceţi rezultatul obţinut în
coloana Total. În cele din urmă, adunaţi numerele
din coloana Total pentru a obţine scorul la scala
de Inconsecvenţă. Apoi, utilizând tabelul de cotare
de pe Fişa de centralizare a rezultatelor, încercuiţi
categoria în care se încadrează scorul la această
scală (a se vedea Figura 3.2).
Pentru a cota scala de Raritate (R), număraţi
itemii aparţinând scalei de Raritate care au fost
cotaţi cu 4. Aceşti itemi sunt marcaţi cu un I, care
apare alături de valoarea 4 a scorului de pe Fişa
de cotare. Treceţi numărul total de itemi în spaţiul
prevăzut pentru scorul la scala de Raritate pe
Fişa de centralizare a rezultatelor. Utilizând tabelul
de cotare de pe Fişa de centralizare a rezultatelor,
încercuiţi categoria corespunzătoare scorului de
Raritate (a se vedea Figura 3.2).
Pentru stabilirea scorului la scala de Impresie
negativă (ING) număraţi itemii care au primit
scorul 4; aceşti itemi sunt marcaţi pe Fişa de cotare
cu ajutorul căsuţelor haşurate. Treceţi numărul
total de itemi în spaţiul prevăzut pentru scorul la
scala de Impresie negativă de pe Fişa de centralizare a
rezultatelor. Utilizând tabelul de cotare de pe Fişa
de centralizare a rezultatelor, încercuiţi categoria
corespunzătoare scorului (vezi Figura 3.2).

49
50
Nume
Model A Data

Scala Risc de tulburare

de comportament Scala compozită Foaie de profil pe baza centilelor
alimentar Risc de tulburare
de comportament Scală compozită psihologică
Scală psihologică
N alimentar N
e in Ne in
De Pe in
Do te sig inte A te D z In te Pr e Pr ps ead
ri fa mul
ţă ţu sin St rp u rp li rfe m F efi r o C ih ap
Bu e s im pe Alie e r e r e n
ro efi
c
emechi
l cţi As pe b m ob
g olo ta
a fi nţa
lim de m că ă d rs na rs an s a e c o i b on ce at rica
ur d ca
c rs lem
o
oţ le
io m
ex on
a
sla de co ire zu e
on re
a
on ţă
a
on re
a
pt ite
iv
ţio ru
n ism tis i ta e i ta n e n g tro ene gic re
b ie rp tă l ă l ă l ă e al m te te ale ale e er l
at
ra ă
lă

Semnificaţie
clinică ridicată
Semnificaţie
clinică tipică
Semnificaţie
clinică scăzută
centil centil
DS B NC SCRTCA SSS AP NI AI DI DE P A FM SCI SCPI SCPE SCCE SCNPG

Figura 3.3. Model de Foaie de profil EDI-3 pe baza centilelor, pentru un adult
Lot non-clinic: PAdulţi din SUA Adulţi străini Adolescenţi din SUA Eşantion de control femei
Lot clinic: PAN-R AN-AC/V BN TCAFAS Notă: Intervalele clinice s-au bazat pe eşantionul combinat de adulţi folosit pentru etalonare.
 Nume
Model A Data

Scala Risc de tulburare

de comportament Scala compozită Foaie de profil pe baza cotelor T
alimentar Risc de tulburare
de comportament Scală compozită psihologică
Scală psihologică
N alimentar N
e in Ne in
De Pe in
Do
ri fa mul te sig inte A te D z rfe In te Pr ps ead
ih ap
ţă ţu sin St p Al
i
er en
rp u rp li
e e ro efi emechi As m Fri efi rp ob em Pro C
a fi nţa Bu de m e s im er ra r c l cţi
ce at ca
u ca er le
s m
oţ ble
i m
ex on ge olog tare
sla de lim co ire că ă d
zu e
so ar
na e
so nţ
na ă
so nar
na e
ep cit
tiv e
oţ ib
io ru
on
ism tis rit de c ita o na e o na e a t
ge rol ne ic
b ie rp tă lă lă lă e na m at
e te le le ra ra ă
lă
l t

Cotă T Cotă T
DS B NC SCRTCA SSS AP NI AI DI DE P A FM SCI SCPI SCPE SCCE SCNPG

Lot non-clinic: PAdulţi din SUA Adulţi străini Adolescenţi din SUA Semnificaţie clinică tipică Eşantion de control femei
(eşantion combinat de
Lot clinic: AN-AC/V BN TCAFAS

Figura 3.4. Model de Foaie de profil EDI-3 pe baza cotelor T, pentru un adult din SUA
PAN-R adulţi)

51
Trasarea profilului pe baza scalelor şi a scalelor
compozite
Foaia de profil EDI‑3 a fost realizată în aşa fel
încât profilurile să poată fi întocmite utilizând
atât cotele T, cât şi centilele. În cazul în care
administraţi EDI‑3 unei persoane despre care
ştiţi că suferă de o tulburare de comportament
alimentar, dar încă nu aţi stabilit un diagnostic,
se recomandă să examinaţi mai întâi intervalul
calitativ al cotelor T sau al centilelor la scalele
de Risc de tulburare de comportament alimentar
şi pentru SCNPG, folosind eşantionul clinic
combinat din eşantioanele clinice de adulţi din
SUA sau eşantioanele clinice de adolescenţi,
prezentate în Tabelele 4.5‑4.9. Acest format îi
permite utilizatorului să compare respondentul,
din punct de vedere calitativ, cu un grup clinic
combinat de adulţi sau de adolescenţi, indiferent
de grupul diagnostic normativ ales. După ce s‑a
stabilit un diagnostic, este posibilă realizarea
profilului pentru scalele de Risc pentru tulburări
de comportament alimentar şi pentru SCNPG, pe
baza cotelor T şi a centilelor, utilizând un eşantion
diagnostic specific folosit la etalonare. Eşantionul
folosit la etalonare şi grupul diagnostic utilizate
pentru a obţine scorurile din etaloane trebuie
specificate pe Foaia de profil. După ce aţi ales
unitatea de măsură pentru realizarea profilului,
copiaţi cotele T sau centilele pentru fiecare scală
şi scală compozită, în spaţiile prevăzute în partea
de jos a Foii de profil (adică pe Foaia de profil pe
baza centilelor sau pe Foaia de profil pe baza cotelor
T). Marcaţi, apoi, cota T sau centilul obţinut
pentru fiecare scală, prin localizarea scorului
pe coloană, urmărind fie coloana din marginea
dreaptă, fie cea din stânga. Marcaţi cu atenţie
punctul respectiv pe coloana potrivită. După ce
aţi marcat toate scorurile, trasaţi o linie pentru a
uni punctele corespunzătoare scorurilor tuturor
scalelor de Risc de tulburare de comportament
alimentar şi al scalei compozite de Risc de tulburare
de comportament alimentar şi alte linii pentru a uni
punctele corespunzătoare scalelor psihologice şi
scalelor psihologice compozite pentru a forma
un profil (a se vedea Figurile 3.3 şi 3.4).
Foaia de profil pe bază de centile conţine o zonă
haşurată, care reprezintă grupul de control,
format din femei fără tulburări de comportament
alimentar. Banda haşurată reprezintă intervalul
dintre centilele 25 şi 67 din eşantionul de control.
Liniile care apar în dreptul centilului 25 şi al
centilului 67 reprezintă pragurile de demarcaţie
dintre cele trei intervale de clasificare calitative
(adică Semnificaţie clinică scăzută, Semnificaţie
clinică tipică, Semnificaţie clinică ridicată) pentru
52
eşantioanele clinice combinate. Scorurile mai mici
de centilul 25 aparţin intervalului de Semnificaţie
clinică scăzută, scorurile cuprinse între centilele
25‑66 aparţin intervalului de Semnificaţie clinică
tipică, în timp ce scorurile cuprinse între centilele
67‑99 aparţin intervalului de Semnificaţie
clinică ridicată. Este important de specificat că
intervalele calitative pot varia în ceea ce priveşte
scalele de Risc de tulburare de comportament
alimentar şi SCNPG la adulţi, în funcţie de grupul
de referinţă utilizat. Clasificările calitative în
ceea ce priveşte Scalele psihologice nu vor varia,
deoarece în EDI‑3 sunt prezentate doar etaloanele
bazate pe un eşantion clinic combinat (a se vedea
Figura 3.3). Intervalele calitative pentru cotele T
şi pentru centile, pentru fiecare dintre grupurile
de diagnostic, atât pentru adolescenţi, cât şi
pentru adulţi, pot fi găsite în tabelele de intervale
calitative din capitolul 4 al acestui Manual.
În mod similar, Foaia de profil pe baza cotelor
T conţine o zonă haşurată, care reprezintă
grupul de control format din femei fără tulburări
de comportament alimentar. Banda haşurată
reprezintă intervalul de cote T echivalent
cu cel cuprins între centilul 25 şi centilul 67,
corespunzător scorurilor brute ale eşantionului
de control. În plus, Foaia de profil pe baza cotelor
T mai conţine o zonă haşurată cu o culoare
mai închisă, care corespunde intervalului de
Semnificaţie clinică tipică. Zona de deasupra
benzii haşurate cu o culoare mai închisă reprezintă
intervalul de Semnificaţie clinică ridicată, iar
zona de dedesubtul acesteia reprezintă intervalul
de Semnificaţie clinică scăzută. De asemenea,
menţionăm că cele trei intervale de clasificare
calitativă pe baza cotelor T, pentru toate scalele
şi scalele compozite ale EDI‑3, sunt supuse
unor variaţii. Acest lucru se întâmplă, deoarece
intervalele de clasificare calitativă au fost
construite folosind centilele ca scoruri de secţiune
(cutoff scores), pentru eşantionul clinic combinat
de adulţi din SUA. Cotele T pot varia, pentru
că scalele EDI‑3 nu au o distribuţie normală, iar
cotele T şi centilele echivalente vor varia de la o
scală la alta, în funcţie de forma distribuţiei în
grupul de referinţă (a se vedea Figura 3.4).
Administrarea EDI‑3 FT
Instrucţiunile de completare a EDI‑3 FT se
găsesc pe prima pagină a formularului EDI‑3
FT şi în Manualul FT. Se recomandă respectarea
următoarelor instrucţiuni şi condiţii de testare:
1. EDI‑3 FT ar trebui prezentat ca fiind un in-
strument de evaluare a atitudinilor, emoţiilor
 şi comportamentelor respondentului legate
de alimentaţie şi de alte aspecte generale.
2. Respondenţii ar trebui să fie informaţi că
nu există răspunsuri corecte sau greşite şi
că nu există o limită de timp în completarea
inventarului. Majoritatea adulţilor tineri sunt
capabili să completeze EDI‑3 FT în mai puţin
de 10 minute.
3. Este cel mai bine să se administreze EDI‑3
FT individual. Acesta trebuie completat în
prezenţa sau sub supravegherea directă a
personalului calificat. În cazul administrării
în grup, respondenţii ar trebui sfătuiţi să
nu se consulte între ei în timp ce răspund la
întrebări.
4. EDI‑3 FT nu este destinat interpretărilor
idiosincrasice ale itemilor, aşadar
respondenţilor ar trebui să li se ofere
oportunitatea de a pune întrebări, iar
examinatorul ar trebui să ofere clarificările
necesare referitoare la itemi.
5. Respondenţii ar trebui să fie informaţi că este
important să răspundă la toţi itemii. Ei ar
trebui încurajaţi să exprime orice îngrijorare
sau dificultate în a răspunde la itemi.
Cotarea EDI‑3 FT
Verificarea Formularului de răspuns EDI‑3 FT
completat
Odată ce Formularul de răspuns EDI‑3 FT a
fost completat de către respondent, examinatorul
ar trebui să îl parcurgă cu vederea, pentru a
identifica itemii omişi sau la care nu s‑a răspuns
şi cei care au răspunsuri multiple. Ca şi în
cazul EDI‑3, respondenţii ar trebui îndrumaţi
să răspundă la itemii rămaşi necompletaţi sau
sfătuiţi să selecteze un singur răspuns pentru un
item dacă, anterior, au ales mai multe răspunsuri.
Lipsa mai multor răspunsuri sau existenţa mai
multor itemi care nu se pot cota poate determina
invalidarea protocolului. În mod special, scalele
DS, B şi NC nu ar trebui cotate atunci când mai
mult de un item per scală a fost omis. Când un
item a fost omis, examinatorul poate alege să îi
atribuie un scor egal cu media (mai precis, media
aritmetică) scorurilor itemilor completaţi la acea
scală; totuşi, astfel de scoruri ar trebui interpretate
cu precauţie, deoarece nu există studii sistematice
asupra validităţii scorurilor bazate pe date
incomplete sau pe media scorurilor itemilor.
Decizia recomandării unui consult de
specialitate
Această secţiune descrie procedura de cotare
a EDI‑3 FT şi de determinare a cazului în care
un individ îndeplineşte oricare dintre criteriile
de recomandare a unui consult de specialitate
bazate pe: (a) greutate corporală mică, în
comparaţie cu standardele corespunzătoare
vârstei/sexului (adică folosind exclusiv criteriul
IMC); (b) greutate corporală mică, în comparaţie
cu standardele corespunzătoare vârstei/sexului
(adică, IMC) şi preocupări excesive legate de
dietă, greutatea corporală şi obiceiuri alimentare
problematice (adică, evaluate cu ajutorul
scorurilor brute totale ale scalelor DS şi B) şi
(c) simptome comportamentale care indică o
tulburare de comportament alimentar (adică
bazate pe răspunsurile la cele cinci întrebări legate
de comportament din EDI‑3 FT). În Capitolul 4
al acestui Manual, găsiţi o discuţie detaliată în
legătură cu rezultatele EDI‑3 FT şi interpretarea
acestora.
Întâi de toate, rupeţi banda perforată de pe
EDI‑3 FT şi deschideţi formularul. Informaţiile
demografice şi scorurile itemilor sunt tipărite
pe Fişa de cotare EDI‑3 FT. Transferaţi scorul
fiecărui item (din grila de cotare din partea
dreaptă) în coloana corespunzătoare din partea
stângă a paginii (a se vedea Figura 3.5). În
continuare, calculaţi scorul pentru fiecare dintre
cele trei scale din EDI‑3, însumând scorurile
tuturor itemilor scalelor DS, B şi NC şi înscriind
totalurile în spaţiile corespunzătoare din partea
de jos a Fişei de cotare. În timp ce scorurile totale
brute la scalele DS şi B sunt utilizate ca parte a
criteriilor de recomandare a unui consult de
specialitate, scorul total brut pentru scala NC
este utilizat într‑o manieră calitativă pentru a
stabili cât de nemulţumite de corpul lor sunt
persoanele respective. EDI‑3 FT oferă trei grade
de insatisfacţie faţă de propriul corp (Scăzută,
Moderată, Crescută), bazate pe scorul brut total
al scalei NC.
Următorul pas este acela de a obţine pragul
indicelui de masă corporală al individului sau
de a‑i calcula IMC‑ul. Obţinerea pragului IMC
sau calculul IMC‑ului unei persoane necesită
stabilirea greutăţii (în kilograme) şi a înălţimii (în
metri) acesteia. Pentru a afla pragul IMC, folosiţi
Tabelul pragurilor IMC pentru recomandarea
unui consult de specialitate (numit „Tabelul
pragurilor” pe formularul care se completează
de către pacient, din respect pentru sensibilitatea
pacienţilor) de pe ultima pagină a EDI‑3 FT.
Localizaţi înălţimea individului (în metri) în
53
 Fişa de cotare
Model A 29/10/2004
Nume şi prenume ________________________________________________ Data ______________________________

Partea a
1. 3 0 0 1 2 3 4
2. 3 4 3 2 1 0 0
3. 4 4 3 2 1 0 0
4. 3 4 3 2 1 0 0
5. 3 4 3 2 1 0 0
6. 2 4 3 2 1 0 0
7. 4 4 3 2 1 0 0
8. 3 0 0 1 2 3 4
9. 4 4 3 2 1 0 0
10. 3 0 0 1 2 3 4
11. 2 4 3 2 1 0 0
12. 4 4 3 2 1 0 0
13. 4 0 0 1 2 3 4
14. 3 4 3 2 1 0 0
15. 3 4 3 2 1 0 0
16. 3 4 3 2 1 0 0
17. 2 4 3 2 1 0 0
18. 4 4 3 2 1 0 0
19. 3 4 3 2 1 0 0
20. 2 4 3 2 1 0 0
21. 3 0 0 1 2 3 4
22. 4 4 3 2 1 0 0
23. 3 4 3 2 1 0 0
24. 4 0 0 1 2 3 4
25. 4 4 3 2 1 0 0
Scor brut total 22 27 31
Nemulţumire faţă de corp (NC)
DS B NC Interval calitativ
Scăzută Moderată Crescută
Partea B Scor brut total 0‑7 8‑30 31‑40

19 F 162 cm 46 kg
Vârsta ______________ Sexul ___________ Înălţimea ________ Care este greutatea dumneavoastră actuală? _________________
53 kg
Care este greutatea cea mai mare pe care aţi avut‑o vreodată (excluzând perioada de sarcină, dacă e cazul)? _______________________
2003
În ce an s‑a întâmplat acest lucru? ______________
45 kg
Care este greutatea cea mai mică pe care aţi avut‑o vreodată, ca adult (sau ca adolescent, dacă nu aveţi încă 18 ani)? _____________
2001 45 kg
În ce an s‑a întâmplat acest lucru? _____________ Ce greutate aţi prefera să aveţi? __________
O dată
De 1‑2 De 3‑5 sau de
În ultimele 3 luni, cât de des: O dată pe De 2‑3 ori pe ori pe mai
lună sau ori pe săptă‑ săptă‑ multe
Niciodată mai puţin lună mână mână ori pe zi
1. Aţi avut episoade de mâncat compulsiv (aţi mâncat o cantitate mare
0 1 2 3 4 5
de alimente, simţind că nu vă puteţi controla)?
2. V‑aţi provocat voma pentru a vă controla greutatea? 0 1 2 3 4 5

3. Aţi luat laxative pentru a vă controla greutatea sau forma corpului? 0 1 2 3 4 5

4. Aţi făcut activităţi fi zice, timp de 60 de minute sau mai mult, pentru
a slăbi sau pentru a vă controla greutatea? 0 1 2 3 4 5

5. În ultimele 6 luni, aţi slăbit 10 kilograme sau mai mult? Nu Da

Figura 3.5. Model al Fişei de cotare şi al Formularului de trimitere din EDI-3 FT pentru un adult
54
 Formular de trimitere

Pragul IMC 17,5 IMC calculat 17,5

sau
(din tabelul de pe ultima pagină) (din chenarul de calcul al IMC de mai jos)

Secţiunea a. Stabilirea trimiterii la un consult de specialitate pe baza criteriului exclusiv al IMC

1. Utilizând tabelul de mai jos din secţiunea A, găsiţi vârsta persoanei, apoi sexul acesteia. Încercuiţi numărul corespunzător, care indică valoarea
critică a IMC‑ului.
2. Criteriile de trimitere sunt îndeplinite, dacă valoarea pragului IMC sau a IMC‑ului calculat este EGALĂ CU SAU MAI MICĂ DECÂT
valoarea critică a IMC‑ului încercuită în tabel. Criteriile de trimitere nu sunt îndeplinite, dacă valoarea pragului IMC sau a IMC‑ului calculat
este MAI MARE DECÂT valoarea critică a IMC‑ului încercuită în tabel.
valoarea critică a IMC
în funcţie de vârstă şi sex
valoare critică
Criterii de trimitere
vârsta Femei Bărbaţi
Se îndeplinesc criteriile de trimitere
9
10
14,0
14,5
14,0
14,5
P (valoarea pragului IMC sau a IMC‑ului
calculat ≤ valoarea critică a IMC‑ului).
11 14,5 15,0
12 15,0 15,0 NU se îndeplinesc criteriile de trimitere
13 15,5 15,5 (valoarea pragului IMC sau a IMC‑ului
14 16,0 16,0 calculat > valoarea critică a IMC‑ului).
15 16,5 17,0
16 17,0 17,5
17 17,5 18,0
18 18,0 18,5
19 18,0 19,0
20+ 18,5 19,5

Secţiunea B. Stabilirea trimiterii la un consult de specialitate pe baza valorii IMC-ului şi a scorurilor totale brute obţinute la scalele DS
şi B
1. În tabelul de mai jos, în funcţie de vârstă, găsiţi rândul care conţine valoarea pragului IMC sau a IMC‑ului calculat. Pe rândul corespunzător
valorii IMC‑ului, se găsesc valorile critice ale DS şi B. Încercuiţi aceste valori.
2. Criteriile de trimitere sunt îndeplinite, dacă scorul brut al DS sau al B de pe Fişa de cotare este EGAL CU SAU MAI MARE DECÂT valoarea
critică a DS sau, respectiv, a B încercuită în tabel. Criteriile de trimitere nu sunt îndeplinite, dacă scorurile brute totale ale DS şi B sunt MAI
MICI decât valorile critice ale DS şi B.
vârsta ≤ 17 ani vârsta ≥ 18 ani
Criterii de trimitere
valoarea critică valoarea critică
Scorul Scorul Scorul Scorul Se îndeplinesc criteriile de trimitere
valoarea brut total brut total valoarea brut total brut total P (scorul brut total al DS sau al B ≥ valoarea
critică a DS sau, respectiv, a B din tabel).
pragului IMC DS B pragului IMC DS B
≤15,5 9 sau 4 ≤18,0 15 sau 5 NU se îndeplinesc criteriile de trimitere
(scorul brut total al DS şi al B < valoarea
>15,5 şi ≤ 22,0 9 sau 4 >18,0 şi ≤ 22,0 22 sau 8 critică a DS şi, respectiv, a B din tabel).
>22,0 şi ≤ 25,0 18 sau 8 >22,0 şi ≤ 25,0 24 sau 10
>25,0 22 sau 10 >25,0 25 sau 12

Secţiunea C. Stabilirea trimiterii la un consult de specialitate exclusiv pe baza simptomelor comportamentale

1. Folosind răspunsurile pe care persoana le‑a dat la cele cinci întrebări din Partea B a Fişei de cotare, stabiliţi dacă oricare dintre criteriile
comportamentale de trimitere a fost îndeplinit, comparând fi ecare scor cu intervalele critice de trimitere prezentate în tabelul de mai jos al
secţiunii C. De exemplu, criteriul pentru întrebarea numărul 1 este îndeplinit, dacă răspunsul dat de o persoană corespunde unui scor cuprins
între 2 şi 5 şi nu este îndeplinit, în cazul în care răspunsul corespunde unui scor de 0 sau 1.
2. Criteriile de trimitere sunt îndeplinite, dacă persoana îndeplineşte unul sau mai multe dintre cele cinci criterii comportamentale (adică, orice
scor situat în intervalul Da). Un individ nu îndeplineşte criteriile de trimitere, dacă la toate cele cinci criterii comportamentale răspunsul este Nu.
Sunt îndeplinite criteriile de trimitere? Criterii de trimitere
1. Alimentaţie compulsivă Nu (0‑1) Da (2‑5)
Se îndeplinesc criteriile de trimitere
2. Vărsături provocate Nu (0) Da (1‑5) P (sunt îndeplinite oricare dintre criteriile de
trimitere, la întrebările 1‑5).
3. Abuz de laxative Nu (0) Da (1‑5)
NU se îndeplinesc criteriile de trimitere
4. Activitate fi zică pentru a pierde sau a controla greutatea Nu (0‑4) Da (5) (nu este îndeplinit niciunul dintre criteriile de
trimitere, la întrebările 1‑5).
5. Pierdere în greutate în ultimele 6 luni (≥ 10 kg) Nu (0) Da (1)

Chenarul de calcul al IMC-ului

Pentru a stabili IMC‑ul unei persoane, utilizaţi formula pusă la dispoziţie. 46 1,62 1,62 17,5
/ ( x ) =
Introduceţi greutatea (în kilograme) şi înălţimea (în metri) în spaţiile greutatea înălţimea înălţimea IMC
corespunzătoare şi calculaţi IMC‑ul. (în kg) (în metri) (în metri)

Figura 3.5. (continuare)

55
coloana stângă şi apoi urmăriţi rândul spre
dreapta, pentru a localiza greutatea individului
(în kilograme). Apoi, urmăriţi coloana greutăţii
până la marginea de jos, pentru a obţine pragul
IMC. Ori de câte ori valorile precise ale înălţimii
sau ale greutăţii individului nu figurează în tabel,
rotunjiţi la valoarea cea mai apropiată din tabel.
Dacă valoarea înălţimii sau a greutăţii se află la
mijloc sau la o distanţă egală între două unităţi,
rotunjiţi la valoarea cea mai mică.
Calculul IMC‑ului unui individ se poate
realiza şi direct, folosind formula din Chenarul
de calcul al IMC‑ului aflată în partea de jos a
Formularului de trimitere. Pentru majoritatea
examinatorilor, ar putea fi mai comod să
folosească Tabelul pragurilor IMC pentru reco-
mandarea unui consult de specialitate. Tabelul
este destinat utilizării în cazul persoanelor cu
valori ale înălţimii cuprinse între 1,44 şi 1,90 m şi
cu valori ale greutăţii între 29 şi 90 de kilograme.
Dacă înălţimea sau greutatea unui individ nu
sunt incluse în aceste intervale, calculaţi IMC‑ul
folosind formula din Chenarul de calcul al
IMC‑ului.
Înregistraţi valoarea pragului IMC (din
Tabelul pragurilor IMC pentru recomandarea
unui consult de specialitate) sau a IMC‑ului
(din Chenarul de calcul al IMC‑ului) persoanei
în chenarul corespunzător din partea de sus a
Formularului de trimitere (a se vedea Figura 3.5).
Stabilirea trimiterii la un consult de
specialitate pe baza criteriului exclusiv al IMC
Găsiţi valoarea critică a IMC‑ului persoanei
respective, localizată la intersecţia dintre vârsta
şi sexul acesteia (a se vedea Figura 3.5, Secţiunea
A a Formularului de trimitere). De exemplu, o
persoană de sex feminin, în vârstă de 18 ani,
ar avea valoarea critică a IMC‑ului de 18,0. În
această secţiune, sunt îndeplinite criteriile de
recomandare a unui consult de specialitate dacă
valoarea pragului IMC sau a IMC‑ului calculat
este EGALĂ SAU MAI MICĂ decât valoarea
critică a IMC‑ului aflată în tabel. Criteriile de
trimitere nu sunt îndeplinite, dacă valoarea
pragului IMC sau a IMC‑ului calculat este MAI
MARE decât valoarea critică a IMC‑ului aflată
în tabel.
56
Stabilirea trimiterii la un consult de
specialitate pe baza valorii IMC‑ului şi a
scorurilor totale brute obţinute la scalele DS
şi B
IMC‑ul corelează pozitiv atât cu scala DS, cât
şi cu scala B; prin urmare, au fost stabilite valori
critice diferite pentru ambele scale, în funcţie de
vârsta şi IMC‑ul respondentului. Întâi, folosind
tabelul corespunzător vârstei (vezi Figura 3.5,
Secţiunea B a Formularului de trimitere), găsiţi
rândul care conţine pragul IMC‑ului sau IMC‑ul
calculat al persoanei. Apoi, găsiţi valorile critice
pentru scalele DS şi B ale persoanei respective,
localizate în coloanele scalelor DS şi B ale
intervalului de vârstă corespunzător. În această
secţiune, criteriile de trimitere sunt îndeplinite,
dacă scorul total brut la DS sau la B de pe Fişa
de cotare este EGAL SAU MAI MARE decât
valorile critice ale DS şi B aflate în tabel. Criteriile
de trimitere nu sunt îndeplinite, dacă scorurile
totale brute ale DS şi B de pe Fişa de cotare sunt
MAI MICI decât valorile critice ale scalelor DS
şi B aflate în tabel.
Stabilirea trimiterii la un consult de
specialitate exclusiv pe baza simptomelor
comportamentale
Folosind răspunsurile individului la
întrebările din Partea B a Fişei de cotare,
stabiliţi dacă a fost îndeplinit vreun criteriu
comportamental de trimitere, comparând
fiecare scor cu intervalele valorilor critice ale
criteriilor de trimitere (vezi Figura 3.5, Secţiunea
C a Formularului de trimitere). De exemplu, este
îndeplinit criteriul pentru Întrebarea 1, dacă
evaluarea făcută de individ corespunde unui
scor cuprins între 2 şi 5 şi nu este îndeplinit dacă
scorul este 0 sau 1. Dacă se îndeplinesc unul sau
mai multe dintre cele 5 criterii comportamentale
de trimitere (adică orice scor situat în intervalul
Da), atunci individul întruneşte criteriile
comportamentale de trimitere din Secţiunea C.
Un individ nu îndeplineşte criteriile de trimitere
ale Secţiunii C, dacă la toate cele cinci criterii
comportamentale răspunsul este Nu.
 Administrarea instrumentului EDI‑3 LS
Instrucţiunile de completare a EDI‑3 LS se
găsesc pe prima pagină a formularului. Întrebările
marcate cu un asterisc solicită informaţii necesare
pentru a pune un diagnostic de tulburare de
comportament alimentar conform criteriilor
DSM‑IV‑TR. Este bine de ştiut că EDI‑3 LS este
un instrument care ajută la formularea unui
diagnostic şi nu este menit pentru a fi utilizat
ca unic instrument de diagnostic. Se recomandă
respectarea următoarelor instrucţiuni şi condiţii
de testare:
1. Respondenţii ar trebui să fie informaţi că
nu există răspunsuri corecte sau greşite şi
că nu există o limită de timp în completarea
inventarului. Majoritatea adulţilor tineri
sunt capabili să completeze EDI‑3 LS în mai
puţin de 10 minute.
2. Este cel mai bine să se administreze EDI‑3
LS individual. Acesta trebuie completat în
prezenţa sau sub supravegherea directă a
personalului calificat. În cazul administrării
în grup, respondenţii ar trebui sfătuiţi să
nu se consulte între ei în timp ce răspund la
întrebări.
3. EDI‑3 LS nu este destinat interpretărilor
idiosincrasice ale itemilor, aşadar
respondenţilor ar trebui să li se ofere
oportunitatea de a pune întrebări, iar
examinatorul ar trebui să ofere clarificările
necesare referitoare la itemi.
4. Respondenţii ar trebui să fie informaţi că
este important să răspundă la toţi itemii.
57
 4
Interpretare
Prezentare generală a metodelor de
evaluare a tulburărilor de comportament
alimentar
Elementele vizate în evaluare depind de
cadrul teoretic aplicat în înţelegerea şi tratamentul
tulburărilor de comportament alimentar. Un
model conceptual extins al factorilor de risc a
fost utilizat ca principal cadru explicativ pentru
înţelegerea factorilor care contribuie la apariţia
tulburărilor de comportament alimentar şi a fost
util în majoritatea cercetărilor asupra factorilor
care determină apariţia şi menţinerea tulburărilor
de comportament alimentar (Garfinkel şi Garner,
1982; Garner şi Garfinkel, 1980). Pentru unii
dintre factorii predispozanţi sau de risc, există
studii care oferă un suport empiric solid; totuşi,
pentru alţi factori s‑au găsit mai puţine dovezi,
atât în cadrul studiilor retrospective, cât şi în
acela al studiilor transversale (Engstrom şi
Norring, 2002; Fairburn şi Harrison, 2003; Fichter,
Quadflieg şi Rehm, 2003; Garner, 1993a; Ghaderi,
2003; Jacobi, Hayward, de Zwaan, Kraemer
şi Agras, 2004; Steiner şi colab., 2003; Stice şi
colab., 1999). În momentul de faţă, modelele
explicative curente nu reuşesc să specifice cu
precizie care este contribuţia acestor factori sau
cum aceştia interacţionează. Totuşi, metode de
măsurare îmbunătăţite, eşantioane mai mari
şi metode analitice mai puternice (de exemplu,
modelarea structurală şi alte tehnici multivariate,
studiile longitudinale) au început să ofere dovezi
convergente care susţin influenţa anumitor
factori predispozanţi şi rolul lor în răspunsul la
tratament. Tabelul 4.1 centralizează principalii
factori predispozanţi, favorizanţi şi de menţinere
care au primit cel mai mult suport empiric,
precum şi formularele, scalele şi scorurile
compozite EDI‑3 corespunzătoare acestor factori.
Prezentare generală a procesului de
interpretare
Scopul principal al acestei secţiuni este acela
de a oferi un cadru larg de evaluare a domeniilor
de funcţionare care sunt în mod deosebit relevante
pentru tratamentul şi cercetarea în tulburările
de comportament alimentar. Nu există niciun
protocol de evaluare standardizat sau general
valabil pentru tulburările de comportament
alimentar; cu toate acestea, în ultimele două
decenii, tehnologia de evaluare în acest domeniu
a evoluat extrem de mult, datorită îmbunătăţirilor
aduse descrierii acestora, precum şi progreselor
care s‑au făcut în înţelegerea aspectelor legate
de diagnostic, etiologie şi tratament. EDI‑3 poate
juca un rol important în evaluarea unui individ
care suferă de o tulburare de comportament
alimentar, prin faptul că îi oferă clinicianului
informaţii valoroase în legătură cu aspectele
psihologice relevante pentru înţelegerea
pacientului şi pentru planificarea tratamentului.
Într‑un context clinic, interpretarea profilului
EDI‑3 ar trebui să reprezinte o parte dintr‑o
evaluare mai complexă, centrată pe o serie de
variabile relevante pentru funcţionarea la nivel
global a individului. Profilul EDI‑3 trebuie
interpretat împreună cu alte date, cum ar fi,
simptomele actuale sau din trecut ale tulburării
de comportament alimentar, trăsăturile de
personalitate, nivelul premorbid de funcţionare,
sprijinul primit din partea familiei, funcţionarea
la nivel interpersonal, complicaţiile de ordin
fizic, istoricul tratamentului şi motivaţia pentru
schimbare. Clinicianul trebuie să fie precaut
atunci când interpretează sursa şi semnificaţia
anumitor simptome psihologice, emoţionale şi
comportamentale. Unele simptome, care pot
părea primare, ar putea fi, de fapt, efecte secun-
dare ale pierderii în greutate şi ale obiceiurilor
haotice de alimentaţie.
59
 Tabelul 4.1
Principalii factori de risc identificaţi pentru tulburările de comportament alimentar şi formularele,
scalele şi scalele compozite EDI-3 corespunzătoare acestor factori

Factor de risc Influenţă1 Formular, Scală, Scală compozită EDI-3

Socio-cultural
Traiul în societatea occidentală Crescută
Sporturi care încurajează o siluetă zveltă Crescută

Individual/psihologic
Sex feminin Crescută Formular: EDI-3 LS
Orientare sexuală Scăzută
Etnie Medie Formular: EDI-3 LS
Diete de tip restrictiv Crescută Formular: EDI-3 LS,
Scală: Dorinţa de a fi slab,
Scală compozită: Risc de tulburare de comportament
alimentar
Greutate premorbidă crescută Scăzută Formular: EDI-3 LS
Nemulţumire faţă de corp şi preocupări Crescută Scale: Dorinţa de a fi slab, Nemulţumire faţă de corp;
legate de greutate Scală compozită: Risc de tulburare de comportament
alimentar
Exerciţii fizice intense Medie Formular: EDI-3 LS
Stimă de sine scăzută sau ineficacitate Crescută Scale: Stimă de sine scăzută, Alienare personală;
Scală compozită: Ineficacitate
Emoţionalitate negativă Scăzută
Perfecţionism Medie Scale: Perfecţionism, Ascetism;
Scală compozită: Control excesiv
Tulburare obsesiv-compulsivă Medie
Tulburări de anxietate Medie Scale: Perfecţionism, Ascetism;
Scală compozită: Control exagerat
Conştiinţă interoceptivă scăzută Medie Scală: Deficite interoceptive;
Scală compozită: Probleme emoţionale
Stil de comunicare evitant Scăzută Scale: Perfecţionism, Ascetism;
Scală compozită: Control exagerat
Frică de maturizare psihologică Scăzută Scală: Frica de maturitate
Abuz de alcool/droguri Scăzută Scală: Instabilitate emoţională;
Scală compozită: Probleme emoţionale;
Cluster: Risc pentru abuz de substanţe
Probleme de control al impulsului Scăzută Scală: Reglare emoţională deficitară;
Scală compozită: Probleme emoţionale
Suport social slab perceput Scăzută Scale: Nesiguranţă interpersonală, Alienare personală;
Scală compozită: Probleme interpersonale
Factorul genetic Crescută

Factori individuali legaţi de dezvoltare

Probleme de alimentaţie în copilăria Scăzută
timpurie
Complicaţii în timpul sarcinii/la naştere Scăzută
Probleme de anxietate în copilărie Scăzută Scale: Perfecţionism, Ascetism;
Scală compozită: Control exagerat
Obezitate în copilărie Scăzută Formular: EDI-3 LS
Pubertate timpurie Scăzută Formular: EDI-3 LS;
Scală: Frica de maturitate
Vîrsta adolescenţei Crescută

60
 Tabelul 4.1 (continuare)
Principalii factori de risc identificaţi pentru tulburările de comportament alimentar şi formularele,
scalele şi scalele compozite EDI-3 corespunzătoare acestor factori
Factor de risc Influenţă1
Eveniment de viaţă negativ
Abuz fizic sau neglijare Medie
Abuz sexual Medie
Intimidare/agresivitate şi tachinare Medie
Boli somatice Scăzută
Scădere în greutate în adolescenţă Medie
Factori de risc parentali
Obezitate Scăzută
Ţinerea de diete Medie
Mama are o tulburare de comportament Crescută
alimentar
Comentarii critice în legătură cu greutatea Medie
Nivel crescut de exerciţii fizice Scăzută
Expectanţe crescute de performanţă Scăzută
Îngrijorare excesivă/Hipervigilenţă Scăzută
Depresie Scăzută
Contact redus/ Neglijare/Conflict Scăzută
Abuz de substanţe Scăzută
1
Estimare făcută pe baza centralizării datelor din: Fairburn şi Harrison (2003); Jacobi, Hayward, de Zwaan, Kraemer şi Agras
(2004); Ricciardelli şi McCabe (2004); Stice (2002).
Astfel, pentru a face o evaluare iniţială,
psihologul clinician trebuie să deţină competenţe
tehnice vaste în domeniul evaluării psihologice,
precum şi competenţe de evaluare a unor
simptome specifice medicale, comportamentale
şi psihologice, frecvent întâlnite la persoanele cu
tulburări de comportament alimentar.
EDI‑3 nu oferă o identificare exhaustivă a
aspectelor psihologice relevante pentru înţele-
gerea şi tratarea tulburărilor de comportament
alimentar. Caracteristici psihologice precum
obsesionalitatea, introversiunea, ostilitatea,
căutarea noutăţii, evitarea neplăcerilor, paranoia,
narcisismul, dependenţa, suportul social
perceput, depresia, anxietatea şi alte trăsături
au fost observate în mod repetat la pacienţii cu
tulburări de comportament alimentar. Aşadar,
evaluarea ideală se bazează pe informaţii obţinute
cu ajutorul unor metode de evaluare multiple şi
al altor instrumente psihometrice standardizate,
care evaluează aspecte psihologice menite să
completeze EDI‑3.
Informaţiile obţinute direct de la pacient
ar trebui completate cu informaţii provenite
din alte surse, ori de câte ori acest lucru este
posibil. Printre sursele de informaţii adiţionale
Formular, Scală, Scală compozită EDI-3
Scale: Nesiguranţă interpersonală, Alienare personală;
Scală compozită: Probleme interpersonale
Scale: Nesiguranţă interpersonală, Alienare personală;
Scală compozită: Probleme interpersonale
Scală: Probleme interpersonale
Cluster: Perfecţionism prescris social
Cluster: Perfecţionism prescris social
Scală: Probleme interpersonale
Scală: Probleme interpersonale
Scală: Probleme interpersonale
se numără: membrii familiei, foşti terapeuţi,
medicul de familie, precum şi alte persoane
care sunt informate direct în privinţa nivelului
de funcţionare a pacientului. Chiar dacă acest
lucru poate părea redundant în cazul majorităţii
evaluărilor clinice, este deosebit de relevant
pentru pacienţii care se prezintă cu o posibilă
tulburare de comportament alimentar. Datorită
problemelor motivaţionale specifice acestui grup
de pacienţi, informaţiile dezvăluite de ei înşişi în
legătură cu starea actuală de funcţionare sau cu
istoricul tulburării ar putea fi inexacte.
Factori care au o influenţă semnificativă
asupra interpretării
Motivaţia pentru tratament
În cazul persoanelor cu tulburări de
comportament alimentar, motivaţia pentru
tratament reprezintă un aspect complicat al
evaluării. Asumpţia conform căreia cei mai mulţi
pacienţi cu tulburări de comportament alimentar
sunt neîncrezători în relaţia terapeutică şi sunt
lipsiţi de motivaţia pentru schimbare este frecvent
întâlnită, însă este falsă. Majoritatea pacienţilor
61
vin la prima consultaţie fiind conştienţi că se află
într‑o stare fizică şi emoţională fragilă şi îşi dau
seama că tulburarea pe care o au are consecinţe
grave la nivel fizic şi interpersonal. Cu toate
acestea, în multe cazuri, nivelul iniţial al motivaţiei
scade la un moment dat, atunci când pacientul
îşi dă seama de complexitatea tratamentului.
Probabil, cel mai des întâlnit scenariu, în cazul
pacienţilor emaciaţi, este „dorinţa anorecticului”,
care se manifestă printr‑o dorinţă sinceră de a se
recupera, atâta timp cât acest lucru nu înseamnă
să se îngraşe (Garner şi Remis, 1982).
Cu toate acestea, este frecvent întâlnită
situaţia în care pacienţii se prezintă la terapie în
urma insistenţelor celorlalţi, cum ar fi soţul/soţia,
părinţii sau alţi membri ai familiei. Este posibil
ca acest lucru să se întâmple după luni sau
chiar ani de eforturi chinuitoare. Adolescenţii şi
copiii mai mici rareori se prezintă la tratament
din proprie iniţiativă; este posibil ca ei să vină la
evaluare cu sentimente de furie, să fie aparent
complianţi, dar să ascundă resentimente sau să
fie cu adevărat cooperanţi. Datorită faptului că
ei se străduiesc să păstreze secretul în legătură
cu faptul că îşi provoacă vărsături şi cu celelalte
comportamente pe care le fac pentru a slăbi sau
neagă pierderea în greutate, încercările de a
face o evaluare acurată ar putea fi împiedicate.
Deoarece cea mai mare parte a procesului de
evaluare se bazează pe date provenite din
declaraţiile pacientului, este extrem de important
ca psihologul să înţeleagă factorii motivaţionali
şi să obţină colaborarea pacientului ori de câte
ori este posibil. Multe dintre simptomele de
bază, atât în AN, cât şi în BN (de exemplu, diete
şi activitate fizică extreme) au fost descrise ca
fiind „ego‑sintonice”, prin faptul că persoana
care suferă de o tulburare de comportament
alimentar îşi acceptă simptomele şi este puţin
sau deloc motivată să se schimbe. Acest lucru
se întâlneşte foarte frecvent în stadiile iniţiale
ale tulburărilor de comportament alimentar,
deoarece este posibil ca pacientul să simtă o
creştere a stimei de sine şi a senzaţiei că deţine
controlul şi să nu se confrunte cu simptomele
neplăcute care se instalează pe parcursul
cronicizării afecţiunii. De asemenea, în stadiile
iniţiale, este posibil ca persoana să primească
întăriri sociale pentru pierderea în greutate şi
să aibă auto‑controlul necesar pentru a respecta
o dietă. Multe dintre simtomele tulburărilor de
comportament alimentar sunt iniţiate de către
pacient şi orice încercare de a‑i sugera că sunt
problematice va întâmpina rezistenţă din partea
lui. Tulburările de comportament alimentar au
căpătat o conotaţie socială pozitivă pentru acele
62
persoane care se străduiesc din răsputeri să
capete o „identitate de anorectic” şi apoi se agaţă
de ea, datorită asocierii ei cu statutul de vedetă
şi cu caracteristici dezirabile din punct de vedere
social.
Sugestii pentru interpretarea EDI‑3
Respondenţi motivaţi. Persoanele care sunt
cooperante şi care par implicate personal în
procesul de evaluare sunt, de obicei, sincere
atunci când completează testele de auto‑evaluare.
Atunci când pacienţii sunt în mod evident
motivaţi, psihologul poate avea mai multă
încredere că interpretarea rezultatelor este
corectă.
Respondenţi nemotivaţi sau ostili. Dimpotrivă,
dacă respondenţii manifestă făţiş ostilitate faţă
de participarea la evaluare, ei pot fi necooperanţi
în timp ce completează testele de evaluare.
Psihologul trebuie să verifice protocolul, în
căutarea unor răspunsuri date la întâmplare
sau neglijente. Pacienţii slab motivaţi oferă
deseori răspunsuri extreme, care indică lipsa
simptomatologiei.
Exagerarea psihopatologiei. Unii respondenţi
cred că „nu sunt suficient de bolnavi ca să
merite tratamentul” şi vor răspunde într‑un
mod exagerat, indicând prezenţa unei
simptomatologii, în încercarea de a „fi apţi”
pentru tratament. Atunci când există puţine
variaţii în protocolul testului, cu răspunsuri
exagerate indicând prezenţa simptomatologiei
la toate întrebările, să aveţi în vedere o retestare
în alt moment, pentru a obţine o evaluare mai
realistă a constructelor măsurate de EDI‑3.
Neîncredere generală în relaţii. Reticenţa în
a participa la o evaluare şi la o terapie poate
reflecta o lipsă generală de încredere în relaţiile
interpersonale. Nu este neobişnuit ca unii
pacienţi să se fi simţit inferiori, incompetenţi şi
vulnerabili în relaţiile anterioare, chiar dacă au
fost complianţi şi pasivi. Un procent semnificativ
de pacienţi cu tulburări de comportament
alimentar au fost victime ale abuzului sexual
sau fizic, iar aceste evenimente au contribuit la
formarea unui sentiment general de neîncredere.
Creşterea motivaţiei pentru procesul de
evaluare
Explicarea scopului evaluării. Evaluarea poate
fi făcută în scopuri diferite, cum ar fi planificarea
tratamentului, studiile de follow‑up (de
urmărire) cu accent pe evaluarea programului şi
cercetarea efectelor. Explicarea scopurilor precise
ale evaluării nu este importantă doar pentru a
respecta standardele de etică profesională, ci şi
pentru a‑i oferi pacientului oportunitatea de a‑şi
reduce anxietatea, punând întrebări.
Stabilirea relaţiei terapeutice. Stabilirea relaţiei
terapeutice şi câştigarea încrederii pacientului
în timpul procesului de testare sunt necesare
pentru a obţine informaţii acurate în legătură
cu istoricul şi cu simptomele pacientului la
momentul testării. Psihologul ar trebui să îi
transmită pacientului că îşi doreşte cu adevărat
să înţeleagă punctul de vedere al acestuia. De
asemenea, înainte de evaluare, psihologul ar
trebui să ia în calcul desfăşurarea unui interviu
cu pacientul.
Evitarea învinovăţirii. Pacienţii şi părinţii lor
se prezintă de multe ori la evaluare cu sentimente
de vină şi sunt defensivi, crezând că ei sunt
„de vină” pentru tulburarea de comportament
alimentar. Deseori, părinţii declară că ei consideră
că tulburarea de comportament reflectă faptul că
ei nu sunt părinţi buni. Pacienţilor li se spune sau
ei cred că, dacă nu se vindecă de tulburarea de
comportament alimentar, dau dovadă de lipsă de
voinţă. Este important ca aceste păreri greşite să
fie restructurate, deoarece ele pot avea ca rezultat
răspunsuri inexacte, cu scopul evitării criticilor.
Afecţiuni psihologice secundare pierderii
în greutate sau înfometării
Efectele importante ale pierderii în
greutate asupra funcţionării psihologice
sunt ilustrate într‑un studiu binecunoscut al
„semi‑înfometării”, realizat de Keys, Brozek,
Henschel, Mickelsen şi Taylor (1950), cu care toţi
clinicienii care evaluează sau tratează indivizi cu
tulburări de comportament alimentar ar trebui să
fie familiarizaţi. Studiul a constat în expunerea
unui grup de bărbaţi sănătoşi, voluntari, la 6
luni de restricţie calorică neîntreruptă, având
ca rezultat pierderea a aproximativ 23% din
greutatea corporală anterioară (Garner, 1997).
Deşi experimentul a fost descris ca fiind un
studiu de semi‑înfometare, bărbaţii au consumat,
în medie, aproximativ 1550 de calorii pe zi,
depăşind astfel numărul de calorii recomandate
în tratamentele „conservatoare” pentru obezitate
(Stunkard, 1993).
Una dintre cele mai remarcabile modificări
care au avut loc în cazul voluntarilor a fost o
creştere dramatică în ceea ce priveşte preocuparea
pentru mâncare (Keys şi colab., 1950). Bărbaţii au
întâmpinat dificultăţi de concentrare din ce în ce
mai mari în activităţile lor cotidiene, deoarece
începuseră să fie chinuiţi de gânduri permanente
Tabelul 4.2
Efectele semi-înfometării
Modificări de atitudine şi comportament în ceea ce priveşte
mâncarea
Preocupare pentru mâncare
Colectarea de reţete, cărţi de bucate şi meniuri
Obiceiuri alimentare neobişnuite
Consum crescut de cafea, ceai şi condimente
Mestecat de gumă
Alimentaţie compulsivă
Modificări emoţionale şi sociale
Depresie
Anxietate
Iritabilitate şi/sau furie
Labilitate
Episoade psihotice
Modificări de personalitate evidenţiate la testele psihologice
Izolare socială
Modificări cognitive
Capacitate de concentrare scăzută
Raţionament defectuos
Apatie
Modificări fizice
Tulburări de somn
Slăbiciune
Tulburări gastrointestinale
Hipersensibilitate la zgomot şi la lumină
Edeme
Hipotermie
Parestezii
Rată scăzută a metabolismului bazal (MB)
Apetit sexual scăzut
Notă. Studiu original realizat de Keys, Brozek, Henschel, Mickelsen
şi Taylor (1950). Din Handbook of treatment for eating disorders - Manual
de tratament pentru tulburările de comportament alimentar (p. 147-177),
de D.M. Garner, 1997, New York: Guilford Press. Copyright 1997 de
Guilford Press. Adaptat cu permisiunea editorului.
despre mâncare şi alimentaţie. S‑au constatat
modificări semnificative în obiceiurile lor
alimentare, ca răspuns la pierderea în greutate.
Bărbaţii îşi petreceau o mare parte din zi
plănuind cum îşi vor consuma raţia de mâncare;
o vor devora sau o vor mânca foarte încet, pentru
a savura gustul fiecărei îmbucături. În timpul
etapei de regim restrictiv a experimentului, toţi
voluntarii au raportat o senzaţie sporită de foame.
Unii s‑au dovedit capabili să tolereze această
experienţă destul de bine, dar în cazul altora
s‑a ajuns la episoade de alimentaţie compulsivă
similare celor înregistrate la pacienţii cu tulburări
de comportament alimentar. În timpul etapei de
realimentare a experimentului, tendinţa spre
alimentaţie compulsivă a persistat sau chiar s‑a
înrăutăţit. Mulţi dintre bărbaţi au raportat că şi‑au
pierdut controlul asupra apetitului şi „mâncau
aproape încontinuu” (p. 843), unii consumând
între 8.000 şi 10.000 de calorii pe zi.
63
 În sfera tulburărilor de comportament
alimentar, multe teorii accentuează rolul
factorilor emoţionali în etiologia şi menţinerea
alimentaţiei compulsive. Alimentaţia compulsivă
este adeseori considerată ca fiind funcţională
în ceea ce priveşte controlul stării afective,
provocând detaşare în faţa unei emoţii neplăcute
sau, dimpotrivă, permiţând manifestarea unor
conflicte psihologice bazale. În timp ce alimentaţia
compulsivă poate servi multor asemenea funcţii
psihologice, experimentul lui Key şi colab.
(1950) arată că explicaţia cea mai succintă pentru
senzaţia crescută de foame şi pentru episoadele
de alimentaţie compulsivă este că acestea au o
legătură directă cu subnutriţia şi pierderea în
greutate.
Deşi participanţii erau sănătoşi din punct
de vedere psihologic înaintea experimentului,
majoritatea au suferit mult emoţional ca rezultat
al pierderii în greutate. Majoritatea bărbaţilor
au avut perioade de timp în care suferinţa lor
emoţională era destul de gravă; aproape 20%
dintre ei au trăit o deteriorare emoţională extrem
de severă, care a interferat considerabil cu
funcţionarea lor cotidiană. Modificarea la nivel
emoţional cea mai des întâlnită a fost depresia
accentuată; cu toate acestea, la unii voluntari s‑a
observat o dispoziţie afectivă bună, iar la alţii
s‑au înregistrat oscilaţii emoţionale extreme. Aşa
cum se prezintă în Tabelul 4.2, semi‑înfometarea
a produs şi alte modificări emoţionale, incluzând
sentimente de inadaptare şi de izolare socială.
Multe dintre simptomele induse prin
înfometare observate în acest studiu au avut
nevoie de luni pentru a se remite, chiar şi după
ce greutatea corporală a revenit la parametrii
normali (Keys şi colab., 1950). Există o serie
de modalităţi prin care aceste simptome pot
menţine AN. Evacuarea gastrică întârziată poate
face ca pacientul cu AN, care este deja sensibil
la cele mai mici creşteri în greutate, să sufere o
balonare postprandială (Lee, 1993). Tendinţa de
a avea episoade de alimentaţie compulsivă, cu
precădere în timpul procesului de restabilire
a greutăţii, generează sentimentul de vină
care poate duce la manifestări compensatorii,
precum provocarea vărsăturilor. Manifestările
obsesionale induse prin înfometare, depresia,
sensibilitatea emoţională şi izolarea socială pot
agrava o tulburare emoţională preexistentă.
Profilurile rezultate în urma administrării
Inventarului multifazic de personalitate Minnesota
(MMPI; Hathaway şi McKinley, 1940) pe un
lot redus de participanţi au indicat prezenţa
unei deteriorări profunde ca rezultat posibil al
pierderii în greutate. Un bărbat, al cărui scor s‑a
64
încadrat în limitele normale la testarea iniţială, a
fost reevaluat după zece săptămâni de pierdere în
greutate (4,5 kg sau aproximativ 7% din greutatea
corporală iniţială) şi a prezentat tulburări majore
de personalitate evidenţiate pe baza MMPI.
Aşa cum apare în Tabelul 4.2, bărbaţii din
studiul menţionat anterior au raportat numeroase
transformări psihice, incluzând disconfort
gastrointestinal, edeme, nevoie redusă de somn
şi toleranţă scăzută la temperaturi joase. Interesul
sexual a fost, de asemenea, drastic diminuat, iar
Keys şi colab. (1950) au observat că „mulţi bărbaţi
au considerat binevenită eliberarea de tensiunile
şi frustrările sexuale prezente, în mod normal, la
bărbaţii tineri” (p. 840). Faptul că înfometarea a
afectat impulsurile sexuale şi conflictele asociate
lor necesită o atenţie specială, deoarece s‑a
presupus că acest proces este forţa motrice din
spatele regimurilor alimentare ale multor pacienţi
cu AN. Conform afirmaţiilor lui Crisp (1980), AN
este o tulburare adaptativă, în sensul că reduce
preocupările sexuale faţă de care adolescenţii se
simt nepregătiţi. În timpul etapei de reabilitare
a greutăţii corporale, interesul sexual a revenit
lent.
Studiul realizat de Keys şi colab. (1950) este
relevant pentru evaluarea funcţionării psihice şi
fizice a indivizilor cu tulburări de comportament
alimentar. Multe dintre semnele presupuse a
fi, în primul rând, tulburări emoţionale, pot fi
interpretate ca secundare pierderii în greutate.
Mai mult decât atât, multe dintre schimbările
observate în cazul acestor bărbaţi au persistat
mai multe luni; prin urmare, clinicianul care
efectuează evaluarea trebuie să fie conştient de
efectele de lungă durată ale pierderii în greutate
asupra multora dintre aspectele psihologice
evaluate de EDI‑3 şi de alte instrumente de
evaluare psihologică.
Afecţiuni psihologice, ca efect secundar al
unor pattern‑uri haotice de alimentaţie
Trăsăturile psihologice evaluate de EDI‑3
pot contribui la apariţia sau la menţinerea unei
tulburări de comportament alimentar; cu toate
acestea, este posibil ca prezenţa sau magnitudinea
lor să fie doar produse secundare ale tulburării.
Generalizările privind caracterul predominant al
trăsăturilor de personalitate şi al altor trăsături
psihopatologice sunt limitate de faptul că cele
mai multe evaluări sunt efectuate atunci când
pacienţii prezintă simptome ale tulburării de
comportament alimentar. Trăsăturile observate
pot însemna modificări secundare care rezultă
din pattern‑uri haotice de alimentaţie. Studiile Tabelul 4.3
efectuate cu ajutorul EDI şi al altor instrumente Stabilitatea subscalelor EDI
de evaluare au arătat că pacienţii cu BN care
răspund la tratament prin ameliorarea rapidă a r
alimentaţiei compulsive şi a vărsăturilor prezintă Subscale EDI Femei adulte Studente
o reducere corespunzătoare a simptomelor de (N=166)a (N=509)b
depresie şi a altor semne de tulburare emoţională Dorinţa de a fi slab 0,70 0,50
(Fairburn, Cooper, Kirk şi O’Connor, 1985; Bulimie 0,75 0,56
Garner şi colab., 1990; Wilson, Rossiter, Kleifield Nemulţumire faţă de corp 0,67 -
şi Lindholm, 1986). Garner şi colaboratorii au Ineficacitate 0,65 -
constatat că pacienţii cu BN, ale căror episoade Perfecţionism 0,73 0,56
de alimentaţie compulsivă şi de vărsături au fost Neîncredere 0,67 0,52
ţinute sub control în timpul tratamentului, au interpersonală
prezentat îmbunătăţiri semnificative în ceea ce Conştiinţă interoceptivă 0,50 -
priveşte trăsăturile de personalitate borderline, Frica de maturitate 0,54 0,34
adaptarea socială, depresia, stima de sine şi alte
aspecte ale funcţionării. Astfel, prezenţa unei
a
studiu cu o durată de 6 ani, incluzând femei adulte din
populaţia generală (Rizvi, Stice şi Agras, 1999); bstudiu cu
tulburări de comportament alimentar poate o durată de 10 ani, incluzând studente (Joiner, Heatherton
avea o influenţă considerabilă asupra evaluării şi Keel, 1997).
distresului psihologic şi a altor trăsături, fapt
care ar putea duce la concluzii eronate privind
prezenţa unei tulburări de personalitate.
Recunoaşterea faptului că pattern‑urile haotice a cinci dintre scalele versiunii originale EDI şi
de alimentaţie afectează funcţionarea psihică au descoperit corelaţii relativ crescute test‑retest
nu anulează observaţiile clinice făcute în timpul pentru toate scalele, mai puţin pentru subscala
manifestării acute a tulburării de comportament Frica de maturitate (a se vedea tabelul 4.3). În
alimentar; totuşi, acest lucru ar trebui să constituie cadrul aceluiaşi eşantion, Heathertorn şi colab. au
un punct de plecare în interpretarea cu precauţie descoperit o diminuare semnificativă, pe aceeaşi
a rezultatelor. Dacă simptomele au fost prezente perioadă de 10 ani, a scorurilor la subscalele
înainte de debutul tulburării de comportament Dorinţa de a fi slab, Bulimie şi Frica de maturitate şi
alimentar, atunci se poate avea o încredere mai nicio modificare semnificativă în cazul subscalei
mare în faptul că ele reflectă tulburarea iniţială. de Neîncredere interpersonală.

Stabilitatea constructelor EDI în timp Variabilitatea în timp a simptomatologiei

Deşi trăsăturile măsurate cu ajutorul EDI
sunt influenţate de pierderea în greutate şi de
pattern‑uri haotice de alimentaţie, există şi dovezi
conform cărora aceste trăsături sunt deosebit de
stabile în timp. Cea mai impresionantă dovadă
de stabilitate în timp a trăsăturilor măsurate
de EDI este adusă de un studiu longitudinal
de 6 ani, pe un eşantion de femei adulte din
populaţia generală (N=166; Rizvi, Stice şi Agras,
1999). După cum se poate observa şi în Tabelul
4.3, coeficienţii de corelaţie cei mai mari sunt
cei pentru subscalele Bulimie şi Perfecţionism,
dar şi celelalte subscale EDI au avut corelaţii
bune între testarea iniţială şi retestarea la 6 ani.
Două studii efectuate pe acelaşi eşantion de
studenţi, pe o perioadă de 10 ani, par să fi avut
rezultate contradictorii (Heatherton, Mahamedi,
Striepe, Field şi Keel, 1997; Joiner, Heatherton şi
Keel, 1997). Joiner şi colab. au examinat, pe un
eşantion de 509 studente, stabilitatea după 10 ani
tulburărilor de comportament alimentar
Cercetările care s‑au ocupat de evoluţia
naturală a tulburărilor de comportament alimen-
tar au scos la iveală o variabilitate semnificativă
a simptomelor psihologice, comportamentale
şi medicale, în momente diferite (Fairburn,
Cooper, Doll, Norman şi O’Connor, 2000; Fichter
şi Quadflieg, 1997, 1999; Herzog şi colab., 1999;
Keel şi colab., 1999; Keller, Herzog, Lavori,
Bradburn şi Mahoney, 1992; Pike, 1998; Strober
şi colab., 1997). Durata, intensitatea şi severitatea
simptomelor pot varia considerabil în rândul
pacienţilor care primesc acelaşi diagnostic. În
plus, anumite simptome (cum ar fi alimentaţia
compulsivă, vărsăturile) se ameliorează relativ
repede ca răspuns la tratament, în timp ce altele
(de exemplu, nemulţumirea faţă de corp) tind să
se soluţioneze în mai mult timp (Garner şi colab.,
1990; Jones, Peveler, Hope şi Fairburn, 1993).

65
 Prezentare generală a metodelor de
evaluare
Pentru evaluarea tulburărilor de compor-
tament alimentar au fost elaborate diferite metode
de colectare de informaţii, printre care interviuri
clinice structurate, interviuri semistructurate,
metode de observaţie comportamentală, me-
ode standardizate de autoevaluare, liste de
simptome, scale clinice de evaluare, proceduri de
automonitorizare şi diete standardizate.
Interviu clinic
Procesul de evaluare începe, de obicei, cu un
interviu clinic detaliat, prin intermediul căruia
se examinează cu atenţie informaţii relevante
pentru anumite domenii. Este important ca,
prin formatul şi stilul interviurilor iniţiale, să se
urmărească crearea unei atmosfere de deschidere
şi încredere între pacient şi evaluator. Acest lucru
este de o importanţă crucială în cazul pacienţilor
cu tulburări de comportament alimentar, care ar
putea crede că scopul evaluării şi al tratamentului
este, în principal, acela de a‑i convinge să
renunţe la simptomele lor, pe care ei le percep ca
fiind funcţionale, necesare sau chiar dezirabile.
Informaţiile clinice şi cele personale pot fi
completate cu ajutorul unor liste nestandardizate
de simptome, cum sunt Formularul de interviu în
bulimie (Bulimia Interview Form, Walsh şi Gladis,
1985); Chestionarul de tulburări de comportament
alimentar (Eating Disorder Questionnaire, Mitchell,
Hatsukami, Eckert şi Pyle, 1985) şi Examinare
în scop diagnostic a tulburărilor de comportament
alimentar (Diagnostic Survey for Eating Disorders,
Johnson, 1985). Aceste instrumente sunt menite
să fie folosite împreună cu datele obţinute
prin interviu şi conţin itemi care se referă
la date demografice, legate de familia şi de
istoricul greutăţii corporale ale pacientului,
alături de întrebări referitoare la atitudinile şi
comportamentele faţă de alimente.
Interviu semistructurat
Construcţia de interviuri standardizate
semistructurate, destinate să evalueze convin-
gerile referitoare la alimente, greutate şi forma
corpului, reprezintă un progres major în
acest domeniu. Interviul semistructurat oferă
psihologului avantajul de a avea mai multă
precizie atunci când trebuie să facă distincţia
între preocupările pentru greutatea şi forma
corpului care au semnificaţie clinică şi cele care
nu sunt relevante pentru punerea unui diagnostic
66
de tulburare de comportament alimentar. În
ultimii ani a fost elaborată o serie de interviuri
structurate, printre care Instrumentul de evaluare
clinică a tulburărilor de comportament alimentar
(Clinical Eating Disorder Rating Instrument - CEDRI;
Palmer, Christie, Cordle, Davies şi Kenrick,
1987); Evaluarea tulburărilor de comportament
alimentar (Eating Disorder Examination - EDE;
Fairburn şi Cooper, 1993); Interviul pentru
diagnosticul tulburărilor de comportament alimentar
(Interview for Diagnosis of Eating Disorders - IDED;
Williamson, 1990) şi Interviul structurat pentru
anorexie nervoasă şi bulimie nervoasă (Structured
Interview for Anorexia and Bulimia Nervosa - SIAB;
Fichter şi colab., 1991).
EDE este cel mai bine validat interviu şi
a generat un număr mare de cercetări. Acesta
este un interviu semistructurat realizat de
către un investigator şi este destinat evaluării
psihopatologiei specifice tulburărilor de
comportament alimentar. Răspunsurile sunt
organizate în patru subscale (acestea fiind
Restricţie, Preocupare pentru mâncare, Preocupare
pentru forma corpului, Preocupare pentru greutate).
EDE este avantajos, deoarece permite o evaluare
extrem de amănunţită a psihopatologiei specifice
tulburărilor de comportament alimentar, cu
examinări realizate de către investigator pentru a
clarifica semnificaţia din spatele răspunsurilor la
întrebări. Printre dezavantajele acestui interviu
se numără faptul că administrarea interviului
durează cel puţin o oră, necesită prezenţa unui
intervievator pregătit şi nu este potrivit atunci
când este nevoie de păstrarea anonimatului sau
în cazul administrării în grup. De asemenea,
interviul evaluează doar un număr restrâns de
variabile referitoare la alimentaţie, fără a măsura
constructe psihologice demonstrate ca fiind
importante în apariţia şi menţinerea tulburărilor
de comportament alimentar. CEDRI este o scală
de evaluare clinică formată din 31 de itemi care
vizează măsurarea a trei tipuri de simptome
(adică, patternuri comportamentale, atitudini
şi alte simptome [de exemplu, depresie, stimă
de sine scăzută]), care apar în mod frecvent în
tulburările de comportament alimentar. CEDRI
are o fidelitate inter‑evaluatori satisfăcătoare.
O limită metodologică a interviurilor
structurate este aceea că se referă doar la
constructe cognitive care sunt definite cu stricteţe
de către investigator. De asemenea, ele se bazează
pe declaraţii retrospective, care ar putea să nu
corespundă cu o reprezentare dinamică în timp
a patternurilor de gândire şi a stilului cognitiv
ale pacientului. Pentru a surprinde temele
cognitive relevante şi valenţa preocupărilor
legate de alimente, greutatea şi forma corpului,
au fost propuse metode mai puţin structurate
(Cooper, 1997). Cooper şi Fairburn (1992) au
utilizat o scurtă listă de gânduri şi verbalizarea
concomitentă, într‑un studiu în care au fost
comparate grupuri de control cu grupuri de
pacienţi cu AN şi BN în ceea ce priveşte trei
sarcini comportamentale. Rezultatele la proba de
verbalizare concomitentă au arătat că pacienţii
cu tulburări de comportament alimentar
adoptă în timpul sarcinilor mai multe afirmaţii
negative la adresa propriei persoane, în legătură
cu alimentele, greutatea şi forma corpului, în
comparaţie cu persoanele din grupurile de
control. Mai mult decât atât, s‑a concluzionat
că pacienţii cu AN s‑au dovedit mai preocupaţi
de alimentaţie, iar aceste preocupări par să fie
diferite din punct de vedere calitativ faţă de cele
care apar în celelalte grupuri.
Rezultatele obţinute cu ajutorul metodei
listelor de gânduri şi a verbalizării concomitente
sunt încurajatoare. Totuşi, aceste metode au
anumite limite, printre care faptul că oferă date
care nu sunt la fel de uşor de analizat precum
datele provenite din metodele de auto‑evaluare,
aplicarea lor necesită mult timp, iar unii
participanţi le pot considera prea intruzive.
Cooper, Todd şi Wells (1998) au utilizat un
interviu semistructurat pentru a investiga
convingerile negative despre sine la pacienţii cu
AN, în comparaţie cu pacienţii cu BN şi cu femei
care nu suferă de tulburări de comportament
alimentar. Persoanele din grupurile de pacienţi au
putut identifica anumite surse ale convingerilor
lor negative despre sine, în legătură cu greutatea
şi forma corpului, printre care tachinări sau
critici din partea membrilor familiei, a colegilor
şi a profesorilor sau acordarea unei importanţe
prea mari alimentelor şi alimentaţiei, acasă sau
la şcoală. Toţi pacienţii credeau că restricţia
alimentară le‑a ameliorat convingerile negative
despre propria persoană. În concluzie, dovezi
obţinute cu ajutorul a diferite metode susţin
teoria cognitivă principală a AN, care afirmă că
pacienţii folosesc un limbaj negativ la adresa
propriei persoane, au gânduri automate şi
scheme cognitive care reflectă o preocupare
exagerată pentru hrană şi alimentaţie, greutate şi
forma corpului.
Instrumente de autoevaluare
Instrumentele de autoevaluare reprezintă
mijloace eficiente de a obţine informaţii în scopuri
clinice şi de cercetare. Chiar dacă instrumentele de
autoevaluare nu ar trebui folosite ca sursă unică
de informaţii pentru diagnostic şi tratament,
acestea oferă avantajul unei administrări şi cotări
economice. De asemenea, acest tip de instrumente
minimizează influenţa intervievatorului şi alte
potenţiale dezavantaje care derivă din evaluarea
în cadrul unei interacţiuni între intervievator şi
participant.
Pe lângă EDI‑3 au mai fost introduse diferite
instrumente de evaluare a simptomatologiei
tulburărilor de comportament alimentar. Testul
atitudinilor faţă de alimentaţie (Eating AttitudesTest
- EAT; Garner şi Garfinkel, 1979) este probabil
cel mai utilizat, iar versiunea sa de 26 de itemi
(EAT‑26; Garner, Olmsted, Bohr şi Garfinkel, 1982)
oferă scoruri factoriale pentru „comportament
alimentar restrictiv”, „bulimie şi preocupare
pentru mâncare” şi „control asupra senzaţiilor
orale”. O soluţie factorială mai relevantă din
punct de vedere clinic, EAT‑26 a rezultat în urma
unui studiu pe un eşantion de 3.032 de femei care
au participat la Programul naţional de screening al
tulburărilor de comportament alimentar din 1998
(The 1998 National Eating Disorder Screening
Program, Garner şi colab., 2004). O soluţie de
trei factori a contribuit la 50,4% din varianţa
scorurilor la EAT‑26 şi o soluţie factorială
identică a fost replicată pe eşantionul de validare
suplimentară. Noii factori ai EAT‑26 care au
rezultat, adică (a) Preocupare faţă de alimente şi
greutate, (b) Control excesiv al alimentaţiei şi (c)
Provocarea vărsăturilor/Alimentaţie compulsivă,
au proprietăţi psihometrice mai bune decât cei
din EAT‑26 iniţial.
Şi alte instrumente de autoevaluare au
demonstrat o preocupare exagerată faţă de
alimente, greutatea şi forma corpului, la pacienţii
cu tulburări de comportament alimentar. De
exemplu, Cooper şi Turner (2000) au investigat
asumpţii şi convingeri în grupuri de paciente
cu AN, de femei care ţin dietă şi grupuri de
control, utilizând Chestionarul convingerilor
despre tulburările de comportament alimentar
(Eating Disorder Belief Questionnaire, Cooper,
Cohen‑Tovee, Todd, Wells şi Tovee, 1997).
Rezultatele au arătat că femeile cu AN diferă
de femeile care ţin dietă şi de cele din grupul
de control în privinţa conţinuturilor cognitive.
Ele au obţinut scoruri mai mari la scalele care
măsoară prezenţa asumpţiilor greşite în legătură
cu greutatea, forma corpului şi alimentaţia,
precum şi a convingerilor negative la adresa
propriei persoane, comparativ cu celelalte
grupuri. Utilizând Scala Mizes a cogniţiilor specifice
anorexiei (Mizes Anorectic Cognition Scale), Mizes
1992) a constatat diferenţe între pacienţii cu AN
şi BN şi pacienţii din grupul de control, alcătuit
67
din pacienţi cu alte tulburări mintale, exceptând
tulburări de comportament alimentar. Pe baza
analizei factoriale efectuată în cazul acestui
instrument, s‑au obţinut trei constructe cognitive
relevante: (a) percepţia greutăţii şi a alimentaţiei
ca sursă de aprobare din partea celorlalţi;
(b)  convingerea conform căreia controlul strict
al greutăţii şi al alimentaţiei este fundamental
pentru valoarea persoanei şi (c) rigiditate în
eforturile de reglare a greutăţii şi a alimentaţiei.
Cu toate acestea, Cooper (1997) a specificat
că există puţine dovezi care să sugereze că
gândurile măsurate prin intermediul metodelor
de autoevaluare sunt suficiente pentru a explica
psihopatologia specifică anorexiei. Instrumentele
de autoevaluare nu sunt întotdeauna instru-
mente sigure pentru pacienţii cu AN, care pot
fi înclinaţi înspre negare şi distorsiune (Cooper,
1997; Vitousek şi Hollon, 1990).
Observaţie comportamentală şi
automonitorizare
Observarea directă a comportamentelor‑ţintă
în tulburările de comportament alimentar oferă
avantajul de a minimiza posibilele declaraţii
distorsionate ale pacientului. Ordman şi
Kirschenbaum (1985) şi Rosen, McKeag, Hough
şi Curley (1986) au recomandat utilizarea
unor diete standardizate pentru evaluarea
comportamentelor alimentare specifice BN şi
susţin că, în acest fel, se pot obţine informaţii
valide în legătură cu severitatea simptomelor
şi cu răspunsul la tratament. S‑au constatat
diferenţe în ceea ce priveşte domeniile abordate
prin automonitorizare în programe diferite
de tratament, în sensul că unele programe se
centrează pe monitorizarea tuturor alimentelor
şi a băuturilor consumate zilnic, iar altele
se concentrează pe înregistrarea stimulilor
situaţionali şi emoţionali care declanşează
episoadele de alimentaţie compulsivă.
Evaluarea generală a psihopatologiei
O evaluare psihiatrică completă a pacienţilor
cu tulburări de comportament alimentar ar
trebui să includă instrumente de evaluare a
trăsăturilor de personalitate, a temperamentului,
a distresului psihologic, a stimei de sine, a
depresiei, a anxietăţii, a funcţionării familiei, a
istoricului de abuz sexual, a adaptării sociale şi
vocaţionale şi a controlului impulsului, care ar
putea fi relevante pentru apariţia şi menţinerea
acestor tulburări. Evaluarea atentă a acestor
dimensiuni menţionate mai sus este importantă
68
în confirmarea unui eventual diagnostic pe Axa II
şi pentru planificarea tratamentului. Aşa cum s‑a
specificat mai devreme, se recomandă reevaluarea
pe parcursul desfăşurării tratamentului, deoarece
aceasta ar putea oferi o imagine mai semnificativă
asupra dimensiunilor personalităţii care persistă
şi după remiterea simptomelor din faza acută a
tulburării de comportament alimentar.
Structura interviului de evaluare
Deşi tipul informaţiilor adunate în timpul
evaluării este acelaşi indiferent de vârsta
pacientului, există diferenţe importante în
modalitatea prin care sunt evaluaţi pacienţii de
vârste diferite. Unii clinicieni solicită participarea
tuturor membrilor familiei, atunci când evaluează
un pacient mai tânăr (Lock, le Grange, Agras şi
Dare, 2001); cu toate acestea, a solicita unei familii
întregi să vină la o întâlnire ar putea fi incomod
sau inutil din punct de vedere clinic. Pentru
evaluarea iniţială ar putea fi suficientă o întâlnire
cu pacientul şi cu părinţii săi, iar includerea altor
membri ai familiei în şedinţele următoare poate
fi făcută pentru atingerea unor scopuri specifice
de evaluare sau de tratament.
Atunci când tulburarea de comportament
alimentar apare la o persoană mai în vârstă, este
de preferat ca toate sau cea mai mare parte a
şedinţelor de evaluare iniţială să fie individuale.
Există posibilitatea ca persoana care este evaluată
pentru o tulburare de comportament alimentar
să nu dorească să vorbească despre simptomele
legate de alimentaţie, de faţă cu părinţii sau
partenerul/partenera de viaţă. Decizia de a
desfăşura evaluarea şi tratamentul doar cu
pacientul sau de a‑i implica şi pe partener(ă), pe
membrii actualei familii sau pe membrii familiei
de provenienţă, depinde de aspectele clinice
specifice fiecărui caz în parte (Vandereycken,
Kog şi Vanderlinden, 1989).
Greutatea corporală şi istoricul greutăţii
corporale
Pacienţii care sunt emaciaţi sau care au
slăbit foarte mult ar trebui să fie cântăriţi de
către clinicianul care îi evaluează sau de către
alt specialist, în perioada imediat următoare
evaluării. E posibil ca pacienţii să nu vrea să se
lase cântăriţi; totuşi, odată ce aţi stabilit o relaţie
terapeutică, este de dorit să obţineţi greutatea pe
care o au în acel moment, îmbrăcaţi în haine de
stradă. Acest lucru se face într‑o manieră delicată,
dar directă. Atunci când o persoană evaluată
pentru o tulburare de comportament alimentar
refuză să se lase cântărită, i se poate spune că
ar fi o dovadă de iresponsabilitate ca această
variabilă să nu fie măsurată, deoarece joacă un
rol foarte important în evaluare şi în stabilirea
diagnosticului. Persoanelor care nu doresc să‑şi
cunoască greutatea li se spune că avem nevoie
de ea doar pentru fişele de evaluare şi li se oferă
posibilitatea de a sta cu spatele pe cântar. Unii
clinicieni preferă să lase verificarea greutăţii
pe seama medicului de familie, a asistentei sau
a altui personal medical; cu toate acestea, a nu
cântări o persoană care se prezintă la evaluare
poate constitui motiv de tragere la răspundere
în cazul unor complicaţii ulterioare legate de
greutate. În plus, în cazul în care nu cântăreşte
pacientul, clinicianul care face evaluarea pierde
informaţii valoroase legate de reacţia pacientului
la cântărire.
Un istoric complet al greutăţii corporale
ar trebui să includă o evaluare detaliată a
modificărilor de greutate şi a evenimentelor
asociate cu acestea, la debutul şi pe parcursul
modificărilor de greutate. Acesta este şi un subiect
oarecum neameninţător la începutul evaluării
şi poate facilita relaţia cu pacientul. În plus,
solicitarea de detalii în legătură cu modificările
de greutate şi cu evenimentele asociate îi oferă
intervievatorului o imagine iniţială asupra
felului în care pacientul înţelege factorii care ar
putea fi responsabili pentru instalarea tulburării
de comportament alimentar. În majoritatea
cazurilor, este de preferat ca istoricul greutăţii
să fie obţinut prin intermediul unui interviu
individual, deoarece, pentru pacient, detaliile
legate de greutate ar putea avea o semnificaţie
personală deosebită. În cazul unor pacienţi mai
tineri, se recomandă obţinerea acestor informaţii
printr‑un interviu la care să fie prezenţi şi părinţii.
În acest context, este important să ţineţi cont de
faptul că greutatea corporală este probabil să fi
devenit un subiect cu încărcătură emoţională în
cadrul familiei. Informaţiile relevante în legătură
cu modificările în greutate sunt obţinute prin
întrebări directe, începând cu perioada în care
pacientul a ajuns pentru prima dată la înălţimea
şi greutatea actuale. Este necesară investigarea
următoarelor aspecte cheie: (a) greutatea actuală;
(b) greutatea cea mai mică şi cea mai ridicată
dinaintea instalării tulburării; (c) detaliile
fluctuaţiilor în greutate pe timpul perioadei
dintre debutul tulburării şi momentul prezent;
(d) greutatea preferată sau dorită de pacient
şi (e)  greutatea pe care pacientul crede că ar
atinge‑o dacă nu şi‑ar controla în mod conştient
greutatea.
EDI‑3 LS şi EDI‑3 FT conţin întrebări specifice
legate de greutate şi înălţime. Aceste date pot fi
folosite pentru a calcula IMC‑ul, care se calculează
prin împărţirea greutăţii (în kilograme) la înălţime
(în metri), împărţind apoi din nou la înălţime (în
metri) sau kg/m2. Indicele de masă corporală mai
poate fi calculat prin împărţirea greutăţii (în livre)
la înălţime (în inci), apoi împărţind din nou la
înălţime (în inci) şi înmulţind cu 703. Valorile de
referinţă ale IMC‑ului, pe baza cărora persoanele
pot fi încadrate în categoriile de „subponderal”,
„greutate normală” sau „obezitate”, au fost
stabilite de Organizaţia Mondială a Sănătăţii
(OMS, 1997) şi de National Heart, Lung and
Blood Institute (NHLBI, 1998). Pe baza datelor
colectate în cadrul National Health and
Nutrition Examination Survey III (NHANES III;
Kuczmarski, Carroll, Flegal şi Troiano, 1997) au
fost stabilite etaloane pentru diferite categorii de
vârstă, la bărbaţi şi la femei.
Evaluarea greutăţii corporale este importantă
şi pentru că se creează contextul pentru înţelegerea
distresului subiectiv legat de greutatea şi forma
corpului. Scala NC corelează pozitiv cu greutatea
corporală şi cu indicele de masă corporală; totuşi,
acelaşi nivel de nemulţumire faţă de corp are
semnificaţii clinice diferite pentru indivizi cu
greutăţi diferite (Garner, Garner şi Van Egeren,
1992). De exemplu, pacientele cu AN şi studentele
sănătoase au scoruri medii brute similare la
subscala EDI de Nemulţumire faţă de corp; cu toate
acestea, pacientele cu tulburări de comportament
alimentar au, în medie, o greutate cu 30% mai
redusă decât studentele sănătoase (Garner, 1991).
Chiar dacă persoanele din ambele grupuri sunt
relativ mulţumite, pacientele cu tulburări de
comportament alimentar sunt mulţumite atunci
când au o greutate corporală aberantă.
Preocuparea exagerată faţă de greutatea şi
de forma corpului
Imediat după evaluarea istoricului greu-
tăţii corporale, urmează evaluarea naturii şi
a intensităţii preocupării exagerate pe care
pacientul o arată faţă de greutatea şi forma
corpului. Magnitudinea preocupării exagerate
faţă de greutatea şi forma corpului, precum şi
lucrurile pe care individul este dispus să le facă
pentru a‑şi controla greutatea sunt elementele
care deosebesc persoanele care sunt doar
nemulţumite de greutatea şi forma corpului de
cele care îndeplinesc criteriile pentru o tulburare
de comportament alimentar. Cu toate acestea,
este extrem de important ca evaluarea să aibă în
vedere presiunile de a fi slabe şi de a respinge o
69
greutate corporală crescută cu care se confruntă
femeile din cultura noastră. A‑i sugera pacientei
că suferă din cauza unei preocupări excesive faţă
de greutatea şi forma corpului ar putea, uneori,
să fie lipsit de tact, având în vedere presiunea
zilnică enormă cu care se confruntă femeile.
Industria modei, cea cinematografică, revistele
şi televiziunea bombardează în mod constant
publicul cu imagini ale unor femei a căror siluetă
perfectă este idealizată. Recunoaşterea influenţei
imense pe care o au aceste presiuni culturale
şi a impactului lor asupra majorităţii femeilor
ar putea fi utilă pentru a contracara atitudinea
defensivă a unor pacienţi. Pacienţii şi membrii
familiei lor au, adesea, o interpretare simplistă
asupra tulburării de comportament alimentar –
ocazional întărită şi de alte persoane – ca fiind un
semn al culpabilităţii persoanei. În acelaşi timp, un
atac prea înverşunat împotriva asumpţiei greşite
că a fi slab reprezintă un criteriu valid pentru
evaluarea propriei valori poate fi interpretat de
către pacient ca un atac direct asupra sistemului
său de valori, iar acest fapt poate sabota eforturile
viitoare de evaluare şi tratament.
Comportamentul alimentar restrictiv,
provocarea vărsăturilor şi alte
comportamente extreme de control al
greutăţii
Intensitatea eforturilor de a slăbi şi tipurile
de comportamente folosite în acest scop trebuie
evaluate în cadrul interviului iniţial. În stabilirea
istoricului curelor de slăbire ar trebui identificate
cu precizie momentul de început al dietelor şi
diferitele metode care au fost folosite pentru a
reduce sau a controla greutatea corporală. Mulţi
dintre pacienţi au urmat un număr mare de
cure de slăbire comerciale, iar unii dintre ei au
dezvoltat o tulburare de comportament alimentar
ca urmare a participării la un program de slăbire
comercial sau într‑un mediu spitalicesc. Unii
pacienţi declară că eforturile lor intense de a slăbi
au început în urma pierderii în greutate datorate
unei boli. Referitor la provocarea vărsăturilor,
ar trebui puse anumite întrebări, printre care:
(a) A folosit vreodată provocarea vărsăturilor ca
măsură de control al greutăţii? Dacă da, când a
început? De ce s‑a întrerupt? Cum îşi provoacă
vărsăturile? (b) Care a fost frecvenţa lunară,
săptămânală sau zilnică, atunci când situaţia
a fost cea mai gravă? Când s‑a întâmplat acest
lucru? Care era greutatea corporală a pacientului
în perioada respectivă şi dacă era vorba de
creştere sau de scădere în greutate? Care erau
circumstanţele din punct de vedere psihologic
70
în acea perioadă? (c) Cum a fost evoluţia în
timp, fluctuantă sau constantă? În cazul în care
greutatea a fluctuat, cum au fost momentele cele
mai intense şi cele mai scăzute, din punctul de
vedere al frecvenţei, al stării emoţionale asociate
şi al circumstanţelor interpersonale? (d) Îşi
provoacă pacientul vărsături în momentul de
faţă şi care este frecvenţa medie săptămânală
în ultimele 3 luni? (e) Care este perioada cea
mai lungă de timp, de la debutul tulburării de
comportament alimentar, în care pacientul a
reuşit să nu‑şi provoace vărsături? (f) În ce fel
a interferat provocarea vărsăturilor cu relaţiile
interpersonale şi cu serviciul? (g) Provocarea
vărsăturilor este vreodată resimţită de pacient
ca fiind o experienţă plăcută? (h) Provocarea
vărsăturilor este asociată în mod constant cu alte
stări emoţionale sau cu modificări ale stării de
conştiinţă (de exemplu, furie, tristeţe, aplatizare
afectivă)? şi (i) Ce crede pacientul că s‑ar
întâmpla dacă nu şi‑ar provoca vărsături timp de
o săptămână?
Evaluatorul ar trebui să pună întrebări
similare şi în legătură cu alte comportamente de
control al greutăţii, cum sunt abuzul de laxative
şi diuretice, de pastile de slăbit sau de alte
medicamente pentru controlul poftei de mâncare;
utilizarea de vomitive; mestecarea şi scuiparea
mâncării înainte de a o înghiţi; înfometarea
prelungită şi practicarea de exerciţii fizice intense
cu scopul explicit de a‑şi controla greutatea
corporală. Unii pacienţi cu diabet îşi manipulează
dozele de insulină pentru a‑şi controla greutatea
(Rodin, 2002). Uneori, pacienţii care sunt trataţi
cu tiroxină îşi modifică doza, pentru a‑şi controla
greutatea (Garfinkel şi Garner, 1982). Multe
dintre aceste comportamente au consecinţe grave
asupra stării de sănătate şi necesită o evaluare
medicală detaliată.
Alimentaţia compulsivă
Alimentaţia compulsivă este definită în
DSM‑IV‑TR ca fiind ingerarea unei cantităţi mari
de alimente, asociată cu sentimentul de pierdere
a controlului. Formularea exactă a criteriilor
este: (a) „mâncatul într‑o anumită perioadă
de timp (de ex., în decursul unei perioade de
două ore), a unei cantităţi de mâncare care este
în mod evident mai mare decât cea pe care ar
mânca‑o cei mai mulţi oameni într‑o perioadă
similară de timp şi în circumstanţe similare” şi
(b) „sentimentul de lipsă de control al mâncatului
în cursul episodului (de ex., sentimentul că
persoana respectivă nu poate stopa mâncatul
sau controla ce sau cât de mult mănâncă” (p.
5943). Chiar dacă definiţia pare clară, există o
ambiguitate destul de mare, asociată cu stabilirea
cantităţii de alimente necesară pentru a defini un
„episod de alimentaţie compulsivă”. Deşi s‑a
propus stabilirea unor indicaţii specifice pentru
evaluarea cantitativă a alimentaţiei compulsive,
nu s‑a ajuns la un acord în ceea ce priveşte
cantitatea exactă de alimente care ar face diferenţa
între un episod de alimentaţie compulsivă şi
cantitatea de mâncare care ar putea fi consumată
în limite normale (Garner, 1993c). Este posibil ca
pacienţii să îşi descrie comportamentul ca fiind
„alimentaţie compulsivă”, chiar şi atunci când
consumă cantităţi mici sau relativ normale de
alimente.
Nu se poate afirma categoric că aspectul cel
mai relevant din punct de vedere clinic, atunci
când se stabileşte dacă alimentaţia reprezintă
un „episod de alimentaţie compulsivă”, este
legat de sentimentul pacientului de pierdere a
controlului asupra alimentaţiei, indiferent de
numărul de calorii consumate. Cu toate acestea,
există o categorie de pacienţi cu tulburări ale
comportamentului alimentar care nu simt că
„îşi pierd controlul” în timpul episoadelor de
alimentaţie compulsivă şi le descriu ca fiind
comportamente plănuite sau premeditate
cu atenţie. Sentimentul de control asupra
alimentaţiei compulsive poate fi strâns legat
de faptul că persoana este conştientă că îşi va
provoca vărsături pentru a elimina caloriile
nedorite, imediat după episodul de alimentaţie
compulsivă. În anumite cazuri, alimentaţia
compulsivă şi provocarea vărsăturilor pot fi
asociate cu beneficii secundare, în sensul că
acestea ar putea îndeplini funcţii specifice în
cadrul anumitor relaţii interpersonale.
Investigaţiile frecvenţei şi duratei
alimentaţiei compulsive, precum şi ale
provocării vărsăturilor sunt esenţiale pentru
a determina severitatea tulburării şi a evalua
necesitatea unui consult medical. Atunci când
se adună informaţii în legătură cu istoricul,
frecvenţa şi durata episoadelor de alimentaţie
compulsivă şi de vărsături, este important să
se înceapă căutarea unor laitmotive în cadrul
analizei funcţionale. Întrebările ar trebui să fie
orientate către identificarea gradului de restricţie
alimentară şi a acţiunilor de scădere în greutate,
care ar putea explica simptomatologia, precum
şi către antecedentele şi consecinţele stărilor
emoţionale, ale situaţiile interpersonale şi ale
altor evenimente sau cogniţii importante, care
3
Pagina corespunde ediţiei în limba română a DSM‑IV‑TR
(Bucureşti, 2003).
preced sau urmează imediat după episoadele
de alimentaţie compulsivă şi/sau de provocare a
vărsăturilor.
Complicaţii medicale ale tulburărilor de
comportament alimentar
Complicaţiile medicale ale tulburărilor de
comportament alimentar sunt semnificative,
posibil ireversibile şi reprezintă o ameninţare
pentru viaţă; astfel, o evaluare medicală ca parte
a unei evaluări cuprinzătoare este esenţială.
Complicaţiile medicale pot implica aproape toate
sistemele şi organele şi pot fi considerate drept
consecinţe ale înfometării, vărsăturilor, abuzului
de laxative, comportamentului alimentar
compulsiv şi activităţii fizice (Becker, Grinspoon,
Klibanski şi Herzog, 1999; Pomeroy şi Mitchell,
2002; Rome şi Ammerman, 2003). Tabelul 4.4
ilustrează multe dintre complicaţiile medicale
asociate cu înfometarea şi simptomele folosite
pentru controlul ponderal.
Anumite complicaţii medicale pot apărea,
direct sau indirect, în urma tratamentului. De
exemplu, în AN, „sindromul realimentării”
poate duce la delir şi deces şi este asociat cu
administrarea pe cale orală sau parenterală a
nutrienţilor hipercalorici, în special a celor bogaţi
în glucoză (Rome şi Ammerman, 2003). În mod
similar, pacienţii cu AN se pot „încărca cu apă”
înainte de a fi cântăriţi pentru a furniza informaţii
false despre greutatea lor. Alţii pot consuma apă
în exces, având convingerea eronată că aceasta
„purifică corpul” sau reduce apetitul. Intoxicaţia
cu apă poate conduce la edem cerebral, ataxie,
convulsii, comă şi deces (Jacquin, Ouvry şi
Alvin, 1992). Multe dintre complicaţiile medicale
se remit prin restabilirea greutăţii corporale
şi încetarea simptomelor tulburărilor de
comportament alimentar; cu toate acestea, unele
dintre ele sunt ireversibile, precum miocardita,
care poate apărea ca un rezultat al intoxicării cu
emetină în urma abuzului de ipeca, disfuncţia
renală şi osteopenia care avansează atâta timp cât
pacientul rămâne subponderal (Hotta, Shibasaki,
Sato şi Demura, 1998). La pacientele cu tulburări
de comportament alimentar, prezenţa sarcinii
determină o rată mai ridicată de avort, complicaţii
obstetrice şi depresie postpartum (Franko şi
Spurrell, 2000). În încheiere, a avea o tulburare
de comportament alimentar în adolescenţă
măreşte considerabil riscul tulburărilor fizice,
precum şi al celor mentale, în timpul primilor ani
de maturitate (Johnson, Cohen, Kasenn şi Brook,
2002).
71
 Tabelul 4.4 Interpretările profilului EDI‑3
Complicaţii medicale ale tulburărilor de
comportament alimentar Utilizarea instrucţiunilor de interpretare şi a
tabelelor
Înfometarea şi pierderea în greutate
Amenoree (primară şi secundară) Instrucţiunile de interpretare a EDI‑3 sunt
Pubertate întârziată prezentate utilizând scorurile brute, cotele T
Rată metabolică redusă
Aritmie cardiacă şi centilele, pentru a‑i permite clinicianului să
Interval QT prelungit folosească unul dintre diferitele standarde de
Bradicardie sinusală referinţă. În secţiunea următoare sunt oferite
Atrofia muşchiului cardiac interpretările descriptive pentru fiecare scală şi
Prolaps de valvă mitrală
scor compozit ale EDI‑3, împreună cu tabelele
Modificări ortostatice (puls, hipotermie, hipotensiune)
Masa ventriculară redusă cu instrucţiuni de interpretare, care prezintă
Atrofie cerebrală intervalele clinice (adică, Semnificaţie clinică
Constipaţie ridicată, Semnificaţie clinică tipică, Semnificaţie
Insuficienţă renală clinică scăzută). Grupul de referinţă pentru
Lanugo
Evacuare gastrică întârziată, motilitate gastrică scăzută tabelele cu instrucţiuni de interpretare este
Densitate osoasă scăzută (osteopenie) eşantionul clinic combinat de pacienţi adulţi
Valori anormale ale analizelor de laborator din S.U.A. Acest grup este format din pacienţi
Hipercolesterolemie aparţinând eşantionului clinic de pacienţi
Hipercortizolemie
adulţi din S.U.A., format din toate grupurile
Hipofosfatemie
Secreţie crescută de hormon de creştere de diagnostic combinate (anorexia nervoasă
Leucopenie – tipul restrictiv [AN‑R]; anorexie nervoasă
– tipul alimentaţie compulsivă/vărsături
Vărsături provocate [AN‑AC/V]; bulimie nervoasă [BN]; tulburări
Oboseală generală
Slăbiciune de comportament alimentar fără altă specificaţie
Slăbiciune musculară şi crampe [TCAFAS]). Intervalele clinice se bazează pe
Aritmii cardiace intervalele de centile pentru eşantionul clinic
Insuficienţă renală combinat de pacienţi adulţi din S.U.A., după
Erodarea smalţului dentar
cum urmează:
Edem postural
Umflarea glandei parotide
Reflux şi iritaţie gastrice Semnificaţie clinică ridicată = intervalul de
Alcaloza metabolică cronică centile 67‑99
Acidoza metabolică cronică (cu abuz de laxative) Semnificaţie clinică tipică = intervalul de
Anormalităţi ale semnelor vitale
Calusuri pe articulaţii sau pe stomac de la vărsăturile centile 25‑66
provocate Semnificaţie clinică scăzută = intervalul de
Valori biologice anormale centile 1‑24
Hipopotasemie
Hipocalcemie
Pentru unele scale, scorurile brute folosite
Hipomagneziemie
Hipofosfatemie pentru a defini intervalele clinice pot devia
Hiperamilazemie uşor de la intervalele centilelor, pentru a
reduce efectele de tavan sau de podea („ceiling or
Alimentaţie compulsivă floor effects”), care pot determina un interval
Perforaţie esofagiană
Dilataţie şi perforaţie gastrică acută al scorurilor brute foarte restrâns, definind
astfel un interval clinic specific. Tabelele cu
Notă: Informaţii compilate din următoarele surse: Becker, instrucţiuni pentru interpretare includ, pentru
Grinspoon, Klibanski şi Herzog (1999); Pomeroy şi Mitchell fiecare scală şi scor compozit, intervalele clinice,
(2002); Rome şi Ammerman (2003). intervalele scorurilor brute, cotele T şi intervalele
centilelor pentru grupul de referinţă, precum şi
pentru eşantionul clinic combinat de pacienţi
adolescenţi din S.U.A. Intervalele eşantionului
clinic combinat de pacienţi adolescenţi din S.U.A.
se bazează pe pacienţi cu vârste cuprinse între 13
şi 17 ani, în care sunt combinate toate grupurile
de diagnostic.

72
 Tabelele cu instrucţiuni de interpretare
prezintă, de asemenea, intervalele centilelor
pentru eşantioanele nonclinice de adulţi şi de
adolescenţi, pentru scorurile brute care definesc
fiecare dintre cele trei intervale clinice pentru
grupul de referinţă cu tulburări de comportament
alimentar. Intervalele centilelor pentru eşantionul
nonclinic de adolescenţi au fost determinate pe
baza eşantionului internaţional nonclinic de
adolescenţi în vârstă de 17 ani sau mai tineri
(N=1.148). Intervalele centilelor pentru eşantionul
nonclinic de adulţi au fost obţinute folosind
eşantionul din populaţia normală de adulţi din
SUA (N=861). Astfel, tabelele cu instrucţiuni de
interpretare îi permit clinicianului să efectueze
o evaluare rapidă a scorurilor la scalele şi la
scalele compozite EDI‑3 ale unui pacient, în
comparaţie cu scorurile brute şi intervalele
cotelor T şi ale centilelor asociate pentru grupul
de referinţă (adică, eşantionul clinic combinat de
pacienţi adulţi din SUA), precum şi cu intervalele
centilelor şi cotelor T pentru eşantionul clinic
combinat de pacienţi adolescenţi din SUA şi
pentru cele două eşantioane nonclinice care
sunt asociate cu scorurile brute ale grupului de
referinţă, definind intervalele Semnificaţie clinică
ridicată, Semnificaţie clinică tipică şi Semnificaţie
clinică scăzută.
Tabelele cu instrucţiuni de interpretare
în cazul scalelor Riscului de tulburare de
comportament alimentar (DS, B, NC) şi al SCRTCA
prezintă separat intervalele centilelor şi ale
cotelor T, pentru subgrupurile de diagnostic
din eşantionul clinic combinat de pacienţi
adulţi din SUA. Tabelele cu instrucţiuni pentru
interpretarea Scalelor psihologice utilizează
eşantionul clinic combinat de pacienţi adulţi din
SUA, pentru a stabili intervalele clinice, cotele T
şi centilele pentru celelalte grupuri (adică clinic şi
nonclinic). În cazul acesta, sunt prezentate doar
datele referitoare la eşantionul clinic combinat
de pacienţi adulţi din SUA, deoarece nu există
diferenţe semnificative între mediile la scale ale
grupurilor individuale de diagnostic.
Tabelele cu instrucţiuni de interpretare
permit o stabilire rapidă a intervalelor clinice
potrivite pentru fiecare scală, construite pe baza
grupului de referinţă; cu toate acestea, în cazul în
care se poate stabili un diagnostic clar, este util să
se consulte etaloanele prezentate separat pentru
fiecare grup de diagnostic în parte în Anexele
A, B şi C ale acestui manual. Determinarea
grupului de referinţă adecvat folosit pentru
etalonare depinde de stabilirea prealabilă a
diagnosticului corect. Acest lucru poate fi
inaplicabil sau imposibil în anumite condiţii. În
aceste situaţii, individul mai poate fi evaluat pe
baza intervalului de scoruri prezentate pentru
diferitele grupuri de diagnostic din eşantionul
clinic combinat. Pe de altă parte, aşa cum a fost
menţionat mai devreme, este important ca factorii
care limitează inferenţele ce pot rezulta doar din
diagnostic să fie trataţi cu multă atenţie. În primul
rând, pacienţii cu tulburări de comportament
alimentar sunt eterogeni din punct de vedere
psihologic. În al doilea rând, studiile asupra
evoluţiei fireşti a tulburărilor alimentare arată că
indivizii fluctuează de‑a lungul timpului dintr‑o
categorie de diagnostic în alta. În al treilea rând,
abordările terapeutice sunt concepute pentru
a remite majoritatea simptomelor specifice
tulburărilor de comportament alimentar, precum
şi caracteristicile psihologice evaluate de EDI‑3,
din toate categoriile de diagnostic.
Scalele de Risc de tulburare de
comportament alimentar şi scala
compozită
Scala Dorinţa de a fi slab (DS)
Constructul „dorinţa de a fi slab” a fost
descris ca fiind una dintre caracteristicile de bază
asociate cu instalarea şi menţinerea simptomelor
tulburărilor de comportament alimentar în
eşantioanele clinice. Cei şapte itemi ai acestei
scale evaluează preocuparea pentru ţinerea unei
diete restrictive, îngrijorări legate de respectarea
unei diete şi temeri de a nu se îngrăşa. În Tabelul
4.5 sunt afişate intervalele scorurilor brute,
ale cotelor T şi ale centilelor care corespund
intervalelor clinice calitative pentru scala DS.
Intervalul de Semnificaţie clinică ridicată.
Un scor brut de 25 până la 28 la scala DS se
situează între centilele 67 şi 99 (cota T≥57) pentru
eşantionul clinic combinat de pacienţi adulţi
din SUA şi indică faptul că respondentul este
îngrozit de creşterea în greutate, este preocupat
de dorinţa de a fi mai slab şi petrece exagerat de
mult timp gândindu‑se la a ţine o cură de slăbire.
Un scor brut la scala DS în acest interval este
neobişnuit printre cei care suferă de tulburări
clinice de comportament alimentar şi este rar
printre respondenţii din eşantioanele nonclinice
(1% dintre adolescenţi şi 2% dintre adulţi).
Aşadar, un scor în acest interval ar trebui să fie
luat serios în considerare în legătură cu prezenţa
unei tulburări de comportament alimentar.
Respondenţii provenind din medii nonclinice
care au obţinut scoruri în acest interval ar trebui
să fie evaluaţi de un specialist familiarizat cu
73
tulburările de comportament alimentar. Datorită
faptului că scala DS corelează cu greutatea
corporală, ne putem aştepta la un scor neobişnuit
de ridicat de la o persoană care se situează la
limita superioară a valorilor posibile ale greutăţii.
Un scor de o asemenea magnitudine poate fi mai
îngrijorător atunci când individul are o greutate
normală sau scăzută.
Intervalul de Semnificaţie clinică tipică. Un
scor brut de 17 până la 24 la scala DS se află
între centilele 25 şi 66 (cota T = 46‑56) pentru
eşantionul clinic combinat de pacienţi adulţi
din SUA şi reflectă dorinţa semnificativă de
a fi mai slab, interes pentru curele de slăbire,
preocupare legată de greutate şi teama de
îngrăşare, aspecte care sunt specifice indivizilor
cu tulburări de comportament alimentar. Un
scor brut la scala DS în acest interval este
obişnuit printre cei diagnosticaţi cu tulburări
de comportament alimentar şi este caracteristic
majorităţii respondenţilor din eşantionul clinic
de etalonare. Un scor în acest interval este relativ
rar întâlnit în eşantioanele nonclinice (8% dintre
adolescenţi şi 18% dintre adulţi) şi reflectă
prezenţa unei preocupări semnificative faţă de
greutatea corporală. Respondenţii provenind
din medii nonclinice care au scoruri în acest
interval ar trebui, în mod ideal, să fie evaluaţi
de către un specialist familiarizat cu tulburările
de comportament alimentar, în special dacă
există scoruri ridicate la alte scale ale Riscului
de tulburare de comportament alimentar, precum şi
la Scalele psihologice. Scala DS corelează pozitiv
cu greutatea corporală; în consecinţă, ne putem
aştepta la un scor ridicat în cazul unei persoane
care se situează la limita superioară a valorilor
posibile ale greutăţii. Un scor de o asemenea
magnitudine poate fi mai îngrijorător atunci
când individul are greutate normală sau scăzută.
Intervalul de Semnificaţie clinică scăzută.
Un scor brut la scala DS mai mic sau egal
cu 16 se situează între centilele 1 şi 24 (cota
T≤45) pentru eşantionul clinic combinat de
pacienţi adulţi din SUA şi apare la o minoritate
semnificativă de pacienţi cu AN‑R (38%), însă
la doar 16% dintre cei diagnosticaţi cu BN. Un
scor în acest interval sugerează că individul nu
are probleme semnificative în ceea ce priveşte
preocupările pentru alimentaţie şi greutate –
care constau în frica de a se îngrăşa şi în dorinţa
de a fi mai slab – comparativ cu alţi pacienţi
diagnosticaţi cu tulburări de comportament
alimentar. Această interpretare ar trebui luată în
considerare, ţinându‑se cont şi de alte surse de
informaţii clinice, pentru a determina acurateţea
autoevaluării. Un scor brut la scala DS în acest
interval este relativ frecvent întâlnit printre
respondenţii din eşantioanele nonclinice (90%
dintre adolescenţi şi 79% dintre adulţi). Scala
DS corelează pozitiv cu greutatea corporală; în

Tabelul 4.5
Intervalele scorurilor brute, ale cotelor T şi ale centilelor corespunzătoare intervalelor clinice
calitative: Scala Dorinţa de a fi slab
Eşantion clinic
Adulţi Adolescenţi Eşantion nonclinic
Interval AN-R AN-AC/V BN TCAFAS Combinat Combinat Adulţi Adolescenţi
Semnificaţie
clinică ridicată
Scor brut 25-28 25-28 25-28 25-28 25-28 25-28
Cota T ≥ 58 ≥ 55 ≥ 56 ≥ 55 ≥ 57 ≥ 58
Centil ≥ 71 ≥ 60 ≥ 67 ≥ 67 ≥ 67 ≥ 74 ≥ 98 ≥ 99
Semnificaţie
clinică tipică
Scor brut 17-24 17-24 17-24 17-24 17-24 17-24
Cota T 49-57 44-54 41-55 43-54 46-56 46-57
Centil 39-70 20-59 17-66 22-60 25-66 33-73 80-97 91-98
Semnificaţie
clinică scăzută
Scor brut 0-16 0-16 0-16 0-16 0-16 0-16
Cota T ≤ 48 ≤ 43 ≤ 40 ≤ 42 ≤ 45 ≤ 45
Centil ≤ 38 ≤ 19 ≤ 16 ≤ 21 ≤ 24 ≤ 32 ≤ 79 ≤ 90

Notă: AN-R = Anorexie nervoasă, tipul restrictiv; AN-AC/V = Anorexie nervoasă, tipul alimentaţie compulsivă/vărsături; BN =
Bulimie nervoasă; TCAFAS = Tulburări de comportament alimentar fără altă specificaţie.

74
consecinţă, ne putem aştepta la un scor mai mic
în cazul unei persoane care se situează la limita
inferioară a valorilor posibile ale greutăţii. Faptul
că respondenţii mai tineri din eşantioanele
nonclinice au o greutate corporală mai scăzută
poate explica procentajul mai mare de scoruri
mai mici sau egale cu 16 la scala DS.
Indicatori de interpretare
Tulburarea atipică de comportament alimentar.
Un scor brut scăzut la scala DS poate indica
prezenţa unei „tulburări atipice de comportament
alimentar”, în care dorinţa de a fi mai slab nu
este un factor motivaţional semnificativ. Există
o minoritate semnificativă de pacienţi care au
scoruri mici la scala DS, deşi îndeplinesc clar
criteriile de diagnostic pentru tulburările de
comportament alimentar. Frecvenţa acestui grup
„atipic” este de 10% până la 20% în eşantioanele
clinice din Canada şi Italia (Ramacciotti şi colab.,
2002), SUA (Strober, Freeman şi Morrell, 1999) şi
China (Lee, Kwok, Liau şi Leung, 2002). Aceste
cazuri „atipice” tind să prezinte o simptomatologie
mai puţin severă, să fie mai puţin asociate cu
psihopatologia şi să obţină rezultate mai bune
decât cazurile tipice (Lee şi colab., 2003; Strober
şi colab.). Lee (1995) a menţionat că dorinţa de a fi
slab sau „fobia de îngrăşare” este o „constrângere
culturală” şi a sugerat extinderea criteriilor de
diagnostic pentru tulburările de comportament
alimentar pentru a include motivele reducerii
aportului alimentar care sunt mai des întâlnite
în culturile non‑vestice, precum China. Acestea
includ balonările stomacale, durerile de stomac
şi pierderea apetitului.
Greutatea corporală actuală. Scala DS ar trebui
să fie întotdeauna interpretată în contextul
greutăţii corporale actuale a respondentului.
O dorinţă foarte puternică de a fi mai slab are
implicaţii diferite pentru cineva care deja este
slab, spre deosebire de o persoană care are o
greutate mai mare decât greutatea standard şi, în
consecinţă, este supusă presiunilor atât interne,
cât şi externe de a slăbi, din motive sociale şi de
sănătate. Un scor brut relativ scăzut la scala DS
poate indica faptul că pacientul este satisfăcut cu
pierderea în greutate obţinută şi, cel puţin pentru
moment, nu îşi doreşte să mai slăbească şi este
încrezător că poate evita câştigul ponderal. Acest
fapt este mai des întâlnit printre pacienţii cu AN;
totuşi, acesta ar putea fi un fenomen temporar,
deoarece pacienţii cu tulburări de comportament
alimentar se pot simţi mulţumiţi, pentru o
perioadă, cu o greutate corporală scăzută, dar pe
urmă simt că trebuie să ajungă la o nouă greutate,
mai scăzută. Acesta este procesul de „pierdere în
greutate până la un nou prag minim” („losing
to a new low”), care este mai satisfăcător decât
greutatea absolută. Mulţi pacienţi diagnosticaţi
cu BN prezintă o greutate normală, însă aceasta
se datorează unei slăbiri semnificative, de la o
greutate mai mare (Garner şi Fairburn, 1988).
Toray şi Cooley (1997) au raportat că scorurile la
subscala Dorinţa de a fi slab au fost semnificativ
mai mari la femeile care prezentau fluctuaţii
în greutate, comparativ cu femeile cu greutate
stabilă. Ackard şi Peterson (2001) au descoperit
că dorinţa de a fi slab este puternic asociată cu
vârsta la care se instalează pubertatea, iar femeile
care s‑au maturizat prematur au avut scoruri
brute mai mari la subscala Dorinţa de a fi slab.
Negarea. Un scor brut mic la scala DS poate
reflecta negarea situaţiei clinice actuale sau
prezenţa unui răspuns distorsionat din partea
pacientului.
Aspecte culturale. Este nepotrivit să
interpretăm dorinţa de a fi slab ca reflectând
psihopatologia individuală, fără să‑i recunoaştem
rădăcinile în semnificaţia prescrisă social a
siluetei perfecte, preluată de majoritatea femeilor
din culturile vestice din zilele noastre. Dorinţa
de a fi slab reprezintă internalizarea directivelor
sociale puternice din partea mass‑media, care
încurajează femeile şi fetele tinere să ţină diete
pentru a atinge anumite standarde de formă
şi greutate corporală, care s‑au dovedit a fi
nerealiste decenii la rând (Garner şi colab., 1980).
Astfel, s‑a ajuns la stabilirea unui nou criteriu
de apreciere, conform căruia femeile raportează
că se simt nesatisfăcute de formele lor şi se simt
vinovate, chiar şi atunci când consumă o cantitate
rezonabilă de mâncare.
Preocuparea faţă de greutatea corporală. Dacă
respondenţii din mediile nonclinice au scoruri
cuprinse în intervalele de Semnificaţie clinică
ridicată sau tipică, atunci pot fi consideraţi
„preocupaţi de greutatea corporală”, în condiţiile
în care au scoruri relativ mici la Scalele psihologice.
Sau, dimpotrivă, aceştia pot să aibă scoruri
ridicate la Scalele psihologice şi să semene cu sau
chiar să fie cazuri clinice (Garner, Olmsted şi
Garfinkel, 1983; Garner, Olmsted, Polivy şi colab.,
1984) şi, astfel, să fie necesară o evaluare făcută
de către un specialist familiarizat cu tulburările
de comportament alimentar.
Factor de risc. Dorinţa de a fi slab a fost
identificată ca fiind un factor de risc potenţial
pentru dezvoltarea simptomelor unei tulburări
de comportament alimentar în eşantioanele
nonclinice. Garner, Garfinkel, Rockert şi
Olmsted (1987) au constatat că scorurile brute
75
ridicate la subscala Dorinţa de a fi slab au prezis
debutul tuburărilor de comportament alimentar
într‑un grup de studenţi la balet. Într‑un studiu
prospectiv de 4 ani pe eleve de liceu, s‑a constatat
că scorurile brute iniţiale crescute la subscala
Dorinţa de a fi slab corelează mai puternic cu
simptomele tulburărilor de comportament
alimentar viitoare decât cu dispoziţia depresivă
sau cu ineficacitatea (Dobmeyer şi Stein, 2003).
Într‑un studiu prospectiv pe parcursul a 10 ani,
Joiner şi colab. (1997) au descoperit că subscala
Dorinţa de a fi slab a fost singurul predictor,
semnificativ şi consecvent, al simptomelor de
bulimie 10 ani mai târziu, după cum au fost
evaluate de subscala Bulimie a EDI.
Marker genetic. Într‑o analiză a legăturilor
genetice la pacienţi cu AN şi la fraţii acestora,
Devlin şi colab. (2002) au descoperit că dorinţa de
a fi mai slab a fost una dintre cele două variabile
asociate cu loci genetici specifici, care afectează
vunerabilitatea la tulburările de comportament
alimentar.
Scorurile ridicate la Dorinţa de a fi slab persistă
la pacienţii însănătoşiţi. Unele studii au arătat că
scorurile la subscala Dorinţa de a fi slab rămân
semnificativ mai ridicate la pacienţii recuperaţi,
care au suferit anterior de AN (Bastiani, Rao,
Weltzin şi Kaye, 1995; Sullivan, Bulik, Fear şi
Pickering, 1998) şi de BN (Stein şi colab., 2002).
Prognostic. Într‑un studiu de follow‑up de
10 până la 15 ani pe pacienţi cu AN, Bizeul,
Sadowsky şi Rigaud (2001) au descoperit că un
scor brut ridicat la subscala Dorinţa de a fi slab a
fost asociat cu un prognostic slab. Astfel, pacienţii
care au scoruri foarte mari la scala DS a EDI‑3
pot avea nevoie de o urmărire mai atentă după
încheierea tratamentului iniţial.
Scala Bulimie (B)
Scala B evaluează tendinţa de a se gândi la şi
de a se angaja în episoade de mâncat excesiv care
nu pot fi controlate (alimentaţie compulsivă). Cei
opt itemi ai acestei scale evaluează prezenţa,
raportată de respondent, a gândurilor şi a
comportamentelor concordante cu alimentaţia
compulsivă, incluzând consumul unei cantităţi
mari de alimente în secret, ca răspuns la o stare
emoţională negativă. Un item evaluează gândul
de a vărsa cu scopul de a slăbi. Cercetările au
arătat că alimentaţia compulsivă este prezentă
şi la persoanele care nu îndeplinesc criteriile
pentru un diagnostic formal de tulburare de
comportament alimentar; cu toate acestea, de cele
mai multe ori, episoadele severe de alimentaţie
compulsivă sunt asociate cu o suferinţă
76
emoţională semnificativă. În Tabelul 4.6, sunt
afişate intervalele scorurilor brute, ale cotelor T şi
ale centilelor care corespund intervalelor clinice
calitative pentru scala B.
Intervalul de Semnificaţie clinică ridicată. Un
scor brut de 19 până la 32 la scala B se situează
între centilele 67 şi 99 (cota T≥56) pentru
eşantionul clinic combinat de pacienţi adulţi din
SUA şi indică faptul că respondentul raportează
că are foarte frecvent gânduri şi comportamente
concordante cu alimentaţia compulsivă. Acest
comportament se asociază cu tendinţa de a fi
secretos, cu distresul emoţional şi cu gândul de
a vărsa cu scopul de a slăbi. 61% dintre adulţii
şi 42% dintre adolescenţii cu BN, precum şi o
mică parte din adulţii diagnosticaţi cu AN‑AC/V
(24%), au scoruri mai mari sau egale cu 19 la scala
B. În orice caz, un scor mai mare sau egal cu 19
este rar întâlnit la pacienţii diagnosticaţi cu AN‑R
şi, cel mai probabil, reflectă un diagnostic eronat.
Un scor brut în acest interval la scala B este, de
asemenea, extrem de rar întâlnit în eşantioanele
nonclinice (1% dintre adolescenţi şi 2% dintre
adulţi). Astfel, un scor în acest interval indică un
nivel ridicat de psihopatologie şi reflectă probabil
prezenţa unei tulburări de comportament
alimentar printre respondenţii din eşantioanele
nonclinice. Persoanele care obţin scoruri în
acest interval ar trebui evaluate de un specialist
familiarizat cu tulburările comportamentului
alimentar.
Intervalul de Semnificaţie clinică tipică. Un scor
brut între 5 şi 18 la scala B se află între centilele
25 şi 66 (cota T = 42‑55) pentru eşantionul clinic
combinat de pacienţi adulţi din SUA şi indică
faptul că respondentul raportează că are frecvent
gânduri şi comportamente concordante cu
alimentaţia compulsivă. Acest comportament se
asociază cu tendinţa de a fi secretos, cu distresul
emoţional şi cu gândul de a vărsa cu scopul de
a slăbi. Un scor brut în acest interval la scala B
este comun la pacienţii adulţi diagnosticaţi cu
AN‑AC/V şi TCAFAS (în special, alimentaţia
compulsivă) şi la minorităţi semnificative de
pacienţi adulţi diagnosticaţi cu AN‑R (centilele
58 până la 99) şi BN (centilele 4 până la 38). În
mod similar, în eşantioanele nonclinice, un
scor brut la scala B mai mare sau egal cu 5 este
neobişnuit printre cei în vârstă de 18 ani sau
mai tineri (12%), dar este mai frecvent întâlnit în
eşantionul de adulţi (30%) şi ar trebui să ridice
întrebări în legătură cu prezenţa unor tendinţe
de alimentaţie compulsivă, relevante din punct
de vedere clinic.
Intervalul de Semnificaţie clinică scăzută. Un
scor brut mai mic sau egal cu 4 la scala B se
 Tabelul 4.6
Intervalele scorurilor brute, ale cotelor T şi ale centilelor corespunzătoare intervalelor clinice
calitative: Scala Bulimie

Eşantion clinic
Adulţi Adolescenţi Eşantion nonclinic
Interval AN-R AN-AC/V BN TCAFAS Combinat Combinat Adulţi Adolescenţi
Semnificaţie
clinică ridicată
Scor brut 19-32 19-32 19-32 19-32 19-32 19-32
Cota T ≥ 90 ≥ 57 ≥ 48 ≥ 61 ≥ 56 ≥ 60
Centil > 99 ≥ 76 ≥ 39 ≥ 82 ≥ 67 ≥ 81 ≥ 98 ≥ 99
Semnificaţie
clinică tipică
Scor brut 5-18 5-18 5-18 5-18 5-18 5-18
Cota T 51-89 40-56 28-47 43-60 42-55 45-59
Centil 58-99 23-75 4-38 25-81 25-66 44-80 70-97 88-98
Semnificaţie
clinică scăzută
Scor brut 0-4 0-4 0-4 0-4 0-4 0-4
Cota T ≤ 50 ≤ 39 ≤ 27 ≤ 42 ≤ 41 ≤ 44
Centil ≤ 57 ≤ 22 ≤3 ≤ 24 ≤ 24 ≤ 43 ≤ 69 ≤ 87

Notă: AN-R = Anorexie nervoasă, tipul restrictiv; AN-AC/V = Anorexie nervoasă, tipul alimentaţie compulsivă/vărsături; BN =
Bulimie nervoasă; TCAFAS = Tulburări de comportament alimentar fără altă specificaţie.

situează între centilele 1 şi 24 (cota T≤41) pentru
eşantionul clinic combinat de pacienţi adulţi
din SUA. Un scor brut în acest interval este rar
întâlnit la cei diagnosticaţi cu BN (3%), AN‑AC/V
(22%) şi TCAFAS (24%; în special, alimentaţia
compulsivă); pe de altă parte, este frecvent la cei
diagnosticaţi cu AN‑R (57%). Este posibil ca un
pacient diagnosticat cu AN‑AC/V, care obţine
scoruri în acest interval, să fi primit un diagnostic
eronat; oricum, este mai probabil ca scorul să
reflecte o întrerupere temporară a episoadelor de
alimentaţie compulsivă. Această interpretare ar
trebui luată în considerare ţinând cont şi de alte
surse de informaţii clinice, pentru a determina
acurateţea autoevaluării. În eşantioanele
nonclinice, un scor brut la scala B mai mic sau
egal cu 4 este tipic celor în vârstă de 17 ani sau
mai tineri (87%), însă este mai rar la adulţi (69%).
În cazul unui pacient care se dovedeşte a avea
comportamente de alimentaţie compulsivă, un
scor brut la scala B mai mic sau egal cu 4 poate
reflecta, de asemenea, negarea situaţiei clinice
actuale.
Indicatori de interpretare
Prognostic. Constructul de bulimie se referă la
atitudini şi comportamente. Majoritatea experţilor
în domeniul tulburărilor de comportament
alimentar sunt de acord că cea mai bună metodă
prin care se măsoară „alimentaţia compulsivă”
este evaluarea comportamentelor foarte specifice,
folosind o terminologie operaţională clară. Cu
toate acestea, valoarea utilitară a scalei B a EDI‑3
este dată de faptul că evaluează mai degrabă
atitudinile şi sentimentele legate de lipsa de
control în alimentaţie, decât comportamentul. La
pacienţii cu BN, aceste atitudini au un pattern de
modificare diferit faţă de acela al simptomelor
comportamentale, în funcţie de existenţa unei
comorbidităţi cu tulburarea de personalitate
borderline (Steiger şi Stotland, 1996; Steiger,
Stotland şi Houle, 1994). Persistenţa acestor
atitudini la pacienţii care dobândesc controlul
asupra simptomelor comportamentale poate să
aibă nu doar semnificaţie clinică, ci poate avea şi
valoare prognostică, în identificarea pacienţilor
mai rezistenţi la schimbare. Norring (1990) a
constatat că un scor brut ridicat la scala B a fost
predictorul cel mai important pentru obţinerea
de rezultate slabe în urma tratamentului, în cazul
unui grup de pacienţi cu AN. În mod similar, un
scor brut mare la scala B a prezis rezultate slabe
la follow‑up după 1 an, pentru pacienţii cu BN
(Bulik, Sullivan, Joyce, Carter şi McIntosh, 1998).
Într‑un alt studiu, Bulik, Sullivan, Carter, McIntosh
şi Joyce (1999) au descoperit că un scor brut mic
la scala B a prezis un răspuns rapid la tratament,

77
în cazul BN. Astfel, scala B ar trebui folosită
împreună cu măsurători comportamentale, ca
parte a unei evaluări complete a tulburărilor de
comportament alimentar.
Scala Nemulţumire faţă de corp (NC)
Scala NC este formată din 10 itemi care
evaluează nemulţumirea faţă de forma corpului
în general şi faţă de dimensiunile acelor zone
ale corpului care constituie un motiv deosebit
de preocupare pentru persoanele care suferă
de tulburări de comportament alimentar (burtă,
şolduri, coapse, fese). Având în vedere faptul
că nemulţumirea faţă de propriul corp este
specifică tinerelor femei din cultura vestică, nu
se poate trage concluzia că numai acest construct
cauzează tulburările de comportament alimentar;
totuşi, aceasta reprezintă un factor de risc
responsabil pentru apariţia şi menţinerea unor
comportamente extreme de control al greutăţii,
care duc la tulburări de comportament alimentar
în cazul persoanelor care prezintă o vulnerabilitate
crescută. Scala NC şi‑a dovedit utilitatea în
măsurarea constructului de nemulţumire faţă de
corp (Cash şi Deagle, 1997). În Tabelul 4.7 sunt
afişate intervalele scorurilor brute, ale cotelor T şi
ale centilelor corespunzătoare intervalelor clinice
calitative pentru scala NC.
Intervalul de Semnificaţie clinică ridicată.
Un scor brut de 36 până la 40 la scala NC se
situează între centilele 67 şi 99 (cota T≥58) pentru
eşantionul clinic combinat de pacienţi adulţi
din SUA şi indică prezenţa unei nemulţumiri
extreme din partea respondentului faţă de
forma şi dimensiunea corpului, precum şi faţă
de greutatea corporală. De asemenea, acest scor
indică o nemulţumire extremă faţă de regiuni
specifice ale corpului − burtă, şolduri, coapse
şi fese −, care constituie un motiv obişnuit de
îngrijorare. Preocupările excesive se reflectă, de
obicei, într‑un nivel extrem de distres, datorat
senzaţiei de balonare în urma unei mese normale.
O minoritate de pacienţi adulţi cu tulburări de
comportament alimentar din toate grupurile de
diagnostic obţine scoruri brute situate în acest
interval la scala NC; cu toate acestea, sunt mai
puţini pacienţi în acest interval care suferă de
AN‑R (18%), faţă de pacienţii care au AN‑AC/V
(26%), BN (34%) şi TCAFAS (37%). Pacienţii
adolescenţi cu AN‑R şi BN obţin rareori scoruri
care pot fi incluse în acest interval. Un scor
la scala NC situat între 36 şi 40 este relativ rar
întâlnit la adolescenţii şi adulţii din eşantioanele
nonclinice (3% şi respectiv 6%).
78
Intervalul de Semnificaţie clinică tipică. Un
scor brut de 22 până la 35 la scala NC se află
între centilele 25 şi 66 (cota T = 45‑57) pentru
eşantionul clinic combinat de pacienţi adulţi din
SUA şi reflectă prezenţa unei insatisfacţii faţă de
propriul corp şi a unei nemulţumiri semnificative
faţă de forma şi dimensiunea corpului, precum
şi faţă de greutatea corporală. De asemenea,
acest scor indică o nemulţumire considerabilă
faţă de regiuni specifice ale corpului – burtă,
şolduri, coapse şi fese –, care constituie un motiv
obişnuit de preocupare. Deseori, este prezent şi
un nivel intens de disconfort, datorat senzaţiei
de balonare în urma unei mese normale. Pacienţii
cu tulburări de comportament alimentar din
eşantionul clinic folosit la etalonare obţin, în mod
obişnuit, scoruri brute situate în acest interval la
scala NC; pe de altă parte, un procent semnificativ
de femei din eşantioanele nonclinice au obţinut
scoruri între 22 şi 35 la scala NC. Acest interval
este cuprins între centilele 55 şi 93 pentru femeile
adulte şi între centilele 71 şi 96 pentru eşantionul
de adolescente, în care majoritatea aveau vârste
cuprinse între 15 şi 17 ani. Acest fapt reflectă
realitatea regretabilă că nemulţumirea faţă de
greutatea şi forma corporală sunt caracteristice
femeilor din cultura vestică. Nu este necesar
ca respondenţii din mediile nonclinice care
obţin scoruri în acest interval să fie evaluaţi de
către un specialist familiarizat cu tulburările de
comportament alimentar, decât dacă aceştia obţin
scoruri ridicate la alte scale de Risc de tulburare
de comportament alimentar. Scala NC corelează
pozitiv cu greutatea corporală; de aceea, ne
putem aştepta ca o persoană care se situează la
limita superioară a valorilor posibile ale greutăţii
să obţină un scor ridicat. Un scor de o asemenea
magnitudine poate fi mai îngrijorător atunci când
individul are o greutate normală sau scăzută.
Intervalul de Semnificaţie clinică scăzută. Un
scor brut mai mic sau egal cu 21 la scala NC se
situează între centilele 1 şi 24 (cota T≤44) pentru
eşantionul clinic combinat de pacienţi adulţi din
SUA. Aproximativ 44% dintre pacienţii adulţi cu
AN‑R din eşantionul clinic folosit la etalonare au
obţinut scoruri în acest interval, ceea ce indică
faptul că un procent semnificativ de pacienţi cu
AN nu manifestă o nemulţumire semnificativă
faţă de greutatea şi forma corporală. Treizeci
la sută dintre pacienţii adolescenţi au obţinut
scoruri în acest interval. Pe de altă parte, un
scor brut la scala NC care se încadrează în acest
interval este mai puţin frecvent la alte grupuri
de diagnostic (între 18% şi 25%), sugerând faptul
că nivelurile scăzute de nemulţumire faţă corp
sunt neobişnuite pentru majoritatea pacienţilor
cu tulburări de alimentaţie, cu excepţia celor cu
AN‑R. Cu toate acestea, o asemenea interpretare
a scorurilor ar trebui făcută ţinându‑se cont
şi de alte surse de informaţii clinice, pentru a
determina acurateţea autoevaluării. Un scor brut
scăzut la scala NC poate, de asemenea, reflecta
negarea situaţiei clinice actuale sau distorsiuni
ale răspunsurilor din partea pacientului. În
eşantioanele nonclinice, respondenţii adolescenţi
au obţinut în mod obişnuit scoruri brute mai
mici sau egale cu 21 la scala NC (70%), însă doar
aproximativ jumătate dintre femeile adulte au
obţinut scoruri asemănătoare (54%). Scala NC
corelează pozitiv cu greutatea corporală; în
consecinţă, ne putem aştepta la un scor mic în
cazul unei persoane care se situează la limita
inferioară a valorilor posibile ale greutăţii.
Indicatori de interpretare
Itemi referitori la burtă. Scala NC conţine trei
itemi care se referă la abdomen (adică, itemii 2,
12, 47). Indivizii care au temeri în legătură cu
dezvoltarea psihosexuală pot fi mai sensibili la
aceşti itemi.
Corelaţia dintre nemulţumirea faţă de corp şi
greutatea corporală. Nemulţumirea faţă de corp
corelează pozitiv cu greutatea corporală în
studiile pe femei tinere, cu sau fără tulburări
de comportament alimentar (Cash şi Deagle,
1997; Garner şi colab., 1992; Mortenson, Hoerr
şi Garner, 1993). Garner şi colab. au raportat
prezenţa unei corelaţii semnificative între
greutatea corporală şi nemulţumirea faţă de
corp, într‑un eşantion de pacienţi cu tulburări
de comportament alimentar (0,39, p<0,00001)
şi în grupurile cu BN (0,33, p<0,00001) şi AN
(0,21, p<0,00001). Autorii au propus o ajustare
a scorului brut al subscalei Nemulţumire faţă
de corp, prin creşterea sistematică a ponderii
scorului, pentru a controla statistic corelaţia sa cu
greutatea corporală. Controlul statistic al scorului
brut la subscala Nemulţumire faţă de corp este mai
puţin critic decât simpla recunoaştere a faptului
că semnificaţia nemulţumirii faţă de corp este
diferită în cazul indivizilor care au o greutate mai
mare decât media, o greutate medie, a celor slabi
sau emaciaţi. Deşi nivelul distresului subiectiv
poate fi similar pentru cei cu greutate corporală
mai mare, un nivel crescut de nemulţumire faţă de
corp denotă existenţa unei probleme psihologice
serioase, dacă apare pe un fond de emaciere la
pacienţii cu AN. Aceşti pacienţi au scoruri brute
medii la subscala Nemulţumire faţă de corp, care
sunt comparabile cu scorurile studentelor din
eşantioanele nonclinice; în orice caz, grupul

Tabelul 4.7
Intervalele scorurilor brute, ale cotelor T şi ale centilelor corespunzătoare intervalelor clinice
calitative: Scala Nemulţumire faţă de corp

Eşantion clinic
Adulţi Adolescenţi Eşantion nonclinic
Interval AN-R AN-AC/V BN TCAFAS Combinat Combinat Adulţi Adolescenţi
Semnificaţie
clinică ridicată
Scor brut 36-40 36-40 36-40 36-40 36-40 36-40
Cota T ≥ 61 ≥ 58 ≥ 57 ≥ 57 ≥ 58 ≥ 59
Centil > 82 ≥ 74 ≥ 66 ≥ 63 ≥ 67 ≥ 74 ≥ 94 ≥ 97
Semnificaţie
clinică tipică
Scor brut 22-35 22-35 22-35 22-35 22-35 22-35
Cota T 48-60 44-57 41-56 43-56 45-57 45-58
Centil 45-81 26-73 19-65 22-62 25-66 31-73 55-93 71-96
Semnificaţie
clinică scăzută
Scor brut 0-21 0-21 0-21 0-21 0-21 0-21
Cota T ≤ 47 ≤ 43 ≤ 40 ≤ 42 ≤ 44 ≤ 44
Centil ≤ 44 ≤ 25 ≤ 18 ≤ 21 ≤ 24 ≤ 30 ≤ 54 ≤ 70

Notă: AN-R = Anorexie nervoasă, tipul restrictiv; AN-AC/V = Anorexie nervoasă, tipul alimentaţie compulsivă/vărsături; BN =
Bulimie nervoasă; TCAFAS = Tulburări de comportament alimentar fără altă specificaţie.

79
AN este cu aproximativ 30% mai „slab” decât
grupul studentelor. Majoritatea pacienţilor cu
AN raportează niveluri extreme de nemulţumire
faţă de corp, asociate cu debutul tulburării lor;
pe de altă parte, aceştia pot avea o imagine
corporală foarte bună dacă au reuşit să scadă în
greutate. Aşadar, scala NC trebuie interpretată
în contextul greutăţii corporale şi al istoricului
acesteia. Nivelurile scăzute de nemulţumire faţă
de corp la pacienţii emaciaţi care suferă de AN
trebuie considerate semne ale tulburării, deoarece
denotă satisfacţia cu o condiţie aberantă. Un nivel
crescut de nemulţumire faţă de corp poate fi un
indicator pozitiv în AN, dacă reflectă prezenţa
unei dorinţe de a câştiga în greutate; în orice caz,
este un semn îngrijorător dacă reflectă dorinţa de
a slăbi şi mai mult.
Pacienţii cu BN raportează o nemulţumire
semnificativ mai mare faţă de corp comparativ cu
cei cu AN (Garner, Garfinkel şi O’Shaughnessy,
1985; Garner, Garner şi colab., 1993; Garner,
Olmsted şi Garfinkel, 1983); cu toate acestea,
pacienţii diagnosticaţi cu BN au, în mod normal,
o greutate mai mare, deşi mulţi dintre aceştia au
slăbit suficient, încât să aibă o greutate corporală
tipică pentru AN (Garner şi Fairburn, 1988).
Pacienţii cu BN „mai slabi”, care au scoruri brute
mari la scala NC tind să prezinte o psihopatologie
mai severă decât pacienţii din eşantionul folosit
pentru comparaţie care au o greutate mai
mare (Garner şi colab., 1992). Scorurile brute
mici la scala NC sunt rare la cei consideraţi
supraponderali în comparaţie cu etaloanele de
greutate; cu toate acestea, acceptarea dimensiunii
corpului în absenţa pierderii în greutate este un
obiectiv fundamental al tratamentelor pentru
obezitate „fără pierdere în greutate” (Wooley şi
Garner, 1994). Scala NC este un instrument de
evaluare a regiunilor corpului asupra cărora se
concentrează persoanele preocupate de greutatea
corporală.
Modelele factorilor de risc multipli.
Nemulţumirea faţă de corp s‑a dovedit a fi
un factor de risc major pentru dezvoltarea
tulburărilor de comportament alimentar, în
eşantioanele din populaţia generală de pre-
adolescente, adolescente şi femei adulte (Jacobi
şi colab., 2004). Cu toate acestea, relaţia dintre
nemulţumirea faţă de corp şi alţi factori mediatori
este complexă. Stice, Schupak‑Neuberg, Shaw
şi Stein (1994) au descoperit o relaţie pozitivă
între expunerea la stereotipurile din mass‑media
privind silueta suplă ideală şi simptomele
tulburărilor de comportament alimentar. De
asemenea, rezultatele au indicat faptul că acest
efect a fost mediat de promovarea rolului de gen
80
şi de internalizarea idealului de avea un corp
suplu. Într‑un studiu pe fete cu vârste cuprinse
între 10 şi 13 ani, Blowers, Loxton, Grady‑Flesser,
Occhipinti şi Dawe (2003) au constatat că masa
corporală a fost direct asociată cu nemulţumirea
faţă de corp, însă predicţia nemulţumirii faţă de
corp a fost îmbunătăţită de un model mai complex,
care include presiunea din partea mass‑media,
internalizarea idealului de supleţe şi comparaţia
socială. Într‑un studiu prospectiv pe un eşantion
din populaţia generală de femei, Ghaderi (2003)
a folosit analiza prin modelare structurală
(structural modeling analysis) pentru a prezice
comportamentul alimentar patologic, folosind
stima de sine scăzută, perceperea unui suport
social scăzut din partea familiei, nemulţumirea
crescută faţă de corp şi copingul bazat pe
evadare‑evitare. Tylka (2004) a descoperit că
inspectarea corpului, neuroticismul şi existenţa
unui membru al familiei sau a unui prieten cu o
tulburare de comportament alimentar au crescut
puterea asocierii dintre nemulţumirea faţă de
corp şi simptomatologia specifică tulburărilor de
comportament alimentar în rândul studentelor.
Nemulţumirea faţă de corp şi depresia. S‑a
constatat, în mod constant, că, în cazul femeilor,
între nemulţumirea faţă de corp şi depresie există
o asociere pozitivă; cu toate acestea, Keel şi colab.
(2002) au constatat, într‑un studiu follow‑up
de 10 ani, pe femei care se tratau pentru BN,
că depresia este un predictor puternic al
nemulţumirii faţă de corp. Depresia poate fi unul
dintre factorii principali care duc la dezvoltarea
şi menţinerea nemulţumirii faţă de corp. De
asemenea, s‑a dovedit că aceasta se asociază şi
cu niveluri scăzute de expresivitate emoţională,
cu un istoric de tachinări din partea celorlalţi, cu
frecvenţa comparaţiilor legate de aspectul fizic şi
cu internalizarea valorilor sociale.
Răspunsul la tratament. S‑a constatat că
nemulţumirea faţă de corp este asociată cu
severitatea simptomelor (Tylka, 2004), cu rezultate
slabe ale tratamentului (Garner şi colab., 1990) şi
cu recidive (Freeman, Beach, Davis şi Solyom,
1985), în cazul pacienţilor cu BN.
Nemulţumirea faţă de corp, etnia şi cultura.
Wildes şi Emery (2001) au realizat o metaanaliză a
35 de studii asupra tulburărilor de comportament
alimentar şi a nemulţumirii faţă de corp pe
populaţii caucaziene şi non‑caucaziene şi au
constatat că persoanele caucaziene sunt mai
nemulţumite faţă de corp decât persoanele
non‑caucaziene care au fost utilizate pentru
comparaţii. Mărimile efectului în studiile care
au folosit subscala Nemulţumire faţă de corp au
fost mai mari decât pentru majoritatea celorlalte
instrumente.
Scala compozită Risc de tulburare de
comportament alimentar (SCRTCA)
Scorul SCRTCA este compus din suma cotelor
T ale scalelor DS, B şi NC. Acesta reprezintă
o măsură globală a preocupărilor în legătură
cu alimentaţia şi greutatea, fiecare scală care
contribuie la formarea lui având o pondere egală.
În tabelul 4.8 sunt afişate intervalele cotelor T şi
ale centilelor care corespund intervalelor clinice
calitative pentru SCRTCA.
Intervalul de Semnificaţie clinică ridicată.
Un scor SCRTCA în intervalul de Semnificaţie
clinică ridicată se situează între centilele 67 şi
99 (cota T≥57) pentru eşantionul clinic combinat
de pacienţi adulţi din SUA şi indică faptul că
respondentul are îngrijorări extreme în legătură
cu alimentaţia şi cu greutatea, preocupări care
constau în teama de îngrăşare, dorinţa de a fi
mai slab, tendinţe de alimentaţie compulsivă şi
nemulţumire faţă de corp. Indivizii cu tulburări
clinice de comportament alimentar nu obţin, în
mod obişnuit, scoruri SCRTCA în acest interval,
iar o estimare a acestui nivel de preocupare
în legătură cu alimentaţia şi greutatea în
eşantioanele nonclinice sugerează faptul că
este rar, fiind prezent la aproximativ 5% din
eşantionul de adulţi şi la 1% din eşantionul de
adolescenţi. Prin urmare, un scor în acest interval
ar trebui să fie luat serios în considerare, întrucât
poate semnifica prezenţa unei tulburări clinice
de comportament alimentar sau a simptomelor
şi a preocupărilor severe privind alimentaţia.
Respondenţii din mediile nonclinice care obţin
scoruri în acest interval ar trebui să fie evaluaţi
de un specialist familiarizat cu tulburările de
comportament alimentar. SCRTCA corelează
pozitiv cu greutatea corporală; aşadar, ne
aşteptăm la un scor mai mare de la o persoană
care se situează la limita superioară a valorilor
posibile ale greutăţii. Un scor de o asemenea
magnitudine poate fi mai îngrijorător dacă
individul are greutate normală sau scăzută.
Intervalul de Semnificaţie clinică tipică. Un scor
SCRTCA în intervalul de Semnificaţie clinică
tipică se situează între centilele 25 şi 66 (cota
T  = 46‑56) pentru eşantionul clinic combinat de
pacienţi adulţi din SUA şi reflectă preocupări
semnificative privind alimentaţia, caracteristice
majorităţii pacienţilor cu tulburări clinice de
comportament alimentar. Obţinerea unui scor
SCRTCA în acest interval sugerează existenţa
unor preocupări semnificative în legătură cu
alimentaţia şi greutatea, caracterizate prin teamă
de îngrăşare, dorinţa de a fi mai slab, tendinţe
de alimentaţie compulsivă şi nemulţumire faţă
de corp. Pacienţii diagnosticaţi cu tulburări
clinice de comportament alimentar obţin, în
mod obişnuit, scoruri SCRTCA cuprinse în
acest interval; în orice caz, respondenţii din
eşantioanele nonclinice obţin relativ rar astfel de
scoruri (pentru adolescenţi, între centilele 91 şi
98; pentru adulţi, între centilele 76 şi 94), fapt ce

Tabelul 4.8
Intervalele cotelor T şi ale centilelor corespunzătoare intervalelor clinice calitative: Scala
compozită Risc de tulburare de comportament alimentar

Eşantion clinic
Adulţi Adolescenţi Eşantion nonclinic
Interval AN-R AN-AC/V BN TCAFAS Combinat Combinat Adulţi Adolescenţi
Semnificaţie
clinică ridicată
Cota T ≥ 56 ≥ 56 ≥ 56 ≥ 55 ≥ 57 ≥ 59
Centil > 69 ≥ 70 ≥ 69 ≥ 70 ≥ 67 ≥ 81 ≥ 95 ≥ 99
Semnificaţie
clinică tipică
Cota T 43-55 44-55 45-55 46-54 46-56 48-58
Centil 25-68 21-69 23-68 25-69 25-66 34-80 76-94 91-98
Semnificaţie
clinică scăzută
Cota T ≤ 42 ≤ 43 ≤ 44 ≤ 45 ≤ 45 ≤ 47
Centil ≤ 24 ≤ 20 ≤ 22 ≤ 24 ≤ 24 ≤ 33 ≤ 75 ≤ 90
Notă: AN-R = Anorexie nervoasă, tipul restrictiv; AN-AC/V = Anorexie nervoasă, tipul alimentaţie compulsivă/vărsături; BN =
Bulimie nervoasă; TCAFAS = Tulburări de comportament alimentar fără altă specificaţie.

81
reflectă prezenţa unor preocupări semnificative
privind greutatea corporală şi a atitudinilor
disfuncţionale în legătură cu alimentaţia.
Intervalul de Semnificaţie clinică scăzută.
Un scor SCRTCA în intervalul de Semnificaţie
clinică scăzută se situează între centilele 1 şi 24
(cota T≤45) pentru eşantionul clinic combinat de
pacienţi adulţi din SUA şi sugerează faptul că
individul nu are probleme semnificative în ceea
ce priveşte preocupările legate de alimentaţie şi
greutate corporală – caracterizate prin teamă de
îngrăşare, dorinţa de a fi mai slab, tendinţe de
alimentaţie compulsivă şi nemulţumire faţă de
corp – în comparaţie cu alţi pacienţi cu tulburări
clinice de comportament alimentar. Această
interpretare ar trebui făcută ţinându‑se cont şi de
alte surse de informaţii clinice, pentru a determina
acurateţea autoevaluării. Un scor SCRTCA scăzut
poate, de asemenea, să reflecte negarea situaţiei
clinice actuale sau distorsiuni ale răspunsurilor
din partea pacientului. Adolescenţii şi adulţii din
eşantioanele nonclinice obţin în mod obişnuit
scoruri SCRTCA în acest interval (90%, respectiv,
75%).
Indicatori de interpretare
Tulburări atipice de comportament alimentar. Un
scor SCRTCA scăzut poate indica o „tulburare
atipică de comportament alimentar”, în care
preocupările în legătură cu alimentaţia nu sunt
un factor motivaţional semnificativ. Aceste cazuri
Tabelul 4.9
Intervalele scorurilor brute, ale cotelor T şi ale centilelor corespunzătoare
intervalelor clinice calitative: Scala Stimă de sine scăzută
Eşantion clinic
Interval Adulţi
Semnificaţie clinică ridicată
Scor brut 17-24
Cota T ≥ 57
Centil ≥ 67
Semnificaţie clinică tipică
Scor brut 9-16
Cota T 43-56
Centil 25-66
Semnificaţie clinică scăzută
Scor brut 0-8
Cota T ≤ 42
Centil ≤ 24
82
„atipice” tind să aibă o severitate mai redusă
a simptomelor, să fie mai puţin asociate cu
psihopatologia şi să aibă rezultate mai bune decât
majoritatea cazurilor tipice (Lee, Lee, Ngai, Lee
şi Wing, 2001; Strober şi colab., 1999). Motivaţia
pentru scăderea în greutate în aceste cazuri
atipice se asociază cu balonări ale stomacului,
dureri stomacale şi pierderea apetitului.
Greutate corporală redusă şi simptome
ego‑sintonice. Un scor SCRTCA mic poate indica
simptome de natură ego‑sintonică la un pacient
cu AN‑R, care este mulţumit cu greutatea sa
extrem de scăzută şi, în consecinţă, nu doreşte
să fie mai „slab” şi nu este angajat momentan în
niciun comportament de tip bulimic. Pe de altă
parte, acesta ar putea fi un fenomen temporar,
deoarece pacienţii cu tulburări de comportament
alimentar se pot simţi satisfăcuţi, pentru o
perioadă, cu greutatea lor corporală scăzută,
dar pe urmă simt că trebuie să ajungă la o nouă
greutate, mai scăzută. Acesta este procesul de
„pierdere în greutate până la un nou prag scăzut”
(„losing to a new low”), care este mai satisfăcător
decât scăderea absolută în greutate.
Negarea. Un scor SCRTCA redus poate indica
negarea situaţiei clinice curente sau o distorsiune
a răspunsurilor din partea unui individ cu o
tulburare de comportament alimentar.
Aşa cum a fost menţionat mai devreme, scalele
DS, B şi NC au fost folosite împreună sau separat,
fără scalele psihologice, pentru a identifica
grupurile cu risc crescut pentru tulburările de
Eşantion nonclinic
Adolescenţi Adulţi Adolescenţi
17-24
≥ 58
≥ 76 ≥ 99 ≥ 99
9-16
46-57
32-75 84-98 82-98
0-8
≤ 45
≤ 31 ≤ 83 ≤ 81
comportament alimentar sau pentru a observa
asocierile cu preocupări semnificative legate de
alimentaţie.
Scale psihologice şi scale compozite
Scala Stimă de sine scăzută (SSS)
Scala SSS măsoară autoevaluările negative,
prin întrebări care se referă la sentimente de
nesiguranţă, neadecvare, ineficacitate şi de lipsă
a valorii personale. Conţinutul adiţional măsoară
percepţia despre propria persoană ca fiind
incapabilă de a‑şi atinge standardele proprii.
Majoritatea teoriilor susţin că stima de sine
scăzută joacă un rol semnificativ în dezvoltarea
şi menţinerea tulburărilor de comportament
alimentar. Tabelul 4.9 prezintă intervalele
scorurilor brute, ale cotelor T şi ale centilelor care
corespund intervalelor clinice calitative pentru
scala SSS cu şase itemi.
Intervalul de Semnificaţie clinică ridicată.
Un scor brut de 17 până la 24 pe scala SSS se
situează între centilele 67 şi 99 (cota T≥57) pentru
eşantionul clinic combinat de pacienţi adulţi din
SUA şi indică sentimente extreme de nesiguranţă
personală, de neadecvare, de ineficacitate şi
de lipsă a propriei valori. Scala SSS implică o
percepţie despre sine permanent negativă în ceea
ce priveşte capacitatea de a atinge standardele
proprii. Un scor în acest interval ar trebui să ridice
întrebări în legătură cu prezenţa unor sentimente
profunde de neadecvare şi de auto‑discreditare.
O dovadă de prudenţă ar fi ca pacientul să fie
evaluat în continuare, pentru a exclude depresia
Tabelul 4.10
Intervalele scorurilor brute, al cotelor T şi al centilelor corespunzătoare
intervalelor clinice calitative: Scala Alienare personală
Eşantion clinic
Interval Adulţi
Semnificaţie clinică ridicată
Scor brut 17-28
Cota T ≥ 55
Centil ≥ 67
Semnificaţie clinică tipică
Scor brut 9-16
Cota T 42-54
Centil 25-66
Semnificaţie clinică scăzută
Scor brut 0-8
Cota T ≤ 41
Centil ≤ 24
severă şi posibila ideaţie suicidară. La pacienţii cu
tulburări de comportament alimentar, scala SSS
corelează adesea cu greutatea corporală; astfel,
scorurile din acest interval pot reflecta o stimă
de sine puternic bazată pe forma şi greutatea
corpului. Pacienţii care suferă de tulburări clinice
de comportament alimentar nu obţin, în mod
obişnuit, scoruri brute în acest interval la scala
SSS, iar respondenţii adolescenţi şi adulţi din
eşantioanele nonclinice obţin rar astfel de scoruri
(1% în ambele cazuri). Aşadar, un scor în acest
interval indică un nivel crescut de psihopatologie.
Intervalul de Semnificaţie clinică tipică. Un scor
brut de 9 până la 16 pe scala SSS se află între
centilele 25 şi 66 (cota T = 43‑56) pentru eşantionul
clinic combinat de pacienţi adulţi din SUA şi
reflectă sentimente semnificative de nesiguranţă
personală, de neadecvare, de ineficacitate şi de
lipsă a propriei valori, care sunt caracteristice
indivizilor diagnosticaţi cu tulburări de
comportament alimentar. Pacienţii care suferă
de tulburări clinice de comportament alimentar
obţin în mod obişnuit scoruri brute în acest
interval la scala SSS; în orice caz respondenţii
adolescenţi şi adulţi din eşantioanele nonclinice
obţin rar astfel de scoruri (între centilele 82 şi 98,
respectiv între 84 şi 98). Astfel, un scor în acest
interval indică îngrijorări în privinţa stimei de
sine.
Intervalul de semnificaţie clinică scăzută. Un
scor brut la scala SSS mai mic sau egal cu 8
se situează între centilele 1 şi 24 (cota T≤42)
pentru eşantionul clinic combinat de pacienţi
adulţi din SUA, sugerând că individul nu are
probleme semnificative la nivelul nesiguranţei
Eşantion nonclinic
Adolescenţi Adulţi Adolescenţi
17-28
≥ 57
≥ 72 ≥ 96 ≥ 99
9-16
45-56
33-71 72-95 77-98
0-8
≤ 44
≤ 32 ≤ 71 ≤ 76
83
personale, al neadecvării, al ineficacităţii şi
al lipsei propriei valori, comparativ cu alţi
pacienţi cu tulburări clinice de comportament
alimentar. Această interpretare ar trebui făcută
ţinând cont şi de alte surse de informaţii clinice,
pentru a determina acurateţea autoevaluării.
Un scor scăzut poate, de asemenea, să reflecte
negarea situaţiei clinice actuale sau prezenţa
unor distorsiuni ale răspunsurilor din partea
pacientului. Respondenţii adolescenţi şi adulţi
din eşantioanele nonclinice obţin, în mod
obişnuit, scoruri brute în acest interval la scala
SSS (81%, respectiv, 83%).
Scala Alienare personală (AP)
Scala AP se suprapune în parte, din punct de
vedere conceptual, cu stima de sine scăzută; totuşi,
aceasta măsoară un domeniu mai larg de stări care
se referă la o senzaţie generală de vid emoţional
şi de singurătate, precum şi la o înţelegere
deficitară a propriei persoane. Conţinutul scalei
AP include itemi care măsoară ceea ce declară
respondentul în legătură cu sentimentul de a fi
separat de ceilalţi, de a‑i pierde sau de a nu i se
recunoaşte meritele de către aceştia. Itemii AP
măsoară, de asemenea, dorinţa de a fi altcineva
şi o senzaţie generală a lipsei de control asupra
lucrurilor. Constructul AP este compatibil cu
sentimentele paralizante de vid emoţional şi de
singurătate, care au fost descrise de unii autori cu
orientare dinamică (Bruch, 1973; Goodsitt, 1997;
Strober, 1981). Guidano şi Liotti (1983) au descris
concepte similare, folosind un cadru cognitiv
pentru a descrie formarea „structurilor cognitive,
profunde” asociate cu identitatea personală.
Tabelul 4.10 prezintă intervalele scorurilor brute,
ale cotelor T şi ale centilelor care corespund
intervalelor clinice calitative pentru scala AP.
Intervalul de Semnificaţie clinică ridicată.
Un scor brut la scala AP de la 17 până la 28 se
situează între centilele 67 şi 99 (cota T≥55) pentru
eşantionul clinic combinat de pacienţi adulţi din
SUA şi indică prezenţa unor sentimente extreme
de vid emoţional şi de singurătate, precum şi o
înţelegere deficitară a propriei persoane. Un scor
brut situat în acest interval la scala AP reflectă,
de asemenea, senzaţia că, adesea sau în mod
constant, lucrurile au scăpat de sub control,
precum şi dorinţa puternică de a fi altcineva.
Pacienţii diagnosticaţi cu tulburări clinice de
comportament alimentar nu obţin în mod obişnuit
scoruri mai mari sau egale cu 17, iar respondenţii
adolescenţi şi adulţi din eşantioanele non‑clinice
obţin rar aceste scoruri (1% şi, respectiv, 4%).
84
Intervalul de Semnificaţie clinică tipică. Un scor
brut de 9 până la 16 la scala AP este situat între
centilele 25 şi 66 (cota T = 42‑54) pentru eşantionul
clinic combinat de pacienţi adulţi din SUA şi
reflectă prezenţa unor sentimente semnificative
de vid emoţional şi singurătate, precum şi o
înţelegere deficitară a propriei persoane. Acesta
indică, de asemenea, senzaţia că lucrurile au
scăpat de sub control şi dorinţa de a fi altcineva.
Adulţii cu tulburări de comportament alimentar
obţin în mod obişnuit scoruri brute situate în acest
interval la scala AP; cu toate acestea, respondenţii
adolescenţi şi adulţi din eşantioanele nonclinice
nu obţin, de obicei, astfel de scoruri (între
centilele 77 şi 98, respectiv şi între centilele 72 şi
95). Aşadar, un scor situat în acest interval poate
indica un nivel ridicat de psihopatologie.
Intervalul de Semnificaţie clinică scăzută. Un
scor brut mai mic sau egal cu 8 la scala AP este
situat între centilele 1 şi 24 (cota T≤41) pentru
eşantionul clinic combinat de pacienţi adulţi
din SUA, indicând faptul că stările care se
referă la o senzaţie generală de vid emoţional şi
singurătate, precum şi la o înţelegere deficitară
a propriei persoane nu sunt atotcuprinzătoare
sau debilitante. Cu toate acestea, interpretarea
ar trebui să ţină cont şi de alte surse de
informaţii clinice, pentru a determina acurateţea
autoevaluării. Un scor scăzut poate, de asemenea,
să reflecte negarea situaţiei clinice actuale sau
prezenţa unor distorsiuni ale răspunsurilor din
partea pacientului. Respondenţii adolescenţi
şi adulţi din eşantioanele nonclinice obţin, de
obicei, scoruri brute situate în acest interval la
scala AP (76% şi, respectiv, 71%).
Scala compozită Ineficacitate (SCI)
Scorul SCI se obţine prin însumarea cotelor
T ale scalelor SSS şi AP. Aceste scale corelează
semnificativ (≥0,80) atât pentru eşantioanele
clinice, cât şi pentru cele nonclinice, iar combina-
ţia lor creşte, în general, fidelitatea (α). SCI
include toţi itemii din subscala Ineficienţă din
varianta originală EDI‑2 şi adaugă trei itemi
puternic corelaţi din subscala Nesiguranţă Socială
a EDI‑2. Valorile mari ale acestui scor compozit
indică atât o autoevaluare scăzută, cât şi senzaţia
de vid emoţional, care reflectă un deficit
fundamental al identităţii personale. Tabelul 4.11
prezintă intervalele cotelor T şi ale centilelor care
corespund intervalelor clinice calitative pentru
SCI.
Intervalul de Semnificaţie clinică ridicată. Un
scor SCI în intervalul de Semnificaţie clinică
ridicată se situează între centilele 67 şi 99 (cota
 Tabelul 4.11
Intervalele cotelor T şi ale centilelor corespunzătoare intervalelor clinice calitative:
Scala compozită Ineficacitate
Eşantion clinic
Interval Adulţi
Semnificaţie clinică ridicată
Cota T ≥ 55
Centil ≥ 67
Semnificaţie clinică tipică
Cota T 43-54
Centil 25-66
Semnificaţie clinică scăzută
Cota T ≤ 42
Centil ≤ 24
T≥55) pentru eşantionul clinic combinat de
pacienţi adulţi din SUA şi reflectă prezenţa unui
deficit extrem la nivelul conceptului de sine, ceea
ce implică prezenţa unor sentimente extreme şi
permanente de vid emoţional şi de singurătate,
precum şi o înţelegere deficitară a propriei
persoane. Pacienţii diagnosticaţi cu tulburări
de comportament alimentar nu obţin, în mod
obişnuit, cote T situate în acest interval, iar un
pacient care obţine scoruri incluse în acest interval
ar trebui evaluat pentru a exclude depresia
severă şi posibila ideaţie suicidară. Respondenţii
adolescenţi şi adulţi din eşantioanele nonclinice
obţin rareori scoruri SCI situate în acest interval
(2% şi, respectiv, 3%).
Intervalul de Semnificaţie clinică tipică. Un scor
SCI în intervalul de Semnificaţie clinică tipică se
situează între centilele 25 şi 66 (cota T  =  43‑54)
pentru eşantionul clinic combinat de pacienţi
adulţi din SUA şi reflectă prezenţa unui deficit
semnificativ la nivelul conceptului de sine, asociat
cu sentimente permanente de vid emoţional şi de
singurătate, precum şi cu o înţelegere deficitară
a propriei persoane. Pacienţii diagnosticaţi cu
tulburări clinice de comportament alimentar
obţin în mod obişnuit scoruri la SCI situate
în acest interval; în orice caz, respondenţii
adolescenţi şi adulţi din eşantioanele non‑clinice
obţin mai rar scoruri SCI situate în acest interval
(între centilele 83 şi 97 şi, respectiv, între centilele
79 şi 96).
Intervalul de Semnificaţie clinică scăzută. Un
scor SCI în intervalul de Semnificaţie clinică
scăzută este situat între centilele 1 şi 24 (cota
T≤42) pentru eşantionul clinic combinat de
pacienţi adulţi din SUA şi sugerează faptul
că sentimentele profunde şi generale de
vid emoţional şi de singurătate, precum şi
înţelegerea deficitară a propriei persoane nu
Eşantion nonclinic
Adolescenţi Adulţi Adolescenţi
≥ 55
≥ 67 ≥ 97 ≥ 98
44-54
27-66 79-96 83-97
≤ 43
≤ 26 ≤ 78 ≤ 82
sunt atotcuprinzătoare sau debilitante. Cu toate
acestea, interpretarea ar trebui să ţină cont şi de
alte surse de informaţii clinice, pentru a determina
acurateţea autoevaluării. Un scor scăzut poate,
de asemenea, să reflecte negarea situaţiei clinice
actuale sau prezenţa distorsiunilor în răspunsuri
din partea pacientului. Respondenţii adolescenţi
şi adulţi din eşantioanele nonclinice obţin în mod
obişnuit scoruri SCI situate în acest interval (82%
şi, respectiv, 78%).
Indicatori de interpretare
Ineficacitatea ca un factor ce contribuie
la dezvoltarea şi menţinerea tulburărilor de
comportament alimentar. Bruch (1962) a fost prima
care a descris „toate sentimentele generalizate
de ineficacitate” ca fiind deficitul esenţial
în tulburările de comportament alimentar.
Formulările acesteia au sugerat o abordare
terapeutică bazată pe „constatarea faptelor”,
care accentua corectarea asumpţiilor defectuoase
legate de respectul de sine şi de percepţiile despre
propria persoană. Aceste principii, împreună cu
cele ale lui Beck (1976), au avut un rol influent
în abordările cognitiv‑comportamentale timpurii
asupra tulburărilor de comportament alimentar
(Garner şi Bemis, 1982; Guidano şi Liotti, 1983;
Slade, 1982). O premisă fundamentală în concep-
tualizările cognitiv‑comportamentale timpurii
ale tulburărilor alimentare a fost ideea conform
căreia stima de sine ajunge să se asocieze cu
greutatea şi forma corporală. Conform lui Garner
şi Bemis, tulburarea se cristalizează în momentul
în care convingerea că „este absolut esenţial
să slăbesc” se asociază implacabil cu reglarea
stimei de sine (în sensul că greutatea, forma sau
supleţea servesc drept „referinţă principală sau
85
predominantă pentru inferarea valorii personale
sau a respectului de sine” [p. 142]).
Rolul critic al stimei de sine scăzute în
dezvoltarea pattern‑urilor patologice de compor-
tament alimentar a fost susţinut în mai multe
studii longitudinale pe copii şi adolescenţi
(Fairburn şi Harrison, 2003; Garner, 1993b;
Jacobi şi colab., 2004; Quadflieg şi Fichter, 2003;
Steiner şi colab., 2003). Leon, Fulkerson, Perry,
Keel şi Klump (1999) au descoperit că stima
de sine scăzută este un predictor semnificativ
pentru dezvoltarea comportamentului alimentar
patologic atât la fete, cât şi la băieţi. Într‑un studiu
prospectiv de doi ani, stima de sine scăzută a fost
un predictor al alimentaţiei compulsive în cazul
adolescentelor (Stice, Presnell şi Spangler, 2002).
Într‑un studiu pe termen lung asupra rezultatelor
tratamentului pe pacienţi cu AN, Löwe şi colab.
(2001) au constatat că scorurile ridicate la
patru subscale EDI (Ineficacitate, Perfecţionism,
Neîncredere interpersonală, Conştiinţă interoceptivă)
au fost predictori puternici ai unui rezultat slab.
Scala Nesiguranţă interpersonală (NI)
Scala NI este compusă din şapte itemi care
evaluează prezenţa disconfortului, a îngrijorării
şi a reticenţei în situaţii de interacţiune socială.
Scala NI se centrează mai ales pe dificultăţi în
exprimarea propriilor gânduri şi emoţii faţă de
ceilalţi. Aceasta evaluează, de asemenea, tendinţa
de retragere şi izolare faţă de ceilalţi. Tabelul 4.12
prezintă intervalele scorurilor brute, ale cotelor
T şi ale centilelor care corespund intervalelor
clinice calitative pentru scala NI.
Tabelul 4.12
Intervalele scorurilor brute, ale cotelor T şi ale centilelor corespunzătoare intervalelor
clinice calitative: Scala Nesiguranţă interpersonală
Eşantion clinic
Interval Adulţi
Semnificaţie clinică ridicată
Scor brut 15-28
Cota T ≥ 56
Centil ≥ 67
Semnificaţie clinică tipică
Scor brut 7-14
Cota T 42-55
Centil 25-66
Semnificaţie clinică scăzută
Scor brut 0-6
Cota T ≤ 41
Centil ≤ 24
86
Intervalul de Semnificaţie clinică ridicată. Un
scor brut la scala NI cuprins între 15 şi 28 se
situează între centilele 67 şi 99 (cota T≥56) pentru
eşantionul clinic combinat de pacienţi adulţi
din SUA şi indică prezenţa unor stări profunde
de disconfort, îngrijorare şi reticenţă în situaţii
sociale. Scorul sugerează deopotrivă prezenţa
unor probleme frecvente şi semnificative în
ceea ce priveşte exprimarea gândurilor şi a
sentimentelor proprii faţă de ceilalţi, ceea ce
duce la retragere şi izolare socială. Scoruri brute
situate în acest interval la scala NI sunt obţinute,
în mod obişnuit, de pacienţi diagnosticaţi cu
tulburări clinice de comportament alimentar,
fapt ce sugerează prezenţa dificultăţilor în
comunicarea interpersonală. Deoarece comu-
nicarea este esenţială în psihoterapie, obţinerea
unui scor brut extrem de ridicat la scala NI
poate limita eficacitatea şi rezultatul final al
tratamentului. Respondenţii adolescenţi şi adulţi
din eşantioanele nonclinice obţin rareori scoruri
brute situate în acest interval la scala NI (4% şi,
respectiv, 5%).
Intervalul de Semnificaţie clinică tipică. Un
scor brut de 7 până la 14 la scala NI este situat
între centilele 25 şi 66 (cota T  =  42‑55) pentru
eşantionul clinic combinat de pacienţi adulţi din
SUA şi reflectă prezenţa unor stări semnificative
de disconfort, îngrijorare şi reticenţă în situaţii
sociale. Acesta sugerează, de asemenea, prezenţa
frecventă a problemelor la nivelul exprimării
gândurilor şi a sentimentelor proprii faţă de
ceilalţi, ceea ce duce la retragere şi izolare
socială. Pacienţii diagnosticaţi cu tulburări de
comportament alimentar obţin în mod obişnuit
Eşantion nonclinic
Adolescenţi Adulţi Adolescenţi
15-28
≥ 57
≥ 74 ≥ 95 ≥ 96
7-14
44-56
29-73 48-94 68-95
0-6
≤ 43
≤ 28 ≤ 47 ≤ 67
scoruri brute situate în acest interval la scala
NI, iar respondenţii adolescenţi şi adulţi din
eşantioanele nonclinice obţin şi ei astfel de
scoruri (între centilele 68 şi 95 şi, respectiv, între
centilele 48 şi 94).
Intervalul de Semnificaţie clinică scăzută. Un
scor brut mai mic sau egal cu 6 la scala NI este
situat între centilele 1 şi 24 (cota T≤41) pentru
eşantionul clinic combinat de pacienţi adulţi
din SUA şi sugerează existenţa unui disconfort
minim în situaţiile interpersonale sau sociale.
Acesta poate indica faptul că respondentul este
capabil să aibă relaţii interpersonale pozitive
şi abilităţi bune de comunicare, care îi permit
să îşi exprime propriile gânduri şi sentimente.
Cu toate acestea, interpretarea ar trebui să
ţină cont şi de alte surse de informaţii clinice,
pentru a determina acurateţea auto‑evaluării.
Un scor scăzut poate, de asemenea, să reflecte
negarea situaţiei clinice actuale sau prezenţa
unor distorsiuni ale răspunsurilor din partea
pacientului. Respondenţii adolescenţi şi adulţi
din eşantioanele nonclinice obţin în mod obişnuit
scoruri mai mici sau egale cu 6 la scala NI (67% şi,
respectiv, 47%).
Scala Alienare interpersonală (AI)
Scala AI este alcătuită din şapte itemi care
evaluează dezamăgirea, distanţarea, înstrăinarea
şi lipsa de încredere în relaţiile interpersonale. De
asemenea, scala măsoară tendinţa de a se simţi
prins în capcană în relaţii, precum şi impresia că
ceilalţi nu oferă suficientă afecţiune şi înţelegere.
Obţinerea unui scor ridicat la această scală
Tabelul 4.13
Intervalele scorurilor brute, ale cotelor T şi ale centilelor corespunzătoare
intervalelor clinice calitative: Scala Alienare interpersonală
Eşantion clinic
Interval Adulţi
Semnificaţie clinică ridicată
Scor brut 13-28
Cota T ≥ 55
Centil ≥ 67
Semnificaţie clinică tipică
Scor brut 6-12
Cota T 41-54
Centil 25-66
Semnificaţie clinică scăzută
Scor brut 0-5
Cota T ≤ 40
Centil ≤ 24
indică o incapacitate fundamentală în formarea
ataşamentului în relaţii. În tabelul 4.13 sunt
prezentate intervalele scorurilor brute, ale cotelor
T şi ale centilelor care corespund intervalelor
clinice calitative pentru scala AI.
Intervalul de Semnificaţie clinică ridicată.
Un scor brut la scala AI de 13 până la 28 se
situează între centilele 67 şi 99 (cota T≥55) pentru
eşantionul clinic combinat de pacienţi adulţi din
SUA şi indică prezenţa unui nivel extrem de
crescut de dezamăgire, distanţare, înstrăinare
şi lipsă de încredere în relaţiile interpersonale.
Acesta indică, de asemenea, o tendinţă puternică
de a se simţi prins în capcană în relaţii, precum şi
impresia că ceilalţi nu oferă suficientă afecţiune şi
înţelegere. Pacienţii diagnosticaţi cu tulburări de
comportament alimentar nu obţin în mod obişnuit
scoruri brute la scala AI situate în acest interval.
Obţinerea de scoruri în acest interval sugerează
prezenţa unor dificultăţi foarte serioase la nivelul
relaţiilor interpersonale. Datorită faptului că
o legătură interpersonală pozitivă s‑a dovedit
a fi un factor care contribuie semnificativ la un
rezultat pozitiv al psihoterapiei, obţinerea unui
scor brut extrem de ridicat reflectă prezenţa unor
obstacole interpersonale care ar putea interfera
cu tratamentul. Respondenţii adolescenţi şi
adulţi din eşantioanele non‑clinice obţin rareori
scoruri brute situate în acest interval la scala AI
(5% şi, respectiv, 9%).
Intervalul de Semnificaţie clinică tipică. Un
scor brut de 6 până la 12 la scala AI este situat
între centilele 25 şi 66 (cota T=41‑54) pentru
eşantionul clinic combinat de pacienţi adulţi din
S.U.A. şi indică prezenţa unui nivel semnificativ
Eşantion nonclinic
Adolescenţi Adulţi Adolescenţi
13-28
≥ 56
≥ 71 ≥ 91 ≥ 95
6-12
43-55
28-70 56-90 57-94
0-5
≤ 42
≤ 27 ≤ 55 ≤ 56
87
de dezamăgire, distanţare, înstrăinare şi lipsă
de încredere în relaţiile interpersonale. Acesta
indică, de asemenea, o tendinţă puternică de
a se simţi prins în capcană în relaţii, precum şi
impresia că ceilalţi nu oferă suficientă afecţiune şi
înţelegere. Pacienţii diagnosticaţi cu tulburări de
comportament alimentar obţin în mod obişnuit
scoruri brute la scala AI situate în acest interval;
în orice caz, respondenţii adolescenţi şi adulţi din
eşantioanele non‑clinice nu obţin în mod obişnuit
astfel de scoruri la scala AI (între centilele 57 şi 94
şi, respectiv, între centilele 56 şi  90).
Intervalul de Semnificaţie clinică scăzută.
Un scor brut mai mic sau egal cu 5 la scala AI
se situează între centilele 1 şi 24 (cota T≤40)
pentru eşantionul clinic combinat de pacienţi
adulţi din SUA şi sugerează faptul că, de obicei,
individul nu simte un nivel semnificativ de
distanţare, înstrăinare şi lipsă de încredere
în relaţiile interpersonale. Scorul denotă, de
asemenea, faptul că respondentul poate avea
relaţii interpersonale pozitive şi de încredere,
care îi oferă sentimentul că este înţeles şi iubit.
Cu toate acestea, interpretarea ar trebui să
ţină cont şi de alte surse de informaţii clinice,
pentru a determina acurateţea autoevaluării.
Un scor scăzut poate să reflecte, de asemenea,
negarea situaţiei clinice actuale sau prezenţa
unor distorsiuni ale răspunsurilor din partea
pacientului. Respondenţii adolescenţi şi adulţi
din eşantioanele nonclinice obţin în mod obişnuit
scoruri brute mai mici sau egale cu 5 la scala AI
(56% şi, respectiv, 55%).
Scala compozită Probleme interpersonale
(SCPI)
Scorul SCPI este obţinut prin însumarea
cotelor T ale scalelor NI şi AI. Aceste scale
Tabelul 4.14
Intervalele cotelor T şi ale centilelor corespunzătoare intervalelor clinice calitative:
Scala compozită Probleme interpersonale
Eşantion clinic
Interval Adulţi
Semnificaţie clinică ridicată
Cota T ≥ 55
Centil ≥ 67
Semnificaţie clinică tipică
Cota T 42-54
Centil 25-66
Semnificaţie clinică scăzută
Cota T ≤ 41
Centil ≤ 24
88
corelează, însă, doar moderat. Scorul SCPI reflectă
experienţa respondentului conform căreia relaţiile
sociale sunt tensionate, nesigure, dezamăgitoare,
nesatisfăcătoare şi, în general, de proastă calitate.
Mulţi pacienţi cu tulburări de comportament
alimentar sunt descrişi ca având sentimente de
nesiguranţă şi îndoială în legătură cu propria
persoană în situaţiile sociale, împreună cu o lipsă
generală de încredere în relaţiile sociale. Acest
fapt indică existenţa unui deficit sever al abilităţii
de a forma ataşamente, ceea ce are nenumărate
implicaţii în relaţia terapeutică. Problemele
interpersonale joacă şi ele un rol în menţinerea
simptomelor tulburărilor de comportament
alimentar la multe dintre persoanele afectate şi
constituie un scop important în terapie. Tabelul
4.14 prezintă intervalele cotelor T şi ale centilelor
care corespund intervalelor clinice calitative
pentru scorul SCPI.
Intervalul de Semnificaţie clinică ridicată. Un
scor SCPI în intervalul de Semnificaţie clinică
ridicată se situează între centilele 67 şi 99 (cota
T≥55) pentru eşantionul clinic combinat de
pacienţi adulţi din S.U.A., indicând prezenţa
unui distres extrem şi senzaţia că relaţiile sociale
sunt tensionate, nesigure, dezamăgitoare,
nesatisfăcătoare şi, în general, de proastă calitate.
Acesta indică totodată o tendinţă puternică de
a se simţi prins în capcană în relaţii, precum şi
impresia că ceilalţi nu oferă suficientă afecţiune
şi înţelegere. Pacienţii diagnosticaţi cu tulburări
clinice de comportament alimentar nu obţin
în mod obişnuit scoruri SCPI situate în acest
interval. Obţinerea unui astfel de scor reflectă
existenţa unor probleme interpersonale foarte
serioase, care pot reprezenta obstacole majore
în cadrul procesului psihoterapeutic, precum şi
în stabilirea unui mediu interpersonal care să
faciliteze recuperarea. Respondenţii adolescenţi
Eşantion nonclinic
Adolescenţi Adulţi Adolescenţi
≥ 63
≥ 89 ≥ 94 ≥ 95
43-62
27-88 59-93 61-94
≤ 42
≤ 26 ≤ 58 ≤ 60
şi adulţi din eşantioanele non‑clinice obţin
rareori scoruri SCPI situate în acest interval (5%
şi, respectiv, 4%).
Intervalul de Semnificaţie clinică tipică. Un
scor SCPI în intervalul de Semnificaţie clinică
tipică se situează între centilele 25 şi 66 (cota
T  =  42‑54) pentru eşantionul clinic combinat
de pacienţi adulţi din SUA şi indică prezenţa
unui distres semnificativ şi senzaţia că relaţiile
sociale sunt tensionate, nesigure, dezamăgitoare,
nesatisfăcătoare şi, în general, de proastă calitate.
Scorul indică totodată o tendinţă puternică de
a se simţi prins în capcană în relaţii, precum şi
impresia că ceilalţi nu oferă suficientă afecţiune
şi înţelegere. Acesta reflectă existenţa unor
probleme interpersonale însemnate, care pot
reprezenta obstacole majore în cadrul procesului
psihoterapeutic, precum şi în stabilirea
unui mediu interpersonal care să faciliteze
recuperarea. Pacienţii diagnosticaţi cu tulburări
clinice de comportament alimentar obţin în mod
obişnuit scoruri SCPI situate în acest interval, iar
respondenţii adolescenţi şi adulţi din eşantioanele
nonclinice obţin şi ei în mod obişnuit scoruri
SCPI situate în acest interval (între centilele 61 şi
94 şi, respectiv, între centilele 59 şi 93).
Intervalul de Semnificaţie clinică scăzută. Un scor
SCPI în intervalul de Semnificaţie clinică scăzută
este situat între centilele 1 şi 24 (cota T≤41) pentru
eşantionul clinic combinat de pacienţi adulţi din
SUA şi sugerează faptul că, de obicei, individul
nu are probleme interpersonale semnificative sau
persistente. Acesta ar putea indica, de asemenea,
prezenţa de ataşamente interpersonale sigure
şi de încredere, care sunt satisfăcătoare şi, în
general, de calitate. Obţinerea unui asemenea
scor mai poate denota faptul că respondentul
are capacitatea de a resimţi sprijinul, înţelegerea
şi dragostea în relaţii. Cu toate acestea,
interpretarea ar trebui să ţină cont şi de alte
surse de informaţii clinice, pentru a determina
acurateţea autoevaluării. De asemenea, un scor
mic poate reflecta negarea situaţiei clinice actuale
sau prezenţa unor răspunsuri distorsionate din
partea pacientului. Respondenţii adolescenţi şi
adulţi din eşantioanele non‑clinice obţin în mod
obişnuit scoruri SCPI situate în acest interval
(60% şi, respectiv, 58%).
Indicatori de interpretare
Probleme interpersonale. Problemele inter-
personale au fost identificate în mod repetat
ca fiind factori de risc importanţi pentru
dezvoltarea tulburărilor de comportament
alimentar (pentru treceri în revistă, a se vedea
Fairburn şi Harrison, 2003; Garner, 1993a;
Jacobi şi colab., 2004; Quadflieg şi Fichter, 2003;
Steiner şi colab., 2003), precum şi factori de risc
pentru menţinerea acestora. Acestea au fost, de
asemenea, asociate cu prognosticul pe termen
lung al pacienţilor care se află sub tratament.
Casper şi Jabine (1996) au constatat că o calitate
scăzută a relaţiilor familiale, a contactelor sociale
şi a funcţionării la locul de muncă − evaluată
prin venit − au prezis un rezultat slab în cazul
pacienţilor adulţi şi adolescenţi cu AN. În mod
similar, într‑un studiu follow‑up de 10 ani,
realizat pe pacienţi diagnosticaţi cu AN cu debut
în adolescenţă, Wentz şi colab. (2001) au observat
că jumătate dintre pacienţi au avut rezultate
psihologice slabe şi că debutul în adolescenţă a
fost un predictor puternic al rezultatului. Într‑un
studiu prospectiv desfăşurat pe parcursul a 21
de ani, realizat pe pacienţi cu AN, Zipfel, Löwe,
Reas, Deter şi Herzog (2000) au raportat faptul
că problemele sociale severe sunt predictori
importanţi ai rezultatului tratamentului. În mod
asemăntor, s‑a dovedit că adaptarea socială
slabă este un predictor al rezultatelor negative,
în cazul pacienţilor cu BN (Fairburn şi Harrison,
2003; Keel şi colab., 2002; Norman şi Herzog,
1984; Quadflieg şi Fichter, 2003; Steiger, Leung
şi Thibaudeau, 1993). S‑a constatat că scorurile
brute ridicate la subscala EDI‑2 Neîncredere
interpersonală prezic rezultate negative pe termen
lung în cazul AN (Bizeul şi colab., 2001) şi o rată
mare a recidivelor în cazul BN (Olmsted, Kaplan
şi Rockert, 1994).
Scala Deficite interoceptive (DI)
Scala DI este formată din nouă itemi care
măsoară confuzia în legătură cu acurateţea
recunoaşterii stărilor emoţionale şi cu răspunsul
în mod adecvat la acestea. Cele două clustere
identificate pentru scala DI sunt clusterul de
itemi Frica de emoţii, care indică starea de distres
atunci când emoţiile sunt prea puternice sau
scăpate de sub control, cluster care contrastează
cu clusterul de itemi Confuzie afectivă, care
evidenţiază dificultăţi în recunoaşterea acurată
a stărilor emoţionale. Confuzia şi lipsa de
încredere cu privire la funcţionarea afectivă
şi a corpului au fost în mod repetat descrise ca
fiind caracteristici importante ale persoanelor
care dezvoltă tulburări ale comportamentului
alimentar. Bruch (1962) a fost prima care a sugerat
că „lipsa conştiinţei interoceptive” este esenţială
pentru înţelegerea tulburărilor de comportament
alimentar. Tabelul 4.15 prezintă intervalele
scorurilor brute, ale cotelor T şi ale centilelor care
89
 Tabelul 4.15
Intervalele scorurilor brute, ale cotelor T şi ale centilelor corespunzătoare intervalelor
clinice calitative: Scala Deficite interoceptive
Eşantion clinic
Interval Adulţi
Semnificaţie clinică ridicată
Scor brut 21-36
Cota T ≥ 55
Centil ≥ 67
Semnificaţie clinică tipică
Scor brut 11-20
Cota T 42-54
Centil 25-66
Semnificaţie clinică scăzută
Scor brut 0-10
Cota T ≤ 41
Centil ≤ 24
corespund intervalelor clinice calitative pentru
scala DI.
Intervalul de Semnificaţie clinică ridicată.
Un scor brut la scala DI de 21 până la 36 se
situează între centilele 67 şi 99 (scor T≥55)
pentru eşantionul clinic combinat de pacienţi
adulţi din SUA şi indică prezenţa unui nivel
extrem de confuzie în legătură cu recunoaşterea
acurată şi cu răspunsul în mod adecvat la stările
emoţionale, precum şi o stare intensă de teamă
şi neîncredere în legătură cu anumite emoţii,
atunci când acestea sunt prea puternice sau
când sunt percepute ca incontrolabile. Pot fi
declanşate diferite strategii de „evadare” din
confuzia, disconfortul sau teama produse de stări
emoţionale negative sau chiar pozitive. Emoţiile
sunt mai degrabă evaluate, pentru a determina
dacă sunt „valide”, „adecvate”, „justificate”
sau „legitime”, decât pur şi simplu acceptate.
Această reacţie poate crea obstacole majore în
psihoterapie, deoarece procesul declanşează, de
multe ori, emoţii intense. Pacienţii diagnosticaţi
cu tulburări de comportament alimentar nu obţin,
de regulă, scoruri brute situate în acest inteval la
scala DI, iar respondenţii adolescenţi şi adulţi
din eşantioanele nonclinice obţin rareori astfel de
scoruri (2% şi, respectiv, 4%). Aşadar, obţinerea
unui scor situat în acest interval arată ca fiind
foarte probabil un nivel ridicat de psihopatologie
în privinţa acestei dimensiuni.
Intervalul de Semnificaţie clinică tipică. Un
scor brut de 11 până la 20 la scala DI este situat
între centilele 25 şi 66 (cota T  =  42‑54) pentru
eşantionul clinic combinat de pacienţi adulţi din
SUA şi indică prezenţa unui grad semnificativ de
confuzie în legătură cu recunoaşterea acurată şi
90
Eşantion nonclinic
Adolescenţi Adulţi Adolescenţi
21-36
≥ 57
≥ 71 ≥ 96 ≥ 98
11-20
46-56
35-70 76-95 77-97
0-10
≤ 45
≤ 34 ≤ 75 ≤ 76
cu răspunsul în mod adecvat la stările emoţionale,
precum şi o stare intensă de teamă şi neîncredere
în legătură cu anumite emoţii, atunci când acestea
sunt prea puternice sau când sunt percepute ca
incontrolabile. Pot fi declanşate diferite strategii
de „evadare” din confuzia, disconfortul sau
teama produse de stări emoţionale negative
sau chiar pozitive, extrem de intense. Emoţiile
sunt mai degrabă evaluate, pentru a determina
dacă sunt „valide”, „adecvate”, „justificate”
sau „legitime”, decât pur şi simplu acceptate.
Această reacţie poate crea obstacole majore în
psihoterapie, deoarece acest proces declanşează
deseori emoţii intense. Experienţele respective
nu sunt caracteristice doar celor cu tulburări
de comportament alimentar, niveluri similare
fiind întâlnite şi la pacienţi cu alte diagnostice
psihiatrice. Pacienţii diagnosticaţi cu tulburări
clinice de comportament alimentar obţin în mod
obişnuit scoruri brute situate în acest interval la
scala DI; pe de altă parte, respondenţii adolescenţi
şi adulţi din eşantioanele nonclinice nu obţin, de
regulă, astfel de scoruri (între centilele 77 şi 97 şi,
respectiv, între centilele 76 şi 95).
Intervalul de Semnificaţie clinică scăzută. Un
scor brut mai mic sau egal cu 10 la scala DI se
situează între centilele 1 şi 24 (cota T≤41) pentru
eşantionul clinic combinat de pacienţi adulţi
din SUA şi sugerează faptul că individul nu
are probleme serioase de identificare a stărilor
emoţionale şi de răspuns în mod adecvat la ele.
Acest lucru presupune prezenţa abilităţii de a
face faţă experienţelor emoţionale inconfortabile,
pozitive sau negative. Emoţiile tind, mai
degrabă, să fie acceptate, decât să fie evaluate
critic pentru a determina dacă sunt „valide”,
„adecvate”, „justificate” sau „legitime”. Cu toate
acestea, interpretarea ar trebui să ţină cont şi de
alte surse de informaţii clinice, pentru a stabili
acurateţea autoevaluării. Un scor scăzut poate,
de asemenea, să reflecte negarea situaţiei clinice
actuale sau prezenţa răspunsurilor distorsionate
din partea pacientului. Respondenţii adolescenţi
şi adulţi din eşantioanele non‑clinice obţin în
mod obişnuit scoruri brute mai mici sau egale cu
10 la scala DI (76% şi, respectiv, 75%).
Clusterele de itemi Frica de emoţii şi Confuzie
afectivă. Analiza factorială exploratorie (AFE)
pentru scala DI a produs două clustere de itemi:
Frica de emoţii (doi itemi) şi Confuzie afectivă
(şapte itemi). Ambele clustere de itemi sunt
experimentale; în consecinţă, scorurile brute
pentru eşantionul clinic de pacienţi adulţi din
SUA sunt prezentate în tabelele 4.16 şi 4.17, fără
indicaţii specifice de interpretare, împreună
cu intervalele asociate ale centilelor pentru
eşantionul clinic de pacienţi adolescenţi din SUA
şi eşantioanele nonclinice de adulţi şi adolescenţi.
S‑a dovedit că deficitele interoceptive, aşa cum au
fost măsurate de subscala Conştiinţă interoceptivă
a EDI‑2, prezic un prognostic defavorabil în
cazul pacienţilor cu AN la un follow‑up de 5
până la 10 ani (Bizeul şi colab., 2001). Aceasta este
totodată şi singura subscală EDI‑2 care prezice
comportamentul de auto‑vătămare compulsivă
la pacienţii cu BN (Favaro şi Santonastaso, 1998,
1999).
Scala Dezechilibru emoţional (DE)
Scala DE este compusă din opt itemi
care evaluează tendinţa spre instabilitate
dispoziţională, impulsivitate, nechibzuinţă, furie
şi comportamente auto‑distructive. Doi dintre
itemii scalei evaluează potenţialele probleme
legate de abuzul de substanţe: unul pentru alcool
şi unul pentru medicamente. Tendinţele către
o reglare deficitară a impulsului şi către lipsa
de toleranţă la schimbările de dispoziţie au fost

Tabelul 4.16
Intervalele scorurilor brute şi ale centilelor: Clusterul Frica de emoţii

Eşantion clinic Eşantion nonclinic

Interval Adulţi Adolescenţi Adulţi Adolescenţi
Semnificaţie clinică ridicată
Scor brut 6-8 6-8
Centil ≥ 67 ≥ 80 ≥ 95 ≥ 98
Semnificaţie clinică tipică
Scor brut 2-5 2-5
Centil 25-66 48-79 75-94 87-97
Semnificaţie clinică scăzută
Scor brut 0-1 0-1
Centil ≤ 24 ≤ 47 ≤ 74 ≤ 86

Tabelul 4.17
Intervalele scorurilor brute şi ale centilelor: Clusterul Confuzie afectivă

Eşantion clinic Eşantion nonclinic

Interval Adulţi Adolescenţi Adulţi Adolescenţi
Semnificaţie clinică ridicată
Scor brut 16-28 16-28
Centil ≥ 67 ≥ 71 ≥ 95 ≥ 97
Semnificaţie clinică tipică
Scor brut 8-15 8-15
Centil 25-66 39-70 75-94 72-96
Semnificaţie clinică scăzută
Scor brut 0-7 0-7
Centil ≤ 24 ≤ 38 ≤ 74 ≤ 71

91
 Tabelul 4.18
Intervalele scorurilor brute, ale cotelor T şi ale centilelor corespunzătoare intervalelor clinice
calitative: Scala Dezechilibru emoţional
Eşantion clinic
Interval Adulţi
Semnificaţie clinică ridicată
Scor brut 10-32
Cota T ≥ 53
Centil ≥ 67
Semnificaţie clinică tipică
Scor brut 4-9
Cota T 42-52
Centil 25-66
Semnificaţie clinică scăzută
Scor brut 0-3
Cota T ≤ 41
Centil ≤ 24
identificate printre semnele unui prognostic
defavorabil în tratamentul tulburărilor de
comportament alimentar. Itemii din scala DE
evaluează atributele emoţionale caracteristice
unui subgrup de pacienţi cu tulburări ale
comportamentului alimentar, care sunt
consideraţi deosebit de rezistenţi la tratament. În
tabelul 4.18 sunt prezentate intervalele scorurilor
brute, ale cotelor T şi ale centilelor care crespund
intervalelor clinice calitative pentru scala DE.
Intervalul de Semnificaţie clinică ridicată.
Un scor brut la scala DE de 10 până la 32 se
situează între centilele 67 şi 99 (cota T≥53) pentru
eşantionul clinic combinat de pacienţi adulţi din
SUA şi indică prezenţa unei tendinţe extreme
spre instabilitate dispoziţională, impulsivitate,
nechibzuinţă, furie şi comportamente auto‑dis-
tructive. Aceasta ar putea fi asociată cu probleme
legate de abuzul de substanţe, cum ar fi alcoolul,
medicamentele sau ambele. Obţinerea unui
scor în acest interval indică tendinţe de reglare
deficitară a impulsului, de lipsă de toleranţă la
schimbările dispoziţionale şi de auto‑vătămare,
indicatori ai unui prognostic defavorabil în
tratamentul tulburărilor de comportament
alimentar. Aceste tendinţe pot crea obstacole
majore în cadrul procesului terapeutic, deoarece
acest proces provoacă deseori declanşarea de
emoţii intense. Pacienţii diagnosticaţi cu tulburări
de comportament alimentar şi respondenţii
adolescenţi şi adulţi din eşantioanele nonclinice
nu obţin în mod obişnuit scoruri brute situate în
acest interval la scala DE (13% şi, respectiv, 12%).
Aşadar, obţinerea unui scor în acest interval
92
Eşantion nonclinic
Adolescenţi Adulţi Adolescenţi
10-32
≥ 55
≥ 73 ≥ 88 ≥ 87
4-9
44-54
28-72 48-87 46-86
0-3
≤ 43
≤ 27 ≤ 47 ≤ 45
poate indica un grad crescut de psihopatologie în
acest domeniu.
Intervalul de Semnificaţie clinică tipică. Un
scor brut de 4 până la 9 la scala DE este situat
între centilele 25 şi 66 (cota T  =  42‑52) pentru
eşantionul clinic combinat de pacienţi adulţi din
SUA şi indică prezenţa unui grad semnificativ
de instabilitate dispoziţională, impulsivitate,
nechibzuinţă, furie şi comportamente auto‑dis-
tructive. Acesta se poate asocia şi cu probleme
legate de abuzul de substanţe, precum alcoolul,
medicamentele sau ambele. Obţinerea unui
scor în acest interval indică tendinţe de reglare
deficitară a impulsului, de lipsă de toleranţă la
schimbările dispoziţionale şi de auto‑vătămare,
indicatori ai unui prognostic defavorabil în
tratamentul tulburărilor de comportament
alimentar. Aceste reacţii pot crea obstacole majore
în cadrul procesului terapeutic, deoarece acesta
provoacă deseori declanşarea de emoţii intense.
Experienţele respective nu sunt caracteristice
doar celor cu tulburări de comportament
alimentar, niveluri similare fiind întâlnite şi la
pacienţi cu alte diagnostice psihiatrice. Pacienţii
diagnosticaţi cu tulburări alimentare clinice
obţin în mod obişnuit scoruri brute la scala DE
situate în acest interval; în orice caz, respondenţii
adolescenţi şi adulţi din eşantioanele nonclinice
obţin şi ei în mod obişnuit astfel de scoruri (între
centilele 46 şi 86 şi, respectiv, între centilele 48
şi  87).
Intervalul de Semnificaţie clinică scăzută. Un scor
brut mai mic sau egal cu 3 la scala DE se situează
între centilele 1 şi 24 (cota T≤41) pentru eşantionul
clinic combinat de pacienţi adulţi din SUA şi
sugerează faptul că individul nu are probleme
semnificative în ceea ce priveşte instabilitatea
emoţională, impulsivitatea, nechibzuinţa, furia
sau comportamentele auto‑distructive. De
asemenea, este puţin probabil să aibă probleme
legate de abuzul de substanţe, precum alcoolul,
medicamentele sau ambele. Un scor mic este
un indicator pozitiv al efectelor tratamentului.
Cu toate acestea, interpretarea scorurilor brute
la scala DE ar trebui să ia în considerare şi alte
surse de informaţii clinice, pentru a determina
acurateţea autoevaluării. Un scor scăzut poate,
de asemenea, să reflecte negarea situaţiei clinice
actuale sau prezenţa răspunsurilor distorsionate
din partea pacientului. Respondenţii adolescenţi
şi adulţi din eşantioanele nonclinice obţin în mod
obişnuit scoruri brute mai mici sau egale cu 3 la
scala DE (45% şi, respectiv, 47%).
Clusterul de itemi Risc pentru abuz de
substanţe (RAS)
Doi itemi din scala DE indică existenţa posi-
bilă a unor probleme legate de abuzul de substan-
ţe: unul pentru alcool şi altul pentru medicamente.
Majoritatea indivizilor din eşantioanele clinice şi
non‑clinice au un scor de 0 sau 1 la clusterul de
itemi RAS. Obţinerea de scoruri în intervalul de
Semnificaţie clinică ridicată la acest cluster de
itemi este neobişnuită, atât pentru eşantioanele
clinice, cât şi pentru cele nonclinice, iar pacienţii
trebuie evaluaţi în continuare pentru a stabili
dacă abuzul de substanţe reprezintă o problemă
de natură clinică. Clusterul de itemi RAS este
experimental; în consecinţă, scorurile brute
corespunzătoare intervalelor clinice şi centilele
în cazul adulţilor sunt prezentate în tabelul 4.19,
fără indicaţii specifice de interpretare, împreună
Tabelul 4.19
Intervalele scorurilor brute şi ale centilelor: Clusterul Risc pentru abuz de substanţe
Eşantion clinic
Interval Adulţi
Semnificaţie clinică ridicată
Scor brut 5-8
Centil ≥ 94
Semnificaţie clinică tipică
Scor brut 2-4
Centil 83-93
Semnificaţie clinică scăzută
Scor brut 0-1
Centil ≤ 82
cu centilele asociate pentru eşantioanele clinice şi
nonclinice de pacienţi adolescenţi.
Paul, Schroeter, Dahme şi Nutzinger (2002)
au descoperit în rândul pacienţilor cu tulburări
de comportament alimentar o rată de 34,6% de
producere a comportamentului de auto‑vătămare
de‑a lungul vieţii, cele mai mari frecvenţe fiind
găsite la pacienţii cu TCAFAS (35,8%) şi cu BN
(34,3%), precum şi o rată de 21,3% de producere
a comportamentului de auto‑vătămare în
decurs de 6 luni. Pacienţii cu comportamente de
auto‑vătămare au relatat un număr semnificativ
mai mare de evenimente traumatice, au avut
scoruri semnificativ mai ridicate la disociere şi
au manifestat semnificativ mai multe gânduri
şi comportamente obsesiv‑compulsive. Pacienţii
cu BN au avut scoruri semnificativ mai mari la
impulsivitate.
În descrierea iniţală a BN, Russell (1979) nota
faptul că abuzul de alcool este o trăsătură asociată
în mod obişnuit cu această tulburare, iar acest
lucru a fost confirmat şi de studii mai recente
(Kozyk, Touyz şi Beumont, 1998). S‑a dovedit, de
asemenea, că dependenţa şi abuzul de alcool şi
de medicamente reprezintă factori de risc pentru
tulburările de comportament alimentar (Jacobi şi
colab., 2004). Majoritatea studiilor au descoperit
că, la pacienţii cu AN-AC/V şi BN, consumul
de alcool şi de medicamente este mai frecvent
decât la pacienţii cu AN-R (Garner şi colab., 1985;
Garner, Garner şi colab., 1993; Herzog, Keller,
Lavori, Kenny şi Sacks, 1992; Toner, Garfinkel şi
Garner, 1986). Cu toate acestea, este important
de notat faptul că majoritatea pacienţilor din
fiecare grup diagnostic nu raportează probleme
legate de consumul de substanţe. Kozyk şi colab.
(1998) au sugerat că nivelurile ridicate observate
în grupul clinic pot fi un artefact al relaţiei dintre
Eşantion nonclinic
Adolescenţi Adulţi Adolescenţi
5-8
≥ 97 ≥ 98 ≥ 95
2-4
93-96 90-97 94
0-1
≤ 92 ≤ 89 ≤ 93
93
tulburările de personalitate şi consumul riscant
de alcool. Loxton şi Dawe (2001) au descoperit
că, la adolescente, abuzul de alcool a fost prezis
de o sensibilitate crescută la recompense,
iar comportamentul alimentar disfuncţional
a fost prezis de sensibilitatea crescută atât
la recompensă, cât şi la pedeapsă. Studiul a
sugerat, de asemenea, că fetele care se angajează
în comportamente alimentare disfuncţionale, în
prezenţa sau în absenţa abuzului de alcool, pot
fi mai sensibile la pedepsele potenţiale decât
fetele fără tulburări de comportament alimentar,
dar care au avut probleme legate de abuzul
de alcool. Autorii au afirmat că cercetarea lor
pare să susţină studiile care arată că femeile
care au consumat alcool au scoruri mai mari
la măsurătorile impulsivităţii şi ale căutării de
senzaţii, decât persoanele din lotul de control.
Scala compozită Probleme emoţionale (SCPE)
Scorul SCPE este obţinut prin însumarea
cotelor T ale scalelor DI şi DE. Acest scor măsoară
abilitatea de a identifica,a înţelege sau a răspunde
în mod corect la stările emoţionale. Aceasta poate
reflecta probleme de identificare a emoţiilor sau
de răspuns prin frică, confuzie sau neîncredere.
Scorul SCPE poate evidenţia, de asemenea,
instabilitatea dispoziţională, labilitatea, in-
toleranţa, impulsivitatea, nechibzuinţa, furia,
comportamentele auto‑distructive şi întrebu-
inţarea greşită a substanţelor pentru controlul
dispoziţiei. Aceste probleme de reglare a
dispoziţiei afective pot fi factori importanţi
care contribuie la menţinerea unei tulburări
de comportament alimentar şi se pot constitui
în probleme dificile pe parcursul terapiei.
Problemele de reglare a dispoziţiei afective au
Tabelul 4.20
Intervalele cotelor T şi ale centilelor corespunzătoare intervalelor clinice calitative:
Scala compozită Probleme emoţionale
Eşantion clinic
Interval Adulţi
Semnificaţie clinică ridicată
Cota T ≥ 54
Centil ≥ 67
Semnificaţie clinică tipică
Cota T 43-53
Centil 25-66
Semnificaţie clinică scăzută
Cota T ≤ 42
Centil ≤ 24
94
fost identificate, de asemenea, ca fiind semne
ale unui prognostic negativ în tulburările de
comportament alimentar. În tabelul 4.20 sunt
prezentate intervalele cotelor T şi ale centilelor
care corespund intervalelor clinice calitative
pentru scorul SCPE.
Intervalul de Semnificaţie clinică ridicată. Un
scor SCPE în intervalul de Semnificaţie clinică
ridicată se situează între centilele 67 şi 99 (cota
T≥54) pentru eşantionul clinic combinat de
pacienţi adulţi din SUA, indicând prezenţa unor
probleme severe şi persistente de identificare,
înţelegere sau răspuns în mod corect la stările
emoţionale. Acest scor poate reflecta dificultăţi
în identificarea sau răspunsul la emoţii sau
reacţie prin frică, confuzie sau neîncredere.
Scorul SCPE poate evidenţia, de asemenea,
instabilitatea dispoziţională, intoleranţa dispo-
ziţională, impulsivitatea, nechibzuinţa, furia,
comportamentele auto‑distructive şi abuzul
de substanţe pentru controlul dispoziţiei.
Pacienţii diagnosticaţi cu tulburări clinice de
comportament alimentar nu obţin, de regulă,
scoruri SCPE situate în acest interval; acest scor
sugerează existenţa unor probleme serioase
de reglare emoţională, ceea ce poate ridica
obstacole majore în această privinţă în cadrul
procesului psihoterapeutic. Astfel, obţinerea
unui scor în acest interval poate indica un grad
ridicat de psihopatologie referitoare la această
dimensiune. Respondenţii adolescenţi şi adulţi
din eşantioanele nonclinice obţin rareori scoruri
SCPE situate în acest interval (4% şi, respectiv,
7%).
Intervalul de Semnificaţie clinică tipică. Un
scor SCPE în intervalul de Semnificaţie clinică
tipică se situează între centilele 25 şi 66 (cota
T  =  43‑53) pentru eşantionul clinic combinat
Eşantion nonclinic
Adolescenţi Adulţi Adolescenţi
≥ 54
≥ 65 ≥ 93 ≥ 96
43-53
27-64 73-92 72-95
≤ 42
≤ 26 ≤ 72 ≤ 71
de pacienţi adulţi din SUA şi indică prezenţa
unor probleme semnificative de identificare,
înţelegere sau răspuns în mod corect la stările
emoţionale. Acesta poate reflecta dificultăţi de
a răspunde în mod adecvat la emoţii sau reacţii
de frică, confuzie sau neîncredere. Scorul SCPE
în acest interval poate evidenţia, de asemenea,
instabilitatea dispoziţională, intoleranţa dispo-
ziţională, impulsivitatea, nechibzuinţa, furia,
comportamentele auto‑distructive şi abuzul
de substanţe cu scopul de a controla dispoziţia
afectivă. Acest scor indică şi prezenţa unor
probleme semnificative de reglare emoţională,
care pot reprezenta obstacole majore în cadrul
psihoterapiei. Pacienţii diagnosticaţi cu tulburări
clinice de comportament alimentar obţin, în mod
obişnuit, scoruri SCPE situate în acest interval;
oricum, acest fapt nu este caracteristic doar
celor cu tulburări de comportament alimentar,
deoarece niveluri similare sunt întâlnite şi la
persoanele cu alte diagnostice psihiatrice. Pe de
altă parte, respondenţii adolescenţi şi adulţi din
eşantioanele nonclinice nu obţin în mod obişnuit
scoruri la scala SCPE situate în acest interval
(între centilele 72 şi 95 şi, respectiv, între centilele
73 şi 92).
Intervalul de Semnificaţie clinică scăzută. Un
scor SCPE în intervalul de Semnificaţie clinică
scăzută este situat între centilele 1 şi 24 (cota
T≤42) pentru eşantionul clinic combinat de
pacienţi adulţi din SUA şi sugerează faptul că
individul nu resimte, de obicei, prezenţa unor
probleme semnificative sau persistente la nivelul
identificării, al înţelegerii sau al răspunsului în
mod corect la stările emoţionale. Este probabil
Tabelul 4.21
Intervalele scorurilor brute, ale cotelor T şi ale centilelor corespunzătoare
intervalelor clinice calitative: Scala Perfecţionism
Eşantion clinic
Interval Adulţi
Semnificaţie clinică ridicată
Scor brut 17-24
Cota T ≥ 55
Centil ≥ 67
Semnificaţie clinică tipică
Scor brut 10-16
Cota T 43-54
Centil 25-66
Semnificaţie clinică scăzută
Scor brut 0-9
Cota T ≤ 42
Centil ≤ 24
ca persoana să nu răspundă la emoţii prin
frică, confuzie sau neîncredere. De asemenea,
este probabil ca impulsivitatea, instabilitatea,
labilitatea şi intoleranţa dispoziţională să nu
reprezinte probleme semnificative. Cu toate
acestea, interpretarea ar trebui să ia în considerare
şi alte surse de informaţii clinice, pentru a stabili
acurateţea auto‑evaluării. Un scor scăzut poate
să reflecte şi negarea situaţiei clinice actuale
sau prezenţa distorsiunilor în răspunsurile
pacientului. Mai mult de 70% dintre respondenţii
adolescenţi şi adulţi din eşantioanele non‑clinice
obţin scoruri situate în acest interval.
Scala Perfecţionism (P)
Scala P conţine şase itemi care determină
măsura în care o persoană pune preţ pe atingerea
unor scopuri înalte şi în care îşi stabileşte nişte
standarde deosebit de înalte. Perfecţionismul
poate fi „orientat către sine”, „prescris social”
sau de ambele tipuri. Perfecţionismul „orientat
către sine” reflectă tendinţa de a atinge standarde
personale pentru performanţă foarte înalte, care
nu sunt legate în mod explicit de familie sau
de profesori; perfecţionismul „prescris social”
se referă la nevoia de a atinge standarde de
performanţă înalte, care se leagă de expectanţele
părinţilor şi ale profesorilor. Cercetările au arătat
că perfecţionismul poate sta la baza eforturilor
necontenite de control al greutăţii, precum şi
al eforturilor nerealiste depuse în alte domenii.
Acesta a fost identificat ca fiind o trăsătură
centrală în instalarea şi menţinerea tulburărilor
de comportament alimentar. În tabelul 4.21 sunt
Eşantion nonclinic
Adolescenţi Adulţi Adolescenţi
17-24
≥ 57
≥ 72 ≥ 87 ≥ 99
10-16
45-56
34-71 44-86 87-98
0-9
≤ 44
≤ 33 ≤ 43 ≤ 86
95
prezentate intervalele scorurilor brute, ale cotelor
T şi ale centilelor care corespund intervalelor
clinice calitative pentru scala P.
Intervalul de Semnificaţie clinică ridicată. Un
scor brut la scala P de 17 până la 24 se situează
între centilele 67 şi 99 (cota T≥55) pentru
eşantionul clinic combinat de pacienţi adulţi din
SUA şi indică prezenţa unei nevoi permanente
de a atinge cele mai înalte standarde posibile de
performanţă. Eşecul de a atinge aceste standarde
este asociat cu autocritica. Un scor brut ridicat
la această scală reflectă prezenţa unei nevoi
extreme a individului de a fi cel mai bun în ceea
ce face, de a atinge scopuri înalte şi de a evita să‑i
dezamăgească pe ceilalţi, de exemplu pe părinţi
şi pe profesori. Respondenţii adolescenţi şi adulţi
din eşantioanele nonclinice obţin rareori un scor
brut la scala P care poate fi încadrat în acest
interval (1% şi, respectiv, 13%). Aşadar, un scor
brut în acest interval poate indica un grad crescut
de psihopatologie în ceea ce priveşte această
dimensiune.
Intervalul de Semnificaţie clinică tipică. Un scor
brut de 10 până la 16 la scala P este situat între
centilele 25 şi 66 (cota T = 43‑54) pentru eşantionul
clinic combinat de pacienţi adulţi din SUA şi
reflectă prezenţa unei nevoi crescute de a atinge
cele mai înalte standarde posibile de performanţă.
Eşecul de a atinge aceste standarde este asociat cu
autocritica. Un scor brut în acest interval reflectă
prezenţa unei nevoi crescute a individului de a
fi cel mai bun în ceea ce face, de a atinge scopuri
înalte şi de evita să‑i dezamăgească pe ceilalţi, de
exemplu pe părinţi şi pe profesori. Obţinerea de
scoruri brute la scala P, încadrate în acest interval,
este frecventă la persoanele diagnosticate cu
tulburări de comportament alimentar; cu toate
acestea, acest lucru nu este caracteristic doar
celor cu tulburări de comportament alimentar,
întrucât niveluri similare pot fi întâlnite şi la
pacienţi cu alte diagnostice psihiatrice. Obţinerea
unui scor inclus în acest interval este relativ
neobişnuită pentru respondenţii din eşantionul
nonclinic de adolescenţi (între centilele 87 şi 98) şi
este mai frecventă la respondenţii din eşantionul
nonclinic de adulţi (între centilele 44 şi 86).
Intervalul de Semnificaţie clinică scăzută.
Un scor brut mai mic sau egal cu 9 la scala P
se situează între centilele 1 şi 24 (cota T≤42)
pentru eşantionul clinic combinat de pacienţi
adulţi din SUA şi sugerează faptul că individul
nu are standarde de performanţă rigide sau
neadecvate. Mai degrabă, acesta indică prezenţa
unor expectanţe mai realiste privind reuşita
personală. În plus, probabil că individul nu a
simţit presiuni exagerate pentru performanţă
96
din partea părinţilor sau a profesorilor. Cu toate
acestea, în interpretarea scorurilor ar trebui să
se ţină cont şi de alte surse de informaţii clinice,
pentru a determina acurateţea autoevaluării.
Un scor scăzut poate, de asemenea, să reflecte
negarea situaţiei clinice actuale sau distorsiuni
ale răspunsurilor din partea pacientului. Un
scor brut la scala P încadrat în acest interval
este întâlnit în mod frecvent la respondenţii din
eşantioanele nonclinice.
Indicatori de interpretare
Perfecţionismul este o caracteristică puternică
şi discriminatorie în tulburările de comportament
alimentar şi a EDI. S‑a dovedit că subscala
Perfecţionism este o măsură utilă a acestui construct
(Garner, Olmsted şi Polivy, 1983). Srinivasagam
şi colab. (1995) au constatat că pacienţii cu AN
au scoruri semnificativ mai mari la subscala
Perfecţionism a EDI‑2 decât indivizii din lotul
de control. La pacienţii cu AN, perfecţionismul
este asociat cu preocupări specifice privind
simetria, ordinea şi precizia. Deşi, în mod
obişnuit, perfecţionismul este considerat ca
fiind o caracteristică a AN‑R, două studii care au
comparat diferitele subtipuri ale acestei tulburări
au arătat că scorurile la subscala Perfecţionism
sunt mari în cazul AN‑AC/V, împreună cu alţi
indicatori de severitate ai tulburării (Garner,
Garner şi colab., 1993; Halmi şi colab., 2000). În
studii de caz controlate retrospective, s‑a dovedit
că perfecţionismul precede debutul tulburărilor
de AN, de BN şi de alimentaţie compulsivă
(Fairburn şi Harrisn, 2003). Scoruri ridicate
iniţiale la subscala Perfecţionism au contribuit la
predicţia unor rezultate slabe într‑un studiu de
urmărire (follow‑up) de 5 până la 10 ani (Bizeul
şi colab., 2001). Sutandar‑Pinnock, Woodside,
Carter, Olmsted şi Kaplan (2003) au constatat
că scorurile mici la subscala Perfecţionism de la
începutul studiului au prezis un rezultat mai
bun la un follow‑up după 6 până la 24 de luni, în
cazul pacienţilor cu AN. Aşa cum s‑a menţionat
mai devreme, într‑un studiu pe termen lung de
evaluare a rezultatelor tratamentului la pacienţi cu
AN, Löwe şi colab. (2001) au constatat că scorurile
ridicate la subscala Perfecţionism, administrată în
al 12‑lea an de studiu, au reprezentat un predictor
puternic pentru rezultate slabe, evaluate în al
21‑lea an al studiului.
Perfecţionismul orientat către sine (POS)
versus Perfecţionismul prescris social (PPS). Joiner
şi Schmidt (1995) au folosit o analiză factorială
confirmatorie (AFC) a subscalei Perfecţionism
din EDI pentru a demonstra faptul că itemii
acestei subscale sunt cel mai bine reprezentaţi
de o structură factorială multidimensională,
cu trei itemi ai Perfecţionismului orientat către
sine (POS) şi trei itemi ai Perfecţionismului
prescris social (PPS). Dimensiuni similare ale
perfecţionismului au fost propuse şi de Hewitt
şi Flett (1991). Modelul multidimensional al
perfecţionismului a fost extins de către Sherry,
Hewitt, Besser, McGee şi Flett (2004), care au folosit
AFC şi modelarea prin ecuaţii structurale pentru
a susţine un model bifactorial, definit prin trei
itemi POS şi trei itemi PPS. Folosind date culese
de la un eşantion de studenţi şi studente, Sherry
şi colab. au constatat că acest model a furnizat
o potrivire mai bună a datelor faţă de un model
unidimensional. POS şi PPS s‑au asociat în mod
independent cu simptomele comportamentului
alimentar patologic. Autorii au descoperit că, în
cazul femeilor, interacţiunea dintre POS şi PPS a
prezis în mod semnificativ prezenţa simptomelor
specifice tulburărilor de comportament alimentar
şi că un nivel ridicat al PPS a crescut impactul
POS asupra tulburărilor de comportament
alimentar. Chiar dacă dimensiunile POS şi PPS
au fost puternic intercorelate, s‑a subliniat faptul
că, dacă nu s-ar face distincţie între aceşti itemi,
s-ar suprima informaţia independentă din fiecare
dimensiune şi informaţia interactivă dintre cele
două dimensiuni. Sherry şi colab. au sugerat
că factorii POS şi PPS ai perfecţionismului ar
putea constitui un mijloc de testare a teoriilor
aflate în competiţie privind impactul relativ al
conceptului de „perfecţionism clinic” orientat
către sine, propus de către Shafran, Cooper şi
Fairburn (2002) sau al perfecţionismului prescris
social, propus de Bruch (1981).

Tabelul 4.22
Intervalele scorurilor brute şi ale centilelor:
Clusterul Perfecţionism orientat către sine

Eşantion clinic Eşantion nonclinic

Interval Adulţi Adolescenţi Adulţi Adolescenţi
Semnificaţie clinică ridicată
Scor brut 9-12 9-12
Centil ≥ 67 ≥ 69 ≥ 91 ≥ 98
Semnificaţie clinică tipică
Scor brut 5-8 5-8
Centil 25-66 43-68 57-90 87-97
Semnificaţie clinică scăzută
Scor brut 0-4 0-4
Centil ≤ 24 ≤ 42 ≤ 56 ≤ 86

Tabelul 4.23
Intervalele scorurilor brute şi ale centilelor:
Clusterul Perfecţionism prescris social

Eşantion clinic Eşantion nonclinic

Interval Adulţi Adolescenţi Adulţi Adolescenţi
Semnificaţie clinică ridicată
Scor brut 7-12 7-12
Centil ≥ 67 ≥ 69 ≥ 74 ≥ 98
Semnificaţie clinică tipică
Scor brut 4-6 4-6
Centil 25-66 43-68 40-73 84-97
Semnificaţie clinică scăzută
Scor brut 0-3 0-3
Centil ≤ 24 ≤ 42 ≤ 39 ≤ 83

97
 Clusterele de itemi POS şi PPS sunt
experimentale; în consecinţă, scorurile brute
pentru pacienţii adulţi sunt prezentate în
tabelele 4.22 şi 4.23, fără indicaţii specifice de
interpretare, împreună cu centilele asociate
pentru eşantioanele clinice şi nonclinice de
adolescenţi.
Scala Ascetism (A)
Scala A evaluează tendinţa de a căuta virtutea
prin urmărirea unor idealuri spirituale, precum
autodisciplina, negarea de sine, austeritatea
auto‑impusă, sacrificiul de sine şi controlul
nevoilor corpului. De asemenea, scala măsoară
şi conotaţiile pozitive ale obţinerii virtuţii prin
austeritate auto‑impusă, vinovăţie şi ruşine în
legătură cu experieţele care oferă plăcere. În
tabelul 4.24 sunt prezentate intervalele scorurilor
brute, ale cotelor T şi ale centilelor care corespund
intervalelor clinice calitative pentru scala A.
Intervalul de Semnificaţie clinică ridicată. Un
scor brut la scala A de 16 până la 28 se situează
între centilele 67 şi 99 (cota T≥56) pentru
eşantionul clinic combinat de pacienţi adulţi din
SUA şi indică prezenţa unei tendinţe extreme
de a căuta virtutea prin urmărirea unor idealuri
spirituale, precum autodisciplina, negarea de
sine, austeritatea auto‑impusă, sacrificiul de
sine şi controlul nevoilor corpului. Un scor brut
încadrat în acest interval reflectă, totodată, o
tendinţă foarte puternică de a oferi conotaţii
pozitive obţinerii de virtuţi prin austeritate
auto‑impusă. De asemenea, există niveluri
considerabile de vinovăţie şi ruşine care însoţesc
Tabelul 4.24
Intervalele scorurilor brute, ale cotelor T şi ale centilelor corespunzătoare
intervalelor clinice calitative: Scala Ascetism
Eşantion clinic
Interval Adulţi
Semnificaţie clinică ridicată
Scor brut 16-28
Cota T ≥ 56
Centil ≥ 67
Semnificaţie clinică tipică
Scor brut 9-15
Cota T 43-55
Centil 25-66
Semnificaţie clinică scăzută
Scor brut 0-8
Cota T ≤ 42
Centil ≤ 24
98
experienţele plăcute. Obţinerea unui scor brut
la scala A care poate fi încadrat în acest interval
este neobişnuită pentru cei diagnosticaţi cu
tulburări de comportament alimentar. Acesta
dovedeşte prezenţa unor probleme foarte grave
legate de tendinţa de a căuta virtutea prin
sacrificiu şi negare de sine, ceea ce ar putea
reprezenta un impediment în terapie, în măsura
în care tratamentul se constituie într‑o formă
de suport. Un scor brut în acest interval este rar
întâlnit la respondenţii adolescenţi şi adulţi din
eşantioanele nonclinice (1% şi, respectiv, 4%);
aşadar, un scor în acest interval poate indica un
grad crescut de psihopatologie în privinţa acestei
dimensiuni.
Intervalul de Semnificaţie clinică tipică. Un scor
brut de 9 până la 15 la scala A este situat între
centilele 25 şi 66 (cota T = 43‑55) pentru eşantionul
clinic combinat de pacienţi adulţi din SUA şi
reflectă prezenţa unei tendinţe semnificative de
a căuta virtutea prin urmărirea unor idealuri
spirituale, precum autodisciplina, negarea de
sine, austeritatea auto‑impusă, sacrificiul de sine
şi controlul nevoilor corpului. Un scor brut inclus
în acest interval reflectă, totodată, o tendinţă
foarte puternică de a oferi conotaţii pozitive
obţinerii virtuţii prin austeritate auto‑impusă.
Este prezentă, de asemenea, şi tendinţa de a simţi
vină şi ruşine în cazul unor experienţe plăcute.
Aceste experienţe nu sunt caracteristice doar
celor cu tulburări de comportament alimentar,
întrucât niveluri similare sunt întâlnite şi la
pacienţi cu alte diagnostice psihiatrice. Un scor
brut la scala A cuprins în acest interval este
frecvent obţinut de persoanele diagnosticate cu
Eşantion nonclinic
Adolescenţi Adulţi Adolescenţi
16-28
≥ 57
≥ 73 ≥ 96 ≥ 99
9-15
46-56
37-72 73-95 86-98
0-8
≤ 45
≤ 36 ≤ 72 ≤ 85
tulburări de comportament alimentar; în orice caz
apare relativ rar la respondenţii din eşantionul
nonclinic de adolescenţi (între centilele 86 şi
98) şi este mai comun printre respondenţii din
eşantionul nonclinic de adulţi (între centilele 73
şi 95).
Intervalul de Semnificaţie clinică scăzută. Un
scor brut mai mic sau egal cu 8 la scala A se
situează între centilele 1 şi 24 (cota T≤42) pentru
eşantionul clinic combinat de pacienţi adulţi din
SUA şi sugerează faptul că, în general, individul
nu simte nevoia de a căuta virtutea prin urmărirea
unor idealuri spirituale, precum autodisciplina,
negarea de sine, austeritatea auto‑impusă,
sacrificiul de sine şi controlul nevoilor corpului.
Respondentul nu are o tendinţă foarte puternică
de a oferi conotaţii pozitive obţinerii de virtuţi
prin austeritate auto‑impusă sau de a se simţi
vinovat şi ruşinat în cazul experienţelor plăcute.
Cu toate acestea, la interpretarea scorurilor ar
trebui să fie luate în considerare şi alte surse de
informaţii clinice, pentru a determina acurateţea
autoevaluării. Un scor mic poate să reflecte,
de asemenea, negarea situaţiei clinice actuale
sau distorsiuni ale răspunsurilor din partea
pacientului. Un scor brut la scala A inclus în acest
interval este întâlnit, de obicei, la respondenţii
din eşantioanele nonclinice.
Indicatori de interpretare
Ascetismul se poate exprima prin respectarea
unei diete, ca formă de purificare, printr‑o
greutate scăzută, ca virtute şi prin postire, ca
act de penitenţă. Respingerea alimentelor sau
„cumpătarea orală auto‑impusă” poate face
parte dintr‑o temă mai generală de renunţare la
gratificarea fizică. Aceasta se poate manifesta prin
Tabelul 4.25
Intervalele cotelor T şi ale centilelor corespunzătoare intervalelor clinice calitative:
Scala compozită Control exagerat
Eşantion clinic
Interval Adulţi
Semnificaţie clinică ridicată
Cota T ≥ 55
Centil ≥ 67
Semnificaţie clinică tipică
Cota T 43-54
Centil 25-66
Semnificaţie clinică scăzută
Cota T ≤ 42
Centil ≤ 24
deprivarea intenţionată de somn; automutilare
prin tăierea sau înţeparea pielii până la
sângerare; vărsături; stat în picioare perioade
îndelungate; activitate fizică în scop de căinţă; şi,
în general, evitarea oricărei plăceri. În ultimele
decenii, unii clinicieni au observat o schimbare
în psihopatologia tulburărilor de comportament
alimentar, unde „motivele ascetice” pentru
pierderea în greutate au fost înlocuite cu „dorinţa
de a fi slab”, aceasta fiind cea mai comună temă
motivaţională. Într‑un studiu pe pacienţi cu
AN‑R, care au fost evaluaţi la începutul perioadei
de spitalizare şi după 6 luni, Fassino şi colab.
(2001) au constatat că ascetismul a prezis un
răspuns slab la tratament.
Scala A are doi factori experimentali sau
clusteri de itemi. Primul cluster este compus
din patru itemi care sunt asociaţi cu „dezgustul
faţă de neputinţă”, un concept potrivit căruia
negarea de sine face persoana mai puternică.
Al doilea cluster este compus din trei itemi
asociaţi cu „negarea de sine şi suferinţa”, adică
tendinţa de a percepe plăcerea, relaxarea şi
slăbiciunea umană ca fiind ruşinoase. Cu toate
acestea, în momentul de faţă, există puţin suport
teoretic pentru aceste clustere de itemi, care sunt
menţionate aici pentru a încuraja cercetarea
asupra multidimensionalităţii constructului de
ascetism.
Scala compozită Control exagerat (SCCE)
Scorul SCCE este obţinut prin însumarea
cotelor T ale scalelor P şi A. Aceste scale sunt
corelate moderat; cu toate acestea, analiza
factorială de ordin superior a tuturor Scalelor
psihologice arată că aceste două scale formează un
factor separat. Împreună, acestea indică faptul
Eşantion nonclinic
Adolescenţi Adulţi Adolescenţi
≥ 54
≥ 63 ≥ 96 ≥ 99
44-54
29-62 69-95 94-98
≤ 43
≤ 28 ≤ 68 ≤ 93
99
că respondentul acordă o importanţă deosebită
atingerii unor standarde înalte de reuşită
personală, precum şi convingerea acestuia
că a fi virtuos înseamnă angajarea în negarea
de sine, sacrificiul de sine şi suferinţă. Aceste
persoane consideră că slăbiciunile personale
sunt ruşinoase şi doresc să îşi controleze cu
stricteţe nevoile corpului. Aceste convingeri
îşi au originile istorice în ascetismul religios,
care a asociat scopurile spirituale cu înfrânarea
nevoilor şi a impulsurilor fiziologice. Aceste
convingeri pot avea semnificaţii diferite în
tulburările de comportament alimentar; în orice
caz, adesea ele reflectă o convingere, cel puţin
la un nivel superficial, că plăcerea sau grija din
partea celorlalţi nu sunt „meritate”. Tabelul 4.25
prezintă intervalele cotelor T şi ale centilelor care
corespund intervalelor clinice calitative pentru
scorul SCCE.
Intervalul de Semnificaţie clinică ridicată. Un
scor SCCE în intervalul de Semnificaţie clinică
ridicată se situează între centilele 67 şi 99 (cota
T≥55) pentru eşantionul clinic combinat de
pacienţi adulţi din SUA şi indică prezenţa unei
nevoi permanente de a atinge cele mai înalte
standarde posibile, precum şi de a se angaja în
practica negării de sine, a sacrificiului de sine şi
a suferinţei. Acest scor reflectă nevoia extremă a
individului de a fi cel mai bun în ceea ce face şi de
a evita să‑i dezamăgească pe ceilalţi, de exemplu
pe părinţi sau pe profesori. Scorul indică,
tototdată, existenţa unor probleme interpersonale
grave, care pot reprezenta obstacole majore în
cadrul procesului psihoterapeutic, precum şi
în stabilirea unui mediu interpersonal care să
faciliteze recuperarea. Un scor SCCE cuprins
în acest interval este neobişnuit la pacienţii
diagnosticaţi cu tulburări clinice de comporta-
ment alimentar şi este rar întâlnit printre
respondenţii adolescenţi şi adulţi din eşantioanele
nonclinice (1% şi, respectiv, 4%). Astfel, un scor
încadrat în acest interval poate indica un nivel
ridicat de psihopatologie.
Intervalul de Semnificaţie clinică tipică. Un scor
SCCE în intervalul de Semnificaţie clinică tipică
se situează între centilele 25 şi 66 (cota T = 43‑54)
pentru eşantionul clinic combinat de pacienţi
adulţi din SUA şi reflectă prezenţa unei nevoi
puternice de a atinge cele mai înalte standarde
posibile, precum şi de a se angaja în practica
negării de sine, a sacrificiului de sine şi a suferinţei.
Eşecul în a atinge aceste standarde este, de obicei,
asociat cu autocritica. Scorul reflectă nevoia
semnificativă a individului de a fi cel mai bun în
ceea ce face şi de a evita să‑i dezamăgească pe
ceilalţi, de exemplu pe părinţi sau pe profesori.
100
Aceste experienţe nu sunt caracteristice doar
celor cu tulburări de comportament alimentar, ci
sunt întâlnite şi la persoane cu alte diagnostice
psihiatrice. Un scor SCCE cuprins în acest interval
este frecvent întâlnit la pacienţii diagnosticaţi cu
tulburări clinice de comportament alimentar;
pe de altă parte, este relativ rar la respondenţii
adolescenţi (între centilele 94 şi 98) şi relativ
neobişnuit la adulţii din eşantioanele non‑clinice
(între centilele 69 şi 95).
Intervalul de Semnificaţie clinică scăzută. Un
scor SCCE în intervalul de Semnificaţie clinică
scăzută este situat între centilele 1 şi 24 (cota T≤42)
pentru eşantionul clinic combinat de pacienţi
adulţi din SUA şi sugerează faptul că individul
nu simte nevoia de a atinge cele mai înalte
standarde posibile de performanţă. Persoana
respectivă nu trăieşte virtutea prin negare de
sine, sacrificiu de sine şi suferinţă. În orice caz,
interpretarea ar trebui să ţină cont şi de alte
surse de informaţii clinice, pentru a determina
acurateţea autoevaluării. Un scor scăzut poate,
de asemenea, să reflecte negarea situaţiei clinice
actuale sau prezenţa răspunsurilor distorsionate
din partea pacientului. Un scor în acest interval
este relativ frecvent întâlnit la respondenţii
adolescenţi (93%) şi adulţi (68%) din eşantioanele
nonclinice.
Scala Frica de maturitate (FM)
Scala FM conţine opt itemi care evaluează
dorinţa de a reveni la siguranţa copilăriei.
Aceasta reprezintă unul dintre principalii
factori de menţinere în cazul unui subgrup de
pacienţi adolescenţi a căror pierdere în greutate
este motivată de teama asociată cu maturizarea
psihosexuală. Crisp (1965, 1997) a afirmat că
psihopatologia centrală în AN şi BN se leagă de
teama de evenimentele psihologice, sociale şi
biologice asociate cu greutatea atinsă la vârsta
adultă. Conform acestei perspective, pierderea
în greutate devine un mecanism de evitare a
agitaţiei, a conflictelor şi a expectanţelor de
dezvoltare specifice adolescenţei, deoarece
are ca rezultat revenirea la înfăţişarea şi la
manifestările hormonale specifice pubertăţii.
Mai mult, pacienţii se simt mai tineri în urma
pierderii excesive în greutate; aceasta se poate
datora inversării profilurilor hormonale specifice
sfârşitului de adolescenţă, care reprezintă baza
biologică a experienţei (Crisp, 1997). În tabelul
4.26 sunt prezentate intervalele scorurilor brute,
ale cotelor T şi ale centilelor care corespund
intervalelor clinice calitative pentru scala FM.
 Tabelul 4.26
Intervalele scorurilor brute, al cotelor T şi al centilelor corespunzătoare intervalelor
clinice calitative: Scala Frica de maturitate
Eşantion clinic
Interval Adulţi
Semnificaţie clinică ridicată
Scor brut 13-32
Cota T ≥ 53
Centil ≥ 67
Semnificaţie clinică tipică
Scor brut 6-12
Cota T 43-52
Centil 25-66
Semnificaţie clinică scăzută
Scor brut 0-5
Cota T ≤ 42
Centil ≤ 24
Intervalul de Semnificaţie clinică ridicată.
Un scor brut la scala FM de 13 până la 32 se
situează între centilele 67 şi 99 (cota T≥53)
pentru eşantionul clinic combinat de pacienţi
adulţi din SUA şi indică prezenţa unei dorinţe
extreme de a fi mai tânăr şi de a se întoarce la
siguranţa copilăriei. Este prezentă convingerea
că solicitările vieţii adulte sunt prea mari şi că
cea mai fericită perioadă din viaţa unui om este
copilăria. Un scor brut la scala FM cuprins în acest
interval este relativ rar întâlnit la cei diagnosticaţi
cu tulburări de comportament alimentar. Un scor
în acest interval este, de asemenea, neobişnuit
şi pentru respondenţii adolescenţi şi adulţi din
eşantioanele nonclinice (17% şi, respectiv, 16%);
aşadar, un scor în acest interval poate indica
prezenţa unei dorinţe puternice de a reveni la
siguranţa copilăriei.
Intervalul de Semnificaţie clinică tipică. Un
scor brut de 6 până la 12 la scala FM este situat
între centilele 25 şi 66 (cota T  =  43‑52) pentru
eşantionul clinic combinat de pacienţi adulţi
din SUA şi indică o preferinţă puternică de
a se întoarce la siguranţa copilăriei, pentru a
evita solicitările care sunt legate de dezvoltare.
Aceste experienţe nu sunt caracteristice doar
celor cu tulburări de comportament alimentar,
întrucât niveluri similare sunt întâlnite şi la
pacienţi cu alte diagnostice psihiatrice. Un scor
brut în acest interval la scala FM este frecvent
întâlnit la persoanele diagnosticate cu tulburări
ale comportamentului alimentar; în orice caz,
este comun şi pentru respondenţii adolescenţi şi
adulţi din eşantioanele nonclinice (între centilele
12 şi 82 şi, respectiv, între centilele 25 şi 83).
Eşantion nonclinic
Adolescenţi Adulţi Adolescenţi
13-32
≥ 52
≥ 64 ≥ 84 ≥ 83
6-12
42-51
20-63 25-83 12-82
0-5
≤ 41
≤ 19 ≤ 24 ≤ 11
Intervalul de Semnificaţie clinică scăzută. Un
scor brut mai mic sau egal cu 5 la scala FM
se situează între centilele 1 şi 24 (cota T≤42)
pentru eşantionul clinic combinat de pacienţi
adulţi din SUA şi sugerează faptul că individul
nu are o dorinţă puternică de a se întoarce la
siguranţa copilăriei. Mai degrabă, acest scor
indică acceptarea maturităţii psihosexuale şi a
vârstei adulte. Cu toate acestea, în interpretarea
scorurilor ar trebui să se ţină cont şi de alte
surse de informaţii clinice, pentru a determina
acurateţea autoevaluării. Un scor scăzut poate,
de asemenea, să reflecte negarea situaţiei clinice
actuale sau distorsiuni ale răspunsurilor din
partea pacientului. Un scor brut în acest interval
la scala FM este relativ neobişnuit la respondenţii
adolescenţi, dar este mai frecvent la respondenţii
adulţi din eşantioanele nonclinice (11% şi,
respectiv, 24%).
Indicatori de interpretare
Crisp (1980, 1997) a sugerat că AN este mai
bine conceptualizată ca o „fobie de îngrăşare”
sau ca „frica de a fi gras”; în orice caz, este
folosită o perspectivă psihodinamică pentru
abordarea problemei. Garner, Vitousek şi Pike
(1997) au tradus această formulare în termeni
cognitiv‑comporamentali, însă au subliniat
faptul că tulburările de comportament alimentar
sunt întreţinute de contingenţe cu rol de întăriri
pozitive, precum şi de „evitare”. Unele paciente
sunt capabile să recunoască imediat faptul că
există o anumită greutate de care se tem cel mai
tare; acesta reprezintă pragul de greutate la care
este posibil să le revină menstruaţia, asociată
101
cu normalizarea funcţionării glandei pituitare
hipotalamice. Ele folosesc această oportunitate
ca pretext pentru a dezvolta în detaliu teama de
„a creşte”; oricum, trebuie menţionat faptul că
această temă este relevantă doar pentru un subset
de pacienţi şi neglijează influenţa puternică a
aspectelor întărite pozitiv ale unei tulburări
de comportament alimentar. Cu toate că cele
menţionate anterior se bazează pe răspunsul
„fobic” al lui Crisp la solicitările percepute ale
vieţii adulte şi la consecinţele acestuia în sensul de
inversare a substratului hormonal normal, acestea
sunt deosebit de asemănătoare cu observaţii ale
altor oameni de ştiinţă, care aduc argumente din
perspective teoretice foarte diferite. Minuchin,
Rosman şi Baker (1978) au descris acest proces
în terapie după cum urmează: „Odată ce copilul
intră în adolescenţă, el se află într‑o criză. Dorinţa
sa de a face parte dintr‑un grup de semeni intră
în conflict cu orientarea sa către familie” (p. 60).
„În final, creşterea copiilor ar trebui întâmpinată
cu schimbări în organizarea vieţii cotidiene,
proces ce implică, în cel mai bun caz, timp şi
neplăceri. În consecinţă, toată familia trebuie să
facă faţă sentimentului de pierdere şi senzaţiei
de stranietate” (p. 58). Selvini‑Palazzoli (1978) a
afirmat că „această situaţie psihologică dificilă
este responsabilă pentru faptul că dezvoltarea
fizică asociată pubertăţii îi copleşeşte [pe pacienţii
anorectici]” (p. 68). Bruch (1978) a identificat
un obiectiv al tratamentului, care constă în
depăşirea fricii de „creştere şi maturizare”.
Autoarea a afirmat că „mulţi pacienţi vor accepta
cu uşurinţă ca acesta să fie scopul lor, că ei doresc
să fie persoane independente, chiar dacă întregul
lor comportament reflectă frica de a fi adulţi şi
înverşunarea de a nu se maturiza” (p. 139).
Tabelul 4.27
Intervalele cotelor T şi ale centilelor corespunzătoare intervalelor clinice calitative:
Scala compozită Neadaptare psihologică generală
Eşantion clinic
Interval Adulţi
Semnificaţie clinică ridicată
Cota T ≥ 55
Centil ≥ 67
Semnificaţie clinică tipică
Cota T 43-54
Centil 25-66
Semnificaţie clinică scăzută
Cota T ≤ 42
Centil ≤ 24
102
Scala compozită Neadaptare psihologică
generală (SCNPG)
Scorul SCNPG se obţine prin însumarea
cotelor T ale tuturor celor nouă Scale psihologice.
Unele cercetări, care au folosit analiza factorială
în cazul EDI pe eşantioane non‑clinice, au sugerat
existenţa a doi factori majori: unul legat de
preocupările pentru alimentaţie şi celălalt legat de
o neadaptare psihologică generală. Combinarea
tuturor scorurilor la Scalele psihologice într‑un
singur scor compozit ar putea fi considerată ca
înşelătoare, deoarece contrazice obiectivul unei
evaluări multidimensionale; cu toate acestea,
ar putea avea o valoare empirică prin predicţia
rezultatelor tratamentului, sugerând un set
de răspunsuri la testare sau indicând niveluri
deosebit de ridicate de psihopatologie. În tabelul
4.27 sunt prezentate intervalele cotelor T şi ale
centilelor care corespund intervalelor clinice
calitative pentru scorul SCNPG.
Intervalul de Semnificaţie clinică ridicată. Un
scor SCNPG în intervalul de Semnificaţie clinică
ridicată se situează între centilele 67 şi 99 (cota
T≥55) pentru eşantionul clinic combinat de
pacienţi adulţi din SUA şi indică prezenţa unui
nivel extrem de crescut de distres, pe o paletă
întinsă de constructe psihologice, incluzând stima
de sine scăzută, alienarea personală, nesiguranţa
interpersonală, alienarea interpersonală,
deficite interoceptive, dezechilibru emoţional,
perfecţionism, ascetism şi frica de maturitate.
Acest scor indică, cel mai probabil, existenţa
unor disfuncţii extreme, atât în domeniul
psihologic personal, cât şi în cel interpersonal.
Un scor SCNPG în acest interval este relativ
neobişnuit printre cei diagnosticaţi cu tulburări
clinice de comportament alimentar şi sugerează
Eşantion nonclinic
Adolescenţi Adulţi Adolescenţi
≥ 54
≥ 65 ≥ 95 ≥ 98
44-53
30-64 79-94 88-97
≤ 43
≤ 29 ≤ 78 ≤ 87
prezenţa unor probleme foarte serioase legate
de adaptarea psihologică. S‑a dovedit că
funcţionarea psihologică globală defectuoasă se
asociază cu rezultate negative în psihoterapie,
iar un scor SCNPG extrem de ridicat reflectă
existenţa unor probleme emoţionale care ar
putea interfera cu tratamentul. Un scor SCNPG
în acest interval este rar întâlnit la respondenţii
adolescenţi şi adulţi din eşantioanele nonclinice
(2% şi, respectiv, 5%).
Intervalul de Semnificaţie clinică tipică. Un
scor SCNPG în intervalul de Semnificaţie clinică
tipică se situează între centilele 25 şi 66 (cota
T  =  43‑54) pentru eşantionul clinic combinat de
pacienţi adulţi din SUA şi reflectă prezenţa unui
nivel semnificativ de distres, pe o paletă întinsă
de constructe psihologice, incluzând stima de
sine scăzută, alienarea personală, nesiguranţa
interpersonală, alienarea interpersonală, defi-
cite interoceptive, dezechilibru emoţional,
perfecţionism, ascetism şi frica de maturitate.
Acest scor indică existenţa unor disfuncţii
semnificative, atât în domeniul psihologic
personal, cât şi în cel interpersonal. Un scor
SCNPG în acest interval este frecvent întâlnit
la pacienţii diagnosticaţi cu tulburări clinice
de comportament alimentar; pe de altă parte,
este relativ neobişnuit ca un scor inclus în acest
interval să apară la respondenţii adolescenţi şi
adulţi din eşantioanele nonclinice (între centilele
88 şi 97 şi, respectiv, între centilele 79 şi 94).
Intervalul de Semnificaţie clinică scăzută. Un
scor SCNPG în intervalul de Semnificaţie clinică
scăzută este situat între centilele 1 şi 24 (cota T≤42)
pentru eşantionul clinic combinat de pacienţi
adulţi din SUA şi sugerează faptul că individul
nu resimte sau nu raportează în mod obişnuit
un nivel crescut de distres la nivelul funcţionării
psihologice globale. Totuşi, este posibil ca scorul
să reflecte, mai degrabă, o tendinţă generală de a
minimaliza neliniştile psihologice, decât absenţa
distresului. Această interpretare ar trebui să ţină
cont şi de alte surse de informaţii clinice, pentru
a determina acurateţea autoevaluării. Un scor
scăzut poate, de asemenea, să reflecte negarea
situaţiei clinice curente sau distorsionări ale
răspunsurilor din partea pacientului. Un scor
SCNPG în acest interval este foarte frecvent
întâlnit la respondenţii adolescenţi şi adulţi din
eşantioanele nonclinice (87% şi, respectiv, 78%).
Indicatori ai stilului de răspuns
Primul pas pentru a decide dacă profilul EDI‑3
poate fi interpretat este de a detecta pattern‑urile
de răspuns potenţial aparte, neregulate, deviante
sau aberante. Aceste pattern-uri pot reflecta
faptul că respondentul a completat testul într‑o
manieră neobişnuită şi acest lucru poate afecta
interpretarea profilului. Un punctaj ridicat la
oricare dintre cele trei scale indicatoare ale stilului
de răspuns sugerează clinicianului că ar trebui să
fie precaut în interpretarea acestor rezultate.
Scala Inconsecvenţă (IN)
Scala Inconsecvenţă (IN) constă în 10 perechi
de itemi care sunt fie (a) opuşi în privinţa
conţinutului, astfel încât răspunsurile similare
reflectă un răspuns inconsecvent, fie (b) atât de
similari în conţinut, încât diferenţele de răspuns
la itemii din cadrul perechii reflectă un răspuns
inconsecvent.
Scala Raritate (R)
Scala Raritate (R) constă în 10 itemi la care
s‑a răspuns foarte rar afirmativ în eşantionul de
standardizare.
Scala Impresie negativă (ING)
Scala Impresie negativă (ING) evaluează
gradul în care respondentul dă răspunsuri care
sugerează prezenţa simptomatologiei. Scala ING
ia în considerare toţi itemii din EDI‑3.
Scoruri mari la toate scalele (variaţie mică
între scale)
Scoruri mari, indiferent de context,
înseamnă că un individ raportează preocupări
legate de alimentaţie şi forma corporală. Acest
lucru poate reflecta un stil de răspuns de tip
„lamentativ”. În acest caz, în timpul evaluării
semnificaţiei scorurilor la test, ar trebui luat în
considerare contextul în următoarele situaţii:
(a) respondentul îndeplineşte criteriile pentru o
tulburare de comportament alimentar sau pentru
o variantă subclinică a acesteia şi este justificată
intervenţia clinică; (b) respondentul suferă,
însă starea lui nu este asociată altor simptome
comportamentale care ar putea conta pentru
un diagnostic de tulburare de comportament
alimentar – cu toate acestea, se recomandă acţiuni
preventive, datorită riscului crescut de a dezvolta
o tulburare clinică de comportament alimentar şi
(c) scorurile la EDI‑3 reflectă o „dietă normală” şi
nu există o psihopatologie asociată care necesită
intervenţie. Chiar şi în aceste circumstanţe, se
103
recomandă reevaluări periodice. De asemenea,
ar trebui să se obţină informaţii din alte surse
pentru a fi convinşi că nu sunt necesare acţiuni
suplimentare.
Scoruri mici la toate scalele
Un alt potenţial exemplu problematic
este un pacient despre care se presupune că
are o tulburare de comportament alimentar şi
care obţine scoruri mici la toate scalele EDI‑3,
comparativ cu grupul de referinţă cu tulburări
de comportament alimentar. Există un număr de
interpretări posibile. De exemplu, acest fapt ar
putea reflecta în mod clar absenţa de preocupări în
sfera psihologică evaluată prin EDI‑3. Alternativ,
poate reflecta negarea simptomelor sau refuzul
de a colabora la evaluare. Este necesară utilizarea
altor surse de informaţie, pentru a ajunge la cea
mai bună concluzie. Indiferent de interpretarea
corectă, informaţia (dacă este vorba de distres
sau de negare) se dovedeşte a fi o informaţie utilă
din punct de vedere clinic.
Scoruri la scale relative unele la altele în
profilurile individuale
Evaluarea iniţială cu EDI‑3 ar trebui să
constituie fundamentul pentru evaluarea
psihometrică clinică şi pentru cea suplimentară.
În cele mai multe cazuri, interpretările scorurilor
EDI‑3 sunt în concordanţă atât cu experienţa
subiectivă a respondentului, cât şi cu informaţiile
provenite din alte surse. Scorurile brute la scalele
EDI‑3 sunt, cel mai adesea, evaluate utilizând
informaţiile atât pentru grupurile de referinţă
cu tulburare de comportament alimentar, cât
şi pentru grupurile nonclinice care servesc la
comparaţii. De asemenea, profilurile EDI‑3 pot fi
evaluate în termeni de scoruri la scale relative une-
le la altele, întrucât valorile maxime şi cele minime
oferă clinicianului o imagine despre aspectele
care reprezintă motivele respondentului de
preocupare relativă. De exemplu, un pacient cu o
tulburare de comportament alimentar poate avea
scoruri foarte mici (≤ centilul 10 la toate scalele,
cu excepţia DS şi SSS, la care scorurile corespund
centilului 35). Scorurile mici obţinute în general
pot reflecta un set general de răspunsuri, însă
scorurile relativ mai mari la cele 2 scale sugerează
preocupări în domeniile respective care sunt
mai însemnate la acest individ decât s‑ar putea
presupune dacă scorurile ar fi interpretate strict
în termenii grupului de referinţă cu tulburare de
comportament alimentar.
104
Exemple de cazuri
Cazul 1: Frica de maturitate psiho‑biologică în
adolescenţă
Kristin avea 13 ani şi era în clasa a 7‑a când
a fost trimisă prima oară la tratament. Avea 1,50
m şi cântărea 36 kg. Pierduse aproape 11 kg în
ultimele 4 luni. În ciuda îngrijorărilor exprimate
de către medicul ei pediatru şi a rugăminţilor
părinţilor ei, ea refuza să recupereze greutatea
pierdută. De asemenea, se părea că Kristin începe
să aibă probleme emoţionale. Mama ei a stabilit
întâlnirea iniţială, care a fost primul ei contact cu
un serviciu de psihiatrie.
Privind retrospectiv, mama ei consideră că
pe Kristin ar fi început să o preocupe greutatea
ei cam la 6 luni după un control fizic de rutină la
ora de sport de la şcoală. Kristin a avut un puseu
de creştere cu o vară înainte, în urma căruia ea
a descoperit cu dezamăgire că avea 47 kg. A
povestit cu lacrimi în ochi că toate celelalte fete
cântăreau sub 45 kg şi că băieţii o necăjeau în
legătură cu greutatea. Mama ei a asigurat‑o că
era „doar în creştere” şi că, atâta timp cât avea
o alimentaţie şi o activitate fizică corecte, va fi în
regulă.
Se pare că acest lucru ar fi diminuat
îngrijorările lui Kristin; cu toate acestea, ea dădea
semne că devenea tot mai preocupată de dietă,
activitate fizică şi starea de sănătate. În plus,
pe lângă participarea în echipa de baschet de
fete, Kristin începuse să alerge şi să folosească
zilnic înregistrarea video cu antrenament de
aerobic a mamei. A începu să citească etichetele
de pe produsele alimentare şi să o întrebe pe
mama ei în legătură cu reţetele de mâncare,
pentru a‑şi restricţiona consumul de grăsimi din
alimentaţie. Mama ei a considerat acest lucru ca
un pas pozitiv, întrucât nu dorea ca fiica ei să
ajungă grasă. Kristin a fost obligată să renunţe
să mai joace baschet în mijlocul sezonului, din
cauza unui deget rupt. Ea a reacţionat prin
intensificarea altor activităţi fizice, cum ar fi
urcatul scărilor şi sărituri pe loc, afirmând că „se
pregătea pentru sezonul de volei”. La momentul
evaluării, Kristin consuma doar mici porţii din
cina luată în familie, chiar dacă i se ofereau toate
mâncărurile ei preferate. Mama ei a fost şocată să
vadă cât de mult slăbise Kristin, când o văzuse
într‑o dimineaţă în lenjerie intimă. A dus‑o
imediat la doctor, care a înregistrat greutatea de
36 kg.
O analiză a istoriei medicale a lui Kristin
a dezvăluit faptul că ea fusese sănătoasă pe
tot parcursul dezvoltării ei. A dat dovadă de
un progres continuu de‑a lungul curbei de
dezvoltare şi sânii începuseră să i se dezvolte în
timpul verii; cu toate acestea, încă nu îi apăruse
menstruaţia. Nu a indicat nicio preferinţă sau
intoleranţă categorice pentru anumite alimente,
înainte de debutul scăderii în greutate.
Mama ei a relatat faptul că fiica ei, Kristin,
a fost mereu prietenoasă, responsabilă şi cu un
temperament calm. Acum era iritabilă, cu accese
dese de plâns. Kristin începuse de curând să‑şi
descrie prietenele drept „snoabe” şi a încetat
brusc să mai primească orice telefoane. Îşi
petrecea cea mai mare a timpului singură în
camera ei, studiind, făcând exerciţii fizice sau
verificându‑se în oglindă. În fiecare zi se cântărea
de mai multe ori pe cântarul din baie. Când se
uita la televizor în camera de zi, obişnuia să stea
în picioare. Cu toate că notele lui Kristin la şcoală
au continuat să fie excelente, devenise iritabilă în
legătură cu temele de casă, petrecând multe ore
făcând şi refăcând lecţiile. Nu exista nicio dovadă
de vărsături sau utilizare de laxative.
La examinare, Kristin era palidă, foarte slabă,
cu păr cârlionţat şi uscat. Stătea îmbrăcată în
colanţi şi pantaloni de sport, o bluză pe gât şi două
bluze de sport, legănându‑şi picioarele în sus şi
în jos. Întrebată fiind în legătură cu mişcările pe
care le făcea, a răspuns că aveau scopul de a „o
face să slăbească”. S‑a uitat atentă prin cameră,
dar a evitat contactul vizual. Vorbirea ei era clară,
coerentă şi emisă într‑un ritm alert. A afirmat că
ea era singura persoană sănătoasă din familie,
aducând ca argument dieta ei slabă în grăsimi,
exerciţiile zilnice şi valorile normale de laborator
înregistrate la vizita ei la doctor. A afirmat că, în
urmă cu şase luni, s‑a decis că vrea să cântărească
mai puţin de 45 kg. Odată atins acest scop, a
decis că ar fi preferabil să aibă 43 kg, „doar ca să
fie sigură”. Iar acum se simţea forţată să aibă o
greutate de 34 kg, deoarece la 36 i se părea că
era prea grasă. Şi‑a descris fratele ca pe „un
porc”, care mănâncă tot ce vrea. Era furioasă
pe mama ei, fiindcă o adusese la interviul de
evaluare; totuşi, a recunoscut că înţelegea grijile
părinţilor. Cu toate acestea, susţinea că nu dorea
să devină din nou grasă şi simţea că nu putea să
tolereze niciun câştig în greutate. A negat că ar
avea orice fel de poftă de mâncare, spunând că
ceea ce mânca o sătura. A negat orice episoade
de alimentaţie compulsivă sau orice utilizare
de laxative, diuretice sau alte medicamente. A
recunoscut că se simţea mai puţin fericită decât
de obicei, că se îngrijora, că îşi petrecea mai
mult timp făcându‑şi lecţiile, simţindu‑se adesea
ameţită, fiindu‑i frig tot timpul şi dormind prost
aproape în fiecare noapte. A negat orice ideaţie
sau intenţie suicidară.
La interviul iniţial de evaluare, Kristin a
fost informată că îndeplinea toate criteriile de
diagnostic pentru AN. A fost asigurată că scopul
principal al oricărui tratament este de a o ajuta să
se simtă mai bine în pielea ei. Între timp, un câştig
în greutate avea să fie necesar pentru atingerea
acestui scop, mai ales pentru că simptomele ei se
datorau înfometării şi, în niciun caz, tratamentul
nu va desconsidera propriile ei nevoi şi dorinţe.
I s‑a adminstrat EDI‑3 cu explicaţia că, în ciuda
faptului că avea AN, fiecare pacient este diferit.
Acest instrument urma să fie folosit pentru a o
ajuta să descopere aspectele specifice importante
pentru ea. Profilul EDI‑3 al lui Kristin a
indicat scoruri la scale situate în intervalul de
Semnificaţie clinică ridicată la scalele DS, P şi
A, utilizând etaloanele pentru adolescente (a se
vedea figura 4.1). Scorul SCCE obţinut de ea s‑a
aflat, de asemenea, în intervalul de Semnificaţie
clinică ridicată.
Sumarul interpretativ al testării iniţiale
• Simptome ego‑sintonice. Scorurile brute mari
la scalele DS, P şi A obţinute de Kristin sunt
în concordanţă cu simptomele ego‑sintonice,
fapt reflectat, de asemenea, prin scorurile
brute de la scala NC situate în intervalul
de Semnificaţie clinică scăzută. Ea se simte
confortabil cu stare ei de emaciere şi nu
este motivată să câştige în greutate. Kristin
priveşte tulburarea ei ca fiind funcţională, iar
respectarea dietei ca pe un mijloc de obţinere
a respectului de sine şi a valorii personale.
Acesta este un profil foarte des întâlnit
în rândul adolescenţilor care au această
tulburare de o perioadă relativ scurtă de
timp.
• Configuraţia scalelor raportate unele la altele.
Chiar dacă alte scoruri brute la scalele
EDI‑3 sunt, de asemenea, ridicate, este utilă
evaluarea scalelor prin raportarea unele la
celelalte (cum ar fi „maxime şi minime”)
pentru a avea o mai bună înţelegere a
constructelor psihologice identificate de către
pacient ca fiind cele mai proeminente. În ceea
ce priveşte atât SCI, cât şi SCPI, deficitele se
situează în intervalul de Semnificaţie clinică
tipică; însă alienarea este relativ redusă în
fiecare domeniu.
• Scala A. Scorul brut la scala A este semnificativ
ridicat şi sugerează că alimentaţia şi controlul
greutăţii sunt o expresie a autocontrolului, a
autodisciplinei, a negării de sine, a austerităţii
105
 Kristin

106
Nume Data

Scala Risc de tulburare

de comportament Scala compozită de Foaie de profil pe baza cotelor T
alimentar Risc de tulburare
de comportament Scală compozită psihologică
Scală psihologică
N alimentar N
e in Ne in
De Pe in ps ead
Do
ri fa mul te sig inte A te D z In te Pr P ih ap
ţă ţu sin St
i p Al
i rp u rp li
e r e
rfe m Fri e rp ob em ro C
a fi nţa Bu es m er en er ra r e n oc fi emechi
l cţi As at ca fic er le oţ ble ex on ge olog tare
lim de m
co ire că ă d so ar
na e
so nţ
na ă
so ar ep cit oţ ib
i r on ce
tis u r d ac so m i o m a tr
ge ol ne ic
sla de zu e na e tiv e on u ism ita e ita na e na e ra ă
b ie rp tă lă lă lă e al m te te le le ra lă
t

cotă T cotă T
DS B NC SCRTCA SSS AP NI AI DI DE P A FM SCI SCPI SCPE SCCE SCNPG

Lot non-clinic: Adulţi din SUA Adulţi străini Semnificaţie clinică tipică Eşantion de control femei
PAdolescenţi din SUA (eşantion combinat de

Figura 4.1. Prima Foaie de profil pe baza cotelor T pentru Exemplul de caz 1 (Kristin)
Lot clinic: PAN-R AN-AC/V BN TCAFAS adulţi)
 auto‑impuse, a sacrificiului de sine, în scopul
controlului nevoilor corpului.
• Scala FM. Scorul brut relativ scăzut la FM
este în concordanţă cu înţelegerea faptului
că tulburarea de comportament alimentar s‑a
dovedit eficientă în reducerea preocupărilor
referitoare la dezvoltarea fizică şi emoţională,
dacă acestea reprezentau, într‑adevăr,
domenii cu probleme. Se anticipează faptul
că scorul brut la scala FM va creşte odată
cu câştigul ponderal, dacă acest construct
a fost un element funcţional în dezvoltarea
tulburării de comportament alimentar.
• Perfecţionism. Scorul ridicat obţinut la
clusterul Perfecţionism prescris social (este
vorba de clusterul experimental) sugerează
faptul că Kristin resimte o anume presiune
din partea familiei sau a altora de a excela.
Perfecţionismul a fost identificat ca fiind
o trăsătură care menţine tulburarea de
comportament alimentar, iar familia lui
Kristin încurajase acest lucru în mod
nechibzuit. Unul dintre scopurile terapiei
familiale a fost de a o ajuta pe Kristin în
reducerea acestei trăsături sau, cel puţin, în
modificarea ei, astfel încât valoarea personală
să nu fie dependentă de o performanţă
fără cusur. Familia ei a fost, de asemenea,
încurajată să tempereze acest sistem de valori
care părea să fie nepotrivit de aspru şi de
rigid.
• Intervalul clinic. Majoritatea cotelor T obţinute
de Kristin se află în intervalul de Semnificaţie
clinică tipică şi indică absenţa relativă a unei
psihopatologii serioase.
Tratamentul a debutat cu un feedback al
evaluării, precum şi cu o analiză a materialelor
educaţionale de bază, atât cu Kristin, cât şi cu
părinţii ei. Apariţia AN a fost descrisă în relaţie
cu intercorelaţia dintre presiunile culturale de a
fi slabă şi factorii familiali sau individuali care
ar fi putut să o predispună la această tulburare.
Simptomele de semi‑înfometare şi simptomele
asociate cu AN au fost scoase în evidenţă cu o
referire specifică la propriile ei experienţe (Garner,
1997). Reabilitarea nutriţională, măsurată prin
restabilirea greutăţii, a fost etichetată ca fiind
primul pas esenţial în recuperare. Ipotezele
psihologice care ar fi putut conta pentru pierderea
în greutate a lui Kristin şi eşecul în recâştigarea ei
au fost iniţiate prin mai multe exemple de teme
comune în rândul adolescenţilor cu AN (Crisp,
1980; Strober şi colab., 1997).
Acest lucru a avut drept scop o introducere
neagresivă la problemele psihologice care ar fi
putut fi relevante pentru dezvoltarea tulburării în
cazul lui Kristin. Kristin şi părinţii ei au fost apoi
întrebaţi dacă credeau că scăderea ei în greutate a
avut vreun efect pozitiv asupra oricărui membru
al familiei. Kristin a sugerat că această scădere
părea să fie asociată cu o reducere a timpului în
care părinţii se certau; totuşi, părinţii nu au fost
de acord cu această formulare. Planul era de a
reveni la această problemă, după evidenţierea
opţiunilor terapeutice.
Au fost descrise opţiunile terapeutice,
inclusiv terapia familială şi individuală, la fel şi
criteriile pentru a stabili dacă internarea într‑un
centru de tratament sau spitalizarea aveau să
fie necesare. Accesul la un nivel mai ridicat
de îngrijire a fost descris ca fiind necesar dacă
greutatea ei ar fi scăzut şi mai mult sau dacă
tratamentul ambulatoriu nu ar fi avut efectul
unei creşteri gradate în greutate. Internarea şi
spitalizarea au fost descrise nu ca ameninţări, ci
ca opţiuni logice şi umane pentru o adolescentă
care rămânea bolnavă. Dacă tratamentele acestea
deveneau necesare, nu trebuiau să fie interpretate
ca un semn al eşecului lui Kristin sau al părinţilor
ei. S‑a subliniat faptul că familia trebuie să
înţeleagă că AN e o tulburare medicală gravă,
care o împiedica temporar pe Kristin să ia decizii
sănătoase. Kristin şi‑a exprimat îngrijorarea
că nimeni n‑o înţelegea cu adevărat şi că era
nedrept să fie forţată să facă lucruri pe care nu
dorea să le facă. I s‑a explicat că adulţii din viaţa
ei aveau responsabilitatea morală şi legală de‑a
avea grijă de ea atunci când era bolnavă şi că
nivelul lor de control asupra rutinei ei zilnice va
scădea în mod firesc, odată ce ea avea să fie în
stare să‑şi poarte singură de grijă. Tratamentul a
fost astfel conceput, încât să fie mai structurat în
ceea ce priveşte alimentaţia, orientând în acelaşi
timp atenţia asupra problemelor psihologice şi
familiale care ar fi putut juca un rol în menţinerea
tulburării. Iniţial, terapia s‑a concentrat asupra
factorilor favorizanţi, mai degrabă decât asupra
etiologiei, întrucât ei puteau fi cu mult mai mare
uşurinţă asociaţi cu obiective comportamentale
săptămânale. De asemenea, s‑a presupus că
discuţiile privitoare la aceşti posibili factori
favorizanţi ar fi putut duce la apariţia altor
convingeri fundamentale, presupuneri subia-
cente şi probleme de dezvoltare care se poate să fi
jucat un rol în desfăşurarea originală a tulburării
de comportament alimentar.
Kristin a menţionat că ezita să participe la
tratament, întrucât avea impresia că obiectivul
principal era acela de‑a o îngrăşa. I s‑au dat
asigurări că luarea în greutate era un scop necesar,
însă insuficient, al tratamentului. Era crucial ca
107
 Nume Kristin Data

108
Scala Risc de tulburare Foaie de profil pe baza cotelor T
de comportament Scala compozită
alimentar Risc de tulburare
de comportament Scală compozită psihologică
Scală psihologică
N alimentar N
e in Ne in
De Pe in
Do
ri fa mul te sig inte A te D z rfe In te Pr ps ead
ih ap
ţă ţu sin St
i p Al
i
er en
rp u
er ra
rp li
e e r e
oc fi emechi As m Fri efi rp ob em Pro C
a fi nţa Bu de m es m r n l cţi
ce at ca
u ca er le
s m
oţ ble
i m
ex on ge olog tare
sla de lim co ire că ă d
zu e
so ar
na e
so nţ
na ă
so ar
na e
ep cit
tiv e
oţ ib
i on ur on
ism tis r d
ita e c ita o na e o na e a tr
ge ol ne ic
b ie rp tă lă lă lă e al m te te le le ra ra ă
lă
t

cotă T cotă T
DS B NC SCRTCA SSS AP NI AI DI DE P A FM SCI SCPI SCPE SCCE SCNPG

Lot non-clinic: Adulţi din SUA Adulţi străini Semnificaţie clinică tipică Eşantion de control femei
PAdolescenţi din SUA (eşantion combinat de
Lot clinic: PAN-R AN-AC/V BN TCAFAS adulţi)

Figura 4.2. A doua Foaie de profil pe baza cotelor T pentru Exemplul de caz 1 (Kristin)
ea să aibă sentimente mai bune faţă de corpul ei
şi de ea însăşi, însă lucrul acesta era probabil să
se întâmple după ce, iniţial, se va fi simţit mult
mai rău în timpul fazei de refacere a greutăţii.
Au fost trecute în revistă unele dintre beneficiile
practice ale tratamentului, inclusiv un somn,
o energie, o concentrare mai bune, o dispoziţie
emoţională mai bună, precum şi încetarea
senzaţiei continue de frig. Pe Kristin a părut s‑o
liniştească ideea conform căreia caloriile erau o
măsură a „energiei” şi nu a „grăsimii”.
Formatul tratamentului a inclus atât întâlniri
individuale, cât şi familiale, pentru a sublinia
faptul că Kristin era atât o persoană autonomă,
cât şi parte a unui sistem familial mai larg.
Întâlnirile individuale au început cu o trecere
în revistă a comportamentului alimentar şi a
greutăţii lui Kristin, precum şi a gândurilor şi a
sentimentelor ei privitoare la propriul corp. Ea
a fost încurajată să ţină un jurnal şi să noteze
alimentele pe care le mânca la fiecare masă. I
s‑a sugerat să‑şi consemneze stările emoţionale
din timpul meselor, împreună cu gândurile şi
sentimentele mai generale privitoare la sine.
Importanţa acestei înregistrări scrise a fost
accentuată, întrucât avea să ofere o documentare
a eforturilor ei şi urma să prezinte interes pentru
ea, atunci când avea să privească în urmă la
procesul de recuperare.
Iniţial, întâlnirile au fost programate de
două ori pe săptămână, cu intenţia de a discuta
cu Kristin jumătate din şedinţă, iar cu părinţii,
cu sau fără Kristin, în restul şedinţei. De la
începutul fiecărei şedinţe, atât în şedinţele
individuale, cât şi în cele familiale, au fost clar
specificate aşteptările comportamentale în
privinţa alimentaţiei şi a greutăţii. S‑a hotărât să
se instituie un moratoriu temporar în privinţa
exerciţiului fizic, cu înţelegerea ca va fi reintegrat
treptat, odată ce recâştigarea greutăţii se va fi
produs. Părinţii aveau datoria să intervină în caz
că exerciţiul fizic ar fi fost reluat. Lui Kristin i se
permitea să se uite la televizor doar dacă rămânea
aşezată. I se permitea să meargă la şcoală, lucru
pe care‑l dorea, doar dacă‑şi menţinea greutatea.
S‑a convenit scoaterea cântarului din casă şi
cântărirea doar la şedinţele de terapie. Părinţii lui
Kristin au fost încurajaţi să ţină un jurnal privind
orice îngrijorări sau întrebări pe care le‑ar fi putut
avea şi care urmau să fie discutate la şedinţe.
A devenit limpede, la întâlnirea familială
iniţială, resentimentul pe care Kristin îl purta
mamei sale, pentru că încerca s‑o „îngraşe” cu
prăjiturele şi cartofi prăjiţi şi adăugând în secret
unt şi ulei în mâncare. S‑a convenit ca mama ei să
renunţe imediat la orice tentative ascunse de a‑i
furniza calorii suplimentare şi că va fi administrată
doar cantitatea de alimente prevăzută înaintea
mesei. Kristin a continuat să consume alimente pe
care le considera „sigure”, precum lapte degresat
şi iaurt dietetic dimineaţa; însă la cină urma să
consume mâncărurile obişnuite ale familiei. Au
fost identificate alimentele faţă de care Kristin
se simţea cel mai confortabil, iar acestea urmau
a‑i fi puse pentru prânz, la şcoală. Kristin a fost
de acord să înceapă să consume două gustări:
una după‑amiaza şi alta după cină. S‑a stabilit
ca aportul caloric să înceapă la 1800 de calorii
pe zi şi să crească treptat până la un nivel care
să ducă la o creştere săptămânală în greutate de
aproximativ 0,5‑1 kg.
Kristin a luat în greutate 0,5 kg în prima
săptămână, dar conflictul din familie s‑a acutizat
radical. În a doua săptămână, greutatea ei s‑a
reîntors la cea iniţială. S‑a stabilit, de comun
acord, că tratamentul zilnic (7 ore pe zi, 5
zile pe săptămână) ar fi mai eficient dacă ar
permite familiei să continue să lucreze asupra
problemelor psihologice, fără ca mâncarea să fie
punctul central al tratamentului. Kristin a părut
uşurată să aibă un mediu structurat în care să ia în
greutate. Ea a urmat planul de mese şi a câştigat
între 1‑1,5 kg pe săptămână, timp de patru
săptămâni, şi a ajuns la o greutate de 41,7 kg. La
început, dispoziţia ei afectivă s‑a îmbunătăţit, a
cerut mai puţin asigurări din partea altora şi a
dormit mai bine. Mama ei a menţionat că Kristin
plângea mai puţin, avea mai puţine ieşiri violente
şi că tolera mai bine faptul că este îndrumată
să renunţe la comportamentul caracteristic
tulburării de comportament alimentar. Cu toate
acestea, pe când se apropia de 42,1 kg, Kristin
a mărturisit o revenire la starea de disconfort
pe care o descrisese la începutul tulburării. A
fost testată din nou cu EDI‑3, iar profilul ei este
prezentat în figura 4.2.
Sumarul interpretativ al celei de‑a doua testări
• Temeri în privinţa maturităţii psihobiologice.
Conform unui model propus de către Crisp
(1980), AN poate avea o funcţie adaptativă
prin reducerea anxietăţilor şi a temerilor
asociate cu provocările biologice şi psihologice
ale dezvoltării normale. În aceste cazuri,
procesul natural de restabilire a greutăţii va
retrezi temerile pubertăţii. Creşterea cotei T
la scala FM în cazul lui Kristin, de la 44 la
testarea iniţială la 60 la retestare, face posibilă
această ipoteză. Alternativ, la a doua testare,
greutatea ei corporală s‑a apropiat de un
nivel asociat cu creşterea secreţiei hormonilor
109
 sexuali, ceea ce poate duce la intensificarea
sentimentului de‑a se simţi „grasă”. Aceste
schimbări fiziologice şi, posibil, psihologice
pot determina o rezistenţă sporită la creşterea
în greutate. Este important ca terapeutul să
explice cu grijă acest proces şi să insiste blând,
dar ferm, pentru continuarea procesului de
luare în greutate. (A se vedea Garner şi colab.,
1997, p. 106‑108, unde se explică integrarea
acestei formulări într‑o evaluare).
• Nemulţumire sporită faţă de corp, odată cu luarea
în greutate. Creşterea scorurilor la scalele NC
şi SSS reflectă dificultăţile asociate cu luarea
în greutate. În acest punct, pacienţii au nevoie
de asigurări considerabile că vor fi asistaţi
pentru a nu lua în greutate mai mult decât
intervalul de greutate stabilit. Acesta este
unul dintre beneficiile alimentaţiei structurate
sau „mecanice”, ca mijloc care oferă control
exterior atunci când un pacient simte că‑şi
pierde controlul asupra alimentaţiei.
• Scala B. Creşterea scorului la scala B ar trebui
să cauzeze o oarecare îngrijorare cu privire
la posibilitatea de apariţie a alimentaţiei
compulsive în cazul lui Kristin.
• Reducerea controlului exagerat. Scăderea
considerabilă a cotei T la scala A de la
testarea inţială sugerează că nivelul iniţial
ridicat al acesteia era legat de sentimente
de autocontrol produse mai degrabă de
tulburarea de comportament alimentar decât
de o caracteristică mai stabilă.
Pe măsură ce Kristin a continuat să ia în
greutate, ea a fost în stare să înţeleagă că „a se
simţi grasă” era asociat cu alte sentimente mai
vagi, neplăcute, de „a nu fi iubită”, „a fi defectă”
şi, în general, „de a nu fi destul de bună”. Această
schemă şi sentimentele asociate ei erau activate
de alte situaţii, precum interacţiunile cu prietenii.
Kristin simţea că lipsa ei de popularitate la şcoală
însemna că era ceva fundamental în neregulă cu
ea. A fost în stare să identifice faptul că nevoia ei
intensă de a fi acceptată de cei de vârsta ei o făcea să
se comporte nefiresc şi să facă presiuni exagerate
asupra relaţiilor de prietenie. De asemenea,
Kristin a admis că nu vedea niciun avantaj în a
se maturiza. Fratele ei mai mic avea mai multă
libertate şi privilegii decât i se permiteau ei.
Lui i se dădea voie să meargă la liceul de stat.
Deşi dorea şi ea să meargă, lui Kristin îi fusese
teamă să‑i roage pe părinţii ei. A fost surprinsă
să afle că ei ar fi fost de acord s‑o înscrie la liceul
de stat, odată ce ajungea la o greutate normală.
Acest fapt a activat o altă schemă fundamentală
şi temerile asociate acesteia, care, probabil,
110
constituiau miezul ezitărilor ei anterioare de a
aborda subiectul şcolii. Îi era teamă de posibilele
aşteptări sociale asociate cu o clasă mixtă. Era
îngrijorată că nu ar fi ştiut cum să reacţioneze.
Kristin a redus treptat numărul de zile
în care participa la programul de spitalizare
parţială şi a trecut la şedinţe săptămânale de
terapie ambulatorie – jumătate dintre acestea,
individuale, jumătate, însoţită de părinţi.
Greutatea ei a crescut constant, ajutată de
asigurările date în cadrul terapiei şi acasă. După
unsprezece luni, greutatea ei a ajuns la aproape
50 de kilograme şi frecvenţa întâlnirilor a fost
redusă la una pe lună. Kristin a început să aibă
ciclu menstrual la un an de la începutul terapiei.
Terapia a fost încheiată şi ea a fost încurajată
să reia terapia, dacă îngrijorările privitoare la
greutate se accentuau sau dacă apăreau alte
probleme. În acest punct, a fost din nou testată
cu EDI‑3; profilul ei este ilustrat în figura 4.3.
Sumarul interpretativ al celei de‑a treia testări
• Perfecţionism persistent. Creşterea scorului la
scala P este obişnuită la pacienţii cu AN, chiar
şi după multe luni de terapie. Cota T la scala
SCCE a rămas în intervalul de Semnificaţie
clinică ridicată; cu toate acestea, terapia a avut
succes în sprijinul oferit lui Kristin pentru
a‑şi „decupla” stima de sine de standardele
ei ridicate de performanţă.
• Scala NC a rămas în intervalul de Semnificaţie
clinică ridicată. Scorul lui Kristin pe scala NC
a fost în intervalul de Semnificaţie clinică
scăzută; dar a fost, totuşi, mai crescut decât al
celor mai mulţi adolescenţi cu aceeaşi greutate.
Acest lucru este tipic pentru pacienţii cu AN
şi trebuie monitorizat îndeaproape, pentru
a fi siguri că orice recădere e întreruptă de
timpuriu.
Kristin a rămas perfecţionistă într‑o oarecare
măsură şi a menţionat că nu era mulţumită
de corpul ei; totuşi, a fost în stare să‑l accepte.
Adaptarea ei a continuat să se îmbunătăţească şi
a continuat să aibă o stare bună, vreme de trei ani
după evaluarea iniţială.
Cazul 2. Bulimia nervoasă cu un istoric de
abuz fizic şi sexual
Pam este o tânără femeie caucaziană în vârstă
de 19 ani, care trăieşte împreună cu părinţii ei
într‑o zonă urbană cu o populaţie din clasa de
mijloc. Pam s‑a prezentat pentru a fi evaluată
la insistenţa unui profesor de la facultate,
 Nume Kristin Data

Scala Risc tulburare Scala compozită Foaie de profil pe baza cotelor T

de comportament Risc de tulburare
alimentar de comportament Scală compozită psihologică
alimentar Scală psihologică
N N
e in Ne in
De Pe in
Do te sig inte A te D z In te Pr e Pr ps ead
ri fa mul
ţă ţu sin St rp u rp li rfe m F efi r o C ih ap
Bu e s im pe Alie e r e r e n
ro efi
c
emechi
l cţi As pe b m ob
g olo ta
a fi nţa de m că ă d rs na rs an s a e c o i b on ce at rica
ur d ca
c rs lem
o
oţ le
io m
ex on
a
lim co ire zu e
on re
a
on ţă
a
on re
a
pt ite
i v
ţio ru
n ism tis i ta e i ta n e n g tro ene gic re
sla de
b ie rp tă l ă l ă lă e al m te te ale ale e er l
at
ra ă
lă

cotă T cotă T
DS B NC SCRTCA SSS AP NI AI DI DE P A FM SCI SCPI SCPE SCCE SCNPG

Lot non-clinic: Adulţi din SUA Adulţi străini Semnificaţie clinică tipică Eşantion de control femei

Figura 4.3. A treia Foaie de profil pe baza cotelor T pentru Exemplul de caz 1 (Kristin)
PAdolescenţi din SUA (eşantion combinat de
Lot clinic: PAN-R AN-AC/V BN TCAFAS adulţi)

111
îngrijorat că ea leşinase de câteva ori la şcoală
în săptămânile precedente. Pam cântărea 54,4
kilograme la o înălţime de 1,60 m. La evaluarea
iniţială, Pam a raportat o istorie de trei ani de
episoade de alimentaţie compulsivă şi vărsături
care variau de la o dată pe zi la o dată pe lună.
În ultimele trei luni, episoadele de vărsături se
înrăutăţiseră şi se produceau cam de două ori pe
zi.
Pam a relatat un istoric de 3 ani de depresie,
care a precedat problemele ei de alimentaţie şi
faptul că fusese spitalizată pentru scurt timp la 16
ani, din cauza unei supradoze de antidepresive.
Pam a mărturisit că se auto‑mutila – inclusiv
tăieturi, zgârieturi superficiale şi lovituri aplicate
sieşi – întrucât era dezgustată sau furioasă pe
propriul corp. Pam a afirmat că era deprimată de
când se ştia şi a menţionat că se gândise de mai
multe ori la sinucidere; totuşi, a negat că simţea
efectiv impulsuri suicidare în perioada în care s‑a
prezentat pentru evaluare.
Întrebările specifice privitoare la istoricul
greutăţii au indicat faptul că Pam fusese un
copil slab, dar că începuse să fie conştientă şi
preocupată de propria greutate pe la 14 ani.
Devenise „obsedată de mâncare” şi a început
să verse după mese. În anul următor, a început
să postească şi să facă exerciţii fizice exagerate
pentru a‑şi controla greutatea. Pam a relatat că
făcea gimnastică aerobică timp de două ore pe
zi şi, în plus, participa la sporturile de la şcoală.
A menţionat că, pe măsură ce creştea, a început
să ia amfetamine pentru energie, să fac abuz de
laxative şi de diuretice şi să folosească din când
în când ipecac pentru a‑şi provoca vărsături.
Pam a relatat un istoric de abuz fizic din
partea tatălui pe când era copil, constând în bătăi
şi încuiatul pentru perioade lungi într‑o debara
drept pedeapsă. Pam a mărturisit şi că prietenul
ei o violase cu aproximativ un an în urmă. N‑a
spus nimănui despre viol la vremea respectivă
şi, la scurt timp după acest incident, simptomele
ei legate de alimentaţie au devenit mult mai
severe. Pam a menţionat că, în vara de după viol,
a început să bea alcool singură, de mai multe ori
pe săptămână şi să fumeze în loc să mănânce.
Pam evita să atingă mâncarea ori tacâmurile cu
buzele în timp ce mânca. Uneori făcea duş după
masă, afirmând că mâncatul i se părea „murdar”
şi „necurat”. A început să‑şi restricţioneze şi mai
mult aportul alimentar şi să verse ori de câte ori
se simţea plină, ceea ce se întâmpla adesea doar
după câteva îmbucături.
Interviul de evaluare a clarificat faptul că,
deşi depresia a precedat scăderea ei în greutate
şi manifestările tulburării de comportament
112
alimentar, dispoziţia afectivă s‑a înrăutăţit
semnificativ după viol. Întrebată dacă s‑a
întâmplat altceva mai recent, Pam a afirmat
că mama ei i‑a spus că nu o va lăsa să plece la
facultate, deoarece familia nu‑şi putea permite
taxele de şcolarizare. Pam a reacţionat cu furie,
întrucât credea că adevăratul motiv al acestei
hotărâri nu erau aspectele financiare. A afirmat
că se simţea prizonieră şi neputincioasă.
Pam a menţionat că părinţii ei nu păreau
îngrijoraţi de tulburarea ei de comportament
alimentar, dar că erau exagerat de preocupaţi
şi implicaţi în alte aspecte ale vieţii ei. În opinia
sa, ei doreau ca ea să locuiască la ei şi să urmeze
un curs de contabilitate la o facultate din oraş.
Încercau să‑i dicteze cum să se comporte în viaţa
socială, impunându‑i o oră la care să se întoarcă
acasă, care se aplica doar anumitor activităţi
sociale. Pam şi‑a descris părinţii ca fiind distanţi
emoţional şi dezaprobatori, dar pozitivi la un
nivel superficial, atunci când erau prezente
şi alte persoane. La această evaluare iniţială,
Pam a afirmat că, deşi dispoziţia ei afectivă şi
capacitatea sa de concentrare erau scăzute şi
suferea de insomnie cronică, era dornică să
înceapă tratamentul, atâta timp cât nu trebuia să
ia în greutate. Profilul ei EDI‑3 este prezentat în
figura 4.4.
Sumarul interpretativ al testării iniţiale
• Scoruri compozite. Cotele T la SCI, SCPI şi SCPE
reflectă suferinţa psihologică accentuată a lui
Pam, o experienţă emoţională haotică şi o
funcţionare interpersonală deficitară.
• Scalele SSS şi AP. Scorurile din intervalul de
Semnificaţie clinică ridicată la scalele SSS şi AP
reflectă sentimentul general de singurătate,
vid emoţional şi lipsă de control pe care îl
trăieşte Pam. Deficitele în sentimentele de
eficacitate reflectate de scorurile la test sunt
concordante cu istoricul de traumă şi cu lipsa
de suport interpersonal.
• Scala AI. Cota T în intervalul de Semnificaţie
clinică ridicată la scala AI reflectă lipsa de
încredere şi apropiere în relaţii a lui Pam,
probabil din cauza abuzului fizic, a celui
sexual şi a unui pattern de relaţii deficitare
cu părinţii şi cu partenerii ei. Creşterea
accentuată ale scorului la scala AI în contextul
celorlalte scoruri mari din punct de vedere
clinic sugerează că terapia s‑ar putea dovedi
un proces dificil, cu rezultat incert.
• SCPE. Scorul din intervalul de Semnificaţie
clinică ridicată la SCPE, asociat cu creşterea
semnificativă a scorului la scala DE, reflectă
 Nume Pam Data

Scala Risc de tulburare Scala compozită Foaie de profil pe baza cotelor T

de comportament Risc de tulburare
alimentar de comportament Scală compozită psihologică
alimentar Scală psihologică
N N
e in Ne in
De Pe in
Do fa mul te sig inte A te D z rfe In te Pr ps ead
ih ap
ri ţă ţu sin St p Al
i
er en
rp u rp li
e e ro efi emechi As m Fri efi rp ob em Pro C
a fi nţa Bu de m e s im er ra r n c l cţi
ce at ca
u ca er le
s m
oţ ble
i m
ex on ge olog tare
lim co ire că ă d
zu e
so ar
na e
so nţ
na ă
so ar
na e
ep cit
tiv e
oţ ib
io ru
on
ism tis rit de c ita o na e o na e a t
ge rol ne ic
sla de
b ie rp tă lă lă lă e na m at
e te le le ra ra ă
lă
l t

cotă T cotă T
DS B NC SCRTCA SSS AP NI AI DI DE P A FM SCI SCPI SCPE SCCE SCNPG

Figura 4.4. Foaia de profil pe baza cotelor T pentru Exemplul de caz 2 (Pam)
Lot non-clinic: Adulţi din SUA Adulţi străini Semnificaţie clinică tipică Eşantion de control femei
PAdolescenţi din SUA (eşantion combinat de
Lot clinic: P AN-R AN-AC/V BN TCAFAS adulţi)

113
 instabilitatea dispoziţiei afective, schimbări
pronunţate de dispoziţie, impulsivitate
şi labilitate emoţională generală. Acestea
sunt obişnuite la indivizii cu experienţe
traumatice.
• Grupul de itemi pentru riscul de abuz de substanţe.
Scorurile ridicate la grupul de itemi pentru
Riscul de abuz de substanţe (aşa cum se vede în
tabelul 4.19) sunt concordante cu consumul
de droguri şi de alcool în scopul de a face
faţă disconfortului emoţional care este parte
a fenomenologiei în cazul multor indivizi cu
traume şi istorii de relaţii deficitare.
• Scala DS. Scorul relativ scăzut la scala DS este
legat de faptul că Pam nu mai respectă o dietă
restrictivă pentru a‑şi controla greutatea.
Vărsăturile reprezintă mecanismul de bază
pentru a controla greutatea corporală, dar
acesta serveşte probabil unui dublu scop
(alături de alimentaţia compulsivă), acela de
a modera sau „amorţi” suferinţa psihologică
şi emoţională asociată temelor traumei şi
ale abuzului, care fac parte din trecutul
lui Pam. Deoarece simptomele tulburării
de comportament alimentar joacă un rol
funcţional în modularea dispoziţiei afective
şi în menţinerea echilibrului psihologic, este
necesar ca terapia să se focalizeze pe ajutorul
acordat lui Pam pentru a‑şi dezvolta strategii
alternative care să reglementeze şi să tolereze
stările emoţionale negative.
• Scalele P şi A, precum şi SCCE. Scorurile la
scalele P şi A, precum şi scorul SCCE sunt mici,
ceea ce reflectă sentimentele respondentului
de lipsă de control asupra propriei vieţi.
• În ciuda ansamblului clinic îngrijorător, este
dificil de evaluat magnitudinea tulburării
emoţionale determinate de inaniţie şi de dieta
haotică. În acest sens, tratamentul reprezintă
un instrument excelent de evaluare, mai ales
dacă este posibil să se recapete controlul
asupra comportamentelor alimentare pro-
blematice şi să se realizeze reabilitarea
nutriţională.
Formularea iniţială a scos în evidenţă
anumite arii de intervenţie. În primul rând, era
important să se întrerupă procesul de scădere
în greutate datorită consecinţelor sale medicale
potenţial serioase. Lui Pam i s‑au dat asigurări că
problemele cu care venea la terapie erau foarte
importante şi că siguranţa ei medicală nu putea fi
compromisă. În al doilea rând, negarea gravităţii
acestei tulburări de comportament alimentar
trebuia să fie discutată atât cu Pam, cât şi cu
părinţii ei. În al treilea rând, istoricul de abuz al
114
lui Pam trebuia explorat în detaliu pe parcursul
terapiei. Existau probleme practice referitoare
la faptul de a raporta sau nu poliţiei violul şi la
evidenţierea opţiunilor legale. Existau probleme
emoţionale legate de explorarea circumstanţelor
relevante ale violului şi ale abuzului fizic
anterior, de confirmarea reacţiilor dureroase şi de
abordarea impactului acestor experienţe asupra
conceptului ei despre sine şi asupra perspectivei
ei asupra celorlaţi. Într‑o întâlnire împreună
cu familia, s‑a subliniat că Pam suferea de o
tulburare gravă de comportament alimentar care
necesita tratament. Afirmaţiile ei că era perfect
sănătoasă au fost aduse în discuţie de către
terapeut, care a ajutat‑o să examineze consecinţele
pe termen lung ale comportamentului ei cu o
conceptualizare mai realistă a tulburării de care
suferea. Declaraţia fermă că Pam suferea de o
tulburare de comportament alimentar evidentă
a fost suficientă pentru a submina negarea
tulburării împărtăşită de Pam şi de părinţii ei.
S‑a clarificat faptul că unele dintre simptomele
ei (de exemplu, insomnia, oboseala, ba chiar şi
obsesia ei pentru mâncare) ar putea fi atribuite
parţial controlului excesiv al greutăţii corporale.
Singura cale de a separa problemele psihologice
primare de efectele secundare ale înfometării
era ca ea să‑şi ia angajamentul de a‑şi normaliza
comportamentul alimentar şi greutatea.
Odată ce greutatea şi sănătatea ei s‑au
stabilizat şi comportamentul alimentar a devenit
mai puţin haotic, a fost clar că problemele legate
de trauma ei din copilărie şi de abuzul sexual
petrecut cu un an înainte constituiau factorii cheie
ai deteriorării psihologice recente. Semnificaţia
acestor experienţe a fost minimalizată la
începutul terapiei, dar a devenit evident că ele
formau conţinutul de amintiri intruzive şi de
coşmaruri. S‑au aplicat metode de restructurare
cognitivă concepute pentru tulburarea de stres
post‑traumatic (TSPT) (Foy, 1992).
Cazul 3: Ineficacitate/alienare interpersonală la
o femeie de 42 de ani
Amy este o femeie de 42 de ani, la care
tulburarea de comportament alimentar s‑a
dezvoltat la vârsta de 18 ani. AN a apărut când ea
avea 16 ani şi a scăzut de la aproape 50 kg la 38,5
de kg (la o înălţime de 1,72 m), în vara în care era
în clasa a 11‑a de liceu. Familia ei avea aşteptări
mari în privinţa performanţelor ei şcolare; atât
mama, cât şi tatăl ei erau avocaţi de succes la
mari firme de avocatură. Amy a avut puţine
contacte cu părinţii ei în copilărie şi s‑a simţit
necorespunzătoare de la o vârstă fragedă. Cu
 Nume Amy Data

Scala Risc de tulburare Scala compozită Foaie de profil pe baza cotelor T

de comportament Risc de tulburare
alimentar de comportament Scală compozită psihologică
alimentar Scală psihologică
N N
e in Ne in De Pe in
Do t s te A in z In te Pr ps ead
ri fa mul
ţă ţu sin St pe Alie erpe igu rp li te D emechi
rfe m F e r o e Pr
m b o C
ih ap
Bu de m e s im r n r e e ro efi
o l i
cţi As at rica fic pe b
oţ le ex on g olo tar
a fi nţa
lim că ă d so ar rs an
o rs na ce c ţ b on ce ur d ac rs lem io m
sla de ie
co ire
rp zu e na e na ţă on re pt ite
iv
io ru
na ism tis
m i t at e i t at
on e n e ag tro ener gică e
er l
b tă lă lă ală e l e e ale ale at ală

cotă T cotă T
DS B NC SCRTCA SSS AP NI AI DI DE P A FM SCI SCPI SCPE SCCE SCNPG

Semnificaţie clinică tipică Eşantion de control femei

Figura 4.5. Foaia de profil pe baza cotelor T pentru Exemplul de caz 3 (Amy)
Lot non-clinic: Adulţi din SUA Adulţi străini PAdolescenţi din SUA (eşantion combinat de
Lot clinic: PAN-R AN-AC/V BN TCAFAS adulţi)

115
toate acestea, era o elevă remarcabilă şi o excelentă
sportivă. Se simţea mai puţin atrăgătoare decât
sora ei, care era cu doi ani mai mare, şi faţă de
care Amy a devenit foarte competitivă, încercând
să câştige laudele părinţilor. Totuşi, n‑a simţit
niciodată că le‑ar fi dobândit aprobarea deplină
şi s‑a simţit nepregătită să satisfacă unele cerinţe
sociale. La începutul scăderii în greutate, a fost
lăudată de colegii ei, însă părinţii s‑au îngrijorat.
În cele din urmă, a fost spitalizată şi a recâştigat
aproape 7 kg în aproximativ două luni. Amy a
început să mănânce compulsiv la scurt timp după
externare, fapt care a trecut neobservat vreme
de mai mulţi ani. Au urmat scurte perioade de
tratament în care a simţit că a dobândit o oarecare
înţelegere a propriilor probleme emoţionale, dar
a continuat episoadele de alimentaţie compulsivă
şi vărsăturile de la o dată pe săptămână la o dată
pe zi vreme de 20 de ani. Doar în ultimele şase
luni nu a mai recurs la alimentaţie compulsivă
şi la vărsături, în favoarea unei restricţii absolute
de la mâncare pentru a scădea în greutate. Amy
era împlinită profesional în afaceri, dar simţea
că a avut puţine relaţii strânse. În ultimii opt
ani, locuia împreună cu un muzician. Acesta
se bucurase de popularitate pentru o scurtă
perioadă, atunci când ei s‑au cunoscut, dar în
anii din urmă el a lucrat doar sporadic, în timp ce
se adâncea tot mai mult în abuzul de alcool. Amy
a fost internată cu o greutate de 34,9 kg (IMC =
11,7) şi avea sentimentul că se afla la o răscruce;
ori avea să moară, ori urma să facă un efort
sincer pentru a‑şi reveni. Ea a spus deschis că ştia
destule despre sine, încât să poată prevedea că va
ajunge la un punct în cursul terapiei în care avea
să devină iraţională şi să dorească să întrerupă
procesul de creştere în greutate. A dezvăluit
că nu se simţea apropiată de nimeni, ci prefera
relaţia pe care o avea cu propria tulburare de
comportament alimentar. A indicat că nu ştia
cum s‑ar fi putut accepta pe sine la o greutate mai
mare. „Identitatea” ei se afla alături de tulburarea
de comportament alimentar şi nu credea că ar fi
fost în stare să facă faţă fără aceasta. Totuşi, nu
voia să moară şi ştia că starea ei medicală era
precară. Figura 4.5 ilustrează profilul EDI‑3 al lui
Amy la internare.
Sumarul interpretativ al testării iniţiale
• Configuraţia scalelor unele faţă de altele. Trei
scale EDI‑3 (SSS, AI, FM) au scoruri mari faţă
de celelalte scale din profilul lui Amy. Poate fi
util să se evalueze scalele unele faţă de altele
(adică „maximele” şi „minimele”), pentru a
căpăta o mai bună înţelegere a constructelor
116
psihologice identificate de către Amy ca fiind
cele mai pronunţate.
• SCI şi SCPI. Scorurile SCI şi SCPI se situează
în intervalul de Semnificaţie clinică ridicată.
Totuşi, există o discrepanţă interesantă între
scalele care formează aceste două scoruri
compozite. Scorurile la scalele SSS şi AP
sunt ambele în intervalul de Semnificaţie
clinică ridicată, dar scorul scalei SSS e mult
mai mare. Acest fapt sugerează că Amy
se simte necorespunzătoare ca persoană,
dar nu înseamnă în mod necesar că nu se
simte singură pe lume sau lipsită de control
asupra vieţii ei sau că nu ştie cine este ca
persoană. Scalele care compun SCPI sunt şi
mai discrepante, cu scorul NI relativ scăzut
(adică în intervalul de Semnificaţie clinică
tipică), în timp ce scorul AI este evident mai
mare. Aşadar, Amy simte că este relaxată în
majoritatea situaţiilor interpersonale şi că este
o persoană sociabilă; totuşi, nu are încredere
în ceilalţi şi nu are relaţii interpersonale
apropiate. Acest fapt concordă în totalitate cu
relaţia ei îndelungată cu un bărbat care are
o capacitate de funcţionare foarte limitată
din cauza problemelor sale cu alcoolul şi cu
medicamentele. Dacă scorul AI clinic ridicat
reflectă dificultăţile lui Amy de a stabili relaţii
adevărate cu alţi oameni, acest lucru va face
dificilă terapia.
• Temeri intense de maturitate. Scorul ridicat
la scala FM este în concordanţă cu temerile
declarate ale lui Amy de a îmbătrâni şi de
a‑şi pierde identitatea ei ca femeie tânără
şi atrăgătoare, care ieşea în evidenţă prin
asocierea cu un muzician „faimos”.
• SCPE şi SCCE. Scorurile relativ scăzute la
SCPE şi SCCE şi la scalele asociate sugerează
că problemele emoţionale şi controlul
exagerat nu sunt percepute de către Amy ca
fiind principalele probleme. Tulburarea ei de
comportament alimentar stabilă, dar cronică,
nu a fost deosebit de supărătoare pentru ea
până la scăderea în greutate relativ recentă.
O problemă majoră de terapie care poate fi
anticipată este că motivaţia ei de a‑şi reveni
s‑ar putea stinge odată cu anularea scăderii
acute în greutate.
Cazul 4. Tulburare de alimentaţie compulsivă
la o femeie adultă
Mary este o doctoriţă de 31 de ani,
necăsătorită, care suferă de alimentaţie
compulsivă din adolescenţa timpurie. Mary
s‑a prezentat îngrijită, atentă şi orientată în
 Nume Mary Data

Scala Risc de tulburare Scala compozită Foaie de profil pe baza cotelor T

de comportament Risc de tulburare
alimentar de comportament Scală compozită psihologică
alimentar Scală psihologică
N N
Do e in Ne in in
De
z Pe in ps ead
fa mul t s te A te D rfe m F In te Pr
r o e Pr
o
ih ap
ri ţă ţu sin St rp li emechi efi p m C
Bu de m e s im pe Alie erpe igu
r ra e e ro efi
ce c l
oţ ib
cţi As at rica er ble
s oţ ble ex on ge olog tare
a fi nţa
lim co ire că ă d rs na
on re s on ţăn rs na
on re pt tei io u r on ce
tis
ur d ca
cit o m
na e i o m a t
ge rol nera ică
sla de zu e iv ism ita e na e
b ie rp tă ală ală ală e
na
l m te at
e le le ra lă
t

cotă T cotă T
DS B NC SCRTCA SSS AP NI AI DI DE P A FM SCI SCPI SCPE SCCE SCNPG

Figura 4.6. Foaia de profil pe baza cotelor T pentru Exemplul de caz 4 (Mary)
Lot non-clinic: Adulţi străini Adolescenţi din SUA Semnificaţie clinică tipică Eşantion de control femei
PAdulţi din SUA (eşantion combinat de
Lot clinic: AN-R AN-AC/V BN PTCAFAS adulţi)

117
toate domeniile. Era anxioasă şi disforică şi
îşi manifesta emoţiile fără reţinere. A devenit
extrem de anxioasă când a fost întrebată despre
comportamentul alimentar şi despre istoria
greutăţii ei corporale. A declarat că are o greutate
actuală de aproape 109 kg şi a adăugat imediat
că era „o persoană foarte capabilă, cu excepţia
alimentaţiei”. A menţionat că se alimenta
compulsiv cu fursecuri, prăjituri şi „junk food” şi
că era copleşită de sentimente de vinovăţie şi de
ruşine din cauza comportamentului ei. A indicat
că fusese „supraponderală” în copilărie şi că a
început să ţină regim în urma interminabilelor
tachinări ale celor de aceeaşi vârstă. Mama ei este
farmacistă şi obeză, iar tatăl ei este proprietarul
unei mici afaceri şi avea o greutate corporală
medie. Mary a afirmat că mama ei avea adesea
comentarii critice referitoare la propria ei greutate
corporală, precum şi la greutatea, forma corpului
şi obiceiurile alimentare ale fiicei. Mary a indicat
că nesiguranţa în privinţa greutăţii corporale
a făcut‑o să se retragă din compania celorlalţi,
de la începutul adolescenţei, şi să‑şi focalizeze
toate energiile asupra studiului. A excelat la
liceu şi a urmat un colegiu prestigios, obţinând
o bursă foarte generoasă. A descris perioade
în care reuşea să‑şi controleze episoadele de
alimentaţie compulsivă şi să scadă în greutate
cu câte 20‑30 de kilograme. Aceste perioade de
„control” o făceau să se simtă virtuoasă şi plină
de speranţa că avea să devină mai activă social; şi
totuşi, aceste perioade erau urmate inevitabil de
pierderea controlului asupra comportamentului
alimentar şi, apoi, de o creştere şi mai mare în
greutate.
Mary a avut puţine relaţii sociale în afara
spitalului. Când era rugată să socializeze în
afara locului de muncă, de obicei căuta scuze,
pentru că nu voia ca alţii să o vadă mâncând.
Mary s‑a descris pe sine ca stoică şi rezervată
ca stil de personalitate. Ea a accentuat foarte
mult trăsăturile de autocontrol emoţional,
autodisciplină, austeritate auto‑impusă şi de
perfecţionism. Acest lucru făcea ca episoadele de
alimentaţie compulsivă să fie şi mai dureroase,
întrucât ele exemplificau o formă de delăsare pe
care ea o considera dovada faptului că nu avea
valoare şi că era o persoană plină de defecte. Ea a
relatat o senzaţie tot mai pronunţată de dezgust
faţă de felul în care arăta şi că se gândise până
şi la a renunţa la medicină, întrucât simţea că dă
un prost exemplu pacienţilor ei. Profilul ei EDI‑3
este prezentat în figura 4.6.
118
Sumarul interpretativ al testării iniţiale
• SCRTCA. Scorul SCRTCA al lui Mary este
situat în intervalul de Semnificaţie clinică
ridicată, iar două dintre scalele asociate sunt,
de asemenea, în intervalul de Semnificaţie
clinică ridicată (B, NC). Aceste rezultate sunt
în concordanţă cu dezgustul şi dispreţul
declarat faţă de propriul corp. Este important
să nu se treacă cu vederea scorul NC al lui
Mary, doar din cauza greutăţii corporale
ridicate. Indiferent de greutatea corporală
a individului, atitudinile negative care
menţionează suferinţă trebuie luate în serios.
• SCPI şi SCCE. Scorurile SCPI şi SCCE sunt
mari şi indică două domenii psihologice
(adică probleme interpersonale, control exa-
gerat) care ar putea interfera cu eforturile
de a‑şi depăşi tulburarea de comportament
alimentar de lungă durată. Există un conflict
între convingerea lui Mary că trebuie să‑şi
păstreze mereu controlul şi sentimentele ei de
inadecvare, asociate „pierderii controlului”
în privinţa mâncării.
• SCPI. Scorul SCPI obţinut de Mary se situează
în intervalul de Semnificaţie clinică ridicată.
Acest lucru este important, întrucât ea ar dori
să aibă relaţii sociale; totuşi, menţionează
că se simte incapabilă de o relaţie susţinută
din cauza greutăţii corporale şi a tulburării
de comportament alimentar. Creşterea
pronunţată a scorului la scala NI pare a
fi legată, în primul rând, de rolul jucat de
dispreţul şi dezgustul faţă de corp în relaţiile
interpersonale.
• SCPE. Scorul mic la SCPE al lui Mary
este, întrucâtva, neobişnuit, pentru că ea
a menţionat o suferinţă extremă legată de
simptome. Se pare că ascetismul şi controlul
ei exagerat împiedică exprimarea deschisă a
instabilităţii afective.
• Scala DE şi SCPE. Scorurile mici la scala DE
şi la SCPE sunt în concordanţă cu controlul
pronunţat pe care respondenta îl manifestă în
alte domenii ale vieţii sale.
Evaluarea a implicat, de asemenea, şi întrebări
detaliate referitoare la cunoştinţele ei despre
„nivelul la care greutatea ei tinde să se stabilizeze
(set‑point)” şi despre eşecul programelor de
tratament tradiţional pentru obezitate în a
produce o scădere durabilă în greutate. Cu toate
că era familiară cu unele principii, Mary a indicat
că nu voia să fie expusă acestor idei, deoarece
credea că le‑ar putea folosi pentru a evita să‑şi
asume responsabilitatea pentru scăderea în
greutate. Mare parte din tratamentul ei a implicat
o trecere în revistă de natură psihoeducaţională
a informaţiilor care indică o legătură între dieta
strictă şi episoadele ei de alimentaţie compulsivă.
Următorul paragraf descrie pe scurt această
abordare (Garner şi Wooley, 1991); acesta este
inclus în secţiunea de evaluare a acestui Manual,
întrucât răspunsul pacienţilor la această abordare
este o parte foarte revelatoare a procesului de
evaluare dinamic.
Eşecul tratamentelor tradiţionale pare a
avea rădăcinile în biologia reglării greutăţii
corporale, care militează împotriva faptului că
majoritatea persoanelor obeze pot să devină
sau să se menţină zvelte prin „normalizarea”
raţiei alimentare (Garner şi Wooley, 1991). Studii
de genetică a obezităţii şi de biologie a reglării
greutăţii susţin în grade diferite următoarele
puncte: (a) destabilizarea greutăţii corporale
are ca rezultat, de obicei, adaptări metabolice,
care au scopul de a readuce organismul la
greutatea corporală menţinută în mod normal;
(b) „apărarea” greutăţii corporale se produce
atât la animalele obeze, cât şi la cele non‑obeze;
(c) factorii genetici joacă un rol major în a stabili
ce individ va deveni obez atunci când este
expus unei diete în care mâncarea are savoare;
(d) anumiţi factori de mediu (de exemplu, gustul
bun al alimentelor, exerciţiul fizic, fumatul,
clima, anumite medicamente) par a influenţa
nivelurile absolute (dar între anumite limite) la
care se reglează greutatea corporală; (e) ciclurile
greutăţii pot duce la o eficienţă metabolică sporită
(adică la o depozitare mai ridicată de energie la
un aport fix de energie) şi la creştere în greutate
(Notă. Acest subiect este foarte controversat şi
este probabil ca observaţiile acestea să se aplice
numai unor subgrupuri specifice de persoane cu
o anumită ascendenţă genetică) şi (f) numeroase
studii ale comportamentului alimentar al
persoanelor obeze arată că majoritatea acestora
nu ingerează cantităţi mari de alimente. Scăderea
în greutate şi menţinerea acesteia cu succes de
către majoritatea persoanelor obeze par a nu
fi atinse prin „normalizarea pattern‑urilor de
alimentaţie”, ci, mai degrabă, printr‑o restricţie
calorică cronică.
Cazul 5: Băiat de 16 ani cu Anorexie nervoasă
John e un băiat de 16 ani care a fost evaluat în
vederea internării şi includerii într‑un program de
tratament pentru adolescenţi, după ce nu a reuşit
să ia în greutate la un alt centru de tratament.
La întâlnirea iniţială, era palid la faţă şi lipsit de
expresie. John avea cea mai scăzută greutate de
până atunci, de 45,3 kg, la o înălţime de 1,70 m, şi
slăbise 72 de kg cu nouă luni înaintea evaluării.
El a specificat că ştia că trebuia să crească în
greutate, pentru că‑şi dădea seama că „mersese
prea departe” cu programul său de scădere în
greutate. John era un elev excelent şi plănuia să
meargă la facultate să studieze ingineria după
absolvirea liceului. Avea un frate mai mare, care
începuse facultatea în toamnă. John a început să
scadă în greutate după ce unii dintre prietenii
săi din echipa de înot au remarcat că arăta cam
„dolofan”. A decis că trebuia să scadă în greutate
şi era foarte hotărât să evite alte comentarii
negative la adresa fizicului său. În timpul
vacanţei, a început să elimine grăsimile din dietă
şi şi‑a intensificat activităţile fizice. A pierdut
rapid din greutate şi a primit complimente din
partea prietenilor şi a familiei. A fost foarte
mândru de regimul său competitiv şi a simţit că
avea un control pe care rareori îl simţea atunci
când făcea sport. Atunci când părinţii săi au
devenit îngrijoraţi de scăderea sa în greutate, el
le‑a spus că se cântărea singur şi că era încă la
o greutate acceptabilă. A început să poarte haine
largi şi a încercat să‑şi evite părinţii, în timp ce‑şi
continua regimul şi planul de exerciţii.
Părinţii lui s‑au îngrijorat din nou când John
s‑a întors la şcoală în toamnă, pentru că era
evident că scăzuse considerabil în greutate. John
a fost de acord să‑şi viziteze săptămânal medicul
pediatru şi să mănânce mai mult. A făcut acest
lucru vreme de câteva săptămâni şi apoi a început
din nou să scadă în greutate, însă a început să‑şi
strecoare pe ascuns greutăţi sub halatul de spital
în timpul cântăririi în cabinetul pediatrului.
Din momentul în care strategia sa a fost dată în
vileag, John a ajuns să cântărească aproximativ
52 de kg. Simţind un impuls competitiv înainte
de vizitele la doctor, John a reuşit să‑şi convingă
medicul pediatru şi părinţii că lua în greutate ca
rezultat al creşterii cantităţii de apă pe care o bea
înainte de fiecare cântărire. Simţea acest impuls
competitiv de fiecare dată când se pregătea
pentru o vizită la doctor şi a ajuns să bea tot
mai multă apă, ca măsură pregătitoare. În acest
timp, părinţii lui au programat o evaluare la un
centru specializat în tratamentul tulburărilor de
comportament alimentar. John a fost cântărit şi i
s‑a dat formularul EDI‑3 pe care să‑l completeze
în sala de aşteptare.
Rezultatele iniţiale la EDI‑3 nu sunt incluse,
deoarece, din vizualizarea profilului, a fost
evident că John a marcat toate răspunsurile pentru
a indica absenţa psihopatologiei. Scorurile mici la
toate scalele EDI‑3 au fost un motiv de îngrijorare
în sensul că John probabil nu oferise răspunsuri
119
120
Nume John Data

Scala Risc de tulburare Scala compozită Foaie de profil pe baza cotelor T

de comportament Risc de tulburare
alimentar de comportament Scală compozită psihologică
alimentar Scală psihologică
N N
e in Ne in De Pe in ps ead
Do fa mul t s te A in
te D z In te Pr ih ap
ri ţă ţu sin St pe Alie erpe igu rp li emechi
rfe m Fri e r p o em Pro C
Bu de m e s im r n r r e e ro efi
o l i
cţi As at ca
u
fic
a er ble oţ ble ex on ge olog tare
a fi nţa
lim co ire că ă d so ar
na e
so anţ rs na
on re
ce c
pt tei ţ io ru b on ce
tis rit de cit son em i o m a tr
ge ol ner ică
zu e na ă ism na e
sla de
b ie rp tă lă lă ală iv
e
na m at
e
at
e ale le ra ală
l t

cotă T cotă T
DS B NC SCRTCA SSS AP NI AI DI DE P A FM SCI SCPI SCPE SCCE SCNPG

Figura 4.7. Foaia de profil pe baza cotelor T pentru Exemplul de caz 5 (John)
Lot non-clinic: Adulţi din SUA Adulţi străini Semnificaţie clinică tipică Eşantion de control femei
PAdolescenţi din SUA (eşantion combinat de
Lot clinic: PAN-R AN-AC/V BN TCAFAS adulţi)
corecte la chestionar. Atunci când a fost întrebat,
John a specificat că acelea erau răspunsurile sale
şi că „nu era nebun”. Clincianul nu a insistat, iar
John a început imediat un tratament complet,
fiind internat. După o săptămână de tratament,
John a fost de acord să completeze din nou
EDI‑3. Profilul a fost foarte diferit şi este ilustrat
în figura 4.7.
Sumarul interpretativ al testării
• Validitate. Prima testare a fost considerată
invalidă, datorită scorurilor scăzute de la
toate scalele. Impresia clinică a fost aceea că
John nu fusese cooperant în timpul interviului
iniţial; a fost mai cooperant în cadrul celui
de‑al doilea interviu.
• Eşantioane comparative. Eşantionul clinic de
adolescenţi din SUA a fost folosit pentru a
reprezenta grafic cotele T pentru profilul
lui John. În general, bărbaţii cu AN prezintă
scoruri EDI similare celor raportate în cazul
femeilor (Andersen, 1990; Ricciardelli şi
McCabe, 2004).
• A doua testare. La cea de‑a doua testare,
profilul lui John a indicat cote T în intervalul
de Semnificaţie clinică ridicată pentru SCPI,
scala NI şi scala P. Dificultăţile în problemele
interpersonale, mai ales cele cu părinţii,
au reprezentat un obstacol major în calea
schimbării şi au constituit obiectivul principal
al terapiei după reabilitarea nutriţională.
• Scalele P, SSS şi NI. Scorurile obţinute de John
la scalele P, SSS şi NI sunt moderat ridicate,
indicând faptul că domeniile acestea sunt
semnificative în relaţie cu alte trăsături.
• SCRTCA. Scorurile SCRTCA obţinute de John
se situează în intervalul de Semnificaţie clinică
scăzută şi reflectă dorinţa lui de‑a câştiga
agresiv în greutate, odată ce era limpede
că urma să fie în tratament până când acest
lucru se îndeplinea. Este un fapt obişnuit în
cazul unei minorităţi semnificative dintre cei
diagnosticaţi cu tulburări de comportament
alimentar să recunoască faptul că sunt prea
slabi şi să dorească să ia în greutate, în urma
unei intervenţii care întrerupe contingenţele
de întărire care întreţin tulburarea.
Interpretarea EDI‑3 FT
EDI‑3 FT este un scurt chestionar
autoadministrat, folosit ca instrument de trimitere
la un consult de specialitate, conceput pentru a
evalua riscul unei tulburări de comportament
alimentar pe baza preocupărilor cu dieta, a greu-
tăţii corporale, a înălţimii, a istoricului greutăţii
corporale, a istoricului ciclului menstrual şi
a simptomelor comportamentale care indică
tulburări de comportament alimentar. Folosind
această abordare, persoanele care obţin un scor
peste o anumită limită ar trebui trimise la un
specialist calificat şi intervievate, pentru a se
stabili dacă îndeplinesc criteriile de diagnostic
pentru o tulburare de comportament alimentar.
EDI‑3 FT poate fi utilizat în grup sau individual
şi este conceput pentru a fi administrat de către
specialişti în sănătate mintală, consilieri şcolari,
instructori, consilieri de tabără şi alte persoane
interesate în strângerea de informaţii cu scopul de
a stabili dacă un anumit individ ar trebui trimis
la specialist pentru o evaluare a unei posibile
tulburări de comportament alimentar. EDI‑3 FT
poate fi administrat persoanelor într‑un cadru
nonclinic sau într‑unul clinic, care nu vizează
direct tulburările de comportament alimentar.
Este ideal pentru un cadru şcolar, pentru clinicile
de fertilitate, cabinetele medicilor de familie şi
pentru departamentele de tratament psihiatric
ambulatoriu.
EDI‑3 FT stabileşte „scoruri de secţiune pentru
risc” la criterii de trimitere bazate pe: (a) greutate
corporală scăzută, comparativ cu etaloanele în
funcţie de vârstă şi sex (adică criterii exclusiv
pe baza IMC); (b) greutate corporală scăzută în
comparaţie cu etaloanele în funcţie de vârstă şi
sex (adică IMC) şi preocupări excesive legate
de dietă, de greutatea corporală sau pattern‑uri
problematice de alimentaţie (adică evaluate
prin scorurile totale brute ale scalelor DS şi B)
şi (c) simptome comportamentale care reflectă
o tulburare de comportament alimentar (adică
bazate pe răspunsuri la cinci întrebări referitoare
la comportamente). În general, o trimitere la
specialist este recomandată, dacă un respondent
are scoruri „pozitive” sau depăşeşte pragurile
pentru unul sau mai multe criterii, precum şi în
funcţie de informaţii clinice colaterale provenite
din alte surse.
Greutate corporală scăzută comparativ cu
etaloanele în funcţie de vârstă şi sex
EDI‑3 FT include întrebări specifice referitoare
la înălţime şi greutate care pot fi utilizate pentru a
calcula indicele de masă corporală (IMC) cu scopul
de a stabili dacă o persoană este la risc pentru
o tulburare de comportament alimentar, din
cauză că este extrem de subponderală, conform
etaloanelor pe populaţia generală în funcţie de
vârstă şi sex. IMC reprezintă o formulă prin care
121
se estimează masa corporală, care ia în calcul EDI‑3 FT utilizează un prag (cutoff) al
atât înălţimea, cât şi greutatea. Se calculează prin IMC‑ului situat între centilul 5 şi centilul 10
împărţirea greutăţii (în kilograme) la înălţime pentru diferite vârste, pe sexe, astfel încât să se
(în metri) şi, apoi, împărţind din nou la înălţime poată stabili dacă un respondent îndeplineşte
(în metri) sau kg/m2. Alternativ, IMC‑ul poate fi criteriile de trimitere la un consult de specialitate
calculat împărţind greutatea (în livre) la înălţime pe baza IMC‑ului. Tabelul 4.29 prezintă, într‑o
(în inci), apoi împărţind din nou la înălţime (în formă uşor de utilizat, criteriile de trimitere
inci) şi înmulţind cu 703. National Heart, Lung, la un consult de specialitate pe baza IMC‑ului
and Blood Institute (NHLBI, 1998) şi Organizaţia calculat cu ajutorul înălţimii, al greutăţii şi al
Mondială a Sănătăţii (OMS, 1992) au stabilit vârstei respondentului, înregistrate în EDI‑3 RF.
valori de referinţă pentru IMC care delimitează O determinare mai precisă a mărimii IMC‑ului
categoriile „obez” (≥30,0), „supraponderal” unei persoane, comparativ cu centilele 5 şi 10
(25,0‑29,9), „greutate normală” (18,5‑24,9) şi asociate cu vârsta şi sexul acesteia, poate fi
„subponderal” (<18,5). obţinută calculând IMC‑ul cu ajutorul formulei
National Health and Nutrition Examination descrise anterior şi comparându‑l cu numerele
Survey III (NHANES III, Kuczmarski şi colab., din tabelul 4.28.
2002) – Studiul Naţional de Investigare a Sănătăţii şi Deşi IMC‑ul este un instrument convenabil
Nutriţiei III din Statele Unite – a colectat date de şi util de clasificare a greutăţii, el are anumite
referinţă pentru a stabili etaloanele de greutate limite. De exemplu, IMC‑ul poate supraestima
şi de înălţime la diferite vârste pentru fete/femei cantitatea de ţesut adipos în cazul persoanelor
şi băieţi/bărbaţi, de la naştere până la 20 de ani. cu conformaţie atletică. De asemenea, anumite
Aceste etaloane indică faptul că IMC‑ul variază grupuri etnice şi naţionalităţi au diferite distribuţii
considerabil în funcţie de vârstă şi de sex, copiii ale ţesutului adipos şi diferite constituţii ale
între 5 şi 8 ani având cele mai scăzute valori ale corpului; prin urmare, datele NHANES III nu
IMC‑ului, urmate de o creştere constantă odată cu sunt valabile pentru toate grupurile (Kuczmarski
vârsta. Schimbările previzibile în IMC asociate cu şi colab., 2002).
vârsta şi sexul trebuie luate în considerare atunci
când se efectuează screening‑ul persoanelor care Îngrijorări exagerate referitoare la alimentaţie
sunt „foarte subponderale”. Acest lucru este şi greutate corporală
ilustrat în tabelul 4.28, care cuprinde datele din
NHANES III, indicând centilele 5 şi 10 ale IMC Preocuparea şi îngrijorarea exagerate în
pentru fete/femei şi băieţi/bărbaţi de la 9 la până privinţa greutăţii corporale, a formei corpului
la 20 de ani. şi a regimului alimentar sunt trăsături centrale
ale tulburărilor de comportament alimentar. S‑a
constatat, în mai multe studii prospective, că
Tabelul 4.28 dorinţa de a fi slab poate fi considerată predictivă
Centilele 5 şi 10 corespunzătoare indicelui pentru dezvoltarea ulterioară a unor tulburări
de masă corporală (IMC) în funcţie de vârstă, de comportament alimentar. În orice caz, atunci
pentru femei şi bărbaţi când această variabilă este combinată cu altele,
precum stima de sine scăzută, depresia sau lipsa
Centilul corespunzător IMC-ului suportului social, rezultatul este o predicţie
Femei Bărbaţi îmbunătăţită a riscului (a se vedea Dobmeyer şi
Vârsta 5 10 5 10 Stein, 2003).
9 13,7 14,2 14,0 14,3 EDI‑3 FT evaluează îngrijorările excesive
10 14,0 14,5 14,2 14,6 legate de regimul alimentar, de greutatea
11 14,4 14,9 14,5 15,0 corporală sau de pattern‑uri problematice de
12 14,8 15,4 15,0 15,5 alimentaţie, folosind 25 de itemi din scalele DS,
13 15,3 15,9 15,4 16,0 B şi NC ale EDI‑3; cu toate acestea, doar itemii
14 15,8 16,4 16,0 16,5 scalelor DS (7 itemi) şi B (8 itemi) sunt efectiv
15 16,3 16,9 16,6 17,1 utilizaţi pentru a calcula scorurile de secţiune
16 16,8 17,4 17,1 17,7 aplicate în procesul de decizie a trimiterii la un
17 17,2 17,8 17,7 18,3 consult de specialitate. Raţionamentul pentru
18 17,6 18,2 18,2 18,9 includerea doar a acestor două scale este legat
19 17,8 18,4 18,7 19,4 de faptul că ele sunt superioare scalei NC în a
20 17,8 18,5 19,1 19,8 face diferenţa între eşantioanele clinice şi cele
nonclinice folosite în construcţia EDI‑3. Scorurile

122
 Tabelul 4.29
Tabel de calcul al Indicelui de masă corporală (IMC)

Înălţime (cm) Greutate (kg)

144 29 30 31 32 33 34 35 36 37 38 39 41 43 45 47 49 51
146 30 31 32 33 34 35 36 37 38 39 40 42 45 47 49 51 53
148 31 32 33 34 35 36 37 38 39 40 41 43 46 48 50 52 54
150 32 33 34 35 36 37 38 39 40 41 43 45 47 49 52 54 56
152 32 33 35 36 37 38 39 40 41 43 44 46 48 51 53 55 57
154 33 34 35 37 38 39 40 41 42 44 45 47 50 52 54 57 59
156 34 35 36 38 39 40 41 42 44 45 46 48 51 53 56 58 60
158 35 36 37 39 40 41 42 43 45 46 47 50 52 55 57 60 62
160 36 37 38 40 41 42 43 45 46 47 48 51 53 56 59 61 64
162 37 38 39 41 42 43 44 46 47 48 50 52 55 58 60 63 66
164 37 39 40 42 43 44 46 47 48 50 51 54 56 59 62 64 67
166 38 40 41 43 44 45 47 48 50 51 52 55 58 60 63 66 69
168 39 41 42 44 45 46 48 49 51 52 54 56 59 62 65 68 71
170 40 42 43 45 46 48 49 50 52 53 55 58 61 63 66 69 72
172 41 43 44 46 47 49 50 52 53 55 56 59 63 65 68 71 74
174 42 44 45 47 48 50 51 53 54 56 57 60 63 66 69 73 76
176 43 45 46 48 49 51 52 54 56 57 59 62 65 68 71 74 77
178 44 46 47 49 50 52 54 55 57 59 60 63 66 70 73 76 79
180 45 47 49 50 52 53 55 57 58 60 62 65 68 71 74 78 81
182 46 48 50 51 53 55 56 58 60 61 63 66 69 73 76 79 83
184 47 49 51 52 54 56 57 59 61 63 64 67 71 74 78 81 85
186 48 50 52 54 55 57 59 60 62 64 66 69 73 76 79 83 86
188 49 51 53 55 57 58 60 62 64 65 67 71 74 78 81 85 88
190 50 52 54 56 58 60 61 63 65 67 69 72 76 79 83 87 90

IMC (kg/m2) 14 14,5 15 15,5 16 16,5 17 17,5 18 18,5 19 20 21 22 23 24 25

Notă. Valorile tabelului, exprimate în manualul original în inchi, respectiv, în livre, au fost convertite de către autorii versiunii
în limba română în centimetri, respectiv, în kilograme.

Tabelul 4.30
Valorile critice pentru scalele EDI-3 Dorinţa de a fi slab şi Bulimie

Vârsta ≤ 17 ani Vârsta ≥ 18 ani

Valoare critică Valoare critică
Prag de trimitere Scor total Scor total Prag de trimitere Scor total Scor total
bazat pe IMC brut DS brut B bazat pe IMC brut DS brut B
≤ 15,5 9 sau 4 ≤ 18,0 15 sau 5
> 15,5 & ≤ 22,0 9 sau 4 > 18,0 & ≤ 22,0 22 sau 8
> 22,0 & ≤ 25,0 18 sau 8 > 22,0 & ≤ 25,0 24 sau 10
> 25,0 22 sau 10 > 25,0 25 sau 12
Notă. IMC = Indice de masă corporală; DS = scala Dorinţa de a fi slab; B = scala Bulimie.

123
medii la scala B au fost relativ mici la eşantioanele
nonclinice; aşadar, scorurile mari la itemii din
această scală sunt utile ca semn de avertizare cu
privire la o posibilă tulburare de comportament
alimentar.
IMC‑ul corelează pozitiv cu scalele DS şi B;
s‑au stabilit, astfel, valori critice diferite pentru
ambele scale, în funcţie de vârsta şi IMC‑ul
respondentului. Criteriile de trimitere bazate pe
îngrijorările exagerate legate de alimentaţia şi
greutatea în exces sunt îndeplinite dacă scorurile
totale brute ale respondentului la scalele DS şi
B sunt mai mari sau egale cu valorile critice din
tabel (a se vedea tabelul 4.30).
Eşantionul de pacienţi adolescenţi cu
tulburări de comportament alimentar care a
fost folosit pentru a obţine valorile critice DS şi
B din EDI‑3 prezentate în tabelul 4.30 a constat
din 302 adolesceni cu tulburări de comportament
alimentar, având vârste cuprinse între 13 şi 17 ani
(M = 15,6 ani, AS = 1,3 ani). Clasificarea în funcţie
de diagnostic a fost AN‑R (30,8%), AN‑AC/V
(7,6%), BN (30,5%) şi TCAFAS (31,1%). 538 de
alţi adolescenţi cu vârste cuprinse între 13 şi 17
ani (M = 15,4 ani, AS = 1,2 ani) au servit drept
eşantion nonclinic de control. Eşantionul clinic
de adulţi folosit pentru a obţine valorile critice
ale DS şi B din EDI‑3 a cuprins 720 de pacienţi cu
vârste între 18 şi 60 de ani (M = 25 ani, AS = 8 ani)
şi a constat din AN‑R (15,8%), AN‑AC/V (10%),
BN (44%) şi TCAFAS (30,2%). Grupul nonclinic
de control de adulţi utilizat pentru comparaţie
a constat din 934 de indivizi cu vârste cuprinse
între 18 şi 55 de ani (M = 21,7 ani, AS = 3,7).
Cu toate că scala NC nu este folosită în mod
direct în algoritmul de trimitere la un consult
de specialitate, studii pe adolescente şi pe adulţi
tineri arată că nemulţumirea faţă de corp este
foarte răspândită şi reprezintă un factor important
de risc pentru dezvoltarea unor simptome
ale tulburărilor de comportament alimentar.
Studiile au arătat că mai mult de 80% dintre
adolescente adesea „se simt grase” (Greenfield,
Quinlan, Harding, Glass şi Bliss, 1987). Într‑un
studiu efectuat pe 16.114 băieţi şi fete, Field şi
colegii (1999) au raportat că 44% dintre fetele
şi 19% dintre băieţii de 14 ani încercau să
slăbească. Patton, Johnson‑Sabine, Wood, Mann
şi Wakeling (1990) au arătat că adolescentele
clasificate ca „ţinând regim” prezintă un risc
de aproximativ opt ori mai mare de a dezvolta
o tulburare de comportament alimentar faţă de
cele care nu ţin regim, iar într‑un studiu mai
recent, s‑a demonstrat că adolescentele care ţin
„regim sever” prezintă un risc de 18 ori mai mare
(Patton, Selzer, Coffey, Carlin şi Wolfe, 1999).
124
Interpretarea punctajului la scala NC ar
trebui efectuată în contextul greutăţii corporale
actuale. S‑a dovedit că scala NC corelează
pozitiv cu greutatea corporală şi cu IMC; totuşi,
acelaşi nivel de nemulţumire faţă de corp are
semnificaţii clinice diferite pentru indivizi de
greutăţi diferite (Garner şi colab., 1992). De
exemplu, pacienţii cu AN şi studentele din
eşantionul nonclinic au scoruri medii similare
la subscala EDI Nemulţumire faţă de corp; totuşi,
pacienţii cu tulburări de comportament alimentar
sunt, în medie, cu aproximativ 30% mai slabi
decât studentele (Garner, 1991). Cu toate că
ambele grupuri ar putea fi relativ satisfăcute
în privinţa greutăţii lor, pacienţii cu tulburări
de comportament alimentar sunt mulţumiţi
în contextul unei greutăţi corporale aberante.
Cu toate acestea, deoarece un scor NC mare
reflectă sentimente negative faţă de corp, aceste
preocupări nu ar trebui pierdute din vedere doar
pentru că un individ se situează, pe intervalul
valorilor posibile ale greutăţii, la extremitatea
superioară.
Întrebări referitoare la comportament
Mai multe întrebări referitoare la comporta-
ment, care sunt destinate să determine prezenţa
unor comportamente extreme de control al
greutăţii, precum şi să ofere o estimare a frecvenţei
lor, sunt incluse în EDI‑3 FT. Aceste întrebări
evaluează alimentaţia compulsivă declarată de
respondent, provocarea vărsăturilor, utilizarea
de laxative şi activitatea fizică drept modalităţi
de a pierde sau de a controla greutatea în ultimele
3 luni. Chiar dacă aceste domenii de conţinut ar
putea fi evaluate în acelaşi format precum alţi
itemi, acest lucru nu ar oferi tipul de date despre
frecvenţă necesar pentru a evalua amploarea
problemei.
Unul dintre scopurile originale ale EDI a fost
de a identifica indivizii care erau descrişi ca fiind
excesiv de „preocupaţi de greutate” şi de a studia
factorii relaţionaţi cu această caracteristică,
precum relaţia lor cu predicţia unui posibil risc
pentru tulburări de comportament alimentar în
viitor (Garner şi colab, 1984).
Decizia de a utiliza un anumit scor de secţiune
a depins de scopul examinării. Este important
să se înţeleagă că scorul de secţiune stabilit în
procedura de examinare efectuată în două etape
nu este fix sau prestabilit. Fiecare dimensiune
surprinsă de EDI este conceptualizată ca o
trăsătură continuă. A împărţi indivizii în categorii
dihotomice, bazate pe scorurile la subscale
implică o relativă toleranţă pentru tipuri diferite
de erori de clasificare. Astfel, un scor de secţiune
relativ mare sau conservativ scade numărul de
falşi pozitivi, însă poate creşte numărul de falşi
negativi. Pe de altă parte, un scor de secţiune
scăzut creşte numărul de falşi pozitivi, dar scade
falşii negativi. Garner şi colab. (1984) au folosit
un scor de secţiune conservativ cu valoarea mai
mare de 14 la subscala EDI Dorinţa de a fi slab,
pentru a defini un grup de studente şi de eleve
la şcoala de balet „preocupate de greutate”.
Acest scor de secţiune corespunde centilului 94
pentru eşantionul original nonclinic de studente
folosit pentru etalonare (Garner, Olmsted şi
Polivy, 1983). Pentru a confirma faptul că scoruri
mari la subscala Dorinţa de a fi slab au reflectat o
preocupare legată de greutate, un eşantion mic
de femei care au obţinut scoruri peste cel de
secţiune, precum şi cele care au obţinut un scor
de 3 (centilul 55) sau mai mic, au fost intervievate
pentru a li se stabili diagnosticul. Dintre
persoanele care au obţinut scoruri peste scorul de
secţiune, 75% aveau tulburări de comportament
alimentar în prezent sau avuseseră în trecut şi
25% au fost clasificate ca ţinând „diete normale”.
Niciuna dintre persoanele care au obţinut un
scor de 3 sau mai mic nu aveau tulburări de
comportament alimentar. Într‑un studiu în care
mai mult de jumătate dintre participanţi erau
pacienţi al căror diagnostic era deja cunoscut,
Norring şi Sohlberg (1988) au constatat că un scor
de secţiune şi mai strict de 17 (centilul 97 pentru
studente) a eliminat toate persoanele din lotul
de control, lăsând doar pacienţii cu tulburări de
comportament alimentar.
Ambele scoruri de secţiune menţionate
ar putea fi prea stricte pentru cele mai multe
scopuri de screening. Garner şi Olmsted (1984)
au raportat că 9% dintre studente şi 11% dintre
elevele de liceu au obţinut scoruri mai mari decât
valoarea 14 a scorului de secţiune la subscala EDI
Dorinţa de a fi slab. Într‑un studiu de etalonare
efectuat pe 1.373 elevi de liceu, Rosen, Silberg şi
Gross (1988) au raportat că 11% dintre fete şi unul
dintre băieţi au obţinut un scor de 14 sau mai
mare la subscala EDI Dorinţa de a fi slab. În acelaşi
eşantion, 19% dintre fete şi 2% dintre băieţi au
obţinut un scor mai mare de 20 la testul EAT‑26.
Shore şi Porter (1990) au relatat că 16% dintr‑un
grup nonclinic de fete cu vârste cuprinse între 11
şi 18 ani au obţinut scoruri peste 14 la subscala
Dorinţa de a fi slab. Într‑un studiu prospectiv pe
un eşantion destul de restrâns de tineri studenţi
la balet, Garner şi colab. (1987) au raportat
că aceia care au dezvoltat în final o tulburare
de comportament alimentar au avut scoruri
semnificativ mai mari la subscalele Dorinţa de
a fi slab şi Nemulţumire faţă de corp la testarea
iniţială, comparativ cu media de 2,6 a grupului
fără tulburare de comportament alimentar
(aproximativ centilul 58 pentru studente).
Decizia de a baza pe scalele DS şi B
formularea criteriilor de trimitere la un consult de
specialitate utilizând EDI‑3 FT a pornit de la mai
multe şiruri de dovezi. În primul rând, s‑a stabilit
că, în timp ce scala NC evaluează un construct
important şi itemii sunt administraţi cu EDI‑3 FT,
scala NC identifică prea mulţi indivizi aflaţi la
limita superioară a intervalului valorilor posibile
de greutate, iar trimiterea ar trebui să fie bazată,
în primul rând, pe atitudini şi comportamente
disfuncţionale legate de alimentaţie. Decizia de
a utiliza atât scala DS, cât şi scala B din EDI‑3,
pentru a determina „nivelul de risc”, are un
precendent istoric. Într‑un studiu prospectiv
de 3 ani pe adolescenţi, Leon, Fulkerson, Perry
şi Early‑Zald (1995) au utilizat suma itemilor
scalelor DS şi B pentru a clasifica un grup mare
de elevi cu vârste cuprinse între 12 şi 15 ani ca
având un risc „crescut”, „moderat” şi „scăzut”
pentru tulburări de comportament alimentar.
Pentru ambele sexe, cei mai puternici predictori
ai nivelului de risc în cel de‑al treilea an au
fost scorurile de risc din primul şi al doilea an.
Pattern‑ul asocierii dintre componentele scorului
de risc (itemii) a fost diferit pentru băieţi şi pentru
fete, mai multe fete răspunzând afirmativ la
itemii referitori la comportamente compensatorii,
alături de itemii referitori la alimentaţia
compulsivă. Într‑un studiu prospectiv de 5 ani
asupra nou‑născuţilor şi a mamelor acestora,
Stice şi colab. (1999) au raportat că scorurile mari
obţinute de către mame la subscalele Dorinţa de a
fi slab, Bulimie şi Nemulţumire faţă de corp au prezis
apariţia tulburărilor de comportament alimentar
la o vârstă fragedă. Într‑un studiu asupra
efectelor hărţuielii asupra altei persoane, la care
asistă un individ, Furmin şi Thompson (2002) au
constatat că îngrijorările legate de alimentaţie,
măsurate prin suma scorurilor la subscalele
Dorinţa de a fi slab şi Bulimie, reprezintă cel mai
bun predictor al unei dispoziţii afective negative,
care a fost manipulată punându‑i pe participanţi
să citească scenarii bazate pe înfăţişarea fizică, în
care o altă femeie era ţinta unor tachinări. Davis
şi colab. (2004) au testat un eşantion nonclinic
de studente, din două perspective privitoare
la factorii familiali şi la relaţia acestora cu un
comportament alimentar dezorganizat: (a) cazul
în care, în familie, accentul pus pe un aspect fizic
atrăgător şi pe înfăţişare era asociat cu tulburări
de comportament alimentar şi (b) cazul în care
această relaţie este accentuată la indivizii care
125
au o personalitate vulnerabilă la tulburări
psihologice. Rezultatele au arătat că factorii de
risc familiali au o influenţă mai mare în cazul
tinerelor care au tendinţa de a manifesta stări
de anxietate, posibil din cauză că acestea sunt
predispuse să internalizeze idealurile familiilor
lor.
Joiner, Vohs şi Heatherton (2000) au analizat
suplimentar problema diferenţelor de gen în
cazul subscalei Bulimie într‑un studiu bazat pe
analiză factorială, arătând că itemul referitor
la vărsături („M‑am gândit să încerc să vomit
ca să slăbesc.”) a format un factor separat
pentru bărbaţi în trei studii separate, însă nu
s‑a evidenţiat ca un factor separat pentru femei.
Ei au concluzionat că femeile care au declarat
că au episoade de alimentaţie compulsivă
sunt mult mai susceptibile să se gândească la
comportamente compensatorii, spre deosebire
de bărbaţi, pentru care s‑au decelat doi factori
distincţi. Waller şi Matoba (1999) au evaluat
trei grupuri: (a) femei japoneze care trăiesc în
Japonia; (b) femei japoneze care trăiesc în Marea
Britanie şi (c) femei britanice care trăiesc în Marea
Britanie. Folosind chestionarul original EDI,
aceştia au descoperit diferenţe interculturale în
asocierea dintre alimentaţia datorată emoţiilor şi
constructele măsurate de subscalele Dorinţa de a
fi slab şi Bulimie. Femeile britanice au prezentat o
relaţie strânsă între alimentaţia datorată emoţiilor
şi cele două subscale din EDI, spre deosebire
de absenţa oricărei asocieri în cazul femeilor
japoneze care trăiesc în Japonia. Femeile japoneze
care trăiesc în Marea Britanie au prezentat un
pattern intermediar, fapt ce a dus la concluzia
că este vorba de un proces de aculturaţie. Atât
subscala Dorinţa de a fi slab, cât şi cea de Bulimie
au niveluri ridicate de stabilitate de‑a lungul mai
multor ani. Joiner şi colab. (1997) au evaluat un
grup de studenţi şi, reevaluându‑i 10 ani mai
târziu, au descoperit corelaţii puternice pentru
scalele Dorinţa de a fi slab (0,50) şi Bulimie (0,56).
În mod similar, într‑un studiu cu o durată de 6
ani asupra istoriei naturale a comportamentului
alimentar dezorganizat, într‑un eşantion de
femei adulte, la nivel comunitar, Rizvi şi colab.
(1999) au descoperit corelaţii puternice pentru
Dorinţa de a fi slab (0,70) şi Bulimie (0,75). Astfel,
şi aceste concluzii susţin utilizarea scalelor DS
şi B ale EDI‑3 FT, datorită stabilităţii lor în timp
relativ ridicate.
126
Screeningul tulburărilor de comportament
alimentar
Screening versus identificarea cazurilor
Screeningul şi identificarea cazurilor se
bazează pe ipoteza potrivit căreia identificarea
precoce a unei tulburări poate conduce la
instituirea mai devreme a tratamentului,
reducând astfel morbiditatea şi mortalitatea.
Screeningul pentru o serie de tulburări de natură
medicală a devenit rutină în numeroase locuri
şi presupune testarea voluntarilor consideraţi
sănătoşi din populaţia generală, cu scopul
împărţirii acestora în grupuri care prezintă fie o
probabilitate ridicată, fie una scăzută de a avea
o tulburare anume. Un exemplu de screening ar
fi un program naţional menit să identifice, într‑o
anumită populaţie, persoanele care sunt HIV
pozitive sau care au cancer mamar. În procesul
de screening, iniţiativa aparţine mai degrabă
personalului calificat decât pacientului.
Spre deosebire de screening, identificarea
cazurilor presupune testarea pacienţilor care
au căutat deliberat asistenţă medicală sau
informaţii, ca parte a unei evaluări amănunţite
a stării de sănătate. Personalul medical sau de
îngrijire poate face examinări pentru depistarea
anumitor tulburări în timpul examinărilor clinice
de rutină la pacienţii care se află la risc sau, la
nivel comunitar, în cazul persoanelor care se
oferă voluntar. Un exemplu de identificare a
cazurilor ar fi măsurarea tensiunii arteriale
într‑un centru comercial sau mamografia oferită
la casa de cultură din localitate. Practica de rutină
a unui medic din unităţile de asistenţă primară
este similară cu această definiţie a identificării
cazurilor, deoarece se întâmplă frecvent ca o
boală pentru care s‑a prezentat pacientul, fie că
îl supără, fie că nu, să fie identificată cu această
ocazie.
Screeningul şi identificarea cazurilor nu se
pretează oricăror situaţii sau tulburări. Indicaţiile
de bază pentru utilizarea unui instrument de
screening pentru o tulburare sau o situaţie
sunt: (a) tulburarea sau situaţia respectivă
constituie o problemă de sănătate importantă,
(b) această problemă de sănătate este tratabilă
şi (c)  identificarea timpurie are consecinţe
favorabile. Decizia de a face un screening depinde
întotdeauna de factorii care se iau în considerare,
inclusiv efectele potenţial benefice şi dăunătoare
ale testării asupra unui individ sau a unei
populaţii investigate. În plus, testul de screening
utilizat trebuie să aibă caracteristici psihometrice
bune (incluzând sensibilitate, specificitate şi o
putere predictivă bună), fiind, de asemenea,
relativ simplu, economicos şi uşor de acceptat
de către cei cărora li se cere să‑l completeze.
Eficienţa screeningului depinde de validitatea
sau de acurateţea testării, precum şi de prevalenţa
tulburării. Aşa cum am mai spus, principala
diferenţă dintre screening şi identificarea
cazurilor constă în persoana care iniţiază
contactul iniţial. Atât în cazul screeningului, cât
şi în acela al identificării cazurilor, personalul
medical trebuie să evalueze cu mare atenţie
riscurile şi beneficiile procedurilor utilizate,
împreună cu caracterul practic, eficacitatea şi
eficienţa procedurilor respective.
Screeningul şi identificarea cazurilor
implică diferite obligaţii de natură etică. Dacă
practicianul iniţiază screeningul, atunci trebuie
să existe dovezi concludente conform cărora
această procedură poate avea un efect pozitiv
asupra evoluţiei fireşti a tulburării. Mai mult,
riscurile procedurii de screening asupra celor
care nu suferă de afecţiunea pentru care se face
screeningul trebuie luate atent în considerare,
deoarece individul vizat nu a solicitat ajutorul
specialistului. Această situaţie este oarecum dife-
rită de identificarea cazurilor, în care pacientul a
solicitat un anumit tip de asistenţă. Deşi pacientul
trebuie asigurat mereu că beneficiază de cea mai
bună îngrijire, identificarea cazurilor se petrece
în contextul în care un pacient solicită asistenţă.
În această situaţie, nu există nicio garanţie a
beneficiului şi, s‑ar putea susţine, există o oarecare
expunere la risc. Cu alte cuvinte, implicaţiile unei
intervenţii nesolicitate asupra unei persoane,
cu presupunerea că aceasta ar putea avea o
problemă de sănătate sau că prezintă cu adevărat
semnele unei boli, implică o răspundere mai
mare în a dovedi faptul că beneficiile potenţiale
depăşesc cu mult riscurile.
În domeniul tulburărilor de comportament
alimentar, studiile atât asupra screeningului, cât
şi asupra identificării cazurilor s‑au desfăşurat
fără prea multe discuţii despre riscurile acestor
proceduri. Nu este ceva neobişnuit ca pacienţii
cu tulburări de comportament alimentar să
dezvăluie la prima consultaţie că au aflat despre
provocarea vărsăturilor sau despre abuzul de
laxative cu ocazia unor cercetări bine intenţionate
sau a unor programe „educative”. Astfel,
identificarea cazurilor trebuie să se desfăşoare
în cabinetele de medicină generală cu măsuri
de precauţie şi cu o atenţie deosebită faţă de
beneficiile şi riscurile posibile asupra individului.
Screeningul tulburărilor de comportament
alimentar la atleţi
În ultimii ani, a existat un interes tot mai
mare în privinţa tulburărilor de comportament
alimentar la atleţi. Majoritatea studiilor asupra
atleţilor care concurează în sporturi care pun
accent pe o siluetă zveltă pentru a obţine
performanţă sau pe aspectul fizic (de exemplu,
dans, gimnastică, alergare pe distanţe lungi,
wrestling) au arătat că aceştia prezintă un risc
crescut de apariţie a tulburărilor de comportament
alimentar (Garner, Rosen şi Barry, 1998). Cauzele
unei prevalenţe crescute a tulburărilor de
comportament alimentar în anumite subgrupuri
de atleţi au făcut obiectul a numeroase speculaţii.
Opinia cea mai întâlnită a fost aceea că presiunile
de a ţine regim şi de a deveni zvelt pot să
provoace într‑adevăr tulburări de comportament
alimentar la persoanele cu vulnerabilităţi
specifice. Alternativ, anumite sporturi pot atrage
atleţi care au deja tulburări de comportament
alimentar. De asemenea, s‑a sugerat că anumiţi
factori de personalitate şi familiali, frecvent
întâlniţi la atleţi, îi pot predispune la apariţia
tulburărilor de comportament alimentar.
Identificarea tulburărilor de comportament
alimentar la atleţi folosind EDI‑3 FT poate fi
complicată, întrucât multe comportamente
patogene de control al greutăţii sunt, prin natura
lor, ego‑sintonice şi ascunse. Un alt obstacol în
ceea ce priveşte dorinţa atleţilor de a mărturisi
că suferă de probleme severe de comportament
alimentar este teama că, astfel, şi‑ar periclita po-
ziţia în echipă. Într‑un studiu sofisticat din punct
de vedere metodologic asupra comportamentului
alimentar dezorganizat la atleţi, Sundgot‑Borgen
(1994) a examinat factorii de risc pentru
tulburările de comportament alimentar la atleţii
de elită reprezentând şase grupuri diferite de
sporturi. Tuturor participanţilor li s‑a administrat
EDI‑2 şi s‑a urmărit cu atenţie ca răspunsurile
respondenţilor să fie sincere. Dintre cele 522
de atlete de elită care au participat la o fază a
studiului, 117 (22,4%) au fost clasificate ca fiind
la risc pentru o tulburare de comportament
alimentar, pe baza scorurilor lor la subscalele DS
şi NC. Dintre atleţii aflaţi la risc care au participat
la un interviu clinic (N=103), 48% au întrunit
criteriile pentru AN sau BN şi 41% au întrunit
criteriile pentru anorexia atletică. Prevalenţa
tulburărilor de comportament alimentar a fost
cea mai ridicată în sporturile în care atleţii sunt
încurajaţi să fie slabi, pentru a atinge standarde
de performanţă sau de înfăţişare.
127
 Acest punct de vedere contrastează cu cel
al lui Wilmore (1996), care a centralizat studii ce
foloseau EDI şi EAT pe eşantioane de atleţi şi a
sugerat că, în unele studii, testele respective nu
reuşeau să identifice persoanele cu tulburări
de comportament alimentar (O’Connor, Lewis
şi Kirchner, 1995; Wilmore, 1996; Wilmore şi
colab., 1992). Wilmore a menţionat un studiu în
care EAT fusese administrat de către un medic
şi un absolvent de facultate la 110 atlete de elită
care au fost asigurate de caracterul complet
anonim al răspunsurilor. Niciunul dintre
cele 87 de chestionare returnate nu prezenta
scoruri care să corespundă unui comportament
alimentar dezorganizat; cu toate acestea, 18
dintre atletele testate au beneficiat de tratament
pentru o tulburare de comportament alimentar
în următorii doi ani. Rezultate similare au fost
raportate de către Wilmore şi colab. folosind EDI.
Pe baza acestor rezultate, Wilmore şi colab. au
susţinut că aceste chestionare autoadministrate
ar fi putut să nu fie valide pentru eşantioanele de
atleţi, deoarece participanţii pot să nu dorească
să răspundă sincer.
Cum ar trebui interpretate rezultatele
contradictorii din diverse studii? În studiile
pe gimnaste, cu precădere, există diferenţe
marcante între rezultate, ceea ce ar putea reflecta
variaţii efective în prevalenţa tulburărilor de
comportament alimentar între eşantioane,
probleme inerente în metodele de evaluare, şi
variaţii ale gradului în care participanţii aflaţi
în diverse medii raportează sincer simptomele.
Variaţiile mari ale rezultatelor reflectă, probabil,
diferenţe în formarea profesională, în nivelul de
competitivitate, în atitudinile părinţilor, precum
şi alte influenţe de mediu. De exemplu, există,
fără îndoială, diferenţe în atitudinile antrenorilor
în privinţa greutăţii corporale şi a alimentaţiei,
care pot, în mod neintenţionat, fie să promoveze
o alimentaţie dezorganizată, fie să prevină
instalarea simptomatologiei.
Răspunsurile pozitive în privinţa alimenta-
ţiei dezorganizate pot fi interpretate ca sincere,
întrucât este dificil de imaginat de ce participanţii
la studiu ar declara prezenţa exagerată a unei
psihopatologii, în condiţiile în care răspunsul
este anonim. Rezultatele negative, însă, pun
dificultăţi mai mari în interpretare. Pe de o parte,
ele pot reflecta în mod corect absenţa relativă a
unor tulburări de comportament alimentar. Pe
de altă parte, dovezile provenind dintr‑o serie de
studii indică faptul că atleţii pot să nu fie dispuşi
să răspundă sincer la anumite instrumente de
evaluare autoadministrate. Rezultatele negative
obţinute prin folosirea unor instrumente
128
standardizate – precum EDI – au fost folosite
pentru a pune sub semnul întrebării utilitatea
acestor instrumente de screening. Totuşi, faptul
că aceleaşi instrumente au fost folosite cu succes
pentru screeningul tulburărilor de comportament
alimentar în alte studii sugerează că rezultatele
fals negative s‑ar putea datora mai mult
designului defectuos al studiului şi mai puţin
limitelor inerente ale instrumentelor de evaluare.
Obţinerea de rezultate valide necesită proceduri
care să‑i asigure pe atleţi că rezultatele vor fi strict
confidenţiale şi că identificarea problemelor de
comportament alimentar nu va duce la represalii,
cum ar fi pierderea poziţiei într‑o echipă. Lipsa
oferirii acestor asigurări aproape că garantează
faptul că atleţii vor aborda problema raţional
şi, pur şi simplu, îşi vor falsifica simptomele.
În condiţiile în care confidenţialitatea nu este
protejată în mod corespunzător, atleţii care îşi
dezvăluie în mod deschis simptomele furnizează
antrenorilor, părinţilor şi altor părţi interesate o
indiscutabilă cerere de ajutor.
Cu toate acestea, succesul altor
investigatori în screeningul tulburărilor de
comportament alimentar cu aceleaşi instrumente
(Sundgot‑Borgen, 1994; Wilmore, 1996) înseamnă
că dorinţa participanţilor de a răspunde sincer
este legată probabil de credibilitatea eforturilor
de a asigura confidenţialitatea. În studiul a 522
de atlete de elită, Sundgot‑Borgen a luat câteva
măsuri pentru a le asigura pe participante
că răspunsurile la EDI vor rămâne strict
confidenţiale. Acestea au inclus următoarele:
(a) antrenorii nu au fost înştiinţaţi în privinţa
studiului şi nu li s‑a cerut permisiunea de a strânge
informaţiile, întrucât studiul era parte a unui
program aprobat la nivel naţional; (b) atletelor
li s‑a garantat confidenţialitatea 100 % (adică
niciun rezultat nu va fi transmis antrenorilor sau
părinţilor, cu excepţia atletelor cu vârsta sub 18
ani); (c) chestionarele au fost trimise prin poştă şi
returnate direct investigatorilor; (d) atletelor cu
probleme li s‑a promis o gamă de tratamente care
să nu le întrerupă programul de antrenamente
şi (e) prezenţa unei tulburări de comportament
alimentar nu avea ca rezultat pierderea locului
din echipă, decât dacă acest lucru era recomandat
medical.
Astfel, se pare că instrumentele standardizate
de screening pot fi folosite pentru identificarea
atleţilor cu tulburări de comportament
alimentar; totuşi, trebuie luate măsuri pentru a
garanta confidenţialitatea în scopul încurajării
răspunsurilor sincere. În aceste situaţii, EDI‑3
FT poate fi un instrument avantajos, de utilizat
într‑o primă fază a unui proces de screening
cu două etape, în care indivizii care obţin un
scor peste un anumit scor de secţiune sunt
intervievaţi de către clinicieni cu experienţă,
pentru a stabili dacă sunt întrunite criteriile de
diagnostic pentru o tulburare de comportament
alimentar. Întrucât negarea poate reprezenta o
problemă în cazul instrumentelor de screening
autoadministrate, nu trebuie considerat că
scorurile mici indică absenţa unei tulburări de
comportament alimentar. Informaţiile colaterale
de la părinţi, colegi de echipă şi antrenori sunt
utile şi pot compensa negarea, auto‑dezvăluirea
limitată şi dezirabilitatea socială. Scorurile
ridicate la instrumentele autoadministrate nu
înseamnă în mod obligatoriu că respondentul
prezintă o tulburare de comportament alimentar;
totuşi, acest fapt denotă îngrijorări privitoare
la greutatea corporală, forma corpului şi la
alimentaţie. Studiile pe atleţi au arătat că un
număr semnificativ de respondenţi cu scoruri
mari prezintă tulburări de comportament
alimentar semnificative clinic.
Rezultatul tratamentului: evaluarea unei
game largi de aspecte ale rezultatelor
Evaluarea eficacităţii tratamentului depinde
foarte mult de metodele şi de instrumentele
alese în evaluarea rezultatului. Evaluarea unei
persoane având o tulburare de comportament
alimentar vizează, într‑o primă fază, simptome
fizice, comportamentale şi atitudinale, necesare
pentru stabilirea unui diagnostic şi pentru
planificarea tratamentului (Pike, 1998). Într‑o
analiză a rezultatelor tratamentului pentru AN,
care a cuprins 119 studii şi 5.590 de pacienţi,
Steinhausen (2002) a observat că concluziile
fiecărui studiu variază considerabil, în funcţie de
includerea sau ignorarea variabilelor care nu sunt
direct relaţionate cu comportamentul alimentar
şi cu greutatea corporală. Rezultatul este mult
mai bun în cazurile în care s‑au luat în calcul
doar simptomele tulburării de comportament
alimentar, faţă de situaţiile în care s‑au luat
în calcul şi variabilele psihosociale. Concluzii
similare au rezultat şi din analizele rezultatelor
obţinute în cazul BN (Keel şi Mitchell, 1997;
Quadflieg şi Fichter, 2003). Astfel, în ceea ce
priveşte variabilitatea considerabilă a trăsăturilor
clinice, este important ca, în evaluarea tulburărilor
de comportament alimentar, să se aibă în vedere
o gamă largă de aspecte ale rezultatelor, cu
scopul de a avea o imagine completă a impactului
tratamentului şi pentru identificarea factorilor
care prezic răspunsul la tratament.
Examinarea tulburărilor de comportament
alimentar (The Eating Disorder Examination – EDE;
Fairburn şi Cooper, 1993) a fost considerată drept
„standardul de aur” în evaluarea simptomelor
specifice unei tulburări de comportament
alimentar (Wade, Tiggemann, Martin şi Heath,
1997), iar interviul structurat are un rol foarte
important, mai ales în protocoale de cercetare.
Cu toate acestea, adesea, cercetarea privind
eficacitatea tratamentului s‑a bazat foarte mult pe
o evaluare îngustă a psihopatologiei tulburărilor
de comportament alimentar, limitând astfel
domeniile de aplicabilitate a concluziilor
obţinute. Jarman şi Walsh (1999) au observat
că „folosind EDE şi alte instrumente similare,
evaluarea recuperării este limitată la absenţa
simptomelor tulburării de comportament
alimentar, mai degrabă decât la prezenţa unor
schimbări calitative în funcţionarea psihologică
a unei persoane, ce trec dincolo de îngrijorări
uşoare în privinţa greutăţii şi formei corpului”
(p. 778).
Keel şi colab. (2002) au sugerat că un obstacol
în identificarea unor predictori semnificativi
ai schimbării în cadrul unor cercetări clinice
efectuate pe termen lung a fost neutilizarea
instrumentelor care să acopere o gamă largă de
aspecte ale funcţionării psihologice.
Cercetătorii au declarat:
Fairburn şi colab. [Fairburn, Kirk,
O’Conner şi Cooper] (1986) au comentat:
„Bulimia nervoasă este o afecţiune complexă
cu multe faţete diferite. Având în vedere
gama largă a psihopatologiei acesteia,
este surprinzător faptul că atât de puţine
aspecte ale tulburării au fost evaluate în
studiile asupra tratamentului (p. 639). După
aproape 15 ani, este la fel de surprinzător
faptul că atât de puţine aspecte ale acestei
tulburări au fost evaluate în studiile asupra
impactului tratamentului pe termen lung.
Singurul studiu care a sprijinit influenţa
CBT [terapia cognitiv‑comportamentală]
asupra rezultatelor pe termen lung în cazul
bulimiei nervoase a evaluat doar efectul
tratamentului asupra statusului tulburărilor
de comportament alimentar (Fairburn şi
colab., 1995) (Keel şi colab., 2002, p. 152).
Mai recent, Fairburn şi colab. (2003) şi‑au
actualizat teoria, incluzând patru variabile
psihologice, considerate ca fiind semnificative în
menţinerea simptomelor tulburărilor de compor-
tament alimentar. Acestea sunt în concordanţă cu
constructe care au fost măsurate prin versiunea
anterioară a EDI şi îmbunătăţite în EDI‑3 (de
129
exemplu, perfecţionism, stimă de sine scăzută,
intoleranţă faţă de dispoziţia afectivă, dificultăţi
interpersonale).
Astfel, una dintre principalele calităţi ale
EDI‑3 este faptul că selectează multiple domenii
extinse ale funcţionării psihologice, care depăşesc
îngrijorările legate de greutate şi formă, asupra
cărora s‑au îndreptat exclusiv unele abordări
anterioare ale tulburărilor de comportament
alimentar. O analiză exhaustivă a studiilor asupra
rezultatelor folosind EDI depăşeşte scopul acestui
Manual de specialitate; totuşi, trebuie menţionat
faptul că acest instrument a fost folosit pe scară
largă şi s‑a dovedit util în evaluarea rezultatelor
tratamentului, precum şi ca o variabilă în predicţia
rezultatelor. Se va trece în revistă o parte dintre
studiile care utilizează EDI, indicându‑se: (a)
sensibilitatea la schimbarea din punct de vedere
clinic în urma tratamentului; (b)  stabilitatea în
timp a schimbării; (c) rezultatele comparative;
(d) predictorii schimbării şi (e) persistenţa perfec-
ţionismului după recuperare.
Sensibilitatea EDI la schimbările clinice în
urma tratamentului
Studiile care au clasificat pacienţii în grupuri
cu rezultate bune şi grupuri cu rezultate slabe,
pe baza variabilelor clinice, au arătat şi că cele
mai multe dintre subscalele EDI sunt sensibile la
modificarea la nivel clinic; totuşi, altele par a nu
fi atât de clar asociate cu îmbunătăţirea din punct
de vedere clinic. De exemplu, într‑o comparaţie
între terapia cognitiv‑comportamentală (CBT) şi
terapia suportiv‑expresivă pentru BN, Bulimia a
fost singura subscală ale cărei scoruri au variat
în favoarea tratamentului CBT (Dorinţa de a fi slab
s‑a apropiat de pragul de semnificaţie [p<0,06],
deşi au existat îmbunătăţiri pe subscalele EDI
în urma ambelor tratamente (Garner, Rocket
şi colab., 1993). Cu toate acestea, atunci când
pacienţii care au obţinut rezultate bune şi cei cu
rezultate slabe au fost comparaţi utilizând EDI,
scorurile la toate subscalele EDI, excepţie făcând
Neîncrederea interpersonală şi Frica de maturitate, au
fost semnificativ mai mici la grupul cu rezultate
bune, indiferent de grupul de tratament din care
făceau parte (Garner şi colab., 1990). Acest lucru
sugerează că EDI este sensibil la schimbarea la
nivel clinic, indiferent de tratament.
Şi alţi cercetători au menţionat faptul că
EDI este sensibil la modificarea la nivel clinic.
Conform unui studiu al lui Blouin şi colab. (1994),
după 10 săptămâni de CBT, pacienţii cu BN au
prezentat ameliorări semnificative pe subscalele
EDI Dorinţa de a fi slab, Bulimie, Nemulţumire faţă
130
de corp, Conştiinţă interoceptivă şi Ineficacitate.
Autorii au constatat că procentul de reducere
a episoadelor de alimentaţie compulsivă era
mai mare printre subiecţii cu scoruri mai mari
(reflectând simptome mai grave) la subscalele
Dorinţa de a fi slab, Bulimie şi Conştiinţă
interoceptivă. S‑a întregistrat o ameliorare
semnificativă a scorurilor subscalelor EDI care
formează o „triadă” (adică Dorinţa de a fi slab,
Bulimie, Nemulţumire faţă de corp), în paralel cu o
reducere semnificativă a frecvenţei episoadelor
de alimentaţie compulsivă şi a vărsăturilor. Cu
toate acestea, scorurile subscalelor EDI au corelat
semnificativ cu procentul de reducere a frecvenţei
episoadelor de alimentaţie compulsivă, dar nu şi
cu procentul de reducere a frecvenţei vărsăturilor.
În mod similar, Rø şi colab. (2003) au constatat
reduceri importante ale celor mai multe scoruri
la subscalele EDI, la pacienţii cu BN care urmau
patru luni de terapie de grup specializată, pe
parcursul internării. Cele mai mari efecte între
pre‑tratament şi post‑tratament s‑au constatat la
subscalele Nemulţumire faţă de corp, Neîncredere
interpersonală şi Frica de maturitate. Nu au existat
schimbări semnificative între post‑tratament şi
follow‑up.
Aceste constatări sunt în corcondanţă cu
cele ale lui Fichter şi Quadflieg (1997, 1999),
care au condus studii separate pe o durată de
şase ani pe pacienţi cu BN şi AN, folosind EDI
ca un instrument psihometric. În ambele studii
s‑a constatat că pacienţii au înregistrat ameliorări
substanţiale în urma terapiei. Dare, Chania,
Eisler, Hodes şi Dodge (2000) au raportat că
subscalele EDI sunt sensibile la schimbările care
au loc în timpul terapiei de familie, la pacienţii
adolescenţi cu AN. Studiul efectuat după primul
an a comparat rezultatele familiilor unite şi
ale celor dezbinate şi s‑a constatat faptul că
subscalele Ineficacitate şi Neîncredere interpersonală
sunt sensibile la modul în care adolescenţii au
trecut prin schimbările în managementul pe care
îl exercită părinţii asupra comportamentului lor
alimentar.
Stabilitatea în timp a schimbării pe perioada
de follow‑up
EDI a măsurat stabilitatea în timp a schimbării
în atitudinile şi comportamentele asociate cu
tulburările de comportament alimentar în mai
multe studii pe termen lung. Fichter şi Quadflieg
(1997, 1999) au raportat un declin uşor, în
general nu foarte grav, după o perioadă de 2 ani
de urmărire, urmat de o ameliorare continuă şi
de stabilizare în cel de‑al 6‑lea an de urmărire,
în cadrul unor studii pe pacienţi cu AN şi BN.
În studiul asupra BN, scorurile la subscala
Nemulţumire faţă de corp nu au fost atât de mari
la pacienţii cu BN, precum au fost la pacienţii cu
alimentaţie compulsivă. În studiul asupra AN,
ameliorarea înregistrată în cazul subscalei Bulimie
în faza de post‑tratament a fost de scurtă durată,
apropiindu‑se de nivelul din pre‑tratament al
AN‑R, AN‑AC/V, BN şi TCAFAS în al doilea
şi al şaselea an de urmărire. De asemenea,
Fisher şi Quadlieg (1996) au publicat un studiu
desfăşurat timp doi ani pe pacienţi adolescenţi
cu AN şi BN, arătând că ambele grupuri au
înregistrat ameliorări în timp ale scorurilor
subscalei Conştiinţă interoceptivă. Autorii au
menţionat diferenţe semnificative din punct de
vedere statistic înregistrate la scorul total EDI şi
la scorurile subscalei Bulimie. Pacienţii cu BN au
prezentat şi o reducere semnificativă a scorurilor
la scala Dorinţa de a fi slab.
Steinhausen şi Seidel (1993) au constatat
că profilul EDI a reflectat îmbunătăţiri în cazul
scorurilor obţinute în faza de tratament din
timpul internării şi că acestea s‑au menţinut la
follow‑up (M = 4 ani şi 10 luni). Analizele de
varianţă ulterioare au relevat faptul că aceste
schimbări s‑au deteriorat la toate subscalele,
cu excepţia celor de Perfecţionism şi Neîncredere
interpersonală, care au avut scoruri relativ scăzute
în faza de pre‑tratament. În studiul lui Rø şi colab.
(2003), s‑au constatat ameliorări semnificative
la toate subscalele EDI, excepţie făcând scalele
Perfecţionism şi Neîncredere interpersonală, care
au avut scoruri relativ scăzute în faza de
pre‑tratament. Din nou, în perioada dintre
post‑tratament şi follow‑up a existat o uşoară
tendinţă de recidivă, aşa cum au arătat subscala
Bulimie şi două dintre subscalele EDE.
Într‑un studiu pe pacienţi chinezi cu AN
din Hong Kong, Lee şi colab. (2003) au constatat
că subscalele EDI au înregistrat o scădere a
scorurilor odată cu tratamentul şi că rezultatele
în momente intermediare au fost foarte
asemănătoare cu rapoartele din Occident. În
afară de subscala Frica de maturitate, subscalele
EDI au prezentat o ameliorare şi au avut în
continuare scoruri scăzute pentru grupurile cu
rezultate bune în comparaţie cu grupurile cu
rezultate slabe. O minoritate semnificativă de
pacienţi chinezi a dezvoltat anorexie nervoasă,
dar nu a obţinut scoruri mari la subscala Dorinţa
de a fi slab, la începutul tratamentului. Acest „grup
atipic” (după standardele occidentale) a avut
rezultate mai bune decât pacienţii mai „tipici”,
caracterizaţi de scoruri mari la subscalele Dorinţa
de a fi slab şi Nemulţumire faţă de corp, la începutul
tratamentului. Fernández‑Aranda şi colab. (1998)
au adaptat EDI pentru populaţia spaniolă într‑un
studiu al pacienţilor cu anorexie nervoasă care
beneficiau de CBT ambulatoriu. Chestionarul
a fost administrat înainte şi după tratament,
precum şi la un control după un an. În faza de
post‑tratament au fost remarcate ameliorări
semnificative la toate subscalele EDI, cu excepţia
subscalei Frica de maturitate, dar a existat o
înrăutăţire la controlul efectuat după un an.
Rezultate comparative prin utilizarea EDI
EDI a avut un rol important în măsurarea
rezultatelor în studiile controlate şi deschise
de psihoterapie şi terapie medicamentoasă din
ultimii douăzeci de ani. O trecere exhaustivă în
revistă a întregii literaturi privitoare la rezultatele
tratamentului depăşeşte cu mult scopurile
acestui Manual de specialitate; cu toate acestea, este
important să ilustrăm gama aplicaţiilor oferite de
EDI în cercetările asupra tratamentului.
O constatare constantă în cercetările
comparative asupra rezultatelor o reprezintă
observaţia că o evaluare limitată a simptomelor
atitudinale şi comportamentale ale tulburărilor
de comportament alimentar produce un rezultat
mai favorabil decât dacă se ia în considerare
şi funcţionarea psihologică şi interpersonală
(Carter şi colab., 2004; Eddy şi colab., 2002,
Fichter şi colab., 2003; Keel şi colab., 1999; Löwe şi
colab., 2001; Steiger şi colab., 1994; Steinhausen,
2002). Aceasta este valabilă şi în cazul studiilor
controlate care compară două forme de terapie.
Într‑un experiment controlat randomizat
cu durata de 6 săptămâni, Esplen, Garfinkel,
Olmsted, Gallop şi Kennedy (1998) au constatat
că tratamentul prin imagerie dirijată – conceput
pentru a spori auto‑consolarea în BN – are efecte
substanţiale în reducerea mediei episoadelor de
alimentaţie compulsivă şi de vărsături. Grupul
de imagerie dirijată a prezentat o reducere a
mediei episoadelor de alimentaţie compulsivă şi
de vărsături de 74% şi, respectiv, 73% şi a dovedit
îmbunătăţiri ale măsurilor atitudinilor legate
de alimentaţie, regim şi greutate corporală,
comparativ cu grupul de control. Au existat
interacţiuni semnificative grup‑timp la subscalele
Dorinţa de a fi slab, Bulimie şi Ineficacitate şi
tendinţe în cazul subscalelor Nemulţumire faţă de
corp, Conştiinţă interoceptivă şi Frica de maturitate.
În fiecare caz, interacţiunea a indicat o reducere
în timp a gradului de afectare pentru grupul de
tratament, însă nu şi pentru grupul de control.
Rezultate similare au fost raportate de către Chen
şi colab. (2003) într‑o comparaţie a eficacităţii
131
clinice a tratamentului CBT în grup vs. tratament
individual, pentru pacienţi cu BN. Autorii au
constatat că ambele modalităţi de terapie erau
echivalente pentru majoritatea subscalelor EDI;
totuşi, pentru Reglarea Impulsurilor a existat o
interacţiune semnificativă care favoriza CBT de
grup (doar pentru cei care finalizau tratamentul)
şi care s‑a menţinut la follow‑up după 3 până la
6 luni. Autorii au observat că, întrucât CBT de
grup costă între o cincime şi o treime din suma
pentru CBT individual, adaptarea acesteia pentru
administrarea în grup ar trebui să constituie
prima opţiune de tratament într‑o abordare
stepped care.
Utilizarea suplimentară a EDI poate fie să
furnizeze un sprijin convergent rezultatelor
referitoare la comportament, fie să reducă
însemnătatea concluziilor derivate doar din
indici comportamentali. Într‑o comparaţie a
unor programe de spitalizare de 4 versus 5 zile,
Olmsted, Kaplan şi Rockert (2003) au constatat că
programul de 5 zile era asociat cu rate mai ridicate
de abstinenţă de la alimentaţia compulsivă şi de
la vărsături, precum şi cu scoruri post‑tratament
mai scăzute la toate cele opt subscale EDI, faţă
de cazul pacienţilor care urmau programul de 4
zile. Cu toate acestea, autorii au concluzionat că
programul de 4 zile era mai eficient din punctul
de vedere al costurilor, atunci când schimbarea
simptomelor era luată în considerare ca reducere
procentuală per zi de tratament. Într‑un alt studiu,
Davis, Olmsted, Rockert, Marques şi Dolhanty
(1997) au stabilit că adăugarea mai multor
sesiuni de psihoterapie în grup la psihoeducaţia
de scurtă durată nu avea drept rezultat viteze
diferite de normalizare a măsurilor psihometrice.
După 12 săptămâni de terapie, ambele grupuri de
pacienţi cu BN au prezentat ameliorări pe toate
subscalele EDI; totuşi, grupul care beneficia doar
de psihoeducaţie a eşuat în a ameliora subscala
Frica de maturitate, iar grupul care beneficia în
plus de psihoterapie nu prezenta ameliorări la
subscala Perfecţionism. În mod clar, rezultatele
măsurătorilor psihologice nu oferă o bază solidă
pentru supremaţia vreunuia dintre tratamente.
Câteva studii anterioare au folosit
rezultatele EDI pentru a compara eficacitatea
relativă a unor forme diferite de tratament.
Într‑un studiu care compara abordarea terapiei
nutriţionale cu cea de management al stresului
în tratarea pacienţilor cu BN, Laessle şi colab.
(1991) au observat îmbunătăţiri semnificative
ale scorurilor la subscalele Dorinţa de a fi slab,
Bulimie, Nemulţumire faţă de corp, Perfecţionism şi
Conştiinţă interoceptivă, în comparaţie cu pacienţii
care beneficiau de management nutriţional, ca
132
formă de terapie. În mod similar, Mitchell şi
colab. (1993) au examinat rezultatele pacienţilor
cu BN împărţiţi într‑o matrice cu patru căsuţe
pe baza a doi factori de terapie: (a) nivelul de
intensitate al CBT şi (b) modul de aplicare a
modelului întreruperii premature. Rezultatele
EDI au sprijinit măsurătorile comportamentale,
indicând îmbunătăţiri la subscalele Dorinţa de a fi
slab, Bulimie, Nemulţumire faţă de corp, Ineficacitate
şi Conştiinţă interoceptivă, favorizând abordarea
caracterizată prin întrerupere prematură, de
intensitate crescută, în comparaţie cu CBT
administrată săptămânal în conformitate cu
manualul.
Predictori ai răspunsului la tratament prin
utilizarea EDI
EDI s‑a dovedit util în predicţia răspunsului la
tratament. Într‑un studiu de urmărire pe o durată
de la 5 până la 10 ani, care compara pacienţii cu
AN recuperaţi şi nerecuperaţi, Bizeul şi colab.
(2001) au constatat că grupul cu rezultate slabe a
avut scoruri mai ridicate în faza de pre‑tratament
la subscalele Dorinţa de a fi slab, Ineficacitate,
Neîncredere interpersonală, Conştiinţă interoceptivă
şi Perfecţionism. Într‑o analiză multi‑variată, doar
scalele Neîncredere interpersonală şi Perfecţionism
au prezis rezultatele pe termen lung. Într‑un
studiu prospectiv pe termen lung, Löwe şi colab.
(2001) au evaluat pacienţi care aveau AN după
9 ani de la un follow‑up anterior şi după 21
de ani de la tratamentul iniţial. Ei au constatat
că scorurile mari la subscalele Ineficacitate,
Perfecţionism, Neîncredere interpersonală şi
Conştiinţă interoceptivă constituiau predictori
semnificativi ai unui rezultat nefavorabil. Scala
Perfecţionism a reprezentat un indicator al unui
rezultat pozitiv într‑un studiu efectuat de către
Carter, Olmsted şi colab. (2003), în care s‑a
examinat eficacitatea auto‑ajutorării fără altă
îndrumare (unguided self‑help), ca un prim pas în
tratarea pacienţilor cu BN. Pacienţii fie primeau
manuale de auto‑ajutorare folosind CBT
(specifică pentru BN) sau care vizau creşterea
încrederii în sine (non‑specifice), fie nu beneficiau
de nicio intervenţie. Cei care au răspuns la
tratament, definiţi ca fiind persoanele care şi‑au
redus episoadele de alimentaţie compulsivă
şi de vărsături cu 50%, aveau scoruri mai mari
la subscala Perfecţionism. În plus, un nivel de
cunoştinţe de bază mai redus despre tulburările
de comportament alimentar, probleme mai
numeroase legate de intimitate şi scoruri mai mari
referitoare la comportamentul compulsiv prezi-
ceau mai bine răspunsul la tratament. Autorii au
concluzionat că auto‑ajutorarea nu reprezenta un
predictor semnificativ al rezultatului.
Fichter şi colab. (2003) au folosit modelarea
cu ecuaţii structurale pentru a oferi predicţii
asupra evoluţiei şi a rezultatului la pacientele
internate cu AN şi BN, evaluându‑le în faza de
pre‑tratament, de post‑tratament, de urmărire
la 2 sau 3 ani şi de urmărire după 6 ani. S‑a
folosit EDI‑2, pe lângă alte măsurători ale unor
constructe, precum încrederea în sine, depresia,
orientarea spre îndeplinirea scopurilor propuse,
durata tulburării şi istoricul greutăţii corporale.
Pentru a formula predicţii cu privire la starea
pacientelor la controlul după 6 ani, s‑au utilizat
analiza factorială confirmatorie şi analiza de
cale. Predictori semnificativi ai recuperării după
6 ani au fost, la începutul tratamentului: (a)  o
încredere în sine scăzută, un nivel redus de
perfecţionism şi o orientare mai ridicată spre
îndeplinirea scopurilor propuse, în cazul AN;
(b)  o manifestare mai redusă a dorinţei de a fi
slab, în cazul BN şi (c) o depresie mai severă,
obezitate în copilărie şi o durată mai scurtă a
tulburării de comportament alimentar înainte de
tratament, pentru alimentaţia compulsivă.
În unele studii, scalele de Risc de tulburare de
comportament alimentar au constituit predictori
semnificativi ai rezultatului. McKisack şi Waller
(1996) au constatat că femeile cu BN, care aveau
o participare redusă la şedinţele de terapie şi care
nu reuşeau să termine terapia de grup, aveau
scoruri mai ridicate la subscalele Dorinţa de a fi
slab şi Nemulţumire faţă de corp. Carter, McIntosh,
Joyce, Sullivan şi Bulik (2003) au constatat, într‑un
studiu care a evaluat eficacitatea adiţională a
tratamentelor comportamentale bazate CBT
de expunere faţă de cele de non‑expunere, la
pacientele cu BN, că, în cazul femeilor cu BN care
au obţinut scoruri ridicate la subscala Bulimie, s‑a
putut prevedea renunţarea la tratament. Acest
lucru este important, deoarece la controlul după
3 ani s‑a constatat că nefinalizarea unui tratament
bazat pe CBT era asociată cu un rezultat
nefavorabil. Într‑un studiu anterior al acestor
autori (Bulik şi colab., 1999), scorurile mici la
subscala Bulimie au prezis un răspuns rapid la
tratament. Aceste rezultate sunt contradictorii
în raport cu cele obţinute de către Steel şi colab.
(2000), care, de asemenea, au examinat predictorii
întreruperii tratamentului CBT pentru pacienţii
cu BN. Autorii au constatat că persoanele care
întrerupeau tratamentul nu erau diferite de cele
care îl duceau la bun sfârşit, în ceea ce priveşte
rezultatele obţinute cu ajutorul unor instrumente
care măsoară severitatea simptomelor tulburării
de comportament alimentar, inclusiv frecvenţa
episoadelor de alimentaţie compulsivă şi a
vărsăturilor, şi nici în privinţa scorurilor la
subscalele EDI‑2 Dorinţa de a fi slab şi Nemulţumire
faţă de corp. Singurii predictori ai renunţării la
tratament s‑au dovedit a fi un nivel mai ridicat al
greutăţii corporale la adulţi şi un scor mai ridicat
la subscala Ineficacitate.
Aşa cum s‑a menţionat mai sus, constructele
Neîncredere interpersonală şi Ineficacitate s‑au
dovedit a fi predictori ai răspunsului la tratament.
Blouin şi colab. (1995) au încercat să identifice
variabilele din faza de pre‑tratament clinic care
ar fi putut prezice întreruperea CBT de grup în
cazul BN. S‑au efectuat şapte analize ale funcţiilor
discriminante independente între ele, pentru a
se putea face predicţii referitoare la renunţarea
la CBT de grup sau la finalizarea terapiei, pe
baza factorilor de evaluare psihometrică a
BN. Doar factorul care se referea la dificultăţi
interpersonale (Neîncredere interpersonală) a făcut
deosebirea între pacienţii care întrerup CBT şi cei
care finalizează terapia. Într‑o analiză de regresie
multiplă, în cazul pacienţilor cu tulburări de
comportament alimentar care participau la un
tratament în condiţii de spitalizare, subscala
Neîncredere interpersonală a constituit un predictor
semnificativ al respectării meselor (Bean, Shiltz,
Hallinan şi Holbrook, 2000). Această subscală,
împreună cu subscalele Ineficacitate şi Conştiinţă
interoceptivă şi cu sexul, au contribuit la aproape
50% din varianţa asociată respectării meselor.
Într‑un studiu al Emoţiei exprimate (EE)
percepute, Moulds şi colab. (2000) au constatat
că, deşi EE nu prevedea rata de creştere în
greutate în cazul AN pe durata a 6 săptămâni
de spitalizare, scorul compozit al EE familiale
percepute reprezenta un predictor semnificativ al
schimbării în funcţionarea psihologică, aşa cum
indică subscalele EDI‑2 Neîncredere interpersonală,
Frica de maturitate şi Perfecţionism. Direcţiile
acestor relaţii au indicat faptul că o EE percepută
mai ridicată a fost asociată cu o îmbunătăţire
mai redusă în cazul subscalelor Perfecţionism
şi Neîncredere interpersonală, în timp ce o EE
mai ridicată a prezis o îmbunătăţire crescută la
subscala Frica de maturitate.
Subscala Frica de maturitate s‑a dovedit a fi un
predictor al rezultatului în alte câteva studii. După
6 luni de tratament utilizând mai multe metode,
Fassino şi colab. (2001) au împărţit un grup de
pacienţi cu AN‑R în două subgrupuri: (a) cei care
prezentau ameliorări clinice relevante şi (b) cei
care încă nu prezentau îmbunătăţiri. Autorii au
constatat că niveluri mai ridicate la subscalele
Ascetism şi Frica de maturitate caracterizau
grupul celor care nu prezentau ameliorări.
133
Hedlund şi colab. (2003) au studiat pacienţi cu
BN proveniţi din familii cu EE familială crescută,
respectiv scăzută, şi au constatat că grupul
cu EE ridicată prezenta o patologie crescută
a tulburărilor de comportament alimentar, în
comparaţie cu grupul cu EE scăzută, aşa cum
a rezultat din evaluarea realizată cu EDI‑2
înainte de tratament, la externare, după 2 ani şi
într‑o anumită măsură, după 6 ani. Dintre cele
32 de perechi de scoruri brute la scalele EDI‑2,
pe parcursul celor patru repere temporale, 29
prezentau frecvenţe mai crescute de patologie
a tulburărilor de comportament alimentar în
grupul cu EE ridicată. Diferenţe semnificative
între grupuri s‑au constatat la scorurile totale
EDI‑2, precum şi la subscalele Bulimie, Ineficacitate
şi Frica de maturitate. La controlul după 6 ani,
diferenţa dintre grupuri pentru subscala Frica de
maturitate era încă semnificativă. Schimbările în
timp continuau să fie semnificative pentru toate
subscalele, cu excepţia subscalelor Nemulţumire
faţă de corp şi Perfecţionism.
În încheiere, într‑un studiu asupra recidive-
lor în AN, Carter şi colab. (2004) au constatat că
pacienţii cu AN recidivau în proporţie de 35%,
având o perioadă medie de supravieţuire de 18
luni; perioada de risc maxim a fost între 6 şi 17
luni de la externare. Analiza de varianţă pentru
măsurători repetate pe baza unui model mixt
a indicat o interacţiune semnificativă statistic
grup‑timp pentru subscalele Bulimie, Conştiinţă
interoceptivă, Perfecţionism, Ineficacitate şi Frica de
maturitate. Atât grupul celor care au recidivat,
cât şi grupul celor care nu au recidivat au
prezentat o reducere semnificativă a scorurilor
la subscalele Ineficacitate, Conştiinţă interpersonală
şi Frica de maturitate, între momentul internării
şi cel al externării, însă aceste scoruri au crescut
semnificativ de la externare până la controalele
post‑tratament în cazul pacienţilor care au
recidivat. Scorurile la subscalele Bulimie şi
Perfecţionism nu s‑au schimbat, însă scorurile celor
din grupul cu recidive au crescut semnificativ
de la externare la controlul ulterior. Predictorii
recidivelor au fost: (a) un istoric de tentative
de suicid, (b) tratament anterior specializat
pentru o tulburare de comportament alimentar,
(c) severitatea simptomelor obsesiv‑compulsive,
la prezentare, (d) exerciţii fizice excesive, imediat
după externare şi (e) îngrijorări reziduale
în privinţa formei corpului şi a greutăţii, la
externare.
134
Perfecţionismul persistă după recuperare
Srinivasagam şi colab. (1995) au investigat
persistenţa comportamentelor perfecţioniste
şi obsesive după recuperare, la pacienţii cu
AN. Pacientele anorectice recuperate (care
s‑au menţinut la greutate normală şi au avut
ciclu menstrual regulat mai mult de un 1 an)
prezentau scoruri semnificativ mai ridicate faţă
de pacientele din lotul de control la subscala
EDI‑2 Perfecţionism şi un perfecţionism general pe
Scala Frost (Frost, Marten, Lahart şi Rosenblate,
1990). Mai mult, pacientele recuperate au avut
scoruri mai mari la Scala Yale‑Brown de obsesii
şi compulsii (Goodman şi colab., 1989a, 1989b),
simptomele ţintă sugerând că multe dintre
ele prezentau îngrijorări specifice cu privire la
simetrie şi exactitate. Autorii au concluzionat că
anumite caracteristici ale AN, cum ar fi nevoia de
ordine şi precizie, persistă după un răspuns bun
la tratament şi după recuperare.
Sullivan, Bulik, Fear şi colab. (1998) au folosit
un design de tip control al cazurilor (case‑control
design) într‑un studiu de urmărire a pacientelor
evaluate sau tratate pentru AN, pe o perioadă
anterioară medie de 12 ani (o medie de 15,4 ani
după debutul tulburării), în care un procent
substanţial (10%) din acest grup cu AN au
continuat să întrunească criteriile pentru AN sau
o variantă subclinică (5,7%). Grupul cu AN a avut
un IMC şi un IMC „ideal” declarat considerabil
mai scăzute faţă de grupul de control (fără
istoric de AN, ceea ce s‑a reflectat în scoruri
semnificativ mai mari faţă de cele ale grupului
de control la subscalele EDI‑2 Dorinţa de a fi slab
şi Perfecţionism). Acest lucru a sugerat faptul că,
deşi majoritatea pacientelor din grupul cu AN
nu mai întruneau criteriile pentru o tulburare de
comportament alimentar, preocupările legate de
greutatea şi de forma corporală persistau într‑un
mod care le distingea de persoanele din grupul
de comparaţie. Scorurile mai ridicate la subscala
Dorinţa de a fi slab ale grupului cu AN sugerează
că menţinerea unei greutăţi corporale scăzute
la pacienţii „recuperaţi” are o componentă
conştientă sau intenţionată. Scorurile considerabil
mai ridicate la subscala Perfecţionism sugerează că
un grad înalt de perfecţionism persistă după faza
acută a tulburării. În mod asemănător, în studiul
lui Carter şi colab. (2004), pacienţii cu AN care au
avut un răspuns pozitiv la tratament prezentau
scoruri ridicate la subscala Perfecţionism la
follow‑up.
Schimbări în EDI‑3: pre‑tratament şi Tabelul 4.31
post‑tratament Vârsta participanţilor în studiul de validare
pre- şi post-tratament a EDI-3
Un obiectiv important al reorganizării
itemilor EDI‑2, aşa cum sunt prezentaţi în EDI‑3, Combinat
a fost acela de a rafina anumite constructe TIZ TAS (TIZ şi TAS)
psihologice la care se referă setul de itemi ai EDI‑2 Vârsta (ani) n % n % n %
şi care pot fi evaluate în privinţa relevanţei lor Adolescenţi
clinice în studii asupra eficacităţii tratamentului. < 13 3 1,9 1 2,7 4 2,6
În această secţiune, sunt prezentate date pentru 13-15 14 8,9 17 45,0 31 16,0
un eşantion non‑probabilistic4 (N=194) de pacienţi 16-17 9 5,7 19 51,4 28 14,0
cu tulburări de comportament alimentar, trataţi la Subtotal 26 16,5 37 100,0 63 32,6
River Centre Clinic (RCC) în Sylvania, Ohio. RCC Adulţi
este un centru privat, specializat în tratamentul 18-21 72 45,9 - - 72 37,1
tulburărilor de comportament alimentar, care 22-25 15 9,6 - - 15 7,6
oferă tratament ambulatoriu şi un program de 26-34 26 16,4 - - 26 13,4
tratament intensiv zilnic (TIZ), fiind autorizat şi ≥ 35 18 11,6 - - 18 9,3
ca un program de tratament pentru adolescenţi Subtotal 131 83,5 - - 131 67,4
pe durata spitalizării (TAS). Pacienţii incluşi în Total 157 100,0 37 100,0 194 100,0
analiză au fost admişi fie în programul TIZ, fie în Notă. TIZ = tratament intensiv de zi; TAS = program de
TAS, între ianuarie 2000 şi ianuarie 2003, şi li s‑a tratament pentru adolescenţi pe durata spitalizării. Ambele
administrat EDI‑3, precum şi alte chestionare de programe de tratament s-au desfăşurat la Centrul clinic
River, Sylvania, OH.
autoevaluare, ca parte a evaluării iniţiale, fiind
reevaluaţi la o săptămână după externare. Doar
persoanele care au oferit informaţii complete în
timpul testărilor au fost incluse în analiză. Tabelul faţă de centru. Programul este bine acceptat de
4.31 prezintă distribuţia pe vârste a pacienţilor către pacienţi, întrucât este mai puţin restrictiv
trataţi în cadrul fiecărui program. decât tratamentul cu internare. Toţi pacienţii au
unul sau doi colegi de cameră şi sunt încurajaţi să
Programul TIZ de la RCC (programul de contacteze oricând personalul de gardă în cazul
spitalizare parţială) în care există întrebări sau îngrijorări legate de
siguranţă. Aranjamentul în stil de internat oferă
TIZ este un program de 5 zile pe săptămână, şansa de a identifica problemele de comunicare şi
7 ore pe zi. TIZ tratează, în primul rând, adulţi cu de a exersa abilităţile interpersonale. Acesta oferă
vârsta de şi peste 18 ani, dar furnizează servicii structură şi suport interpersonal, încurajând în
şi unui număr redus de adolescenţi care locuiesc acelaşi timp propria responsabilitate, întrucât
la distanţe scurte de centrul de tratament şi pot personalul nu este disponibil să supravegheze
face naveta. direct comportamentul în afara programului
O componentă cheie a programului TIZ regulat de tratament, cu excepţia urgenţelor.
este aceea că majoritatea pacienţilor locuiesc Programul TIZ aplică CBT cu spectru
într‑o reşedinţă de „sejur independent”, care larg pacienţilor cu AN care, în mod obişnuit,
se aseamănă mult cu internatul unei facultăţi şi necesită o durată mai îndelungată de tratament
care se află în complexul centrului de tratament. pentru a recâştiga greutatea corporală, precum
Nu există o supraveghere directă din partea şi pacienţilor cu BN „rezistentă la tratament” şi
unui personal profesionist; totuşi, există pacienţilor din categoria de diagnostic TCAFAS,
personal de gardă 24 de ore pe zi. Li se permite cărora fie nu li se potriveşte tratamentul
participanţilor la program să consume toate ambulatoriu, fie, în mod repetat, tratamentul
caloriile necesare pentru fiecare zi în timpul nu le‑a fost eficient dacă s‑au utilizat terapii
programului. Aproximativ 20% dintre pacienţi mai puţin intensive (Garner, 1986; Garner şi
nu necesită componenta de sejur independent a Bemis, 1982; Garner şi colab., 1987). Deşi această
tratamentului, întrucât locuiesc la distanţe scurte abordare a fost iniţial concepută pentru pacienţii
cu AN, ea se dovedeşte adecvată pentru toţi
4
Eşantionul non‑probabilistic este obţinut prin includerea pacienţii cu tulburări de comportament alimentar
tuturor persoanelor disponibile pentru cercetare la un la care severitatea simptomelor reclamă o
moment dat; este format datorită uşurinţei de a‑l obţine. Ex: abordare de intensitate mai crescută şi de durată
toate persoanele care se prezintă la medic într‑o anumită zi
(n. ed.). mai mare decât versiunea de 18 săptămâni a

135
CBT descrisă de către Fairburn, Jones, Peveler,
Hope şi O’Connor (1993) pentru pacienţii cu
BN. Aşa cum a observat Wilson (1999), CBT‑ul
lui Fairburn bazat pe manual pentru pacienţii cu
BN este foarte eficient pentru aproximativ 50%
dintre pacienţii care se prezintă cu episoade de
alimentaţie compulsivă şi vărsături; totuşi, restul
ar putea avea nevoie de o abordare cu „spectru
larg”, care este „în esenţă, cea recomandată de
către Garner şi colab. (1997) pentru AN” (p. S87).
Primul pas al acestui program este normalizarea
alimentaţiei şi a greutăţii corporale, prin aplicarea
principiilor psihoeducaţionale ale reabilitării
nutriţionale şi ale educării în privinţa problemelor
inerente asociate unui regim restrictiv şi altor
comportamente extreme de control al greutăţii.
Tratamentul este administrat în grup, individual
şi în familie (cu accent pe terapia de grup),
precum şi ca tratament medicamentos, în caz
de nevoie. Al doilea aspect al acestei abordări
cu spectru larg a CBT este accentul asupra
temelor psihopatologice, interpersonale şi
familiale centrale, care au condus la dezvoltarea
şi persistenţa simptomelor. Multe dintre temele
atinse de această abordare corespund domeniului
psihologic evaluat de scalele EDI‑3.
Programul TAS de la RCC
TAS este un program rezidenţial pentru
adolescenţi, cuprinzând nouă paturi şi operând
24 de ore pe zi, 7 zile pe săptămână. Acest nivel de
îngrijire este necesar în cazul multor adolescenţi
din cauza severităţii simptomelor, a eşecurilor
anterioare în tratament la niveluri mai reduse
de îngrijire, a lipsei motivaţiei şi a vârstei care
nu permite nivelul mai redus de supraveghere
al programului TIZ. TAS funcţionează conform
unor principii de tratament identice cu cele ale
Tabel 4.32. Variabile demografice şi clinice pe grupuri diagnostice pentru participantele
la studiul de validare a EDI-3
AN-R
(n = 62)
M AS
Vârsta (ani) 20,8 10,6
Zile de tratament 48,8 24,1
Câştig ponderal (livre pe săptămână) 2,8 3,3
Notă. N =194, AN-R = Anorexie nervoasă de tip restrictiv; AN-AC/V = Anorexie nervoasă de tip alimentaţie
compulsivă/vărsături, BN = Bulimie nervoasă, TCAFAS = Tulburare de comportament alimentar fără altă
specificaţie.
136
TIZ şi unii membri ai personalului consultă
în ambele programe. Acest program de 24 de
ore oferă terapie individuală, de grup şi de
familie, concentrându‑se asupra planificării
meselor, abilităţilor de reducere a simptomelor,
prevenirii recidivelor şi a factorilor care au
dus la dezvoltarea şi persistenţa tulburării de
comportament alimentar. Pacienţii mai tineri
care nu au participat la TAS au fost participanţi
din partea locului, care se puteau întoarce să
locuiască împreună cu părinţii, după orele de
tratament din timpul zilei.
Participanţi. Toţi participanţii în studiul
de validare a EDI‑3 au fost femei care au venit
la tratament la RCC pentru o tulburare de
comportament alimentar şi care au fost de acord
să participe la o evaluare pre‑ şi post‑tratament.
S‑a constituit un eşantion non‑probabilistic;
sumarul datelor demografice şi al datelor
referitoare la simptome nu este menit să
reprezinte eficacitatea generală a programului.
Tabelul 4.31 oferă un sumar al vârstelor celor 157
de participante în programul TIZ şi ale celor 37
de participante în programul TAS (N=194). Au
existat 63 de participante adolescente (TIZ, 26;
TAS, 37) şi patru dintre acestea au avut vârsta
de 12 ani sau mai mică. Tabelul 4.32 ilustrează
variabilele demografice şi clinice pentru
grupurile combinate conform diagnosticului,
de paciente participante la programele TIZ şi
TAS. Aproximativ o treime dintre participante
au fost adolescente, 37% având vârste cuprinse
între 18 şi 21 de ani, iar 30% cu vârsta peste 21
de ani. Aproximativ jumătate dintre pacientele
incluse în program au fost diagnosticate cu AN,
iar restul cu BN „rezistentă la tratament” sau
TCAFAS. Numărul mediu de zile de tratament
pentru pacientele din programul TAS este de
47,2 zile (AS=21,8 zile), în comparaţie cu 40,3 zile
Grup de diagnostic
AN-AC/V BN TCAFAS
(n = 38) (n = 62) (n = 32)
M AS M AS M AS
23,0 7,2 22,0 7,1 21,8 6,8
41,6 21,9 35,7 19,0 38,7 22,8
2,4 1,1 1,1 1,3 1,3 1,6
(AS=22,3 zile) la pacientele din programul TIZ
(t=1,7, p>0,1). Totuşi, este important de reţinut
că 40 de zile de program TIZ sunt echivalente cu
aproximativ două luni de tratament, deoarece
este vorba de un program de 5 zile pe săptămână,
în comparaţie cu programul TAS de 7 zile pe
săptămână.
Aşa cum se observă din tabelul 4.32, rata
de creştere în greutate a pacientelor cu AN este
între 2,4 livre (1,08 kg) şi 2,8 livre (1,27 kg) pe
săptămână, o rată similară de creştere în greutate
cu cea obţinută în programele specializate cu
internare (Watson, Bowers şi Andersen, 2000).
De asemenea, majoritatea pacientelor cu BN s‑au
abţinut de la episoade de alimentaţie compulsivă
(80%), de vărsături (86%) şi de abuz de laxative
(95%) la sfârşitul tratamentului.
Tabelul 4.33 prezintă mediile scorurilor brute
pentru scalele şi scalele compozite ale EDI‑3,
atât în pre‑tratament, cât şi în post‑tratament.
În aceste analize, scorurile compozite au fost
obţinute prin însumarea scorurilor brute la
scalele asociate cu fiecare scală compozită.
Această procedură are dezavantajul de a da o
pondere disproporţionată scalelor cu mai mulţi
itemi. Totuşi, ea este prezentată ca o aproximare
ilustrativă. Alternativa de a însuma cotele T
în calcularea scorurilor compozite corectează
această problemă, dând pondere egală fiecărei
scale.
Este evident din mediile obţinute în fazele
de pre‑ şi post‑tratament de eşantionul de
adolescente şi de eşantioanele de femei adulte,
prezentate în tabelele 4.34 şi 4.35, că adolescentele
tind să aibă scoruri ceva mai scăzute pe scalele
EDI‑3, acolo unde par să existe diferenţe. Acest
lucru este în concordanţă cu etaloanele prezentate
în Anexele A şi C. Totuşi, nu s‑au efectuat teste
de semnificaţie separat pe fiecare grup, din cauza
numărului relativ scăzut de paciente adolescente
în unele grupuri de diagnostic.
Aşa cum se observă din tabelele cu date pre‑
şi post‑tratament (tabelele 4.34 şi 4.35), există un
declin semnificativ al scorurilor la scala EDI‑3
a Riscului de tulburare de comportament alimentar,
precum şi al scorurilor la Scalele psihologice, ceea ce
susţine sensibilitatea clinică a acestor scale în cazul
grupurilor care au obţinut un nivel satisfăcător de
control al simptomelor prin tratamentul intensiv
al tulburărilor de comportament alimentar.
Tabelele 4.36 şi 4.37 prezintă date descriptive
pentru grupurile combinate de femei adulte şi
adolescente. În general, aceste date sunt dovada
unei reduceri semnificative a mediilor scorurilor
la scale şi la scalele compozite ale EDI‑3 de la
evaluarea pre‑tratament la cea post‑tratament.
137
 Tabelul 4.33
Mediile scorurilor la scale şi la scalele compozite în faza de pre-tratament şi în cea de post-
tratament ale participanţilor în studiul de validare EDI-3

Pre-tratament Post-tratament
Scala/Scala compozită EDI-3 M AS M AS t* (gl) p
Scala de Risc de tulburare de comportament
alimentar /scala compozită
AN-Ra
Dorinţa de a fi slab (DS) 19,6 8,1 13,5 9,2 6,1 (54) <0,001
Bulimie (B) 4,3 4,4 2,5 3,2 3,2 (55) 0,003
Nemulţumire faţă de corp (NC) 23,7 11,4 21,8 13,0 1,6 (54) 0,120
Scala compozită Risc de tulburare de comportament 46,8 20,6 38,5 23,4 3,4 (44) 0,002
alimentar (SCRTCA)
AN-AC/Vb
Dorinţa de a fi slab (DS) 20,3 6,5 13,1 9,6 4,7 (33) <0,001
Bulimie (B) 15,7 9,5 4,4 5,0 7,8 (34) <0,001
Nemulţumire faţă de corp (NC) 28,8 8,8 25,9 11,4 1,1 (30) 0,280
Scala compozită Risc de tulburare de comportament 66,1 18,3 43,8 23,1 5,8 (27) <0,001
alimentar (SCRTA)
BNc
Dorinţa de a fi slab (DS) 23,6 4,9 11,7 8,0 9,8 (53) <0,001
Bulimie (B) 21,2 7,3 6,0 7,0 12,7 (51) <0,001
Nemulţumire faţă de corp (NC) 31,9 9,4 23,8 11,0 5,0 (57) <0,001
Scala compozită Risc de tulburare de comportament 77,0 16,1 41,9 21,8 8,1 (41) <0,001
alimentar (SCRTA)
TCAFASd
Dorinţa de a fi slab (DS) 22,8 7,6 14,4 6,9 4,0 (26) <0,001
Bulimie (B) 10,9 8,2 3,3 3,4 5,7 (27) <0,001
Nemulţumire faţă de corp (NC) 30,3 10,0 26,3 9,0 2,1 (29) 0,046
Scala compozită Risc de tulburare de comportament 65,8 16,3 44,2 16,5 4,7 (23) <0,001
alimentar (SCRTA)
Scala psihologică/scala compozită
Stimă de sine scăzută (SSS) 13,9 6,0 9,0 6,4 8,5 (175) <0,001
Alienare personală (AP) 15,2 6,1 8,6 6,3 11,2 (173) <0,001
Nesiguranţă interpersonală (NI) 12,2 4,8 9,5 4,5 7,4 (171) <0,001
Alienare interpersonală (AI) 12,0 5,7 8,5 5,4 8,5 (178) <0,001
Deficite interoceptive (DI) 18,5 8,6 11,5 8,0 10,9 (172) <0,001
Dezechilibru emoţional (DE) 9,3 5,9 5,2 4,9 9,3 (164) <0,001
Perfecţionism (P) 14,1 5,9 11,7 5,6 6,2 (177) <0,001
Ascetism (A) 14,1 6,3 8,9 6,2 9,7 (157) <0,001
Frica de maturitate (FM) 11,8 6,2 8,6 6,4 7,0 (169) <0,001
Scala compozită Ineficacitate (SCI) 29,3 11,2 17,5 12,2 9,8 (160) <0,001
Scala compozită Probleme interpersonale (SCPI) 24,1 9,2 18,0 9,0 8,6 (162) <0,001
Scala compozită Probleme emoţionale (SCPE) 28,4 12,8 16,8 11,5 11,5 (149) <0,001
Scala compozită Control exagerat (SCCE) 28,2 10,5 20,6 10,2 9,1 (146) <0,001
Scala compozită Neadaptare psihologică generală 125,6 38,5 82,1 40,2 9,2 (87) <0,001
(SCNPG)

Notă: AN-R = Anorexie nervoasă de tip restrictiv; AN-AC/V = Anorexie nervoasă de tip alimentaţie compulsivă/vărsături; BN
= Bulimie nervoasă; TCAFAS = Tulburare de comportament alimentar fără altă specificaţie.
n=62. bn=38. cn=62. dn = 32.
a

* testul t bidirecţional.

138
 Tabelul 4.34
Variabilele demografice şi clinice şi scorurile medii la scala de Risc de tulburare de comportament alimentar şi scorul mediu compozit de Risc de
tulburare de comportament alimentar pentru eşantioanele clinice de adulţi şi adolescenţi din studiul de validare a EDI-3
Eşantion de adulţi (n = 131) Eşantion de adolescenţi (n = 63)
AN-R AN-AC/V BN TCAFAS AN-R AN-AC/V BN TCAFAS
(n = 31) (n = 31) (n =46) (n = 23) (n = 31) (n = 7) (n = 16) (n = 9)
Variabila demografică/clinică M AS M AS M AS M AS M AS M AS M AS M AS
Vârsta (ani) 27,4 11,7 24,8 6,6 24,0 7,3 24,3 6,5 14,3 1,6 14,7 1,7 16,2 0,8 15,6 1,6
Greutatea (livre)
Pre-tratament 93,7 14,2 95,7 8,6 136,4 40,0 132,0 22,1 89,0 11,8 93, 8,9 122,2 18,4 116,4 27,3
Post-tratament 117,0*** 13,5 113,4*** 9,6 142,8*** 38,6 138,6* 24,0 108,2*** 10,6 107,6** 9,5 128,6** 15,6 126,5** 25,6
Creştere în greutate (pe săptămână) 3,4 4,2 2,4 1,1 1,2 1,3 1,3 1,7 2,0 0,7 2,0 0,2 0,5 0,8 1,1 0,4
IMC
Pre-tratament 15,1 1,8 16,2 1,3 22,3 6,0 21,8 4,1 15,5 1,4 15,7 0,8 19,8 1,9 20,0 3,7
Post-tratament 18,9*** 1,5 19,2*** 1,3 23,4*** 5,7 22,9* 4,7 19,0*** 1,3 18,0** 1,5 20,9** 1,6 21,8** 3,5
Episoade de alimentaţie compulsivă (pe lună)
Pre-tratament 0,0 0,0 67,0 110,8 71,3 76,6 0,5 1,2 0,0 0,0 67,1 94,6 76,1 134,8 1,9 2,8
Post-tratament 0,2 0,9 2,0** 5,1 1,5*** 5,2 1,7 4,6 0,5 1,7 0,0 0,0 0,0* 0,0 1,3 3,0
Vărsături (pe lună)
Pre-tratament 0,0 0,0 95,6 109,3 92,3 74,4 63,0 74,0 0,0 0,0 102,6 72,5 80,9 58,9 48,6 84,1
Post-tratament 0,6 2,7 1,7*** 3,9 1,5*** 2,9 0,7** 1,5 0,2 0,7 0,1* 0,4 0,4*** 0,8 0,2 0,7
Scor EAT
Pre-tratament 45,8 16,9 46,8 12,3 45,2 11,3 51,5 13,1 36,7 18,7 30,7 17,1 48,9 20,6 45,4 17,2
Post-tratament 11,2 19,6*** 17,0 19,9 13,3 10,7*** 3,1 12,8** 8,3
19,4*** 16,2 17,6*** 13,8 15,6*** 11,4
18,6***
Zile de tratament 50,8 28,2 42,0 21,9 32,6 17,1 36,3 22,1 46,7 19,4 39,7 23,5 44,9 22,0 44,9 24,6
Scala EDI-3 de Risc de tulburare de
comportament alimentar
Dorinţa de a fi slab (DS)
Pre-tratament 20,5 7,4 21,6 5,0 22,8 5,4 23,0 7,7 19,4 8,7 14,3 9,0 24,7 3,6 21,8 8,4
Post-tratament 14,1*** 10,1 13,1*** 9,5 13,1*** 7,8 15,9** 6,3 13,0*** 9,0 13,0 10,9 7,7*** 8,0 13,1 7,9
Bulimie (B)
Pre-tratament 5,0 4,3 16,9 8,6 21,6 7,7 11,5 8,2 3,5 4,7 12,5 12,3 17,8 5,3 12,3 8,8
Post-tratament 3,1 2,1 2,9 3,0 3,0 3,2*** 4,8 3,4* 4,2
2,6** 3,3 4,8*** 5,4 6,8*** 7,5
3,4***
Nemulţumire faţă de corp (NC)
Pre-tratament 23,6 11,3 29,9 6,7 31,5 9,6 31,1 9,8 24,5 11,6 22,5 17,3 17,8 5,3 12,3 8,8
Post-tratament 22,7 13,5 26,2* 11,5 26,4** 8,9 26,8 8,1 20,1* 13,2 30,0 10,2 3,2*** 4,8 3,4* 4,2
Scala compozită Risc de tulburare de
comportament alimentar (SCRTCA)
Pre-tratament 45,1 19,7 64,5 16,7 73,6 18,6 62,7 17,7 45,6 21,7 45,1 35,8 75,1 17,4 52,0 28,1
Post-tratament 14,3 34,0** 23,8 32,6 26,4 22,3*** 22,3 37,2 22,2
37,6* 22,3 40,6*** 24,4 43,9*** 18,6
43,8***
Notă: N = 194. Valorile pragului de semnificaţie au fost calculate doar pe baza comparaţiilor între pre-tratament şi post-tratament (toate valorile sunt obţinute pe baza testului t bidirecţional). AN-R = Anorexie

139
nervoasă de tip restrictiv; AN-AC/V = Anorexie nervoasă de tip alimentaţie compulsivă/vărsături; BN = Bulimie nervoasă; TCAFAS = Tulburare de comportament alimentar fără altă specificaţie; IMC = Indice de
masă corporală; EAT = Testul de atitudini faţă de alimentaţie (Garner, 1993b, 1997).
*p<0,05; **p<0,01; ***p<0,001.
 Tabelul 4.35
Mediile scorurilor la scalele psihologice şi mediile scorurilor compozite în faza de pre-tratament şi
post-tratament pentru eşantioanele de adulţi şi de adolescenţi din studiul de validare EDI-3

Pre-tratament Post-tratament
Scala psihologică/Scala compozită Eşantion M AS M AS t* (gl) p
Stimă de sine scăzută (SSS) Adulţi 14,4 5,7 9,5 6,4 7,9 (120) <0,001
Adolescenţi 12,8 7,0 7,9 6,6 4,0 (54) <0,001
Alienare personală (AP) Adulţi 15,6 5,6 8,7 6,2 10,5 (120) <0,001
Adolescenţi 14,3 7,2 8,8 6,6 4,7 (52) <0,001
Nesiguranţă interpersonală (NI) Adulţi 12,2 4,8 9,6 4,5 6,1 (117) <0,001
Adolescenţi 12,2 4,9 9,5 4,6 4,3 (53) <0,001
Alienare interpersonală (AI) Adulţi 12,4 5,4 8,6 5,2 8,1 (123) <0,001
Adolescenţi 11,2 6,4 8,3 5,9 3,4 (54) 0,001
Deficite interoceptive (DI) Adulţi 19,6 7,9 12,1 8,0 9,3 (119) <0,001
Adolescenţi 17,2 9,7 9,4 7,5 5,7 (52) <0,001
Dezechilibru emoţional (DE) Adulţi 9,7 5,8 5,5 4,8 8,4 (111) <0,001
Adolescenţi 8,8 6,6 5,1 5,4 4,4 (52) <0,001
Perfecţionism (P) Adulţi 14,7 5,7 12,4 5,7 5,4 (120) <0,001
Adolescenţi 12,9 6,2 10,3 5,3 3,3 (56) 0,002
Ascetism (A) Adulţi 14,7 5,9 9,2 5,8 9,2 (110) <0,001
Adolescenţi 13,1 7,0 8,3 7,3 4,1 (46) <0,001
Frica de maturitate (FM) Adulţi 11,2 6,2 7,8 5,6 6,7 (117) <0,001
Adolescenţi 12,8 6,5 10,3 8,0 2,8 (51) 0,007
Scala compozită Ineficacitate (SCI) Adulţi 29,9 10,3 18,1 12,1 9,5 (112) <0,001
Adolescenţi 27,3 13,8 17,3 13,0 4,0 (47) <0,001
Scala compozită Probleme Adulţi 24,7 8,9 18,1 8,7 7,8 (113) <0,001
interpersonale (SCPI) Adolescenţi 23,2 10,0 17,9 10,0 3,8 (48) <0,001
Scala compozită Probleme Adulţi 29,6 11,8 17,9 11,4 9,9 (102) <0,001
emoţionale (SCPE) Adolescenţi 26,5 15,2 14,2 12,4 5,9 (46) <0,001
Scala compozită Control exagerat Adulţi 29,7 9,9 21,3 9,5 8,9 (102) <0,001
(SCCE) Adolescenţi 26,0 11,3 19,0 11,1 3,6 (43) 0,001
Scala compozită Neadaptare Adulţi 119,1 35,9 78,6 37,0 11,3 (130) <0,001
psihologică generală (SCNPG) Adolescenţi 104,7 48,8 72,2 45,0 5,0 (61) <0,001
Notă: N = 194 (Adulţi, n = 131; Adolescenţi, n = 63). Valorile pragului de semnificaţie au fost calculate doar pe baza comparaţiilor
între pre‑tratament şi post-tratament (toate valorile sunt obţinute pe baza testului t bidirecţional).

140
 Tabelul 4.36
Mediile scorurilor în fazele de pre-tratament şi în faza post-tratament pentru eşantioanele clinice
combinate de adulţi şi adolescenţi din studiul de validare a EDI-3, în funcţie de variabilele
demografice şi clinice

Eşantion clinic
AN-R AN-AC/V BN TCAFAS
(n = 62) (n = 38) (n =62) (n = 32)
Variabila demografică/clinică M AS M AS M AS M AS
Vârsta (ani) 20,8 10,6 23,0 7,2 22,0 7,1 21,8 6,8
Greutatea (livre)
Pre-tratament 91,3 13,2 95,3 8,5 132,7 36,0 127,5 24,3
Post-tratament 112,5*** 12,9 112,4*** 9,7 139,1*** 34,6 135,2*** 24,7
Creştere în greutate (pe săptămână) 2,8 3,3 2,4 1,1 1,1 1,3 1,3 1,6
IMC
Pre-tratament 15,3 1,6 16,1 1,2 21,7 5,2 21,3 4,1
Post-tratament 18,9*** 1,4 19,0*** 1,4 22,7*** 5,0 22,6*** 4,4
Episoade de alimentaţie compulsivă
(pe lună)
Pre-tratament 0,0 0,4 67,0 106,8 72,6 93,9 0,9 1,9
Post-tratament 0,3 1,4 1,6*** 4,7 1,1*** 4,6 1,6 4,2
Vărsături (pe lună)
Pre-tratament 0,0 0,0 96,9 102,7 89,3 70,4 58,9 75,7
Post-tratament 0,4 2,0 1,4*** 3,6 1,2*** 2,5 0,6*** 1,3
Scor EAT
Pre-tratament 41,3 18,2 43,3 14,4 44,7 14,5 50,3 14,2
Post-tratament 19,5*** 16,4 17,4*** 13,5 14,1*** 11,1 16,5*** 10,5
Zile de tratament 48,8 24,1 41,6 21,9 35,7 19,0 38,7 22,8
Scala EDI-3 de Risc de tulburare de
comportament alimentar
Dorinţa de a fi slab (DS)
Pre-tratament 19,6 8,1 20,3 6,5 23,6 4,9 22,8 7,6
Post-tratament 13,5*** 9,2 13,1*** 9,6 11,7*** 8,0 14,1*** 6,9
Bulimie (B)
Pre-tratament 4,3 4,4 15,7 9,5 21,2 7,3 10,9 8,2
Post-tratament 2,5** 3,2 4,4*** 5,0 6,0*** 7,0 3,3*** 3,4
Nemulţumire faţă de corp (NC)
Pre-tratament 23,7 11,4 28,8 8,8 31,9 9,4 30,3 10,0
Post-tratament 21,8 13,0 25,9 11,4 23,8*** 11,0 26,3* 9,0
Scala compozită Risc de tulburare de
comportament alimentar (SCRTA)
Pre-tratament 46,8 20,6 66,1 18,3 77,0 16,1 65,8 16,3
Post-tratament 38,5*** 23,4 43,8*** 23,1 41,9*** 21,8 44,2*** 16,5

Notă: N = 194. Valorile pragului de semnificaţie au fost calculate doar pe baza comparaţiilor între pre-tratament şi post-
tratament (toate valorile sunt obţinute pe baza testului t bidirecţional). AN-R = Anorexie nervoasă de tip restrictiv; AN-AC/V
= Anorexie nervoasă de tip alimentaţie compulsivă/vărsături; BN = Bulimie nervoasă; TCAFAS = Tulburare de comportament
alimentar fără altă specificaţie; IMC = Indice de masă corporală; EAT = Testul de atitudini faţă de alimentaţie (Garner, 1993b,
1997).
*p<0,05; **p<0,01; ***p<0,001.

141
 Tabelul 4.37
Mediile scorurilor în fazele de pre-tratament şi post-tratament pentru eşantioanele clinice
combinate de adulţi şi adolescenţi din studiul de validare a EDI-3,
la scalele psihologice şi la scalele compozite

Pre-tratament Post-tratament
Scala psihologică/scala compozită M AS M AS t (gl) p
Stimă de sine scăzută (SSS) 13,9 6,0 9,0 6,4 8,5 (175) <0,001
Alienare personală (AP) 15,2 6,1 8,6 6,3 11,2 (173) <0,001
Nesiguranţă interpersonală (NI) 12,2 4,8 9,5 4,5 7,4 (171) <0,001
Alienare interpersonală (AI) 12,0 5,7 8,5 5,4 8,5 (178) <0,001
Deficite interoceptive (DI) 18,5 8,6 11,5 8,0 10,9 (172) <0,001
Dezechilibru emoţional (DE) 9,3 5,9 5,2 4,9 9,3 (164) <0,001
Perfecţionism (P) 14,1 5,9 11,7 5,6 6,2 (177) <0,001
Ascetism (A) 14,1 6,3 8,9 6,2 9,7 (157) <0,001
Frica de maturitate (FM) 11,8 6,2 8,6 6,4 7,0 (169) <0,001
Scala compozită Ineficacitate (SCI) 29,3 11,2 17,5 12,2 9,8 (160) <0,001
Scala compozită Probleme interpersonale (SCPI) 24,1 9,2 18,0 9,0 8,6 (162) <0,001
Scala compozită Probleme emoţionale (SCPE) 28,4 12,8 16,8 11,5 11,5 (149) <0,001
Scala compozită Control exagerat (SCCE) 28,2 10,5 20,6 10,2 9,1 (146) <0,001
Scala compozită Neadaptare psihologică generală 125,6 38,5 82,1 40,2 9,2 (87) <0,001
(SCNPG)
Notă: N = 194. Valorile pragului de semnificaţie au fost calculate doar pe baza comparaţiilor între pre-tratament şi post‑tratament
(toate valorile sunt obţinute pe baza testului t bidirecţional).

142
 5
Standardizarea şi construirea etaloanelor
Standardizarea
Selecţia eşantioanelor
O tradiţie importantă a EDI şi EDI‑2 o
reprezintă încrederea în etaloane separate, în
funcţie de diagnostic şi vârstă. S‑a dovedit că
persoanele cu tulburări clinice de comportament
alimentar se deosebesc de grupurile de control
formate din persoane care nu sunt pacienţi.
Efectele vârstei în cadrul EDI şi EDI‑2 pot fi
semnificative în cazul anumitor subscale, în
special în rândul adolescenţilor şi al adulţilor
tineri. Disponibilitatea diferitelor grupuri
de etalonare ridică întrebarea cu caracter
practic cu care dintre grupuri să fie comparată
persoana respectivă. În cele mai multe cazuri,
un grup referitor la un criteriu este cel mai
indicat pentru subscalele EDI, pentru că acestea
reflectă simptomatologia şi distresul în domenii
particulare ale experienţei subiective.
Descrierea eşantioanelor folosite la etalonare
Tabelul 5.1 afişează locurile de unde s‑au
colectat datele, precum şi numărul şi procentul
persoanelor din grupurile de diagnostic de
tulburări de comportament alimentar, pe baza
criteriilor de diagnostic DSM‑IV‑TR.
Grupurile de diagnostic cuprind anorexia
nervoasă de tip restrictiv (AN‑R) şi anorexia
nervoasă de tip alimentaţie compulsivă/vărsături
(AN‑AC/V), bulimia nervoasă (BN), precum şi
tulburările de comportament alimentar fără altă
specificaţie (TCAFAS). Primele două eşantioane
clinice, de adulţi din SUA (N=983) şi de adulţi din
eşantionul internaţional (N=662), cuprind adulţi
cu vârste de cel puţin 18 ani. Al treilea eşantion,
de adolescenţi din SUA (N=335), cuprinde
adolescenţi cu vârste între 11 şi 17 ani. Toţi
participanţii din aceste eşantioane de etalonare
sunt fete sau femei diagnosticate cu tulburări
clinice de comportament alimentar şi care au
completat EDI‑3. Marea majoritate a femeilor
care formează aceste grupuri de etalonare
aparţin tipului caucazian. În plus, tabelele 5.2 şi
5.3 prezintă date statistice descriptive referitoare
la vârstă şi la IMC, pentru fiecare categorie de
diagnostic dintre cele trei eşantioane de etalonare.
Proceduri de etalonare
Obţinerea cotelor T ajustate în funcţie de
vârstă
Au fost calculate scorurile brute pentru
fiecare scală EDI‑3, pentru fiecare eşantion de
etalonare. Apoi, au fost examinate momentele
distribuţiilor scorurilor brute la scalele EDI‑3
pentru femeile cu vârste cuprinse între 11 şi 53 de
ani. S‑au observat câteva diferenţe semnificative
din punct de vedere statistic între mediile
scorurilor brute la scalele EDI‑3, în special între
participantele adolescente şi cele adulte. Aceste
analize, împreună cu consideraţiile teoretice,
au contribuit la formarea celor două grupuri
de vârstă: (a) de la 11 la 17 ani şi (b) de 18 ani şi
peste 18 ani. Tabelele 5.4 şi 5.5 prezintă mediile şi
abaterile standard pentru grupurile de etalonare.
Examinarea mediilor scorurilor brute din
cadrul grupurile de diagnostic şi de vârstă
dezvăluie câteva asemănări, precum şi câteva
diferenţe evidente. De exemplu, aşa cum era de
aşteptat, scala B pentru grupul de diagnostic
AN‑R prezintă medii mult mai mici decât pentru
grupul de diagnostic AN‑AC/V. S‑au calculat,
apoi, cotele T şi centilele pentru fiecare dintre
grupurile de etalonare obţinute, iar procedurile
folosite pentru a deduce aceste scoruri folosite la
etalonare sunt descrise în secţiunile următoare.
143
Obţinerea cotelor T
Media, abaterea standard, asimetria,
boltirea şi distribuţia frecvenţelor cumulate au
fost calculate pentru fiecare grup de etalonare
şi pentru fiecare dintre cele trei scale ale Riscului
de tulburare de comportament alimentar şi pentru
cele nouă Scale psihologice. Scorurile brute au
fost apoi reprezentate grafic pentru fiecare
grup de etalonare, iar distribuţia de frecvenţe
şi distribuţiile frecvenţelor cumulate au fost
examinate pentru identificarea asimetriilor.
Distribuţiile frecvenţelor cumulate au fost netezi-
te apoi, folosind un procedeu al mediei ponderate
(Cureton şi Turkey, 1951). Această procedură
netezeşte în mod eficient neregularităţile
minore ale distribuţiei datorate eşantionării,
fără să afecteze forma originală a distribuţiei.
Distribuţiile scorilor brute obţinute au fost,
apoi, transformate în distribuţii ale mijloacelor
intervalelor de centile nenormalizate şi în
distribuţii ale cotelor T nenormalizate. Cotele T
sunt scoruri scalate cu o medie de 50 şi o abatere
standard de 10. Tabelele de conversie a scorului
brut în cotă T, a scorului brut în centil şi a sumei
cotelor T în cotă T pentru scalele EDI‑3 sunt
prezentate în Anexele A – C. Aceste tabele includ
şi centilele corespunzătoare fiecărui scor, precum
şi intervalele de încredere (IC) corespunzătoare
probabilităţii de 90% pentru scale, pentru fiecare
grup utilizat pentru etalonare.
Obţinerea cotelor T compozite
Anexele A – C prezintă şi scorurile scalelor
compozite EDI‑3 ale grupurilor utilizate pentru
144
etalonare. Scorurile scalelor compozite au fost
calculate după cum urmează. Pentru fiecare
participant al grupului de etalonare din care
face parte, s‑au însumat cotele T efective din
scalele corespunzătoare şi s‑a calculat distribuţia
frecvenţelor cumulate a noilor scoruri.
Distribuţiile frecvenţelor cumulate au fost,
apoi, netezite prin proceduri analitice utilizând
aceeaşi procedură folosită pentru scale (adică un
procedeu al mediei ponderate). Fiecare sumă a
cotelor T a fost scalată într‑o cotă T nenormalizată
(adică, M=50, AS=10). În plus, valoarea din
mijlocul intervalului centilelelor a fost calculată
pentru fiecare valoare posibilă a scorului brut.
Intervalele de încredere
Anexele A – C prezintă intervalele de
încredere corespunzătoare probabilităţii de
90% pentru fiecare scor al scalelor EDI‑3
şi, de asemenea, intervalele de încredere
corespunzătoare probabilităţii de 90% pentru
fiecare dintre scorurile scalelor compozite ale
EDI‑3. Intervalele de încredere prezentate în
Anexele A – C au fost calculate folosind scorul
real estimat şi eroarea standard de estimare (ESE;
Stanley, 1971). Această metodă compensează
regresia către medie (adică a scorului real). Spre
deosebire de intervalele de încredere simetrice
care folosesc ESM (adică, metoda folosită la
nivelul scalelor), această metodă produce adesea
intervale asimetrice, în special când scorurile
deviază de la media distribuţiei. Indiferent dacă
folosim intervalele de încredere simetrice sau
asimetrice, interpretarea este aceeaşi.
 Tabelul 5.1
Reprezentarea geografică pentru eşantioanele clinice EDI-3, adulţi din lotul internaţional
şi din SUA şi adolescenţi din SUA, pe grupuri de diagnostic

Grupul de diagnostic
AN-R AN-AC/V BN TCAFAS
Eşantion/ loc n % n % n % n %
Eşantion clinic de adulţi din SUAa
Indiana 18 12,4 8 8,7 139 32,4 92 29,0
Maryland 30 20,7 24 26,0 36 8,4 16 5,1
Michigan 14 9,7 10 10,9 44 10,3 32 10,1
Ohio 38 26,2 40 43,5 82 19,1 80 25,2
Wisconsin 45 31,0 10 10,9 128 29,8 97 30,6
Total 145 100,0 92 100,0 429 100,0 317 100,0
Eşantion clinic internaţional de adulţib
Australia 72 43,6 20 18,2 18 6,0 17 19,5
Canada 0 0,0 3 2,7 83 27,7 11 12,6
Italia 25 15,2 12 10,9 39 13,0 27 31,1
Olanda 68 41,2 75 68,2 160 53,3 32 36,8
Total 165 100,0 110 100,0 300 100,0 87 100,0
Eşantion clinic de adolescenţi din SUAc
Indiana 5 5,0 0 0,0 10 10,2 16 14,2
Maryland 17 16,8 3 13,1 11 11,3 4 3,5
Michigan 4 4,0 1 4,3 11 11,2 6 5,3
Ohio 45 44,5 13 56,5 31 31,6 47 41,6
Wisconsin 30 29,7 6 26,1 35 35,7 40 35,4
Total 101 100,0 23 100,0 98 100,0 113 100,0

Notă: AN-R = Anorexie nervoasă de tip restrictiv; AN-AC/V = Anorexie nervoasă de tip alimentaţie compulsivă/vărsături; BN
= Bulimie nervoasă; TCAFAS = Tulburare de comportament alimentar fără altă specificaţie.
a
N=983; bN=662; cN=335.

Tabelul 5.2
Valorile medii ale vârstei şi ale IMC-ului pentru eşantioanele clinice EDI-3 de adulţi din SUA
şi din lotul internaţional, pe grupuri de diagnostic

Grupul de diagnostic
AN-R AN-AC/V BN TCAFAS
SUA a
Internaţional b
SUA c
Internaţional d
SUA e
Internaţional f
SUA g
Internaţionalh
18-53 ani 18-53 ani 18-53 ani 18-43 ani 18-53 ani 18-54 ani 18-54 ani 18-47 ani
Variabila M AS M AS M AS M AS M AS M AS M AS M AS
Vârsta 25,73 9,10 25,25 7,06 25,95 7,93 25,10 5,03 23,93 6,74 25,89 6,65 26,03 8,91 25,87 6,34
IMC 15,48 1,87 14,78 1,67 16,86 1,86 15,94 1,24 22,33 4,84 21,45 3,32 21,62 6,35 22,09 5,00

Notă: IMC = Indice de masă corporală; AN-R = Anorexie nervoasă de tip restrictiv; AN-AC/V = Anorexie nervoasă de tip
alimentaţie compulsivă/vărsături; BN = Bulimie nervoasă; TCAFAS = Tulburare de comportament alimentar fără altă
specificaţie.
a
n=145; bn=165; cn=92; dn=110; en=429; fn=300; gn=317; hn=87.

145
 Tabelul 5.3
Valorile medii ale vârstei şi ale IMC-ului pentru eşantionul clinic EDI-3 de adolescenţi din SUA,
pe grupuri de diagnostic

Grupul de diagnostic
AN-R a
AN-AC/Vb BNc TCAFASd
Variabila M AS M AS M AS M AS
Vârsta 15,02 1,59 15,26 1,63 15,89 1,12 15,69 1,32
IMC 15,72 1,56 17,05 1,70 21,23 3,91 20,92 5,73
Notă: IMC = Indice de masă corporală; AN-R = Anorexie nervoasă de tip restrictiv; AN-AC/V = Anorexie nervoasă de tip
alimentaţie compulsivă/vărsături; BN = Bulimie nervoasă; TCAFAS = Tulburare de comportament alimentar fără altă
specificaţie.
n=101; bn=23; cn=98; dn=113.
a

Tabelul 5.4
Mediile scorurilor brute la scalele EDI-3 pentru eşantionul clinic EDI-3 de adolescenţi din SUA, pe
grupuri de diagnostic

Grupa de diagnostic
AN-Ra AN-AC/Vb BNc TCAFASd
Scala EDI-3 M AS M AS M AS M AS
Scala de Risc de tulburare de
comportament alimentar
Dorinţa de a fi slab ( DS) 17,74 8,96 18,04 8,83 20,72 6,80 20,79 6,87
Bulimie (B) 2,86 3,38 8,39 8,38 16,59 8,93 9,77 7,87
Nemulţumire faţă de corp (NC) 24,06 12,21 25,52 12,92 28,82 10,09 29,46 10,40

Scala psihologică
Stimă de sine scăzută (SSS) 11,56 6,54 11,56 6,54 11,56 6,54 11,56 6,54
Alienare personală (AP) 12,45 6,93 12,45 6,93 12,45 6,93 12,45 6,93
Nesiguranţă interpersonală (NI) 10,46 6,32 10,46 6,32 10,46 6,32 10,46 6,32
Alienare interpersonală (AI) 9,63 5,81 9,63 5,81 9,63 5,81 9,63 5,81
Deficite interoceptive(DI) 14,82 8,84 14,82 8,84 14,82 8,84 14,82 8,84
Dezechilibru emoţional (DE) 7,33 5,79 7,33 5,79 7,33 5,79 7,33 5,79
Perfecţionism (P) 12,52 6,19 12,52 6,19 12,52 6,19 12,52 6,19
Ascetism (A) 11,32 6,40 11,32 6,40 11,32 6,40 11,32 6,40
Frica de maturitate (FM) 11,39 6,79 11,39 6,79 11,39 6,79 11,39 6,79

Notă: AN-R= Anorexie nervoasă de tip restrictiv; AN-AC/V= Anorexie nervoasă de tip alimentaţie compulsivă/vărsături;
BN= Bulimie nervoasă; TCAFAS= Tulburare de comportament alimentar fără altă specificaţie.
n=101; bn=23; cn=98; dn=113.
a

146
 Tabelul 5.5
Mediile scorurilor brute pentru eşantioanele clinice EDI-3 de adulţi din SUA şi din lotul internaţional, pe grupuri de diagnostic

Grupul de diagnostic
AN-R AN-AC/V BN TCAFAS
a c d e g
SUA Internaţionalb SUA Internaţional SUA Internaţionalf SUA Internaţionalh
Scala EDI-3 M AS M AS M AS M AS M AS M AS M AS M AS
Scala de Risc pentru tulburări
de comportament alimentar
Dorinţa de a fi slab ( DS) 17,98 8,59 17,29 8,51 21,24 7,04 19,96 7,15 21,49 5,68 22,01 5,76 21,24 6,95 20,55 7,72
Bulimie (B) 4,01 3,78 3,92 5,30 13,05 8,40 14,56 7,60 20,40 7,27 20,20 6,67 10,54 7,97 12,13 8,18
Nemulţumire faţă de corp (NC) 23,86 10,60 25,07 10,11 28,17 10,00 25,92 9,81 29,92 9,10 29,07 9,12 29,22 10,17 28,89 10,70

Scala psihologică
Stimă de sine scăzută (SSS) 13,05 6,07 14,06 5,44 13,05 6,07 14,06 5,44 13,05 6,07 14,06 5,44 13,05 6,07 14,06 5,44
Alienare personală (AP) 13,60 6,28 14,55 5,95 13,60 6,28 14,55 5,95 13,60 6,28 14,55 5,95 13,60 6,28 14,55 5,95
Nesiguranţă interpersonală (NI) 11,59 6,16 11,90 5,46 11,59 6,16 11,90 5,46 11,59 6,16 11,90 5,46 11,59 6,16 11,90 5,46
Alienare interpersonală (AI) 10,30 5,36 12,01 4,91 10,30 5,36 12,01 4,91 10,30 5,36 12,01 4,91 10,30 5,36 12,01 4,91
Deficite interoceptive (DI) 16,94 8,14 17,82 6,96 16,94 8,14 17,82 6,96 16,94 8,14 17,82 6,96 16,94 8,14 17,82 6,96
Dezechilibru emoţional (DE) 8,16 5,70 9,16 5,09 8,16 5,70 9,16 5,09 8,16 5,70 9,16 5,09 8,16 5,70 9,16 5,09
Perfecţionism (P) 13,80 5,89 11,88 5,29 13,80 5,89 11,88 5,29 13,80 5,89 11,88 5,29 13,80 5,89 11,88 5,29
Ascetism (A) 12,73 5,72 12,85 5,12 12,73 5,72 12,85 5,12 12,73 5,72 12,85 5,12 12,73 5,72 12,85 5,12
Frica de maturitate (FM) 10,82 6,91 12,00 6,68 10,82 6,91 12,00 6,68 10,82 6,91 12,00 6,68 10,82 6,91 12,00 6,68

Notă: AN-R = Anorexie nervoasă de tip restrictiv; AN-AC/V = Anorexie nervoasă de tip alimentaţie compulsivă/vărsături; BN = Bulimie nervoasă; TCAFAS = Tulburare de comportament
alimentar fără altă specificaţie.
a
n=145; bn=165; cn=92; dn=110; en=429; fn=300; gn=317; hn=87.

147
 6
Fidelitate şi validitate
Fidelitatea
Fidelitatea unui test se referă la acurateţea
sau precizia, consistenţa şi stabilitatea scorurilor
la test într‑o varietate de condiţii sau în ocazii
separate (Anastasi şi Urbina, 1997; Crocker şi
Algina, 1986). Utilizând teoria clasică a testelor,
sunt posibile evaluarea şi estimarea gradului
de eroare asociată cu un scor particular la test.
Diferenţa dintre scorul real estimat al unei
persoane (adică scorul ipotetic, în cazul în care
testul ar fi perfect fidel) şi scorul obţinut la test se
numeşte eroare de măsurare. Eroarea de măsurare
se exprimă, în mod normal, utilizând următoarea
formulă a erorii standard de măsurare (ESM):
ESM = ASt √ (1 - rtt)
ASt este abaterea standard a distribuţiei
scorurilor la test, iar rtt este coeficientul de
fidelitate. O valoare mai mică a ESM denotă o
precizie crescută în aproximarea scorului real
obţinut de către o persoană. Altfel spus, există o
relaţie inversă între ESM şi precizia scorului la un
test; precizia scorului creşte pe măsură ce ESM
scade. Utilizând ESM, intervalele de încredere
(IC) ţin cont de eroarea de măsurare şi, dat
fiind un anumit nivel de probabilitate, acestea
sunt construite în aşa fel încât să evidenţieze
intervalul probabil al scorului real al persoanei.
Relaţia dintre fidelitate, ESM şi IC este de o
asemenea factură, încât, pe măsură ce fidelitatea
testului creşte, valorile ESM şi IC scad, indicând
o mai mare precizie a testului. În ceea ce priveşte
fidelitatea testului, trebuie luată în considerare
atât consistenţa internă, cât şi cea inter‑teste
a scorurilor la test. Astfel, fidelitatea ar trebui
evaluată atât în contextul scorurilor obţinute, cât
şi al stabilităţii în timp a scorurilor la test. Această
secţiune prezintă coeficienţii de fidelitate, ESM şi
intervalele de încredere pentru scorurile EDI‑3.
Consistenţa internă
Fidelitatea scorurilor EDI‑3 a fost estimată,
la început, după o singură administrare a
testului. Coeficientul alfa al lui Cronbach (1951)
a fost folosit în estimarea consistenţei interne.
Coeficientul alfa al lui Cronbach reprezintă o
estimare laxă a fidelităţii unui test, pentru că
subestimează fidelitatea (Allen şi Yen, 1979).
Coeficienţii compoziţi de fidelitate au fost
calculaţi cu ajutorul formulei tradiţionale a
fidelităţii compozite, după recomandarea lui
Guilford (1954) şi a lui Nunnally şi Bernstein
(1994). Tabelul 6.1 prezintă coeficienţii alfa,
folosind sistemul de cotare de la 0 la 4, pentru cele
trei eşantioane folosite pentru etalonare (adică
eşantionul clinic de adulţi din SUA, eşantionul
clinic internaţional de adulţi şi eşantionul clinic
de adolescenţi din SUA).
Fidelitatea SCRTCA variază în intervalul
cuprins între 0,90 şi 0,97 (mediana = 0,94), în
cadrul celor patru grupuri de diagnostic şi al celor
trei grupuri folosite pentru etalonare. Pentru cele
trei scale de Risc de tulburare de comportament
alimentar, toţi coeficienţii de fidelitate în cazul
celor trei grupuri folosite pentru etalonare au
valori peste 0,80 şi puţin peste 0,90. Un pattern
similar al coeficienţilor de fidelitate pentru cele
trei grupuri folosite pentru etalonare a fost
identificat şi în cazul celor patru grupuri cu
diagnostic specific. Excepţia generală a constat
în coeficienţii de fidelitate relativ mici ai scalei B
pentru grupul diagnosticat cu Anorexie nervoasă
de tip restrictiv (AN‑R). Aşa cum era de aşteptat,
acest grup prezintă o distribuţie semnificativ
mai scăzută şi mai aplatizată pentru scala B, care
duce la un interval restrâns al scorurilor şi, deci,
la o valoare mai scăzută a fidelităţii estimate.
149
 În plus, coeficienţii de fidelitate ai Scalelor
psihologice şi ai scalelor compozite sunt afişaţi în
tabelul 6.1. În general, pentru SCNPG coeficienţii
de fidelitate sunt cuprinşi în intervalul 0,93 – 0,97
pentru cele trei grupuri folosite pentru etalonare.
Toţi ceilalţi coeficienţi compoziţi de fidelitate se
încadrau între 0,80 şi 0,90 în cele trei eşantioane
folosite pentru etalonare, excepţie făcând SCCE
pentru eşantionul clinic internaţional de adulţi
(0,78). Medianele coeficienţilor de fidelitate
pentru Scalele psihologice au fost de 0,84, 0,74
şi 0,85 pentru eşantionul clinic de adulţi din
SUA, eşantionul clinic internaţional de adulţi
şi, respectiv, eşantionul clinic de adolescenţi din
SUA.
Pentru comparaţie, tabelul 6.2 prezintă
coeficienţii alfa pentru scalele EDI‑3 reconfigu-
rate, folosind sistemul de cotare de la 0 la 3 al
EDI‑2. Coeficienţii alfa din tabelele 6.1 şi 6.2
sunt comparabili în mare măsură, majoritatea
scalelor indicând doar o diferenţă minimă între
coeficienţii alfa de fidelitate. Diferenţa cea mai
semnificativă o reprezintă atenuarea relativă a
coeficienţilor alfa ai scalei B pentru eşantioanele
folosite pentru etalonare ale grupului cu AN‑R.
Similar coeficienţilor alfa ai scalei B a EDI‑3,
coeficienţii alfa ai EDI-2 în cadrul eşantioanelor
cu AN-R folosite pentru etalonare au valori mici,
datorită restrângerii pronunţate a intervalului
scorurilor acestor grupuri.
Erori standard de măsurare (ESM) şi intervale
de încredere (IC)
ESM oferă o estimare a variaţiei aşteptate
a scorului unei persoane examinate faţă de
scorul real al acesteia (Crocker şi Algina, 1986).
Scopul practic al calculării ESM este acela de a
oferi utilizatorului o indicaţie asupra modului în
care erorile de măsurare afectează interpretarea
scorurilor unui test. Aceasta se face, de obicei,
utilizând ESM pentru stabilirea IC care formează
o zonă sau un interval în jurul valorii scorului
obţinut de o persoană. ESM‑urile pentru fiecare
scală EDI‑3 şi scală compozită pentru cele
trei eşantioane folosite pentru etalonare sunt
prezentate în tabelul 6.3. ESM‑urile reprezintă
baza pentru stabilirea IC, corespunzătoare
scorurilor obţinute de către o persoană.
Intervalele de încredere sunt exprimate sub
forma unui interval care se extinde deasupra şi
dedesubtul scorului obţinut de o persoană, în
interiorul căruia se află, probabil, scorul real.
Un interval de încredere obişnuit reprezintă
un interval corespunzător probabilităţii de
90%, cu ajutorul căruia utilizatorii testului pot
150
fi 90% siguri că scorul real al persoanei va fi
cuprins între limita superioară şi cea inferioară a
intervalului. Utilizarea intervalelor de încredere
ar trebui să reprezinte un avertisment, pentru
utilizator, asupra faptului că există o variaţie
inerentă de eroare în scorurile unei persoane
şi că precizia scorurilor obţinute nu poate fi de
100%. Cu alte cuvinte, scorul obţinut reprezintă
o estimare a scorului real al unei persoane.
Intervalul de încredere de 90% se calculează
prin multiplicarea valorii critice de 1,65 cu
ESM, după care se adaugă şi se scade acest
produs din scorul obţinut, pentru a găsi limita
superioară şi cea inferioară ale intervalului. De
exemplu, o cotă T de 50 a SCRTCA, împreună
cu un ESM de 3,16, produce un interval de
încredere corespunzător probabilităţii de 90%
pentru cota T de 44‑56 (adică 50 ± 1,65 ESM). În
acest exemplu, examinatorul poate fi 90% sigur
de faptul că scorul real al persoanei examinate
este cuprins în acest interval. Intervalele de
încredere corespunzătoare probabilităţii de 90%
pentru scorurile compozite EDI‑3 sunt afişate în
Anexele A- C şi se bazează pe erorile standard de
estimare (Stanley, 1971), o rectificare a regresiei
către medie a scorului real. Diferenţa practică
în privinţa IC între ESM şi eroarea standard de
estimare constă în relativa asimetrie a intervalului
bazat pe eroarea standard de estimare, pe măsură
ce scorurile obţinute deviază semnificativ de
la media cotelor T. Aceasta înseamnă că, pe
măsură ce scorurile obţinute deviază mai mult
de la media cotelor T, IC va deveni mai asimetric.
Anexele A – C prezintă şi intervalele de încredere
corespunzătoare probabilităţii de 90% pentru
scalele EDI‑3 bazate pe ESM. Aceste IC ale
scalelor sunt simetrice în cadrul intervalului de
scoruri observate şi sunt interpretate în aceeaşi
manieră ca IC pentru scorurile compozite EDI‑3.
Stabilitatea test‑retest
Corelaţia test‑retest oferă o indicaţie a
stabilităţii testului, între două ocazii de testare.
Ţinând cont de faptul că EDI‑3 este un instrument
creat astfel încât să fie sensibil la schimbarea
apărută în timp, stabilitatea temporală a acestuia
a fost evaluată într‑un interval scurt de timp.
Acest lucru s‑a făcut cu scopul de a minimiza
atât factorii inerenţi, cât şi cei externi, care ar
putea influenţa scorurile testelor (de exemplu,
schimbarea tratamentului, fluctuaţii ale stărilor
psihologice). Eşantionul de test‑retest a fost
alcătuit din 34 de participante, care au urmat,
în trecut, un tratament pentru tulburări de
comportament alimentar. Participantele aveau
 Tabelul 6.1
Coeficienţii alfa pentru eşantioanele clinice, internaţional şi din SUA, de adulţi şi cel clinic de
adolescenţi din SUA ale EDI-3, folosind sistemul de cotare de la 0 la 4

Eşantionul clinic (α)

Adulţi Adolescenţi
Scala de Risc de tulburare de comportament alimentar/ SUAa Internaţionalb SUAc
Scala compozită (pe grupuri de diagnostic)
AN-Ra
Dorinţa de a fi slab (DS) 0,91 0,91 0,93
Bulimie (B) 0,63 0,84 0,63
Nemulţumire faţă de corp (NC) 0,91 0,90 0,93
Scala compozită Risc de tulburare de comportament alimentar 0,90 0,94 0,91
(SCRTCA)
AN-AC/Vb
Dorinţa de a fi slab (DS) 0,86 0,87 0,93
Bulimie (B) 0,90 0,85 0,93
Nemulţumire faţă de corp (NC) 0,91 0,89 0,96
Scala compozită Risc de tulburare de comportament alimentar 0,94 0,92 0,97
(SCRTCA)
BNc
Dorinţa de a fi slab (DS) 0,81 0,82 0,87
Bulimie (B) 0,88 0,83 0,92
Nemulţumire faţă de corp (NC) 0,91 0,88 0,91
Scala compozită Risc de tulburare de comportament alimentar 0,93 0,91 0,95
(SCRTCA)
TCAFASd
Dorinţa de a fi slab (DS) 0,89 0,90 0,88
Bulimie (B) 0,87 0,87 0,86
Nemulţumire faţă de corp (NC) 0,92 0,92 0,92
Scala compozită Risc de tulburare de comportament alimentar 0,94 0,95 0,94
(SCRTCA)

Eşantion Eşantion Eşantion

Scala psihologică/ Scala compozită total total total
Stimă de sine scăzută (SSS) 0,89 0,81 0,89
Alienare personală (AP) 0,84 0,78 0,87
Nesiguranţă interpersonală (NI) 0,84 0,73 0,85
Alienare interpersonală (AI) 0,78 0,69 0,80
Deficite interoceptive (DI) 0,87 0,79 0,89
Dezechilibru emoţional (DE) 0,75 0,67 0,77
Perfecţionism (P) 0,82 0,74 0,82
Ascetism (A) 0,75 0,64 0,80
Frica de maturitate (FM) 0,87 0,82 0,86
Scala compozită Ineficacitate (SCI) 0,92 0,88 0,93
Scala compozită Probleme interpersonale (SCPI) 0,88 0,81 0,90
Scala compozită Probleme emoţionale (SCPE) 0,88 0,82 0,89
Scala compozită Control exagerat (SCCE) 0,85 0,78 0,88
Scala compozită Neadaptare psihologică generală (SCNPG) 0,96 0,93 0,97

Notă: AN-R = Anorexie nervoasă de tip restrictiv; AN-AC/V = Anorexie nervoasă de tip alimentaţie compulsivă/vărsături; BN
= Bulimie nervoasă; TCAFAS = Tulburare de comportament alimentar fără altă specificaţie.
a
AN-R: n = 145, AN-AC/V: n = 92, BN: n = 429, TCAFAS: n = 317, eşantion total: N = 983. b AN-R: n = 165, AN-AC/V: n = 110,
BN: n = 300, TCAFAS: n = 87, eşantion total: N = 662. c AN-R: n = 101, AN-AC/V: n = 23, BN: n = 98, TCAFAS: n = 113, eşantion
total: N = 335.

151
vârste cuprinse între 15 şi 55 de ani (M=25,2 ani;
AS=9,9 ani), iar intervalul dintre test şi retest a
fost cuprins între una şi şapte zile (M=2,6 zile;
AS=1,9 zile). Compoziţia acestui grup în funcţie
de diagnostic a fost de 40,6%, 15,6%, 31,3% şi
12,5% pentru AN‑R, anorexie nervoasă de tip
alimentaţie compulsivă/vărsături (AN‑AC/V),
bulimie nervoasă (BN) şi, respectiv, tulburări de
comportament alimentar fără altă specificaţie
(TCAFAS). Tabelul 6.4 prezintă datele descriptive
ale cotelor T şi corelaţiile test‑retest pentru
fiecare scală şi scală compozită. Per ansamblu,
coeficienţii test‑retest de stabilitate s‑au dovedit
excelenţi. Coeficientul pentru SCRTCA a fost de
0,98, iar coeficientul pentru SCNPG a fost de 0,97.
Medianele coeficienţilor test‑retest pentru scalele
de Risc de tulburare de comportament alimentar
şi pentru Scalele psihologice au fost de 0,95 şi,
respectiv, de 0,93.

Tabelul 6.2
Coeficienţii alfa pentru eşantioanele clinice, internaţional şi din SUA, de adulţi şi cel clinic de
adolescenţi din SUA ale EDI-3, folosind sistemul de cotare de tip 0-3 al EDI-2

Eşantionul clinic (α)

Adulţi Adolescenţi
Scala de Risc de tulburare de comportament alimentar (pe SUAa Internaţionalb SUAc
grupuri de diagnostic)
AN-Ra
Dorinţa de a fi slab (DS) 0,91 0,90 0,92
Bulimie (B) 0,34 0,78 0,33
Nemulţumire faţă de corp (NC) 0,92 0,90 0,93
AN-AC/Vb
Dorinţa de a fi slab (DS) 0,86 0,87 0,87
Bulimie (B) 0,87 0,83 0,89
Nemulţumire faţă de corp (NC) 0,91 0,90 0,95
BNc
Dorinţa de a fi slab (DS) 0,82 0,83 0,87
Bulimie (B) 0,87 0,82 0,90
Nemulţumire faţă de corp (NC) 0,91 0,89 0,91
TCAFASd
Dorinţa de a fi slab (DS) 0,88 0,88 0,88
Bulimie (B) 0,84 0,85 0,83
Nemulţumire faţă de corp (NC) 0,93 0,93 0,92

Eşantion Eşantion Eşantion

Scala psihologică total total total
Stimă de sine scăzută (SSS) 0,89 0,83 0,88
Alienare personală (AP) 0,83 0,79 0,85
Nesiguranţă interpersonală (NI) 0,83 0,73 0,83
Alienare interpersonală (AI) 0,76 0,68 0,78
Deficite interoceptive (DI) 0,86 0,79 0,88
Dezechilibru emoţional (DE) 0,71 0,66 0,75
Perfecţionism (P) 0,81 0,73 0,83
Ascetism (A) 0,71 0,63 0,78
Frica de maturitate (FM) 0,85 0,82 0,85
Notă: AN-R = Anorexie nervoasă de tip restrictiv; AN-AC/V = Anorexie nervoasă de tip alimentaţie compulsivă/vărsături; BN
= Bulimie nervoasă; TCAFAS = Tulburare de comportament alimentar fără altă specificaţie.
a
AN-R: n=145, AN-AC/V: n = 92, BN: n = 429, TCAFAS: n = 317, eşantion total: N = 983. b AN-R: n = 165, AN-AC/V: n = 110,
BN: n = 300, TCAFAS: n = 87, eşantion total: N = 662. c AN-R: n = 101, AN-AC/V: n = 23, BN: n = 98, TCAFAS: n = 113, eşantion
total: N = 335.

152
 Tabelul 6.3
Erori standard de măsurare (ESM) ale EDI-3 şi pentru eşantioanele clinice, internaţional şi din
SUA, de adulţi şi cel clinic de adolescenţi din SUA, pentru sistemul de cotare de tip 0-4

Eşantionul clinic (ESM)

Adulţi Adolescenţi
Scala de Risc de tulburare de comportament alimentar/
SUAa Internaţionalb SUAc
Scala compozită (pe grupuri de diagnostic)
AN-R
Dorinţa de a fi slab (DS) 3,00 3,00 2,65
Bulimie (B) 6,08 4,00 6,08
Nemulţumire faţă de corp (NC) 3,00 3,16 2,65
Scala compozită Risc de tulburare de comportament 3,16 2,45 3,00
alimentar (SCRTCA)
AN-AC/V
Dorinţa de a fi slab (DS) 3,74 3,61 2,65
Bulimie (B) 3,16 3,87 2,65
Nemulţumire faţă de corp (NC) 3,00 3,32 2,00
Scala compozită Risc de tulburare de comportament 2,45 2,83 1,73
alimentar (SCRTCA)
BN
Dorinţa de a fi slab (DS) 4,36 4,24 3,61
Bulimie (B) 3,46 4,12 2,83
Nemulţumire faţă de corp (NC) 3,00 3,46 3,00
Scala compozită Risc de tulburare de comportament 2,65 3,00 2,24
alimentar (SCRTCA)
TCAFAS
Dorinţa de a fi slab (DS) 3,32 3,16 3,46
Bulimie (B) 3,61 3,61 3,74
Nemulţumire faţă de corp (NC) 2,83 2,83 2,83
Scala compozită Risc de tulburare de comportament 2,45 2,24 2,45
alimentar (SCRTCA)
Eşantion Eşantion Eşantion
Scala psihologică/ Scala compozită total total total
Stimă de sine scăzută (SSS) 3,32 4,36 3,32
Alienare personală (AP) 4,00 4,69 3,61
Nesiguranţă interpersonală (NI) 4,00 5,20 3,87
Alienare interpersonală (AI) 4,69 5,57 4,47
Deficite interoceptive (DI) 3,61 4,58 3,32
Dezechilibru emoţional (DE) 5,00 5,74 4,80
Perfecţionism (P) 4,24 5,10 4,24
Ascetism (A) 5,00 6,00 4,47
Frica de maturitate (FM) 3,61 4,24 3,74
Scala compozită Ineficacitate (SCI) 2,83 3,46 2,65
Scala compozită Probleme interpersonale (SCPI) 3,46 4,36 3,16
Scala compozită Probleme emoţionale (SCPE) 3,46 4,24 3,32
Scala compozită Control exagerat (SCCE) 3,87 4,96 3,46
Scala compozită Neadaptare psihologică generală (SCNPG) 2,00 2,65 1,73

Notă: AN-R = Anorexie nervoasă de tip restrictiv; AN-AC/V = Anorexie nervoasă de tip alimentaţie compulsivă/vărsături; BN
= Bulimie nervoasă; TCAFAS = Tulburare de comportament alimentar fără altă specificaţie.
a
AN-R: n = 145, AN-AC/V: n = 92, BN: n = 429, TCAFAS: n = 317, eşantion total: n = 983. bAN-R: n = 165, AN-AC/V: n = 110, BN:
n = 300, TCAFAS: n = 87, eşantion total: n = 662. cAN-R: n = 101, AN-AC/V: n = 23, BN: n = 98, TCAFAS: n = 113, eşantion total:
n = 335.

153
 Validitatea
Dovezi bazate pe structura internă
Studii de intercorelaţie
Corelaţiile dintre scalele EDI‑3 şi scalele
compozite pentru cele trei grupe utilizate
pentru etalonare sunt prezentate în Anexa D.
Aceste matrici de corelaţie au fost create după
eliminarea cazurilor care aveau informaţii
absente pentru oricare dintre scalele folosite în
matricea de inter‑corelaţii. Tabelul 6.5 prezintă
compoziţia în funcţie de diagnostic şi procentele
participanţilor pentru fiecare dintre cele două
eşantioane utilizate pentru etalonare din SUA,
împreună cu eşantionul internaţional utilizat
pentru etalonare. Vârsta medie a participanţilor
a fost de 25,2 ani (AS=8,1 ani) şi 15,6 ani (AS=1,3
ani) pentru eşantionul clinic combinat de adulţi
din SUA şi, respectiv, pentru eşantionul clinic
combinat de adolescenţi din SUA. Scalele DS
şi NC înregistrează cele mai puternice corelaţii
dintre cele ale scalelor Riscului de tulburare de
comportament alimentar pentru ambele grupuri
menţionate mai sus. Dată fiind combinaţia de
pacienţi care îşi provoacă vărsături şi pacienţi
care nu fac acest lucru, s‑a anticipat faptul că
corelaţia dintre scalele B şi DS şi dintre scalele B
şi NC ar fi relativ reduse. Anexa D indică faptul
că există un pattern valabil pentru aceste grupuri
utilizate pentru etalonare. Scalele care intră în
compoziţia SCI, SCPI şi SCPE prezintă corelaţii
mai puternice cu scalele care fac parte din
aceeaşi scală compozită decât cu celelalte Scale
psihologice. Excepţia de la această regulă generală
se observă în cazul scalelor P şi A care compun
SCCE. Scala A prezintă o corelaţie mai mare cu
scala DI decât cu scala P. Acest pattern este, de
obicei, concordant cu rezultatele AFE şi AFC,
care sunt prezentate în următoarele trei secţiuni
ale acestui capitol.
Analiza factorială a versiunilor anterioare
ale EDI
Structura internă a versiunilor anterioare ale
EDI a fost examinată pe larg. În general, studiile
susţin o structură cu opt factori pentru versiunea
EDI cu 64 de itemi, utilizând eşantioane clinice
(Eberenz şi Gleaves, 1994; Raciti şi Norcross,
1987; Welch şi colab., 1990). În schimb, de obicei,
s‑au identificat mai puţini factori atunci când
EDI a fost administrat eşantioanelor nonclinice
(Bennett şi Stevens, 1997; Franko şi colab., 2004;
Machado şi colab., 2001; Phelps şi Wilczenski,
154
1993; Welch şi colab., 1998). În cazul eşantioanelor
nonclinice, factorii EDI au tendinţa să se separe
în factori care măsoară patologia principală a
comportamentului alimentar şi în factori care
sunt strâns legaţi de variabile psihologice. Joiner
şi Heatherton (1998) au examinat structura
factorilor pentru cinci dintre scalele EDI‑2
(adică Dorinţa de a fi slab, Bulimie, Perfecţionism,
Neîncredere interpersonală, Frica de maturitate), în
cadrul unui eşantion relativ extins de studenţi,
testându‑i de două ori (la o distanţă de 10 ani),
şi au găsit suport pentru structura de factori
urmărită. Oricum, este important de precizat că
numărul de itemi incluşi influenţează rezultatele
studiilor de analiză factorială cu mai puţini itemi,
crescând probabilitatea identificării constructelor
urmărite.
Chiar dacă a existat o susţinere generală
pentru structura de factori a variantelor originale
a EDI şi EDI‑2 în eşantioanele clinice, gradul înalt
de intercorelaţii dintre subscalele EDI a condus
la rezultatele prezise în studiile analitice, ale
saturaţiilor itemilor în mai mult de o singură
scală (Eberenz şi Gleaves, 1994; Espelage şi
colab., 2003; Franko şi colab., 2004; van Strien şi
Ouwens, 2003; Welch şi colab., 1990). Espelage şi
colab. au utilizat AFC în studiul unui eşantion
clinic şi au constatat că modelul cu 8 factori
presupus nu se potrivea la nivelul itemilor;
oricum, acest fapt a fost confirmat printr‑o AFC,
utilizând datele statistice referitoare la itemi şi
scalele din care aceştia provin. Această abordare
a condus la estimări ale fidelităţii scalei cu valori
cuprinse între 0,82 şi 0,93. Ca urmare a acestor
rezultate, autorii au stabilit că „aceste rezultate
sugerează că cele opt scale reprezintă constructe
diferite, iar utilizarea EDI la nivel de scale este
parţial susţinută” (pp. 77‑78).
Constatările cercetărilor anterioare, potri-
vit cărora subscalele Riscului de tulburare de
comportament alimentar sunt empiric diferite
de Scalele psihologice, sugerează că, cel puţin la
nivelul scalelor, prin EDI sunt evaluate două
constructe cuprinzătoare şi distincte. Această
constatare a stat la baza deciziei de a efectua
separat AFE şi AFC asupra acelor scale şi asupra
scalelor psihologice.
Analiza factorială exploratorie a itemilor
scalei compozite EDI‑3 Risc de tulburare de
comportament alimentar
Relaţiile care stau la baza itemilor au fost
analizate utilizând AFE. Toate AFE au fost
realizate folosind versiunea de software 11.5
a SPSS‑PC. Pentru fiecare analiză s‑a utilizat
 Tabelul 6.4
Coeficienţi de stabilitate test-retest pentru scalele şi scalele compozite EDI-3

Prima testare A doua testare Fidelitate

Scala/Scala compozită EDI-3 M AS M AS r
Scala de Risc de tulburare de comportament alimentar/
Scala compozită
Dorinţa de a fi slab (DS) 46,6 11,8 48,0 11,2 0,95
Bulimie (B) 40,7 9,1 40,5 8,8 0,94
Nemulţumire faţă de corp (NC) 52,6 10,8 52,6 11,7 0,95
Scala compozită Risc de tulburare de comportament alimentar 45,6 11,5 46,2 11,5 0,98
(SCRTCA)

Scala psihologică/ Scala compozită

Stimă de sine scăzută (SSS) 50,9 11,3 50,5 11,2 0,95
Alienare personală (AP) 49,6 10,8 49,2 10,3 0,94
Nesiguranţă interpersonală (NI) 51,7 10,4 51,9 10,6 0,94
Alienare interpersonală (AI) 52,8 11,8 51,9 11,0 0,98
Deficite interoceptive (DI) 50,7 11,0 51,3 10,9 0,93
Dezechilibru emoţional (DE) 50,2 12,9 49,7 12,3 0,93
Perfecţionism (P) 50,8 10,9 51,2 11,5 0,93
Ascetism (A) 54,3 12,9 54,9 13,5 0,86
Frica de maturitate (FM) 48,0 8,0 47,6 7,5 0,89
Scala compozită Ineficacitate (SCI) 50,2 11,4 49,8 11,2 0,95
Scala compozită Probleme interpersonale (SCPI) 52,4 11,4 52,0 11,2 0,98
Scala compozită Probleme emoţionale (SCPE) 50,4 12,1 50,6 12,0 0,93
Scala compozită Control exagerat (SCCE) 52,9 12,9 53,6 13,6 0,91
Scala compozită Neadaptare psihologică generală (SCNPG) 51,1 12,6 51,1 12,4 0,97

Notă: N = 34.

metoda Principal axis factoring, urmată de o

Tabelul 6.5 rotaţie Promax a factorilor care au fost reţinuţi.
Procentul participanţilor pe grupuri de Toate soluţiile de factori au fost examinate prin
diagnostic pentru intercorelaţiile dintre itemii metodele tradiţionale (de exemplu, examinarea
scalei compozite din EDI-3 Risc de tulburare de scree plot‑urilor şi a valorilor proprii).
comportament alimentar, pentru eşantioanele De asemenea, au fost luate în considerare
clinice internaţional şi din SUA fundamentele teoretice ale EDI‑3 şi semnificaţia
factorilor, aşa cum recomandă Gorsuch (1983,
Eşantion clinic 1996). Tabelul 6.6 prezintă compoziţia în funcţie
Grup de Adulţi (%) Adolescenţi (%) de diagnostic şi procentul participanţilor pentru
diagnostic SUAa Internaţionalb SUAc fiecare dintre cele trei eşantioane utilizate pentru
AN-R 15,2 25,0 29,5 etalonare, iar tabelele 6.7 – 6.9 prezintă cele
AN-AC/V 9,6 16,4 6,8 mai potrivite rezultate ale AFE pentru cele trei
BN 42,2 45,6 30,2 grupuri utilizate pentru etalonare.
TCAFAS 33,0 13,0 33,5 Modelul AFE cu trei factori pentru eşantionul
clinic de adulţi din SUA (a se vedea tabelul 6.7) a
Notă: AN-R = Anorexie nervoasă de tip restrictiv; AN-
AC/V = Anorexie nervoasă de tip alimentaţie compulsivă/ reprezentat 63,0% din varianţa totală, în vreme ce
vărsături; BN = Bulimie nervoasă; TCAFAS = Tulburare de modelele pentru eşantionul clinic internaţional
comportament alimentar fără altă specificaţie. de adulţi şi cel clinic de adolescenţi din SUA
a
N =864; bN =647; cN=295. Variaţia în mărimea eşantionului (a se vedea tabelele 6.8 şi 6.9) au reprezentat
este un rezultat al utilizării procedurii listwise deletion. 60,8%, respectiv 65,6% din varianţă. În timp ce
itemii scalei NC definesc primul factor pentru
ambele eşantioane utilizate pentru etalonare
din SUA (a se vedea tabelele 6.7 şi 6.9), itemii

155
scalei B definesc primul factor pentru eşantionul Tabelul 6.6
clinic internaţional de adulţi (a se vedea tabelul Procentajul participanţilor pe grupuri de
6.8). Această inversare de ordine este probabil diagnostic la analiza factorială exploratorie a
influenţată de procentul relativ mare al pacienţilor itemilor scalei compozite Risc de tulburare de
cu diagnostice asociate cu alimentaţia compulsivă comportament alimentar pentru eşantioanele
şi cu provocarea vărsăturilor în eşantionul clinic clinice internaţional şi din SUA
internaţional de adulţi (tabelul 6.6). Examinarea
tabelelor 6.7 – 6.9 indică faptul că, pentru marea Eşantion clinic
lor majoritate, itemii din scalele DS, B şi NC Adulţi (%) Adolescenţi (%)
prezintă cea mai mare saturaţie pe respectiva Grup de SUAa Internaţionalb SUAc
scală. Oricum, există câteva excepţii de la acest diagnostic
pattern. De exemplu, itemul 2 (item al scalei NC) AN-R 16,8 24,9 30,1
AN-AC/V 9,4 16,6 6,9
are saturaţii mari şi pe scala DS, în fiecare dintre
BN 41,6 45,4 29,9
grupurile utilizate pentru etalonare. Utilizând o TCAFAS 32,2 13,1 33,1
soluţie cu 11 factori în cazul itemilor scalei EDI‑2,
van Strien şi Ouwens (2003) raportează saturaţii Notă: AN-R= Anorexie nervoasă de tip restrictiv; AN-AC/
V= Anorexie nervoasă de tip alimentaţie compulsivă/
în scale diferite pentru itemul 2 într‑un eşantion vărsături; BN= Bulimie nervoasă; TCAFAS= Tulburări de
clinic şi în unul nonclinic de elevi de liceu; în comportament alimentar fără altă specificaţie.
cazul unui eşantion nonclinic de studenţi, itemul a
N=983; bN=662; cN=335.
2 şi itemul 12 (ambii asociaţi cu nemulţumirea
faţă de burtă) au, fiecare, saturaţie mare în alt
factor. Acest fapt sugerează că, cel puţin în cazul Tabelul 6.7
studenţilor, nemulţumirea faţă de burtă poate Saturaţiile în factorul principal ale scalelor din
avea o semnificaţie anume, oarecum diferită de EDI-3 de Risc de tulburare de comportament
atitudinile obişnuite faţă de alte părţi ale corpului. alimentar pentru eşantionul clinic de adulţi
În mod similar, itemul 53 (un item al scalei B) din SUA
prezintă o saturaţie secundară semnificativă pe
scala DS, pentru fiecare dintre cele trei grupuri Scala de Risc de tulburare de
utilizate pentru etalonare. Itemul 47 (un item de comportament alimentar
curând atribuit scalei NC a EDI-3) are saturaţie Item/scală NC B DS
mare pe scala DS în toate grupurile utilizate Itemul 62 NC 0,96
pentru etalonare. Din motive legate de conţinut, Itemul 55 NC 0,86
precum şi pe baza altor dovezi psihometrice Itemul 59 NC 0,85
(cum ar fi, corelaţiile item‑scor total), itemul 47 Itemul 45 NC 0,82
rămâne atribuit scalei NC. Itemul 31 NC 0,78
Itemul 9 NC 0,73
Itemul 19 NC 0,61
Analiza factorială exploratorie a itemilor Scalei
Itemul 12 NC 0,50 0,26
Psihologice EDI‑3 Itemul 2 NC 0,40 0,36
Itemul 5 B 0,90
Rezultatele AFE pentru itemii Scalei psiholo- Itemul 28 B 0,87
gice în cele trei grupe utilizate pentru etalonare Itemul 4 B 0,86
au fost obţinute printr‑o modalitate identică cu Itemul 46 B 0,86
analizele realizate pentru itemii scalei Riscului de Itemul 38 B 0,86
tulburare de comportament alimentar. Tabelul 6.10 Itemul 64 B 0,72
prezintă compoziţia în funcţie de diagnostic şi Itemul 61 B 0,70
procentul participanţilor pentru fiecare dintre Itemul 16 DS 0,89
cele trei eşantioane utilizate pentru etalonare care Itemul 49 DS 0,84
au dat răspunsuri la toţi itemii. Aceleaşi criterii Itemul 7 DS 0,68
ale AFE, utilizate în evaluarea itemilor scalei Itemul 32 DS 0,21 0,65
Riscului de tulburare de comportament alimentar, au Itemul 11 DS 0,61
fost folosite pentru evaluarea rezultatelor AFE Itemul 47 NC 0,58
Itemul 25 DS 0,58
efectuate asupra itemilor Scalei psihologice. După
Itemul 1 DS 0,48
evaluarea unei serii de soluţii cu 6 până la 10
Itemul 53 B 0,36 0,39
factori, a apărut o soluţie AFE cu 8 factori, care
s‑a potrivit cel mai bine datelor. Tabelele 6.11 – Notă: Metoda de extracţie: axa principală; Metoda de rotaţie:
Promax; NC = Nemulţumire faţă de corp; B = Bulimie; DS =
6.13 prezintă patternul de saturaţii ale factorilor Dorinţa de a fi slab.

156
 Tabelul 6.8
Saturaţiile în factorul principal ale scalelor din
EDI-3 de Risc de tulburare de comportament
alimentar pentru eşantionul clinic
internaţional de adulţi
Tabelul 6.9
Saturaţiile în factorul principal ale scalelor din
EDI-3 de Risc de tulburare de comportament
alimentar pentru eşantionul clinic de
adolescenţi din SUA

Scala de Risc de tulburare de Scala de Risc de tulburare de

comportament alimentar comportament alimentar
Item/scală B NC DS Item/scală B NC DS
Itemul 5 B 0,94 Itemul 59 NC 0,86
Itemul 28 B 0,86 Itemul 62 NC 0,86
Itemul 46 B 0,84 Itemul 55 NC 0,84
Itemul 4 B 0,83 Itemul 45 NC 0,79
Itemul 38 B 0,83 Itemul 31 NC 0,73
Itemul 61 B 0,72 Itemul 9 NC 0,69
Itemul 64 B 0,69 Itemul 12 NC 0,64
Itemul 53 B 0,45 0,23 Itemul 19 NC 0,46 0,27
Itemul 55 NC 0,93 Itemul 2 NC 0,45 0,36
Itemul 62 NC 0,92 Itemul 5 B 0,92 -0,21
Itemul 31 NC 0,83 Itemul 46 B 0,90
Itemul 59 NC 0,71 Itemul 4 B 0,87
Itemul 19 NC 0,70 Itemul 28 B 0,87
Itemul 45 NC 0,63 0,23 Itemul 38 B 0,79
Itemul 9 NC 0,56 0,25 Itemul 61 B 0,70
Itemul 12 NC 0,55 Itemul 64 B 0,67 0,26
Itemul 16 DS 0,96 Itemul 53 B 0,40 0,27
Itemul 49 DS 0,88 Itemul 49 DS 0,91
Itemul 25 DS 0,78 Itemul 16 DS 0,89
Itemul 32 DS 0,69 Itemul 32 DS 0,76
Itemul 11 DS 0,61 Itemul 7 DS 0,66
Itemul 7 DS 0,57 Itemul 47 NC 0,65
Itemul 1 DS 0,40 Itemul 25 DS 0,60
Itemul 2 NC 0,32 0,33 Itemul 11 DS 0,59
Itemul 47 NC 0,32 Itemul 1 DS 0,56
Notă: Metoda de extracţie: axa principală; Metoda de rotaţie: Notă: Metoda de extracţie: axa principală; Metoda de rotaţie:
Promax; NC = Nemulţumire faţă de corp; B = Bulimie; DS = Promax; NC = Nemulţumire faţă de corp; B = Bulimie; DS =
Dorinţa de a fi slab. Dorinţa de a fi slab.

pentru o soluţie cu 8 factori pentru fiecare dintre
cele trei grupuri utilizate pentru etalonare.
Modelul AFE cu 8 factori pentru eşantionul clinic
de adulţi din SUA (tabelul 6.11) a reprezentat
52,3% din varianţa totală, în vreme ce modelele
eşantionului clinic internaţional de adulţi şi cel
clinic de adolescenţi din SUA au reprezentat
procente similare de 57,4% şi, respectiv, 46,6%
din varianţa totală.
Aşa cum se observă în tabelele 6.11 – 6.13,
există un grad de consistenţă în ceea ce priveşte
factorii AFE; cu toate acestea, există şi un grad
moderat de inconsistenţă la nivelul factorilor
în cadrul celor trei grupuri utilizate pentru
etalonare. De exemplu, itemii scalelor SSS şi AP
formează, în mare măsură, primul factor pentru
eşantioanele clinice de adulţi din SUA şi cel
internaţional (a se vedea tabelele 6.11 şi 6.12). În
vreme ce primul factor pentru eşantionul clinic
de adolescenţi din SUA conţine majoritatea
itemilor scalelor SSS şi AP, itemii scalei A au
saturaţii mari şi în acest factor şi sunt, de obicei,
itemii cu cea mai mare saturaţie în acest factor.
Acest lucru poate indica faptul că negarea de sine
şi stinghereala în ceea ce priveşte funcţionarea
corpului sunt strâns legate de insuficienta
cunoaştere de sine a adolescenţilor. O altă
explicaţie ar putea fi şi aceea că ascetismul nu
reuşeşte să se constituie într‑un factor unitar,
deoarece constructul este insuficient format la
adolescenţii pentru care itemii au saturaţii mari
în constructul factorial dominant. Dimpotrivă,
itemii scalei A au saturaţii mari preponderent
într‑un factor unitar pentru eşantionul clinic
de adulţi din SUA (a se vedea tabelul 6.11) şi
împart un factor cu alţi itemi ai scalei P, pentru

157
eşantionul internaţional de adulţi. Indicând un
anumit grad de variabilitate, itemii scalelor NI şi
AI au avut tendinţa de a forma un factor în cadrul
celor trei eşantioane utilizate pentru etalonare.
Itemii sclei DI au avut tendinţa de a forma un
factor de o consistenţă moderată, în cadrul celor
trei eşantioane, în vreme ce factorul FM a apărut
constant în toate cele trei eşantioane.
Analiza factorială confirmatorie a Scalelor
psihologice EDI‑3
S‑a folosit o AFC pentru a evalua două
modele configurale ale scalelor psihologice.
Modelul 1, prezentat în figura 6.1, este o
reprezentare conceptuală cu un singur factor
a scalelor psihologice. Acest factor unitar
reprezintă configuraţia SCNPG. Modelul 2,
prezentat în figura 6.2, reprezintă structura
scalelor/scalelor compozite pentru SCI, SCPI,
SCPE şi SCCE. Modelul 2 exclude scala FM,
pentru că aceasta nu contribuie la niciuna
dintre scalele compozite testate în acest model.
Ambele modele din figurile 6.1 şi 6.2, reprezintă
variabilele studiate (adică, scalele psihologice)
sub formă de dreptunghiuri, iar constructele
latente sau „factorii” sub formă de ovale mai
mari. Săgeţile îndreptate dinspre factori către
scale indică structura specifică a factorului care
este evaluat. Figurile 6.1 şi 6.2 conţin şi ovale mai
mici sub fiecare scală psihologică, reprezentând
un termen de eroare pentru varianţa care nu este
măsurată de modelul AFC.
Analizele factoriale confirmatorii au
fost realizate utilizând programul software
de modelare prin ecuaţii structurale AMOS
(versiunea 4.0) (Arbuckle şi Wothke, 1999).
Modelele 1 şi 2 au fost evaluate folosind EDI‑3
pentru ambele eşantioane clinice de adulţi şi de
adolescenţi din SUA. Eliminarea tuturor cazurilor
având date incomplete a fost realizată înainte de
calculul rezultatelor AFC, iar procentul obţinut
al participanţilor din fiecare grup de diagnostic
este prezentat în tabelul 6.14.
Figurile 6.3 şi 6.4 prezintă rezultatele
standardizate din Modelul 1 pentru eşantionul
clinic de adulţi şi, respectiv, pentru eşantionul
clinic de adolescenţi din SUA. În mod similar,
figurile 6.5 şi 6.6 prezintă rezultatele standardi-
zate analoage din Modelul 2 pentru aceste două
grupuri.
Statisticile referitoare la potrivirea modelului
pentru Modelele 1 şi 2 sunt prezentate în
tabelul 6.15. Următoarele statistici referitoare
la potrivirea modelului sunt prezentate pentru
aceste modele: (a) χ2, (b) gradele de libertate
158
pentru model [gl], (c) probabilitatea [p],
(d)  raportul dintre χ2 şi gradele de libertate [χ2:
gl], (e) indicele de potrivire comparativ [ICP] şi
(f) rădăcina pătrată medie a erorii de aproximare
[RPMEA]. Datorită influenţei dimensiunii
eşantionului asupra testului chi‑square (χ2),
s‑au interpretat preferenţial indicii de potrivire
ICP şi RPMEA, deoarece aceştia oferă evaluări
mai stabile şi precise (Hu şi Bentler, 1995). Hu şi
Bentler (1999) au demonstrat că valorile RPMEA
de 0,06 sau mai mici şi valorile ICP de 0,95 sau
mai mari indică o bună potrivire a modelului la
datele obţinute.
Aşa cum se observă în tabelul 6.15, datele
statistice referitoare la potrivirea modelului
indică faptul că Modelul 2 reprezintă o potrivire
mai bună a constructelor fundamentale, în
comparaţie cu Modelul 1. Raportul dintre χ2 şi
gradele de libertate şi RPMEA este mai mic pentru
Tabelul 6.10
Procentul participanţilor pe grupuri de
diagnostic la analiza factorială exploratorie
a itemilor psihologici pentru eşantioanele
clinice din SUA şi cel internaţionale
Eşantion clinic
Adulţi (%) Adolescenţi (%)
Grupul de SUAa Internaţionalb SUAc
diagnostic
AN-R 15,2 25,2 29,4
AN-AC/V 9,8 16,4 6,8
BN 42,1 45,5 30,2
TCAFAS 32,9 12,9 33,6
Notă: AN-R = Anorexia nervoasă de tip restrictiv; AN-
AC/V = Anorexia nervoasă de tip alimentaţie compulsivă/
vărsături; BN = Bulimia nervoasă; TCAFAS = Tulburare de
comportament alimentar fără altă specificaţie.
a
N=866; bN=650; cN=295. Variaţia în mărimea eşantionului
este rezultatul utilizării metodei de eliminare listwise.
Modelul 2 (comparativ cu Modelul 1), atât pentru
eşantionul de adolescenţi, cât şi pentru cel de
adulţi. În mod similar, ICP pentru Modelul 2 este
mai mare atât pentru eşantionul de adolescenţi,
cât şi pentru cel de adulţi. Aceşti indici de potrivire
sugerează că Modelul 2 prezintă o potrivire
relativă mai bună în comparaţie cu Modelul 1.
Cu toate acestea, Modelul 2 nu întruneşte toate
criteriile de potrivire, aşa cum au fost specificate
de Hu şi Bentler (1999). Mai precis, în vreme
ce valorile ICP sunt mai mari de 0,95, valorile
RPMEA pentru Modelul 2 sunt mai mari decât
limita sugerată de 0,06. Per ansamblu, aceste
rezultate sugerează că scalele psihologice EDI‑3
pot fi explicate mai bine printr‑o reprezentare
multifactorială, aşa cum apare în scalele
psihologice compozite multiple EDI‑3. În vreme
ce Modelul 2 nu prezintă o potrivire satisfăcătoare
în ceea ce priveşte evaluarea scalelor psihologice
compozite, dintr‑o perspectivă bazată exclusiv
pe constructe factoriale, trebuie menţionat faptul
că scopul acestei cercetări nu a fost să ofere scale
compozite pure factorial. Relevanţa clinică a
reprezentat principalul motiv în construcţia
scalelor EDI‑3. Ca atare, alte motive, alături de
analiza factorială, au fost luate în considerare
pe parcursul construcţiei scalelor (de exemplu,
decizii legate de conţinut, de continuitatea
itemilor între EDI‑2 şi EDI‑3). Cu toate acestea,
rezultatele obţinute prin AFC la nivelul scalelor
de ordinul întâi asigură suport empiric pentru
scalele compozite EDI‑3, ca reprezentând
constructe distincte de ordin superior din punct
de vedere teoretic.
159
 Tabelul 6.11
Saturaţiile principalilor factori pentru eşantionul clinic de adulţi din SUA pentru
Scalele psihologice EDI-3
Item/Scală Factorul 1 Factorul 2 Factorul 3 Factorul 4 Factorul 5 Factorul 6 Factorul 7 Factorul 8
Itemul 41 SSS 0,87
Itemul 37 SSS 0,84
Itemul 50 SSS 0,80
Itemul 27 SSS 0,79
Itemul 10 SSS 0,75
Itemul 42 SSS 0,68
Itemul 20 AP 0,59
Itemul 24 AP 0,58
Itemul 91 AP 0,57 0,26
Itemul 84 AP 0,48 0,23
Itemul 56 AP 0,41 0,26
Itemul 18 AP 0,41
Itemul 23 NI 0,73
Itemul 15 NI 0,71 -0,32
Itemul 73 NI 0,21 0,60
Itemul 57 NI 0,59 -0,25
Itemul 69 NI 0,24 0,58
Itemul 30 AI 0,57 0,28
Itemul 34 NI 0,52 0,49
Itemul 54 AI 0,46 0,28 0,24
Itemul 87 NI 0,45
Itemul 17 AI 0,43 0,38
Itemul 76 AI
Itemul 60 DI 0,81
Itemul 21 DI 0,80
Itemul 51 DI 0,80
Itemul 26 DI 0,27 0,70
Itemul 33 DI 0,23 0,58
Itemul 44 DI 0,41 0,33
Itemul 40 DI 0,35
Itemul 8 DI 0,33
Itemul 22 FM 0,79
Itemul 3 FM 0,78
Itemul 14 FM 0,74
Itemul 39 FM 0,72
Itemul 48 FM 0,69
Itemul 58 FM 0,58
Itemul 6 FM 0,56
Itemul 35 FM 0,35 0,29
Itemul 79 DE 0,71
Itemul 83 DE 0,63
Itemul 70 DE 0,57
Itemul 65 AI 0,56
Itemul 67 DE 0,30 0,47
Itemul 85 DE 0,43
Itemul 80 AP 0,31 0,39

(continuare)

160
 Tabelul 6.11 (continuare)
Saturaţiile principalilor factori pentru eşantionul clinic de adulţi din SUA pentru
Scalele psihologice EDI-3

Item/Scală Factorul 1 Factorul 2 Factorul 3 Factorul 4 Factorul 5 Factorul 6 Factorul 7 Factorul 8

Itemul 89 AI 0,20 0,29 0,37
Itemul 74 AI 0,33
Itemul 88 A 0,71
Itemul 75 A 0,58
Itemul 78 A 0,56
Itemul 82 A 0,52
Itemul 86 A 0,20 0,43
Itemul 90 DE 0,39
Itemul 66 A 0,31 0,37
Itemul 68 A 0,31
Itemul 77 DI 0,22 0,28 0,29
Itemul 43 P -0,22 0,87
Itemul 13 P 0,82
Itemul 29 P -0,21 0,58
Itemul 36 P 0,36 0,51
Itemul 63 P 0,34 0,50
Itemul 52 P 0,25 0,49
Itemul 72 DE 0,79
Itemul 81 DE 0,71
Notă: Metoda de extracţie: Axa principală. Metoda de rotaţie: Promax. SSS = Stimă de sine scăzută; AP = Alienare personală;
NI= Nesiguranţă interpersonală; AI = Alienare interpersonală; DI = Deficite interoceptive; FM = Frica de maturitate; DE =
Dezechilibru emoţional; P= Perfecţionism; A = Ascetism.

Scala compozită
Neadaptare
psihologică
generală

SSS AP NI AI DI DE P A FM

E1 E2 E3 E4 E5 E6 E7 E8 E9

Figura 6.1. Modelul 1: Model uni-factorial pentru Scala compozită a neadaptării psihologice generale
EDI-3. SSS = Stimă de sine scăzută; AP = Alienare personală; NI= Nesiguranţă interpersonală; AI =
Alienare interpersonală; DI = Deficite interoceptive; DE = Dezechilibru emoţional; P = Perfecţionism;
A = Ascetism; FM = Frica de maturitate.

161
 Tabelul 6.12
Saturaţiile principalilor factori pentru eşantionul clinic internaţional de adulţi pentru
Scalele psihologice EDI-3

Item/Scală Factorul 1 Factorul 2 Factorul 3 Factorul 4 Factorul 5 Factorul 6 Factorul 7 Factorul 8

Itemul 10 SSS 0,87
Itemul 27 SSS 0,83
Itemul 84 AP 0,79
Itemul 41 SSS 0,75
Itemul 24 AP 0,61
Itemul 37 SSS 0,60 0,28
Itemul 18 AP 0,49
Itemul 56 AP 0,35 0,31
Itemul 66 A 0,31 0,27
Itemul 67 DE 0,28 0,27
Itemul 76 AI 0,25 0,24
Itemul 42 SSS 0,68
Itemul 50 SSS 0,31 0,63
Itemul 91 AP 0,61 0,22
Itemul 20 AP 0,61
Itemul 80 AP 0,42
Itemul 23 NI 0,73
Itemul 73 NI 0,72 -0,26
Itemul 57 NI 0,62 0,26
Itemul 15 NI 0,53 0,27
Itemul 30 AI 0,49
Itemul 17 AI 0,24 0,41
Itemul 69 NI 0,34 0,41
Itemul 89 AI 0,25 0,41
Itemul 87 NI 0,22 0,26
Itemul 3 FM 0,73
Itemul 22 FM -0,21 0,70
Itemul 14 FM 0,67
Itemul 39 FM 0,66
Itemul 48 FM 0,65
Itemul 58 FM 0,43 0,52
Itemul 6 FM 0,49
Itemul 35 FM 0,24 0,34
Itemul 60 DI 0,64
Itemul 21 DI 0,29 0,63
Itemul 51 DI 0,62
Itemul 26 DI -0,30 0,36 0,26 0,53
Itemul 33 DI 0,21 0,48
Itemul 34 NI 0,30 0,43 -0,22
Itemul 44 DI 0,39
Itemul 40 DI 0,34 0,30
Itemul 8 DI 0,27 0,34
Itemul 54 AI 0,26
Itemul 72 DE 0,26
Itemul 81 DE 0,25
Itemul 74 AI 0,25
(continuare)

162
 Tabelul 6.12 (continuare)
Saturaţiile principalilor factori pentru eşantionul clinic internaţional de adulţi pentru
Scalele psihologice EDI-3

Item/Scală Factorul 1 Factorul 2 Factorul 3 Factorul 4 Factorul 5 Factorul 6 Factorul 7 Factorul 8

Itemul 52 P 0,56 0,21
Itemul 75 A 0,53 -0,20
Itemul 63 P 0,46 0,32
Itemul 78 A 0,44
Itemul 36 P 0,43 0,33
Itemul 88 A 0,37
Itemul 86 A 0,21 0,32
Itemul 68 A 0,32
Itemul 90 DE 0,27
Itemul 82 A 0,26
Itemul 77 DI 0,20 0,22
Itemul 43 P 0,81
Itemul 13 P 0,73
Itemul 29 P 0,25 0,36
Itemul 65 AI 0,30
Itemul 79 DE 0,80
Itemul 83 DE 0,68
Itemul 70 DE 0,48
Itemul 85 DE 0,24 0,44
Notă: Metoda de extracţie: Axa principală. Metoda de rotaţie: Promax. SSS = Stimă de sine scăzută; AP = Alienare personală;
A = Ascetism; DE = Dezechilibru emoţional; AI = Alienare interpersonală; NI= Nesiguranţă interpersonală; FM = Frica de
maturitate; DI = Deficite interoceptive; P= Perfecţionism.

Scala compozită Scala compozită Scala compozită Scala compozită

Ineficacitate Probleme Probleme Control
interpersonale emoţionale exagerat

SSS AP NI AI DI DE P A

E1 E2 E3 E4 E5 E6 E7 E8

Figura 6.2. Modelul 2: Model cu 4 factori pentru scalele psihologice compozite EDI-3. SSS = Stimă de
sine scăzută; AP = Alienare personală; NI= Nesiguranţă interpersonală; AI = Alienare interpersonală;
DI = Deficite interoceptive; DE = Dezechilibru emoţional; P = Perfecţionism; A = Ascetism.

163
 Tabelul 6.13
Saturaţiile principalilor factori pentru eşantionul clinic de adolescenţi din SUA pentru
Scalele psihologice EDI-3

Item/Scală Factorul 1 Factorul 2 Factorul 3 Factorul 4 Factorul 5 Factorul 6 Factorul 7 Factorul 8

Itemul 75 A 0,84
Itemul 78 A 0,83
Itemul 86 A 0,81
Itemul 88 A 0,72
Itemul 66 A 0,70 0,21
Itemul 90 DE 0,70 0,33
Itemul 82 A 0,63 -0,32
Itemul 68 A 0,62 -0,20
Itemul 56 AP 0,61 0,22
Itemul 10 SSS 0,57 0,27
Itemul 41 SSS 0,56
Itemul 50 SSS 0,55 0,40
Itemul 27 SSS 0,52 0,31
Itemul 77 DI 0,46 0,35
Itemul 18 AP 0,42
Itemul 24 AP 0,40 0,27
Itemul 37 SSS 0,39 0,27
Itemul 8 DI 0,36 0,31
Itemul 74 AI 0,30
Itemul 91 AP 0,25 0,25
Itemul 30 AI 0,86
Itemul 17 AI 0,85
Itemul 23 NI -0,27 0,79 0,23
Itemul 15 NI 0,74 -0,36
Itemul 57 NI 0,65 -0,40
Itemul 54 AI 0,25 0,57
Itemul 34 NI 0,56 0,42
Itemul 69 NI 0,53 0,32 0,48
Itemul 87 NI 0,42 0,30
Itemul 89 AI 0,30 0,35
Itemul 76 AI 0,32
Itemul 83 DE -0,33 1,06
Itemul 79 DE 0,86
Itemul 70 DE -0,21 0,81
Itemul 67 DE 0,72
Itemul 85 DE 0,67 0,21
Itemul 84 AP 0,29 0,45
Itemul 80 AP 0,40
Itemul 20 AP 0,26 0,34
Itemul 42 SSS 0,31 0,32
Itemul 65 AI 0,31 0,26 -0,21
Itemul 60 DI 0,83
Itemul 21 DI 0,80
Itemul 51 DI 0,76
Itemul 26 DI 0,30 0,73
Itemul 33 DI 0,21 0,58
(continuare)

164
 Tabelul 6.13 (continuare)
Saturaţiile principalilor factori pentru eşantionul clinic de adolescenţi din SUA pentru
Scalele psihologice EDI-3

Item/Scală Factorul 1 Factorul 2 Factorul 3 Factorul 4 Factorul 5 Factorul 6 Factorul 7 Factorul 8

Itemul 40 DI 0,36
Itemul 44 DI 0,26 0,28
Itemul 3 FM 0,76
Itemul 48 FM 0,76
Itemul 14 FM 0,71
Itemul 6 FM 0,23 0,67
Itemul 58 FM -0,23 0,63
Itemul 39 FM 0,63
Itemul 22 FM 0,61
Itemul 35 FM 0,38
Itemul 43 P -0,22 0,21 0,83
Itemul 13 P 0,27 0,73
Itemul 29 P 0,33 0,48
Itemul 36 P 0,23 0,47 0,26
Itemul 63 P 0,38 0,46
Itemul 52 P 0,30 0,34 0,29
Itemul 72 DE 0,27 0,86
Itemul 81 DE 0,73
Itemul 73 NI 0,57 0,58

Notă: Metoda de extracţie: Axa principală. Metoda de rotaţie: Promax. A = Ascetism; DE = Dezechilibru emoţional; AP =
Alienare personală; SSS = Stimă de sine scăzută; DI = Deficite interoceptive; AI = Alienare interpersonală; NI = Nesiguranţă
interpersonală; FM = Frica de maturitate; P = Perfecţionism.

Tabelul 6.14 Dovezi bazate pe relaţiile cu alte variabile

Procentul participanţilor pe grupuri (externe)
de diagnostic pentru analiza factorială
confirmatorie a itemilor scalei compozite Corelaţii cu EDI‑2
din EDI-3 Risc de tulburare de comportament
alimentar pentru eşantioanele clinice de adulţi Răspunsurile la EDI‑2, obţinute într‑un
şi adolescenţi din SUA eşantion mixt de 864 femei şi 295 de adolescente,
au fost studiate cu scopul de a examina relaţia
Eşantion clinic (%) dintre EDI‑3 şi EDI‑2. Tabelele 6.16 şi 6.17 prezintă
Grup de Adulţi din Adolescenţi din corelaţiile dintre scalele/scalele compozite EDI‑3
diagnostic SUAa SUAb şi subscalele EDI‑2. Pentru scala de Risc de tulburare
AN-R 15,2 29,4 de comportament alimentar, subscalele DS şi NC
AN-AC/V 9,8 6,8 corelează semnificativ (cu valori de 0,96 şi 0,97)
BN 42,1 30,2 cu scalele corespondente din EDI‑2, atât în cazul
TCAFAS 32,9 33,6
eşantionului clinic de adulţi din SUA, cât şi în cel
de adolescenţi din SUA. Acest fapt sugerează că
Notă: AN-R = Anorexie nervoasă de tip restrictiv; AN‑AC/V cercetătorii şi clinicienii pot admite echivalenţa
= Anorexie nervoasă de tip alimentaţie compulsivă/ dintre EDI‑2 şi EDI‑3 pentru aceste scale. Scala B
vărsături; BN = Bulimie nervoasă; TCAFAS = Tulburare de
comportament alimentar fără altă specificaţie. a obţinut corelaţii cu valori de 0,73 pentru adulţi
a
N=866. bN=295. Variaţia în mărimea eşantionului este şi 0,71 pentru adolescenţi. Ţinându‑se cont de
rezultatul utilizării metodei de eliminare listwise. suprapunerea semnificativă în ceea ce priveşte
conţinutul itemilor, corelaţia relativ scăzută
dintre scala B a EDI‑3 şi subscala EDI‑2 de Bulimie
se datorează, probabil, unui interval bimodal

165
 Scala compozită
Neadaptare
psihologică
generală

0,83 0,90 0,65 0,74 0,76 0,60 0,37 0,65 0,46

SSS AP NI AI DI DE P A FM

E1 E2 E3 E4 E5 E6 E7 E8 E9

Figura 6.3. Analiza factorială confirmatorie (AFC) cu factor unic EDI-3: Modelul 1 pentru eşantionul
clinic de adulţi din SUA. SSS = Stimă de sine scăzută; AP = Alienare personală; NI = Nesiguranţă
interpersonală; AI = Alienare interpersonală; DI = Deficite interoceptive; DE = Dezechilibru emoţional;
P = Perfecţionism; A = Ascetism; FM = Frica de maturitate.

Scala compozită
Neadaptare
psihologică
generală

0,88 0,94 0,71 0,79 0,78 0,65 0,53 0,74 0,38

SSS AP NI AI DI DE P A FM

E1 E2 E3 E4 E5 E6 E7 E8 E9

Figura 6.4. Analiza factorială confirmatorie (AFC) cu factor unic EDI-3: Modelul 1 pentru eşantionul
clinic de adolescenţi din SUA. SSS = Stimă de sine scăzută; AP = Alienare personală; NI = Nesiguranţă
interpersonală; AI = Alienare interpersonală; DI = Deficite interoceptive; DE = Dezechilibru emoţional;
P = Perfecţionism; A = Ascetism; FM = Frica de maturitate.

166
 0,66

0,86 0,66

0,84 0,83 0,79

Scala compozită Scala compozită Scala compozită Scala compozită

Ineficacitate Probleme Probleme Control
interpersonale emoţionale exagerat

0,84 0,95 0,71 0,82 0,83 0,64 0,51 0,87

SSS AP NI AI DI DE P A

E1 E2 E3 E4 E5 E6 E7 E8

Figura 6.5. Analiza factorială confirmatorie (AFC) cu patru factori EDI-3: Modelul 2 pentru
eşantionul clinic de adulţi din SUA. SSS = Stimă de sine scăzută; AP = Alienare personală; NI =
Nesiguranţă interpersonală; AI = Alienare interpersonală; DI = Deficite interoceptive; DE =
Dezechilibru emoţional; P = Perfecţionism; A = Ascetism.
0,81

0,94 0,75

0,87 0,84 0,86

Scala compozită Scala compozită Scala compozită Scala compozită

Ineficacitate Probleme Probleme Control
interpersonale emoţionale exagerat

0,88 0,96 0,78 0,88 0,81 0,67 0,62 0,87

SSS AP NI AI DI DE P A

E1 E2 E3 E4 E5 E6 E7 E8

Figura 6.6. Analiza factorială confirmatorie (AFC) cu patru factori EDI-3: Modelul 2 pentru
eşantionul clinic de adolescenţi din SUA. SSS = Stimă de sine scăzută; AP = Alienare personală;
NI = Nesiguranţă interpersonală; AI = Alienare interpersonală; DI = Deficite interoceptive; DE =
Dezechilibru emoţional; P = Perfecţionism; A = Ascetism.

167
 Tabelul 6.15
Rezumatul statisticilor referitoare la potrivire pentru analiza factorială confirmatorie pentru
Modelele 1 şi 2 pentru eşantioanele clinice de adulţi şi adolescenţi din SUA
Eşantion/Model χ2
Clinic de adulţi din SUA
Model 1 370,313
Model 2 130,605
Clinic de adolescenţi din SUA
Model 1 118,141
Model 2 36,890
Notă: gl= grade de libertate; p = probabilitate; ICP = Indicele de potrivire comparativ; RPMEA= rădăcina pătrată medie a erorii
de aproximare.
N=866. bN=295. Variaţia în mărimea eşantionului este rezultatul utilizării metodei de eliminare listwise.
a
restrâns, respondenţii cu AN‑R înclinând către
scoruri mai mici, iar grupul cu bulimie în direcţia
opusă (a se vedea etaloanele din Anexele A – C
şi, de asemenea, tabelele de corelaţii din Anexa
D). Aşa cum se observă în tabelele 6.16 şi 6.17,
scalele EDI‑3 prezintă cea mai mare corelaţie cu
subscalele EDI‑2 corespondente. Este important
de reţinut că constructul EDI‑2 Ineficacitate
corelează semnificativ cu constructul EDI‑3
SSS (0,95 pentru eşantionul clinic combinat de
adolescenţi şi adulţi). De asemenea, semnificaţia
constructului de „interocepţie” s‑a păstrat în
varianta revizuită a EDI‑3, aşa cum dovedeşte
corelaţia de 0,95 pentru scalele care‑l măsoară din
EDI‑2 şi EDI‑3, atât în cadrul eşantionului clinic
de adulţi, cât şi în cel de adolescenţi din SUA.
Corelaţii cu alte instrumente de măsură ale
tulburărilor de comportament alimentar
Corelaţiile cu EAT‑26. Un grup clinic format
din 210 femei şi 110 adolescente au completat
atât EDI‑3, cât şi EAT‑26. EAT‑26 este un
chestionar standardizat, utilizat pe scară largă,
de autoevaluare a simptomelor tulburărilor de
comportament alimentar. Acest instrument cu 26
de itemi oferă scoruri corespunzătoare factorilor
„comportament alimentar restrictiv”, „bulimie şi
preocupări legate de alimente” şi „control asupra
senzaţiilor orale”, iar fidelitatea şi validitatea
acestui instrument au fost în mod clar dovedite
(Dotti şi Lazzari, 1998; Garner şi colab., 1982; Lee
şi colab., 2002; Mintz şi O’Halloran, 2000).
Vârsta medie a acestor eşantioane a fost de
26,0 ani (AS=8,7 ani) pentru eşantionul de adulţi
şi 15,4 ani (AS=1,5 ani) pentru eşantionul de
adolescenţi. Tabelul 6.18 prezintă compoziţia în
funcţie de diagnostic şi procentul participanţilor
168
gl p Raportul χ2 : gl ICP RPMEA
27 0,000 13,715 0,908 0,121
14 0,000 9,329 0,967 0,098
27 0,000 4,376 0,942 0,107
14 0,001 2,635 0,985 0,075
pentru fiecare eşantion. Aşa cum se observă
din tabelul 6.19, există un pattern consecvent
între scalele de Risc de tulburare de comportament
alimentar şi EAT‑26. Subscala DS din EDI‑3 a
corelat cel mai puternic cu EAT‑26, atât în grupul
de adulţi, cât şi în cel de adolescenţi (cu valori de
0,72 şi, respectiv, 0,70). Cea mai slabă corelaţie s‑a
înregistrat între subscala B şi EAT‑26. Subscala
NC a corelat cu EAT‑26, înregistrând valori
ale coeficienţilor de corelaţie de 0,52 şi 0,54 în
eşantionul de adulţi şi, respectiv, de adolescenţi.
Pentru eşantionul de adulţi, corelaţiile Scalei
psihologice au variat de la 0,15 (scala P) la 0,50
(scala A), cu o mediană a corelaţiilor de 0,27.
Mediana corelaţiilor dintre Scalele psihologice
şi EAT‑26 în eşantionul de adolescenţi a fost
moderat mai ridicată (0,45). Pentru eşantionul de
adolescenţi, EAT‑26 a corelat cel mai slab cu scala
FM (0,24) şi cel mai puternic cu scala DI (0,54).
Corelaţiile cu BULIT‑R. Un grup nonclinic
de 543 de femei a completat EDI‑3 şi Testul de
Bulimie‑Revizuit (Bulimia Test‑Revised BULIT‑R;
Thelan, Farmer, Wonderlich şi Smith, 1991).
BULIT‑R este un chestionar de autoevaluare
cu 28 de itemi, cu răspunsuri multiple, care se
bazează pe criteriile pentru BN ale Manualului de
diagnostic şi statistică a tulburărilor mentale, ediţia
a 3‑a revizuită (DSM‑III‑R; Asociaţia Americană
de Psihiatrie, 1987). Acest chestionar a stat la
baza multor cercetări şi reprezintă un instrument
psihometric fidel pentru BN.
Vârsta medie a participanţilor a fost de 20,6
ani (AS=3,1 ani), iar valoarea medie a IMC‑ului a
fost de 22,78 (AS=4,45 ani). Aşa cum se observă
în Tabelul 6.20, scala B a corelat cel mai puternic
cu BULIT‑R (0,81). Corelaţiile dintre scalele DS şi
NC şi BULIT‑R au valori de 0,77 şi, respectiv, 0,64.
Coeficienţii de corelaţie dintre Scalele psihologice şi
 Tabelul 6.16
Corelaţiile dintre EDI-2 şi EDI-3 pentru eşantionul clinic de adulţi din SUA

Subscla EDI-2 (r)

Scala/ Scala compozită EDI-3 DS B NC I P NI AI FM A RI NS
Scala de Risc de tulburare de
comportament alimentar/
Scala compozită
Dorinţa de a fi slab (DS) 0,97 0,24 0,64 0,41 0,28 0,26 0,42 0,23 0,46 0,24 0,33
Bulimie (B) 0,31 0,73 0,22 0,32 0,17 0,22 0,43 0,20 0,29 0,29 0,27
Nemulţumire faţă de corp (NC) 0,69 0,21 0,96 0,48 0,28 0,31 0,41 0,21 0,45 0,27 0,38
Scala compozită Risc de tulburare 0,84 0,50 0,77 0,51 0,31 0,33 0,54 0,27 0,50 0,34 0,42
de comportament alimentar
(SCRTCA)

Scala psihologică/
Scala compozită
Stimă de sine scăzută (SSS) 0,45 0,25 0,49 0,95 0,26 0,53 0,56 0,36 0,53 0,46 0,72
Alienare personală (AP) 0,40 0,30 0,40 0,89 0,28 0,58 0,66 0,44 0,54 0,58 0,83
Nesiguranţă interpersonală (NI) 0,28 0,14 0,30 0,59 0,20 0,85 0,49 0,30 0,39 0,32 0,77
Alienare interpersonală (AI) 0,26 0,24 0,31 0,62 0,35 0,77 0,54 0,34 0,47 0,58 0,72
Deficite interoceptive (DI) 0,39 0,35 0,36 0,64 0,37 0,58 0,95 0,39 0,57 0,59 0,58
Dezechilibru emoţional (DE) 0,23 0,31 0,23 0,52 0,18 0,35 0,51 0,33 0,37 0,93 0,50
Perfecţionism (P) 0,28 0,16 0,28 0,27 0,98 0,30 0,38 0,17 0,43 0,23 0,25
Ascetism (A) 0,52 0,30 0,45 0,55 0,45 0,43 0,61 0,33 0,96 0,47 0,48
Frica de maturitate (FM) 0,22 0,16 0,18 0,39 0,14 0,27 0,35 0,97 0,29 0,35 0,39
Scala compozită Ineficacitate (SCI) 0,45 0,29 0,47 0,97 0,28 0,58 0,64 0,42 0,56 0,55 0,81
Scala compozită Probleme 0,30 0,21 0,34 0,68 0,31 0,91 0,57 0,36 0,49 0,51 0,84
interpersonale (SCPI)
Scala compozită Probleme 0,36 0,38 0,34 0,66 0,32 0,53 0,84 0,41 0,54 0,87 0,61
emoţionale (SCPE)
Scala compozită Control exagerat 0,47 0,27 0,43 0,48 0,84 0,43 0,58 0,29 0,81 0,41 0,43
(SCCE)
Scala compozită Neadaptare 0,48 0,35 0,47 0,85 0,50 0,73 0,79 0,56 0,71 0,70 0,82
psihologică generală (SCNPG)

Notă: N= 864. Variaţia în mărimea eşantionului este rezultatul utilizării metodei de eliminare listwise. Numerele îngroşate indică
corelaţiile dintre subscala EDI-2 şi scala corespondentă EDI-3. Subscalele EDI-2: DS = Dorinţa de a fi slab; B = Bulimie; NC =
Nemulţumire faţă de corp; I = Ineficacitate; P = Perfecţionism; NI = Neîncredere interpersonală CI = Conştiinţă interoceptivă; FM
= Frica de maturitate; A = Ascetism; RI= Reglarea impulsurilor; NS = Nesiguranţă socială.

BULIT‑R au variat între 0,15 (scala P) şi 0,60 (scala
A). Mediana corelaţiilor dintre Scalele psihologice
EDI‑3 şi BULIT‑R a fost de 0,45.
Corelaţiile cu instrumente de măsură a
personalităţii şi psihopatologiei
Corelaţii cu Scala Stimei de sine a lui Rosenberg
şi cu CESD. Un grup nonclinic de 543 de femei
a completat EDI‑3 şi Scala Stimei de sine a lui
Rosenberg (Rosenberg, 1965), precum şi EDI‑3 şi
Scala de depresie a Centrului de studii epidemiologice
(Center for Epidemiologic Studies Depression Scale
– CESD; Radloff, 1977, 1991). Vârsta medie
a participantelor a fost de 20,6 ani (AS=3,1),
iar valoarea medie a IMC‑ului a fost de 22,78
(AS=4,45). Tabelul 6.21 prezintă corelaţiile dintre
EDI‑3 şi aceste instrumente. Scalele psihologice
EDI‑3 au prezentat, în general, corelaţii mai
puternice decât scalele de Risc de tulburare de
comportament alimentar, care au variat între ‑0,40
şi ‑0,48 pentru Scala Stimei de sine a lui Rosenberg
şi între 0,42 şi 0,50 pentru Scala CESD. Medianele
corelaţiilor scalelor psihologice EDI‑3 au fost de
‑0,52 şi ‑0,62 cu Scala Stimei de sine a lui Rosenberg
şi, respectiv, cu Scala CESD. În concordanţă
cu predicţiile teoretice, Scala Stimei de sine a lui
Rosenberg corelează cel mai puternic (invers) cu

169
 Tabelul 6.17
Corelaţiile dintre EDI-2 şi EDI-3 pentru eşantionul clinic de adolescenţi din SUA

Subscla EDI-2 (r)

Scala/ Scala compozită EDI-3 DS B NC I P NI AI FM A RI NS
Scala de Risc de tulburare de
comportament alimentar/
Scala compozită
Dorinţa de a fi slab (DS) 0,97 0,28 0,70 0,60 0,40 0,33 0,60 0,23 0,51 0,39 0,51
Bulimie (B) 0,36 0,71 0,31 0,41 0,21 0,22 0,47 0,14 0,30 0,39 0,37
Nemulţumire faţă de corp (NC) 0,74 0,23 0,97 0,61 0,35 0,34 0,50 0,22 0,46 0,37 0,48
Scala compozită Risc de tulburare de 0,85 0,51 0,81 0,67 0,39 0,36 0,65 0,25 0,53 0,48 0,56
comportament alimentar (SCRTCA)
Scala psihologică/
Scala compozită
Stimă de sine scăzută (SSS) 0,65 0,36 0,66 0,95 0,43 0,60 0,65 0,28 0,61 0,58 0,79
Alienare personală (AP) 0,61 0,42 0,59 0,91 0,45 0,62 0,75 0,34 0,62 0,67 0,88
Nesiguranţă interpersonală (NI) 0,38 0,18 0,34 0,64 0,33 0,87 0,53 0,33 0,44 0,44 0,79
Alienare interpersonală (AI) 0,43 0,35 0,42 0,71 0,38 0,82 0,56 0,24 0,53 0,62 0,78
Deficite interoceptive (DI) 0,57 0,37 0,44 0,67 0,44 0,54 0,95 0,33 0,56 0,62 0,66
Dezechilibru emoţional (DE) 0,42 0,39 0,39 0,59 0,33 0,38 0,55 0,20 0,41 0,93 0,59
Perfecţionism (P) 0,46 0,29 0,40 0,48 0,99 0,35 0,47 0,16 0,50 0,40 0,43
Ascetism (A) 0,62 0,36 0,54 0,69 0,54 0,49 0,65 0,23 0,95 0,56 0,63
Frica de maturitate (FM) 0,24 0,06 0,23 0,33 0,17 0,28 0,32 0,97 0,23 0,28 0,36
Scala compozită Ineficacitate (SCI) 0,66 0,40 0,65 0,97 0,46 0,64 0,72 0,32 0,64 0,65 0,87
Scala compozită Probleme 0,44 0,29 0,42 0,74 0,39 0,92 0,60 0,31 0,53 0,58 0,86
interpersonale (SCPI)
Scala compozită Probleme 0,56 0,44 0,47 0,72 0,44 0,53 0,85 0,30 0,55 0,88 0,71
emoţionale (SCPE)
Scala compozită Control exagerat 0,61 0,37 0,54 0,66 0,87 0,48 0,64 0,22 0,83 0,55 0,61
(SCCE)
Scala compozită Neadaptare 0,65 0,42 0,59 0,89 0,61 0,74 0,81 0,45 0,72 0,76 0,88
psihologică generală (SCNPG)

Notă: N = 295. Variaţia în mărimea eşantionului este rezultatul utilizării metodei de eliminare listwise. Numerele îngroşate
indică corelaţiile dintre subscala EDI-2 şi scala corespondentă EDI-3. Subscalele EDI-2 : DS = Dorinţa de a fi slab; B = Bulimie; NC
= Nemulţumire faţă de corp; I = Ineficacitate; P = Perfecţionism; NI = Neîncredere interpersonală; CI = Conştiinţă interoceptivă;
FM = Frica de maturitate; A = Ascetism; RI= Reglarea impulsurilor; NS = Nesiguranţă socială.

scala EDI‑3 SSS (0,82) şi cu SCI (0,82). În plus,
în concordanţă cu relaţia teoretică dintre stima
de sine scăzută şi depresie (Beck, 1976), CESD
corelează cel mai puternic cu scala SSS (0,72), scala
AP (0,77), SCI (0,78) şi SCNPG (0,78). Utilizând
suprapunerea dintre un set de date şi sistemul
original de cotare EDI, Espelage şi colab. (2003)
au identificat o corelaţie negativă între CESD şi
subscala EDI Bulimie (‑0,18) şi cea mai puternică
corelaţie între CESD şi subscalele EDI Ineficacitate
(0,72) şi Conştiinţă interoceptivă (0,59).
Corelaţii cu DEBQ şi SCL‑90‑R. Un grup de
362 de femei fără tulburări de comportament
alimentar şi un grup de 305 femei cu tulburări
de comportament alimentar au completat EDI‑3,
Chestionarul olandez de evaluare a comportamentului
alimentar (the Dutch Eating Behavior Questionnaire
– DEBQ; van Strien, Frijters, Bergers şi Defares,
1986) şi versiunea olandeză a Listei de simptome‑90
(SCL‑90; Arrindell şi Ettema, 1986), bazată
pe varianta originală a Listei de simptome‑90
(Derogatis, 1977).
DEBQ cuprinde trei scale care evaluează
comportamentul alimentar determinat de
emoţii, cel determinat de factori externi şi
comportamentul alimentar restrictiv. Acest
instrument are fidelitate şi validitate solide (van
Strien şi colab., 1986) în cazul eşantioanelor
clinice şi nonclinice (van Strien şi Ouwens,
2003). Scalele au făcut distincţie între femei cu
tulburări de comportament alimentar şi femei
supraponderale sau cu o greutate normală fără

170
 Tabelul 6.18 tulburări de comportament alimentar (van
Procentajul participanţilor pe grupuri de Strien şi Ouwens). Diferenţele dintre grupuri
diagnostic la administrarea EDI-3 şi EAT-26 în s‑au încadrat în tendinţele teoretice prevăzute
eşantioanele clinice de adulţi şi pentru fiecare scală. Participantele fără tulburări
de adolescenţi din SUA de comportament alimentar au variat ca vârstă
între 18 şi 57 de ani (M=25,8 ani; AS=9,7 ani).
Eşantion clinic (%) Valoarea medie a IMC‑ului acestora a fost de
Grup de Adulţia Adolescenţib 23,97 (AS=8,02). Participantele cu tulburări de
diagnostic comportament alimentar au variat ca vârstă
AN-R 15,7 32,7 între 18 şi 53 de ani (M=26,1 ani; AS=6,1 ani).
AN-AC/V 16,7 8,1 Compoziţia în funcţie de diagnosticele AN‑R,
BN 34,8 24,4 AN‑AC/V, BN şi TCAFAS este de 19%, 22%, 49%
TCAFAS 32,9 34,6
şi, respectiv, de 10%. Valoarea medie a IMC‑ului
pentru eşantionul clinic a fost de 19,26 (AS=4,51).
Notă: EAT-26 = Testul de atitudini faţă de alimentaţie-26 SCL‑90 reprezintă un inventar scurt,
(Garner, Olmsted, Bohr şi Garfinkel, 1982). AN-R = Anorexie multidimensional, de autoevaluare, creat pentru
nervoasă de tip restrictiv; AN-AC/V = Anorexie nervoasă screening‑ul unei game largi de probleme
de tip alimentaţie compulsivă/vărsături; BN = Bulimie
nervoasă; TCAFAS = Tulburări de comportament alimentar psihologice şi simptome psihopatologice. De
fără altă specificaţie asemenea, SCL‑90 este foarte util ca o măsură
a
N = 210; bN = 110. a evoluţiei sau a răspunsului la tratament.
S‑a dovedit că are fidelitate şi validitate bune

Tabelul 6.19
Corelaţiile dintre EDI-3 şi EAT-26 pentru eşantioanele clinice de adulţi şi de
adolescenţi din SUA

EAT-26 (r)
Scala/ Scala compozită EDI-3 Adulţia Adolescenţib
Scala de Risc de tulburare de comportament alimentar/
Scala compozită
Dorinţa de a fi slab (DS) 0,72 0,70
Bulimie (B) 0,25 0,23
Nemulţumire faţă de corp (NC) 0,52 0,54
Scala compozită Risc de tulburare de comportament alimentar (SCRTCA) 0,63 0,60

Scala psihologică/
Scala compozită
Stimă de sine scăzută (SSS) 0,30 0,52
Alienare personală (AP) 0,37 0,45
Nesiguranţă interpersonală (NI) 0,17 0,29
Alienare interpersonală (AI) 0,18 0,26
Deficite interoceptive (DI) 0,36 0,54
Dezechilibru emoţional (DE) 0,27 0,31
Perfecţionism (P) 0,15 0,49
Ascetism (A) 0,50 0,53
Frica de maturitate (FM) 0,27 0,24
Scala compozită Ineficacitate (SCI) 0,39 0,50
Scala compozită Probleme interpersonale (SCPI) 0,19 0,30
Scala compozită Probleme emoţionale (SCPE) 0,36 0,48
Scala compozită Control exagerat (SCCE) 0,38 0,58
Scala compozită Neadaptare psihologică generală (SCNPG) 0,42 0,54
Notă: EAT-26 = Testul de atitudini faţă de alimentaţie-26 (Garner, Olmsted, Bohr şi Garfinkel, 1982).
a
N = 210; bN = 110.

171
 Tabelul 6.20
Corelaţiile dintre EDI-3 şi BULIT-R pentru un eşantion nonclinic
Scala/ Scala compozită EDI-3
Scala de Risc pentru tulburări de comportament alimentar/
Scala compozită
Dorinţa de a fi slab (DS)
Bulimie (B)
Nemulţumire faţă de corp (NC)
Scala compozită Risc de tulburare de comportament alimentar (SCRTCA)
Scala psihologică/
Scala compozită
Stimă de sine scăzută (SSS)
Alienare personală (AP)
Nesiguranţă interpersonală (NI)
Alienare interpersonală (AI)
Deficite interoceptive (DI)
Dezechilibru emoţional (DE)
Perfecţionism (P)
Ascetism (A)
Frica de maturitate (FM)
Scala compozită Ineficacitate (SCI)
Scala compozită Probleme interpersonale (SCPI)
Scala compozită Probleme emoţionale (SCPE)
Scala compozită Control exagerat (SCCE)
Scala compozită Neadaptare psihologică generală (SCNPG)
Notă: N = 543. BULIT-R = Testul de Bulimie-Revizuit (Bulimia Test-Revised, Thelan, Farmer, Wonderlich şi Smith, 1991).
(Derogatis, 1977). Lista de simptome a versiunii
olandeze are nouă subscale legate de simptome:
Agorafobie, Anxietate, Depresie, Somatizare,
Insuficienţă, Sensibilitate, Ostilitate, Probleme de
somn şi Altele.
Tabelele 6.22 şi 6.23 prezintă corelaţiile
dintre EDI‑3 şi DEBQ, precum şi dintre EDI‑3
şi SCL‑90, pentru ambele grupuri, clinic şi
nonclinic. Corelaţiile între scalele EDI‑3 şi scala
DEBQ de alimentaţie determinată de emoţii sunt
relativ mari, atât pentru eşantionul clinic, cât şi
pentru cel nonclinic. Dimpotrivă, scala DEBQ
de alimentaţie determinată de factori externi
prezintă corelaţii moderate (de la 0,30 la 0,50) cu
scalele EDI‑3, în cadrul eşantionului nonclinic (cu
excepţia P şi FM) şi corelaţii slabe sau negative în
cadrul eşantionului clinic. Patternul este acelaşi
pentru scala DEBQ de comportament alimentar
restrictiv, exceptând faptul că corelaţiile sunt mai
slabe pentru eşantionul nonclinic.
Corelaţiile dintre SCL‑90 şi scalele EDI‑3
indică faptul că scalele de Risc de tulburare
de comportament alimentar prezintă corelaţii
pozitive cu toate scalele SCL‑90, atât pentru
172
BULIT-R (r)
0,77
0,81
0,64
0,83
0,57
0,55
0,27
0,44
0,52
0,45
0,15
0,60
0,35
0,59
0,41
0,53
0,44
0,59
eşantionul clinic, cât şi pentru cel nonclinic.
Pattern‑ul corelaţiilor indică deopotrivă o
validitate discriminantă şi convergentă pentru
EDI‑3. În cazul scalelor de Risc de tulburare de
comportament alimentar în eşantionul clinic există
doar două (din 40 posibile) corelaţii mai mari
de 0,50 (DS şi Agorafobie; SCRTCA şi Somatizare)
şi şase corelaţii mai mari de 0,50 în eşantionul
nonclinic. În cazul scalelor psihologice EDI‑3,
pattern‑ul este acelaşi, atât pentru eşantionul
clinic, cât şi pentru cel nonclinic, înregistrând
cea mai puternică validitate discriminantă
pentru domeniul interpersonal (adică, scalele
NI, AI şi SCPI), precum şi pentru scalele P şi
FM. În eşantionul clinic s‑a înregistrat o singură
corelaţie mai mare de 0,50 pentru SCCE, în
comparaţie cu trei în eşantioanele nonclinice
(adică, Ostilitate, Somatizare, Scor total). Scalele
EDI‑3 care prezintă cea mai mare suprapunere
cu scalele SCL‑90 sunt scalele SSS şi AP (adică
SCI) şi scalele DI şi DE (adică SCPE). Este de
remarcat faptul că scala de Ostilitate SCL‑90
prezintă cea mai mare convergenţă cu scalele
EDI‑3. Deşi pattern‑ul general al corelaţiilor
 Tabelul 6.21
Corelaţiile dintre EDI-3 şi Scala Stimei de sine Rosenberg şi scala CESD
pentru un eşantion nonclinic

r
Scala Stimei de Scala
Scala/ Scala compozită EDI-3
sine Rosenberga CESDb
Scala de Risc de tulburare de comportament alimentar/
Scala compozită
Dorinţa de a fi slab (DS) -0,40 0,42
Bulimie (B) -0,48 0,50
Nemulţumire faţă de corp (NC) -0,44 0,44
Scala compozită Risc pentru tulburări de comportament alimentar -0,50 0,51
(SCRTCA)

Scala psihologică/
Scala compozită
Stimă de sine scăzută (SSS) -0,82 0,72
Alienare personală (AP) -0,75 0,77
Nesiguranţă interpersonală (NI) -0,45 0,47
Alienare interpersonală (AI) -0,54 0,64
Deficite interoceptive (DI) -0,60 0,67
Dezechilibru emoţional (DE) -0,52 0,62
Perfecţionism (P) -0,13 0,26
Ascetism (A) -0,48 0,56
Frica de maturitate (FM) -0,40 0,43
Scala compozită Ineficacitate (SCI) -0,82 0,78
Scala compozită Probleme interpersonale (SCPI) -0,57 0,64
Scala compozită Probleme emoţionale (SCPE) -0,62 0,71
Scala compozită Control exagerat (SCCE) -0,35 0,48
Scala compozită Neadaptare psihologică generală (SCNPG) -0,71 0,78

Notă. N = 543
a
Scala Rosenberg a Stimei de sine (Rosenberg, 1965). bScala de depresie a Centrului de studii epidemiologice (CESD; Radloff, 1977,
1991).

este similar pentru eşantioanele clinice şi
nonclinice, magnitudinea acestor corelaţii este
diferită pentru mai multe scale. Pattern‑ul
diferit al varianţei pentru eşantioanele clinice şi
nonclinice subliniază recomandarea la prudenţă
în generalizarea constatărilor obţinute de la
eşantioanele nonclinice la eşantioanele clinice în
ceea ce priveşte EDI (Garner, 1991).
Corelaţiile cu MCMI‑II. Aşa cum se prezintă
în tabelul 6.24, 73 de persoane cu tulburări de
comportament alimentar au completat atât EDI‑3,
cât şi MCMI‑II. MCMI‑II este un instrument
de măsură a psihopatologiei la adulţi, creat să
evalueze 22 de tulburări de personalitate de pe
Axa I şi Axa II şi alte entităţi clinice asociate
cu DSM‑III. Acest instrument s‑a dovedit a fi
suficient de fidel şi valid (Wetzler, 1990; Wise,
1996). Tabelul 6.24 conţine un set de informaţii
preluat de la Espelage şi colab. (2003), care au
utilizat sistemul original de cotare pentru EDI.
Participanţii au variat ca vârstă între 18 şi 44 de
ani (M=22,2 ani; AS=4,9 ani). Compoziţia grupului
în funcţie de diagnosticele AN‑R, AN‑AC/V, BN şi
TCAFAS a fost de 1,4%, 1,4%, 49,3% şi, respectiv,
47,9%. Valoarea medie a IMC‑ului grupului
a fost de 21,27 (AS=3,27). Aşa este indicat în
tabelul 6.24, corelaţiile dintre MCMI‑II şi scalele
Riscului de tulburare de comportament alimentar
sunt, în general, foarte scăzute, ceea ce indică o
validitate discriminantă. În general, corelaţiile
cele mai ridicate au fost înregistrate pentru scala
MCMI‑II de Tulburare Anxios‑Evitantă. În cadrul
scalelor psihologice EDI‑3 au existat dovezi atât
pentru validitatea discriminantă, cât şi pentru
cea convergentă, pentru un anumit număr de
scale. În concordanţă cu previziunile teoretice,
scala EDI‑3 SCI, împreună cu scalele asociate SSS

173
 Tabelul 6.22

174
Coeficienţii de corelaţie dintre EDI-3 şi DEBQ şi dintre EDI-3 şi versiunea olandeză a SCL-90 pentru un eşantion nonclinic
DEBQ SCL-90
Scala/ Scala compozită EDI-3 a b c d e f g h i j k Altele Scor total
Scala de Risc de tulburare de
comportament alimentar/
Scala compozită
Dorinţa de a fi slab (DS) 0,47 0,54 0,30 0,59 0,33 0,27 0,47 0,36 0,30 0,46 0,22 0,16 0,55
Bulimie (B) 0,48 0,70 0,42 0,25 0,37 0,21 0,42 0,37 0,35 0,50 0,29 0,20 0,55
Nemulţumire faţă de corp (NC) 0,41 0,54 0,41 0,50 0,27 0,23 0,39 0,33 0,27 0,41 0,19 0,22 0,44
Scala compozită Risc pentru tulburări 0,50 0,65 0,42 0,55 0,35 0,27 0,48 0,40 0,33 0,51 0,25 0,22 0,56
de comportament alimentar (SCRTCA)

Scala psihologică/
Scala compozită
Stimă de sine scăzută (SSS) 0,64 0,38 0,27 0,18 0,45 0,44 0,62 0,43 0,53 0,66 0,36 0,21 0,56
Alienare personală (AP) 0,71 0,41 0,27 0,15 0,55 0,50 0,68 0,49 0,52 0,73 0,43 0,21 0,66
Nesiguranţă interpersonală (NI) 0,46 0,23 0,14 0,11 0,33 0,34 0,43 0,33 0,37 0,49 0,26 0,12 0,36
Alienare interpersonală (AI) 0,51 0,32 0,20 0,14 0,34 0,35 0,46 0,31 0,38 0,60 0,29 0,24 0,43
Deficite interoceptive (DI) 0,63 0,37 0,25 0,17 0,46 0,47 0,59 0,49 0,52 0,56 0,39 0,20 0,55
Dezechilibru emoţional (DE) 0,58 0,31 0,33 0,12 0,36 0,42 0,50 0,44 0,50 0,51 0,65 0,25 0,51
Perfecţionism (P) 0,41 0,23 0,17 0,16 0,33 0,31 0,36 0,35 0,35 0,36 0,19 0,14 0,38
Ascetism (A) 0,54 0,50 0,31 0,38 0,41 0,31 0,50 0,38 0,45 0,55 0,31 0,17 0,59
Frica de maturitate (FM) 0,23 0,12 0,04 0,14 0,15 0,21 0,23 0,13 0,20 0,22 0,11 0,07 0,24
Scala compozită Ineficacitate (SCI) 0,72 0,42 0,29 0,17 0,53 0,50 0,69 0,49 0,55 0,74 0,42 0,22 0,64
Scala compozită Probleme 0,53 0,30 0,19 0,14 0,36 0,37 0,48 0,35 0,40 0,60 0,30 0,20 0,43
interpersonale (SCPI)
Scala compozită Probleme emoţionale 0,71 0,40 0,34 0,17 0,48 0,52 0,65 0,55 0,60 0,63 0,61 0,26 0,62
(SCPE)
Scala compozită Control exagerat 0,56 0,43 0,29 0,32 0,44 0,37 0,51 0,44 0,47 0,53 0,30 0,18 0,57
(SCCE)
Scala compozită Neadaptare 0,77 0,47 0,32 0,25 0,55 0,55 0,71 0,55 0,62 0,77 0,48 0,26 0,69
psihologică generală (SCNPG)
Notă: N = 362. DEBQ = Chestionarul olandez pentru evaluarea comportamentului alimentar (van Strien, Frijters, Bergers, şi Defares, 1986); SCL-90 = versiunea olandeză a Listei de simptome-90
(SCL-90; Arrindell şi Ettema, 1986).
a = alimentaţie determinată de emoţii, b = alimentaţie determinată de factori externi, c = comportament alimentar restrictiv, d = agorafobie, e = anxietate, f= depresie, g = somatizare,
h = insuficienţă, i = sensibilitate, j = ostilitate, k = probleme de somn.
 Tabelul 6.23
Coeficienţii de corelaţie dintre EDI-3 şi DEBQ şi dintre EDI-3 şi versiunea olandeză a SCL-90 pentru un eşantion clinic

DEBQ SCL-90
Scala/ Scala compozită EDI-3 a b c d e f g h i j k Altele Scor total
Scala de Risc de tulburare de
comportament alimentar/
Scala compozită
Dorinţa de a fi slab (DS) 0,46 0,05 0,06 0,55 0,32 0,38 0,44 0,37 0,41 0,40 0,23 0,24 0,42
Bulimie (B) 0,33 0,54 0,43 -0,01 0,14 0,28 0,35 0,27 0,31 0,29 0,22 0,08 0,36
Nemulţumire faţă de corp (NC) 0,42 -0,04 -0,03 0,35 0,32 0,33 0,39 0,43 0,37 0,35 0,23 0,25 0,33
Scala compozită Risc pentru 0,52 0,23 0,20 0,39 0,34 0,42 0,51 0,46 0,47 0,45 0,29 0,25 0,48
tulburări de comportament alimentar
(SCRTCA)
Scala psihologică/
Scala compozită
Stimă de sine scăzută (SSS) 0,58 0,12 0,09 0,16 0,42 0,51 0,62 0,35 0,49 0,54 0,31 0,27 0,53
Alienare personală (AP) 0,67 0,19 0,14 0,15 0,47 0,57 0,68 0,43 0,56 0,62 0,41 0,28 0,61
Nesiguranţă interpersonală (NI) 0,40 -0,07 -0,13 0,15 0,35 0,28 0,40 0,26 0,34 0,42 0,25 0,17 0,26
Alienare interpersonală (AI) 0,45 0,13 0,09 0,07 0,36 0,34 0,43 0,30 0,37 0,50 0,27 0,19 0,35
Deficite interoceptive (DI) 0,57 0,16 0,12 0,27 0,36 0,54 0,53 0,39 0,50 0,51 0,33 0,28 0,56
Dezechilibru emoţional (DE) 0,54 0,14 0,20 0,15 0,38 0,45 0,44 0,40 0,43 0,50 0,57 0,25 0,51
Perfecţionism (P) 0,32 0,17 0,07 0,10 0,20 0,31 0,27 0,26 0,26 0,33 0,08 0,19 0,30
Ascetism (A) 0,57 0,05 -0,02 0,37 0,39 0,48 0,52 0,40 0,51 0,56 0,27 0,29 0,52
Frica de maturitate (FM) 0,26 -0,17 -0,17 0,15 0,18 0,23 0,28 0,14 0,22 0,26 0,20 0,11 0,18
Scala compozită Ineficacitate (SCI) 0,66 0,17 0,12 0,16 0,47 0,57 0,69 0,42 0,56 0,62 0,38 0,29 0,60
Scala compozită Probleme 0,49 0,04 -0,01 0,12 0,41 0,36 0,48 0,32 0,41 0,53 0,30 0,20 0,35
interpersonale (SCPI)
Scala compozită Probleme emoţionale 0,64 0,17 0,18 0,25 0,43 0,57 0,56 0,45 0,54 0,58 0,52 0,30 0,62
(SCPE)
Scala compozită Control exagerat 0,52 0,13 0,03 0,28 0,34 0,47 0,47 0,38 0,46 0,53 0,20 0,28 0,49
(SCCE)
Scala compozită Neadaptare 0,73 0,11 0,06 0,26 0,52 0,62 0,70 0,49 0,62 0,71 0,45 0,34 0,64
psihologică generală (SCNPG)

Notă: N = 305. DEBQ= Chestionarul olandez pentru evaluarea comportamentului alimentar (van Strien, Frijters, Bergers, şi Defares, 1986); SCL-90= versiunea olandeză a Listei de simptome-90
(Arrindell şi Ettema, 1986)
a = alimentaţie determinată de emoţii, b = alimentaţie determinată de factori externi, c = comportament alimentar restrictiv, d = agorafobie, e = anxietate, f= depresie, g = somatizare,
h = insuficienţă, i = sensibilitate, j = ostilitate, k = probleme de somn.

175
şi AP, prezintă corelaţii relativ ridicate cu scalele
MCMI‑II de Tulburare Anxios‑Evitantă, Schizotipală
şi Distimică. Scala EDI‑3 SCPE, împreună cu
scalele asociate DI şi DE, prezintă cele mai mari
corelaţii cu scalele de Tulburare Pasiv‑agresivă,
Anxios‑Evitantă şi Borderline. Aşa cum era de
aşteptat, scala EDI‑3 DE a corelat puternic cu
scalele de Tulburare Pasiv‑agresivă, Borderline,
Dependenţa de substanţe şi Dependenţa de alcool.
Validitatea discriminantă, după cum reiese din
corelaţiile slabe sau negative dintre scale, a fost
dovedită pentru scalele EDI‑3, precum P, A şi
FM, care prezintă o slabă suprapunere din punct
de vedere teoretic cu scalele MCMI‑II.
Dovezi obţinute pe baza performanţelor
persoanelor de sex masculin cu tulburări de
comportament alimentar
Au fost sintetizate datele a trei grupuri
de bărbaţi cu diagnosticul de tulburări de
comportament alimentar. Tabelul 6.25 indică
compoziţia în funcţie de diagnostic şi procentul
participanţilor pentru fiecare eşantion. Vârsta
medie a fost de 26,8 ani (AS=8,9 ani), 28,3 ani
(AS=6,8 ani) şi 15,4 ani (AS=1,4 ani) pentru
eşantioanele clinice de adulţi internaţional şi
din SUA şi, respectiv, eşantionul internaţional
de adolescenţi. Tabelul 6.26 prezintă mediile
scorurilor brute şi abaterile standard pentru cele
trei eşantioane clinice. Pentru scalele Riscului
de tulburare de comportament alimentar, bărbaţii
au obţinut, în general, scoruri mai mici decât
eşantionul utilizat pentru etalonare, format
exclusiv din femei (a se vedea tabelele 5.4 şi 5.5
din capitolul 5). Pentru bărbaţii din eşantionul
clinic de adulţi din SUA, cel de adolescenţi din
SUA şi cel internaţional de adolescenţi, medianele
scalelor Riscului pentru tulburări de comportament
alimentar sunt 15,10, 14,93 şi, respectiv, 17,77.
Pentru femeile din eşantioanele utilizate pentru
standardizare, medianele scalelor Riscului de
tulburare de comportament alimentar sunt 19,40,
19,75 şi, respectiv, 20,89. De asemenea, s‑a
observat un pattern similar în cazul comparaţiei
dintre bărbaţi şi femei la scalele psihologice, deşi
176
valorile medianelor pentru bărbaţi au fost doar
cu puţin mai scăzute decât cele din eşantioanele
de femei. Pentru bărbaţii din eşantionul clinic de
adulţi din SUA, cel clinic internaţional de adulţi
şi cel clinic internaţional de adolescenţi, valorile
medianelor la scalele psihologice sunt de 10,10,
11,27 şi, respectiv, 11,45. Grupurile de femei
cu care s‑a făcut comparaţia au avut valorile
medianelor de 11,18, 11,89 şi 12,68. Acest pattern
este în concordanţă cu cel înregistrat în versiunile
anterioare ale EDI (Garner, 1991).
Dovezi obţinute pe baza performanţelor
persoanelor de sex masculin şi feminin fără
tulburări de comportament alimentar
Au fost evaluate câte trei eşantioane de
persoane fără tulburări de comportament
alimentar, de sex masculin şi feminin. Tabelele
6.27 şi 6.28 prezintă mediile scorurilor brute
şi abaterile standard ale scalelor EDI‑3 pentru
eşantioanele nonclinice. Tabelul 6.27 prezintă
informaţii descriptive despre participantele de
sex feminin, iar tabelul 6.28 prezintă date similare
pentru participanţii de sex masculin. Pentru
scalele Riscului de tulburare de comportament
alimentar, cea mai mare diferenţă dintre bărbaţi
şi femei s‑a înregistrat la scala NC, unde mediile
scorurilor brute ale femeilor au fost cu mai mult
de două ori mai mari decât mediile scorurilor
brute ale bărbaţilor, în fiecare dintre cele trei
grupuri. Diferenţe moderate înspre mari au fost,
de asemenea, înregistrate la scala DS, femeile
obţinând scoruri mai mari decât bărbaţii. La
scala B au apărut doar diferenţe mici de gen între
femei şi bărbaţi.
La Scalele psihologice s‑au înregistrat doar
diferenţe mici între femeile şi bărbaţii fără
tulburări de comportament alimentar. Pentru
femeile din eşantioanele clinice de adulţi din SUA,
de adolescenţi din SUA şi cel clinic internaţional
de adolescenţi, valorile medianelor pentru Scalele
psihologice sunt 6,29, 5,67 şi, respectiv, 5,54.
Grupurile de bărbaţi cu care s‑a făcut comparaţia
au înregistrat valori ale medianelor de 7,00, 4,32
şi 5,07.
 Tabelul 6.24
Coeficienţii de corelaţie dintre scalele şi scalele compozite EDI-3 şi scalele MCMI-II pentru un eşantion clinic

Scala MCMI-II
Scala/ Scala compozită EDI-3 a b c d e f g h i j k l
Scala de Risc de tulburare de comportament
alimentar/
Scala compozită
Dorinţa de a fi slab (DS) 0,16 -0,04 0,16 0,00 0,25 -0,08 -0,06 0,10 0,17 0,12 -0,01 0,11
Bulimie (B) 0,14 0,02 0,11 0,19 0,20 0,01 -0,06 0,02 0,01 0,11 0,00 0,18
Nemulţumire faţă de corp (NC) 0,37 -0,04 0,37 0,02 0,43 0,15 0,01 -0,01 0,22 0,11 -0,03 0,29
Scala compozită Risc de tulburare de comportament 0,30 -0,02 0,28 0,10 0,39 0,04 -0,05 0,04 0,17 0,15 -0,02 0,26
alimentar (SCRCTA)

Scala psihologică/
Scala compozită
Stimă de sine scăzută (SSS) 0,42 -0,27 0,51 0,26 0,53 0,17 -0,27 -0,31 0,17 -0,03 0,03 0,38
Alienare personală (AP) 0,50 -0,27 0,51 0,36 0,56 0,09 -0,27 -0,21 0,21 0,11 0,05 0,45
Nesiguranţă interpersonală (NI) 0,37 -0,33 0,45 0,63 0,57 0,13 -0,61 -0,32 0,05 0,07 0,28 0,25
Alienare interpersonală (AI) 0,55 -0,26 0,45 0,36 0,51 -0,10 -0,29 0,05 0,40 0,34 0,16 0,54
Deficite interoceptive (DI) 0,47 -0,11 0,44 0,25 0,44 0,08 -0,09 0,00 0,29 0,15 0,03 0,49
Dezechilibru emoţional (DE) 0,64 -0,26 0,61 0,30 0,46 0,05 -0,11 -0,08 0,44 0,37 -0,08 0,71
Perfecţionism (P) 0,26 0,17 0,18 0,03 0,17 0,05 0,08 0,19 0,17 0,09 0,19 0,24
Ascetism (A) 0,52 0,04 0,36 0,14 0,43 0,04 0,02 0,16 0,30 0,35 0,19 0,47
Frica de maturitate (FM) 0,20 -0,17 0,19 0,19 0,17 0,06 -0,25 -0,23 0,00 0,03 0,15 0,07
Scala compozită Ineficacitate (SCI) 0,50 -0,28 0,54 0,33 0,59 0,14 -0,29 -0,27 0,20 0,05 0,05 0,44
Scala compozită Probleme interpersonale (SCPI) 0,50 -0,33 0,49 0,55 0,59 0,02 -0,50 -0,16 0,24 0,22 0,25 0,43
Scala compozită Probleme emoţionale (SCPE) 0,64 -0,21 0,60 0,31 0,51 0,08 -0,11 -0,05 0,42 0,30 -0,02 0,69
Scala compozită Control exagerat (SCCE) 0,46 0,13 0,32 0,11 0,35 0,06 0,06 0,21 0,27 0,26 0,23 0,42
Scala compozită Neadaptare psihologică generală 0,65 -0,25 0,62 0,42 0,64 0,11 -0,30 -0,13 0,33 0,24 0,17 0,60

177
(SCNPG)

(continuare)
 Tabelul 6.24 (continuare)

178
Coeficienţii de corelaţie dintre scalele şi scalele compozite EDI-3 şi scalele MCMI-II pentru un eşantion clinic

Scala MCMI-II
Scala/ Scala compozită EDI-3 m n o p r s t u v x y
Scala de Risc de tulburare de comportament alimentar/
Scala compozită
Dorinţa de a fi slab (DS) 0,14 0,13 0,13 0,23 0,00 0,18 0,06 0,11 0,14 0,17 0,29
Bulimie (B) 0,16 0,09 0,05 0,11 0,13 0,08 0,00 0,06 0,15 0,17 0,16
Nemulţumire faţă de corp (NC) 0,36 0,25 0,31 0,30 -0,03 0,32 0,19 0,24 0,34 0,40 0,35
Scala compozită Risc de tulburare de comportament 0,30 0,21 0,22 0,28 0,05 0,26 0,12 0,18 0,29 0,34 0,35
alimentar (SCRTCA)
Scala psihologică/
Scala compozită
Stimă de sine scăzută (SSS) 0,49 0,50 0,29 0,09 -0,10 0,46 0,31 0,17 0,37 0,51 0,19
Alienare personală (AP) 0,51 0,54 0,35 0,19 -0,12 0,43 0,33 0,25 0,41 0,45 0,25
Nesiguranţă interpersonală (NI) 0,32 0,64 0,07 0,11 -0,35 0,32 0,19 0,05 0,36 0,43 0,20
Alienare interpersonală (AI) 0,37 0,55 0,42 0,30 -0,12 0,31 0,34 0,29 0,41 0,37 0,31
Deficite interoceptive (DI) 0,42 0,45 0,39 0,24 0,07 0,41 0,33 0,33 0,40 0,38 0,34
Dezechilibru emoţional (DE) 0,51 0,50 0,62 0,19 0,07 0,41 0,57 0,52 0,47 0,47 0,31
Perfecţionism (P) 0,19 0,05 0,16 0,27 0,24 0,11 0,14 0,15 0,17 0,23 0,22
Ascetism (A) 0,44 0,35 0,44 0,38 0,22 0,39 0,24 0,28 0,32 0,34 0,40
Frica de maturitate (FM) 0,07 0,39 0,07 0,18 -0,24 0,25 0,01 -0,09 0,14 0,16 0,09
Scala compozită Ineficacitate (SCI) 0,53 0,56 0,35 0,16 -0,12 0,48 0,34 0,22 0,42 0,52 0,24
Scala compozită Probleme interpersonale (SCPI) 0,38 0,66 0,26 0,22 -0,27 0,35 0,29 0,18 0,42 0,44 0,28
Scala compozită Probleme emoţionale (SCPE) 0,53 0,54 0,58 0,24 0,07 0,47 0,52 0,49 0,50 0,49 0,37
Scala compozită Control exagerat (SCCE) 0,37 0,24 0,35 0,38 0,27 0,29 0,22 0,25 0,29 0,33 0,37
Scala compozită Neadaptare psihologică generală (SCNPG) 0,55 0,66 0,47 0,31 -0,07 0,52 0,42 0,32 0,51 0,56 0,38

Notă: N = 73. MCMI-II = Inventarul Clinic Multiaxial Millon – II (Millon, 1987)

a = dezvăluire, b = dezirabilitate, c = degradare, d = shizoid, e = evitant, f = dependent, g = histrionic, h = narcisist, i = antisocial, j = agresiv/sadic, k = compulsiv, l = pasiv-
agresiv, m = auto-distrugere, n = schizotipal, o = borderline, p = paranoic, r = tulburare bipolară: episod maniacal, s = tulburare distimică, t = dependenţă de alcool, u =
dependenţa de droguri, v = tulburări de gândire, x = depresie majoră, y = halucinaţii.
 Tabelul 6.25
Procentul participanţilor de sex masculin pe grupuri de
diagnostic din eşantionul clinic de adulţi din SUA, eşantionul
clinic internaţional de adulţi şi eşantionul internaţional de
adolescenţi la itemii scalei EDI-3 de Risc de tulburare de
comportament alimentar

Eşantion clinic masculin (%)

Adulţi Adolescenţi
Grup de
SUAa Internaţionalb Internaţionalc
diagnostic
AN-R 14,7 40,1 31,8
AN-AC/V 13,7 13,3 13,6
BN 35,3 33,3 31,8
TCAFAS 36,3 13,3 22,8
Notă: AN-R = Anorexie nervoasă de tip restrictiv; AN-AC/V = Anorexie nervoasă de
tip alimentaţie compulsivă/vărsături; BN = Bulimie nervoasă; TCAFAS = Tulburare
de comportament alimentar fără altă specificaţie.
a
N = 102; bN = 15; cN = 22

Tabelul 6.26
Mediile scorurilor brute la EDI-3 ale participanţilor de sex masculin din
eşantionul clinic de adulţi din SUA, eşantionul clinic internaţional
de adulţi şi eşantionul internaţional de adolescenţi

Eşantion clinic masculin (%)

Adulţi Adolescenţi
SUAa Internaţional b
Internaţionalc
Scala EDI-3 M AS M AS M AS
Scala de Risc de tulburare de
comportament alimentar
Dorinţa de a fi slab ( DS) 15,10 8,52 14,93 8,45 17,77 7,65
Bulimie (B) 12,61 9,63 10,53 10,90 10,95 10,64
Nemulţumire faţă de corp (NC) 22,05 11,81 22,80 10,14 25,00 13,35

Scala psihologică
Stimă de sine scăzută (SSS) 9,99 6,73 12,27 7,03 11,45 6,84
Alienare personală (AP) 10,97 7,21 12,40 5,78 12,95 6,93
Nesiguranţă interpersonală (NI) 9,68 5,22 10,93 6,31 9,91 5,91
Alienare interpersonală (AI) 9,04 6,00 10,20 5,89 10,55 5,95
Deficite interoceptive (DI) 12,98 8,38 14,80 9,01 13,73 7,65
Dezechilibru emoţional (DE) 6,75 5,69 7,60 4,75 7,41 6,34
Perfecţionism (P) 12,08 5,60 10,60 5,30 12,59 6,29
Ascetism (A) 10,34 5,97 11,27 6,35 11,45 5,26
Frica de maturitate (FM) 10,10 6,87 12,07 7,26 11,41 7,37
a
n = 102; bn = 15; cn = 22.

179
 Tabelul 6.27
Mediile scorurilor brute la EDI-3 ale participanţilor de sex feminin din eşantioanele
nonclinice de control (fără tulburări de comportament alimentar)

Eşantion feminin de control (%)

Adulţi Adolescenţi
SUAa Internaţionalb Internaţionalc
Scala EDI-3 M AS M AS M AS
Scala de Risc de tulburare de
comportament alimentar
Dorinţa de a fi slab (DS) 9,94 7,82 6,62 6,46 6,03 6,59
Bulimie (B) 4,65 5,42 2,69 4,36 2,22 3,61
Nemulţumire faţă de corp (NC) 19,95 11,27 16,37 10,52 15,51 10,77

Scala psihologică
Stimă de sine scăzută (SSS) 4,76 4,87 4,90 4,31 5,65 4,56
Alienare personală (AP) 6,29 5,47 4,79 4,18 5,34 4,44
Nesiguranţă interpersonală (NI) 7,34 3,98 6,22 4,68 6,85 4,72
Alienare interpersonală (AI) 6,19 4,81 5,67 4,10 5,54 4,04
Deficite interoceptive (DI) 7,34 6,57 5,93 5,19 7,51 5,36
Dezechilibru emoţional (DE) 5,14 4,81 4,06 3,67 5,28 4,62
Perfecţionism (P) 10,87 5,19 5,73 4,32 5,07 4,29
Ascetism (A) 6,16 4,35 4,02 3,67 4,18 3,61
Frica de maturitate (FM) 8,65 5,66 7,80 4,21 9,83 4,52
a
n = 679, bn = 1.018; cn = 1.074.

Tabelul 6.28
Mediile scorurilor brute la EDI-3 ale participanţilor de sex masculin
din eşantioanele nonclinice

Eşantion nonclinic masculin (%)

Adulţi Adolescenţi
SUA a
Internaţional b
Internaţionalc
Scala EDI-3 M AS M AS M AS
Scala de Risc de tulburare de
comportament alimentar
Dorinţa de a fi slab (DS) 5,63 6,41 2,26 3,21 1,54 3,17
Bulimie (B) 4,05 5,11 1,35 2,30 2,19 3,35
Nemulţumire faţă de corp (NC) 9,65 8,47 6,96 6,75 6,20 6,66

Scala psihologică
Stimă de sine scăzută (SSS) 3,95 5,16 2,99 3,38 2,74 3,29
Alienare personală (PA) 6,00 5,21 3,38 3,35 3,00 3,45
Nesiguranţă interpersonală (NI) 7,77 5,32 6,36 4,62 6,88 4,76
Alienare interpersonală (AI) 7,00 5,61 4,87 3,67 4,70 3,55
Deficite interoceptive (DI) 6,35 7,11 4,32 4,67 5,07 4,92
Dezechilibru emoţional (DE) 7,26 7,40 3,38 3,58 5,51 5,13
Perfecţionism (P) 11,23 4,92 5,53 3,99 6,29 4,87
Ascetism (A) 6,53 4,43 3,56 3,29 4,10 3,72
Frica de maturitate (FM) 8,42 5,82 7,89 4,74 9,99 5,19
a
n = 43; bn = 465; cn = 523.

180
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191
 Anexa A

Tabelele de conversie a scorurilor brute în cote T, a scorurilor brute

în centile şi a sumei cotelor T în cote T: eşantionul clinic de adulţi
din SUA al EDI-3

193
 Tabelul A1
Conversia scorurilor brute în cote T: Scalele EDI-3 de Risc de tulburare de comportament alimentar,
pentru eşantionul clinic de adulţi din SUA, în funcţie de grupul de diagnostic

Cote T pentru scalele de Risc de tulburare de comportament alimentar

Scor AN-R AN-C/V BN TCAFAS Scor
brut DS B NC DS B NC DS B NC DS B NC brut
0 29 39 27 20 34 22 12 22 17 19 37 21 0
1 30 42 28 21 36 23 14 23 18 21 38 22 1
2 31 45 29 23 37 24 16 25 19 22 39 23 2
3 32 47 30 24 38 25 17 26 20 24 41 24 3
4 34 50 31 25 39 26 19 27 21 25 42 25 4
5 35 53 32 27 40 27 21 29 23 27 43 26 5
6 36 55 33 28 42 28 23 30 24 28 44 27 6
7 37 58 34 30 43 29 24 32 25 29 46 28 7
8 38 61 35 31 44 30 26 33 26 31 47 29 8
9 40 63 36 33 45 31 28 34 27 32 48 30 9
10 41 66 37 34 46 32 30 36 28 34 49 31 10
11 42 69 38 35 48 33 31 37 29 35 51 32 11
12 43 71 39 37 49 34 33 38 30 37 52 33 12
13 44 74 40 38 50 35 35 40 31 38 53 34 13
14 45 77 41 40 51 36 37 41 32 40 54 35 14
15 47 79 42 41 52 37 39 43 34 41 56 36 15
16 48 82 43 43 54 38 40 44 35 42 57 37 16
17 49 85 44 44 55 39 42 45 36 44 58 38 17
18 50 87 44 45 56 40 44 47 37 45 59 39 18
19 51 90 45 47 57 41 46 48 38 47 61 40 19
20 52 92 46 48 58 42 47 49 39 48 62 41 20
21 54 95 47 50 60 43 49 51 40 50 63 42 21
22 55 98 48 51 61 44 51 52 41 51 64 43 22
23 56 100 49 53 62 45 53 54 42 53 66 44 23
24 57 100 50 54 63 46 54 55 43 54 67 45 24
25 58 100 51 55 64 47 56 56 45 55 68 46 25
26 59 100 52 57 66 48 58 58 46 57 69 47 26
27 61 100 53 58 67 49 60 59 47 58 71 48 27
28 62 100 54 60 68 50 61 60 48 60 72 49 28
29 100 55 69 51 62 49 73 50 29
30 100 56 70 52 63 50 74 51 30
31 100 57 71 53 65 51 76 52 31
32 100 58 73 54 66 52 77 53 32
33 59 55 53 54 33
34 60 56 54 55 34
35 60 57 56 56 35
36 61 58 57 57 36
37 62 59 58 58 37
38 63 60 59 59 38
39 64 61 60 60 39
40 65 62 61 61 40
IC 90% ±5 ±10 ±5 ±6 ±5 ±5 ±7 ±6 ±5 ±5 ±6 ±5 IC 90%
Notă. N = 983. AN-R = Anorexie nervoasă de tip restrictiv (n = 145); AN-AC/V = Anorexie nervoasă de tip alimentaţie compulsivă/
vărsături (n = 92); BN = Bulimie nervoasă (n = 429); TCAFAS = Tulburare de comportament alimentar fără altă specificaţie (n =
317). DS = Dorinţa de a fi slab; B = Bulimie; NC = Nemulţumire faţă de corp.

194
 Tabelul A2
Conversia scorurilor brute în cote T: Scalele psihologice EDI-3,
pentru eşantionul clinic de adulţi din SUA

Scor brut Cote T pentru Scalele psihologice Scor

SSS AP NI AI DI DE P A FM brut
0 28 28 31 31 29 36 27 28 34 0
1 30 30 33 33 30 37 28 29 36 1
2 32 32 34 35 32 39 30 31 37 2
3 33 33 36 36 33 41 32 33 39 3
4 35 35 38 38 34 43 33 35 40 4
5 37 36 39 40 35 44 35 36 42 5
6 38 38 41 42 37 46 37 38 43 6
7 40 39 43 44 38 48 38 40 44 7
8 42 41 44 46 39 50 40 42 46 8
9 43 43 46 48 40 51 42 43 47 9
10 45 44 47 49 41 53 44 45 49 10
11 47 46 49 51 43 55 45 47 50 11
12 48 47 51 53 44 57 47 49 52 12
13 50 49 52 55 45 58 49 50 53 13
14 52 51 54 57 46 60 50 52 55 14
15 53 52 56 59 48 62 52 54 56 15
16 55 54 57 61 49 64 54 56 58 16
17 57 55 59 62 50 66 55 57 59 17
18 58 57 60 64 51 67 57 59 60 18
19 60 59 62 66 53 69 59 61 62 19
20 61 60 64 68 54 71 61 63 63 20
21 63 62 65 70 55 73 62 64 65 21
22 65 63 67 72 56 74 64 66 66 22
23 66 65 69 74 57 76 66 68 68 23
24 68 67 70 76 59 78 67 70 69 24
25 68 72 77 60 80 71 71 25
26 70 73 79 61 81 73 72 26
27 71 75 81 62 83 75 73 27
28 73 77 83 64 85 77 75 28
29 65 87 76 29
30 66 88 78 30
31 67 90 79 31
32 69 92 81 32
33 70 33
34 71 34
35 72 35
36 73 36
IC 90% ±5 ±7 ±7 ±8 ±6 ±8 ±7 ±8 ±6 IC 90%
Notă: N = 983. SSS = Stimă de sine scăzută; AP = Alienare personală; NI= Nesiguranţă interpersonală; AI = Alienare interpersonală;
DI = Deficite interoceptive; DE = Dezechilibru emoţional; P= Perfecţionism; A = Ascetism ; FM = Frica de maturitate.

195
 Tabelul A3
Conversia scorurilor brute în centile: Scalele EDI-3 de Risc de tulburare de comportament
alimentar, pentru eşantionul clinic de adulţi din SUA, în funcţie de grupul de diagnostic

Scor Cote T pentru scalele de Risc de tulburare de comportament alimentar Scor

brut AN-R AN-C/V BN TCAFAS brut
DS B NC DS DS B NC DS DS B NC DS
0 2 12 1 1 2 1 1 1 1 1 3 1 0
1 4 29 1 1 5 1 1 1 1 1 9 1 1
2 5 41 1 3 11 2 1 1 1 2 14 1 2
3 7 49 1 4 19 2 1 2 1 3 18 1 3
4 10 57 2 4 22 2 1 3 1 4 24 2 4
5 12 64 3 5 25 3 1 4 2 4 32 3 5
6 13 71 3 5 28 4 2 5 2 6 37 3 6
7 14 78 4 6 29 4 3 6 2 6 42 4 7
8 17 83 5 7 31 4 4 7 3 7 46 5 8
9 18 87 8 8 33 5 4 8 3 9 50 6 9
10 20 90 10 9 38 6 5 10 4 9 54 6 10
11 23 93 11 11 41 7 7 12 5 10 58 7 11
12 27 97 13 12 43 7 8 14 5 12 62 7 12
13 29 99 16 14 47 8 9 16 6 13 67 9 13
14 32 99 20 16 51 10 11 19 6 16 70 9 14
15 35 99 23 18 57 11 13 21 7 18 73 11 15
16 38 99 26 19 61 13 16 25 9 21 75 14 16
17 41 99 31 21 65 16 19 30 10 22 77 15 17
18 44 99 36 26 70 18 22 35 12 25 79 17 18
19 47 99 39 29 76 21 26 39 14 28 82 18 19
20 51 99 41 33 80 24 32 43 16 32 84 19 20
21 55 99 44 36 83 25 38 49 18 36 87 21 21
22 59 99 47 39 84 26 44 54 20 39 89 23 22
23 62 99 49 43 84 27 50 58 21 44 90 25 23
24 66 99 52 51 88 29 59 63 23 53 92 27 24
25 71 99 54 60 91 32 67 69 24 61 94 30 25
26 76 99 57 69 93 35 76 75 29 70 95 33 26
27 82 99 60 82 96 39 86 81 32 80 96 36 27
28 93 99 62 94 96 42 96 86 36 93 97 39 28
29 99 64 97 45 89 39 99 42 29
30 99 67 98 48 92 43 99 45 30
31 99 69 99 53 96 47 99 49 31
32 99 72 99 58 99 51 99 52 32
33 75 62 54 55 33
34 77 66 58 57 34
35 79 70 61 58 35
36 82 74 66 63 36
37 85 78 71 69 37
38 87 79 77 74 38
39 89 84 84 81 39
40 95 94 94 93 40
Notă. N = 983. AN-R = Anorexie nervoasă de tip restrictiv (n = 145); AN-AC/V = Anorexie nervoasă de tip alimentaţie compulsivă/
vărsături (n = 92); BN = Bulimie nervoasă (n = 429); TCAFAS = Tulburare de comportament alimentar fără altă specificaţie (n =
317). DS = Dorinţa de a fi slab; B = Bulimie; NC = Nemulţumire faţă de corp.

196
 Tabelul A4
Conversia scorurilor brute în centile: Scalele psihologice EDI-3,
pentru eşantionul clinic de adulţi din SUA

Scor Centile pentru Scalele psihologice Scor

brut SSS AP NI AI DI DE P A FM brut
0 1 1 1 1 1 2 1 1 1 0
1 3 2 3 2 1 7 1 1 3 1
2 5 4 5 4 2 13 2 2 6 2
3 7 5 9 8 4 19 4 4 11 3
4 9 6 13 13 6 27 6 6 16 4
5 11 8 17 19 8 35 9 9 22 5
6 14 12 21 25 10 43 11 13 29 6
7 18 16 26 31 12 50 14 17 35 7
8 22 21 31 37 14 57 18 22 41 8
9 27 25 36 44 18 63 23 28 46 9
10 32 30 41 50 22 67 27 33 51 10
11 35 35 47 56 26 71 33 38 57 11
12 41 41 53 62 30 76 39 45 62 12
13 48 47 59 68 34 80 44 52 67 13
14 54 52 64 74 38 84 50 60 72 14
15 59 59 69 80 42 87 56 66 75 15
16 64 64 75 84 47 89 62 72 81 16
17 70 69 80 88 51 91 68 77 84 17
18 77 74 83 91 55 93 73 81 86 18
19 82 79 87 94 59 95 77 85 88 19
20 86 83 90 96 64 96 82 89 90 20
21 90 87 92 97 68 97 87 91 91 21
22 94 90 95 98 71 98 92 93 93 22
23 96 92 97 99 75 99 95 96 94 23
24 99 94 98 99 79 99 98 97 96 24
25 97 99 99 83 99 98 97 25
26 99 99 99 86 99 99 98 26
27 99 99 99 88 99 99 99 27
28 99 99 99 90 99 99 99 28
29 92 99 99 29
30 94 99 99 30
31 95 99 99 31
32 97 99 99 32
33 98 33
34 98 34
35 99 35
36 99 36
Notă: N = 983. SSS = Stimă de sine scăzută; AP = Alienare personală; NI= Nesiguranţă interpersonală; AI = Alienare interpersonală;
DI = Deficite interoceptive; DE = Dezechilibru emoţional; P= Perfecţionism; A = Ascetism ; FM = Frica de maturitate.

197
 Tabelul A5
Conversia sumei cotelor T în cote T: Scala compozită EDI-3 Risc de tulburare de comportament
alimentar, pentru eşantionul clinic de adulţi din SUA, în funcţie de grupul de diagnostic

SCRTCA
AN-R AN-AC/V BN TCAFAS
Suma Cota % IC 90% Suma Cota % IC 90% Suma Cota % IC 90% Suma Cota % IC 90%
cotelor T cotelor T cotelor T cotelor T
T T T T
95 26 1 23-34 76 18 1 16-24 51 7 1 6-14 77 18 1 16-24
96 26 1 23-34 77 19 1 17-25 52 8 1 7-15 78 18 1 16-24
97 27 1 24-35 78 19 1 17-25 53 8 1 7-15 79 19 1 17-25
98 27 1 24-35 79 19 1 17-25 54 9 1 7-16 80 19 1 17-25
99 28 1 25-35 80 20 1 18-26 55 9 1 7-16 81 19 1 17-25
100 28 1 25-35 81 20 1 18-26 56 9 1 7-16 82 20 1 18-26
101 29 1 26-36 82 21 1 19-27 57 10 1 8-17 83 20 1 18-26
102 29 1 26-36 83 21 1 19-27 58 10 1 8-17 84 21 1 19-27
103 29 1 26-36 84 22 1 20-28 59 11 1 9-18 85 21 1 19-27
104 30 2 27-37 85 22 1 20-28 60 11 1 9-18 86 22 1 20-28
105 30 2 27-37 86 22 1 20-28 61 12 1 10-19 87 22 2 20-28
106 31 2 28-38 87 23 1 21-29 62 12 1 10-19 88 22 2 20-28
107 31 2 28-38 88 23 1 21-29 63 12 1 10-19 89 23 2 21-29
108 32 2 29-39 89 24 1 22-30 64 13 1 11-20 90 23 2 21-29
109 32 3 29-39 90 24 1 22-30 65 13 1 11-20 91 24 3 22-30
110 32 4 29-39 91 24 1 22-30 66 14 1 12-21 92 24 3 22-30
111 33 4 29-40 92 25 1 22-31 67 14 1 12-21 93 25 3 22-31
112 33 5 29-40 93 25 1 22-31 68 15 1 13-22 94 25 4 22-31
113 34 5 30-41 94 26 2 22-31 69 15 1 13-22 95 25 4 22-31
114 34 6 30-41 95 26 3 22-31 70 15 1 13-22 96 26 4 23-31
115 34 6 30-41 96 27 3 24-32 71 16 1 14-23 97 26 4 23-31
116 35 6 31-42 97 27 4 24-32 72 16 1 14-23 98 27 4 24-32
117 35 8 31-42 98 27 4 24-32 73 17 1 15-24 99 27 4 24-32
118 36 9 32-43 99 28 5 25-33 74 17 1 15-24 100 28 5 25-33
119 36 10 32-43 100 28 5 25-33 75 18 1 16-25 101 28 5 25-33
120 37 11 33-44 101 29 5 26-34 76 18 1 16-25 102 29 5 26-34
121 37 12 33-44 102 29 5 26-34 77 18 1 16-25 103 29 5 26-34
122 37 13 33-44 103 30 5 27-35 78 19 1 17-26 104 29 6 26-34
123 38 15 34-44 104 30 5 27-35 79 19 1 17-26 105 30 6 27-35
124 38 17 34-44 105 30 5 27-35 80 20 1 18-26 106 30 7 27-35
125 39 18 35-45 106 31 5 28-36 81 20 1 18-26 107 31 7 28-36
126 39 18 35-45 107 31 6 28-36 82 20 1 18-26 108 31 7 28-36
127 40 19 36-46 108 32 7 29-37 83 21 1 19-27 109 32 7 29-37
128 40 20 36-46 109 32 8 29-37 84 21 1 19-27 110 32 7 29-37
129 40 21 36-46 110 33 8 30-38 85 22 2 20-28 111 32 8 29-37
130 41 22 37-47 111 33 8 30-38 86 22 2 20-28 112 33 8 30-38
131 41 22 37-47 112 33 8 30-38 87 23 2 21-29 113 33 8 30-38
132 42 24 38-48 113 34 9 31-39 88 23 2 21-29 114 34 9 31-39
133 42 26 38-48 114 34 9 31-39 89 23 2 21-29 115 34 9 31-39
134 43 26 38-49 115 35 9 32-40 90 24 2 21-30 116 35 9 32-40
135 43 27 38-49 116 35 10 32-40 91 24 2 21-30 117 35 9 32-40
136 43 28 38-49 117 36 10 33-41 92 25 3 22-31 118 35 10 32-40
137 44 30 39-50 118 36 12 33-41 93 25 3 22-31 119 36 10 33-41
138 44 30 39-50 119 36 13 33-41 94 26 3 23-32 120 36 11 33-41
139 45 31 40-51 120 37 13 34-42 95 26 3 23-32 121 37 11 34-42
140 45 32 40-51 121 37 13 34-42 96 26 3 23-32 122 37 11 34-42
141 46 33 41-52 122 38 14 35-43 97 27 3 24-33 123 38 11 35-43
(continuare)

198
 Tabelul A5
Conversia sumei cotelor T în cote T: Scala compozită EDI-3 Risc de tulburare de comportament
alimentar, pentru eşantionul clinic de adulţi din SUA, în funcţie de grupul de diagnostic
(continuare)

SCRTCA
AN-R AN-AC/V BN TCAFAS
Suma Cota % IC 90% Suma Cota % IC 90% Suma Cota % IC 90% Suma Cota % IC 90%
cotelor T cotelor T cotelor T cotelor T
T T T T
142 46 34 41-52 123 38 15 35-43 98 27 3 24-33 124 38 12 35-43
143 46 35 41-52 124 38 15 35-43 99 28 3 25-34 125 39 12 36-44
144 47 36 42-53 125 39 16 36-44 100 28 3 25-34 126 39 12 36-44
145 47 37 42-53 126 39 17 36-44 101 29 3 26-35 127 39 12 36-44
146 48 38 43-53 127 40 17 37-45 102 29 3 26-35 128 40 13 37-45
147 48 40 43-53 128 40 17 37-45 103 29 3 26-35 129 40 14 37-45
148 49 44 44-54 129 41 17 37-46 104 30 4 27-36 130 41 14 37-46
149 49 46 44-54 130 41 17 37-46 105 30 4 27-36 131 41 15 37-46
150 49 47 44-54 131 41 17 37-46 106 31 5 28-37 132 42 16 38-47
151 50 49 45-55 132 42 18 38-47 107 31 5 28-37 133 42 17 38-47
152 50 51 45-55 133 42 19 38-47 108 32 5 29-38 134 42 18 38-47
153 51 52 46-56 134 43 20 39-47 109 32 5 29-38 135 43 19 39-47
154 51 53 46-56 135 43 22 39-47 110 32 6 29-38 136 43 20 39-47
155 51 55 46-56 136 44 25 40-48 111 33 6 30-39 137 44 21 40-48
156 52 57 47-57 137 44 26 40-48 112 33 7 30-39 138 44 23 40-48
157 52 58 47-57 138 44 26 40-48 113 34 7 31-39 139 45 24 41-49
158 53 59 47-58 139 45 27 41-49 114 34 7 31-39 140 45 25 41-49
159 53 61 47-58 140 45 27 41-49 115 35 8 32-40 141 46 26 42-50
160 54 63 48-59 141 46 27 42-50 116 35 8 32-40 142 46 27 42-50
161 54 65 48-59 142 46 28 42-50 117 35 9 32-40 143 46 28 42-50
162 54 65 48-59 143 47 28 43-51 118 36 10 33-41 144 47 29 43-51
163 55 66 49-60 144 47 29 43-51 119 36 10 33-41 145 47 31 43-51
164 55 67 49-60 145 47 32 43-51 120 37 10 34-42 146 48 32 44-52
165 56 68 50-61 146 48 34 44-52 121 37 11 34-42 147 48 33 44-52
166 56 69 50-61 147 48 35 44-52 122 38 12 34-43 148 49 34 45-53
167 57 69 51-62 148 49 35 45-53 123 38 13 34-43 149 49 35 45-53
168 57 70 51-62 149 49 36 45-53 124 38 14 34-43 150 49 38 45-53
169 57 72 51-62 150 49 37 45-53 125 39 15 35-44 151 50 40 46-54
170 58 74 52-62 151 50 39 46-54 126 39 16 35-44 152 50 41 46-54
171 58 76 52-62 152 50 40 46-54 127 40 16 36-45 153 51 44 47-55
172 59 77 53-63 153 51 42 47-55 128 40 17 36-45 154 51 46 47-55
173 59 77 53-63 154 51 43 47-55 129 41 17 37-46 155 52 48 48-56
174 60 78 54-64 155 52 47 48-56 130 41 18 37-46 156 52 50 48-56
175 60 79 54-64 156 52 49 48-56 131 41 18 37-46 157 52 52 48-56
176 60 81 54-64 157 52 51 48-56 132 42 19 38-47 158 53 55 49-57
177 61 82 55-65 158 53 52 49-57 133 42 20 38-47 159 53 58 49-57
178 61 84 55-65 159 53 54 49-57 134 43 21 39-48 160 54 61 50-58
179 62 85 56-66 160 54 57 50-58 135 43 22 39-48 161 54 64 50-58
180 62 86 56-66 161 54 60 50-58 136 44 22 40-49 162 55 68 51-59
181 63 87 56-67 162 55 62 51-59 137 44 23 40-49 163 55 70 51-59
182 63 88 56-67 163 55 65 51-59 138 44 24 40-49 164 56 72 52-60
183 63 89 56-67 164 55 67 51-59 139 45 25 41-50 165 56 74 52-60
184 64 90 57-68 165 56 68 52-60 140 45 25 41-50 166 56 76 52-60
185 64 92 57-68 166 56 70 52-60 141 46 27 42-51 167 57 78 53-61
186 65 94 58-69 167 57 73 53-61 142 46 28 42-51 168 57 79 53-61
187 65 95 58-69 168 57 74 53-61 143 47 30 43-52 169 58 81 53-62

(continuare)

199
 Tabelul A5
Conversia sumei cotelor T în cote T: Scala compozită EDI-3 Risc de tulburare de comportament
alimentar, pentru eşantionul clinic de adulţi din SUA, în funcţie de grupul de diagnostic
(continuare)

SCRTCA
AN-R AN-AC/V BN TCAFAS
Suma Cota % IC 90% Suma Cota % IC 90% Suma Cota % IC 90% Suma Cota % IC 90%
cotelor T cotelor T cotelor T cotelor T
T T T T
188 66 96 59-70 169 58 77 53-62 144 47 31 43-52 170 58 82 53-62
189 66 97 59-70 170 58 79 53-62 145 47 34 43-52 171 59 84 54-63
190 66 98 59-70 171 58 82 53-62 146 48 35 44-53 172 59 85 54-63
191 67 98 60-71 172 59 84 54-63 147 48 37 44-53 173 59 87 54-63
192 67 99 60-71 173 59 86 54-63 148 49 38 45-54 174 60 87 55-63
193 68 99 61-71 174 60 88 55-63 149 49 40 45-53 175 60 88 55-63
194 68 99 61-71 175 60 88 55-63 150 49 41 45-53 176 61 90 56-64
195 68 99 61-71 176 61 89 56-64 151 50 43 46-54 177 61 91 56-64
196 69 99 62-72 177 61 91 56-64 152 50 44 46-54 178 62 91 57-65
197 69 99 62-72 178 61 92 56-64 153 51 45 47-55 179 62 92 57-65
198 70 99 63-73 179 62 92 57-65 154 51 46 47-55 180 62 92 57-65
199 70 99 63-73 180 62 93 57-65 155 52 49 47-56 181 63 93 58-66
200 71 99 64-74 181 63 94 58-66 156 52 51 47-56 182 63 93 58-66
201 71 99 64-74 182 63 95 58-66 157 52 52 47-56 183 64 94 59-67
202 71 99 64-74 183 63 96 58-66 158 53 54 48-57 184 64 95 59-67
203 72 99 65-75 184 64 97 59-67 159 53 55 48-57 185 65 96 60-68
204 72 99 65-75 185 64 98 59-67 160 54 56 49-58 186 65 96 60-68
205 73 99 65-76 186 65 98 60-68 161 54 58 49-58 187 66 97 61-69
206 73 99 65-76 187 65 98 60-68 162 55 60 50-59 188 66 98 61-69
207 74 99 66-77 188 66 98 61-69 163 55 62 50-59 189 66 98 61-69
208 74 99 66-77 189 66 98 61-69 164 55 64 50-59 190 67 98 62-70
209 74 99 66-77 190 66 99 61-69 165 56 67 51-60 191 67 99 62-70
210 75 99 67-78 191 67 99 62-70 166 56 69 51-60 192 68 99 63-71
211 75 99 67-78 192 67 99 62-70 167 57 71 52-61 193 68 99 63-71
212 76 99 68-79 193 68 99 63-71 168 57 73 52-61 194 69 99 64-72
213 76 99 68-79 194 68 99 63-71 169 58 74 53-62 195 69 99 64-72
214 77 99 69-80 195 69 99 64-72 170 58 76 53-62 196 69 99 64-72
215 77 99 69-80 171 58 78 53-62 197 70 99 65-73
216 77 99 69-80 172 59 81 54-63 198 70 99 65-73
217 78 99 70-80 173 59 84 54-63
218 78 99 70-80 174 60 86 55-64
219 79 99 71-81 175 60 88 55-64
220 79 99 71-81 176 61 90 56-65
221 80 99 72-82 177 61 92 56-65
222 80 99 72-82 178 61 93 56-65
223 80 99 72-82 179 62 94 57-66
224 81 99 73-83 180 62 95 57-66
225 81 99 73-83 181 63 96 58-66
226 82 99 74-84 182 63 97 58-66
227 82 99 74-84 183 64 97 59-67
184 64 98 59-67
185 64 98 59-67
186 65 99 60-68
187 65 99 60-68
188 66 99 61-69
Notă. N = 983. SCRTCA = scala compozită Risc de tulburare de comprotament alimentar; AN-R = Anorexie nervoasă de tip
restrictiv (n = 145); AN-AC/V = Anorexie nervoasă de tip alimentaţie compulsivă/vărsături (n = 92); BN = Bulimie nervoasă (n
= 429); TCAFAS = Tulburare de comportament alimentar fără altă specificaţie (n = 317).

200
 Tabelul A6
Conversia sumei cotelor T în cote T: Scale compozite psihologice EDI-3, pentru eşantionul clinic de
adulţi din SUA

Scalele compozite psihologice

SCI SCPI SCPE SCCE
Suma Cota % IC 90% Suma Cota % IC 90% Suma Cota % IC 90% Suma Cota % IC 90%
cotelor T cotelor T cotelor T cotelor T
T T T T
56 26 1 23-33 62 28 1 25-36 65 29 1 26-37 55 23 1 21-33
57 27 1 24-34 63 29 1 26-37 66 30 1 27-38 56 24 1 22-34
58 27 1 24-34 64 29 1 26-37 67 31 1 28-39 57 24 1 22-34
59 28 1 25-34 65 30 1 27-38 68 31 1 28-39 58 25 1 22-35
60 28 1 25-34 66 30 1 27-38 69 32 1 28-40 59 25 1 22-35
61 29 2 26-35 67 31 1 28-39 70 32 2 28-40 60 26 1 23-36
62 29 2 26-35 68 31 2 28-39 71 33 2 29-41 61 26 1 23-36
63 30 3 27-36 69 32 2 28-40 72 33 3 29-41 62 27 1 24-37
64 30 3 27-36 70 33 2 29-41 73 34 4 30-42 63 28 1 25-38
65 31 4 28-37 71 33 3 29-41 74 35 5 31-43 64 28 1 25-38
66 32 4 29-38 72 34 4 30-42 75 35 6 31-43 65 29 1 26-39
67 32 5 29-38 73 34 5 30-42 76 36 7 32-43 66 29 1 26-39
68 33 5 30-39 74 35 6 31-43 77 36 8 32-43 67 30 2 27-39
69 33 6 30-39 75 35 7 31-43 78 37 9 33-44 68 31 2 27-40
70 34 6 31-40 76 36 8 32-43 79 37 10 33-44 69 31 3 27-40
71 34 7 31-40 77 36 9 32-43 80 38 11 34-45 70 32 4 28-41
72 35 7 32-41 78 37 10 33-44 81 39 12 35-46 71 32 4 28-41
73 35 8 32-41 79 38 11 34-45 82 40 14 35-46 72 33 5 29-42
74 36 9 32-42 80 38 13 34-45 83 40 15 35-47 73 34 5 30-43
75 36 10 32-42 81 39 15 35-46 84 41 17 35-47 74 34 6 30-43
76 37 10 33-43 82 39 16 35-46 85 41 19 36-48 75 35 7 31-44
77 37 12 33-43 83 40 18 35-47 86 42 21 36-48 76 35 8 31-44
78 38 13 34-44 84 40 20 35-47 87 42 23 37-49 77 36 9 32-44
79 38 14 34-44 85 41 22 36-48 88 43 26 38-50 78 37 10 33-45
80 39 15 35-45 86 42 23 37-49 89 43 28 38-50 79 37 11 33-45
81 39 16 35-45 87 42 25 37-49 90 44 30 39-50 80 38 13 33-46
82 40 18 36-45 88 43 27 38-50 91 44 32 39-50 81 38 14 33-46
83 40 19 36-45 89 43 28 38-50 92 45 34 40-51 82 39 16 34-47
84 41 20 37-46 90 44 30 39-50 93 45 36 40-51 83 39 17 34-47
85 42 21 38-47 91 44 32 39-50 94 46 38 41-52 84 40 18 35-48
86 42 22 38-47 92 45 34 40-51 95 47 40 42-53 85 41 19 36-49
87 43 24 39-48 93 45 35 40-51 96 47 42 42-53 86 41 21 36-49
88 43 25 39-48 94 46 37 41-52 97 48 45 43-54 87 42 22 37-50
89 44 27 40-49 95 47 39 42-53 98 48 46 43-54 88 42 24 37-50
90 44 29 40-49 96 47 41 42-53 99 49 49 43-55 89 43 25 38-50
91 45 31 41-50 97 48 43 43-54 100 49 51 43-55 90 44 26 39-51
92 45 32 41-50 98 48 45 43-54 101 50 53 44-56 91 44 29 39-51
93 46 34 42-51 99 49 47 43-55 102 51 56 45-57 92 45 30 39-52
94 46 35 42-51 100 49 49 43-55 103 51 59 45-57 93 45 33 39-52
95 47 37 43-52 101 50 51 44-56 104 52 61 46-57 94 46 35 40-53
96 47 39 43-52 102 51 52 45-57 105 52 62 46-57 95 47 37 41-54
97 48 41 43-53 103 51 53 45-57 106 53 64 47-58 96 47 40 41-54
98 48 43 43-53 104 52 55 46-57 107 53 66 47-58 97 48 41 42-55
99 49 45 44-54 105 52 57 46-57 108 54 69 48-59 98 48 44 42-55
100 49 46 44-54 106 53 60 47-58 109 55 70 49-60 99 49 45 43-56
101 50 49 45-55 107 53 62 47-58 110 55 72 49-60 100 49 47 43-56
102 51 50 46-56 108 54 64 48-59 111 56 73 50-61 101 50 49 44-56
103 51 53 46-56 109 54 66 48-59 112 56 74 50-61 102 51 52 44-57
104 52 55 47-57 110 55 68 49-60 113 57 75 50-62 103 51 54 44-57
105 52 56 47-57 111 56 70 50-61 114 57 76 50-62 104 52 55 45-58
106 53 58 48-57 112 56 72 50-61 115 58 78 51-63 105 52 58 45-58
107 53 59 48-57 113 57 74 50-62 116 59 79 51-63 106 53 60 46-59
(continuare)

201
 Tabelul A6
Conversia sumei cotelor T în cote T: Scale compozite psihologice EDI-3, pentru eşantionul clinic de
adulţi din SUA (continuare)

Scalele compozite psihologice

SCI SCPI SCPE SCCE
Suma Cota % IC 90% Suma Cota % IC 90% Suma Cota % IC 90% Suma Cota % IC 90%
cotelor T cotelor T cotelor T cotelor T
T T T T
108 54 61 49-58 114 57 76 50-62 117 59 80 52-64 107 54 62 47-60
109 54 64 49-58 115 58 77 51-63 118 60 81 53-65 108 54 65 47-60
110 55 65 50-59 116 58 79 51-63 119 60 83 53-65 109 55 66 48-61
111 55 68 50-59 117 59 81 52-64 120 61 84 54-65 110 55 69 48-61
112 56 69 51-60 118 60 82 53-65 121 61 85 54-65 111 56 71 49-61
113 56 71 51-60 119 60 83 53-65 122 62 87 55-66 112 57 73 50-62
114 57 73 52-61 120 61 85 54-65 123 63 88 56-67 113 57 75 50-62
115 57 74 52-61 121 61 86 54-65 124 63 89 56-67 114 58 77 50-63
116 58 76 53-62 122 62 86 55-66 125 64 90 57-68 115 58 79 50-63
117 58 77 53-62 123 62 88 55-66 126 64 91 57-68 116 59 80 51-64
118 59 79 54-63 124 63 89 56-67 127 65 91 57-69 117 60 82 52-65
119 59 80 54-63 125 63 90 56-67 128 65 92 57-69 118 60 83 52-65
120 60 82 55-64 126 64 91 57-68 129 66 93 58-70 119 61 85 53-66
121 61 84 55-65 127 65 92 57-69 130 67 94 59-71 120 61 87 53-66
122 61 85 55-65 128 65 93 57-69 131 67 94 59-71 121 62 88 54-67
123 62 87 56-66 129 66 94 58-70 132 68 95 60-72 122 62 89 54-67
124 62 89 56-66 130 66 94 58-70 133 68 96 60-72 123 63 91 55-67
125 63 90 57-67 131 67 95 59-71 134 69 96 61-72 124 64 92 56-68
126 63 91 57-67 132 67 95 59-71 135 69 96 61-72 125 64 92 56-68
127 64 92 58-68 133 68 96 60-72 136 70 97 62-73 126 65 93 56-69
128 64 92 58-68 134 68 97 60-72 137 71 97 63-74 127 65 94 56-69
129 65 93 59-68 135 69 97 61-72 138 71 98 63-74 128 66 95 57-70
130 65 94 59-68 136 70 97 62-73 139 72 98 64-75 129 67 95 58-71
131 66 95 60-69 137 70 98 62-73 140 72 98 64-75 130 67 95 58-71
132 66 96 60-69 138 71 98 63-74 141 73 98 65-76 131 68 96 59-72
133 67 97 61-70 139 71 98 63-74 142 73 99 65-76 132 68 97 59-72
134 67 97 61-70 140 72 99 64-75 143 74 99 65-77 133 69 97 60-73
135 68 98 62-71 141 72 99 64-75 144 75 99 66-78 134 70 97 61-73
136 68 98 62-71 142 73 99 65-76 145 75 99 66-78 135 70 98 61-73
137 69 99 63-72 143 74 99 65-77 146 76 99 67-79 136 71 99 61-74
138 70 99 64-73 144 74 99 65-77 147 76 99 67-79 137 71 99 61-74
139 70 99 64-73 145 75 99 66-78 148 77 99 68-79 138 72 99 62-75
140 71 99 65-74 146 75 99 66-78 149 78 99 69-80 139 72 99 62-75
141 71 99 65-74 147 76 99 67-79 150 78 99 69-80 140 73 99 63-76
148 76 99 67-79 151 79 99 70-81 141 74 99 64-77
149 77 99 68-79 152 79 99 70-81 142 74 99 64-77
150 77 99 68-79 153 80 99 71-82 143 75 99 65-78
151 78 99 69-80 154 80 99 71-82 144 75 99 65-78
152 79 99 70-81 155 81 99 72-83
153 79 99 70-81 156 82 99 72-84
154 80 99 71-82 157 82 99 72-84
155 80 99 71-82 158 83 99 73-85
156 81 99 72-83 159 83 99 73-85
157 81 99 72-83 160 84 99 74-86
158 82 99 72-84 161 84 99 74-86
159 83 99 73-85 162 85 99 75-87
160 83 99 73-85 163 86 99 76-87
164 86 99 76-87
165 87 99 77-88
Notă. N = 983. SCI = Scala compozită Ineficacitate; SCPI = Scala compozită Probleme interpersonale; SCPE = Scala compozită
Probleme emoţionale; SCCE = Scala compozită Control exagerat.

202
 Tabelul A7
Conversia sumei cotelor T în cote T: Scala compozită EDI-3 Neadaptare psihologică generală,
pentru eşantionul clinic de adulţi din SUA

SCNPG
Suma Cota T % IC 90% Suma Cota T % IC 90% Suma Cota T % IC 90%
cotelor cotelor T cotelor
T T
272 21 1 19-25 316 28 1 26-32 360 35 7 32-39
273 22 1 20-26 317 28 1 26-32 361 35 8 32-39
274 22 1 20-26 318 29 1 27-33 362 36 8 33-40
275 22 1 20-26 319 29 1 27-33 363 36 8 33-40
276 22 1 20-26 320 29 2 27-33 364 36 8 33-40
277 22 1 20-26 321 29 2 27-33 365 36 8 33-40
278 22 1 20-26 322 29 2 27-33 366 36 8 33-40
279 23 1 21-27 323 29 2 27-33 367 36 9 33-40
280 23 1 21-27 324 30 2 28-34 368 36 9 33-40
281 23 1 21-27 325 30 2 28-34 369 37 9 34-41
282 23 1 21-27 326 30 3 28-34 370 37 9 34-41
283 23 1 21-27 327 30 3 28-34 371 37 10 34-41
284 23 1 21-27 328 30 3 28-34 372 37 10 34-41
285 23 1 21-27 329 30 3 28-34 373 37 10 34-41
286 24 1 22-28 330 31 3 28-35 374 37 10 34-41
287 24 1 22-28 331 31 3 28-35 375 38 11 35-42
288 24 1 22-28 332 31 3 28-35 376 38 11 35-42
289 24 1 22-28 333 31 3 28-35 377 38 12 35-42
290 24 1 22-28 334 31 3 28-35 378 38 12 35-42
291 24 1 22-28 335 31 3 28-35 379 38 12 35-42
292 25 1 23-29 336 31 3 28-35 380 38 13 35-42
293 25 1 23-29 337 32 3 29-36 381 39 13 36-43
294 25 1 23-29 338 32 4 29-36 382 39 14 36-43
295 25 1 23-29 339 32 4 29-36 383 39 14 36-43
296 25 1 23-29 340 32 4 29-36 384 39 14 36-43
297 25 1 23-29 341 32 4 29-36 385 39 14 36-43
298 26 1 24-30 342 32 4 29-36 386 39 14 36-43
299 26 1 24-30 343 33 4 30-37 387 39 15 36-43
300 26 1 24-30 344 33 4 30-37 388 40 15 37-44
301 26 1 24-30 345 33 4 30-37 389 40 16 37-44
302 26 1 24-30 346 33 5 30-37 390 40 16 37-44
303 26 1 24-30 347 33 5 30-37 391 40 17 37-44
304 26 1 24-30 348 33 5 30-37 392 40 18 37-44
305 27 1 25-31 349 33 5 30-37 393 40 18 37-44
306 27 1 25-31 350 34 6 31-38 394 41 18 38-45
307 27 1 25-31 351 34 6 31-38 395 41 19 38-45
308 27 1 25-31 352 34 6 31-38 396 41 19 38-45
309 27 1 25-31 353 34 6 31-38 397 41 20 38-45
310 27 1 25-31 354 34 6 31-38 398 41 20 38-45
311 28 1 26-32 355 34 6 31-38 399 41 21 38-45
312 28 1 26-32 356 35 7 32-39 400 41 21 38-45
313 28 1 26-32 357 35 7 32-39 401 42 22 39-46
314 28 1 26-32 358 35 7 32-39 402 42 22 39-46
315 28 1 26-32 359 35 7 32-39 403 42 23 39-46
404 42 23 39-46 447 49 46 46-52 491 56 71 52-59
405 42 23 39-46 448 49 47 46-52 492 56 71 52-59
406 42 24 39-46 449 49 48 46-52 493 56 72 52-59
407 43 24 40-47 450 49 48 46-52 494 56 72 52-59
408 43 25 40-47 451 49 49 46-52 495 56 73 52-59
(continuare)

203
 Tabelul A7
Conversia sumei cotelor T în cote T: Scala compozită EDI-3 Neadaptare psihologică generală,
pentru eşantionul clinic de adulţi din SUA (continuare)

SCNPG
Suma Cota T % IC 90% Suma Cota T % IC 90% Suma Cota T % IC 90%
cotelor cotelor T cotelor
T T
409 43 25 40-47 452 50 50 47-53 496 57 73 53-60
410 43 26 40-47 453 50 51 47-53 497 57 74 53-60
411 43 26 40-47 454 50 52 47-53 498 57 74 53-60
412 43 27 40-47 455 50 52 47-53 499 57 74 53-60
413 44 27 41-48 456 50 53 47-53 500 57 74 53-60
414 44 27 41-48 457 50 53 47-53 501 57 75 53-60
415 44 28 41-48 458 51 54 48-54 502 57 75 53-60
416 44 28 41-48 459 51 54 48-54 503 58 76 54-61
417 44 28 41-48 460 51 55 48-54 504 58 77 54-61
418 44 29 41-48 461 51 55 48-54 505 58 78 54-61
419 44 29 41-48 462 51 56 48-54 506 58 79 54-61
420 45 30 42-49 463 51 56 48-54 507 58 79 54-61
421 45 31 42-49 464 51 56 48-54 508 58 79 54-61
422 45 31 42-49 465 52 57 49-55 509 59 80 55-62
423 45 32 42-49 466 52 57 49-55 510 59 80 55-62
424 45 32 42-49 467 52 58 49-55 511 59 80 55-62
425 45 33 42-49 468 52 58 49-55 512 59 81 55-62
426 46 34 43-49 469 52 58 49-55 513 59 81 55-62
427 46 34 43-49 470 52 59 49-55 514 59 81 55-62
428 46 35 43-49 471 53 60 50-56 515 59 81 55-62
429 46 35 43-49 472 53 60 50-56 516 60 82 56-63
430 46 35 43-49 473 53 61 50-56 517 60 82 56-63
431 46 36 44-50 474 53 62 50-56 518 60 83 56-63
432 46 36 44-50 475 53 63 50-56 519 60 83 56-63
433 47 37 44-50 476 53 63 50-56 520 60 84 56-63
434 47 37 44-50 477 54 64 51-57 521 60 84 56-63
435 47 38 44-50 478 54 64 51-57 522 61 84 57-64
436 47 39 44-50 479 54 65 51-57 523 61 85 57-64
437 47 40 44-50 480 54 65 51-57 524 61 85 57-64
438 47 40 44-50 481 54 65 51-57 525 61 85 57-64
439 48 41 45-51 482 54 65 51-57 526 61 86 57-64
440 48 41 45-51 483 54 66 51-57 527 61 86 57-64
440 48 41 45-51 484 55 67 52-58 528 62 86 58-65
441 48 42 45-51 485 55 67 52-58 529 62 86 58-65
442 48 43 45-51 486 55 68 52-58 530 62 87 58-65
443 48 43 45-51 487 55 69 52-58 531 62 87 58-65
444 48 44 45-51 488 55 69 52-58 532 62 87 58-65
445 49 45 46-52 489 55 70 52-58 533 62 87 58-65
446 49 45 46-52 490 56 70 52-59 534 62 88 58-65
535 63 88 59-66 579 69 98 65-72 623 76 99 72-78
536 63 88 59-66 580 70 98 66-73 624 77 99 73-79
537 63 88 59-66 581 70 98 66-73 625 77 99 73-79
538 63 89 59-66 582 70 98 66-73 626 77 99 73-79
539 63 89 59-66 583 70 98 66-73 627 77 99 73-79
540 63 90 59-66 584 70 98 66-73 628 77 99 73-79
541 64 90 60-67 585 70 98 66-73 629 77 99 73-79
542 64 91 60-67 586 71 98 67-73 630 77 99 73-79
543 64 91 60-67 587 71 99 67-73 631 78 99 74-80
544 64 91 60-67 588 71 99 67-73 632 78 99 74-80
(continuare)

204
 Tabelul A7
Conversia sumei cotelor T în cote T: Scala compozită EDI-3 Neadaptare psihologică generală,
pentru eşantionul clinic de adulţi din SUA (continuare)

SCNPG
Suma Cota T % IC 90% Suma Cota T % IC 90% Suma Cota T % IC 90%
cotelor cotelor T cotelor
T T
545 64 91 60-67 589 71 99 67-73 633 78 99 74-80
546 64 92 60-67 590 71 99 67-73 634 78 99 74-80
547 64 92 60-67 591 71 99 67-73 635 78 99 74-80
548 65 92 61-68 592 72 99 68-74 636 78 99 74-80
549 65 92 61-68 593 72 99 68-74 637 79 99 75-81
550 65 93 61-68 594 72 99 68-74 638 79 99 75-81
551 65 93 61-68 595 72 99 68-74 639 79 99 75-81
552 65 93 61-68 596 72 99 68-74 640 79 99 75-81
553 65 93 61-68 597 72 99 68-74 641 79 99 75-81
554 66 93 62-69 598 72 99 68-74 642 79 99 75-81
555 66 93 62-69 599 73 99 69-75 643 80 99 76-82
556 66 94 62-69 600 73 99 69-75 644 80 99 76-82
557 66 94 62-69 601 73 99 69-75 645 80 99 76-82
558 66 94 62-69 602 73 99 69-75 646 80 99 76-82
559 66 94 62-69 603 73 99 69-75 647 80 99 76-82
560 67 95 63-70 604 73 99 69-75 648 80 99 76-82
561 67 95 63-70 605 74 99 70-76 649 80 99 76-82
562 67 95 63-70 606 74 99 70-76 650 81 99 76-83
563 67 95 63-70 607 74 99 70-76 651 81 99 76-83
564 67 96 63-70 608 74 99 70-76 652 81 99 76-83
565 67 96 63-70 609 74 99 70-76 653 81 99 76-83
566 67 96 63-70 610 74 99 70-76 654 81 99 76-83
567 68 96 64-71 611 75 99 71-77 655 81 99 76-83
568 68 96 64-71 612 75 99 71-77 656 82 99 77-84
569 68 96 64-71 613 75 99 71-77 657 82 99 77-84
570 68 97 64-71 614 75 99 71-77 658 82 99 77-84
571 68 97 64-71 615 75 99 71-77 659 82 99 77-84
572 68 97 64-71 616 75 99 71-77 660 82 99 77-84
573 69 97 65-72 617 75 99 71-77 661 82 99 77-84
574 69 97 65-72 618 76 99 72-78 662 82 99 77-84
575 69 98 65-72 619 76 99 72-78 663 83 99 78-85
576 69 98 65-72 620 76 99 72-78 664 83 99 78-85
577 69 98 65-72 621 76 99 72-78 665 83 99 78-85
578 69 98 65-72 622 76 99 72-78 666 83 99 78-85
667 83 99 78-85 675 85 99 80-87 683 86 99 81-88
668 83 99 78-85 676 85 99 80-87 684 86 99 81-88
669 84 99 79-86 677 85 99 80-87 685 86 99 81-88
670 84 99 79-86 678 85 99 80-87 686 86 99 81-88
671 84 99 79-86 679 85 99 80-87 687 86 99 81-88
672 84 99 79-86 680 85 99 80-87 688 87 99 82-89
673 84 99 79-86 681 85 99 80-87 689 87 99 82-89
674 84 99 79-86 682 86 99 81-88 690 87 99 82-89
691 87 99 82-89
Notă: N = 983. SCNPG = Scala compozită Neadaptare psihologică generală.

205
 Anexa B

Tabele de conversie a scorurilor brute în cote T, a scorurilor brute în

centile şi a sumei cotelor T în cote T: Eşantion clinic internaţional
EDI-3 de adulţi

207
 Tabelul B1
Conversia scorurilor brute în cote T: Scalele EDI-3 de Risc de tulburare de comportament alimentar,
pentru eşantionul clinic internaţional de adulţi, în funcţie de grupul de diagnostic

Cote T pentru scalele de Risc de tulburare de comportament alimentar

Scor AN-R AN-C/V BN TCAFAS Scor
brut DS B NC DS B NC DS B NC DS B NC brut
0 30 43 25 22 31 23 12 20 18 23 35 23 0
1 31 44 26 23 32 24 13 21 19 25 36 24 1
2 32 46 27 25 33 26 15 23 20 26 38 25 2
3 33 48 28 26 35 27 17 24 21 27 39 26 3
4 34 50 29 28 36 28 19 26 22 28 40 27 4
5 36 52 30 29 37 29 20 27 24 30 41 28 5
6 37 54 31 30 39 30 22 29 25 31 42 28 6
7 38 56 32 32 40 31 24 30 26 32 44 29 7
8 39 58 33 33 41 32 26 32 27 34 45 30 8
9 40 60 34 35 43 33 27 33 28 35 46 31 9
10 41 62 35 36 44 34 29 35 29 36 47 32 10
11 43 63 36 37 45 35 31 36 30 38 49 33 11
12 44 65 37 39 47 36 33 38 31 39 50 34 12
13 45 67 38 40 48 37 34 39 32 40 51 35 13
14 46 69 39 42 49 38 36 41 33 41 52 36 14
15 47 71 40 43 51 39 38 42 35 43 54 37 15
16 48 73 41 44 52 40 40 44 36 44 55 38 16
17 50 75 42 46 53 41 41 45 37 45 56 39 17
18 51 77 43 47 55 42 43 47 38 47 57 40 18
19 52 79 44 49 56 43 45 48 39 48 58 41 19
20 53 80 45 50 57 44 47 50 40 49 60 42 20
21 54 82 46 51 59 45 48 51 41 51 61 43 21
22 56 84 47 53 60 46 50 53 42 52 62 44 22
23 57 86 48 54 61 47 52 54 43 53 63 44 23
24 58 88 49 56 62 48 53 56 44 54 65 45 24
25 59 90 50 57 64 49 55 57 46 56 66 46 25
26 60 92 51 58 65 50 57 59 47 57 67 47 26
27 61 94 52 60 66 51 59 60 48 58 68 48 27
28 63 96 53 61 68 52 60 62 49 60 70 49 28
29 97 54 69 53 63 50 71 50 29
30 99 55 70 54 65 51 72 51 30
31 100 56 72 55 66 52 73 52 31
32 100 57 73 56 68 53 74 53 32
33 58 57 54 54 33
34 59 58 56 55 34
35 60 59 57 56 35
36 61 60 58 57 36
37 62 61 59 58 37
38 63 62 60 59 38
39 64 63 61 60 39
40 65 64 62 60 40
IC 90% ±5 ±7 ±5 ±6 ±6 ±5 ±7 ±7 ±6 ±5 ±6 ±5 IC 90%
Notă. N = 662. AN-R = Anorexie nervoasă de tip restrictiv (n = 165); AN-AC/V = Anorexie nervoasă de tip alimentaţie
compulsivă/vărsături (n = 110); BN = Bulimie nervoasă (n = 300); TCAFAS = Tulburare de comportament alimentar fără altă
specificaţie (n = 87). DS = Dorinţa de a fi slab; B = Bulimie; NC = Nemulţumire faţă de corp.

208
 Tabelul B2
Conversia scorurilor brute în cote T: Scalele psihologice EDI-3, pentru eşantionul clinic
internaţional de adulţi din SUA

Scor Cote T pentru Scalele psihologice Scor

brut SSS AP NI AI DI DE P A FM brut
0 24 26 28 25 24 32 28 25 32 0
1 26 27 30 28 26 34 29 27 34 1
2 28 29 32 30 27 36 31 29 35 2
3 30 31 34 32 29 38 33 31 37 3
4 32 32 36 34 30 40 35 33 38 4
5 33 34 37 36 32 42 37 35 39 5
6 35 36 39 38 33 44 39 37 41 6
7 37 37 41 40 34 46 41 39 42 7
8 39 39 43 42 36 48 43 41 44 8
9 41 41 45 44 37 50 45 42 45 9
10 43 42 47 46 39 52 46 44 47 10
11 44 44 48 48 40 54 48 46 48 11
12 46 46 50 50 42 56 50 48 50 12
13 48 47 52 52 43 58 52 50 51 13
14 50 49 54 54 45 60 54 52 53 14
15 52 51 56 56 46 61 56 54 54 15
16 54 52 58 58 47 63 58 56 56 16
17 55 54 59 60 49 65 60 58 57 17
18 57 56 61 62 50 67 62 60 59 18
19 59 57 63 64 52 69 63 62 60 19
20 61 59 65 66 53 71 65 64 62 20
21 63 61 67 68 55 73 67 66 63 21
22 65 63 69 70 56 75 69 68 65 22
23 66 65 70 72 57 77 71 70 66 23
24 68 66 72 74 59 79 73 72 68 24
25 68 74 76 60 81 74 69 25
26 69 76 79 62 83 76 71 26
27 71 78 81 63 85 78 72 27
28 73 79 83 65 87 80 74 28
29 66 89 75 29
30 68 91 77 30
31 69 93 78 31
32 70 95 80 32
33 72 33
34 73 34
35 75 35
36 76 36
IC 90% ±7 ±8 ±9 ±9 ±8 ±9 ±8 ±10 ±7 IC 90%
Notă: N = 662. SSS = Stimă de sine scăzută; AP = Alienare personală; NI = Nesiguranţă interpersonală; AI = Alienare interpersonală;
DI = Deficite interoceptive; DE = Dezechilibru emoţional; P = Perfecţionism; A = Ascetism ; FM = Frica de maturitate.

209
 Tabelul B3
Conversia scorurilor brute în centile: Scalele EDI-3 de Risc de tulburare de comportament
alimentar, pentru eşantionul clinic internaţional de adulţi din SUA, în funcţie de grupul de
diagnostic

Scor Cote T pentru scalele de Risc de tulburare de comportament alimentar Scor

brut AN-R AN-C/V BN TCAFAS brut
DS B NC DS DS B NC DS DS B NC DS
0 1 15 1 1 1 1 1 1 1 2 2 1 0
1 3 37 1 1 4 1 1 1 1 4 7 1 1
2 5 52 1 1 6 1 1 1 1 5 13 2 2
3 8 62 1 1 8 1 1 1 1 5 17 3 3
4 11 69 1 2 10 1 1 2 1 6 21 3 4
5 13 72 2 2 12 1 1 3 1 7 25 3 5
6 15 75 3 3 15 1 1 3 2 9 30 4 6
7 16 79 4 4 18 3 2 4 2 10 34 5 7
8 18 83 4 6 22 4 2 5 2 11 38 5 8
9 21 87 4 8 26 5 4 7 3 12 40 5 9
10 24 88 5 10 30 6 6 9 4 13 43 5 10
11 28 90 7 14 35 7 8 11 5 15 47 6 11
12 30 92 8 20 39 8 10 13 6 17 52 9 12
13 31 93 10 23 42 10 11 15 8 17 57 11 13
14 33 94 12 26 46 13 13 18 9 18 60 14 14
15 37 95 17 28 50 15 16 21 10 20 61 16 15
16 40 96 23 30 55 17 17 24 11 20 66 17 16
17 42 97 27 32 59 20 19 29 12 21 71 18 17
18 45 98 30 35 64 25 22 34 15 23 72 21 18
19 48 98 32 39 69 27 25 39 17 25 74 22 19
20 52 98 35 43 75 29 27 44 19 30 76 23 20
21 56 98 40 47 80 34 29 50 21 37 81 24 21
22 61 99 44 52 81 40 34 55 23 43 85 25 22
23 65 99 48 57 85 43 42 61 25 49 87 26 23
24 70 99 52 61 89 45 52 68 27 57 90 28 24
25 78 99 54 67 92 46 62 74 30 67 94 30 25
26 85 99 55 73 94 50 72 81 32 75 96 33 26
27 90 99 57 78 95 55 82 86 35 82 98 34 27
28 96 99 60 90 97 57 94 90 38 93 99 37 28
29 99 62 98 60 93 41 99 39 29
30 99 64 99 62 95 45 99 42 30
31 99 66 99 63 97 48 99 45 31
32 99 67 99 66 99 51 99 47 32
33 69 69 55 48 33
34 72 71 59 51 34
35 76 73 63 56 35
36 78 76 72 66 36
37 82 81 80 75 37
38 87 87 85 79 38
39 90 92 91 86 39
40 95 98 97 95 40

Notă. N = 662. AN-R = Anorexie nervoasă de tip restrictiv (n = 165); AN-AC/V = Anorexie nervoasă de tip alimentaţie compulsivă/
vărsături (n = 110); BN = Bulimie nervoasă (n = 300); TCAFAS = Tulburare de comportament alimentar fără altă specificaţie (n
= 87). DS = Dorinţa de a fi slab; B = Bulimie; NC = Nemulţumire faţă de corp.

210
 Tabelul B4
Conversia scorurilor brute în centile: Scalele psihologice EDI-3, pentru eşantionul clinic
internaţional de adulţi din SUA

Scor Centile pentru Scalele psihologice Scor

brut SSS AP NI AI DI DE P A FM brut
0 1 1 1 1 1 1 1 1 1 0
1 1 1 2 1 1 3 1 1 2 1
2 1 1 3 1 1 6 2 2 3 2
3 2 2 5 3 1 10 4 3 5 3
4 3 3 8 5 2 15 6 4 8 4
5 5 5 11 8 3 21 9 6 13 5
6 8 8 14 10 4 29 14 10 18 6
7 11 11 19 14 6 38 20 13 23 7
8 14 15 25 20 8 46 26 17 30 8
9 19 20 31 27 11 53 32 23 36 9
10 25 24 38 35 14 60 38 29 43 10
11 31 29 44 44 18 67 45 36 51 11
12 36 35 51 52 23 73 52 44 57 12
13 42 42 58 60 27 78 60 52 63 13
14 49 48 65 68 30 83 67 59 69 14
15 55 54 72 75 35 87 72 66 73 15
16 62 60 77 80 40 90 77 73 77 16
17 69 66 82 84 46 92 82 78 80 17
18 75 71 86 87 52 94 86 85 82 18
19 79 75 90 90 57 96 89 89 85 19
20 84 79 93 93 62 97 92 92 87 20
21 88 84 94 96 66 98 95 94 89 21
22 92 87 96 97 72 98 97 96 91 22
23 95 91 98 98 77 99 98 97 92 23
24 98 94 99 99 81 99 99 98 93 24
25 96 99 99 84 99 99 94 25
26 98 99 99 86 99 99 96 26
27 99 99 99 89 99 99 97 27
28 99 99 99 92 99 99 97 28
29 95 99 98 29
30 96 99 98 30
31 97 99 99 31
32 98 99 99 32
33 99 33
34 99 34
35 99 35
36 99 36

Notă: N = 662. SSS = Stimă de sine scăzută; AP = Alienare personală; NI= Nesiguranţă interpersonală; AI = Alienare interpersonală;
DI = Deficite interoceptive; DE = Dezechilibru emoţional; P= Perfecţionism; A = Ascetism; FM = Frica de maturitate.

211
 Tabelul B5
Conversia sumei cotelor T în cote T: Scala compozită EDI-3 de Risc de tulburare de comportament
alimentar, pentru eşantionul clinic internaţional de adulţi din SUA, în funcţie de grupul de
diagnostic

SCRTCA
AN-R AN-AC/V BN TCAFAS
Suma Cota % IC Suma Cota % IC 90% Suma Cota % IC 90% Suma Cota % IC 90%
cotelor T 90% cotelor T cotelor T cotelor T
T T T T
98 27 1 24-32 76 17 1 15-24 50 5 1 4-14 81 20 1 18-25
99 28 1 25-33 77 17 1 15-24 51 6 1 5-15 82 21 1 19-26
100 28 1 25-33 78 18 1 16-25 52 6 1 5-15 83 21 1 19-26
101 29 1 26-34 79 18 1 16-25 53 7 1 6-16 84 22 1 20-27
102 29 1 26-34 80 19 1 17-26 54 7 1 6-16 85 22 1 20-27
103 29 1 26-34 81 19 1 17-26 55 8 1 7-17 86 23 1 21-28
104 30 1 27-35 82 19 1 17-26 56 8 1 7-17 87 23 1 21-28
105 30 1 27-35 83 20 1 18-27 57 8 1 7-17 88 23 1 21-28
106 31 1 28-36 84 20 1 18-27 58 9 1 8-18 89 24 2 22-29
107 31 1 28-36 85 21 1 19-28 59 9 1 8-18 90 24 2 22-29
108 32 1 29-37 86 21 1 19-28 60 10 1 9-19 91 25 3 23-30
109 32 1 29-37 87 22 1 20-29 61 10 1 9-19 92 25 3 23-30
110 32 1 29-37 88 22 1 20-29 62 11 1 10-19 93 25 3 23-30
111 33 2 30-38 89 22 1 20-29 63 11 1 10-19 94 26 4 24-31
112 33 2 30-38 90 23 1 20-30 64 12 1 10-20 95 26 5 24-31
113 34 3 31-39 91 23 1 20-30 65 12 1 10-20 96 27 5 24-32
114 34 5 31-39 92 24 1 21-31 66 12 1 10-20 97 27 5 24-32
115 35 5 32-40 93 24 1 21-31 67 13 1 11-21 98 28 5 25-33
116 35 6 32-40 94 25 1 22-32 68 13 1 11-21 99 28 5 25-33
117 35 7 32-40 95 25 1 22-32 69 14 1 12-22 100 28 5 25-33
118 36 7 33-41 96 26 1 23-33 70 14 1 12-22 101 29 6 26-34
119 36 8 33-41 97 26 1 23-33 71 15 1 13-23 102 29 6 26-34
120 37 9 34-42 98 26 1 23-33 72 15 1 13-23 103 30 6 27-35
121 37 11 34-42 99 27 1 24-34 73 16 1 14-24 104 30 6 27-35
122 37 13 34-42 100 27 1 24-34 74 16 1 14-24 105 30 6 27-35
123 38 14 35-43 101 28 1 25-34 75 16 1 14-24 106 31 7 28-36
124 38 15 35-43 102 28 1 25-34 76 17 1 15-25 107 31 7 28-36
125 39 15 36-44 103 29 2 26-35 77 17 1 15-25 108 32 7 29-37
126 39 17 36-44 104 29 2 26-35 78 18 1 16-26 109 32 7 29-37
127 40 18 37-45 105 30 3 27-36 79 18 1 16-26 110 33 7 30-38
128 40 19 37-45 106 30 3 27-36 80 19 1 17-27 111 33 7 30-38
129 40 20 37-45 107 30 3 27-36 81 19 1 17-27 112 33 7 30-38
130 41 21 37-46 108 31 4 28-37 82 19 1 17-27 113 34 8 31-38
131 41 22 37-46 109 31 4 28-37 83 20 1 18-28 114 34 9 31-38
132 42 24 38-47 110 32 5 29-38 84 20 1 18-28 115 35 10 32-39
133 42 25 38-47 111 32 6 29-38 85 21 1 19-29 116 35 11 32-39
134 43 27 39-47 112 33 6 30-39 86 21 1 19-29 117 36 11 33-40
135 43 29 39-47 113 33 7 30-39 87 22 1 20-29 118 36 11 33-40
136 43 31 39-47 114 34 7 31-40 88 22 1 20-29 119 36 11 33-40
137 44 32 40-48 115 34 8 31-40 89 23 1 20-30 120 37 11 34-41
138 44 33 40-48 116 34 9 31-40 90 23 1 20-30 121 37 12 34-41
139 45 33 41-49 117 35 10 32-41 91 23 1 20-30 122 38 13 35-42
140 45 34 41-49 118 35 11 32-41 92 24 1 21-31 123 38 13 35-42
141 46 35 42-50 119 36 12 32-42 93 24 1 21-31 124 38 13 35-42
(continuare)

212
 Tabelul B5
Conversia sumei cotelor T în cote T: Scala compozită EDI-3 de Risc de tulburare de comportament
alimentar, pentru eşantionul clinic internaţional de adulţi din SUA, în funcţie de grupul de
diagnostic (continuare)

SCRTCA
AN-R AN-AC/V BN TCAFAS
Suma Cota % IC Suma Cota % IC 90% Suma Cota % IC 90% Suma Cota % IC 90%
cotelor T 90% cotelor T cotelor T cotelor T
T T T T
142 46 37 42-50 120 36 13 32-42 94 25 2 22-32 125 39 14 36-43
143 46 39 42-50 121 37 13 33-43 95 25 2 22-32 126 39 16 36-43
144 47 41 43-51 122 37 14 33-43 96 26 2 23-33 127 40 18 37-44
145 47 42 43-51 123 37 15 33-43 97 26 2 23-33 128 40 20 37-44
146 48 43 44-52 124 38 15 34-44 98 27 2 24-34 129 41 20 38-45
147 48 44 44-52 125 38 16 34-44 99 27 2 24-34 130 41 20 38-45
148 49 44 45-53 126 39 18 35-45 100 27 3 24-34 131 41 20 38-45
149 49 45 45-53 127 39 18 35-45 101 28 3 25-35 132 42 20 39-46
150 49 46 45-53 128 40 18 36-45 102 28 4 25-35 133 42 20 39-46
151 50 48 46-54 129 40 19 36-45 103 29 4 26-36 134 43 20 40-47
152 50 51 46-54 130 41 21 37-46 104 29 5 26-36 135 43 20 40-47
153 51 52 47-55 131 41 23 37-46 105 30 6 27-37 136 44 21 41-48
154 51 55 47-55 132 41 23 37-46 106 30 7 27-37 137 44 21 41-48
155 52 56 48-56 133 42 24 38-47 107 30 7 27-37 138 44 22 41-48
156 52 58 48-56 134 42 25 38-47 108 31 7 28-38 139 45 22 42-49
157 52 60 48-56 135 43 27 39-48 109 31 8 28-38 140 45 24 42-49
158 53 60 49-57 136 43 28 39-48 110 32 8 29-39 141 46 25 43-50
159 53 61 49-57 137 44 28 40-49 111 32 8 29-39 142 46 25 43-50
160 54 62 50-58 138 44 28 40-49 112 33 9 30-39 143 46 25 43-50
161 54 63 50-58 139 45 29 41-50 113 33 9 30-39 144 47 26 43-51
162 54 64 50-58 140 45 30 41-50 114 34 10 30-40 145 47 26 43-51
163 55 65 51-59 141 45 30 41-50 115 34 10 30-40 146 48 29 44-52
164 55 67 51-59 142 46 31 42-51 116 34 10 30-40 147 48 32 44-52
165 56 70 52-60 143 46 31 42-51 117 35 10 31-41 148 49 33 45-53
166 56 72 52-60 144 47 33 43-52 118 35 11 31-41 149 49 34 45-53
167 57 74 53-61 145 47 34 43-52 119 36 11 32-42 150 49 36 45-53
168 57 76 53-61 146 48 35 43-53 120 36 12 32-42 151 50 40 46-54
169 57 77 53-61 147 48 35 43-53 121 37 12 33-43 152 50 44 46-54
170 58 79 53-62 148 49 36 44-54 122 37 13 33-43 153 51 44 47-55
171 58 80 53-62 149 49 37 44-54 123 38 14 34-44 154 51 47 47-55
172 59 82 54-63 150 49 39 44-54 124 38 14 34-44 155 52 50 48-56
173 59 83 54-63 151 50 40 45-55 125 38 14 34-44 156 52 52 48-56
174 60 84 55-63 152 50 41 45-55 126 39 14 35-45 157 52 54 48-56
175 60 85 55-63 153 51 42 46-56 127 39 14 35-45 158 53 57 49-57
176 60 86 55-63 154 51 45 46-56 128 40 15 36-46 159 53 60 49-57
177 61 87 56-64 155 52 47 47-57 129 40 16 36-46 160 54 62 50-57
178 61 88 56-64 156 52 49 47-57 130 41 17 37-47 161 54 64 50-57
179 62 89 57-65 157 52 50 47-57 131 41 18 37-47 162 54 65 50-57
180 62 89 57-65 158 53 51 48-57 132 42 19 38-48 163 55 67 51-58
181 63 89 58-66 159 53 54 48-57 133 42 20 38-48 164 55 70 51-58
182 63 90 58-66 160 54 55 49-58 134 42 21 38-48 165 56 72 52-59
183 63 90 58-66 161 54 57 49-58 135 43 21 39-49 166 56 74 52-59
184 64 91 59-67 162 55 59 50-59 136 43 21 39-49 167 57 75 53-60
185 64 91 59-67 163 55 60 50-59 137 44 23 40-49 168 57 75 53-60
(continuare)

213
 Tabelul B5
Conversia sumei cotelor T în cote T: Scala compozită EDI-3 de Risc de tulburare de comportament
alimentar, pentru eşantionul clinic internaţional de adulţi din SUA, în funcţie de grupul de
diagnostic (continuare)

SCRTCA
AN-R AN-AC/V BN TCAFAS
Suma Cota % IC Suma Cota % IC 90% Suma Cota % IC 90% Suma Cota % IC 90%
cotelor T 90% cotelor T cotelor T cotelor T
T T T T
186 65 92 60-68 164 56 63 51-60 138 44 25 40-49 169 57 76 53-60
187 65 93 60-68 165 56 68 51-60 139 45 26 41-50 170 58 77 54-61
188 66 93 61-69 166 56 71 51-60 140 45 27 41-50 171 58 78 54-61
189 66 94 61-69 167 57 75 52-61 141 45 28 41-50 172 59 79 55-62
190 66 95 61-69 168 57 77 52-61 142 46 29 41-51 173 59 80 55-62
191 67 96 62-70 169 58 79 53-62 143 46 30 41-51 174 59 80 55-62
192 67 96 62-70 170 58 82 53-62 144 47 32 42-52 175 60 82 56-63
193 68 96 63-71 171 59 83 54-63 145 47 34 42-52 176 60 85 56-63
194 68 96 63-71 172 59 84 54-63 146 48 36 43-53 177 61 87 57-64
195 68 96 63-71 173 60 85 55-64 147 48 37 43-53 178 61 89 57-64
196 69 96 64-72 174 60 87 55-64 148 49 39 44-54 179 62 89 58-65
197 69 96 64-72 175 60 89 55-64 149 49 41 44-54 180 62 91 58-65
198 70 97 65-73 176 61 89 55-65 150 49 41 44-54 181 62 94 58-65
199 70 97 65-73 177 61 89 55-65 151 50 42 45-55 182 63 96 59-66
200 71 98 66-74 178 62 89 56-66 152 50 44 45-55 183 63 97 59-66
201 71 98 66-74 179 62 90 56-66 153 51 46 46-56 184 64 97 60-67
202 71 98 66-74 180 63 90 57-67 154 51 47 46-56 185 64 98 60-67
203 72 98 67-75 181 63 92 57-67 155 52 49 47-57 186 65 98 61-68
204 72 98 67-75 182 63 94 57-67 156 52 51 47-57 187 65 99 61-68
205 73 98 68-76 183 64 95 58-68 157 53 53 48-58 188 65 99 61-68
206 73 98 68-76 184 64 97 58-68 158 53 55 48-58 189 66 99 62-69
207 74 98 69-77 185 65 97 59-68 159 53 57 48-58 190 66 99 62-69
208 74 98 69-77 186 65 97 59-68 160 54 58 49-59 191 67 99 62-70
209 74 99 69-77 187 66 97 60-69 161 54 59 49-59 192 67 99 62-70
210 75 99 69-78 188 66 98 60-69 162 55 60 50-60 193 67 99 62-70
211 75 99 69-78 189 67 99 61-70 163 55 62 50-60 194 68 99 63-71
212 76 99 70-78 190 67 99 61-70 164 56 64 51-60
213 76 99 70-78 191 67 99 61-70 165 56 67 51-60
214 77 99 71-79 192 68 99 62-71 166 56 69 51-60
215 77 99 71-79 193 68 99 62-71 167 57 71 51-61
216 77 99 71-79 194 69 99 63-72 168 57 73 51-61
217 78 99 72-80 195 69 99 63-72 169 58 76 52-62
218 78 99 72-80 196 70 99 64-73 170 58 78 52-62
219 79 99 73-81 197 70 99 64-73 171 59 81 53-63
220 79 99 73-81 198 71 99 65-74 172 59 83 53-63
221 80 99 74-82 173 60 84 54-64
222 80 99 74-82 174 60 86 54-64
223 80 99 74-82 175 60 87 54-64
224 81 99 75-83 176 61 88 55-65
225 81 99 75-83 177 61 90 55-65
226 82 99 76-84 178 62 92 56-66
227 82 99 76-84 179 62 94 56-66
228 82 99 76-84 180 63 95 57-67
181 63 96 57-67
(continuare)

214
 Tabelul B5
Conversia sumei cotelor T în cote T: Scala compozită EDI-3 de Risc de tulburare de comportament
alimentar, pentru eşantionul clinic internaţional de adulţi din SUA, în funcţie de grupul de
diagnostic (continuare)

SCRTCA
AN-R AN-AC/V BN TCAFAS
Suma Cota % IC Suma Cota % IC 90% Suma Cota % IC 90% Suma Cota % IC 90%
cotelor T 90% cotelor T cotelor T cotelor T
T T T T
182 64 96 58-68
183 64 97 58-68
184 64 98 58-68
185 65 99 59-69
186 65 99 59-69
187 66 99 60-70
188 66 99 60-70
189 67 99 61-70
190 67 99 61-70
Notă: N = 983. SCRTCA = scala compozită Risc de tulburare de comprotament alimentar; AN-R = Anorexie nervoasă
de tip restrictiv (n = 165); AN-AC/V = Anorexie nervoasă de tip alimentaţie compulsivă/vărsături (n = 110); BN =
Bulimie nervoasă (n = 300); TCAFAS = Tulburare de comportament alimentar fără altă specificaţie (n = 87).

215
 Tabelul B6
Conversia sumei cotelor T în cote T: Scalele compozite psihologice EDI-3, pentru eşantionul clinic
internaţional de adulţi din SUA

Scalele compozite psihologice

SCI SCPI SCPE SCCE
Suma Cota % IC Suma Cota % IC Suma Cota % IC 90% Suma Cota % IC 90%
cotelor T 90% cotelor T 90% cotelor T cotelor T
T T T T
50 23 1 21-32 53 23 1 21-35 56 25 1 23-36 53 21 1 20-35
51 23 1 21-32 54 24 1 22-36 57 25 1 23-36 54 22 1 20-36
52 24 1 21-33 55 24 1 22-36 58 26 1 23-37 55 23 1 21-37
53 24 1 21-33 56 25 1 23-37 59 26 1 23-37 56 23 1 21-37
54 25 1 22-34 57 25 1 23-37 60 27 1 24-38 57 24 1 22-37
55 25 1 22-34 58 26 1 23-38 61 27 1 24-38 58 24 1 22-37
56 26 1 23-35 59 26 1 23-38 62 28 1 25-39 59 25 1 23-38
57 27 1 24-35 60 27 1 24-39 63 28 1 25-39 60 26 1 24-39
58 27 1 24-35 61 28 1 25-39 64 29 1 26-40 61 26 1 24-39
59 28 1 25-36 62 28 1 25-39 65 30 1 27-41 62 27 1 24-40
60 28 1 25-36 63 29 1 26-40 66 30 1 27-41 63 27 1 24-40
61 29 1 26-37 64 29 2 26-40 67 31 2 27-41 64 28 2 25-41
62 29 1 26-37 65 30 2 27-41 68 31 2 27-41 65 29 2 26-41
63 30 1 27-38 66 30 2 27-41 69 32 3 28-42 66 29 2 26-41
64 30 2 27-38 67 31 3 27-42 70 32 3 28-42 67 30 3 27-42
65 31 2 28-39 68 32 4 28-43 71 33 4 29-43 68 30 3 27-42
66 31 3 28-39 69 32 4 28-43 72 34 5 30-44 69 31 3 27-43
67 32 3 28-40 70 33 5 29-43 73 34 5 30-44 70 32 3 28-44
68 32 4 28-40 71 33 5 29-43 74 35 6 31-45 71 32 3 28-44
69 33 4 29-41 72 34 5 30-44 75 35 7 31-45 72 33 4 29-44
70 33 5 29-41 73 34 6 30-44 76 36 8 32-46 73 33 4 29-44
71 34 5 30-42 74 35 6 31-45 77 36 9 32-46 74 34 5 30-45
72 35 6 31-43 75 35 7 31-45 78 37 10 32-46 75 35 6 31-46
73 35 6 31-43 76 36 8 31-46 79 38 11 33-47 76 35 6 31-46
74 36 7 32-43 77 37 8 32-47 80 38 12 33-47 77 36 7 31-47
75 36 8 32-43 78 37 9 32-47 81 39 13 34-48 78 36 7 31-47
76 37 9 33-44 79 38 10 33-47 82 39 15 34-48 79 37 8 32-48
77 37 10 33-44 80 38 11 33-47 83 40 16 35-49 80 38 10 33-48
78 38 11 34-45 81 39 12 34-48 84 40 18 35-49 81 38 11 33-48
79 38 13 34-45 82 39 13 34-48 85 41 20 36-50 82 39 12 34-49
80 39 14 35-46 83 40 14 35-49 86 42 21 36-50 83 39 13 34-49
81 39 16 35-46 84 40 16 35-49 87 42 23 36-50 84 40 14 34-50
82 40 18 35-47 85 41 18 36-50 88 43 25 37-51 85 40 15 34-50
83 40 19 35-47 86 42 20 36-51 89 43 28 37-51 86 41 18 35-51
84 41 21 36-48 87 42 22 36-51 90 44 30 38-52 87 42 20 36-51
85 41 23 36-48 88 43 24 37-52 91 44 31 38-52 88 42 22 36-51
86 42 24 37-49 89 43 26 37-52 92 45 33 39-53 89 43 24 37-52
87 43 26 38-50 90 44 28 38-52 93 46 35 40-54 90 43 25 37-52
88 43 28 38-50 91 44 30 38-52 94 46 37 40-54 91 44 27 38-53
89 44 29 39-50 92 45 33 39-53 95 47 39 41-55 92 45 29 38-54
90 44 31 39-50 93 46 35 40-54 96 47 40 41-55 93 45 32 38-54
91 45 32 40-51 94 46 36 40-54 97 48 42 41-55 94 46 34 39-55
92 45 34 40-51 95 47 38 40-55 98 48 44 41-55 95 46 37 39-55
93 46 36 41-52 96 47 40 40-55 99 49 46 42-56 96 47 40 40-55

(continuare)

216
 Tabelul B6
Conversia sumei cotelor T în cote T: Scalele compozite psihologice EDI-3, pentru eşantionul clinic
internaţional de adulţi din SUA (continuare)

Scalele compozite psihologice

SCI SCPI SCPE SCCE
Suma Cota % IC Suma Cota % IC Suma Cota % IC 90% Suma Cota % IC 90%
cotelor T 90% cotelor T 90% cotelor T cotelor T
T T T T
94 46 38 41-52 97 48 42 41-56 100 50 48 43-57 97 48 42 41-56
95 47 39 42-53 98 48 45 41-56 101 50 50 43-57 98 48 45 41-56
96 47 40 42-53 99 49 47 42-56 102 51 51 44-58 99 49 48 41-57
97 48 42 43-54 100 49 49 42-56 103 51 53 44-58 100 49 51 41-57
98 48 44 43-54 101 50 52 43-57 104 52 56 45-59 101 50 54 42-58
99 49 46 43-55 102 51 54 44-58 105 52 59 45-59 102 51 56 43-59
100 49 49 43-55 103 51 55 44-58 106 53 61 45-59 103 51 57 43-59
101 50 50 44-56 104 52 58 44-59 107 54 64 46-60 104 52 59 44-59
102 51 51 45-57 105 52 60 44-59 108 54 65 46-60 105 52 61 44-59
103 51 53 45-57 106 53 62 45-60 109 55 67 47-61 106 53 63 45-60
104 52 55 46-57 107 53 65 45-60 110 55 69 47-61 107 54 65 45-61
105 52 57 46-57 108 54 66 46-60 111 56 71 48-62 108 54 66 45-61
106 53 59 47-58 109 54 68 46-60 112 56 73 48-62 109 55 68 46-62
107 53 61 47-58 110 55 70 47-61 113 57 75 49-63 110 55 70 46-62
108 54 63 48-59 111 56 72 48-62 114 57 77 49-63 111 56 72 47-62
109 54 65 48-59 112 56 74 48-62 115 58 79 50-64 112 56 73 47-62
110 55 67 49-60 113 57 76 48-63 116 59 81 50-64 113 57 75 48-63
111 55 68 49-60 114 57 77 48-63 117 59 82 50-64 114 58 77 49-64
112 56 70 50-61 115 58 78 49-64 118 60 83 51-65 115 58 80 49-64
113 56 71 50-61 116 58 79 49-64 119 60 85 51-65 116 59 81 49-65
114 57 73 50-62 117 59 81 50-64 120 61 87 52-66 117 59 83 49-65
115 57 75 50-62 118 60 82 51-65 121 61 88 52-66 118 60 84 50-66
116 58 76 51-63 119 60 84 51-65 122 62 88 53-67 119 61 85 51-66
117 59 78 52-64 120 61 85 52-66 123 63 89 54-68 120 61 86 51-66
118 59 79 52-64 121 61 86 52-66 124 63 90 54-68 121 62 87 52-67
119 60 81 53-65 122 62 87 53-67 125 64 91 54-68 122 62 88 52-67
120 60 82 53-65 123 62 87 53-67 126 64 93 54-68 123 63 89 52-68
121 61 83 54-65 124 63 88 53-68 127 65 93 55-69 124 64 90 53-69
122 61 85 54-65 125 63 90 53-68 128 65 94 55-69 125 64 91 53-69
123 62 85 55-66 126 64 91 54-69 129 66 95 56-70 126 65 91 54-69
124 62 87 55-66 127 65 92 55-69 130 67 95 57-71 127 65 92 54-69
125 63 88 56-67 128 65 92 55-69 131 67 96 57-71 128 66 93 55-70
126 63 89 56-67 129 66 93 56-70 132 68 96 58-72 129 67 94 56-71
127 64 91 57-68 130 66 94 56-70 133 68 97 58-72 130 67 95 56-71
128 64 92 57-68 131 67 94 57-71 134 69 97 59-73 131 68 96 56-72
129 65 92 57-69 132 67 95 57-71 135 69 97 59-73 132 68 97 56-72
130 65 93 57-69 133 68 96 57-72 136 70 97 59-73 133 69 97 57-73
131 66 95 58-70 134 68 96 57-72 137 71 98 60-74 134 70 98 58-73
132 67 95 59-71 135 69 96 58-73 138 71 98 60-74 135 70 98 58-73
133 67 96 59-71 136 70 97 59-73 139 72 98 61-75 136 71 98 59-74
134 68 97 60-72 137 70 98 59-73 140 72 98 61-75 137 71 99 59-74
135 68 97 60-72 138 71 98 60-74 141 73 98 62-76 138 72 99 59-75
136 69 98 61-72 139 71 98 60-74 142 73 99 62-76 139 73 99 60-76
137 69 98 61-72 140 72 98 61-75 143 74 99 63-77 140 73 99 60-76

(continuare)

217
 Tabelul B6
Conversia sumei cotelor T în cote T: Scalele compozite psihologice EDI-3, pentru eşantionul clinic
internaţional de adulţi din SUA (continuare)

Scalele compozite psihologice

SCI SCPI SCPE SCCE
Suma Cota % IC Suma Cota % IC Suma Cota % IC 90% Suma Cota % IC 90%
cotelor T 90% cotelor T 90% cotelor T cotelor T
T T T T
138 70 99 62-73 141 72 99 61-75 144 75 99 64-77 141 74 99 61-76
139 70 99 62-73 142 73 99 61-76 145 75 99 64-77 142 74 99 61-76
140 71 99 63-74 143 74 99 62-77 146 76 99 64-78 143 75 99 62-77
141 71 99 63-74 144 74 99 62-77 147 76 99 64-78 144 75 99 62-77
145 75 99 63-77 148 77 99 65-79 145 76 99 63-78
146 75 99 63-77 149 77 99 65-79 146 77 99 63-79
147 76 99 64-78 150 78 99 66-80 147 77 99 63-79
148 76 99 64-78 151 79 99 67-81 148 78 99 64-80
149 77 99 65-79 152 79 99 67-81 149 78 99 64-80
150 77 99 65-79 153 80 99 68-82 150-153 79 99 65-80
151 78 99 65-80 154 80 99 68-82
152 79 99 66-81 155 81 99 68-82
153 79 99 66-81 156 81 99 68-82
154 80 99 67-81 157 82 99 69-83
155 80 99 67-81 158 83 99 70-84
156 81 99 68-82 159 83 99 70-84
157 81 99 68-82 160 84 99 71-85
158 82 99 69-83 161-171 84 99 71-85
159-162 82 99 69-83

Notă. N = 662. SCI = Scala compozită Ineficacitate; SCPI = Scala compozită Probleme interpersonale; SCPE = Scala compozită
Probleme emoţionale; SCCE = Scala compozită Control exagerat.

218
 Tabelul B7
Conversia sumei cotelor T în cote T: Scala compozită EDI-3 Neadaptare psihologică generală,
pentru eşantionul clinic internaţional de adulţi din SUA

SCNPG
Suma Cota % IC 90% Suma Cota % IC 90% Suma Cota T % IC 90% Suma Cota % IC 90%
cotelor T cotelor T cotelor cotelor T
T T T T
244 15 1 13-22 288 22 1 20-28 332 30 2 27-35 376 37 8 34-42
245 15 1 13-22 289 22 1 20-28 333 30 2 27-35 377 37 9 34-42
246 15 1 13-22 290 23 1 21-29 334 30 2 27-35 378 37 9 34-42
247 15 1 13-22 291 23 1 21-29 335 30 2 27-35 379 37 10 34-42
248 15 1 13-22 292 23 1 21-29 336 30 2 27-35 380 38 10 35-43
249 16 1 14-22 293 23 1 21-29 337 30 2 27-35 381 38 11 35-43
250 16 1 14-22 294 23 1 21-29 338 31 2 28-36 382 38 11 35-43
251 16 1 14-22 295 23 1 21-29 339 31 2 28-36 383 38 11 35-43
252 16 1 14-22 296 24 1 22-30 340 31 2 28-36 384 38 11 35-43
253 16 1 14-22 297 24 1 22-30 341 31 2 28-36 385 38 12 35-43
254 16 1 14-22 298 24 1 22-30 342 31 2 28-36 386 39 12 36-44
255 17 1 15-23 299 24 1 22-30 343 31 2 28-36 387 39 13 36-44
256 17 1 15-23 300 24 1 22-30 344 32 3 29-37 388 39 13 36-44
257 17 1 15-23 301 24 1 22-30 345 32 3 29-37 389 39 14 36-44
258 17 1 15-23 302 25 1 23-31 346 32 3 29-37 390 39 14 36-44
259 17 1 15-23 303 25 1 23-31 347 32 3 29-37 391 39 14 36-44
260 17 1 15-23 304 25 1 23-31 348 32 3 29-37 392 40 15 37-45
261 18 1 16-24 305 25 1 23-31 349 32 3 29-37 393 40 15 37-45
262 18 1 16-24 306 25 1 23-31 350 33 3 30-38 394 40 16 37-45
263 18 1 16-24 307 25 1 23-31 351 33 3 30-38 395 40 16 37-45
264 18 1 16-24 308 26 1 24-32 352 33 3 30-38 396 40 17 37-45
265 18 1 16-24 309 26 1 24-32 353 33 3 30-38 397 40 17 37-45
266 19 1 17-25 310 26 1 24-32 354 33 3 30-38 398 41 17 38-46
267 19 1 17-25 311 26 1 24-32 355 33 3 30-38 399 41 18 38-46
268 19 1 17-25 312 26 1 24-32 356 34 4 31-39 400 41 18 38-46
269 19 1 17-25 313 26 1 24-32 357 34 4 31-39 401 41 18 38-46
270 19 1 17-25 314 27 1 25-33 358 34 4 31-39 402 41 19 38-46
271 19 1 17-25 315 27 1 25-33 359 34 4 31-39 403 41 20 38-46
272 20 1 18-26 316 27 1 25-33 360 34 4 31-39 404 42 20 39-47
273 20 1 18-26 317 27 1 25-33 361 34 4 31-39 405 42 20 39-47
274 20 1 18-26 318 27 1 25-33 362 35 4 32-40 406 42 21 39-47
275 20 1 18-26 319 27 1 25-33 363 35 5 32-40 407 42 22 39-47
276 20 1 18-26 320 28 1 25-34 364 35 5 32-40 408 42 23 39-47
277 20 1 18-26 321 28 1 25-34 365 35 5 32-40 409 42 23 39-47
278 21 1 19-27 322 28 1 25-34 366 35 6 32-40 410 43 24 39-48
279 21 1 19-27 323 28 1 25-34 367 35 6 32-40 411 43 25 39-48
280 21 1 19-27 324 28 1 25-34 368 36 6 33-41 412 43 26 39-48
281 21 1 19-27 325 28 1 25-34 369 36 7 33-41 413 43 26 39-48
282 21 1 19-27 326 29 1 26-35 370 36 7 33-41 414 43 27 39-48
283 21 1 19-27 327 29 1 26-35 371 36 8 33-41 415 43 28 39-48
284 22 1 20-28 328 29 1 26-35 372 36 8 33-41 416 44 28 40-48
285 22 1 20-28 329 29 1 26-35 373 36 8 33-41 417 44 29 40-48
286 22 1 20-28 330 29 2 26-35 374 37 8 34-42 418 44 29 40-48
287 22 1 20-28 331 29 2 26-35 375 37 8 34-42 419 44 29 40-48

(continuare)

219
 Tabelul B7
Conversia sumei cotelor T în cote T: Scala compozită EDI-3 Neadaptare psihologică generală,
pentru eşantionul clinic internaţional de adulţi din SUA (continuare)

SCNPG
Suma Cota % IC 90% Suma Cota % IC 90% Suma Cota T % IC 90% Suma Cota % IC 90%
cotelor T cotelor T cotelor cotelor T
T T T T
420 44 30 40-48 464 52 56 48-56 508 59 81 54-62 552 66 94 61-69
421 44 31 40-48 465 52 57 48-56 509 59 82 54-62 553 66 94 61-69
422 45 32 41-49 466 52 58 48-56 510 59 82 54-62 554 67 95 62-70
423 45 32 41-49 467 52 58 48-56 511 59 82 54-62 555 67 95 62-70
424 45 33 41-49 468 52 59 48-56 512 60 83 55-63 556 67 95 62-70
425 45 34 41-49 469 52 59 48-56 513 60 83 55-63 557 67 95 62-70
426 45 35 41-49 470 53 60 49-57 514 60 84 55-63 558 67 95 62-70
427 45 35 41-49 471 53 60 49-57 515 60 84 55-63 559 68 95 63-71
428 46 36 42-50 472 53 61 49-57 516 60 85 55-63 560 68 96 63-71
429 46 36 42-50 473 53 61 49-57 517 60 85 55-63 561 68 96 63-71
430 46 37 42-50 474 53 62 49-57 518 61 86 56-64 562 68 96 63-71
431 46 37 42-50 475 53 62 49-57 519 61 86 56-64 563 68 96 63-71
432 46 38 42-50 476 54 63 50-58 520 61 86 56-64 564 68 96 63-71
433 46 38 42-50 477 54 64 50-58 521 61 87 56-64 565 69 97 64-72
434 47 39 43-51 478 54 65 50-58 522 61 87 56-64 566 69 97 64-72
435 47 40 43-51 479 54 66 50-58 523 61 87 56-64 567 69 97 64-72
436 47 41 43-51 480 54 67 50-58 524 62 88 57-65 568 69 97 64-72
437 47 41 43-51 481 54 67 50-58 525 62 88 57-65 569 69 97 64-72
438 47 41 43-51 482 55 68 51-59 526 62 88 57-65 570 69 97 64-72
439 47 41 43-51 483 55 68 51-59 527 62 88 57-65 571 70 97 65-73
440 48 42 44-52 484 55 69 51-59 528 62 88 57-65 572 70 97 65-73
441 48 43 44-52 485 55 69 51-59 529 62 88 57-65 573 70 98 65-73
442 48 44 44-52 486 55 70 51-59 530 63 89 58-66 574 70 98 65-73
443 48 45 44-52 487 55 70 51-59 531 63 89 58-66 575 70 98 65-73
444 48 46 44-52 488 56 71 52-60 532 63 89 58-66 576 70 98 65-73
445 48 46 44-52 489 56 72 52-60 533 63 89 58-66 577 71 98 65-74
446 49 47 45-53 490 56 72 52-60 534 63 90 58-66 578 71 98 65-74
447 49 47 45-53 491 56 72 52-60 535 63 90 58-66 579 71 98 65-74
448 49 48 45-53 492 56 73 52-60 536 64 91 59-67 580 71 98 65-74
449 49 49 45-53 493 56 73 52-60 537 64 91 59-67 581 71 98 65-74
450 49 49 45-53 494 57 74 52-61 538 64 91 59-67 582 71 98 65-74
451 49 49 45-53 495 57 74 52-61 539 64 92 59-67 583 72 98 66-75
452 50 50 46-54 496 57 75 52-61 540 64 92 59-67 584 72 98 66-75
453 50 50 46-54 497 57 76 52-61 541 64 93 59-67 585 72 98 66-75
454 50 51 46-54 498 57 77 52-61 542 65 93 60-68 586 72 98 66-75
455 50 51 46-54 499 57 78 52-61 543 65 93 60-68 587 72 98 66-75
456 50 51 46-54 500 58 78 53-61 544 65 93 60-68 588 72 98 66-75
457 50 52 46-54 501 58 78 53-61 545 65 93 60-68 589 73 99 67-75
458 51 52 47-55 502 58 79 53-61 546 65 94 60-68 590 73 99 67-75
459 51 53 47-55 503 58 79 53-61 547 65 94 60-68 591 73 99 67-75
460 51 54 47-55 504 58 80 53-61 548 66 94 61-69 592 73 99 67-75
461 51 55 47-55 505 58 80 53-61 549 66 94 61-69 593 73 99 67-75
462 51 55 47-55 506 59 81 54-62 550 66 94 61-69 594 73 99 67-75
463 51 56 47-55 507 59 81 54-62 551 66 94 61-69 595 74 99 68-76

(continuare)

220
 Tabelul B7
Conversia sumei cotelor T în cote T: Scala compozită EDI-3 Neadaptare psihologică generală,
pentru eşantionul clinic internaţional de adulţi din SUA (continuare)

SCNPG
Suma Cota % IC 90% Suma Cota % IC 90% Suma Cota T % IC 90% Suma Cota % IC 90%
cotelor T cotelor T cotelor cotelor T
T T T T
596 74 99 68-76 620 78 99 72-80 644 82 99 76-84 668 86 99 79-88
597 74 99 68-76 621 78 99 72-80 645 82 99 76-84 669 86 99 79-88
598 74 99 68-76 622 78 99 72-80 646 82 99 76-84 670 86 99 79-88
599 74 99 68-76 623 78 99 72-80 647 82 99 76-84 671 86 99 79-88
600 74 99 68-76 624 78 99 72-80 648 82 99 76-84 672 86 99 79-88
601 75 99 69-77 625 79 99 73-81 649 83 99 77-85 673 87 99 80-88
602 75 99 69-77 626 79 99 73-81 650 83 99 77-85 674 87 99 80-88
603 75 99 69-77 627 79 99 73-81 651 83 99 77-85 675 87 99 80-88
604 75 99 69-77 628 79 99 73-81 652 83 99 77-85 676 87 99 80-88
605 75 99 69-77 629 79 99 73-81 653 83 99 77-85 677 87 99 80-88
606 75 99 69-77 630 79 99 73-81 654 83 99 77-85 678 87 99 80-88
607 76 99 70-78 631 80 99 74-82 655 84 99 78-86 679 88 99 81-89
608 76 99 70-78 632 80 99 74-82 656 84 99 78-86 680 88 99 81-89
609 76 99 70-78 633 80 99 74-82 657 84 99 78-86 681 88 99 81-89
610 76 99 70-78 634 80 99 74-82 658 84 99 78-86 682 88 99 81-89
611 76 99 70-78 635 80 99 74-82 659 84 99 78-86 683 88 99 81-89
612 76 99 70-78 636 80 99 74-82 660 84 99 78-86 684 88 99 81-89
613 77 99 71-79 637 81 99 75-83 661 85 99 78-87 685 89 99 82-90
614 77 99 71-79 638 81 99 75-83 662 85 99 78-87 686 89 99 82-90
615 77 99 71-79 639 81 99 75-83 663 85 99 78-87 687 89 99 82-90
616 77 99 71-79 640 81 99 75-83 664 85 99 78-87
617 77 99 71-79 641 81 99 75-83 665 85 99 78-87
618 77 99 71-79 642 81 99 75-83 666 85 99 78-87
619 78 99 72-80 643 82 99 76-84 667 86 99 79-88
Notă. N = 662. SCNPG = Scala compozită Neadaptare psihologică generală.

221
 Anexa C

Tabele de conversie a scorurilor brute în cote T, a scorurilor brute

în centile şi a sumei cotelor T în cote T: eşantionul clinic EDI-3 de
adolescenţi din SUA

223
 Tabelul C1
Conversia scorurilor brute în cote T: Scalele EDI-3 de Risc de tulburare de comportament alimentar,
pentru eşantionul clinic de adolescenţi din SUA, în funcţie de grupul de diagnostic

Cote T pentru scalele de Risc de tulburare de comportament alimentar

Scor AN-R AN-C/V BN TCAFAS Scor
brut DS B NC DS B NC DS B NC DS B NC brut
0 30 41 30 29 40 30 19 31 21 20 38 22 0
1 31 44 31 30 41 31 21 32 22 21 39 23 1
2 32 47 32 31 42 31 22 34 23 23 40 23 2
3 33 50 33 33 43 32 24 35 24 24 41 24 3
4 35 53 33 34 45 33 25 36 25 25 43 25 4
5 36 56 34 35 46 34 27 37 26 27 44 26 5
6 37 59 35 36 47 35 28 38 27 28 45 27 6
7 38 62 36 37 48 35 30 39 28 30 46 28 7
8 39 65 37 38 50 36 31 40 29 31 48 29 8
9 40 68 38 40 51 37 33 41 30 33 49 30 9
10 41 71 38 41 52 38 34 43 31 34 50 31 10
11 42 74 39 42 53 39 36 44 32 36 52 32 11
12 44 77 40 43 54 39 37 45 33 37 53 33 12
13 45 80 41 44 56 40 39 46 34 39 54 34 13
14 46 83 42 45 57 41 40 47 35 40 55 35 14
15 47 86 43 46 58 42 42 48 36 42 57 36 15
16 48 89 43 48 59 42 43 49 37 43 58 37 16
17 49 92 44 49 61 43 44 50 38 44 59 38 17
18 50 95 45 50 62 44 46 52 39 46 61 39 18
19 51 98 46 51 63 45 47 53 40 47 62 40 19
20 53 100 47 52 64 46 49 54 41 49 63 41 20
21 54 100 47 53 65 46 50 55 42 50 64 42 21
22 55 100 48 55 67 47 52 56 43 52 66 43 22
23 56 100 49 56 68 48 53 57 44 53 67 44 23
24 57 100 50 57 69 49 55 58 45 55 68 45 24
25 58 100 51 58 70 50 56 59 46 56 69 46 25
26 59 100 52 59 71 50 58 61 47 58 71 47 26
27 60 100 52 60 73 51 59 62 48 59 72 48 27
28 62 100 53 62 74 52 61 63 49 61 73 49 28
29 100 54 75 53 64 50 75 50 29
30 100 55 76 54 65 51 76 51 30
31 100 56 78 54 66 52 77 51 31
32 100 57 79 55 67 53 78 52 32
33 57 56 54 53 33
34 58 57 55 54 34
35 59 58 56 55 35
36 60 58 57 56 36
37 61 59 58 57 37
38 61 60 59 58 38
39 62 61 60 59 39
40 63 61 61 60 40
IC 90% ±4 ±10 ±4 ±4 ±4 ±3 ±6 ±5 ±5 ±6 ±6 ±5 IC 90%

Notă. N = 335. AN-R = Anorexie nervoasă de tip restrictiv (n = 101); AN-AC/V = Anorexie nervoasă de tip alimentaţie compulsivă/
vărsături (n = 23); BN = Bulimie nervoasă (n = 98); TCAFAS = Tulburare de comportament alimentar fără altă specificaţie (n =
113). DS = Dorinţa de a fi slab; B = Bulimie; NC = Nemulţumire faţă de corp.

224
 Tabelul C2
Conversia scorurilor brute în cote T: Scalele psihologice EDI-3, pentru eşantionul clinic de
adolescenţi din SUA

Scor brut Cote T pentru Scalele psihologice Scor

SSS AP NI AI DI DE P A FM brut
0 32 32 33 33 33 37 30 32 33 0
1 34 33 35 35 34 39 31 34 35 1
2 35 35 37 37 35 41 33 35 36 2
3 37 36 38 39 37 43 35 37 38 3
4 38 38 40 40 38 44 36 39 39 4
5 40 39 41 42 39 46 38 40 41 5
6 41 41 43 44 40 48 39 42 42 6
7 43 42 45 45 41 49 41 43 44 7
8 45 44 46 47 42 51 43 45 45 8
9 46 45 48 49 43 53 44 46 46 9
10 48 46 49 51 45 55 46 48 48 10
11 49 48 51 52 46 56 48 50 49 11
12 51 49 52 54 47 58 49 51 51 12
13 52 51 54 56 48 60 51 53 52 13
14 54 52 56 58 49 62 52 54 54 14
15 55 54 57 59 50 63 54 56 55 15
16 57 55 59 61 51 65 56 57 57 16
17 58 57 60 63 52 67 57 59 58 17
18 60 58 62 64 54 68 59 60 60 18
19 61 59 64 66 55 70 60 62 61 19
20 63 61 65 68 56 72 62 64 63 20
21 64 62 67 70 57 74 64 65 64 21
22 66 64 68 71 58 75 65 67 66 22
23 68 65 70 73 59 77 68 68 67 23
24 69 67 71 75 60 79 69 70 69 24
25 68 73 77 62 81 71 70 25
26 70 75 78 63 82 73 72 26
27 71 76 80 64 84 75 73 27
28 72 78 82 65 86 76 75 28
29 66 88 76 29
30 67 89 77 30
31 68 91 79 31
32 69 93 80 32
33 71 33
34 72 34
35 73 35
36 74 36
IC 90% ±5 ±6 ±6 ±7 ±5 ±8 ±7 ±7 ±6 IC 90%

Notă: N = 335. SSS = Stimă de sine scăzută; AP = Alienare personală; NI= Nesiguranţă interpersonală; AI = Alienare interpersonală;
DI = Deficite interoceptive; DE = Dezechilibru emoţional; P= Perfecţionism; A = Ascetism ; FM = Frica de maturitate.

225
 Tabelul C3
Conversia scorurilor brute în centile: Scalele EDI-3 de Risc de tulburare de comportament
alimentar, pentru eşantionul clinic de adolescenţi din SUA, în funcţie de grupul de diagnostic

Scor Cote T pentru scalele de Risc de tulburare de comportament alimentar Scor

brut AN-R AN-C/V BN TCAFAS brut
DS B NC DS DS B NC DS DS B NC DS
0 2 17 1 2 9 4 1 2 1 1 4 1 0
1 4 40 3 7 24 9 1 4 1 1 12 1 1
2 7 52 4 9 30 9 2 5 2 2 16 2 2
3 11 63 5 11 33 9 2 7 3 2 19 2 3
4 13 72 7 13 37 9 2 9 3 2 27 3 4
5 16 80 9 13 43 9 3 12 4 4 35 3 5
6 18 84 10 13 52 9 6 15 4 6 39 4 6
7 18 87 11 13 59 11 9 20 4 6 44 5 7
8 19 90 12 13 63 13 9 24 5 6 50 5 8
9 21 92 12 15 65 13 9 27 5 8 54 6 9
10 24 96 14 17 65 15 10 29 5 10 58 7 10
11 27 98 16 20 65 17 12 31 6 12 62 8 11
12 28 98 17 22 67 17 13 34 7 14 67 9 12
13 29 99 20 24 72 17 14 35 8 15 73 11 13
14 31 99 23 26 76 20 16 38 9 17 77 12 14
15 33 99 25 33 80 24 18 42 11 20 79 12 15
16 35 99 28 41 83 26 22 44 12 22 81 13 16
17 38 99 33 43 83 26 24 48 14 26 82 13 17
18 41 99 37 46 83 28 26 55 16 31 83 14 18
19 44 99 40 52 83 30 28 58 19 33 84 15 19
20 46 99 42 57 85 33 32 58 22 36 85 15 20
21 49 99 43 57 89 35 39 61 23 39 87 18 21
22 54 99 46 57 93 35 45 66 24 42 88 20 22
23 60 99 47 59 96 37 51 71 27 47 89 23 23
24 67 99 48 65 96 39 59 74 29 54 92 26 24
25 75 99 50 72 96 43 67 78 30 65 93 29 25
26 82 99 51 76 96 48 77 81 32 77 95 31 26
27 88 99 53 80 96 48 87 84 35 84 97 34 27
28 96 99 55 91 96 48 95 89 38 93 99 38 28
29 99 58 98 50 95 41 99 41 29
30 99 60 99 52 98 44 99 45 30
31 99 61 99 57 98 49 99 47 31
32 99 64 99 61 99 56 99 50 32
33 68 63 60 53 33
34 72 65 61 56 34
35 74 67 63 58 35
36 77 70 69 62 36
37 80 74 74 69 37
38 84 80 78 73 38
39 87 85 83 79 39
40 94 93 93 91 40

Notă. N = 335. AN-R = Anorexie nervoasă de tip restrictiv (n = 101); AN-AC/V = Anorexie nervoasă de tip alimentaţie compulsivă/
vărsături (n = 23); BN = Bulimie nervoasă (n = 98); TCAFAS = Tulburare de comportament alimentar fără altă specificaţie (n =
113). DS = Dorinţa de a fi slab; B = Bulimie; NC = Nemulţumire faţă de corp.

226
 Tabelul C4
Conversia scorurilor brute în centile: Scalele psihologice EDI-3, pentru eşantionul clinic de
adolescenţi din SUA

Scor Centile pentru Scalele psihologice Scor

brut SSS AP NI AI DI DE P A FM brut
0 2 2 3 1 2 3 1 1 1 0
1 6 4 7 4 5 10 1 3 3 1
2 9 6 9 8 7 18 3 5 7 2
3 12 7 13 13 10 27 5 8 10 3
4 15 11 18 20 13 36 9 13 14 4
5 19 17 23 27 15 43 14 18 19 5
6 22 22 28 34 18 48 18 24 24 6
7 26 27 34 40 22 54 22 29 29 7
8 31 32 39 44 26 62 26 36 34 8
9 36 36 43 48 31 68 33 43 38 9
10 42 40 48 53 34 73 39 48 44 10
11 50 44 53 59 38 77 44 52 52 11
12 56 48 58 65 42 81 49 57 58 12
13 60 52 64 71 46 83 55 62 64 13
14 64 57 69 75 49 87 58 66 69 14
15 68 62 74 79 52 89 62 70 74 15
16 72 68 80 84 56 91 67 73 78 16
17 76 72 85 88 60 92 72 77 81 17
18 79 76 88 92 63 93 75 82 84 18
19 84 81 91 94 65 94 80 86 87 19
20 88 84 93 96 68 95 86 90 89 20
21 91 87 94 96 71 96 90 92 91 21
22 94 89 95 97 76 97 94 94 92 22
23 96 92 97 98 81 98 97 96 94 23
24 98 95 98 99 84 99 99 97 95 24
25 97 99 99 85 99 98 96 25
26 98 99 99 87 99 99 97 26
27 99 99 99 90 99 99 97 27
28 99 99 99 92 99 99 97 28
29 94 99 98 29
30 95 99 98 30
31 96 99 99 31
32 97 99 99 32
33 98 33
34 99 34
35 99 35
36 99 36

Notă: N = 335.

227
 Tabelul C5
Conversia sumei cotelor T în cote T: Scala compozită EDI-3 de Risc de tulburare de comportament
alimentar, pentru eşantionul clinic de adolescenţi din SUA

SCRTCA
AN-R AN-AC/V BN TCAFAS
Suma Cota % IC 90% Suma Cota % IC 90% Suma Cota % IC 90% Suma Cota % IC 90%
cotelor T cotelor T cotelor T cotelor T
T T T T
101 29 1 26-36 99 28 1 26-32 71 16 1 14-21 80 20 1 18-26
102 30 1 27-37 100 29 1 27-32 72 17 1 15-22 81 21 1 19-27
103 30 1 27-37 101 29 1 27-32 73 17 1 15-22 82 21 1 19-27
104 30 1 27-37 102 30 1 28-33 74 18 1 16-23 83 22 1 20-28
105 31 2 28-38 103 30 1 28-33 75 18 1 16-23 84 22 1 20-28
106 31 2 28-38 104 30 2 28-33 76 18 1 16-23 85 23 1 21-29
107 32 3 29-39 105 31 4 29-34 77 19 1 17-24 86 23 1 21-29
108 32 3 29-39 106 31 4 29-34 78 19 1 17-24 87 23 1 21-29
109 33 3 30-39 107 32 4 30-35 79 20 1 18-25 88 24 1 22-30
110 33 4 30-39 108 32 4 30-35 80 20 1 18-25 89 24 1 22-30
111 33 5 30-39 109 33 7 31-36 81 20 1 18-25 90 25 2 22-31
112 34 6 30-40 110 33 9 31-36 82 21 1 19-26 91 25 2 22-31
113 34 7 30-40 111 33 11 31-36 83 21 1 19-26 92 25 2 22-31
114 35 8 31-41 112 34 15 32-37 84 22 1 20-27 93 26 3 23-31
115 35 9 31-41 113 34 17 32-37 85 22 1 20-27 94 26 4 23-31
116 35 9 31-41 114 35 17 33-38 86 23 1 21-28 95 27 4 24-32
117 36 10 32-42 115 35 17 33-38 87 23 1 21-28 96 27 4 24-32
118 36 10 32-42 116 35 17 33-38 88 23 2 21-28 97 27 4 24-32
119 37 11 33-43 117 36 17 34-39 89 24 2 22-29 98 28 4 25-33
120 37 13 33-43 118 36 17 34-39 90 24 2 22-29 99 28 6 25-33
121 37 14 33-43 119 37 17 35-40 91 25 2 23-30 100 29 6 26-34
122 38 15 34-44 120 37 17 35-40 92 25 2 23-30 101 29 6 26-34
123 38 16 34-44 121 37 17 35-40 93 26 3 24-31 102 30 6 27-35
124 39 17 35-45 122 38 17 36-41 94 26 3 24-31 103 30 7 27-35
125 39 19 35-45 123 38 17 36-41 95 26 4 24-31 104 30 7 27-35
126 39 20 35-45 124 39 20 36-42 96 27 4 24-32 105 31 7 28-36
127 40 21 36-46 125 39 22 36-42 97 27 4 24-32 106 31 8 28-36
128 40 22 36-46 126 40 22 37-43 98 28 4 25-33 107 32 8 29-37
129 41 24 37-47 127 40 22 37-43 99 28 4 25-33 108 32 8 29-37
130 41 25 37-47 128 40 22 37-43 100 28 4 25-33 109 32 8 29-37
131 42 25 38-48 129 41 22 38-44 101 29 4 26-34 110 33 8 30-38
132 42 25 38-48 130 41 22 38-44 102 29 4 26-34 111 33 8 30-38
133 42 25 38-48 131 42 22 39-45 103 30 5 27-35 112 34 8 31-39
134 43 26 39-49 132 42 22 39-45 104 30 5 27-35 113 34 8 31-39
135 43 28 39-49 133 42 22 39-45 105 31 6 28-36 114 35 8 32-40
136 44 29 40-49 134 43 22 40-46 106 31 7 28-36 115 35 8 32-40
137 44 29 40-49 135 43 24 40-46 107 31 8 28-36 116 35 9 32-40
138 44 30 40-49 136 44 26 41-47 108 32 9 29-37 117 36 10 33-41
139 45 30 41-50 137 44 26 41-47 109 32 9 29-37 118 36 10 33-41
140 45 32 41-50 138 44 28 41-47 110 33 9 30-38 119 37 11 34-42
141 46 33 41-51 139 45 30 42-48 111 33 9 30-38 120 37 11 34-42
142 46 35 41-51 140 45 30 42-48 112 33 10 30-38 121 37 12 34-42
143 46 36 41-51 141 46 30 43-49 113 34 11 31-38 122 38 12 35-43
144 47 37 42-52 142 46 30 43-49 114 34 11 31-38 123 38 12 35-43

(continuare)

228
 Tabelul C5
Conversia sumei cotelor T în cote T: Scala compozită EDI-3 de Risc de tulburare de comportament
alimentar, pentru eşantionul clinic de adolescenţi din SUA (continuare)

SCRTCA
AN-R AN-AC/V BN TCAFAS
Suma Cota % IC 90% Suma Cota % IC 90% Suma Cota % IC 90% Suma Cota % IC 90%
cotelor T cotelor T cotelor T cotelor T
T T T T
145 47 38 42-52 143 47 30 44-50 115 35 11 32-39 124 39 13 36-44
146 48 41 43-53 144 47 30 44-50 116 35 11 32-39 125 39 13 36-44
147 48 43 43-53 145 47 30 44-50 117 36 11 33-40 126 39 13 36-44
148 49 44 44-54 146 48 30 45-51 118 36 11 33-40 127 40 14 37-45
149 49 46 44-54 147 48 30 45-51 119 36 11 33-40 128 40 15 37-45
150 49 47 44-54 148 49 33 46-52 120 37 11 34-41 129 41 16 37-46
151 50 47 45-55 149 49 35 46-52 121 37 12 34-41 130 41 17 37-46
152 50 48 45-55 150 49 37 46-52 122 38 12 35-42 131 42 17 38-47
153 51 49 46-56 151 50 39 47-53 123 38 13 35-42 132 42 18 38-47
154 51 50 46-56 152 50 41 47-53 124 38 13 35-42 133 42 20 38-47
155 51 51 46-56 153 51 46 48-54 125 39 13 36-43 134 43 22 39-47
156 52 53 47-57 154 51 48 48-54 126 39 14 36-43 135 43 23 39-47
157 52 54 47-57 155 52 48 49-55 127 40 15 37-44 136 44 24 40-48
158 53 55 48-58 156 52 48 49-55 128 40 16 37-44 137 44 25 40-48
159 53 57 48-58 157 52 48 49-55 129 41 16 38-45 138 44 25 40-48
160 53 59 48-58 158 53 48 50-56 130 41 17 38-45 139 45 26 41-49
161 54 61 49-59 159 53 48 50-56 131 41 19 38-45 140 45 27 41-49
162 54 62 49-59 160 54 48 51-57 132 42 19 39-46 141 46 28 42-50
163 55 62 50-60 161 54 48 51-57 133 42 20 39-46 142 46 29 42-50
164 55 64 50-60 162 54 50 51-57 134 43 20 40-47 143 46 30 42-50
165 56 68 51-60 163 55 57 52-58 135 43 21 40-47 144 47 31 43-51
166 56 69 51-60 164 55 63 52-58 136 43 22 40-47 145 47 33 43-51
167 56 71 51-60 165 56 67 53-59 137 44 22 41-48 146 48 34 44-52
168 57 73 51-61 166 56 72 53-59 138 44 22 41-48 147 48 35 44-52
169 57 73 51-61 167 56 74 53-59 139 45 22 42-49 148 49 37 45-53
170 58 73 52-62 168 57 74 54-60 140 45 23 42-49 149 49 40 45-53
171 58 74 52-62 169 57 76 54-60 141 46 26 43-50 150 49 42 45-53
172 58 75 52-62 170 58 78 55-61 142 46 27 43-50 151 50 43 46-54
173 59 75 53-63 171 58 78 55-61 143 46 27 43-50 152 50 44 46-54
174 59 75 53-63 172 59 78 56-62 144 47 28 43-51 153 51 45 47-55
175 60 77 54-64 173 59 78 56-62 145 47 30 43-51 154 51 46 47-55
176 60 81 54-64 174 59 78 56-62 146 48 32 44-52 155 51 47 47-55
177 60 84 54-64 175 60 83 57-63 147 48 35 44-52 156 52 48 48-56
178 61 85 55-65 176 60 87 57-63 148 49 36 45-53 157 52 49 48-56
179 61 86 55-65 177 61 89 58-64 149 49 36 45-53 158 53 52 49-57
180 62 89 56-66 178 61 91 58-64 150 49 37 45-53 159 53 54 49-57
181 62 91 56-66 179 61 93 58-64 151 50 38 46-54 160 54 56 50-58
182 63 92 57-67 180 62 96 59-64 152 50 39 46-54 161 54 57 50-58
183 63 92 57-67 181 62 96 59-64 153 51 41 47-55 162 54 60 50-58
184 63 93 57-67 182 63 96 60-65 154 51 44 47-55 163 55 63 51-59
185 64 93 58-68 183 63 96 60-65 155 51 46 47-55 164 55 67 51-59
186 64 94 58-68 184 63 96 60-65 156 52 47 48-56 165 56 69 52-60
187 65 96 59-69 185 64 96 61-66 157 52 47 48-56 166 56 70 52-60
188 65 97 59-69 186 64 96 61-66 158 53 49 49-57 167 56 73 52-60

(continuare)

229
 Tabelul C5
Conversia sumei cotelor T în cote T: Scala compozită EDI-3 de Risc de tulburare de comportament
alimentar, pentru eşantionul clinic de adolescenţi din SUA (continuare)

SCRTCA
AN-R AN-AC/V BN TCAFAS
Suma Cota % IC 90% Suma Cota % IC 90% Suma Cota % IC 90% Suma Cota % IC 90%
cotelor T cotelor T cotelor T cotelor T
T T T T
189 65 97 59-69 187 65 98 62-67 159 53 54 49-57 168 57 76 53-61
190 66 97 60-70 188 65 99 62-67 160 54 58 50-57 169 57 78 53-61
191 66 97 61-70 189 66 99 63-68 161 54 61 50-57 170 58 81 53-62
192 67 97 61-70 190 66 99 63-68 162 54 62 50-57 171 58 82 53-62
193 67 98 61-70 191 66 99 63-68 163 55 64 51-58 172 58 84 53-62
194 67 98 61-70 192 67 99 64-69 164 55 66 51-58 173 59 85 54-63
195 68 98 61-71 193 67 99 64-69 165 56 67 52-59 174 59 86 54-63
196 68 98 61-71 194 68 99 65-70 166 56 69 52-59 175 60 87 55-63
197 69 99 62-72 195 68 99 65-70 167 56 72 52-59 176 60 88 55-63
198 69 99 62-72 196 68 99 65-70 168 57 74 53-60 177 61 88 56-64
199 70 99 63-73 197 69 99 66-71 169 57 76 53-60 178 61 89 56-64
200 70 99 63-73 198 69 99 66-71 170 58 77 54-61 179 61 90 56-64
201 70 99 63-73 199 70 99 67-72 171 58 79 54-61 180 62 91 57-65
202 71 99 64-74 200 70 99 67-72 172 59 82 55-62 181 62 91 57-65
203 71 99 64-74 201 71 99 68-73 173 59 84 55-62 182 63 91 58-66
204 72 99 65-75 202 71 99 68-73 174 59 86 55-62 183 63 92 58-66
205 72 99 65-75 175 60 88 56-63 184 63 92 58-66
206 72 99 65-75 176 60 89 56-63 185 64 93 59-67
207 73 99 66-76 177 61 89 57-64 186 64 94 59-67
208 73 99 66-76 178 61 90 57-64 187 65 95 60-68
209 74 99 67-77 179 61 91 57-64 188 65 96 60-68
210 74 99 67-77 180 62 93 58-65 189 66 98 61-69
211 74 99 67-77 181 62 95 58-65 190 66 99 61-69
212 75 99 68-78 182 63 96 59-66 191 66 99 61-69
213 75 99 68-78 183 63 96 59-66 192 67 99 62-70
214 76 99 69-79 184 64 96 60-67 193 67 99 62-70
215 76 99 69-79 185 64 97 60-67 194 68 99 63-71
216 76 99 69-79 186 64 99 60-67 195 68 99 63-71
217 77 99 70-80 187 65 99 61-68 196 68 99 63-71
218 77 99 70-80 188 65 99 61-68 197 69 99 64-72
219 78 99 71-80 189 66 99 62-69 198 69 99 64-72
220 78 99 71-80 199 70 99 65-73
221 79 99 71-81
222 79 99 71-81
223 79 99 71-81
224 80 99 72-82
225 80 99 72-82

Notă. N = 335. AN-R = Anorexie nervoasă de tip restrictiv (n = 101); AN-AC/V = Anorexie nervoasă de tip alimentaţie compulsivă/
vărsături (n = 23); BN = Bulimie nervoasă (n = 98); TCAFAS = Tulburare de comportament alimentar fără altă specificaţie (n =
113).

230
 Tabelul C6
Conversia sumei cotelor T în cote T: Scalele compozite psihologice EDI-3, pentru eşantionul clinic
de adolescenţi din SUA

Scalele compozite psihologice

SCI SCPI SCPE SCCE
Suma Cota % IC 90% Suma Cota % IC 90% Suma Cota % IC 90% Suma Cota % IC 90%
cotelor T cotelor T cotelor T cotelor T
T T T T
64 31 1 28-37 66 31 1 28-38 70 32 1 29-39 62 28 1 25-36
65 31 1 28-37 67 31 1 28-38 71 33 1 29-40 63 28 1 25-36
66 32 1 29-38 68 32 1 29-39 72 33 1 29-40 64 29 1 26-37
67 32 3 29-38 69 32 1 29-39 73 34 3 30-41 65 29 1 26-37
68 33 4 30-39 70 33 2 29-40 74 35 4 31-42 66 30 1 27-38
69 33 4 30-39 71 34 2 30-41 75 35 4 31-42 67 31 1 28-39
70 34 4 31-39 72 34 3 30-41 76 36 4 32-43 68 31 1 28-39
71 34 5 31-39 73 35 3 31-42 77 36 6 32-43 69 32 1 28-40
72 35 6 32-40 74 35 4 31-42 78 37 8 33-44 70 32 2 28-40
73 35 7 32-40 75 36 5 32-43 79 37 9 33-44 71 33 2 29-41
74 36 9 33-41 76 36 7 32-43 80 38 11 34-45 72 33 3 29-41
75 36 10 33-41 77 37 8 33-44 81 39 12 35-46 73 34 4 30-42
76 37 11 34-42 78 37 10 33-44 82 39 14 35-46 74 35 5 31-43
77 37 12 34-42 79 38 12 34-44 83 40 17 36-47 75 35 5 31-43
78 38 13 34-43 80 38 15 34-44 84 40 19 36-47 76 36 6 32-43
79 38 14 34-43 81 39 17 35-45 85 41 21 37-47 77 36 7 32-43
80 39 15 35-44 82 40 18 36-46 86 41 24 37-47 78 37 8 33-44
81 40 17 36-45 83 40 20 36-46 87 42 26 37-48 79 37 11 33-44
82 40 18 36-45 84 41 22 37-47 88 43 27 38-49 80 38 14 34-45
83 41 19 37-46 85 41 24 37-47 89 43 30 38-49 81 39 15 35-46
84 41 21 37-46 86 42 26 38-48 90 44 32 39-50 82 39 18 35-46
85 42 23 38-47 87 42 28 38-48 91 44 34 39-50 83 40 19 35-47
86 42 24 38-47 88 43 29 38-49 92 45 35 40-51 84 40 21 35-47
87 43 26 39-48 89 43 31 38-49 93 45 36 40-51 85 41 23 36-48
88 43 28 39-48 90 44 32 39-50 94 46 38 41-52 86 41 24 36-48
89 44 31 40-49 91 45 33 40-51 95 47 40 42-53 87 42 27 37-49
90 44 33 40-49 92 45 36 40-51 96 47 43 42-53 88 43 28 38-50
91 45 35 41-50 93 46 37 41-52 97 48 45 43-54 89 43 29 38-50
92 45 36 41-50 94 46 39 41-52 98 48 47 43-54 90 44 31 39-50
93 46 38 42-51 95 47 41 42-53 99 49 49 44-55 91 44 32 39-50
94 46 40 42-51 96 47 43 42-53 100 49 52 44-55 92 45 35 40-51
95 47 42 43-52 97 48 46 43-53 101 50 54 45-55 93 45 37 40-51
96 47 43 43-52 98 48 47 43-53 102 51 57 45-56 94 46 38 41-52
97 48 44 44-53 99 49 49 44-54 103 51 59 45-56 95 47 41 42-53
98 48 46 44-53 100 49 51 44-54 104 52 60 46-57 96 47 43 42-53
99 49 47 45-53 101 50 52 45-55 105 52 62 46-57 97 48 44 43-54
100 49 48 45-53 102 51 54 46-56 106 53 63 47-58 98 48 45 43-54
101 50 52 46-54 103 51 56 46-56 107 53 64 47-58 99 49 46 43-55
102 51 54 47-55 104 52 57 47-57 108 54 65 48-59 100 49 48 43-55
103 51 55 47-55 105 52 58 47-57 109 55 67 49-60 101 50 51 44-56
104 52 56 47-56 106 53 59 47-58 110 55 69 49-60 102 51 53 45-57
105 52 58 47-56 107 53 61 47-58 111 56 71 50-61 103 51 55 45-57
106 53 59 48-57 108 54 62 48-59 112 56 73 50-61 104 52 57 46-57
107 53 61 48-57 109 54 64 48-59 113 57 75 51-62 105 52 58 46-57
(continuare)

231
 Tabelul C6
Conversia sumei cotelor T în cote T: Scalele compozite psihologice EDI-3, pentru eşantionul clinic
de adolescenţi din SUA (continuare)

Scalele compozite psihologice

SCI SCPI SCPE SCCE
Suma Cota % IC 90% Suma Cota % IC 90% Suma Cota % IC 90% Suma Cota % IC 90%
cotelor T cotelor T cotelor T cotelor T
T T T T
108 54 63 49-58 110 55 65 49-60 114 57 76 51-62 106 53 59 47-58
109 54 64 49-58 111 55 67 49-60 115 58 78 52-63 107 53 61 47-58
110 55 65 50-59 112 56 70 50-61 116 59 79 53-63 108 54 63 48-59
111 55 67 50-59 113 57 72 51-62 117 59 81 53-63 109 55 64 49-60
112 56 68 51-60 114 57 74 51-62 118 60 82 53-64 110 55 65 49-60
113 56 70 51-60 115 58 77 52-62 119 60 83 53-64 111 56 68 50-61
114 57 72 52-61 116 58 78 52-62 120 61 85 54-65 112 56 71 50-61
115 57 73 52-61 117 59 79 53-63 121 61 86 54-65 113 57 72 50-62
116 58 74 53-62 118 59 81 53-63 122 62 87 55-66 114 57 74 50-62
117 58 76 53-62 119 60 82 54-64 123 63 88 56-67 115 58 77 51-63
118 59 76 54-63 120 60 84 54-64 124 63 89 56-67 116 59 78 52-64
119 59 78 54-63 121 61 86 55-65 125 64 90 57-68 117 59 79 52-64
120 60 80 55-64 122 61 87 55-65 126 64 91 57-68 118 60 80 53-65
121 60 82 55-64 123 62 88 56-66 127 65 92 58-69 119 60 81 53-65
122 61 83 56-65 124 63 89 56-67 128 65 93 58-69 120 61 83 54-65
123 61 84 56-65 125 63 89 56-67 129 66 94 59-70 121 61 84 54-65
124 62 86 57-66 126 64 90 57-68 130 67 95 60-71 122 62 86 55-66
125 63 88 58-66 127 64 91 57-68 131 67 95 60-71 123 63 87 56-67
126 63 89 58-66 128 65 92 58-69 132 68 95 61-71 124 63 88 56-67
127 64 90 59-67 129 65 92 58-69 133 68 95 61-71 125 64 89 57-68
128 64 91 59-67 130 66 93 59-70 134 69 96 61-72 126 64 91 57-68
129 65 92 60-68 131 66 94 59-70 135 69 96 61-72 127 65 92 57-69
130 65 93 60-68 132 67 94 60-71 136 70 96 62-73 128 65 93 57-69
131 66 93 61-69 133 67 95 60-71 137 71 97 63-74 129 66 94 58-70
132 66 94 61-69 134 68 96 61-71 138 71 97 63-74 130 67 94 59-71
133 67 95 61-70 135 69 96 62-72 139 72 97 64-75 131 67 95 59-71
134 67 96 61-70 136 69 97 62-72 140 72 97 64-75 132 68 97 60-72
135 68 97 62-71 137 70 97 63-73 141 73 98 65-76 133 68 97 60-72
136 68 98 62-71 138 70 98 63-73 142 73 98 65-76 134 69 98 61-72
137 69 98 63-72 139 71 98 64-74 143 74 98 66-77 135 69 98 61-72
138 69 98 63-72 140 71 98 64-74 144 75 99 67-78 136 70 98 62-73
139 70 99 64-73 141 72 98 65-75 145 75 99 67-78 137 71 99 63-74
140 70 99 64-73 142 72 98 65-75 146 76 99 68-79 138 71 99 63-74
141 71 99 65-74 143 73 99 65-76 147 76 99 68-79 139 72 99 64-75
144 73 99 65-76 148 77 99 69-80 140 72 99 64-75
145 74 99 66-77 149 77 99 69-80 141 73 99 65-76
146 75 99 67-78 150 78 99 69-80 142 73 99 65-76
147 75 99 67-78 151 79 99 70-81 143 74 99 65-77
148 76 99 68-79 152 79 99 70-81 144 75 99 66-78
149 76 99 68-79 153 80 99 71-82 145 75 99 66-78
150 77 99 69-80 154 80 99 71-82
151 77 99 69-80 155 81 99 72-83
152 78 99 70-80 156 81 99 72-83
153 78 99 70-80 157 82 99 73-84
(continuare)

232
 Tabelul C6
Conversia sumei cotelor T în cote T: Scalele compozite psihologice EDI-3, pentru eşantionul clinic
de adolescenţi din SUA (continuare)

Scalele compozite psihologice

SCI SCPI SCPE SCCE
Suma Cota % IC 90% Suma Cota % IC 90% Suma Cota % IC 90% Suma Cota % IC 90%
cotelor T cotelor T cotelor T cotelor T
T T T T
154 79 99 71-81 158 83 99 74-85
155 80 99 72-82 159 83 99 74-85
156 80 99 72-82 160 84 99 75-86
157 81 99 73-83 161 84 99 75-86
158 81 99 73-83 162 85 99 76-87
159 82 99 74-84 163 85 99 76-87
160 82 99 74-84 164 86 99 77-88
165 87 99 77-88
166 87 99 77-88
167 88 99 78-89

Notă. N = 335. SCI = Scala compozită Ineficacitate; SCPI = Scala compozită Probleme interpersonale; SCPE = Scala compozită
Probleme emoţionale; SCCE = Scala compozită Control exagerat.

233
 Tabelul C7
Conversia sumei cotelor T în cote T: Scala compozită EDI-3 Neadaptare psihologică generală,
pentru eşantionul clinic de adolescenţi din SUA

SCNPG
Suma Cota T % IC 90% Suma Cota T % IC 90% Suma Cota T % IC 90%
cotelor cotelor T cotelor
T T
295 26 1 24-30 339 33 2 31-36 383 39 15 36-42
296 26 1 24-30 340 33 2 31-36 384 39 16 36-42
297 26 1 24-30 341 33 2 31-36 385 40 17 37-43
298 27 1 25-31 342 33 2 31-36 386 40 17 37-43
299 27 1 25-31 343 33 2 31-36 387 40 18 37-43
300 27 1 25-31 344 33 2 31-36 388 40 19 37-43
301 27 1 25-31 345 34 2 32-37 389 40 19 37-43
302 27 1 25-31 346 34 2 32-37 390 40 20 37-43
303 27 1 25-31 347 34 2 32-37 391 41 20 38-44
304 28 1 26-32 348 34 3 32-37 392 41 21 38-44
305 28 1 26-32 349 34 3 32-37 393 41 21 38-44
306 28 1 26-32 350 34 3 32-37 394 41 22 38-44
307 28 1 26-32 351 35 3 33-38 395 41 23 38-44
308 28 1 26-32 352 35 4 33-38 396 41 23 38-44
309 28 1 26-32 353 35 4 33-38 397 41 24 38-44
310 28 1 26-32 354 35 5 33-38 398 42 25 39-45
311 29 1 27-32 355 35 5 33-38 399 42 25 39-45
312 29 1 27-32 356 35 5 33-38 400 42 26 39-45
313 29 1 27-32 357 35 5 33-38 401 42 27 39-45
314 29 1 27-32 358 36 5 34-39 402 42 27 39-45
315 29 1 27-32 359 36 5 34-39 403 42 28 39-45
316 29 1 27-32 360 36 5 34-39 404 42 28 39-45
317 29 1 27-32 361 36 5 34-39 405 43 29 40-46
318 30 1 28-33 362 36 6 34-39 406 43 29 40-46
319 30 1 28-33 363 36 6 34-39 407 43 30 40-46
320 30 1 28-33 364 36 6 34-39 408 43 30 40-46
321 30 1 28-33 365 37 7 35-40 409 43 31 40-46
322 30 1 28-33 366 37 7 35-40 410 43 32 40-46
323 30 1 28-33 367 37 8 35-40 411 43 33 40-46
324 31 1 29-34 368 37 9 35-40 412 44 34 41-47
325 31 1 29-34 369 37 10 35-40 413 44 34 41-47
326 31 1 29-34 370 37 10 35-40 414 44 35 41-47
327 31 1 29-34 371 38 10 36-41 415 44 35 41-47
328 31 1 29-34 372 38 11 36-41 416 44 35 41-47
329 31 1 29-34 373 38 12 36-41 417 44 36 41-47
330 31 1 29-34 374 38 13 36-41 418 45 36 42-48
331 32 1 30-35 375 38 13 36-41 419 45 37 42-48
332 32 1 30-35 376 38 13 36-41 420 45 38 42-48
333 32 1 30-35 377 38 13 36-41 421 45 38 42-48
334 32 2 30-35 378 39 13 36-42 422 45 38 42-48
335 32 2 30-35 379 39 14 36-42 423 45 39 42-48
336 32 2 30-35 380 39 14 36-42 424 45 39 42-48
337 32 2 30-35 381 39 15 36-42 425 46 40 43-49
338 33 2 31-36 382 39 15 36-42 426 46 41 43-49

(continuare)

234
 Tabelul C7
Conversia sumei cotelor T în cote T: Scala compozită EDI-3 Neadaptare psihologică generală,
pentru eşantionul clinic de adolescenţi din SUA (continuare)

SCNPG
Suma Cota T % IC 90% Suma Cota T % IC 90% Suma Cota T % IC 90%
cotelor cotelor T cotelor
T T
427 46 41 43-49 471 52 59 49-55 515 59 78 56-62
428 46 41 43-49 472 53 60 50-56 516 59 78 56-62
429 46 41 43-49 473 53 60 50-56 517 59 78 56-62
430 46 41 43-49 474 53 60 50-56 518 59 78 56-62
431 46 42 43-49 475 53 61 50-56 519 60 79 57-63
432 47 43 44-50 476 53 61 50-56 520 60 80 57-63
433 47 43 44-50 477 53 62 50-56 521 60 81 57-63
434 47 43 44-50 478 53 62 50-56 522 60 81 57-63
435 47 44 44-50 479 54 62 51-57 523 60 81 57-63
436 47 44 44-50 480 54 62 51-57 524 60 81 57-63
437 47 44 44-50 481 54 63 51-57 525 60 81 57-63
438 48 44 45-51 482 54 63 51-57 526 61 82 58-64
439 48 45 45-51 483 54 64 51-57 527 61 82 58-64
440 48 45 45-51 484 54 65 51-57 528 61 83 58-64
441 48 46 45-51 485 55 65 52-58 529 61 83 58-64
442 48 46 45-51 486 55 65 52-58 530 61 83 58-64
443 48 46 45-51 487 55 66 52-58 531 61 83 58-64
444 48 47 45-51 488 55 67 52-58 532 62 84 59-64
445 49 48 46-52 489 55 67 52-58 533 62 85 59-64
446 49 48 46-52 490 55 68 52-58 534 62 85 59-64
447 49 48 46-52 491 55 69 52-58 535 62 85 59-64
448 49 49 46-52 492 56 69 53-59 536 62 85 59-64
449 49 49 46-52 493 56 69 53-59 537 62 85 59-64
450 49 49 46-52 494 56 69 53-59 538 62 86 59-64
451 49 50 46-52 495 56 69 53-59 539 63 86 60-65
452 50 51 47-53 496 56 70 53-59 540 63 86 60-65
453 50 51 47-53 497 56 70 53-59 541 63 86 60-65
454 50 51 47-53 498 56 71 53-59 542 63 87 60-65
455 50 52 47-53 499 57 71 54-60 543 63 87 60-65
456 50 52 47-53 500 57 72 54-60 544 63 88 60-65
457 50 53 47-53 501 57 72 54-60 545 63 88 60-65
458 50 53 47-53 502 57 73 54-60 546 64 88 61-66
459 51 54 48-54 503 57 73 54-60 547 64 88 61-66
460 51 54 48-54 504 57 74 54-60 548 64 89 61-66
461 51 54 48-54 505 58 74 55-61 549 64 90 61-66
462 51 54 48-54 506 58 75 55-61 550 64 91 61-66
463 51 55 48-54 507 58 75 55-61 551 64 91 61-66
464 51 56 48-54 508 58 76 55-61 552 65 92 62-67
465 52 56 49-55 509 58 76 55-61 553 65 93 62-67
466 52 57 49-55 510 58 76 55-61 554 65 93 62-67
467 52 57 49-55 511 58 76 55-61 555 65 93 62-67
468 52 57 49-55 512 59 77 56-62 556 65 94 62-67
469 52 58 49-55 513 59 78 56-62 557 65 94 62-67
470 52 59 49-55 514 59 78 52-62 558 65 94 62-67
(continuare)

235
 Tabelul C7
Conversia sumei cotelor T în cote T: Scala compozită EDI-3 Neadaptare psihologică generală,
pentru eşantionul clinic de adolescenţi din SUA (continuare)

SCNPG
Suma Cota T % IC 90% Suma Cota T % IC 90% Suma Cota T % IC 90%
cotelor cotelor T cotelor
T T
559 66 94 63-68 571 67 96 64-69 583 69 99 66-71
560 66 94 63-68 572 68 96 65-70 584 69 99 66-71
561 66 94 63-68 573 68 96 65-70 585 69 99 66-71
562 66 94 63-68 574 68 96 65-70 586 70 99 67-72
563 66 94 63-68 575 68 97 65-70 587 70 99 67-72
564 66 94 63-68 576 68 97 65-70 588 70 99 67-72
565 66 94 63-68 577 68 98 65-70 589 70 99 67-72
566 67 94 64-69 578 68 98 65-70 590 70 99 67-72
567 67 95 64-69 579 69 98 66-71
568 67 95 64-69 580 69 98 66-71
569 67 96 64-69 581 69 99 66-71
570 67 96 64-69 582 69 99 66-71

Notă. N = 335. SCNPG = Scala compozită Neadaptare psihologică generală.

236
 Anexa D

Intercorelaţii pentru eşantioanele clinice

combinate EDI-3

237
238
Tabelul D1
Intercorelaţii pentru eşantionul clinic combinat EDI-3 de adulţi din SUA

Scala/scala compozită EDI-3 DS B NC SCRTCA SSS AP NI AI DI DE P A FM SCI SCPI SCPE SCCE SCNPG
Scala/ Scala compozită de Risc
de tulburare de comportament
alimentar
DS -
B 0,35 -
NC 0,69 0,24 -
SCRTCA 0,86 0,68 0,82 -
Scala/ Scala compozită psihologică
SSS 0,44 0,32 0,51 0,53 -
AP 0,38 0,36 0,42 0,49 0,80 -
NI 0,27 0,22 0,32 0,34 0,57 0,57 -
AI 0,25 0,27 0,33 0,36 0,57 0,66 0,60 -
DI 0,39 0,37 0,38 0,49 0,57 0,67 0,51 0,56 -
DE 0,22 0,30 0,25 0,32 0,46 0,54 0,31 0,49 0,53 -
P 0,28 0,18 0,29 0,32 0,25 0,27 0,21 0,35 0,36 0,18 -
A 0,49 0,33 0,47 0,54 0,53 0,54 0,38 0,49 0,59 0,40 0,44 -
FM 0,24 0,21 0,22 0,28 0,37 0,46 0,31 0,34 0,38 0,30 0,14 0,31 -
SCI 0,43 0,36 0,49 0,54 0,95 0,95 0,60 0,65 0,66 0,53 0,27 0,56 0,43 -
SCPI 0,29 0,27 0,36 0,39 0,64 0,69 0,89 0,89 0,60 0,45 0,31 0,48 0,36 0,70 -
SCPE 0,35 0,38 0,36 0,46 0,59 0,70 0,47 0,60 0,87 0,88 0,31 0,56 0,39 0,68 0,60 -
SCCE 0,46 0,30 0,45 0,51 0,46 0,48 0,34 0,49 0,56 0,34 0,85 0,85 0,27 0,49 0,47 0,51 -
SCNPG 0,46 0,40 0,50 0,57 0,80 0,86 0,70 0,79 0,80 0,65 0,50 0,73 0,56 0,88 0,83 0,83 0,72 -

Notă. N = 864. Variaţia în mărimea eşantionului este rezultatul utilizării procedurii de eliminare a cazurilor (listwise deletion). DS = Dorinţa de a fi slab; B = Bulimie; NC = Nemulţumire faţă
de corp; SCRTCA = scala compozită de Risc de tulburare de comprotament alimentar; SSS = Stimă de sine scăzută; AP = Alienare personală; NI = Nesiguranţă interpersonală; AI = Alienare
interpersonală; DI = Deficite interoceptive; DE = Dezechilibru emoţional; P= Perfecţionism; A = Ascetism ; FM = Frica de maturitate¸ SCI = Scala compozită Ineficacitate; SCPI = Scala
compozită Probleme interpersonale; SCPE = Scala compozită Probleme emoţionale; SCCE = Scala compozită Control exagerat; SCNPG = Scala compozită Neadaptare psihologică generală.
 Tabelul D2
Intercorelaţii pentru eşantionul clinic combinat EDI-3 de adolescenţi din SUA

Scala/ Scala compozită EDI-3 DS B NC SCRTCA SSS AP NI AI DI DE P A FM SCI SCPI SCPE SCCE SCNPG
Scala/ Scala compozită de Risc
de tulburare de comportament
alimentar
DS -
B 0,38 -
NC 0,75 0,33 -
SCRTCA 0,88 0,70 0,85 -
Scala/ Scala compozită
psihologică
SSS 0,64 0,40 0,66 0,70 -
AP 0,61 0,47 0,58 0,68 0,86 -
NI 0,41 0,24 0,38 0,43 0,68 0,67 -
AI 0,42 0,35 0,41 0,48 0,70 0,75 0,70 -
DI 0,57 0,43 0,45 0,60 0,64 0,73 0,58 0,56 -
DE 0,40 0,41 0,36 0,48 0,57 0,62 0,45 0,55 0,56 -
P 0,41 0,24 0,36 0,41 0,46 0,47 0,34 0,42 0,45 0,35 -
A 0,58 0,40 0,53 0,62 0,65 0,68 0,52 0,61 0,63 0,50 0,56 -
FM 0,24 0,20 0,24 0,28 0,31 0,36 0,39 0,28 0,37 0,21 0,17 0,25 -
SCI 0,65 0,45 0,64 0,71 0,96 0,96 0,70 0,75 0,71 0,62 0,48 0,69 0,35 -
SCPI 0,45 0,32 0,43 0,49 0,75 0,77 0,92 0,92 0,62 0,54 0,41 0,61 0,36 0,79 -
SCPE 0,54 0,48 0,46 0,61 0,69 0,77 0,58 0,63 0,88 0,88 0,46 0,64 0,32 0,76 0,66 -
SCCE 0,56 0,36 0,50 0,59 0,62 0,65 0,48 0,58 0,61 0,48 0,88 0,88 0,24 0,66 0,58 0,62 -
SCNPG 0,63 0,46 0,58 0,69 0,87 0,91 0,78 0,82 0,81 0,71 0,62 0,79 0,48 0,92 0,87 0,86 0,80 -
Notă. N = 295. Variaţia în mărimea eşantionului este rezultatul utilizării preocedurii de eliminare a cazurilor (listwise deletion). DS = Dorinţa de a fi slab; B = Bulimie; NC = Nemulţumire faţă
de corp; SCRTCA = scala compozită de Risc de tulburare de comprotament alimentar; SSS = Stimă de sine scăzută; AP = Alienare personală; NI= Nesiguranţă interpersonală; AI = Alienare
interpersonală; DI = Deficite interoceptive; DE = Dezechilibru emoţional; P = Perfecţionism; A = Ascetism ; FM = Frica de maturitate¸ SCI = Scala compozită Ineficacitate; SCPI = Scala
compozită Probleme interpersonale; SCPE = Scala compozită Probleme emoţionale; SCCE = Scala compozită Control exagerat; SCNPG = Scala compozită Neadaptare psihologică generală

239
241
 7
Studiul de adaptare şi standardizare a Inventarului tulburărilor de
comportament alimentar – 3 (EDI-3) pe populaţia din România
Obiectivul studiului
Obiectivul principal al studiul de faţă
îl reprezintă adaptarea şi standardizarea
Inventarului tulburărilor de comportament alimentar
– 3 (EDI‑3) pe populaţia României. Acest inventar
este un instrument de autoevaluare a trăsăturilor
sau a constructelor psihologice relevante din
punct de vedere clinic la persoanele cu tulburări
de comportament alimentar. EDI‑3 nu este
destinat stabilirii unui diagnostic de tulburare de
comportament alimentar; scopul acestuia este,
mai degrabă, evaluarea simptomelor relevante
pentru dezvoltarea şi menţinerea tulburărilor
de comportament alimentar. În consecinţă,
am întreprins o serie de studii de fidelitate şi
validitate, pe diverse categorii de participanţi,
adolescenţi şi adulţi, din populaţia generală.
Participanţi
Studiile întreprinse pentru construcţia şi
revizuirea variantei originale a EDI‑3 au fost
desfăşurate pe eşantioane de pacienţi cu diferite
diagnostice de tulburări de comportament
alimentar, în centre de asistenţă terţiară
specializate în tulburări de comportament
alimentar. Accesul autorilor la persoane cu
patologie a comportamentului alimentar a fost
posibil datorită existenţei acestor instituţii pe
teritoriul SUA şi în celelalte ţări de unde au
provenit datele de cercetare (a se vedea manualul
de faţă, Locuri de unde s‑au colectat datele). În
varianta propusă de noi, EDI‑3 se constituie în
aceeaşi măsură cuprinzătoare a prezenţei şi a
intensităţii manifestării trăsăturilor psihologice
sau ale clusterilor de simptome relevante din
punct de vedere clinic pentru tulburările de
comportament alimentar. Diferenţa faţă de
varianta originală a EDI‑3, propusă de autori,
este că acest instrument este destinat, în aceeaşi
măsură, evaluării atât a persoanelor diagnosticate
cu o tulburare de comportament alimentar, cât şi a
populaţiei generale, precum şi identificării acelor
caracteristici ale patologiei comportamentului
alimentar considerate precursori ai unei tulburări
de comportament alimentar.
Participanţii în studiile de validare şi
adaptare a EDI‑3 pe populaţia din România sunt
persoane din populaţia generală, provenind din
judeţele Alba, Bihor, Cluj, Harghita, Mureş şi
Satu‑Mare, şi persoane cu diagnostic clinic de
tulburare de comportament alimentar, evaluate
la Institutul de Endocrinologie „I.C. Parhon”
din Bucureşti. Colectarea datelor s‑a efectuat în
perioada septembrie 2010 ‑ mai 2011.
Procedura
Procedura iniţială
Procedura iniţială de adaptare a EDI‑3 a
constat în cele trei faze specifice: (1) traducerea
inventarului din limba engleză în limba română
şi retroversiunea, (2) un studiu pilot, cu scopul
de verificare a itemilor traduşi şi (3) determinarea
caracteristicilor psihometrice (fidelitate şi
validitate) ale primei versiuni în limba română.
Primele două faze ale procesului iniţial
de adaptare au fost conforme recomandărilor
generale privind procedeele de traducere şi de
adaptare a scalelor (a se vedea Miclea, Albu, Ciuca,
2009). Astfel, a fost analizată prima formă tradusă
a EDI‑3, într‑un grup format din cinci psihologi
atestaţi. S‑au sugerat variante pentru unele
formulări neadecvate, în special pentru a creşte
accesibilitatea limbajului în populaţia formată
din adolescenţi. În urma analizei traducerii şi a
variantelor generate, au fost operate modificările
243
 Tabelul 7.1. Datele demografice ale participanţilor din eşantionul nonclinic iniţial
Adolescenţi
Băieţi Fete
N = 49 N = 120
Vârsta minimă (ani) 130 13,00
Vârsta maximă (ani) 17,0 17,00
m 15,37 15,82
σ 1,54 1,25
Legendă: m = media; σ = abaterea standard.
necesare şi s‑a convenit asupra primei versiuni a
EDI‑3 în limba română. Retroversiunea a urmat
aceleaşi etape, iar rezultatul a constituit versiunea
preliminară a EDI‑3. Aceasta a fost testată în
cadrul studiului pilot, în faza a doua a procesului
iniţial de adaptare. Participanţii au fost 338 de
persoane, adolescenţi şi adulţi, fără tulburări de
comportament alimentar. Datele demografice ale
eşantionului iniţial sunt prezentate în tabelul 7.1.
În etapa analizei statistice a datelor obţinute
în cadrul studiului pilot, s‑au efectuat studiile
de validitate a variantei iniţiale a EDI‑3. În urma
analizei factoriale, s‑a constatat că, atât în cazul
adolescenţilor, cât şi al adulţilor, mai mulţi itemi
ai unor scale ale inventarului au cea mai mare
saturaţie în factori diverşi, fapt care a impus
revizuirea acestor itemi.
Procedura de revizuire a itemilor s‑a aplicat
asupra a 24 de itemi provenind din 11 scale. Opt
persoane care nu cunoşteau structura internă
a EDI‑3 au generat variante ale acestor itemi
problematici, pe care, ulterior, le‑au alocat
scalelor EDI‑3. În urma centralizării tuturor
variantelor de itemi şi a relocării acestora, s‑au
eliminat acele variante care au întrunit un număr
mai mic de 5 atribuiri corecte. S‑au păstrat 24 de
variante finale, care au înlocuit cei 24 de itemi
iniţiali.
În urma remedierii tuturor problemelor
apărute pe parcursul studiului pilot şi după
operarea tuturor modificărilor necesare, a rezultat
versiunea finală a EDI‑3. Această versiune a
fost utilizată în toate studiile de validare şi
standardizare pe populaţia din România.
Procedura de validare şi standardizare
EDI‑3 s‑a administrat în şcoli generale, licee,
universităţi, la domiciliul sau la locul de muncă
al participanţilor, atât în zone urbane, cât şi în
zone rurale, precum şi în cadrul Institutului de
Endocrinologie „I.C. Parhon” din Bucureşti (în
cazul persoanelor cu diagnostic de tulburare de
244
Adulţi
Total Bărbaţi Femei Total
N = 169 N = 23 N = 146 N = 169
13,00 19,00 18,00 18,00
17,00 58,00 55,00 58,00
15,69 28,48 23,28 23,99
1,35 9,61 7,59 8,07
comportament alimentar). În funcţie de situaţie,
administrarea s‑a realizat individual sau în grup,
obţinându‑se consimţământul verbal de la fiecare
participant înaintea completării chestionarelor.
Toate persoanele care au administrat EDI‑3
au fost instruite în legătură cu modalitatea
de administrare, pentru a se diminua sau a
elimina eventualele influenţe în completarea
răspunsurilor de către participanţi. Au fost
respectate instrucţiunile de administrare din
manualul original EDI‑3 (Garner, 2004).
Date de etalonare
Pentru a identifica eventualele diferenţe
dintre sexe la scalele EDI‑3, s‑au efectuat
comparaţii ale mediilor scorurilor tuturor
scalelor. S‑au ales două eşantioane, formate
din 32 de femei cu vârste cuprinse între 18 şi 55
de ani (m=27,61; σ=12,81), respectiv din 29 de
bărbaţi, cu vârste cuprinse între 18 şi 57 de ani
(m=27,24; σ=12,61). Caracteristicile demografice şi
IMC‑ul participanţilor sunt similare. Rezultatele
comparaţiilor sunt prezentate în tabelul 7.2. Aşa
cum se poate observa, la majoritatea scalelor
EDI‑3 nu s‑au înregistrat diferenţe semnificative
între sexe. Excepţie fac scalele Dorinţa de a fi
slab şi Nemulţumire faţă de corp, femeile având
scoruri mai ridicate decât bărbaţii (t=3,548,
p=0,001, respectiv t=2,468, p<0,05). Acest fapt
este în concordanţă atât cu rezultatele raportate
de către autori (Garner, 2004), cât şi cu literatura
de specialitate (Greenfeld şi colab., 1987; Rosen,
Silberg şi Gross, 1988; Cash şi Deagle, 1997; Field
şi colab., 1999 ş.a.).
Eşantionul folosit pentru etalonare a cuprins
304 femei din populaţia generală, cu vârsta
cuprinsă între 18 şi 55 de ani (m=24,97; σ=8,81).
Decizia de a include exclusiv femei în eşantionul
folosit pentru etalonare s‑a bazat, în primul
rând, pe incidenţa şi prevalenţa substanţial
mai crescute ale tulburărilor de comportament
alimentar în rândul fetelor şi al femeilor (Lucas,
Beard, O’Fallon şi Kurland, 1991; Hoek şi colab.,
1995), precum şi pe procedurile de etalonare
utilizate de către autorii EDI‑3.
Urmându‑se aceleaşi proceduri (a se vedea
cap. 5 al manualului), s‑au calculat mediile şi
abaterile standard pentru fiecare dintre cele trei
scale de Risc de tulburare de comportament alimentar
şi pentru cele nouă scale psihologice. Tabelul 7.3.
prezintă indicatorii statistici ai scalelor EDI‑3.
S‑au calculat, apoi, cotele T şi centilele
pentru toate scalele EDI‑3. Tabelele de conversie
a scorurilor brute în cote T, a scorurilor brute în
centile şi a sumelor cotelor T în cote T pentru
scalele şi scalele compozite EDI‑3 sunt prezentate
în Anexele A1, B1 şi C1‑C6. Aceste tabele includ

Tabelul 7.2. Diferenţele între sexe la scalele EDI-3

Bărbaţi Femei
Scala EDI-3 t g.l. p
N m σ N m σ
Scala de Risc de tulburare de
comportament alimentar
Dorinţa de a fi slab 29 2,66 3,66 31 8,03 7,54 3,548 44 0,001
Bulimie 28 2,04 2,38 30 2,00 3,18 0,048 56 0,962
Nemulţumire faţă de corp 28 5,18 6,13 31 10,29 9,28 2,468 57 0,017
Scala psihologică
Stimă de sine redusă 29 3,28 4,85 31 2,97 3,19 0,292 58 0,771
Alienare personală 29 3,55 4,12 31 4,48 3,45 0,952 58 0,345
Nesiguranţă interpersonală 29 7,07 5,87 30 6,73 4,95 0,238 57 0,813
Alienare interpersonală 27 7,04 4,48 31 7,13 4,06 0,082 56 0,935
Deficite interoceptive 29 4,79 5,16 31 6,10 4,34 1,062 58 0,293
Dezechilibru emoţional 28 5,36 5,83 30 6,03 4,60 0,492 56 0,625
Perfecţionism 28 11,79 5,34 31 10,42 5,42 0,973 57 0,334
Ascetism 29 6,41 3,66 31 6,81 3,82 0,406 58 0,686
Frica de maturitate 29 10,62 4,07 31 13,23 5,81 1,997 58 0,050
Date personale
Vârsta 29 27,24 12,61 31 27,61 12,81 0,113 58 0,910
IMC 29 24,12 4,32 31 23,37 3,64 0,722 58 0,473

Legendă: m = media; σ = abaterea standard.

Tabelul 7.3. Indicatorii statistici ai scalelor

Scala din EDI-3 Nr. itemi N min. max. m σ

Scala de Risc de tulburare de
comportament alimentar
Dorinţa de a fi slab 7 299 0 28 7,09 7,42
Bulimie 8 294 0 27 2,55 4,02
Nemulţumire faţă de corp 10 297 0 40 10,32 9,16
Scala psihologică
Stimă de sine redusă 6 299 0 18 3,90 3,97
Alienare personală 7 296 0 21 4,47 3,89
Nesiguranţă interpersonală 7 296 0 26 6,60 5,31
Alienare interpersonală 7 298 0 21 6,57 4,37
Deficite interoceptive 9 291 0 24 6,44 5,26
Dezechilibru emoţional 8 290 0 24 4,96 4,55
Perfecţionism 6 295 0 24 9,88 4,86
Ascetism 7 293 0 24 6,30 4,38
Frica de maturitate 8 294 0 32 12,38 6,04

245
şi intervalele de încredere (IC) corespunzătoare Tabelul 7.4. Coeficienţii de corelaţie liniară
probabilităţii de 90% pentru fiecare scor al fiecărei între test şi retest (N=49)
scale, pentru grupul utilizat pentru etalonare.
Scala EDI-3 r p
Scala de Risc de tulburare
Caracteristici psihometrice de comportament alimentar
Dorinţa de a fi slab 0,834 0,000
Fidelitatea Bulimie 0,717 0,000
Nemulţumire faţă de corp 0,760 0,000
Au fost efectuate studii de fidelitate a EDI‑3, Scala psihologică
ce au vizat stabilitatea în timp a rezultatelor
Stimă de sine redusă 0,779 0,000
(fidelitatea test‑retest) şi consistenţa internă a
Alienare personală 0,791 0,000
itemilor.
Nesiguranţă interpersonală 0,844 0,000
Fidelitatea test‑retest Alienare interpersonală 0,734 0,000
Deficite interoceptive 0,644 0,000
Stabilitatea în timp a rezultatelor la EDI‑3 Dezechilibru emoţional 0,829 0,000
a fost măsurată prin calcularea coeficienţilor de Perfecţionism 0,729 0,000
fidelitate test‑retest. Subiecţilor li s‑a administrat Ascetism 0,613 0,000
EDI‑3 în două date diferite, la un interval de două Frica de maturitate 0,631 0,000
săptămâni între ele. Deşi autorii menţionează
sensibilitatea EDI‑3 la modificările datorate
factorilor interni şi externi de‑a lungul timpului 0,844, toţi coeficienţii test‑retest fiind pozitivi
şi sugerează retestarea la un interval scurt de şi semnificativi la un prag p<0,001. Acest fapt
timp (1‑7 zile), am decis să administrăm EDI‑3 dovedeşte o stabilitate ridicată în timp a EDI‑3.
după un timp ceva mai îndelungat, pentru a ne De asemenea, mediile scorurilor scalelor
asigura de stabilitatea reală în timp. EDI‑3 nu diferă semnificativ între test şi
Astfel, unui eşantion format din 49 de fete, cu retest, exceptând trei scale (Bulimie, Alienare
vârste cuprinse între 13 şi 18 ani (m=15,02; σ=1,63) interpersonală, Dezechilibru emoţional), la care
i s‑a administrat EDI‑3 în două ocazii diferite, mediile sunt uşor mai scăzute la retest decât
la un interval de două săptămâni. Corelaţiile la test, diferenţa mediilor fiind semnificativă
test‑retest sunt prezentate în tabelul 7.4. la pragul p=0,05 (tabelul 7.5). Pe baza acestor
Aşa cum se poate observa, valorile rezultate, putem considera că EDI‑3 este o
coeficienţilor de corelaţie variază între 0,613 şi

Tabelul 7.5. Compararea mediilor prin testul t pentru eşantioane perechi

Scala EDI-3 N Test Retest t g.l. p

m σ m σ
Scala de Risc de tulburare de
comportament alimentar
Dorinţa de a fi slab 46 8,30 8,17 8,00 7,75 0,448 45 0,656
Bulimie 48 1,79 2,92 1,06 2,10 2,477 47 0,017
Nemulţumire faţă de corp 46 12,20 10,25 10,37 10,27 1,744 45 0,088
Scala psihologică
Stimă de sine redusă 48 4,21 5,27 3,92 5,15 0,582 47 0,563
Alienare personală 48 4,38 4,33 4,33 5,17 0,091 47 0,928
Nesiguranţă interpersonală 47 6,45 4,73 5,96 4,27 1,314 46 0,195
Alienare interpersonală 48 6,92 4,32 6,00 4,11 2,062 47 0,045
Deficite interoceptive 46 5,98 4,78 5,63 6,16 0,493 45 0,624
Dezechilibru emoţional 46 7,41 6,35 6,20 5,47 2,320 45 0,025
Perfecţionism 48 10,17 4,97 9,19 4,97 1,854 47 0,070
Ascetism 44 7,66 4,58 6,59 3,98 1,862 43 0,069
Frica de maturitate 46 15,63 5,49 14,85 6,30 1,038 45 0,305

246
măsură stabilă în timp a aspectelor măsurate cu
ajutorul scalelor acestuia.
Consistenţa internă
S‑au calculat coeficienţii α Cronbach pentru
eşantionul folosit pentru etalonare (tabelul 7.6).
Valorile coeficienţilor α ale scalelor EDI‑3 sunt
cuprinse în intervalul 0,600 şi 0,899.
Valori similare ale coeficienţilor de consistenţă
internă s‑au obţinut şi pentru scalele compozite
ale EDI‑3, acestea variind între 0,705 şi 0,838, cu
o singură excepţie, în cazul Scalei compozite a
controlului exagerat (SCCE), al cărei coeficient α
Cronbach a fost de 0,460. Această scală compozită
este derivată din suma scorurilor scalelor A şi
P. Ambele scale, mai ales cea de Ascetism, au
prezentat o consistenţă mai scăzută şi în studiile
originale, fapt dovedit de valorile mari ale erorii
standard de măsurare (ESM), atât pentru lotul de
adulţi, cât şi pentru cel de adolescenţi din SUA
(a se vedea tabelul 6.3). De asemenea, valoarea
coeficientului α pentru scala A are cea mai mică
valoare dintre coeficienţii α calculaţi pentru
scalele din EDI‑3 (tabelul 6.1). Cu toate acestea,
în mod similar cu datele raportate de către autori,
rezultatele dovedesc o bună consistenţă internă a
EDI‑3 în versiunea din limba română.
Validitatea
Validitatea de criteriu
Validitatea de criteriu a EDI‑3 fost evaluată
prin analiza corelaţiilor dintre scorurile la
scalele EDI‑3 şi scorurile la alte instrumente
relevante de măsurare a comportamentului
alimentar, a unor aspecte relaţionate cu
tulburări ale comportamentului alimentar sau
a altor constructe psihologice relevante pentru
psihopatologia alimentaţiei.
Corelaţiile dintre scorurile la scalele EDI‑3
şi scorurile la alt instrument de măsurare a
comportamentului alimentar – EAT‑26
Unui grup de 30 de femei, cu vârsta cuprinsă
între 19 şi 48 de ani (m=29,47; σ=8,42) i s‑a
administrat atât EDI‑3, cât şi EAT‑26 (Eating
Attitudes Test‑26 – Testul de atitudini faţă de
alimentaţie‑26, Garner şi colab., 1982). EAT‑26 este
un instrument autoadministrat, standardizat, de
măsurare a simptomelor specifice tulburărilor de
comportament alimentar. Cei 26 de itemi sunt
grupaţi în trei subscale: Comportament alimentar
restrictiv, Bulimie şi preocupări legate de alimente şi
Control asupra senzaţiilor orale.

Tabelul 7.6. Coeficienţii de consistenţă internă α ai EDI‑3

Femei
Scala/ Scala compozită din EDI‑3
N α
Dorinţa de a fi slab (DS) 299 0,899
Bulimie (B) 294 0,776
Nemulţumire faţă de corp (NC) 297 0,886
Scala compozită Risc de tulburare de comportament alimentar (SCRTCA) 291 0,797
Stimă de sine redusă (SSS) 299 0,794
Alienare personală (AP) 296 0,721
Nesiguranţă interpersonală (NI) 296 0,817
Alienare interpersonală (AI) 298 0,695
Deficite interoceptive (DI) 291 0,738
Dezechilibru emoţional (DE) 290 0,711
Perfecţionism (P) 295 0,631
Ascetism (A) 293 0,600
Frica de maturitate (FM) 294 0,766
Scala compozită Ineficacitate (SCI) 294 0,838
Scala compozită Probleme interpersonale (SCPI) 295 0,705
Scala compozită Probleme emoţionale (SCPE) 283 0,746
Scala compozită Control exagerat (SCCE) 290 0,460
Scala compozită Neadaptare psihologică generală (SCNPG) 268 0,832

247
 Tabelul 7.7. Corelaţiile liniare dintre scorurile la scalele EDI‑3 şi scorurile la EAT‑26

Comportament Bulimie Control EAT‑26

Scala EDI‑3/ alimentar asupra total
Scala compozită restrictiv senzaţiilor
orale
Dorinţa de a fi slab (DS) 0,833*** 0,272 0,094 0,740***
Bulimie (B) 0,451* 0,533** ‑0,264 0,375*
Nemulţumire faţă de corp (NC) 0,471** 0,547** ‑0,223 0,417*
Risc de tulburare de comportament alimentar (SCRTCA) 0,737*** 0,574*** ‑0,152 0,656***
Stimă de sine redusă (SSS) ‑0,182 ‑0,155 0,029 ‑0,171
Alienare personală (AP) ‑0,077 ‑0,152 0,055 ‑0,082
Nesiguranţă interpersonală (NI) ‑0,151 ‑0,170 0,164 ‑0,105
Alienare interpersonală (AI) ‑0,252 ‑0,134 0,091 ‑0,184
Deficite interoceptive (DI) ‑0,104 ‑0,248 ‑0,026 ‑0,155
Dezechilibru emoţional (DE) ‑0,074 ‑0,116 0,070 ‑0,060
Perfecţionism (P) 0,142 0,042 0,277 0,212
Ascetism (A) 0,251 0,352 ‑0,067 0,233
Frica de maturitate (FM) 0,004 ‑0,053 ‑0,204 ‑0,080
Ineficacitate (SCI ) ‑0,098 ‑0,199 ‑0,091 ‑0,165
Probleme interpersonale (SCPI ) ‑0,224 ‑0,203 0,082 ‑0,192
Probleme emoţionale (SCPE) ‑0,108 ‑0,198 0,020 ‑0,127
Control exagerat (SCCE) 0,272 0,232 0,170 0,304
Neadaptare psihologică generală (SCNPG) ‑0,035 ‑0,112 0,065 ‑0,035
Notă. ***p<0,001; **p<0,01; *p<0,05

Tabelul 7.7 prezintă coeficienţii de corelaţie
liniară dintre scorurile la scalele EDI‑3 şi cele
ale sub‑scalelor EAT‑26. Aşa cum se poate
observa, cele trei scale specifice tulburărilor de
comportament alimentar (DS, B şi NC) corelează
semnificativ cu sub‑scala de comportament
alimentar restrictiv a EAT‑26, cel mai ridicat
coeficient de corelaţie înregistrându‑se în cazul
scalei DS (r=0,833, p<0,001), rezultat similar cu
cel obţinut de autorii variantei originale EDI‑3 (a
se vedea tabelul 6.19). De asemenea, s‑au obţinut
corelaţii semnificative între scalele Bulimie şi
Nemulţumire faţă de corp ale EDI‑3 şi subscala
Bulimie a EAT‑26. Toate aceste rezultate susţin o
bună validitate de criteriu a EDI‑3.
Corelaţiile dintre scorurile la scalele EDI‑3
şi scorurile la alte instrumente de măsurare a
trăsăturilor de personalitate şi a psihopatologiei
Corelaţiile cu Scala Rosenberg a stimei de sine.
Scala Rosenberg a stimei de sine a fost administrată,
împreună cu EDI‑3, unui grup de 33 de femei,
cu vârsta cuprinsă între 21 şi 49 de ani (m=32,29;
σ=8,70). Tabelul 7.8 prezintă corelaţiile liniare
dintre scalele EDI‑3 şi acest instrument. În
mod similar cu rezultatele obţinute de autorii
manualului original, s‑au înregistrat corelaţii
mai puternice ale acestei măsuri a stimei de sine
cu Scalele psihologice ale EDI‑3 decât cu scalele
de Risc de tulburare de comportament alimentar.
Astfel, coeficienţii de corelaţie pentru scalele
psihologice au variat între ‑0,084 şi ‑0,624, în
timp ce aceia ai scalelor de Risc de tulburare de
comportament alimentar sunt cuprinşi între ‑0,229
şi 0,171. Scala Stimă de sine din EDI‑3 corelează
puternic negativ cu Scala Rosenberg a stimei de
sine (r=‑0,584, p<0,001), valori asemănătoare
obţinându‑se şi în cazul scalelor Alienare
personală (r=‑0,624, p<0,001), Dezechilibru emoţional
(r=‑0,567, p<0,001), precum şi în cel al scalelor
psihologice compozite: Ineficacitate (r=‑0,694,
p<0,001), Probleme emoţionale (r=‑0,601, p<0,001) şi
Neadaptare psihologică generală (r=‑0,765, p<0,001).
Aceste rezultate sunt în concordanţă cu altele
menţionate în literatura de specialitate, care
susţin prezenţa unei relaţii semnificative între
stima de sine scăzută şi prezenţa depresiei,
anxietăţii sau a simptomelor de tulburare de
comportament alimentar (Roberts şi colab., 1996;
Kostanski, Gullone, 1998; Pelkonen, Marttunen şi
colab., 2008).

248
 Tabelul 7.8. Corelaţiile liniare dintre scorurile la scalele EDI‑3 şi scorurile la
Scala Rosenberg a stimei de sine
Scala EDI‑3
Scala de Risc de tulburare de comportament alimentar/
Scala compozită
Dorinţa de a fi slab
Bulimie
Nemulţumire faţă de corp
Risc de tulburare de comportament alimentar (SCRTCA)
Scala psihologică/ Scala compozită
Stimă de sine redusă
Alienare personală
Nesiguranţă interpersonală
Alienare interpersonală
Deficite interoceptive
Dezechilibru emoţional
Perfecţionism
Ascetism
Frica de maturitate
Ineficacitate (SCI )
Probleme interpersonale (SCPI )
Probleme emoţionale (SCPE)
Control exagerat (SCCE)
Neadaptare psihologică generală (SCNPG)
Notă. ***p<0,001, **p<0,01, *p<0,05.
Corelaţiile cu Chestionarul de personalitate
Eysenck (EPQ). Tabelul 7.9 cuprinde corelaţiile
liniare dintre scorurile obţinute la EPQ şi la
EDI‑3 de un grup de 42 de femei, cu vârsta
cuprinsă între 18 şi 40 de ani (m=20,74; σ=4,17).
Aşa cum se poate observa, s‑au obţinut corelaţii
semnificative între scorurile la scalele din EPQ
şi cele la scalele psihologice ale EDI‑3, însă nu
şi la cele ale scalelor de Risc de tulburare de
comportament alimentar. Cele mai multe corelaţii
semnificative s‑au obţinut cu scala Neuroticism
a EPQ, valorile coeficienţilor de corelaţie fiind
cuprinşi între 0,311 şi 0,538. Cea mai puternică
corelaţie a scorurilor la scala Neuroticism s‑a
înregistrat cu cele la scala Dezechilibru emoţional
(r=0,538, p<0,001), rezultat concordant cu modelul
personalităţii propus de Eysenck (Eysenck, 1991),
conform căruia persoanele cu un nivel ridicat de
neuroticism manifestă stări emoţionale intens
negative, întâmpină dificultăţi în inhibarea sau
în controlul reacţiilor emoţionale, putând fi
caracterizate drept persoane instabile emoţional.
De asemenea, s‑a înregistrat o corelaţie
negativă foarte puternică între scorurile la scala
Scala Rosenberg a
stimei de sine
‑0,124
0,171
‑0,229
‑0,011
‑0,584***
‑0,624***
‑0,417*
‑0,463**
‑0,462**
‑0,567***
‑0,400*
‑0,169
‑0,084
‑0,694***
‑0,536**
‑0,601***
‑0,412*
‑0,765***
Extraversiune a EPQ şi cele la scala Nesiguranţă
interpersonală (r=‑808, p<0,001). Persoanele care
obţin scoruri scăzute la scala Extraversiune
au tendinţa de retragere din faţa stimulilor,
manifestă mai frecvent emoţii negative şi sunt
descrise ca fiind tăcute, reţinute şi inhibate.
Astfel, corelaţiile obţinute între scorurile la
EPQ şi scorurile la EDI‑3 confirmă validitatea
celui din urmă în măsurarea dimensiunilor
psihologice care corelează cu scalele EPQ
enumerate.
Corelaţiile cu scorurile la Inventarul de depresie
Beck (BDI) şi cu cele la Scalele EMAS. EDI‑3 a fost
administrat, împreună cu BDI (Beck şi colab.,
1961) şi cu scalele EMAS unui lot format din
33 de subiecţi, femei, cu vârsta cuprinsă între
18 şi 20 de ani (m=19,15; σ=0,44). Scalele EMAS
evaluează atât anxietatea ca stare (scala EMAS‑S,
compusă din două subscale care măsoară
dimensiunile emoţional‑fiziologică, respectiv
cognitivă ale anxietăţii), cât şi anxietatea ca
trăsătură, încorporând patru subscale distincte
(care măsoară anxietatea în situaţii de evaluare
socială, pericol fizic, ambiguitate şi rutine
249
 Tabelul 7.9. Corelaţiile liniare dintre scorurile la scalele EDI‑3 şi scorurile la EPQ

Scala EDI‑3 Extraversiune Neuroticism Psihoticism

Scala de Risc de tulburare de
comportament alimentar
Dorinţa de a fi slab 0,147 0,198 ‑0,188
Bulimie ‑0,038 0,165 ‑0,042
Nemulţumire faţă de corp ‑0,054 0,048 ‑0,106
Scala psihologică
Stimă de sine redusă ‑0,413** 0,311* ‑0,066
Alienare personală ‑0,297 0,460** ‑0,018
Nesiguranţă interpersonală ‑0,808*** 0,210 ‑0,058
Alienare interpersonală ‑0,315* 0,412** ‑0,167
Deficite interoceptive ‑0,253 0,380* 0,057
Dezechilibru emoţional ‑0,001 0,538*** ‑0,193
Perfecţionism 0,287 0,367* ‑0,206
Ascetism ‑0,244 0,312* 0,003
Frica de maturitate 0,111 ‑0,042 ‑0,135

Notă. ***p<0,001; **p<0,01; *p<0,05.

Tabelul 7.10. Corelaţiile liniare dintre scorurile la scalele EDI‑3 şi cele la BDI
şi la scalele EMAS‑stare

Scala EDI‑3 BDI EMAS‑S‑EF EMAS‑S‑C EMAS‑S

Scala de Risc de tulburare de
comportament alimentar
Dorinţa de a fi slab 0,242 ‑0,170 0,147 ‑0,020
Bulimie 0,218 ‑0,056 0,124 0,081
Nemulţumire faţă de corp 0,187 ‑0,009 0,045 0,019
Scala psihologică
Stimă de sine redusă 0,581*** 0,302 0,641*** 0,556***
Alienare personală 0,658*** 0,358* 0,581*** 0,545***
Nesiguranţă interpersonală 0,564*** 0,446** 0,550*** 0,569***
Alienare interpersonală 0,693*** 0,282 0,465** 0,419*
Deficite interoceptive 0,590*** 0,368* 0,553*** 0,563***
Dezechilibru emoţional 0,494** 0,310 0,577*** 0,545***
Perfecţionism 0,277 0,374* 0,198 0,312
Ascetism 0,323 0,454** 0,646*** 0,633***
Frica de maturitate 0,258 ‑0,027 0,198 0,128

Notă. ***p<0,001; **p<0,01; *p<0,05. BDI = Inventarul de depresie Beck; EMAS‑S‑EF = anxietatea ca stare, subscala
emoţional‑fiziologică; EMAS‑S‑C = anxietatea ca stare, subscala cognitivă; EMAS‑S = anxietatea ca stare.

zilnice); detaliile despre fiecare sub‑scală sunt
oferite în manualul EMAS (Miclea, Ciuca, Albu,
2009). Corelaţiile liniare obţinute sunt prezentate
în tabelele 7.10 şi 7.11. Aşa cum se poate observa
în tabelul 7.10, corelaţii pozitive semnificative
între măsurătorile depresiei şi ale anxietăţii ca
stare şi scorurile la scalele EDI‑3 se înregistrează
la aproape toate scalele psihologice, nu şi la cele
de Risc de tulburare de comportament alimentar.
Un nivel ridicat al anxietăţii ca stare (EMAS‑S)
se asociază cu o stimă de sine mai scăzută,
un grad mai mare de alienare personală şi
interpersonală, de nesiguranţă interpersonală, cu
dificultăţi în recunoaşterea reacţiilor emoţionale

250
 Tabelul 7.11. Corelaţiile liniare dintre scorurile la scalele EDI‑3 şi
scorurile la scalele EMAS‑trăsătură

Scala EDI‑3 EMAS‑T‑ES EMAS‑T‑PF EMAS‑T‑AM EMAS‑T‑RZ

Scala de Risc de tulburare de
comportament alimentar
Dorinţa de a fi slab 0,012 ‑0,046 ‑0,116 0,138
Bulimie 0,258 0,284 0,067 0,232
Nemulţumire faţă de corp 0,069 0,038 0,195 0,212
Scala psihologică
Stimă de sine redusă 0,423* 0,288 0,355 0,721***
Alienare personală 0,516** 0,343 0,427** 0,576***
Nesiguranţă interpersonală 0,455** 0,327 0,498** 0,572***
Alienare interpersonală 0,247 0,149 0,248 0,536***
Deficite interoceptive 0,529** 0,469** 0,422* 0,524**
Dezechilibru emoţional 0,369* 0,300 0,209 0,294
Perfecţionism 0,201 0,096 0,230 0,195
Ascetism 0,402* 0,136 0,133 0,444**
Frica de maturitate 0,291 0,376* 0,195 0,228
Notă. ***p<0,001, **p<0,01, *p<0,05. EMAS‑T‑ES = anxietatea ca trăsătură, subscala de evaluare socială; EMAS‑T‑PF =
anxietatea ca trăsătură, subscala de pericol fizic; EMAS‑T‑AM = anxietatea ca trăsătură, subscala de ambiguitate; EMAS‑T‑RZ
= anxietatea ca trăsătură, subscala de rutine zilnice.

proprii şi cu prezenţa altor stări emoţionale
negative. De asemenea, scala EMAS‑S corelează
puternic şi cu scala Ascetism, mai ales în ceea ce
priveşte dimensiunea cognitivă a anxietăţii ca
stare (r=0,646, p<0,001), indicând prezenţa unei
încărcături emoţionale negative suplimentare la
persoanele cu o tendinţă excesivă de autocontrol,
de austeritate auto‑impusă sau de sacrificiu de
sine.
Tabelul 7.11 cuprinde coeficienţii de corelaţie
liniară dintre scalele EDI‑3 şi scalele EMAS
referitoare la anxietatea ca trăsătură (EMAS‑T)
în cele patru situaţii specifice. Similar, s‑au
înregistrat corelaţii pozitive semnificative în cazul
scalelor psihologice, nu şi în cel al scalelor de Risc
de tulburare de comportament alimentar ale EDI‑3.
Valori mai mari ale coeficienţilor de corelaţie s‑au
obţinut în ceea ce priveşte anxietatea ca trăsătură
în situaţii cotidiene, de rutină zilnică; cu alte
cuvinte, persoanele cu o stimă de sine scăzută, cu
diverse dificultăţi în gestionarea propriilor stări
emoţionale şi a relaţiilor interpersonale, prezintă
şi o predispoziţie la anxietate, manifestată la
nivel cotidian. Singura scală din EDI‑3 care
corelează semnificativ cu toate subscalele EMAS
(atât pentru anxietatea ca stare, cât şi pentru
anxietatea ca trăsătură) este cea de Deficite
interoceptive, posibil indicând faptul că unui
nivel crescut al anxietăţii i se asociază constant
dificultăţi în recunoaşterea stărilor emoţionale şi
un răspuns neadecvat la acestea, mai ales când
sunt prea puternice sau sunt percepute ca fiind
incontrolabile.
Corelaţiile cu scorurile la PDSQ. Tabelul 7.12
prezintă corelaţiile liniare dintre scorurile la
EDI‑3 şi cele la PDSQ, rezultate din prelucrarea
datelor obţinute pe un lot de 49 de femei, cu
vârsta cuprinsă între 19 şi 45 de ani (m=21,67;
σ=4,53), cărora li s‑au administrat ambele
instrumente de evaluare. PDSQ este un
instrument de autoevaluare, multidimensional,
conceput pentru a detecta simptomele specifice a
13 tulburări de pe axa I, conform DSM‑IV (Ciuca,
Albu, 2010).
O importanţă deosebită o reprezintă
corelaţiile crescute, semnificative statistic, dintre
scalele de Risc de tulburare de comportament
alimentar ale EDI‑3 şi scala Bulimie a PDSQ,
întrucât ele dovedesc indubitabil validitatea de
construct a acestor scale. De asemenea, similar cu
rezultatele obţinute în cazul BDI şi EMAS, cele
mai multe dintre scalele psihologice ale EDI‑3
corelează semnificativ cu scala de Depresie, dar
şi cu cea de Fobie socială. Scala Alienare personală
a EDI‑3 înregistrează cele mai multe corelaţii
semnificative cu scalele PDSQ, probabil reflectând
elementul comun al tulburărilor de pe axa I,
acela al unei senzaţii generale de lipsă de control
asupra lucrurilor şi al unei suferinţe emoţionale
(valoarea cea mai ridicată a coeficienţilor de

251
 Tabelul 7.12. Corelaţiile liniare dintre scorurile la scalele EDI-3 şi scorurile la scalele PDSQ

252
Scala din EDI Depresie Stres post- Bulimie Tulb. Panică Psihoze Agora- Fobie Abuz de Abuz Anxietate Somatizare Ipohondrie
traumatic obsesiv- fobie socială alcool medicam. gen.
compulsivă
Scala de Risc de tulburare
de comportament alimentar

Dorinţa de a fi slab -0,078 -0,116 0,530*** 0,048 0,183 0,063 -0,020 0,086 -0,071 0,170 -0,061 0,244 -0,022
Bulimie 0,071 0,178 0,544*** 0,296 -0,032 0,099 0,034 0,083 0,140 -0,142 0,002 0,236 -0,012
Nemulţumire faţă de corp -0,042 -0,058 0,466*** -0,075 0,040 0,045 -0,138 0,119 -0,044 0,010 -0,107 0,350 0,032
Scala psihologică
Stimă de sine redusă 0,503*** 0,086 0,164 0,328* 0,117 0,202 0,103 0,312* 0,271 -0,011 0,382** 0,272 0,117
Alienare personală 0,662*** 0,351* 0,269 0,374** 0,166 0,324* 0,227 0,431** 0,522*** 0,100 0,240 0,392** 0,413**
Nesiguranţă interpersonală 0,588*** 0,292 0,011 0,214 0,074 0,141 0,176 0,499*** 0,285 0,065 0,326* 0,057 0,309*
Alienare interpersonală 0,447** 0,266 0,172 0,194 0,079 -0,036 -0,010 0,482*** 0,368** -0,023 0,088 0,269 0,170
Deficite interoceptive 0,311* 0,402** 0,326* 0,187 0,099 0,156 0,001 0,329* 0,357* 0,063 0,222 0,454 0,279
Dezechilibru emoţional 0,219 0,101 0,410** 0,205 0,133 0,174 0,117 0,300* 0,278 0,270 0,246 0,436** 0,248
Perfecţionism 0,305* 0,337* 0,176 0,278 0,282 0,469*** 0,073 0,110 0,491*** 0,073 0,128 0,501*** 0,455**
Ascetism 0,297 0,093 0,393* 0,218 0,388* 0,307 0,222 0,188 0,194 0,071 0,233 0,331* 0,491***
Frica de maturitate 0,277 0,159 0,154 0,208 0,168 -0,176 0,076 0,028 0,295 -0,018 0,317* 0,190 0,247

Notă. ***p<0,001, **p<0,01, *p<0,05.

 Tabelul 7.13. Corelaţiile liniare dintre scorurile la scalele EDI‑3
şi greutatea corporală şi valorile IMC

Scala EDI‑3 IMC Greutate

Scala de Risc de tulburare de
comportament alimentar
Dorinţa de a fi slab 0,395*** 0,395***
Bulimie 0,195*** 0,219***
Nemulţumire faţă de corp 0,410*** 0,384***
Scala psihologică
Stimă de sine redusă ‑0,013 ‑0,016
Alienare personală ‑0,023 ‑0,036
Nesiguranţă interpersonală 0,004 0,003
Alienare interpersonală ‑0,078 ‑0,049
Deficite interoceptive ‑0,067 ‑0,062
Dezechilibru emoţional ‑0,012 ‑0,013
Perfecţionism ‑0,079 ‑0,073
Ascetism 0,095 0,089
Frica de maturitate ‑0,083 ‑0,059
Notă. ***p<0,001, **p<0,01, *p<0,05.

corelaţie, r= 0,662, p<0,001, s‑a obţinut cu scala de
Depresie a PDSQ).
Corelaţiile cu valorile IMC‑ului. Scorurile
obţinute în urma administrării EDI‑3 unui lot de
302 femei, cu vârsta cuprinsă între 18 şi 55 de ani
(m=24,97; σ=8,81) au fost corelate cu greutatea
corporală a participantelor (măsurată în kg) şi
cu valorile IMC‑ului, calculate conform formulei
IMC = înălţimea (în m) / greutatea (în kg)2.
Coeficienţii de corelaţie liniară sunt prezentaţi în
tabelul 7.13.
Toate scalele de Risc de tulburare de
comportament alimentar corelează semnificativ
(p<0,001) cu ambii indicatori ai greutăţii corporale,
însemnând că tendinţa ca o persoană să prezinte
semne ale unei tulburări de comportament
alimentar creşte odată cu greutatea corporală,
fapt demonstrat şi de alte cercetări în domeniu
(Garner, Garner, Van Egeren, 1992). Acest
rezultat susţine importanţa evaluării obligatorii
a greutăţii corporale, în contextul unei mai bune
înţelegeri a prezenţei eventuale a unor niveluri
extrem de ridicate de nemulţumire faţă de corp,
a unei dorinţe aberante de a fi slab(ă), respectiv a
simptomelor specifice bulimiei.
Comparaţiile scorurilor la scalele EDI‑3 între
loturile clinic şi nonclinic
EDI‑3 a fost administrat unor persoane
cu şi fără un diagnostic clar de tulburare de
comportament alimentar. Lotul clinic a fost
format din 26 de femei cu vârsta cuprinsă între
13 şi 38 de ani (m=20,81; σ=7,04) şi cu diferite
diagnostice de tulburare de comportament
alimentar (anorexie nervoasă restrictivă şi de
tip alimentaţie compulsivă/vărsături, bulimie
nervoasă, tulburări de comportament alimentar
fără altă specificaţie). Aceşti participanţi au fost
comparaţi cu 45 de femei cu vârsta cuprinsă între
13 şi 38 de ani (m=21,11 şi σ=1,04), reprezentând
lotul de control. Au fost comparate mediile
scorurilor scalelor EDI‑3 între cele două
loturi, folosindu‑se testul t pentru eşantioane
independente.
Aşa cum se poate observa din tabelul 7.14,
nu există diferenţe semnificative între cele două
loturi în privinţa greutăţii corporale (IMC) şi
a vârstei. Aşa cum era de aşteptat, femeile cu
tulburări de comportament alimentar au obţinut
scoruri mai ridicate decât femeile fără patologie
a comportamentului alimentar la toate scalele
de Risc de tulburare de comportament alimentar şi
la patru scale psihologice. Chiar dacă, la celelalte
scale psihologice, diferenţele dintre cele două
loturi nu au fost semnificative statistic, scorurile
lotului clinic au fost constant mai ridicate decât
cele ale lotului nonclinic. Aceste rezultate
dovedesc puterea de discriminare a EDI‑3 între
populaţiile clinice şi cele nonclinice.

253
 Tabelul 7.14. Compararea mediilor scorurilor scalelor EDI‑3 între lotul clinic şi cel nonclinic

Lot clinic Lot nonclinic Testul t bilateral

Scala EDI‑3
N m σ N m σ t g.l. p
Scala de Risc de tulburare de
comportament alimentar
Dorinţa de a fi slab 25 11,12 9,68 45 4,87 5,79 2,951 33,8 0,001
Bulimie 25 7,60 8,43 45 1,40 2,54 3,589 26,5 0,001
Nemulţumire faţă de corp 25 16,88 9,75 45 8,20 7,95 4,032 68 0,000
Scala psihologică
Stimă de sine redusă 26 7,58 5,30 45 4,09 4,86 2,818 69 0,006
Alienare personală 26 7,88 4,96 45 4,67 5,14 2,573 69 0,012
Nesiguranţă interpersonală 26 8,04 5,37 45 6,96 6,53 0,717 69 0,476
Alienare interpersonală 26 7,23 4,89 45 6,51 5,86 0,528 69 0,599
Deficite interoceptive 26 7,85 5,63 45 5,62 4,59 1,808 69 0,075
Dezechilibru emoţional 25 8,32 6,67 45 4,40 4,63 2,890 68 0,005
Perfecţionism 26 10,23 5,72 45 9,31 4,27 0,770 69 0,444
Ascetism 25 7,40 5,89 45 5,51 4,71 1,467 68 0,147
Frica de maturitate 26 14,62 7,28 45 11,18 6,59 2,037 69 0,045
IMC 25 19,45 7,25 45 20,91 3,27 0,957 29,5 0,346
Vârsta 26 20,81 7,04 45 21,11 6,95 0,176 69 0,861

Validitatea de construct şi Nemulţumirea faţă de corp, rezultat previzibil

Structura internă a EDI‑3 a fost validată cu
ajutorul analizei intercorelaţiilor dintre scalele
EDI‑3 şi al analizei factoriale.
a) Studiul intercorelaţional între scalele EDI‑3
Corelaţiile liniare dintre scalele EDI‑3 sunt
prezentate în tabelele 7.15 ‑ 7.16 pentru un
lot de 304 femei, cu vârsta cuprinsă între 18 şi
55 de ani (m=24,97; σ=8,81). Aşa cum se poate
observa din tabelul 7.15, scala Dorinţa de a fi slab
corelează puternic cu celelalte două scale de Risc
de tulburare de comportament alimentar, susţinând
ideea acestui construct ca fiind una dintre
trăsăturile fundamentale asociate cu debutul
şi cu menţinerea simptomelor de tulburare
de comportament alimentar. Cel mai puternic
corelează scorurile la scalele Dorinţa de a fi slab
şi în concordanţă atât cu opiniile laice, cât şi cu
cele ale specialiştilor (Garner, Olmsted şi colab.,
1984).
Rezultatele vizând scalele psihologice şi
prezentate în tabelul 7.16 sunt similare cu cele
obţinute de autorii instrumentului EDI‑3, în
sensul înregistrării celei mai ridicate valori a
unui coeficient de corelaţie între scalele Stima de
sine scăzută şi Alienare personală (r=0,721; p<0,001),
susţinând suprapunerea conceptuală a celor
două constructe. Se constată, în mod similar cu
rezultatele obţinute de autori, că scalele care
intră în compoziţia SCI, SCPI şi SCPE prezintă
corelaţii mai puternice cu scalele care fac parte
din aceeaşi scală compozită decât cu celelalte
Scale psihologice. Excepţia de la această regulă
generală o constituie scalele P şi A (care compun

Tabelul 7.15. Intercorelaţiile între scalele de

Risc de tulburare de comportament alimentar ale EDI‑3

Scala EDI‑3 DS B NC
Dorinţa de a fi slab (DS) 1,000 0,494*** 0,715***
Bulimie (B) 1,000 0,492***
Nemulţumire faţă de corp (NC) 1,000
Notă. ***p<0,001, **p<0,01, *p<0,05. Numărul de persoane variază între perechile de
scale, deoarece unii participanţi nu au răspuns la toţi itemii.

254
SCCE). Scala A prezintă corelaţia cea mai mare b) Analiza factorială
cu scala DI, nu cu scala P. Acest rezultat este, de S‑a efectuat analiza factorială a itemilor
asemenea, concordant cu rezultatele obţinute de scalelor de Risc de tulburare de comportament
autori. alimentar ale EDI‑3, utilizându‑se metoda

Tabelul 7.16. Intercorelaţiile între scalele psihologice ale EDI‑3

Scala EDI‑3 SSS AP NI AI DI DE P A FM

Stimă de sine scăzută (SSS) 1,000 0,721*** 0,485*** 0,524*** 0,519*** 0,366*** 0,132* 0,343*** 0,293***
Alienare personală (AP) 1,000 0,498*** 0,656*** 0,617*** 0,519*** 0,203*** 0,364*** 0,294***
Nesiguranţă interpersonală (NI) 1,000 0,545*** 0,340*** 0,239*** 0,105 0,268*** 0,133*
Alienare interpersonală (AI) 1,000 0,409*** 0,394*** 0,235** 0,369*** 0,243***
Deficite interoceptive (DI) 1,000 0,595*** 0,242*** 0,426*** 0,402***
Dezechilibru emoţional (DE) 1,000 0,217*** 0,389*** 0,234***
Perfecţionism (P) 1,000 0,299*** 0,113
Ascetism (A) 1,000 0,279***
Frica de maturitate (FM) 1,000
Notă. ***p<0,001, **p<0,01, *p<0,05. Numărul de persoane variază între perechile de scale, deoarece unii participanţi nu au
răspuns la toţi itemii.

Tabelul 7.17. Saturaţiile itemilor în factorii extraşi pentru scalele de

Risc de tulburare de comportament alimentar din EDI‑3

Scala din care face Factor (N = 291)

Item
parte itemul F1 F2 F3
1 0,294 0,493 0,197
7 0,590 0,783 0,366
11 0,517 0,756 0,455
Dorinţa de fi slab 16 0,556 0,820 0,463
25 0,593 0,730 0,408
32 0,704 0,834 0,382
49 0,430 0,773 0,389
4 0,233 0,385 0,496
5 0,276 0,325 0,794
28 0,359 0,430 0,635
38 0,242 0,234 0,624
Bulimie
46 0,180 0,240 0,520
53 0,166 0,310 0,387
61 0,189 0,217 0,390
64 0,367 0,551 0,572
2 0,454 0,584 0,527
9 0,721 0,542 0,343
12 0,426 0,533 0,537
19 0,686 0,564 0,401
Nemulţumire faţă 31 0,643 0,411 0,283
de corp 45 0,837 0,583 0,352
47 0,258 0,413 0,383
55 0,841 0,526 0,285
59 0,768 0,545 0,353
62 0,767 0,428 0,294
Notă. Pentru fiecare item a fost haşurată căsuţa în care se află cea mai mare saturaţie.

255
componentelor principale şi rotaţia factorilor
extraşi prin metoda Promax. Lotul studiat a
fost format din 291 de femei cu vârsta cuprinsă
între 18 şi 55 ani (m=24,78; σ =8,54). Au fost
extraşi 3 factori, care acoperă, împreună, 53,04%
din varianţa totală (F1 = 36,99%; F2 = 9,47%; F3 =
6,59%). Saturaţiile itemilor în factorii extraşi sunt
prezentate în tabelul 7.17.
Din datele prezentate, este evident că toţi
itemii scalei Dorinţa de a fi slab şi toţi cei ai scalei
Bulimie au cea mai mare saturaţie în factorul
corespunzător scalei din care fac parte. 7 dintre 10
itemi ai scalei Nemulţumire faţă de corp îndeplinesc
aceeaşi condiţie. Aceste rezultate ale analizei
factoriale dovedesc o deosebit de bună validitate
de construct a scalelor de Risc de tulburare de
comportament alimentar, cele mai relevante pentru
psihopatologia tulburărilor de comportament
alimentar.
Concluzii
Inventarul tulburărilor de comportament
alimentar – 3 (EDI‑3) s‑a dovedit a fi un instrument
cu un nivel crescut de fidelitate şi de validitate
în evaluarea simptomelor relevante din punct de
vedere clinic ale tulburărilor de comportament
alimentar. El este destinat administrării în
populaţia generală (nonclinică), la persoane cu
vârste peste 18 ani. EDI‑3 evaluează trăsături
caracteristice acestei categorii de tulburări:
Dorinţa de a fi slab, Bulimia, Nemulţumirea fată
de corp, precum şi nouă constructe psihologice,
importante atât în apariţia, cât şi în manifestarea
şi menţinerea tulburărilor de comportament
alimentar. În mod similar cu rezultatele obţinute
de autorii acestui inventar, varianta în limba
română a EDI‑3 discriminează între persoanele cu
un diagnostic clar de tulburare de comportament
alimentar şi cele fără o astfel de patologie,
recomandându‑se pentru utilizarea ei atât ca
instrument de screening, cât şi ca instrument
adjuvant în evaluarea severităţii simptomelor
prezente de tulburare de comportament
alimentar.
Cotarea şi interpretarea scorurilor la scalele
EDI‑3
Cotarea
Cotarea versiunii în limba română a EDI‑3
se realizează identic cu cea descrisă în manualul
original, conform instrucţiunilor prezentate în
capitolul 3. Astfel, este obligatorie verificarea
256
datelor demografice (vârstă, sex), a parametrilor
fizici (greutate corporală şi înălţime) şi a
istoricului greutăţii din Broşura cu itemi,
precum şi cea a Formularului de răspuns, pentru
identificarea răspunsurilor omise (respondentul
nu a dat niciun răspuns la itemul respectiv) sau
cu răspunsuri multiple (sunt marcate mai multe
răspunsuri la acelaşi item). Un protocol este
invalid dacă conţine mai multe răspunsuri lipsă
sau care nu pot fi cotate. Atunci când lipseşte
răspunsul la mai mult de un item la o anumită
scală, se recomandă a nu se calcula scorurile
pentru acea scală. Pe cale de consecinţă, scorul
compozit format din suma scorurilor unor scale
care au fost invalidate nu se va calcula. În cazurile
în care se constată lipsa unui singur item la o
scală, se consideră acceptabil calculul scorului
scalei respective pe baza mediei cotelor itemilor
completaţi, cu condiţia ca scorul final la această
scală să fie interpretat cu prudenţă.
În situaţiile în care au fost completate toate
datele demografice şi toate scalele sunt valide,
se poate face cotarea. Procedura de cotare
este descrisă în detaliu în capitolul 3. Astfel,
utilizând formularele de răspuns cu auto‑cotare
şi respectând atent instrucţiunile se va obţine pe
Fişa de cotare câte un scor brut pentru fiecare scală
EDI‑3. Scorurile brute ale scalelor se vor transfera
de pe Fişa de cotare în spaţiile special prevăzute pe
Fişa de centralizare a rezultatelor aflată pe verso‑ul
Formularului de răspuns şi în partea stângă a Fişei
de cotare.
Transformarea cotelor brute în cote T şi în
centile
După transferarea tuturor scorurilor brute,
consultaţi Anexa A1 pentru transformarea
acestora în cote T. Fiecare cotă T corespunzătoare
scorului brut al unei scale se va trece în căsuţa
special destinată, în coloana din dreapta celei a
scorului brut de pe Fişa de centralizare a rezultatelor.
Calculul scorurilor compozite se realizează
prin însumarea cotelor T ale scalelor care intră
în compoziţia scalei compozite respective. De
exemplu, pentru aflarea scorului compozit
de Risc de tulburare de comportament alimentar
(SCRTCA), se însumează cotele T ale scalelor
Dorinţa de a fi slab, Bulimie şi Nemulţumire faţă
de corp. La fel se procedează şi pentru celelalte
scoruri compozite (SCI, SCPI, SCPE, SCCE,
SCNPG). Suma cotelor T va fi trecută în căsuţa
aferentă fiecărui scor compozit, pe Fişa de
centralizare a rezultatelor. Anexele C1 – C6 se vor
consulta pentru transformarea sumelor cotelor T
ale scorurilor compozite în cote T. Cota T astfel
obţinută se trece în căsuţa corespunzătoare din
dreptul fiecărui scor compozit.
Exemplu
O persoană de sex feminin a obţinut un scor
total brut de 21 la scala Dorinţa de a fi slab, un scor
brut de 8 la scala Bulimie şi unul de 14 la scala
Nemulţumire faţă de corp. Consultând tabelul de
conversie a scorurilor brute în cote T (Anexa A1),
se constată că:
-- unui scor de 21 la scala Dorinţa de a fi slab
îi corespunde o cotă T de 68,75;
-- unui scor de 8 la scala Bulimie îi
corespunde o cotă T de 63,56;
-- unui scor de 14 la scala Nemulţumire faţă
de corp îi corespunde o cotă T de 54,02.
Pentru a obţine scorul compozit SCRTCA,
se însumează cotele T ale acestor trei scale,
obţinându‑se valoarea de 186,33. Făcând
conversia acestei valori (rotunjită la cel mai
apropiat întreg, adică la 186) în cotă T (Anexa
C1), se obţine 64,47.
În mod similar, Anexa B1 se utilizează
pentru transformarea scorurilor brute ale tuturor
scalelor EDI‑3 în centile, iar Anexele C1 – C6 se
vor consulta pentru transformarea scorurilor
brute ale scalelor compozite în centile. Centilul
corespunzător se trece în căsuţa aferentă, în
coloana din dreapta celei a cotei T de pe Fişa de
centralizare a rezultatelor.
Calcularea scorurilor la scalele de validitate
Fişa de centralizare a rezultatelor cuprinde şi
scorurile scalelor de validitate (Inconsecvenţă,
Raritate şi Impresie negativă).
Pentru a realiza cotarea scalei Inconsecvenţă,
copiaţi de pe Fişa de cotare scorurile itemilor
corespunzători acestei scale şi treceţi‑i în
căsuţele destinate lor de pe Fişa de centralizare
a rezultatelor. Pentru fiecare pereche de itemi
obţinută, se scade scorul mai mic din scorul mai
mare, iar diferenţa se trece în căsuţa Total a scalei
Inconsecvenţă. Scorul total de Inconsecvenţă se
obţine prin însumarea tuturor diferenţelor din
coloana Total. Raportaţi acest scor la tabelul de
cotare şi încercuiţi categoria în care se încadrează
scorul la această scală (Tipic, Atipic, Foarte atipic).
Scorul total la scala Raritate se obţine
numărând itemii notaţi cu R de pe Fişa de cotare
care au fost cotaţi cu 4. Acest scor se notează în
căsuţa corespunzătoare şi se raportează la tabelul
de cotare. La fel ca în cazul scalei Inconsecvenţă,
se încercuieşte categoria căreia îi aparţine scorul
Raritate.
Pentru cotarea scalei Impresie negativă, se
numără itemii care au primit scorul 4 (marcaţi pe
Fişa de cotare cu ajutorul căsuţelor haşurate) din
întregul chestionar EDI‑3, exceptând itemul 71.
Numărul total de itemi se trece în spaţiul prevăzut
pentru scorul la scala de Impresie negativă de pe
Fişa de centralizare a rezultatelor şi se încercuieşte
categoria corespunzătoare acestui scor în tabelul
de cotare de pe Fişa de centralizare a rezultatelor.
Utilizarea intervalelor de încredere ale
cotelor T
Intervalele de încredere ale cotelor T permit
compararea persoanelor între ele. Se consideră
că două persoane diferă una de cealaltă în ceea
ce priveşte variabila psihologică măsurată de
o scală, doar dacă intervalele de încredere ale
cotelor T corespunzătoare scorurilor brute ale
acestor persoane la scală nu au porţiuni comune
(sunt disjuncte). Atunci când intervalele de
încredere ale cotelor T pentru două persoane
se intersectează, este posibil ca scorurile reale,
transformate în cote T, ale celor două persoane
să se afle în porţiunea comună, fiind egale sau
chiar într‑o relaţie de ordine opusă celei în
care se găsesc scorurile obţinute la scală de
cele două persoane. În Anexele A1‑A2 sunt
trecute intervalele de încredere ale cotelor T
corespunzătoare scorurilor brute la toate scalele
EDI‑3, iar Anexele C1‑C6 cuprind intervalele de
încredere ale cotelor T corespunzătoare sumelor
cotelor T la toate scalele compozite ale EDI‑3.
Exemplu
Aceeaşi persoană de sex feminin care a
obţinut un scor total brut de 21 la scala Dorinţa
de a fi slab este comparată cu o altă persoană de
sex feminin, care are un scor brut de 16 la această
scală. Se poate afirma că prima femeie are o
dorinţă de a fi slabă mai ridicată decât cea de‑a
doua femeie? În Anexa A1, se caută intervalele
de încredere ale cotelor T corespunzătoare
probabilităţii P = 0,90:
-- pentru scorul 21: [64,70, 72,79];
-- pentru scorul 16: [57,96, 66,05].
Intervalele au o porţiune comună: intervalul
[64,70, 66,05]. Scorurile reale ale celor două
persoane, transformate în cote T, se pot afla în
acest interval; cu alte cuvinte scorul real al primei
persoane poate fi mai mare, egal cu sau mai mic
decât scorul real al celei de‑a doua persoane. În
257
consecinţă, nu se poate afirma că prima femeie îşi
doreşte să fie slabă mai mult decât îşi doreşte cea
de‑a doua femeie, chiar dacă scorul brut obţinut
de prima este mai mare decât cel al celei de‑a
doua.
Utilizarea foilor de profil
obţinută pe baza scorurilor celor mai ridicate
ale persoanelor din lotul clinic (deasupra ei se
află centilele corespunzătoare celor mai mari
scoruri obţinute de jumătate din persoanele din
lotul clinic). Intervalul cuprins între centilul 25 şi
centilul 66 reprezintă zona tipică corespunzătoare
eşantionului nonclinic.

Trasarea profilurilor EDI‑3 poate fi făcută Utilizarea EDI-3 FT

utilizând atât cotele T, cât şi centilele. În funcţie de
unitatea de măsură pentru realizarea profilului,
alegeţi Foaia de profil pe baza cotelor T sau Foaia
de profil pe baza centilelor şi copiaţi pe aceasta
valorile cotelor T sau ale centilelor pentru fiecare
scală şi scală compozită, în spaţiile prevăzute în
partea de jos a Foii de profil. Localizaţi şi marcaţi
cu atenţie poziţia cotelor T sau a centilelor pe
coloana potrivită, urmărind coloana scorurilor
din marginea dreaptă sau cea din stânga. După ce
aţi marcat toate scorurile, uniţi cu o linie punctele
corespunzătoare scorurilor tuturor scalelor
de Risc de tulburare de comportament alimentar
şi al scalei compozite de Risc de tulburare de
comportament alimentar şi trasaţi alte linii pentru a
uni punctele corespunzătoare scalelor psihologice
şi scalelor psihologice compozite pentru a forma
un profil (a se vedea Figurile 7.1 şi 7.2).
Foaia de profil pe baza cotelor T conţine o linie
de demarcaţie, corespunzătoare limitei inferioare
a intervalului de Semnificaţie clinică ridicată,
obţinută pe baza scorurilor celor mai ridicate ale
persoanelor din lotul clinic (deasupra ei se află
cotele T corespunzătoare celor mai mari scoruri
obţinute de jumătate dintre persoanele din lotul
clinic), precum şi o zonă haşurată care reprezintă
intervalul de cote T echivalent intervalului
scorurilor brute ale eşantionului folosit la
etalonare, cuprinse între centilul 25 şi centilul 66.
Foaia de profil pe bază de centile conţine o linie
de demarcaţie, care reprezintă limita inferioară
a intervalului Semnificaţie clinică ridicată,
Procedura de administrare şi cea de cotare
ale EDI-3 FT sunt descrise în capitolul 3 al acestui
manual.
Pe Fişa de cotare sunt notate intervalele de
semnificaţie clinică pentru scala Nemulţumire
faţă de corp şi pragurile critice pentru scalele
Dorinţa de a fi slab şi Bulimie, determinate folosind
eşantionul de femei adulte utilizat la etalonarea
chestionarului EDI-3.
Intervalele de semnificaţie clinică pentru
scala Nemulţumire faţă de corp corespund
intervalelor de centilele 0‑25 (semnificaţie clinică
scăzută), 26‑65 (semnificaţie clinică moderată) şi
66‑100 (semnificaţie clinică ridicată). Pragurile
critice pentru scalele Dorinţa de a fi slab şi Bulimie
au fost determinate pentru fiecare interval de
valori ale IMC‑ului : ≤18, (18, 22], (22, 25] şi >25.
S‑a ales drept prag critic acel scor brut al scalei
care îndeplinea condiţia că aproximativ 15%
dintre persoanele din eşantionul non‑clinic au
scorul brut la scală cel puţin egal (≥) cu valoarea
respectivă (a se vedea tabelul 7.18).
Utilizarea EDI‑3 LS
Procedura de administrare a EDI‑3 LS
este descrisă în capitolul 3. Pe prima pagină a
EDI‑3 LS sunt clar prezentate instrucţiunile de
administrare, respondenţii urmând să completeze
cu răspunsurile proprii spaţiile special prevăzute
de la fiecare secţiune a formularului.

Tabelul 7.18. Frecvenţa (în %) persoanelor din eşantionul utilizat la etalonare care au scorul brut
al scalei cel puţin egal cu pragul critic, pentru scalele Dorinţa de a fi slab şi Bulimie, în funcţie de
valoarea IMC-ului

Pragul critic pentru IMC Scala Dorinţa de a fi slab Scala Bulimie

IMC ≤ 18 11,5% 15,4%
18 < IMC ≤ 22 14,3% 14,6%
22 < IMC ≤ 25 13,2% 16,2%
25 < IMC 15,6% 11,6%

258
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259
Anexa A

261
 Anexa A1. Transformarea scorurilor brute în cote T şi intervalele de încredere - IC (P=0,90)
ale cotelor T pentru scalele de Risc de tulburare de comportament alimentar ale EDI-3

Scor DS B NC Scor
brut brut
Cota T IC Cota T IC Cota T IC
0 40,44 40,44 - 44,49 43,66 43,66 - 51,12 38,73 38,73 - 44,19 0
1 41,79 40,44 - 45,84 46,14 43,66 - 53,61 39,83 38,73 - 45,28 1
2 43,14 40,44 - 47,18 48,63 43,66 - 56,09 40,92 38,73 - 46,38 2
3 44,49 40,44 - 48,53 51,12 43,66 - 58,58 42,01 38,73 - 47,47 3
4 45,84 41,79 - 49,88 53,61 46,14 - 61,07 43,10 38,73 - 48,56 4
5 47,18 43,14 - 51,23 56,09 48,63 - 63,56 44,19 38,73 - 49,65 5
6 48,53 44,49 - 52,57 58,58 51,12 - 66,04 45,28 39,83 - 50,74 6
7 49,88 45,84 - 53,92 61,07 53,61 - 68,53 46,38 40,92 - 51,83 7
8 51,23 47,18 - 55,27 63,56 56,09 - 71,02 47,47 42,01 - 52,93 8
9 52,57 48,53 - 56,62 66,04 58,58 - 73,51 48,56 43,10 - 54,02 9
10 53,92 49,88 - 57,96 68,53 61,07 - 76,00 49,65 44,19 - 55,11 10
11 55,27 51,23 - 59,31 71,02 63,56 - 78,48 50,74 45,28 - 56,20 11
12 56,62 52,57 - 60,66 73,51 66,04 - 80,97 51,83 46,38 - 57,29 12
13 57,96 53,92 - 62,01 76,00 68,53 - 83,46 52,93 47,47 - 58,38 13
14 59,31 55,27 - 63,36 78,48 71,02 - 85,95 54,02 48,56 - 59,48 14
15 60,66 56,62 - 64,70 80,97 73,51 - 88,43 55,11 49,65 - 60,57 15
16 62,01 57,96 - 66,05 83,46 76,00 - 90,92 56,20 50,74 - 61,66 16
17 63,36 59,31 - 67,40 85,95 78,48 - 93,41 57,29 51,83 - 62,75 17
18 64,70 60,66 - 68,75 88,43 80,97 - 95,90 58,38 52,93 - 63,84 18
19 66,05 62,01 - 70,09 90,92 83,46 - 98,38 59,48 54,02 - 64,93 19
20 67,40 63,36 - 71,44 93,41 85,95 - 100,87 60,57 55,11 - 66,03 20
21 68,75 64,70 - 72,79 95,90 88,43 - 103,36 61,66 56,20 - 67,12 21
22 70,09 66,05 - 74,14 98,38 90,92 - 105,85 62,75 57,29 - 68,21 22
23 71,44 67,40 - 75,49 100,87 93,41 - 108,33 63,84 58,38 - 69,30 23
24 72,79 68,75 - 76,83 103,36 95,90 - 110,82 64,93 59,48 - 70,39 24
25 74,14 70,09 - 78,18 105,85 98,38 - 113,31 66,03 60,57 - 71,48 25
26 75,49 71,44 - 78,18 108,33 100,87 - 115,80 67,12 61,66 - 72,58 26
27 76,83 72,79 - 78,18 110,82 103,36 - 118,28 68,21 62,75 - 73,67 27
28 78,18 74,14 - 78,18 113,31 105,85 - 120,77 69,30 63,84 - 74,76 28
29 115,80 108,33 - 123,26 70,39 64,93 - 75,85 29
30 118,28 110,82 - 123,26 71,48 66,03 - 76,94 30
31 120,77 113,31 - 123,26 72,58 67,12 - 78,03 31
32 123,26 115,80 - 123,26 73,67 68,21 - 79,13 32
33 74,76 69,30 - 80,22 33
34 75,85 70,39 - 81,31 34
35 76,94 71,48 - 82,40 35
36 78,03 72,58 - 82,40 36
37 79,13 73,67 - 82,40 37
38 80,22 74,76 - 82,40 38
39 81,31 75,85 - 82,40 39
40 82,40 76,94 - 82,40 40

Notă. DS = Dorinţa de a fi slab; B = Bulimie; NC = Nemulţumire faţă de corp.

262
 Anexa A2. Transformarea scorurilor brute în cote T şi intervalele de încredere - IC (P=0,90)
ale cotelor T pentru scalele psihologice ale EDI-3

Scor SSS AP NI AI DI Scor

brut brut
Cota T IC Cota T IC Cota T IC Cota T IC Cota T IC
0 40,18 40,18 - 45,21 38,51 38,51 - 46,22 37,57 37,57 - 43,22 34,97 34,97 - 41,83 37,76 37,76 - 45,36 0
1 42,70 40,18 - 47,73 41,08 38,51 - 48,79 39,45 37,57 - 45,10 37,25 34,97 - 44,12 39,66 37,76 - 47,26 1
2 45,21 40,18 - 50,25 43,65 38,51 - 51,36 41,34 37,57 - 46,99 39,54 34,97 - 46,41 41,56 37,76 - 49,16 2
3 47,73 42,70 - 52,77 46,22 38,51 - 53,93 43,22 37,57 - 48,87 41,83 34,97 - 48,70 43,46 37,76 - 51,06 3
4 50,25 45,21 - 55,29 48,79 41,08 - 56,50 45,10 39,45 - 50,75 44,12 37,25 - 50,98 45,36 37,76 - 52,97 4
5 52,77 47,73 - 57,81 51,36 43,65 - 59,07 46,99 41,34 - 52,64 46,41 39,54 - 53,27 47,26 39,66 - 54,87 5
6 55,29 50,25 - 60,33 53,93 46,22 - 61,65 48,87 43,22 - 54,52 48,70 41,83 - 55,56 49,16 41,56 - 56,77 6
7 57,81 52,77 - 62,85 56,50 48,79 - 64,22 50,75 45,10 - 56,40 50,98 44,12 - 57,85 51,06 43,46 - 58,67 7
8 60,33 55,29 - 65,37 59,07 51,36 - 66,79 52,64 46,99 - 58,29 53,27 46,41 - 60,14 52,97 45,36 - 60,57 8
9 62,85 57,81 - 67,88 61,65 53,93 - 69,36 54,52 48,87 - 60,17 55,56 48,70 - 62,43 54,87 47,26 - 62,47 9
10 65,37 60,33 - 70,40 64,22 56,50 - 71,93 56,40 50,75 - 62,05 57,85 50,98 - 64,71 56,77 49,16 - 64,37 10
11 67,88 62,85 - 72,92 66,79 59,07 - 74,50 58,29 52,64 - 63,94 60,14 53,27 - 67,00 58,67 51,06 - 66,27 11
12 70,40 65,37 - 75,44 69,36 61,65 - 77,07 60,17 54,52 - 65,82 62,43 55,56 - 69,29 60,57 52,97 - 68,17 12
13 72,92 67,88 - 77,96 71,93 64,22 - 79,64 62,05 56,40 - 67,70 64,71 57,85 - 71,58 62,47 54,87 - 70,08 13
14 75,44 70,40 - 80,48 74,50 66,79 - 82,21 63,94 58,29 - 69,59 67,00 60,14 - 73,87 64,37 56,77 - 71,98 14
15 77,96 72,92 - 83,00 77,07 69,36 - 84,78 65,82 60,17 - 71,47 69,29 62,43 - 76,16 66,27 58,67 - 73,88 15
16 80,48 75,44 - 85,52 79,64 71,93 - 87,35 67,70 62,05 - 73,35 71,58 64,71 - 78,44 68,17 60,57 - 75,78 16
17 83,00 77,96 - 88,04 82,21 74,50 - 89,92 69,59 63,94 - 75,24 73,87 67,00 - 80,73 70,08 62,47 - 77,68 17
18 85,52 80,48 - 90,55 84,78 77,07 - 92,49 71,47 65,82 - 77,12 76,16 69,29 - 83,02 71,98 64,37 - 79,58 18
19 88,04 83,00 - 93,07 87,35 79,64 - 95,06 73,35 67,70 - 79,00 78,44 71,58 - 85,31 73,88 66,27 - 81,48 19
20 90,55 85,52 - 95,59 89,92 82,21 - 97,63 75,24 69,59 - 80,89 80,73 73,87 - 87,60 75,78 68,17 - 83,38 20
21 93,07 88,04 - 98,11 92,49 84,78 - 100,21 77,12 71,47 - 82,77 83,02 76,16 - 89,89 77,68 70,08 - 85,29 21
22 95,59 90,55 - 100,63 95,06 87,35 - 102,78 79,00 73,35 - 84,65 85,31 78,44 - 92,17 79,58 71,98 - 87,19 22
23 98,11 93,07 - 100,63 97,63 89,92 - 105,35 80,89 75,24 - 86,53 87,60 80,73 - 94,46 81,48 73,88 - 89,09 23
24 100,63 95,59 - 100,63 100,21 92,49 - 107,92 82,77 77,12 - 88,42 89,89 83,02 - 96,75 83,38 75,78 - 90,99 24
25 102,78 95,06 - 110,49 84,65 79,00 - 90,30 92,17 85,31 - 99,04 85,29 77,68 - 92,89 25
26 105,35 97,63 - 110,49 86,53 80,89 - 90,30 94,46 87,60 - 99,04 87,19 79,58 - 94,79 26
27 107,92 100,21 - 110,49 88,42 82,77 - 90,30 96,75 89,89 - 99,04 89,09 81,48 - 96,69 27
28 110,49 102,78 - 110,49 90,30 84,65 - 90,30 99,04 92,17 - 99,04 90,99 83,38 - 98,59 28
29 92,89 85,29 - 100,49 29
30 94,79 87,19 - 102,40 30
31 96,69 89,09 - 104,30 31
32 98,59 90,99 - 106,20 32
33 100,49 92,89 - 106,20 33
34 102,40 94,79 - 106,20 34
35 104,30 96,69 - 106,20 35
36 106,20 98,59 - 106,20 36

263
 Anexa A2. Transformarea scorurilor brute în cote T şi intervalele de încredere - IC (P=0,90)
ale cotelor T pentru scalele psihologice ale EDI-3 (continuare)

Scor DE P A FM Scor
brut brut
Cota T IC Cota T IC Cota T IC Cota T IC
0 39,10 39,10 - 47,89 29,67 29,67 - 37,90 35,62 35,62 - 44,75 29,50 29,50 - 36,13 0
1 41,30 39,10 - 50,09 31,73 29,67 - 39,96 37,90 35,62 - 47,03 31,16 29,50 - 37,78 1
2 43,49 39,10 - 52,29 33,79 29,67 - 42,02 40,18 35,62 - 49,32 32,81 29,50 - 39,44 2
3 45,69 39,10 - 54,48 35,84 29,67 - 44,07 42,47 35,62 - 51,60 34,47 29,50 - 41,09 3
4 47,89 39,10 - 56,68 37,90 29,67 - 46,13 44,75 35,62 - 53,88 36,13 29,50 - 42,75 4
5 50,09 41,30 - 58,88 39,96 31,73 - 48,19 47,03 37,90 - 56,16 37,78 31,16 - 44,40 5
6 52,29 43,49 - 61,08 42,02 33,79 - 50,25 49,32 40,18 - 58,45 39,44 32,81 - 46,06 6
7 54,48 45,69 - 63,27 44,07 35,84 - 52,30 51,60 42,47 - 60,73 41,09 34,47 - 47,72 7
8 56,68 47,89 - 65,47 46,13 37,90 - 54,36 53,88 44,75 - 63,01 42,75 36,13 - 49,37 8
9 58,88 50,09 - 67,67 48,19 39,96 - 56,42 56,16 47,03 - 65,30 44,40 37,78 - 51,03 9
10 61,08 52,29 - 69,87 50,25 42,02 - 58,48 58,45 49,32 - 67,58 46,06 39,44 - 52,68 10
11 63,27 54,48 - 72,07 52,30 44,07 - 60,53 60,73 51,60 - 69,86 47,72 41,09 - 54,34 11
12 65,47 56,68 - 74,26 54,36 46,13 - 62,59 63,01 53,88 - 72,15 49,37 42,75 - 55,99 12
13 67,67 58,88 - 76,46 56,42 48,19 - 64,65 65,30 56,16 - 74,43 51,03 44,40 - 57,65 13
14 69,87 61,08 - 78,66 58,48 50,25 - 66,71 67,58 58,45 - 76,71 52,68 46,06 - 59,30 14
15 72,07 63,27 - 80,86 60,53 52,30 - 68,77 69,86 60,73 - 79,00 54,34 47,72 - 60,96 15
16 74,26 65,47 - 83,05 62,59 54,36 - 70,82 72,15 63,01 - 81,28 55,99 49,37 - 62,62 16
17 76,46 67,67 - 85,25 64,65 56,42 - 72,88 74,43 65,30 - 83,56 57,65 51,03 - 64,27 17
18 78,66 69,87 - 87,45 66,71 58,48 - 74,94 76,71 67,58 - 85,84 59,30 52,68 - 65,93 18
19 80,86 72,07 - 89,65 68,77 60,53 - 77,00 79,00 69,86 - 88,13 60,96 54,34 - 67,58 19
20 83,05 74,26 - 91,85 70,82 62,59 - 79,05 81,28 72,15 - 90,41 62,62 55,99 - 69,24 20
21 85,25 76,46 - 94,04 72,88 64,65 - 79,05 83,56 74,43 - 92,69 64,27 57,65 - 70,89 21
22 87,45 78,66 - 96,24 74,94 66,71 - 79,05 85,84 76,71 - 94,98 65,93 59,30 - 72,55 22
23 89,65 80,86 - 98,44 77,00 68,77 - 79,05 88,13 79,00 - 97,26 67,58 60,96 - 74,21 23
24 91,85 83,05 - 100,64 79,05 70,82 - 79,05 90,41 81,28 - 99,54 69,24 62,62 - 75,86 24
25 94,04 85,25 - 102,84 92,69 83,56 - 99,54 70,89 64,27 - 77,52 25
26 96,24 87,45 - 105,03 94,98 85,84 - 99,54 72,55 65,93 - 79,17 26
27 98,44 89,65 - 107,23 97,26 88,13 - 99,54 74,21 67,58 - 80,83 27
28 100,64 91,85 - 109,43 99,54 90,41 - 99,54 75,86 69,24 - 82,48 28
29 102,84 94,04 - 109,43 77,52 70,89 - 82,48 29
30 105,03 96,24 - 109,43 79,17 72,55 - 82,48 30
31 107,23 98,44 - 109,43 80,83 74,21 - 82,48 31
32 109,43 100,64 - 109,43 82,48 75,86 - 82,48 32

Notă: SSS = Stimă de sine scăzută; AP = Alienare personală; NI = Nesiguranţă interpersonală; AI = Alienare interpersonală;
DI  = Deficite interoceptive; DE = Dezechilibru emoţional; P = Perfecţionism; A = Ascetism; FM = Frica de maturitate.

264
Anexa B

265
 Anexa B1. Transformarea scorurilor brute în centile pentru scalele EDI-3

Scor DS B NC SSS AP NI AI DI DE P A FM Scor

brut brut
0 10 20 7 12 6 5 3 4 7 0 3 7 0
1 24 50 16 30 18 14 8 14 20 1 9 20 1
2 33 65 22 42 29 22 15 23 31 4 16 31 2
3 41 73 27 52 42 30 22 31 40 6 25 40 3
4 48 79 30 61 55 36 29 39 51 11 35 51 4
5 53 83 34 68 66 43 39 47 61 16 44 61 5
6 58 86 40 74 74 52 49 55 67 23 53 67 6
7 62 88 46 79 79 60 59 62 74 32 62 74 7
8 66 90 51 84 84 68 69 68 81 41 68 81 8
9 69 91 54 88 88 73 76 73 85 46 76 85 9
10 71 93 57 91 91 77 82 77 87 53 82 87 10
11 74 95 61 93 92 82 87 81 89 60 85 89 11
12 77 96 64 95 94 84 89 85 91 67 89 91 12
13 79 98 68 97 95 88 92 88 93 74 92 93 13
14 81 98 71 97 96 90 93 91 94 80 94 94 14
15 82 98 74 98 98 92 95 93 85 86 95 95 15
16 84 99 76 99 99 93 96 94 96 89 97 96 16
17 86 99 79 99,3 99,2 95 96 95 98 92 98 98 17
18 88 99 80 99,8 99,6 96 97 96 99,1 94 99 99,1 18
19 90 99 82 100 99,7 97 98 97 99,3 95 99,1 99,3 19
20 92 99 83 100 99,7 98 99 98 99,3 97 99,5 99,3 20
21 93 99,1 84 100 99,8 98 99,8 98 99,3 98 99,7 99,3 21
22 94 99,5 86 100 100 99 100 99 99,3 99 99,7 99,5 22
23 95 99,7 87 100 100 99,7 100 99 99,5 99,3 99,7 99,8 23
24 96 99,7 88 100 100 100 100 99,7 99,8 99,8 99,8 100 24
25 98 99,7 90 100 100 100 100 100 100 100 25
26 98 99,7 91 100 100 100 100 100 100 100 26
27 99 99,8 93 100 100 100 100 100 100 100 27
28 99,5 100 95 100 100 100 100 100 100 100 28
29 100 96 100 100 100 29
30 100 97 100 100 100 30
31 100 98 100 100 100 31
32 100 98 100 100 100 32
33 98 100 33
34 98 100 34
35 99 100 35
36 99,2 100 36
37 99,5 37
38 99,7 38
39 99,7 39
40 99,8 40

Notă. DS = Dorinţa de a fi slab; B = Bulimie; NC = Nemulţumire faţă de corp; SSS = Stimă de sine scăzută;
AP = Alienare personală; NI = Nesiguranţă interpersonală; AI = Alienare interpersonală; DI = Deficite interoceptive;
DE = Dezechilibru emoţional; P = Perfecţionism; A = Ascetism; FM = Frica de maturitate.

266
Anexa C

267
 Anexa C1. Transformarea sumelor cotelor T ale scalei compozite Risc de tulburare de
comportament alimentar în cote T şi în centile şi intervalele de încredere ale cotelor T pentru
probabilitatea P=0,90

Suma cotelor T Cota T Interval de încredere Centil

123 39,40 32,24 – 46,56 3
124 39,80 32,63 - 46,96 8
125 40,19 33,03 - 47,36 11
126 40,59 33,43 - 47,76 13
127 40,99 33,83 - 48,15 15
128 41,39 34,23 - 48,55 17
129 41,79 34,62 - 48,95 20
130 42,18 35,02 - 49,35 23
131 42,58 35,42 - 49,75 27
132 42,98 35,82 - 50,14 29
133 43,38 36,22 - 50,54 31
134 43,78 36,61 - 50,94 32
135 44,17 37,01 - 51,34 33
136 44,57 37,41 - 51,73 35
137 44,97 37,81 - 52,13 38
138 45,37 38,21 - 52,53 39
139 45,77 38,60 - 52,93 41
140 46,16 39,00 - 53,33 44
141 46,56 39,40 - 53,72 47
142 46,96 39,80 - 54,12 49
143 47,36 40,19 - 54,52 51
144 47,76 40,59 - 54,92 53
145 48,15 40,99 - 55,32 55
146 48,55 41,39 - 55,71 57
147 48,95 41,79 - 56,11 59
148 49,35 42,18 - 56,51 60
149 49,75 42,58 - 56,91 62
150 50,14 42,98 - 57,31 63
151 50,54 43,38 - 57,70 65
152 50,94 43,78 - 58,10 65
153 51,34 44,17 - 58,50 67
154 51,73 44,57 - 58,90 68
155 52,13 44,97 - 59,30 69
156 52,53 45,37 - 59,69 70
157 52,93 45,77 - 60,09 71
158 53,33 46,16 - 60,49 73
159 53,72 46,56 - 60,89 73
160 54,12 46,96 - 61,29 74
161 54,52 47,36 - 61,68 74
162 54,92 47,76 - 62,08 75
163 55,32 48,15 - 62,48 77
164 55,71 48,55 - 62,88 78
165 56,11 48,95 - 63,27 80
166 56,51 49,35 - 63,67 80
167 56,91 49,75 - 64,07 80
168 57,31 50,14 - 64,47 81
169 57,70 50,54 - 64,87 82
170 58,10 50,94 - 65,26 82
171 58,50 51,34 - 65,66 83
172 58,90 51,73 - 66,06 84
173 59,30 52,13 - 66,46 85

268
 Anexa C1. Transformarea sumelor cotelor T ale scalei compozite Risc de tulburare de
comportament alimentar în cote T şi în centile şi intervalele de încredere ale cotelor T pentru
probabilitatea P=0,90 (continuare)
Suma cotelor T Cota T Interval de încredere Centil
174 59,69 52,53 - 66,86 85
175 60,09 52,93 - 67,25 85
176 60,49 53,33 - 67,65 86
177 60,89 53,72 - 68,05 86
178 61,29 54,12 - 68,45 87
179 61,68 54,52 - 68,85 87
180 62,08 54,92 - 69,24 87
181 62,48 55,32 - 69,64 87
182 62,88 55,71 - 70,04 88
183 63,27 56,11 - 70,44 88
184 63,67 56,51 - 70,84 88
185 64,07 56,91 - 71,23 88
186 64,47 57,31 - 71,63 89
187 64,87 57,70 - 72,03 90
188 65,26 58,10 - 72,43 90
189 65,66 58,50 - 72,83 91
190 66,06 58,90 - 73,22 91
191 66,46 59,30 - 73,62 91
192 66,86 59,69 - 74,02 91
193 67,25 60,09 - 74,42 92
194 67,65 60,49 - 74,81 93
195 68,05 60,89 - 75,21 94
196 68,45 61,29 - 75,61 94
197 68,85 61,68 - 76,01 95
198 69,24 62,08 - 76,41 95
199 69,64 62,48 - 76,80 96
200 70,04 62,88 - 77,20 96
201 70,44 63,27 - 77,60 96
202 70,84 63,67 - 78,00 97
203 71,23 64,07 - 78,40 97
204 71,63 64,47 - 78,79 97
205 72,03 64,87 - 79,19 97
206 72,43 65,26 - 79,59 97
207 72,83 65,66 - 79,99 97
208 73,22 66,06 - 80,39 97
209 73,62 66,46 - 80,78 97
210 74,02 66,86 - 81,18 97
211 74,42 67,25 - 81,58 97
212 74,81 67,65 - 81,98 98
213 75,21 68,05 - 82,38 98
214 75,61 68,45 - 82,77 98
215 76,01 68,85 - 83,17 98
216 76,41 69,24 - 83,57 98
217 76,80 69,64 - 83,97 98
218 77,20 70,04 - 84,37 98
219 77,60 70,44 - 84,76 98
220 78,00 70,84 - 85,16 98
221 78,40 71,23 - 85,56 98
222 78,79 71,63 - 85,96 99
223 79,19 72,03 - 86,35 99
224 79,59 72,43 - 86,75 99
225 79,99 72,83 - 87,15 99

269
 Anexa C1. Transformarea sumelor cotelor T ale scalei compozite Risc de tulburare de
comportament alimentar în cote T şi în centile şi intervalele de încredere ale cotelor T pentru
probabilitatea P=0,90 (continuare)

Suma cotelor T Cota T Interval de încredere Centil

226 80,39 73,22 - 87,55 99
227 80,78 73,62 - 87,95 99
228 81,18 74,02 - 88,34 99
229 81,58 74,42 - 88,74 99
230 81,98 74,81 - 89,14 99
231 82,38 75,21 - 89,54 99
232 82,77 75,61 - 89,94 99
233 83,17 76,01 - 90,33 99
234 83,57 76,41 - 90,73 99
235 83,97 76,80 - 91,13 99
236 84,37 77,20 - 91,53 99
237 84,76 77,60 - 91,93 99
238 85,16 78,00 - 92,32 99
239 85,56 78,40 - 92,72 99
240 85,96 78,79 - 93,12 99
241 86,35 79,19 - 93,52 99
242 86,75 79,59 - 93,92 99
243 87,15 79,99 - 94,31 99
244 87,55 80,39 - 94,71 99,1
245 87,95 80,78 - 95,11 99,3
246 88,34 81,18 - 95,51 99,3
247 88,74 81,58 - 95,91 99,3
248 89,14 81,98 - 96,30 99,3
249 89,54 82,38 - 96,70 99,3
250 89,94 82,77 - 97,10 99,3
251 90,33 83,17 - 97,50 99,5
252 90,73 83,57 - 97,89 99,7
253 91,13 83,97 - 98,29 99,7
254 91,53 84,37 - 98,69 99,7
255 91,93 84,76 - 99,09 99,7
256 92,32 85,16 - 99,49 99,7
257 92,72 85,56 - 99,88 99,7
258 93,12 85,96 - 100,28 99,7
259 93,52 86,35 - 100,68 99,7
260 93,92 86,75 - 101,08 99,7
261 94,31 87,15 - 101,48 99,7
262 94,71 87,55 - 101,87 99,7
263 95,11 87,95 - 102,27 99,7
264 95,51 88,34 - 102,67 99,7
265 95,91 88,74 - 103,07 99,7
266 96,30 89,14 - 103,47 99,8

270
Anexa C2. Transformarea sumelor cotelor T ale scalei compozite Ineficacitate
în cote T şi în centile şi intervalele de încredere ale cotelor T
pentru probabilitatea P=0,90

Suma cotelor T Cota T Interval de încredere Centil

79 38,72 32,28 - 45,16 4
80 39,25 32,81 - 45,70 8
81 39,79 33,35 - 46,23 11
82 40,33 33,89 - 46,77 14
83 40,86 34,42 - 47,31 14
84 41,40 34,96 - 47,84 17
85 41,94 35,50 - 48,38 20
86 42,47 36,03 - 48,92 25
87 43,01 36,57 - 49,45 31
88 43,55 37,11 - 49,99 31
89 44,08 37,64 - 50,53 35
90 44,62 38,18 - 51,06 39
91 45,16 38,72 - 51,60 41
92 45,70 39,25 - 52,14 44
93 46,23 39,79 - 52,67 45
94 46,77 40,33 - 53,21 48
95 47,31 40,86 - 53,75 50
96 47,84 41,40 - 54,28 51
97 48,38 41,94 - 54,82 54
98 48,92 42,47 - 55,36 55
99 49,45 43,01 - 55,89 58
100 49,99 43,55 - 56,43 61
101 50,53 44,08 - 56,97 61
102 51,06 44,62 - 57,50 63
103 51,60 45,16 - 58,04 65
104 52,14 45,70 - 58,58 68
105 52,67 46,23 - 59,11 71
106 53,21 46,77 - 59,65 71
107 53,75 47,31 - 60,19 73
108 54,28 47,84 - 60,72 74
109 54,82 48,38 - 61,26 76
110 55,36 48,92 - 61,80 78
111 55,89 49,45 - 62,33 78
112 56,43 49,99 - 62,87 79
113 56,97 50,53 - 63,41 80
114 57,50 51,06 - 63,95 80
115 58,04 51,60 - 64,48 81
116 58,58 52,14 - 65,02 81
117 59,11 52,67 - 65,56 83
118 59,65 53,21 - 66,09 84
119 60,19 53,75 - 66,63 85
120 60,72 54,28 - 67,17 87
121 61,26 54,82 - 67,70 87
122 61,80 55,36 - 68,24 87
123 62,33 55,89 - 68,78 88
124 62,87 56,43 - 69,31 88
125 63,41 56,97 - 69,85 89
126 63,95 57,50 - 70,39 90
127 64,48 58,04 - 70,92 90

271
 Anexa C2. Transformarea sumelor cotelor T ale scalei compozite Ineficacitate
în cote T şi în centile şi intervalele de încredere ale cotelor T
pentru probabilitatea P=0,90 (continuare)

Suma cotelor T Cota T Interval de încredere Centil

128 65,02 58,58 - 71,46 91
129 65,56 59,11 - 72,00 91
130 66,09 59,65 - 72,53 91
131 66,63 60,19 - 73,07 92
132 67,17 60,72 - 73,61 92
133 67,70 61,26 - 74,14 92
134 68,24 61,80 - 74,68 92
135 68,78 62,33 - 75,22 92
136 69,31 62,87 - 75,75 93
137 69,85 63,41 - 76,29 94
138 70,39 63,95 - 76,83 95
139 70,92 64,48 - 77,36 95
140 71,46 65,02 - 77,90 95
141 72,00 65,56 - 78,44 96
142 72,53 66,09 - 78,97 97
143 73,07 66,63 - 79,51 97
144 73,61 67,17 - 80,05 97
145 74,14 67,70 - 80,59 97
146 74,68 68,24 - 81,12 97
147 75,22 68,78 - 81,66 97
148 75,75 69,31 - 82,20 97
149 76,29 69,85 - 82,73 98
150 76,83 70,39 - 83,27 98
151 77,36 70,92 - 83,81 98
152 77,90 71,46 - 84,34 98
153 78,44 72,00 - 84,88 98
154 78,97 72,53 - 85,42 98
155 79,51 73,07 - 85,95 98
156 80,05 73,61 - 86,49 99
157 80,59 74,14 - 87,03 99
158 81,12 74,68 - 87,56 99
159 81,66 75,22 - 88,10 99,3
160 82,20 75,75 - 88,64 99,3
161 82,73 76,29 - 89,17 99,3
162 83,27 76,83 - 89,71 99,3
163 83,81 77,36 - 90,25 99,5
164 84,34 77,90 - 90,78 99,7
165 84,88 78,44 - 91,32 99,7
166 85,42 78,97 - 91,86 99,7
167 85,95 79,51 - 92,39 99,7
168 86,49 80,05 - 92,93 99,7
169 87,03 80,59 - 93,47 99,7
170 87,56 81,12 - 94,00 99,7
171 88,10 81,66 - 94,54 99,7
172 88,64 82,20 - 95,08 99,7
173 89,17 82,73 - 95,61 99,7
174 89,71 83,27 - 96,15 99,7
175 90,25 83,81 - 96,69 99,7
176 90,78 84,34 - 97,22 99,8

272
Anexa C3. Transformarea sumelor cotelor T ale scalei compozite Probleme interpersonale
în cote T şi în centile şi intervalele de încredere ale cotelor T
pentru probabilitatea P=0,90

Suma cotelor T Cota T Interval de încredere Centil

73 34,65 26,13 - 43,16 1
74 35,21 26,70 - 43,73 3
75 35,78 27,26 - 44,30 4
76 36,35 27,83 - 44,87 5
77 36,92 28,40 - 45,43 7
78 37,48 28,97 - 46,00 8
79 38,05 29,53 - 46,57 10
80 38,62 30,10 - 47,14 11
81 39,19 30,67 - 47,71 13
82 39,76 31,24 - 48,27 15
83 40,32 31,81 - 48,84 15
84 40,89 32,37 - 49,41 17
85 41,46 32,94 - 49,98 20
86 42,03 33,51 - 50,55 22
87 42,60 34,08 - 51,11 25
88 43,16 34,65 - 51,68 27
89 43,73 35,21 - 52,25 29
90 44,30 35,78 - 52,82 31
91 44,87 36,35 - 53,38 34
92 45,43 36,92 - 53,95 36
93 46,00 37,48 - 54,52 39
94 46,57 38,05 - 55,09 40
95 47,14 38,62 - 55,66 41
96 47,71 39,19 - 56,22 45
97 48,27 39,76 - 56,79 48
98 48,84 40,32 - 57,36 51
99 49,41 40,89 - 57,93 55
100 49,98 41,46 - 58,50 57
101 50,55 42,03 - 59,06 59
102 51,11 42,60 - 59,63 62
103 51,68 43,16 - 60,20 64
104 52,25 43,73 - 60,77 66
105 52,82 44,30 - 61,33 67
106 53,38 44,87 - 61,90 68
107 53,95 45,43 - 62,47 71
108 54,52 46,00 - 63,04 73
109 55,09 46,57 - 63,61 73
110 55,66 47,14 - 64,17 75
111 56,22 47,71 - 64,74 77
112 56,79 48,27 - 65,31 78
113 57,36 48,84 - 65,88 79
114 57,93 49,41 - 66,45 80
115 58,50 49,98 - 67,01 82
116 59,06 50,55 - 67,58 83
117 59,63 51,11 - 68,15 84
118 60,20 51,68 - 68,72 85
119 60,77 52,25 - 69,28 86
120 61,33 52,82 - 69,85 87
121 61,90 53,38 - 70,42 88

273
 Anexa C3. Transformarea sumelor cotelor T ale scalei compozite Probleme interpersonale
în cote T şi în centile şi intervalele de încredere ale cotelor T
pentru probabilitatea P=0,90 (continuare)

Suma cotelor T Cota T Interval de încredere Centil

122 62,47 53,95 - 70,99 89
123 63,04 54,52 - 71,56 89
124 63,61 55,09 - 72,12 90
125 64,17 55,66 - 72,69 91
126 64,74 56,22 - 73,26 92
127 65,31 56,79 - 73,83 93
128 65,88 57,36 - 74,40 93
129 66,45 57,93 - 74,96 94
130 67,01 58,50 - 75,53 95
131 67,58 59,06 - 76,10 96
132 68,15 59,63 - 76,67 96
133 68,72 60,20 - 77,23 96
134 69,28 60,77 - 77,80 96
135 69,85 61,33 - 78,37 96
136 70,42 61,90 - 78,94 96
137 70,99 62,47 - 79,51 97
138 71,56 63,04 - 80,07 97
139 72,12 63,61 - 80,64 97
140 72,69 64,17 - 81,21 97
141 73,26 64,74 - 81,78 97
142 73,83 65,31 - 82,35 98
143 74,40 65,88 - 82,91 98
144 74,96 66,45 - 83,48 98
145 75,53 67,01 - 84,05 98
146 76,10 67,58 - 84,62 98
147 76,67 68,15 - 85,18 98
148 77,23 68,72 - 85,75 98
149 77,80 69,28 - 86,32 98
150 78,37 69,85 - 86,89 98
151 78,94 70,42 - 87,46 98
152 79,51 70,99 - 88,02 98
153 80,07 71,56 - 88,59 98
154 80,64 72,12 - 89,16 99
155 81,21 72,69 - 89,73 99
156 81,78 73,26 - 90,30 99
157 82,35 73,83 - 90,86 99,3
158 82,91 74,40 - 91,43 99,3
159 83,48 74,96 - 92,00 99,3
160 84,05 75,53 - 92,57 99,3
161 84,62 76,10 - 93,13 99,3
162 85,18 76,67 - 93,70 99,3
163 85,75 77,23 - 94,27 99,3
164 86,32 77,80 - 94,84 99,3
165 86,89 78,37 - 95,41 99,5
166 87,46 78,94 - 95,97 99,7
167 88,02 79,51 - 96,54 99,7
168 88,59 80,07 - 97,11 99,7
169 89,16 80,64 - 97,68 99,7

274
Anexa C4. Transformarea sumelor cotelor T ale scalei compozite Probleme emoţionale
în cote T şi în centile şi intervalele de încredere ale cotelor T
pentru probabilitatea P=0,90

Suma cotelor T Cota T Interval de încredere Centil

77 37,20 29,40 - 45,01 1
78 37,76 29,96 - 45,56 2
79 38,32 30,51 - 46,12 5
80 38,87 31,07 - 46,68 8
81 39,43 31,63 - 47,24 11
82 39,99 32,19 - 47,79 14
83 40,55 32,74 - 48,35 16
84 41,10 33,30 - 48,91 19
85 41,66 33,86 - 49,46 22
86 42,22 34,41 - 50,02 24
87 42,78 34,97 - 50,58 26
88 43,33 35,53 - 51,14 29
89 43,89 36,09 - 51,69 31
90 44,45 36,64 - 52,25 33
91 45,01 37,20 - 52,81 36
92 45,56 37,76 - 53,37 39
93 46,12 38,32 - 53,92 43
94 46,68 38,87 - 54,48 45
95 47,24 39,43 - 55,04 48
96 47,79 39,99 - 55,60 51
97 48,35 40,55 - 56,15 54
98 48,91 41,10 - 56,71 56
99 49,46 41,66 - 57,27 58
100 50,02 42,22 - 57,83 60
101 50,58 42,78 - 58,38 63
102 51,14 43,33 - 58,94 64
103 51,69 43,89 - 59,50 65
104 52,25 44,45 - 60,06 67
105 52,81 45,01 - 60,61 69
106 53,37 45,56 - 61,17 71
107 53,92 46,12 - 61,73 72
108 54,48 46,68 - 62,29 72
109 55,04 47,24 - 62,84 73
110 55,60 47,79 - 63,40 75
111 56,15 48,35 - 63,96 76
112 56,71 48,91 - 64,52 77
113 57,27 49,46 - 65,07 79
114 57,83 50,02 - 65,63 81
115 58,38 50,58 - 66,19 82
116 58,94 51,14 - 66,74 83
117 59,50 51,69 - 67,30 84
118 60,06 52,25 - 67,86 85
119 60,61 52,81 - 68,42 86
120 61,17 53,37 - 68,97 87
121 61,73 53,92 - 69,53 88
122 62,29 54,48 - 70,09 88
123 62,84 55,04 - 70,65 88
124 63,40 55,60 - 71,20 89
125 63,96 56,15 - 71,76 90

275
 Anexa C4. Transformarea sumelor cotelor T ale scalei compozite Probleme emoţionale
în cote T şi în centile şi intervalele de încredere ale cotelor T
pentru probabilitatea P=0,90 (continuare)

Suma cotelor T Cota T Interval de încredere Centil

126 64,52 56,71 - 72,32 90
127 65,07 57,27 - 72,88 91
128 65,63 57,83 - 73,43 91
129 66,19 58,38 - 73,99 92
130 66,74 58,94 - 74,55 92
131 67,30 59,50 - 75,11 93
132 67,86 60,06 - 75,66 94
133 68,42 60,61 - 76,22 94
134 68,97 61,17 - 76,78 94
135 69,53 61,73 - 77,34 95
136 70,09 62,29 - 77,89 95
137 70,65 62,84 - 78,45 95
138 71,20 63,40 - 79,01 95
139 71,76 63,96 - 79,57 96
140 72,32 64,52 - 80,12 96
141 72,88 65,07 - 80,68 97
142 73,43 65,63 - 81,24 97
143 73,99 66,19 - 81,79 97
144 74,55 66,74 - 82,35 97
145 75,11 67,30 - 82,91 98
146 75,66 67,86 - 83,47 98
147 76,22 68,42 - 84,02 98
148 76,78 68,97 - 84,58 98
149 77,34 69,53 - 85,14 99
150 77,89 70,09 - 85,70 99
151 78,45 70,65 - 86,25 99
152 79,01 71,20 - 86,81 99
153 79,57 71,76 - 87,37 99
154 80,12 72,32 - 87,93 99,1
155 80,68 72,88 - 88,48 99,3
156 81,24 73,43 - 89,04 99,3
157 81,79 73,99 - 89,60 99,3
158 82,35 74,55 - 90,16 99,3
159 82,91 75,11 - 90,71 99,3
160 83,47 75,66 - 91,27 99,3
161 84,02 76,22 - 91,83 99,3
162 84,58 76,78 - 92,39 99,3
163 85,14 77,34 - 92,94 99,3
164 85,70 77,89 - 93,50 99,3
165 86,25 78,45 - 94,06 99,3
166 86,81 79,01 - 94,62 99,3
167 87,37 79,57 - 95,17 99,5
168 87,93 80,12 - 95,73 99,6
169 88,48 80,68 - 96,29 99,6
170 89,04 81,24 - 96,85 99,6
171 89,60 81,79 - 97,40 99,6
172 90,16 82,35 - 97,96 99,6
173 90,71 82,91 - 98,52 99,8

276
Anexa C5. Transformarea sumelor cotelor T ale scalei compozite Control exagerat
în cote T şi în centile şi intervalele de încredere ale cotelor T
pentru probabilitatea P=0,90

Suma cotelor T Cota T Interval de încredere Centil

70 31,46 19,65 - 43,28 0
71 32,08 20,27 - 43,90 1
72 32,71 20,89 - 44,52 2
73 33,33 21,51 - 45,14 2
74 33,95 22,13 - 45,76 3
75 34,57 22,75 - 46,39 4
76 35,19 23,38 - 47,01 5
77 35,81 24,00 - 47,63 6
78 36,44 24,62 - 48,25 7
79 37,06 25,24 - 48,87 8
80 37,68 25,86 - 49,50 9
81 38,30 26,49 - 50,12 10
82 38,92 27,11 - 50,74 13
83 39,55 27,73 - 51,36 15
84 40,17 28,35 - 51,98 17
85 40,79 28,97 - 52,61 18
86 41,41 29,60 - 53,23 20
87 42,03 30,22 - 53,85 21
88 42,66 30,84 - 54,47 22
89 43,28 31,46 - 55,09 25
90 43,90 32,08 - 55,72 29
91 44,52 32,71 - 56,34 31
92 45,14 33,33 - 56,96 33
93 45,76 33,95 - 57,58 36
94 46,39 34,57 - 58,20 39
95 47,01 35,19 - 58,82 44
96 47,63 35,81 - 59,45 47
97 48,25 36,44 - 60,07 49
98 48,87 37,06 - 60,69 51
99 49,50 37,68 - 61,31 54
100 50,12 38,30 - 61,93 56
101 50,74 38,92 - 62,56 59
102 51,36 39,55 - 63,18 61
103 51,98 40,17 - 63,80 62
104 52,61 40,79 - 64,42 64
105 53,23 41,41 - 65,04 66
106 53,85 42,03 - 65,67 68
107 54,47 42,66 - 66,29 71
108 55,09 43,28 - 66,91 73
109 55,72 43,90 - 67,53 74
110 56,34 44,52 - 68,15 76
111 56,96 45,14 - 68,77 77
112 57,58 45,76 - 69,40 78
113 58,20 46,39 - 70,02 79
114 58,82 47,01 - 70,64 80
115 59,45 47,63 - 71,26 81
116 60,07 48,25 - 71,88 83
117 60,69 48,87 - 72,51 84
118 61,31 49,50 - 73,13 85

277
 Anexa C5. Transformarea sumelor cotelor T ale scalei compozite Control exagerat
în cote T şi în centile şi intervalele de încredere ale cotelor T
pentru probabilitatea P=0,90 (continuare)

Suma cotelor T Cota T Interval de încredere Centil

119 61,93 50,12 - 73,75 87
120 62,56 50,74 - 74,37 89
121 63,18 51,36 - 74,99 90
122 63,80 51,98 - 75,62 90
123 64,42 52,61 - 76,24 91
124 65,04 53,23 - 76,86 91
125 65,67 53,85 - 77,48 92
126 66,29 54,47 - 78,10 93
127 66,91 55,09 - 78,73 94
128 67,53 55,72 - 79,35 95
129 68,15 56,34 - 79,97 96
130 68,77 56,96 - 80,59 96
131 69,40 57,58 - 81,21 97
132 70,02 58,20 - 81,83 97
133 70,64 58,82 - 82,46 97
134 71,26 59,45 - 83,08 97
135 71,88 60,07 - 83,70 98
136 72,51 60,69 - 84,32 98
137 73,13 61,31 - 84,94 98
138 73,75 61,93 - 85,57 98
139 74,37 62,56 - 86,19 98
140 74,99 63,18 - 86,81 99
141 75,62 63,80 - 87,43 99
142 76,24 64,42 - 88,05 99
143 76,86 65,04 - 88,68 99
144 77,48 65,67 - 89,30 99
145 78,10 66,29 - 89,92 99,1
146 78,73 66,91 - 90,54 99,3
147 79,35 67,53 - 91,16 99,3
148 79,97 68,15 - 91,78 99,3
149 80,59 68,77 - 92,41 99,3
150 81,21 69,40 - 93,03 99,3
151 81,83 70,02 - 93,65 99,3
152 82,46 70,64 - 94,27 99,3
153 83,08 71,26 - 94,89 99,5
154 83,70 71,88 - 95,52 99,7
155 84,32 72,51 - 96,14 99,7
156 84,94 73,13 - 96,76 99,8

278
Anexa C6. Transformarea sumelor cotelor T ale scalei compozite Neadaptare psihologică generală
în cote T şi în centile şi intervalele de încredere ale cotelor T
pentru probabilitatea P=0,90

Suma cotelor T Cota T Interval de încredere Centil

349 33,03 26,29 - 39,77 0
350 33,20 26,47 - 39,94 1
351 33,38 26,64 - 40,12 1
352 33,55 26,81 - 40,29 1
353 33,72 26,99 - 40,46 1
354 33,90 27,16 - 40,63 1
355 34,07 27,33 - 40,81 1
356 34,24 27,50 - 40,98 1
357 34,41 27,68 - 41,15 2
358 34,59 27,85 - 41,33 2
359 34,76 28,02 - 41,50 2
360 34,93 28,19 - 41,67 2
361 35,11 28,37 - 41,84 3
362 35,28 28,54 - 42,02 3
363 35,45 28,71 - 42,19 3
364 35,62 28,89 - 42,36 4
365 35,80 29,06 - 42,53 4
366 35,97 29,23 - 42,71 5
367 36,14 29,40 - 42,88 5
368 36,31 29,58 - 43,05 6
369 36,49 29,75 - 43,23 6
370 36,66 29,92 - 43,40 6
371 36,83 30,10 - 43,57 6
372 37,01 30,27 - 43,74 6
373 37,18 30,44 - 43,92 7
374 37,35 30,61 - 44,09 7
375 37,52 30,79 - 44,26 7
376 37,70 30,96 - 44,44 7
377 37,87 31,13 - 44,61 7
378 38,04 31,30 - 44,78 7
379 38,22 31,48 - 44,95 8
380 38,39 31,65 - 45,13 9
381 38,56 31,82 - 45,30 10
382 38,73 32,00 - 45,47 11
383 38,91 32,17 - 45,64 11
384 39,08 32,34 - 45,82 12
385 39,25 32,51 - 45,99 12
386 39,42 32,69 - 46,16 12
387 39,60 32,86 - 46,34 13
388 39,77 33,03 - 46,51 13
389 39,94 33,20 - 46,68 13
390 40,12 33,38 - 46,85 14
391 40,29 33,55 - 47,03 14
392 40,46 33,72 - 47,20 15
393 40,63 33,90 - 47,37 16
394 40,81 34,07 - 47,54 16
395 40,98 34,24 - 47,72 18
396 41,15 34,41 - 47,89 18
397 41,33 34,59 - 48,06 19
398 41,50 34,76 - 48,24 20
399 41,67 34,93 - 48,41 21

279
 Anexa C6. Transformarea sumelor cotelor T ale scalei compozite Neadaptare psihologică generală
în cote T şi în centile şi intervalele de încredere ale cotelor T
pentru probabilitatea P=0,90 (continuare)

Suma cotelor T Cota T Interval de încredere Centil

400 41,84 35,11 - 48,58 21
401 42,02 35,28 - 48,75 22
402 42,19 35,45 - 48,93 23
403 42,36 35,62 - 49,10 24
404 42,53 35,80 - 49,27 26
405 42,71 35,97 - 49,45 27
406 42,88 36,14 - 49,62 28
407 43,05 36,31 - 49,79 28
408 43,23 36,49 - 49,96 29
409 43,40 36,66 - 50,14 29
410 43,57 36,83 - 50,31 29
411 43,74 37,01 - 50,48 29
412 43,92 37,18 - 50,65 30
413 44,09 37,35 - 50,83 30
414 44,26 37,52 - 51,00 31
415 44,44 37,70 - 51,17 32
416 44,61 37,87 - 51,35 32
417 44,78 38,04 - 51,52 33
418 44,95 38,22 - 51,69 34
419 45,13 38,39 - 51,86 36
420 45,30 38,56 - 52,04 36
421 45,47 38,73 - 52,21 37
422 45,64 38,91 - 52,38 37
423 45,82 39,08 - 52,56 38
424 45,99 39,25 - 52,73 38
425 46,16 39,42 - 52,90 39
426 46,34 39,60 - 53,07 40
427 46,51 39,77 - 53,25 41
428 46,68 39,94 - 53,42 42
429 46,85 40,12 - 53,59 42
430 47,03 40,29 - 53,76 43
431 47,20 40,46 - 53,94 45
432 47,37 40,63 - 54,11 45
433 47,54 40,81 - 54,28 46
434 47,72 40,98 - 54,46 48
435 47,89 41,15 - 54,63 50
436 48,06 41,33 - 54,80 50
437 48,24 41,50 - 54,97 50
438 48,41 41,67 - 55,15 51
439 48,58 41,84 - 55,32 51
440 48,75 42,02 - 55,49 51
441 48,93 42,19 - 55,67 53
442 49,10 42,36 - 55,84 54
443 49,27 42,53 - 56,01 55
444 49,45 42,71 - 56,18 56
445 49,62 42,88 - 56,36 57
446 49,79 43,05 - 56,53 57
447 49,96 43,23 - 56,70 58
448 50,14 43,40 - 56,87 59
449 50,31 43,57 - 57,05 60
450 50,48 43,74 - 57,22 60
451 50,65 43,92 - 57,39 61

280
Anexa C6. Transformarea sumelor cotelor T ale scalei compozite Neadaptare psihologică generală
în cote T şi în centile şi intervalele de încredere ale cotelor T
pentru probabilitatea P=0,90 (continuare)

Suma cotelor T Cota T Interval de încredere Centil

452 50,83 44,09 - 57,57 61
453 51,00 44,26 - 57,74 62
454 51,17 44,44 - 57,91 62
455 51,35 44,61 - 58,08 63
456 51,52 44,78 - 58,26 63
457 51,69 44,95 - 58,43 64
458 51,86 45,13 - 58,60 65
459 52,04 45,30 - 58,78 65
460 52,21 45,47 - 58,95 65
461 52,38 45,64 - 59,12 66
462 52,56 45,82 - 59,29 66
463 52,73 45,99 - 59,47 67
464 52,90 46,16 - 59,64 67
465 53,07 46,34 - 59,81 67
466 53,25 46,51 - 59,98 68
467 53,42 46,68 - 60,16 69
468 53,59 46,85 - 60,33 69
469 53,76 47,03 - 60,50 69
470 53,94 47,20 - 60,68 69
471 54,11 47,37 - 60,85 70
472 54,28 47,54 - 61,02 71
473 54,46 47,72 - 61,19 71
474 54,63 47,89 - 61,37 72
475 54,80 48,06 - 61,54 72
476 54,97 48,24 - 61,71 72
477 55,15 48,41 - 61,88 73
478 55,32 48,58 - 62,06 74
479 55,49 48,75 - 62,23 74
480 55,67 48,93 - 62,40 74
481 55,84 49,10 - 62,58 75
482 56,01 49,27 - 62,75 76
483 56,18 49,45 - 62,92 76
484 56,36 49,62 - 63,09 76
485 56,53 49,79 - 63,27 76
486 56,70 49,96 - 63,44 76
487 56,87 50,14 - 63,61 77
488 57,05 50,31 - 63,79 77
489 57,22 50,48 - 63,96 77
490 57,39 50,65 - 64,13 78
491 57,57 50,83 - 64,30 78
492 57,74 51,00 - 64,48 79
493 57,91 51,17 - 64,65 79
494 58,08 51,35 - 64,82 80
495 58,26 51,52 - 64,99 81
496 58,43 51,69 - 65,17 82
497 58,60 51,86 - 65,34 82
498 58,78 52,04 - 65,51 82
499 58,95 52,21 - 65,69 82
500 59,12 52,38 - 65,86 83
501 59,29 52,56 - 66,03 84
502 59,47 52,73 - 66,20 84

281
 Anexa C6. Transformarea sumelor cotelor T ale scalei compozite Neadaptare psihologică generală
în cote T şi în centile şi intervalele de încredere ale cotelor T
pentru probabilitatea P=0,90 (continuare)

Suma cotelor T Cota T Interval de încredere Centil

503 59,64 52,90 - 66,38 84
504 59,81 53,07 - 66,55 85
505 59,98 53,25 - 66,72 85
506 60,16 53,42 - 66,90 85
507 60,33 53,59 - 67,07 85
508 60,50 53,76 - 67,24 86
509 60,68 53,94 - 67,41 86
510 60,85 54,11 - 67,59 86
511 61,02 54,28 - 67,76 87
512 61,19 54,46 - 67,93 87
513 61,37 54,63 - 68,10 87
514 61,54 54,80 - 68,28 88
515 61,71 54,97 - 68,45 88
516 61,88 55,15 - 68,62 88
517 62,06 55,32 - 68,80 88
518 62,23 55,49 - 68,97 89
519 62,40 55,67 - 69,14 89
520 62,58 55,84 - 69,31 90
521 62,75 56,01 - 69,49 90
522 62,92 56,18 - 69,66 90
523 63,09 56,36 - 69,83 90
524 63,27 56,53 - 70,01 90
525 63,44 56,70 - 70,18 91
526 63,61 56,87 - 70,35 91
527 63,79 57,05 - 70,52 91
528 63,96 57,22 - 70,70 91
529 64,13 57,39 - 70,87 91
530 64,30 57,57 - 71,04 92
531 64,48 57,74 - 71,21 92
532 64,65 57,91 - 71,39 92
533 64,82 58,08 - 71,56 92
534 64,99 58,26 - 71,73 92
535 65,17 58,43 - 71,91 92
536 65,34 58,60 - 72,08 92
537 65,51 58,78 - 72,25 92
538 65,69 58,95 - 72,42 92
539 65,86 59,12 - 72,60 92
540 66,03 59,29 - 72,77 92
541 66,20 59,47 - 72,94 92
542 66,38 59,64 - 73,12 92
543 66,55 59,81 - 73,29 93
544 66,72 59,98 - 73,46 93
545 66,90 60,16 - 73,63 93
546 67,07 60,33 - 73,81 93
547 67,24 60,50 - 73,98 93
548 67,41 60,68 - 74,15 93
549 67,59 60,85 - 74,32 93
550 67,76 61,02 - 74,50 93
551 67,93 61,19 - 74,67 93
552 68,10 61,37 - 74,84 94
553 68,28 61,54 - 75,02 94

282
Anexa C6. Transformarea sumelor cotelor T ale scalei compozite Neadaptare psihologică generală
în cote T şi în centile şi intervalele de încredere ale cotelor T
pentru probabilitatea P=0,90 (continuare)

Suma cotelor T Cota T Interval de încredere Centil

554 68,45 61,71 - 75,19 94
555 68,62 61,88 - 75,36 94
556 68,80 62,06 - 75,53 94
557 68,97 62,23 - 75,71 94
558 69,14 62,40 - 75,88 94
559 69,31 62,58 - 76,05 94
560 69,49 62,75 - 76,22 94
561 69,66 62,92 - 76,40 94
562 69,83 63,09 - 76,57 94
563 70,01 63,27 - 76,74 94
564 70,18 63,44 - 76,92 94
565 70,35 63,61 - 77,09 94
566 70,52 63,79 - 77,26 95
567 70,70 63,96 - 77,43 95
568 70,87 64,13 - 77,61 95
569 71,04 64,30 - 77,78 95
570 71,21 64,48 - 77,95 96
571 71,39 64,65 - 78,13 96
572 71,56 64,82 - 78,30 96
573 71,73 64,99 - 78,47 96
574 71,91 65,17 - 78,64 96
575 72,08 65,34 - 78,82 96
576 72,25 65,51 - 78,99 96
577 72,42 65,69 - 79,16 97
578 72,60 65,86 - 79,33 97
579 72,77 66,03 - 79,51 97
580 72,94 66,20 - 79,68 97
581 73,12 66,38 - 79,85 97
582 73,29 66,55 - 80,03 98
583 73,46 66,72 - 80,20 98
584 73,63 66,90 - 80,37 98
585 73,81 67,07 - 80,54 98
586 73,98 67,24 - 80,72 98
587 74,15 67,41 - 80,89 98
588 74,32 67,59 - 81,06 98
589 74,50 67,76 - 81,24 98
590 74,67 67,93 - 81,41 98
591 74,84 68,10 - 81,58 98
592 75,02 68,28 - 81,75 98
593 75,19 68,45 - 81,93 98
594 75,36 68,62 - 82,10 98
595 75,53 68,80 - 82,27 98
596 75,71 68,97 - 82,44 98
597 75,88 69,14 - 82,62 98
598 76,05 69,31 - 82,79 98
599 76,22 69,49 - 82,96 98
600 76,40 69,66 - 83,14 98
601 76,57 69,83 - 83,31 99
602 76,74 70,01 - 83,48 99
603 76,92 70,18 - 83,65 99
604 77,09 70,35 - 83,83 99
605 77,26 70,52 - 84,00 99

283
 Anexa C6. Transformarea sumelor cotelor T ale scalei compozite Neadaptare psihologică generală
în cote T şi în centile şi intervalele de încredere ale cotelor T
pentru probabilitatea P=0,90 (continuare)

Suma cotelor T Cota T Interval de încredere Centil

606 77,43 70,70 - 84,17 99
607 77,61 70,87 - 84,35 99
608 77,78 71,04 - 84,52 99
609 77,95 71,21 - 84,69 99
610 78,13 71,39 - 84,86 99
611 78,30 71,56 - 85,04 99
612 78,47 71,73 - 85,21 99
613 78,64 71,91 - 85,38 99
614 78,82 72,08 - 85,55 99
615 78,99 72,25 - 85,73 99
616 79,16 72,42 - 85,90 99
617 79,33 72,60 - 86,07 99,1
618 79,51 72,77 - 86,25 99,3
619 79,68 72,94 - 86,42 99,3
620 79,85 73,12 - 86,59 99,3
621 80,03 73,29 - 86,76 99,3
622 80,20 73,46 - 86,94 99,3
623 80,37 73,63 - 87,11 99,3
624 80,54 73,81 - 87,28 99,3
625 80,72 73,98 - 87,46 99,3
626 80,89 74,15 - 87,63 99,3
627 81,06 74,32 - 87,80 99,3
628 81,24 74,50 - 87,97 99,3
629 81,41 74,67 - 88,15 99,3
630 81,58 74,84 - 88,32 99,3
631 81,75 75,02 - 88,49 99,3
632 81,93 75,19 - 88,66 99,4
633 82,10 75,36 - 88,84 99,6
634 82,27 75,53 - 89,01 99,6
635 82,44 75,71 - 89,18 99,6
636 82,62 75,88 - 89,36 99,6
637 82,79 76,05 - 89,53 99,6
638 82,96 76,22 - 89,70 99,6
639 83,14 76,40 - 89,87 99,6
640 83,31 76,57 - 90,05 99,6
641 83,48 76,74 - 90,22 99,6
642 83,65 76,92 - 90,39 99,6
643 83,83 77,09 - 90,56 99,6
644 84,00 77,26 - 90,74 99,6
645 84,17 77,43 - 90,91 99,8

284
Anexa D

285
 Anexa D1. Frecvenţele şi frecvenţele cumulate, exprimate procentual,
şi centilele corespunzătoare scorurilor brute pentru scala Inconsecvenţă

Scor brut Frecvenţa Frecvenţa cumulată Centil

(%) (%)
0 2,0 2,0 1
1 4,0 6,1 4
2 4,7 10,8 8
3 4,0 14,8 13
4 5,7 20,5 18
5 8,4 29,0 25
6 11,8 40,7 35
7 10,1 50,8 46
8 8,8 59,6 55
9 11,1 70,7 65
10 6,1 76,8 74
11 6,1 82,8 80
12 4,7 87,5 85
13 4,0 91,6 90
14 2,0 93,6 93
15 2,4 96,0 95
16 1,7 97,6 97
`17 1,0 98,7 98
18 0,7 99,3 99
19 0,3 99,7 99,5
20 0,0 99,7 99,7
21 0,0 99,7 99,7
22 0,0 99,7 99,7
23 0,0 99,7 99,7
24 0,0 99,7 99,7
25 0,3 100,0 99,8
26 0,0 100,0

Notă: N=297.

286
Anexa D2. Frecvenţele şi frecvenţele cumulate, exprimate procentual,
şi centilele corespunzătoare scorurilor brute pentru scala Raritate

Scor brut Frecvenţa Frecvenţa cumulată Centil

(%) (%)
0 70,2 70,2 35
1 22,3 92,5 81
2 5,1 97,6 95
3 1,4 99,0 98
4 0,7 99,7 99,3
5 0,0 99,7 99,7
6 0,3 100,0 99,8
7 100

Notă: N=292.

287
 Anexa D3. Frecvenţele şi frecvenţele cumulate, exprimate procentual,
şi centilele corespunzătoare scorurilor brute pentru scala Impresie negativă

Scor brut Frecvenţa Frecvenţa cumulată Centil

(%) (%)
0 20,2 20,2 10
1 13,7 34,0 27
2 11,1 45,0 40
3 13,4 58,4 52
4 8,8 67,2 63
5 5,3 72,5 70
6 6,5 79,0 76
7 1,9 80,9 80
8 2,7 83,6 82
9 3,8 87,4 85
10 1,5 88,9 88
11 1,9 90,8 90
12 1,5 92,4 92
13 1,9 94,3 93
14 0,8 95,0 95
15 1,1 96,2 96
16 0,4 96,6 96
`17 0,8 97,3 97
18 0,0 97,3 97
19 0,4 97,7 98
20 0,4 98,1 98
21 0,0 98,1 98
22 0,0 98,1 98
23 0,4 98,5 98
24 0,0 98,5 98
25 0,0 98,5 98
26 0,0 98,5 98
27 0,0 98,5 98
28 0,0 98,5 98
29 0,4 98,9 99
30 0,0 98,9 99
31 0,0 98,9 99
32 0,0 98,9 99
33 0,0 98,9 99
34 0,0 98,9 99
35 0,4 99,2 99
36 0,0 99,2 99,2
37 0,4 99,6 99,4
38 0,0 99,6 99,6
39 0,4 100,0 99,8
40 0,0 100,0
Notă: N=262.

288
 Anexa E
Broşura cu itemi

289
 INSTRUCŢIUNI
Completaţi numele, data, vârsta, sexul, statutul marital şi ocupaţia. Răspundeţi la întrebările de mai jos.
Apoi urmăriţi atent instrucţiunile de pe pagina următoare.

Nume şi prenume _______________________________________ Data completării ______________

□
*Vârstă ____ Sex __ Statut marital: Căsătorit(ă)/cu partener(ă) Ocupaţie _____________________
□
Divorţat(ă)/Separat(ă)
Văduv(ă) □
Singur(ă) □

a. *Greutate actuală: _____ kg

B. *Înălţime: _____ cm
C. Cea mai mare greutate până în prezent (excluzând perioada de sarcină): ____ kg
Cu cât timp în urmă aţi ajuns, pentru prima dată, la această greutate? Cu ____ luni.
Cât timp aţi avut această greutate? ____ luni.
D. *Cea mai mică greutate ca adult (sau ca adolescent, dacă nu aveţi încă 18 ani) ____ kg
Cu cât timp în urmă aţi ajuns, pentru prima dată, la această greutate? Cu ____ luni.
Cât timp aţi avut această greutate? ____ luni.
e. La ce greutate v‑aţi menţinut cel mai mult timp? La _____ kg.
La ce vârstă aţi avut, pentru prima dată, această greutate? La _____ ani.
F. În cazul în care greutatea dumneavoastră a variat mult de‑a lungul anilor, există o greutate la care
tot reveniţi, atunci când nu ţineţi o dietă? Da Nu □ □
Dacă da, care este această greutate? _____ kg.
La ce vârstă aţi avut prima dată această greutate? La ____ ani.
G. Câte kilograme aţi slăbit cel mai mult? _____ kg.
Aţi pierdut aceste kilograme intenţionat? Da Nu □ □
La ce greutate aţi ajuns? La _____ kg.
La ce vârstă aţi ajuns la această greutate? La ____ ani.
H. Care credeţi că ar fi greutatea dumneavoastră, dacă nu aţi încerca să o controlaţi? ____ kg.
I. Ce greutate v‑ar plăcea să aveţi? ____ kg.
J. Vârsta la care aţi început să aveţi probleme cu greutatea (dacă este cazul): ____ ani.
K. Ocupaţia tatălui: _________________________________
L. Ocupaţia mamei: _________________________________

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INSTRUCŢIUNI
În primul rând, completaţi numele şi data pe Formularul de răspuns EDI‑3. Încercuiţi răspunsul ales
de dumneavoastră la fi ecare dintre afi rmaţiile de mai jos, pe Formularul de răspuns. Afi rmaţiile se referă la
atitudinile, emoţiile şi comportamentele dumneavoastră. Unele dintre afi rmaţii se referă la mâncare sau la
comportamentul alimentar; altele se referă la ceea ce simţiţi faţă de persoana dumneavoastră.
Pentru fi ecare afi rmaţie, decideţi dacă este adevărată în cazul dumneavoastră: ÎNTOTDeaUNa (Î),
De OBICeI (O), aDeSea (a), CÂTeODaTĂ (C), RaR (R) sau NICIODaTĂ (N). Încercuiţi litera
care corespunde alegerii făcute de dumneavoastră, pe Formularul de răspuns. De exemplu, dacă aţi ales
aDeSea, veţi încercui litera a corespunzătoare acelei afi rmaţii, pe Formularul de răspuns.
Răspundeţi la toate afi rmaţiile, asigurându‑vă că încercuiţi litera care corespunde alegerii corecte în
cazul dumneavoastră. NU ŞTeRGeŢI! Dacă trebuie să modifi caţi un răspuns, marcaţi un X peste litera
greşită şi încercuiţi, apoi, litera corectă.

1. Mănânc dulciuri şi carbohidraţi (pâine, paste făinoase, produse de patiserie etc.), fără să mă
neliniştească acest lucru.
2. Cred că burta mea este prea mare.
3. Îmi doresc să mă pot întoarce la siguranţa copilăriei.
4. Mănânc când sunt supărat(ă).
5. Mă îndop cu mâncare.
6. Îmi doresc să fi u mai tânăr(ă).
7. Mă gândesc să fac o cură de slăbire.
8. Mă înspăimânt atunci când sentimentele mele sunt prea puternice.
9. Cred că am coapsele prea mari.
10. Simt că sunt o persoană inefi cientă.
11. Mi‑e frică să nu mă îngraş după ce mănânc.
12. Cred că burta mea are mărimea potrivită.
13. În familia mea, doar performanţele deosebite sunt sufi cient de bune.
14. Cea mai fericită perioadă din viaţă este atunci când eşti copil.
15. Vorbesc uşor despre sentimentele mele.
16. Sunt îngrozit(ă) că aş putea să mă îngraş.
17. Am încredere în ceilalţi.
18. Mă simt singur(ă) pe lume.
19. Sunt mulţumit(ă) de forma corpului meu.
20. Am sentimentul de control asupra lucrurilor din viaţa mea.
21. Sunt confuz(ă) în legătură cu ceea ce simt.
22. Aş dori să fi u mai degrabă adult decât copil.
23. Comunic uşor cu alte persoane.
24. Mi‑aş dori să fi u altcineva. (se continuă)

2
25. Dau o importanţă mare sau exagerată greutăţii corporale.
26. Pot să disting clar ce emoţie simt.
27. Mă simt nelalocul meu.
28. Am continuat să mănânc compulsiv atunci când simţeam că nu mă pot opri.
29. Copil fi ind, am încercat din greu să nu îmi dezamăgesc părinţii şi profesorii.
30. Mă afl u în relaţii apropiate cu ceilalţi.
31. Îmi place forma feselor mele.
32. Sunt preocupat(ă) de dorinţa de a fi mai slab(ă).
33. Nu ştiu ce se întâmplă în interiorul corpului meu.
34. Am difi cultăţi în a‑mi exprima emoţiile faţă de ceilalţi.
35. Cerinţele vârstei adulte sunt prea mari.
36. Urăsc să nu fi u cel/cea mai bun(ă) în tot ceea ce fac.
37. Am încredere în mine.
38. Mă gândesc să mă îndop cu mâncare.
39. Sunt fericit(ă) că nu mai sunt copil.
40. Nu‑mi dau seama dacă mi‑e foame sau nu.
41. Am o părere proastă despre mine.
42. Mă simt în stare să îmi ating standardele.
43. Părinţii mei s‑au aşteptat să fi u cel/cea mai bun(ă).
44. Mi‑e greu să‑mi controlez sentimentele.
45. Cred că şoldurile mele sunt prea mari.
46. Mănânc moderat în faţa altora şi mă îndop cu mâncare când rămân singur(ă).
47. Mă simt umfl at(ă) după ce mănânc o masă normală.
48. Simt că oamenii sunt cei mai fericiţi atunci când sunt copii.
49. Dacă mă îngraş cu un kilogram sau două, mă îngrijorez că mă voi îngrăşa în continuare.
50. Simt că sunt o persoană valoroasă.
51. Când mă supără ceva, nu ştiu dacă sunt trist(ă), înspăimântat(ă) sau furios/furioasă.
52. Simt că trebuie să fac lucrurile perfect sau să nu le fac deloc.
53. Mă gândesc să încerc să vomit ca să slăbesc.
54. Mai bine ţin oamenii la distanţă (mă incomodează dacă se apropie prea mult de mine).
55. Cred că am coapsele de mărime potrivită.
56. Am un sentiment de gol interior.
57. Îmi este uşor să vorbesc despre gândurile şi sentimentele mele.
58. Cei mai buni ani din viaţa ta sunt atunci când devii adult.
59. Cred că fesele mele sunt prea mari.
60. Am sentimente pe care nu le prea pot distinge. (se continuă)

3
61. Mănânc sau beau pe ascuns.
62. Cred că şoldurile mele au mărimea potrivită.
63. Îmi fi xez scopuri foarte măreţe.
64. Mă îngrijorez că, atunci când sunt supărat(ă), voi începe să mănânc.
65. Mă vor dezamăgi, până la urmă, chiar şi oamenii pe care îi plac.
66. Mi‑e ruşine de slăbiciunile mele omeneşti.
67. Alţi oameni ar putea spune că sunt instabil(ă) emoţional.
68. Vreau să am control total asupra poftelor şi pornirilor corpului meu.
69. Mă simt în largul meu când sunt într‑un grup.
70. Spun lucruri la primul impuls, pe care regret că le‑am spus.
71. Aş face orice ca să simt plăcere.
72. Trebuie să am grijă cu tendinţa mea de a abuza de medicamente.
73. Sunt comunicativ(ă) cu aproape toată lumea.
74. Mă simt prins(ă) în relaţii ca într‑o capcană.
75. Faptul că mă abţin, mă face să mă simt mai puternic(ă) din punct de vedere spiritual.
76. Oamenii înţeleg problemele mele reale.
77. Nu reuşesc să‑mi scot din minte gânduri ciudate.
78. A mânca de plăcere este un semn de slăbiciune morală.
79. Sunt predispus(ă) la izbucniri de furie sau de mânie.
80. Cred că oamenii îmi oferă încrederea pe care o merit.
81. Trebuie să am grijă cu tendinţa mea de a abuza de alcool.
82. Cred că a te relaxa este doar pierdere de vreme.
83. Ceilalţi ar spune că mă enervez uşor.
84. Simt că ies în pierdere pe toate planurile.
85. Am schimbări evidente de dispoziţie emoţională.
86. Sunt jenat(ă) de poftele şi de pornirile corpului meu.
87. Prefer să‑mi petrec timpul de unul/una singur(ă), decât cu ceilalţi.
88. Suferinţa te face o persoană mai bună.
89. Ştiu că oamenii mă iubesc.
90. Simt nevoia de a‑i face rău cuiva.
91. Mă cunosc destul de bine.