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Despite usual onset during adolescence the cause of low bone density in adolescent onset anorexia nervosa is incompletely understood. Puberty is known to be a crucial time for the development of peak bone mass, due principally to growth plate bone formation and modelling on preformed surfaces. This results in bone formation uncoupled from bone resorption leading to increased bone size due to increase in matrix and bone mineral content. It was hypothesized that low bone density in adolescent anorexia nervosa was caused by malnutrition during puberty suppressing normal bone matrix formation at all sites of bone formation thus arresting bone mineralization. Method 49 female adolescents with anorexia nervosa and 109 healthy female adolescent controls were studied. 22 of the anorexia nervosa subjects were studied again a year later. Bone area, mineral content and density were measured using Dual Xray Absorptiometry at the spine, hip and whole body sites, including body composition assessment. Estimated volumetric bone density was calculated using published equations in order to study bone density independent of bone size. Height, weight and Tanner stage in puberty were measured. Dietary intake and physical exercise were assessed using questionnaires. In a subset of anorexia nervosa and control subjects bone age was measured. In a subset of anorexia nervosa subjects bone formation was assessed using serum bone specific alkaline phosphatase and osteocalcin, and bone resorption was assessed using urine N-telopeptide.

Chow Yuet-ming. / Thesis (M.Phil.)--Chinese University of Hong Kong, 2000. / Includes bibliographical references (leaves 254-262). / Abstracts in English and Chinese, appendix in Chinese. / Abstract --- p.i / Acknowledgement --- p.iv / Chapter Chapter 1: --- Introduction --- p.1 / Chapter 1.1 --- Rationale for Selecting this Research Topic --- p.1 / Chapter 1.2 --- Research Objectives --- p.4 / Chapter 1.3 --- Research Questions --- p.5 / Chapter 1.4 --- Overview of the Present Thesis --- p.5 / Chapter Chapter 2: --- Literature review --- p.7 / Chapter 2.1 --- Anorexia Nervosa in Western Countries --- p.7 / Chapter 2.1.1 --- Historical Perspective --- p.8 / Chapter 2.1.2 --- Biomedical Perspective --- p.10 / Chapter 2.1.2.1 --- Physiological manifestation of anorexia nervosa patients --- p.10 / Chapter 2.1.2.2 --- Behavioral manifestation of anorexia nervosa patients --- p.12 / Chapter 2.1.3 --- Psychological Models --- p.14 / Chapter 2.1.3.1 --- Bruch ´ةs view --- p.14 / Chapter 2.1.3.2 --- Minuchin´ةs view --- p.16 / Chapter 2.1.3.3 --- Palazzoli 's view --- p.17 / Chapter 2.1.4 --- Sociological Perspective --- p.24 / Chapter 2.1.5 --- Summary of Part I (2.1) --- p.30 / Chapter 2.2 --- Psychology of Self-development --- p.33 / Chapter 2.2.1 --- "Erikson ,s identity formation" --- p.33 / Chapter 2.2.2 --- Women self-development --- p.38 / Chapter 2.2.3 --- Bowen's differentiation of self --- p.42 / Chapter 2.2.4 --- Summary of Part II (2.2) --- p.46 / Chapter 2.3 --- Anorexia Nervosa in Hong Kong Context --- p.48 / Chapter 2.3.1 --- The notion of self in traditional Chinese family --- p.49 / Chapter 2.3.2 --- Women position in Hong Kong --- p.55 / Chapter 2.3.3 --- Related research in Hong Kong --- p.62 / Chapter 2.3.4 --- Summary of Part III (2.3) --- p.69 / Chapter Chapter 3: --- Theoretical framework --- p.71 / Chapter 3.1 --- Theoretical Framework as Summarized from the Literature Review --- p.71 / Chapter 3.2 --- Definition of Terms --- p.77 / Chapter 3.2.1 --- Anorexia nervosa --- p.77 / Chapter 3.2.2 --- Family --- p.78 / Chapter 3.2.3 --- Family interaction --- p.79 / Chapter 3.2.4 --- Family rule --- p.79 / Chapter 3.2.5 --- Family myths --- p.80 / Chapter 3.2.6 --- Family myths as quest for meaning --- p.80 / Chapter 3.2.7 --- Meaning --- p.80 / Chapter 3.2.8 --- Power --- p.81 / Chapter 3.2.9 --- Power struggle --- p.81 / Chapter 3.2.10 --- Differentiation of self --- p.81 / Chapter Chapter 4: --- Research Methodology --- p.83 / Chapter 4.1 --- General Overview --- p.83 / Chapter 4.2 --- Research Methodology of this Study --- p.88 / Chapter 4.2.1 --- Rationale in Selecting Qualitative Method --- p.88 / Chapter 4.2.2 --- Research Design --- p.89 / Chapter 4.2.3 --- Unit of Analysis --- p.90 / Chapter 4.2.4 --- Sampling --- p.90 / Chapter 4.2.5 --- Methods of Data Collection --- p.92 / Chapter 4.2.5.1 --- Direct Observation of the Family Interviews of AN families --- p.92 / Chapter 4.2.5.2 --- Participant Observation in an AN Mutual Support Group --- p.94 / Chapter 4.2.5.3 --- Summary of the Case Study Protocol of this Study --- p.96 / Chapter 4.2.6 --- Time Frame for Data Collection --- p.96 / Chapter 4.2.7 --- Method of Analysis --- p.97 / Chapter 4.2.8 --- Validity and Reliability of this Study --- p.97 / Chapter 4.2.9 --- Summary of Chapter --- p.98 / Chapter Chapter 5: --- Results of the Study :Data Gathered from Family Interview Sessions --- p.100 / Chapter 5.1 --- Case History --- p.100 / Chapter 5.2 --- Results Gathered from Family Interview Sessions --- p.104 / Chapter 5.2.1 --- Having difficulties in differentiating from the family and self- starvation as a means of asserting the personal boundariesin the families --- p.104 / Chapter 5.2.2 --- Being triangulated in the parents' marital discords and self- starvation as a means of diluting their conflicts --- p.122 / Chapter 5.2.3 --- Self-sacrificing for the family interest --- p.131 / Chapter 5.2.4 --- "Being helpless and powerless in the families, self-starvation as a means of empowering the mothers in the families " --- p.134 / Chapter Chapter 6: --- Results of the Study:Data Gathered from Mutual Support Group Sessions --- p.138 / Chapter 6.1 --- Case History --- p.138 / Chapter 6.2 --- Results Gathered from Mutual Support Group sessions --- p.140 / Chapter 6.2.1 --- Having difficulties in handling peer relationship --- p.140 / Chapter 6.2.2 --- Having difficulties in resisting their mothers intrusiveness to their personal boundaries and self-starvation as a means of exerting their personal boundaries --- p.143 / Chapter 6.2.3 --- Being triangulated in their parents marital discords and self- starvation as a means of diluting the marital conflicts --- p.149 / Chapter 6.2.4 --- Acting for their mothers in the families --- p.149 / Chapter 6.3 --- Cross-checking of findings with group members and worker --- p.161 / Chapter Chapter 7: --- Discussions and Conclusion --- p.163 / Chapter 7.1 --- Research Findings of this Study --- p.163 / Chapter 7.2 --- Contributions of this Study --- p.173 / Chapter 7.3 --- Limitations of this Study --- p.174 / Chapter 7.4 --- Recommendation --- p.175 / Chapter 7.4.1 --- Future Research --- p.175 / Chapter 7.4.1.1 --- Proposed Theoretical Framework for Future Study --- p.175 / Chapter 7.4.1.2 --- Proposed Methodology --- p.179 / Chapter 7.4.2 --- Management of AN patients --- p.179 / Chapter 7.4.3 --- Prevention of AN --- p.181 / Appendix I: The Chinese verbatim of family interview sessions --- p.183 / Appendix II: The Chinese verbatim of mutual support group sessions --- p.234 / List of Figures: / Figure 1: Summary of the framework from western literature --- p.75 / "Figure 2: Interplay among individual, family and society " --- p.76 / Figure 3: Socio-demographic characteristics of the AN patients and their families of the family interview sessions --- p.91 / Figure 4: Socio-demographic characteristics of the AN patients and their families of the mutual support group --- p.92 / Figure 5: Summary of the proposed theoretical framework of Understanding self-starvation in Hong Kong --- p.178 / Bibliography --- p.254

徐文艷. / Thesis (doctoral)--Chinese University of Hong Kong, 2007. / Includes bibliographical references (p. 259-278). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstracts in Chinese and English. / Xu Wenyan.

The present work has been implemented as a literature study aimed to investigate the prevalence, possibly causes and consequences of an eating disorder. In today's modern society individuals are living with a constant reminder from the media about how a person should look and act to blend into the social norms and expectations of the modern society. This literature review has been analysed on the basis of concepts such as identity, gender identity and gender. In addition previous research has been analysed in terms of themes, history, possible causes/risk factors, media, body image and control, depression, shame and guilt as well as culture. The above themes were analysed on the basis of behaviouristic theory and role theory. The conclusion of the present work is that an eating disorder is 10 times more common in girls than boys. Furthermore present work has shown that Anorexia Nervosa, Bulimia Nervosa and UNS previously existed even though it was not documented as a medical condition. Another conclusion is medias exposure of the stereotypical body image which contributes to an increased development of the medical conditions mentioned above.

In contemporary culture, while there is an excessive preoccupation with the body, there is eating symptoms emergence. Despite the previously existence of these symptoms, they were not that common and frequent in the clinic. Anorexia is considered one of these symptoms and according to that it was possible to question the relation betweenincreased anorexia incidence nowadays and idealization of thin body. The aimed of this study was to examine the relation between the cult of the body culture and anorexia in contemporaneity, reflecting on that context, if anorexia can be considered an analytical symptom. This work conducted a theoretical study, based on psychoanalysis. The method adopted was to read the texts more than once, from the researcher's encounter with the text, the purpose of producing a speech and not just the pursuit for the meaning of interpretative texts. So, it was used texts from Sigmund Freud, Jacques Lacan and authors that argue the binomials: body worship and contemporary culture, beauty codes and standards and anorexia, anorexia and ideal cultural;ideal body and ways / lifestyles; anorexia and symptoms. We also used two published clinical cases, to convey and intensifyconcepts, specifically anorexia, in psychoanalytic theory. It was observed that anorexia is presented differently nowadays, since there are individuals who participate in pro-anorexia movements and conceive it as a lifestyle. The anorexia exaltation is related to aspects of this culture and mostly with the idealization of thin body. In view of the increasing incidence of anorexia, it is understood that culture is not the cause but can propel this growth, since the constitution of the symptom is related to various life experiences of the subject. Accordingly, anorexia can only be considered an analytical symptom, from the encounter between analyst and patient. To do so, depends on the position of the subject to the treatment and the analyst’s intervention. / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / Na cultura contemporânea, ao mesmo tempo que há uma preocupação excessiva com o corpo, constata-se a emergência de sintomas alimentares. Apesar de eles existirem anteriormente, não eram tão comuns e frequentes na clínica. A anorexia é considerada um desses sintomas e, nesse sentido, questionou-se a relação entre o aumento da incidência da anorexia na atualidade e a idealização do corpo magro. A pesquisa teve como objetivo analisar a relação entre a cultura do culto ao corpo e a anorexia no contemporâneo, refletindo se nesse contexto, a anorexia pode ser considerada sintoma analítico. Para tanto, foi realizado estudo teórico, fundamentado na psicanálise. O método adotado foi o da releitura, que a partir do encontro do pesquisador com o texto, tem como propósito a produção de um discurso e não apenas a busca do sentido interpretativo dos textos. Assim, foram utilizados textos de Sigmund Freud, Jacques Lacan e autores que discutem os binômios: culto ao corpo e cultura contemporânea; padrões e códigos de beleza e anorexia; anorexia e ideal cultural; corpo ideal e modos/estilos de vida; anorexia e sintoma. Também foram utilizados dois casos clínicos publicados, para transmitir e aprofundar conceitos, especificamente da anorexia, na teoria psicanalítica. Verificou-se que a anorexia se apresenta de maneira distinta na contemporaneidade, visto que há sujeitos que participam de movimentos pró-anorexia e a concebem como estilo de vida. A exaltação da anorexia está relacionada com os aspectos desta cultura e principalmente com a idealização do corpo magro. Tendo em vista o aumento da incidência da anorexia, entende-se que a cultura não é causadora, mas pode propulsionar esse aumento, uma vez que a constituição do sintoma está relacionada com diversas experiências da vida do sujeito. Nesse sentido, a anorexia só pode ser considerada um sintoma analítico a partir do encontro entre analista e analisando. Para isso, depende da posição do sujeito em face do tratamento e das intervenções do analista.

Bakgrund: Anorexia nervosa är en allvarlig psykisk störning. Sjukdomen förekommer främst bland flickor och kvinnor. God kunskap och terapeutisk kompetens hos vårdpersonal krävs för att kunna bemöta en patient med diagnosen anorexia nervosa som en enskild individ med unika behov. Syfte: Syftet med denna litteraturstudie var att belysa anorexiadrabbade flickors och kvinnors upplevelser i samband med vård. Metod: Åtta kvalitativa studier har granskats och analyserats. Resultat: Genom analys av studierna framkom att anorexiadrabbade patienters upplevelser i samband med vård har betydelse för deras återhämtning. Utifrån analysen framkom två teman och fem subteman. Det första temat belyser positiva upplevelser i samband med vård understött av två subteman: att bli bemött som en individ och vårdpersonalens engagemang. Det andra temat belyser negativa upplevelser i samband med vård understött av tre subteman: att bli bemött som en anorektiker, behandling fokuserar på viktuppgång i stället för psykiska problem och känslor av skam och osäkerhet. Slutsats: För patienternas återhämtning är det viktigt att vårdpersonal bemöter patienterna som unika individer och ser till deras olika behov. Vårdpersonalens engagemang samt god terapeutisk kompetens är en förutsättning för att patienten ska uppleva behandlingen som givande och som stöd för tillfrisknandet.

Background: Anorexia nervosa is a common and very serious mental illness that most people know about. The fear of losing control and the low motivation for change makes it difficult for the patient to realize how serious the condition is. It is important that health professionals pay attention to these patients to reduce pain and to shorten the period of illness. Objective: The aim of this descriptive literature review was to describe how patients with anorexia nervosa experience being treated by nurses and how nurses experience treating and caring for patients with anorexia nervosa. Method: A systematic literature review was completed and 14 studies were used in the result. Results: Analyzed data shows that there are many different thoughts and experiences about the care of anorexia nervosa. An important part of the care and also important for the patients recovery, was that the patient and the nurse were communicating with each other and that they developed a relationship. Anorexia nervosa is characterized by a large need for the patient to take control that could lead to a struggle between the patient and the nurse. A lack of knowledge among the nurses in care of these patients was also noted. Conclusion: Through good communication and by building up a relationship, the understanding of the disease is increased. This has shown to be an important part of the patients’ recovery and therefore it is important that the nurses consider the needs of each patient and threat them with respect and empathy. / Bakgrund: Anorexia nervosa är idag ett vanligt och mycket allvarligt psykosocialt tillstånd som de flesta känner till. Rädslan för att tappa kontrollen och den låga motivationen till förändring gör det dock svårt för den sjuka att inse sitt eget bästa. Det är viktigt att sjukvårdspersonal uppmärksammar dessa patienter för att kunna minska lidande och förkorta sjukdomstiden. Syfte: Syftet var att utifrån relevanta vetenskapliga studier beskriva hur patienter med anorexia nervosa upplever att de blir bemötta av sjuksköterskor, samt hur sjuksköterskor upplever att vårda patienter med anorexia nervosa. Metod: En systematisk litteraturstudie genomfördes och 14 studier användes i resultatet. Resultat: Analyserad data visar att det föreligger olika tankar och upplevelser kring omvårdnaden av anorexia nervosa. Kommunikation var en central del i omvårdnaden och blev en viktig del i patientens återhämtning. Att en relation mellan patient och sjuksköterska byggdes upp visade sig vara betydelsefullt. Sjukdomen anorexia nervosa karaktäriseras av ett stort kontrollbehov vilket kunde leda till en kamp om kontroll mellan patient och sjuksköterska. Utifrån resultatet märktes även en bristande kunskap hos sjuksköterskor i vårdandet av patienter med anorexia nervosa. Slutsats: God kommunikation förbättrar chanserna att utveckla en relation och det har visat sig ge ökad förståelse för sjukdomen hos båda parterna. Ökad förståelse för sjukdomen har visat sig underlätta då patienter upplever en trygghet och tillit till sjuksköterskan. En förståelse för sjukdomen har också stor betydelse för patienters tillfrisknande och det är därmed viktigt att sjuksköterskan ser till varje enskild individs behov och bemöter dem med respekt och empati.

<p><strong>Bakgrund: </strong>Anorexia nervosa karaktäriseras av en beslutsam strävan efter viktnedgång. Fler kvinnor än män drabbas och sjukdomen debuterar oftast i samband med puberteten.</p><p><strong>Syfte: </strong>Syftet var att belysa anorektikers upplevelser av att leva med anorexia nervosa. <strong></strong></p><p><strong>Metod: </strong>En kvalitativ ansats som baserades på fyra självbiografier. För att få fram biografiernas essens genomfördes en analys som baserades på Graneheim och Lundmans (2004) innehållsanalys. <strong>Resultat: </strong>Kvinnorna i biografierna uttryckte olika former av lidande. Sjukdomen är ett sätt att uttrycka sin olycka och sitt inre kaos. Den dagliga kampen mellan den friska och den sjuka sidan leder till att kvinnorna känner maktlöshet inför det inre kaos de drabbats av. Den drabbades vardag präglas av tvång, av en inre röst som bestämmer hur personen ska agera samtidigt som självförtroendet sakta men säkert bryts ner. Sjukdomen får dem att tvivla på sig själva och den bidrar till den skeva kroppsbild som är central för sjukdomen. <strong>Slutsats:</strong> Studien visar att sjukdomen anorexia nervosa är psykisk, fysisk och socialt påfrestande, vilket kräver att vi som vårdpersonal bör ha en bra förståelse och tillräckligt med kunskap som kan underlätta att hjälpa patienterna i deras lidande.</p>

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