Introduction : Cette thèse est issue de réflexions et d'expériences cliniques suite à un travail avec des femmes souffrant d'un trouble des conduites alimentaires (TCA) et accédant à la maternité. Dans notre recherche, parmi les différentes méthodes de Procréation Médicalement Assistée (PMA), nous avons choisi d'étudier une population ciblée : les femmes ayant recours à la pompe à la GnRH pour concevoir leurs enfants. Hypothèse principale : il existerait un grand nombre de femmes, souffrant ou ayant souffert d'un TCA, qui auraient recours à la pompe à GnRH. Hypothèse secondaire : le TCA maternel aurait des influences sur le désir d'enfant, la grossesse et les interactions précoces mère-enfant. Objectif principal : évaluer un groupe de femmes souffrant d'un TCA, enceintes après utilisation de la pompe à GnRH, à partir du 4ème mois de grossesse et jusqu'à la 8ème semaine du post-partum. Objectifs secondaires : obtenir des données scientifiques à propos des femmes souffrant d'un TCA et ayant recours à la pompe à GnRH, afin de mieux éclairer le parcours de soin de ces patientes dans les services de PMA ; obtenir des données scientifiques sur le vécu de la grossesse par les femmes TCA ; obtenir des données scientifiques sur la présence et la gravité des TCA durant la grossesse et en post-partum ; évaluer la prévalence de la dépression du postpartum chez les femmes souffrant d'un TCA. Critère d'évaluation principal : comparaison du groupe d'étude avec deux groupes témoins, l'un composé de femmes exemptes de TCA devenues enceintes par des méthodes de PMA autres que la pompe à GnRH, et l'autre composé de femmes exemptes de TCA devenues enceintes spontanément. Critères d'évaluation secondaires : évaluation de l'évolution du TCA, en pré et postnatal, par l'hétéro-questionnaire EDE ; évaluation du vécu de la grossesse par des entretiens semi-structurés ; évaluation des représentations maternelles par l'IRMAG ; évaluation de l'état psychique en pré et postnatal par l'auto-questionnaire HAD ; évaluation de l'anxiété par l'utilisation du STAI ; évaluation du risque de survenue d'une dépression du postpartum par l'auto-questionnaire EPDS. Cette étude est observationnelle et prospective : étape prénatale - 3 évaluations, entre 16 et 20 semaines d'aménorrhée (SA), entre 24 et 28 SA et entre 28 et 32 SA ; étape postnatale - 1 évaluation, à la 8ème semaine environ du postpartum. Conclusion : on constate que le TCA maternel peut être un facteur de risque en ce qui concerne la grossesse et les interactions précoces mère-bébé. L'utilisation de la pompe à GnRH par les femmes souffrant d'un TCA devrait être considéré comme un véritable enjeu de santé publique, requérant évaluation, prévention et prise en charge pluridisciplinaire de la grossesse jusqu'au post-partum. / Introduction: This thesis is the result of reflexions and clinical experiences from our work of pregnancy in women suffering from lifetime eating disorders (ED). Among different methods of assisted reprodutive technology (ART), we chose to study a special population: women seeking GnRH pulsatile administration treatment. Main hypothesis: there is an important rate of women with a lifetime ED seeking GnRH pulsatile administration treatment . Secondary hypothesis: maternal ED have influences on the desire for a child, pregnancy and early mother-child interactions. Main objective: to evaluate pregnant women with a lifetime ED after seeking GnRH pulsatile administration treatment, from the 4th month of pregnancy until the 8th week of postpartum. Secondary objectives: to obtain scientific data about women with lifetime ED seeking GnRH pulsatile administration treatment ; to better inform the multidisplinary care of these patients in the ART services ; to obtain scientific data about the experience of pregnancy in women with a lifetime ED and about the presence and severity of ED during pregnancy and postpartum ; to estimate the prevalence of postpartum depression in these women. Design: A descriptive comparative three-group design in which collected data were compared - one of women with lifetime ED who became pregnant after GnRH pulsatile administration treatment, one of women without lifetime ED who became pregnant after using other ART methods , one of women without lifetime ED who had a spontaneous pregnancy. Evaluation criteria: EDE to evaluate ED during the pre- and post-natal period ; clinical semi-structured interviews to evaluate how the pregnancy is experienced ; IRMAG to evaluate maternal representations ; HAD to evaluate anxiety and depression during the pre and postnatal period ; STAI to evaluate anxiety ; EPDS to evaluate risk of postpartum depression. This study is observational and prospective: during the prenatal period - 3 evaluations were conducted, between 16 and 20 weeks of amenorrhea (SA), between 24 and 28 SA and between 28 and 32 SA ; during the postnatal period - 1 evaluation was conducted around the 8th week. Conclusion: Eating disorders and GnRH pulsatile administration can be considered as a real public health issue, requiring strategies to address prevention, identification and multidisciplinary care for these women during pregnancy and postpartum. An eating disorder screening tool should be included in the initial intake, because these patients may be at a higher risk for negative maternal and fetal outcomes than non eating disorder patients.

Obesity prevalence continues to increase worldwide, yet few safe and effective treatment options are available suggesting there needs to be a greater emphasis on preventing rather than treating obesity. This research investigated the association of obesity predisposing SNPs and a gene score with nutrient consumption patterns including total energy intake and macronutrient distribution in a European ancestry population as well as discussing an evolutionary perspective on eating disorders using current epidemiological evidence to identify genes which may be involved. The association of two of the 14 obesity predisposing SNPs and the gene score with BMI was confirmed in the EpiDREAM population. Novel associations between two SNPs located in or near BDNF (rs6265 and rs1401635) were found with total fat, MUFA, and PUFA intake. Rs1401635 was also associated with total energy and trans fat intake. Novel associations of rs6235 (PCSK1) and the gene score were found with total energy intake. The novel associations found indicate that food related behaviours are one of the mechanisms of action through which obesity predisposing SNPs cause obesity and therefore warrant further investigation. The lack of association among all genes and the modest association of the gene score show that mechanisms other than food consumption are important. The investigation of the evolutionary history of eating disorders revealed that the adapted to flee famine hypothesis is a plausible theory explaining anorexia nervosa while the thrifty genotype hypothesis provides a possible explanation for bulimia nervosa and binge eating disorder. These evolutionary theories can be applied to identify new candidate genes as well as phenotypic traits to investigate to better understand the genetic architecture of eating disorders. Understanding genes associated with disordered eating patterns may highlight future areas for obesity prevention. / Thesis / Master of Science (MSc) / A large percentage of the risk of developing obesity or an eating disorder (anorexia nervosa, bulimia nervosa, and binge eating disorder) is determined by genetics. For obesity, many genes have been identified as influencing risk, but the mechanisms through which the genes work are largely unknown. For eating disorders, gene identification efforts have been mostly unsuccessful and no mechanisms of action have been determined. In the first component of this thesis we found an association between previously identified obesity risk genes and food intake, specifically the total number of calories consumed per day and the percentage of calories from total fat and fat subtypes. These results support that food related behaviours are possible mechanisms of action which need to be further investigated. In the second half of the thesis we viewed eating disorder behaviours from an evolutionary perspective. We concluded that there are theories that possibly explain eating disorder behaviours including being able to live off of small quantities of food as well as binging. These evolutionary theories can be applied to identify new genes to study in the context of eating disorders as well as different definitions of eating disorders.

Ätstörningar är en sjukdomsgrupp som blir allt vanligare i samhället. En av orsakerna till att sjukdomen ökar är det orealistiska idealet som presenters i media. Mediatrycket blir även mer påtagligt och lättåtkomligt. Idealet medför en ökad missnöjdhet med den egna kroppen och med utseendet som bidrar till ett driv för förändring. Syftet med denna studie är att undersöka om män påverkats av media i samma utsträckning som kvinnor i insjuknandet av en ätstörning. Samt om könet spelar en central roll för vem som drabbas. Av de som drabbas av en ätstörning och söker vård utgörs enbart 10% av män. Kan idealet ha en påverkan till att färre män drabbas? Eller medför de olika föreställningarna kring könen och sjukdomen att män inte inser att se är sjuka, vågar de inte söka hjälp eftersom det anses vara en kvinnosjukdom? Resultatet tyder på att sjukdomen är komplex till sin natur, där inte enbart en mediafaktorn bidrar till att en person drabbas. / Eating disorders are a disease group that is becoming more common in society. One of the reasons that the disease is increasing is the unrealistic ideal that is presented in media. The media-pressure is substantial and accessible. The beauty ideal involve a dissatisfaction of a persons own body and his or hers appearance that will contribute to the drive of change. The purpose of this study is to investigate if men, as well as women, are influenced by the media-factor in the sicken of an eating disorder. Also if the sex matters and plays a certain role for those who suffer. Only 10 percent of those who are suffering from an eating disorder and that seeks help are men. Can the ideal have an direct affect that less men suffer from this disease? Or can the different expectations of the sexes and of the disease implicate that men don´t realize that they are sick, or that they feel shameful to seek help because eating disorders are known to be a women’s disease? The results implicate that eating disorders is a complex disease and that the media-factor alone does not contribute to sicken or the cause of sickness.

Bakgrund: Man kan se att en stor andel unga kvinnor lider av ätstörning samtidigt som det ä rbrist på kunskap om vilka hälsopromotiva åtgärder som är viktiga vid tillfrisknande. Syftet med studien var att undersöka vilka hälsofrämjande faktorer som bidragit till att unga kvinnor tagit sig ur en ätstörning. Metod: Kvalitativ metod med snöbollsurval och bekvämlighetsurval användes för att nå deltagarna. 17 kvinnor i åldrarna 19-59 år medverkade i studien. Öppna brev användes för att samla in data. De öppna breven analyserades enligt kvalitativinnehållsanalys med latent ansats där författarna tog ut meningsbärande enheter, koder, kategorier och teman. Analysen resulterade i tre huvudteman: Jag och min starka kropp, En främjande och glädjefylld miljö där jag kan vara mig själv och “Det löser sig nog -”stärkande insatser. Sex subteman skapades: Inom mig, Lyssna på kroppens olika behov, Balans mellan krav och stöd från betydelsefulla människor i min närhet, Faktorer i minomgivning, Konsten att sköta kosten och Professionell personal och preventiva verktyg som resurs. Resultat: Det som framkommer i resultatet är att flera olika faktorer främjade hälsa hos de unga kvinnorna och bidrog till att de tillfrisknande från ätstörning. Dessa faktorer var; att acceptera den man är och ge sig själv kärlek. Att få stöd och uppmuntran från nära. Aktiviteter och positiva sammanhang. Matstöd och preventiva åtgärder på klinik samt vägledning av utbildad personal. Slutsats: Riskåldern för att drabbas av ätstörning är 13-30 år och därför är det viktigt att jobba med hälsofrämjande insatser redan i ung ålder. I den här studien framkom det att flera olika faktorer är viktiga för tillfrisknande från ätstörning men även för att stärka hälsa hos kvinnor som är friska. / Backgound: A large population of young women suffers from eating disorders and at the same time there is a lack of knowledge about which health promotive tools are important in the fight to get well. The aim of the study was to investigate which health promoting factors that contributed to the womens recovery. Methods: Qualitative method with snowball sampling and convenience sampling was used to find the participants. 17 women in the age of 19-59 years participated in the study. Data was collected by open letters and then analyzedwith latent qualitative content analysis where the authors arranged meaning units, codes, categories, sub-themes and themes. The analysis resulted in three main themes: Me and my strong body, An encouraging and joyful environment where I can be myself and "It will all be alright" - strong efforts. Six sub-themes were created: Within me, Listening to the different needs of the body, Balance between demands and support from important people in my environment, Factors in my environment, The art of manage the diet and Professional staff and preventive tools as a resource. Results: What is evident in the results is that several factors promote health for the young women and contributed to the recovery from eating disorders. To accept who you are and give yourself love. To get support and encouragement from near. Activities and positive contexts. Food support and preventive methods at the clinic and guidance of healthcare professionals. Conclution: Most common age to suffer from eating disorder is 13-30 years old. Therefore, it is important to work with health promotive efforts at a young age. In this study, it emerged that several factors are important for recovery from eating disorders, but also for strengthening the health of women who are healthy.

No description available.

This thesis investigates the application of TrueBalance, a conversational agent designed to support young adults vulnerable to eating disorders (EDs). TrueBalance integrates Cognitive Behavioral Therapy (CBT) techniques with biomedical insights, including genetic and neurobiological factors, to provide a more personalized and scientifically grounded support system. It addresses limitations in existing dietary monitoring tools that usually focus on calorie tracking and food intake, often neglecting the nuanced needs of specific groups like young females and elite athletes, who are particularly vulnerable to EDs and disordered eating behaviors.  The study addresses how biomedical determinants can be integrated into a conversational agent, how these agents can utilize CBT principles to support individuals vulnerable to EDs, and what challenges and opportunities arise from the user’s perspective when using such a dialogue model. The research strives to bridge the gap in current dietary self-monitoring tools by offering a more robust and empathetic support system for individuals struggling with EDs. Through iterative development and user testing, TrueBalance has demonstrated its potential as an engaging educational tool. Feedback from both therapists and users has highlighted the tool’s utility in real-world settings. It has led to suggestions for enhancements in personalizing interactions and making response systems more adaptive. The findings suggest conversational agents like TrueBalance have potential in non-clinical support environments for individuals with EDs and function as a potential informative, supportive tool for therapists’ education. / Denna masteruppsats undersöker användningen av TrueBalance, en konversationsagent designad för att stödja unga vuxna som är sårbara för ätstörningar. TrueBalance integrerar tekniker från Kognitiv beteendeterapi (KBT) med biomedicinska insikter, inklusive genetiska och neurobiologiska faktorer, för att tillhandahålla ett mer personligt och vetenskapligt förankrat stödsystem. Den tar itu med begränsningarna i befintliga verktyg för kostövervakning, som vanligtvis fokuserar på kalorispårning och matintag men ofta förbiser de nyanserade behoven hos specifika grupper, såsom unga kvinnor och elitidrottare, som är särskilt sårbara för ätstörningar och ätstörda beteenden. Studien behandlar hur biomedicinska determinanter kan integreras i en konversationsagent, hur dessa agenter kan använda KBT-principer för att stödja individer sårbara för ätstörningar, samt vilka utmaningar och möjligheter som uppstår från användarens perspektiv när de använder en sådan dialogmodell. Forskningen strävar efter att överbrygga klyftan i nuvarande verktyg för kostövervakning genom att erbjuda ett robustare och mer empatiskt stödsystem för individer som kämpar med ätstörningar. Genom iterativ utveckling och användartester har TrueBalance visat sin potential som ett engagerande pedagogiskt verktyg. Återkoppling från både terapeuter och användare har belyst verktygets nytta i verkliga sammanhang. Det har lett till förslag på förbättringar för att personalisera interaktioner och göra responssystemen mer adaptiva. Resultaten tyder på att konversationsagenter som TrueBalance har potential i icke-kliniska stödmiljöer för individer med ätstörningar och kan fungera som ett potentiellt informativt, stödjande verktyg för terapeuters utbildning.

1 online resource (vii, 138 leaves : ill.) / Following an awareness of an increased turn over of staff in the eating disorder unit as compared with other specialised units, in a psychiatric hospital in Johannesburg, South Africa, Tara Hospital, the researcher was motivated to investigate the issue. An exploratory, descriptive based research was chosen to explore and gain information about the topic and its implications. A qualitative research approach was used to gain insight into the perceptions and needs of the team working on the unit. The case study method was used. A pilot study was undertaken to test the validity of the interview schedules. The sampling category was a non- probability one. Individuals were selected from the population of staff working on the unit. Participants were selected from two groups, those who were presently working on the unit and those who had previously worked on the unit and now working in other units. Interview procedure involved personal semi-structured interviews conducted by the researcher and analysed qualitatively and a structured interview questionnaire analysed quantitatively. The researchers assumption that many staff members move from working in an eating disorders unit was confirmed and is due to the following: Staff turnover is due to constant exposure to occupational stress and burnout. Feelings of helplessness, a sense of being unappreciated and excessive exposure to conflict from the patients. In addition, staff experience minimum rewards leading to lowered job satisfaction due to the patients slow recovery rates and a poor prognosis of the illness. Staff also experience a change in their eating patterns and an increased awareness around food and food issues. Recommendations to the staff include: * Psycho-education on eating disorders. * Implementation of strategies to provide supportive care for all staff members. * Education on stress management and strategies to prevent staff burnout and lowered job satisfaction. * A multidisciplinary teamwork approach by the staff, when working in the unit. / Social Work / M. A. (Social Science in Mental Health)

Eating disorders remain a phenomenon that escapes full comprehension, resulting in frustration for those who suffer from the disorders, their families, and their therapists. It is becoming increasingly necessary to describe the mechanism by which eating disorders develop, in order to effectively treat and prevent these disorders. The aim of this study was to illuminate factors that contributed to the development of eating disorders within the individual contexts of the lives of the participants, as well as how those factors interacted in context to culminate in the development of an eating disorder. This qualitative study was conducted from an interpretive perspective. The findings show how individual contextual factors interact to produce a marked fear of gaining weight, which is driven by fear of negative evaluation, and that the eating disorder behaviour serves specific functions that are related to coping with stress within the lives of the participants. / Psychology / M. Sc. (Psychology with specialisation in Research Consultation)

As a whole, eating disorders have been characterised as having the following key features: a persistent over concern with body size and shape; and weight control behaviours such as fasting, exercise, and self-induced vomiting. However, there tends to be a blurred line between those that do and do not meet diagnostic thresholds as the level of psychological distress is comparably similar. This study examined whether psychological inflexibility (from an Acceptance and Commitment Therapy perspective) was associated with eating disorders and whether it mediated the relationship between childhood abuse and invalidation and eating disorders. This was considered to be important because high rates of abuse have consistently been found in this population, yet not everyone goes on to develop an eating disorder. In addition, the role of emotional abuse has been largely neglected. A clinical sample of 190 participants with a clinical or subclinical eating disorder were recruited from eating disorder charities and support forums; they completed a range of questionnaires measuring experiences of abuse and maternal/paternal emotional invalidation in childhood, current levels of cognitive fusion and experiential avoidance and current levels of eating pathology. The sample was split into three groups based on their Eating Disorder Risk Composite scores: elevated, typical and low clinical range. It was found that those in the elevated clinical range (most severe eating pathology) had the poorest emotional processing and significantly higher levels of psychological inflexibility, thought-shape-fusion, depression and anxiety than those in the low clinical range (least severe eating pathology). In terms of predicting current levels of eating pathology, three variables emerged as significant predictors: emotional processing, thought-shape fusion and depression. In terms of predicting current levels of psychological inflexibility, five variables emerged as significant predictors: childhood emotional abuse, emotional processing, thought-shape-fusion, depression and anxiety. The results add novel findings to the literature regarding the role of early experiences on the development of psychological inflexibility, and the role of psychological inflexibility in the maintenance of eating pathology and psychological distress. Clinical implications of these findings in relation to assessment, formulation, intervention and prevention are discussed.

Poruchy příjmu potravy ve spojitosti s jinými diagnózami. Eating Disorders in Connection with other Diagnoses Bc. Marie Vavrušková The aim of this thesis, which focuses on the topic "Eating Disorders in Connection with Other Diagnoses," is to introduce the different types of eating disorders that have been previously diagnosed (anorexia nervosa, bulimia nervosa, psychogenic overeating and new forms of eating disorders), to specify the medical treatment offered to patients in the Czech Republic, and in particular to describe what other mental or somatic disorders are most commonly associated with eating disorders. The empirical part of the thesis presents a questionnaire which analyses the following aspects: type of eating disorder from which the clients of Centrum Anabell Praha suffer most frequently, where their medical treatment takes place, whether they suffer from another mental or somatic disorder associated with eating disorders, and whether eating disorders have a negative impact on their lives. The empirical part also presents a case report, which describes the life story, history and prognosis of a man who suffers from an eating disorder and other associated disorders.