To gain a better understanding of those struggling with severe eating disorders (anorexia nervosa and bulimia nervosa), the inner life-world and subjective experiences of therapy clients were explored within the South African context. This was an empirical qualitative study. Specifically, the study’s focus was on the psychological construct of perfectionism as experienced during the respondents’ treatment resistant eating disorders. The two objectives of the research were to describe and explain perfectionism, which served to increase an overall improved understanding of perfectionism. The study’s methodology encompassed a combination of phenomenological- and grounded theory methodology, exploring the narratives of six female candidates that were undergoing individual therapy for their eating disorders. These candidates were considered to have a treatment resistant eating disorder, because they had been struggling with this diagnosis for longer than a decade, and/or had previously received multiple treatment interventions without recovering. The therapy sessions were recorded via digital audio recordings, and used in the data analysis process. The discourses pertaining to the study’s focus were transcribed and analysed using phenomenological- and grounded theory methods. The phenomenological analysis produced individual descriptions of the participants’ experiences of their perfectionism, as well as a general description for perfectionism. The grounded theory analysis produced an emerging theory in the form of a cognitive schema. This schema was named The Perfectionistic Eating Disorder Self-schema (PEDSS), and explains the inner psychological process of perfectionism within a treatment resistant eating disorder client. The results of this study, in particular the PEDSS, has implications for those trying to understand, assist, and treat those who suffer from treatment resistant eating disorders, as well as helping those who struggle with perfectionism to understand their own problem more. / Psychology / D. Phil. (Psychology)

The thesis focuses on body image - defines the main characteristics of this area, describes cultural influences and body image history and explains basic quantitative values (Body Mass Index, Waist Hip Ratio, Bioelectrical Impedance Analysis). Furthemore the thesis deals with media influence on body ideal formation process, especially in gay subculture. The research part explores recent situation of body image in gay subculture compared with heterosexual males. This section includes the content analysis of mainstream gay movies which compares media presentation of gays and the real situation and examines media influence on gay body image formation.

La première cause de maigreur chez les femmes dans les pays occidentaux est l’anorexie mentale (AM). La maigreur constitutionnelle (MC) regroupe des femmes d’Indice de masse corporelle identique aux AM mais sans les anomalies psychologiques, biologiques ou hormonales (pas d’aménorrhée) rencontrées dans l’AM. Les troubles du comportement alimentaire (TCA) comprennent l’AM restrictive pure (AM-R), l’AM avec crises boulimiques (AM-BP) et la boulimie nerveuse (BN). Notre travail explore ces troubles à la lumière de la régulation de l’appétit dont le centre organique (noyau arqué) reçoit des afférences de peptides périphériques tels que la leptine, le PYY, le GLP1 , la ghréline et l’obéstatine. Nous montrons un profil orexigène dans l’AM-R, témoignant d’une intégrité du système de régulation de la prise alimentaire et adaptatif, luttant contre la restriction alimentaire. Nous avançons le concept de ghrélino-résistance dans l’AM-R dont le substratum biologique est peut-être l’obéstatine. Nous montrons une ghréline basse chez les AM-BP comme chez les BN permettant un diagnostic différentiel précis et rapide. A l’inverse, nous montrons un profil anorexigène constitutif chez les MC participant au maintien du poids bas, proposant la MC comme un modèle humain de résistance à la prise de poids. Ces hormones peuvent agir comme arbitre organique objectif entre des entités cliniques parfois à tort confondues. Une leptine basse chez une jeune fille maigre signe une AM, une ghréline basse chez une AM signe la présence de crises boulimiques. Ces éléments forts nous poussent à continuer notre travail de précision et de phénotypage de ces entités pour mieux en comprendre la physiopathologie / The commonest group of underweight young women in the developed world is restrictive anorexia nervosa (AN). However, constitutional thinness (CT) is a condition described in the same low weight range as AN. CT women display normal menstruation an do not present with psychological or hormonal features of AN. Eating disorders (EA) displays Anorexia Nervosa with restrictive food behaviour (AN-R), Anorexia Nervosa with binge purge associated (AN-BP) and bulimia Nervosa (BN ). Food intake is controlled by the arcuate nucleus through integration of peripheral hormonal signals such as leptin, ghrelin, peptide YY (PYY) and glucagon like peptide 1 (GLP-1). Our objective was to understand thinness and EA through those hormonal signals. AN-R presents an orexigenic adaptative profile contrasting with the anorexigenic constitutive one in CT, proving the integrity of the appetite regulation system. We propose the ghrelin resistance concept with the putative obestatin. AN-BP presents a very different profile of appetite regulatory peptides when compared with AN-R, with low ghrelin levels. The hormones appear to be valuable biomarkers to distinguish AN and CT in severe underweight patients and to diagnose binge purge in AN. The assessment of ghrelin (and eventually obestatin) could be of particular interest for differential diagnosis between AN-R and AN-BP. The assessment of leptin could also be useful for differential diagnosis between AN and CT