<p>Adolescence means an increased risk for eating disorders (ED) and the female gender is the most important risk factor. Empirical studies of the perceptions of gender ideals—as potential mediating factors between the socio-cultural context and ED—were this thesis’ primary goals. Further aims implied evaluating the psychometric properties of the Eating Disorders Inventory for Children (EDI-C) and providing normative data for boys and girls concerning self-assessed ED symptoms and related psychological traits.</p><p>The EDI-C has satisfying psychometric properties, and normative data are now provided. The vast majority of preadolescent and adolescent boys and girls (n=4725) are not preoccupied with weight concerns, but 1–3% of the boys and 9–20% of the girls here indicate feelings of anxiety and problematic attitudes. An increase of self-reported ED symptoms occurs during female preadolescence and early adolescence. </p><p>Responses to three open-ended questions—addressing perceived and personal gender ideals of adolescent boys (n=347) and girls with (n=204) and without (n=417) an ED—indicate that girls are, compared to boys, more involved in images of ideals. The perceived ideal man and ideal woman differ in body size and strength. This corresponds with different health risk behaviours reported in boys (body building) and girls (dieting). Awareness of media ideals and an ability to discriminate them from individual values was common in the normal groups and in girls who had recovered from an ED. A poor outcome was associated with thinness stated as ideals of the media, without mentioning good looks. Factors that could predict outcome at the 3-year follow-up of an ED in adolescent girls were: good looks (media ideal), maturity fears, profession (individual ideal), sexual debut, and vomiting.</p><p>The addition of a gender perspective would add a dimension to programmes aiming at preventing and treating ED in adolescence.</p>

Adolescence means an increased risk for eating disorders (ED) and the female gender is the most important risk factor. Empirical studies of the perceptions of gender ideals—as potential mediating factors between the socio-cultural context and ED—were this thesis’ primary goals. Further aims implied evaluating the psychometric properties of the Eating Disorders Inventory for Children (EDI-C) and providing normative data for boys and girls concerning self-assessed ED symptoms and related psychological traits. The EDI-C has satisfying psychometric properties, and normative data are now provided. The vast majority of preadolescent and adolescent boys and girls (n=4725) are not preoccupied with weight concerns, but 1–3% of the boys and 9–20% of the girls here indicate feelings of anxiety and problematic attitudes. An increase of self-reported ED symptoms occurs during female preadolescence and early adolescence. Responses to three open-ended questions—addressing perceived and personal gender ideals of adolescent boys (n=347) and girls with (n=204) and without (n=417) an ED—indicate that girls are, compared to boys, more involved in images of ideals. The perceived ideal man and ideal woman differ in body size and strength. This corresponds with different health risk behaviours reported in boys (body building) and girls (dieting). Awareness of media ideals and an ability to discriminate them from individual values was common in the normal groups and in girls who had recovered from an ED. A poor outcome was associated with thinness stated as ideals of the media, without mentioning good looks. Factors that could predict outcome at the 3-year follow-up of an ED in adolescent girls were: good looks (media ideal), maturity fears, profession (individual ideal), sexual debut, and vomiting. The addition of a gender perspective would add a dimension to programmes aiming at preventing and treating ED in adolescence.

This thesis investigated (1) social status and shaming experiences in relation to aggressive behaviour and depression, and (2) gene-environment interactions between two genetic polymorphisms related to the serotonergic system – MAOA-VNTR and 5HTTLPR – and experiences of maltreatment in relation to delinquent behaviour and depression among adolescents. The four included studies are based on questionnaire data from the Survey of Adolescent Life in Vestmanland 2006 (SALVe-2006). A total of 5396 students in 9th (15-16 years old) grade of elementary school and 2nd (17-18 years old) grade of high school comprised the target population. The students in 2nd grade of high school also provided a saliva sample for gene extraction. There were strong associations between shaming experiences and both aggressive behaviour and depression. In addition, individuals who reported many shaming experiences and had either low or high social status had increased risks of physical aggression or depression, whereas medium social status seemed to have a protective effect. Gene-environment interactions were found between experiences of maltreatment and the MAOA-VNTR in relation to delinquent behaviour. Moreover, the direction of the gene-environment interaction differed depending on sex: boys with the short (S) variant of the MAOA-VNTR, in contrast to girls with the long (LL) variant, had the highest risk of delinquency in combination with maltreatment. Gene-environment interactions were also found between experiences of maltreatment and the 5HTTLPR in relation to depression among girls. The girls that were homozygous for the S allele (SS) had the highest risk of depression in combination with maltreatment. Among boys however, no gene-environment interaction was found between the 5HTTLPR and maltreatment in relation to depression. In conclusion, it is important to consider both genetic effects, and psychosocial factors such as social status, shaming experiences, and experiences of maltreatment when investigating different aspects of health and behaviour among adolescents.

Background: In a rapidly changing and increasingly interconnected world, the issue of mental health and well-being among adolescents is one of the important research topics. However, there have been few studies amongst Japanese adolescents that have been published in international journals. Objectives: (I) to make a comparison in selfconcept between healthy adolescents in Japan and Sweden, (II) to address the influence of perceived parental rearing on self-concept and mental health problems among Japanese adolescents, (III) to investigate contributions of attachment and self-concept to mental health problems reported by Japanese adolescents, (IV) to address a comparison of mental health problems and self reported competence in adolescents from Greece, Japan, Russia, and Sweden. Methods: The following self-report instruments were used: Self- Description Questionnaire II (Marsh, 1992), Actual-Ideal Questionnaire (Nishikawa, 2003), Self-Description Questionnaire IIShort (Marsh, Ellis, Parada, Richards, &amp; Heubeck, 2005), Youth Self- Report (Achenbach, 1991), Attachment Questionnaire- for Children (Sharpe et al., 1998), and Egna Minnen Beträffande Uppfostran (my memories of child upbringing) for Children (Muris, Meesters, &amp; van Brakel, 2003). The participants for Paper I were adolescents aged 14 and 15 from Japan (n=144) and Sweden (n=96). One hundred ninety three Japanese students between the ages of 15-19 participated in Paper II and 228 students for Paper III. The participants for Paper IV were 812 healthy adolescents between 15 and 17 years of age from Greece (n=152), Japan (n=219), Russia (n=159), and Sweden (n=282).  Results: Paper I showed that Japanese students reported less positive self-concept compared to the Swedish counterparts. The results were discussed in terms of different response style and modesty in Japanese culture. Paper II showed that dysfunctional parental rearing and insecure peer attachment were associated with negative self-concept and more mental health problems. A unique influence on mental health problems from parent-adolescent relationships depending on the gender of parents and adolescents was also found. Paper III showed a mediating role of self-concept in influencing the relationships between attachment style and Internalizing Problems. Paper IV indicated rather small differences across countries in the syndrome scales. Japanese and Swedish adolescents tended to score lower than Russian and Greek counterparts. Some cultural specific syndromes were found. Conclusion: These results reported in this thesis present a general view of Japanese adolescents’ self-concept and the influence of interpersonal relationships in mental health problems assessed by Western self-report instruments. When being compared with other countries, cultural background and response style must be taken into account.

Anorexia Nervosa is a psychiatric illness with peak onset in ages 14-17. Most cases recover within a few years, but the illness can have a fatal outcome or long duration. Multifactor causes of anorexia nervosa include genetics, personality, family, and socio-cultural factors. This study measures mortality, recovery from anorexia nervosa, and psychosocial outcome of patients with adolescent onset anorexia nervosa that were treated in Child and Adolescent Psychiatry in northern Sweden from 1980 to 1985. In addition, this study assesses the predictive value of background variables and studies perfectionism in relation to recovery. Finally, this study looks at how patients understand the causes of their anorexia nervosa and how they view their recovery process. Follow ups were made 8 and 16 years after initial assessment at CAP. Quantitative and qualitative methods were used. These included a semistructured interview, DSM diagnostics of eating disorders (including GAF), and the self-assessment questionnaires EDI and SCL-90. The interview also contained questions about causes and recovery. Recovery increased from 68% to 85% from first to second follow-up and the mortality rate was 1%. Somatic problems and paediatric inpatient care during the first treatment period could predict long-term outcome of eating disorders. Most former patients had a satisfying family and work situation. At both follow-ups, individuals with long-term recovery had a lower level of perfectionism than those that recovered later. On individual levels, eating disorder symptoms and psychiatric symptoms decreased during recovery, whereas the levels of perfectionism stayed the same. Causes were attributed to self, family, and socio-cultural stressors outside of the family. The most common self-reported causes were high own demands and perfectionism. All recovered subjects could remember and describe a special turning point when the recovery started and 62% saw themselves as an active agent in the recovery process. Supportive friends, treatment, activities, family of origin, boyfriend, husband, and children were also helpful in the recovery process. Compared to other outcome studies, the results were good. In spite of the good outcome, some individuals had a long duration of illness and were not yet fully recovered after 16 years of follow-up. Predictors of non-recovery were related to initial somatic problems. Levels of perfectionism were associated to recovery and patients with initial high levels of perfectionism may need more complex treatment strategies. Results from the study also implied that one should stimulate the patients’ social contacts and their sense of self-efficacy in their recovery- process.

Syftet med denna studie är att utifrån ett föräldraperspektiv undersöka behov av och önskemål om stödsom föräldrar med diagnos inom autismspektrum beskriver i sin föräldraroll. Ett annat syfte är att bidra med ökad kunskaptill en diskussion kring utformandet av stödinsatser för dessa familjer. Studien är kvalitativ med intervjuer som gjorts ihalvstrukturerad form. Åtta föräldrar har intervjuats. Föräldrarna beskriver att deras svårigheter gör det svårt för dem isamspelet med barn och partner. De försöker själva och tillsammans med partnern finna lösningar i samspelet. Till hjälp attfinna lösningar har varit insikt om de egna svårigheterna, stöd riktat till AST-problematiken och att få hjälp i parrelationen.Avlastning framför allt genom utökad tid i förskola beskrivs som väsentlig. Önskemål framförs om att stödet ges med enhelhetssyn på familjen, att stödet anpassas och möjlighet att få samtala med föräldrar med liknande problematik. Studienvisar att föräldrarna efterfrågar stöd i sitt föräldraskap och att ytterligare studier behövs för att kunna möta dessa föräldrarsoch deras barns och partners behov. / The purpose of this study is to examine the needs and wishes of support in the parental role described by parents with diagnosis within the autism spectrum from a parental perspective. Another purpose is to contribute to increased knowledge to a discussion of the design of support for these families. The study is qualitative with interviews carried out in a semistructured format. Eight parents were interviewed. The parents describe their own difficulties, the difficulties in the interaction with the children and with their partner. They try to find solutions in the interaction both by themselves and with their partner. Helpful for finding solutions has been insight into their own difficulties, aid directed at problems related to their diagnosis and to get help in relationship. Relief, particularly through extended time in preschool described as essential. Wishes were expressed that the support is given with a holistic view of the family, that the support is adapted to the parental diagnosis and that opportunity to talk with parents with similar problems is provided. The study shows that the parents desire support in their parenting, and that further studies are needed to meet these needs of these parents, their children andtheir partner.

Diss. (sammanfattning) Umeå : Umeå universitet, 2010. / Härtill 4 uppsatser.

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2007. / Härtill 5 uppsatser.

Diss. (sammanfattning) Linköping : Linköpings universitet, 2005. / Härtill 5 uppsatser.

Diss. (sammanfattning) Stockholm : Karol. inst., 2005. / Härtill 4 uppsatser.