Thesis (Ph. D.)--Drexel University, 2006. / Includes abstract and vita. Includes bibliographical references (leaves 99-114).

Thesis (Ph. D.)--University of Notre Dame, 2009. / Thesis directed by David A. Smith for the Department of Psychology. "July 2009." Includes bibliographical references (leaves 75-81).

Thesis (M.S.)--University of Oregon, 2005. / Includes bibliographical references (leaves 14-15). Also available online (PDF file) by a subscription to the set or by purchasing the individual file.

Thesis (M.S.)--University of Oregon, 2005. / Includes bibliographical references (leaves 14-15).

Thesis (honors)--Georgia State University, 2006. / Title from title screen. Lisa Lilenfeld, advisor. Electronic text (45 p. : col. ill.) : digital, PDF file. Description based on contents viewed June 6, 2007 . Includes bibliographical references (p. 31-35).

Thesis (D.C.P./Ph. D.)--University of Sydney, 2008. / Title from title screen (viewed February 4, 2009). Includes graphs, tables and questionnaries. Includes list of publications co-authored with others: leaves 21-22. Submitted in fulfilment of the requirements for the degree of Doctor of Clinical Psychology / Doctor of Philosophy to the Department of Psychology, Faculty of Science. Includes bibliographical references. Also available in print form.

A theoretical model of eating disorders called the shame and pride model has suggested that pride is a key psychological mechanism underpinning restrictive eating disorders and that it is also important in the maintenance of such conditions. Despite being included in this model, pride has been little investigated in the eating disorders field, especially when compared to shame, which has received extensive theoretical and empirical attention. Therefore, the overall aim of this PhD thesis was to investigate the role of pride related to eating disorders and its relation to motivation to change in clinical and non-clinical samples. Firstly, a systematic mixed studies review was conducted to examine the empirical evidence concerning pride and eating disorders. This review showed that this is an under-researched area (only 10 studies were identified). However, it provided initial evidence highlighting that low levels of pride in physical appearance precipitated the onset of eating disorder behaviours, such as food restriction, binge eating, and purging. It also suggested that over time, high levels of pride experienced through the ability to control food/calorie intake and weight loss, appeared to maintain eating disorders. Secondly, three empirical studies were conducted; a qualitative study, followed by two quantitative studies. The grounded theory qualitative study aimed to understand the meaning of pride in eating disorders from the perspective of women with anorexia nervosa. The second study aimed to develop and validate a measure to assess the component structure of pride in eating pathology. The third study investigated, over a period of 12 months: i. whether pride in eating pathology acted as a mediator between anorexia nervosa symptoms and the precontemplation stage of change (i.e. no motivation to change), and ii. whether pride in healthy weight and healthy eating interacted with anorexia nervosa symptoms to predict the action stage of change (i.e. actively engaging to change eating disorder behaviours). Both qualitative and exploratory component analysis indicated that pride in eating pathology is a multidimensional self-conscious emotion that is comprised of unhealthy and healthy aspects. In addition, findings from the qualitative study and the longitudinal mediational study demonstrated that pride in eating pathology evolves over time and predicted people’s unwillingness to change eating disorder behaviours after a year. Finally, results from the longitudinal moderational analysis revealed that pride in healthy weight and healthy eating did not act as a moderator between anorexia symptoms and being in the action stage to change eating disorder behaviours at 12 months. However, the qualitative study revealed that pride related to healthy eating behaviours promotes recovery in a clinical sample. Results from this PhD thesis provide empirical evidence to further develop the shame and pride model postulated by Goss and Gilbert (2002) and highlight the role of pride as a precipitating and maintaining factor of eating disorder behaviours. In addition, it was found that pride in eating disorders influences motivation to change. Clinical implications of the findings from these empirical studies are discussed throughout the PhD thesis, along with directions for future research.

AN ABSTRACT OF THE THESIS OF MICHELLE OSTIEN, for the Master of Science degree in FOOD AND NUTRITION, presented on November 20, 2008, at Southern Illinois University Carbondale. TITLE: SIMILARITIES AND DIFFERENCES IN FEMALES WITH REGARDS TO PERFECTIONISM IN THOSE WITH ANOREXIA NERVOSA, HIGH BMI (BINGE EATERS VS. NON-BINGE EATERS), AND THOSE SEEKING A HEALTHIER LIFESTYLE MAJOR PROFESSOR: Dr. Sharon Peterson One in five women in the United States struggle with an eating disorder or distorted eating patterns (National Institute of Mental Health, 2001). Perfectionism, one of the risk factors for developing an eating disorder, is a trait that many of these women have in common. While much research has been done on perfectionism in women with anorexia nervosa and bulimia nervosa, few studies have looked at perfectionism in women with binge eating disorder (Pratt, Telch, Labouvie, Wilson, & Agras, 2001). Our study sought to further understand the similarities and differences of the total and individual components of perfectionism in females seeking a healthier lifestyle, high BMI binge eaters, high BMI non-binge eaters, and anorexics. Our study found that the first component of the perfectionism scale (representing self-oriented perfectionism) was found to be significant between groups (p=0.002). When comparing females seeking a healthier lifestyle to high BMI binge eaters, females seeking a healthier lifestyle were more likely to answer "no", while high BMI binge eaters were more likely to answer "yes" (p=0.006). When comparing females seeking a healthier lifestyle to anorexics, females seeking a healthier lifestyle were more likely to answer "no" when compared to anorexics (p=0.033). When comparing high BMI binge eaters to high BMI non-binge eaters, high BMI binge eaters were also more likely to answer "yes" to this question when compared to high BMI non-binge eaters (p=0.048). Compared to 76.9% (N=10) of female anorexics, 74.4% (N=32) of female high BMI binge eaters, 50.0% (N=32) of female high BMI non-binge eaters, and 31.2 % (N=5) of females seeking a healthier lifestyle answered "yes" to perfectionism component one, which represented self-oriented perfectionism. Anorexics had the greatest tendency for perfectionism, followed by binge eaters, and then non-binge eaters. This study demonstrated that self-oriented perfectionism is the greatest indicator of perfectionism between subject groups and that perfectionism does exist in binge eaters.

Study one explored the service user experience of treatment for anorexia nervosa in the Welsh healthcare service. Factors such as treatment expectations, satisfaction, therapeutic alliance, motivation to change and engaging in treatment were considered by conducting indepth interviews with participants who had a diagnosis of anorexia nervosa and were receiving secondary care. Qualitative data were analysed using thematic framework analysis revealing six main concepts: service user description of anorexia; expectations of treatment for anorexia; the journey through the health service for anorexia; therapeutic alliance during treatment for anorexia; satisfaction with the health service; and service user recommendations to improve the health service. Mapping and interpretation of the concepts drawn from the interviews resulted in a model exploring the relationship between expectations and satisfaction of treatment for patients with anorexia nervosa, and the effect upon motivation to engage in treatment and recover. Another model describing factors that affect therapeutic alliance was developed. The results are described with particular reference to the Self-Determination Theory (Ryan & Deci, 2000). Study two used a four-stage, mixed-methods approach to develop and evaluate an anorexia nervosa awareness campaign for healthcare professionals. The campaign was developed using an integrative social marketing approach (NSMC: 2013): including formative research, process evaluation and outcome evaluation. Formative research included audience research (interviews and focus groups with healthcare professionals and healthcare professionals in training) in combination with theories of social cognition and persuasion to develop four posters. Process evaluation included campaign evaluation by healthcare professionals using questionnaires (open and closed ended questions). Appropriate modifications to the posters were made following the process evaluation, and two posters were chosen as the final intervention. Outcome evaluation of the campaign was conducted by using a brief, four-item evaluation questionnaire completed by healthcare professionals (General Practitioners and nurses). Results from all phases indicated that the use of posters as the medium of the anorexia Study three included development of a comprehensive audio-visual intervention to increase nursing students’ self-effcacy regarding initial management of patients with anorexia nervosa. The intervention was developed and underpinned using the Transtheoretical Model Framework (Levesque et al., 2001), and then evaluated using a pre-post-test design. The intervention was successful in significantly increasing nursing students’ self-efficacy regarding the initial management of anorexia nervosa. Furthermore, the nursing students’ self-efficacy was high prior to the intervention, indicating that nursing students already feel confident to manage patients with the disorder. The methodological and theoretical implications are discussed. nervosa awareness campaign did not sufficiently raise awareness of anorexia nervosa, and therefore the limitations of the second study were considered.

Ballet dancing is a rigorous activity, the requisite skill acquisition for which begins at an early age. For girls, the activity requires a clearly defined body shape and composition, the attainment of which may result in low body weight and BNH, the development of eating disorders, menstrual dysfunction, and poor nutrient intake. The combination of the high levels of exercise for both sexes and the sylph-like figure required by females may have an effect upon growth and development, injury and repair, and long-term health. No evidence could be found in the literature of investigations on retired ballet dancers and the potential effects of their career upon their long-term health. Therefore, a retrospective study was carried out on sixty-three male and female dancers by means of a 'health' questionnaire. Although the results from the retrospective study showed that no serious health effects had occurred in the sample investigated, there was nevertheless a high incidence of injury amongst both sexes. During their career, the retired females were found to have had: low body weights, with many of them having been on slimming diets; a lack of knowledge concerning food and fluid intake; and poor menstrual status, including delays in menarche. It was concluded that many of the injuries sustained by the males could be attributed to their role of partnering and therefore constantly physically supporting and lifting the female dancers. No definitive work could be found on nutrient intakes of ballet dancers and no prospective studies appeared to have been carried out on the overall injury status of currently active female ballet dancers. None of the studies had concurrently assessed nutrient intake and injury status and factors which may affect this, as well as assessing their general wellbeing. Thus, thirty-eight pre-professional female ballet dancers were recruited to the prospective study. All types of injury from minor to major were recorded over a period of ten weeks, concurrent with life events and menstrual patterns. During this period, nutrient intake was also estimated over seven consecutive days using the weighed inventory method. The dancers completed a general background questionnaire; EAT-26 and BIT'E - two screening questionnaires clinically used to assess for the symptoms of anorexia and bulimia nervosa; and, a nutritional quiz compiled by the author and largely based on what the students had been taught. The dancers had significantly lower dietary intakes of energy, carbohydrate, fat, iron, and NSP than their relative DRV's. Low intakes of energy and particularly carbohydrate could reduce muscle glycogen concentrations, and thus promote fatigue. The dancers had busy schedulesw hich restrictedt heir ability to eat well and the majority of them had poor nutritional knowledge. The injury rates of the majority of the dancers were found to be high and a statistically significant correlation was found between these injury rates and fatigue. These findings suggest that the dancers needed to receive a more fruitful method of nutrition education and have less hectic schedules, a combination of which could well result in the dancers having greater opportunity to eat well and rest sufficiently to reduce their overall levels of fatigue, enhance their overall feeling of wellbeing, and thus, possibly, reduce the risk of injury.