published_or_final_version / Nursing Studies / Master / Master of Nursing

Responding to strong indications in the research that anorexia and bulimia are reaching epidemic proportions in many Westernized nations, including the United States, Paul Garfinkel and David Garner have proposed a three-part model which implicates individual, familial, and sociocultural factors in the development of these multidetermined disorders. The present study uses Garfinkel and Garner's model to investigate factors related to the existence of an eating disorder in women between the ages of 18 and 38. Three groups of subjects were used in the study: an eating-disordered group (bulimics and anorexic bulimics; 18 women), a normal control group (26 women), and a second, depressed control group (24 women). The hypothesis that eating-disordered women were more impaired than normal controls, as measured by individual, familial, and socio-cultural factors, was largely supported, with the exception of the Bem Sex Role Inventory (socio-cultural measure), where little difference was found between groups. The hypothesis that depressed women would look healthier than women with an eating disorder but more dysfunctional than the normal controls was not supported; depressed women tended to look very much like bulimics and anorexic bulimics on the measures used in this study. Further exploration of socio-cultural factors by measures other than the Bem Sex Role Inventory, as well as further investigation of additional similarities--and differences--between depressed women and eating-disordered women would suggest more specific treatment strategies as well as possible prevention techniques for women afflicted by or at risk for an eating disorder.

Eating disorders can be viewed on a continuum, with disordered eating not reaching clinical diagnostic criteria but having potentially negative effects including increasing the risk of an eating disorder or obesity. This study investigated disordered eating in relation to emotional processing from an Acceptance and Commitment (ACT) perspective. Body image dissatisfaction is recognised as a risk factor in eating disorders and was therefore included in this study to investigate whether the ACT concept of inflexibility was associated with ‘less acceptance’ of body image and an increased eating disorder risk as well as general mood disturbance (i.e. depression and anxiety). A non-clinical sample of 96, 12-15 year old females at secondary schools in London was used. Eating disorder risk, inflexibility as well as depression and anxiety were measured. When comparing high, low and moderate eating disorder risk groups it was found that the low and moderate eating disorder risk groups had lower levels of inflexibility and the low eating disorder risk group had a higher body image acceptance than the moderate and the high risk groups as predicted. Inflexibility was also associated with higher rates of anxiety and depression and a negative association was found between depression and anxiety in relation to acceptance of body image. Thus providing supporting evidence for the transdiagnostic significance of ‘inflexibility’. Clinical implications of these findings in relation to prevention and treatment are discussed.

Objectives: To determine if emotion regulation mediates the link between emotional maltreatment and disordered eating behaviour in a community sample of adolescents. Design and method: Participants were 222 secondary school pupils (aged 14-18 years) from a state high school in a rural area in Scotland. Standardised questionnaire measures were used to gather data on history of emotional abuse and neglect using the Childhood Trauma Questionnaire (CTQ), emotion regulation strategies using the Regulation of Emotions Questionnaire (REQ) and subclinical disordered eating behaviour using the Eating Attitudes Test (EAT-26) and the Dutch Eating Behaviour Questionnaire (DEBQ). Pearson correlation and multiple mediation analyses were conducted to determine significant relationships and to identify whether dysfunctional emotion regulation was a mediator of the relationship between emotional maltreatment and disordered eating behaviour. Results: Multiple mediation analyses found both emotional abuse and emotional neglect to have a significant direct relationship with EAT-26 total score and DEBQ restraint scores - mediated by internal dysfunctional emotion regulation (with external dysfunctional emotion regulation also being a significant mediator in the analysis with emotional neglect and EAT-26 total). The direct relationship between emotional abuse/neglect and DEBQ emotional eating scores was non-significant, although a specific indirect effect through internal dysfunctional emotion regulation was observed. Conclusions: To the best of the author‟s knowledge, this is the first study which has looked at history of emotional maltreatment and disordered eating behaviour focussing on the influence of emotion regulation in particular. Results were indicative of significant indirect effects between emotional abuse and neglect and all measures of disordered eating through internal dysfunctional emotion regulation. Findings suggest the role of emotion regulation warrants further study in the research on childhood maltreatment and disordered eating behaviour.

Training in sport environments that emphasize leanness and muscularity may damage athletes' body image and negatively influence male athletes' eating behaviors and attitudes. The Questionnaire for Eating Disorder Diagnosis and the Bulimia Test – Revised were completed anonymously online by 732 male intercollegiate athletes. Most male collegiate athletes were classified as asymptomatic (82.9%), followed by symptomatic (16%) and eating disordered (1.1%). The most common forms pathogenic behaviors were excessive exercise (51.6%), binge eating (21.4%), and dieting or fasting (20.5%). Results suggested that athletes who participate in weight class sports are at higher risk for developing these behaviors than endurance sport or ball game athletes. Counseling and other implications for professionals working with athletes are discussed.

The purpose of this study was to examine sociocultural and psychological correlates of bulimic symptomatology and drive for thinness in a sample of nonclinical female adolescents.

Purpose of the Study: The purpose of this study was to test an investigator-developed culturally relevant eating disorder assessment tool, the Risk Assessment of Eating Disorders (RAED), for eventual clinical application in assessing eating disorders in Hispanic women. This study also examined clinical guidelines, developed by the investigator to guide providers in using culturally appropriate behaviors during the assessment process.Research Questions: 1. What do Hispanic women identify and endorse as relevant areas of assessment for detection of potential eating disorders? 2. What culturally competent questions and provider behaviors or interactions do Hispanic women endorse as enabling them to volunteer specific information about their eating disorders? Background: Although some knowledge exists regarding appropriate and effective assessment questions to detect eating disorders, clinicians lack a culturally relevant and brief tool for use in primary care. Literature on existing assessment instruments and the Theory of Cultural Marginality informed development of the tool and guidelines.Method: Five Hispanic females with diagnosed eating disorders completed the RAED tool and scored items for relevance and clarity. This was followed by interviews and discussions with participants concerning perceptions of provider behaviors that enable or inhibit women reporting specific disordered eating behaviors to providers. Results: The results supported relevance and clarity of a 14-item RAED for assessing eating disorders. Seven clinical guidelines were developed on culturally appropriate provider behaviors to help Hispanic women volunteer specific information on their eating disorder behaviors. Discussion: A shorter assessment was developed for eventual use in advance practice nursing. The participants also identified provider behaviors including empathy, a non-judgmental attitude, and being willing to sit down with the patients, as enabling them to speak up about their eating disorder. The Theory of Cultural Marginality was useful in developing the RAED items and Provider Guidelines for assessment. Continued research of the RAED and clinical guidelines was recommended to provide adequate empirical support for use of the assessment tools and theory by advance practice nurses in primary care of Hispanic women, as well as all women with eating disorders.

A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, in partial fulfillment of the requirements for the degree of Master of Medicine in the branch of Psychiatry Johannesburg, 2017 / Introduction. Eating disorders are an important group of mental illnesses in Psychiatry. The aetiology is multifactorial, developing from distorted beliefs around body image and shape, with resultant abnormal eating behaviours. This study explores the views and perceptions of a group of university students regarding their peers’ body image and shape and eating behaviours, which they experienced (at the time) during their senior high school years. The majority of these students attended high schools in Johannesburg. Method. This was an explorative, qualitative study using qualitative methods. A sample of 153 participants was voluntarily recruited from students in the Faculty of Health Sciences at the University of the Witwatersrand. A manually distributed anonymous questionnaire was used, with questions about their high school peers’ personality traits, early and late childhood experiences, eating behaviour, and the last three years of high school environment. Questions in each section were deconstructed and categorised into subthemes. Subthemes were further deconstructed into replicated ideas. These subthemes and ideas were presented in hierarchical tables. Findings in this study were compared with the literature. Results. The most commonly described subtheme of participants’ perceptions of high school peers’ personality traits was “poor self-confidence”. The most replicated subthemes of views on peers’ childhood experiences were “personal conflict with members of the family”, “a disruptive home environment” and “mother’s attitude”. In terms of peers’ eating behaviour, a subtheme on “body shapes” included “fat”, “skinny” and “fit” and “muscular” bodies. In terms of the high school environment, the subtheme of “bullying and peer discrimination” was regarded as important, while “the impact of media” was regarded as extremely important. Fifty percent of participants viewed body image to be important for social status. There were mixed views on whether specific programmes should be introduced to identify pupils at risk. Conclusion. Although bullying and peer pressure have been described as contributing factors in the development of eating behaviour problems in high school learners, as perceived by a group of university students, the most prominent potential contributing factor considered was the media, specifically social media. This finding could contribute to further research looking at the role of social media, not only its relationship in the potential development of a Psychiatric Illness, but possibly, too, its role in the educational and rehabilitation process. / MT2017

Thesis (Ph.D.)--Boston University / PLEASE NOTE: Boston University Libraries did not receive an Authorization To Manage form for this thesis or dissertation. It is therefore not openly accessible, though it may be available by request. If you are the author or principal advisor of this work and would like to request open access for it, please contact us at open-help@bu.edu. Thank you. / INTRODUCTION: Evidence supporting outpatient treatments for anorexia nervosa (AN) is severely lacking, due to low retention rates and poor outcome in treatment studies. One explanation for patient drop-out is weak treatment alliances, which are also associated with poor outcome. This study investigates a novel treatment for AN, Alliance Focused Treatment (AFT), which attends to ruptures in the alliance as well as interpersonal difficulties and emotional avoidance commonly associated with AN. Group analyses are presented along with one detailed case. METHOD: Seven women with AN-spectrum illnesses were randomized to receive both AFT and Behavioral Change Treatment (BCT) using a replicated single case A-B-C-B design. Participants began with a Baseline Phase (A) and then received the experimental treatment (AFT) and the comparison treatment (BCT) in alternating fashion. This design allowed each participant to provide comparison (control) data for each treatment. "Time" (session number) was used as a covariate in analyses. Each treatment phase was four weeks long, with twice-weekly sessions. Participants recorded daily kilocalorie intake and post-session treatment alliance. Generalized Estimating Equations were used to examine differences in kilocalorie intake and treatment alliance between phases and within participants. Graphs of slopes of kilocalorie and alliance change for each participant, in each phase, facilitated observation of treatment effects. RESULTS: Six participants completed treatment. Significant overall increases in kilocalorie intake were observed only in BCT relative to a baseline period when controlling for time, however, both AFT and BCT showed interactions with time indicating kilocalorie intake increased in both conditions. No significant differences between active treatments in kilocalorie intake were observed. Participants rated global working alliance significantly higher in BCT, while they rated the task dimension of alliance significantly higher in AFT. Global patient-rated treatment alliance was significantly associated with kilocalorie intake, and the relationship between global alliance and kilocalorie intake became stronger over time. Participants rated ruptures in 39% of sessions and frequently reported discussion of the rupture as a component of its resolution. DISCUSSION: This study provides preliminary support for the feasibility and effect of AFT and BCT, and highlights the importance of the alliance in treating adults with AN. / 2031-01-02

Background: Eating disorder (ED) researchers continue to explore the effectiveness of e-therapy in improving symptoms and its treatment acceptability, however issues relating to poor uptake, adherence and dropout pose a challenge. Within this portfolio, the systematic review aimed to explore adherence to e-therapy for the treatment of ED, specifically exploring rates and predictors of uptake, completion, and dropout from randomised controlled trials (RCT) of ED e-therapy. The empirical project aimed to explore in-depth symptom change for ED cases engaged in blended internet-based cognitive behavioural therapy (ICBT) and face-to-face ED input. Acceptability of blended input was also explored. Methods: For the systematic review, literature searches were undertaken in March and September 2017 across EMBASE, PsycINFO, MEDLINE, Ovid and Cochrane Central Register of Controlled Trials (CENTRAL) and ProQuest databases. Key papers were assessed against five quality criteria (random assignment to groups, blinding to treatment allocation, quality of content, level of contact, sample size with sufficient power). Using a retrospective case series design, the empirical project explored changes over time of ED, anxiety, depression, quality of life (QoL), motivation for change, overall psychological functioning and clinician-rated/patient-rated improvement. Standardised health assessment measures captured symptoms over multiple time-points, and data was analysed using t-tests, multi-level modelling (MLM) and visual analysis. Acceptability of treatment was tentatively explored using an open feedback questionnaire. Results: Systematic review results identified intervention (content, acceptability, delivery method/location), participant (nature of symptoms, BMI, education, prior therapy, personality, views on e-therapy) and therapist-related factors (therapeutic support) were indicated in predicting uptake, completion and dropout across ED e-therapy. In the empirical project, study findings were inconclusive regarding symptom change attributable to blended input. Model fit improved when severity of ED symptoms predicted overall psychological functioning and patient-rated improvement over time, however findings were non-significant - potentially due to the study being underpowered. Conclusions: Promising evidence exists for ED e-therapy as an acceptable treatment option, however understanding which content nurtures engagement best is needed. Further research is needed into the factors predicting ED blended treatment outcome.