Introduction: Studies investigating prevalence and comorbidity of eating disorders (ED) and disordered eating in large general population samples are limited. This thesis adds to the existing literature by employing general population studies to investigate prevalence and comorbidity of disordered eating and ED in adults and adolescents. Secondary aims were to explore occurrence of ED in relation to ethnicity and patterns of service use. Methods: The studies included in this thesis employed three general population samples of adults (UK) and adolescents (UK and Finland) to cross-sectionally investigate the prevalence of ED and disordered eating, and their comorbidity with several psychiatric conditions. Results: Disordered eating was highly prevalent amongst adults, especially amongst those from an ethnic minority background, and in overweight to obese individuals. Prevalence of ED was in line with previous studies although we found a high prevalence of binge eating disorder and purging disorder amongst older and younger participants, respectively. Use of purging practices was highly prevalent amongst adolescent girls, and was associated with high levels of psychiatric comorbidity. Amongst adults, those diagnosed with purging disorder had the greatest psychiatric comorbidity. Conclusions: High prevalence of disordered eating in the general population, in specific ethnic groups, and in obese individuals, suggests the presence of socio-cultural risk factors for ED. Heightened risk-taking attitudes proper of adolescence could also act as specific risk factors for onset of purging behaviours and other comorbid conditions, such as substance use. Risk trajectories for binge eating disorder in older individuals require further exploration. Results from this thesis highlight the need for comprehensive approaches to treatment and prevention of ED in clinical practice. In the future more longitudinal research in the general population is also encouraged in order to explore the interaction between biological and societal risk factors for the onset of ED and disordered eating.

This thesis examines how adult ADHD alters the processing of information in three task unrelated domains; distractor interference, incidental information processing and time perception, and how this is affected by the level of perceptual load in the attended task. An enhanced susceptibility to irrelevant distraction is a core clinical characteristic of ADHD. Despite this, previously established laboratory measures of distraction have failed to consistently report evidence for excessive distractibility in ADHD. Therefore, this thesis starts by investigating whether a recently developed measure of distraction (Forster & Lavie, 2008), which uses entirely task irrelevant distractors, is sensitive to the type of distraction experienced by patients with ADHD (Chapter 2). A wealth of empirical evidence has shown that high perceptual load reduces task irrelevant distraction in the neurotypical population (see Lavie, 2010). Importantly, this thesis examines whether high perceptual load could also reduce task irrelevant distraction (Chapter 2) and task irrelevant incidental information processing (Chapter 3) in this high distractible clinical group. Another form of task unrelated information processing is the perception of time. Previous research suggests that there is a time perception deficit in children with ADHD. However, it is unclear whether such a deficit is retained in adulthood, and whether time perception will be differentially affected by attention in those with ADHD (vs. controls). Therefore, I first established the effect of perceptual load on time perception (Chapter 4) and then compared the effects between adults with a clinical diagnosis of ADHD and age and IQ equated controls (Chapter 5). The attention tasks used were either visual search or rapid streams presented at fixation. Perceptual load was varied by either changing the similarity of the non-target visual search items, or by requesting participants to search for either a feature target (low load) or a conjunction target (high load). In chapters 2-3 an irrelevant distractor image was presented and either interference effects (Chapter 2) or its priming and recognition effects (Chapter 3) were assessed. In chapters 4-5 participants were asked to perform a visual task while also attempting to monitor the passage of time. The results establish that the novel method of distraction developed by Forster and Lavie (2008) is sensitive to the heightened distraction reported in ADHD patients (Chapter 2). Most importantly, it was found that high perceptual load was equally as effective at reducing task irrelevant distraction in adults with ADHD as it was for controls (Chapter 2), and that this effect generalises to incidental task irrelevant information (Chapter 3). In relation to the third task unrelated information processing domain assessed in this thesis, it was established that high perceptual load reduces the perceived length of time intervals (Chapter 4), and that no deficit in time perception or differential effect of load on timing was found for the adult ADHD group (vs. controls) (Chapter 5). The findings from this thesis demonstrate the importance of considering perceptual load and distractor type in studies of task unrelated distraction, incidental information processing and time perception, in those with and without ADHD.

The pathways through which traumatic events are encoded into memory and subsequently retrieved affect the development of posttraumatic symptoms such as intrusion, as well as recovery from posttraumatic stress disorder (PTSD). This thesis examined how cardiovascular and hormonal processes are related to memory processing. Individual differences in traumatic history, as well as two cardiovascular stress response features, startle heart rate (sHR) and cardiac defence response (CDR), were investigated in this context as predictors and moderators. Relevant literature and the methods are reviewed in Chapter One and Chapter Two respectively. Chapter Three and Four adopted the trauma film paradigm to assess the memory encoding phase of trauma. The former found a dominant vagal activation during the analogue trauma, and identified a subgroup, in whom relationships between the psychological and physiological measures were different from the rest of the sample. The latter found increases in cortisol, and decreases in salivary alpha-amylase (sAA) levels, in response to the trauma film. Lower cortisol levels predicted greater vividness of intrusions. Individual differences in CDR and sAA levels moderated the relationship between cortisol and the frequency of intrusions. Chapters Five and Six examined PTSD patients’ psychological and physiological reactions to voluntary retrieval of traumatic memories. Significant relationships between HR decreases and overall negative psychological states were found in the former. Associations between greater dissociation and a smaller suppression of cortisol were found in the latter. An overall discussion regarding the psychological and physiological activities at the memory encoding and retrieval phases, as well as the roles of trauma history, sHR and CDR in moderating these responses, are presented in Chapter Seven.

Aims: The aim of this study was to develop and validate a short version of the Eating Disorder Examination Questionnaire (EDE-Q) for sessional outcome assessment, which is sensitive to clinical change. Method: A principal component analysis was conducted to determine the factor structure of 489 EDE-Qs completed by individuals with a range of eating disorders. Rasch analysis was carried out on each identified factor. The statistical information and expert ratings (N=10) informed the inclusion/exclusion criteria for each EDE-Q item. The EDE-Q's response scale properties were also investigated using the Rasch model. Data from people with (N=54) and without eating disorders (N=503) were collected through an online survey to assess the reliability, validity and sensitivity of the new measure. Results: A 12-item short version, the Eating Disorder Examination Questionnaire Short (EDE-QS) was developed. Initial psychometric evaluation showed that the EDE-QS is a reliable, valid and sensitive questionnaire. Conclusions: The EDE-QS appears suitable for the use as a brief and user-friendly sessional outcome measure.

High-functioning adults with autism spectrum disorder (ASD) frequently report difficulties with speech perception in background noise, which cannot be explained simply by an impairment in peripheral hearing or structural language ability. In spite of the apparent prevalence of this problem, however, only a handful of studies so far have evaluated speech reception thresholds (SRTs) in this group under controlled conditions, and then only with a limited range of (mainly non-speech) masking sounds. Results have indicated relatively minor deficits in some types of background noise, but not in others: at most, ASD listeners have required the signal-to-noise ratio to be around 3 dB more favourable than matched controls to report speech with 50% accuracy. This thesis describes a series of sentence in noise tasks, in which SRTs were measured for a far wider range of speech and non-speech masking sounds than before. Two groups of normally-hearing young adult participants completed the experiments: one group who had received a clinical diagnosis of Asperger's syndrome, and the other a group of neurotypical controls matched for age, verbal IQ and non-verbal IQ. The key results were that a substantial proportion of the ASD group ('ASD+') performed consistently within the normal range across the majority of target sentence types and masking conditions, whereas around half ('ASD-') tended to perform significantly poorly. When these two subgroups' results were analysed separately, it became clear that the ASD- listeners showed much greater deficits in SRT with speech maskers than with non-speech. Moreover, they were particularly affected by masking speech with similar perceptual and linguistic features to the target material, showing deficits of up to 15 dB in these conditions. This pattern of performance is strongly suggestive of an impairment in auditory stream segregation and/or selective attention to speech in a subset of high-functioning adults with ASD.

Modern accounts of “self-harm” commonly attribute self-inflicted wounds with emotional or other psychological “meaning”, while assuming that these acts are a product of twentieth-century concerns. While self-harm is certainly a modern concept, the attribution of meaning to self-inflicted injury – above and beyond the physical existence of the wounds themselves – is not new. This thesis explores the way in which medical writers in the later nineteenth century understood and explained what they called “self-mutilation”, situating this debate within the history of asylum psychiatry (where most discussion occurred). Self-mutilation as a concept, it is argued, could only exist within the context of a prior understanding of “the self” as a specific physical and psychological entity, and physiological, anthropological and psychological approaches to selfhood are closely associated with medical attention to self-injury. While it might have been expected that writing on self-mutilation emerged from the bureaucratic nature of the contemporary asylum system, and psychiatric concern with the expansion of diagnostic nosologies, this was not necessarily the case. In fact, most of the alienists writing on this topic did not embrace “medical materialism” and hereditary models of illness wholeheartedly, but drew on a wide variety of fields – including anthropology, normal psychology, spiritualism and religious and literary allegory – in their efforts to understand self-injurious acts. This approach encouraged the idea that self-mutilation described more than just a physical wound, but was an act which could be analysed to uncover underlying mental or emotional meaning. In the writings and practices of these psychiatrists and, indeed, in cases of so-called “insane self-mutilation” reported more widely, I show that ideas and attitudes towards self-mutilation in this period can also inform the historian about ideas of the human condition, normal versus abnormal behaviour, and the very idea of selfhood.

This thesis focuses on the question 'what is bulimia?' A purposive sample of thirteen mature bulimic women were accessed via local newspapers. Multiple, in depth, nondirective interviews were carried out following a narrative story-telling approach. The women all told stories of how their bulimia started with a set of behaviours that provided a logical solution to a problem; the need to maintain control over body weight and shape in keeping with perceived norms of society. Following this they soon came to experience a sense of shame generated by a social gaze that views over-eating as indicative of a lack of personal control, and purging as disgusting. Their response was to maintain secrecy and attempt to find out more about bulimia. A social constructionist approach gave insights into the complex meaning-making processes that the women engage with. Popular material found in the public domain, constructed by health 'experts', functions to make up the dominant discourses of bulimia. Poststructuralist analyses focused on the relations of power and knowledge which allow certain powerful groups access to promote versions of 'bulimia' as truths. Foucault's poststructural approach goes beyond social constructionism by suggesting that discourse constitutes the individual and actually produces the 'bulimic'. Poststructural feminist perspectives, along with Foucault's concept of disciplinary power, provides understandings into how the female body as 'slim and beautiful' is used as a means by which women are regulated within Western societies. The dominant conceptualisation of bulimia as a condition that adolescent women predominantly suffer functioned to increase the shame that mature women experienced. Consequently, the analysis located narratives of resistance which involved rejections of dominant discourses. These resistant narratives challenge the notion of irrationality and uncontrollability that constructs both 'bulimia' and 'woman/femininity'. This in tum functions to challenge the shame and secrecy that surrounds 'bulimia'. These unique insights suggest that any definition of 'bulimia' is dependent upon the angle at which the 'lens' is focused or upon which the 'gaze' is fixed. There is not one, but many definitions of 'bulimia' that contradict, compete with and constrain each other. 'Bulimia' has been shown to be a multiple, fluid, and ever-changing phenomenon.

Research has started to recognise premature birth and subsequent hospitalisation of the infant as a potentially traumatic experience for parents. There is also a growing interest within the trauma literature, of the potentially positive psychological changes that can occur following a traumatic experience, termed posttraumatic growth (PTG). The purpose of this cross-sectional, correlational study was to report rates of posttraumatic stress symptoms (PTSS) and PTG in parents of premature babies, 4-8 weeks after discharge from the Neonatal Unit (NNU) or Neonatal Intensive Care Unit (NICU). The study also aimed to explore the role of intrusive and deliberate rumination and social support in the development of PTG as described by the Tedeschi and Calhoun (2004) model of PTG. Thirty mother-father pairs and an additional twenty-three mothers were recruited from 2 NNUs and 2 NICUs in East Anglia, during 2 recruitment periods lasting 7 months and 3 months respectively. These parents completed 6 self-report questionnaires, 4-8 weeks post discharge from hospital. Parents completed validated measures of PTSS (IES-R), PTG (PTGI), intrusive and deliberate rumination (ERRI), social support (CSS) and depression (CES-D). Deliberate rumination was found to be a significant predictor of PTG development, more so than PTSS, intrusive rumination and social support. PTSS and PTG were positively correlated for mothers only (r = .381, p < .01). Of the whole sample, 10/53 (19%) of mothers and 1/30 (3%) of fathers met the screening criteria for PTSD. Twelve of 53 (23%) of mothers and 5/30 (17%) of fathers reported moderate levels of PTG. Mothers reported significantly higher levels of PTSS (p = .023), PTG (p = .018), deliberate rumination (p = .007) and intrusive rumination (p = .000) than fathers. This study demonstrated the existence of both PTSS and PTG in mothers and fathers of premature infants who have been hospitalised on a NICU. These data suggest that further study is indicated of the impact of PTG on future parental well-being following the stress associated with premature birth and hospitalisation. Deliberate rumination has been found to be a potentially significant factor in the development of PTG, therefore, future studies are needed to test this aspect of the PTG (Tedeschi & Calhoun, 2004) model further.

No description available.

This thesis is an historical study of anorexia nervosa in the German Democratic Republic. Its central premise is that any understanding of the existence of anorexia nervosa must be predicated upon an investigation of the material conditions, cultural discourses and social practices surrounding eating and the body, and the ways in which these conditions, discourses and practices constructed (gendered) subjectivities and behaviours. The thesis draws on archival material, questionnaires and oral history interviews addressing the topics of food, health and bodies, as well as personal experiences of self-starvation. The thesis tests and contests current socio-cultural approaches to anorexia nervosa which locate it within a specifically capitalist context of abundance, linking it not only to the economic imperatives of capitalist industries but also to societal gender structures. The GDR presents a very different socio-cultural context. Not only did it have a “shortage economy” with an absence of capitalist industries, but the economic position of women was different from that of their western counterparts, with over 90% of them in paid employment by the end of the 1980s. This study also provides new ways of understanding the GDR by teasing out the complex interactions between Nazi and pre-Nazi cultural legacies, new socialist ideas and values, and western cultural influences in the production of East German discourses and practices relating to eating and the body. By exploring the production of these discourses and practices, and the interactions between government propaganda, popular culture and the medical and scientific professions, the thesis provides an analysis of the inter-connectedness of body, self and society in the GDR, 1949-1990.