The aim of this study is to analyze how individuals experience their eating disorder, the focus being if anorexia may be perceived as a secure safe zone in the new modern world. The aim is to examine if individuals affected with anorexia nervosa understand the disorder as a solution to the modern worlds changes and the new individual freedom that it entails. This will be analyzed with the help of terms in Erich Fromms theories about escape mechanisms and Catarina Kinnvalls theories about the modern worlds ontological insecurity. The study is based on data collected from four informants of different ages and gender. The interviews were conducted through email and informants were chosen based on a strategic selection and snowball sampling. For the analysis of the empirical material Fromms escape mechanisms (authoritarianism, destructiveness and automaton conformity) and Kinnvalls theories of identity in the modern world have been used. The results of the analysis show that the eating disorder has a great significance for the individual construction and maintenance of identity and that the eating disorder becomes a safe zone to retreat to in a world of performance anxiety. To escape the anxiety that arises when individuals are faced with unmanageable choices he/she develops anorexia in an attempt to regain a sense of control and security.

Bakgrund: I Sverige lever cirka 100 000 personer med någon typ av ätstörning och den mest omtalade är Anorexia Nervosa. Sjukdomen är allvarlig, långvarig och drabbar främst unga kvinnor. Ett flertal olika faktorer orsakar och påverkar utvecklingen av sjukdomen. Anorexia Nervosa är svår att behandla optimalt och kan kräva både psykiatrisk och somatisk vård. Även omvårdnaden av denna patientgrupp är problematisk, då vårdpersonalen uttrycker en svårighet att förhålla sig professionellt till patientgruppen som visar ambivalens kring sitt tillfrisknande. Syfte: Att beskriva upplevelser av att leva med Anorexia Nervosa hos unga kvinnor under de sex första månaderna efter utskrivning från slutenvården. Metod: En kvalitativ innehållsanalys tillämpades på fem bloggar från bloggportalen och Google. Bloggarna var skrivna av 18 till 21-åriga kvinnor som vårdats inom slutenvården för Anorexia Nervosa. Upplevelser av att leva med sjukdomen eftersöktes i deras bloggar de första sex månaderna efter utskrivning. 407 meningsenheter identifierades och grupperades efter likheter och skillnader i tre kategorier. Resultat: Kategorierna som framkom i analysen var Kampen mot beteendet, Kampen om självbilden och Kampens villkor. De tre kategorierna redovisar olika upplevelser av att leva med sjukdomen efter utskrivning från slutenvården. Slutsats: Positiva upplevelser, som att lyckas eller att få stöd var hälsofrämjande och upplevelser av utsatthet eller att misslyckas ledde till att beteendet relaterat till AN förstärktes. Klinisk betydelse: Studien kan leda till en större förståelse för personer med Anorexia Nervosa, vilket leder till att sjuksköterskan kan ge ett bättre bemötande och bättre omvårdnad. / Background: Approximately 100 000 people in Sweden are living with an eating disorder and the most frequently mentioned is Anorexia Nervosa. The disorder is severe, time consuming and primarily affects young women. Several factors affect the development of the disease. Anorexia nervosa is complex to treat and requires both psychiatric and somatic care. The nursing of the patients is found problematic, as health care staff expresses difficulties in meeting the group of patients, who are showing ambivalence about recovery. Aim: Describing the experience of living with Anorexia Nervosa in young women the first six months after discharge from inpatient care. Method: A qualitative content analysis was applied on five blogs that were found on bloggportalen and Google. The blog were written by 18 to 21 year old women who been treated for Anorexia Nervosa in inpatient care. The experiences of living with the disease were examined the first six months after discharge, 407 meaning units were identified and sorted on similarities and differences to three main categories. Results: The categories were; The fight with the behavior, The fight with the self-image and The conditions of the fight. The three categories represented the experience of living with the disease after patient discharge. Conclusion: Positive experiences, such as succeeding in the treatment or feeling social support were health promoting. Negative experiences on the other hand, such as feeling vulnerable, reinforced the behavior related to AN. Clinical implication: The result may be used to increase the understanding of patients with Anorexia Nervosa, which could improve the nurse’s approach and nursing.

Anorexi nervosa är ett globalt problem men förekommer främst i Västvärlden. Det är en komplex sjukdom som orsakas av biologiska, psykologiska och sociokulturella faktorer som många gånger samverkar med varandra. Syftet med denna fenomenologiska studie är att få en större förståelse för hur friskförklarade kvinnor fann mening i sitt insjuknande och om det finns gemensamma nämnare i deras livshistorier. Särskilt fokus har lagts vid familjemönster och kommunikationen inom familjen. Vi har utgått ifrån symbolisk interaktionism som teoretiskt perspektiv. Studien är av kvalitativt slag där vi använde oss av semistrukturerade intervjuer som sedan tolkades utifrån en hermeneutisk fenomenologisk ansats. I vårt resultat kunde vi se att meningsskapandet kring sjukdomens olika stadier var centralt och tog sig i uttryck på olika sätt hos respondenterna. Tio teman kunde urskiljas och de viktigaste fynden var att sjukdomen på olika sätt var en aktiv handling och att den är ett uttryck för ett självhat och låg självkänsla. Vi kunde även se brist på känslouttryck inom familjen och att inte bli emotionellt erkänd av sina föräldrar var en viktig faktor. Det mest vitala resultatet var respondenternas egna uppfattningar om att anorexin var en symboliserande handling och att den handlar om så mycket mer än vikt och utseende. / Anorexia is a global issue but occurs mainly in the Western world. Anorexia nervosa is a complex disease caused by biological, psychological, and sociocultural factors which often interacts with each other. The purpose of this phenomenological study is to gain a greater understanding of how recovered women created meaning in their illness and if there are mutual factors in their life-stories. We have especially focused on family patterns and the communication within the family. We have based our study on symbolic interactionism as our theoretical perspective. The study is of a qualitative nature and we used semi structured interviews which later were interpreted from a hermeneutic phenomenological approach. In our result we could see that creating meaning was central throughout the disease and was expressed in different ways by our respondents. Ten themes appeared and the most vital findings were that anorexia was an active action and that it is an expression for self-hatred and low self-esteem. We could also see that lack of expression regarding emotions within the families and not being emotionally recognized by their parents were crucial factors. The most important result was the respondents own perception of anorexia as a symbolizing action and the content of the disease is about so much more than weight and looks.

Ätstörningar som anorexia nervosa (AN) och bulimia nervosa (BN) innebär ett folkhälsoproblem som kan orsaka oral ohälsa Studiens syfte: Syftet med denna litteraturstudie var att undersöka vilka orala problem som förekommer vid AN och BN. Material och metod: Studien genomfördes i form av en litteraturstudie. Material samlades in via sökningar i databasen Web of Science. Resultatet baserades på en sammanställning av sju vetenskapliga artiklar. Resultat: Resultatet visade att ett flertal studier har redovisat förekomst av orala förändringar vid diagnoserna AN och BN. Mest förekommande var dentala erosioner och hypertrofi av glandula parotis. Men även förekomst av karies, parodontal sjukdom samt orala slemhinneförändringar och infektioner framgick. Slutsats: Slutsatsen med denna studie visar att de mest förekommande orala problemen som uppstår vid AN och BN är dentala erosioner samt hypertrofi av salivkörtlarna, även orala slemhinneförändringar och infektioner förekommer. / Eating disorders such as anorexia nervosa (AN) and bulimia nervosa (BN) represents public health problem that may cause poor oral health. Objective: The aim of this study was to examine the side effects that arise in the oral health with AN and BN. Material and methods: The study was carried out as a literature review. The data was collected through searches in the database “Web of Science”. The final result was based on the findings of seven scientific articles. Results: The results showed that several studies have reported the occurrence of oral changes in the diagnoses of AN and BN. Dental erosions and hypertrophy of the parotid gland were the most common oral changes. The presence of caries, periodontal disease, oral mucosal lesions and infections also appeared. Conclusion: The conclusion of this study is that the most common oral problems associated with AN and BN are dental erosions, hypertrophy of the salivary glands, and oral mucosal lesions. Infections may also appear.

Bakgrund: Anorexia Nervosa (AN) är en allvarlig psykisk sjukdom som främst drabbar unga kvinnor. Till följd av extrem matvägran och ökat behov av motion svälter sig dessa individer och får allvarliga rubbningar i flertalet organsystem. Syfte: Metod: Studien baseras på en kvalitativ studie med en narrativ ansats, där fem stycken självbiografier har sammanställts enligt narrativitetsanalys av Dahlborg- Lyckhage (2012). Resultat: Resultatet formas utifrån tre kategorier, (1) Att inte hitta sig själv i sin sjukdom, (2) Känna maktlöshet när ångesten styr, (3) Ta paus från anorexin och våga vara sig själv. Diskussion: Tonåren är en tid då identiteten formas och steget ifrån att ha varit barn till att bli vuxen ökar, vilket kan ha en bidragande orsak till att AN utvecklas. Att ständigt leva med ångest och lidande gör att dem drabbade ständigt mår dåligt. Familjen är en viktig del av tillfriskningsfasen, med hjälp av en god omvårdnad ökar chansen till överlevnad. Konklusion: Genom att sjuksköterskan bekräftar patienten, ökar förtroendet mellan dem och patienten känner sig mer betydelsefull. På så sätt får sjuksköterskan kännedom om patientens låga självkänsla och självförtroende och kan bemöta patienten med öppenhet och respekt. / Background: Anorexia Nervosa (AN) is a seriously mental disease that mainly affects young women. The result of extreme starvation and increased need of exercise these women get seriously disorders in almost every organ system. Aim: To illustrate young women’s experience of living with Anorexia Nervosa. Method: The study is based on a qualitative study with a narrative approach. Five autobiographies have been complied through the narrative analysis of Dahlborg- Lyckhage (2012). Results: The result is based on three categories (1) Not finding yourself in your illness, (2) Feeling powerless when anxiety controls, (3) Taking a break from the anorexia and dare to be yourself. Discussion: The teenage years are a time when the identity is formed and the step from childhood towards adulthood becomes bigger, which can be one of the reasons why Anorexia Nervosa can evolve. Continuous living with anxiety and suffering makes these patients feel bad all the time. The family is an important part of the convalescence phase and with the help of good nursing, the chance of survival increases. Conclusion: Through the nurse acknowledging the patient, the trust between them increases and the patient can feel more important. By acquiring information about the patient’s low self- esteem and self confidence, the nurse is able to meet the patient with frankness and respect.

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2005. / Härtill 5 uppsatser.

Diss. Göteborg : Göteborgs universitet, 2005.

<p>Anorexia nervosa är en psykisk sjukdom som kännetecknas av en rädsla för att gå upp i vikt eller att bli tjock. Denna sjukdom gör att hela familjen involveras och kan känna hopplöshet. Genom sjuksköterskans kunskaper i medicinsk vetenskap och psykiatrisk omvårdnad och ett professionellt bemötande kan sjuksköterskan underlätta i familjens situation. Syftet med studien är att belysa hur familjen upplever situationen när en familjemedlem har anorexia nervosa. Metoden i detta arbete är en litteraturstudie baserad på tio vetenskapliga artiklar. Resultatet visar fyra teman. Dessa teman är bristande delaktighet i omvårdnaden, familjelivet fokuserar sjukdomen, föräldrar emotionellt pressade och syskonrelationen förändras. I den här studien har det framkommit att anhöriga kände att de var bortkopplade i omvårdnaden och hade negativ inställning till omvårdnadspersonalen. Det är av stor vikt att anhöriga och omvårdnadspersonalen samarbetar med varandra vilket framkom i resultatet. Vår slutsats är att omvårdnadspersonalen behöver mer kunskap och utbildning om anorexia nervosa. Vår förhoppning är att denna studie ska ge sjuksköterskan mer inblick i familjesituationen kring sjukdomen anorexia nervosa så att sjuksköterskans omvårdnad kan underlätta för dem.</p> / <p>Anorexia nervosa is a mental disorder characterized by a fear of gaining weight or become fat. This disease involves the whole family that also feels a lack of hope. By nurses’ knowledge in medicine and mental nursing care and trough a professional behaviour the nurses can ease their situation. Our aim was to describe how the family’s experiences the situation when a family member has anorexia nervosa. The method in this consists of a literature review. The result shows four themes. These themes were lack of participation in nursing care, the family life focus on the illness, parent’s emotional strain and sibling’s relationship change. In this study it’s been found that relatives felt a distance to the nursing care and had a negative attitude towards the nursing staff. It’s by great importance that the relatives and the nursing staff cooperate which is shown in the result. Our conclusion is that the nursing staffs need more knowledge and education about anorexia nervosa. Our hope is that this study will give the nursing care more insight to the situation around anorexia nervosa so it could ease for the relatives.</p>

Introdução e objetivo: Anorexia e desnutrição são causas importantes de desnutrição nas crianças e adolescentes com cirrose. A grelina e a leptina são hormônios envolvidos na homeostase energética, possuem efeitos antagônicos e estão associadas com anorexia em cirróticos. O objetivo deste estudo é avaliar as concentrações de grelina, leptina, insulina e glicose, e o estado nutricional entre crianças e adolescentes cirróticos e hígidos. Métodos: Estudo transversal prospectivo, realizado com 39 crianças e adolescentes com cirrose (66,7% atresia biliar) idade entre 2,5 e 188 meses, sendo 51,3% do sexo feminino e 51,3% eram Child-Pugh A; 41%, B e 7,7%, C respectivamente, e 39 controles hígidos pareados por sexo e idade. As concentrações de grelina, leptina, insulina e glicose foram dosadas pelo método de ELISA. Amostras de sangue foram coletadas pelo menos após 3 horas de jejum. A gravidade da doença hepática foi avaliada pela classificação de Child-Pugh e pelo escore PELD e/ou MELD. A avaliação antropométrica foi realizada pelos índices de estatura para idade, prega cutânea tricipital e a classificação foi determinada de acordo com os padrões WHO 2009 e Frisancho 2008. Resultados: A grelina apresentou correlação inversa com a idade. Os valores medianos (percentil 25-75) de grelina acilada foram significativamente menores nos cirróticos do que nos controles [140,3 (93,9-269,7) pg/ml versus 277,8 (209,9-557,8) pg/ml, P=0,003]. Os valores medianos da grelina total e desacilada dos cirróticos foram 913,4 pg/ml (760,8- 1443,7) e 1397,8 pg/ml (815,27-2.047) respectivamente. Os valores medianos da leptina, insulina e glicose não foram significativamente diferentes entre os cirróticos e os controles (P=0,421; P=0,908; P=0,851). A grelina acilada foi associada com a gravidade e classificação de Child-Pugh, e a grelina desacilada com o escore PELD `15. A leptina apresentou correlação positiva com os parâmetros antropométicos, hematócrito e hemoglobina. Os cirróticos desnutridos apresentaram níveis diminuídos de leptina quando comparados aos cirróticos bem nutridos (P=0,023). Conclusões: A concentração diminuída de grelina acilada e aumentada de grelina total e desacilada relacionaram-se com a gravidade da doença hepática, enquanto os níveis séricos de leptina com desnutrição em crianças e adolescentes cirróticos. A insulina e a glicose não apresentaram associação com as variáveis estudadas. / Introduction and Objective: Anorexia and undernutrition state are a problem of paramount importance in children and adolescents with cirrhosis. Ghrelin and leptin are the main hormones involved in the control of food intake and body weigth, having antagonic effects and being associated with anorexia in cirrhotic patients. This study aimed to investigate the relationship between fasting ghrelin, leptin, insulin and glucose concentrations; and the nutritional status in pediatric cirrhotic patients, comparing with sex- and age-matched healthy controls. Methods: Cross-sectional study evaluated 39 children with cirrhosis (biliary atresia as etiology in 66.7%) aged between 2.5 and 188 months, 51.3% female were evaluated, 51.3% were Child-Pugh A; 41%, B and 7.7%, C. Other 39 healthy children matched for sex and age, taken as controls, were also evaluated. Blood samples were collected at least after 3-hours fasting. Fasting total ghrelin, acyl grelin, leptin, insulin and glucose levels were measured using a commercial ELISA kit. Severity of liver disease was assessed by Child-Pugh classification, and PELD or MELD score. Antropometric papameters including, body fat mass and height for age were determined and classified according to WHO 2009 and Frisancho 2008 standard reference. Results: Plasma ghrelin levels showed an inverse correlation with age. Median values (25-75 centile) of acylated ghrelin were significantly lower in cirrhotics than in healthy controls [142 (93-278) pg/ml vs 275 (208-481) pg/ml, P=0.001]. Median values of leptin, insulin and glucose were not significantly different between cirrhotics and controls (P=0.421; P=0.908; P=0.851). Ghrelin levels were associated with the severity of Child-Pugh classification and PELD or MELD scores `15. Ghrelin levels did not associate with gender and causes of cirrhosis. Leptin levels were correlated positively with anthropometric parameters, hematocrit and hemoglobin. Undernourished cirrhotic patients had lower leptin levels than wellnourished (P=0.023). Conclusion: Plasma acyl ghrelin concentration are lower and total and desacyl ghrelin were higher and associated with cirrhosis severity, whereas leptin was associated with undernourishment in children and adolescents with cirrhosis. Insulin and glucosis werent associated with any variable.

O tema Transtorno Alimentar vem recebendo nas últimas décadas uma atenção especial tanto da comunidade científica quanto dos meios de comunicação de massa. Assistimos a um aumento no número de publicações nas revistas especializadas na área da psiquiatria, a formação de centros de atendimento e pesquisa no eixo Rio-SãoPaulo, concomitante a certa efervescência nas publicações da imprensa leiga. Todo esse interesse parece indicar que estamos diante de um novo fenômeno. Entretanto nesse trabalho procuramos desenvolver uma linha de pesquisa que pretende explorar a hipótese na qual casos graves de anorexia nervosa poderiam ser entendidos, a partir do ponto de vista psicodinâmico, como similares as histerias de conversão do final do século XIX Grande Hysterie. Para sustentar tal hipótese faremos um recuo no tempo investigando a história da evolução dos conceitos tanto da anorexia nervosa como da histeria e seus respectivos desdobramentos. Durante a realização desse percurso teórico percebemos que na verdade estávamos lidando com velhos dramas, ou seja, que no pano de fundo dessa questão encontrava-se a feminilidade e seus percalços. Assim sendo, nossa proposta toma um outro rumo: alicerçada na perspectiva freudiana do tornar-se mulher, nos indagarmos se a anorexia nervosa não seria uma recusa do feminino capaz de assumir máscaras diversas. Recuperamos então o conceito de feminilidade da teoria psicanalítica, considerando a anorexia nervosa como uma possibilidade de recusa articulada, ora a histeria, ora a perversão. Verificamos na prática clínica um desaparecimento, sobretudo nas camadas mais elitizadas da população, dos fenômenos conversivos francos ou floridos. Entretanto, nos prontos-socorros do serviço público e nas grandes emergências psiquiátricas, a histeria sobrevive com toda a exuberância de sua sintomatologia. Nos indagamos se a essas moças de classe média ou classe média alta restou apenas a possibilidade de implodir toda essa angústia psíquica, sob a forma de um controle alimentar tão rígido e uma tal distorção da imagem corporal que são capazes de aproximá-las de um quadro de falência psíquica.