Eating disorders are difficult to treat: there is still no NICE-approved first-line treatment for anorexia nervosa. In part this could be due to a lack of a compelling theoretical model to account for the development and dogged persistence of the illness. Sociocultural factors implicating western preoccupation with thinness and attractiveness are likely to play a contributory role, but cannot be by themselves causal in societies where such ideals are dominant. Recent theoretical models in neuroscience predict that predisposing neurobiological factors in early brain development may render some young people more vulnerable than others to universal psychosocial pressures, especially during adolescence. This dissertation reviews the existing evidence for abnormal neurobiological functioning in eating disorders, acknowledging that it is difficult to distinguish between the acute effects of starvation on the brain and possibly pre-existing underlying factors. Nevertheless, such empirical studies do support the development of a novel hypothesis implicating abnormal functioning of a neural network centred on the insula cortex in anorexia nervosa. The insula hypothesis is tested in a series of functional imaging studies using Single Positron Emission Computed Tomography (SPECT) indicating focal abnormalities in the temporal region that persist following weight restoration treatment and correlate with neuropsychological deficits. A subsequent study using higher resolution functional Magnetic Resonance Imaging (fMRI) lends further partial support to the insula hypothesis (in three out of four tasks) and also implicates additional brain structures in the basal ganglia. These findings, if replicated, could contribute to the development of novel therapeutic approaches to the treatment of anorexia nervosa, including realtime fMRI and mindfulness-based approaches, both of which have been shown to modulate insula activation. The studies presented here could hopefully also help to reduce the stigma and shame so often associated with eating disorders, for the benefit of sufferers and their families.

En el presente estudio se investiga a la anorexia y bulimia nerviosas, realizando un análisis histórico-crítico de fuentes básicamente bibliográficas. Se hizo uso del método histórico abarcando el espacio de tiempo comprendido entre la antigüedad y la época actual, enfatizando en los períodos de mayor relevancia en la aparición y desarrollo de estos trastornos. Se plantea que: (1) la llegada a Occidente de creencias orientales como las sostenidas por el Jainismo (s. IV) y diseminadas a través de órdenes Mendicantes (Edad Media alta); y, (2) los valores de la ética protestante, promovidos a partir de la Reforma, acompañados del desarrollo de la burguesía y el modo de vida capitalista; fueron dos hitos esenciales en el origen y desarrollo de la anorexia y bulimia nerviosas actuales. / The current research covers the study of eating disorders (anorexia nervosa, bulimia nervosa), essentially through a historical-critical analysis of bibliographic sources. It was used the historical method covering the space of time between the antiquity and the actual era, emphasizing on the periods of major relevance in relation to the origin and development of these eating disorders. It is proposed that: (1) the arrival to Occident of oriental beliefs such as those claimed by the Jainism (s. IV a. D.) and disseminated with the Mendicant orders (High Middle Age); and (2) the values of the protestant ethic, promoted since the Reformation, accompanied with the development of the bourgeoisie and the capitalist way of life; were two landmarks in the origin and development of anorexia nervosa and bulimia nervosa, it means in the history of eating disorders. / Tesis

Fundamento: Actualmente la Anorexia Nerviosa es un problema social y sanitario relevante en la juventud; debido a que los medios de comunicación presentan una figura delgada como ideal de belleza y éxito; convirtiéndose en una especie de culto en el pensamiento de los adolescentes que al intentar parecerse pueden desencadenar trastornos alimentarios. La anorexia nerviosa es una perturbación mental y de comportamiento, siendo la 2da causa de muerte entre los adolescentes. En el Perú en los últimos 10 años el número de casos se ha incrementado 20 veces. Actualmente para comprender este problema se requiere de una perspectiva multidimensional que incluya factores individuales, familiares, socioculturales y psicológicos, que interactúen entre sí. El presente estudio tiene por Objetivos: Determinar y relacionar los factores biológicos, socioculturales y psicológicos en el riesgo de Anorexia Nerviosa en adolescentes de un colegio estatal y particular de Villa María del Triunfo – 2011. Metodología: Estudio descriptivo de corte transversal – correlacional y comparativo en una población muestral de 296 adolescentes estudiantes del Colegio Julio C. Tello y la I.E María de los Ángeles, se utilizó un cuestionario constituido por 5 preguntas cerradas de selección múltiple, 5 dicotómicas y una escala de Likert. La confiabilidad del instrumento se logró mediante una muestra Piloto seleccionando a la unidad de análisis con características similares a la muestra del estudio. Los resultados fueron evaluados por el Coeficiente de Correlación Kuder-Richardson obteniéndose 0.82 que indica significancia estadística P < 0.05. Los resultados encontrados en la prueba resaltan que la edad, el sexo, un nivel de conocimiento bajo, la alta influencia de la televisión, la autoestima baja y una percepción de la imagen corporal alterada son aspectos que influyen en la aparición de trastornos de conducta alimentaria.

Psicóloga / Este estudio busca conocer y describir la experiencia de la práctica de Kundalini yoga en mujeres diagnosticadas con Anorexia Nerviosa y Bulimia Nerviosa respecto de los posibles efectos en su autoestima. Se realizó una intervención de ocho clases de Kundalini yoga para una muestra de nueve participantes. Se utilizó un diseño descriptivo de carácter cualitativo, basado en la Grounded Theory (Glaser y Strauss, 1967), utilizando entrevistas semiestructuradas y autoreportes escritos. Además la información fue complementada con un instrumento cuantitativo, la Escala de Autoestima de Rosenberg (Rosenberg, 1965) aplicada al inicio y al término del taller. El análisis cuantitativo de los datos se realizó mediante dos pruebas no paramétricas, la prueba del signo T para muestras pareadas y la prueba de Mann Whitney para muestras independientes. Los principales resultados y conclusiones señalan que las participantes percibieron un cambio beneficioso en su autoestima, traducido como un fortalecimiento de ésta. Además se encontraron una serie de elementos asociados al concepto de autoestima y que estarían relacionados al cambio experimentado. Asimismo, los resultados cuantitativos muestran un aumento significativo en la autoestima de las participantes luego de la intervención. Como conclusión, se consideran relevantes los beneficios a partir de la práctica de Kundalini yoga, así como permite cuestionar la relevancia de incluir esta intervención dentro del tratamiento multidisciplinario de estas patologías

Diese Arbeit beschäftigt sich mit der Überprüfung der bestehenden Leitlinien für die Kriterien einer stationären versus ambulanten Therapie von Patienten mit Anorexie oder Bulimie. Es zeigte sich, dass manche wichtige Kriterien noch nicht in den Leitlinien verankert sind. Außerdem sind zentrale Begriffe wie "kritisches Untergewicht" oder "häufige Frequenz an Ess-/Brechattacken" nicht ausreichend definiert. / There are guidelines when to treat patients with anorexia or bulimia stationarily and when ambulant. This work takes a closer look on how far the guidelines are used. It is shown that important facts are not included in the guidelines and words with central meaning like "critical underweight" or "high frequency of binge-eating-attacks" are not defined properly.

El propósito del presente trabajo es describir el curso psicológico de los desórdenes alimentarios desde las perspectivas freudiana y posfreudiana. El valor de una aproximación histórica es que ésta se constituye en un antídoto tanto para la aceptación no crítica como para el rechazo no informado de las ideas. / Tesis

The present study investigated perceptions, attitudes, and beliefs toward individuals with anorexia nervosa (AN) of varying weight. The primary aim was to examine the associations between eating disorder symptom level and stigma toward eating disorders, perceptions of acceptability/desirability of AN, and perceptions of severity of AN. The second aim was to investigate the impact of body weight on males’ and females’ perceptions and attitudes toward AN, specifically on their stigma toward eating disorders, perception of the severity of AN, and perception of acceptability or desirability of AN behaviors and characteristics. Two-hundred fifty-seven university students (187 females, 70 males, mean age = 22.5, SD = 6.59) in undergraduate courses participated in the online study, and were randomly assigned to view one of three underweight female figures (extremely thin, moderately thin, and mildly thin). Participants read a vignette describing an individual meeting full diagnostic criteria for anorexia and completed measures assessing stigma toward individuals with AN and eating disorder symptomatology. Regarding the first aim, it was hypothesized that an inverse relationship would emerge between eating disorder pathology in participants and stigmatizing attitudes and beliefs. In support of the hypothesis, findings revealed that increased acceptability of AN and greater perceptions of AN severity were associated with higher levels of eating disorder symptoms. In contrast to the hypothesis, current self-reported eating disorder symptoms were not significantly associated with lower levels of eating disorder stigma. It was also hypothesized that female participants would perceive AN as more positive and acceptable, and as less severe than male participants. The hypothesis was partially supported in that females indicated less stigma toward EDs and reported perceiving AN to be more serious than males. Greater acceptability was not more common among women. In regard to the second aim, there was no significant group differences found in eating disorder stigma, perceived acceptance of AN, and perceived severity of AN according to weight conditions, which was contrary to expectations. Implications of the study are discussed in terms of future research.

Seit Jahren wird trotz der stetigen Modernisierung der medizinischen Versorgungsleistungen ein Anstieg der stationären Einweisungen in den psychiatrischen Kliniken registriert. Dabei nutzt eine kleine Gruppe von Patienten, die sogenannten Heavy User, den Großteil der zur Verfügung stehenden therapeutischen Ressourcen. Diese explorative Studie beschreibt eine Gruppe von erwachsenen, weiblichen Heavy Usern (n=23) mit restriktiver bzw. bulimischer Anorexie oder Bulimie, die mindestens drei stationäre Aufnahmen in einer psychiatrischen Klinik aufwiesen. Als Vergleich dient eine Kontrollgruppe von weiblichen Nicht-Heavy Usern (n=13) mit maximal einem stationären Voraufenthalt. Die Ergebnisse zeigen, dass Heavy User mit der Hauptdiagnose einer Essstörung spezifische soziodemographische, diagnostische und psychopathologische als auch Persönlichkeitsmerkmale aufweisen, die eine rechtzeitige Identifizierung dieser Patientengruppe ermöglichen könnten. Der Heavy Use wird als multifaktorielles Geschehen verdeutlicht und die Notwendigkeit einer frühen Identifikation und Intervention betont. Da die bisherigen Studienergebnisse sehr uneinheitliche Resultate lieferten, sind weitere Untersuchungen dieser Patientengruppe unerlässlich. Die Entwicklung alternativer und individueller Therapieansätze ist angezeigt, um passende Versorgungsangebote für diese therapieresistenten Patienten zu schaffen. / Despite the constant modernization of medical services, an increase of inpatient readmissions in psychiatric services has been noted for years. Patients who show a higher extent of use of inpatient medical treatment are known as heavy users. This explorative study describes a group of female adult heavy users (n=23) with at least three inpatient treatments and compares the findings with a control group of female non-heavy user patients (n=13) with a maximum of one previous admission, both suffering from restrictive or purging-type anorexia nervosa or bulimia nervosa. The results of this paper show that heavy users diagnosed with an eating disorder, appear to have individual sociodemographic, diagnostic and psychopathological characteristics as well as particular personality traits, which seemingly contribute to heavy service use and could be taken into consideration for early identification of this treatment resistant group of patients. The findings stress the heavy use as a multifactorial phenomenon and emphasize the need of early identification and intervention. Since prior studies show inhomogenous results, further qualitative analysis is necessary to develop alternative and individual treatment strategies for heavy users.

Anorexia nervosa (AN) is a chronic and complex psychosomatic condition, characterised by a primary drive to be thin and a refusal to maintain normal body weight. Only a minority of people diagnosed with AN ever become asymptomatic and more research has been called for to address high drop-out rates and lack of engagement in AN treatment services, in particular psychotherapeutic treatment. Prior studies have generally examined this problem in terms of patient mediated variables, such as attitudes and behaviours, with little focus on contextual factors. Research that has studied therapeutic engagement in the area of AN has yet to examine psychotherapeutic treatments-in-practice. Guided by this gap in the literature this thesis examines ways in which therapists engage with adolescents diagnosed with AN in naturally occurring psychotherapeutic interactions. A secondary and concurrent focus is to look at how the therapists’ underlying theoretical models are reflected in in situ practice. The data corpus comprises twenty-four therapy sessions recorded in an eating disorders programme based in a children’s hospital. In contrast to eating disorders treatment statistics reported in the literature, the programme has a low drop-out rate, zero mortality rate and good long-term patient outcomes, making it an especially suitable setting to examine engagement. Drawing on methods from discursive psychology (DP) and conversation analysis (CA), a number of interactional practices are found which show how the key principles of engagement and neutrality are brought off, or achieved as such in turn-by-turn interaction. Central to the analysis, is the recurrent production of patients’ bodily states and conduct as delicate items. As these topics are also the primary focus of the institutional setting, the analysis shows how practices such as perspective display series and dispositional management allow delicately marked institutional tasks to be carried out. The analysis also examines how patients’ bodies and conduct are embedded in, and constituted as problematic in the interactions. Regularities, such as agentic repositioning in accounts, demonstrate the co-production of patients as psychologically compliant with treatment while physically non-compliant. This thesis contributes to work in applied CA concerning links between theoretical models and interactional practices by demonstrating naturally occurring regularities that describe key guiding principles of the eating disorders programme. It also builds on work in DP concerning examinations of the body and embodiment, by showing how patients’ physical bodies are an integrated feature of the interactions. Finally, this thesis has implications for a clinical audience in terms of extending therapists’ awareness of how engagement with patients is constituted interactionally, which also contributes to wider AN literature on ‘resistance’ to therapy.

This thesis aimed to examine the functioning of families with a sufferer of Anorexia Nervosa (AN), using self-report measures and a direct observation family discussion task. Researchers and clinicians have long been interested in the interactional patterns of these sufferers within the family unit, although few have furthered our understanding of the interplay between family functioning, cohesion and emotional expression and issues such as control, by directly examining these interactions. The construct of control has been another area of interest in recent research, although how it is constructed and operates within this disorder remains unclear and ambiguous. Thus the purpose of this research was to expand the study of adolescents suffering Anorexia Nervosa who still resided within the family unit, from merely studying self-report measures and retrospective surveys of recovery, to include a direct examination of sufferers and their families at the time of the disorder. Participants included 16 female sufferers of Anorexia Nervosa and their parents, 17 drug and alcohol sufferers, and 18 non-clinic families. Both parents and their daughters completed self-report inventories assessing their clinical status as well as family functioning and marital happiness. In addition, family members participated in a series of family discussion tasks which were coded for the dimensions of autonomy, cohesiveness, avoidance and control. In Study 1 (Chapter 7), the self-report measures of the anorexic families were examined specifically in relation to the construct of control acting as a mediating variable between level of dysfunction and severity of the disorder. Consistent with previous research, levels of marital happiness and family cohesion influenced the severity level of the daughter's Anorexia Nervosa. This study also explored the construct of control within the family system and found that the more moral-religious emphasis in the family, the more concerned the daughter was with her weight. At the same time daughters were reporting higher levels of moral-religious emphasis, they were reporting higher levels of self-control. The daughters in this study appeared to be inconsistent in their behavioural responses. The daughters' weight concern increased with their own reported levels of moral-religious emphasis in the family. However, as this emphasis increased, so too did their control scores. It was supposed that conflict may be created in a family when strong religious and/or strong moral values are emphasized, particularly when one of the family members suffers AN. This issue is discussed in depth. Study 2 sought to examine these variables further by using a direct observation family discussion task to compare an independent observer's ratings to the family's ratings of the discussion, across the three groups. The study examined the daughters' and mothers' perceptions and compared significant results to the observer's ratings. This study highlighted that the mothers of sufferers appeared not to be concerned about their own bodies and weight, and not distressed when discussing with their daughters the issues of control in the areas of family, body, school and friends. Furthermore, the anorexic daughters presented as more sad and anxious than the two other groups and indicated that their parents had more control over their bodies than they did themselves. Finally, for the majority of participating families, the fathers were absent and this issue is explored.