Women with anorexia nervosa tend to be ambivalent about change and resistant to treatment. A growing number of researchers suggest that this ambivalence must be targeted early on, before attempting to engage clients in action-oriented treatment that focuses on immediate symptom reduction. However, in order to appropriately address client ambivalence, it must be accurately evaluated with empirically validated instruments. The purpose of this thesis was to develop and validate a Decisional Balance (DB) measure of readiness for change in anorexia nervosa. In Study 1, 246 women with anorexia nervosa completed the DB, and a subset completed the DB again one week later. Unlike traditional decisional balance measures that have two factor (pro-con) solutions, factor analytic techniques indicated that a three factor solution provided the best fit for the DB data in this study. These factors included general negative consequences of the disorder (Burdens), valued achievements such as self-control, being very thin, and striving for perfection (Benefits), and using anorexia nervosa as a means for avoiding aversive emotions, challenges, and responsibilities (Avoidance Coping). The DB demonstrated good internal consistency and test-retest stability. In study 2, 80 women with anorexia nervosa completed the DB, along with other measures of readiness for change, as well as measures unrelated to readiness. Support was found for both convergent and divergent validity. Finally, in study 3, 80 women with anorexia nervosa completed the DB, and a measure of anticipated difficulty completing symptom-challenging recovery activities. In addition, participants attempted to complete three recovery activities in the week following initial assessment. Criterion validity was not well supported, most likely because the concurrent and predictive validity measures focused on behavior change, when non-behavioral measures may have been more appropriate. Overall, the results suggest that the DB for anorexia nervosa is a measure of awareness or insight about the functions of this disorder. The theoretical and clinical implications of this research are reviewed and directions for future investigations are proposed.

M.A. / Anorexia nervosa is an eating disorder characterised by an intense fear of gaining weight, a refusal to maintain a minimally normal body weight and a significant disturbance in the perception of the shape or size of his or her body (American Psychiatric Association, 2000). Anorexia nervosa typically begins in mid-to-late adolescence (age 14-18 years). Follow-up studies show that only 10% of those with anorexia nervosa fully recover. While almost half may show partial recovery, many continue to be seriously impaired by depression, social phobias or recurrent symptoms (Herzog et al., 1993). Early onset (before 16) may be associated with a less negative prognosis, although a far from favourable one (Theander, 1996). Considerable clinical literature exists on the etiology of anorexia nervosa, but for the purpose of the current study cognitive factors that may relate to anorexia nervosa were examined. Specifically, the study focused on two self-evaluations: self-efficacy and self-esteem. Generalized self-efficacy can be defined as a global confidence in one's coping ability across a wide range of demanding or novel situations (Schwarzer, 1993). Self-esteem is defined as the evaluation that the individual makes and customarily maintains with regard to himself/ herself (Rosenberg, 1965). To ascertain levels of self-efficacy and self-esteem, the Generalized Self-Efficacy Scale (GSE) (Schwarzer & Jerusalem, 1993) and Rosenberg Self-Esteem Scale (RSE) (Rosenberg, 1965) were administered in an experimental group of white adolescent girls diagnosed with anorexia nervosa (n=24) as well as a control group (n=24). An ex-post-facto experimental control group correlational design was implemented, andtwo-tailed t-tests conducted to determine the significance of differences regarding levels of self-efficacy and self-esteem between the two groups. The results indicated that there was no significant difference between the experimental group and control group with regard to their levels of self-efficacy. However, the experimental group exhibited lower levels of self-esteem in comparison to the control group. These results indicate that generalized self-efficacy, as a cognitive self-evaluation on its own, does not distinguish between adolescent girls with anorexia nervosa and a control group, and that domain-specific self-efficacy should also be considered in future research. The results further confirmed that girls diagnosed with anorexia nervosa exhibit lower levels of self-esteem as suggested in previous research (e.g. Wilksch & Wade, 2004). With regard to future research, larger groups are needed to elaborate on the current findings. Furthermore, additional research investigating the role of other aspects of self-esteem such as outer self-esteem and inner or trait self-esteem, as well as other aspects of self-efficacy such as domain specific self-efficacy, could contribute to the current findings.

Women with anorexia nervosa tend to be ambivalent about change and resistant to treatment. A growing number of researchers suggest that this ambivalence must be targeted early on, before attempting to engage clients in action-oriented treatment that focuses on immediate symptom reduction. However, in order to appropriately address client ambivalence, it must be accurately evaluated with empirically validated instruments. The purpose of this thesis was to develop and validate a Decisional Balance (DB) measure of readiness for change in anorexia nervosa. In Study 1, 246 women with anorexia nervosa completed the DB, and a subset completed the DB again one week later. Unlike traditional decisional balance measures that have two factor (pro-con) solutions, factor analytic techniques indicated that a three factor solution provided the best fit for the DB data in this study. These factors included general negative consequences of the disorder (Burdens), valued achievements such as self-control, being very thin, and striving for perfection (Benefits), and using anorexia nervosa as a means for avoiding aversive emotions, challenges, and responsibilities (Avoidance Coping). The DB demonstrated good internal consistency and test-retest stability. In study 2, 80 women with anorexia nervosa completed the DB, along with other measures of readiness for change, as well as measures unrelated to readiness. Support was found for both convergent and divergent validity. Finally, in study 3, 80 women with anorexia nervosa completed the DB, and a measure of anticipated difficulty completing symptom-challenging recovery activities. In addition, participants attempted to complete three recovery activities in the week following initial assessment. Criterion validity was not well supported, most likely because the concurrent and predictive validity measures focused on behavior change, when non-behavioral measures may have been more appropriate. Overall, the results suggest that the DB for anorexia nervosa is a measure of awareness or insight about the functions of this disorder. The theoretical and clinical implications of this research are reviewed and directions for future investigations are proposed. / Arts, Faculty of / Psychology, Department of / Graduate

徐文艷. / Thesis (doctoral)--Chinese University of Hong Kong, 2007. / Includes bibliographical references (p. 259-278). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstracts in Chinese and English. / Xu Wenyan.

M.A. / In this project the researcher explores, analyses and interprets the narratives of seven women who have recovered from anorexia and/or bulimia. The investigation is conveyed from the sufferers' point of view, an approach suggestive of a qualitative inquiry, and is formulated within a qualitative theoretical and methodological framework. Linear approaches like the medical model, that endorse a pathological view of mental and emotional problems, are challenged for contributing to the notion of a defect model of mental illness. The dominant view that psychological and emotional problems like physical illnesses should be treated and eradicated, is contextualised within the framework of a defect model of mental illness. The researcher proposes that this position disempowers the recipients of therapy, can become a self fulfilling prophecy, and ultimately furthers the argument that emotionally disturbed people are sick. Concepts from systems theory such as homeostasis and dialectic thinking, are cited to illustrate the rationale behind the notion of a `competency' model of mental illness. The continuance of either anorexic or bulimic behavior is seen as playing a central role in the maintenance of an equilibrium (albeit a painful one) in the sufferer's personal and family system - thus serving a purpose. The researcher subsequently proposes that it can be beneficial to view an eating disorder as a milestone, where from much good can be derived.

Text in Afrikaans / Die doel van hierdie studie was om vas te stel of kunsterapie wei suksesvol aangewend kan word met die anorexia nervosa-lyer. Daar is spesifiek gefokus op die verbetering van die selfkonsep van die adolessent met anorexia nervosa. Anorexia nervosa en kunsterapie is bespreek. Daar is aandag gegee aan die spesifieke kenmerke wat kuns geskik maak vir terapeutiese aanwending in die bebandeling van die anorexia nervosa-lyer. Die praktiese toepassing van kunsterapie is uiteengesit met die Jdem op kunsterapeutiese tegnieke wat fokus op die verbetering van die selfkonsep van die adolessent met anorexia nervosa. Twee adolessente wat met anorexia nervosa gediagnoseer is, is as proefpersone vir die studie gebruik. Die Adolessente-Selfkonsepskaal (ASKS) en die Sacks Sinsvoltooiingsmedium is as voor- en natoetse ingeskakel om die stand van die twee proetpersone se selfkonsep te bepaal. Kunsterapie is vir twaalf sessies met die proefpersone gedoen. Uit die navorsingsresultate is tot die gevolgtrekking gekom dat kunsterapie gelei het tot 'n verbetering rakende aspekte van die seltkonsep van die adolessent met anorexia nervosa. Kunsterapie is positief beleef deur die proefpersone. Gevoelens kon op 'n nie-bedreigende manier geeksploreer word en onopgeloste situasies kon met vrymoedigheid aangespreek word. / The aim of this study was to assess and describe the potential value of art therapy as an intervention strategy for the treatment of adolescents suffering from anorexia nervosa. Anorexia nervosa was described and defined. Diagnostic criteria, the manifestation and contributory causes, as well as the treatment and the prognosis for recovery, were discussed. Art therapy, as well as specific therapeutic techniques suitable for the anorexia nervosa sufferer were explained. The specific objective of the study was to determine the influence of certain art therapy techniques on the self-concept of two adolescents suffering from anorexia nervosa. The results indicated that there were significant changes in the self-concept of the two adolescents. Art therapy can be an effective therapeutic intervention strategy for the adolescent suffering from anorexia nervosa and gives the client the opportunity to come to tenns with the self in a non-threatening way. / Psychology of Education / M. Ed. (Sielkundige Opvoedkunde)

Text in Afrikaans / Die doel van hierdie studie was om vas te stel of kunsterapie wei suksesvol aangewend kan word met die anorexia nervosa-lyer. Daar is spesifiek gefokus op die verbetering van die selfkonsep van die adolessent met anorexia nervosa. Anorexia nervosa en kunsterapie is bespreek. Daar is aandag gegee aan die spesifieke kenmerke wat kuns geskik maak vir terapeutiese aanwending in die bebandeling van die anorexia nervosa-lyer. Die praktiese toepassing van kunsterapie is uiteengesit met die Jdem op kunsterapeutiese tegnieke wat fokus op die verbetering van die selfkonsep van die adolessent met anorexia nervosa. Twee adolessente wat met anorexia nervosa gediagnoseer is, is as proefpersone vir die studie gebruik. Die Adolessente-Selfkonsepskaal (ASKS) en die Sacks Sinsvoltooiingsmedium is as voor- en natoetse ingeskakel om die stand van die twee proetpersone se selfkonsep te bepaal. Kunsterapie is vir twaalf sessies met die proefpersone gedoen. Uit die navorsingsresultate is tot die gevolgtrekking gekom dat kunsterapie gelei het tot 'n verbetering rakende aspekte van die seltkonsep van die adolessent met anorexia nervosa. Kunsterapie is positief beleef deur die proefpersone. Gevoelens kon op 'n nie-bedreigende manier geeksploreer word en onopgeloste situasies kon met vrymoedigheid aangespreek word. / The aim of this study was to assess and describe the potential value of art therapy as an intervention strategy for the treatment of adolescents suffering from anorexia nervosa. Anorexia nervosa was described and defined. Diagnostic criteria, the manifestation and contributory causes, as well as the treatment and the prognosis for recovery, were discussed. Art therapy, as well as specific therapeutic techniques suitable for the anorexia nervosa sufferer were explained. The specific objective of the study was to determine the influence of certain art therapy techniques on the self-concept of two adolescents suffering from anorexia nervosa. The results indicated that there were significant changes in the self-concept of the two adolescents. Art therapy can be an effective therapeutic intervention strategy for the adolescent suffering from anorexia nervosa and gives the client the opportunity to come to tenns with the self in a non-threatening way. / Psychology of Education / M. Ed. (Sielkundige Opvoedkunde)

Chan Chung Yee Zenobia. / "August 2003." / Thesis (Ph.D.)--Chinese University of Hong Kong, 2003. / Includes bibliographical references (p. 407-438). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Mode of access: World Wide Web. / Abstracts in English and Chinese.

To gain a better understanding of those struggling with severe eating disorders (anorexia nervosa and bulimia nervosa), the inner life-world and subjective experiences of therapy clients were explored within the South African context. This was an empirical qualitative study. Specifically, the study’s focus was on the psychological construct of perfectionism as experienced during the respondents’ treatment resistant eating disorders. The two objectives of the research were to describe and explain perfectionism, which served to increase an overall improved understanding of perfectionism. The study’s methodology encompassed a combination of phenomenological- and grounded theory methodology, exploring the narratives of six female candidates that were undergoing individual therapy for their eating disorders. These candidates were considered to have a treatment resistant eating disorder, because they had been struggling with this diagnosis for longer than a decade, and/or had previously received multiple treatment interventions without recovering. The therapy sessions were recorded via digital audio recordings, and used in the data analysis process. The discourses pertaining to the study’s focus were transcribed and analysed using phenomenological- and grounded theory methods. The phenomenological analysis produced individual descriptions of the participants’ experiences of their perfectionism, as well as a general description for perfectionism. The grounded theory analysis produced an emerging theory in the form of a cognitive schema. This schema was named The Perfectionistic Eating Disorder Self-schema (PEDSS), and explains the inner psychological process of perfectionism within a treatment resistant eating disorder client. The results of this study, in particular the PEDSS, has implications for those trying to understand, assist, and treat those who suffer from treatment resistant eating disorders, as well as helping those who struggle with perfectionism to understand their own problem more. / Psychology / D. Phil. (Psychology)