Att leva med barn som insjuknat i anorexia nervosa - En litteraturstudie om familjens upplevelser Abstrakt (Sv) Bakgrund: I Sverige är de ca 1 % av alla kvinnor som fått diagnosen anorexia nervosa. När ett barn insjuknat i anorexia nervosa påverkas hela familjen av denna livssituationsförändring. Familjens inflytande är en viktig del i behandlingen av anorexia nervosa, genom att sjukdomen har en okänd orsak upplever familjen sig som den bidragande faktorn till insjuknandet. Syfte: Belysa familjemedlemmars upplevelse av att leva med ett barn som insjuknat i anorexia nervosa. Metod: En litteraturstudie baserad på elva artiklar med en kvalitativ ansats. Resultatet från varje artikel har granskat, analyserat och sammanställts. Resultat: Resultatet redovisades i två kategorier och sju underkategorier. Huvudkategorierna är att leva i vanmakt och att leva under förändrade livsförhållanden. Konklusion: Att leva med ett barn som insjuknat i anorexia nervosa upplevs av familjen som påfrestande på grund av att sjukdomen bidrog till stora livsförändringar. Utifrån denna studies resultat kan sjuksköterskan anpassa sitt bemötande och ge god omvårdnad till alla familjemedlemmar. Nyckelord: Familj, barn, upplevelse, anorexia nervosa / Living with a child diagnosed with anorexia nervosa - A literature review of the family's experiences Abstract (En) Background: Approximately 1 % of all women in Sweden is diagnosed with anorexia nervosa. When a child is diagnosed with anorexia nervosa the whole family is affected by the life change the dieses brings. The family's influence is an important part of the treatment of anorexia nervosa. Since the disease has an unknown cause, the family often blame themselves as the contributing factor to the onset. Aim: The aim of the study is to highlight the family members' experience of living with a child suffering from anorexia nervosa. Method: A literature study was conducted based on eleven articles using a qualitative approach. The results from each article has been reviewed, analysed and compiled. Results: The results were presented in two categories and seven subcategories. The main categories are to live in powerlessness and to live under lifechanging conditions. Conclusion: Living with a child suffering from anorexia is experienced by the family as stressful because the disease contributed to major life changes. Based on the result of this study, the nurse can adjust attitude and provide good care for all family members. Keywords: Family, child, experience, anorexia nervosa

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.

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

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.

<p><strong>Bakgrund:</strong> Anorexia nervosa är en allvarlig sjukdom som påverkar hela familjen. Familjemedlemmar tar oftast på sig skulden av sjukdomen, vilket leder till psykisk ohälsa. <strong>Syftet:</strong><em> </em>Var att belysa anhörigas behov av stöd när en familjemedlem drabbats av anorexia nervosa. <strong>Metod:</strong><em> </em>En systematisk litteraturstudie. Litteratursökningen gjordes i databaserna PubMed, PsycInfo och Cinahl. Av de 13 artiklar som ingick i studien gjordes en analys av resultatet i artiklarna. <strong>Resultat:</strong> För de anhöriga var det en mycket påfrestande situation att vårda den sjuke familjemedlemmen. De hade många obemötta behov som exempelvis brist på information om sjukdomen, bristande kommunikation med de professionella, behov av stöd från sjukvården och önskan om att få träffa andra i liknande situation<strong>. Slutsats:</strong> Anorexia är en svår sjukdom som tar mycket på anhörigas krafter. Därför behövs lättillgängligt stöd som information om sjukdomen samt råd och guidning i omhändertagandet.</p>

<p>Bakgrund: Anorexia Nervosa (AN) är en allvarlig sjukdom som påverkar hela familjen. Den sjuke är ofta medveten om att hon skadar hela familjen men är oförmögen att rätta till det. Då orsaken till AN är okänd finns heller ingen konsensus om vilken behandling som är den rätta, men flertalet forskare anser att familjen har stor betydelse i behandlingen. Syftet med denna litteraturstudie var att belysa</p><p>föräldrars upplevelser av att ha ett barn med AN. Metoden* var en systematisk litteraturstudie. Litteratursökning gjordes i databaserna, Pubmed, Chinal och PsychInfo. Av funnen litteratur gjordes innehållsanalyser som ledde till 3 teman. Resultatet visade att det var mycket krävande att vara förälder till ett barn med AN</p><p>samt att behovet av stöd var stort och föräldrar uttryckte bland annat stor besvikelse på hälso- och sjukvårdens bemötande. I brist på stöd och information var det många föräldrar som skuldbelade sig själva för barnets sjukdom. Till slut kretsade hela familjens liv kring sjukdomen och familjens sociala liv inskränks eller till och med upphör. Även syskon påverkades och de påverkade sjukdomen i olika riktningar. Vår slutsats är att föräldrar är i stort behov av information och stöd, vilket de idag upplever vara brist av. Detta är något som både vårdcentraler och sjukhus måste bli bättre på för att främja hälsa för föräldrar med barn med anorexia.</p>

<p>Syftet med denna studie var att undersöka kvinnors upplevda erfarenheter och uppfattningar av sambandet mellan personlighet, träning och kroppsuppfattning, varje faktor för sig, och utvecklandet av ätstörningar, med fokus på anorexia nervosa. Åtta kvinnor mellan 18- 24 år intervjuades utifrån en semistrukturerad intervjuguide. Intervjuerna analyserades utifrån en induktiv analysmetod. Ur analysmetoden framstod tre kategorier: personlighetsdrag, träning och kroppsuppfattning. Resultaten visade att majoriteten av informanterna hade gemensamma personlighetsdrag såsom perfektionism, hög självkontroll och låg självkänsla vilket är i enlighet med tidigare forskning. Samtliga informanter upplevde att träning hade en central roll i deras liv och de flesta av informanterna hade en negativ kroppsuppfattning. Önskvärt för framtiden vore ett kontinuerligt samarbete mellan den kliniska verksamheten och forskningen. </p><p>Möjligheterna som skapas av att dela erfarenheter och kunskap, skulle vara av stor betydelse för den långsiktiga forskningen och för de personer som drabbas av en ätstörning.</p>

Bakgrund: Anorexia Nervosa (AN) är en allvarlig sjukdom som påverkar hela familjen. Den sjuke är ofta medveten om att hon skadar hela familjen men är oförmögen att rätta till det. Då orsaken till AN är okänd finns heller ingen konsensus om vilken behandling som är den rätta, men flertalet forskare anser att familjen har stor betydelse i behandlingen. Syftet med denna litteraturstudie var att belysa föräldrars upplevelser av att ha ett barn med AN. Metoden* var en systematisk litteraturstudie. Litteratursökning gjordes i databaserna, Pubmed, Chinal och PsychInfo. Av funnen litteratur gjordes innehållsanalyser som ledde till 3 teman. Resultatet visade att det var mycket krävande att vara förälder till ett barn med AN samt att behovet av stöd var stort och föräldrar uttryckte bland annat stor besvikelse på hälso- och sjukvårdens bemötande. I brist på stöd och information var det många föräldrar som skuldbelade sig själva för barnets sjukdom. Till slut kretsade hela familjens liv kring sjukdomen och familjens sociala liv inskränks eller till och med upphör. Även syskon påverkades och de påverkade sjukdomen i olika riktningar. Vår slutsats är att föräldrar är i stort behov av information och stöd, vilket de idag upplever vara brist av. Detta är något som både vårdcentraler och sjukhus måste bli bättre på för att främja hälsa för föräldrar med barn med anorexia.