Addictive patterns in anorexia nervosa and bulimia were examined in eighty one women between eighteen and forty years of age. Women were assigned to five groups based upon their eating behavior as follows: Group 1--Normal Comparison Group (no eating disorder; no substance abuse disorder); Group 2--Drug-Alcohol Comparison Group (no eating disorder; diagnosable substance abuse disorder); Group 3--Bulimic (bulimia without presence of anorexia nervosa; no substance abuse disorder); Group 4--Bulimic Anorectic (bulimia with presence of anorexia nervosa, either past or present; not substance abuse disorder); and Group 5--Eating Disordered With Drug-Alcohol Problem (bulimia with or without the presence of anorexia nervosa, either past or present; diagnosable substance abuse disorder). Addictive patterns were examined using a variety of personality and self-report measures including: The Minnesota Multiphasic Personality Inventory (MMPI), Partial Addiction Research Center Inventory (ARCI-P), Eysenck Personality Questionnaire (EPQ), Rotter Internal-External Locus of Control Scale and the Rosenberg Self-Esteem Scale. It was hypothesized that the three eating disordered groups would share similar behavior patterns when compared to the normal and drug-alcohol comparison groups but would differ significantly from one another when just the three eating disordered groups were compared. The Eating Disordered With Drug-Alcohol Group would manifest the most pathology followed by the Bulimic Anorectic Group and then the Bulimic Group. The use of univariate analysis of variance and multiple discriminant function analysis confirmed these hypotheses. Variables that best discriminated among the groups were in the hypothesized direction and pertained to depression and impulsivity on the MMPI, efficiency and general drug effect on the ARCI-P and extraversion and low self-esteem on the Rotter and Rosenberg respectively. The study revealed that the patterns of pathology reflected in the eating disordered groups were in the predicted direction and are similar to the behavior and personality patterns observed in women with other addictions. Such findings have particular implications for the treatment of bulimic anorectics, as current treatment procedures are least effective with this eating disordered subgroup.

No description available.

Studien syftar till att ge en bild av hur unga kvinnor med anorexia nervosa konstruerar sin identitet via bloggar på internet. Materialet vi använde var sex bloggar skrivna av kvinnor över 18 år med diagnosen anorexia nervosa. Metoden och teorin som använs i studien är diskurspsykologi vilket är en form av diskursanalys. Resultaten kring kvinnornas identitet och diskurserna de befinner sig i presenteras utifrån begreppen subjektspositioner och tolkningsrepertoarer.   Synen på sjukdomen anorexia nervosa utgår ofta från ett biomedicinskt perspektiv. Att studera bloggar skrivna av kvinnor med anorexia nervosa kan istället ge en inblick i hur sjukdomen ter sig utifrån kvinnornas egna ord, med ett socialkonstruktionistiskt perspektiv. Kvinnorna i studien skriver i sina bloggar om sin sjukdom och deras relation till den. Genom att studera kvinnornas texter fann vi tre framträdande tolkningsrepertoarer vilka kvinnorna utgår från när de skriver. Dessa tre Det Ljuva livet, Den andra sidan och Vi anorektiker beskriver vilka diskurser de ser sig själva tillhör och vill tillhöra. Kvinnorna beskriver sig själva befinna sig i tolkningsrepertoaren Den andra sidan, en värld som är skild från den ”normala” livet samt tolkningsrepertoaren Vi Anorektiker en tolkningsrepertoar som beskriver kvinnornas syn på anorektiker. Det ljuva livet beskriver den diskurs som kvinnorna önskar sig tillhöra, en diskurs kring hur det är att vara frisk. Utifrån tolkningsrepertoarerna fann vi de fyra subjektspositionerna Den kluvna, Offret, Mitt namn är Anorexia samt Livskamraten. Dessa positioner visar på de olika identiteter som kvinnan kan inta i de rådande tolkningsrepertoarerna. I subjektspositionerna framställs kvinnan som osäker, rädd och ambivalent. Hon förhåller sig till sin sjukdom på olika sätt beroende på vilken position hon befinner sig i, men genomgående är hennes strävan efter kontroll över sig själv och sin sjukdom.

Anorexia nervosa ses som allvarligaste och det tredje mest vanliga tillståndet bland ungdomar. Behandlingsalternativen för personer med anorexia nervosa ser olika ut i olika delar i Sverige men det viktigaste i behandlingen är att bryta svälten och hjälpa till att normalisera ätmönstret. Syftet med denna litteraturöversikt var att belysa vilka faktorer som individer med anorexia nervosa upplever ha betydelse för tillfrisknandet. Studien baserades på 11 kvalitativa vetenskapliga artiklar som hittades via sökningar i databaserna Cinahl, Psycinfo och PubMed. Analysförfarandet skedde med hjälp av manifest innehållsanalys. Vård av personer med diagnosen anorexia nervosa bör handla om att balansera det psykiska och det fysiska tillståndet. Det handlar om en inre motivation hos dessa personer att tillfriskna. I resultatet framkom att självförtroendet var den viktigaste faktorn för en framgångsrik behandling. Samtidigt så hade faktorerna insikt som motivator, tillit, sjukvårdens kunskap och fysisk återhämtning stor betydelse.    Betydelsen av att vårdgivaren möter personen med anorexia nervosa på rätt sätt vid rätt tillfälle och med rätt medel är stor. Det är viktigt att upptäcka förändringsvillighet redan i ett tidigt stadium av sjukdomsförloppet. För att god vård skall kunna uppstå bör synen på framgångsfaktorer, för alla inblandade i vården, inklusive vårdtagaren vara överensstämmande.

Bakgrund: Anorexia nervosa karaktäriseras av en beslutsam strävan efter viktnedgång. Fler kvinnor än män drabbas och sjukdomen debuterar oftast i samband med puberteten. Syfte: Syftet var att belysa anorektikers upplevelser av att leva med anorexia nervosa. Metod: En kvalitativ ansats som baserades på fyra självbiografier. För att få fram biografiernas essens genomfördes en analys som baserades på Graneheim och Lundmans (2004) innehållsanalys. Resultat: Kvinnorna i biografierna uttryckte olika former av lidande. Sjukdomen är ett sätt att uttrycka sin olycka och sitt inre kaos. Den dagliga kampen mellan den friska och den sjuka sidan leder till att kvinnorna känner maktlöshet inför det inre kaos de drabbats av. Den drabbades vardag präglas av tvång, av en inre röst som bestämmer hur personen ska agera samtidigt som självförtroendet sakta men säkert bryts ner. Sjukdomen får dem att tvivla på sig själva och den bidrar till den skeva kroppsbild som är central för sjukdomen. Slutsats: Studien visar att sjukdomen anorexia nervosa är psykisk, fysisk och socialt påfrestande, vilket kräver att vi som vårdpersonal bör ha en bra förståelse och tillräckligt med kunskap som kan underlätta att hjälpa patienterna i deras lidande.

Anorexia Nervosa (AN) has the highest mortality rate of any psychiatric condition, and despite its recognition for centuries, remains a significant treatment challenge. Marked by firmly entrenched maladaptive beliefs about body, weight and food, as well as high rates of psychiatric comorbidity, AN is a chronic illness in a large proportion of patients. The neural substrates of AN are now beginning to emerge, and appear to be related to dysfunctional, primarily limbic, circuits driving pathological thoughts and behaviours. Deep Brain Stimulation (DBS) is a neurosurgical procedure where implanted electrodes are used to regulate activity in critical nodes comprising such aberrant circuits. The promise of DBS in motor-circuit conditions, such as Parkinson’s Disease, has driven it’s investigation in other circuit-based disorders, including some psychiatric conditions. Converging evidence from clinical and imaging literatures suggests that AN is in large part a disorder of emotional processing, wherein disordered mood, anxiety, and affective dysregulation contribute to disease maintenance and are obstacles to effective treatment. The subcallosal cingulate (SCC), a key medial frontal structure involved in affective processing, has further been directly implicated in AN relevant pathways. As such, this work had three broad objectives: i) to establish the safety and initial efficacy of SCC DBS in a group of chronic and highly-refractory AN patients; ii) to show that SCC DBS can have network wide cerebral metabolic influence, on AN-relevant circuits and structures; and, iii) to investigate whether structural brain features, including hippocampal volume changes, are correlated with clinical outcomes of DBS. Our results showed that DBS is safe in AN, and associated in some patients with significant improvements in mood, anxiety and, over time, weight and treatment-response. Imaging results further showed DBS to be associated with substantial changes in glucose utilization in disease-relevant circuits, with preliminary evidence supporting a relationship between hippocampal volume changes and clinical improvements. In the context of highly refractory disease, these promising results suggest that DBS can inform AN circuit models, and be explored as a novel therapeutic option for treatment-resistant patients.

Anorexia Nervosa (AN) has the highest mortality rate of any psychiatric condition, and despite its recognition for centuries, remains a significant treatment challenge. Marked by firmly entrenched maladaptive beliefs about body, weight and food, as well as high rates of psychiatric comorbidity, AN is a chronic illness in a large proportion of patients. The neural substrates of AN are now beginning to emerge, and appear to be related to dysfunctional, primarily limbic, circuits driving pathological thoughts and behaviours. Deep Brain Stimulation (DBS) is a neurosurgical procedure where implanted electrodes are used to regulate activity in critical nodes comprising such aberrant circuits. The promise of DBS in motor-circuit conditions, such as Parkinson’s Disease, has driven it’s investigation in other circuit-based disorders, including some psychiatric conditions. Converging evidence from clinical and imaging literatures suggests that AN is in large part a disorder of emotional processing, wherein disordered mood, anxiety, and affective dysregulation contribute to disease maintenance and are obstacles to effective treatment. The subcallosal cingulate (SCC), a key medial frontal structure involved in affective processing, has further been directly implicated in AN relevant pathways. As such, this work had three broad objectives: i) to establish the safety and initial efficacy of SCC DBS in a group of chronic and highly-refractory AN patients; ii) to show that SCC DBS can have network wide cerebral metabolic influence, on AN-relevant circuits and structures; and, iii) to investigate whether structural brain features, including hippocampal volume changes, are correlated with clinical outcomes of DBS. Our results showed that DBS is safe in AN, and associated in some patients with significant improvements in mood, anxiety and, over time, weight and treatment-response. Imaging results further showed DBS to be associated with substantial changes in glucose utilization in disease-relevant circuits, with preliminary evidence supporting a relationship between hippocampal volume changes and clinical improvements. In the context of highly refractory disease, these promising results suggest that DBS can inform AN circuit models, and be explored as a novel therapeutic option for treatment-resistant patients.

No description available.

Use of language is thought to be particularly important when considering an individual’s motivation to change. The present thesis has expanded on existing knowledge of the relation between motivation to change and psychotherapy outcome for individuals with anorexia nervosa. This was accomplished by rating 148 audiotaped psychotherapy sessions with four measures of motivation to change. Data were derived from an existing clinical trial of three types of psychotherapy (Cognitive-Behaviour Therapy, Interpersonal Therapy, and Specialist Supportive Clinical Management). Three sessions were rated for each of the 53 participants who received up to twenty sessions of psychotherapy, early (sessions 1-5, middle (sessions 6-14), and late (sessions 15-20). Participant expressions of motivation to change were analysed across sessions, within sessions (beginning, mid, and end intervals), by change talk type, and therapy type for those with good and poor outcomes. Resistance and readiness to change, positive psychotherapy process, and readiness to recover from anorexia nervosa were also examined. The main findings were significantly more positive change talk expressed in the beginning than mid and end therapy intervals and significantly more negative change talk expressed in the beginning than end therapy interval and in the mid than end interval. When change talk type was examined, a significant difference in the ratio of positive to negative change talk expressed between change talk types was found. Results from other motivation measures indicated that readiness to change was expressed significantly more frequently in the middle and late than early phase of therapy. There were higher levels of positive process in psychotherapy in the late than early phase of therapy, and higher levels in those with good than poor outcomes. There were significantly higher levels of readiness to recover from anorexia nervosa expressed in the middle and late phases of therapy than in the early phase, and higher levels in those with good than poor outcomes. Limitations to these results include a modest sample size, rater biases, and lack of reliability measures. Notwithstanding these limitations, the present study has produced several potentially important findings that merit further investigation.

Metacognitions play a crucial role in the development and maintenance of psychiatric disorders, such as depression and anxiety. Its function in anorexia nervosa (AN), however, has been neglected. Examining the role of metacognitions in AN may prove useful for developing the AN conceptualization currently lacking. Additionally, it may provide a desperately needed new route for AN treatment, as no efficacious treatment for adult AN is available to date. This study aimed to build on preliminary findings suggesting that individuals with AN are characterized by the cognitive attentional syndrome (CAS), the vital component in the Self-regulatory Executive Function (S-REF) model underlying metacognitive processes. Hence, quantitative and qualitative measures of individuals with AN, dieting, and non-dieting adult women were examined to ascertain whether these groups embodied differences in their metacognitive frequency and nature. ANOVA, bivariate correlation, and ANCOVA were used for data analysis. Findings showed that the AN sample experienced higher overall metacognitions; particularly negative metacognitions and metacognitions around control. When anxiety and depression were controlled for, however, the association became non-significant. Nonetheless, anxious and depressive symptoms are greatly intertwined with eating symptoms and increased metacognitions in the AN sample are still highly plausible. Metacognitive themes endorsed by the AN sample were around sociability and control. Thought control strategies were found to be the same in all groups; however, the AN sample endorsed a higher utilization of punishment and a lower utilization of distraction. Several limitations including small AN sample size and no psychiatric control group should be taken into account. Overall, however, findings suggested that, because the AN sample was characteristic of the CAS and the S-REF model, dysfunctional metacognitions may be worth targeting in AN treatment.