Thesis (Ph. D.)--University of Washington, 2000. / Vita. Includes bibliographical references (leaves 135-140).

Dissertação (mestrado) - Universidade Federal de Santa Catarina, Centro de Filosofia e Ciências Humanas. Programa de Pós-Graduação em Psicologia / Made available in DSpace on 2012-10-23T15:13:46Z (GMT). No. of bitstreams: 1 239604.pdf: 1312685 bytes, checksum: 1368980bb8e6940ac9d5d906403050be (MD5) / Esta pesquisa propõe-se, a partir da perspectiva foucaultiana, a investigar a corporeidade e o corpo anoréxicos, através da arqueologia dos discursos disponibilizados na Internet por sujeitos que se declaram e se vinculam ao movimento virtual denominado Pró-Ana, rede de atuações que se constitui e se coloca a favor da anorexia e a outorga enquanto um estilo de vida. Tais sujeitos em seus weblogs pessoais, constroem diários confessionais de práticas e vigilâncias dietéticas e estéticas, proclamando determinadas formas de relacionarem-se consigos mesmos, tendo como exercícios centrais de si a negação da alimentação e a busca infindável pelo decréscimo de peso. Elaborou-se a arqueologia destes discursos através da análise comparativa de três weblogs (pertencentes a uma adolescente, a uma jovem e a uma adulta), buscando dar visibilidade às tecnologias de si que se dissipam e estruturam a subjetividade anoréxica, e delineou-se, através da leitura de cem weblogs catalogados pela pesquisadora, selecionados aleatoriamente, a genealogia dos poderes que visam estabelecer os regimentos e as características do movimento Pró-Ana (pró-anorexia), objetivando localizar as regularidades do mesmo. O exame do material em questão possibilitou uma contextualização histórica-política do transtorno alimentar #anorexia nervosa#, bem como a reflexão acerca da construção midiática e estética dos corpos extremamente magros da contemporaneidade. Proporcionou, outrossim, constatar que muitos dispositivos e práticas se instituem neste tecido virtual e rizomático, moldando condutas que aproximam a magreza corporal à promessa e à garantia de felicidade futura. Da mesma forma, favoreceu a discussão sobre a insustentável leveza dos exercícios de si, quando vinculados a busca de ideais padronizados de beleza.

The thesis has been prepared in paper based format and includes three papers: paper 1 is a literature review, paper 2 is an empirical study and paper 3 is a critical reflection. Paper 1 has been prepared for submission to Clinical Psychology and Psychotherapy and systematically reviews the qualitative literature pertaining to the process of recovery from anorexia nervosa (AN). A metasynthesis of 12 studies was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) principles. The metasynthesis identified factors that helped and factors that hindered recovery from AN, in addition to offering an interpretation of how these factors underpin the process of recovery. The strengths and limitations of the review are discussed, as are the implications of the findings for clinical practice. Paper 2 has been prepared for submission to the British Journal of Clinical Psychology and is a qualitative exploration of the nature of the relationship between the self and the eating disorder in individuals with a lifetime history of AN. Semi-structured interviews were conducted with 11 women and the interview transcripts analysed using constructivist grounded theory methodology. The results suggested that the self is shared with AN and separating the self from AN has an important role to play in recovery from the disorder. A theoretical framework explaining the nature of the relationship between the self and AN is presented and discussed. The strengths and limitations of the study are considered, as are the implications of the findings on the content of therapeutic interventions. Paper 3 is not intended for publication and is a critical reflection of the research process as a whole. It evaluates the strengths and limitations of both paper 1 and paper 2, in addition to offering a critical review of completing a qualitative research project. Paper 3 also discusses issues surrounding reflexivity, implications of the research for clinical practice/working as a clinical psychologist and draws overall conclusions.

Bakgrund: anorexia nervosa har under de senaste decennierna ökat i Sverige och liknande trend ses även i andra länder. Sjukdomens mångfacetterade och ibland svårförstådda natur baseras på dess upplevda för- och nackdelar. Behandling mot ätstörningar har förhållandevis hög andel som avslutar den i förtid och det påvisas att många uppvisar motvilja till att delta. Syfte: Syftet med studien var att belysa erfarenheter av att leva med anorexia nervosa. Metod: En litteraturbaserad studie baserad på nio kvalitativa forskningsartiklar. Resultat: Ur analysen av datamaterialet framträdde tre kategorier; Ambivalens mellan gott och ont, Ett pendlande känsloliv samt Att andra människor påverkas och påverkar med fyra underkategorier. Slutsats: Att få kunskap om erfarenheter från de som lever med sjukdomen kan öka förståelsen om dess komplexitet. Därmed kan sjuksköterskor förmedla det stöd som behövs för att ge patienten ökad motivation till att bli frisk. / Background: during the last decades anorexia nervosa has had a rising incidence in Sweden as well as in other countries. The disorder may sometimes be difficult to understand due to its multifaceted nature of experienced pros and cons. Furthermore, reluctance toward treatment is frequent among people suffering from anorexia nervosa and treatment for eating disorders have rather high drop-out rates. Aim: The aim of this study was to highlight experiences of living with anorexia nervosa. Method: A literature based study consisting of nine qualitative research articles. Results: Three categories emerged from the analysis; the ambivalence between good and evil, varying emotions and other people are influenced and influences the person with four subcategories. Conclusion: Emphasis on achieving increased knowledge of the lived experiences of anorexia nervosa to enhance understanding for its complexity, might enable nurses’ support-providing to enlarge the patient’s motivation to recovery.

Bakgrund: I grund och botten är människan utseendefixerad och med ett ständigt informationsflöde utsätts den, medvetet eller omedvetet, dagligen för information som förmedlar signaler och budskap om hur man ska se ut och vara. Syfte: Att beskriva vuxna människors upplevelser av att leva med Anorexia Nervosa och hur undersökningsgrupperna i inkluderade studier beskrivs. Metod: Tio kvalitativa studier har granskats, analyserats och sammanställts till litteraturstudiens resultat. De databaser som använts är Cinahl och PubMed. Huvudresultat: Ett av det starkaste inslaget i sjukdomen är känslan av ambivalens, känslan av att sjukdomen är ens bästa vän som man vill vårda och behålla för att inte mista den trygghet den ger. En trygghet att gömma sig bakom, en tröst och en identitet som är väldigt stark. Samtidigt tampas patienterna med viljan att bli frisk som resulterar i känslor som oro, ångest och depression. Metodologisk aspekt: Alla artiklar presenterade sin undersökningsgrupp. Slutsats: Medvetenheten om AN ökar och dessa patienter kan förekomma överallt inom sjukvården. Som grundutbildad sjuksköterska är det troligt att man kommer att möta denna patientgrupp varför det är av största vikt med kunskap om hur människor med AN upplever sin sjukdom. / Background: People are in general obsessed with their looks. With constant influences from the society, people are always vulnerable for daily information which passes signals and messages about how you should look and be. Aim: To describe the adult experience of living with Anorexia Nervosa and the study groups. Method: A quality review with ten qualitative articles which has been analysed and compiled in the result Result: Ambivalence is one of the strongest characteristics of Anorexia Nervosa. The feeling that the disease is your best friend which you want to nurture and keep to feel safe. A security to hide behind, a comfort and identity which is strong. Meanwhile people with AN have to fight with the desire to be healthy which gives them feelings of worry, anxiety and depression. Methodological aspect: All articles presented their study group. Conclusion: The awareness about AN is increasing and these patients can occur everywhere within health-care institutions. A general nurse will probably meet these patients and it’s important to have knowledge about how people with AN experience their disease.

Os transtornos alimentares se caracterizam por comportamentos inadequados no consumo e padrão alimentar, além de crenças equivocadas sobre alimentação, que ocasionam uma piora da qualidade nutricional. Os Transtornos alimentares são determinados por uma etiologia multifatorial, onde os fatores socioculturais, as diferenças étnicas e psicossociais, associados à vulnerabilidade biológica, tem grande importância no desencadeamento, manutenção e perpetuação dos sintomas alimentares. Na Anorexia Nervosa o medo intenso ou mórbido de engordar representa o aspecto psicopatológico central desta doença. Estes pacientes caracterizam-se por uma excessiva perturbação da imagem corporal e pela busca incessante da magreza. Em função do medo de engordar, são incapazes de manter o peso em medidas ideais, além de apresentarem comportamentos alimentares inadequados na intenção de perpetuar o baixo peso. Para a compreensão dinâmica da personalidade destes pacientes é de extrema importância o conhecimento da personalidade na patogênese e patoplastia deste transtorno. Neste sentido, o Inventário de Temperamento e Caráter avalia fatores de temperamento e caráter aplicados à percepção dos traços de personalidade de pacientes com o transtorno alimentar, no caso, Anorexia Nervosa. Este trabalho teve como o objetivo avaliar os traços de personalidade, segundo o Inventário de Temperamento e Caráter (ITC), em pacientes com anorexia nervosa e compara-los a um grupo controle. Os RESUMO resultados indicaram que estes pacientes apresentam características sóciodemográficas de uma população jovem, com início do transtorno na adolescência, composta por mulheres, de etnia branca e solteiras. Os pacientes com Anorexia Nervosa diferenciam-se do grupo controle devido à presença de sintomatologia depressiva moderada pelo BDI. Além disso, na avaliação de personalidade confirmou-se a presença de elevados traços em esquiva ao dano e diminuídos em autodirecionamento nos pacientes com AN comparados aos controles normais. Houve diferenciação entre o grupo restritivo e purgativo na dimensão busca de novidades. A exclusão de pacientes com sintomatologia depressiva grave não interferiu na análise dos resultados dos traços de personalidade. / The eating disorders are characterized by behavior not good in consumption and dietary patterns, and wrong beliefs about diet that cause a worser nutritional quality. The Eating disorders are determined by a multifactorial etiology, where the sociocultural factors, psychosocial and ethnic differences associated to the biological vulnerability, have been great importance in triggering, maintenance and perpetuation of food´s symptoms. In anorexia nervosa the intense fear or morbid to be fat is the psychopathological central aspect of this disease. These patients are characterized by an excessive disturbance of theirs body image and the incessant quest for thinness. Depending on the fear of fat, are unable to keep the weight on measures ideals, and doing inadequate eat in order to perpetuate the low weight. To understand the dynamics of personality of these patients is very important knowledge of the personality and patoplasty in the pathogenesis of this disorder. In this case the Inventory of Temperament and Character value factors of temperament and character applied to the perception of the personality traits of patients with the eating disorder, in the case, anorexia nervosa. This study have been evaluate how the traits of personality, according to the inventory of Temperament and Character (ITC) in patients to anorexia nervosa and compares them to a control group. The results indicated that these patients present social-demographic characteristics of a young population, beginning the disorder in adolescence, composed of women, which ethnic white and single. Patients with anorexia nervosa are differentiated from the ABSTRACT control group because of the presence of moderate depressive symptoms by BDI. Also, the personality avaliation is confirmed the presence of high traits damage and reduced in selfdirection in patients with AN compared with normal controls. There was differentiation between the restrictive group and purgative in a dimension a search of news. The exclusion of patients with severe depressive symptoms had not been interfered in the analysis of the results in a personality traits.

Esta pesquisa parte da constatação clínica de que os sujeitos anoréxicos apresentam subjetividades uniformizadas e uma propensão à homogeneidade discursiva e atitudinal entre si. Tal identidade levanta a hipótese sobre a presença de um tipo de contágio psíquico entre as pacientes anoréxicas. Consideramos a epidemia anoréxica como um movimento coletivo definido por uma mesma narrativa de sofrimento, que possui uma frequência significativamente relevante, entre mulheres jovens, de aproximadamente 0,4% ao ano. Investigamos o conceito de identificação em Freud e em Lacan, e encontramos comentadores que tratam da identificação na anorexia, sugerindo a presença de um tipo especial de identificação necessário para explicar a noção de epidemia anoréxica. Tal hipótese nos levou simultaneamente a um modelo epidemiológico psicanalítico para certas formas de sofrimento que se propagam, historicamente, sob a forma de um contágio psíquico. Localizamos a epidemia anoréxica na identificação imaginária, do estádio do espelho, e a relacionamos ao discurso do capitalista e a uma comunidade de gozo. O fracasso da identificação narcísica nas anorexias severas mais especificamente as falhas na constituição da unidade da imagem é responsável por um excesso no plano da identificação imaginária entre as anoréxicas, que se identificam com o semblante do sintoma. Os sujeitos nas anorexias severas fazem epidemia para se livrarem do saber inconsciente, e se fixam num gozo autístico, que exclui o Outro. A psicanálise que se propõe a tratar o sofrimento, e não o sintoma aborda o que fica de fora da comunidade de gozo. Como resultado, postulamos que o conceito de identificação na epidemia anoréxica é importante para o tratamento institucional da anorexia, incluindo a fundamentação de projetos terapêuticos / This research is based on the clinical finding that anorexic subjects show, among them, standardized subjectivities and a tendency to homogeneity in discourse and attitude. That identity leads to the hypothesis of the presence of a type of psychic transmition among anorexic patients. We have considered anorexic epidemics as a groupal movement defined by the same suffering narrative, with significantly relevant frequency among young women, of approximately 0.4% per year. We have investigated the concept of identification in Freud and in Lacan theories and found commentators who treat anorexia identification suggesting the presence of a special type of identification necessary to explain the notion of anorexic epidemics. Simultaneously, such hypothesis has led us to a psychoanalytic epidemiologic model for certain forms of suffering historically spread as psychic transmition. We have found the anorexic epidemics in the imaginary identification of the mirror stage and established its relationship to the capitalist discourse and to a joy community. Failure of a narcissist identification in severe anorexics more specifically failures in the constitution of the image unit , is responsible for excess in the level of the imaginary identification among anorexics who identify themselves with the symptom semblance. The subjects in severe anorexia make epidemics to become free from the unconscious knowledge, and stick to an autistic joy which excludes the Other. The Psychoanalysis that proposes treating the suffering and not the symptom, addresses to what is outside the joy community. As a result of this research, we have postulated that the concept of identification in anorexic epidemics is important to the institutional treatment of anorexia and serves as basis for therapeutic projects

Thesis (M.A.)--Georgia State University, 2007. / Cynthia Hoffner, committee chair; Jaye Atkinson, Mary Ann Romski, committee members. Electronic text (90 p.) : digital, PDF file. Title from file title page. Description based on contents viewed Dec. 14, 2007. Includes bibliographical references (p. 67-74).

BAKGRUND: Anorexia nervosa är latin och betyder ”nervös aptitlöshet” och det som präglar sjukdomen är självförvållad svält. Sjukdomen börjar vanligtvis med en bantning för att gå ned i vikt som spårar ur.  Anorexia nervosa förkommer hos cirka 1 % unga kvinnor, vilka också är de som drabbas i störst utsträckning. En rad allvarliga somatiska komplikationer kan ses till följd av sjukdomen som i svåra fall kan leda till döden.  Sjukdomen är individuell och det finns av den anledningen ingen självklar behandling. SYFTE: Syftet med studien är att beskriva kvinnors upplevelser av vändpunkter vid anorexia nervosa efter tillfrisknande. METOD: Fem självbiografier analyserades med hjälp av kvalitativ innehållsanalys. RESULTAT: Den kvalitativa innehållsanalysen resulterade i fyra kategorier som beskrev vändpunkter vid anorexia nervosa efter tillfrisknande: Sjukdomsinsikt, Motivation, Tillit samt Beslut. Tillfriskningsprocessen har visat sig vara individuell och olika kvinnor i studien har upplevt olika kombinationer av de nämnda vändpunkterna i tillfrisknandet. DISKUSSION: Sjukdomsinsikt har visat sig vara den viktigaste vändpunkten vid tillfrisknande i anorexia nervosa. Om en person inte vet om att hon eller han är sjuk, är det svårt att bli frisk. / BACKGROUND: Anorexia nervosa is latin for “nervous appetite lose” and what characterizes the disease is self-starvation. It usually starts with dieting to lose weight which loses control. Anorexia nervosa exists in about 1 % of all young women, and young women are also in the front of the disease. A number of serious somatic complications can follow the disease which in severe cases can cause death. The disease is individual and there is no obvious treatment. AIM: The aim of the study is to describe woman’s experiences of the turning-points in anorexia nervosa after recovery. METHOD: Five autobiographies were analyzed with qualitative content analysis. RESULTS: Qualitative analyses revealed four core categories who described the turning points of recovery in anorexia nervosa: Awareness of disease, Motivation, Trust and Decision. The recovery has proved to be individual and different women in the study have experienced different combinations of those turning-points for recovery. DISCUSSION: Awareness of disease provides to be the most essential turning-point for recovery in anorexia nervosa. If a person doesn’t know she or he is sick, there is no reason to get well.

Bakgrund: Anorexia nervosa innebär att under en tid avsiktligen undvika intag av kaloririk föda. Ofta går även kroppsaktiviteten till överdrift. Statistik visar på att en procent av Sveriges befolkning i åldrarna 13-30 har diagnosen. Då sjukdomen inte är ovanlig är det av stor vikt att sjuksköterskan har kunskap om sjukdomen och personernas upplevelse. Syfte: Personers upplevelse av att leva med anorexia nervosa. Metod: En systematisk och strukturerad litteraturstudie. Resultat: Det var lättare att underhålla anorexin än att ta tag i sjukdomen på grund utav ett inre kaos av känslor. Att leva med ständig kontroll och identifiera sig med sjukdomen var vanligt. Stöd från personal och närstående var av betydelse och brist på detta upplevdes som negativt i återhämtningen. Diskussion: Personerna med anorexia nervosa upplevde det som att de skapade en ny identitet som gav de mening med livet. Personerna önskade att få förståelse och stöd från närstående och personal, för att kunna tillgodose sig en god återhämtning. Slutsats: För att uppnå en optimal omvårdnad krävs det att sjuksköterskan utgår från en personcentreradvård och ökar sin förståelse för anorexia nervosa. / Background: Anorexia nervosa means that for a time deliberately avoid intake of high calorie foods, and where physical activity is an exaggeration. As statistics show that one percent of the Swedish population aged 13-30 are diagnosed with anorexia nervosa, it is of great importance that nurses are knowledgeable about the disease and the individual’s experience. Purpose: Persons with experience of living with anorexia nervosa. Method: A systematic and structured literature. Results: It was easier to maintain anorexia than fighting the disease because out of an inner turmoil of emotions. Living with constant control and identify oneself with the disease was common. Support from professionals and family were important and the lack of this was perceived as a negative in the recovery. Discussion: The persons with anorexia nervosa experienced it as if they created a new identity that gave meaning to life. The people wanted to get understanding and support from family and staff, in order to reach recovery. Conclusion: To achieve optimal care requires that the nursing is based on a person-centered care as well as a deeper understanding of the meaning of living with anorexia nervosa