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

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

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

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.