Made available in DSpace on 2014-06-12T22:58:49Z (GMT). No. of bitstreams: 2 arquivo4164_1.pdf: 1985097 bytes, checksum: fb5a7c489c24f882d9786d4fc3193884 (MD5) license.txt: 1748 bytes, checksum: 8a4605be74aa9ea9d79846c1fba20a33 (MD5) Previous issue date: 2008 / Os transtornos alimentares (TAs) são síndromes comportamentais cujos critérios diagnósticos têm sido amplamente estudados nos últimos 30 anos. Suas primeiras manifestações são na infância e na adolescência, podendo apresentar efeitos nocivos sobre a saúde bucal. O objetivo deste estudo foi determinar a prevalência das principais complicações clínicas bucais encontradas entre adolescentes de 12 e 16 anos de idade, estudantes de escolas públicas estaduais na cidade do Recife, Brasil, nos anos de 2007 e 2008, que apresentavam sintomas de TAs, verificando a existência de associações entre as lesões encontradas, os gêneros, faixas etárias, fatores biodemográficos e socioeconômicos e sintomas depressivos. Foram examinados 650 estudantes através das escalas EAT-26, BITE e QAEH-D. Todos os adolescentes passaram também por um exame clínico bucal para a identificação de lesões. A prevalência de lesões bucais na população com sintomas de TAs, segundo as escalas EAT-26 e BITE, respectivamente, foi de: 33,0% e 33,1% para mucosites, com localização mais freqüente no palato; 34,4% e 27,8% para queilites; 47% e 54,4% para hipertrofia das glândulas salivares, acometendo com maior freqüência as glândulas parótidas; 52,1% e 57,3% para gengivites, cujo IPV, em sua maioria, foi considerado moderado (42,7% e 45,8%) e ISG, leve (57,2% e 52,0%); 56,7% e 59,3% para erosões dentais, mais freqüentes nas faces palatinas e linguais dos elementos anteriores; 69,3% e 66,9% para experiência de cárie, cujo CPO-D médio foi considerado como prevalência moderada (3,15 e 3,24) e 56,7% e 55,6% para bruxismo. Entre as lesões bucais foram observadas associações significativas com a presença de sintomas de TAs nas mucosites, queilites, hipertrofia das glândulas salivares e erosões, o que não ocorreu na gengivite, na experiência de cárie e nos índices IPV, ISG e CPO-D e no bruxismo. A prevalência de adolescentes com sintomas de TAs foi de 33,1%, segundo a escala EAT-26 e 1,7% (escore elevado) e 36,5% (escore médio), na escala BITE, sendo maior entre o gênero feminino e na idade de 13 anos, apresentando associação significativa apenas no EAT-26. Com relação aos fatores socioeconômicos e biodemográficos, o fato de ter irmãos, ser o filho caçula, morar numa residência com um número de até 2 cômodos, responsáveis analfabetos ou de escolaridade de nível fundamental, segundo a escala EAT-26, mostraram associação com a presença de sintomas dos TAs. Esta associação, segundo a escala BITE, foi mostrada apenas com relação ao analfabetismo do responsável. A prevalência de sintomas depressivos na população geral foi de 29,8%, segundo a escala QAEH-D. Entre os adolescentes com sintomas de TAs, segundo as escalas EAT-26 e BITE, esta prevalência foi de 44,2% e 62,1%, apresentando associação significativa. Após a análise dos dados pode-se concluir que a presença de alterações bucais como erosões dentais, hipertrofias de glândulas salivares, mucosites e queilites está associada aos sintomas de TAs, podendo auxiliar da detecção precoce de casos subclínicos, antes da instalação da síndrome completa. O conhecimento dessas alterações por parte do dentista possibilitará o encaminhamento do adolescente a um tratamento integral, que envolve a participação de uma equipe multidisciplinar

This inquiry adopts the non-dualist stance of Merleau-Ponty regarding embodiment, where the “body” is considered to be a socially embedded lived experience (Merleau-Ponty, 1945/1962), and considers whether this concept is useful to counselling psychologists who work with individuals with a diagnosis of anorexia nervosa. The study adopts a horizonal structure arising from understandings of Gadamer’s (1960) hermeneutics, which requires an awareness of the limitations afforded by different perspectives. Semi-structured interviews are conducted with eight practitioners of psychotherapy, who have experience with individuals diagnosed with anorexia nervosa. They are invited to speak about their experience of practice with these individuals, then to respond to a Merleau-Ponty quote regarding embodiment and to consider its usefulness in their work. Interview transcripts are thematically analysed (Braun & Clarke, 2006). Initial themes conceptualise anorexia nervosa as emotional control and denial of needs; where it is helpful to have a model of understanding; understand weight issues but don’t’ talk about food and weight, be aware of power-relations and avoid control battles, overemphasising weight gain and refeeding; and to understand ambivalence and work motivationally. The findings suggest practitioners use knowledge, in the form of theories, to provide structure and a familiar language with which to explore clients’ unfamiliar worlds. Embodied views are found to open up conceptualisations regarding ontology and embeddedness, where “anorexia” becomes an ontological split, with controlling minds punishing bodies, where words aren’t enough and the symptoms are a paradoxical solution to problems of power and agency. The study finds engaging with embodied views highlights the embedded nature of being, opens up ambiguity, challenges dichotomies and acknowledges non-psychological aspects of existence and practice. It is suggested this supports the humanistic value base of counselling psychology practice by raising awareness of the ways in which the use of theory iii can help and hinder intersubjective contact with clients and the importance of embodying hermeneutic openness.

Magister Psychologiae - MPsych / Anorexia nervosa is a debilitating disorder with dangerous potential health consequences. Body dissatisfaction is an important aetiological aspect of the development and maintenance of Anorexia Nervosa (AN). The purpose of this research study was to ascertain how clinical psychologists assess body dissatisfaction and how they formulate treatment for AN considering body dissatisfaction. In this qualitative study, semi-structured interviews were conducted with 9 registered clinical psychologists who specifically work in the area of eating disorders. The information provided by the participants was analysed using thematic analysis. Participants were recruited using snowball sampling. Sampling, data collection and analysis occurred concurrently until saturation was reached after 9 interviews have been conducted. Permission to conduct the study was obtained from the Senate Research Ethics Committee (Social and Human Sciences) of the university of the Western Cape. Participation was voluntary and could be withdrawn at any time without fear of negative consequence or loss of perceived benefit. Ethics principles were strictly adhered to in the management of data and dissemination of findings. Potential participants received an information sheet detailing what participation entailed, as well as the rights and responsibilities of the student researcher and research participants respectively. An indication was also provided of the recourse participants had in the event of dissatisfaction with or concerns about the study. The research contributed to the knowledge base of how body dissatisfaction is conceptualised and operationalised in treatment planning for patients presenting with AN. Findings revealed that the role of theory is essential as it facilitates an explanatory system, which creates an understanding of body dissatisfaction in AN. Another finding was that the participants had their own subjective operationalisation of body dissatisfaction but feels that it is important to formally operationalise body dissatisfaction in anorexia nervosa. In terms of treatment, the participants believed that a multimodal approach is the most beneficial when treating body dissatisfaction in anorexia nervosa.

Ätstörningen anorexia nervosa är ett samhällsproblem som har sin historia långt bak i tiden. Trots det finns det inte särskilt mycket forskning om de som har sjukdomen eller om de som arbetar med det. Syftet med denna kandidatuppsats var därmed att belysa de professionellas kunskaper och erfarenheter i arbetet med ungdomar (13–16 år) som har diagnostiserats med anorexia nervosa. Vilka behandlingar erbjuds det för dessa ungdomar och vilka är de betydelsefulla faktorerna för ett tillfrisknande? Med hjälp av undersökningens resultat insåg vi vilken betydelsefull roll den professionella kan ha i en sådan komplex situation som patienten befinner sig. Det gav oss även en inblick i hur det socialpedagogiska förhållningssättet kan tillämpas i ett sådant arbete. Resultatet visar att familjebaserad terapi (FBT) är den behandling som används mest för ungdomar med anorexia nervosa, vilket stämmer överens med tidigare forskning. Det visar även att arbetet bygger på relationer, där den professionella behöver ta hänsyn till många olika faktorer som berör patienten samt att det kan vara svårt att räcka till för dem som behöver mer omfattande vård. Undersökningen utgår ifrån en kvalitativ metod, med semistrukturerade intervjuer, samt utifrån Aaron Antonovskys teori om Känsla av sammanhang (KASAM). / The eating disorder anorexia nervosa is a societal problem that has a long history. Despite this, there is not much research on those who have the disease or on those who work with it. The aim of this bachelor’s thesis was thus to illustrate the professionals’ knowledge and experience in the work with adolescences (13-16 years old) who have been diagnosed with anorexia nervosa. What treatment is offered to young people and what are the important factors for recovery? The results of the survey made us realize what significant role the professional can play in such complex situation as a patient. It also gave us an insight into how the social pedagogical approach can be applied in such work. The results show that family-based therapy (FBT) is the most commonly treatment, used for adolescents with anorexia nervosa, which is consistent with previous research. It also shows that the work is based on relationships, where the professional needs to make allowances for many different factors that affect the patient and that it can be difficult to suffice for those who need more comprehensive care. The survey is based on a qualitative method, with semi-structured interviews, and based on Aaron Antonovsky’s theory Sence of coherence (SOC).

Anorexia Nervosa (AN) är en sjukdom då den drabbade svälter sig själv. Oftast är den drabbade en flicka i tonåren, men även pojkar och vuxna kvinnor och män kan drabbas. Prevalensen beräknas vara cirka en procent i västvärlden. Tidigare har forskningen fokuserat på den sociala sidan av saken, skönhetsideal och smalhets. Men på senare tid har forskarna börjat intressera sig mer för den kroppsliga sidan av saken, till exempel arv och olika kroppsliga substanser. Den här litteraturstudien fokuserar på dopamin, ghrelin och östrogen och vilken betydelse de tros ha för AN. Sex artiklar, funna i databaserna PubMed, SwePub och OneSearch, har granskats. Syftet med denna litteraturstudie var att ta reda på ifall dopamin, ghrelin och östrogen har någon betydelse för sjukdomen AN. Frågeställningarna var  ”har anorektiker högre eller lägre dopaminhalt än friska?”, ”syns skillnader i ghrelinhalt och ghrelinrespons även hos individer som återhämtat sig från AN?” och ”kan östrogen vara orsaken till att AN är vanligare hos kvinnor?”. AN är en komplex sjukdom och frågorna har visat sig vara svåra att besvara. Efter att artiklar och bakgrundsinformation analyserats har slutsatsen blivit att olika forskare kommit till olika resultat, vilket betyder att mer forskning behövs för att få fram tydliga svar på frågeställningarna. Dopamin, ghrelin och östrogen är dock alla substanser som är intressanta att forska vidare på då det gäller AN.

Eating-disorder clients show low motivation, poor follow-through, and inordinate premature dropout rates in treatment. To date, little research has been conducted that might provide clinicians with an understanding of the critical factors that may aid clients' recovery. Such factors may be used by clinicians to better motivate clients to collaborate in treatment. The purpose of this study was to identify some of the critical factors that women with eating disorders believed were crucial in prompting or facilitating their recovery. Identification of these factors was accomplished through a systematic content analysis of semistructured interviews with recovered or recovering bulimics and anorexics. This study may contribute significantly to future research into the development of motivational supplements to eating disorder therapy (e.g., psychoeducational materials or therapy orientation programs). Of interest were what personal, interpersonal, or environmental factors anorexic and bulimic clients reported increased their motivation to recover, and prompted them to begin the recovery process, maintain recovery, and cope with the threat ofrelapse. Also, factors that subjects reported hindered their progress in recovery were examined. The anorexic and bulimic subjects reported social support as a critical factor across three stages of recovery, including beginning recovery, maintaining recovery, and coping with relapse. Being "tired" of the disorder and therapy were indicated to be relevant to beginning recovery. Improved self-esteem was deemed significant in helping subjects both maintain recovery and cope with the threat of relapse. Establishing healthy eating habits and attitudes was a necessary factor required to maintain recovery. Subjects shared that developing healthy ways to deal with emotions enabled them to deal successfully with the threat of relapse. Anorexic subjects reported that people and societal expectations, fear of becoming fat, incentive to numb emotions, and poor eating habits and attitudes impeded their recovery. Bulimic subjects indicated that people and societal expectations, incentive to numb emotions, lack of understanding, and poor eating habits and attitudes hindered their recovery.

Eating disorders have a dramatic effect on the lives of people who struggle with them, including cardiovascular and gastrointestinal problems, and death. Individuals with these diagnoses are also often struggling with comorbid diagnoses such as depression, anxiety, and substance abuse/dependence. Building on a conceptualization of eating disorders as a means to dysfunctionally regulate negative affect and escape unwanted thoughts, psychological flexibility, the ability of a person to contact unwanted thoughts or feelings and behave without escape or avoidance, is investigated as a tool for treatment. Additionally, because quantitative analysis of the construct of psychological flexibility has often employed the use of college samples, this study employed a sample of participants drawn from a residential treatment facility dedicated to the treatment of eating disorders. Through regression and modeling, psychological flexibility demonstrates its utility in the treatment of eating disorders through its relationship with body dissatisfaction and quality of life.

Ziel: Das Ziel der explorativen Studie war es, erwachsene Patientinnen mit restriktiver bzw. bulimischer Anorexie oder Bulimie mit einer starken Inanspruchnahme von stationären Versorgungsleistungen, sogenannte Heavy User (HU), die eine vollstationäre Behandlung in der Klinik und Poliklinik für Psychiatrie, Psychosomatik und Psychotherapie des Universitätsklinikums Würzburg erhalten haben, zu beschreiben, soziodemographische sowie erkrankungsbezogene somatische und kognitive Charakteristika darzustellen und die Ergebnisse mit einer Kontrollgruppe aus Patientinnen mit dem gleichen Störungsbild, aber einer geringeren Inanspruchnahme medizinischer Versorgungsangebote, den Nicht-Heavy Usern (NHU), zu vergleichen. Teilnehmer und Methode: 23 anorektische bzw. bulimische Heavy User-Patientinnen, die sich im Zeitraum der Datenerhebung (1997-2008) zum mindestens dritten Mal in einer stationären Therapie aufgrund ihrer Essstörung befanden, und eine Vergleichsgruppe von 13 Nicht-Heavy User-Patientinnen mit höchstens einem stationären Voraufenthalt wurden in dieser Studie untersucht. Allgemein- und neurologischer Status sowie die Laborparameter zum Aufnahmezeitpunkt und die Auswertungen der kranialen CTs bzw. MRTs sowie der kognitiven Testverfahren zu Beginn der Therapie und vor der Entlassung wurden analysiert und miteinander verglichen. Ergebnisse und Schlußfolgerung: Die anorektischen und bulimischen Heavy User weisen viele auffällige somatische Befunde, von der Norm abweichende Laborparameter sowie im Falle der anorektischen Heavy User eine häufig bestehende Hirnatrophie auf. Darüber hinaus zeigen sie eine Reihe von kognitiven Defiziten in verschiedenen Bereichen. Am stärksten davon betroffen sind die restriktiv anorektischen Heavy User. Die Ausprägungen der untersuchten pathologischen Befunde unterscheiden sich jedoch nicht signifikant von denen der Nicht-Heavy User. Spezifische Eigenschaften der Heavy User, die es zulassen, sie von einem Nicht-Heavy User abzugrenzen, wurden nicht gefunden. Weitere Studien sind notwendig, um andere typische Merkmale der Heavy User zu eruieren, damit sie möglichst frühzeitig identifiziert und ihnen für sie geeignetere alternative Behandlungsmöglichkeiten angeboten werden können. / Objective: The objective of this explorative study was to describe female adult patients with restricting- respectively purging-type anorexia nervosa or bulimia nervosa with a high use of hospital services, so called heavy users, who received full inpatient treatment in the Clinics and Polyclinics for Psychiatry, Psychosomatics and Psychotherapy of the University Hospital of Würzburg, to show sociodemographic and disease-related somatic and cognitive characteristics and to compare the results with a control group of female patients with the same disorder, but a reduced demand of healthcare offerings, the non-heavy users. Patients and Methods: 23 anorectic respectively bulimic female heavy user patients, who were for at least the third time in inpatient treatment due to their eating disorder, and a comparison group of 13 female non-heavy user patients with a maximum of one inpatient prior stay were studied. General and neurological status, as well as the laboratory parameters at the time of exposure and the evaluation of the cranial CTs or MRTs plus the cognitive test methods at the beginning of the therapy and before discharge were analysed and compared with each other. Results and Conclusion: The anorectic and bulimic heavy users show a lot of noticeable somatic findings, laboratory parameters deviating from the norm and in case of the anorectic heavy users an often existing atrophy of the brain. Furthermore they present a series of cognitive deficits in various sectors. The most affected are the heavy users with restricting-type anorexia nervosa. The manifestations of the examined pathological findings are not significantly different from those of the non-heavy users. Specific characteristics of the heavy users which permit to differentiate them from a non-heavy user were not found. Further studies are necessary, to determine other typical features of heavy users, in order to identify them as early as possible and offer them more suitable alternative treatment options.

In dieser Arbeit wurde die Herzratenvariabilität (HRV), das Interbeat-Intervall (IBI) sowie die Beziehung zwischen HRV und IBI bei gesunden Probanden, bradykarden Patienten mit einer Mutation im hyperpolarization-activated cyclic nucleotide-gated channel 4-(HCN4) Gen sowie Patienten mit einer Anorexie nervosa (AN) untersucht. Die Haupthypothese lautete, dass die bei Patienten mit AN oft zu beobachtenden Bradykardien durch neurale Mechanismen verursacht werden. Daher wurde angenommen, dass ein Sättigungseffekt der HRV/IBI Beziehung infolge einer anhaltenden parasympathischen Kontrolle des Sinusknotenareals lediglich bei Patienten mit einer AN nachzuweisen ist. In dieser Arbeit konnte ein Sättigungseffekt der HRV/IBI-Beziehung bei Patienten mit einer Anorexia nervosa sowie bei zwei von vier Patienten mit einer HCN4-Mutation nachgewiesen werden. Bei Kontrollen konnten hingegen kaum Zeichen eines Sättigungseffekts der HRV/IBI Beziehung nachgewiesen werden. Es wurde daher geschlussfolgert, dass ein Sättigungseffekt der HRV/IBI Beziehung keine parasympathisch-vermittelte Bradykardie beweist. Es zeigt sich vielmehr, dass die Regulation des HCN4-Gens für die Bradykardie und den festgestellten HRV-Sättigungseffekt bei Patienten mit einer AN verantwortlich sein könnte. / We examined heart rate variability (HRV), interbeat interval (IBI), and the HRV/IBI interrelationship in three groups of patients: healthy subjects, carriers of bradycardic hyperpolarization-activated cyclic nucleotide-gated channel 4 (HCN4) mutations, and patients with anorexia nervosa (AN) to investigate if neural mechanisms control bradycardia in patients with AN. We speculated that HRV/IBI saturation due to parasympathetic control of the sinus node is detectable in patients with AN. The relationship between IBI and HRV showed saturation in patients with AN, while HRV saturation was present in two of four HCN4 mutation carriers. HRV saturation was not observed in control subjects. We conclude that HRV saturation does not prove that bradycardia is modulated by the parasympathetic nervous system. Rather, HCN4 downregulation may be responsible for bradycardia and HRV saturation in patients with AN.

The purpose of this study was to examine the relationships between family differentiation, family recreation and symptoms of eating disorders. The Family Intrusiveness Scales, the Perceived Social Support from Family, the Family Leisure Activity Profile and the Eating Attitudes Test were used. Participants were students at two large universities, one in the East and one in the West. Data were analyzed using correlation and ANCOVA. Findings supported the hypothesis that a positive relationship exists between family leisure involvement and family differentiation. In addition, a negative relationship between family differentiation and symptoms of eating disorders for individuals whose parents are not in their first marriage was indicated by the results.