Using Grounded theory this thesis analyses the forms of support that are present on two online anorexia forums. Data was collected through non-participant observation and online interviews with members of two online anorexia forums, one pro-anorexic in orientation, one pro-recovery. Despite the clear differences that exist between the two communities, continuities are strongly apparent, especially when looking at these forums as support environments. This thesis illustrates that support is conditional, that is takes on a variety of forms in any one environment and highlights the role of offline discourses in shaping online support. It also provides an in-depth comparison of two online anorexia forums.

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Bakgrund: Anorexia nervosa är en ätstörning där personerna har en förvrängd kroppsuppfattning och en intensiv rädsla för att gå upp i vikt. Detta leder till att personen använder olika metoder för att få en så låg kroppsvikt som möjligt. Sjukdomen debuterar ofta i tonåren och påverkar främst kvinnor. Syfte: Att beskriva unga kvinnors (12-25år) erfarenheter av omvårdnaden med Anorexia nervosa samt granska de inkluderade artiklarnas datainsamlingsmetod. Metod: Designen för litteraturstudien var deskriptiv och tio kvalitativa vetenskapliga artiklar inkluderades i resultatet. För att hitta dessa användes databaserna Cinahl, Medline och Scopus. Huvudresultat: I föreliggande studie har det visat sig att en god vårdrelation bidrar till trygghet och motivation till att tillfriskna. Det finns både negativa och positiva aspekter med att vårdas i grupp. Patienterna kunde hitta stöd hos varandra men samtidigt uppstod det ofta konkurrens mellan dem. Att ha strikta restriktioner i behandlingen upplevdes som något positivt hos vissa medan det skapade frustration hos andra. Många patienter ansåg att för mycket fokus låg på den fysiska återhämtningen medans det psykologiska stödet saknades. Slutsats: Tillit, respekt och förtroende behövs för att upprätthålla en god vårdrelation. En individualisering av vården behövs för att öka förutsättningarna för en optimal omvårdnad. Då Anorexia nervosa i grunden är ett psykiskt problem bör hela personen behandlas annars är risken för återfall stor. Det är även viktigt med information och adekvata motiveringar till de strikta metoderna i behandlingen.

The eating disorders, encompassing both bulimia and anorexia nervosa, have become a matter of increasing concern for mental health professionals. The presence of bulimic symptoms within the syndrome of anorexia nervosa has been associated with greater individual and family psychopathology as well as with poorer prognosis when compared to restricter type anorectics. This study hypothesizes that when compared with a normal control group, non-anorectic bulimics would show higher levels of individual psychopathology and family dysfunction, and more disordered eating attitudes and behaviors. This study further hypothesizes that an anorectic group would exhibit a similar pattern on these variables due to the presence of bulimic symptoms in many anorectics. These hypotheses were confirmed and support was generated for the proposition that bulimia even in normal weight persons is associated with significant pathology comparable to that documented in the bulimic subtype of anorexia nervosa.

Anorexia nervosa är den allvarligare och mest omtalade formen av ätstörning. Sjukdomen är ett självinducerat svälttillstånd då de drabbade bekämpar hunger och sina impulser att äta. Ätstörningar som anorexia är ett växande problem. Endast en del patienter tillfrisknar och behandlingen tar lång tid. Det är viktigt att sjuksköterskor har kunskap om patienters erfarenhet av behandling. Med denna kunskap kan sjuksköterskan bemöta, förstå och behandla patienter på rätt sätt. Syftet är att belysa patienters upplevelser av omvårdnad vid behandling av anorexia nervosa. Metoden är en allmän litteraturstudie av tio vetenskapliga artiklar som sammanställdes i ett resultat. I resultatet kom det fram sex teman: tillit till andra, förståelse från andra, känsla av att bli omhändertagen, andra som förebilder, stöd i behandlingen och upplevelser av autonomi. Det visar att patienter har olika upplevelser av omvårdnad vid behandling och att de har olika behov i sin behandling mot anorexia nervosa. Slutsatserna är att vårdandet bör vara individcentrerad för att kunna tillfredsställa olika behov samt att vårdpersonalens omvårdnad är viktig för patientens tillfrisknande. / Anorexia nervosa is the most serious and the most discussed about form of eating disorder. The disease is a self-induced starvation where sufferers fight hunger and its impulses to eat. Eating disorders like anorexia are a growing problem. Only some patients recover and the treatment takes a long time. It is important that nurses have knowledge of patients' experience of treatment. With this knowledge the nurse can understand and treat patients properly. The aim is to illuminate patients' experiences of care in the treatment of anorexia nervosa. The method is a literature review that consisted of ten articles that were compiled in a result. The results revealed six themes: trust in others, understanding of others, feeling of being taken care of, others as role models, support in treatment and experience of autonomy. It shows that patients have different experiences of care in treatment and that they have different needs in their treatment for anorexia nervosa. The conclusions are that caring should be focused on the individual in order to satisfy different needs and that nursing staff care is important for the patient's recovery.

Bakgrund: Anorexia Nervosa är en psykiatrisk sjukdom som främst drabbar unga kvinnor mellan 15 och 23 år med hög mortalitet. Sjukdomen orsakar ätstörning vilket medför kraftig viktnedgång. Syftet: Syftet är att beskriva kvinnors upplevelser av att leva med Anorexia Nervosa. Metod: Denna studie är genomförd av kvalitativ metod med analys av narratives. Datainsamlingen är baserad på fyra självbiografier skrivna av kvinnor som drabbats av Anorexia Nervosa. Resultat: Resultatet visade att samtliga kvinnor har haft olika upplevelser av Anorexia Nervosa. Kvinnornas upplevelser delas in i tre olika teman vilket förtydligades med citat. Teman som beskrivs avspelar kvinnors olika upplevelser. De teman som uppkom var Det svåruppnåeliga kvinnoidealet, Den ångestfyllda tillvaron, Betydelsen av att ha kontroll. Slutsats: Anorexia är en komplex psykiatrisk sjukdom som kräver en optimal omvårdnad med beredskap och förståelse från vårdpersonal. Sjuksköterskor strävar efter att förhindra ett lidande och främja hälsa i vårdandet av patienter. Studiens resultat bidrog med en bredare kunskap och förståelse kring sjukdomen Anorexia Nervosa för en optimal återhämtning hos patient. / Background: Anorexia nervosa is a psychiatric disorder that primarily affects young women between 15 and 23 years with high mortality. The disease causes eating disorder resulting in significant weight loss. Purpose: Purpose of the study was to describe women's experiences of living with anorexia nervosa. Method: This study was conducted by qualitative method of analysis of narratives. Data collection was based on four autobiographies written by women who have lived with Anorexia Nervosa. Results: The results showed that all women have had different experiences of Anorexia Nervosa. This experiences were divided into three different themes which are clarified with quote. Themes described reflects women's different experiences with anorexia nervosa, which is the elusive ideal of women, the anguished existence and the importance of being in control. Conclusion: Anorexia is a complex psychiatric illness that requires an optimum care of preparedness and understanding of health professionals. Nurses strive to prevent suffering and promote health in the care of patients. The study's results contributed to a wider knowledge and understanding of the disease anorexia nervosa for optimal recovery of the patient.

Bakgrund: Det finns olika sorters ätstörningar. Bland dessa är anorexia nervosa den allvarligaste. Sjukdomen drabbar mest unga kvinnor men även unga män kan insjukna. Anorexia nervosa påverkar patienternas kroppsuppfattning negativt vilket resulterar i att de svälter sig och/eller tränar frenetiskt. Syfte: Syftet var att beskriva patienter med anorexia nervosas upplevelser av omvårdnaden under slutenvård. Metod: En litteraturöversikt med kvalitativ ansats valdes som metod för att svara på studiens syfte. Resultat: Det framkom fem teman ur analysen, dessa är; ”Vikten av den goda relationen”, ”En objektifierad omvårdnad”, ”Vikten av stöd”, ”Känsla av att vara övervakad” samt ”Vikten av att uppleva delaktighet”. Dessa teman beskriver patienternas upplevelser av omvårdnaden inom slutenvård. Konklusion: Patienterna upplevde omvårdnaden som både positiv och negativ. Det hade stor betydelse för patienterna om de upplevde en god relation till sjuksköterskorna. För att kunna övervinna sjukdomen var det viktigt att patienterna kände sig delaktiga i omvårdnaden. Att patienterna fick känna sig som unika personer var också något som hjälpte dem att återhämta sig. / Background: There are different types of eating disorders. Among these are anorexia nervosa the most serious. It is mostly young women who develop the disease, but also young men can become ill. Anorexia nervosa affects patient´s body image negatively, which results in the patient starving him- or herself and/or exercising frenetically. Aim: The aim was to describe patients with anorexia nervosa experiences of care during hospitalization. Method: A literature review with qualitative approach was chosen as the method to answer the aim of the study. Results: It emerged five themes from the analysis. These are; “The importance of a good relationship”, “An objectified care”, “The importance of support”, “The feeling of being monitored” and “The importance of experiencing participation”. These themes describe patients' experiences of care in hospitalization. Conclusion: The patients experienced the care to be both positive and negative. It was of great importance to the patients if they experienced a good relationship with the nurses. In order to overcome the disease, it was important that patients felt involved in their own care. For the patients to recover from anorexia nervosa, the patients needed to be treated like individuals and not like the stereotype of the disease.

O objetivo geral deste trabalho foi compreender as práticas discursivas de pessoas diagnosticadas com Anorexia Nervosa (AN) ou Bulimia Nervosa (BN) com relação a produção de sentidos sobre as relações profissional-paciente no âmbito do tratamento desses transtornos alimentares (TA), aqui considerados não como quadros diagnósticos, mas como construções sociais. Esse objetivo foi traçado no diálogo com a literatura científica na área que identifica poucos espaços de escuta dessas pessoas sobre o que elas consideram importante em suas relações com os profissionais de saúde, e no diálogo com as narrativas das participantes deste estudo que apontaram a boa qualidade do relacionamento profissionalpaciente como importante na construção de um atendimento considerado satisfatório. De maneira específica, buscou-se compreender como o uso de diferentes repertórios interpretativos e discursos sociais participam da produção de sentidos sobre as relações profissional-paciente, além de investigar as implicações dos diferentes posicionamentos assumidos por ambos na coconstrução de descrições de si, direitos, deveres e lugares ocupados pelos pacientes na relação com os profissionais. Para tanto, foram entrevistadas 12 mulheres diagnosticadas com AN e BN atendidas por um serviço de assistência em TA. 5 dessas mulheres responderam de forma mais pessoal sobre o que é um relacionamento significativo com um profissional, oferecendo histórias de seus relacionamentos anteriores e atuais com os profissionais, narradas com riqueza de detalhes. Considerando-se a vasta quantidade de material a ser analisado, um recorte do material foi necessário e essa riqueza narrativa foi o critério utilizado para a seleção dessas 5 entrevistas para análise. O corpus de análise foi composto pelo recorte dos momentos das entrevistas nos quais o tema do relacionamento profissional-paciente estava presente. Assumindo-se uma perspectiva construcionista social sobre produção do conhecimento, utilizou-se, para a análise desse corpus, a Teoria relacional do sentido, a Teoria do posicionamento e a proposta teóricometodológica das Práticas discursivas e produção de sentidos. A partir da análise desse material foi possível abordar: as implicações do uso do discurso biomédico, que entende a AN e BN como psicopatologias, para as construções de si das participantes deste estudo e para a construção de possibilidades e limites da sua participação nas decisões sobre o tratamento; o pedido das participantes para uma maior proximidade afetiva com o profissional; o lugar ocupado pelo psicólogo e pelos demais profissionais da equipe multidisciplinar frente a esse pedido; os efeitos dos repertórios interpretativos disponibilizados pela literatura da área sobre a dificuldade no relacionamento profissional-paciente para as práticas discursivas das participantes ao falarem de seus desentendimentos com os profissionais; e as implicações da eleição do tratamento hospitalar como locus privilegiado de cuidado dessas pessoas. Alguns aportes teóricos construcionistas sociais, como a responsabilidade relacional, o ser relacional, o diálogo transformador e a postura colaborativa foram ofertados para pensar cenários relacionais entre profissionais e pacientes que pudessem incluir: a noção de identidade como movimento e não como estabilidade; o entendimento dos sucessos e insucessos nesses relacionamentos como ações conjuntas; a defesa do paciente como agente coconstrutor de seu cuidado e a possibilidade de convivência de diferentes verdades em saúde. / The general aim of this work was to understand the discursive practices of people diagnosed with Anorexia Nervosa (AN) and Bulimia Nervosa (BN) in the meaning production about professional-patient relationships in the treatment of eating disorders. Eating disorders are understood here as social constructions. This objective was delineated in dialogue with the scientific literature in the field that identifies a lack of spaces to listen to these people as well as in dialogue with this study participants\' narratives that associated meaningful assistance with the possibility of good quality in professional-patient relationship. Specifically, we aimed at understanding how the use of different interpretive repertoire and social discourses participate in the meaning production about the professional-patient relationship. We also tried to comprehend the implications of different positions assumed by both of them in the coconstruction of self descriptions, rights, duties and places occupied by patients in their relations with professionals. In order to do that, 12 women diagnosed with AN and BN assisted by an eating disorder service were interviewed. 5 interviews were selected to be analysed considering its richness of narratives about professional-patient relationship. Interview excerpts in which the theme of professional-patient relationship was discussed were selected to compose the analysis corpus Assuming a social constructionist perspective about knowledge construction, the following theoretical and methodological resources were used: Relational Theory of Meaning, Positioning Theory and Discursive practices and production of meanings. The analysis highlighted: the implications of biomedical discourse use, in which AN and BN is understood as psychopathologies, to the self constructions of the participants of this study and to the construction of possibilities and limitations of their participation in the decisions about the treatment; the participants\' request for closer and emotional relationship with professionals; the role of the psychologist and the rest of the multidisciplinary team to address this request; the effects of the use of the literature in the field that constructs the professional-patient relationships in terms of its difficulties in the discursive practice of the participants when they talked about their conflicts with professionals; and the implication of electing treatment as the privileged scenario of health care. Some social constructionist resources such as Relational Responsibility, Relational Being, Transformative Dialogue and Collaborative Partnership, were implemented to think about relational scenarios between professionals and patients that could include: the idea of identity as movement instead of stability; the understanding of the success and failure in these relationships as conjoint actions; the defense of the patient\'s protagonism in the construction of health; and the possibility of the coexistence of diverse realities.

A anorexia nervosa (AN) é um dos principais tipos de transtornos alimentares, caracterizado por uma limitação dietética auto-imposta pelo paciente, com temor intenso de engordar, recusa em manter o peso na faixa normal mínima e alteração na percepção da forma e do tamanho corporais. Geralmente apresenta graves complicações de saúde devido a seu estado nutricional e comorbidades psiquiátricas que dificultam o tratamento. Por esses aspectos, pacientes com AN tendem a apresentar dificuldades na vida cotidiana e no desempenho dos papéis ocupacionais, os quais são responsáveis por auxiliar na organização do comportamento do indivíduo e na construção de sua identidade envolvendo- o em contextos e posições sociais. O objetivo desta pesquisa é entender como se configuram os papéis ocupacionais dos sujeitos com AN. O estudo foi aprovado pelo Comitê de Ética em Pesquisa do HCFMRP-USP (processo nº 9109/2008). A casuística foi composta por 11 sujeitos diagnosticados com AN (GE), todos adultos do sexo feminino, que estavam em tratamento no Grupo de Assistência em Transtornos Alimentares (GRATA) do Hospital das Clinicas da Faculdade de Medicina de Ribeirão Preto (HCFMRP-USP). Um grupo controle (GC) foi formado com 11 mulheres adultas. A metodologia desenvolvida é quali-quantitativa; os dados foram coletados pela aplicação da \"Lista de Identificação de Papéis Ocupacionais\" e de uma entrevista semiestruturada audiogravada com 3 mulheres do GE. Os dados quantitativos foram analisados pelo Teste Exato de Fisher e os dados qualitativos pelo método de análise de conteúdo temática. Os resultados obtidos mostraram que de modo geral, houve mudança, com perda de papéis no desempenho ocupacional devido à AN. Na comparação entre os grupos, os papéis que tiveram resultados estatisticamente significativos em relação ao padrão de desempenho foram o de trabalhador, voluntário, amigo, e passatempo amador. Pela análise dos dados qualitativos, quatro temas emergiram das entrevistas: Percepções anteriores ao diagnóstico de AN, Percepções frente ao diagnóstico de AN, Percepção da interferência da AN no desempenho de papéis ocupacionais e Desejos para o futuro. Embora todos os papéis ocupacionais tenham sido influenciados pelo transtorno, as pacientes não percebem as perdas trazidas pela AN. Elas mostraram-se ambivalentes em relação ao adquirir papéis esperados para o adulto em relação ao que se espera para o adolescente, época do início do transtorno. Além disso, apresentavam dificuldade no relacionamento social e familiar, com prejuízo em relação às atividades e participação social o que sugere que o isolamento social, a preocupação com o outro e a diminuição destas atividades poderiam ter iniciado em fases mais precoces, anteriormente à doença. Esses resultados demonstraram a importância de avaliar questões ocupacionais no tratamento da AN, com vistas a diminuir os possíveis prejuízos psicossociais. Ainda, outros estudos tornam-se necessários para compreender essas dificuldades sociais iniciadas na infância e pré adolescência como um possível fator precipitante do transtorno. / The anorexia nervosa (AN) is one of the main types of eating disorders, characterized by a self-imposed dietary restriction by the patient, with intense fear of gaining weight, refusal to maintain weight in the normal range and change in the perception of body shape. The patient usually presents serious health complications due to his nutritional status and psychiatric comorbidities, which complicate the disease\'s treatment. Because of that the patient usually has difficulties in daily life and performance of occupational roles, which are responsible for assisting in the organization of individual behavior and get his identity besides involve him in social contexts and positions. The objective of this research is to understand how to configure the occupational roles of the subjects with AN. The study was approved by Ethics Committee in Research of HCFMRP-USP (process n º 9109/2008). The specific case included a research group with eleven diagnosed subjects with AN (GE - in portuguese Grupo Experimental), adult women, who were under treatment at the Assistance Group on Eating Disorders (GRATA - in portuguese Grupo de Assistência em Transtornos Alimentares ) of Hospital das Clínicas de Ribeirão Preto belonging to Medicine College (USP-HCFMRP) . A control group (CG) was created with eleven adult women. The methodology is qualitative and quantitative; the data was collected by applying the \"Identification List of Occupational Roles\" and through a semi structured interview audio recorded with three GP women. Quantitative data were analyzed by Fisher\'s Exact Test and the qualitative one by the Thematic Analysis of Content. The results show that there is usually loss of occupational performance roles due to the AN. Comparing the groups, the roles that had significant results regarding the standard of performance were the worker, volunteer, friend and hobby. Through the qualitative data analysis four themes emerged from the interviews: Perceptions before to the Diagnosis of AN, Perceptions With the Diagnosis of AN, Perception of AN Interference in the Occupational Roles Performance and Wishes to the future. Although all occupational roles have been influenced by the disorder, patients do not realize the losses caused by the AN. They had present themselves ambivalent about getting adult expected roles to what is expected for the adolescent, age of onset of the disorder. Moreover, they present social and familiar relationships difficulties, with loss in activities and social participation which suggests the social isolation, but the lack of concern with others and reduction of these activities may have started in a previous stage of the disease. These results demonstrate the importance of occupational activities in the treatment of AN, to reduce the possible psychosocial damage. Still other studies are needed to understand these social difficulties started in childhood or adolescence as a factor that may indicate the development of this disorder.

Esta tese tem como perspectiva a hipótese segundo a qual os conceitos de Eu-Pele e de Envelopes Psíquicos, desenvolvidos pelo psicanalista Didier Anzieu, permitem um viés importante na compreensão da questão da constituição dos limites e fronteiras psíquicos, nas patologias da anorexia e da bulimia na clínica psicanalítica. Tomando como eixo principal na abordagem desses quadros patológicos o tema dos limites - eu/outro, dentro/fora, corpo/psique, são discutidas as concepções dos autores Brusset, Jeammet e McDougall, referentes às condições necessárias para o estabelecimento dos limites nessas patologias alimentares. É realizado um percurso pela obra de Didier Anzieu de tal forma a permitir, a partir dos conceitos de eu-pele e envelopes psíquicos, a compreensão da teorização do autor acerca dos limites e fronteiras, que serão, posteriormente, articulados a sua presença na anorexia e na bulimia. Por fim, é possível afirmar que falhas nas funções e constituição do eu-pele e dos envelopes psíquicos, acarretam um sério comprometimento na constituição dos limites do psiquismo nas patologias alimentares da anorexia e da bulimia / This thesis is based on the perspective that the concepts of skin-ego and psychic envelope, developed by the psychoanalyst Didier Anzieu, bring an important contribution for the comprehension of the problematic of the constitution of psychic limits and boundaries in the disorders of anorexia and bulimia in the psychoanalytic clinic. Taking this as the main theoretical framework for the understanding of these pathological frames, the question of the limits - I/other, inside/outside, body/psyche - is discussed based on contributions from Brusset, Jeammet and McDougall, concerning the necessary conditions for the establishment of the limits within these pathologies. It is undertaken, therefore, a reading of the work of Didier Anzieu, in a way to allow, from the concepts of skin-ego and psychic envelope, the comprehension of the proposition of the author on the limits and boundaries for the articulation with anorexia and bulimia. Finally, we argue that the lack in the function and constitution of the skin-ego and psychic envelope, brings serious consequences to the constitution of the psychic limits in the eating disorders of anorexia and bulimia