This autoethnographic study is an attempt to humanize the deviant behaviors and bodies of eating disordered and physically disabled persons in Western culture. The narratives included within are from the author’s own personal experiences as a heterosexual, eating disordered, disabled man. The narratives unfold chronologically in ways that explicate the transitions between identities and the onset and acceptance of each. The goal of this study is to unveil aspects of both eating disorders and disabilities as they relate to the locus of attention surrounding individuals that experience them. The researcher argues that the attention a deviant body draws from others may form the deviant body as a spectacle that can be either eagerly sought after, or reluctantly ascribed to, the individual that holds it.

Subjects for this study were 40 women (N= 40) with subclinical bulimia nervosa who were randomly assigned to either a Cognitive Behavioral Treatment group (CBT) or to a waiting list control group. Treatment was provided for 8 weeks in an individual, self-administered format, using an audio-taped treatment package for Body Image Dissatisfaction (BID). Cognitive behavioral treatment focused on changing negative thoughts and feelings about one's body. No specific treatment focused on changing eating symptomatology or concomitant symptoms, although these were assessed. The waiting list control condition received assessment, followed by 8 weeks of no treatment. Treatment outcome measures were three self-report scales that assessed BID and two measures that assessed eating symptomatology and concomitant symptoms. At posttest, treated subjects showed improvement on two of three measures of BID, with a trend towards improvement on the third measure, when compared to waiting list control subjects. Treated subjects also showed a trend towards improved eating symptomatology and concomitant symptoms such as depression and anxiety, relative to waiting list control subjects. The results indicated that CBT is effective for decreasing BID in women with subclinical bulimia nervosa when administered in a self-directed manner.

The research concerning eating disorders and concomitant conditions shows that anorexia nervosa and bulimia nervosa are serious disorders that pose many diagnostic and therapeutic challenges to mental health and nutrition professionals. Most psychologists and nutritionists receive broad-based training that likely only superficially touches upon the importance of these diagnostic issues. Nevertheless, effective treatment planning requires that diagnostic issues and concomitant conditions be evaluated and incorporated into the diagnosis and treatment of eating disorders. Thus, there is an increasing need for specialized training in order to better evaluate and treat the complicated clinical picture presented by eating disorder clients. However to date, no systematic training package has been available to meet this training need. The present study was designed to fulfill this need by developing and initially validating an expert system-based, computer-assisted training program (ES-CAT). The initial validation involved comparing the mean overall post-test scores of 56 subjects. Subjects were randomly assigned to one of three groups [i.e., expert system-based, computer assisted trainer (ES-CAT), expert system-based trainer without computer guidance (ES), and traditional self-study (SS)]. The ES-CAT was shown to be more effective in training subjects in the diagnosis and treatment of eating disorders than either an expert system-based trainer without computer guidance (ES) or a traditional method of training (SS). Indeed, subjects who used the ES-CAT showed large gains in knowledge and mastery of the material at better than 85%. The addition of the computer-based guidance to the expert system trainer showed more significant gains (from a pre-test to post-test) of learning than the expert system trainer manual only. Furthermore, the expert system-based trainer without computer guidance (ES) was significantly more effective in training subjects than a traditional method of reading and studying textbooks (SS). The total training time of the ES-CAT was approximately 16 hours. Thus, a reasonable and effective means of training practitioners to better evaluate and treat the complicated clinical picture presented by eating disorder patients was developed and initially validated.

Women in general seem to have a complicated relationship with their bodies and their body image. A small percent of the female population develop a serious pathological eating pattern which is characterized by a disturbed image of body size and shape. This disturbance has been investigated by many researchers and the quest of finding the underlying neural correlates has progressed enormously during the last decade. The relationship between disturbed eating patterns and body image distortions is highly complicated. The purpose of this review article is to give an overview of current research literature and scientific results. The aim is to find a framework for the phenomenon of body image distortions among both healthy and non-healthy women. Differences between genders and how food intake affects body image will also be addressed. The focus lies on behavioral traits and the underlying neural correlates, with focus on both the perceptual and the cognitive-affective component.

Syftet med föreliggande randomiserade kontrollerade studie var att undersöka effekten av internetadministrerad kognitiv beteendeterapi (iKBT) vid olika former av ätstörningsproblematik. Behandlingen pågick i åtta veckor och baserades på beteendeterapi (BT) med inslag av Acceptance and Commitment Therapy (ACT). Behandlingen inkluderade en skräddarsydd del som riktades mot vanliga komorbida tillstånd vid ätstörningar. 92 deltagare randomiserades till två grupper, en behandlingsgrupp (n = 46) och en kontrollgrupp (n = 46). Behandlingsgruppen som erhöll iKBT förbättrades signifikant på utfallsmått som avsåg att mäta ätstörningssymptom. På huvudutfallsmåtten BSQ respektive EDE-Q uppvisades signifikanta mellangruppsskillnader, kontrollerat för förmätning. Effektstorleken för mellangruppsskillnaden vad gäller EDE-Q var måttlig (d = 0.54) och för BSQ liten (d = 0.48). För de som fullföljde behandlingen var effektstorleken stor för EDE-Q (d = 0.98) och BSQ (d = 0.97). Andelen som betraktas blivit kliniskt signifikant förbättrade vid behandlingsslut varierade mellan 31.3 och 46.5 % beroende på vilka kriterier som avsågs. Detta var betydligt fler än för kontrollgruppen (9.5-26.1 %). På sekundära utfallsmått (PHQ-9, GAD-7, SWLS, QOLI) erhölls ej signifikanta skillnader mellan grupperna, kontrollerat för förmätningen, vid mätning direkt efter behandlingsavslut. Sammantaget visar resultaten att iKBT för ätstörningsproblem är lovande som behandlingsmetod. Långtidsuppföljningar och replikationsstudier behövs på området.

This qualitative study is based on the reality that disordered eating such as anorexia nervosa, bulimia nervosa, and compulsive overeating resulting in obesity represent a major and growing problem in community health. Treatment models using cognitive behavioral therapy suggest that those diagnosed with an eating disorder tend to judge themselves in terms of their body shape, weight, and eating habits. However, the recovery rate for those treated for an eating disorder that only addresses those three issues identified above is less than 60%. A number of quantitative studies have provided evidence that other maladaptive schema may contribute to bulimic and anorexic behaviors. Fewer studies have addressed this issue in relationship to compulsive overeating resulting in obesity. This collective case study further explored and identified other maladaptive schema associated with anorexia nervosa, bulimia nervosa and compulsive overeating resulting in obesity that interfere in the long term recovery. This case study will allow the participants to express thoughts and emotions surrounding their disordered eating in their own voices. This collective case study provides evidence that persons diagnosed with disordered eating have carried early life events into adulthood and that these events have created maladaptive schema which may be interfering in their recovery process.

Body, weight and shape related obsessions and ruminations are characteristic traits of individuals with eating disorders (ED) that are found to predate the onset of the disorder. Individuals with chronic ED display altered neural activation in response to food stimuli, and are reported to have volumetric differences compared to healthy individuals, which is likely an effect of prolonged starvation. ED individuals are also seen to dispose an attentional bias to food stimuli, even when perceived sub-consciously, which are reported to interfere with cognitive tasks, including working memory (WM). However, whether the differences in neural activation and structure are present in adolescents with a recent ED diagnosis is not known. In paper I we describe how images of high- and low-calorie foods resulted in greater responses in the prefrontal circuitry in ED adolescents compared to healthy controls (HC). Obsessive-compulsive symptoms in ED individuals were associated with prefrontal circuitry and cerebellar activation, whereas faster reaction times to the WM were associated with greater superior frontal gyrus activity. The findings indicate that ED cognitions may be linked to WM abilities, both of which are associated with frontal cortex functioning. WM performance is examined further in paper II, where we found that the presence of subliminal food images were seen to disrupt WM performance in terms of slower reaction times and less correct responses in ED but not HC. The WM interference was associated with increased activity in the parietal and superior temporal cortex. WM interference caused by subliminal food stimuli may reflect a pre-attentive bias to food in adolescents with ED, which could be a risk factor for further development of an ED. The structural differences in brain volume between adolescents with ED and HC were examined in paper III. ED symptoms were found to be associated with volume differences in insular cortex and superior temporal gyrus, whereas obsessive-compulsive symptoms were associated with reduced volumes in the putamen and cerebellum. These volumetric differences in regions implicated in restraint, obsessions and WM are likely to precede structural variations caused by starvation as seen in chronic ED’s. Connectivity from these regions, in addition to other regions believed to be implicated in ED, was studied in paper IV. Fronto-parietal regions as well as the insula showed increased connectivity in ED, whereas connectivity from the mesolimbic reward regions did not differ from HC. Regions with increased connectivity in ED are involved with self-awareness, body image and ED related ruminations, connections that could influence how one’s body is perceived. In conclusion, the studies included in this thesis describes changes in functional activity, connectivity and brain volume in regions involved with ED cognitions, eating behaviour, and body image in adolescents recently diagnosed with an ED.

Föreliggande studie undersökte hur kvinnor med ätstörningar upplevde den vård och behandling som gavs för deras ätstörningar. På en klinik i Mellansverige deltog 45 kvinnor. Alla deltagare var över 18 år gamla. Kvinnorna fick besvara en enkät med öppna och slutna frågor rörande välmående, behandlingens innehåll och påverkan, samt interaktionen mellan vårdtagare och personal. Vidare undersöktes vad som skulle kunnat förbättra den behandling som erbjöds, samt om det förekom ett samband mellan antal månader kvinnorna fått behandling på kliniken och upplevelsen av välmående. Resultatet av studien visade att majoriteten av kvinnorna var nöjda med den vård och behandling som gavs. Förtroendet för personalen var stort, och upplevelsen att någon lyssnar och förstår var viktig. Det fanns inget signifikant samband mellan antalet månader vårdtagarna fått behandling och deras uppskattade välmående. Däremot framkom signifikanta skillnader i välmående före behandlingens start och efter att behandling hade påbörjats, oberoende av antal månader behandlingen hade pågått.

Introduction: Recently published reviews and meta-analytic studies have shown increased interest in research of the ADHD and ED comorbidity. We conducted a case-control study (133 ED female patients/93 healthy control), screening for ED among ADHD patients (N=64) and a pilot study of a support group program for adults with ADHD and psychiatric comorbidities. Methods: Adult and childhood ADHD symptoms were assessed by self-report and other- report versions of a Barkley Adult ADHD questionnaire (BAARS-IV). Patients with ED and ADHD comorbidity underwent a structured interview (DIVA 2) and Integrated Visual and Auditory Performance Tests (IVA Plus) to confirm the ADHD diagnosis. Participants of the pilot program were assessed prior to and after the therapy by the Schwartz Outcome Scale (SOS) and Quality of life (SQUALA) questionnaires. Results: Using self-report questionnaire of current symptoms 61 (46 %) of ED patients were detected as likely having ADHD compared to 22 (24 %) from a healthy control group, 37 (28 % ) of ED patients were identified with the high probability of ADHD diagnose compared to 12 (13 %) from a healthy control group with significant differences. Screening for disordered eating behaviors indicated previously documented higher prevalence of overweight among men with ADHD...

This thesis deals with the issue of eating disorders of pupils attending upper primary schools of rural and urban type. The issue of eating disorders is very complex and public often fails to understand it. People do not see the fact that the food and its rejection can turn into a real habit. Eating disorders are not only observed in young women, but also increasingly in children and adolescents. Eating disorders involve serious psychosomatic disorders, significantly affecting the mental and physical status. Thus, they may very negatively affect personality development from childhood to adulthood. They are accompanied with many somatic problems and complications and they can have a very negative influence to the overall health status of an individual. Eating disorders cause long-term problems not only to patients themselves but also to their families, spouses and friends. It is very easy to fall ill with eating disorder, but is very hard to get better.