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.

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.

A questionnaire was mailed to a random sample of 771 undergraduate women at Virginia Tech. The research instrument was designed to accurately estimate the frequency of bulimia among university women. Bulimia was operationalized in specific behavioral terms that extend the DSM-III definition. The response rate for the mail survey was 87%, with 669 surveys used in the descriptive data analysis. One hundred and twelve subjects, 17% of the total sample, were classified as bulimic. The bulimic subjects were matched on height, weight, and age with 112 women without an eating disorder. This subset of 224 subjects was analyzed in order to assess the degree to which the respondent's family system, use of coping strategies, and weight preoccupation are predictive of bulimia. Multiple regression analysis indicated that 28% of the variance in bulimia can be explained by these three variables. The survey findings and implications for future research are discussed. / Ph. D.

Eating disorders fall within the top nine health ailments affecting young people today. These illnesses such as Anorexia Nervosa, Bulimia Nervosa, and Eating Disorders Not Otherwise Specified affect a large number of people, particularly female adolescents. The disorders can further cause complications in one’s health, systemically and orally, sometimes resulting in death. The purpose of this paper is to closely examine published studies examining the link between eating disorders and oral health. Multiple studies have found that patients suffering from eating disorders are more likely to develop tooth erosion. Behaviors often found in eating disorder patients such as self-induced vomiting and ingestion of highly acidic diets can lead to such enamel loss, a condition that is irreversible. Other researchers disagree about whether eating disorders can lead to an increase in dental caries, with some finding amplification and others finding no significant results. Parotid gland swelling is another side effect of eating disorders but this complication often recedes once the unhealthy behavior is halted. Most studies have not yet found a link between these illnesses and increased periodontal disease. However, they do seem to lead to decreased unstimulated salivary flow rates. Furthermore, it also appears that the disorders lead to augmented levels of S. mutans and Lactobacilli. One’s oral mucosa can also be affected via angular cheilitis and oral candidiasis. Additionally, eating disorders may serve as a risk factor for bone and joint disorders such as osteoporosis and temporomandibular joint disorders, respectively. The illnesses may show effect outside the oral cavity through Russell’s sign on one’s knuckles and oral function may be impaired. With all these possible oral complications being some of the first to indicate the presence of an eating disorder, dentists may be integral to identifying and stopping the progression of the disease. However, it has been suggested that eating disorder patients may have greater dental anxiety keeping them from visiting the dentist in the first place, let alone divulging their disease to their dentist. Furthermore, oral health professionals may not be adequately prepared to notice the presence of an eating disorder. Dental schools must do more to teach future oral health professionals about eating disorders, especially in the clinic, as simple suggestions like avoiding brushing one’s teeth immediately after participating in self-induced vomiting may help to reduce the likelihood of enamel erosion. Through this analysis it was determined that while sufficient baseline research has been done, there is still a great deal more to learn about how eating disorders affect one’s oral health. There are multiple forms of diagnostic criteria that could possibly prevent patients from receiving the best treatment possible. Furthermore, more research needs to be done on disorders other than Anorexia Nervosa and Bulimia Nervosa as not every patient falls under these two categories. Since it has been shown that certain types of medication can decrease one’s salivary flow rate, future studies need to also consider any medication that patients may be on. In order to really aid those affected by eating disorders, men should be considered as future subjects too, since most studies have currently only focused on women. By completing more research on eating disorders and their consequences on oral health, health care professionals will be better able to serve those affected.

Bulimia is often viewed as an extreme expression of eating concerns and body image disturbances that afflicts many adolescent and adult women. The cognitive strategies employed by individuals to inhibit eating and facilitate bingeing and purging are thought to include disattending internal sensations of hunger and satiety while sustaining attention on food, distorted beliefs, and interoceptive experiences (e.g., Heatherton & Baumeister, 1991). To the extent that these attentional and perceptual shifts mediate bulimic symptomatology, individuals with bulimic tendencies should exhibit certain cognitive attributes. Because hypnotizability, dissociation, and absorption have each been invoked (either directly or indirectly) as explanatory constructs for clinical and subclinical bulimia, the present study evaluated the absolute and relative effects of these factors on bulimic symptomatology in a large sample of undergraduate women (N = 309) using structural equation modeling. Following 2 assessments of hypnotic susceptibility (Harvard Group Scale of Hypnotic Susceptibility, Form A [Shor & Orne, 1962] & Group Stanford Hypnotic Susceptibility Scale, Form C [Crawford & Allen, 1982]), participants completed measures of eating disorder symptomatology (Eating Disorders Inventory-2 [Garner, 1991]; Three Factor Eating Questionnaire [Stunkard & Messick, 1985]), dissociation (Dissociative Experiences Scale [Carlson & Putnam, 1986]; Dissociation Questionnaire [Vanderlinden et al., 1993]), and absorption (Tellegen Absorption Scale [Tellegen & Atkinson, 1974]; Differential Attentional Processes Inventory [Crawford, Brown, & Moon, 1993; Grumbles & Crawford, 1981]). A final model including the latent constructs Hypnotizability, Dissociation, Absorption, and Bulimic Symptomatology provided a very good fit to the data (X 2 (58, N = 309) = 31.09, NFI = .932, CFI = .967, & RMSEA = .053). As hypothesized, dissociation was found to a have moderate effect (Standardized coefficient = .32, p < .01) on Bulimic Symptomatology when controlling for Hypnotizability and Absorption. Moreover, contrary to past research, the path between Hypnotizability and Bulimic Symptomatology and the path between Absorption and Bulimic Symptomatology were not significant. Based on these finding, we can now speak with increased confidence of a meaningful link between dissociation and the continuum of bulimic symptomatology. A pathological dissociative style appears to contribute to the development of bulimia. / Ph. D.

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.

The research of Stice et al. (1994) and Stice and Shaw (1994) proposed several mechanisms that may mediate the adverse effects of media exposure to the thin ideal including internalization of the thin-ideal, negative affect, and body dissatisfaction. The purpose of this study was to extend initial research of Stice and Shaw (1994) by incorporating two forms of media (e.g., TV and Magazines) to assess the effects of exposure to the media portrayal of ideal body shape on women's mood, body satisfaction, and internalization of societal values concerning attractiveness. The relation of these variables to bulimic symptomatology was examined. The current study improved upon Stice and Shaw's study (1994) by matching participants' scores on BMI, level of negative affect, and level of body satisfaction before random assignment to the experimental conditions. Female undergraduates aged 18 to 25 years participated in premeasure (N = 198) and post measure (N = 164) conditions. Results from repeated mulitvariate analysis indicated media exposure to ideal-body images demonstrated no significant changes in women's affect, body satisfaction or endorsement of the thin ideal. Indirect support for the sociocultural theory of eating disorders was provided by multiple regression analyses that demonstrated lower levels of satisfaction with size and shape of body and higher levels of negative affect predicted bulimic symptomatology in women. Future research should determine which females are at greater risk than others for the development of body dissatisfaction, negative mood, and internalization of U.S. values of attractiveness in response to media related messages communicating a thin ideal.

The incidence of bulimia seems to be increasing dramatically as actors, models, dancers, and college populations are seeking help for this eating disorder. In this study, the Adjective Checklist was administered to 21 bulimic women and 17 normal women to compare personality characteristics on the following scales: abasement, affiliation, autonomy, achievement, aggression, personal adjustment, succorance, and self-control. Results showed bulimic women scored higher on abasement and succorance. A multiple regression was performed which elucidated the scales responsible for the greatest amount of variance. These were aggression, autonomy, and self-control. Further studies of personality measures may aid in describing this population more fully.

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.