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.

While dieting is relatively normative in our society, it is controversial within the fields of eating disorders and obesity. Dieting for weight loss has been touted by the obesity prevention field as a solution to the growing obesity epidemic, yet a body of research in the eating disorders field has also implicated it in the etiology and maintenance of eating pathology. Thus, a divergence in approaches toward dieting has emerged, with both prodieting and anti-dieting messages being recommended. Little is known, however, about the impact of these two types of messages on immediate and short-term psychological functioning and weight control intentions and behaviors. The current study sought to explore this gap in the extant literature by conducting an experimental study that evaluated the two messages. Undergraduate women (N=139) were randomly assigned to either a pro-dieting, anti-dieting, or no-dieting (control) message condition. Psychological functioning and weight control variables were assessed at baseline, posttest, and a two-week follow-up. Results indicated that the pro-dieting message resulted in significantly greater post-test perceived pressure to lose weight, dieting intentions, and thin-ideal internalization intentions while the anti-dieting message yielded significantly lower post-test bulimic intentions. Healthy eating behavior significantly increased from baseline to follow-up in the pro-dieting condition while there were no changes in the other two conditions. Post-test perceived pressure was found to fully mediate the relationship between diet message and post-test dieting, bulimic, thin-ideal internalization, and healthy eating intentions as well as follow-up healthy eating behavior. Trait thin-ideal internalization levels moderated the relationship between diet message and post-test perceived pressure and thin-ideal internalization intentions. Exploratory analyses revealed that overweight participants in the pro-dieting condition increased significantly from pre to post-test on state body dissatisfaction and had the highest level of post-test perceived pressure compared to all other groups. Nonoverweight participants in the pro-dieting condition also had significantly greater posttest perceived pressure to lose weight than both weight status groups in the other two conditions. Findings are discussed in the context of the prevention goals of the obesity and eating disorders fields. Limitations of the study and directions for future research are offered.

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.

Syftet med denna uppsats har varit att belysa behandlares uppfattningar om syskon och partners upplevelser av att ha en nära person med en ätstörning, samt betydelsen av att involvera dem i den drabbades behandling. Studien genomfördes med en kvalitativ metod där semistrukturerade intervjuer utfördes med 6 behandlare på olika ätstörningsverksamheter i Sverige. Resultat och slutsats visade att syskon och partners, samt andra närstående, är betydelsefulla för patientens tillfriskande. Det är viktigt att syskon och partners involveras i behandling, och att de får information om sjukdom och behandling. Syskon ska inte anta en ansvarsroll, medan partner behöver ta ett visst ansvar i vardagen. Ätstörningar har en tydlig påverkan på partners och syskon, samt på närstående i allmänhet. Närstående bör få goda verktyg till hur de kan vara ett stöd på bästa sätt till den drabbade. Behandlaren ska bemöta närstående med förståelse, respekt och ingen skuldbeläggning. Det är väsentligt för patientens motivation och tillfrisknande att det finns en god och nära relation till de närstående som är involverade i behandlingen. Det finns en brist på forskning inom detta område. Vidare forskning krävs för att stärka studiens resultat och slutsats.

The purpose of this paper is to explore the experiences in the lives of women with binge eating disorder (BED). Eating disorders affect 5 to 10 million individuals in North America and 70 million worldwide. In Canada, approximately 3% of all women will be affected by an eating disorder during their lifetime. Due to the secretive nature of this illness these statistics are most likely under-reported rendering these illnesses difficult to treat. The complexity of eating disorders and potential for long-term side effects warrants attention from the mental health community. There are many theories as to the origins of this illness but no known causes or cures. BED is the most recent eating disorder included in the DSM-IV, (Diagnostic and Statistical Manual of Mental Disorders). This research explored the phenomenon from the perspective of nine women who suffer from BED. These women were interviewed as to their emotional, psychological, physical, and cognitive experience of this illness and its effects in their everyday lives. The results found a number of distinctive themes emerging from the data; emotional connection to food; loss of control; isolative behaviour and secrets; cognitive obsessions; sense of not belonging/not fitting-in; feelings of not being good enough and weight issues/poor body image. The women felt strongly that BED was often misdiagnosed and misunderstood by both the general public and health professionals. They experienced a lack of adequate resources and support groups that offer relevant information and that were not "diet" related. Some women with BED who were also overweight or obese suffered the additional stigma and negative attitudes of "weight-ism" in North American culture where thinness is equated with success and happiness. This study provides a unique opportunity for these women to express their concerns, and offers valuable insights and information for mental health professionals working with the eating disorder population thus support the development of much needed programs for BED. This paper provides an opportunity for greater understanding of compulsive over-eating and challenges stereotypical attitudes while promoting self-reflection on the part of the reader.

Cholecystokinin, or "CCK" peptides, originally identified in the gastrointestinal tract, are now considered to be one of the most abundant peptide systems in the mammalian central nervous system. Prompted by recent findings that implicated the cholecystokinergic system in the pathophysiology of various illnesses, we developed a novel assay system to measure the various forms of cholecystokinin peptides in human plasma and cerebrospinal fluid. The system detects CCK-4, sulfated CCK-8 (CCK-8s) and nonsulfated CCK-8 (CCK-8ns) with equal affinity, with the lower detection limit of 2.7 fmol and an ED50 of 10.6 +/- 2.2 fmol. Using the assay system, we determined that mean CCK-like immunoreactivity (CCK-LI) in the plasma of 12 healthy subjects was 12.9 +/- 2.1 pM CCK-4 equivalents. / After developing the cholecystokinin assay system, we were able to combine our unique methodology with other established techniques to investigate the role of CCK in illnesses such as premenstrual dysphoric disorder (PMDD), anxiety, bulimia nervosa, and cardiomyopathy. / Briefly, we observed no significant differences in plasma CCK levels between women with PMDD and healthy volunteers. However, we found that, independent of diagnosis, plasma cholecystokinin concentrations were higher in women during their first visit to the clinic to participate in the study, as compared to later visits. / In addition, application of our assay system allowed us to determine that oral ingestion of caffeine increased plasma CCK-LI levels 2--4 fold in humans. Moreover, we observed substantial variation in post-caffeine cholecystokinin levels among individuals. / In another study of cholecystokinin and anxiety, we used our CCK assay to determine the effects of ondansetron, a serotonin receptor antagonist, on cholecystokinin levels in plasma. We found that multiple oral doses of ondansetron influence the pharmacokinetic parameters of exogenous CCK. / We also used the three-step assay system to measure CCK-LI in patients with the eating disorder, bulimia nervosa. Baseline fasted cholecystokinin plasma levels were lower in bulimic women as compared to control subjects. However, at "satiety", or the post-binge stage, CCK levels in bulimic women were similar to those of control women. / Finally, our investigation into the role of cholecystokinin in cardiomyopathy revealed that neuronal cholecystokinin receptor density was altered in the cardiomyopathic hamster brain, as compared to age- and sex-matched control animals. (Abstract shortened by UMI.)

Thesis (Ph. D.)--University of Toronto, 2005. / Includes bibliographical references (leaves 148-172).

Thesis (M.A.)--State University of New York at Binghamton, Psychology Department, 2006. / Includes bibliographical references.