The purpose of this exploratory research was to analyze, through a qualitative in-depth approach, the attitudes and perceptions of food and portion sizes of a group of clients diagnosed with anorexia nervosa, bulimia nervosa or an eating disorder with bulimic features. To accomplish this, a set of two questionnaires and a food portion test were administered; one at the beginning of treatment and a second at a given interval after treatment began. These responses, along with observations made by the author during patient interviews, will be reported. All patients received either inpatient and/or outpatient treatment from a mental health professional, a dietitian and a medical physician. The exploratory nature of the study and small sample size (12) prohibit positing of causative connections. Observations were made however, that a distortion of nutrition attitudes exists in the sample studied that were responsive to improvements while receiving treatment from a multidisciplinary team. A tendency to over estimate portions was evident, and no improvement in the second administration supports the need for additional food portion training. These findings were discussed in terms of the study limitations, along with suggestions for future research. / Master of Science

Two studies were conducted to investigate psychological features of bulimia. Both studies focused on cognitive variables; additionally, the second study included affective variables. ln Study I, 569 students were screened with questionnaires. Based on correspondence of questionnaire items to DSM-III criteria, 20 bulimic women were selected, along with 20 matching, nonbulimic women as a control group. These 40 subjects were assigned randomly to either a success or failure condition, in which their ”performance” on laboratory tasks was predetermined by very easy or impossible tasks, respectively. Standardized feedback statements, positive or critical, were issued during the experiments. Before, in the middle of, and after the experiment, subjects completed rating forms of expectancy and generalized self-efficacy; also, they completed attribution ratings at the middle point and end of the experiment. Results indicated lower generalized self-efficacy and slightly higher persistence in bulimics. ln Study ll, 1526 students were screened and, using similar but more stringent criteria, 26 bulimics were selected along with 26 controls. Study II incorporated similar procedures as Study l, but added the assessment of: self-efficacy to solve the tasks, performance satisfaction, self-statements, and measures of four affective dimensions: general depression, and situational anxiety, depression, and hostility. Results indicated that bulimics had lower self-efficacy to solve the tasks, lower generalized self-efticacy, greater maladaptive self-statements, and higher levels of all affective variables. No differences were found between bulimics and controls with respect to attributions, performance satisfaction, or expectancy. These data are congruent with a cognitive social learning perspective of bulimia, and they suggest that lowered confidence in specific abilities and certain types of self-statements operate to maintain bulimic symptoms. Furthermore, this research confirmed earlier reports in the literature regarding affective components of bulimia, especially that they are more depressed and anxious. Also noted in this research was a tendency for bulimics to experience greater mood elevation after success, and greater difficulty in recovering from situationally-induced anxiety and depression after failure, compared to nonbulimics. Future research should attend to the interrelationships among various classes of cognitions and affective variables, with respect to bulimic symptomatology. / Ph. D. / incomplete_metadata

The current study investigated the relationship between principles of social learning theory and binge eating episodes in 31 normal weight bulimic women. Participants were asked to monitor the following: (1) levels of self-efficacy related to resisting the urge to binge and/or purge as well as levels of self-efficacy related to handling stressful events, (2) mood states, (3) enjoyment of daily activities, (4) number of stressful events, and (5) number of binging and purging episodes. Participants were asked to monitor these events four times a day for seven days. Measures of locus of control and enjoyment ratings of binging and purging were also gathered prior to monitoring. Results indicated that components of social learning theory predict number of binging and purging episodes. The best predictors were a combination frequency of binging, lowered levels of self-efficacy to resist the urge to binge, and having a general tendency to not feel in control of one's response-outcomes. However, heterogeneity within the group was apparent in that the predictive models failed to significantly predict binging and purging for all participants. It was also the case that there were differences in predictors of binging and purging on an individual level of analysis. For all individuals, self-efficacy to resist the urge to binge/purge was the only consistent predictor of these episodes. For four individuals, frequency of prior binging was an important predictor. Post-hoc analyses suggest that for the group as a whole self-efficacy expectancies affect current behavior more than current behavior affects future expectancies. Even here, variability exists at the individual level of analysis. For four participants, behaviors were more strongly related to subsequent expectancies than expectancies were related to subsequent behaviors. These findings increase our understanding of the role of social learning theory in predicting episodes of binge eating and purging, often thought to be a cycle of maladaptive, negatively reinforced behaviors. The results also have important implications for assessment and treatment of bulimia using a cognitive/behavioral model. The presence of individual differences in the applicability of the predictive models and the relationships between expectancies and behaviors over the course of several time periods suggests that a treatment approach emphasizing the relationship between expectancies and behaviors may have more or less meaning for different individuals. Future research should replicate, cross-validate and expand these findings in order to clarify these issues. / Ph. D.

The majority of research dealing with the eating disorder of bulimia has focused on characteristics of college-aged women, with those findings forming a basis for treatment planning with younger, adolescent women. While research in recent years has begun to examine those characteristics specifically related to bulimia in adolescence, there has been a relative lack of consideration of the effect of the developmental stage of the individual on these psychological characteristics. Such differential characteristics, if found to be present, would have implications for both the prevention and treatment of bulimia in younger populations. The purpose of the present study was to investigate the concerns of high school and college females at high risk for bulimia at different developmental levels as well as to identify the psychological characteristics of high risk subjects across the age groups. Participants were asked to complete questionnaires assessing their self-perceptions on a variety of intrapersonal and interpersonal dimensions. Individuals aged 12-14 who were also at high risk for bulimia reported greater levels of depression and more feelings of inefficacy than did older, high risk individuals. Across all ages, women at high risk for bulimia were more dissatisfied with their body shape, were more depressed, experienced more difficulty with peer and family relationships, and felt more alienated from others than did individuals at low risk for bulimia. These results were discussed within a developmental framework, and it was suggested that individuals who cannot come to terms with the multiple changes of adolescence are at increased risk for engaging in bulimic behavior. / Ph. D.

Although factors associated with eating disorders (ED) have been studied, no comprehensive source of research findings was identified in this review. The purpose of this study was to identify and synthesize research findings of factors associated with ED in women published from 1992-2006. These findings may be useful to nurses, other professionals, families, and the public to facilitate the prevention, detection, treatment, and rehabilitation of women with EDs. The factors identified as most pertinent through this review were depression, sexual abuse, substance abuse, anxiety disorders, early pubertal onset and the personality traits of perfectionism and impulsivity. No factor was identified as causative for EDs, but sexual abuse and anxiety disorders often preceded the ED. Findings varied among ED subtypes, with sexual abuse and substance abuse more common with binge/purge behaviors and bulimic symptomology, while depression and anxiety disorders were more common with both anorexia nervosa and bulimia nervosa. Perfectionism was most common in anorexics; in one study it was identified independent of stress and persisted after recovery. Limitations noted in the research reviewed include using self-report questionnaires, some small samples, exclusion of some ED subtypes, and a predominant use of cross-sectional and clinical samples. Recommendations for further research included large epidemiological samples containing multiple ED subtypes and males, as well as longitudinal studies and methods to determine causal relationships among EDs and the associated factors identified. Implications for nursing education, practice, and policy development focus on screening for ED during physical examinations and interviews, posing questions to facilitate disclosure, addressing emotions elicited, and suggestions for routine monitoring of patients in clinical settings.

Bakgrund: Anorexia Nervosa och Bulimia Nervosa är de två främsta ätstörningarna enligt medicinsk praxis. För att förstå en lidande människas verklighet är det av vikt att ta del av dennes livsvärld, samt känsla av hälsa, välbefinnande och lidande. Hur en människa påverkas av sin ätstörning är individuellt, och sättet människan påverkas av sin omgivning är således olika för alla. Syfte: Studiens syfte var att belysa hur människor med ätstörning erfar sin omgivning. Metod: Studien har en kvalitativ metodansats och baseras på tre skönlitterära böcker. Texterna analyserades med hjälp av en innehållsanalys och analysprocessen genomfördes i två steg bestående av en induktiv och en deduktiv del. Materialet har analyserats från helhet till delhet för att återgå till helhet. Resultat: Resultatet redovisas i tre kategorier utefter beskrivningen av hur människor erfar sin omgivning: Drar sig undan sin omgivning, Vilja vara accepterad av sin omgivning och Känsla av oförståelse från omgivningen. Utifrån en fördjupning av dessa tre kategorier framkom sex underkategorier: Känsla av utanförskap, Känsla av att vara ovärdig vänskap, Undviker att vara social, Jämför sig med andra, Känsla av brist på förtroende och Döljer sitt beteende. Slutsats: Livet med en ätstörning upplevs som en kamp. Resultatet visar att personer med ätstörning väljer att dra sig undan sin omgivning, istället för att be om deras stöd i denna kamp. Det har även framkommit att de känner en stark oförståelse från sin omgivning, vilket bidrar till deras vilja att isolera sig. I sin isolering drömmer de dock om att vara sociala, populära och åtråvärda människor.

Während Leitlinien „Gold-Standards“ für die Psychotherapie bei bulimischen Essstörungen (Bulimia Nervosa und Binge-Eating-Störung) empfehlen, ist über psychotherapeutische Prozessfaktoren bei Essstörungen wenig bekannt. Ziel war es, mit Hilfe des etablierten Generic Model of Psychotherapy zur Systematisierung psychotherapeutischer Prozessfaktoren die aktuelle Literatur zum Einfluss dieser Faktoren auf den Therapieerfolg, operationalisiert als Symptomreduktion oder -remission, auf Basis einer systematischen Datenbanksuche zu sichten. Während der Einfluss des therapeutischen Settings nach bisheriger Forschungslage kaum Schlüsse hinsichtlich des Therapieerfolgs zulässt, konnte dieser durch spezifische Interventionen, frühe Symptomreduktionen und eine gute therapeutische Beziehung vorhergesagt werden. Weitere Forschung zu Prozessfaktoren bei bulimischen Essstörungen erscheint notwendig, um die praktische psychotherapeutische Arbeit zu unterstützen und Behandlungen effektiver gestalten zu können. / While guidelines recommend gold standards for psychotherapy in bulimic eating disorders (bulimia nervosa and binge eating disorder), less is known about psychotherapeutic process aspects. We aimed to summarize the current literature on the impact of process aspects on significant symptom reductions and/or abstinence as treatment outcome using the Generic Model of Psychotherapy. A systematic literature search was conducted. While effects of treatment settings can not yet be estimated, specific interventions, rapid response, and the therapeutic bond repeatedly predicted outcome. Process-outcome research in bulimic eating disorders will be necessary to support clinical practice and to enhance treatment efficacy.

The purpose of this study was to examine how parental separation is related to eating disturbances and assertiveness in females who struggle with bulimic symptoms. Two-hundred ninety-two undergraduate females from the University of North Texas comprised the subject group. Using pen and paper measures of assertiveness, bulimia, and parental separation, support was found for the prediction that there would be a relationship between assertiveness and parental separation. Likewise, partial support was found for the prediction that there would be a relationship between bulimia and parental separation. Parental separation was found to affect levels of bulimia and assertiveness. Finally, it was found that subjects endorsed greater emotional independence from fathers than from mothers.

Die vorliegende Literatursichtung belegt, gerade im Lichte neuen Störungswissens und für neue diagnostische Kategorien, die Notwendigkeit, die Wirksamkeit bestehender Therapieformen zu erhöhen und/oder neue Behandlungen für Essstörungen, speziell für Bulimia Nervosa und Binge Eating-Störung, zu entwickeln. Ein wesentlicher Erkenntnisgewinn wird zudem von einer systematischen Analyse des therapeutischen Prozesses sowie von Moderatoren und Mediatoren erwartet. Darüber hinaus stellen die Dissemination evidenzbasierter Therapiemethoden in die Praxis und eine Überprüfung gestufter Behandlungsmodelle wichtige Aufgaben zukünftiger Forschung dar. / The consideration of existing literature, especially in light of new knowledge of eating disorders and new diagnostic categories, highlights the necessity to increase the efficacy of current forms of therapy, and to develop novel therapies for eating disorders. This pertains, in particular, to bulimia nervosa and binge eating disorder. A considerable gain in knowledge is to be expected from a systematic analysis of the therapeutic process as well as the moderators and mediators. Furthermore, dissemination of evidence-based treatment methods in practical settings and an examination of stepped care models are important avenues of future research.

Os transtornos alimentares são doenças graves que podem cursar com comorbidades importantes se não tratadas com abordagens múltiplas do ponto de vista clínico, nutricional, psicológico e psiquiátrico. Sendo assim, o objetivo deste estudo foi investigar aspectos nutricionais e psicossociais dos indivíduos que foram portadores de anorexia e bulimia nervosas do Grupo de Assistência em Transtornos Alimentares - (GRATA) - do Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo-USP , se trataram e obtiveram alta hospitalar. Para tanto, elaborou-se uma entrevista semi - estruturada com dados demográficos de saúde atual, além as principais mudanças após o tratamento. Avaliou-se também o estado nutricional, por aferição de peso, altura, pregas cutâneas e circunferência do braço. O hábito alimentar foi questionado por meio de recordatório alimentar de 24 horas e questionário de freqüência alimentar. Para avaliação do ajustamento psicossocial do indivíduo, utilizou-se os seguintes instrumentos auto-aplicáveis: Questionário de Saúde Geral de Goldberg (QSG), Inventário de Depressão de Beck, Escala Hospitalar de Ansiedade e Depressão (HAD), Teste de Atitudes Alimentares (EAT-26).Foram encontrados 10 sujeitos, 9 mulheres e 1 homem, com idade entre 21 e 34 anos.Por meio da entrevista semi-estruturada, observou-se mudanças significativas após a alta hospitalar como: 5 sujeitos já concluíram o ensino superior e contribuem com a renda da família, 3 sujeitos estão concluindo esses cursos, 5 sujeitos casaram-se e já presenciaram o nascimento do primeiro filho.Apenas 1 sujeito faz acompanhamento psiquiátrico,e nenhum deles tem acompanhamento nutricional. A presença de ciclos menstruais regulares constando em todos sujeitos do sexo feminino.Atualmente 1 sujeito usa medicação fitoterápica e chás diuréticos para manter o peso. A ingestão calórica se aproximou das Recomendações Diárias (RDA) em 9 sujeitos e excedeu a recomendação diária de proteína em 9 sujeitos. Algumas vitaminas e minerais se mostraram deficientes como ferro, cálcio e retinol em 6 indivíduos. O questionário de freqüência alimentar quando comparado com a pirâmide alimentar adaptada para a população brasileira, se mostrou adequado nos itens: grupo do leite, verduras e carboidratos. Alimentos hipocalóricos e dietéticos são consumidos com freqüência por 7 sujeitos.O QSG mostrou valores indicativos de normalidade em todos os fatores. O HAD classificou com ansiedade leve 4 sujeitos da amostra. O Inventário de Beck detectou depressão leve 1 sujeito da amostra. O EAT-26 não apresentou pontuação indicativa de comportamento alimentar anormal. Conclui-se que esses indivíduos após a doença, desenvolveram-se de maneira positiva para a vida familiar, profissionale emocional, com progresos significativos. / Eating disorders are serious diseases that can go along important comorbidities if not treated from a clinical, nutritional, psychological and psychiatric point of view. Thus, the aim of the study was to investigate nutritional and psychosocial aspects of individuals that carried anorexia nervosa and bulimia nervosa from the group of assistants in alimentary disorders – GRATA – of the clinic hospital of the University of Medicine of Ribeirão Preto, University of São Paulo – USP, which received treatment and were discharged from the hospital.For that, a semi-structured interview was elaborated, and the individuals studied were asked about their occupation, marital status, number of children and main changes that occurred after their treatment. Their nutritional state was also evaluated, by checking their weight, height, cutaneous fold and the arm circumference. We analyzed their eating habits through alimentary 24-hour records and questionnaire of alimentary frequency. In order to evaluate the psychosocial adjustment of the individual, the following auto-applicable instruments were utilized: The general health questionnaire of Goldberg, Beck’s Depression Inventory, the Hospital scale of Anxiety and Depression (HAD) and the Alimentary Attitude Test (EAT-26)We found 10 subjects, of which 9 were females and 1 was male with ages between 21 and 34 that felt euphoric. There was only 1 subject that was overweight. In the semi-structured interview, significant changes were observed after the discharge from the hospital, as follows: 5 subjects have already graduated from college and contribute to their family income, 3 subjects are still in college, 5 subjects have gotten married and have already had their first child, 1 subject has been getting a psychiatric follow-up, and none of them has been getting a nutritional follow-up. We noticed the presence of regular menstrual cycles in all of the female subjects. Currently, one subject uses phytotherapic medication and diuretic teas to maintain her weight. The caloric ingestion has become closer to the daily recommendations (RDA) for 9 subjects and was exceeded to the daily protein recommendations in 9 subjects. Some vitamins and minerals were deficient in 6 subjects, such as iron, calcium and retinol. The questionnaire of alimentary frequency, when compared to the alimentary pyramid adapted to the Brazilian populations was considered adequate in the following items: dairy group, vegetables and carbohydrates. Hypo caloric and diet aliments are frequently ingested by 7 subjects. The QSG shows values that indicate normality in all factors, HAD detected a slight anxiety in 4 subjects. Beck’s inventory detected a slight depression in 1 subject from the group. The EAT-26 didn’t present a negative score as to the indication of abnormal alimentary behavior. In conclusion, the group studied was within the adequate nutritional state as well as a psychosocial adjustment of what are considered normal boundaries. Therefore, further investigations are necessary with respect of the prognostics of the carriers of these disorders, in order to aid in more specific therapeutical approaches.