Thesis (Ph. D.)--Carleton University, 1996. / Also available in electronic format on the Internet.

Thesis (M.S.)--University of Louisville, 2009. / Department of Surgery. Vita. "May 2009." Includes bibliographical references (leaves 59-61).

Thesis (M.S.)--Florida State University, 2005. / Advisor: Gary W. Peterson, Florida State University, College of Education, Dept. of Educational Psychology and Learning Systems. Title and description from dissertation home page (viewed Oct. 12, 2005). Document formatted into pages; contains viii, 76 pages. Includes bibliographical references.

Thesis (Ph.D.)--Victoria University (Melbourne, Vic.), 2010.

Thesis (M.P.H.)--University of Hong Kong, 2005.

Thesis (Ph. D.)--University of Oregon, 2006. / Typescript. Includes vita and abstract. Includes bibliographical references (leaves 134-138). Also available for download via the World Wide Web; free to University of Oregon users.

Introduction There is now a greater understanding of the significance of attachment and the importance of the mother-child dyad in relation to Eating Disorders (ED). Mothers with this illness may not be able to offer their child the best environment to develop in a healthy way. Previous literature has indicated the probability of transgenerational effect and recognised that children of mothers with an ED are a high risk group. This research takes forward such awareness in relation to transgenerational EDs. It focuses on environmental factors and attachment. It explores the effectiveness of a group therapy intervention to prevent or mitigate the perpetuation of an ED through the generations. This study presents the outcomes of the group process, discussing the effects on the participants. Aims 1. To conduct a group intervention. 2. To aid the recovery of the mother from her ED. 3. To investigate the possibility of primary prevention of an ED for the child. 4. To develop a transferable protocol from the group therapy that can be used by other therapists within a health care setting. Method Participants with an ED (AN, BN or EDNOS) as defined by DSM-IV, who had children under the age of 13 were recruited from NHS settings. Two hour sessions were conducted by a therapist at weekly intervals for 19 weeks; each session was recorded and transcribed. The transcriptions were thematically analysed using NUD*ST. The CORE and the EDI together with a semi-structured interview were administered at the beginning and end of the group and at the six and twelve month follow ups. The n=1 case study methodology was used to design and analyse the study, using the group intervention as the case investigated. Results At the end of the intervention and at 6 month follow up all participants demonstrated an improvement in their ED, but at 12 months this improvement was only sustained by 50%. At all points including the 12 month follow up all participants showed substantial improvement in the nurturing of their children. From this study we were able to complete a manual that could be disseminated to health professionals in order to replicate the organization of further groups for this particular client population. Discussion These results gave encouraging support to the hypothesis that group therapy can be a useful intervention for mothers with an ED in order to break the transgenerational cycle of dysfunction.

Randomized trials provide support for the Body Project, an eating disorder prevention program wherein young women with body image concerns critique the thin ideal, which putatively reduces pursuit of this unrealistic ideal as a result of dissonance-induction. Despite medium to large effects, some Body Project participants subsequently develop an eating disorder during 3-year study follow-up, suggesting intervention or recruitment procedures could be improved. This study was the first to delineate the heterogeneous pathways of eating disorder symptom trajectories among Body Project versus control group participants during 3-year study follow-up. This study also investigated the predictive role of baseline risk factors on qualitatively distinct developmental pathways of eating disorder symptomology, helping to explain contributing factors to suboptimal Body Project response. Existing data from three randomized controlled trials were combined to examine response trajectories of prevention intervention versus control participants through 3-year follow-up. Group-Based Trajectory Modeling distinguished distinct response trajectories and the impact of prevention on mitigating the developmental course of eating disorder symptoms. The three-group solution for control participants produced the strongest model fit. The resulting trajectories were those of low-stable, moderate-stable, or high-variable levels of eating disorder symptom courses. Dietary restraint and negative affect predicted increased likelihood of membership in the high-risk trajectory. The optimal solution for Body Project participants was a two-group trajectory model with low-decreasing or high-decreasing trajectories, with the moderate-level risk group observed in the control group seemingly deflected by prevention effects. This study also determined the predictive role of risk factors on qualitatively distinct developmental pathways of eating disorder symptomology, confirming the hypothesized impact of thin-ideal internalization, negative affect, and dietary restraint on sub-optimal prevention response. The results of this novel study supplement developmental research regarding eating disorder symptom predictors and course, ultimately informing future design and adaptation of evidence-based eating disorder prevention programs.

In today’s world, eating disorders are plaguing adolescent women at alarming rates. Anorexia nervosa and bulimia nervosa are the two most common disorders and differ in their symptoms and prognoses. While the symptoms of these diseases are not readily visible in systemic health, deteriorating oral health can be a positive indication of abnormal eating habits. Anorexia nervosa and bulimia nervosa result in declining systemic health due to resulting nutritional imbalances and physical harm that patients exert upon themselves. Malnutrition results in altered endocrine function and consequent loss of menstruation, abnormal hair growth, and decreased peak bone mass. Although risk factors for anorexia nervosa and bulimia nervosa vary, the resulting nutritional impoverishment produces the similar systemic effects. In addition to systemic health degradation, symptoms of anorexia and bulimia commonly manifest in the oral cavity. Chemically, salivary composition may be altered resulting in lower pH values. Patients may also exhibit temporary bilateral parotid gland swelling as a result of repeated purge episodes. The most critical oral effect of repeated purge episodes is loss of permanent enamel and is defined as perimolysis. Presently, research does not agree on whether or not eating disorders elevate the risk of dental carries. Although current literature unanimously agrees on the importance of early oral health detection and diagnosis of eating disorders, most dentist are not trained to properly identify and diagnose the manifestations of AN and BN within the oral cavity. Dental school and dental hygiene curriculums lack emphasis on the severity of eating disorders in general and do not allot adequate teaching hours for this matter. Sadly, even when dentists suspect the presence of eating disorders, they are not likely to intervene. Fortunately, full recovery is possible in eating disorder patients if proper therapy and medical attention is provided in a timely manner. Damaged dentition may also be fully restored with the use of crowns, composite fillings, and porcelain veneers. However, if disordered eating habits persist after dental restoration, the dentition will once again erode and deteriorate accordingly. Anorexia nervosa and bulimia nervosa are serious diseases that need proper attention and medical intervention. Their severity should not be minimized as they may ultimately result in grave side effects and eventual death. Dental health practitioners have the ability of observe the presence of these diseases before others as obvious symptoms may present in the oral cavity. Dentists and dental hygienists need to be educated on the oral manifestations of eating disorders and proper protocol regarding timely intervention. With proper education and knowledge, dental health practitioners can reduce the severity of disease, resulting in better prognoses for patients.

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