A theoretical model of eating disorders called the shame and pride model has suggested that pride is a key psychological mechanism underpinning restrictive eating disorders and that it is also important in the maintenance of such conditions. Despite being included in this model, pride has been little investigated in the eating disorders field, especially when compared to shame, which has received extensive theoretical and empirical attention. Therefore, the overall aim of this PhD thesis was to investigate the role of pride related to eating disorders and its relation to motivation to change in clinical and non-clinical samples. Firstly, a systematic mixed studies review was conducted to examine the empirical evidence concerning pride and eating disorders. This review showed that this is an under-researched area (only 10 studies were identified). However, it provided initial evidence highlighting that low levels of pride in physical appearance precipitated the onset of eating disorder behaviours, such as food restriction, binge eating, and purging. It also suggested that over time, high levels of pride experienced through the ability to control food/calorie intake and weight loss, appeared to maintain eating disorders. Secondly, three empirical studies were conducted; a qualitative study, followed by two quantitative studies. The grounded theory qualitative study aimed to understand the meaning of pride in eating disorders from the perspective of women with anorexia nervosa. The second study aimed to develop and validate a measure to assess the component structure of pride in eating pathology. The third study investigated, over a period of 12 months: i. whether pride in eating pathology acted as a mediator between anorexia nervosa symptoms and the precontemplation stage of change (i.e. no motivation to change), and ii. whether pride in healthy weight and healthy eating interacted with anorexia nervosa symptoms to predict the action stage of change (i.e. actively engaging to change eating disorder behaviours). Both qualitative and exploratory component analysis indicated that pride in eating pathology is a multidimensional self-conscious emotion that is comprised of unhealthy and healthy aspects. In addition, findings from the qualitative study and the longitudinal mediational study demonstrated that pride in eating pathology evolves over time and predicted people’s unwillingness to change eating disorder behaviours after a year. Finally, results from the longitudinal moderational analysis revealed that pride in healthy weight and healthy eating did not act as a moderator between anorexia symptoms and being in the action stage to change eating disorder behaviours at 12 months. However, the qualitative study revealed that pride related to healthy eating behaviours promotes recovery in a clinical sample. Results from this PhD thesis provide empirical evidence to further develop the shame and pride model postulated by Goss and Gilbert (2002) and highlight the role of pride as a precipitating and maintaining factor of eating disorder behaviours. In addition, it was found that pride in eating disorders influences motivation to change. Clinical implications of the findings from these empirical studies are discussed throughout the PhD thesis, along with directions for future research.

AN ABSTRACT OF THE THESIS OF MICHELLE OSTIEN, for the Master of Science degree in FOOD AND NUTRITION, presented on November 20, 2008, at Southern Illinois University Carbondale. TITLE: SIMILARITIES AND DIFFERENCES IN FEMALES WITH REGARDS TO PERFECTIONISM IN THOSE WITH ANOREXIA NERVOSA, HIGH BMI (BINGE EATERS VS. NON-BINGE EATERS), AND THOSE SEEKING A HEALTHIER LIFESTYLE MAJOR PROFESSOR: Dr. Sharon Peterson One in five women in the United States struggle with an eating disorder or distorted eating patterns (National Institute of Mental Health, 2001). Perfectionism, one of the risk factors for developing an eating disorder, is a trait that many of these women have in common. While much research has been done on perfectionism in women with anorexia nervosa and bulimia nervosa, few studies have looked at perfectionism in women with binge eating disorder (Pratt, Telch, Labouvie, Wilson, & Agras, 2001). Our study sought to further understand the similarities and differences of the total and individual components of perfectionism in females seeking a healthier lifestyle, high BMI binge eaters, high BMI non-binge eaters, and anorexics. Our study found that the first component of the perfectionism scale (representing self-oriented perfectionism) was found to be significant between groups (p=0.002). When comparing females seeking a healthier lifestyle to high BMI binge eaters, females seeking a healthier lifestyle were more likely to answer "no", while high BMI binge eaters were more likely to answer "yes" (p=0.006). When comparing females seeking a healthier lifestyle to anorexics, females seeking a healthier lifestyle were more likely to answer "no" when compared to anorexics (p=0.033). When comparing high BMI binge eaters to high BMI non-binge eaters, high BMI binge eaters were also more likely to answer "yes" to this question when compared to high BMI non-binge eaters (p=0.048). Compared to 76.9% (N=10) of female anorexics, 74.4% (N=32) of female high BMI binge eaters, 50.0% (N=32) of female high BMI non-binge eaters, and 31.2 % (N=5) of females seeking a healthier lifestyle answered "yes" to perfectionism component one, which represented self-oriented perfectionism. Anorexics had the greatest tendency for perfectionism, followed by binge eaters, and then non-binge eaters. This study demonstrated that self-oriented perfectionism is the greatest indicator of perfectionism between subject groups and that perfectionism does exist in binge eaters.

Study one explored the service user experience of treatment for anorexia nervosa in the Welsh healthcare service. Factors such as treatment expectations, satisfaction, therapeutic alliance, motivation to change and engaging in treatment were considered by conducting indepth interviews with participants who had a diagnosis of anorexia nervosa and were receiving secondary care. Qualitative data were analysed using thematic framework analysis revealing six main concepts: service user description of anorexia; expectations of treatment for anorexia; the journey through the health service for anorexia; therapeutic alliance during treatment for anorexia; satisfaction with the health service; and service user recommendations to improve the health service. Mapping and interpretation of the concepts drawn from the interviews resulted in a model exploring the relationship between expectations and satisfaction of treatment for patients with anorexia nervosa, and the effect upon motivation to engage in treatment and recover. Another model describing factors that affect therapeutic alliance was developed. The results are described with particular reference to the Self-Determination Theory (Ryan & Deci, 2000). Study two used a four-stage, mixed-methods approach to develop and evaluate an anorexia nervosa awareness campaign for healthcare professionals. The campaign was developed using an integrative social marketing approach (NSMC: 2013): including formative research, process evaluation and outcome evaluation. Formative research included audience research (interviews and focus groups with healthcare professionals and healthcare professionals in training) in combination with theories of social cognition and persuasion to develop four posters. Process evaluation included campaign evaluation by healthcare professionals using questionnaires (open and closed ended questions). Appropriate modifications to the posters were made following the process evaluation, and two posters were chosen as the final intervention. Outcome evaluation of the campaign was conducted by using a brief, four-item evaluation questionnaire completed by healthcare professionals (General Practitioners and nurses). Results from all phases indicated that the use of posters as the medium of the anorexia Study three included development of a comprehensive audio-visual intervention to increase nursing students’ self-effcacy regarding initial management of patients with anorexia nervosa. The intervention was developed and underpinned using the Transtheoretical Model Framework (Levesque et al., 2001), and then evaluated using a pre-post-test design. The intervention was successful in significantly increasing nursing students’ self-efficacy regarding the initial management of anorexia nervosa. Furthermore, the nursing students’ self-efficacy was high prior to the intervention, indicating that nursing students already feel confident to manage patients with the disorder. The methodological and theoretical implications are discussed. nervosa awareness campaign did not sufficiently raise awareness of anorexia nervosa, and therefore the limitations of the second study were considered.

Ballet dancing is a rigorous activity, the requisite skill acquisition for which begins at an early age. For girls, the activity requires a clearly defined body shape and composition, the attainment of which may result in low body weight and BNH, the development of eating disorders, menstrual dysfunction, and poor nutrient intake. The combination of the high levels of exercise for both sexes and the sylph-like figure required by females may have an effect upon growth and development, injury and repair, and long-term health. No evidence could be found in the literature of investigations on retired ballet dancers and the potential effects of their career upon their long-term health. Therefore, a retrospective study was carried out on sixty-three male and female dancers by means of a 'health' questionnaire. Although the results from the retrospective study showed that no serious health effects had occurred in the sample investigated, there was nevertheless a high incidence of injury amongst both sexes. During their career, the retired females were found to have had: low body weights, with many of them having been on slimming diets; a lack of knowledge concerning food and fluid intake; and poor menstrual status, including delays in menarche. It was concluded that many of the injuries sustained by the males could be attributed to their role of partnering and therefore constantly physically supporting and lifting the female dancers. No definitive work could be found on nutrient intakes of ballet dancers and no prospective studies appeared to have been carried out on the overall injury status of currently active female ballet dancers. None of the studies had concurrently assessed nutrient intake and injury status and factors which may affect this, as well as assessing their general wellbeing. Thus, thirty-eight pre-professional female ballet dancers were recruited to the prospective study. All types of injury from minor to major were recorded over a period of ten weeks, concurrent with life events and menstrual patterns. During this period, nutrient intake was also estimated over seven consecutive days using the weighed inventory method. The dancers completed a general background questionnaire; EAT-26 and BIT'E - two screening questionnaires clinically used to assess for the symptoms of anorexia and bulimia nervosa; and, a nutritional quiz compiled by the author and largely based on what the students had been taught. The dancers had significantly lower dietary intakes of energy, carbohydrate, fat, iron, and NSP than their relative DRV's. Low intakes of energy and particularly carbohydrate could reduce muscle glycogen concentrations, and thus promote fatigue. The dancers had busy schedulesw hich restrictedt heir ability to eat well and the majority of them had poor nutritional knowledge. The injury rates of the majority of the dancers were found to be high and a statistically significant correlation was found between these injury rates and fatigue. These findings suggest that the dancers needed to receive a more fruitful method of nutrition education and have less hectic schedules, a combination of which could well result in the dancers having greater opportunity to eat well and rest sufficiently to reduce their overall levels of fatigue, enhance their overall feeling of wellbeing, and thus, possibly, reduce the risk of injury.

In the present study, the author tested the validity of certain variables and paths from a model of eating disorder (ED) symptomatology (T. L. Tylka & L. M. Subich, 2004) along with several alternative models (i.e., including poor interoceptive awareness, ethnic identity, and body mass) within a sample of U.S. University women of South Asian origin. The original sample included 440 women, but responses differed based on graduate and international status. Therefore, path analytic procedures focused on 255 undergraduate, non-international women. Results indicated excellent fit for 5 models and adequate fit for the 6th model. Exploratory analyses did not support self-esteem as a moderator but did support the role of internalization of beauty standards in the ED symptomatology of South Asian American women (c.f., Reddy & Crowther, 2007). The results are discussed in light of their contributions, implications, and limitations.

Using a strength-based paradigm, this study explored resilience factors (i.e. ethnic identity, familismo, and spirituality) associated with a continuum of eating disorder (ED) and obesity risk variables, depression, anxiety, and acculturation among Latina women. Two models predicting psychological distress and ED outcomes were tested using cross-sectional data (N= 262) from an internet-based survey. Results indicated that cultural resilience factors were associated with less psychological distress, fewer ED symptoms, and less ED risk. Psychological distress partially mediated the relationship between cultural resilience and ED symptoms and risk, indicating the possibility of heightened ED risk when cultural resilience is low and psychological distress is high. Acculturation to U.S. mainstream culture was not associated with cultural resilience or negative outcomes; rather, biculturalism, or successful negotiation of both cultures, appeared to facilitate use of cultural practices and values that protect Latinas from negative eating behaviors and psychological outcomes. Implications for practice and future research are discussed. / 2015-10-10

Background/aim: Pro-anorexia is a relatively new internet phenomenon. Few papers have been published on the topic; however, these have largely focused on the content of the sites and the effects of viewing them. The studies presented in the thesis were designed to inform our understanding of both the lifeworld and lived experiences of pro-anorexia, with a view to informing both academic and clinical understanding of the phenomenon. Design: Interpretative phenomenological analysis (IPA) was employed to explore the lived experience and descriptive phenomenology (DP) was utilised to investigate the lifeworld of the pro-anorexic user. Methods: Eight females were recruited to interviews, which were later transcribed and analysed with IPA. Two pro-anorexic blogs were identified one of which was written by a female and the other a male; these were analysed using DP. Results: The IPA study identified sub-ordinate themes: 'trajectory', 'boosting of the self and 'thinspiration', each with their own independent subordinate themes. The blog studies produced differing themes; however, the studies collectively demonstrated similarities which contributed to the understanding of why people may use these and subsequently disengage from the websites across the stages of eating disorder illness. Conclusion: Pro-anorexia clearly has a significant meaning and is very consuming for its users who present with eating disorder symptoms across the spectrum of illness. Clinicians should adopt a clinical stance (Geller, Williams and Srikameswaran, 2001) which fosters curiosity and acceptance, whilst suspending judgment when working with clients with eating disorders, specifically those who use pro-ana. In doing this it is anticipated that shame associated with use will be reduced and in being heard, users will be less likely to resort to pro-anorexic materials. It has been found that where services fail to work with the clients current stage of change (Prochaska and DiClemente, 1983) then pro-anorexic use is likely to re-occur. The findings of the studies included in this thesis also demonstrate a need for contributors to both popular and academic media alike, to engage in wider consultation to establish the most useful way in which to present pro-anorexia in the public and academic domain and hence, provide warnings on the topic, rather than signpost those who are vulnerable to eating disorder symptomology.

Made available in DSpace on 2014-06-11T19:29:35Z (GMT). No. of bitstreams: 0 Previous issue date: 2008-03-19Bitstream added on 2014-06-13T20:19:32Z : No. of bitstreams: 1 camargo_elb_me_botfm.pdf: 490449 bytes, checksum: 81cc0e09e8026d3d388b7b92bf475ac2 (MD5) / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / O presente estudo teve por objetivo estimar a prevalência de comportamentos sugestivos de transtornos alimentares entre estudantes universitárias de todos os anos dos cursos de Medicina, Enfermagem e Nutrição da Faculdade de Medicina de Botucatu-UNESP. Foram também investigadas as associações desses comportamentos com características sócio-demográficas, curso, auto-avaliação de desempenho escolar, índice de massa corporal, auto-imagem corporal, e realização de tratamento psiquiátrico atual ou prévio. Método: Foi utilizado formulário estruturado para investigar aspectos sócio-demográficos, auto-avaliação de desempenho escolar, informações sobre realização prévia de tratamento psiquiátrico, uso e tempo de uso de psicofármacos. Para avaliar alterações no comportamento alimentar foram utilizados o Teste de Atitudes Alimentares (EAT-26) e o Teste de Investigação Bulímica de Edimburgo (BITE). Na análise univariada foram utilizados o teste do Qui-quadrado, o teste de Goodman para contrastes entre e dentro de proporções multinomiais. Posteriormente, foi realizada a análise multivariada através de regressão logística para controle de possíveis variáveis confundidoras. Resultados e Conclusões: Responderam o questionário 76,7% da população alvo, totalizando 468 alunas. A idade média foi 21,6 anos (DP±2,05); 98,7% eram solteiras; 64,1% residiam com amigos; seus pais tinham alto nível de escolaridade, 85,5% dos pais e 81,8% das mães com nível escolar acima ou equivalente ao nível médio completo; sendo a média de renda per capita das famílias de 3,9 salários mínimos. A maioria das alunas (81,8%) considerou seu desempenho acadêmico “bom ou excelente”, 84,4% nunca haviam... / This study aimed at estimating the prevalence of behaviors suggesting eating disorders among university students of all years in the Medicine, Nursing and Nutrition Programs of the Botucatu School of Medicine - UNESP. The associations of such behaviors with socio-demographic characteristics, academic program, self-evaluation of school performance, body mass index, body self-image and the existence of current or previous psychiatric treatment were also investigated. Method: A structured form was used in order to investigate socio-demographic aspects, self-evaluation of school performance, information concerning the existence of previous psychiatric treatment and the use and period of use of psychiatric drugs. In order to study alterations in dietary behavior, the Eating Attitudes Test (EAT-26) and the Bulimic Investigation Test of Edinburgh (BITE) were used. For univariate analysis, the Chi-square test and Goodman’s contrast test among and within multinomial proportions were used. Later, multivariate analysis was performed by means of logistic regression in order to control possible confusing variables. Results and Conclusions: 76.7% of the target population answered the questionnaire, which totaled 468 students whose mean age was 21.6 years (DP±2.05); 98.7% were single; 64.1% shared a place of residence with friends; their parents were highly educated, 85.5% of their fathers and 81.8% of their mothers had graduated from high school or had attended college; their families’ mean per capita income was of 3.9 minimum salaries. Most of the students (81.8%) considered their academic performance to be “good or excellent”, 84.4% had never undergone psychiatric treatment. According to the Eating Attitudes Test (EAT-26), 93 students (19.9%) were identified as presenting a Abstract possible eating disorder, and 184 students (39.3%) were observed to exhibit abnormal eating patterns as shown by the Bulimic Investigation Test of Edinburgh (BITE).

Introduction. Eating disorders (EDs) are a public health problem, and their relationship to mass media is still controversial. Objective. To assess whether there is an association between models of body image shown in mass media and the risk of developing EDs among female adolescent students from Lima, Peru. Methodology. Cross-sectional study conducted in three schools located in the district of La Victoria, Lima, Peru. The risk of developing EDs was measured using the Eating Attitudes Test-26 (EAT-26), while mass media influence was measured using the Sociocultural Attitudes Towards Appearance Questionnaire-3 (SATAQ-3), which was categorized into tertiles both in the overall score and its subscales (information, pressure, general internalization, and athletic internalization). Adjusted prevalence ratios (aPR) for EDs were estimated. Results. Four hundred and eighty-three students were included, their median age was 14 ± 3 years old. A risk of developing an ED was observed in 13.9% of them. Students who are more influenced by mass media (upper tertile of the SATAQ-3) have a higher probability of having a risk of developingan ED (aPR: 4.24; 95% confidence interval [CI]: 2.10-8.56), as well as those who have a greater access to information (PR: 1.89; 95% CI: 1.09-3.25), suffer more pressure (PR: 4.97; 95% CI: 2.31-10.69), show a greater general internalization (PR: 5.00; 95% CI: 2.39-10.43), and show a greater level of athletic internalization (PR: 4.35; 95% CI: 2.19-8-66). Conclusion.The greater the influence of mass media, the greater the probability of having a risk of developing an ED among female students from Lima, Peru. / Introducción. Los trastornos de conducta alimentaria (TCA) son un problema de salud pública y su relación con los medios de comunicación es aún controversial. Objetivo. Evaluar si existe asociación entre los modelos de imagen corporal mostrados por los medios de comunicación y el riesgo de TCA en adolescentes escolares mujeres de Lima, Perú. Metodología. Estudio transversal realizado en tres centros educativos del distrito de La Victoria, Lima, Perú. Se midió el riesgo de TCA con la prueba de actitud alimentaria (Eating Attitudes Test-26; EAT-26, por sus siglas en inglés) y la influencia de los medios de comunicación con el cuestionario sobre actitudes socioculturales con respecto a la apariencia (Sociocultural Attitudes Towards Appearance Questionnaire-3; SATAQ-3, por sus siglas en inglés), categorizada en terciles tanto en el puntaje global como en sus subescalas (acceso a la información, presión, internalización general y atlética). Se calcularon las razones de prevalencia ajustadas (RPa) para TCA. Resultados. Se incluyeron483 escolares con edad mediana de 14 ? 3 años. El 13,9% presentó riesgo de padecer TCA. Las escolares que presentan mayor influencia de los medios de comunicación (tercil superior del SATAQ-3) tienen mayor probabilidad de tener un riesgo de TCA (RPa: 4,24; IC 95%: 2,10-8,56), así como quienes tienen mayor acceso a la información (RP: 1,89; IC 95%: 1,09-3,25), mayor presión (RP: 4,97; IC 95%: 2,3110,69), las que presentaron mayor internalización general (RP: 5,00; IC 95%: 2,39-10,43) y las que mostraron mayor grado de internalización atlética (RP: 4,35; IC 95%: 2,19-8,66). Conclusión. A mayor influencia de los medios de comunicación, existe una mayor probabilidad de riesgo de padecer TCA en escolares mujeres en Lima, Perú.

Although it is generally acknowledged and accepted that case formulations are useful in psychotherapy treatment, there is significantly little research illustrating how case formulations are useful in treatment. Research also suggests that case formulations are seldom used in practice after initial training (Eells, 1997; Sim, Gwee, & Bateman, 2005). This research was premised on a particular case study which appeared to highlight shifts in psychotherapy treatment in the sessions directly after the writing or revising of the case formulation, thus prompting the inquiry into the influence of the case formulation on therapeutic work. The research utilised a qualitative methodology and focused on a single case which was a 19 year old university student who expressed a problem with binge eating. The data was drawn from five original and revised case formulations. The participant was seen for 27 therapy sessions, over which time five case formulations were developed and revised. The findings in this study highlight the process of how a psychodynamic case formulation can influence therapeutic work, as reflected in three broad themes of adherence to the case formulation, the confidence of the therapist, and using the formulation as an intervention. The study contributes to arguments for the revival of the case formulation as a necessary therapeutic tool. / KMBT_363 / Adobe Acrobat 9.54 Paper Capture Plug-in