This thesis examines aspects of adolescent family mealtimes and psychopathology among both non-clinical (adolescents and mothers of adolescents) and clinical (adolescents with anorexia nervosa (AN)) samples. It contains seven studies employing quantitative methodology, which address three broad aims. First, to examine relationships between aspects of family mealtimes and psychopathology among adolescents. Second, to examine links between family mealtime emotions and psychopathology among mothers of adolescents. Finally, to examine associations between specific parental mealtime interactions and adolescent outcomes during a therapeutic meal session for adolescents with AN. Self-report questionnaires were completed by non-clinical adolescents and mothers of adolescents to examine associations between characteristics of family mealtimes (mealtime environment, mealtime emotions and parental feeding practices) and eating psychopathology, anxiety and depression. In addition, observational analyses were conducted on recordings of the family meal session (session two) of Family-Based Treatment (FBT) for adolescent AN. Key findings from this research include: identifying a new factor structure for the Eating Disorders Examination Questionnaire when used in research with adolescents; developing a measure to assess mealtime emotions in both adolescents and their parents; and, identifying the feeding strategies used by parents of adolescents with AN during the family meal session of FBT. Overall, the findings reported on in this thesis suggest that family mealtimes may have an important protective role in adolescent psychopathology. In addition to providing frequent family mealtimes, families should be encouraged to concentrate on the positivity of the mealtime environment and emotional experience, which may help to promote psychological well-being, and lower levels of eating psychopathology among adolescents. In relation to family mealtimes within adolescent AN, the findings increase understanding of the types of mealtime strategies parents use with their adolescent child to encourage food consumption during the family meal session of FBT. Furthermore, the research findings highlight that certain strategies may be effective in promoting eating during the session and weight gain later on in treatment. Consequently, such findings might provide a focus for therapists when supporting and coaching parents during the family meal session.

Exercise has come to be the most common cause to eating disorder and athletes is more often represented among patients with ED than rest of the population. It has been known that men barely notice the symptoms before it’s too late, often because ED is labeled as a woman disorder. Altough it’s not primary an urge to change how you look, among athletes it can be a willing to improve sport enhancement. To work preventive in sports can give us a chance to reduce the cases of ED. The intention with this qualitative study was to broaden the understanding of for ED in sports. The study is based on interviews and the results will be presented by three themes: trigger factors of ED, prevention and communication. / Träning är idag tyvärr den vanligaste utlösande faktorn till ätstörning och idrottare drabbas oftare av ätstörning än övriga befolkningen. Hos män upptäcks sällan symptomen då ätstörning blivit en kvinnligt kodad sjukdom. Dock är det inte alltid en önskan att ändra sitt utseende som triggar en ätstörning, bland atleter kan det vara att man vill förbättra sin prestation som utlöser ätstörning. Att arbeta förebyggande inom idrotten kan ge en chans att reducera antalet fall av ätstörningar. Intentionen med den här studien var att bredda förståelsen för ätstörningar inom idrotten. Studien är baserad på intervjuer och resultaten kommer att redovisas under tre teman: utlösande faktorer, prevention och kommunikation. Resultaten visar att behovet finns och att coachens roll för ungdomarna blir viktig för att upptäcka symptom till ätstörning.

Submitted by Irene Nascimento (irene.kessia@ufpe.br) on 2017-03-29T19:31:11Z No. of bitstreams: 2 license_rdf: 1232 bytes, checksum: 66e71c371cc565284e70f40736c94386 (MD5) TESE_MADGE FARIAS FECHINE_.pdf: 4788089 bytes, checksum: 648782ee88724431e5d44996b0235367 (MD5) / Made available in DSpace on 2017-03-29T19:31:11Z (GMT). No. of bitstreams: 2 license_rdf: 1232 bytes, checksum: 66e71c371cc565284e70f40736c94386 (MD5) TESE_MADGE FARIAS FECHINE_.pdf: 4788089 bytes, checksum: 648782ee88724431e5d44996b0235367 (MD5) Previous issue date: 2016-05-31 / CAPES / Objetivo: Investigar os efeitos da desnutrição proteica perinatal ou manipulação do sistema serotoninérgico durante a lactação sob o comportamento alimentar compulsivo após ciclos de Restrição/Realimentação (R/R). Materiais e métodos: Foram formados quatro grupos conforme os tratamentos dietéticos e farmacológicos: Controle (17% caseína na vida perinatal) e Desnutrido (8% caseína na vida perinatal); Salina (10mg/Kg) e Fluoxetina (10mg/Kg) foram submetidos a três consecutivos ciclos de Restrição/Realimentação (ciclos R/R). Cada ciclo R/R é composto por uma fase de restrição (4 dias com 40% do consumo individual médio de dieta padrão nos 7 dias antes de iniciar os ciclos R/R) seguida por uma fase realimentação (4 dias com dieta padrão ad libitum). Assim, os quatro grupos anteriormente descritos foram subdivididos ou não de acordo com a fase de restrição dos ciclos R/R para formar oito grupos: Grupos não restritos [Controle Naïve (CN) n=6 e 10 ou Desnutrido Naïve (DN) n=7 e 11 e Salina Naïve (SN) n=13/15 ou Fluoxetina Naïve (FN) n=12/13] e Grupos restritos [Controle Restrito (CR) n=6 e 11 ou Desnutrido Restrito (DR) n=7 e 10 e Salina Restrito (SR) n=11/13 ou Fluoxetina Restrito (FR) n=13/14]. Após os três ciclos R/R, todos os animais foram submetidos ao teste alimentar (dieta padrão e palatável por 24hs). Após uma semana, os animais dos grupos [Controle Naïve (CN) n=10 ou Controle Restrito (CR) n=11 e Desnutridos Naïve (DN) n=11 ou Desnutrido Restrito (DR) n=10] foram submetidos a um teste de privação alimentar (24hs sem dieta padrão) e em seguida receberam dieta palatável (2hs) e dieta padrão (22hs). Já todos os animais dos grupos Salina e Fluoxetina, aos 120 dias de vida foram submetidos a outro teste alimentar semelhante ao primeiro teste alimentar (após os ciclos R/R). Resultados: Após ciclos R/R os animais Desnutrido Restrito demonstraram hiperfagia por dieta palatável comparados com os animais do grupo Controle Naïve, como também aumentaram o peso corporal sugerindo o desenvolvimento de obesidade. Contudo, estes animais perderam a capacidade para aumentar o consumo de dieta palatável quando estavam com fome, após a privação alimentar. Em relação aos grupos Salina e Fluoxetina não houve diferenças significativas no consumo alimentar (dieta palatável e padrão) nos dois testes alimentares. Conclusão: Desnutrição proteica perinatal ou tratamento de fluoxetina no aleitamento não contribuem para o desenvolvimento de compulsão alimentar após três ciclos R/R. / Objective: To investigate the effects of the perinatal protein undernourishment or manipulation of the serotonergic system in breastfeeding on the binge eating behavior after Restriction/Refeeding cycles (R/R cycles). Materials and methods: Four groups were formed as dietary and pharmacological treatments: Control (17% casein in perinatal life) and Undernourished (8% casein in perinatal life); Saline (10mg/kg) and Fluoxetine (10mg/kg) were submitted to three consecutive cycles of Restriction/Refeeding cycles (R/R cycles). Each R/R cycle was composed of a restriction phase (4 days with 40% of the mean individual consumption standard diet 7 days before starting cycles R/R) followed by a feedback phase (4 days with a standard diet ad libitum). Thus, the four groups described above were subdivided or not according to the restriction phase of R/R cycles to form eight groups: not restricted Groups [Control Naïve (CN) n=6 and 10 or Undernourished Naïve (UN) n=7 and 11 and Saline Naïve (SN) n=13/15 or Fluoxetine Naïve (FN) n=12/13] and Restricted Groups [Restricted Control (CR) n=6 and 11 or Undernourished Restricted (DR) n=7 and 10 and Saline Restricted (SR) n=11/13 or Fluoxetine Restricted (FR) n=13/14]. After three R/R cycles, all animals were subjected to the feeding test (standard diet and palatable food for 24hrs). After one week, the animals of the groups [Control Naïve (CN) n=10 or Restricted Control (CR) n=11 and Undernourished Naïve (DN) n=11 or Undernourished Restricted (UR) n=10] were subjected to a test food deprivation (24hrs without standard diet) and then received palatable food (2hrs) and standard diet (22hrs). Already all the animals of Saline and Fluoxetine groups at 120 days of age were subjected to a similar feeding test the first test (after R/R cycles). Results: After R/R cycles the Restricted Undernourished animals showed hyperphagia by palatable food compared to animals Naïve control group, as well as increased body weight suggesting the development of obesity. However, these animals have lost the ability to increase the intake of palatable food when they were hungry after food deprivation. Regarding Saline and Fluoxetine groups there was not significant differences in food intake (standard diet and palatable food) in both feeding tests. Conclusion: Perinatal protein undernourishment or treatment of fluoxetine in breastfeeding do not contribute to the development of binge eating after three R/R cycles.

Bakgrund Ätstörningar är psykiatriska tillstånd som innefattar problem som nedsatt kroppsuppfattning och stegrad muskelspänning. En ökad risk för att hamna i ett ohälsosamt träningsbeteende finns. Fysioterapeutisk behandling syftar till att hjälpa patienterna återfå en realistisk självbild och en positiv upplevelse av kroppen. Syfte Att undersöka vilka erfarenheter och upplevelser fysioterapeuter i Sverige hade kring sitt arbete och vad de kunde bidra med inom ätstörningsvården samt vilka faktorer de upplevde hade betydelse för följsamhet till fysioterapeutisk behandling. Design och metod En kvalitativ design användes. Sex fysioterapeuter med minst ett halvårs erfarenhet av arbete med ätstörningar inom specialistvården deltog. För bearbetning användes en kvalitativ innehållsanalys enligt Graneheims och Lundmans induktiva strategi. Resultat Arbetet som fysioterapeut beskrevs som viktigt och utmanande. Upplevelser av fysioterapeutiska expertis, patientcentrerat arbete, otillräckliga riktlinjer och behandlingsmetoder lyftes. Underlättande faktorer för följsamhet gentemot den fysioterapeutiska behandlingen var färre än de försvårande och inkluderade bland annat socialt stöd och tålamod från vårdgivaren. Försvårande faktorer var framförallt en längre tids sjukdom och träningsstopp. Konklusion Fysioterapeuter kan bidra med sina kunskaper om kroppen, fysisk aktivitet och träning gällande behandling av ätstörningar. Tålamod från vårdgivaren, socialt stöd, en längre tids sjukdom, och träningsstopp är några faktorer som enligt studien påverkar följsamheten gentemot den fysioterapeutiska behandlingen. / Background Eating disorders are psychiatric conditions that contribute to problems such as impaired body perception and increased muscular tension. The patients also run an increased risk of executing an unhealthy exercise behaviour. Physiotherapeutic treatment aims to help these patients regain a realistic self-image and a positive perception of the body. Purpose To explore what experiences physiotherapists in Sweden had regarding their work and what they could contribute within the treatment of eating disorders, as well as to find what factors they judge were important for compliance within physiotherapeutic treatment. Design and method A qualitative design was used in this study. Six physiotherapists with at least six months experience working with eating disorders in specialist care were selected to participate. A qualitative content analysis was used according to Graneheim and Lundman's inductive strategy. Results The work as a physiotherapist in eating disorder care was described as important and challenging. Experiences about physiotherapeutic expertise, patient-centered work, insufficient guidelines and treatment methods were mentioned. The facilitating factors for compliance with the physiotherapeutic treatment were fewer than the aggravating factors and included social support and patience from the healthcare provider. Aggravating factors were above all a longterm illness and exercise stops. Conclusion Physiotherapists can contribute with their knowledge of the body, physical activity and exercise in the treatment of eating disorders. Patience from the healthcare provider, social support, longterm illness, and exercise stops are some of the factors that, according to this study, will influence compliance with the physiotherapeutic treatment.

Syftet med denna uppsats är att genom att använda ett specifikt teoretiskt ramverk kunna undersöka och problematisera den stora förekomsten av transpersoner med erfarenhet av ätstörningar. Ramverket är baserat på Sara Ahmeds teorier om orientering och bygger på synen på samhället som uppbyggt av heteronormativa linjer vilka transpersoner förhåller sig till. Genom att välja ut illustrerande exempel från två antologier kretsade kring kropp och identitet har jag kunnat peka på att den press som transpersoner utsätts för i samhället leder till minskat handlingsutrymme, maktlöshet, kroppslig dysfori och assimilation. Med behovet av att reglera de känslor som uppstår samt den fysiska kroppen kan ätstörningen ses som ett verktyg med dubbel funktion. Dels för att hantera maktlösheten inför världen och återta kontroll över den kropp som någon annan definierat och begränsat. Och dels utifrån behovet av att skapa sig själv som begriplig inför sig själv och världen - för att kunna existera.

There is evidence that functions related to attachment may play an important role in the etiology and maintenance of eating disorders, particularly anorexia and bulimia nervosa (Kuipers & Bekker, 2012; Tasca & Balfour, 2014). However, there is little research available on attachment functioning in those with binge-eating disorder (BED). This dissertation consists of three studies that examine the role of attachment states of mind and attachment dimensions in understanding BED and co-morbid overweight, and to examine mechanisms related to group treatment response for those with BED. The first study assessed attachment state of mind classifications (i.e., attachment categories) to understand better: 1) the psychopathology and maintenance of BED and co-morbid overweight, and 2) the treatment response of women with BED who receive Group Psychodynamic Interpersonal Psychotherapy (GPIP; Tasca, Mikail, & Hewitt, 2005). Overweight women with BED (subsequently referred to as women with BED), overweight women without BED, and normal weight women without BED completed the Adult Attachment Interview (AAI; Main, Goldwyn, & Hesse, 2002). Those with BED completed the AAI pre- and six months post- GPIP and those without BED completed the AAI at one-time point. Women with BED have significantly higher rates of insecure (preoccupied) and unresolved/disorganized attachment states of mind compared to normal weight women without BED. Women with BED had similar rates of insecure and unresolved/disorganized attachment states of mind as overweight women without BED. With respect to treatment completers, changes in attachment states of mind were not statistically significant. However, follow-up analyses indicated clinically meaningful changes which are discussed in the study. The second study used attachment dimensions of coherence of mind and reflective functioning (measured using the AAI) to add to our understanding of the psychopathology and maintenance of BED and co-morbid overweight. Higher Reflective Functioning scores differentiated normal weight women from both women with BED and overweight women without BED, and the latter two groups did not differ from each other. Coherence of Mind scores did not differentiate the groups. The third study used attachment dimensions of coherence of mind and reflective functioning to understand better group psychotherapy response for those with BED who received GPIP. Greater reflective functioning at pre-treatment was associated with a decline in binge eating frequency at 12 months post-treatment. Pre-treatment levels of coherence of mind was not related to group treatment outcomes. Reflective Functioning scores significantly improved from pre- to six months post-treatment. Further, more than 39% of participants demonstrated clinically reliable improvement and almost 32% experienced clinically reliable recovery with respect to reflective functioning. These results were moderated by pre-treatment self-reported attachment anxiety. That is, those with lower attachment anxiety showed significant improvement in reflective functioning, whereas those with higher attachment anxiety did not show this improvement. A third of participants experienced clinically significant improvement in coherence of mind, but this change was not statistically significant. Overall, attachment dimensions and attachment state of mind classification contribute to our understanding of the etiology and maintenance of BED and co-morbid overweight, as well as to our understanding of the group treatment response of those with BED. Addressing attachment insecurity and low reflective functioning in those with BED may improve treatment outcomes.

Hälsa är viktigt för många människor och uppnås vanligen genom regelbunden träning och en bra kost. Men för vissa kan det gå över styr och istället för att uppnå en god psykisk och fysisk hälsa finns det dem som drabbas av ätstörningen ortorexi. Syftet med denna undersökningen var att se om det fanns någon skillnad mellan män och kvinnors risk att drabbas av ortorexi samt om olika relationsstatus och social umgängeskrets med olika högt hälso- och träningsrelaterande intresse och beteende kan öka risken att drabbas av ortorexi. Åttiotvå deltagare svarade på en enkät som bestod av Doninins ORTO-15 samt egenkonstruerade frågor. Resultatet visade att det inte fanns någon signifikant skillnad mellan könen gällande att visa tecken på ortorexi men att relationsstatus och att den sociala umgängeskretsen med högt hälso- och träningsrelaterande intresse och beteende hade en betydelse för risk att drabbas av ortorexi. Varför det inte fanns någon skillnad mellan könen kan tänkas bero på att träning och hälsa vänder sig till alla människor oavsett kön och därav påverkas både män och kvinnor lika mycket.

The purpose of this study was to test the effectiveness of a cognitive-dissonance based intervention in reducing disordered eating attitudes and behaviors. The intervention program created dissonance through discussion, exercises, and homework aimed at addressing and countering internalized sociocultural pressures, beliefs and values about women's bodies, attractiveness, and worth in the U.S. Seventy-seven female undergraduates were randomly assigned to one of four conditions: cognitive-dissonance, combined cognitive-dissonance, healthy weight placebo control, and wait-list control To determine effectiveness of the intervention, MANCOVA procedures were used, with Time 1 scores serving as the covariate. Overall, the women who received the dissonance based interventions produced the strongest effects among measures assessing sociocultural pressures, internalization, and body dissatisfaction in comparison to the control group, and experienced significant reductions in dieting behaviors and bulimic symptoms over the course of the study, suggesting that the creation of dissonance via the intervention assisted the women in reducing eating disorder risk factors.

In the current study, I examined the general sociocultural model of eating disorders that suggests that sociocultural pressures leads to internalization, which in turn leads to body dissatisfaction and ultimately disordered eating. Because I am testing this model with a sample of African American women, I also am including acculturation as a variable of interest. Specifically, I hypothesized that (a) the experience of more societal pressure to be thin will be related to greater internalization, (b) higher levels of acculturation will be related to greater internalization, (c) internalization of the thin ideal will be directly and positively related to body image concern, and (d) body image concern will be associated with higher levels of disordered eating. It was determined that there is a direct, negative relationship between Level of Identification with Culture of Origin and Internalization. Perceived Pressure was directly and positively related to both Internalization and Body Image Concerns. Body Concerns and Internalization were both directly and positively related to Disordered Eating. These findings suggest that although many of the same constructs related to disordered eating in other ethnic groups are also related to disordered eating among African American women, the relationships between the factors differs across racial/ethnic groups. This information can help clinicians and researchers to better treat and understand the nature of disordered eating behavior and correlates among African American women.

No description available.