The diploma thesis is focusing on the topic of eating disorders in young men. The literature review summarizes the current information concerning eating disorders in this population. Eating and feeding disorders included in DSM - 5 are described. The thesis also focuses on orthorexia nervosa and muscle dysmorphia. A separate chapter deals with body image in men and its connection to eating disorders. The final chapter of the literary review section is focused on the possibilities of diagnostics and therapy. The empirical part of the work consists of a quantitative research conducted on a sample of 164 men aged 18-30 years. A questionnaire survey was carried out. Using Spearman's correlation coefficient, a significant correlation was found between the symptomatology of eating disorders and muscle dysmorphia. There was also a significant correlation between Body Mass Index and the symptoms of eating disorders and also between BMI and muscular dysmorphia. Data analysis revealed a positive correlation between the higher symptomatology of eating disorders and dissatisfaction with the amout of body fat. No significant relationship was found between the symptomatology of eating disorders and dissatisfaction with muscle mass. There was a significant correlation between Body Mass Index and dissatisfaction...

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Despite well-established diagnostic measures and measures of specific dimensions of eating disorder symptomatology, little work has been done to develop a brief, comprehensive, and valid measure for assessing change in eating disorder symptoms. Further, empirically-supported change indices to assess treatment progression and outcome have not yet been developed. The Change in Eating Disorder Symptoms Scale (CHEDS) is a new comprehensive measure designed to assess progress and change during treatment in persons with diagnoses on the eating disorder spectrum. Previous studies have demonstrated the subscale structure, reliability, and validity of the CHEDS. This study determined clinically significant change criteria for the CHEDS to complement the studies that have supported the CHEDS as a reliable and valid measure of eating disorder symptomatology. The CHEDS was also compared to a life functioning scale, the Clinical Impairment Assessment. A reliable change index (RCI) was developed, which generated an inferential statistic that estimates the magnitude of change in a score necessary for a change score to be considered statistically reliable. A cutscore was also developed, which differentiates between functional and dysfunctional populations, between eating disordered clinical subjects and non-clinical subjects. Trajectories were identified using hierarchical linear modeling methods for use in conjunction with clinical significance criteria to aid in the tracking of symptoms during treatment, treatment decision-making, and tailoring treatment according to expected and observed progress. The clinical significance change criteria were then applied to the clinical sample to determine change patterns descriptive of recovered, reliable improvement, deterioration, and no change. Finally, a scoring program with clinical significance change criteria and trajectory analyses for total and subscale scores was developed.

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.

The first aim of this study was to develop a research based, integrated, secondary prevention programme, called the Weight Over-concern and Well-being (WOW) programme, for the reduction of Subclinical Eating Disorder (SED) symptoms, associated traits and negative mood states, and the promotion of psychological well-being (PWB) in female students. Consequently the second aim was to determine the effectiveness of the WOW-programme on its own, in comparison with a combined Tomatis Method of sound stimulation (Tomatis, 1990) and WOW-programme, regarding the reduction of SED-symptoms, associated traits and negative mood states; the promotion of PWB; and outcome maintenance. The last aim was to obtain a deeper understanding and "insiders' perspective" of the lived experience of SED, through an interpretative phenomenological inquiry (Smith & Osborn, 2003). The motivation for the current study is a need for research based, integrated, risk-protective, secondary prevention programmes from a social-developmental perspective for female university students (Garner, 2004; Phelps, Sapia, Nathanson & Nelson, 2000; Polivy & Herman, 2002), given their risk status (Edwards & Moldan, 2004; Senekal, Steyn, Mashego & Nel, 2001; Wassenaar, Le Grange, Winship & Lachenicht, 2000). Concurrently in-depth descriptions from an "insiders' perspective" on the lived experience of SED are non-existent and require interpretative phenomenological study (Brocki & Wearden, 2006). Consequently this thesis consists of three articles, namely: (i) Development of a secondary prevention programme for female university students with Subclinical Eating Disorder, (ii) A secondary prevention programme for female students with Subclinical Eating Disorder: a comparative evaluation; and (iii) Lived experiences of Subclinical Eating Disorder: female students' perceptions. The research context comprised Subclinical Eating Disorder, secondary prevention and Positive Psychology. The first article, Development of a secondary prevention programme for female university students with Subclinical Eating Disorder (Kirsten, Du Plessis & Du Toit, 2007a), is qualitative in nature, and narrates a process of participatory action research followed to develop the WOW-programme. This social process of knowledge construction, embedded in Social Constructivist theory (Koch, Selim & Kralik, 2002), gradually revealed best clinical practice, and in retrospect, evolved over four phases. Phase One comprised experiential learning based on personal experiences with SED as undergraduate student and interaction with "participant researchers" as scientist practitioner (Strieker, 2002), resulting in a provisional risk model of intervention. Phase Two, a formal pilot study (Du Plessis, Vermeulen & Kirsten, 2004), afforded an evaluation of ideas generated in Phase One through a three-group pre-post-test design. Outcomes of Phase Two informed Phase Three, an integration of prior learning with Positive Psychology theory and clinical practice, resulting in a risk-protective model of prevention. Theoretical assumptions previously constructed were integrated and operationalised during Phase Four, into the final 9-session WOW-programme. In conclusion the process of knowledge construction was rigorous, despite the small overall sample size (n=28), since data saturation occurred within that sample. Although the multitude of aims involved in each session of the WOW-programme could be seen as unrealistic, in some direct or indirect way, they were addressed by means of relevant interventions due to the integrative approach. Thus future refinement is essential. Finally, despite aforementioned concerns, the WOW-programme proved to be robust on its own in reducing SED-symptoms and associated traits and enhancing PWB, as described in the second article of this thesis. The second article, A secondary prevention programme for female students with Subclinical Eating Disorder: a comparative evaluation (Kirsten, Du Plessis & Du Toit, 2007b), describes the outcomes of the WOW-programme on its own, evaluated comparatively with a combined Tomatis sound stimulation and WOW-programme. In this article the research aims were to determine: (i) whether participation in the combined sound stimulation and WOW-programme (Group 1); and (ii) participation in a WOW-programme only (Group 2), would lead to statistically significant reductions in SED-symptoms, psychological traits associated with eating disorders and negative mood states, and enhancement of PWB; (iii) whether results of Groups 1 and 2 would exceed results of a non-intervention control group (Group 3) practically significantly; and (iv) whether programme outcomes for Groups 1 and 2 would be retained at four-month follow-up evaluation. A mixed method design (Creswell, 2003; Morse, 2003) was used, including a three-group pre-post-test (n=45) and multiple case study (n=30) design. Various questionnaires measuring SED-symptoms, associated traits, negative mood states and PWB were completed. Qualitative data were obtained by means of metaphor drawings, letters to and from the "SED-problem", focus group interviews, the researchers' reflective field notes and individual semi-structured feedback questionnaires (Morse, 2003). Participation in Groups 1 and 2 proved effective, since decreases in SED-symptoms, associated traits, most negative mood states, and increases in PWB differed practically significantly from the results of Group 3. Outcomes for Groups 1 and 2 were maintained at four-month follow-up evaluation. Qualitative findings provided depth, support and trustworthiness to quantitative findings in light of the small sample size, and highlighted the value of using a mixed method design in prevention programming. It was concluded that the WOW-programme on its own, was an effective secondary prevention programme, since it led to reduced SED-symptoms, associated psychological traits and enhanced PWB, with retention of gains at four-months follow-up evaluation. The combined programme involving Tomatis stimulation and WOW-intervention proved to be even more effective, thus the complimentary role of Tomatis stimulation was demonstrated. However, the cost-effectiveness and comparative brevity of the WOW-programme rendered it the programme of choice regarding individuals with SED. Findings showed that conceptually, pathogenic and salutogenic perspectives can be successfully combined into a risk-protective model of secondary prevention. Lastly, the WOW-programme may even prove useful as an enrichment programme for female students in general. The third article, Lived experiences of Subclinical Eating Disorder: female students' perceptions (Kirsten, Du Plessis & Du Toit, 2007c), provides a qualitative, in-depth perspective on the lived experience of SED of 30 white, undergraduate females, purposively sampled. In this interpretative phenomenological, multiple case study (Brocki & Wearden, 2006), Groups 1 and 2 of the aforementioned primary study in the second article were used, since they fitted the criteria of "good informants" and were able to answer the research question (Morse, 2003). Further sampling was deemed unnecessary since data saturation occurred within their written and verbal responses and no negative cases were found. Rich individual qualitative data, further clarified through focus groups, emerged from graphic colour representations of lived SED, explanatory written records and "correspondence" with and from their "SED problem" (Gilligan, 2000; Loock, Myburgh, & Poggenpoel, 2003; White & Epston, 1990). Four main categories, characterised by serious intra-, interpersonal, existential and body image concerns were subdivided into seven subcategories, namely: Personal Brokenness, Personal Shame, Perceived Personal Inadequacy and Enslavement, Existential Vacuum, Perceived Social Pressure, Perceived Social Isolation and Body-image Dysfunction. Results were indicative of underestimation of SED-severity, its comprehensive detrimental impact on participants' PWB and high risk for escalation into full-blown eating disorders. It was concluded that the lived experiences of SED depicted the severity of SED-symptoms; descriptions resonated well with most of their pre-programme mean scores; and their risk status and need for contextually and developmentally relevant secondary prevention programmes were highlighted by the findings. / Thesis (Ph.D. (Psychology))--North-West University, Potchefstroom Campus, 2008.

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.

Master of Science / School of Journalism and Mass Communications / Nancy Muturi / This study was an examination of the determinants of disordered eating development among female collegiate distance runners. More specifically, the study examined the impact of thinness-emphasizing and thinness-promoting messages disseminated by mass media and running-specific media, and how those messages affected disordered eating among a sample of female collegiate distance runners. It also examines current female collegiate distance runners’ attitudes toward disordered eating, subjective norms from referent individuals close to female collegiate distance runners regarding disordered eating, and female collegiate distance runners’ perceived behavioral control regarding disordered eating—which was divided into various internal and external control factors either inhibiting or facilitating disordered eating among them. The study was qualitative in nature and assumed a multi-method approach. It included an online, anonymous, self-administered questionnaire among 166 current NCAA Division I female distance runners; four small, confidential focus groups with current NCAA Division I female distance runners from four different teams; and 16 in-depth interviews with professional distance runners, dietitians, coaches, physicians, and sports psychologists. The study sought to answer four research questions—each based on an element of the study’s guiding theory, the theory of planned behavior (Ajzen, 1991). Overall, the study found media messages, attitudes, subjective norms, and various internal and external control factors all facilitated disordered eating among NCAA Division I female distance runners. Based upon these findings, the study offers recommendations for practitioners in the field of health communication, coaches, academic institutions with cross country and track teams, and female collegiate distance runners.

Objective: Emerging prospective evidence from mixed samples, mostly covering short-term follow-up periods, suggests that childhood loss of control (LOC) eating predicts significant impairment in mental and physical health. This study sought to investigate the natural course of childhood LOC eating over the long term and in relation to binge eating disorder (BED) diagnosis, psychopathology, and body weight trajectory in the community. Method: A total of 60 children (8-13 years) with LOC eating within the past three months and 60 demographically-matched children without LOC history were assessed with the Eating Disorder Examination adapted for Children and self-report questionnaires over a 5.5 year follow-up period. Missing data were imputed. Results: Over follow-up, 38.3% of children showed persistent LOC eating, and 28.3% revealed an onset of LOC eating. Persistent LOC eating significantly predicted onset of partial-/full-syndrome BED at follow-up. Negative prognostic effects on eating disorder psychopathology, depressive symptoms, and body mass index were non-significant. Discussion: The results indicate a moderate stability of LOC eating over the long term. LOC eating, especially if stable, was suggested as a variable risk factor of clinically relevant eating disturbances. In contrast, a prognostic value for psychopathology and body mass index was not confirmed.

This research focused primarily on exploring the talk of mothers of daughters with Anorexia Nervosa, paying specific attention to their emic perceptions of the underlying causes of Anorexia Nervosa. The research sought to reveal the discourses underpinning participants talk. Further, the way in which these discourses serve to construct Anorexia Nervosa in particular ways as well as the function these discourses serve were explored. This study is qualitative and exploratory in design and provides a unique understanding of Anorexia Nervosa in the form of emic accounts gleaned from mothers' own experiences. The findings of this research suggest that mothers of daughters with Anorexia Nervosa primarily reproduce a discourse on the causality of Anorexia Nervosa that is family or biomedically focused. Through analysis of the discourses embedded in participants’ talk, it became evident that participants reproduce discourses of gender and femininity and are influenced by societal pressure as well as the constructions of womanhood and motherhood. Insight into a side of the mother of the Anorectic, often concealed in the literature, was revealed through a semi-structured interview process with nine urban, middle-class, white South African mothers of daughters with Anorexia Nervosa. Interviews were then transcribed and analysed according to Braun and Clarke's thematic analysis. Incorporating the silenced voices of mothers of daughters with Anorexia Nervosa appears to have allowed for the emergence of a more generous view of the mother and has contributed to a larger set of discursive repertoires through which to understand Anorexia Nervosa. This research further gave rise to the realisation of a need for a critical education program whereby taken for granted notions can be revealed and actively engaged. This program would ideally seek to free the anorexic woman as well as the mother from the constraints of the uncritically constructed conceptualisations of Anorexia Nervosa and femininity.

Bakgrund: Ätstörning bland barn och ungdomar leder till fysiskt och psykiskt lidande. Symtomen är matvägran, tvångsmässiga tankar på kost och vikt samt störd kroppsuppfattning. Trauma, grupptryck och genetiska faktorer är riskfaktorer för att insjukna och tidig upptäckt och behandling är viktigt för ett tillfrisknande. Skolsköterskans hälsofrämjande och förebyggande arbete är viktigt för att upptäcka och förhindra ätstörning.  Syfte: Studiens syfte är att beskriva skolsköterskans upplevelser av det hälsofrämjande arbetet för att förebygga ätstörning.  Metod: Kvalitativ metod med induktiv ansats. Semistrukturerade enskilda intervjuer samt semistrukturerade intervjuer i fokusgrupper med tio skolsköterskor analyserades enligt kvalitativ innehållsanalys.  Resultat: Studien resulterade i tre huvudkategorier: salutogena möten, stödjande miljöer och känslor av otillräcklighet och frustration. Utöver detta identifierades åtta underkategorier.  Konklusion: Skolsköterskans hälsofrämjande arbete för att förebygga ätstörning bygger på ett salutogent förhållningssätt. Med sin närvaro och genom samarbetet med skolpersonal och föräldrar bidrar skolsköterskan till en stödjande miljö. Skolsköterskan känner ambition och meningsfullhet men avsaknad av resurser och kompetens leder till frustration och begränsning av ett fullvärdigt hälsofrämjande arbete för att förebygga ätstörning / Background: Eating disorder among children and adolescents lead to physical and emotional suffering. Symptoms include refusing to eat, obsessive thoughts about food and weight and disturbed body image. Trauma, genetic factors and peer-pressure are risk factors and early discovery and treatment is important for recovery. The school nurse has, through health promotion and preventive work, an important role to prevent and discover eating disorder.  Purpose: The aim of this study was to describe the school nurse's experiences of health promotion in school to prevent eating disorder.  Method: A qualitative method with an inductive approach was used and the result was achieved using a qualitative content analysis. Semi-structured interviews and focus group interviews were conducted with ten school nurses.  Result: The study resulted in three main categories; salutogenic meetings, supportive environments and feelings of inadequacy and frustration.  Furthermore, eight subcategories were identified.  Conclusion: The school nurse health promotion to prevent eating disorder is based on a salutogenic approach. By being present and by cooperating with school staff and parents, the school nurse contributes a supportive environment. The school nurse has ambitions for this work and finds the work meaningful, but lack of resources and competence leads to a sense of frustration and limitation of an effective health promotion to prevent eating disorder.