Eating disorders remain a phenomenon that escapes full comprehension, resulting in frustration for those who suffer from the disorders, their families, and their therapists. It is becoming increasingly necessary to describe the mechanism by which eating disorders develop, in order to effectively treat and prevent these disorders. The aim of this study was to illuminate factors that contributed to the development of eating disorders within the individual contexts of the lives of the participants, as well as how those factors interacted in context to culminate in the development of an eating disorder. This qualitative study was conducted from an interpretive perspective. The findings show how individual contextual factors interact to produce a marked fear of gaining weight, which is driven by fear of negative evaluation, and that the eating disorder behaviour serves specific functions that are related to coping with stress within the lives of the participants. / Psychology / M. Sc. (Psychology with specialisation in Research Consultation)

Numerous studies have reported psychological benefits associated with the practice of values-based self-affirmation. However, there is little evidence regarding their clinical applicability. Many of the purported benefits of values-based self-affirmation are highly relevant to people with bulimia nervosa (BN). This study used a multiple case study design in order to investigate the effectiveness, underlying mechanisms and acceptability of a brief (three week) intervention focussing on the development and practice of values-based self-affirmations with people who have BN. Two participants were recruited from an Eating Disorders (ED) Service waiting list. They completed questionnaires measuring cognitions associated with ED, attitude towards change, self-esteem, self-compassion, body image acceptance, psychological flexibility, cognitive defusion, and SELF repertory grids over four time points. Following appointments qualitative data was collected, and on completion of the intervention participants were interviewed, regarding their experiences. Pre and post intervention behavioural measures of BN were also collected. The use of a personal values-based self-affirmation intervention was associated with reductions in behaviours associated with BN, enhanced attitude towards change and reduced discrepancy between self and ideal self. There was little convincing evidence that the intervention was associated with a reduction in cognitions associated with ED. A very small degree of change in a positive direction was observed in relation to self-esteem, self-compassion, body image acceptance, psychological flexibility and cognitive fusion. However, scores did not reflect Reliable Change in these processes. Overall, results appeared to be slightly better explained by theory underpinning Personal Construct Psychotherapy rather than Acceptance and Commitment Therapy. However, neither theoretical explanation fully accounted for the data. Participants generally found the intervention to be acceptable. The results add novel findings to the literature regarding the use of values-based self-affirmation within the treatment of BN. They suggest that a brief values-based self-affirmation intervention might be a useful adjunct to evidence based treatment of BN. However, the case study design that is utilised in this study limits the degree to which these results may be generalised and future research should explore this further.

Bakgrund: Ätstörningar, som främst kännetecknas som ett skadligt beteendemönster gällande mat, är idag den psykiska sjukdomen med högst dödsfrekvens och att vårda en sjukdomsdrabbad person är i regel mycket krävande och utmanande. Ofta kan det innebära en signifikant stress för vårdgivaren och en stark känsla av skuld. Syfte: Att beskriva föräldrars upplevelser och känslor kring att vara förälder till ett barn med ätstörningar. Metod: Studien utfördes som en kvalitativ intervjustudie med en deskriptiv design. Sex semistrukturerade intervjuer genomfördes, tre via muntlig intervju och tre via enkät, som analyserades med hjälp av en kvalitativ innehållsanalys. Resultat: Föräldrarna beskrev en tillvaro med mycket smärta, känslor av frustration, förtvivlan och maktlöshet av att inte veta hur situationer skulle hanteras, samt känslan att vara övervakare och att tvingas begränsa barnet. Stöd upplevde föräldrarna få från partners, barnets skola och vården. Det beskrevs hur syskon reagerade olika på situationen och att familjen hade begränsats, både socialt och gällande flexibilitet kring matrutiner, men att sjukdomen ändå förde familjen närmare varandra. Slutsats: Resultatet visar att ätstörningar kan påverka sin omgivning mycket starkt och föräldrar beskriver en tillvaro som kan vara väldigt jobbig, emotionellt krävande, tålamodsprövande och ibland rent skrämmande. Föräldrarna är till majoritet mycket nöjda med vårdens hjälp och stöd. Hälso- och sjukvårdspersonal bör fortsätta se till både den sjukdomsdrabbade och de anhöriga som en helhet. Trots allt negativt omkring sjukdomen, tycker sig föräldrarna se positiva faktorer såsom öppnare samtalsklimat och en mer sammansvetsad familj.

A collection of short stories and one novella featuring women’s issues, fairy tales, a coming-of-age story, and a pregnancy that turns out differently than expected upon delivery.

Introduction: Eating is a highly motivated and reinforced behaviour, therefore human eating behaviour is not a passive response or merely physiological drives providing nutrients for survival; it is about cognitive and emotional processes based choice. Obesity is a condition in which the natural energy reserve, stored in the fatty tissue of humans is increased to a point where it is associated with certain health conditions or increased mortality. Anorexia nervosa is a condition of self initiated weight loss characterised by a profound disturbance of the body image, distorted self-perception, and obsessive fear of gaining weight and problem in the cognitive and the emotional functioning. Continuum model proposed that eating disorders from restriction to overeating can be placed on a linear dimension. Aim: The main goal of the doctorate thesis is to examine the existence of certain common dysfunction related to the two extreme sides of the dimension of the eating disorders (restrictive anorexia and stable obesity). Therefore we compared cognitive profile, emotion functioning (explicit and early categorization of facial emotions) and attitudes (explicit and implicit) towards body image both in obesity and anorexia. Results: The neuropsychological tasks show attentional deficit and distractibility in obesity and anorexia nervosa. In obesity we have found perseveration, deficit on the shifting and inhibition capacity, while in anorexia nervosa perseveration was linked to anxiety. These findings suggest that the PFC based executive function can be associated with modified brain dopamine turnover in the PFC area in obesity. Beside, the higher level of depression in both patient groups; our findings proved that obese patients were more sensitive to the positive emotions and the same time they ignored the negative emotions. In contrary to obesity, anorexic patients were more sensitive to negative emotions specifically those one which represent possible threats such as anger. Obese patients evaluated implicitly more positive the overweight body figures than controls. There was an attitudinal discrepancy between the explicit, socially exposed “ideal body” and the internal (implicit) body shape preference. The anorexic group did not evaluate positively the underweight body shape as we expected either implicitly or explicitly. Based on these findings we suggest that not the underweight body preference is a key issue in anorexia, but the obsessive fear for the obesity. Conclusion: We have found different psychological mechanisms in the pathology of restrictive anorexia nervosa and stable obesity. Our results did not confirm the idea of the continuum model about the linear spectrum based on eating behaviour (from the restriction to overeating), and from body weight (from underweight to obese). Our results suggest that restrictive anorexia nervosa has several common features with anxiety disorder or affective disorders, while obesity most probably can be associated with addictive pathologies.

Section A is a systematic review of emotional processing in people with Anorexia Nervosa (AN). By drawing together all self-report research, it outlines the specific emotional processing difficulties experienced by this population. It concludes that theoretical assertions that poor emotional processing maintains AN are tentatively empirically supported, but data is limited and largely cross-sectional. Section B Background. Effective treatments for AN in adults remain elusive. Recent research suggests poor socio-emotional and neurocognitive functioning may act as underpinning maintaining mechanisms for AN. These difficulties are therefore indicated as treatment targets; however, their roles as maintaining factors and the benefits of including socio-emotional and neurocognitive difficulties as foci for therapy lack empirical evidence. Methods. A randomised control trial design was employed to compare the Maudsley AN Treatment for Adults (MANTRA) based on a novel maintenance model of AN seeking to target key socio-emotional factors (maladaptive emotion beliefs and over-control of emotion, alongside poor social cognition) and neurocognitive factors (poor set-shifting and extreme detail-focus), against a control treatment mimicking treatment as usual (specialist supportive clinical management; SSCM). It was hypothesised that: (1) baseline socio-emotional and neurocognitive difficulties would predict outcomes, highlighting their role as maintenance factors; and (2) MANTRA would significantly improve these factors over SSCM leading to better clinical outcomes, therefore confirming them ‘causal’ maintenance factors. Results. Emotional avoidance (behavioural/cognitive avoidance, low acceptance) and some other elements of control (submissive behaviour) predicted clinical outcomes. Social cognitive (emotion recognition, emotional Theory of Mind) and neurocognitive functioning (set-shifting, detail-focus) had limited predictive ability. There were socio-emotional (social comparison, cognitive avoidance) and neurocognitive (set-shifting) improvements following MANTRA over SSCM, but no clinical advantage. Conclusions. Emotional avoidance and submissive behaviours may represent maintenance factors for AN. Social cognitive and neurocognitive variables appear less important. No ‘causal’ maintenance factors could be concluded from the data. Implications for adapting MANTRA are discussed. Section C is a critical appraisal of this research reflecting on key learning points and the limitations of the study, as well as the impact of the study on clinical work and in planning future research.

This study investigated the intrapersonal and interpersonal context of female dieting and partner support for dieting in 44 heterosexual couples. Participants completed questionnaires assessing self and relationship functioning, dieting levels and eating disordered attitudes, and weight-loss support frequency and helpfulness, in both a cross-sectional and longitudinal study. As predicted, a) higher levels of unhealthy dieting were significantly related to more negative views of the self (e.g., lower self-esteem), and b) lower perceived levels of support from the partner were significantly related to higher levels of eating-disordered attitudes, anxious attachment, and lower relationship satisfaction. However, testing more complex causal models showed that self-esteem played a pivotal role. First, tests confirmed that the impact of self-esteem on unhealthy dieting was mediated by more disordered attitudes to eating. Second, those with low-self-esteem were much less likely to diet in an unhealthy fashion with more frequent and positive partner support, whereas high self-esteem women were not influenced by the support offered by their partners. These findings did not apply to the frequency of healthy dieting, with the important exception that more frequent partner support encouraged healthier dieting, and they held up when plausible third variables were statistically controlled. The findings suggest that dieting behaviour is influenced both by individual differences and the nature of support in intimate relationship contexts.

Introduction: The prevalence of obesity in South Africa and throughout the world is increasing. Obesity is related to hypertension, atherosclerosis, diabetes, dyslipidemia and other sub-clinical conditions. Aim: To establish the prevalence of obesity and related risk factors among nurses in a public health hospital in KwaZulu-Natal. Methods: The design entailed a cross-sectional survey among 250 randomly selected nurses (22-64 years) working in King Edward Hospital (KZN). Obesity was measured using anthropometric and derived parameters of stature, body mass, body mass index (BMI) and waist to hip ratios (WHR). Related risks were determined using a screening questionnaire. Results: The mean body mass and BMI observed was 84.42 ± 17.49 kg and 32.60± 6.34 kg/m2, respectively with 76.10% of the sample being overweight or obese (64.80%; BMI~30). The mean waist circumference (93.01±12.73 cm) fell into the high risk category. A large proportion (30.4%) reported experiencing lower back pain. A significant crude odds ratio (OR) was found between obesity and the risk for lower back pain with an OR of 2.53 (CI 1.12 - 5.71). An increased but insignificant risk was observed in obese individuals for hypertension (OR 1.85: CI 0.63 - 5.40). Stressed individuals (PSS> 13) had an increased but insignificant risk for obesity (OR 1.78: CI 0.70 - 4.50) but a significantly increased risk for lower back pain (OR 8.59: CI 2.00-36.85; p:S0.05). Only 79 of the 250 nurses (31.6%) from our sample reported doing vigorous exercises on a regular basis and the nature of their exercise programs did not protect against the risk of obesity (OR 2.18: CI 1.03-4.60; p:S0.05). Discussion and Conclusion: A high prevalence of obesity and related risk factors among this population of nurses in a public hospital, and potentially in the nursing occupation at large, should be addressed within the context of employee wellbeing. The need for education on appropriate diet and exercise programming in order to prevent hypokinesis and associated diseases of lifestyle is evident. Key words: Nurses, Body Mass Index, Obesity, Low Back Pain, Hypertension, Stress, Hypokinesis / Thesis (M.Sport Sc.)-University of KwaZulu-Natal, Durban, 2010.

Aim: Schema therapy is becoming an increasingly popular psychological model for working with individuals who have a variety of mental health and personality difficulties. The aim of this review is to look at the current evidence base for schema therapy and highlight directions for further research. Method: A systematic search of the literature was conducted up until January 2011. All studies that had clinically tested the efficacy of schema therapy as described by Jeffrey Young (Young, 1994; Young et al., 2003) were considered. These studies underwent detailed quality assessments based on Scottish Intercollegiate Guidelines Network (SIGN-50) culminating in twelve studies being included in the review. Results: The culminative message (both from the popularity of this model and the medium to large effect sizes) is of a theory which has already demonstrated clinically effective outcomes in a small number of studies and which would benefit from ongoing research and development with complex client groups. Recommendations: It is imperative that psychological practice be guided by high quality research that demonstrates efficacious, evidence based interventions. It is therefore recommended that researchers and clinicians working with schema therapy seek to build on these positive outcomes and further demonstrate the clinical effectiveness of this model through ongoing research.

Background: A topic more frequently discussed nowadays is orthorexia nervosa (ON), which is an atypical eating disorder where the person is obsessed with healthy eating to avoid illness and disease. Signs of ON often begin with a wish for getting rid of bad habits, such as eating meals containing a lot of sugar and fat. Eventually the person’s behaviour changes and eating healthy becomes an unhealthy obsession that takes over the everyday life. Recently, it has also been related to excessive training, especially in Swedish media. Furthermore, it has been shown that athletes are at higher risk for developing ON. However, there is insufficient research in this area, as well as the ON prevalence among adolescent girls and correlation between ON and body mass index adjusted for children and adolescents. To investigate this, as well as the correlation between ON and hand strength, which is used as an indicator of general muscle strength, is therefore of great importance.  Aim: The aim of this study was to compare ON prevalence among adolescent girls in seventh grade in a sports secondary school and adolescent girls in seventh grade in general secondary schools and investigate the correlation between ON and BMI and ON and hand strength.  Method: A total of 48 girls in seventh grade participated in the study: 28 girls from the sports secondary school and 20 girls from the general secondary schools. To investigate the ON prevalence the questionnaire ORTO-15 was used. To calculate BMI standing length and body weight was measured and thereafter adjusted to the cut-off points constructed by the International Obesity Task Force. Hand strength was registered with a hand grip dynamometer.  Results: There was no significant difference in ON prevalence between the girls in the sports secondary school and the general secondary schools. However, a majority of all girls had an indication of ON. Furthermore, a higher indication of ON had a small correlation with both a higher BMI and a higher muscle strength. Conclusion: More studies and better instruments are needed to further investigate ON prevalence among adolescent girls, as well as relationships between ON and BMI and ON and hand strength. Interesting to consider in further research is also how these variables evolve over time in persons with ON. / Malmö Youth Sport Study / Halmstad Youth Sport Study