The present study examined the claim that neuropsychological deficits in set-shifting and emotional decision making are present in eating disordered patients, and to what extent these deficits relate to specific aspects of disordered eating. Sixteen eating disordered patients and 38 controls were given a battery of neuropsychological measures, as well as questionnaires measuring disordered eating. Compared to controls, patients demonstrated poorer performance on tasks of set-shifting, but not decision making, psychomotor speed, working memory, or IQ. Across groups, poor set-shifting was correlated with food-, shape-, and weight concerns, and restricting, whereas poor decision making was correlated to restricting. The study demonstrates that set-shifting deficits are present in eating disordered patients, and that specific relations exist between cognitive performance in different domains and disordered eating.

This investigation examined multidimensional perfectionism, shame and maltreatment in 45 women with bulimia nervosa, 14 women with binge eating disorder and 26 women with anorexia nervosa, purging type, all of whom suffered from comorbid substance use disorders. Participants completed three perfectionism scales, one shame scale and one maltreatment scale. Results revealed that in the bulimia nervosa and binge eating disorder group, perfectionistic self-promotion and bodily shame were significant predictors of eating disorder severity while other-oriented perfectionism was a significant predictor of alcohol use severity. In the anorexia group, other-oriented perfectionism and bodily shame were significant predictors of eating disorder severity and nondisplay of imperfection was a significant predictor of drug use severity. All participants experienced elevated levels on all types of shame and maltreatment and on most perfectionism dimensions compared to normative samples. Findings should be utilized in developing treatment programs for those with comorbid eating and substance use disorders.

The purpose of this study was to investigate the presentation and outcome of anorexia nervosa (AN) within the pediatric population. A retrospective chart review of individuals who were admitted for the first time to hospital between 2000-2005 for treatment of AN was completed. Individuals were classified as Early Pediatric AN (admitted <14 years old) or Later Pediatric AN (≥14 years old). It was hypothesized that the Early Pediatric AN group would have a less severe presentation, as measured by percent ideal body weight (%IBW) and medical stability at admission, and better outcome as measured by rate of weight gain post-discharge, number of hospitalizations and the Morgan-Russell General Outcome Scale rating. The study contained a total of 207 cases, larger than many previous studies in pediatric AN. The study found that younger age at presentation was associated with admission at a higher %IBW but not medical stability. Age at presentation did not predict rate of weight gain or rehospitalization; however, the Early Pediatric AN group had a better outcome on the Morgan-Russell scale.

This investigation examined multidimensional perfectionism, shame and maltreatment in 45 women with bulimia nervosa, 14 women with binge eating disorder and 26 women with anorexia nervosa, purging type, all of whom suffered from comorbid substance use disorders. Participants completed three perfectionism scales, one shame scale and one maltreatment scale. Results revealed that in the bulimia nervosa and binge eating disorder group, perfectionistic self-promotion and bodily shame were significant predictors of eating disorder severity while other-oriented perfectionism was a significant predictor of alcohol use severity. In the anorexia group, other-oriented perfectionism and bodily shame were significant predictors of eating disorder severity and nondisplay of imperfection was a significant predictor of drug use severity. All participants experienced elevated levels on all types of shame and maltreatment and on most perfectionism dimensions compared to normative samples. Findings should be utilized in developing treatment programs for those with comorbid eating and substance use disorders.

The purpose of this study was to investigate the presentation and outcome of anorexia nervosa (AN) within the pediatric population. A retrospective chart review of individuals who were admitted for the first time to hospital between 2000-2005 for treatment of AN was completed. Individuals were classified as Early Pediatric AN (admitted <14 years old) or Later Pediatric AN (≥14 years old). It was hypothesized that the Early Pediatric AN group would have a less severe presentation, as measured by percent ideal body weight (%IBW) and medical stability at admission, and better outcome as measured by rate of weight gain post-discharge, number of hospitalizations and the Morgan-Russell General Outcome Scale rating. The study contained a total of 207 cases, larger than many previous studies in pediatric AN. The study found that younger age at presentation was associated with admission at a higher %IBW but not medical stability. Age at presentation did not predict rate of weight gain or rehospitalization; however, the Early Pediatric AN group had a better outcome on the Morgan-Russell scale.

Eating disorders have the highest mortality rate of all mental illnesses. Currently, web-logs are hosts to thousands of pro-ana (short for pro-anorexia) blogring participants, joining together with a common claim that eating disorders are "lifestyles not illnesses." This study explored participation motives among pro-ana blogring participants, relationships to individual psycho-social factors, and to unique web-log features. Results from the cross-sectional online survey suggest three main participation motives among blogring participants (community, obtaining social/ emotional support, and ego-protection). Results also indicate individual factors such as; social support satisfaction, drive-for-thinness, and BMI were related to blogger motives in a various diverse ways. Analyses of the findings from the present study reflect the self-disclosive nature of the blogging process. The results have several implications for eating disorder, computer-mediated communication, internet social support, and blog/blogring research.

The primary purpose of this study was to investigate the knowledge and experiences of school counsellors, teachers, and school-based personnel in the area of girls body image. Participants perspectives were described and implications identified for ways in which teachers can encourage positive body image for girls in their classrooms. The idea for this research evolved from my interest in positive self-esteem, and academic and social success. As a teacher, I find that girls (more so than boys) base their success on body image. Girls often turn to harmful health behaviours such as disordered eating or excessive exercise because of dissatisfaction with their bodies (Tiggemann, 2005; ODea, 2000). I hoped to find ways for teachers to foster positive body image, and I believed school counsellors, teachers, and school-based personnel would be a useful source of information on this topic. I brought to this research a desire to hear, understand, and make meaning from these professionals experiences of working with girls.<p>There are a variety of things a teacher can do to create a positive environment in the school setting relating to body image. Focus group participants felt teachers and other school personnel could: <br>(a) openly allow body image discussion in the classrooms either through Talking Circles or Body Talk; <br>(b) promote active lifestyles; <br>(c) promote healthy eating habits; and <br>(d) act as role models by modelling the right examples. <p>Listening and encouraging students can also create a positive environment. The normal development of bodies should be discussed openly in the classrooms. In order to help create positive body images in young girls, participants believed it was important for teachers and school personnel to: participate in empathy training (learning to talk to each other and to listen to each other), educate parents; train physical education teachers; encourage students to write daily journals and critically analyze media literacy.

The present study examined the claim that neuropsychological deficits in set-shifting and emotional decision making are present in eating disordered patients, and to what extent these deficits relate to specific aspects of disordered eating. Sixteen eating disordered patients and 38 controls were given a battery of neuropsychological measures, as well as questionnaires measuring disordered eating. Compared to controls, patients demonstrated poorer performance on tasks of set-shifting, but not decision making, psychomotor speed, working memory, or IQ. Across groups, poor set-shifting was correlated with food-, shape-, and weight concerns, and restricting, whereas poor decision making was correlated to restricting. The study demonstrates that set-shifting deficits are present in eating disordered patients, and that specific relations exist between cognitive performance in different domains and disordered eating.

The central scientific objective of the current dissertation was to take a multidisciplinary approach to make use of the full potential information, both scientific and clinical to aid prevention and treatment of EDs. In our studies we assessed a.) social and individual risk factors in EDs (Study 1), b.) empirical ED subtypes based on drive for thinness (DT) and depression (Study 2) and c.) the classification based on these four different empirical ED subtypes without cluster analysis and based on the use of clinical cutoff scores of DT and depression. Finally, we assessed the predictive validity for this subtyping scheme with regard to dropout from CBT in an unselected BN-P population seeking treatment. Our first line of investigation (Study 1) assessed social and self-standards in EDs. The results of the study suggest that compared to healthy controls, standards for physical appearance, family standards and self-achievements were higher in individuals with EDs, that ED patients show higher self-discrepancy between their personal and social values and confidence to attain them and that the conflict with their significant others over these issues was higher. Furthermore, high social and self-standards was associated with developing an ED, which emphasize the importance of assessing risk factors in ED. Finally we also observed differences in the ED subtypes; physical appearance a greater risk factor in BN and EDNOS while social-other standards were more associated with AN. The second research area (Study 2 and 3) explored new empirical ED subtypes along DT and depression. In our initial study (Study 2) we found four new ED subtypes through cluster analysis; “DT”, “DT-Depressive”, “mild DT” and “depressive-moderate DT”. This result indicates that dieting and depression are useful for analyzing and identifying ED subtypes. Study 3 further assessed these empirical subtypes and found that the same subtypes emerged when basing them on scores from clinical well-validated questionnaires and moreover that attrition rates differed between subtypes and that the dropout rate was highest for the “DT-Depressive” subtype. Our findings agree with the growing body of research indicating the importance of dieting and comorbid depression as contributing factors in ED diagnoses. Finally, these findings will hopefully aid in resolving the current controversy surrounding current DSM-ED classifications. / El objetivo central de esta tesis ha sido, desde una perspectiva multidisciplinar, integrar los conocimientos clínicos y científicos para contribuir en el avance de la prevención y tratamiento de los Trastornos de la Conducta Alimentaria (TCA). En estos estudios, se han explorado una serie de aspectos como a) factores de riesgo sociales e individuales en los TCA (estudio 1), b) identificación de subtipos empíricos de los TCA, basados en el impulso a la delgadez y la realización de dietas y la depresión (estudio 2), y c) asociación entre los cuatro subtipos de TCA, basados en los factores descritos, y respuesta a un abordaje cognitivo-conductual, en una población con diagnóstico de bulimia nerviosa purgativa (BN-P), que solicitaron tratamiento por su trastorno (estudio 3). Nuestra primera línea de investigación (estudio 1) analizó la implicación de las expectativas sociales e individuales en los TCA. Los resultados de este trabajo sugirieron que las expectativas familiares, individuales y las relacionadas con la apariencia física, eran superiores en pacientes con TCA que en sujetos control. Asimismo, los pacientes con diagnóstico de TCA mostraban mayor discrepancia entre sus valores personales y sociales, menor confianza en poder alcanzarlos y mayor conflicto con sus familiares por estas cuestiones. Por otra parte, la presencia de elevadas expectativas sociales y personales se asociaba al desarrollo de un TCA, lo que enfatizaba la importancia de evaluar estos factores de riesgo. Finalmente, se observaron diferencias significativas entre los subtipos de TCA, siendo la apariencia física un factor de riesgo más presente en BN y en trastornos de la conducta alimentaria no especificados (TCANE), mientras que otras expectativas sociales se asociaban más a la anorexia nerviosa (AN). La segunda línea de investigación (estudios 2 y 3) exploraba nuevos subtipos empíricos de TCA, teniendo en cuenta las variables de impulso a la delgadez y realización de dietas (ID) y la depresión (D). En el primer trabajo (estudio 2), se obtuvieron cuatro nuevos subtipos a través de un análisis de cluster. Los subgrupos fueron “ID”, “IDDepresivo”, “ID moderado” y “D-ID moderado”. Estos resultados mostraban que la realización de dietas y la depresión eran útiles en el análisis e identificación de subtipos en los TCA. En el estudio 3 se exploraban estos subtipos con mayor profundidad, observando que se obtenían los mismos subgrupos, cuando nos basábamos en las puntuaciones de diversos cuestionarios clínicos validados. Asimismo, la respuesta al tratamiento era distinta en función de los subtipos de TCA, presentando tasas de abandonos más elevadas el subtipo “ID-Depresivo”. De este modo, los resultados estaban en concordancia con las evidencias empíricas, cada vez mayores, que indican la importancia de la realización de dietas y la depresión comórbida como factores que contribuyen a explicar características diagnósticas en los TCA. Finalmente, estos hallazgos podrían tener una relevancia destacada en la controversia actual sobre las clasificaciones diagnósticas en el próximo DSM. / L’objectiu central d’aquesta tesi ha estat, des d’una perspectiva multidisciplinar, integrar els coneixements clínics i científics per a contribuir a l’avenç de la prevenció i tractament dels trastorns de la conducta alimentària (TCA). En aquests estudis, s’han explorat una sèrie d’aspectes com a) factors de risc socials i individuals en els TCA (estudi 1), b) identificació de subtipus empírics dels TCA, i c) associació entre els quatre subtipus de TCA, basats en els factors descrits, i resposta a un abordatge cognitivoconductual, en una població amb diagnòstic de bulímia nerviosa purgativa (BN-P), que varen sol•licitar tractament pel seu trastorn (estudi 3). La nostra primera línia de recerca (estudi 1) va analitzar la implicació de les expectatives socials i individuals en els TCA. Els resultats d’aquest treball varen suggerir que les expectatives familiars, individuals i les relacionades amb l’aparença física, eren superiors en pacients amb TCA que en subjectes control. Alhora, els pacients amb diagnòstic de TCA mostraven major discrepància entre els seus valors personals i socials, menor confiança en poder aconseguir-los i major conflicte amb els seus familiars per aquestes qüestions. Per altra banda, la presència d’elevades expectatives socials i personals s’associava al desenvolupament d’un TCA, fet que emfatitzava la importància d’avaluar aquests factors de risc. Finalment, es varen observar diferències significatives entre els subtipus de TCA, sent l’aparença física un factor de risc més present en BN i en trastorns de la conducta alimentària no especificats (TCANE), mentre que altres expectatives socials s’associaven més a l’anorèxia nerviosa (AN). La segona línia de recerca (estudis 2 i 3) explorava nous subtipus empírics de TCA, tenint en compte les variables d’impuls a estar prim i realització de dietes (ID) i la depressió (D). En el primer treball (estudi 2), es varen obtenir quatre nous subtipus a través d’una anàlisi de cluster. Els subgrups foren “ID”, “ID-Depressiu”,“ID moderat” i “D-ID moderat”. Aquests resultants mostraven que la realització de dietes i la depressió eren útils en l’anàlisi i identificació de subtipus en els TCA. En l’estudi 3 s’exploraven aquests subtipus amb major profunditat, observant que s’obtenien els mateixos subgrups, quan ens basàvem en les puntuacions de diversos qüestionaris clínics validats. Alhora, la resposta al tractament era diferent en funció dels subtipus de TCA, presentant taxes d’abandonament més elevades el subtipus “IDDepressiu”. D’aquesta manera, els resultats estaven en concordança amb les evidències empíriques, cada vegada més grans, que indiquen la importància de la realització de dietes i la depressió comòrbida, com a factors que contribueixen a explicar les característiques diagnòstiques en els TCA. Finalment, aquestes troballes podrien tenir una rellevància destacada en la controvèrsia actual sobre les classificacions diagnòstiques en el proper DSM.

The primary purpose of this study was to investigate the knowledge and experiences of school counsellors, teachers, and school-based personnel in the area of girls body image. Participants perspectives were described and implications identified for ways in which teachers can encourage positive body image for girls in their classrooms. The idea for this research evolved from my interest in positive self-esteem, and academic and social success. As a teacher, I find that girls (more so than boys) base their success on body image. Girls often turn to harmful health behaviours such as disordered eating or excessive exercise because of dissatisfaction with their bodies (Tiggemann, 2005; ODea, 2000). I hoped to find ways for teachers to foster positive body image, and I believed school counsellors, teachers, and school-based personnel would be a useful source of information on this topic. I brought to this research a desire to hear, understand, and make meaning from these professionals experiences of working with girls.<p>There are a variety of things a teacher can do to create a positive environment in the school setting relating to body image. Focus group participants felt teachers and other school personnel could: <br>(a) openly allow body image discussion in the classrooms either through Talking Circles or Body Talk; <br>(b) promote active lifestyles; <br>(c) promote healthy eating habits; and <br>(d) act as role models by modelling the right examples. <p>Listening and encouraging students can also create a positive environment. The normal development of bodies should be discussed openly in the classrooms. In order to help create positive body images in young girls, participants believed it was important for teachers and school personnel to: participate in empathy training (learning to talk to each other and to listen to each other), educate parents; train physical education teachers; encourage students to write daily journals and critically analyze media literacy.