Family-based treatment for anorexia nervosa is a relatively recent form of therapy that is commonly used with families of child and adolescent patients. While current efficacy research of this treatment is promising, little research has been conducted on families' experiences of this treatment. This qualitative study investigates the experiences of parents who have participated in family-based treatment for a child or adolescent (ages 10-21) diagnosed with anorexia nervosa. Analytic induction (AI) methodology was used in this qualitative study to examine the various factors contributing the effectiveness of family-based treatment for families. Purposeful sampling was employed to obtain a wide variety of participants. In depth, semi-structured interviews were conducted with 15 parents via telephone or web-based chat. These interviews were coded and analyzed to generate themes, which were combined to form a theory regarding which factors influence families' treatment outcomes when using FBT-AN. Sufficient and necessary conditions of successful and unsuccessful treatment outcomes were identified. Two sufficient conditions of treatment success were identified--namely, that parents were provided with practical suggestions by their treatment teams and that parents were able to implement their treatment teams' advice at home. Eighteen themes were identified as being necessary, but not sufficient, conditions to treatment success. These themes related to aspects of treatment sessions and treatment providers' relationships with parents; parental, familial, and other supportive relationships; and the processes of re-feeding, exposure to food, and parental monitoring and oversight. Two necessary conditions of unsuccessful treatment outcome were identified. The first condition was that the time period during which the child or adolescent restored weight was prolonged, or greater than six months. The second necessary condition was that the child demonstrated inconsistent progress during FBT. Additional themes present across treatment outcomes were also explored. This study aims to highlight the diverse experiences of parents who have participated in family-based treatment for anorexia nervosa and to serve as a resource for clinicians and researchers providing this treatment. Potential clinical and research applications of the study's results are discussed.

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.

Background: Theory and research declares that family memberes engagement in adolescent treatment has positive impact on treatment outcomes. To get the famillies engaged is quite challenging for proffesionals in addiction treatment services. Motivation of individual members fluctuate a lot. The impact on treatment is due to the voluntarity of treatment or recomendation of a third side. Even dough engagement of legal representatives is declared condition of treatment in Regional Ambulance for Adddictions in Children and Youth, it is complicated to motivate them for cooperation. Aims: The aim of the thesis is to find out how the legal representatives percieve cooperation with outpatient services, if they percieve any obstacles in getting more involved and to find out, what is their view on adolescent's profit from treatment. Methods: For the research a qualitative approach was used in the form of semi- structured interview and interpretation of the data from client files and UniData program. Data collection took work during 05/18-11/18. For the data analysis the method of gestalts was used. Results: Thesis has shown that the main motivational element was some crisis of legal representatives, when they didn't know how to solve demanding situation. The main obstacles are the technical ones like...

Eating disorders (ED) usually develop during adolescence, and intervention to stop further weight loss is believed to improve outcome and long-term prognosis. Adolescents with ED who do not receive effective treatment risk poor outcome and even untimely death as adults. The first aim of this thesis was to investigate long-term mortality and causes of death in a series of female adults with chronic ED. The second aim was to study the one-year outcome of an unselected series of adolescent girls with anorexia nervosa (AN) and “other restrictive eating disorders” who had been treated within a specialist ED out-patient service focused on nutritional rehabilitation based on family therapy and without planned hospitalization. The third aim was to investigate the possible metabolic and hormonal side effects of olanzapine when used as an adjunct to facilitate nutritional rehabilitation. The fourth aim was to investigate the relationship between polyunsaturated fatty acid (PUFA) status and depression. In adult women with chronic ED, a very low body mass index and psychiatric co-morbidity confer a substantially increased risk of premature death. A treatment programme for adolescent ED with rapid access to assessment and prompt start of treatment with initial emphasis on nutritional rehabilitation proved efficient. The outcome was encouraging, as 43% of all patients with ED and 19% of those with AN did not have an ED at one-year follow-up. Of the remaining patients the vast majority had gained weight and regained menstruation, and were back in school on a full-time basis. Olanzapine was used to reduce anxiety, excessive exercise and rumination over weight and shape. Side effects were similar to those observed in normal-weight individuals, and do not preclude its use in underweight adolescents with ED. Low ω3 PUFA were associated with depression. The ω3 PUFA status improved during nutritional rehabilitation with ordinary foods and without supplementation. The investigations indicate that adolescent ED can be successfully treated in an out-/day-patient setting. An essential feature of the service is rapid handling and weight gain. Further weight loss can be avoided, and chronic disease hopefully prevented.

Introduction. Anorexia nervosa (AN) is an eating disorder with one of the highest mortalityrates of all psychiatric illnesses. One county hospital in Sweden has seen an increase in theprevalence of adolescent AN over the last year. To meet these heightened demands, thecounty’s child and adolescent psychiatric (CAP) clinic established a new level of care for thesepatients. The main component of the intervention was mealtime support. Aim. The aim of the study was to evaluate the experiences of adolescent patients and theirparents regarding a day-patient treatment for AN in a county hospital in Sweden. Methods. Patients and their legal guardians were interviewed separately or in dyads, accordingto their wishes. An interview guide with open-ended questions was used. The audio files weretranscribed verbatim, and the texts were then studied with inductive content analysis. Fivepatients and nine parents from seven different families participated in the study. Results. The participants painted a nuanced picture of the intervention. The four overarchingthemes that emerged were ambivalence, distinguishing the person from the disease, parentalstruggling and perceptions of the treatment and the staff. Strict rules around food combinedwith an empathetic and flexible attitude towards the child were described as successful carestrategies. The treatment was depicted as time-consuming and strenuous, but parents alsoexperienced the intervention as relieving. Conclusions. The intervention was for the most part experienced as well-functioning, and theintensive nature of the treatment was described as a key factor.