Aspects of the ecological systemic approach were used to provide a framework for the understanding of the dynamics of anorexia nervosa and were empirically tested by comparing 30 anorexics and their parents to 34 matched control subjects and their parents. The theoretical model employed was an adaptation of Conger's Ecological-Systems approach which was based on the principles of Bronfenbrennei's theory of human development. The subjects were compared on selected variables arising from the individual, parent, family, and community systems using: 1) the California Psychological Inventory (CPI), 2) the Structural Analysis of Social Behavior (SASB), 3) the Family Environment Scale (FES), and 4) the Pattison Psychosocial Inventory (PPI). Statistical analysis of the difference between means was tested using Hotelling's (T²) procedure followed by a discriminant analysis. The final analysis occured using a Stepwise Discriminant procedure. The results of the stepwise analysis revealed that the Affiliation score (SASB) for the anorexics and the control subjects and the Psychopathic Deviancy score (CPI-Clinical) of the mothers of the anorexics and the controls were the variables which contributed to the discriminant analysis. With the Affiliation and the Psychopathic Deviancy scores alone, it was possible to correctly classify 87.5% of the research subjects. Analyses also showed statistically significant results at the individual, parent, and family levels. Specifically, the anorexic daughters were found to have a negative self-worth as measured by the SASB. They were also more anxious and at odds with themselves and others (CPI). The anorexics were more depressed than the controls, had a greater tendency toward rebelliousness and hostility toward authority, and expressed their feelings in a more indirect manner. The anorexics may use ritualistic thoughts and actions in an attempt to structure their lives to overcome their feelings of losing control. They lack a sense of who they are emotionally and generally feel alienated and lonely as if on the outside looking in. The CPI-Psychopathic Deviancy scale was significantly higher for the mothers of the anorexics than for the controls. No differences were found between the two groups of fathers. Interactions within the family, as perceived by the anorexics, were characterized by overprotection and control by the mothers while the anorexics responded with significantly less affiliation to both their mothers and their fathers. The mothers of the anorexics also viewed their daughters as being less friendly in the relationship. There were no significant findings regarding the perceptions of the fathers of the anorexics and the controls. The families of the anorexics were less supportive, helpful and committed to each other than were the families of the control subjects as measured by the FES. / Education, Faculty of / Educational and Counselling Psychology, and Special Education (ECPS), Department of / Graduate

M.A. (Psychology) / Please refer to full text to view abstract

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Zugl.: Diplomarbeit.

Thesis (M A(Psychology))--University of Pretoria, 2008. / Includes bibliographical references. Available on the Internet via the World Wide Web.

Seit Jahren wird trotz der stetigen Modernisierung der medizinischen Versorgungsleistungen ein Anstieg der stationären Einweisungen in den psychiatrischen Kliniken registriert. Dabei nutzt eine kleine Gruppe von Patienten, die sogenannten Heavy User, den Großteil der zur Verfügung stehenden therapeutischen Ressourcen. Diese explorative Studie beschreibt eine Gruppe von erwachsenen, weiblichen Heavy Usern (n=23) mit restriktiver bzw. bulimischer Anorexie oder Bulimie, die mindestens drei stationäre Aufnahmen in einer psychiatrischen Klinik aufwiesen. Als Vergleich dient eine Kontrollgruppe von weiblichen Nicht-Heavy Usern (n=13) mit maximal einem stationären Voraufenthalt. Die Ergebnisse zeigen, dass Heavy User mit der Hauptdiagnose einer Essstörung spezifische soziodemographische, diagnostische und psychopathologische als auch Persönlichkeitsmerkmale aufweisen, die eine rechtzeitige Identifizierung dieser Patientengruppe ermöglichen könnten. Der Heavy Use wird als multifaktorielles Geschehen verdeutlicht und die Notwendigkeit einer frühen Identifikation und Intervention betont. Da die bisherigen Studienergebnisse sehr uneinheitliche Resultate lieferten, sind weitere Untersuchungen dieser Patientengruppe unerlässlich. Die Entwicklung alternativer und individueller Therapieansätze ist angezeigt, um passende Versorgungsangebote für diese therapieresistenten Patienten zu schaffen. / Despite the constant modernization of medical services, an increase of inpatient readmissions in psychiatric services has been noted for years. Patients who show a higher extent of use of inpatient medical treatment are known as heavy users. This explorative study describes a group of female adult heavy users (n=23) with at least three inpatient treatments and compares the findings with a control group of female non-heavy user patients (n=13) with a maximum of one previous admission, both suffering from restrictive or purging-type anorexia nervosa or bulimia nervosa. The results of this paper show that heavy users diagnosed with an eating disorder, appear to have individual sociodemographic, diagnostic and psychopathological characteristics as well as particular personality traits, which seemingly contribute to heavy service use and could be taken into consideration for early identification of this treatment resistant group of patients. The findings stress the heavy use as a multifactorial phenomenon and emphasize the need of early identification and intervention. Since prior studies show inhomogenous results, further qualitative analysis is necessary to develop alternative and individual treatment strategies for heavy users.

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