Background: It is posited that attachment difficulties in infancy may result in reduced mentalisation capacity (understanding self and others’ subjective thoughts/mental processes), leading to potentially deleterious psychopathological outcomes such as eating disorders. The exact nature of the relationship between mentalisation and eating disorders/disordered eating is unclear however. Objectives: A systemic review examined whether those with Anorexia Nervosa (AN) experience mentalisation deficits compared to those without EDs. An empirical study, examining the link between mentalisation and disordered eating (DE) in an adolescent sample, was conducted to assess whether borderline trait features mediated the relationship between the two constructs. Method: A systematic search of 6 databases was conducted, and articles were assessed against predetermined inclusion/exclusion criteria. Included articles were assessed against 14 quality criteria and study findings were reported. For the empirical study, 162 participants aged 12-18 completed a questionnaire pack including mentalisation, borderline traits, impulsivity, emotion dysregulation and depression scales, and sociodemographic questions. Results: Results from 10 articles indicated those with AN may experience subtle mentalisation deficits, particularly in recognising negative emotions in others. Mentalisation ability may also vary according to interpersonal context. Mediation analyses found mentalisation ability exerted a significant effect on DE indirectly through borderline trait features, and partially through emotion dysregulation, but not impulsivity. Conclusion: More robust empirical studies are required in order to assess the relationship between mentalisation and AN. Findings regarding the link between mentalisation, borderline traits and DE may further aid psychological assessment/treatment. Therapies where the main focus is improving mentalisation capacity may be useful.

Este estudo apresenta a criação e análise da Sessão de Transtornos Alimentares do DAWBA, um instrumento construído para rastrear e fornecer, em estudos epidemiológicos, o diagnóstico de transtorno alimentar (TA) - anorexia e bulimia nervosas e síndromes parciais - em meninas de 8 a 17 anos. O estudo ocorreu em 3 fases: (1) criação do instrumento, (2) aprimoramento aplicando-o em 45 mulheres e seus familiares e (3) aprimoramento testando-o em 30 meninas e seus pais. Participaram das fases 2 e 3 sujeitos com TA, transtornos obsessivo-compulsivo e depressivo unipolar e com doenças de acometimento gastrintestinal. Dessa forma, produziu-se a versão final do instrumento, que está pronta para validação / This study presents the creation and analysis of The Eating Disorders Section of The DAWBA, a measure designed for epidemiological studies to screen and diagnose eating disorders (ED) - anorexia and bulimia nervosa and partial syndromes - in 8 to 17 year-old girls. The study was carried out in 3 phases: (1) measure creation, (2) refinement by applying it to 45 women and their relatives and (3) fine-tuning by testing it in 30 girls and their parents. Phases 2 and 3 involved subjects with ED, obsessive-compulsive and unipolar depression disorders and gastrointestinal disease, producing the final version of the measure, which is ready for validation

El presente estudio tiene como objetivo comprender cómo se han configurado el apego y la mentalización en mujeres con trastornos alimenticios (TA) y cómo esta experiencia particular teje una narrativa propia de la vivencia de la enfermedad. Para ello, se realizó una investigación cualitativa de corte narrativo. Se entrevistó a 6 mujeres con diferentes patologías alimentarias y en diferentes estadios del tratamiento en 2 oportunidades. La primera entrevista fue centrada en el tema y giró en torno a la vivencia del TA; la segunda, en torno a las experiencias tempranas con los cuidadores primarios. Se encontró en ellas dificultades para la elaboración de experiencias difíciles con sus figuras de apego. Asimismo, dificultades en la organización del discurso, la regulación del afecto, sus vínculos con los demás y una pobre función reflexiva. Se discute lo hallado hipotetizando que el tratamiento recibido puede haber actuado como una herramienta que les ha permitido progresar hacia apegos más organizados y un funcionamiento reflexivo más articulado. / Attachment styles and reflective function in women with eating disorders The present study aims to understand how attachment and reflective function have developed in women with eating disorders (ED) and how this particular experience itself weaves a singular narrative of the experience with the disease. In order to do this, a qualitative narrative study was conducted. Six women with various eating disorders at different stages of treatment were interviewed twice. The first interview focused on the experience of the ED and the second focused on early experiences with their primary caregivers. We found difficulties in the way they work through their distressing experiences with their attachment figures, in the coherence of their speech, in affect regulation, their interpersonal relations and their reflective function. Findings are discussed hypothesizing that treatment is a mean that enables them to progress to more organized attachment styles and improved reflective function. / Tesis

Made available in DSpace on 2019-03-29T23:39:29Z (GMT). No. of bitstreams: 0 Previous issue date: 2015-03-20 / This study based on the Foucaultian s perspective of Ethics starts from the differences among the acts of the food refusal of three figures that lie in different moments of the Western cultural history: middle age, modernity and contemporary namely saints, hystericals and anorexics. Under this vision of this perspective, the food refusal of these three figures is addressed as a moral action, which only makes sense within the ethical Christians, modern and contemporary fields, that are different from each other, in a way that acts on them knowledge, regulatory practices and forms of relation to itself. Thus, by means of such approach, we seek to explore the specificities of the figures of the food refusal as subjectivity practices. This paper has studied the food refusal of the saints, hystericals and anorexics, exploring the moral dimension, that relates to the way in which the subject implies itself in the feeding practice, in such a manner that the moral behavior not only relates to the rules but also implies certain relation to itself, which is not only self-awareness, but the constitution of the self as a moral subject. The form of relation to itself is, therefore, a mechanism by which values are inscribed in the conduct of individuals. It can be known through the subjective elements, defined within a field of values, such as the ethical substance, the way of subjection, the techniques of the self and the teleology. We initially examined the Ethical fields from where emerge the figures of the food refusal, through the analysis of the dominant speech of each period: the Christian religious domain and the medical, modern and contemporary fields seeking to explain the parameters by means of which the subjects are taken as objects of the knowledge-powers, religious and medical, and then to examine the way in which the individual becomes subject of his actions referring to the social mechanisms. The study engendered a perspective of analyses on the human experience that surpass its medical and scientific objectivities. While the strict diet of the middle age saints as Catarina de Siena and Clara de Assis, can be understood as ascetic and spiritualization practices in the extent they constitute themselves as ethical Christians subjects, resulting in resignation of the flesh, forgiveness of sins, mortification of vices, elimination of the bad thoughts, spiritual strength, purity of soul, spirit salvation, self-perfection and immortality; the histericals, constitute themselves, ethically, in the Modernity, as subjects of a sexuality, showing the food repulsion as a symptom of a subjective world divided in pulsions/drive, desires and interdictions. In the other hand the anorexic is the character of the food refusal drama, that respects the contemporary normative values system, which is the reverse of the health standard, meaning that she is the one who doesn t control her acts, either regulate her actions, such as the act of eat, the appetite and the satiety, much less succeed to use the body in a way to align herself with the demands of caring for the welfare, health and quality of life. Key-words: Saints, Hystericals and Anorexics: figures of the food refusal. Practices of Subjectivity. Foucault. Knowledge-Power. / Este estudo, ao se basear na perspectiva foucaultiana da ética, parte das diferenças entre os atos de recusa alimentar de três figuras situadas em momentos distintos da história da cultura ocidental - Idade Média, Modernidade e Contemporaneidade - quais sejam: santas, histéricas e anoréxicas. Sob a visão dessa perspectiva, a recusa alimentar dessas três figuras é abordada como ação moral, que só adquire sentido no interior dos campos éticos cristão, moderno e contemporâneo, os quais se diferenciam, na medida em que neles operam saberes, práticas regulatórias e, também, formas de relação a si. Desse modo, busca-se, por meio de tal abordagem, explorar as especificidades das figuras da recusa alimentar como práticas de subjetivação. Eis que este trabalho estudou a recusa alimentar das santas, histéricas e anoréxicas, explorando a dimensão moral, que diz respeito ao modo pelo qual o sujeito se implica na prática alimentar, de tal maneira que a conduta moral não só diz respeito às regras, mas ela implica certa relação a si, que não é somente consciência de si, mas constituição de si como sujeito moral. A forma de relação a si é, portanto, um dispositivo pelo qual os valores se inscrevem na conduta dos indivíduos. Ela pode ser conhecida com amparo nos aspectos subjetivos, definidos em um campo de valores, como a substância ética, o modo de sujeição, as técnicas de si e a teleologia. Foram, pois, investigados, inicialmente, os campos éticos de onde emergem as figuras da recusa alimentar por intermédio da análise dos discursos dominantes de cada época: o domínio religioso-cristão e as searas médicas, moderna e contemporânea, procurando explicitar os parâmetros por via dos quais os sujeitos são tomados como objetos dos saberes-poderes, religioso e médico, para em seguida, examinar a forma pela qual o indivíduo se torna sujeito de suas ações em referência aos dispositivos sociais. Tal estudo engendrou, assim, uma perspectiva de análise sobre a experiência humana que ultrapassa as suas objetivações médico-científicas. Enquanto o rigoroso regime alimentar das santas medievais, como Catarina de Siena e Clara de Assis, pode ser entendido como prática ascética e de espiritualização, na medida em que elas se constituem como sujeitos éticos cristãos, resultando em renúncia da carne, remissão dos pecados, mortificação dos vícios, eliminação dos maus pensamentos, fortalecimento espiritual, pureza da alma, salvação do espírito, perfeição de si e imortalidade; as histéricas constituem se, eticamente, na Modernidade, como sujeitos de uma sexualidade, exibindo a repulsa alimentar como sintoma de um mundo subjetivo dividido entre pulsões, desejos e interdições. Já a anoréxica é a personagem do drama da recusa alimentar, respeitante ao sistema de valores normativos contemporâneo, que se constitui como o avesso da norma da saúde, quer dizer, ela é aquela que não sabe controlar os seus atos, tampouco regular suas ações, como o ato de comer, o apetite e a saciedade, muito menos logra usar o corpo, de modo a se alinhar com as exigências de cuidados com a saúde, o bem-estar e a qualidade de vida. Palavras-chave: Santas, histéricas e anoréxicas: figuras da recusa alimentar. Práticas de Subjetividade. Foucault. Saber-Poder.

Föräldrar och deras barn är en del av varandras livsvärld i och med att de lever ihop vilket gör att även föräldern påverkas när barnet drabbas av en sjukdom såsom anorexia nervosa. Sjukdomen innebär en medveten viktförlust och även förändringar i personlighet och beteende hos den unge. I Sverige beräknas 0,2-0,4 % av de unga kvinnorna leva med sjukdomen och förhållandet mellan pojkar och flickor är 1:10. Att se sitt barn svälta väcker många känslor hos föräldrarna och för att sjuksköterskan ska kunna ge ett bra stöd och bemötande krävs kunskaper om föräldrarnas upplevelser. Syftet med vår studie är därför att beskriva föräldrars upplevelser av att leva med ett barn med anorexia nervosa. För att uppnå syftet på bästa sätt använde vi oss av en metod formulerad av Dahlberg (1997) i analysen av självbiografier. I resultatet framträdde fyra teman och nio subteman. I temat att känna ängslan beskriver föräldrarna en rädsla, oro och osäkerhet som är genomgående under sjukdomsperioden. Föräldrarna upplever negativa känslor som ger dem känslan av att tappa kontrollen över situationen och sitt barn. Under sjukdomsperioden upplever föräldrarna en utmattning och isolering som ger dem en känsla av att inte räcka till, vilket förstärks av den okunskap de har om sjukdomen. Bland dessa negativa känslor finns även ljusglimtar, främst i de framsteg som deras barn gör, vilket tillsammans med relationer till andra människor får föräldrarna att känna styrka. Resultatet visar att föräldrarna är i behov av ett bra bemötande och stöd från sjuksköterskan för att orka vidare. Föräldrarna upplever även att de behöver kunskap om sjukdomen för att kunna ta hand om sitt barn, i vilket sjuksköterskan kan vara behjälplig. / Program: Sjuksköterskeutbildning

Bakgrund: Anorexia nervosa är en svår psykisk sjukdom som kan förklaras som ett självdestruktivt sätt att hantera livet på. Utveckling av anorexia sker genom tre steg vilka benämns; bakomliggande faktorer, utlösande faktorer och vidmakthållande faktorer. Sjukdomen kan orsakas av både psykologiska, biologiska eller sociala omständigheter. Även kroppsideal i samhället kan ha inverkan på utvecklingen av anorexia. Syfte: Syftet var att beskriva hur patienter med anorexia nervosa upplever sjukvården. Metod: En beskrivande litteraturstudie utifrån 12 kvalitativa vetenskapliga artiklar som utgick från patientens perspektiv. Huvudresultat: Tre huvudteman identifierades vilka var måltidssituationen, relationer på vårdavdelningen samt vårdmiljö. Måltidssituationen upplevdes ångestladdad och som ett tvång, vissa upplevde att det var jobbigt att förlora matkontrollen medan andra upplevde det som en lättnad. Relationer på vårdavdelningen upplevdes viktiga eftersom ju bättre relationerna var desto bättre vårdupplevelse fick patienterna. Vidare upplevdes individanpassad vård vara betydelsefullt samt att sjuksköterskan lät patienten vara delaktig. Vårdmiljön kunde upplevas negativ eftersom patienter med anorexia inspirerades och påverkades av andra patienter vilket kunde leda till jämförelser och mer självsvält. Slutsats: Kunskapen kring hur patienter med anorexia upplever vården och önskar att bli behandlade är bristfällig hos sjuksköterskor och övrig vårdpersonal. Det är viktigt att nyexaminerade sjuksköterskor får en ökad kunskap och blir medvetna om hur de kan bidra till så goda vårdupplevelser för patienten med anorexia som möjligt.

El trastorno de la conducta alimentaria es considerado como una de las patologías que cobra mayor importancia debido a su número creciente de víctimas a lo largo de los últimos años. Recientes estudios han demostrado que tanto la anorexia como la bulimia nerviosa han aumentado su incidencia en la población masculina, lo que antes era prácticamente desconocido. La presente investigación tuvo como finalidad hacer un estudio de la validez y confiabilidad del Inventario Sobre Trastornos Alimentarios (ITA) de Joan Hartley, para saber si es posible utilizarlo en una población masculina. El inventario de 50 ítems con seis alternativas de respuesta tipo Likert, se administró a un grupo de 164 varones adolescentes pertenecientes a un centro universitario y pre universitario privados de Lima. La edad comprendida de los participantes fue entre 16 y 20 años. Luego de la administración, se inició el proceso de análisis, resultado que este inventario a pesar de tener una confiabilidad dentro de rangos adecuados (α=,591-, 901), tiene una pobre validez de contenido y de constructo debido a que las áreas no logran funcionar como se planteó por la autora original en la muestra seleccionada. Es así, que a modo tentativo se hace una propuesta de un inventario reorganizado que consiste en 21 ítems que conforman 4 áreas. Cabe resaltar que esta última versión tiene única función de servir como una base altamente estructurada, para que a partir de ésta, se puedan realizar futuras investigaciones y construir una versión mejorada y completa / Tesis

Bakgrund: Anorexia nervosa är en psykisk sjukdom som främst drabbar unga kvinnor och är ett växande problem i samhället. Vid behandling av anorexia nervosa har det visat sig att familjebaserad omvårdnad är det bästa alternativet för en positiv utgång. Relationen mellan patient, föräldrar och vårdpersonal är därför mycket viktig. Det är viktigt att förstå hur föräldrarna upplever omvårdnaden och behandlingen när deras barn lider av anorexia nervosa för att kunna ge bästa möjliga vård. Syfte: Syftet med studien var att beskriva föräldrars upplevelser av den omvårdnad som ges deras barn med anorexia nervosa. Metod: En kvalitativ innehållsanalys där åtta biografier analyserades. Resultat: Ur analysen framkom fem teman: Rädsla och oro för sjukdomen och framtiden, Att känna skuldkänslor och otillräcklighet, Isolering från omvärlden, Erfarenheten av ofullständig vård med kunskapsbrister och Närvaro av ångest och sorg. Konklusion: Upplevelserna som framkom var framförallt att vården brister i information och kommunikation till föräldrar med barn som drabbats av anorexia nervosa. Bristerna i kombination med upplevd okunskap orsakade lidande för familjerna. Upplevelserna kantades av känslor såsom ångest, sorg, oro och rädsla. Men även av fysiska faktorer som brist på ork och upprätthållande av socialt liv vilket i längden resulterade i isolering.

Objective: Neuropsychology models of anorexia nervosa (AN) propose that cognitive difficulties including poor Emotion Recognition (ER) and set-shifting ability may be central to the development and maintenance of eating pathology. This study aimed to test the central positions of such models by assessing specific ER difficulties in AN as well as the relationship between ER deficits and set-shifting performance. Methods: Fifty-one women were assessed (25 with AN; M = 28.20 SD = 8.69 and 26 control M = 21.27 SD = 5.10) on a novel measure of ER, a set-shifting test and self-report questionnaires concerning co-morbid factors. Results: The data did not reveal a global difference in ER or set-shifting performance between groups. Specific hypotheses of ER deficits in AN were also not met as performance on individual emotions was comparable between groups. There was an unexpected negative correlation between disgust recognition and set-shifting performance, however, this was only significant across the whole sample. ER performance was not related with any confounding factors. Conclusions: Despite an abundance of research supporting the position of social cognitive difficulties in AN, the current study failed to find global or specific deficits in ER in the present sample. Similarly, ER performance was not related to set-shifting as proposed by neuropsychological models of AN aetiology. Possible explanations for a lack of difference observed using this novel ER task are explored and future directions for evaluating ER in AN are discussed.

This thesis sought to develop and assess a novel scale to measure the experience of an anorexic voice in anorexia nervosa. It consists of three standalone papers. Papers one and two have been prepared for submission to two separate journals relevant to the methodology and research area for each, and comply with the journal guidelines. Paper one is a thematic synthesis of qualitative literature exploring "inner speech" for individuals with a diagnosed psychological disorder. Following a standardised procedure for thematic synthesis, six databases were searched and 10 studies were included. In total, three analytical themes were identified within the data: 1) Withdrawing to an inner world, 2) A fragmented and conflicted self and 3) Re-connecting with the outside world. The results found several similarities regarding the nature, function and negative consequences of engaging with critical inner dialogues across clinical samples. IS as both a coping mechanism and a maintaining factor of psychological distress was a key finding. The results indicated therapeutic approaches facilitating acceptance of internal experiences and disengagement from critical internal dialogues may be helpful. Paper two is a two-stage quantitative study that describes the development and assessment of a novel scale, the Experience of an Anorexic VoicE Questionnaire (EAVE-Q). Using data collected in an earlier qualitative study, Stage 1 generated scale items and tested for face and content validity using cognitive interviews with seven individuals with a diagnosis of anorexia nervosa. In Stage 2, 148 individuals with a diagnosis of anorexia nervosa were recruited from mental health services, eating disorder charities, the community and online to complete the EAVE-Q and measures of eating disorder symptoms, mood and quality of life. The dimensionality of the scale was assessed using principle axis factoring and associations between the EAVE-Q domains and clinical outcomes were evaluated. Factor analysis derived an 18 item scale with five domains. Two domains related to negative consequences of the AV, two to positive functions and one to the externalisation of the AV from the self. There were significant associations between individual EAVE-Q domains and eating disorder symptoms, mood and quality of life. The results highlighted the value in further research to refine the EAVE-Q, and to use this in future research to assess if changes in AV experiences are associated with clinical change over time. Paper three is a critical appraisal of this research. It includes reflections on the research process, discussion of the methodological limitations, and consideration of the implications of the findings for existing theory, future research and clinical practice.