Magister Psychologiae - MPsych / Anorexia nervosa is a debilitating disorder with dangerous potential health consequences. Body dissatisfaction is an important aetiological aspect of the development and maintenance of Anorexia Nervosa (AN). The purpose of this research study was to ascertain how clinical psychologists assess body dissatisfaction and how they formulate treatment for AN considering body dissatisfaction. In this qualitative study, semi-structured interviews were conducted with 9 registered clinical psychologists who specifically work in the area of eating disorders. The information provided by the participants was analysed using thematic analysis. Participants were recruited using snowball sampling. Sampling, data collection and analysis occurred concurrently until saturation was reached after 9 interviews have been conducted. Permission to conduct the study was obtained from the Senate Research Ethics Committee (Social and Human Sciences) of the university of the Western Cape. Participation was voluntary and could be withdrawn at any time without fear of negative consequence or loss of perceived benefit. Ethics principles were strictly adhered to in the management of data and dissemination of findings. Potential participants received an information sheet detailing what participation entailed, as well as the rights and responsibilities of the student researcher and research participants respectively. An indication was also provided of the recourse participants had in the event of dissatisfaction with or concerns about the study. The research contributed to the knowledge base of how body dissatisfaction is conceptualised and operationalised in treatment planning for patients presenting with AN. Findings revealed that the role of theory is essential as it facilitates an explanatory system, which creates an understanding of body dissatisfaction in AN. Another finding was that the participants had their own subjective operationalisation of body dissatisfaction but feels that it is important to formally operationalise body dissatisfaction in anorexia nervosa. In terms of treatment, the participants believed that a multimodal approach is the most beneficial when treating body dissatisfaction in anorexia nervosa.

Ätstörningen anorexia nervosa är ett samhällsproblem som har sin historia långt bak i tiden. Trots det finns det inte särskilt mycket forskning om de som har sjukdomen eller om de som arbetar med det. Syftet med denna kandidatuppsats var därmed att belysa de professionellas kunskaper och erfarenheter i arbetet med ungdomar (13–16 år) som har diagnostiserats med anorexia nervosa. Vilka behandlingar erbjuds det för dessa ungdomar och vilka är de betydelsefulla faktorerna för ett tillfrisknande? Med hjälp av undersökningens resultat insåg vi vilken betydelsefull roll den professionella kan ha i en sådan komplex situation som patienten befinner sig. Det gav oss även en inblick i hur det socialpedagogiska förhållningssättet kan tillämpas i ett sådant arbete. Resultatet visar att familjebaserad terapi (FBT) är den behandling som används mest för ungdomar med anorexia nervosa, vilket stämmer överens med tidigare forskning. Det visar även att arbetet bygger på relationer, där den professionella behöver ta hänsyn till många olika faktorer som berör patienten samt att det kan vara svårt att räcka till för dem som behöver mer omfattande vård. Undersökningen utgår ifrån en kvalitativ metod, med semistrukturerade intervjuer, samt utifrån Aaron Antonovskys teori om Känsla av sammanhang (KASAM). / The eating disorder anorexia nervosa is a societal problem that has a long history. Despite this, there is not much research on those who have the disease or on those who work with it. The aim of this bachelor’s thesis was thus to illustrate the professionals’ knowledge and experience in the work with adolescences (13-16 years old) who have been diagnosed with anorexia nervosa. What treatment is offered to young people and what are the important factors for recovery? The results of the survey made us realize what significant role the professional can play in such complex situation as a patient. It also gave us an insight into how the social pedagogical approach can be applied in such work. The results show that family-based therapy (FBT) is the most commonly treatment, used for adolescents with anorexia nervosa, which is consistent with previous research. It also shows that the work is based on relationships, where the professional needs to make allowances for many different factors that affect the patient and that it can be difficult to suffice for those who need more comprehensive care. The survey is based on a qualitative method, with semi-structured interviews, and based on Aaron Antonovsky’s theory Sence of coherence (SOC).

Anorexia Nervosa (AN) är en sjukdom då den drabbade svälter sig själv. Oftast är den drabbade en flicka i tonåren, men även pojkar och vuxna kvinnor och män kan drabbas. Prevalensen beräknas vara cirka en procent i västvärlden. Tidigare har forskningen fokuserat på den sociala sidan av saken, skönhetsideal och smalhets. Men på senare tid har forskarna börjat intressera sig mer för den kroppsliga sidan av saken, till exempel arv och olika kroppsliga substanser. Den här litteraturstudien fokuserar på dopamin, ghrelin och östrogen och vilken betydelse de tros ha för AN. Sex artiklar, funna i databaserna PubMed, SwePub och OneSearch, har granskats. Syftet med denna litteraturstudie var att ta reda på ifall dopamin, ghrelin och östrogen har någon betydelse för sjukdomen AN. Frågeställningarna var  ”har anorektiker högre eller lägre dopaminhalt än friska?”, ”syns skillnader i ghrelinhalt och ghrelinrespons även hos individer som återhämtat sig från AN?” och ”kan östrogen vara orsaken till att AN är vanligare hos kvinnor?”. AN är en komplex sjukdom och frågorna har visat sig vara svåra att besvara. Efter att artiklar och bakgrundsinformation analyserats har slutsatsen blivit att olika forskare kommit till olika resultat, vilket betyder att mer forskning behövs för att få fram tydliga svar på frågeställningarna. Dopamin, ghrelin och östrogen är dock alla substanser som är intressanta att forska vidare på då det gäller AN.

Eating-disorder clients show low motivation, poor follow-through, and inordinate premature dropout rates in treatment. To date, little research has been conducted that might provide clinicians with an understanding of the critical factors that may aid clients' recovery. Such factors may be used by clinicians to better motivate clients to collaborate in treatment. The purpose of this study was to identify some of the critical factors that women with eating disorders believed were crucial in prompting or facilitating their recovery. Identification of these factors was accomplished through a systematic content analysis of semistructured interviews with recovered or recovering bulimics and anorexics. This study may contribute significantly to future research into the development of motivational supplements to eating disorder therapy (e.g., psychoeducational materials or therapy orientation programs). Of interest were what personal, interpersonal, or environmental factors anorexic and bulimic clients reported increased their motivation to recover, and prompted them to begin the recovery process, maintain recovery, and cope with the threat ofrelapse. Also, factors that subjects reported hindered their progress in recovery were examined. The anorexic and bulimic subjects reported social support as a critical factor across three stages of recovery, including beginning recovery, maintaining recovery, and coping with relapse. Being "tired" of the disorder and therapy were indicated to be relevant to beginning recovery. Improved self-esteem was deemed significant in helping subjects both maintain recovery and cope with the threat of relapse. Establishing healthy eating habits and attitudes was a necessary factor required to maintain recovery. Subjects shared that developing healthy ways to deal with emotions enabled them to deal successfully with the threat of relapse. Anorexic subjects reported that people and societal expectations, fear of becoming fat, incentive to numb emotions, and poor eating habits and attitudes impeded their recovery. Bulimic subjects indicated that people and societal expectations, incentive to numb emotions, lack of understanding, and poor eating habits and attitudes hindered their recovery.

Ziel: Das Ziel der explorativen Studie war es, erwachsene Patientinnen mit restriktiver bzw. bulimischer Anorexie oder Bulimie mit einer starken Inanspruchnahme von stationären Versorgungsleistungen, sogenannte Heavy User (HU), die eine vollstationäre Behandlung in der Klinik und Poliklinik für Psychiatrie, Psychosomatik und Psychotherapie des Universitätsklinikums Würzburg erhalten haben, zu beschreiben, soziodemographische sowie erkrankungsbezogene somatische und kognitive Charakteristika darzustellen und die Ergebnisse mit einer Kontrollgruppe aus Patientinnen mit dem gleichen Störungsbild, aber einer geringeren Inanspruchnahme medizinischer Versorgungsangebote, den Nicht-Heavy Usern (NHU), zu vergleichen. Teilnehmer und Methode: 23 anorektische bzw. bulimische Heavy User-Patientinnen, die sich im Zeitraum der Datenerhebung (1997-2008) zum mindestens dritten Mal in einer stationären Therapie aufgrund ihrer Essstörung befanden, und eine Vergleichsgruppe von 13 Nicht-Heavy User-Patientinnen mit höchstens einem stationären Voraufenthalt wurden in dieser Studie untersucht. Allgemein- und neurologischer Status sowie die Laborparameter zum Aufnahmezeitpunkt und die Auswertungen der kranialen CTs bzw. MRTs sowie der kognitiven Testverfahren zu Beginn der Therapie und vor der Entlassung wurden analysiert und miteinander verglichen. Ergebnisse und Schlußfolgerung: Die anorektischen und bulimischen Heavy User weisen viele auffällige somatische Befunde, von der Norm abweichende Laborparameter sowie im Falle der anorektischen Heavy User eine häufig bestehende Hirnatrophie auf. Darüber hinaus zeigen sie eine Reihe von kognitiven Defiziten in verschiedenen Bereichen. Am stärksten davon betroffen sind die restriktiv anorektischen Heavy User. Die Ausprägungen der untersuchten pathologischen Befunde unterscheiden sich jedoch nicht signifikant von denen der Nicht-Heavy User. Spezifische Eigenschaften der Heavy User, die es zulassen, sie von einem Nicht-Heavy User abzugrenzen, wurden nicht gefunden. Weitere Studien sind notwendig, um andere typische Merkmale der Heavy User zu eruieren, damit sie möglichst frühzeitig identifiziert und ihnen für sie geeignetere alternative Behandlungsmöglichkeiten angeboten werden können. / Objective: The objective of this explorative study was to describe female adult patients with restricting- respectively purging-type anorexia nervosa or bulimia nervosa with a high use of hospital services, so called heavy users, who received full inpatient treatment in the Clinics and Polyclinics for Psychiatry, Psychosomatics and Psychotherapy of the University Hospital of Würzburg, to show sociodemographic and disease-related somatic and cognitive characteristics and to compare the results with a control group of female patients with the same disorder, but a reduced demand of healthcare offerings, the non-heavy users. Patients and Methods: 23 anorectic respectively bulimic female heavy user patients, who were for at least the third time in inpatient treatment due to their eating disorder, and a comparison group of 13 female non-heavy user patients with a maximum of one inpatient prior stay were studied. General and neurological status, as well as the laboratory parameters at the time of exposure and the evaluation of the cranial CTs or MRTs plus the cognitive test methods at the beginning of the therapy and before discharge were analysed and compared with each other. Results and Conclusion: The anorectic and bulimic heavy users show a lot of noticeable somatic findings, laboratory parameters deviating from the norm and in case of the anorectic heavy users an often existing atrophy of the brain. Furthermore they present a series of cognitive deficits in various sectors. The most affected are the heavy users with restricting-type anorexia nervosa. The manifestations of the examined pathological findings are not significantly different from those of the non-heavy users. Specific characteristics of the heavy users which permit to differentiate them from a non-heavy user were not found. Further studies are necessary, to determine other typical features of heavy users, in order to identify them as early as possible and offer them more suitable alternative treatment options.

In dieser Arbeit wurde die Herzratenvariabilität (HRV), das Interbeat-Intervall (IBI) sowie die Beziehung zwischen HRV und IBI bei gesunden Probanden, bradykarden Patienten mit einer Mutation im hyperpolarization-activated cyclic nucleotide-gated channel 4-(HCN4) Gen sowie Patienten mit einer Anorexie nervosa (AN) untersucht. Die Haupthypothese lautete, dass die bei Patienten mit AN oft zu beobachtenden Bradykardien durch neurale Mechanismen verursacht werden. Daher wurde angenommen, dass ein Sättigungseffekt der HRV/IBI Beziehung infolge einer anhaltenden parasympathischen Kontrolle des Sinusknotenareals lediglich bei Patienten mit einer AN nachzuweisen ist. In dieser Arbeit konnte ein Sättigungseffekt der HRV/IBI-Beziehung bei Patienten mit einer Anorexia nervosa sowie bei zwei von vier Patienten mit einer HCN4-Mutation nachgewiesen werden. Bei Kontrollen konnten hingegen kaum Zeichen eines Sättigungseffekts der HRV/IBI Beziehung nachgewiesen werden. Es wurde daher geschlussfolgert, dass ein Sättigungseffekt der HRV/IBI Beziehung keine parasympathisch-vermittelte Bradykardie beweist. Es zeigt sich vielmehr, dass die Regulation des HCN4-Gens für die Bradykardie und den festgestellten HRV-Sättigungseffekt bei Patienten mit einer AN verantwortlich sein könnte. / We examined heart rate variability (HRV), interbeat interval (IBI), and the HRV/IBI interrelationship in three groups of patients: healthy subjects, carriers of bradycardic hyperpolarization-activated cyclic nucleotide-gated channel 4 (HCN4) mutations, and patients with anorexia nervosa (AN) to investigate if neural mechanisms control bradycardia in patients with AN. We speculated that HRV/IBI saturation due to parasympathetic control of the sinus node is detectable in patients with AN. The relationship between IBI and HRV showed saturation in patients with AN, while HRV saturation was present in two of four HCN4 mutation carriers. HRV saturation was not observed in control subjects. We conclude that HRV saturation does not prove that bradycardia is modulated by the parasympathetic nervous system. Rather, HCN4 downregulation may be responsible for bradycardia and HRV saturation in patients with AN.

Bakgrund: Anorexia Nervosa är en sjukdom som innebär att patienten har en onormalt låg kroppsvikt och en extrem rädsla för att gå upp i vikt. Sjukdomen påverkar stora delar av kroppen och medför ofta olika komplikationer som i värsta fall leder till döden. Sjuksköterskans omvårdnad är till för att lindra lidande och främja hälsa. Då sjukdomsbilden ofta är komplex hos patienter med Anorexia Nervosa är omvårdnadsbehovet många gånger stort.  Syfte: Syftet med litteraturstudien var att belysa patientens erfarenhet av att vårdas till följd av Anorexia Nervosa. Metod: En litteraturstudie med integrerad analys och induktiv ansats baserad på sju kvalitativa artiklar och de kvalitativa delarna av en studie med mixad metod användes för att besvara syftet. Artiklarna är inhämtade från databaserna Cinahl och Psycinfo.  Resultat: Analysen grundade ett resultat bestående av tre huvudkategorier samt sex underkategorier. Huvudkategorierna var: erfarenhet av vårdmötet, vikten av delaktighet och autonomi samt vikten av stöd. Huvudkategorierna innefattade fem underkategorier, dessa var: vårdpersonalens förståelse och kunskap, individanpassad vård, kontinuitet i vården, betydelsen av en god relation samt vägledning & struktur.  Slutsats: Patienterna erfor många gånger att vården de fick var bristande. Den bristande vården berodde ofta på kunskapsbrist hos vårdpersonal. Det var viktigt att bli behandlad med respekt, empati och känsla av förståelse. Individanpassad vård var positivt för tillfrisknandet.

Background: Eating disorders are defined as serious psychiatric conditions that in many cases have psychological and physical consequences. In Sweden 190 000 people between the age of 15 and 60 estimated to suffer from an eating disorder. Anorexia nervosa is one of the most serious psychiatric disorders and the mortality rate for these patients is higher than any other mental illness. The care of eating disorders is often experienced as complicated by both healthcare professionals and patients. The nurse has a profession which requires care with a focus on each patient as unique. It’s important that the nurse sees the person behind the eating disorder. Purpose: The purpose of this study was to synthesize experiences of care and support within clinics specialized in eating disorders among patients with anorexia nervosa. Method: For this work, a qualitative literature study has been used as a study design. A qualitative content analysis was applied. Results: Four categories were identified with fifteen associated subcategories. The categories were individualized care, the importance of good communication, the importance of the environment and extended treatment. Conclusion: A personcentered and individual care and treatment proved to be of greatest importance for patients to recover. That the patients were allowed to feel involved, where they were seen as a person not their ilness and had a good collaboration with healthcare staff was decisive.

Eating disorders fall within the top nine health ailments affecting young people today. These illnesses such as Anorexia Nervosa, Bulimia Nervosa, and Eating Disorders Not Otherwise Specified affect a large number of people, particularly female adolescents. The disorders can further cause complications in one’s health, systemically and orally, sometimes resulting in death. The purpose of this paper is to closely examine published studies examining the link between eating disorders and oral health. Multiple studies have found that patients suffering from eating disorders are more likely to develop tooth erosion. Behaviors often found in eating disorder patients such as self-induced vomiting and ingestion of highly acidic diets can lead to such enamel loss, a condition that is irreversible. Other researchers disagree about whether eating disorders can lead to an increase in dental caries, with some finding amplification and others finding no significant results. Parotid gland swelling is another side effect of eating disorders but this complication often recedes once the unhealthy behavior is halted. Most studies have not yet found a link between these illnesses and increased periodontal disease. However, they do seem to lead to decreased unstimulated salivary flow rates. Furthermore, it also appears that the disorders lead to augmented levels of S. mutans and Lactobacilli. One’s oral mucosa can also be affected via angular cheilitis and oral candidiasis. Additionally, eating disorders may serve as a risk factor for bone and joint disorders such as osteoporosis and temporomandibular joint disorders, respectively. The illnesses may show effect outside the oral cavity through Russell’s sign on one’s knuckles and oral function may be impaired. With all these possible oral complications being some of the first to indicate the presence of an eating disorder, dentists may be integral to identifying and stopping the progression of the disease. However, it has been suggested that eating disorder patients may have greater dental anxiety keeping them from visiting the dentist in the first place, let alone divulging their disease to their dentist. Furthermore, oral health professionals may not be adequately prepared to notice the presence of an eating disorder. Dental schools must do more to teach future oral health professionals about eating disorders, especially in the clinic, as simple suggestions like avoiding brushing one’s teeth immediately after participating in self-induced vomiting may help to reduce the likelihood of enamel erosion. Through this analysis it was determined that while sufficient baseline research has been done, there is still a great deal more to learn about how eating disorders affect one’s oral health. There are multiple forms of diagnostic criteria that could possibly prevent patients from receiving the best treatment possible. Furthermore, more research needs to be done on disorders other than Anorexia Nervosa and Bulimia Nervosa as not every patient falls under these two categories. Since it has been shown that certain types of medication can decrease one’s salivary flow rate, future studies need to also consider any medication that patients may be on. In order to really aid those affected by eating disorders, men should be considered as future subjects too, since most studies have currently only focused on women. By completing more research on eating disorders and their consequences on oral health, health care professionals will be better able to serve those affected.

Bakgrund: Anorexia Nervosa är en psykisk sjukdom som innebär en förvrängd kroppssyn,där patienten upplever sig överviktig trots undervikt. Kvinnor insjuknar oftare än män.Prevalensen för AN i Sverige är 1–2 procent av den svenska befolkningen. Bantning är alltidförsta steget in i AN.Syfte: Syftet med litteraturstudien var att beskriva patienters upplevelse av tillfrisknande frånanorexia nervosa.Metod: En litteraturstudie med systematisk sökning. För att sammanställa resultatet ilitteraturstudien har en integrerad analys använts. Efter bearbetning av artiklarna resulteradedet i tio artiklar som användes i litteraturstudien.Resultat: Depressioner, ångest, stress och utmattning är vanligt vid AN. Västerländskaskönhetsidealet är en riskfaktor för att insjukna i AN. AN kan upplevas som en vän och entrygghet, vilket kan skapa en identitetskris vid tillfrisknandet. Stöd från anhöriga är viktigt förtillfrisknandet.Slutsats: AN är en komplicerad sjukdom med en lång återhämtningsprocess som krävermotivation och tålamod av patienten. Det behövs mer forskning på män med AN, då denmesta forskningen är på kvinnor med sjukdomen.