M.A. / In the Western world, anorexia nervosa has long been regarded as an age-old medical syndrome and was conceded to have reached epidemic proportions in white South African females by the 1970s. On the contrary, it has been deemed to be non-existent in indigenous African females, this being attributed to the African socio-cultural preference for the fuller figure. The first clinical case in an indigenous female was reported in Nigeria (Nwaefuna, 1981). In South Africa, the first diagnosis in 1993 and earliest reporting of three cases by Szabo, Berk, Tlou and Allwood (1995) coloured the face of prevailing conceptualisation and was viewed as a nascent indication of global acculturation to a Western lifestyle and value system. This research represents the researcher’s invitation to the reader to embark on an exploratory journey into the biographically situated experience of anorexia nervosa as revealed through the personal experience stories of three black South African female participants. With the researcher’s quest to explore this as a uniquely human, lived experience, it became essential to open up the life of each participant as the arena in which this experience unfolded, so that seminal vicissitudes as well their sense of self in the course of this experience could be gleaned. Further, the researcher shied away from a fait accompli acceptance of the acculturation discourse and sought to interrogate it by giving voice to participants’ lived sense of the relationship between this experience and their cultural identity and affiliation. As its dialectic, the researcher also allowed participants to give voice to the cultural scrutiny of their experience through the lens of their culturally-referent others. Finally, the researcher opened up some of the seminal vicissitudes of her personal experience as the space for introspection and reflection on nuances and resonance between her experience and that of participants, without a concomitant attempt to generalise about either. Through post-modernist interpretive interactionism (Denzin, 1989), the researcher undertook a comprehensive deconstructive review of biopsychosocial discourses on the experience of anorexia nervosa, which sought to uncover and juxtapose various underlying models of human action. This review also included a feminist lens, which allowed that images and conceptions of women that exist within these discourses could be revealed, while simultaneously offering a critique of inherent culturally gendered dynamics. Through metaphoric simultaneity, the crystallised use of personal stories, drawings and naïve sketches sought to provide deepened, complexified and, if it be so, competing accounts of participants’ experience. The researcher drew a number of conclusions pursuant to participants’ experience of anorexia nervosa. First, that although biological factors could not be excluded, especially the role of genetics and hormones in adolescence, the exact nature thereof was beyond the scope of this inquiry and therefore inferential. Second, that although there were varying degrees of resonance in participants’ experience with some of the macro socio-cultural discourses considered, these did not appear to have been pathogenically pre-eminent. Third, that in the exploration of particular vicissitudes of participants’ family relational dynamics, the embryonic seeds and gestalt effect of their susceptibility matrix was vividly exposed. All factors considered, the researcher stands strongly in the opinion that gleaning this as the personal experience of three black female participants and drawing in sediments of her own personal experience, anorexia nervosa is ultimately a uniquely individual experience that stands as a covert and metaphoric language of personal distress. While it may sometimes overlap with some of the dynamics that have coloured the socio-cultural landscape in different epochs, it has its own dynamics and internal logic that is uniquely and inextricably tied to the specific vicissitudes of each person’s biographically constructed self. The specific probing of participants’ cultural identity and affiliation served to confirm that while the evolving cultural identity and affiliation of black females may be undeniable, the prevalent causal attribution of anorexia nervosa to acculturation appears to have been compellingly shown in this case to be an external and cursory one. Finally, the specific probing of participants’ experience through the eye of their culturally-referent others revealed that anorexia nervosa is culturally enigmatic. Its attribution, in participants’ socio-cultural context, to witchcraft, acculturation and especially to HIV and AIDS and attendant stigmatisation and shaming of an already deeply wounded person serves to indicate the degree of distress, isolation and rejection experienced by sufferers. By the same token, it also serves to illumine the felt equivalence of this period in participants’ socio-cultural context with HIV and AIDS. This study represents the researcher’s endeavour to convey participants’ experience of anorexia nervosa in its richness, in an attempt to render it understandable, without any concomitant attempt to foreclose or pretence of being exhaustive. Therefore, it recognises that the understanding presented here inalienably represents the researcher’s hermeneutic circle. The reader is thus invited, if not challenged, to discern their own understanding. Finally, it offers itself as a signpost for future research into what by all accounts, stands starkly as an untapped minefield.

Thesis advisor: Barbara E. Wolfe / Background: Anorexia nervosa (AN) is a serious mental illness with physical and emotional consequences. Currently, there are limited effective treatments available to address this devastating condition. One possible biomarker implicated in this condition is brain derived neurotrophic factor (BDNF), a member of the neuron growth family. Pre-clinical studies indicate administration of BDNF is associated with decreased food intake and weight loss. Serum BDNF levels also have been shown to be reduced in AN compared to healthy controls (HC). In studies of selective serotonin reuptake inhibitors (SSRI's), blood levels of BDNF have been shown to increase following SSRI administration. This study sought to examine the possible relationship between peripheral BDNF levels and influence of an SSRI, and augmentation with 5-hydroxytryptophan (5-HTP) in persons with AN and HC's. Methods: This study examined previously collected samples from an investigation assessing the influence of SSRI administration and augmentation with 5-HTP on serotonin function in AN. The original study utilized a randomized double-blind placebo-controlled design. AN (n=16) and HC (n=49) subjects were randomized to 1 of 3 treatment conditions (fluoxetine, fluoxetine plus 5-HTP, and placebo) for 7 days of drug administration. Blood samples were collected following an overnight fast and stored at -70°C prior to batch analysis (ELISA). Results: Plasma BDNF levels in AN subjects (59.7 (SD 43.3) pg/ml) were not significantly (p=0.24) different from HC's (76.2 (SD 49.0) pg/ml). There were no significant differences between SSRI, SSRI plus 5-HTP, and placebo treatment groups within or between AN and HC groups. Conclusions: Although BDNF levels in AN subjects were lower than HC, the difference was not statistically significant. After 7 days of SSRI, SSRI plus 5-HTP, or placebo, there were no differences in BDNF levels between or within groups. The possibility exists that 7 days is not long enough to see an expressed effect of SSRI's on BDNF. Future studies would benefit from longer duration of SSRI's, assessing potential covariates (e.g. BMI, depression), and a larger sample. / Thesis (PhD) — Boston College, 2013. / Submitted to: Boston College. Connell School of Nursing. / Discipline: Nursing.

Esta tese teve por objetivo validar e pesquisar a confiabilidade da Sessão de Transtornos Alimentares do DAWBA (“Development and Well-Being Assessment"), um pacote de entrevistas e técnicas de avaliação planejado para ser aplicado por entrevistadores sem experiência clínica prévia, para rastrear e diagnosticar transtornos alimentares em crianças e adolescentes do sexo feminino, de 7 a 17 anos, em estudos epidemiológicos. Participaram deste estudo 174 crianças e adolescentes de 8 a 17 anos, do sexo feminino, procedentes de três grupos: (1) 48 meninas com transtornos alimentares; (2) 55 controles clínicos – 21 em tratamento para depressão unipolar, 14 em tratamento para transtorno obsessivo-compulsivo e 20 em tratamento para doença gastrointestinal – e (3) 71 controles comunitários. Um dos pais de cada menina também foi entrevistado com o instrumento. Foram eleitos sujeitos destes três grupos para pesquisar a validade discriminante do instrumento quanto à sua capacidade de diferenciar jovens com transtornos alimentares e outros transtornos físicos ou psiquiátricos mimetizantes. O diagnóstico da presença ou não de transtorno alimentar – anorexia e bulimia nervosas e síndromes parciais - em cada sujeito, foi gerado utilizando-se três métodos diferentes independentes: (1) diagnóstico padrão-ouro, baseado no DSM-IV e CID-10, estabelecido através de entrevista clínica livre do pai e da menina juntos, realizada por psiquiatra infantil especialista em transtornos alimentares, cego para o grupo de origem da menina; (2)diagnóstico preliminar do computador gerado por algoritmo específico baseado na CID-10 e DSM-IV levando em considerando a informação estruturada coletada pelo instrumento e (3) diagnóstico final DAWBA, estabelecido por especialista treinado, baseado na CID-10 e DSM-IV, através da revisão cuidadosa dos relatórios fornecidos pelo software DAWBA com o resumo das informações colhidas com o instrumento. A validade concorrente dos diagnósticos DAWBA (preliminar do computador e final) foi pesquisada mediante comparação com o diagnóstico padrão ouro. A confiabilidade teste-reteste foi pesquisada reaplicando o instrumento duas ou três semanas após a primeira utilização, em 55 sujeitos (7 com transtornos alimentares, 20 controles clínicos e 28 controles comunitários). Os aplicadores estiveram cegos (tanto no teste quanto no reteste) para o grupo de origem do sujeito. Pesquisou-se a consistência interna (Alfa de Crombach) e os melhores pontos de corte das cinco questões de rastreamento, bem como sua sensibilidade e especificidade. Houve diferença significativa na média de idade entre os grupos com transtornos alimentares (média de 16,0 anos) e controles clínicos (média de 14,5 anos). Para a detecção de qualquer transtorno alimentar segundo o DSM-IV e a CID-10, o diagnóstico final pelo DAWBA apresentou sensibilidade de 100% e especificidade de 94%. Houve boa concordância teste-reteste (Kappa de 0,81) e boa consistência interna das questões de rastreamento, sendo o Alfa de Crombach de 0,76 na entrevista com as meninas e 0,81 na entrevista dos pais. Os melhores pontos de corte nas questões de rastreamento foram de dois e três, observando que, para um ponto de corte de três a sensibilidade foi de 89,8% em ambas as entrevistas (meninas e pais) e a especificidade de 85,6% na entrevista das meninas e 85,5% na entrevista dos pais. Foram limitações do estudo a diferença significativa na média de idade entre os grupos ‘com transtornos alimentares’ e ‘controles clínicos’, a não inclusão de crianças com transtornos alimentares menores de 11 anos e a impossibilidade de estabelecer comparações entre os grupos com relação a variáveis sócio-econômicas. Desta forma, pode-se concluir com o presente estudo que a Sessão de Transtornos Alimentares do DAWBA apresenta boa validade e confiabilidade no rastreamento e diagnóstico de transtornos alimentares em crianças e adolescentes do sexo feminino e tem aplicabilidade tanto em pesquisa clínica quanto em estudos epidemiológicos comunitários. / This thesis concerns the validation and investigation of the reliability of The Eating Disorders Section of The Development and Well-eing Assessment (DAWBA), a package of interviews and assessment techniques designed to be administered by trained interviewers without previous experience in eating disorders, for screening and diagnosis in epidemiological studies of eating disorders in female children and adolescents, from 7 to 17 years old. This study was carried out with the participation of 174 female children and adolescents, from 8 to 17 years old, recruited from three groups: (1)48 girls with eating disorders; (2) 55 clinical controls – 21 in treatment for unipolar depression, 14 for obsessive compulsive disorder and 20 for gastrointestinal disease – and (3) 71 community controls. One of the parents of each girl was also interviewed with the measure. Subjects were recruited from the three groups to assess the discriminant validity of the measure concerning its ability in discriminate girls with eating disorders from other mimicking psychiatric or physic disorders. The diagnosis of the presence or not of eating disorder in each subject – anorexia, bulimia nervosa and partial syndromes – was made using three different independent methods – (1) gold standard diagnosis, based on DSM-IV and ICD-10, assigned through free clinical interview of the parent and the girl together, made by a child and adolescent psychiatrist specialized in eating disorders, blind to the group of origin of the girl; (2) preliminary computer diagnosis, generated by a specific algorithm based on ICD-0 and the DSM-IV, using the structured information collected with the measure and (3) final DAWBA diagnosis, established by a trained specialist, based on DSM-IV and ICD-10, through the careful review of the information on the reports provided by the DAWBA software, containing the abstracts of the information collected by the measure. The concurrent validity of the DAWBA diagnoses (computer preliminary and final) was assessed through the comparison with the gold standard. The test-retest reliability was assessed reassessing 55 subjects (7 with eating disorders, 20 clinical controls and 28 community controls) with the measure two or three weeks after the first assessment. The DAWBA interviewers were blind (both in test and retest) for the origin group of the subject. Internal consistency (Crombach Alpha), best cutoffs in the screening questions, sensibility and specificity were assessed. There was a significant difference in mean age between the eating disorder (mean = 16 years) and clinical control (mean = 14,5 years) groups. For the detection of any eating disorder according the DSM-IV and ICD-10, the final DAWBA diagnosis presented sensibility of 100% and specificity of 94%. There was good test-retest agreement (Kappa = 0,81) and good internal consistency in the screening questions, being the Crombach Alpha of 0,76 in the girls interview and 0,81 in the parent interview. The best cutoffs on the screening questions were two and three, noting that for a cutoff of three the sensibility was 89,8% in both interviews (girls and parents) and the specificity was 85,6% for the girls interview and 85,5% for the parent interview. The significant difference in mean age between the eating disorder and clinical control groups, not including children with eating disorders younger than 11 years old and the absence of comparisons of social economic variables between groups were limitations of this study. In summary, the present study shows that The Eating Disorders Section of the DAWBA has good validity and reliability for the screening and diagnosis of female children and adolescents with eating disorders and has applicability both in clinical and community settings.

Bakgrund: Anorexia Nervosa (AN) är en allvarlig psykisk sjukdom som drabbar främst unga kvinnor. AN innebär att personerna har en rädsla för viktuppgång och en skev kroppsuppfattning. Rädslan för viktuppgång resulterar till en allvarlig viktminskning. Den skeva kroppsuppfattningen kan påverkas av samhällets skönhetsideal. Sjukdomen påverkar inte bara den drabbade utan hela familjen drabbas. Sjuksköterskan bör skapa en god vårdrelation till personer med AN eftersom det är betydelsefullt för den fortsatta vården. Syfte: Syftet med studien var att belysa unga kvinnors upplevelse av att leva med Anorexia Nervosa. Metod: En kvalitativ litteraturstudie med induktiv ansats. Data analyserades utifrån en manifest innehållsanalys som baseras på fem självbiografier. Resultat: Unga kvinnors upplevelser av att leva med AN innebar ett stort lidande. Livsvärlden förändrades samtidigt eftersom de kände en ökad livskraft med hjälp från vårdpersonal och familjen. Resultatet presenteras i tre kategorier och tillhörande underkategorier. Kategorierna är: Leva med röstens kommentarer, Sjukdomen påverkar ständigt och Bevara kontrollen i sjukdomen. Slutsats: Personer med AN finner det jobbigt att förlora sitt självbestämmande till sjukdomen och andra vilket kan medföra ett ökat lidande. Det är viktigt att sjuksköterskan skapar tillit hos de unga kvinnorna med AN i syfte att öka livskraften för att bli fri från sjukdomen.

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

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.

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.