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.

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Researchers have suggested there is a wide range of neuropsychological deficits individuals with anorexia nervosa (AN) possess, including impairments in nonverbal reasoning, attention and processing speed, memory, and executive functioning. While growing, examination of the neuropsychological functioning of children and adolescents with AN is quite sparse compared to the abundance of research on adults with AN, and the many conflicting findings have been attributed to inconsistent methodologies across studies. This study examined the neuropsychological functioning of children and adolescents with AN by conducting a quantitative study loosely based on Bayless et al. (2002) and Remberk, Namysłowska, Krempa-Kowalewska, Gadaś, and Skalska (2011). Results indicated verbal intellectual functioning was significantly higher than other intellectual domains, and verbal memory was almost significantly higher than nonverbal memory (p = .051). Negative correlations were found between individual subtests and clinical data (e.g., age of onset of AN and duration of AN) as well as the EDI-3 Personal Alienation scale and the BMI-for-age percentile. Clinical implications include providing treatment improving cognitive functioning and implementing a biopsychosocial model.

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 of relapse. 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.

This thesis argues that although the anorexic patient is subjugated in the medical encounter, subjects find ways to resist and disrupt this subversion. The analysis is largely based on life history interviews with teenage girls with a medical diagnosis of anorexia. Other data sources include interview field-notes, my research journal and selected popular magazines. The data was analysed using a discourse analytic methodology to explore how girls constituted hospitalisation, anorexia, doctors and patients, among other issues. The analysis draws on insights from poststructuralist theory. In the earlier chapters, an analysis of the complex medical, psychological and feminist theories of anorexia nervosa; and a description of the hospitals where girls are treated is developed to situate the study in its socio-historical context. The analysis consists of three main arguments. The first is that clinical notions of food, eating and embodiment are in direct contrast to social discourses on these topics. Girls draw on this discrepancy in their resistance to hospital practices. The second argument is that girls are aware they are positioned as irrational because of their malnourished state and are also aware that if they blatantly resist treatment they will be subjected to further surveillance. Girls take up medical discourses in different ways and to different effects in constituting themselves as agenetic subjects. The third argument focuses on the shifting construction of the anorexia subject in the clinic. Although discourses of anorexia and psychiatry have a powerful impact on the girls; girls resist these positionings, finding other ways to constitute themselves. The contention of this thesis is that clinical constructions of anorexia work to form the subject and provide the possibilities for the creation of other subjectivities. On the basis of this research, some suggestions for how inpatient treatment regimes may work differently are provided. / Doctor of Philosophy (PhD)

Public view removed at the authors request. 16/07/2006 / The daily experience of anorexia nervosa sufferers has not previously been studied and yet it is fundamental to understanding anorexia nervosa. This study examined and compared the daily experiences of anorexia nervosa patients and control participants in terms of sense of self, mood states and flow states. Flow is characterised by undivided concentration and interest in an activity for intrinsic benefits. Flow is not always desirable, as some ways of experiencing it may be harmful to the individual and society. Anorexia nervosa participants were recruited from hospitals and private practices of clinicians specialising in the treatment of anorexia nervosa. Exclusion criteria included male gender, chronic anorexia nervosa, drug abuse, and current participation in an inpatient program. Anorexia nervosa participants completed a series of questionnaires at baseline, 3-6 month follow-up and 7-12 month follow-up (stage one, two and three respectively). The questionnaires were designed to measure the severity of their eating disorder. Anorexia nervosa and control group participants completed Experience Sampling Forms (ESF) and a Repertory Grid at baseline and 3-6 months. The ESFs were completed each time a pager was activated. The pager was activated seven times a day, for four days at random times between 8.00am and 10.00pm. The pager signals were a minimum of two hours apart. The Repertory Grid consisted of 23 constructs and 13 elements provided to the participant. Thirty-one anorexia nervosa sufferers and thirty-two control participants completed stage one and eighteen anorexia nervosa sufferers and twenty-seven control group participants completed stage two of the study. Eighteen anorexia nervosa sufferers completed stage three of the study. Control participants were not required to participate in stage three. There was no difference in the severity of anorexia nervosa between completers and drop-outs The analysis of the ESFs at stage one indicated that the anorexia nervosa group participants did not spend more time alone at home or more time alone in any situation than the control group. For both groups, being alone had a negative influence on mood state, but had no effect on sense of self. The anorexia nervosa group felt lonelier and less sociable than the control group. The mood state and sense of self for the anorexia nervosa group was significantly lower over all the ESFs when compared to the control group. They were also more self-critical, experienced higher levels of guilt, were less able to live up to their own expectations, and were less satisfied with their performance in the activity they were doing. The anorexia nervosa group experienced less flow states than the control group at stage one. There was an improvement in mood state, sense of self and self-criticism for the anorexia nervosa group when they were in a flow state compared to when they were not in a flow state. There was an improvement in mood state, sense of self, guilt and self-criticism for the control group when they experienced flow, however these differences were not significant. The anorexia nervosa group had a more positive mood state and sense of self at stage two when compared to stage one. Correspondingly, there was a trend towards a reduced severity of the disorder indicated by a significant improvement on some of the psychological tests (EAT, REDS, BDI, DT). There was also a significant improvement in BMI. However, there was a significant decline in the amount of flow of anorexia nervosa participants experienced at stage two when compared to stage one. This result may be attributed to the significant decline in the response rate on ESFs in the second stage of the study for both the anorexia nervosa and control groups. Anorexia nervosa non-responders at stage two reported more severe symptoms of anorexia nervosa than anorexia nervosa responders, although this was a trend and reached significance only on minor indicators of eating disorder severity. The identification of a factor that predicted severity over a six-month period was not possible. The repertory grid analysis showed that the construct system of the anorexia nervosa participants was tighter and less complex than that of the control group. The anorexia nervosa group construed themselves as dissimilar from the way they would like to be in any context. The control group construed themselves as similar to the way they would like to be when they were alone, but as dissimilar from the way they would like to be when they were with other people. While the most salient element for both the anorexia nervosa and control groups was 'alone at home', it appears that the controls use this time for goal-directed activities. In contrast, this time was dominated by fear of losing control for the anorexia nervosa group. Although there was a trend towards a decrease in the amount of variance accounted for by the first component for the anorexia nervosa group at stage two compared to stage one, the interpretation of this result was complicated by mixed result of the control group. The anorexia nervosa groups' daily experience of life was bleak when compared to the daily experience of the control group, except for periods when the anorexia nervosa participants experienced a flow state. DeVries (1992) has documented the success of therapeutic interventions that involve the identification and replication of activities that resulted in a flow state. This investigation suggests that a similar result may be possible in the treatment of anorexia nervosa.

<p><strong>Bakgrund.</strong> Anorexia nervosa anses vara en multifaktoriell sjukdom där psykologiska, sociala, kulturella och biologiska faktorer inverkar. En förvrängd kroppsuppfattning, rädsla att gå upp i vikt och en kroppsvikt mindre än 85 procent av den förväntade är bland annat karakteristiskt för ätstörningen anorexia nervosa. Sjukdomen debuterar vanligen i tonåren. <strong>Syfte. </strong>Syftet med denna litteraturstudie var att belysa patienters erfarenhet av behandling och omvårdnad vid anorexia nervosa. <strong>Metod.</strong> En systematisk litteraturstudie genomfördes och 14 för syftet relevanta artiklar inkluderades. Artiklarna granskades och kvalitetsbedömdes. Genom innehållsanalys bearbetades artiklarna. <strong>Resultat.</strong> Följande fem kategorier identifierades:Patienten måste ha viljan att bli frisk, betydelsen av relationen till vårdpersonalen, behovet av stöd från närstående, att inte få välja själv och medpatientens betydelse för tillfriskande. Patientens egen vilja och motivation till ett förändrat beteende ansågs avgörande för en effektiv behandling. Patienterna ansåg det viktigt att vårdpersonalen inte bara ser de kroppsliga symtomen utan även att det finns en unik individ bakom sjukdomen. Stöd från närstående och medatienter ansågs viktigt under tillfriskningsprocessen. <strong>Diskussion.</strong> Patientens unika behov bör sättas i centrum för behanlingen och omvårdnaden. Det är viktigt att vårdperonalen har en helhetssyn och är införstådd i att anorexia nervosa är en multifaktoriell sjukdom för att förstå sig på sjukdomen och kunna skapa en en god relation till patienten. Det kan anses fel att påtvinga en person med anorexia nervosa vård, men kan vara livsavgörande.<strong> Slutsats.</strong> Utveckling av vården vid anorexia nervosa bör ständigt utvecklas utifrån patientens behov i takt med att samhället förändras.</p>

<p><strong>Bakgrund</strong>: Eftersom det blivit allt vanligare med ätstörningar som anorexia nervosa finns det en stor möjlighet att vårdpersonal träffar på dessa patienter inom vården oavsett vårdområde. För att som sjuksköterska kunna bemötta dem på bästa sätt och erbjuda en god vård, krävs det kunskap kring upplevelser av att leva med denna sjukdom.</p><p><strong>Syfte</strong>: Syftet med litteratur studien var att undersöka upplevelsen av anorexia nervosa.</p><p><strong>Metod</strong>: Metoden som användes var en litteraturstudie med en kvalitativ analys. Fem självbiografier utgjorde studiens datamaterial och de analyserades med en kvalitativ innehållsanalys.</p><p><strong>Resultat</strong>: I analysen framkom två huvudkategorier som ligger till grund för resultatet. Dessa var upplevelsen av lidande och upplevelsen av trygghet. Resultatet visade att individen med anorexia nervosa går igenom ett lidande som genomtränger hela deras liv. Lidande kunde yttra sig på olika sätt och i samband med olika upplevelser. Framförallt upplevdes lidandet ihop med maktlöshet över sin situation och tvångsåtgärder som de utsattes för. Och ett kontrollbehov som skapade en negativ trygghet och ett lidande då individen upplevde sig fängslad i rutiner och regler. Det fanns även ljus i mörkret där människan kunde uppleva en trygghet i sin livsvärld med hjälp utav familj och vänner.</p><p><strong>Slutsats</strong>: Människor med anorexi går ständigt igenom ett lidande i kampen emot sjukdomen och en inre röst som begränsar dem i deras livsvärld. Individer med anorexisjukdom har ett stort kontrollbehov och lever i en maktlöshet som genomsyrar deras livsvärld. Relationen till familj och vänner var mycket betydelsefullt för kvinnornas livsvilja. Det var familjens och vännernas kärlek som fick kvinnorna börja känna tro och hoppas att någon dag bli frisk.</p><p> </p><p> </p><p> </p>

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