No description available.

Bakgrund: Anorexia nervosa är en ätstörning som debuterar i allt yngre ålder och kan yttra sig på olika sätt beroende på individen. Detta leder till att det inte finns ett enkelt svar på hur sjukdomen ska behandlas. Det ställer krav på både kunskap och erfarenhet hos sjuksköterskorna för att förstå komplexiteten av anorexia nervosa, vilket är nödvändigt för att uppnå ett lyckat behandlingsresultat.   Syfte: Syftet är att beskriva sjuksköterskans omvårdnadsåtgärder vid behandling av anorexia nervosa hos unga kvinnor.   Metod: En litteraturstudie grundad på åtta kvalitativa artiklar. Artiklarnas resultat har granskats, analyserats och sammanställts för att besvara syftet. Databassökningen har genomförts i Cinahl, Pubmed samt PsykInfo.   Resultat: Sammanfattningen av artiklarnas resultat bildade tre kategorier som beskriver de omvårdnadsåtgärder sjuksköterskorna använder: 1) Bygga och upprätthålla en god relation till patienten, 2) Säkerställa viktökning och 3) Återställa ett normalt ätbeteende.     Slutsats: Litteraturstudien beskriver hur behandlingen påverkas av hur sjuksköterskorna genomför omvårdnaden. Att skapa en god relation till patienten är en avgörande komponent för att lyckas med viktökning och en beteendeförändring hos patienten.      Nyckelord: Anorexia nervosa, behandling, kvinnor, omvårdnad, ungdomar

Anorexia nervosa är ett folkhälsoproblem som leder till allvarliga konsekvenser för de drabbade. Det anses vara en psykisk sjukdom men resulterar ofta i fysiska symptom som undernäring och hjärtsvikt. I svåra fall bedöms personerna med anorexia nervosa vara i behov av psykiatrisk tvångsvård. Detta trots att det inte framgår tydligt i lagstiftning eller förarbeten att anorexia nervosa ger förutsättningar för psykiatrisk tvångsvård. Denna studie har syftat till att undersöka förutsättningarna för att vårdas enligt lagen (1991:1128) om psykiatrisk tvångsvård för anorexia nervosa samt hur det skildras i domar där frågan avgjorts. Studien har genomförts genom tematisk analys av domar där frågan om psykiatrisk tvångsvård för kvinnor över 18 år med diagnosen anorexia nervosa avgjorts. De tematiska analyserna utfördes med teoretisk utgångspunkt i Foucaults begrepp om disciplin och vansinne samt Johannissons teori om kvinnosjuklighet och patientrollen. Resultatet av studien visade att de juridiska grunder som åberopas för att tvångsvårdas för anorexia nervosa är att personen har anorexia nervosa i en grad som bedöms vara en allvarlig psykisk störning samt motsätter sig psykiatrisk vård. Det har dock förekommit att personerna samtycker till antingen frivillig vård eller vård under tvång, men dessa samtycken har av rätterna inte bedömts tillförlitliga. Vidare visade analysen av domarna fyra teman vilka vi benämnde som samtycke, paternalism, sannolika konsekvenser samt motsägande uppfattningar. Den valda metoden har givit oss möjlighet att analysera konstruerandet av anorexia nervosa ur ett samhällsvetenskapligt perspektiv samt hur professionella riskerar att reproducera rådande maktstrukturer. Studien har bidragit till ett mer nyanserat perspektiv på hur förutsättningarna för psykiatrisk tvångsvård för personer med anorexia nervosa kan förstås.

M.A. / Anorexia nervosa is an eating disorder characterised by an intense fear of gaining weight, a refusal to maintain a minimally normal body weight and a significant disturbance in the perception of the shape or size of his or her body (American Psychiatric Association, 2000). Anorexia nervosa typically begins in mid-to-late adolescence (age 14-18 years). Follow-up studies show that only 10% of those with anorexia nervosa fully recover. While almost half may show partial recovery, many continue to be seriously impaired by depression, social phobias or recurrent symptoms (Herzog et al., 1993). Early onset (before 16) may be associated with a less negative prognosis, although a far from favourable one (Theander, 1996). Considerable clinical literature exists on the etiology of anorexia nervosa, but for the purpose of the current study cognitive factors that may relate to anorexia nervosa were examined. Specifically, the study focused on two self-evaluations: self-efficacy and self-esteem. Generalized self-efficacy can be defined as a global confidence in one's coping ability across a wide range of demanding or novel situations (Schwarzer, 1993). Self-esteem is defined as the evaluation that the individual makes and customarily maintains with regard to himself/ herself (Rosenberg, 1965). To ascertain levels of self-efficacy and self-esteem, the Generalized Self-Efficacy Scale (GSE) (Schwarzer & Jerusalem, 1993) and Rosenberg Self-Esteem Scale (RSE) (Rosenberg, 1965) were administered in an experimental group of white adolescent girls diagnosed with anorexia nervosa (n=24) as well as a control group (n=24). An ex-post-facto experimental control group correlational design was implemented, andtwo-tailed t-tests conducted to determine the significance of differences regarding levels of self-efficacy and self-esteem between the two groups. The results indicated that there was no significant difference between the experimental group and control group with regard to their levels of self-efficacy. However, the experimental group exhibited lower levels of self-esteem in comparison to the control group. These results indicate that generalized self-efficacy, as a cognitive self-evaluation on its own, does not distinguish between adolescent girls with anorexia nervosa and a control group, and that domain-specific self-efficacy should also be considered in future research. The results further confirmed that girls diagnosed with anorexia nervosa exhibit lower levels of self-esteem as suggested in previous research (e.g. Wilksch & Wade, 2004). With regard to future research, larger groups are needed to elaborate on the current findings. Furthermore, additional research investigating the role of other aspects of self-esteem such as outer self-esteem and inner or trait self-esteem, as well as other aspects of self-efficacy such as domain specific self-efficacy, could contribute to the current findings.

Bakgrund: Anorexia Nervosa (AN) är en viljestyrd viktnedgång bland kvinnor som upplever sig vara för tjocka och därför vill gå ner i vikt. Yngre kvinnor som insjuknar i AN är i regel mellan 12–25 år och har en överdriven rädsla för att gå upp i vikt och har därför ett onormalt förhållningssätt till kost och fysisk aktivitet. Det är inte ovanligt att yngre kvinnor med AN förnekar sin sjukdom trots en utpräglad undervikt. AN är ofta en långdragen sjukdom som kan pågå under 5-15 år. Vid tidig insatt behandling kan tillfrisknandet gå betydligt fortare.    Syfte: Syftet med studien var att beskriva yngre kvinnors upplevelse av att leva med Anorexia Nervosa. Metod: En litteraturstudie med kvalitativ ansats baserad på tre patografier utifrån yngre kvinnors upplevelse av att leva med AN har utförts. Data har analyserats med Graneheims och Lundmans beskrivning av innehållsanalys. Resultat: I analysen framkom fem kategorier: förändrad självbild, matens betydelse, känna behov av kontroll, upplevelsen av att bestraffa sig själv och känna rädsla och ensamhet. Slutsats: I resultatet framkom yngre kvinnors upplevelser som var både negativa och positiva känslor som påverkade kvinnorna i vardagen. För att sjuksköterskan ska kunna bemöta yngre kvinnor med AN krävs förståelse för yngre kvinnors livsvärld samt kunna se individuella behov. I framtiden kan det behövas mer forskning hur yngre kvinnor upplever att leva med AN då det sker en ökning av sjukdomen AN bland yngre kvinnor.

This thesis explores the decision making styles demonstrated by people with anorexia. It is presented as three papers: 1) a literature review; 2) an empirical study and 3) a personal reflection on the processes involved in conducting the research and critical appraisal of the issues which emerged. The literature review in Paper 1 systematically explored the existing research that examined decision making in disordered eating populations. Twenty seven papers were reviewed and their findings synthesised to develop a comprehensive overview of decision making across a spectrum of disordered eating populations. Parallels in decision making across diagnostic categories were identified, and the relationship between decision making and clinical, personality and demographic variables was also explored. Methodological quality of studies was reviewed; recommendations for future research were also identified. Broadly, the findings indicated that similar styles of decision making appear evident in anorexia and bulimia. No characteristically different decision making patterns were demonstrated by people with eating disorder-not otherwise specified or by people recovered from anorexia. The evidence regarding nature of decision making in obesity and binge eating disorder was less conclusive. The empirical study conducted in Paper 2 endeavoured to enhance our understanding of the nature of decision making in disordered eating. The study examined a specific decision making bias i.e. the ‘jumping to conclusions’ bias in people with anorexia. The study also explored whether eating disorder related beliefs in anorexia could be considered to be of ‘delusional’ proportions. The results indicated that compared with a healthy control group, people with anorexia did not display a ‘jumping to conclusions’ bias. They did not display a tendency to make decisions on the basis of little evidence. The majority of individuals with anorexia did demonstrate limited insight into their eating disorder related beliefs, though only a minority subgroup held beliefs that could be considered ‘delusional’. Methodological limitations and clinical implications of the findings are discussed. The third paper provides a personal and critical reflective account of the processes involved in conducting both the literature review and the scientific study. It critically appraises aspects of the research process including strengths and limitations of both studies. Implications for clinical practice, replication and directions for future research are also identified. This paper also includes personal reflections on the approaches used and the challenges encountered within these.

No description available.

The thesis sought to explore the experience of caring for an individual with an eating disorder. It is comprised of three standalone papers. Paper one and two have been prepared for submission to a journal and in accordance with the journal guidelines. Paper one is a systematic literature review synthesising qualitative studies relating to the experience and impact of caring for, or living with an individual with an eating disorder. Databases were systematically searched and twenty studies were included in the review. Nine core themes emerged from the meta-synthesis. Eating disorders were found to have a pervasive impact on family members mediated by a number of factors. Cognitive appraisals affected the caregiving experience and responses to the individual. The experience of caregiving was continually reappraised leading to a process of adaptation over time. Paper two is a qualitative study which sought to examine caregivers’ accounts of managing Anorexia Nervosa with an emphasis on accommodation responses. Eight participants were interviewed and transcripts were analysed using a grounded theory approach. A theory of the processes by which accommodation responses operate was developed which emphasised the importance of caregivers’ emotional resources in mediating responses. Difficulty managing anorexia nervosa led to low perceived efficacy and diminished resources. Subsequently caregiving aims shifted in line with accommodation responses. Carers recognised accommodation as counterproductive to recovery and experienced internal conflict (dissonance) which was reduced using a number of cognitive and behavioural strategies. The clinical implications of the findings are discussed with reference to existing literature. Paper three is a critical review of the research process, focusing on the experience of undertaking qualitative research. Personal reflections of the process, as well as the implications of the research for the researcher’s professional practice and for the wider profession are discussed.

Although many factors have been Implicated in the etiology and maintenance of anorexia nervosa and bulimia, anxiety, particularly in the context of eating, may be critical. Applying the tri-partite model of anxiety, this study was designed to assess anxiety before, during, and after eating in eating disorder and normal control subjects. The experimental eating procedure was preceded by a neutral task. Four groups of ten female subjects each participated: normal-weight females, restricting-anorexics, bulimic-anorexics, and bulimics. Anxiety was assessed by self-report (ratings of pleasure, arousal, and anxiety), psychophysiological (heart rate and skin conductance) and behavioural (food consumption) measures. Controls reported themselves to be non-anxious throughout the study arid ate almost all of the small test meal. Somewhat surprisingly, physiological arousal (especially heart rate) was high during eating. During the neutral task, heart rate declined slightly in all groups. The eating disorder groups indicated a high level of anxiety throughout the study which showed a trend to increase further during eating. In addition, anorexics and bulimics described dysfunctional beliefs regarding the effects of eating on body shape and weight. Similar to controls, physiological arousal was high during eating. Overall, heart rate proved to be a more useful measure of arousal than skin conductance because many anorexics were hyporesponsive. Restricting-anorexics ate the least amount, bulimic-anorexics ate slightly more, and bulimics ate similar amounts to controls. Thus, food consumption was probably associated with weight status. Several conclusions were drawn. Women with eating disorders have a high level of general anxiety probably because of a conflict between biological pressures to eat and fears of weight gain. The high physiological arousal during eating appears to reinforce perceptions of anxiety. The eating disorder groups showed different degrees of concordance among measures of anxiety. Borrowing from the research on phobias, therapeutic procedures such as cognitive therapy, progressive relaxation, and exposure treatments can address the different components of anxiety anorexics and bulimics experience during eating. / Arts, Faculty of / Psychology, Department of / Graduate

Women with anorexia nervosa tend to be ambivalent about change and resistant to treatment. A growing number of researchers suggest that this ambivalence must be targeted early on, before attempting to engage clients in action-oriented treatment that focuses on immediate symptom reduction. However, in order to appropriately address client ambivalence, it must be accurately evaluated with empirically validated instruments. The purpose of this thesis was to develop and validate a Decisional Balance (DB) measure of readiness for change in anorexia nervosa. In Study 1, 246 women with anorexia nervosa completed the DB, and a subset completed the DB again one week later. Unlike traditional decisional balance measures that have two factor (pro-con) solutions, factor analytic techniques indicated that a three factor solution provided the best fit for the DB data in this study. These factors included general negative consequences of the disorder (Burdens), valued achievements such as self-control, being very thin, and striving for perfection (Benefits), and using anorexia nervosa as a means for avoiding aversive emotions, challenges, and responsibilities (Avoidance Coping). The DB demonstrated good internal consistency and test-retest stability. In study 2, 80 women with anorexia nervosa completed the DB, along with other measures of readiness for change, as well as measures unrelated to readiness. Support was found for both convergent and divergent validity. Finally, in study 3, 80 women with anorexia nervosa completed the DB, and a measure of anticipated difficulty completing symptom-challenging recovery activities. In addition, participants attempted to complete three recovery activities in the week following initial assessment. Criterion validity was not well supported, most likely because the concurrent and predictive validity measures focused on behavior change, when non-behavioral measures may have been more appropriate. Overall, the results suggest that the DB for anorexia nervosa is a measure of awareness or insight about the functions of this disorder. The theoretical and clinical implications of this research are reviewed and directions for future investigations are proposed. / Arts, Faculty of / Psychology, Department of / Graduate