Several studies have shown that patients with anorexia nervosa (AN) have elevated levels of shame. To the researcher's knowledge there was a lack of research concerning how healthcare professionals experienced shame in their patients with AN when the study was conducted. Against this background, the purpose of the present study was to contribute to a deeper insight into how healthcare professionals experienced shame in patients with AN, which was investigated through the research question: How do healthcare professionals experience shame in patients with anorexia nervosa? Based on a qualitative method and a phenomenological approach, the research question was investigated through semi-structured interviews with seven participants. The material was analyzed using thematic analysis. The analysis generated the overarching theme of self-contempt and the themes: shame against the anorexic voice, shame against their self and the impossible choice between the shame-loyalties, and seven sub-themes. Healthcare professional´s experience is in line with previous studies on patients, which have shown that shame plays a central role in AN. Further research is encouraged to investigate whether psychoeducation about shame as well as targeted treatment interventions for shame could be helpful in treating patients with AN. / Flera studier har påvisat att patienter med anorexia nervosa (AN) har förhöjda nivåer av skam. Till författarens vetskap, saknades vid studiens genomförande, forskning om hur vårdpersonal upplevde skam hos sina patienter med AN. Föreliggande studies syfte var mot bakgrund av detta att bidra till en djupare insyn i hur vårdpersonal upplevde skam hos patienter med AN, vilket undersöktes genom frågeställningen: Hur upplever vårdpersonal skam hos patienter med anorexia nervosa? Utifrån en kvalitativ metod och en fenomenologisk ansats undersöktes frågeställningen genom semistrukturerade intervjuer med sju deltagare. Materialet analyserades med hjälp av tematisk analys. I analysen skapades det överordnade temat självförakt och temana: skam mot den anorektiska rösten, skam mot sitt ”jag” och det omöjliga valet mellan skamlojaliteterna, samt sju underteman. Vårdpersonals upplevelse ligger i linje med tidigare studier på patienter, vilka har påvisat att skam spelar en central roll vid AN. Framtida forskning uppmuntras undersöka huruvida psykoedukation om skam samt riktade behandlingsinsatser för skam kan vara hjälpsamt vid behandling av patienter med AN.

Bakgrund: Anorexia nervosa och bulimia nervosa är komplexa ätstörningar som medför stort lidande för patienterna. Patienterna drar sig bort från att söka vård då de bland annat inte har sjukdomsinsikt men även andra bidragande faktorer som medför olika känslor kring vårdupplevelsen. Syfte: Belysa upplevelsen av vården bland patienter med anorexia nervosa och bulimia nervosa. Metod: Litteraturöversikt där elva artiklar valdes ut, granskades och sammanställdes för att besvara syftet. Resultat: Upplevelsen av vården bland patienter med anorexia nervosa och bulimia nervosa redovisas via tre huvudteman; patienters upplevelse av att ta första steget till vård, att vara patient och att tillfriskna under vårdtiden. Under varje huvudtema tillkommer två subteman. Det framkom att det är en komplex vårdprocess som innerverar ett brett spektrum av känslor samt olika faktorer som medför både positiva och negativa känslor för berörd patientgrupp. Det föreligger även betydande faktorer i omvårdnaden som påverkar patientens relation till sjuksköterskan samt hur behandlingen, omvårdnaden och tillfrisknande sker. Konklusion: Att vårda patienter med anorexia nervosa och bulimia nervosa är komplext. Genom visat stöd, kommunikation, empati och en god relation mellan sjuksköterskan och patienten kan en adekvat vård utföras där patienten får en god vårdupplevelse. / Background: Anorexia nervosa and bulimia nervosa are complex eating disorders that cause suffering to patients. Patients tend to avoid seeking treatment because, among other things, they have no insight into the disease, but also other contributing factors that lead to different feelings about the care experience. Aim: To shed light on the experience of care among patients with anorexia nervosa and bulimia nervosa. Method: Literature review where eleven articles were selected, reviewed and compiled to answer the purpose. Findings: The experience of care among patients with anorexia nervosa and bulimia nervosa is reported via three main themes; patients' experience of taking the first step, patients' care experience and recovering during the care period. Under each main theme, two subthemes are added. It turned out that it is a complex care process that innervates a wide range of emotions as well as various contributes both positive and negative emotions for this group of patients. Conclusion: Caring for patients with anorexia nervosa and bulimia nervosa is complex.Through shown support, communication, empathy and a good relationship between the nurse and the patient, adequate care can be carried out where the patient gets a good care experience.

Bakgrund: Anorexia nervosa (AN) är en komplex psykiatrisk sjukdom som inte endast drabbar individen utan även många i personens närhet. Tillståndet kännetecknas av en ohälsosam fokusering på kropp, vikt och mat. Det är ett påtagligt problem i samhället med ett stort mörkertal där många inte har tillgång till en korrekt behandling, vilket kan öka lidandet för personerna. Sjuksköterskans arbetsuppgift inkluderar att motverka ohälsa och lidande, vilket kräver större kompentens kring AN för att kunna vara ett stöd i individens väg tillbaka till en god hälsa. Det enda sättet att besitta kunskapen är att lyssna på patientens subjektiva upplevelser och erfarenheter.  Syfte: Syftet var att beskriva hur det är att leva med anorexia nervosa från ett patientperspektiv.  Metod: Denna icke-systematiska litteraturöversikt är baserad på 15 orginalartiklar, varav 13 är kvalitativa och 2 är kvantitativa. Artiklarna är hämtade från PubMed, CINAHL och PsycInfo. Artiklarna kvalitetsgranskades efter Sophiahemmets Högskolas bedömningsunderlag. Resultatets artiklar analyserades och kategoriserades i tre huvudkategorier samt sju underkategorier.  Resultat: I huvudkategorin relationen till sjukdomen urskildes det att kontroll, inre konflikt, kroppsbild och återhämtningpåverkades av sjukdomen. I den andra huvudkategorin påverkan på identiteten kunde underkategorierna stigma och isolering urskiljas som bidragande faktorer till en påverkad självbild. I den sista huvudkategorin bli fri från sjukdomen identifierades vårdupplevelse vilket visade på hur processen till tillfrisknande upplevs.  Slutsats: Föreliggande litteraturöversikt visade att individens tillvaro och identitet påverkades negativt på grund av AN. Individen är ansvarig att starta tillfriskningsprocessen, där sjukvårdens roll är att motivera, stötta och hjälpa längs en komplex och jobbig process. Ökad kunskap och förståelse kring individens upplevelser av AN, möjliggör att en holistisk vård kan ges som är bättre anpassad till att möta personens behov. / Background: Anorexia nervosa (AN) is a complex psychiatric disorder that affects not only the individual but also many people closest to the person. The condition is characterized by an unhealthy focus on the body, weight and food. It is a significant problem in society with a large number of people that are living in the dark with the AN and never treated, where many do not have access to proper treatment, which can increase the suffering of the people. The nurse's task includes preventing ill health and suffering, which requires greater knowledge around AN in order to assist in restoring the individual's health. The only way to possess the knowledge is to listen to the patient's subjective experiences and experiences.   Aim: The purpose was to describe what it is like to live with anorexia nervosa from a patient perspective.  Method: This non-systematic literature review is based on 15 original articles, of which 13 are qualitative and 2 are quantitative. The articles are taken from PubMed, CINAHL and PsycInfo. The articles were quality reviewed according to Sophiahemmet University's assessment basis. The article's articles were analyzed and categorized into three main categories and seven subcategories.  Results: In the main category the relationship to the disease, it was distinguished that control, internal conflict, body image and recovery were affected by the disease. In the second main category influence on identity, the subcategories of stigma and isolation could be distinguished as contributing factors to an affected self-image. In the last main category of being free from the disease, care experience was identified, which showed how the process of recovery is experienced.  Conclusions: The current literature review showed that the individual's existence and identity were negatively affected due to AN. The individual is responsible for starting the recovery process, where the role of healthcare is to motivate, support and help along a complex and difficult process. Greater knowledge and understanding of the individual's experiences of AN, enables holistic care to be provided that is better adapted to meet the individual's needs.

Chan Chung Yee Zenobia. / "August 2003." / Thesis (Ph.D.)--Chinese University of Hong Kong, 2003. / Includes bibliographical references (p. 407-438). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Mode of access: World Wide Web. / Abstracts in English and Chinese.

Text in Afrikaans / Die doel van hierdie studie was om vas te stel of kunsterapie wei suksesvol aangewend kan word met die anorexia nervosa-lyer. Daar is spesifiek gefokus op die verbetering van die selfkonsep van die adolessent met anorexia nervosa. Anorexia nervosa en kunsterapie is bespreek. Daar is aandag gegee aan die spesifieke kenmerke wat kuns geskik maak vir terapeutiese aanwending in die bebandeling van die anorexia nervosa-lyer. Die praktiese toepassing van kunsterapie is uiteengesit met die Jdem op kunsterapeutiese tegnieke wat fokus op die verbetering van die selfkonsep van die adolessent met anorexia nervosa. Twee adolessente wat met anorexia nervosa gediagnoseer is, is as proefpersone vir die studie gebruik. Die Adolessente-Selfkonsepskaal (ASKS) en die Sacks Sinsvoltooiingsmedium is as voor- en natoetse ingeskakel om die stand van die twee proetpersone se selfkonsep te bepaal. Kunsterapie is vir twaalf sessies met die proefpersone gedoen. Uit die navorsingsresultate is tot die gevolgtrekking gekom dat kunsterapie gelei het tot 'n verbetering rakende aspekte van die seltkonsep van die adolessent met anorexia nervosa. Kunsterapie is positief beleef deur die proefpersone. Gevoelens kon op 'n nie-bedreigende manier geeksploreer word en onopgeloste situasies kon met vrymoedigheid aangespreek word. / The aim of this study was to assess and describe the potential value of art therapy as an intervention strategy for the treatment of adolescents suffering from anorexia nervosa. Anorexia nervosa was described and defined. Diagnostic criteria, the manifestation and contributory causes, as well as the treatment and the prognosis for recovery, were discussed. Art therapy, as well as specific therapeutic techniques suitable for the anorexia nervosa sufferer were explained. The specific objective of the study was to determine the influence of certain art therapy techniques on the self-concept of two adolescents suffering from anorexia nervosa. The results indicated that there were significant changes in the self-concept of the two adolescents. Art therapy can be an effective therapeutic intervention strategy for the adolescent suffering from anorexia nervosa and gives the client the opportunity to come to tenns with the self in a non-threatening way. / Psychology of Education / M. Ed. (Sielkundige Opvoedkunde)

Thesis (MScMedSc) -- Stellenbosch University, 2001. / ENGLISH ABSTRACT: Osteopenia is a well documented complication of anorexia nervosa (AN). The pathogenesis of this bone loss is presently poorly defined in the literature. Pathogenetic mechanisms that have been implicated include certain nutritional factors, exercise abuse, hypogonadism, hypercortisolism and/or vitamin 0 deficiency. We studied, 59 Caucasian eating disorder patients aged 15-45yr. The eating disorder was classified by a single, qualified psychiatrist according to OSM IV R criteria as either anorexia nervosa (AN: n =25), bulimia nervosa (BN: n = 17) or eating disorder not otherwise specified (EONOS: n = 17). All patients were subjected to a detailed dietary and general history. We assessed the prevalence and severity (OEXA), the nature (osteocalcin, deoxypyridinoline) and site (vertebral versus hip) of osteopenla in these patients. he role of nutritional factors (energy intake, weight, height, BMI, plasma albumin, lipids), physical activity, hypercortisolemia (plasma and urinary free cortisol), vitamin 0 deficiency (plasma 250HD) and hypogonadism (amenorrhoea, E2, LH, FSH) in the pathogenesis of bone loss were also evaluated. Mild osteopenia (BMO decreased by more than 1SO below age-matched controls) was documented in 46% of the total study population, with more marked osteopenia (Z-Score < -2 SO) present in 15%. Both vertebral and hip osteopenia were documented. In the study population those patients with AN (Lumbar BMO (q/cm") = 0.869 ± 0.121) were most likely to develop osteoporosis, although a significant percentage of patients with BN (Lumbar BMO (q/crn") = 0.975 ± 0.16) and EONOS (Lumbar BMO (g/cm2) = 0.936 ± 0.10) were also osteopenic (29% and 35% respectively). Twenty four percent (24%) of the total patient population had a history of fragility fractures. These fractures were reported more commonly amongst patients with AN and EONOS (28% and29.4%). Fracture prevalence was however similar in patients with normal and low bone mass. Conventional risk factors were similar in patients with normal and low bone mass, except for a significantly longer duration of amenorrhoea (p = 0.009), a lower BMI (p = 0.0001) and greater alcohol consumption (p = 0.05) in the osteopenic patients. Nutritional parameters (S-albumin, protein, Ca, and P04 intakes), physical activity, as well as 25(OH) vitamin D levels were similar in AN and BN subjects, as well as in patients with a low versus normal BMD. Plasma and urine cortisol levels were also similar in these subgroups. With the exception of two patients with borderline osteopenia, significant bone loss was only documented in those patients with a past or current history of amenorrhoea. In the total patient population the duration of amenorrhoea was significantly (p<0.009) longer in patients with osteopenia versus those with a normal bone mass. A significant negative correlation between BMD (Z-Score) and duration of amenorrhoea was also documented in the total patient population (r = -0.4, P = 0.001) as well as in all three eating disorder groups (AN r - -0.4, P = 0.03; BN r = - 0.6, P = 0.008; EDNOS r = -0.6, P = 0.005). In the total patient population, those patients with amenorrhoea, had lower BMD and BMI values and lower estrogen levels compared to those with a normal menstrual cycle. We conclude that osteopenia commonly attends AN, as well as BN and EDNOS. Nutritional (with the exception of alcohol consumption) and mechanical factors as well as hypercortisolemia did not appear to contribute significantly to bone loss in this study population. Hypogonadism appeared to be the main cause of the bone loss observed in these patients. / AFRIKAANSE OPSOMMING: Osteopenie is In welbekende komplikasie van anorexia nervosa (AN). Die patogenese van hierdie beenverlies is swak in die huidige literatuur omskryf en nutrisiele faktore, 'n vita mien 0 gebrek, oormatige oefening, hiperkortisolemie en hipogonadisme word onder andere qeimpliseer. Vir die doel van die studie is In totaal van 59 Kaukasier eetsteurnis pasiente patients volledig ondersoek. Die tipe eetsteurnis is deur In enkel gekwalifiseerde psigiater volgens die DSM IV R kriteria geklassifiseer as anorexia nervosa (AN: n =25) of bulimia nervosa (BN: n = 17) of eetsteurnis nie anders gespesifiseer (EDNOS: n = 17). Elke pasient is ook aan In gedetailleerde dieet en algemene risikofaktor vraelys vir osteoporose onderwerp. Die voorkoms en graad (DEXA), die aard (osteokalsien, deoksipiridinolien) asook die tipe (werwelkolom/heup) osteopenie is ondersoek. Die rol van nutrisiele faktore (totale kalorie-inmame, gewig ,Iente LMI, plasma albumien, lipiede) en vitamien 0 gebrek, oefening, hiperkortisolemie (plasma en urinere kortisol) en hipogonadisme (amenoree, plasma E2, LH,FSH) in die patogenese van die beenverlies is ook evalueer. Matige osteopenie (BMD meer as 1 SO onder die van ouderdomskontrole) is in 46% van die totale pasientpopulasie gedokumenteer, met erge osteopenie (Z-Telling < -2) in 15%. Aantasting van beide werwelkolom en heup is aangetoon. In hierdie studiepopulasie kom osteopenie meer algemeen voor in die AN (Lumbaal BMD (g/cm2) = 0.869 ± 0.121) groep (64%) in vergelyking met BN (Lumbaal BMD (g/cm2) = 0.975 ± 0.16) (29%) en (EDNOS) (Lumbaal BMD (g/cm2) = 0.936 ± 0.10) (32%). Vier-en-twintig persent van die totale pasientpopulasie het In geskiedenis van frakture gehad. Frakture het meer algemeen in AN en EDNOS pasiente voorgekom (28% en 29%). Pasiente met 'n lae beenmassa was gekenmerk deur In betekenisvolle laer LMI (p = 0.0001), hoer alkolholverbruik (p = 0.05) en langer duurte van amenoree(p = 0.009). Nutrisiele parameters (s-albumien, protetene, Ca, P04 inname) oefening, asook 25(OH) vitamien 0 vlakke was soortgelyk in AN en BN pasiente. Hierdie parameters het ook nie verskil tussen pasiente met osteopenie en die met In normale BMD nie. Plasma en urinere vry kortisolvlakke was ook soortgelyk in hierdie twee groepe. Betekenisvolle beenverlies (met die uitsondering van twee pasiente met grenslyn osteopenie) het slegs voorgekom in pasiete met 'n huidige of In vorige geskiedenis van amenoree. In die totale pasientpopulasie was die duurte van amenoree (p< 0.009) betekenisvollanger in die pasiente met osteopenie. In Betekenisvolle negatiewe korrelasie tussen BMD (Z-Telling) en die duurte van amenoree in die toale pasient populasie (r = -0.4; P = 0.001) asook in al drie eetsteurnis groepe (AN: r = -0.4; P = 0.03; BN: r = -0.06; P = 0.008; EDNOS: r = - 0.6, P = 0.005) is aangetoon. In die groep as 'n geheel, het die amenoree pasiente In laer LMI, E2vlakke en BMD gehad in vergelyking met die pasiente met normale menses. Opsommend dus, kom osteopenie algemeen in pasiente met AN, asook BN en EDNOS voor. In Betekenisvolle bydrae van nutrisiele (met die uitsondering van alkoholinname) en meganiese faktore asook hiperkortisolemie tot been verlies, kon nie in hierdie tudie populasie gedemonstreer word nie. Hipogonadisme is as die hoofoorsaak van osteopenie in die pasiente qefdentifiseer.

This study sought to examine risk and onset patterns in anorexia nervosa (AN), bulimia nervosa (BN), and binge eating disorder (BED). Women with AN (n=71), BN (n=66), BED (n=160) and non-psychiatric controls (n=323) were compared retrospectively on risk factors, symptom onset, and diagnostic migration. Eating disorder groups reported greater risk exposure than non-psychiatric controls. AN and BED differed on premorbid personality/behavioral problems, childhood obesity, and family overeating. Risk factors for BN were shared with AN and BED. Dieting was the most common onset symptom in AN, whereas binge eating was most common in BN and BED. Migration between AN and BED was rare, but more frequent between AN and BN and between BN and BED. AN and BED have distinct risk factors and onset patterns, while BN shares similar risk factors and onset patterns with both AN and BED. Results should inform future classification schemes and prevention programs.

The purpose of this study was to examine the degree to which several psychological and personality variables relate to anorexic and bulimic symptomatology in female undergraduates. Past research investigating the relationship between such variables and eating disorders has been contradictory for several reasons, including lack of theoretical bases, discrepant criteria, or combination of anorexia and bulimia nervosa. Recent investigators have concluded that it is important to examine subdiagnostic levels of eating pathology, especially within a college population. Thus, the present investigation used a female undergraduate sample in determining the extent to which several psychological factors--obsessiveness, dependency, over-controlled hostility, assertiveness, perceived control, and self-esteem--account for anorexic and bulimic symptomatology. Regression analyses revealed that anorexic symptoms were best explained by obsessiveness and then two measures of dependency, emotional reliance on another and autonomy. Bulimic symptoms were related most strongly to lack of social self-confidence (a dependency measure) and obsessiveness. Clinical implications and directions for future research are addressed.

Essstörungen sind prävalente psychische Störungen mit schwerwiegenden, oftmals langfristigen Auswirkungen auf die psychische und körperliche Gesundheit. Eine zunehmende Anzahl von klinischen Studien dokumentiert die Wirksamkeit verschiedener psychotherapeutischer Ansätze für spezifische Essstörungen. Im vorliegenden Themenheft 5 werden die Wirksamkeit von neuen Ansätzen zur Einzeltherapie und zur internet-basierten Rückfallprophylaxe, die Patientensicht auf die Therapie sowie die Relevanz von Faktoren des therapeutischen Prozesses bei verschiedenen Essstörungen beleuchtet. Weiterer Forschungsbedarf besteht insbesondere hinsichtlich des Prozesses und der Dissemination evidenzbasierter Psychotherapie für Essstörungen. / Eating disorders are prevalent psychiatric disorders with severe and longstanding 15 implications for mental and physical health. An increasing number of clinical studies documents the efficacy of certain psychotherapeutic approaches for specific eating disorders. This special issue addresses the efficacy of novel approaches in face-to-face individual therapy and Internet-based relapse prevention, patient views of treatment, and the relevance of therapeutic process factors for diverse eating disorders. Further research is particularly 20 warranted regarding the process and dissemination of evidence-based psychotherapy for eating disorders.

Avaliar a Qualidade de Vida (QV) de pacientes com Transtornos Alimentares (TA), verificar diferenças entre os subtipos de TA e identificar dimensões de QV mais prejudicadas. Métodos: O instrumento de QV da Organização Mundial de Saúde (WHOQOL-100) foi respondido por 69 mulheres com TA (Anorexia Nervosa AN=34; Bulimia Nervosa BN=26 e Transtorno Alimentar Não Especificado TANE=9) e por 69 mulheres saudáveis. Utilizou-se a Entrevista Clínica Estruturada para Transtornos do Eixo I do DSM-IV (SCID) para a realização dos diagnósticos psiquiátricos. Resultados: Pacientes com TA apresentaram piores escores na QV geral e em todos os domínios (físico, psicológico, relações sociais, meio ambiente, nível de independência e espiritualidade), tendo sido o psicológico aquele com maior prejuízo. Não foram encontradas diferenças entre os subtipos de TA quanto aos prejuízos de QV. As comorbidades psiquiátricas encontradas com maiores prevalências foram os Transtornos do Humor, os Relacionados ao Uso de Álcool e Outras Substâncias e os de Ansiedade. Pacientes com AN e comorbidade com o Transtorno de Pânico apresentaram QV mais prejudicada que pacientes com AN sem Pânico. A maioria dos pacientes apresentava múltiplas comorbidades e histórico de diversas tentativas de suicídio. Conclusões: Pacientes com TA apresentam significativo prejuízo de QV em todos os domínios, em especial no psicológico, provavelmente em função das peculiaridades da psicopatologia alimentar, sem diferenças entre os subtipos de TA. Pacientes com AN e comorbidade com Pânico devem ser avaliados com mais critério / Purpose: To assess quality of life in patients with eating disorders, verify differences among eating disorder subtypes, and identify the domains of quality of life most affected by eating disorders. Methods: The World Health Organization quality-of-life assessment instrument (WHOQOL-100) was completed by 69 women with eating disorders (34 with anorexia nervosa, 26 with bulimia nervosa, and 9 with eating disorder not otherwise specified) and 69 healthy women. The Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I) was used for the diagnosis of psychiatric disorders. Results: Patients with eating disorders reported lower (worse) total quality- of-life scores and lower scores on all quality-of-life domains (physical, psychological, social relationships, environment, level of independence, and spirituality) compared with healthy patients, with the psychological domain being the most impaired. No significant differences in impairment of quality of life were found among eating disorders subtypes. The most prevalent psychiatric comorbidities were mood disorders, alcohol or substance abuse- related disorders, and anxiety disorders. Patients with anorexia nervosa and comorbid panic disorder had greater impairment in quality of life than patients with anorexia nervosa but no panic disorder. Most patients had multiple comorbidities and history of suicide attempts. Conclusions: Patients with eating disorders experience significantly greater impairment in quality of life on all domains, especially on the psychological domain, compared with healthy patients, probably because of peculiarities in eating disorders psychopathology. No difference in quality of life impairment was observed among eating disorders subtypes. Patients with anorexia nervosa and comorbid panic disorder should be carefully evaluated