Syfte: Att studera den tillgängliga litteraturen om hur minskad näringstillförsel i form av fasta, Anorexia nervosa (AN), protein-energiundernäring (PEU) och sondmatning påverkar det orala ekosystemet. Material och metod: Det utfördes en narrative review på artiklar som identifierats med hjälp av Pubmed databas. Artiklar som handlar om minskad näringstillförsel och dess konsekvenser för den orala miljön har granskats. Resultat: Fasta hade effekt på salivens sammansättning, flödeshastighet och buffringskapacitet. Personer med svält tillståndet Anorexia nervosa (AN) upplevde bland annat förändringar i slemhinnor, saliv pH-värde och salivflödeshastighet. Personer med protein-energiundernäring (PEU) löpte stor risk för flera orala förändringar som medför bland annat högre kariesförekomst och sämre prognos för inflammatoriska lesioner. Flera av bakterierna som dominerade hos personer med sondmatning var patogena bakterier som kan vara hälsoskadliga. Slutsats: Vid fasta uppstår det förändringar i salivflödeshastighet, sammansättning, mängd och buffringskapacitet. AN kan leda till förändringar i saliven. PEU innebär stor risk för flera orala förändringar som medför bland annat högre kariesförekomst och sämre prognos för inflammatoriska lesioner. Tidig PEU har en fortsatt negativ effekt på salivens funktion även i tonårsåldern. Flera av bakterierna som dominerar hos personer med sondmatning är patogenabakterier som kan vara hälsohotande. Flera orala, mikrobiella och biologiska förändringar manifesterar sig i samband med minskad näringstillförsel. Det behövs fler studier för att få en bättre förståelse av dessa förändringars kliniska betydelse. / Aim: To review the available literature on how reduced nutrient supply in the form of fasting, Anorexia nervosa (AN), protein-energy malnutrition (PEU) as well as tube feeding affect the oral ecosystem. Material and method: A narrative review was performed on articles identified using the Pubmed database. Articles about nutritional deficiencies and their consequences on the oral environment have been reviewed. Results: Fasting influenced saliva composition, flow rate and buffering capacity. People with Anorexia nervosa (AN) experienced, among other things, changes inmucous membranes, saliva pH-value and saliva flow rate. It was shown that people with protein-energy malnutrition are at high risk for several oral changesthat lead to a higher incidence of caries and a worse prognosis for inflammatory lesions etc. Several of the bacteria that dominated in people with enteral nutrition were pathogenic bacteria; that can be damaging to health. Conclusions: During fasting, changes in saliva flow rate, composition, amount, and buffering capacity occur. People with AN experience among other things, changes in mucous membranes, pH value and flow rate of saliva. PEU involves a high risk of several oral changes that lead to, among other things, a higher incidence of caries and a worse prognosis for inflammatory lesions. Early PEU has a continued negative effect on saliva function in adolescence. Several of the bacteria that predominate in people with tube feeding are pathogenic bacteria that can be health-threatening. Several oral, microbial, and biological changes manifest themselves in connection with malnutrition. More studies are needed to gain a better understanding of the clinical significance of these changes.

Bakgrund: Anorexia nervosa (AN) är en ätstörning där den drabbade försöker gå ner i vikt genom självsvält. Förvrängd kroppsuppfattning och ett starkt behov av kontroll över kropp och vikt är förekommande. Många som drabbas av AN avbryter sin behandling i förtid. Att sammanställa personers erfarenheter av att vårdas för AN på ätstörningskliniker kan bidra till viktig kunskap. Denna kunskap kan vara betydande vid utvecklingen av tillvägagångsätt för att stödja personer med AN.   Syfte: Syftet var att beskriva personers erfarenheter av att vårdas för anorexia nervosa på ätstörningskliniker. Metod: Åtta kvalitativa studier har granskats, analyserats och sammanställts i denna litteraturstudie. Databassökning genomfördes i Cinahl, PubMed och PsycInfo. Resultat: Analysen resulterade i två kategorier och sju underkategorier. De två följande kategorierna är ”Att behöva personcentrerad vård” och ”Att dela vardagen med andra personer med ätstörningar och behöva släppa kontrollen”. Konklusion: Litteraturstudien resultat visar att personer med AN upplever ett behov av personcentrerat vård. De beskriver även att vid delaktighet i sin vård ökas motivationen till fortsatt behandling. Med ett gott bemötande från vårdpersonalen kan goda relationer skapas. För att personer med AN ska uppleva att deras behov och önskemål tillgodoses kan det vara av betydelse att vårdpersonalen har kunskap om hur de kan tillämpa personcentrerad vård för personer med AN. / Background: Anorexia nervosa (AN) is an eating disorder in which the individual attempts to lose weight through self-starvation. Distorted body image and a strong need for control over body and weight are common characteristics. Many individuals who suffer from AN discontinue their treatment prematurely. Compiling people's experiences of being treated for AN in eating disorder clinics can contribute to valuable knowledge. This information can be significant in the development of approaches to support individuals with AN.  Aim: The aim of this study was to describe individuals' experiences of being treated for anorexia nervosa at a specialized clinic for eating disorders.  Methods: Eight qualitative studies were reviewed, analyzed, and compiled. A database search was conducted in CINAHL, PubMed, and PsycInfo.  Results: The analysis resulted in two main categories: "Requiring person-centered care" and "Sharing everyday life with others who have eating disorders and learning to let go of control." Conclusion: The results of the literature study indicate that individuals with anorexia nervosa (AN) express a need for person-centered care. They also report that active involvement in their care enhances motivation to sustain treatment. Establishing positive relationships is facilitated by effective treatment from the care staff. To ensure that the needs and preferences of individuals with AN are addressed, it is crucial for the care staff to possess knowledge on the application of person-centered care tailored to this population.

Background. Individuals with anorexia nervosa (AN) are often thought to show heightened selfcontrol and increased ability to inhibit desires. In addition to inhibitory self-control, antecedentfocused strategies (e.g., cognitive reconstrual—the re-evaluation of tempting situations) might contribute to disorder maintenance and enable disorder-typical, maladaptive behaviors. - Methods. Over a period of 14 days, 40 acutely underweight young female patients with anorexia nervosa (AN) and 40 healthy control (HC) participants reported their affect and behavior in selfcontrol situations via ecological momentary assessment during inpatient treatment (AN) and everyday life (HC). Data were analyzed via hierarchical analyses (linear and logistic modeling). - Results. Conflict strength had a significantly lower impact on self-control success in AN compared to HC. While AN and HC did not generally differ in the number or strength of self-control conflicts or in the percentage of self-control success, AN reported self-controlled behavior to be less dependent on conflict strength. - Conclusions. While patients with AN were not generally more successful at self-control, they appeared to resolve self-control conflicts more effectively. These findings suggest that the magnitude of self-control conflicts has comparatively little impact on individuals with AN, possibly due to the use of antecedent-focused strategies. If confirmed, cognitive-behavioral therapy might focus on and help patients to exploit these alternative self-control strategies in the battle against their illness.

Alterations in executive functions have repeatedly been found in individuals suffering from eating and weight disorders. However, less is known about how these cognitive processes might contribute to the etiology of the disorders, as large prospective population-based studies have been missing. Here, we comment on the results of Steegers et al. (2021), a study that helped to fill this gap with a focus on set-shifting abilities predicting symptoms of anorexia nervosa (AN) in children. The main goal of this commentary is to encourage further interpretation of the population-based data beyond its relevance to AN. More specifically, we discuss the role of impaired inhibition as a risk factor for weight gain and obesity.

Bakgrund: Anorexia nervosa är en allvarlig psykiatrisk sjukdom med hög samsjuklighet vilket medför ett komplext omvårdnadsbehov. Sjukdomen uppstår oftast i tonåren eller ung vuxen ålder. Sjuksköterskor har en viktig roll i omvårdnaden där bemötandet är en avgörande del i behandlingen. Syfte: Belysa sjuksköterskors upplevelser av att vårdapatienter i tonåren med Anorexia nervosa. Metod: En kvalitativ litteraturöversikt, där syftet besvaras med en induktiv ansats. Resultat: Sjuksköterskors upplevelser av att vårda patienter med Anorexia nervosa redovisas genom tre teman: terapeutisk vårdrelation mellan sjuksköterska och patient, att se personen bakom sjukdomen samt sjuksköterskors förutsättningar för god omvårdnad, med efterföljande åtta subteman. Konklusion: Sjuksköterskor behövde kompetens, erfarenhet, specifika omvårdnadsstrategier och etablera en terapeutisk vårdrelation för att nå denna patientgrupp. Andra förutsättningar för en god omvårdnad innebar att sjuksköterskor beaktade patienternas delaktighet och inkluderade ett personcentrerat förhållningssätt. För att optimera patienternas välbefinnande krävdes ett helhetsperspektiv där patienter inte betraktades som sin sjukdom eller diagnos. / Background: Anorexia nervosa is a severe psychiatric disorder with high comorbidity, which entails a complex need for nursing care. The disease usually occurs in adolescence or early adulthood. The nurse plays a pivotal role in the provision of care, where the manner of interaction is a crucial component of the treatment process. Aim: Nurses´experiences of caring for adolescent patients with Anorexia nervosa. Method: Aqualitative literature review with an inductive approach. Findings: The nurses´experience of caring for patients with Anorexia nervosa is presented through three themes: therapeutic care relationship between the nurse and the patient, recognizing the person beyond the illness and the nurses´ prerequisites for good care, followed by eight subthemes. Conclusion: The nurse required competence, experience, specific nursing strategies and a good therapeutic care relationship to reach this patient group. Other prerequisites for high quality care meant that the nurse considered the patient's participation and included a person-centered approach. In order to optimize the patient's well-being, a holistic perspective was essential whereby the patient was not viewed merely as their illness or diagnosis.

A growing body of research recognizes spirituality as a key element in well-being, but the agency of individual spirituality remains unclear. This study explores the role of embodied knowledge in reality construction and its effect on illness by considering how spirituality as embodied existence shapes reality. Spirituality, as a form of embodied knowing, is shown to reach deeply into the fundamental relatedness of existence. The study argues for a mindbody- spirit unity, making no distinction between self and spirit, emotions and subjective experiences situated in the spirit. As the medium between body and self, spirituality gives form to the felt reality of embodied knowledge and meaning, shaping language, cognition, thought and action towards lived reality. New ways of thinking about eating disorders were stimulated by innovative discoveries through investigating the lived reality of the illness within an epistemology that included subjective experiences as part of reality. While acknowledging the influence of social discourse, the study calls for a recognition of vulnerability in the human condition giving rise to the embodiment of a wounded self or disenabling spirituality, manifested in the development of an eating disorder. It uncovers the anti-spiritual properties involved in the lived reality of people struggling with anorexia/bulimia, evident in social withdrawal and/or self-injury. Behavioural patterns of obsession and repetition underscore similarities to addiction and ritual. The study synthesised pastoral therapy and research. A postmodern approach to illness and a qualitative design with interpretive phenomenology were used. Three young women struggling with anorexia/bulimia participated in semi-structured research interviews. Their narrative accounts provided a chronology of developing, living with and healing from anorexia /bulimia. Emphasis shifted from an approach aimed at fixing the body to focusing on individual experiences of the illness; what she brought to the encounter in her own resources and potential to heal. Healing is envisaged as the ongoing development of a renewed sense of self, an inherently spiritual process orchestrated from within. Previous disassociation of body and self is replaced with reconnection between body, self and other, care of the spirit became care of the body, expressed in harmony and wholeness of being. / Practical Theology / D.Div. (Pastoral therapy)

Maladaptive interpersonal functioning is considered typical of eating disorders. The present thesis aimed to add to existing knowledge of interpersonal functioning in the eating disorders in terms of both symptomatology and treatment. In Study 1, relationships were found between eating disorder attitudes and several types of poor interpersonal functioning. These associations were present when controlling for depression and anxiety. Study 2 found that generalised interpersonal problems were more likely to be reported by women with bulimic disorders than comparison women, apart from problems with being too open, which were more likely to be reported by comparison women. In Study 3, individuals with self identified eating disorders were found to have poorer problem solving skills in specific interpersonal situations than healthy controls, generating less means to solve the problem, with these means being significantly less effective and less specific than those generated by healthy controls. In Study 4, the experience of an invalidating childhood environment was explored as a potential predictor of adult interpersonal problems in the eating disorders. Viewing the expression of emotions as a sign of weakness was a mediator of the relationship between having a more invalidating mother and adult eating concern in a nonclinical population. In Study 5, the interpersonal experiences of patients with bulimic disorders are explored using qualitative methodology. They report a range of problems characterised by social avoidance, social anxiety, non-assertiveness, and a difficulty with being genuine in relationships. In Study 6, patients reported their experiences of interpersonal psychotherapy for bulimic disorders. In general, they experienced the therapy as positive and beneficial. They express that it helped them address a range of interpersonal problems, and reduced but did not cure their eating disordered behaviours. Patients liked that therapy focused on both interpersonal relationships and eating. In Study 7, interpersonal psychotherapists discussed their perceptions of the modified therapy. They identified several factors as being related to outcome, such as the existence or willingness to build a support network, motivation to change, a clear interpersonal problem identified in the patient, level of depression, duration of the eating disorder and keeping therapy focused on the interpersonal. Results of these studies suggest that those with higher levels of eating disorder related attitudes and behaviours often have significant problems with interpersonal functioning. This thesis supports the use of interpersonal psychotherapy as a viable treatment approach to the eating disorders. It also supports the use of the modified version of the therapy, which addresses eating as well as interpersonal functioning.

Background: Patients with anorexia nervosa have been consistently reported to show impairments in set shifting ability. Such deficits may be associated with characteristics commonly observed in this patient group, such as obsessive thoughts and behaviours around eating, maladaptive problem solving and a rigid thinking style. Objective: Much of the preceding literature on set shifting ability has involved inpatient samples meeting strict diagnostic criteria for anorexia nervosa. However most eating disorder patients are outpatients and commonly do not meet full criteria for anorexia nervosa. This study thus aimed to investigate the relationship between set shifting ability and psychological characteristics in a community sample of outpatients with symptoms of anorexia nervosa. Methods: Performance on selected measures of set-shifting ability (Wisconsin Card Sort Test, WCST; Delis-Kaplan Executive Function System, Hayling & Brixton) were compared between an eating disorders group comprising 17 female outpatients with symptoms of anorexia nervosa and a control group comprising 27 students. Set shifting performance was then correlated with eating disorder severity (Eating Disorders Examination), obsessive-compulsive symptoms (Yale-Brown Obsessive Compulsive Scale), and the Social Problem Solving Inventory. Results: The eating disorder group demonstrated significantly worse set shifting ability than the healthy control group on the primary outcome measure (WCST), with 47% of eating disorder participants showing impairment on this measure. Severity of obsessive-compulsive symptoms and an impulsive and careless approach to problem solving were associated with poorer scores on the WCST in the eating disorder group. Although the eating disorder group were significantly more impaired in set shifting than controls, set shifting ability was not associated with eating disorder severity. Conclusions: The results indicate that set shifting impairments are present in outpatients with eating disorders with anorexic symptoms, and may be trait characteristics. Impaired set shifting was associated with obsessive-compulsive symptoms and maladaptive problem solving. These findings highlight a need for neuropsychological assessment of eating disorder outpatients in order to identify individuals who may benefit from psychological interventions to reduce the impact of these impairments.

This thesis reports five studies investigating cognitive processes in eating disorder (ED) psychopathology. Chapter 1 describes background information about EDs. Chapter 2 reviews cognitive theories of Anorexia Nervosa (AN), and discusses how integration of a process-focused framework, originally applied to depression, may advance under-standing of maintaining mechanisms in AN. Chapter 3 reports a focus group with AN patients that explores features of the subjective experience of the disorder. Findings highlight ruminative, avoidant and discrepancy-based thinking: features that are suggested to be indicative of a ‘conceptualising’ mode of processing. Patients’ reports suggest positive effects of a body-mindfulness group, which encourages an alternative, ‘experiential’ mode of processing. Chapter 4 presents data on rumination, experiential avoidance, negative self-beliefs and underlying assumptions in an analogue population and shows elevated levels for ED-concerned individuals on all of these measures. Chapter 5 examines mode of processing effects (conceptual vs. experiential) in an analogue population. Findings show differential stress-induced emotional reactivity, particularly in the ED-concerned group. Chapter 6 investigates mode of processing effects in a sample of AN patients. Results confirm that modes of processing have differential effects on stress-induced emotional reactivity. Chapter 7 presents data from a 10-month follow-up of AN patients. This study shows that changes in ED-symptoms are associated with changes in rumination, avoidance and aspects of schematic thinking. Differential stress-induced reactivity is associated with outcome. Finally, chapter 8 discusses theoretical and clinical implications of this research and the mode of processing framework in EDs, particularly AN, as well describing how future investigations may continue integrating this framework to the study of ED psycho-pathology. The current findings suggest that both cognitive-affective content and the underlying mental processing activity need consideration in cognitive models of EDs.

Introduction: Anorexia nervosa is characterized by a strong focus on body weight and a strong desire to lose weight. The disease leads to extreme anxiety and constant thoughts about diet and body weight. Currently, there are still no clear guidelines and scientific evidence for the treatment of Anorexia Nervosa with a special method. The evidence for the effectiveness of different treatments is weak and lacks empirical support. Therefore, there is a need to document and study the effectiveness of existing treatment methods for Anorexia Nervosa. Aim: The study aims to study the efficacy of CBT in the treatment of Anorexia nervosa. Method: A literature study was conducted where five studies about CBT as treatment and it’s efficacy for Anorexia nervosa was studied. Result: CBT as a single treatment at Anorexia Nervosa leads to an increase in BMI and a decrease in the eating disorder's psychopathology. Conclusion: CBT is a potent treatment that can be used advantageously in the treatment of Anorexia nervosa, but further research is needed in the field with, among other things, several studies comparing CBT with other treatment methods.