Background: Motivation to change is a core variable in understanding and treating women with both anorexia and bulimia nervosa. The transtheoretical model (TTM) has been put forward as a framework for the assessment and treatment of motivation to change for a variety of disorders, including eating disorders. Even though motivation and ambivalence should be assessed with regard to specific symptoms in eating disorders, there is a lack of validated measures in the German language. Due to the importance of motivation to change in women with eating disorders, several studies have used the TTM to develop, and test the effectiveness of face-to-face motivational programs for this clientele. However, no randomized controlled trial for an internet-based program enhancing motivation to change has been conducted. The present thesis aimed to establish symptom-specific measures of motivation to change and ambivalence, and to develop and evaluate an internet-based therapy program for women with eating disorders. Methods: Two observational studies and one randomized controlled trial including a total of N=460 women with eating disorders were performed. The first study tested the psychometric properties (reliability and validity) of a questionnaire assessing motivation to change in a sample of N= 63 inpatients. In the second study, the psychometric properties of a questionnaire assessing ambivalence in a sample of N =195 women with eating disorders were investigated. The third study comprised a randomized controlled trial with N =202 women assessing the effectiveness of an internet-based motivational program for women with eating disorders. The fourth study systematically investigated the dropout from this program using survival analysis. Results: In the observational studies, the questionnaires showed satisfactory psychometric properties, with good reliabilities and validities. The randomized controlled trial showed significant time x group interactions, demonstrating that the internet-based program was effective in enhancing motivation to change, and in reducing some eating disorder symptoms. However, the dropout from the program was 51 %, with participants with more severe eating disorder pathology and depressive mood being more likely to terminate the program prematurely. Discussion: The results demonstrate the feasibility of both symptom-specific assessment of motivation to change and measurements of ambivalence across eating disorder diagnoses, enabling novel research questions and supporting clinical work. Evidence for the efficacy of the internet-based program in enhancing participants’ motivation to change and reducing eating disorder symptoms support the wider adoption of such programs. The results from the dropout analysis offer new perspectives for future research on additional treatment modulesm for women at risk of terminating treatment prematurely.

Introduction : l'adolescence est une phase de remaniements intenses, et ce de manière inter ou intrapersonnelle, de l'image qu'on a de soi et de son corps, au fantasme de l'adulte que l'on espère devenir. L'adolescente cherche sa place, dans sa famille en tant que « plus une enfant mais pas encore une adulte », dans ses relations avec ses pairs, et avec l'Autre. Mais l'anorexie bloque ces processus de changement, en enfermant la jeune fille dans un corps qui n'est plus tout à fait enfant, mais surtout pas femme. La problématique de l'affect est centrale dans ces troubles. Quand certaines sont dans un trop-plein d'émotions non-régulables, d'autres sont dans le refus du ressenti. Mais est-ce propre à l'anorexie, l'état dépressif ou une résultante de cette période de crise qu'est l'adolescence ? Le concept récent d'intelligence et de compétence émotionnelle aborde et modélise toutes les capacités et les difficultés émotionnelles qu'une personne peut avoir, et permet de percevoir de manière plus globale les différentes facettes de la structure affective d'un individu. Objectifs : nous voulons isoler les difficultés émotionnelles chez ces patientes en les comparant à des adolescentes sans troubles du comportement alimentaire mais présentant une dépression, et à des adolescentes contrôles, afin d'établir quels types de profils émotionnels existent dans l'anorexie mentale à l'adolescence. Méthodologie : 40 patientes présentant une anorexie restrictive ou purgative sont rencontrées lors de leurs suivis en hospitalisation ou en consultations au sein de l'Institut Mutualiste Montsouris, ainsi que 18 adolescentes dépressives, et 39 adolescentes contrôles. Afin d'évaluer leurs compétences émotionnelles, les sujets ont répondu à une batterie de questionnaires ainsi qu'une expérience de Reconnaissance Emotionnelle Faciale. Les données ont été analysées par des outils statistiques de comparaison et de Classification Ascendante Hiérarchique. Résultats : on retrouve des problématiques de manque de confiance en soi et de failles narcissiques à l'adolescence, communes à tous les groupes, néanmoins les patientes présentant une anorexie ont davantage de difficulté ayant trait à l'identification des émotions, leur régulation - en trop ou pas assez- et trois profils émotionnels ressortent de nos analyses. Un premier présentant une forte labilité affective, chez qui l'Affect est subi sans possibilité de modulation et de régulation adaptée, un second dans l'hyper-contrôle affectif, et un troisième intermédiaire, dans lequel se juxtaposent des traits alexithymiques et une appétence reconnue mais crainte pour une vie affective. Conclusion : l'évaluation des compétences émotionnelles d'un patient, avant de décider de la nature de la prise en charge à proposer, nous semble importante à systématiser. De plus, dans les recherches portant sur l'anorexie mentale, la constitution des groupes devrait se faire en fonction du profil émotionnel présenté plutôt que par l'opposition anorexie restrictive vs. anorexie purgative. / Introduction: Adolescence is a period of intense reorganization, in and out, intrapersonally and interpersonally, of our self-image and of our body, and to the fantasy of the adult that we hope to become. The teenage girl looks for her place: in her family, as " more than a child but no yet an adult ", in her relations with his(her) peers, and with the 'special Other'. But Anorexia Nervosa blocks these processes of change by locking the girl into a body which is not completely one of a healthy child, but especially not one of a woman and a potential mother. The problematic of the Affect is central to these disorders. While some are experiencing one too many feelings that they cannot regulate, others are in denial or refusal of an affective experience. But is it specific to Anorexia Nervosa, the depressive state in which some of the patients are in, or is it a result of this period of crisis that is adolescence? Furthermore, the recent concept of emotional intelligence and ability model approaches all the capacities and the emotional difficulties which can be met in an individual, and allows one to perceive and collect in a more global way the various facets of the emotional structure of an individual. Objectives: We aim to isolate the emotional difficulties in place in these patients by comparing them with both teenagers without eating disorders but presenting with depression, as well as with healthy teenagers, to establish which types of emotional profiles exist in anorexia nervosa in adolescence. Methodology: 40 patients presenting a restrictive anorexia or binge and purge type are met during their hospitalization or in consultations within the Mutualist Institute Montsouris, as well as 18 depressive teenagers, and 39 teenagers without any psychiatric disorder. To assess their emotional abilities, subjects were asked to undergo a series of questionnaires as well as an experience of Facial Emotional Recognition. The data was analysed by statistical tools of comparison and Ascendant Hierarchical Clustering. Results: We found problems of lack of self-confidence and narcissistic wounds in adolescents, common to all the groups, nevertheless the patients presenting with anorexia nervosa had more difficulties with the identification of emotions, their regulation - over or under regulated, and three emotional profiles stood out from our analyses. The first one presented a strong emotional lability, for which the Affect is endured without any possibility of modulation or adapted regulation, the second presented an emotional hyper-control, and the third, which is more intermediate, presented juxtaposed alexithymia traits and a recognized and ambivalent desire for an emotional life. Conclusion: Assessing a patient's emotional competencies before deciding on a therapeutic course should become a standard procedure. And researchers should divide anorexic populations in their protocols depending on their emotional profile rather than their anorexic sub-type (restrictive or binge/purge).

Ätstörningsproblematik hos barn/ungdomar är  ett väl utforskat område, anhörigperspektivet är inte lika beforskat. Den forskning som finns förespråkar ofta familjebehandling där hela familjen inkluderas. Graden av psykisk belastning på föräldrar har visats ha påverkan på barnets tillfrisknande. Syftet med denna studie är att undersöka upplevelsen hos föräldrar till ett barn med anorexia nervosa, kopplat till upplevda emotioner samt stöd från vården. Åtta intervjuer analyserades med tematisk analys. Här identifierades frustration kring sjukdomssituationen, oro, rädsla och att sjukdomen drabbar andra relationer. Upplevelserna av stöd visade en upplevd kamp för att få rätt vård och att stort ansvar läggs på föräldrarna. Föräldrarna uttryckte en önskan om att erbjudas stödgrupper för anhöriga. Resultaten överenstämmer med tidigare forskning och pekar på den utsatta situation som föräldrar till barn med anorexia nervosa lever under. En slutsats är att vården behöver bli bättre på stötta dessa sjukdomsdrabbade familjer, till exempel genom ökad delaktighet i vårdplaneringen.

This diploma thesis deals with the issue of mental anorexia (AN), clinical and laboratory manifestations of the disease. The theoretical part is focused on summarizing the existing knowledge about the diagnosis, complications and treatment of AN. Attention is paid to the effects of the disease on individual organ systems and clinical and laboratory consequences. The practical part deals with the evaluation of laboratory parameters and clinical symptoms of patients monitored at the Department of Pediatrics and Inherited Metabolic Disorders, 1st Faculty of Medicine, Charles University and General Hospital in Prague. The performed clinical examinations include anthropometric measurements, bioimpedance, measurement of resting energy consumption by indirect calorimetry, measurement of skin algae with a caliper and comparison of the results of methods for determining the proportion of adipose tissue using a caliper and bioimpedances. All patients underwent EKG and cardiological examination, blood pressure measurement, heart rate. The laboratory examination was focused on the determination of serum protein levels, lipidogram, electrolyte levels, triiodothyronine and vitamin D. The aim of the practical part of the work was to find out what are the most common clinical manifestations and laboratory...

京都大学 / 0048 / 新制・課程博士 / 博士(医学) / 甲第20666号 / 医博第4276号 / 新制||医||1024(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 伊佐 正, 教授 富樫 かおり, 教授 髙橋 良輔 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

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Bakgrund: Ätstörningar blir allt vanligare i samhället och drabbar främst unga kvinnor. Två av de vanligaste ätstörningsdiagnoserna är Anorexia Nervosa och Bulimia Nervosa, i båda fallen är orsakerna okända. Återhämtningen från en ätstörning kan vara en svår utmaning på grund av sjukdomens komplexitet som kan ha en negativ påverkan på det dagliga livet. Arbetsterapi kan främja återhämtningen vid ätstörning till exempel genom att tillgängliggöra meningsfulla aktiviteter. Genom att utgå från den arbetsterapeutiska teoretiska modellen Model of Human Occupation (MOHO) underlättar det för arbetsterapeuten att få en helhetsbild av människan även i komplexa sjukdomstillstånd. Syftet var att ur ett arbetsterapeutiskt perspektiv beskriva återhämtningsprocessen hos kvinnor som levt med någon form av ätstörning. Metod: En litteraturstudie för att sammanställa resultaten från tidigare forskning. Samtliga artiklar som valdes var kvalitativa och grundar sig på kvinnors upplevelser. De databaser som användes var Cinahl with full text och PsychInfo. Artiklarna analyserades utifrån Fribergs analysprocess i fem steg. Analysen gjordes deduktivt med förutbestämda teman utifrån MOHO med målet att identifiera olika upplevelser i återhämtningsprocessen. Huvudresultatet: Resultatet utgick från MOHO’s centrala begrepp: vanebildning, miljö, viljekraft och utförandekapacitet. Kvinnorna som befinner sig i eller har befunnit sig i återhämtningsprocessen upplevde att vanor, strategier och omgivningen är betydelsefull för tillfrisknandet. Slutsats: Återhämtningsprocessen av en ätstörning kan beskrivas ur ett arbetsterapeutiskt perspektiv utifrån MOHO. Vidare forskning inom arbetsterapi kan vara hur arbetsterapeutiska insatser kan tillämpas i återhämtningsprocessen av ätstörning.

Anorexia Nervosa (AN) is a severe and complex psychiatric disorder characterized by significantly low body weight, an intense fear of gaining weight, and a distorted body image. Despite otherwise successful treatments, body image distortions are often persistent and are considered a critical factor in the persistence, development, and relapse of AN. The present review outlines the current literature on tactile distance processing in AN to investigate and discuss its proposed role in the persistence and development of a distorted body image. The discussion of literature further discusses its implications for cognitive neuroscience since AN patients display similar symptoms as patients diagnosed with body image-related neuropsychiatric disorders with damage to the parietal lobe. The evidence suggests that individuals with AN have poorer tactile distance estimation than controls but do not differ regarding tactile detection. This review outlines the current literature, identifies gaps within the methodology, and proposes novel directions for future research.

Bakgrund: Ätstörningar finns i dagens samhälle i en stor utsträckning. Forskning visar på de allvarliga konsekvenser som uppkommer av tillstånden, både medicinskt, psykiskt och socialt. Att leva med en ätstörning skapar en stor problematik för personen som till slut inte kan kontrollera sig själv, sin vardag eller sitt liv. Trots den forskning som finns som visar hur djupgående dessa tillstånd är, så uppvisas fortfarande brister i vården och omvårdnaden av dessa personer. Syfte: Att beskriva personers upplevelse av att leva med en ätstörning. Metod: En litteraturstudie som bygger på en kvalitativ innehållsanalys med induktiv ansats på 10 vetenskapliga artiklar. Resultat: Ur analysen framställdes 5 slutkategorier: Att känna skam och skuld inför sig själv och andra, Att känna sig dömd och missförstådd av utomstående och samhället, Att använda sjukdomen som coping-strategi när de negativa känslorna tar över, Att uppleva ambivalens inför sitt destruktiva beteende och inför sin kroppsbild och Att inte kunna kontrollera sig själv och sina val. Slutsats: Att förstå att varje person med en ätstörning är unik och har olika föreliggande orsaker trots sina likheter i uttryck. Därav vikten med att inkludera alla delar av den drabbades liv för att kunna bilda sig en uppfattning om hur den drabbade kan nå återhämtning.

This study examined the cost effectiveness of treating Anorexia Nervosa, Bulimia Nervosa, and Eating Disorder Not Otherwise Specified (NOS), as well as the effects that modality of therapy (i.e. individual, family, and mixed therapy), license of therapist, and secondary diagnosis had on recidivism and total cost of treatment in the care of these patients. One-thousand and thirty-eight patients (56 males, 982 females) diagnosed with Anorexia Nervosa, 1,674 patients (56 males, 1,618 females) diagnosed with Bulimia Nervosa, and 1,997 patients (197 males, 1,800 females) diagnosed with Eating Disorder NOS were included in this study. Results revealed that family therapy was the least expensive form of therapy in average total cost of therapy. Individuals who had family therapy were 3.3 times less likely to recidivate than those who had individual therapy and 7.5 times less likely to recidivate than those who had mixed therapy. Having a secondary diagnosis on average increased the total cost of treatment by $437.34, irrespective of the type of secondary diagnosis (i.e. depression, anxiety, or substance-abuse). These findings suggest that modality of therapy should be considered in the treatment of Anorexia Nervosa, Bulimia Nervosa, and Eating Disorder NOS. Future research should examine the effects of treatment for individuals with a secondary diagnosis.