Anorexia Nervosa is a psychiatric illness with peak onset in ages 14-17. Most cases recover within a few years, but the illness can have a fatal outcome or long duration. Multifactor causes of anorexia nervosa include genetics, personality, family, and socio-cultural factors. This study measures mortality, recovery from anorexia nervosa, and psychosocial outcome of patients with adolescent onset anorexia nervosa that were treated in Child and Adolescent Psychiatry in northern Sweden from 1980 to 1985. In addition, this study assesses the predictive value of background variables and studies perfectionism in relation to recovery. Finally, this study looks at how patients understand the causes of their anorexia nervosa and how they view their recovery process. Follow ups were made 8 and 16 years after initial assessment at CAP. Quantitative and qualitative methods were used. These included a semistructured interview, DSM diagnostics of eating disorders (including GAF), and the self-assessment questionnaires EDI and SCL-90. The interview also contained questions about causes and recovery. Recovery increased from 68% to 85% from first to second follow-up and the mortality rate was 1%. Somatic problems and paediatric inpatient care during the first treatment period could predict long-term outcome of eating disorders. Most former patients had a satisfying family and work situation. At both follow-ups, individuals with long-term recovery had a lower level of perfectionism than those that recovered later. On individual levels, eating disorder symptoms and psychiatric symptoms decreased during recovery, whereas the levels of perfectionism stayed the same. Causes were attributed to self, family, and socio-cultural stressors outside of the family. The most common self-reported causes were high own demands and perfectionism. All recovered subjects could remember and describe a special turning point when the recovery started and 62% saw themselves as an active agent in the recovery process. Supportive friends, treatment, activities, family of origin, boyfriend, husband, and children were also helpful in the recovery process. Compared to other outcome studies, the results were good. In spite of the good outcome, some individuals had a long duration of illness and were not yet fully recovered after 16 years of follow-up. Predictors of non-recovery were related to initial somatic problems. Levels of perfectionism were associated to recovery and patients with initial high levels of perfectionism may need more complex treatment strategies. Results from the study also implied that one should stimulate the patients’ social contacts and their sense of self-efficacy in their recovery- process.

Thesis (doctoral)--Universität Erfurt, 2009. / Includes bibliographical references.

Eating disorders (ED) usually develop during adolescence, and intervention to stop further weight loss is believed to improve outcome and long-term prognosis. Adolescents with ED who do not receive effective treatment risk poor outcome and even untimely death as adults. The first aim of this thesis was to investigate long-term mortality and causes of death in a series of female adults with chronic ED. The second aim was to study the one-year outcome of an unselected series of adolescent girls with anorexia nervosa (AN) and “other restrictive eating disorders” who had been treated within a specialist ED out-patient service focused on nutritional rehabilitation based on family therapy and without planned hospitalization. The third aim was to investigate the possible metabolic and hormonal side effects of olanzapine when used as an adjunct to facilitate nutritional rehabilitation. The fourth aim was to investigate the relationship between polyunsaturated fatty acid (PUFA) status and depression. In adult women with chronic ED, a very low body mass index and psychiatric co-morbidity confer a substantially increased risk of premature death. A treatment programme for adolescent ED with rapid access to assessment and prompt start of treatment with initial emphasis on nutritional rehabilitation proved efficient. The outcome was encouraging, as 43% of all patients with ED and 19% of those with AN did not have an ED at one-year follow-up. Of the remaining patients the vast majority had gained weight and regained menstruation, and were back in school on a full-time basis. Olanzapine was used to reduce anxiety, excessive exercise and rumination over weight and shape. Side effects were similar to those observed in normal-weight individuals, and do not preclude its use in underweight adolescents with ED. Low ω3 PUFA were associated with depression. The ω3 PUFA status improved during nutritional rehabilitation with ordinary foods and without supplementation. The investigations indicate that adolescent ED can be successfully treated in an out-/day-patient setting. An essential feature of the service is rapid handling and weight gain. Further weight loss can be avoided, and chronic disease hopefully prevented.

Geringfügig geänderte Fassung der Diss. Freie Universiẗat Berlin, 1998. / Literaturverzeichnis.

Die vorliegende Arbeit entwickelt einen Vorschlag für einen neuen, kompakteren Fragebogen mit dem Akronym „BaFEK-45“ zur Diagnostik von Essstörungen, der auf einer statistischen Analyse von Daten aus fünf bereits etablierten Fragebogen (ANIS, EAT – 26, FBeK, EDI – 2, EDES) mit einer Gesamtzahl von 231 Items basiert. Dabei wurden die Antworten von Patientinnen aus den 1990er- und 2000er-Jahren der Klinik und Poliklinik für Psychiatrie, Psychotherapie und Psychosomatik des Kindes- und Jugendalters der Universität Leipzig ausgewertet. Auf Grundlage zweier „Signalfragen“ zu Ess-Anfällen wurden die Fragebogen-Serien in drei Gruppen (anorektisch, bulimisch und grenzwertig) eingeteilt, daraufhin konnte eine Analyse zu den Unterschieden im Antwortverhalten zwischen eben diesen Gruppe vorgenommen werden. Nach einem auf dieser Analyse basierenden Auswahlverfahren wurden die verbliebenen Items einer mehrstufigen Faktorenanalyse und kritischen inhaltlichen Differenzierung unterzogen. An deren Ende steht der o.g. Vorschlag eines neuen Diagnostikinstruments, das sich aus 45 Fragen in fünf Skalen zusammensetzt.

No description available.

This thesis consists of both theoretical and practical parts. The aim of the theoretical part is to present the basic concepts of this field of research, then discuss the types of nourishment intake defects, their causes and treatment, and also to define the term "pubescent". The entire theoretical part is based on the examined professional literature. The practical part focuses on research which ascertains pubescents´ awareness of the topic and the possible influence and occurrence of the nourishment intake defects in pubescents. Following the practical part, there is a summary and evaluation of the results based on the questionnaire method.

CoordenaÃÃo de AperfeiÃoamento de Pessoal de NÃvel Superior / Esta dissertaÃÃo à um estudo sociolÃgico realizado com jovens acometidas por anorexia nervosa, pacientes de um serviÃo mÃdico especializado no tratamento de transtornos alimentares. Com base no depoimento de trÃs jovens, pretende-se apresentar as contradiÃÃes vivenciadas por elas no curso do tratamento mÃdico. Neste estudo investigo como as anorÃxicas produzem um corpo considerado saudÃvel pela ciÃncia mÃdica. Para tanto, conto como principal interlocutor Michel Foucault. A partir de seu conceito de resistÃncia pretendo perceber como as pacientes anorÃxicas produzem suas subjetividades ao negociarem com os saberes mÃdicos e midiÃticos de saÃde, bem-estar e beleza. à ainda interesse deste trabalho compreender como produÃÃo da identidade de gÃnero aparece no processo de renÃncia a um corpo prÃ-pÃbere para assumir um corpo sexualmente maduro. Baseada numa abordagem qualitativa e, especificamente, na prÃtica de pesquisa de campo foi possÃvel observar que a experiÃncia anorÃxica à essencialmente paradoxal. A produÃÃo do corpo anorÃxico em corpo saudÃvel exige recomposiÃÃes entre o desejo de permanecer excessivamente magra e o desejo de ficar boa. A partir dos depoimentos das anorÃxicas à possÃvel afirmar que o transtorno à uma manifestaÃÃo do desacordo entre a tentativa dessas garotas em construir um sentimento de autonomia ao controlar os impulsos alimentares e a impossibilidade de mediar a multiplicidade de discursos sobre saÃde, beleza e dietas ou de eleger apenas um desses discursos como modo de vida / This dissertation is a sociological study about young girls stricken with nervous anorexia attending a medical service that specializes in the treatment of alimentary disorders. Based on cases related by three youths, this work aims at presenting conflicting aspects that those patients had to go through during their medical treatment. It is investigated how anorexic subjects display a body that is considered healthy by medical science. To this end it was engaged as main support the work of Michel Foucault. Based on his concept of resistance, it is sought to unveil how anorexic patients produce their subjectivities in dealing with medical knowledge and information obtained from the media about health, well being and beauty. In the same fashion, this works is interested in discovering how production of genre identity appears in the process of renouncing a prepubescent body in order to adopt a sexually mature body. Based on a qualitative approach, especially from data obtained from field research, it was possible to observe that the anorexic experience is essentially a paradoxical feature. The production of an anorexic body into a healthy body requires rearrangements going from the will of keeping an excessively slender figure and the desire of obtaining cure. Based on statements from anorexic subjects it is possible to assert that the disorder is both a manisfestation of disagreement presented by these girls in their attempt at building a feeling of autonomy by reining their feeding drives and the plentiful offer of discourses about health, beauty and diets in order to elect just one of these discourses as their guidance to a way of life

Anorexia Nervosa (AN) is a serious psychiatric disorder marked by the refusal to maintain a healthy body weight and excessive fear of gaining weight or becoming fat. This eating disorder is most prevalent among young women. Most research on hospitalized AN patients has been quantitative, and the experiences and perspectives of young women struggling with AN are underrepresented in the literature. Using a social constructionist and relational cultural lens, the research question addressed in the current study was What are AN participants’ experiences of helpful and not helpful factors in hospitalized care that affect recovery, motivation, and subjective well-being? The study used a narrative approach, where eight young women aged 1725 were interviewed regarding their stories of being treated in general or paediatric wards for AN. A thematic analysis was conducted to identify salient themes in the research interviews. The young women identified factors grouped into six main theme clusters that either helped or hindered their recovery during their time in the hospital, including: Staff Knowledge and Training, Treatment Experiences, Identity, Negative Treatment Impact, Abandonment, and Relationships. Implications of the findings for research, theory, and practice are discussed. / Graduate

L’anorexie mentale (AM) est une pathologie psychiatrique caractérisée par sa gravité et la sévérité de son pronostic. A ce jour, si une approche pluridisciplinaire et multifocale est privilégiée pour prendre en charge les patients, il n’en demeure pas moins qu’aucun traitement n’a démontré sa supériorité chez l’adulte. Des avancées récentes dans le domaine des neurosciences cognitives et affectives ont permis d’ouvrir la voie au développement de nouvelles modalités thérapeutiques. Ainsi, la thérapie de remédiation cognitive (CRT) a été adaptée à l’AM par l’équipe du Pr. Tchanturia. Cette approche se base sur les difficultés cognitives mises en évidence chez ces patients (notamment le manque de flexibilité et de cohérence centrale) et propose leur remédiation par une approche courte, motivationnelle et décentrée des problématiques alimentaires, de manière complémentaire aux soins habituels. Plusieurs études ont été menées sur les apports de la CRT et soulignent son intérêt dans l’amélioration de certains critères cognitifs ainsi que sa bonne acceptabilité. L’essai clinique randomisé Trecogam développé par notre équipe avait pour objectif l’adaptation en français de la CRT dans l’AM ainsi que son évaluation en comparaison à une thérapie « contrôle » appelée PER (Personnalité-Emotions-Relations) axée sur les difficultés socio-émotionnelles mises en évidence dans l’AM. La partie expérimentale de ce travail de thèse s’inscrit dans le cadre de cette étude plus large. Soixante-quatre patientes hospitalisées pour AM sévère ont été recrutées dans 4 hôpitaux parisiens et randomisées dans l’un ou l’autre des bras de traitement. Le fonctionnement cognitif et émotionnel ainsi que la sévérité clinique ont été évalués avant et après la prise en charge. Ce travail s’organise donc autour de deux axes. Dans un premier axe ciblant le fonctionnement cognitif, nous nous sommes tout d’abord intéressés au développement et à l’étude de versions alternatives aux évaluations neuropsychologiques fréquemment employées dans le cadre de l’évaluation de la CRT, afin de contrôler l’effet d’apprentissage. Une seconde étude avait pour objectif d’évaluer les apports de la CRT sur le fonctionnement cognitif objectif et auto-rapporté, en comparaison à une thérapie basée sur les émotions et relations interpersonnelles (PER). Le second axe de ce travail concerne les difficultés émotionnelles dans l’AM. Une première étude a permis la validation d’un instrument de mesure de l’Intelligence Emotionnelle Perçue (IEP) dans un échantillon de 824 jeunes adultes issus de la population générale et la caractérisation des difficultés rencontrées par les patientes souffrant d’AM comparativement à ces données normatives. Une seconde étude a concerné l’évaluation des apports de la PER sur les dimensions de l’IEP et sur les symptômes anxio-dépressifs, en comparaison à la CRT. Sur le plan méthodologique, ce travail a permis de mettre à disposition des cliniciens-chercheurs des outils d’évaluation fiables, tant concernant le fonctionnement cognitif (versions alternatives au Brixton et à la Figure de Rey) qu’émotionnel (Trait Meta-Mood Scale). Concernant l’efficacité thérapeutique des approches testées, nos résultats ne mettent pas en évidence de supériorité de l’une ou l’autre sur les variables théoriquement ciblées. Cependant, nous faisons le constat d’une bonne acceptabilité de la CRT et de la PER ainsi que d’une satisfaction importante de la part des patientes, et faisons l’hypothèse qu’ils pourraient constituer de bons leviers thérapeutiques dans un parcours de soins pour AM. Ce travail a également nourri des réflexions concernant les potentielles améliorations pouvant être apportées à ces programmes. / Anorexia Nervosa (AN) is a complex and difficult-to-treat illness characterised by the severity of its prognosis. There is growing evidence suggesting that some cognitive difficulties (poor set-shifting, lack of central coherence) may be critically involved in the development and maintenance of AN. Studies in schizophrenia showed that it is possible to translate evidence-based research into clinical practice and to improve neuropsychological and cognitive functioning using Cognitive Remediation Therapy (CRT). CRT for AN was developed by Pr Tchanturia and colleagues to address the AN patients’ thinking styles. Rather than targeting eating symptoms, CRT is designed to encourage the patients to reflect on and try to modify their information-processing styles and behaviors, by using simple cognitive exercises, delivered in a motivational style. To date, studies on CRT for AN showed some improvements in cognitive functioning but also a good acceptability. The aims of the randomized controlled trial Trecogam were to adapt CRT for AN in French, then to compare its effectiveness with a sham therapy. The sham therapy has been designed to match the CRT format: an individual manualized therapist-led 10-sessions program (2 sessions/week). It avoids set-shifting and central coherence training but rather taps 3 domains: emotional expression and recognition, personality exploration and interpersonal functioning (PER: Personality – Emotions – Relationships). We recruited 64 AN inpatients in 4 specialized care units (Parisian area); they were randomized in CRT or PER arm. Clinical status, cognitive and socio-emotional functioning were assessed before and after intervention. Our first line of research (two studies) concerned cognitive functioning. First, in order to control for learning effects, we developed and explored, in the entire AN sample, alternative versions of neuropsychological tests that are widely used in the context of the evaluation of CRT. The aim of the second study was to assess the contribution of CRT (relative to the PER) on objective and subjective cognitive functioning. Our second line of research (two studies) concerned emotional difficulties in AN. A first study was conducted in a general sample of 824 young adults to validate a measure of Perceived Emotional Intelligence (PEI): the Trait-Meta-Mood-Scale (TMMS). The TMMS was completed by the AN patients and this study allowed to further characterize their emotional difficulties, in comparison with our normative sample. In a second study, we explored contributions of the PER intervention (versus the CRT) on the PEI dimensions and anxio-depressive symptoms. From a methodological perspective, this work helped to provide reliable measures of cognitive (alternative versions of Brixton task and Rey Complex Figure) and emotional functioning (TMMS). Regarding the interventions (CRT and PER), our results do not show superiority of one over another on our variables of interest. However, we observed a good retention and acceptability of both interventions, and an important satisfaction from patients’ perspective. We believe that they could be useful first steps and complementary approaches to the treatment as usual of patients with severe AN. We also discuss future potential improvements of these interventions.