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Public view removed at the authors request. 16/07/2006 / The daily experience of anorexia nervosa sufferers has not previously been studied and yet it is fundamental to understanding anorexia nervosa. This study examined and compared the daily experiences of anorexia nervosa patients and control participants in terms of sense of self, mood states and flow states. Flow is characterised by undivided concentration and interest in an activity for intrinsic benefits. Flow is not always desirable, as some ways of experiencing it may be harmful to the individual and society. Anorexia nervosa participants were recruited from hospitals and private practices of clinicians specialising in the treatment of anorexia nervosa. Exclusion criteria included male gender, chronic anorexia nervosa, drug abuse, and current participation in an inpatient program. Anorexia nervosa participants completed a series of questionnaires at baseline, 3-6 month follow-up and 7-12 month follow-up (stage one, two and three respectively). The questionnaires were designed to measure the severity of their eating disorder. Anorexia nervosa and control group participants completed Experience Sampling Forms (ESF) and a Repertory Grid at baseline and 3-6 months. The ESFs were completed each time a pager was activated. The pager was activated seven times a day, for four days at random times between 8.00am and 10.00pm. The pager signals were a minimum of two hours apart. The Repertory Grid consisted of 23 constructs and 13 elements provided to the participant. Thirty-one anorexia nervosa sufferers and thirty-two control participants completed stage one and eighteen anorexia nervosa sufferers and twenty-seven control group participants completed stage two of the study. Eighteen anorexia nervosa sufferers completed stage three of the study. Control participants were not required to participate in stage three. There was no difference in the severity of anorexia nervosa between completers and drop-outs The analysis of the ESFs at stage one indicated that the anorexia nervosa group participants did not spend more time alone at home or more time alone in any situation than the control group. For both groups, being alone had a negative influence on mood state, but had no effect on sense of self. The anorexia nervosa group felt lonelier and less sociable than the control group. The mood state and sense of self for the anorexia nervosa group was significantly lower over all the ESFs when compared to the control group. They were also more self-critical, experienced higher levels of guilt, were less able to live up to their own expectations, and were less satisfied with their performance in the activity they were doing. The anorexia nervosa group experienced less flow states than the control group at stage one. There was an improvement in mood state, sense of self and self-criticism for the anorexia nervosa group when they were in a flow state compared to when they were not in a flow state. There was an improvement in mood state, sense of self, guilt and self-criticism for the control group when they experienced flow, however these differences were not significant. The anorexia nervosa group had a more positive mood state and sense of self at stage two when compared to stage one. Correspondingly, there was a trend towards a reduced severity of the disorder indicated by a significant improvement on some of the psychological tests (EAT, REDS, BDI, DT). There was also a significant improvement in BMI. However, there was a significant decline in the amount of flow of anorexia nervosa participants experienced at stage two when compared to stage one. This result may be attributed to the significant decline in the response rate on ESFs in the second stage of the study for both the anorexia nervosa and control groups. Anorexia nervosa non-responders at stage two reported more severe symptoms of anorexia nervosa than anorexia nervosa responders, although this was a trend and reached significance only on minor indicators of eating disorder severity. The identification of a factor that predicted severity over a six-month period was not possible. The repertory grid analysis showed that the construct system of the anorexia nervosa participants was tighter and less complex than that of the control group. The anorexia nervosa group construed themselves as dissimilar from the way they would like to be in any context. The control group construed themselves as similar to the way they would like to be when they were alone, but as dissimilar from the way they would like to be when they were with other people. While the most salient element for both the anorexia nervosa and control groups was 'alone at home', it appears that the controls use this time for goal-directed activities. In contrast, this time was dominated by fear of losing control for the anorexia nervosa group. Although there was a trend towards a decrease in the amount of variance accounted for by the first component for the anorexia nervosa group at stage two compared to stage one, the interpretation of this result was complicated by mixed result of the control group. The anorexia nervosa groups' daily experience of life was bleak when compared to the daily experience of the control group, except for periods when the anorexia nervosa participants experienced a flow state. DeVries (1992) has documented the success of therapeutic interventions that involve the identification and replication of activities that resulted in a flow state. This investigation suggests that a similar result may be possible in the treatment of anorexia nervosa.

Public view removed at the authors request. 16/07/2006 / The daily experience of anorexia nervosa sufferers has not previously been studied and yet it is fundamental to understanding anorexia nervosa. This study examined and compared the daily experiences of anorexia nervosa patients and control participants in terms of sense of self, mood states and flow states. Flow is characterised by undivided concentration and interest in an activity for intrinsic benefits. Flow is not always desirable, as some ways of experiencing it may be harmful to the individual and society. Anorexia nervosa participants were recruited from hospitals and private practices of clinicians specialising in the treatment of anorexia nervosa. Exclusion criteria included male gender, chronic anorexia nervosa, drug abuse, and current participation in an inpatient program. Anorexia nervosa participants completed a series of questionnaires at baseline, 3-6 month follow-up and 7-12 month follow-up (stage one, two and three respectively). The questionnaires were designed to measure the severity of their eating disorder. Anorexia nervosa and control group participants completed Experience Sampling Forms (ESF) and a Repertory Grid at baseline and 3-6 months. The ESFs were completed each time a pager was activated. The pager was activated seven times a day, for four days at random times between 8.00am and 10.00pm. The pager signals were a minimum of two hours apart. The Repertory Grid consisted of 23 constructs and 13 elements provided to the participant. Thirty-one anorexia nervosa sufferers and thirty-two control participants completed stage one and eighteen anorexia nervosa sufferers and twenty-seven control group participants completed stage two of the study. Eighteen anorexia nervosa sufferers completed stage three of the study. Control participants were not required to participate in stage three. There was no difference in the severity of anorexia nervosa between completers and drop-outs The analysis of the ESFs at stage one indicated that the anorexia nervosa group participants did not spend more time alone at home or more time alone in any situation than the control group. For both groups, being alone had a negative influence on mood state, but had no effect on sense of self. The anorexia nervosa group felt lonelier and less sociable than the control group. The mood state and sense of self for the anorexia nervosa group was significantly lower over all the ESFs when compared to the control group. They were also more self-critical, experienced higher levels of guilt, were less able to live up to their own expectations, and were less satisfied with their performance in the activity they were doing. The anorexia nervosa group experienced less flow states than the control group at stage one. There was an improvement in mood state, sense of self and self-criticism for the anorexia nervosa group when they were in a flow state compared to when they were not in a flow state. There was an improvement in mood state, sense of self, guilt and self-criticism for the control group when they experienced flow, however these differences were not significant. The anorexia nervosa group had a more positive mood state and sense of self at stage two when compared to stage one. Correspondingly, there was a trend towards a reduced severity of the disorder indicated by a significant improvement on some of the psychological tests (EAT, REDS, BDI, DT). There was also a significant improvement in BMI. However, there was a significant decline in the amount of flow of anorexia nervosa participants experienced at stage two when compared to stage one. This result may be attributed to the significant decline in the response rate on ESFs in the second stage of the study for both the anorexia nervosa and control groups. Anorexia nervosa non-responders at stage two reported more severe symptoms of anorexia nervosa than anorexia nervosa responders, although this was a trend and reached significance only on minor indicators of eating disorder severity. The identification of a factor that predicted severity over a six-month period was not possible. The repertory grid analysis showed that the construct system of the anorexia nervosa participants was tighter and less complex than that of the control group. The anorexia nervosa group construed themselves as dissimilar from the way they would like to be in any context. The control group construed themselves as similar to the way they would like to be when they were alone, but as dissimilar from the way they would like to be when they were with other people. While the most salient element for both the anorexia nervosa and control groups was 'alone at home', it appears that the controls use this time for goal-directed activities. In contrast, this time was dominated by fear of losing control for the anorexia nervosa group. Although there was a trend towards a decrease in the amount of variance accounted for by the first component for the anorexia nervosa group at stage two compared to stage one, the interpretation of this result was complicated by mixed result of the control group. The anorexia nervosa groups' daily experience of life was bleak when compared to the daily experience of the control group, except for periods when the anorexia nervosa participants experienced a flow state. DeVries (1992) has documented the success of therapeutic interventions that involve the identification and replication of activities that resulted in a flow state. This investigation suggests that a similar result may be possible in the treatment of anorexia nervosa.

Although factors associated with eating disorders (ED) have been studied, no comprehensive source of research findings was identified in this review. The purpose of this study was to identify and synthesize research findings of factors associated with ED in women published from 1992-2006. These findings may be useful to nurses, other professionals, families, and the public to facilitate the prevention, detection, treatment, and rehabilitation of women with EDs. The factors identified as most pertinent through this review were depression, sexual abuse, substance abuse, anxiety disorders, early pubertal onset and the personality traits of perfectionism and impulsivity. No factor was identified as causative for EDs, but sexual abuse and anxiety disorders often preceded the ED. Findings varied among ED subtypes, with sexual abuse and substance abuse more common with binge/purge behaviors and bulimic symptomology, while depression and anxiety disorders were more common with both anorexia nervosa and bulimia nervosa. Perfectionism was most common in anorexics; in one study it was identified independent of stress and persisted after recovery. Limitations noted in the research reviewed include using self-report questionnaires, some small samples, exclusion of some ED subtypes, and a predominant use of cross-sectional and clinical samples. Recommendations for further research included large epidemiological samples containing multiple ED subtypes and males, as well as longitudinal studies and methods to determine causal relationships among EDs and the associated factors identified. Implications for nursing education, practice, and policy development focus on screening for ED during physical examinations and interviews, posing questions to facilitate disclosure, addressing emotions elicited, and suggestions for routine monitoring of patients in clinical settings.

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.

Objective: For eating disorders, a vast number of investigations have demonstrated the efficacy of psychological treatments. However, evidence supporting the impact of therapeutic process aspects on outcome (i.e., process-outcome research) has not been disentangled. Method: Using the Generic Model of Psychotherapy (GMP) to organize various process aspects, a systematic literature search was conducted on psychological treatment studies for anorexia nervosa, bulimia nervosa, binge-eating disorder, and eating disorders not otherwise specified. Results: Improved outcomes resulted for family-based treatment compared to individual treatment, for individual compared to group treatment, booster sessions, and positive patient expectations (GMP contract aspect); for nutritional counseling and exercising but not exposure with response prevention as adjunct interventions (therapeutic operations); for highly motivated patients and, to a lesser extent, for therapeutic alliance (therapeutic bond); as well as for rapid response and longer overall treatment duration (temporal patterns). Regarding other GMP aspects, studies on self-relatedness were completely lacking and in-session impacts were rarely investigated. Discussion: As most studies assessed only a limited number of process aspects, the ability to draw conclusions about their overall impact regarding outcome is rather limited. Therefore, future process-outcome research is needed beyond investigations of treatment efficacy for eating disorders.

No description available.

Diss. (sammanfattning) Stockholm : Karol. inst., 2006. / Härtill 4 uppsatser.

The most common eating disorders (EDs) according to DSM-5 are anorexia nervosa (AN), bulimia nervosa (BN) and binge eating disorder (BED). These disorders have received increasing attention in psychiatry due to rising prevalence and high morbidity and mortality. The diagnostic category “anorexia nervosa,” introduced by Ernest-Charles Lasègue and William Gull in 1873, first appears a century later in a German textbook of psychiatry, authored by Gerd Huber in 1974. However, disordered eating behavior has been described and discussed in German psychiatric textbooks throughout the past 200 years. We reviewed content regarding eating disorder diagnoses but also descriptions of disordered eating behavior in general. As material, we carefully selected eighteen German-language textbooks of psychiatry across the period 1803–2017. Previously, in German psychiatry, disordered eating behaviors were seen as symptoms of depressive disorders, bipolar disorder or schizophrenia, or as manifestations of historical diagnoses no longer used by the majority of psychiatrists such as neurasthenia, hypochondria and hysteria. Interestingly, 19th and early 20th century psychiatrists like Kraepelin, Bumke, Hoff, Bleuler, and Jaspers reported symptom clusters such as food refusal and vomiting under these outdated diagnostic categories, whereas nowadays they are listed as core criteria for specific eating disorder subtypes. A wide range of medical conditions such as endocrinopathies, intestinal or brain lesions were also cited as causes of abnormal food intake and body weight. An additional consideration in the delayed adoption of eating disorder diagnoses in German psychiatry is that people with EDs are commonly treated in the specialty discipline of psychosomatic medicine, introduced in Germany afterWorld War II, rather than in psychiatry. Viewed from today’s perspective, the classification of disorders associated with disordered eating is continuously evolving. Major depressive disorder, schizophrenia and physical diseases have been enduringly associated with abnormal eating behavior and are listed as important differential diagnoses of EDs in DSM-5. Moreover, there are overlaps regarding the neurobiological basis and psychological and psychopharmacological therapies applied to all of these disorders.