The aim of this study was to examine the depiction of mental illness with elite athletes. Mental illness has long been a sensitive object in the public's eye, but in recent years that has started to shift and the subject has destigmatized. More and more people are open and talk about their inner problems. But in one group in society the development has not been up to pace, and that is elite athletes. The study has also looked at the difference between tabloid and daily press. The theoretical framework was constructed by using the agenda setting theory, the framing theory, theories of media logic and the thoughts of news evaluation. The method used in the study was critical discourse analysis, and used in the way through out by Norman Fairclough and his three dimensional modell. A total of 38 articles from the newspapers Dagens Nyheter, Svenska dagbladet, Aftonbladet and Expressen was analyzed. The analysis found that the papers tend to portray mental illness as a negative major problem of today's society. A majority of the articles analyzed tended put the athlete aspect of the person in limelight, rather than letting the athlete just be a suffering person. They way the papers achieved to sustain the image of being a unbeatable hero by reminding the audience about the athletic achievements won, when the athlete was presented in the article. Keywords: Johan Franzén, Jenny Rissveds, mental illness, depression, concussions, concussion, eating disorder and eating disorders.

Introdução: A alteração da percepção da imagem corporal (IC) está relacionada à busca pelo considerado corpo ideal, padrão este resultado de uma construção histórica influenciada pelo meio sociocultural e também por fatores individuais. Tais fatores, aliados às exigências dos esportes de competição (como performance, adequação de peso e massa corporal), ao stress e à ansiedade consequentes, e também ao fato de que o ambiente esportivo pode ser um meio ampliador de pressões socioculturais motivadas pelo ideal de corpo magro, contribuem para que os atletas sejam uma população vulnerável à insatisfação corporal e possam constituir, consequentemente, um grupo de risco para o desenvolvimento de transtornos alimentares (TA). Considerados transtornos mentais e comportamentais, entende-se que os TA são também diretamente influenciados pela família, cujo funcionamento pode ser determinante do bem-estar e da saúde física e emocional do indivíduo. Objetivos: Investigar fatores associados ao risco para transtornos alimentares em corredores de média e longa distância adolescentes e adultos de ambos os sexos. Metodologia: Foi realizado um estudo transversal com corredores adolescentes do projeto social Kiatleta do São Paulo Futebol Clube e com corredores adultos que treinam no Campus da Cidade Universitária por meio de instrumentos que foram aplicados em sequência lógica: o questionário socioeconômico e demográfico, o Apgar Familiar, o Teste de Atitude Alimentar (Eating Attitudes Test EAT-26) e a Escala de Silhuetas de Stunkard, além da coleta de medidas antropométricas para avaliação do estado nutricional. Os resultados obtidos foram analisados de forma descritiva, comparativa e estatística a fim de correlacionar as variáveis relativas a gênero, perfil socioeconômico e demográfico dos atletas e de suas famílias, qualidade do funcionamento familiar e ocorrência de insatisfação corporal ao risco para TA. Resultados: As variáveis analisadas indicaram maior risco para TA e distorção de IC na população adulta feminina e uma parcela significativa de risco para TA e de distorção de IC em corredores adolescentes do sexo masculino. Insatisfação corporal e família disfuncional estiveram associados ao risco para TA. Conclusão: A prevenção de transtornos alimentares em corredores de média e longa distância devem considerar o atleta de forma integral, como alguém que precisa não apenas de treinamento esportivo, mas também de orientação segura sobre alimentação e de apoio familiar saudável. / Introduction: Change in the perception of body image (BI) is related to the search for the ideal body, a pattern that is the result of a historical construction influenced by sociocultural environment and personal factors. These factors, linked to demands of competitive sports (such as performance, weight and body mass adequacy), to stress, to inevitable anxiety, and also to the fact that sports atmosphere can be an amplifying way to sociocultural pressure motivated by the ideal of a thin body, contribute to the vulnerability and BI distortion of athletes and may build, consequently, an eating disorder (ED) risk group. Eating disorders are considered mental and behavioral disorders and are also directly influenced by family. A family way of functioning may determine a person\'s emotional and physical health and also her/his well-being. Objectives: the investigation of associated risk factors to eating disorders in average and long distance adolescents and adults. Methods: A cross-sectional study with adolescent runners from Kiatleta do São Paulo Futebol clube project and adult runners that train in the Campus of São Paulo University. This study applied instruments in a logical sequence: a socioeconomic and demographic questionnaire, Family Apgar, Eating Attitudes Test EAT-26, the Stunkard Silhouettes Scale and data from anthropometric measures to assess nutritional status. The results were analyzed in a descriptive, comparative and statistical way in order to see variables related to genre, social, economic and demographic profile of athletes and its families, family functioning quality and relation of the distortion in BI to predisposition of eating disorder development. Results: The variables indicated higher incidence of ED and body dissatisfaction in adult females and a significant group for ED and body dissatisfaction in adolescent male runners. Body dissatisfaction and dysfunctional family are associated to eating disorder risk. Conclusion: The prevention of eating disorders on average and long distance runners must consider the athlete as a whole, as a person that needs not only sport training, but also a healthy family support and a safe guidance for eating.

Les troubles des conduites alimentaires (TCA) et les troubles des conduites suicidaires (TCS) sont des pathologies mentales graves. Ces deux troubles représentent un problème de santé publique majeur. En effet, il s’agit de pathologies pour lesquelles les pronostics sont médiocres, ayant un impact lourd sur la vie des patients et de leur entourage et représentant un coût élevé pour la société. Il n’existe actuellement aucun biomarqueur validé dans l’une ou l’autre de ces pathologies. L’objectif de ce travail est de réussir à identifier de potentiels biomarqueurs dans ces deux troubles. L’identification de biomarqueurs potentiels pourrait être utile dans divers domaines : faciliter le diagnostic des patients, améliorer la prise en charge des patients et enfin servir de cibles thérapeutiques dans le but d’élaborer de nouveaux traitements plus efficaces. Nous présenterons dans ce travail l’intérêt et l’utilisation des biomarqueurs en psychiatrie puis deux axes d’exploration des TCA ainsi qu’un axe d’exploration des TCS: l’approche neuropsychologique ainsi que l’approche biologique pour les TCA et l’approche génétique pour les TCS. Concernant les TCA, nos résultats suggèrent un intérêt potentiel des oestro-progestatifs dans l’amélioration des fonctions cognitives des patientes. Au sujet des TCS, il semblerait que deux des polymorphismes génétiques que nous avons étudiés (l’un du gène MOR et l’autre du gène SKA2) soient associés avec le risque d’émergence d’idées suicidaires au cours de l’initiation d’un traitement antidépresseur. Si ces études étaient répliquées, ces divers éléments pourraient s’avérer être des outils diagnostics et thérapeutiques. / Eating Disorders (EDs) and Suicidal Behavior (SB) are severe mental illnesses. Those two disorders represent a major public health problem. Indeed, those pathologies present a poor prognosis, induce a heavy impact on patient and their families and represant an important cost for society. There is currently no validated biomarker in one or the other disorder. The goal of this work is to successfully identify potential biomarkers in both disorders. The identification of potential biomarkers could be useful in various areas: facilitating patient’s diagnosis, improving patient management, and serving as therapeutic targets for the development of new and more effective treatments. We will present in this work the interest and the use of biomarkers in psychiatry then two axes of exploration of EDs and finally an axis of exploration of SB: the neuropsychological approach as well as the biological approach for EDs and genetic approach for SB. Regarding TCA, our results suggest a potential interest of estrogen-progestins in improving the cognitive functions of patients. With regards to SB, it appears that two of the genetic polymorphisms we studied (one from the MOR gene and the other from the SKA2 gene) are associated with the risk of suicidal ideation during the initiation of suicide an antidepressant treatment. If those studies are replicated, those elements could peep out diagnostic and therapeutic tools.

Submitted by Nara Lays Domingues Viana Oliveira (naradv) on 2015-07-07T14:42:08Z No. of bitstreams: 1 RositaEstevesPsico.pdf: 4589927 bytes, checksum: 1571c9cace25a7d8e1598aa32bf7c141 (MD5) / Made available in DSpace on 2015-07-07T14:42:08Z (GMT). No. of bitstreams: 1 RositaEstevesPsico.pdf: 4589927 bytes, checksum: 1571c9cace25a7d8e1598aa32bf7c141 (MD5) Previous issue date: 2010-12-21 / Nenhuma / Este estudo buscou analisar e compreender como se apresenta a imagem do corpo em jovens mulheres com bulimia em relação aos próprios ideais e aos de sua mãe. O foco do estudo centrou-se nos aspectos psíquicos referentes à constituição da imagem do corpo e suas alterações na bulimia, utilizando o referencial psicanalítico. Também foram examinadas pesquisas científicas atuais que tratam da imagem do corpo e da bulimia. A abordagem foi qualitativo-exploratória, utilizando como estratégia o procedimento de estudo de casos múltiplos. As participantes do estudo foram duas jovens do sexo feminino, com idades de 19 e 24 anos, com diagnóstico de bulimia e suas respectivas mães. O estudo de cada jovem e sua mãe foi considerado um caso. O acesso aos casos se deu através de encaminhamento por profissionais especialistas do Centro de Especialidades em Saúde (CES) - Secretária Municipal da Saúde (SMS) da Prefeitura Municipal de Caxias do Sul. Como instrumentos, foram utilizadas entrevistas não estruturadas e semiestruturadas com as jovens e com suas mães, o Desenho da Figura Humana, o EAT-26, o BITE, o BSQ e a Escala de Imagem Corporal de Stunkard. Os resultados indicaram a presença de insatisfação com a imagem do corpo tanto nas jovens bulímicas como em suas mães, gerada a partir dos próprios ideais e dos ideais maternos. Também indicaram que as jovens participantes do estudo buscaram uma imagem de corpo ideal como manifestação de falhas na constituição do narcisismo e da identidade frente à relação pouco discriminada com a figura materna. Indicaram, ainda, que as filhas, através da bulimia, estariam respondendo aos ideais conscientes e inconscientes de suas mães. / This study aimed to analyze and understand how body image is seen by young bulimic women regarding their own ideals as well as their mothers’. It focused on psychic aspects related to how body image is constituted and its alterations in bulimia, using psychoanalytical references. Recent scientific research being carried out on body image and bulimia were also examined. The approach was qualitative-exploratory, using the strategy of multiple case studies. Subjects of the study were two young women, who were 19 and 24 years old, diagnosed as bulimic, and their respective mothers. The study carried out on each young woman and her mother was considered one case. Access to the cases took place thanks to recommendations by specialized professionals from the Centro de Especialidades em Saúde (CES) - Secretaria Municipal da Saúde (SMS) (Specialized Health Center – Municipal Health Secretary) which is run by the City Hall of Caxias do Sul. Research instruments used were non-structured and semi-structured interviews with the young women and their mothers, the Human Figure Drawing Test, the EAT-26, the BITE, the BSQ, and Stunkard Body Image Scale. Results indicated that both the young bulimic women and their mothers showed dissatisfaction with their body images, from their own ideals as well as their mothers’ ideals. They also indicated that the young women taking part in the study sought for an ideal body image as manifestation of flaws in the constitution of narcissism and identity given the relationship with the mother figure not being much discriminated. In addition to that, results indicated that through bulimia, the daughters would be responding to their mothers’ conscious and unconscious ideals.

Submitted by Suzana Dias (suzana.dias@famerp.br) on 2018-11-05T14:52:19Z No. of bitstreams: 1 SabrinaLiberatore_dissert.pdf: 576438 bytes, checksum: 784a87c03c876bd0617bd075a625192c (MD5) / Made available in DSpace on 2018-11-05T14:52:19Z (GMT). No. of bitstreams: 1 SabrinaLiberatore_dissert.pdf: 576438 bytes, checksum: 784a87c03c876bd0617bd075a625192c (MD5) Previous issue date: 2017-08-18 / Obesity is a chronic, multifactorial disease that involves psychological, genetic and environmental issues. Studies have been conducted to analyze the psychological profile of the patient who will undergo bariatric surgery. Objective: To characterize obesity patients, candidates for bariatric surgery and to identify lifestyle and the presence of symptoms of anxiety, depression and binge eating. Method: A retrospective study was carried out based on data from patients' charts in a private clinic in the interior of São Paulo, who were candidates for bariatric surgery, evaluated by psychology between January 2010 and December 2015. The psychological evaluation included a data questionnaire (BMI), the Beck Anxiety Inventory (BAI), the Beck Depression Inventory (BDI) and the Periodic Feed Compulsion Scale (ECAP). Results: 188 medical records were analyzed. Age ranged from 16 to 65 years (mean 34.7; SD: 11.3), 73% (n = 137) were female, 48.4% (n = 91) were married, and BMI ranged from 30 to 67 (mean 42.8; dp: 6.5). The BAI results indicated that 53% (n = 100) had minimal anxiety symptoms; of BDI that 52% (n = 97) presented symptoms of mild to severe depression; and ECAP, that 26% (n = 50) presented binge eating. Conclusion: Most of the patients were female, sedentary, young adults, with a history of family obesity and childhood obesity onset. Arterial Hypertension was the most common comorbidity among participants. Symptoms of anxiety and depression were present as well as binge eating. / Obesidade é uma doença crônica, multifatorial, que envolve questões psicológicas, genéticas e ambientais. Estudos têm sido realizados para analisar o perfil psicológico do paciente que será submetido à cirurgia bariátrica. Objetivo: Caracterizar pacientes com obesidade, candidatos à cirurgia bariátrica e identificar estilo de vida e a presença de sintomas de ansiedade, de depressão e de compulsão alimentar. Método: Estudo retrospectivo, realizado com base em dados de prontuários de pacientes em uma clínica particular do interior de São Paulo, candidatos à cirurgia bariátrica, avaliados pela psicologia, entre janeiro de 2010 e dezembro de 2015. A avaliação psicológica incluiu um questionário de dados pessoais, o Índice de Massa Corporal (IMC) fornecido pelo médico, o Inventário de Ansiedade de Beck (BAI), o Inventário de Depressão de Beck (BDI) e a Escala de Compulsão Alimentar Periódica (ECAP). Resultados: Foram analisados 188 prontuários. A idade variou de 16 a 65 anos (média 34,7; dp: 11,3), 73% (n=137) eram do sexo feminino, 48,4% (n=91) eram casados, e o IMC variou de 30 a 67 (média 42,8; dp: 6,5). Os resultados do BAI indicaram que 53% (n=100) tinham sintomas mínimos de ansiedade; do BDI que 52% (n=97) apresentaram sintomas de depressão de leve a severo; e do ECAP, que 26% (n=50) apresentaram compulsão alimentar. Conclusão: A maioria dos pacientes era do sexo feminino, sedentários, adultos jovens, com história de obesidade familiar e início da obesidade na infância. Hipertensão Arterial foi a comorbidade mais encontrada entre os participantes. Sintomas de ansiedade e depressão estiveram presentes, bem como compulsão alimentar.

A incidência global de obesidade tem aumentado nas últimas décadas e o consumo excessivo de alimentos industrializados ricos em açúcar e gordura está entre suas principais causas. Pesquisas recentes têm mostrado que estes alimentos desencadeiam mecanismos neurais e comportamentos semelhantes à adicção a drogas. Sabe-se que hábitos e preferências alimentares de adultos são adquiridos na infância, mas intervenções efetivas para prevenção da obesidade e suas comorbidades em crianças e adolescentes ainda constituem um desafio para a saúde pública. O objetivo do presente estudo foi avaliar os efeitos do consumo de dieta de cafeteria e retirada desta no comportamento alimentar, peso corporal, perfil lipídico, regularidade do ciclo estral, e comportamento de ansiedade e motivação. Ratas Wistar tiveram acesso limitado a itens alimentares de consumo humano de alta densidade energética por quatro semanas, ao final das quais foi realizada a retirada da dieta experimental de duas maneiras: para um grupo total e brusca, e para outro gradual durante uma semana. Após essa retirada, que simula dietas humanas de restrição, as ratas foram submetidas a testes comportamentais para avaliar ansiedade (labirinto em cruz elevado), e motivação para restabelecimento do acesso à dieta de cafeteria (modelo de restabelecimento). O grupo submetido à dieta de cafeteria apresentou maior consumo de gorduras totais e saturadas (p<0,05), e menor consumo de proteínas totais e fibras (p<0,05). Apesar disso, o consumo energético diário entre os grupos não atingiu diferença estatisticamente significativa, assim como o peso corporal das ratas. Após retirada da dieta de cafeteria, o consumo energético foi reduzido significativamente, porém, não acompanhado de perda de peso. Houve diferença significativa no perfil lipídico, sendo que ratas do grupo Cafeteria Sem Retirada tiveram os maiores valores de colesterol total e colesterol LDL (p<0,05). As ratas que sofreram retirada da dieta de cafeteria tiveram seus valores de colesterol similares às alimentadas somente com ração. A retirada completa da dieta de cafeteria e consequente diminuição do consumo energético foi responsável por irregularidade no ciclo estral das ratas. Os resultados no labirinto em cruz elevado não atingiram diferença estatisticamente significativa. O grupo Ração passou mais tempo no lado claro (p<0,05), conforme mostrado pelo teste de restabelecimento. A oferta limitada, de curto prazo, pós-desmame da dieta de cafeteria foi efetiva no desenvolvimento de compulsão alimentar em ratas adolescentes, porém sem evidências de vício alimentar. É provável que a obesidade seja condição necessária para o vício. Esperamos que os resultados deste estudo contribuam para o conhecimento da relação entre qualidade da dieta e comportamento alimentar e de adicção em ratas adolescentes. / The global incidence of obesity has steadily risen in the last decades and the excessive intake of industrialized food rich in sugar and fat is among its main causes. Recent researches have shown that these foods activate neural mechanism and behaviors similar to what is seen with drug addiction. It is known that adults eating habits and preferences are generally established during childhood, but effective preventive measures against obesity and its comorbities in children and adolescents are still a current public health challenge. The goal of the present study was to evaluate the effects of a cafeteria diet intake and withdrawal on eating behavior, body weight, lipid profile, estrous cycle regularity, and anxiety-like and motivational behavior. Female Wistar rats had limited access to energy-dense food items typically consumed by humans for four weeks, at the end of which, withdrawal from this diet occurred in one of two ways: for a group withdrawal was abrupt and total, and for another group, gradual for one week. After withdrawal, which attempts to mimic human restrictive dieting, we evaluated rats anxiety-like behavior through the elevated plus maze, and their motivation to reinstate access to the cafeteria diet through a reinstatement model. Daily energy intake between groups did not reach significant difference, as well as their body weight. Cafeteria fed rats did gain weight at a faster pace, and had a significant greater intake of total and saturated fat, and sodium (p<0.05); and a significantly lower intake of proteins and fibers (p<0.05). Groups that underwent withdrawal reduced their caloric intake significantly, but there was no weight loss. Rats with continuous access to cafeteria diet also had higher levels of total and LDL cholesterol (p<0.05), and rats from withdrawal groups had their cholesterol levels similar to chow-only animals. The total withdrawal of the cafeteria diet and resulting lower energy intake were also responsible for estrous cycle irregularities. There was no significant difference in rats performance in the EPM test. Chow only rats spent significantly more time in an aversive setting in order to gain access to an item from the cafeteria diet (p<0.05). The limited, short term, post-weaning offer of a cafeteria diet was effective in developing compulsive eating disorder, but without signs of food addiction. It is likely that obesity is precedent to the development of addiction. We expect that the results from this project contribute to the ongoing discussion and investigation on eating and addiction behavior in female adolescents rats.

A incidência global de obesidade tem aumentado nas últimas décadas e o consumo excessivo de alimentos industrializados ricos em açúcar e gordura está entre suas principais causas. Pesquisas recentes têm mostrado que estes alimentos desencadeiam mecanismos neurais e comportamentos semelhantes à adicção a drogas. Sabe-se que hábitos e preferências alimentares de adultos são adquiridos na infância, mas intervenções efetivas para prevenção da obesidade e suas comorbidades em crianças e adolescentes ainda constituem um desafio para a saúde pública. O objetivo do presente estudo foi avaliar os efeitos do consumo de dieta de cafeteria e retirada desta no comportamento alimentar, peso corporal, perfil lipídico, regularidade do ciclo estral, e comportamento de ansiedade e motivação. Ratas Wistar tiveram acesso limitado a itens alimentares de consumo humano de alta densidade energética por quatro semanas, ao final das quais foi realizada a retirada da dieta experimental de duas maneiras: para um grupo total e brusca, e para outro gradual durante uma semana. Após essa retirada, que simula dietas humanas de restrição, as ratas foram submetidas a testes comportamentais para avaliar ansiedade (labirinto em cruz elevado), e motivação para restabelecimento do acesso à dieta de cafeteria (modelo de restabelecimento). O grupo submetido à dieta de cafeteria apresentou maior consumo de gorduras totais e saturadas (p<0,05), e menor consumo de proteínas totais e fibras (p<0,05). Apesar disso, o consumo energético diário entre os grupos não atingiu diferença estatisticamente significativa, assim como o peso corporal das ratas. Após retirada da dieta de cafeteria, o consumo energético foi reduzido significativamente, porém, não acompanhado de perda de peso. Houve diferença significativa no perfil lipídico, sendo que ratas do grupo Cafeteria Sem Retirada tiveram os maiores valores de colesterol total e colesterol LDL (p<0,05). As ratas que sofreram retirada da dieta de cafeteria tiveram seus valores de colesterol similares às alimentadas somente com ração. A retirada completa da dieta de cafeteria e consequente diminuição do consumo energético foi responsável por irregularidade no ciclo estral das ratas. Os resultados no labirinto em cruz elevado não atingiram diferença estatisticamente significativa. O grupo Ração passou mais tempo no lado claro (p<0,05), conforme mostrado pelo teste de restabelecimento. A oferta limitada, de curto prazo, pós-desmame da dieta de cafeteria foi efetiva no desenvolvimento de compulsão alimentar em ratas adolescentes, porém sem evidências de vício alimentar. É provável que a obesidade seja condição necessária para o vício. Esperamos que os resultados deste estudo contribuam para o conhecimento da relação entre qualidade da dieta e comportamento alimentar e de adicção em ratas adolescentes. / The global incidence of obesity has steadily risen in the last decades and the excessive intake of industrialized food rich in sugar and fat is among its main causes. Recent researches have shown that these foods activate neural mechanism and behaviors similar to what is seen with drug addiction. It is known that adults eating habits and preferences are generally established during childhood, but effective preventive measures against obesity and its comorbities in children and adolescents are still a current public health challenge. The goal of the present study was to evaluate the effects of a cafeteria diet intake and withdrawal on eating behavior, body weight, lipid profile, estrous cycle regularity, and anxiety-like and motivational behavior. Female Wistar rats had limited access to energy-dense food items typically consumed by humans for four weeks, at the end of which, withdrawal from this diet occurred in one of two ways: for a group withdrawal was abrupt and total, and for another group, gradual for one week. After withdrawal, which attempts to mimic human restrictive dieting, we evaluated rats anxiety-like behavior through the elevated plus maze, and their motivation to reinstate access to the cafeteria diet through a reinstatement model. Daily energy intake between groups did not reach significant difference, as well as their body weight. Cafeteria fed rats did gain weight at a faster pace, and had a significant greater intake of total and saturated fat, and sodium (p<0.05); and a significantly lower intake of proteins and fibers (p<0.05). Groups that underwent withdrawal reduced their caloric intake significantly, but there was no weight loss. Rats with continuous access to cafeteria diet also had higher levels of total and LDL cholesterol (p<0.05), and rats from withdrawal groups had their cholesterol levels similar to chow-only animals. The total withdrawal of the cafeteria diet and resulting lower energy intake were also responsible for estrous cycle irregularities. There was no significant difference in rats performance in the EPM test. Chow only rats spent significantly more time in an aversive setting in order to gain access to an item from the cafeteria diet (p<0.05). The limited, short term, post-weaning offer of a cafeteria diet was effective in developing compulsive eating disorder, but without signs of food addiction. It is likely that obesity is precedent to the development of addiction. We expect that the results from this project contribute to the ongoing discussion and investigation on eating and addiction behavior in female adolescents rats.

Wenn die Familie in der Entstehung und Genesung einer Essstörung (Anorexie und Bulimie) entscheidend ist, wird sie auch in der Behandlung des essgestörten Kindes eine wesentliche Rolle spielen. In dieser Studie wurden Eltern-Kind-Therapiewochen im stationären Rahmen essgestörter Patientinnen untersucht. In einem Zwei-Gruppen-Studiendesign mit Messwiederholungen wurden Patientinnen, die gemeinsam mit ihren Eltern an der Therapiewoche teilnahmen, mit Klinikpatientinnen verglichen, die nicht an der Therapiewoche teilnahmen. Die Zuteilung auf die Untersuchungsgruppe erfolgte aus verschiedenen Gründen durch die Teilnehmer selbst. Mögliche Konfundierungen durch diese Selbstselektion, die die Ergebnisse zu Fragen der Wirksamkeit der Eltern-Kind-Therapiewochen beeinflussen könnten, wurden vorab durch Regressionsanalysen ermittelt, und in den Berechnungen statistisch kontrolliert. Die Evaluation der Therapiewoche ergab eine hohe Zufriedenheit und Erwartungserfüllung bei den Patientinnen und deren Eltern. Außerdem konnten signifikante Symptombesserungen innerhalb des kurzen Zeitraums von dieser einen Woche nachgewiesen werden. Innerhalb der Familien konnte eine hohe Übereinstimmung festgestellt werden, die sich aber nicht über die Zeit von unmittelbar vor bis nach dem Treatment bedeutsam verändert hat. Das Treatment scheint also nicht bestimmten Familien stärker zu helfen als anderen. Allerdings ließen sich bestimmte Prädiktoren finden, die dazu führten, dass bestimmte Patientinnen stärker von dem Treatment profitierten. Zu diesen Prädiktoren gehörten u.a. die Einflussnahme der Familien auf die Pat sowie das Profitieren der Mütter vom Treatment. Im Vergleich zur Kontrollgruppe nahmen die Patientinnen signifikant stärker an Gewicht zu, schafften es, ihr Ineffektivitätsgefühl von einem deutlich kränkeren Anfangswert bis auf die Anfangs-Belastungsstärke der Kontrollgruppe zu bessern und erkannten stärker die Mitverantwortung ihrer Familie an der Erkrankung. Insgesamt haben sich die Patientinnen während des Klinikaufenthaltes signifikant mit teils großen Effektstärken (im Mittel d = .96) in ihrer Symptomatik gebessert. Eine Halbjahres-Katamnese ergab auf Grund eines Rücklaufes von unter 25% nur wenig Aufschluss. Die Ergebnisse zeigen, wie bedeutsam das Einbeziehen der Familie auch in die stationäre Behandlung sein kann.

The first aim of this study was to develop a research based, integrated, secondary prevention programme, called the Weight Over-concern and Well-being (WOW) programme, for the reduction of Subclinical Eating Disorder (SED) symptoms, associated traits and negative mood states, and the promotion of psychological well-being (PWB) in female students. Consequently the second aim was to determine the effectiveness of the WOW-programme on its own, in comparison with a combined Tomatis Method of sound stimulation (Tomatis, 1990) and WOW-programme, regarding the reduction of SED-symptoms, associated traits and negative mood states; the promotion of PWB; and outcome maintenance. The last aim was to obtain a deeper understanding and "insiders' perspective" of the lived experience of SED, through an interpretative phenomenological inquiry (Smith & Osborn, 2003). The motivation for the current study is a need for research based, integrated, risk-protective, secondary prevention programmes from a social-developmental perspective for female university students (Garner, 2004; Phelps, Sapia, Nathanson & Nelson, 2000; Polivy & Herman, 2002), given their risk status (Edwards & Moldan, 2004; Senekal, Steyn, Mashego & Nel, 2001; Wassenaar, Le Grange, Winship & Lachenicht, 2000). Concurrently in-depth descriptions from an "insiders' perspective" on the lived experience of SED are non-existent and require interpretative phenomenological study (Brocki & Wearden, 2006). Consequently this thesis consists of three articles, namely: (i) Development of a secondary prevention programme for female university students with Subclinical Eating Disorder, (ii) A secondary prevention programme for female students with Subclinical Eating Disorder: a comparative evaluation; and (iii) Lived experiences of Subclinical Eating Disorder: female students' perceptions. The research context comprised Subclinical Eating Disorder, secondary prevention and Positive Psychology. The first article, Development of a secondary prevention programme for female university students with Subclinical Eating Disorder (Kirsten, Du Plessis & Du Toit, 2007a), is qualitative in nature, and narrates a process of participatory action research followed to develop the WOW-programme. This social process of knowledge construction, embedded in Social Constructivist theory (Koch, Selim & Kralik, 2002), gradually revealed best clinical practice, and in retrospect, evolved over four phases. Phase One comprised experiential learning based on personal experiences with SED as undergraduate student and interaction with "participant researchers" as scientist practitioner (Strieker, 2002), resulting in a provisional risk model of intervention. Phase Two, a formal pilot study (Du Plessis, Vermeulen & Kirsten, 2004), afforded an evaluation of ideas generated in Phase One through a three-group pre-post-test design. Outcomes of Phase Two informed Phase Three, an integration of prior learning with Positive Psychology theory and clinical practice, resulting in a risk-protective model of prevention. Theoretical assumptions previously constructed were integrated and operationalised during Phase Four, into the final 9-session WOW-programme. In conclusion the process of knowledge construction was rigorous, despite the small overall sample size (n=28), since data saturation occurred within that sample. Although the multitude of aims involved in each session of the WOW-programme could be seen as unrealistic, in some direct or indirect way, they were addressed by means of relevant interventions due to the integrative approach. Thus future refinement is essential. Finally, despite aforementioned concerns, the WOW-programme proved to be robust on its own in reducing SED-symptoms and associated traits and enhancing PWB, as described in the second article of this thesis. The second article, A secondary prevention programme for female students with Subclinical Eating Disorder: a comparative evaluation (Kirsten, Du Plessis & Du Toit, 2007b), describes the outcomes of the WOW-programme on its own, evaluated comparatively with a combined Tomatis sound stimulation and WOW-programme. In this article the research aims were to determine: (i) whether participation in the combined sound stimulation and WOW-programme (Group 1); and (ii) participation in a WOW-programme only (Group 2), would lead to statistically significant reductions in SED-symptoms, psychological traits associated with eating disorders and negative mood states, and enhancement of PWB; (iii) whether results of Groups 1 and 2 would exceed results of a non-intervention control group (Group 3) practically significantly; and (iv) whether programme outcomes for Groups 1 and 2 would be retained at four-month follow-up evaluation. A mixed method design (Creswell, 2003; Morse, 2003) was used, including a three-group pre-post-test (n=45) and multiple case study (n=30) design. Various questionnaires measuring SED-symptoms, associated traits, negative mood states and PWB were completed. Qualitative data were obtained by means of metaphor drawings, letters to and from the "SED-problem", focus group interviews, the researchers' reflective field notes and individual semi-structured feedback questionnaires (Morse, 2003). Participation in Groups 1 and 2 proved effective, since decreases in SED-symptoms, associated traits, most negative mood states, and increases in PWB differed practically significantly from the results of Group 3. Outcomes for Groups 1 and 2 were maintained at four-month follow-up evaluation. Qualitative findings provided depth, support and trustworthiness to quantitative findings in light of the small sample size, and highlighted the value of using a mixed method design in prevention programming. It was concluded that the WOW-programme on its own, was an effective secondary prevention programme, since it led to reduced SED-symptoms, associated psychological traits and enhanced PWB, with retention of gains at four-months follow-up evaluation. The combined programme involving Tomatis stimulation and WOW-intervention proved to be even more effective, thus the complimentary role of Tomatis stimulation was demonstrated. However, the cost-effectiveness and comparative brevity of the WOW-programme rendered it the programme of choice regarding individuals with SED. Findings showed that conceptually, pathogenic and salutogenic perspectives can be successfully combined into a risk-protective model of secondary prevention. Lastly, the WOW-programme may even prove useful as an enrichment programme for female students in general. The third article, Lived experiences of Subclinical Eating Disorder: female students' perceptions (Kirsten, Du Plessis & Du Toit, 2007c), provides a qualitative, in-depth perspective on the lived experience of SED of 30 white, undergraduate females, purposively sampled. In this interpretative phenomenological, multiple case study (Brocki & Wearden, 2006), Groups 1 and 2 of the aforementioned primary study in the second article were used, since they fitted the criteria of "good informants" and were able to answer the research question (Morse, 2003). Further sampling was deemed unnecessary since data saturation occurred within their written and verbal responses and no negative cases were found. Rich individual qualitative data, further clarified through focus groups, emerged from graphic colour representations of lived SED, explanatory written records and "correspondence" with and from their "SED problem" (Gilligan, 2000; Loock, Myburgh, & Poggenpoel, 2003; White & Epston, 1990). Four main categories, characterised by serious intra-, interpersonal, existential and body image concerns were subdivided into seven subcategories, namely: Personal Brokenness, Personal Shame, Perceived Personal Inadequacy and Enslavement, Existential Vacuum, Perceived Social Pressure, Perceived Social Isolation and Body-image Dysfunction. Results were indicative of underestimation of SED-severity, its comprehensive detrimental impact on participants' PWB and high risk for escalation into full-blown eating disorders. It was concluded that the lived experiences of SED depicted the severity of SED-symptoms; descriptions resonated well with most of their pre-programme mean scores; and their risk status and need for contextually and developmentally relevant secondary prevention programmes were highlighted by the findings. / Thesis (Ph.D. (Psychology))--North-West University, Potchefstroom Campus, 2008.

Most girls in Gopher Slough, Florida, worry about whether GSHS will win the next football game (they won't), when their boyfriends will take them muddin', and how many times they can sneak cigarettes behind the bleachers before they get thrown into in-school suspension. Libby Hoyer is not most girls. Instead, Libby is worried about her slipping grades, especially in Geometry, where she can barely keep her head up long enough to take the weekly quizzes. She's concerned about losing her friendship with her best (only) friend, Bobbi Jo, who's distracted with her own Aber-zombie boyfriend, and she's unsure of how to define her new relationship with Neil, a mysterious boy from her class who is not as carefree as he pretends to be. Libby is also troubled by the fact that she can't seem to remember her distant father, even though he only left five years ago. Everyone else, it seems, is worried about Libby's sporadic eating habits. If she continues to refuse to eat or to purge anything she's forced to eat, she might disappear. But Libby isn't afraid of disappearing. She's afraid of being seen.