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.

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.

A partir da problematização do conceito de Transtornos Alimentares, esta dissertação busca investigar a nossa relação com o corpo, colocando em discussão as práticas normativas que constituem nossos modos de vida. Diante de um certo padrão estético que associa o corpo com a beleza e a imagem de sucesso, pretendemos problematizar o contexto social no qual os Transtornos Alimentares vêm sendo produzidos. Para isso, utilizaremos como recorte a análise da anorexia e bulimia. De difícil tratamento e de grande morbidade, os sintomas dessa psicopatologia refletem uma preocupação excessiva com o peso, a imagem corporal e o medo de engordar. Nosso interesse é contribuir para essa discussão, saindo de uma perspectiva individualizante voltada para a jovem anorética e/ou bulímica e as interações disfuncionais do seu sistema familiar, passando a considerar os transtornos alimentares como um dispositivo que denuncia o extremismo na forma de pensar, sentir e experimentar o corpo em nossa sociedade. Assim, nosso objetivo é apresentar alguns subsídios que permitam deslocar essa questão do âmbito exclusivo da experiência individual para uma análise das práticas sociais de relação com o corpo que habitam a experiência contemporânea, entendendo os transtornos alimentares, na atualidade, como a exacerbação de um sintoma social. / Based on the problematization of the concept of eating disorders, this paper aims on the investigation of our relation with the body, discussing the normative practices that constitute our ways of life. From an esthetic standard that relates the body with the beauty and success, we intend to problematize the social context where the eating disorders have been produced. To achieve this objective, we base our study on the anorexia and bulimia analysis. The symptoms of this psychopathology of difficult treatment reflect an excessive worry about the weight, corporal image and of getting fatter. Our interest is to contribute to this discussion, leaving from an individual perspective focused on the anorectic and/or bulimic young and the dysfunctional interactions of his/her familiar system, shifting the focus to the eating disorders as a device that denunciates the extremism in the way of thinking, feeling and experiencing the body in our society. Therefore, our objective is to present some subsidies that allow us to dislocate this matter from the exclusive scope of individual experience to an analysis of the social practices of the relation with the body that resides the contemporary experience, considering the eating disorders in the present as the exacerbation of a social symptom.

A partir da problematização do conceito de Transtornos Alimentares, esta dissertação busca investigar a nossa relação com o corpo, colocando em discussão as práticas normativas que constituem nossos modos de vida. Diante de um certo padrão estético que associa o corpo com a beleza e a imagem de sucesso, pretendemos problematizar o contexto social no qual os Transtornos Alimentares vêm sendo produzidos. Para isso, utilizaremos como recorte a análise da anorexia e bulimia. De difícil tratamento e de grande morbidade, os sintomas dessa psicopatologia refletem uma preocupação excessiva com o peso, a imagem corporal e o medo de engordar. Nosso interesse é contribuir para essa discussão, saindo de uma perspectiva individualizante voltada para a jovem anorética e/ou bulímica e as interações disfuncionais do seu sistema familiar, passando a considerar os transtornos alimentares como um dispositivo que denuncia o extremismo na forma de pensar, sentir e experimentar o corpo em nossa sociedade. Assim, nosso objetivo é apresentar alguns subsídios que permitam deslocar essa questão do âmbito exclusivo da experiência individual para uma análise das práticas sociais de relação com o corpo que habitam a experiência contemporânea, entendendo os transtornos alimentares, na atualidade, como a exacerbação de um sintoma social. / Based on the problematization of the concept of eating disorders, this paper aims on the investigation of our relation with the body, discussing the normative practices that constitute our ways of life. From an esthetic standard that relates the body with the beauty and success, we intend to problematize the social context where the eating disorders have been produced. To achieve this objective, we base our study on the anorexia and bulimia analysis. The symptoms of this psychopathology of difficult treatment reflect an excessive worry about the weight, corporal image and of getting fatter. Our interest is to contribute to this discussion, leaving from an individual perspective focused on the anorectic and/or bulimic young and the dysfunctional interactions of his/her familiar system, shifting the focus to the eating disorders as a device that denunciates the extremism in the way of thinking, feeling and experiencing the body in our society. Therefore, our objective is to present some subsidies that allow us to dislocate this matter from the exclusive scope of individual experience to an analysis of the social practices of the relation with the body that resides the contemporary experience, considering the eating disorders in the present as the exacerbation of a social symptom.

A partir da problematização do conceito de Transtornos Alimentares, esta dissertação busca investigar a nossa relação com o corpo, colocando em discussão as práticas normativas que constituem nossos modos de vida. Diante de um certo padrão estético que associa o corpo com a beleza e a imagem de sucesso, pretendemos problematizar o contexto social no qual os Transtornos Alimentares vêm sendo produzidos. Para isso, utilizaremos como recorte a análise da anorexia e bulimia. De difícil tratamento e de grande morbidade, os sintomas dessa psicopatologia refletem uma preocupação excessiva com o peso, a imagem corporal e o medo de engordar. Nosso interesse é contribuir para essa discussão, saindo de uma perspectiva individualizante voltada para a jovem anorética e/ou bulímica e as interações disfuncionais do seu sistema familiar, passando a considerar os transtornos alimentares como um dispositivo que denuncia o extremismo na forma de pensar, sentir e experimentar o corpo em nossa sociedade. Assim, nosso objetivo é apresentar alguns subsídios que permitam deslocar essa questão do âmbito exclusivo da experiência individual para uma análise das práticas sociais de relação com o corpo que habitam a experiência contemporânea, entendendo os transtornos alimentares, na atualidade, como a exacerbação de um sintoma social. / Based on the problematization of the concept of eating disorders, this paper aims on the investigation of our relation with the body, discussing the normative practices that constitute our ways of life. From an esthetic standard that relates the body with the beauty and success, we intend to problematize the social context where the eating disorders have been produced. To achieve this objective, we base our study on the anorexia and bulimia analysis. The symptoms of this psychopathology of difficult treatment reflect an excessive worry about the weight, corporal image and of getting fatter. Our interest is to contribute to this discussion, leaving from an individual perspective focused on the anorectic and/or bulimic young and the dysfunctional interactions of his/her familiar system, shifting the focus to the eating disorders as a device that denunciates the extremism in the way of thinking, feeling and experiencing the body in our society. Therefore, our objective is to present some subsidies that allow us to dislocate this matter from the exclusive scope of individual experience to an analysis of the social practices of the relation with the body that resides the contemporary experience, considering the eating disorders in the present as the exacerbation of a social symptom.

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.

Eating disorders can lead to a negative impact on students' academic growth, nutrition and can cause death (Claude-Pierre, 1997; Manley, Rickson, & Standeven, 2000; Romeo, 1996). Early intervention by referring students to professional counseling might help counter these negative consequences. The teacher is in the position to assist students by providing health information, identifying those with problems, and intervening for a variety of dysfunctions that may include the eating disorders called anorexia nervosa and bulimia nervosa (Myers-Clark & Christopher, 2000). However teachers are in a difficult position to know when to address student concerns and judge what action to take (Ransley,1999). Teachers' engagement seems crucial (Smolak, Harris, Levine, & Shisslak, 2001) since eating disorders are being identified in younger children.The purpose of this study was to examine (a) the relationships of the theoretical constructs, attitude, subjective norm, and perceived behavioral control of the theory of planned behavior as predictors of behavioral intention (Ajzen & Fishbein, 1980) of middle school teachers to identify and refer suspected anorexia nervosa (AN) and/or bulimia nervosa (BN) students for professional help; and (b) the actual behavior of middle school teachers who reported having ever referred a student suspected of having AN and BN and those teachers who reported not having made such a referral. One hundred fourteen middle school teachers in Broward County, Florida volunteered to participate in the ex post facto research. Data were collected from a questionnaire. Multiple regression analysis revealed that the constructs of subjective norm (perception of what others think about one's performance of behavior combined with motivation to comply) and perceived behavioral control (perception regarding the extent of the difficulty of performing the behavior) were predictive of teachers' intent (likelihood of engaging in a behavior) to refer. However, the analysis revealed that attitude (overall positive or negative feeling with respect to performing the behavior) was not predictive of teachers' intent. Discriminant function analysis revealed that both intent and perceived behavioral control were predictive of group membership, either having referred a student suspected of having an eating disorder for counseling or not having made such a referral. Attitude and subjective norm were not predictive of group membership.

No description available.