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.

Avaliar a Qualidade de Vida (QV) de pacientes com Transtornos Alimentares (TA), verificar diferenças entre os subtipos de TA e identificar dimensões de QV mais prejudicadas. Métodos: O instrumento de QV da Organização Mundial de Saúde (WHOQOL-100) foi respondido por 69 mulheres com TA (Anorexia Nervosa AN=34; Bulimia Nervosa BN=26 e Transtorno Alimentar Não Especificado TANE=9) e por 69 mulheres saudáveis. Utilizou-se a Entrevista Clínica Estruturada para Transtornos do Eixo I do DSM-IV (SCID) para a realização dos diagnósticos psiquiátricos. Resultados: Pacientes com TA apresentaram piores escores na QV geral e em todos os domínios (físico, psicológico, relações sociais, meio ambiente, nível de independência e espiritualidade), tendo sido o psicológico aquele com maior prejuízo. Não foram encontradas diferenças entre os subtipos de TA quanto aos prejuízos de QV. As comorbidades psiquiátricas encontradas com maiores prevalências foram os Transtornos do Humor, os Relacionados ao Uso de Álcool e Outras Substâncias e os de Ansiedade. Pacientes com AN e comorbidade com o Transtorno de Pânico apresentaram QV mais prejudicada que pacientes com AN sem Pânico. A maioria dos pacientes apresentava múltiplas comorbidades e histórico de diversas tentativas de suicídio. Conclusões: Pacientes com TA apresentam significativo prejuízo de QV em todos os domínios, em especial no psicológico, provavelmente em função das peculiaridades da psicopatologia alimentar, sem diferenças entre os subtipos de TA. Pacientes com AN e comorbidade com Pânico devem ser avaliados com mais critério / Purpose: To assess quality of life in patients with eating disorders, verify differences among eating disorder subtypes, and identify the domains of quality of life most affected by eating disorders. Methods: The World Health Organization quality-of-life assessment instrument (WHOQOL-100) was completed by 69 women with eating disorders (34 with anorexia nervosa, 26 with bulimia nervosa, and 9 with eating disorder not otherwise specified) and 69 healthy women. The Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I) was used for the diagnosis of psychiatric disorders. Results: Patients with eating disorders reported lower (worse) total quality- of-life scores and lower scores on all quality-of-life domains (physical, psychological, social relationships, environment, level of independence, and spirituality) compared with healthy patients, with the psychological domain being the most impaired. No significant differences in impairment of quality of life were found among eating disorders subtypes. The most prevalent psychiatric comorbidities were mood disorders, alcohol or substance abuse- related disorders, and anxiety disorders. Patients with anorexia nervosa and comorbid panic disorder had greater impairment in quality of life than patients with anorexia nervosa but no panic disorder. Most patients had multiple comorbidities and history of suicide attempts. Conclusions: Patients with eating disorders experience significantly greater impairment in quality of life on all domains, especially on the psychological domain, compared with healthy patients, probably because of peculiarities in eating disorders psychopathology. No difference in quality of life impairment was observed among eating disorders subtypes. Patients with anorexia nervosa and comorbid panic disorder should be carefully evaluated

Although several writers have emphasized the habit-like characteristics of bulimia nervosa, no study has investigated the extent to which bulimia responds to treatment specifically for habit disorders. Habit reversal is a general treatment plan which teaches individuals to regain lost awareness of all aspects of a habit. The habit is then interrupted at the earliest movement in the chain by a physically competing response. Habit reversal (Azrin & Nunn, 1973) has been effective in treating other habits (e.g., stuttering, tics, bruxism). In the present study, habit reversal was adapted for the treatment of bulimia. In response to newspaper advertisements, ten females (aged 21-26) with a minimum of two binges/week were included in the study. Bingeing and vomiting ranged from .5/day to 3.57/day during baseline; duration of the disorder ranged from one to eight years. In a multiple-baseline, across-subjects design, subjects were randomly assigned to begin treatment following 14 days of baseline data collection. Subjects self-monitored and reported daily binge eating, vomiting, fasting and laxative use. Daily social contacts and athletic activities were self-monitored and reported as secondary dependent measures. A blood chemistry analysis to assess metabolic functioning, the Beck Depression Inventory (BDI) and the Symptom Checklist 90-Revised (SCL-90R) were administered pre- and post-treatment. Two subjects reported cessation of bulimic episodes during baseline data collection apparently as a result of self-monitoring and frequent phone contacts. A rapid and substantial reduction in the target behaviors for the subjects who received treatment was reported following presentation of habit reversal (mean bingeing reduction=66.7%; mean vomiting reduction=52.0%). As reports of bingeing and vomiting decreased, concomitant increase in reported social contacts and athletic activities was observed in five of seven subjects without treatment for social behavior. Scores on the BDI and SCL-90 R did not change as a function of treatment. However, the self-reported frequency of binge eating during treatment correlated positively with psychopathology (r=.95, p

Anorexia nervosa (AN) is a chronic and complex psychosomatic condition, characterised by a primary drive to be thin and a refusal to maintain normal body weight. Only a minority of people diagnosed with AN ever become asymptomatic and more research has been called for to address high drop-out rates and lack of engagement in AN treatment services, in particular psychotherapeutic treatment. Prior studies have generally examined this problem in terms of patient mediated variables, such as attitudes and behaviours, with little focus on contextual factors. Research that has studied therapeutic engagement in the area of AN has yet to examine psychotherapeutic treatments-in-practice. Guided by this gap in the literature this thesis examines ways in which therapists engage with adolescents diagnosed with AN in naturally occurring psychotherapeutic interactions. A secondary and concurrent focus is to look at how the therapists’ underlying theoretical models are reflected in in situ practice. The data corpus comprises twenty-four therapy sessions recorded in an eating disorders programme based in a children’s hospital. In contrast to eating disorders treatment statistics reported in the literature, the programme has a low drop-out rate, zero mortality rate and good long-term patient outcomes, making it an especially suitable setting to examine engagement. Drawing on methods from discursive psychology (DP) and conversation analysis (CA), a number of interactional practices are found which show how the key principles of engagement and neutrality are brought off, or achieved as such in turn-by-turn interaction. Central to the analysis, is the recurrent production of patients’ bodily states and conduct as delicate items. As these topics are also the primary focus of the institutional setting, the analysis shows how practices such as perspective display series and dispositional management allow delicately marked institutional tasks to be carried out. The analysis also examines how patients’ bodies and conduct are embedded in, and constituted as problematic in the interactions. Regularities, such as agentic repositioning in accounts, demonstrate the co-production of patients as psychologically compliant with treatment while physically non-compliant. This thesis contributes to work in applied CA concerning links between theoretical models and interactional practices by demonstrating naturally occurring regularities that describe key guiding principles of the eating disorders programme. It also builds on work in DP concerning examinations of the body and embodiment, by showing how patients’ physical bodies are an integrated feature of the interactions. Finally, this thesis has implications for a clinical audience in terms of extending therapists’ awareness of how engagement with patients is constituted interactionally, which also contributes to wider AN literature on ‘resistance’ to therapy.

This thesis aimed to examine the functioning of families with a sufferer of Anorexia Nervosa (AN), using self-report measures and a direct observation family discussion task. Researchers and clinicians have long been interested in the interactional patterns of these sufferers within the family unit, although few have furthered our understanding of the interplay between family functioning, cohesion and emotional expression and issues such as control, by directly examining these interactions. The construct of control has been another area of interest in recent research, although how it is constructed and operates within this disorder remains unclear and ambiguous. Thus the purpose of this research was to expand the study of adolescents suffering Anorexia Nervosa who still resided within the family unit, from merely studying self-report measures and retrospective surveys of recovery, to include a direct examination of sufferers and their families at the time of the disorder. Participants included 16 female sufferers of Anorexia Nervosa and their parents, 17 drug and alcohol sufferers, and 18 non-clinic families. Both parents and their daughters completed self-report inventories assessing their clinical status as well as family functioning and marital happiness. In addition, family members participated in a series of family discussion tasks which were coded for the dimensions of autonomy, cohesiveness, avoidance and control. In Study 1 (Chapter 7), the self-report measures of the anorexic families were examined specifically in relation to the construct of control acting as a mediating variable between level of dysfunction and severity of the disorder. Consistent with previous research, levels of marital happiness and family cohesion influenced the severity level of the daughter's Anorexia Nervosa. This study also explored the construct of control within the family system and found that the more moral-religious emphasis in the family, the more concerned the daughter was with her weight. At the same time daughters were reporting higher levels of moral-religious emphasis, they were reporting higher levels of self-control. The daughters in this study appeared to be inconsistent in their behavioural responses. The daughters' weight concern increased with their own reported levels of moral-religious emphasis in the family. However, as this emphasis increased, so too did their control scores. It was supposed that conflict may be created in a family when strong religious and/or strong moral values are emphasized, particularly when one of the family members suffers AN. This issue is discussed in depth. Study 2 sought to examine these variables further by using a direct observation family discussion task to compare an independent observer's ratings to the family's ratings of the discussion, across the three groups. The study examined the daughters' and mothers' perceptions and compared significant results to the observer's ratings. This study highlighted that the mothers of sufferers appeared not to be concerned about their own bodies and weight, and not distressed when discussing with their daughters the issues of control in the areas of family, body, school and friends. Furthermore, the anorexic daughters presented as more sad and anxious than the two other groups and indicated that their parents had more control over their bodies than they did themselves. Finally, for the majority of participating families, the fathers were absent and this issue is explored.

This study examined the effectiveness of a systemic cybernetic counselling approach with 3 females with bulimia nervosa. Bulimia nervosa is a relatively recent diagnosed condition (1980). Thus, little is known about the efficacy of different treatment approaches. The systemic cybernetic counselling approach (White; de Shazer) which informs family therapy represents a potentially powerful form of treatment in that it allows a complex construction of the problem. The research design employed a multiple (3) single case study approach with embedded units of analyses. The 3 women, aged 17 to 27, were seen over a 2-3 month period for 4-8 one hour sessions. Predicted patterns of non-equivalent dependent variables were compared with empirically based patterns over time. Continuous (including pre-, post-treatment and long-term follow up) assessment of frequency of bingeing/purging was established as well as ratings on other dependent variables - psychometric measures (Eating Disorders Inventory, Beck Depression Inventory, Coopersmith Self Esteem Inventory), affective self reports and reports by others. Results show that all three clients eliminated bingeing/purging by post-treatment. Two clients maintained this improvement on all dependent measures at long-term follow up. The most marked improvements were associated with the least severe pre-treatment scores. In the case where the whole family attended counselling sessions, the number of sessions was reduced. On the basis of the results, systemic cybernetic counselling procedures hold promise for the successful treatment of bulimia nervosa.

<p><strong>Bakgrund:</strong> Anorexia nervosa är en allvarlig sjukdom som påverkar hela familjen. Familjemedlemmar tar oftast på sig skulden av sjukdomen, vilket leder till psykisk ohälsa. <strong>Syftet:</strong><em> </em>Var att belysa anhörigas behov av stöd när en familjemedlem drabbats av anorexia nervosa. <strong>Metod:</strong><em> </em>En systematisk litteraturstudie. Litteratursökningen gjordes i databaserna PubMed, PsycInfo och Cinahl. Av de 13 artiklar som ingick i studien gjordes en analys av resultatet i artiklarna. <strong>Resultat:</strong> För de anhöriga var det en mycket påfrestande situation att vårda den sjuke familjemedlemmen. De hade många obemötta behov som exempelvis brist på information om sjukdomen, bristande kommunikation med de professionella, behov av stöd från sjukvården och önskan om att få träffa andra i liknande situation<strong>. Slutsats:</strong> Anorexia är en svår sjukdom som tar mycket på anhörigas krafter. Därför behövs lättillgängligt stöd som information om sjukdomen samt råd och guidning i omhändertagandet.</p>

<p>Bakgrund: Anorexia Nervosa (AN) är en allvarlig sjukdom som påverkar hela familjen. Den sjuke är ofta medveten om att hon skadar hela familjen men är oförmögen att rätta till det. Då orsaken till AN är okänd finns heller ingen konsensus om vilken behandling som är den rätta, men flertalet forskare anser att familjen har stor betydelse i behandlingen. Syftet med denna litteraturstudie var att belysa</p><p>föräldrars upplevelser av att ha ett barn med AN. Metoden* var en systematisk litteraturstudie. Litteratursökning gjordes i databaserna, Pubmed, Chinal och PsychInfo. Av funnen litteratur gjordes innehållsanalyser som ledde till 3 teman. Resultatet visade att det var mycket krävande att vara förälder till ett barn med AN</p><p>samt att behovet av stöd var stort och föräldrar uttryckte bland annat stor besvikelse på hälso- och sjukvårdens bemötande. I brist på stöd och information var det många föräldrar som skuldbelade sig själva för barnets sjukdom. Till slut kretsade hela familjens liv kring sjukdomen och familjens sociala liv inskränks eller till och med upphör. Även syskon påverkades och de påverkade sjukdomen i olika riktningar. Vår slutsats är att föräldrar är i stort behov av information och stöd, vilket de idag upplever vara brist av. Detta är något som både vårdcentraler och sjukhus måste bli bättre på för att främja hälsa för föräldrar med barn med anorexia.</p>

<p>Syftet med denna studie var att undersöka kvinnors upplevda erfarenheter och uppfattningar av sambandet mellan personlighet, träning och kroppsuppfattning, varje faktor för sig, och utvecklandet av ätstörningar, med fokus på anorexia nervosa. Åtta kvinnor mellan 18- 24 år intervjuades utifrån en semistrukturerad intervjuguide. Intervjuerna analyserades utifrån en induktiv analysmetod. Ur analysmetoden framstod tre kategorier: personlighetsdrag, träning och kroppsuppfattning. Resultaten visade att majoriteten av informanterna hade gemensamma personlighetsdrag såsom perfektionism, hög självkontroll och låg självkänsla vilket är i enlighet med tidigare forskning. Samtliga informanter upplevde att träning hade en central roll i deras liv och de flesta av informanterna hade en negativ kroppsuppfattning. Önskvärt för framtiden vore ett kontinuerligt samarbete mellan den kliniska verksamheten och forskningen. </p><p>Möjligheterna som skapas av att dela erfarenheter och kunskap, skulle vara av stor betydelse för den långsiktiga forskningen och för de personer som drabbas av en ätstörning.</p>

Bakgrund: Anorexia Nervosa (AN) är en allvarlig sjukdom som påverkar hela familjen. Den sjuke är ofta medveten om att hon skadar hela familjen men är oförmögen att rätta till det. Då orsaken till AN är okänd finns heller ingen konsensus om vilken behandling som är den rätta, men flertalet forskare anser att familjen har stor betydelse i behandlingen. Syftet med denna litteraturstudie var att belysa föräldrars upplevelser av att ha ett barn med AN. Metoden* var en systematisk litteraturstudie. Litteratursökning gjordes i databaserna, Pubmed, Chinal och PsychInfo. Av funnen litteratur gjordes innehållsanalyser som ledde till 3 teman. Resultatet visade att det var mycket krävande att vara förälder till ett barn med AN samt att behovet av stöd var stort och föräldrar uttryckte bland annat stor besvikelse på hälso- och sjukvårdens bemötande. I brist på stöd och information var det många föräldrar som skuldbelade sig själva för barnets sjukdom. Till slut kretsade hela familjens liv kring sjukdomen och familjens sociala liv inskränks eller till och med upphör. Även syskon påverkades och de påverkade sjukdomen i olika riktningar. Vår slutsats är att föräldrar är i stort behov av information och stöd, vilket de idag upplever vara brist av. Detta är något som både vårdcentraler och sjukhus måste bli bättre på för att främja hälsa för föräldrar med barn med anorexia.