Numerous studies have reported psychological benefits associated with the practice of values-based self-affirmation. However, there is little evidence regarding their clinical applicability. Many of the purported benefits of values-based self-affirmation are highly relevant to people with bulimia nervosa (BN). This study used a multiple case study design in order to investigate the effectiveness, underlying mechanisms and acceptability of a brief (three week) intervention focussing on the development and practice of values-based self-affirmations with people who have BN. Two participants were recruited from an Eating Disorders (ED) Service waiting list. They completed questionnaires measuring cognitions associated with ED, attitude towards change, self-esteem, self-compassion, body image acceptance, psychological flexibility, cognitive defusion, and SELF repertory grids over four time points. Following appointments qualitative data was collected, and on completion of the intervention participants were interviewed, regarding their experiences. Pre and post intervention behavioural measures of BN were also collected. The use of a personal values-based self-affirmation intervention was associated with reductions in behaviours associated with BN, enhanced attitude towards change and reduced discrepancy between self and ideal self. There was little convincing evidence that the intervention was associated with a reduction in cognitions associated with ED. A very small degree of change in a positive direction was observed in relation to self-esteem, self-compassion, body image acceptance, psychological flexibility and cognitive fusion. However, scores did not reflect Reliable Change in these processes. Overall, results appeared to be slightly better explained by theory underpinning Personal Construct Psychotherapy rather than Acceptance and Commitment Therapy. However, neither theoretical explanation fully accounted for the data. Participants generally found the intervention to be acceptable. The results add novel findings to the literature regarding the use of values-based self-affirmation within the treatment of BN. They suggest that a brief values-based self-affirmation intervention might be a useful adjunct to evidence based treatment of BN. However, the case study design that is utilised in this study limits the degree to which these results may be generalised and future research should explore this further.

Bakgrund: Anorexia är en ätstörning som främst drabbar unga kvinnor och som yttrar sig både fysiskt och psykiskt. Sjukdomen drabbar inte enbart den enskilda individen utan hela dess omgivning. Mötet med vården är viktigt för att underlätta tillfrisknandet för kvinnorna. Syfte: Syftet var att belysa unga kvinnors upplevelser av att leva med anorexia. Metod: En kvalitativ litteraturstudie baserad på fem självbiografier som analyserades med Lundman och Hällgren-Graneheims (2012) manifesta innehållsanalys. Resultat: Det framkom att anorexia medförde stora förändringar i kvinnornas liv. De upplevde anorexian som en inre röst som styrde över livet. Sociala relationer blev lidande som följd av att mat och vikt blev livets medelpunkt. I tillfrisknandet var vårdrelationerna och anhörigas stöd av stor vikt för att främja hälsan.  Slutsats: Anorexia är en komplex sjukdom där många faktorer påverkar behandlingsresultatet, inte minst patientens egen vilja att bli frisk. Alla möten och personer, exempelvis ett välfungerande teamarbete mellan professioner i vården har betydelse för att uppnå ett gott behandlingsresultat. Sjuksköterskan kan, genom att ge trygghet och vara en fast punkt, bli en viktig tillgång i behandlingen av unga kvinnor med anorexia. Även anhöriga har en avgörande roll för kvinnornas tillfrisknande då de både kan vara ett stöd och skapa motivation.

<p>Emotions guide the way individuals interact with the world, influencing nearly every psychological process from attention, to learning, to metacognition. Constructionist models of emotion posit that emotions arise out of combinations of more general psychological ingredients. These psychological ingredients, however, also form the building blocks of other affective responses such as subjective reactions to rewarding and social stimuli. Here, I propose a domain-general account of affective functioning; I contend that subjective responses to emotional, rewarding, and social stimuli all depend on common psychological and neural mechanisms. I support this hypothesis with three independent studies using both a basic science approach and a clinical approach. In the first study (Chapter 2) I demonstrate that the ventromedial prefrontal cortex (vmPFC), which has been implicated in encoding the value of primary, monetary, and social rewards, also encodes the hedonic value of emotional stimuli. In addition to showing that the mechanisms responsible for processing affective information are shared across reward and emotional processing, I also discuss the relevance of a domain-general constructionist account of affect for clinical disorders. In particular, I hypothesize that in anorexia nervosa (AN), affective disturbances should be manifest across responses to emotional, rewarding, and social stimuli (Chapter 3). In Chapter 4, I provide empirical evidence for this conclusion by demonstrating that when viewing social stimuli, women with a history of AN show disturbances in the insula, a brain region that is responsible for interoceptive and affective processing. This suggests that the interpersonal difficulties frequently observed in patients with AN may be due to biases in domain-general affective responses. In Chapter 5, I support this conclusion by showing that individual differences in harm avoidance in healthy women, women with a current diagnosis of AN, and women who have recovered from AN explain the relationship between disordered eating and social dysfunction. Collectively, these results indicate that subjective affective responses to rewarding, emotional, and social information all rely on common mechanisms as would be suggested by a domain-general theory of affect. Furthermore, the application of a constructionist domain-general account of affect can help to explain the fundamental nature of affective disturbances in psychiatric disorders such as AN.</p> / Dissertation

<p><strong>Bakgrund:</strong> Anorexia nervosa drabbar ca 1 procent av alla kvinnor och 0,1 procent av alla män innan 18 års ålder i Sverige. Patientgruppen återfinns i både allmänsjukvård och psykiatriska vårdavdelningar. Sjuksköterskan behöver redskap för att utveckla en vårdrelation till dessa patienter, då vårdrelationen är essentiell för att uppnå hälsa. <strong>Syfte:</strong> Att belysa de olika faktorer som påverkar vårdrelationen mellan sjuksköterska och patient med diagnosen anorexia nervosa. <strong>Metod:</strong> Studien är en systematisk litteraturstudie. Totalt åtta artiklar analyserades för att få fram ett resultat. <strong>Resultat:</strong> Vi kom fram till fyra kategorier som påverkade vårdrelationen. Dessa är bemötande, kunskap, föreställningar och kontroll. <strong>Slutsats:</strong> Vi kom fram till att en medvetenhet och kunskap om dessa faktorer hos sjuksköterskan bör leda till en förbättrad vårdrelation.</p>

This study hypothesized body weight and eating patterns to be important discriminators of psychological characteristics among eating disordered groups. A total of 146 bulimic and non-bulimic women from underweight (anorexic), normal weight, and overweight (obese) categories were examined. Based upon the theoretical and research literature reviewed, this study hypothesized locus of control, personal potency, self-esteem, and psychopathology to be central psychological characteristics in anorexia nervosa, bulimia, and obesity. These variables were measured by Rotter's Internal-External Locus of Control Scale, the Semantic Differential Potency Scale, Rosenberg's Self-Esteem Scale, and the Minnesota Multiphasic Personality Inventory, respectively. The relative importance of these variables in the disorders was also addressed. Results showed women in the eating disordered groups examined to demonstrate the following psychological characteristics: (1) Non-bulimic anorexics--an external locus of control, low self-esteem, and hysteria; (2) Bulimic anorexics--the greatest external locus of control, the lowest self-esteem, psychopathic deviance, hysteria, thought disorder, depression, a preoccupation with somatic concerns, and hypofemininity; (3) Normal weight bulimics--an external locus of control, low self-esteem, psychopathic deviance, hysteria, thought disorder, and depression; (4) Non-bulimic obese--low self-esteem; and (5) Bulimic obese--low self-esteem, an external locus of control, thought disorder and depression. The primary conclusion drawn from this study is that bulimia is a better predictor of the psychological characteristics than body weight. Bulimia, across all weight categories, was associated with an external locus of control, low self-esteem, psychopathic deviance, hysteria, thought disorder, and depression. That there was little variability in personality characteristics associated with bulimia across weight categories emphasized the stability of the symptom constellation associated with this disorder. This study supported the view of the normal weight bulimic as psychologically similar to the bulimic anorexic. This study also supported the stance that simple obesity does not represent a unitary psychological disorder.

No description available.

Background: Response to treatment in anorexia nervosa entails various challenges, including an increased risk of relapse and re-admission in those treated as inpatients. A better understanding of patients’ experiences is paramount to improve treatment acceptability and outcome. This qualitative study aimed to explore the lived experiences of adult female inpatients undergoing a specialist inpatient treatment programme for anorexia nervosa. Methods: Semi-structured interviews were carried out with 21 female participants (aged 18-41 years) with a diagnosis of anorexia nervosa, undergoing treatment in a specialist inpatient eating disorder unit. Data were analysed using interpretative phenomenological analysis (IPA). Results: Qualitative analysis highlighted 5 master themes which underpinned treatment experiences: (1) Shifts in control, (2) Experience of transition, (3) The importance of supportive staff relationships, (4) Sharing with peers and (5) Process of recovery and self-discovery. Conclusions: Overall, findings suggest patients experience a process of change and adjustment during inpatient treatment in relation to their levels of perceived control, attachment to the treatment environment and a sense of self-identity. Treatment experiences appear to be influenced by the development of supportive relationships and the provision of individualised care.

Research has described and many clinicians have reported the anorectic patient as socially disconnected, having a disembodied sense of self, perfectionist expectations, and inadequate and shameful feelings. The more intense the internal war, the more food-focused and self-defeating behavior ensues, thwarting one's ability to receive value, self-acceptance, and love. Addressing the anorexia phenomenon, this study considered, from a sociological perspective, the dynamics of attachment and shame. On the basis of 4 propositions and using a multi-method, case-replication design, attachment and shame patterns for 5 restrictive and 5 normal eaters were compared, as determined by scores from the Parental Bonding Instrument, Inventory of Parental and Peer Attachment, Internalized Shame Scale, and personal interviews. Analysis was progressive, as propositions were tested by pattern-matching steps of rating, comparing, and interpreting recurring responses to self-report and interview questions. All anorectics reported a dominant mother, with whom 4 were over attached and struggled ambivalently for autonomy, and a quiet, inexpressive father, whom 4 considered frequently absent or unavailable. As compared to normal eaters, anorectics' trust and communication scores were lower for both parents and peers. Generally, anorectics showed markedly higher internalized shame. Findings indicated that nonoptimal parental bonding patterns were related to shame. The maternal bonding pattern of affectionless control (high protection, low care) showed the highest shame score, although affectionate constraint (high protection, high care), the most frequently found pattern, also showed a high shame level. There were polarized differences between restrictive and normal eaters, especially in regards to self-hatred, low self-esteem, and suicide ideation. Anorectics also reported more inferiority and peer alienation. Other emergent findings were noted. A modification of a self-definition/relatedness illustration was suggested, as well as a model for the development of anorexia. Social implications, treatment suggestions, and future research recommendations were also presented.

Background: A topic more frequently discussed nowadays is orthorexia nervosa (ON), which is an atypical eating disorder where the person is obsessed with healthy eating to avoid illness and disease. Signs of ON often begin with a wish for getting rid of bad habits, such as eating meals containing a lot of sugar and fat. Eventually the person’s behaviour changes and eating healthy becomes an unhealthy obsession that takes over the everyday life. Recently, it has also been related to excessive training, especially in Swedish media. Furthermore, it has been shown that athletes are at higher risk for developing ON. However, there is insufficient research in this area, as well as the ON prevalence among adolescent girls and correlation between ON and body mass index adjusted for children and adolescents. To investigate this, as well as the correlation between ON and hand strength, which is used as an indicator of general muscle strength, is therefore of great importance.  Aim: The aim of this study was to compare ON prevalence among adolescent girls in seventh grade in a sports secondary school and adolescent girls in seventh grade in general secondary schools and investigate the correlation between ON and BMI and ON and hand strength.  Method: A total of 48 girls in seventh grade participated in the study: 28 girls from the sports secondary school and 20 girls from the general secondary schools. To investigate the ON prevalence the questionnaire ORTO-15 was used. To calculate BMI standing length and body weight was measured and thereafter adjusted to the cut-off points constructed by the International Obesity Task Force. Hand strength was registered with a hand grip dynamometer.  Results: There was no significant difference in ON prevalence between the girls in the sports secondary school and the general secondary schools. However, a majority of all girls had an indication of ON. Furthermore, a higher indication of ON had a small correlation with both a higher BMI and a higher muscle strength. Conclusion: More studies and better instruments are needed to further investigate ON prevalence among adolescent girls, as well as relationships between ON and BMI and ON and hand strength. Interesting to consider in further research is also how these variables evolve over time in persons with ON. / Malmö Youth Sport Study / Halmstad Youth Sport Study

Examensarbetet skildrar föräldrars upplevelser av att ha ett barn med Anorexia Nervosa. Föräldrarna har ett stort ansvar och en betydande roll under sjukdomstiden. Anorexia Nervosa har blivit en alltmer vanlig sjukdom som ofta drabbar flickor i tonåren och sjukdomen kännetecknas av en självsvält med en rädsla för att öka i vikt. Studien är litteraturbaserad. Nio vetenskapliga artiklar användes och analyserades i relation till syftet. Resultatet visar att föräldrarna upplevde att sjukdomen förändrade livssituationen. Äktenskapet blev drabbat och det beskrevs att det ofta fanns en oro för hur syskon påverkades. Stora delar av dygnet bestod av att se till att det drabbade barnet fick i sig näring. Föräldrar upplevde även en förändring av sitt egna liv då allt fokus låg på att hjälpa sitt barn att övervinna sin sjukdom. Frustration, oro och skuld var återkommande känslor som föräldrar upplevde i vardagen. Inledningsvis sökte föräldrarna information på egen hand för att få sina farhågor om sjukdomen bekräftade. Då de senare beslutade sig för att söka hjälp via vården upplevde ett flertal av föräldrarna att de blev dåligt bemötta av vårdpersonal. För att kunna hantera vardagen under sjukdomstiden beskrev föräldrar strategier som varit betydelsefulla för dem. Resultatet pekar på att föräldrar upplever ett behov av stöd under barnets sjukdomstid. Sjuksköterskan kan uppfylla föräldrars behov av stöd genom att bekräfta deras situation och inge ett hopp. Genom kunskap om föräldrars upplevelser kan sjuksköterskan utveckla sitt kompetensområde och öka kvalitén i omvårdnadsarbetet utifrån föräldrarnas behov. / Background Until the 80’s Anorexia Nervosa (AN) was a rare disease. With the influence from media and the growing ideal of how a human body should look like, AN is nowadays a more common disease. AN often have a negative effect on parents. Therefore, it is important that nurses and society gain an understanding of parents experiences of having a child with AN, and how it impact their lifes. Aim The aim of the study was to illuminate the experience of being a parent to a child with AN. Method This study is a literature review over qualitative scientific articles, which have been analyzed through a method of five steps according to Friberg. Results The results showed that AN has a negative impact on parents, both the personal life and family life. It also describes parents’ need for support. Parents experience many negative feelings as worrying, frustration and fear. They often had bad experiences of treatment from medical staff. Conclusion This study provides an understanding of parents’ feelings of having a child with AN. Parents have an important role for their children during their illness and on the road to recovery. If parents should be able to take the responsibility that comes with having a child with AN, they need support. Otherwise they can be a threat to their own health. This is something that the nurse should pay attention to.