A anorexia nervosa caracteriza-se pela recusa em manter um peso corporal na faixa mínima, um temor intenso de engordar, acompanhado por grave distorção da imagem corporal. Nas avaliações neuropsicológicas em pacientes com AN, além das complicações clínicas, também são identificadas alterações neurocomportamentais, déficits cognitivos, distorções da imagem corporal e por vezes alterações cognitivas leves. Este trabalho teve como objetivo geral, identificar as funções cognitivas de atenção, linguagem, habilidade visuo espacial e viso construtiva, funções executivas e memória, por meio da avaliação neuropsicológica, de pacientes com Anorexia Nervosa internadas, no início e após alta hospitalar. Teve como objetivos específicos, relacionar o perfil neuropsicológico aos aspectos sócio demográficos, número de internações prévias, aspectos diagnósticos de índice de massa corporal - IMC, distorção de imagem corporal, comorbidades, o tempo de doença, e traços de personalidade, de pacientes internadas, avaliando a evolução e/ou declínio no funcionamento cognitivo ao final da internação de pacientes com Anorexia Nervosa. Foram avaliadas 17 pacientes internadas, no início e na alta hospitalar, com protocolo de avaliação neuropsicológica, sintomas de depressão e ansiedade, e traços de personalidade. As pacientes não apresentaram melhora no desempenho na memória visual tardia, na atenção, nas habilidades visuo espaciais, visuo construtivas, e nas funções executivas, na flexibilidade cognitiva, controle inibitório, raciocínio verbal, formação de conceitos e planejamento, após a alta hospitalar. Os resultados apresentados nesta pesquisa, sugerem que pacientes com AN apresentam vários déficits neuropsicológicos na internação, e mesmo recebendo tratamento de forma intensiva para o transtorno alimentar e suas comorbidades, ainda apresentam déficits cognitivos, após a alta hospitalar. Sugere-se que esses déficits cognitivos possam fazer parte de um padrão de funcionamento associado aos sintomas psicopatológicos da doença, possam ser traços pré mórbidos, ou seja, existentes anterior à doença, bem como por se tratarem de pacientes graves, com um tempo de doença significativo. Propõe-se, portanto, a realização de reabilitação neuropsicológica a fim de compensar ou reduzir os déficits cognitivos, visando trazer uma melhora funcional que auxilie não só no funcionamento cognitivo, buscando remodelar a capacidade cerebral, reformulando suas conexões em função das necessidades, como nos aspectos emocionais, interação social, comportamento e aprendizagem / Anorexia nervosa is characterized by refusal to maintain a body weight at minimum range, an intense fear of gaining weight, accompanied by severe distortion of body image. In neuropsychological evaluations in patients with AN, in addition to clinical complications, are also identified neurobehavioral alterations, cognitive deficits, distortions of body image and sometimes mild cognitive impairment. This study aimed to identify the cognitive functions of attention, language, spatial ability and visuo constructive vision, executive function and memory, through neuropsychological assessment of patients with Anorexia Nervosa hospitalized at the beginning and after discharge. Its specific objectives relate profile neuropsychological socio demographics, number of previous admissions, diagnostic aspects of body mass index - BMI, body image distortion, comorbidities, disease duration, and personality traits of hospitalized patients, assessing the progress and / or decline in cognitive functioning at the end of hospitalization of patients with Anorexia Nervosa. 17 hospitalized patients were evaluated at baseline and at discharge, with neuropsychological evaluation protocol, symptoms of depression and anxiety, and personality traits. Patients showed no improvement in performance on delayed visual memory, attention, visuo in spatial skills, visuo constructive and executive functions, cognitive flexibility, inhibitory control, verbal reasoning, concept formation and planning, after hospital discharge. The results presented in this study suggest that patients with AN have several neuropsychological deficits on admission, and even being treated intensively for the eating disorder and its comorbidities, still have cognitive deficits after hospital discharge. It is suggested that these cognitive deficits may be part of an operation pattern associated with psychopathological symptoms of the disease may be pre morbid traits, or existing before the disease, and because they are seriously ill patients with a disease duration significant. Therefore, it is proposed to carry out neuropsychological rehabilitation in order to compensate or reduce cognitive deficits, aiming to bring a functional improvement that helps not only in cognitive functioning, seeking to reshape the brain capacity, revamping its connections to the needs, as in emotional, social interaction, behavior and learning

Introdução: A Anorexia Nervosa (AN) é um transtorno alimentar grave com altas taxas de morbimortalidade. O tratamento padrão para adolescentes com AN é baseado na inclusão da família e quanto mais precoce for o início em pacientes mais jovens, menor o risco de cronificação. Como o Family based treatment (FBT) pode não se adequar a todas as famílias ou pacientes, a Terapia Cognitivo-Comportamental (TCC) pode ser uma alternativa, porém ainda apresenta dados insuficientes na literatura cientifica. Objetivos: Desenvolver e avaliar os efeitos de um programa piloto de TCC em grupo no cuidado de adolescentes com AN. Desfechos primários: recuperação do peso, com base na adequação ou melhora do percentil esperado para a idade, de acordo com a curva de crescimento, e melhora dos sintomas, avaliada pelo Questionário de Exame para Transtornos Alimentares (Eating Disorder Examination Questionnaire [EDE-Q]). Desfechos secundários: funcionamento global avaliado pelo Children Global Assessment of Functioning Scale (CGAS), autoestima avaliada pelo Rosenberg Self-Esteem Scale (RSES), motivação medida através da Anorexia Nervosa Stages of Change Questionnaire (ANSOCQ) e satisfação de vida investigada pela Escala Multidimensional de Satisfação de Vida (ESMVA). Método: Ensaio clínico com 22 pacientes com AN (DSM IV) divididos em dois grupos: grupo intervenção (GI) (n=11; TCC, psiquiatria, nutrição e psicoeducativo familiar) e grupo controle GC (n=11; psiquiatria, nutrição e psicoeducativo familiar). Dados coletados antes dos grupos, ao final e seis meses após seu término. Resultados: Grupos homogêneos na linha de base, com exceção da medida de funcionamento global, superior no GI (p=0,024). Adesão de 91% no GI vs 54% no GC (Z=1,91; p=0,05). Todos os pacientes que concluíram o GI (n=10) e o GC (n=06) recuperaram peso e diminuíram sintomas de transtornos alimentares (TA). Embora apenas a subescala de restrição do EDE-Q tenha apresentado diferença estatisticamente significativa na comparação de desempenho entre GI e GC, no follow-up (W=6,19, p=0,012), a análise descritiva das médias de todas as escalas do EDE-Q é inferior no GI, o que indica menor severidade de sintomas de transtorno alimentar nesse grupo. Nas medidas de desfechos secundários os dois grupos produziram efeitos positivos entre o início e o final e entre o início e o follow-up. GI se diferenciou do GC por produzir efeitos entre o final e o follow-up, com melhora significativa nas medidas de autoestima, motivação e nas dimensões da escala de satisfação de vida relacionadas ao \"self\" e à \"não violência\", o que indica que continua produzindo efeitos, mesmo após o término do grupo, diminuindo o risco de recaídas. Conclusão: Os resultados sugerem que o programa de TCC em grupo foi aceito, produziu efeitos positivos e pode ser aplicado em adolescentes brasileiros com AN como coadjuvante no tratamento multidisciplinar para melhorar a adesão e evitar o risco de recaídas / Introduction: Anorexia Nervosa (AN) is a severe eating disorder with high morbimortality rates. The standard treatment for adolescents with anorexia nervosa always includes the family. The earlier treatment is initiated, higher the chances of avoiding chronicity. Family based treatment (FBT) might not work for all families and cognitive behavioral therapy (CBT) becomes an alternative. However the scientific reaserch investigating effectiveness of CBT for adolescents with anorexia nervosa still needs to develop further. Objective: To develop and evaluate the effects of a pilot program of CBT in group when treating adolescents with AN. Primary outcomes: weight gain based on adjustment to or improvement of percentile for their age according to the growth curve, and improvement in symptoms assessed through Eating Disorder Examination Questionnaire (EDE-Q). Secondary outcomes: Global functioning assessed through the Children Global Assessment of Functioning Scale (CGAS), self-esteem through the Rosenberg Self-Esteem Scale (RSES), motivation measure by the Anorexia Nervosa Stages of Change Questionnaire (ANSOCQ) and life satisfaction according to the Multidimensional Life Satisfaction Scale (ESMVA). Method: Clinical trial with 22 AN patients (DSM IV) divided into two groups: intervention group (IG) (n = 11; received CBT, psychiatric, nutritional and psychoeducational treatment) and control group (CG) (n = 11; received psychiatric, nutritional and psychoeducational treatment. Data collected at baseline, post-treatment and at a 6-month follow-up were analysed. Results: Homogeneous baseline groups, with the exception of the superior overall functioning measure in the IG (p=0,024). Adherence to treatment was 91% in the IG vs 54% in the CG (Z=1,91; p=0,05). All patients who completed the IG (n=10) and the CG (n=06) regained weight and decreased symptoms of eating disorders (ED). Although only the restriction subscale of the EDE-Q presented a statistically significant difference in the comparison between groups. At follow-up the descriptive analysis of the means of all scales of the EDE-Q were lower in the IG, which indicates a lower severity of eating disorder symptoms (W=6,19, p=0,012). The secondary outcomes showed that the two groups produced positive effects between baseline and post-treatment and between baseline and follow-up. IG differed from CG because it presented effects between the end and the follow-up, with significant improvement in measures of self-esteem, motivation and the dimensions \"self\" and \"non-violence\" at the life satisfaction scale, suggesting that IG might continue to show effects even after the end of treatment, possibly decreasing the risk of relapse. Conclusion: The results suggest that the program of group CBT was accepted, produced positive effects and can be applied in Brazilian adolescents with AN, as a coadjuvant in a multidisciplinary approach to improve adherence and avoid the risk of relapse

BIGHETTI, F. Tradução e validação do Eating Attitudes Test (EAT-26) em adolescentes do sexo feminino na cidade de Ribeirão Preto - SP. 2003. (número de páginas) Dissertação de Mestrado – Escola de Enfermagem de Ribeirão Preto da Universidade de São Paulo, Ribeirão Preto - SP. Os distúrbios da conduta alimentar, entre eles, a anorexia e bulimia nervosas, são síndromes psicossomáticas consideradas graves e de prognóstico ruim, caracterizadas pelo medo mórbido de engordar, levando à redução voluntária da ingestão alimentar com perda progressiva de peso, ingestão maciça de alimentos seguida de vômitos e uso abusivo de laxantes e/ou diuréticos. Desta forma, é de suma importância que o diagnóstico dessas doenças seja realizado precocemente, sendo que um dos instrumentos que auxiliam na triagem de possíveis doentes é o Eating Attitudes Test (EAT-26). O objetivo dessa pesquisa foi traduzir e validar o EAT-26 para a língua portuguesa em adolescentes do sexo feminino de nível sócio-econômico alto e, para tanto, o teste foi aplicado em 365 estudantes com idade entre 12 e 18 anos de duas escolas particulares de Ribeirão Preto-SP onde essas doenças ocorrem com maior incidência. Para desenvolver esta investigação, foram utilizados o referencial metodológico da tradução e retro-tradução do instrumento e métodos de análise estatística para avaliar a consistência interna dos itens do teste, isto é, a intensidade da concordância entre as versões traduzidas e sua confiabilidade. Além disso, caracterizou-se a amostra sob o ponto de vista nutricional e socioeconômico. Como resultados, a idade média das meninas foi de 14,2 anos com desvio-padrão de 1,7 anos e a maioria (81,7%) se mostrou eutrófica pelo índice de massa corporal. A avaliação socioeconômica revelou que praticamente todas as adolescentes recebem desconto na mensalidade escolar, moram em bairros de estrato socioeconômico médio-baixo e médio-alto, cujas famílias têm renda mensal entre 5 e 10 salários mínimos (28,8%) e 10 e 15 salários mínimos (7,5%). A contagem total média do EAT-26 foi de 19,8 pontos. A validação e confiabilidade de consistência interna do teste, representadas pelo alfa de Crombach 0,80, foram consideradas estatisticamente bastante satisfatórias por este valor estar próximo de 1,00. Concluímos assim, que o EAT-26 encontra-se em ótimas condições para ser aplicado em adolescentes, auxiliando no pré-diagnóstico de possíveis casos de transtornos alimentares. Além disso, políticas públicas devem reconhecer e valorizar a elaboração de programas informativos para adolescentes e outros grupos de risco para conhecimento mais amplo desses quadros, possibilitando a precocidade do tratamento e favorecendo o seu prognóstico. / The disturbances of eating conduct, among them, anorexia and nervous bulimia, are psychosomatical syndrome considered serious and of a bad prognostic, characterized by the morbid fear of getting fat, taking to a volunteer reduction of the food ingestion with a losing of weight, solid food ingestion followed by vomit and abusive use of laxatives and/or diuretics. This way, it is very important to obtain the diagnostic for these diseases precociously, and one of the instruments that helps the triagem of possible sick people is the Eating Attitude Test (EAT-26). The objective of this research was translating EAT-26 into Portuguese and validating it in female adolescents and so, the test was applied in 365 students from two private schools from Ribeirão Preto, ages between 12 and 18, the ages where these diseases most frequently occur. To develop this investigation, the metodological referencial of translation and retro-translation of the instrument were used, and statistical analysis method, to evaluate the internal consistence of the items of the test, this is, the intensity of the concordance between the translated versions and their confiability. Besides that, the sample was characterized under the nutritional and socioeconomical point of view. As results, the girls’ average age was 14,2 years old and most of them looked eutrofic by the body mass index. The socioeconomical evaluation revelead that practically all the adolescents receive a discount in their school payment, they live in neighborhoods of middle-low and middle-high socioeconomical standard of living, whose families have a month income between 5 and 15 minimum wages. The total average count of EAT-26 was 19,8 points. The validation and confiability of internal consistence of the test, represented by alfa of 0,80, were considered statistically satisfactory, because this value is next to 1,00. We can conclude that, the EAT-26 is in great conditions for being applied in adolescents helping the pre-diagnostic of possible cases of these diseases. Besides that, public policies must recognize and value the elaboration of informative programs for adolescents and other risk groups so that they can have more knowledge about these diseases, allowing the precocity of the treatment and favoring its prognostic.

INTRODUÇÃO: Anorexia nervosa (AN) e transtorno alimentar não especificado (TANE) são os transtornos alimentares (TA) mais frequentes na adolescência. Cursam com amenorreia e comprometimento da massa óssea. A Anorexia nervosa é responsável por anormalidades na mineralização óssea, que são bem conhecidas e descritas em mulheres adultas, porém menos documentadas em adolescentes. Está associada à diminuição da densidade mineral óssea (DMO) em adolescentes, comprometendo o pico de massa óssea e aumentando o risco de fraturas. OBJETIVO: Avaliar a densidade mineral óssea lombar (L1-L4) em adolescentes do sexo feminino com transtorno alimentar no momento do diagnóstico e a evolução após seis meses e um ano de tratamento. PACIENTES E MÉTODOS: Estudo prospectivo com 35 adolescentes do sexo feminino, portadoras de anorexia nervosa ou TANE acompanhadas ao longo de um ano em serviço especializado no tratamento de transtornos alimentares. As pacientes foram submetidas a tratamento psicológico, acompanhamento psiquiátrico e endocrinológico e terapia nutricional. A densitometria óssea da coluna lombar L1-L4 pelo método de DXA (absorciometria por dupla emissão de raios X) foi realizada no início do acompanhamento, após seis meses e um ano de tratamento. RESULTADOS: Das 35 pacientes avaliadas, inicialmente quatro pacientes apresentavam DO lombar L1-L4 com escore-Z < -2 DP (11,4 %), esta proporção diminuiu para duas (5,7%) após seis meses e um ano de tratamento. Houve um aumento significativo do peso, da altura e do IMC das pacientes quando comparados os valores iniciais com os valores com seis meses e um ano de tratamento (p<0,001). Houve progressão da idade óssea (p<0,001) e 70% das adolescentes com amenorreia secundária restabeleceram os ciclos menstruais durante o primeiro ano de tratamento. No entanto não houve diferença significativa do escore-Z da densitometria óssea lombar ao longo de um ano de seguimento (p = 0,76). CONCLUSÕES: Amenorreia e comprometimento do ganho de massa óssea foram complicações frequentes encontradas no estudo. Mais de dois terços das pacientes recuperaram a função menstrual, porém no seguimento de um ano, não houve uma melhora da massa óssea nesta amostra estudada. Considerando que a amostra estudada é pequena, novos estudos, incluindo um maior número de pacientes, são necessários para confirmar nossos achados / INTRODUCTION: Anorexia nervosa (AN) and eating disorder not otherwise specified (EDNOS) are the most frequent eating disorders in adolescence. Amenorrhea and bone loss are the main complications. Anorexia nervosa is responsible for abnormalities in bone mineralization, which are well known and described in adults, but less well documented in adolescents. It is associated with low bone mineral density (BMD) in adolescents, concerning for suboptimal peak bone mass and for an increased risk of fractures. OBJECTIVE: The aim of this study was to evaluate lumbar (L1-L4) bone mineral density in female adolescents with eating disorders in the beginning of the study, at six months and after one year of treatment. PATIENTS AND METHODS: This prospective study involved 35 female adolescents with anorexia nervosa or EDNOS who were treated at an eating disorders unit during one year. Patient treatment involved psychotherapy, medical intervention and nutritional rehabilitation. Lumbar (L1-L4) bone mineral density by DXA (dual energy X-ray absorptiometry) was performed on patients in the beginning of the study, at six months and after one year of treatment. RESULTS: In total, four patients presented lumbar BMD Z-score < -2 SD (11,4 %) in the beginning, and from those, only two patients (5,7%) presented Z-score < -2 after six months and one year of treatment. Patients had good nutritional recovery, with improvement of weight, length and BMI (p<0.001). There was improvement of bone age (p<0.001) and 70% of the adolescents with secondary amenorrhea had their menstrual cycles restored. However, the Z-score of lumbar BMD did not showed significant difference during one year of follow-up (p = 0.76). CONCLUSIONS: Amenorrhea and lack of bone mass gain were the main complications showed by this study. More than two thirds of the patients had restoration of menses, but there was no significant change in lumbar DXA with treatment. One limitation to this study was the short size of the sample. Further studies are needed to confirm these findings

Adolescentes do sexo feminino são a população mais frequentemente acometida pela anorexia nervosa (AN), com prevalência média de 2,5%, quando considerados critérios diagnósticos adaptados para esta faixa etária. A apresentação da AN em adolescentes é semelhante a de adultos, no entanto existem particularidades nos sintomas relacionadas ao nível de desenvolvimento cognitivo e emocional. A AN manifesta-se por: perda de peso, perturbações na forma de vivenciar a forma corporal, medo de engordar, restrição alimentar, comportamentos compensatórios e alterações menstruais. No Brasil, existem poucos recursos especializados para o tratamento da AN na adolescência e não foram realizados previamente estudos sistematizados sobre o tema. Estudos realizados em países de língua inglesa demonstram que o tratamento familiar (TF) apresenta bons resultados no tratamento da AN em adolescentes. Este estudo tem como objetivo a comparação de efetividade e de custos entre o TF e o tratamento multidisciplinar (TM). Inicialmente foi realizado um estudo piloto, incluindo nove pacientes de 11 a 17 anos do sexo feminino com diagnóstico de AN, tratadas com o TF. Posteriormente foi realizado um estudo comparativo, com os mesmos critérios de inclusão, com 20 pacientes que receberam o TF e foram comparadas com um grupo-controle histórico de 24 pacientes tratadas com TM. Foram calculados os custos diretos de ambas as modalidades de tratamento. Foram utilizadas como medidas de avaliação: DAWBA, CGAS, EDE-Q. No estudo piloto, as variáveis peso, IMC, EDE-Q, CGAS e amenorreia foram comparadas antes e após o TF. Foram observados resultados estatisticamente significativos em recuperação de peso e IMC (p=0,036). Foi observada melhora das demais variáveis após o tratamento, no entanto estes resultados não foram estatisticamente significativos. No estudo comparativo, 75% das pacientes que receberam o TF e 62,5% das pacientes que receberam TM apresentaram recuperação dos sintomas de AN, sem diferença estatisticamente significativa entre os grupos (p=0,378). Ambos os grupos apresentaram recuperação de peso, IMC e CGAS satisfatórias após o tratamento, sem diferença estatisticamente significativa entre os grupos. Tanto no TF quanto no TM, o maior tempo de sintomas antes do início do tratamento interferiu negativamente na resposta ao tratamento, reduzindo a chance de recuperação dos sintomas. Os custos diretos do TM são aproximadamente o dobro dos custos do TF. Tanto o TF quanto o TM demonstraram-se alternativas efetivas de tratamento para AN ! na população estudada. No entanto, o custo do TM é consideravelmente maior. O TF é uma alternativa de tratamento efetiva e economicamente viável, podendo ser disseminado para outros centros, possibilitando maior acesso a tratamento para adolescentes com AN / Female adolescents are the population most frequently affected by anorexia nervosa (AN), with average prevalence of 2.5% when adapted diagnostic criteria for this age group are considered. AN presentation in adolescents is similar to that of adults, but there are peculiarities in symptoms related to the level of cognitive and emotional development. AN main symptoms are: weight loss, disturbance in the way body shape is experienced, fear of becoming fat, dietary restriction, compensatory behaviors and menstrual abnormalities. In Brazil, there are few specialized resources for AN treatment in adolescence and no previous systematic studies have been conducted on this theme. In English-speaking countries, some studies have shown that the family-based treatment (FBT) is effective for adolescent AN. The aim of this study is to compare the effectiveness and the costs between the FBT and the multidisciplinary treatment (MT). Initially, a pilot study was conducted, including nine female patients from 11 to 17 years old diagnosed with AN, and treated with FBT. It was later performed a comparative study with the same inclusion criteria. Twenty patients who received FBT were compared with a historical control group of 24 patients treated with MT. We calculated the direct costs of both treatment modalities. The evaluation measures were: DAWBA, CGAS, EDE-Q. In the pilot study, the variables weight, BMI, EDE-Q, CGAS and amenorrhea were compared before and after FBT. We observed statistically significant results in weight and BMI recovery (p=0.036). The other variables have improved after treatment, although results were not statistically significant. In the comparative study, 75% of patients receiving FBT and 62.5% of patients receiving MT recovered from AN symptoms, no statistically significant difference was found between groups (p=0.378). Both groups have shown satisfactory recovery of weight, BMI and CGAS after treatment, with no statistical significant difference between groups. Both in the FBT and in the MT, the greater duration of symptoms before starting treatment had negative influence on treatment response, reducing the chance of recovery. The direct costs of the MT are approximately twice the cost of the FBT. Both the FBT and the MT were shown to be effective for AN treatment in the study population. However, the costs of MT are considerably higher. The FBT is an effective and economically viable treatment alternative and, can be disseminated to other centers, allowing ! greater treatment access for adolescents with AN

This autoethnographic study is an attempt to humanize the deviant behaviors and bodies of eating disordered and physically disabled persons in Western culture. The narratives included within are from the author’s own personal experiences as a heterosexual, eating disordered, disabled man. The narratives unfold chronologically in ways that explicate the transitions between identities and the onset and acceptance of each. The goal of this study is to unveil aspects of both eating disorders and disabilities as they relate to the locus of attention surrounding individuals that experience them. The researcher argues that the attention a deviant body draws from others may form the deviant body as a spectacle that can be either eagerly sought after, or reluctantly ascribed to, the individual that holds it.

The research concerning eating disorders and concomitant conditions shows that anorexia nervosa and bulimia nervosa are serious disorders that pose many diagnostic and therapeutic challenges to mental health and nutrition professionals. Most psychologists and nutritionists receive broad-based training that likely only superficially touches upon the importance of these diagnostic issues. Nevertheless, effective treatment planning requires that diagnostic issues and concomitant conditions be evaluated and incorporated into the diagnosis and treatment of eating disorders. Thus, there is an increasing need for specialized training in order to better evaluate and treat the complicated clinical picture presented by eating disorder clients. However to date, no systematic training package has been available to meet this training need. The present study was designed to fulfill this need by developing and initially validating an expert system-based, computer-assisted training program (ES-CAT). The initial validation involved comparing the mean overall post-test scores of 56 subjects. Subjects were randomly assigned to one of three groups [i.e., expert system-based, computer assisted trainer (ES-CAT), expert system-based trainer without computer guidance (ES), and traditional self-study (SS)]. The ES-CAT was shown to be more effective in training subjects in the diagnosis and treatment of eating disorders than either an expert system-based trainer without computer guidance (ES) or a traditional method of training (SS). Indeed, subjects who used the ES-CAT showed large gains in knowledge and mastery of the material at better than 85%. The addition of the computer-based guidance to the expert system trainer showed more significant gains (from a pre-test to post-test) of learning than the expert system trainer manual only. Furthermore, the expert system-based trainer without computer guidance (ES) was significantly more effective in training subjects than a traditional method of reading and studying textbooks (SS). The total training time of the ES-CAT was approximately 16 hours. Thus, a reasonable and effective means of training practitioners to better evaluate and treat the complicated clinical picture presented by eating disorder patients was developed and initially validated.

Bakgrund: Anorexia nervosa klassificeras som en ätstörning som går ut på en avsiktlig viktnedgång som beror på förändrad kroppsuppfattning. I vårdandet av AN är det av stor vikt att sjuksköterskan fokuserar på individen bakom ätstörningen och är stöttande. Sjuksköterskan spelar en stor roll i vårdrelationen till patienten. Syfte: Syftet var att beskriva sjuksköterskan och patienten med anorexia nervosa perspektiv på den terapeutiska vårdrelationen. Metod: En allmän litteraturöversikt. Data analyserades kvalitativt och kvalitetsgranskades. Efter kvalitetsgranskning användes nio artiklar till resultatet. Resultat: Resultat som framkom i studien var att en positiv terapeutisk vårdrelationen mellan sjuksköterska och patient kan vara avgörande för tillfrisknandet. De kategorier som framkom i resultatet var: vårdrelation, stöd och motivation, Sjuksköterskans delaktighet och negativ vårdrelation. Konklusion: Den terapeutisk vårdrelation var essentiell för patientens välmående och upplevelse av trygghet under behandling. Arbetar sjuksköterskan utifrån en terapeutisk utgångspunkt och att ge patienten stöd under behandling kan patienten uppleva motivation till att genomgå behandling. / Background: Anorexia nervosa classifies as an eating disorder that involves a intentional weight loss that is caused by changed body image. In the caring of anorexia nervosa, it is essential that the nurse pay focus to the individual behind the eating disorder, as well as being supporting. The nurse plays a major role in the nursing care relationship with the patient. Purpose: The aim of this study was to describe the nurse and patient with anorexia nervosa perspective on a therapeutic alliance. Method: General literature review. Data were analysed on qualitative steps and quality-tested based on five analysis steps. After quality review, nine articles used for the result. Result: The results that emerged from the study were that a positive therapeutic alliance between the nurse and patient can be decisive for recovery. The categories that emerged in the result were: nursing care, support and motivation, the nurse’s participation and negative care relationship. Conclusion: The therapeutic alliance was essential for the patient’s wellbeing and feeling of safety during treatment. If the nurse work from a therapeutic alliance and support the patient during treatment, the patient gains motivation to undergo treatment.

Includes bibliographical references (leaves [287]-309). Concerned with a group of people's everyday experiences of anorexia. The fieldwork on which the thesis is based was conducted in multiple sites (Vancouver, Edinburgh, and Adelaide) over 15 months (August 1998-October 1999) and deals with 44 women and 3 men ranging in ages from 14-55. Primarily concerned with the processes that propelled them towards and away from this phenomenon: the desires, connections, disconnections, practice, contested performances and struggles of becoming and unbecoming 'anorexic'.

The increasing prevalence and severity of anorexia among the young has led to an increase in the number of paediatric hospital admissions and readmissions over the years. Moreover there has been a significant drop in the age of patients being admitted to hospitals for treatment. Recognising the importance of the nursing role and the therapeutic relationship, this thesis reports specific detailed insights into the daily routine of nurses and adolescents with anorexia on a ward, which bases its re-feeding program on behaviour-modification principles (‘The Level System’), and the impact of this program on nurse-patient relationships. In many ways, life for an adolescent with anorexia on the ward mirrored life for a prison inmate. Within ‘The Level System’ program, nurses and doctors became analogous to prison officers. The subsequent themes reflect these similarities. The study provides positive recommendations for constructive change to improve the lives of both nurses and patients and further enhances lay and professional understandings of the nursing care for adolescents with anorexia within a behaviour-modification treatment program. / Doctor of Philosophy (PhD)