Public view removed at the authors request. 16/07/2006 / The daily experience of anorexia nervosa sufferers has not previously been studied and yet it is fundamental to understanding anorexia nervosa. This study examined and compared the daily experiences of anorexia nervosa patients and control participants in terms of sense of self, mood states and flow states. Flow is characterised by undivided concentration and interest in an activity for intrinsic benefits. Flow is not always desirable, as some ways of experiencing it may be harmful to the individual and society. Anorexia nervosa participants were recruited from hospitals and private practices of clinicians specialising in the treatment of anorexia nervosa. Exclusion criteria included male gender, chronic anorexia nervosa, drug abuse, and current participation in an inpatient program. Anorexia nervosa participants completed a series of questionnaires at baseline, 3-6 month follow-up and 7-12 month follow-up (stage one, two and three respectively). The questionnaires were designed to measure the severity of their eating disorder. Anorexia nervosa and control group participants completed Experience Sampling Forms (ESF) and a Repertory Grid at baseline and 3-6 months. The ESFs were completed each time a pager was activated. The pager was activated seven times a day, for four days at random times between 8.00am and 10.00pm. The pager signals were a minimum of two hours apart. The Repertory Grid consisted of 23 constructs and 13 elements provided to the participant. Thirty-one anorexia nervosa sufferers and thirty-two control participants completed stage one and eighteen anorexia nervosa sufferers and twenty-seven control group participants completed stage two of the study. Eighteen anorexia nervosa sufferers completed stage three of the study. Control participants were not required to participate in stage three. There was no difference in the severity of anorexia nervosa between completers and drop-outs The analysis of the ESFs at stage one indicated that the anorexia nervosa group participants did not spend more time alone at home or more time alone in any situation than the control group. For both groups, being alone had a negative influence on mood state, but had no effect on sense of self. The anorexia nervosa group felt lonelier and less sociable than the control group. The mood state and sense of self for the anorexia nervosa group was significantly lower over all the ESFs when compared to the control group. They were also more self-critical, experienced higher levels of guilt, were less able to live up to their own expectations, and were less satisfied with their performance in the activity they were doing. The anorexia nervosa group experienced less flow states than the control group at stage one. There was an improvement in mood state, sense of self and self-criticism for the anorexia nervosa group when they were in a flow state compared to when they were not in a flow state. There was an improvement in mood state, sense of self, guilt and self-criticism for the control group when they experienced flow, however these differences were not significant. The anorexia nervosa group had a more positive mood state and sense of self at stage two when compared to stage one. Correspondingly, there was a trend towards a reduced severity of the disorder indicated by a significant improvement on some of the psychological tests (EAT, REDS, BDI, DT). There was also a significant improvement in BMI. However, there was a significant decline in the amount of flow of anorexia nervosa participants experienced at stage two when compared to stage one. This result may be attributed to the significant decline in the response rate on ESFs in the second stage of the study for both the anorexia nervosa and control groups. Anorexia nervosa non-responders at stage two reported more severe symptoms of anorexia nervosa than anorexia nervosa responders, although this was a trend and reached significance only on minor indicators of eating disorder severity. The identification of a factor that predicted severity over a six-month period was not possible. The repertory grid analysis showed that the construct system of the anorexia nervosa participants was tighter and less complex than that of the control group. The anorexia nervosa group construed themselves as dissimilar from the way they would like to be in any context. The control group construed themselves as similar to the way they would like to be when they were alone, but as dissimilar from the way they would like to be when they were with other people. While the most salient element for both the anorexia nervosa and control groups was 'alone at home', it appears that the controls use this time for goal-directed activities. In contrast, this time was dominated by fear of losing control for the anorexia nervosa group. Although there was a trend towards a decrease in the amount of variance accounted for by the first component for the anorexia nervosa group at stage two compared to stage one, the interpretation of this result was complicated by mixed result of the control group. The anorexia nervosa groups' daily experience of life was bleak when compared to the daily experience of the control group, except for periods when the anorexia nervosa participants experienced a flow state. DeVries (1992) has documented the success of therapeutic interventions that involve the identification and replication of activities that resulted in a flow state. This investigation suggests that a similar result may be possible in the treatment of anorexia nervosa.
| Identifer | oai:union.ndltd.org:ADTP/220805 |
| Date | January 2001 |
| Creators | Scicluna, Helen |
| Publisher | University of Sydney. Psychological Medicine |
| Source Sets | Australiasian Digital Theses Program |
| Language | English, en_AU |
| Detected Language | English |
| Rights | Copyright Scicluna, Helen;http://www.library.usyd.edu.au/copyright.html |
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