Gunn Pettersen

The "double life" of bulimia: patients' experiences in daily life interactions.

This qualitative study, using interviews with 38 subjects, explored how and why they conceal bulimic symptoms and the understanding of concealing in terms of social interaction. A “double life” was described as a dichotomy between being active and outgoing versus performing shameful bulimic behaviors and constantly living with fear of stigmatization, and striving against exposure. Concealing was well planned to avoid such fear, and to preserve dignity. Bulimia may be understood as volitional exertion of interaction control, not just as a result of poor impulse regulation. Understanding the meaning of secrecy and “double life” may facilitate help seeking behavior and guide treatment.

Psychopathy in women: theoretical and clinical perspectives

Prior research on psychopathy has primarily focused on the problem in men. Only a few studies have examined whether psychopathy even exists in women, and if so, how the disorder manifests itself in them. This paper presents a narrative review of the literature on gender and psychopathy. We briefly discuss why this is an important topic for women and we discuss its causes. The concept of psychopathy is defined and related to the diagnostic systems. The discussion includes a presentation of diagnostic tools, including the Hare Psychology Checklist – Revised, which are examined in relationship to the importance of biological gender. While emphasizing the similarities as well as the differences between the sexes, we discuss the matters of prevalence, behavioral expressions, comorbidity, progression, and treatment of the disorder.

Eating disorders: challenges in the later phases of the recovery process: a qualitative study of patients' experiences.

Scand J Caring Sci; 2013; 27; 92-98 Eating disorders: challenges in the later phases of the recovery process Little is known about how patients experience the later recovery phases of eating disorders. The aim of this study was to describe such experiences using an explorative and descriptive design based on content analysis. Thirteen female patients participated in qualitative interviews. The analysis resulted in four main categories, that is, (i) realising negative consequences, (ii) searching for alternative coping, (iii) searching for normality and identity and (iv) accepting the losses. The categories represent normal psychological processes related to grief, commitment and reconciliation. Such processes may be functionally or dysfunctionally resolved. The clinical implication is that patients in the later recovery phases may need professional help or counselling to accomplish a functional resolving. While in the initial phases of illness and recovery, a focus is on controlling symptoms and the changing of overvalued ideas about weight and shape, therapy in the later recovery phases should focus on the psychological management of the challenges represented in the four categories resulting from the present study.

Male Experiences of Life After Recovery From an Eating Disorder

The aim of this study was to describe how former male patients perceive life after recovery from an eating disorder. A qualitative method with a phenomenographic approach was used to identify ways of experiencing recovery. Two descriptive categories were developed: body acceptance and self-worth. Six conceptions describe how recovered patients now relate in a balanced way to exercise and food, using strategies to avoid relapse. With a sense of self-acceptance and autonomy, they now appreciate their social life. Some perceive recovery as coping with remaining impulses to diet or exercise. Others experience themselves as totally free from the eating disorder.

Epidemiology of eating disorders part II: an update with a special reference to the DSM-5

The present article is the second one of three about the epidemiology of eating disorders. The first introductory article outlined basic epidemiological issues, approaches and concepts and provided a historical panorama of the epidemiology of eating disorders. The present paper presents an updated review about the incidence and prevalence of eating disorders and eating problems. A particular concern is to discuss the impact of using the DSM-5 for case definitions. Moreover, the current paper will discuss recent findings with respect to outcome distributions. Finally, advances within analytic epidemiology are discussed in terms of risk for onset and predictors of outcome and how recent evidence may increase the potentials for prevention or other social epidemiology strategies.

Violence affects physical and mental health differently: the general population based Tromsø study

This general population-based study examined associations between violence and mental health, musculoskeletal pain, and early disability pension. The prevalence and consequences of good vs. poor adjustment (resilience vs. vulnerability) following encounters with violence were also examined. Data were based on the sixth wave of the “Tromsø Study” (N = 12,981; 65.7% response rate, 53.4% women, M-age = 57.5 years, SD-age = 12.7 years). Self-reported data on psychological (threats) and physical violence (beaten/kicked), mental health (anxiety/depression), musculoskeletal pain (MSP), and granting of disability pension (DP) were collected. Men suffered more violent events during childhood than women did, and vice versa during adulthood. Psychological violence implied poorer mental health and slightly more MSP than physical violence. The risk of MSP was highest for violence occurring during childhood in women and during the last year for men. A dose-response relationship between an increasing number of violent encounters and poorer health was observed. About 58% of individuals reported no negative impact of violence (hence, resilience group), whereas 42% considered themselves as more vulnerable following encounters with violence. Regression analyses indicated comparable mental health but slightly more MSP in the resilience group compared to the unexposed group, whereas the vulnerable group had significantly worse health overall and a higher risk of early granting of DP. Resilience is not an all-or-nothing matter, as physical ailments may characterize individuals adapting well following encounters with violence.

Epidemiology of eating disorders, part I: introduction to the series and a historical panorama

The present article is the first of three about the epidemiology of eating disorders. This first introductory article provides an outline of basic epidemiological issues, approaches and concepts and a historical panorama of epidemiology within the field of eating disorders. The second article in this series will present an updated review while the third one will focus on the nature and prevalence of comorbidities and possible implications for epidemiological research. Moreover, the third paper will discuss the potentials for social epidemiology. Does epidemiological research provide the necessary and sufficient knowledge to initiate universal, indicative or selective prevention strategies? How may a possible diversified clinical picture affect such a potential?

Clinical confidence following an interprofessional educational program on eating disorders for health care professionals: a qualitative analysis

There are an increasing number of educational programs to improve clinical competence and skills to treat mental disorders. For complex disorders there is also a focus on improving the quality of interprofessional work. This paper reports on interprofessional outputs of an educational program on eating disorders. A total of 207 professionals who completed the program were requested to describe up to 12 possible scenarios depicted as realistic prospects for their future work within this field. Analyzing the scenarios resulted in three categories of describing the participants’ preferences: (1) interprofessional interventions and treatment; (2) the further development of competence; and (3) organization of the health care system. The findings showed that the participants were considering working across new lines in their current workplaces or crossing borders to new frontiers in the execution of competence. Our findings may be summarized into the concept of “clinical confidence.” This concept has so far been understood as some kind of personal trait, disposition, or attitude. The present findings add nuances to this concept in terms of state-dependent encouragement, engagement, and a potential to act and to cross professional borders in order to better treat complex mental disorders.

Towards a Comprehensive Model of Recovery

Most people with eating disorders do recover, but they do so according to changing diagnostic criteria and the many different definitions of recovery and the recovery process appearing in the literature. The definitions of recovery rest on various assumptions about the nature of eating disorders and the nature of “normality”, risk factor research as well as on targets for change and end points developed within specific therapeutic traditions.

Predicting interest in liposuction among women with eating problems: A population-based study

The purpose of this paper was to examine predictors of an interest in liposuction among women with eating problems. A questionnaire was sent to 3500 women aged 18-35 years, whereof 378 of 1861 responders screened positively on eating problems. Assessments included sociodemographic status, social network, physical exercise, attitudes towards cosmetic surgery, teasing history, body dysmorphic disorder-like symptoms, body image, self-esteem, personality, interpersonal attachment and emotional distress. Fifty-two percent reported an interest in liposuction, which was independently predicted by appearance orientation, appearance evaluation, being critical/quarrelsome, teasing history, wish for a better relationship with father, low education and being unmarried. Predictors differed somewhat from those previously found in the general population. Considering that our sample consisted of women with self-reported eating problems, the association between liposuction and eating behaviors should be further examined in a sample of patients with a formal eating disorder diagnosis.