Joyce L. C. Ma

Family themes of food refusal: disciplining the body and punishing the family.

A problematic issue in studying anorexia nervosa (AN) has been the absence of a qualitative study that probes the deep meanings of food refusal. We attempt to close this gap by studying the family meanings of food refusal by a single case study of a family in Hong Kong with an AN daughter. Eight videotapes of family therapy sessions, each lasting 90 minutes, were intensively reviewed, transcribed verbatim, and content analyzed. Two family themes of food refusal were discerned: the AN daughter disciplined her body and punished her family. The conclusions imply a need to revisit the Chinese gender role expectation in understanding AN patients and their families.

Family meaning of self-starvation: themes discerned in family treatment in Hong Kong

This study aims to identify themes from the treatment of Chinese families with an adolescent or an adult member suffering from anorexia nervosa (AN), through a multiple case study. This study reveals that self-starvation may be regarded as a cultural metaphor. Four major themes emerged at the family level: self-starvation as an expression of love and control, coalition of the AN daughter with the mother, family loyalty, and the powerlessness and helplessness of the mother. The themes identified are narrative accounts of the Hong Kong Chinese families, rather than causal explanations proposed by Western literature. The emerging themes are believed to be constructed and legitimized by traditional Chinese cultural values, with females being subordinated to and dependent on males and the self being subjugated to or sacrificed for the collective. Treatment implications are discussed.

Perceived Family Functioning and Family Resources of Hong Kong Families: Implications for Social Work Practice.

This article reports the results of a telephone survey (n = 1,015 respondents) that aims to identify the perceived general family functioning and family resources of Hong Kong Chinese families and their linkage to each other in a rapidly transforming society. The perceived general family functioning of the respondents was average, and the five types of family resources—time, income, human capital, psychological capital, and social capital—of the respondents ranged from average to good. The following family resource domains, in descending order, have accounted for significant variance in perceived general family functioning: income, time spent with family, stress coping efficacy, religion, and satisfaction with the living environment. Our findings provide empirical support for policy formulation and social work practice.

Family Engagement in Children with Mental Health Needs in a Chinese Context: A Dream or Reality?

Exploratory and qualitative in nature, this study aimed to identify the subjective experiences of Chinese parents with a child suspected of or diagnosed with attention deficit hyperactivity disorder (ADHD), in problem identification and management of the child, and to explore if the educational and mental health professionals have actively involved the parents in the decision-making process. A total of 24 parents/caregivers participated in this study. Data were collected through focus-group interviews and in-depth family interviews. Emerging from the data were seven major themes capturing the Chinese parents/caregivers’ experience, with three themes in problem identification and four in helping the child. Implications of this study on our service development are discussed.

Applicability of Family Therapy for Chinese Children and Adolescents Suffering from Anorexia Nervosa in a Chinese Context: A Preliminary Study

ABSTRACT This article presents the results of a preliminary study that assesses the applicability of family therapy for Chinese adolescents suffering from anorexia nervosa in Hong Kong, an area that had never been studied in the past. A total of 27 Chinese emaciated children and adolescents received family therapy and conventional psychiatric treatment from the university-based family treatment center, in collaboration with the psychiatric unit of the university hospital. The treatment outcome was evaluated by changes in body weight, body mass index, symptoms associated with the disorder, level of psychological distress, marital quality of parents, and perceived family functioning at three different phases, namely, at the pretreatment phase, immediately upon the completion of treatment, and 6 months after treatment. The results of this study have shown that family therapy combined with conventional psychiatric treatment was effective in restoring body weight, increasing the body mass index, and recovering menstruation. Six months after treatment, patients were clinically no longer symptomatic in Drive for Thinness and Perfectionism; six psychological dimensions of the Symptoms Checklist-90 (R) have changed from a dysfunctional range to a functional range; and the fathers perceived significant improvement in dyadic consensus. However, changes of perceived family functioning 6 months after treatment were statistically insignificant, suggesting limitations of the assessment measure in capturing changes in this area.

Enhancing quality of life in people with disordered eating using an online self-help programme

BackgroundEating disorders are serious mental illnesses that have a significant effect on afflicted individuals’ quality of life. Evidence has shown that they can be improved with treatment. Internet-based interventions are useful in engaging individuals with eating disorders in self-management and treatment. This study aimed primarily to identify the change in quality of life of individuals with disordered eating after participating in an open trial of an Internet-based self-help programme, and compared their quality of life at assessment with that of healthy controls. Factors affecting their quality of life were examined. Secondary outcomes related to symptom improvement were also reported.MethodsThis study included 194 individuals with disordered eating and 50 healthy controls. The former group was recruited from eating disorder outpatient clinics and treatment units, as well as via information disseminated through various Internet websites, while the healthy controls were recruited from university student newspapers and university campuses. The Medical Outcomes Study Short Form Survey (SF-36v2) was used to assess participants’ quality of life. Other measures were used to assess their symptoms and motivational stages of change to recover from an eating disorder. The Wilcoxon signed ranks test and one-way repeated measures ANOVA were used to identify the change in quality of life of individuals with disordered eating from baseline to 1-, 3- and 6-month follow-ups. The Mann–Whitney U test was employed to compare the difference in quality of life between participants with disordered eating and the healthy controls. Spearman rank order correlations were performed to examine the factors associated with quality of life.ResultsThe participants with disordered eating had significantly poorer quality of life than the healthy controls in both physical and psychological domains. The factors associated with their poor quality of life included dieting behaviour, use of laxatives, severe eating disorder psychopathology, depression and anxiety. Over a six-month follow-up period, a significant number of participants engaged in self-help behaviours using the Internet-based programme. They experienced improvements in their quality of life, eating disorder psychopathology, depression severity, anxiety level and motivational stages of change.ConclusionsInternet-based self-help programmes have the potential to enhance quality of life in individuals with disordered eating and could be useful adjuncts to professional treatment.

The Different Meanings of Food in Chinese Patients Suffering from Anorexia Nervosa

Abstract The metaphoric meanings of food have cast new lights on Social Work intervention with Chinese patients suffering from anorexia nervosa (AN) and their families. Hitherto, there is inadequate documentation on the different meanings of food in families with a daughter suffering from AN in a Chinese context. To fill this knowledge gap, this article reports the 3-year clinical observations of a sample of 34 adolescents and young women suffering from AN, as well as their families under family treatment. These observations show that food can be conceptualized in the following ways: (1) eating as an expression of filial piety; (2) food preparation as part of the womans nurturing role; (3) self-starvation as refusal to grow up; (4) self-starvation as struggle for autonomy; (5) assignment of food as part of the family hierarchy; and (6) assignment of food as part of parental control. Its implications for clinical social work practice and the roles of social workers in helping are discussed.

A Systems Approach to the Social Difficulties of Transsexuals in Hong Kong

This paper identifies social difficulties commonly faced by a group of forty-two Hong Kong transsexuals who had applied for sex reassignment surgery. It describes the use of a systems perspective to conceptualize their problems and a structural family therapy approach to social work intervention.

Enhancing motivation to change in eating disorders with an online self‐help program

Ambivalence to change is a major obstacle to treating people with eating disorders. Enhancing motivation to change can contribute to recovery from the disorders. This study used an Internet-based self-help program developed in the Asia-Pacific region to identify the motivational stages of change in people with eating disorders. It explored their perceptions of the benefits and costs of taking action against their eating disorders, and assessed their involvement in motivational enhancement exercises and their improvement in eating disorder psychopathology. A total of 185 participants, aged 16-50 years (mean age, 26.5) were involved in the open-trial program with a motivational enhancement component and completed the Motivational Stages of Change Questionnaire (MSCARED), the Eating Disorder Examination Questionnaire version 5 (EDE-Q5) and the Eating Disorder Inventory version 3 (EDI-3). The results show that more participants perceived the benefits of taking action against their eating disorders than the costs. Completer analysis shows that they experienced significant improvement in motivational stages of change and eating disorder psychopathology, from a baseline assessment to 1-month and 3-month follow ups. The self-help program has potential benefit for people with eating disorders and its use could be encouraged by health-care professionals to enhance the motivation to change and facilitate recovery.

Multifamily Group Intervention for Chinese Parents and Their Children with Attention Deficit Hyperactivity Disorder in a Chinese Context

ABSTRACT Despite the empirical evidence of multifamily group (MFG) in helping children with mental health needs in Western contexts, there is a dearth of clinical studies in Chinese societies such as Hong Kong to explore such adaption to help Chinese families of children diagnosed with attention deficit hyperactivity disorder. In this article, the authors describe the MFG model adapted to the Chinese context and assess the perceived helpfulness of the intervention, using a client-driven approach in evaluation. The parents’ evaluation toward the MFG program is positive whereas the children’s feedback is less favorable. Modifications have been made including a 30-minute pregroup meeting for the parents and more challenging games and outdoor activities for the children.