Sanna Aila Gustafsson

Risk and protective factors for disturbed eating in adolescent girls : aspects of perfectionism and attitudes to eating and weight

The aim of this study was to longitudinally examine the role of personal standards, self-evaluation, perceived benefits of thinness and attitudes to eating and weight in the development of healthy versus disturbed eating in adolescent girls. In a longitudinal study, girls who participated in two assessments, four to five years apart, were divided into three groups according to the attitudes to eating that they manifested at the second evaluation: those with disturbed eating patterns (DE-group, n = 49), those with intermediate concerns about eating (IE-group, n = 260) and those with healthy eating attitudes (HE-group, n = 120). Variables concerning attitudes to eating and weight and physical self-evaluation emerged as risk factors, whereas personal standards or self-evaluation in general did not. Protective factors were a low BMI, healthy eating attitudes, an accepting attitude towards body size and a positive self-evaluation, particularly with regard to physical and psychological characteristics. The results of this study contribute to the understanding of early risk and protective factors for eating disturbances in girls.

Characteristics measured by the Eating Disorder Inventory for children at risk and protective factors for disordered eating in adolescent girls

Objective The aim of this study was to examine longitudinally the role of characteristics measured by the Eating Disorder Inventory-Child version (EDI-C) to find early predictors that might constitute risk and protective factors in the development of disordered eating. Method Participants were divided into three groups based on eating attitudes at T2: disordered eating (n = 49), intermediate eating concern (n = 260), and healthy eating attitudes (n = 120). EDI-C from T1 (four to five years earlier) was then analyzed to find predictors of group classification at T2. Results Drive for thinness and body dissatisfaction emerged as risk factors at T1, while drive for thinness, body dissatisfaction, and interoceptive awareness emerged as protective factors after controlling for initial eating concerns and body mass index. Discussion Eating disorders should not be seen as a result of a premorbid personality type. Rather we should take a more social-psychological perspective to explain how individual and sociocultural factors work together in the development of these conditions.

Personal standards, self-evaluation and perceived benefits of thinness in girls and young women with disturbed eating

The aim of this study was to examine personal standards, self-evaluation and perceived benefits of thinness in Swedish females 14-21 years with disturbed eating (DE) and to compare these to a group with other psychosocial problems and to a symptom free group. Seventy subjects with DE-group, 65 subjects with psychosocial problems and 70 symptom free subjects were compared regarding items selected from four questionnaires. High personal standards expressed in a competitive way were specific for the DE-group. In comparison with the other groups the DE-group also reported significantly more perceived benefits of thinness and they more frequently believed that thinness would make them more popular. The DE-group also reported a more negative self-evaluation, although this was a trait shared with the subjects with other psychosocial problems and consequently not specific for the DE-group. Identifying specific factors that perpetuate DE habits is important in order to improve our understanding and enhance the treatment of eating disorders.

Therapist behaviours in internet-based cognitive behaviour therapy (ICBT) for depressive symptoms

Internet-based cognitive behaviour therapy (ICBT) is efficacious for treating depression, with therapist guidance identified as important for favourable outcomes. We have limited knowledge, however, about the fundamental components of therapist guidance in ICBT. The purpose of this study was to systematically examine therapist messages sent to patients during the course of ICBT for depressive symptoms in order to identify common “therapist behaviours” and the extent to which these behaviours correlate with completion of modules and improvements in symptoms at post-treatment, one- and two-year follow-up. A total of 664 e-mails from 5 therapists to 42 patients were analysed using qualitative content analysis. The most frequent behaviour was encouraging that accounted for 31.5% of the total number of coded behaviours. This was followed by affirming (25.1%), guiding (22.2%) and urging (9.8%). Less frequently the therapists clarified the internet treatment framework, informed about module content, emphasised the importance of patient responsibility, confronted the patient and made self-disclosures. Six of the nine identified therapist behaviours correlated with module completion. Three behaviours correlated with symptom improvement. Affirming correlated significantly (r = .42, p = .005) with improvement in depressive symptoms at post-treatment and after two years (r = .39, p = .014). Encouraging was associated with outcome directly after treatment (r = .52, p = .001). Self-disclosure was correlated with improvement in depressive symptoms at post-treatment (r = .44, p = .003). The study contributes to a better understanding of therapist behaviours in ICBT for depressive symptoms. Future directions for research are discussed.

Being Me and Being Us - Adolescents' Experiences of Treatment for Eating Disorders

BackgroundThis qualitative study addresses adolescents’ perception of treatment for eating disorders. The importance of involving parents in treatment of young people with eating disorders, especially young people with Anorexia Nervosa, is emphasized in a number of studies. Even so, this form of treatment does not work for everybody, not even within a limited diagnostic group. Previous research has revealed that many young people are not entirely satisfied with their treatment. However, there is a lack of knowledge concerning the perspectives of adolescents in outpatient treatment, whose treatment often involves family. The aim of the present study was to investigate how young people with experience from adolescent outpatient treatment for eating disorders, involving family-based and individual based interventions, perceive their time in treatment.MethodsThis study was conducted using a hermeneutic phenomenological approach. Fifteen participants were recruited in collaboration with four specialized eating disorder units and interviewed with the purpose to gather narratives.ResultsThe analysis revealed that the adolescents sometimes felt more or less forced into treatment, and strong ambivalent feelings about if and how to participate in treatment permeated the adolescents’ narratives. The common factors which emerged in the narratives were assembled under the two major themes: Having to involve family in treatment - in one way or another and Making progress in treatment - a matter of trust.ConclusionsIt is of great importance to involve family in treatment in order to understand the problems of the adolescents in their context and be able to take advantage of the resource that parents constitute. However, in certain situations, it is necessary to prioritise individual treatment interventions so that instead of sorting out difficult family situations the therapist focuses on enhancing the young people’s resilience, thus enabling them to tackle problematic situations in life.

Mental health-promoting dialogues from the perspective of community-dwelling seniors with multimorbidity.

Mental health promotion needs to be studied more deeply within the context of primary care, because persons with multiple chronic conditions are at risk of developing poor mental health. In order to make progress in the understanding of mental health promotion, the aim of this study was to describe the experiences of health-promoting dialogues from the perspective of community-dwelling seniors with multimorbidity – what these seniors believe is important for achieving a dialogue that may promote their mental health. Seven interviews with six women and one man, aged 83–96 years, were analyzed using qualitative content analysis. The results were summarized into nine subcategories and three categories. The underlying meaning of the text was formulated into an overarching theme that embraced every category, “perceived and well-managed as a unique individual”. These seniors with multimorbidity missed someone to talk to about their mental health, and needed partners that were accessible for health dialogues that could promote mental health. The participants missed friends and relatives to talk to and they (crucially) lacked health care or social service providers for health-promoting dialogues that may promote mental health. An optimal level of care can be achieved through involvement, continuity, and by providing a health-promoting dialogue based on seniors’ needs and wishes, with the remembrance that general health promotion also may promote mental health. Implications for clinical practice and further research are discussed.

How to deal with sociocultural pressures in daily life : reflections of adolescent girls suffering from eating disorders

Adolescent girls with eating disorders experience unattainable and contradictory expectations in daily life, which create stress and negatively affect their self-evaluation. Disordered eating may function as a way of seeking control and consistency. In order to make progress in the understanding of eating disorders, the aim of this study was to describe how adolescent girls with eating disorders reflect upon ways of dealing with sociocultural pressures in daily life. Eighteen interviews with girls aged 15–19 years were analyzed using a phenomenographic approach. The results were summarized into three conceptions: “Striving to be oneself ” (conception A) was described as the most desirable, but also the hardest. “Adapting to various situations” (conception B) was used without much reflection, as long as it worked, but when this way of dealing with everyday expectations was unsuccessful it was evaluated negatively. “Presenting oneself in a positive light” (conception C) was described negatively even when it was successful. Within these conceptions, the participants described various strategies that could be used more or less effectively depending on the circumstances. A common theme was their difficulties in finding a balance between trying harder to live up to perceived expectations from others on one hand, and trying to accept the situation as it was, without trying to change themselves or the situation, on the other hand. The participants believed that their eating disorder was partly a result of being unable to deal with sociocultural pressures in an effective way, and they experienced a conflict between societal values of being assertive and values of being interpersonally oriented. Implications for treatment are discussed.

Patient-controlled hospital admission: A novel concept in the treatment of severe eating disorders.

Patient-controlled hospital admission : A novel concept in the treatment of severe eating disorders

A qualitative analysis of participants’ reflections on body image during participation in a randomized controlled trial of acceptance and commitment therapy

BackgroundNegative body image is a risk factor for development and relapse in eating disorders (ED). Many patients continue to be dissatisfied with their body shape or weight after treatment. This study presents a qualitative analysis of written reflections on body image from patients with an ED and a negative body image before and after an Acceptance and Commitment Therapy group treatment at a specialized ED-unit.MethodBefore and after the treatment participants (n = 47) answered a questionnaire with open ended questions on their thoughts on body image. Data were analyzed through conventional content analysis.ResultsBody image meant different things for different participants. For some it had to do with how you evaluate your body, whereas others focused on whether their body image was realistic or not. Some emphasized their relationship with their body, while some described body image as strongly related to global self-esteem. These different views on the concept of body image affected the participants’ descriptions of their own body image, and how they wanted it to change. Body image was considered a state that fluctuated from day to day. After treatment the participants described changes in their body image, for instance perceiving oneself as less judgmental towards one’s body, and a shift in focus to the important things in life.ConclusionsThe participants had different views on body image and how they wished it to change. Thus treatment interventions targeting negative body image needs to address various aspects of this complex construct.Trial registrationThis study is part of an RCT registered 02/06/2014 in Clinical Trials, registration number: NCT02058121.

Living with a sibling who suffers from an eating disorder: a pilot interview study

Background and objective Having a sibling who suffers from an eating disorder (ED) has a profound effect on healthy siblings’ own health, quality of life and family relationships, yet siblings have been an excluded group within health care, and there is a lack of knowledge regarding healthy siblings’ needs and wishes for information and support. Thus, the aim of this study was to examine adolescents’ experiences of living with a sibling who suffers from an ED. Method In this small-scale pilot study, three boys and two girls aged 15–20 years were interviewed, and the interviews were analyzed by qualitative content analysis. Results This study confirms prior knowledge of adolescents’ experiences of living with a sibling who is suffering from an ED. The adolescents were concerned about their siblings and lacked information about their siblings’ illness and treatment progress. The girls described that their everyday life had been heavily influenced by their sisters’ illness, while the boys described that their everyday life with friends and activities were not affected to such a great extent. One new result that emerged as something positive was that some informants described that although the ED was a source of conflict in the family, it had led to greater awareness of the importance of gaining sufficient energy and had contributed to better meal situations in the family. Conclusion Having a sibling with an ED had a profound and negative effect on family relationships, and was often a source of conflict, especially around mealtime. However, it appeared that if parents were able to organize family meals and create an open and supportive climate, the negative effects for the family could be reduced. The health care professionals need to acknowledge the siblings’ need for information and support, and support parents in their important role of caring for well siblings.