Dissertations / Theses on the topic 'Eating disorders – Personal narratives'

The following paper explores the ways in which we currently understand eating disorders, examining the current theory and literature as well as providing the stories of three women and one man with first-hand experience with eating disorders. Through the use of formal interviews, the paper focuses not only on the ways in which an eating disorder affects an individual’s life but also on the ways in which an individual’s life affects the manifestation of his or her eating disorder.

Orientador: Heloisa André Pontes
Tese (doutorado) - Universidade Estadual de Campinas, Instituto de Filosofia e Ciências Humanas
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Resumo: Esta tese surgiu do interesse em pesquisar em maior profundidade alguns aspectos da intrincada relação entre corporificação, gênero e assujeitamento, através da análise do conjunto de perturbações denominadas "transtornos alimentares". No contexto contemporâneo em que o corpo torna-se alvo privilegiado de investimento e intervenção, assumindo centralidade nos processos de construção identitária, uma investigação antropológica destas perturbações permite pensar como a constituição de sujeitos corporificados é perpassada por múltiplas normatividades de gênero, classe, regionalidade, raça e etnicidade, presentes na socialidade cotidiana e nas práticas e discursos biomédicos. Tomando como eixo central a composição de três histórias de vida, em colaboração com mulheres que tiveram experiências pessoais com transtornos alimentares, é possível ter acesso ao processo através do qual pessoas vivenciam formas particulares de assujeitamento, compostas por distintas articulações entre múltiplas dimensões de poder, deforma inseparável, constituindo-se, assim, como sujeitos de ação em meio a conformações e resistências. Ainda que o fio condutor da tese encontre-se nas histórias de vida, escritas ao longo de quatro anos em colaboração com três interlocutoras voluntárias, sua trama é composta pelos diversos percursos teóricos e empíricos de uma etnografia multi-situada (HANNERZ, 2003), que transitou pelo universo de comunidades virtuais brasileiras sobre transtornos alimentares, um serviço ambulatorial de um hospital universitário, congressos de psiquiatria, uma vasta bibliografia e uma agência feminista de base comunitária para tratamento, educação e prevenção de transtornos alimentares na Nova Zelândia.
Abstract The aim of this thesis is to investigate in greater depth some aspects of the intricate relation between embodiment, gender and subjectification, through the analysis of the group of perturbations named "eating disorders". In the contemporary context, in which the body becomes the privileged target of investment and intervention, assuming a central role in the processes of identity construction, an anthropological investigation of these perturbations allows us to evaluate how the constitution of embodied subjects is fraught with multiple normativities of gender, class, regionality, race and ethnicity, present in daily sociality and in biomedical practices and discourses. Taking as a central axis the composition of three life-histories, in collaboration with women who had personal experiences with eating disorders, it is possible to gain access to the process by means which persons live particular forms of subjectification, composed by distinct inseparable articulations of multiple dimensions of power, becoming, thus, subjects of agency amidst conformation and resistance. If the connecting thread of the thesis is found in the life histories, written with the voluntary research collaborators along four years, its warp is the woven out of the different theoretical and empirical paths of a multi-sited ethnography (HANNERZ, 2003), along the universe of Brazilian virtual communities about eating disorders, an outpatient treatment unit at an University hospital, Psychiatry congresses, a wide bibliography and a feminist community based service for the education, prevention and counseling for eating difficulties in New Zealand.
Doutorado
Estudos de Gênero
Doutor em Ciências Sociais

This research, based on a random sample of undergraduates at the University of Arizona, is an exploration of the relationships between normative conformity, self-perception, and eating behavior. The goal of this study was to examine how norms governing appearance and sex roles contribute to a view of self that may result in serious eating problems. Three dimensions of self were included in the study: body image, control, and orientation to others. Specifically, it was hypothesized that overconformity would contribute to a self-concept defined in terms of negative body image, including a high degree of weight consciousness, strong need to exercise self-constraint, and high degree of orientation to others. In turn, this negative self image is likely to be associated with eating behavior which may be described as "weight obsessed," although not necessarily meeting clinical criteria for eating disorders. One of the major purposes of this research was to examine gender differences in the processes contributing to disturbances in eating behavior. It was hypothesized that definitions of the female and male self would have different outcomes in terms of eating behavior. It was also hypothesized that conformity to norms would be a more salient issue for females than for males. Findings of this research indicate that females experience more disturbed eating than males; that societal standards of appearance do affect eating behavior of both females and males, although this effect is greater for females; and that a self-concept defined in terms of negative body image, high weight consciousness, need for constraint, and feelings of failure/inadequacy contribute to problematic eating among females. These results imply that solutions to the problem of disordered eating must be examined in terms of social causes: specifically, current definitions of femininity, attractiveness, and self-concept.

This research focuses on pushing forward the understanding of mental disorders portrayals in games, more specifically social anxiety, which still lies as a marginalized topic in this medium. In order to understand honest manifestations of social anxiety in games, the first step is to conduct a close reading of games made by people who suffer from this mental disorder. A collection of five indie games, all of autobiographical nature and featuring social anxiety as an important part of their text, was put together for this analysis. This was done embracing the need to address the representational complexity, in order to tap into such a nuanced and elusive topic as social anxiety, not to identify rights or wrongs, but to engage in a discussion of how experiences are represented in games by people directly affected by this mental disorder. Individual experiences also contribute to expand interpretations and to identify additional keys of social anxiety representation. This is done by reaching informants, people living with a comorbid mental illnesses or disorders, that face or had faced social anxiety, and assess their perspectives through an experiential workshop. This work intends to further explore the practice of game design as mediator of experiences, contributing to both deepen the knowledge of game design and explore nuances of individual experiences present in autobiographical games and how this relates to perspectives of other people living with social anxiety. By combining the games and informants perspectives it is possible to structure a debate about game design patterns based on the findings of the game analysis and further elaborated with the nuanced perceptions gathered from informants. The knowledge acquired through this work is a step towards understanding of how games can represent, in an honest and non-stereotypical way, mental disorders, starting with social anxiety and, hopefully, contribute to spark other studies to broaden the spectrum of how the complexity of adverse mental conditions can be more respectfully addressed in games.

Numerous studies have reported psychological benefits associated with the practice of values-based self-affirmation. However, there is little evidence regarding their clinical applicability. Many of the purported benefits of values-based self-affirmation are highly relevant to people with bulimia nervosa (BN). This study used a multiple case study design in order to investigate the effectiveness, underlying mechanisms and acceptability of a brief (three week) intervention focussing on the development and practice of values-based self-affirmations with people who have BN. Two participants were recruited from an Eating Disorders (ED) Service waiting list. They completed questionnaires measuring cognitions associated with ED, attitude towards change, self-esteem, self-compassion, body image acceptance, psychological flexibility, cognitive defusion, and SELF repertory grids over four time points. Following appointments qualitative data was collected, and on completion of the intervention participants were interviewed, regarding their experiences. Pre and post intervention behavioural measures of BN were also collected. The use of a personal values-based self-affirmation intervention was associated with reductions in behaviours associated with BN, enhanced attitude towards change and reduced discrepancy between self and ideal self. There was little convincing evidence that the intervention was associated with a reduction in cognitions associated with ED. A very small degree of change in a positive direction was observed in relation to self-esteem, self-compassion, body image acceptance, psychological flexibility and cognitive fusion. However, scores did not reflect Reliable Change in these processes. Overall, results appeared to be slightly better explained by theory underpinning Personal Construct Psychotherapy rather than Acceptance and Commitment Therapy. However, neither theoretical explanation fully accounted for the data. Participants generally found the intervention to be acceptable. The results add novel findings to the literature regarding the use of values-based self-affirmation within the treatment of BN. They suggest that a brief values-based self-affirmation intervention might be a useful adjunct to evidence based treatment of BN. However, the case study design that is utilised in this study limits the degree to which these results may be generalised and future research should explore this further.

Dominant narratives about psychosis portray individuals as lonely, dangerous and unable to contribute to society. Such views may be incorporated into an individual’s personal story and are associated with negative outcomes for personal and clinical recovery. Art-making is associated with personal meaning-making and alternative forms of expression. It is therefore considered potentially relevant to narrative modification. Adult service-users with psychosis participated in a gallery-based art-making intervention. At interview, participants used their self-created images to help tell their story. Literary, experience-centred and culturally-oriented lenses were used to analyse narratives. Turning-points as modifiers of stigmatised dominant narratives were explored, as was how the intervention supported recovery. Art-making was associated with achievement, challenge and satisfaction. Story-telling using visual and verbal means opened up stories and alternative perspectives for participants. Recovery-principles including hope and aspiration were supported, identified through goals and recognition of achievement. Sharing experiences with others with similar experiences was viewed as impacting positively on mental-health. The intervention represented effective partnership working between NHS services and a gallery in overcoming barriers to accessing the arts, for people with psychosis. Achievements in art-making and narrating experience using visual and verbal means offered alternatives to personally limiting and illness-dominated narratives.

Personal biases exhibited by mental health professionals can adversely affect treatment outcomes (Servais & Saunders, 2007; Currin, Waller, & Schmidt, 2009). Eating disorders are often stigmatized and ultimately marginalized even within professional realms, thereby presenting (1) an unnecessary barrier to treatment and (2) adverse consequences for affected individuals (Hackler, Vogel, & Wade, 2010; Roehrig & McLean, 2010; Ebneter, Latner, & O'Brien, 2011; Walker & Lloyd, 2011). Conjunctively, the presence of weight discrimination has increased drastically in recent years. (Bannon, Hunter-Reel, Wilson, & Karlin, 2009). This study assessed levels of weight-related and eating disorder-related stigma in a sample of clinical psychology doctoral students.

This study explored three areas believed to play a central role in the pathogenesis and presenting clinical picture of the eating disorders, anorexia nervosa and bulimia. Measures of personal effectiveness, family dynamics, and traditional sex-role beliefs were assessed in groups of restricted anorexics, bulimic anorexics, normal weight bulimics and controls. Control subjects manifested the highest degree of psychological adjustment, resourcefulness, and self-direction, while restricting anorexics obtained the lowest score on this measure. Bulimics experienced the highest degree of personal effectiveness of the patient groups, with bulimic anorexics falling in-between restricting anorexics and bulimics. Control subjects also reported that they felt more independent, accepted and tolerated in their family than any of the eating disorder groups. Bulimic subjects scored closest to controls on this measure, with bulimic anorexics experiencing the least degree of acceptance, tolerance and independence of all groups. Finally, control subjects defined themselves in a more traditionally masculine role than did any of the eating disorder groups. Restricting anorexics were most likely to describe themselves as passive, submissive, constricted and sensitive; bulimic subjects were more likely to endorse such self-descriptive adjectives as assertive, uninhibited, self-confident and competitive. Bulimic anorexics perceived themselves to be less traditionally feminine than did restricting anorexics, but more than bulimics or controls. The results of this study support the theory that ego deficits contribute to the development of eating disorders.

Studien handlar om patienters upplevelse av vilka fördelar och nackdelar det finns med att personal använder egna erfarenheter av ätstörningar som en resurs i vårdarbetet. Insamlingen av empirin genomfördes i form av åtta stycken kvalitativa intervjuer där forskaren intervjuade patienter som går i behandling för ätstörningar. Samtliga intervjupersoner hade varit i kontakt med personal som har egna erfarenheter av ätstörningar. Ämnet analysers utifrån teoretiska begrepp som erfarenhetskunskap, förståelse, bemötande, identifikation och att vara en förebild respektive överidentifikation, motöverföring samt självexponering. Resultatet visar att det finns flera fördelar med att personal använder egna erfarenheter av ätstörningar. Denna personal kan bland annat tillhandahålla en särskild resurs inom vårdarbetet, nämligen erfarenhetskunskap, vilket är en typ av kunskap som inte går att läsa sig till och som övrig personal därför inte kan bistå med. Patienterna upplever även att personal med egna erfarenheter av ätstörningar har en ökad förståelse för deras sjukdomssituation och kan hjälpa patienterna att förstå sig själva bättre genom att förklara varför de tänker, känner eller agerar på att visst sätt. Patienterna beskriver även att denna personal har ett bättre bemötande gentemot dem på så sätt att de får patienterna att inte känna sig lika utsatta i den hjälpsökande positionen samt har förmågan att se sjukdomen utifrån ett individuellt perspektiv istället för att enbart utgå ifrån diagnosens kännetecken. Deltagarna upplever att de kan identifiera sig med personalens sjukdomsupplevelse och resa till att bli frisk vilket leder till att patienterna lättare tar till sig denna personals budskap. Patienterna kan se anställda med egna erfarenheter av ätstörningar som förebilder eftersom att de lyckades bli friska och stå emot ätstörningen. Denna personal har även en förmåga att reducera patientens känsla av skam kring sjukdomen eftersom att den anställde själv har varit sjuk tidigare. Studiens resultat visar även att det finns nackdelar med att personal använder sig av sina egna erfarenheter av ätstörningar i vårdarbetet. En nackdel är när personalens arbete påverkas av överidentifikation vilket ges i uttryck när personalen antar saker som inte stämmer om patienters sjukdomstillstånd baserat på deras egna sjukdomsupplevelser, vilket skapar frustration hos patienten. Personalens motöverföring kan även påverka hur de utformar behandlingen eftersom att denna personal har en känslomässig koppling till sjukdomen vilket kan resultera i att det är svårare att ställa krav på patienterna. Patienterna beskriver även att personalens självexponering kan påverkar deras behandling negativt om personalen berättar något om sin tidigare sjukdomsupplevelse som kan ge patienten nya ätstörda idéer eller vara triggande. Alternativt om personalen fokuserar för mycket på att berätta om sina egna erfarenheter istället för att fokusera på patientens behandling. Om personalens självexponering uppfattas vara oprofessionell i patientens ögon kan det få vårdtagaren att tveka på den professionellas kompetens.
The study is about patients' experience of the advantages and disadvantages of staff using their own experience of eating disorders as a resource in the care work. The gathering if empiric was conducted in the form of eight qualitative interviews where the researcher interviewed patients undergoing treatment for eating disorders. All interviewees have previously been in contact with staff who have their own experience of eating disorders. The subject of the study is analyzed based on theoretical themes such as experience knowledge, understanding, treatment, identification, being a role model, over-identification, countertransference and self-disclosure. The results show that there are several benefits that staff use their own experience of eating disorders. This staff may, among other things, provide a special resource in the field of care, namely experience knowledge, which is a type of knowledge individuals can’t learn by reading, so other staff do not possess this knowledge. Patients also find that staff with their own experiences of eating disorders have a better understanding of their disease situation and can help patients to understand themselves better, by explaining why they think, feel or act in a certain way. Patients also describe that these staff treat them better, in a certain way that they make the patients feel less vulnerable in their care-seeking position and has the ability to see the disease from an individual perspective instead of being based solely on the diagnosis's characteristics. Participants find that they can identify themselves whit the staff's disease experience and travel to recovery, which leads to that the patients more easily receive this personals message. Patients can see employees with their own experience of eating disorders as role models, because they managed to get healthy and resist eating disorders. This staff also has the ability to reduce the patient's sense of shame about the disease, because the employee self has been ill previously. The study's results also show that there are disadvantages to staff using their own experience of eating disorders in the care word. On disadvantage is when staff work is affected by over-identification, which is expressed in terms of staff assuming things that do not match patient's disease state based on their own disease experiences, which causing the patient to feel frustrated. The countertransference of the staff can also affect how they design the treatment because these personal have an emotional link to the disease, which may result that it is more difficult to make demands to the patient. Patients also describe that staffs’ self-disclosure may adversely affect their treatment if the staff tells something about their own previous disease experience that can give the patient new eating ideas or be triggering. Alternatively, the staff focus too much on telling their own experiences instead of focusing on the patient's treatment. If the self-disclosure of the staff is perceived to be unprofessional in the patient's eyes, it may cause that the patient will be doubtful about their professional competence.

Objectius: Determinar la percepció de la imatge corporal dels universitaris de ciències de la salut, el nivell de distorsió, els canvis d'hàbits per a conservar-la o millorar-la i l’impacte en l'estat nutricional. Mètodes: Es va aplicar una enquesta transversal als alumnes de Ciències de la Salut de la Universitat de Lleida durant el curs 2009-2010, de 18 a 25 anys. L’enquesta va incloure el model CICAE per a la percepció de la imatge corporal, el test EAT-26 per a les actituds alimentàries i dos recordatoris del consum d'aliments de 24 hores, El grau de significació acceptat va ser de p <0.05. Resultats: Van respondre 306 alumnes. El 69,2% es van percebre més grassos del que realment estaven, en les dones el 75,0%. Els homes i les dones tenien diferents comportaments i actituds alimentàries. Ser dona és la variable que incrementa el risc de manera omnipresent.
Objetivos: Determinar la percepción de la imagen corporal de los universitarios de ciencias de la salud, el nivel de distorsión, los cambios de hábitos para conservarla o mejorarla y el impacto en el estado nutricional. Métodos: Se aplicó una encuesta transversal a los alumnos de Ciencias de la Salud de la Universidad de Lleida durante el curso 2009-2010, de 18 a 25 años. La encuesta incluyó el modelo CICAE para la percepción de la imagen corporal, el test EAT-26 para las actitudes alimentarias y dos recordatorios del consumo de alimentos de 24 horas, El grado de significación aceptado fue de p <0,05 . Resultados: Respondieron 306 alumnos. El 69,2% se percibieron más grasos de lo que realmente estaban, en las mujeres el 75,0%. Los hombres y las mujeres tenían diferentes comportamientos y actitudes alimentarias.
Aims: To determine the perception of body image, the level of distortion, changes of habits to conserve or improve it and the impact on nutritional status of undergraduate students of health sciences. Methods: A cross-sectional survey was administered to 18-25 years old undergraduate students of Health Sciences of the University of Lleida during the course 2009-2010. The survey included the CICAE model for the perception of body image, the EAT-26 test for eating attitudes, and two reminders of food consumption the previous 24 hours. The accepted significance level was p <0.05. Results: 306 students answered the surveys. 69.2% perceived themselves as thicker than they really were; in women this percentage was 75.0%. Men and women had different dietary behaviours and attitudes. Being a woman is the variable that increases the risk ubiquitously.

La capacité de voyager mentalement dans le temps constitue un élément fondamental du sentiment d’identité et de continuité de l’existence. Les souvenirs définissant le soi (SDS) et les projections futures définissant le soi (PFDS) font l’objet ainsi d’une voie privilégiée pour approfondir la compréhension du vécu subjectif des expériences personnelles et de la fragilité identitaire dont souffrent les personnes atteintes d’anorexie mentale (AM) et de boulimie nerveuse (BN). Par l’exploration des caractéristiques spécifiques des SDS et PFDS, l’objectif principal de ce travail de thèse est de proposer un dispositif expérimental basé sur la médiation par réminiscences sensorielles, dans une visée d’amélioration thérapeutique des troubles des conduites alimentaires (TCA). Nos résultats mettent en évidence que les femmes atteintes d’AM évoquent, en comparaison à des sujets sains, des événements définissant le soi généralisés, négatifs, avec une présence de contamination et de tension. Les patientes se souviennent davantage d’événements en lien avec des abus sexuels et se projettent dans l’avenir avec moins d’épisodes en lien avec les loisirs et les relations. Néanmoins, les événements en lien avec la maladie sont les plus intégrés par les patientes. Après avoir participé aux trois séances structurées du dispositif expérimental basé sur la réminiscence et la stimulation sensorielle, les patientes (n = 22) évoquent une majorité de réminiscences positives, en lien avec la nostalgie de l’enfance et perçues comme ayant une valeur importante dans la définition du soi. Les observations préliminaires de ce dispositif à vocation thérapeutique confortent l’intérêt de la stimulation polysensorielle comme support à la remémoration des souvenirs autobiographiques et la reconstruction du Self chez les patientes atteintes de TCA
The ability to travel mentally through time is a fundamental element of a sense of identity and continuity of existence. Self-defining memories (SDM) and self-defining future projections (SDFP) are thus the subject of a privileged path to deepen the understanding of the subjective experience of personal experiences and the identity fragility suffered from patients with anorexia nervosa (AN) and bulimia nervosa (BN). By exploring the specific characteristics of SDS and PFDS, the main objective of this thesis work is to propose an experimental device based on mediation by sensory reminiscences, with the aim of therapeutic improvement of eating disorders (ED). Our results showed that patients with AN, compared to healthy controls, generalized, reported negative self-defining events with a presence of contamination and tension. Patients remembered more events related to sexual abuse and project themselves into the future with fewer episodes related to leisure and relationships. Nevertheless, events related to the illness are the most integrated by patients. After participating in the three structured sessions of the experimental device based on reminiscence and sensory stimulation, patients (n = 22) reported a majority of positive reminiscences, related to childhood nostalgia and perceived as having an important value in defining the Self. The preliminary observations of this therapeutic device confirm the interest of polysensory stimulation as a support for the recollection of autobiographical memories and the reconstruction of the Self in patients with ED

Background: Co-morbidity of eating disorders and alcohol use among women is a topical theme. Eating disorders can be seen as a disease of modern women and alcohol use as very frequent and tolerated by society. Co-morbidity of these disorders is not given enough attention. Aim: The theoretical part defines basic terms of eating disorders, alcohol abuse and their co-morbidity. In the practical part my goal was to identify the risk and protective factors, personal characteristics that were common for women suffering with co-morbidity and to outline the subjective perception of respondents regarding this issue. Methods and sample: Data were obtained by the method of a semistructured interview with five respondents - clients of the aftercare group for alcohol addicts. Two methods were used for the purpose of data analysis: qualitative type of an approach and a pattern (gestalt) recognition method. Results: The thesis described risk factors on the individual, familial and social level. It also described personal characteristics of respondents that overlapped with the risk factors. They can therefore be taken as risk factors on the individual level. Protective factors are mainly positive influence of peers, hobbies and awareness of one's value. Respondents and their subjective view on this issue point out...