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Anorexia nervosa: treatment expectations, outcome and satisfaction
Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
2012 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Anorexia nervosa is a serious mental disorder with high mortality. It has the lowest prevalence compared with other eating-disorder diagnoses and the onset is related to adolescence, with a majority of female patients. The focus of this thesis is anorexia nervosa and the aim is to study adolescent and adult patients' comprehension and the course of treatment in order to make a contribution to the clinical work relating to these patients. The areas that were studied are expectations of treatment, outcome, predictors of outcome and satisfaction with treatment. Four research papers are included; three originate from work at a specialist eating-disorder unit at Queen Silvia Children's Hospital, Göteborg, Sweden and one from a multicentre study comprising 15 specialised eating-disorder units in Sweden.

Paper I has a qualitative design, where participants, 18-25 years of age, were interviewed about their expectations while on the waiting list at a specialist eating-disorder unit. Three main categories of expectations emerged: "Treatment content," "Treatment professionals" and "Treatment focus." The participants expected to receive the appropriate therapy in a collaborative therapeutic relationship and to recover. Paper II evaluated the outcome of a family-based treatment for adolescent patients, 13-18 years old, and their parents. The results indicate that the treatment that is offered appears to be effective, as 78% of the patients were in full remission with less distance and a less chaotic family climate at the 36-month follow-up. Paper III examined the importance of motivation to change eating behaviour, treatment expectationsand experiences, ED symptomatology, self-image and treatment alliance for predicting weight increase in adult patients, 18-46 years of age. Patients' motivation to change eating habits, social relations, self-image, body image and duration of illness were found to predict weight increase both in both the short term (six months) and the long term (36 months). PaperIV studied adolescent patients' and their parents' satisfaction with a family-based treatment a tan 18-month follow-up. The majority of patients (73%) and parents (83%) stated that their expectations had been fulfilled and individual sessions for patients and parents respectively were of great help. Family-based treatment with a combination of individual and family sessions corresponds well to patients' and parents' treatment expectations.

Young adult patients' expectations before treatment are multifaceted and should be taken into account in the therapeutic relationship. From the start of treatment, issues relating to patients' motivation, self-image, body image and social relationships should be continuously addressed in order to establish positive collaboration and a weight increase. Anorexia nervosa treatment for adolescents and their parents should be family-based and include family sessions as well as individual sessions for patients and parents. In addition, prevention programmes with the emphasis on early detection should be a prioritised area.

Place, publisher, year, edition, pages
Örebro: Örebro universitet , 2012. , 119 p.
Series
Örebro Studies in Medicine, ISSN 1652-4063 ; 76
Keyword [en]
Anorexia nervosa, treatment, adolescents, adults, expectations, outcome, predictors, weight increase, satisfaction
National Category
Medical and Health Sciences
Research subject
Medicine
Identifiers
URN: urn:nbn:se:oru:diva-26142ISBN: 978-91-7668-900-4 (print)OAI: oai:DiVA.org:oru-26142DiVA: diva2:559498
Public defence
2012-11-23, Hörsal P2, Prismahuset, Örebro universitet, Fakultetsgatan 1, Örebro, 13:00 (English)
Opponent
Supervisors
Available from: 2012-10-09 Created: 2012-10-09 Last updated: 2013-05-17Bibliographically approved
List of papers
1. Anorexia nervosa: treatment expectations – a qualitative study
Open this publication in new window or tab >>Anorexia nervosa: treatment expectations – a qualitative study
2012 (English)In: Journal of Multidisciplinary Healthcare, ISSN 1178-2390, E-ISSN 1178-2390, Vol. 5, 169-177 p.Article in journal (Refereed) Published
Abstract [en]

Background: Anorexia nervosa is a serious illness with a high mortality rate, a poor outcome, and no empirically supported treatment of choice for adults. Patients with anorexia nervosa strive for thinness in order to obtain self-control and are ambivalent toward change and toward treatment. In order to achieve a greater understanding of patients’ own understanding of their situation, the aim of this study was to examine the expectations of potential anorexic patients seeking treatment at a specialized eating-disorder unit.

Methods: A qualitative study design was used. It comprised 15 women between 18 and 25 years of age waiting to be assessed before treatment. The initial question was, “What do you expect, now that you are on the waiting list for a specialized eating-disorder unit?” A content analysis was used, and the text was coded, categorized according to its content, and further interpreted into a theme. Results: From the results emerged three main categories of what participants expected: “treatment content,” “treatment professionals,” and “treatment focus.” The overall theme, “receiving adequate therapy in a collaborative therapeutic relationship and recovering,” described how the participants perceived that their expectations could be fulfilled./p>

Discussion: Patients’ expectations concerning distorted thoughts, eating behaviors, a normal, healthy life, and meeting with a professional with knowledge and experience of eating disorders should be discussed before treatment starts. In the process of the therapeutic relationship, it is essential to continually address patients’ motivations, in order to understand their personal motives behind what drives their expectations and their desire to recover.

Place, publisher, year, edition, pages
Macclesfield, United kingdom: Dove Medical Press Ltd. (Dovepress), 2012
Keyword
Anorexia nervosa, expectations, treatment, qualitative research
National Category
Health Sciences Nursing
Research subject
Health and Medical Care Research
Identifiers
urn:nbn:se:oru:diva-26296 (URN)10.2147/JMDH.S33658 (DOI)22888259 (PubMedID)2-s2.0-84874772962 (Scopus ID)
Available from: 2012-10-22 Created: 2012-10-22 Last updated: 2016-04-19Bibliographically approved
2. A pilot study of a family-based treatment for adolescent anorexia nervosa: 18- and 36-month follow-ups
Open this publication in new window or tab >>A pilot study of a family-based treatment for adolescent anorexia nervosa: 18- and 36-month follow-ups
2009 (English)In: Eating Disorders, ISSN 1064-0266, E-ISSN 1532-530X, Vol. 17, no 1, 72-88 p.Article in journal (Refereed) Published
Abstract [en]

The current study evaluated the outcome of family-based treatment for female adolescents with anorexia nervosa (N = 32), at the Anorexia-Bulimia Outpatient Unit in Göteborg, Sweden. Patients/parents were assessed pre-treatment, at 18- and 36-month follow-ups concerning eating disorder symptoms, general psychopathology, family climate and BMI. At the 36-month follow-up, 75% of the patients were in full remission with reduction in eating disorder symptoms and internalizing problems and they experienced a less distant and chaotic atmosphere in their families. These results show that family-based treatment appears to be effective in adolescent anorexia nervosa patients regarding areas examined in this study.

National Category
Medical and Health Sciences Psychiatry
Research subject
Medicine
Identifiers
urn:nbn:se:oru:diva-12117 (URN)10.1080/10640260802570130 (DOI)19105062 (PubMedID)
Available from: 2010-10-07 Created: 2010-10-07 Last updated: 2012-10-22Bibliographically approved
3. Prediction of weight increase in anorexia nervosa
Open this publication in new window or tab >>Prediction of weight increase in anorexia nervosa
(English)Manuscript (preprint) (Other academic)
Abstract [en]

Background: Anorexia nervosa is a serious psychiatric disorder with high mortality rates apoor outcome and no empirically supported treatment of choice for adults. Weight increase isessential for recovery from anorexia nervosa why research exploring important contributors iscrucial.

Aims: The current study examined the importance of motivation to change eating behaviour,treatment expectations and experiences, ED symptomatology, self-image and treatmentalliance for predicting weight increase.

Methods: Female patients (n = 89) between 18-46 years of age with anorexia nervosa were assessed pre-treatment and at 6- and 36- monthfollow-ups with interviews and self-report questionnaires. At the 6-month follow-up the responserates differed from n = 58 to 66 and at the 36-month follow-up the response rates differedfrom n = 71 to 82.

Results: At treatment start, expressed motivation to change eatinghabits, social insecurity and self-neglect were predictors of weight increase from 0- to 6-months while duration, the time from onset to entering treatment, body dissatisfaction andinteroceptive awareness were predictors of weight increase from 0- to 36- months.

Conclusions: In designing treatment for adult patients with AN it is essential to include multifacetedinterventions addressed to patients‟ motivation to change, social relations, negative self-imageand body dissatisfaction in order to achieve weight increase. Early detection and thereby shortduration is an additional important factor that contributes to weight increase.

Keyword
eating disorders; anorexia nervosa; predictors; weight increase
National Category
Health Sciences
Research subject
Health and Medical Care Research; Medicine
Identifiers
urn:nbn:se:oru:diva-26298 (URN)
Available from: 2012-10-22 Created: 2012-10-22 Last updated: 2016-12-08Bibliographically approved
4. Anorexia nervosa: treatment satisfaction
Open this publication in new window or tab >>Anorexia nervosa: treatment satisfaction
2006 (English)In: Journal of Family Therapy, ISSN 0163-4445, E-ISSN 1467-6427, Vol. 28, no 3, 293-306 p.Article in journal (Refereed) Published
Abstract [en]

Patient satisfaction plays a central role in treatment alliance and outcome. Investigating patient expectations and experiences of treatment sheds light on its importance. This study examines adolescent anorexia nervosa patients and their parents' satisfaction with family-based treatment. Patients and parents answered a questionnaire at the eighteen-month follow-up focusing on expectations and experiences of treatment, therapists, aims of treatment and accomplishment. The results show that 73 per cent of the patients and 83 per cent of the parents felt that their pre-treatment expectations had been fulfilled. The majority agreed that individual patient sessions and parental sessions were of great help, while the patients valued family therapy sessions as being less helpful than did parents. In overall terms, parents were more pleased with the therapists than were the patients. These data suggest that family-based treatment with individual sessions for patients, in parallel with parental sessions combined with family sessions, corresponds well to patients' and parents' treatment expectations.

Place, publisher, year, edition, pages
Oxford, United Kingdom: Blackwell, 2006
National Category
Psychiatry Medical and Health Sciences
Research subject
Psychiatry; Medicine
Identifiers
urn:nbn:se:oru:diva-12041 (URN)10.1111/j.1467-6427.2006.00353.x (DOI)000239008500006 ()2-s2.0-33745965685 (Scopus ID)
Note

Gunilla Paulson-Karlsson is also affiliated to Queen Silvia Childrens Hosp, Anorexia Bulimia Unit, SE-41685 Gothenburg, Sweden

Ingemar Engström is also affiliated to Child andAdolescent Psychiatry Centre, Queen Silvia Children’s Hospital, Go¨teborg, Sweden

Available from: 2010-10-05 Created: 2010-10-05 Last updated: 2016-12-08Bibliographically approved

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