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  • 1. Björck, Caroline
    et al.
    Björk, Tabita
    Örebro University, School of Health and Medical Sciences.
    Clinton, David
    Sohlberg, Staffan
    Norring, Claes
    Self-image and treatment drop-out in eating disorders2008In: Psychology and Psychotherapy: Theory, Research and Practice, ISSN 1476-0835, E-ISSN 2044-8341, Vol. 81, no 1, p. 95-104Article in journal (Refereed)
    Abstract [en]

    Introduction: Drop-out from treatment is a serious problem in eating disorders which remains poorly understood. The present study investigated whether self-image and interpersonal theory could help to explain why eating disorder patients drop out of treatment. Method: Intake data on eating disorder patients who terminated treatment prematurely (N=54) were compared with patients who had completed treatment (N=54) and those who were still in treatment after 12 months (N=54). Self-image was assessed using the structural analysis of social behaviour (SASB), and comparisons were made on demographic and clinical variables. Results: Patients who dropped out had initially presented with less negative self-image and fewer psychological problems compared with remainers. Low levels of SASB self-blame discriminated drop-outs from completers and remainers and significantly predicted treatment drop-out. Discussion: Drop-out in eating disorders appears to be a complex phenomenon, not necessarily as pathological as often assumed. There may be important differences in the treatment goals of drop-outs and therapists; patients who drop out may be choosing to disengage at a time when symptom improvement creates space for closer examination of interpersonal issues.

  • 2.
    Björk, Tabita
    Örebro University, School of Health and Medical Sciences.
    Measuring eating disorder outcome: definitions, dropout and patients' perspectives2008Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Background: Despite a plethora of research, there are serious limitations in our knowledge of outcome in eating disorders. Almost all studies have been compromised by the problem of treatment dropout or non-participation in follow-ups. There exists a lack of consensus in definitions of outcome and choice of outcome measures, and there is a dearth of studies focusing on how patients subjectively perceive recovery. The overall aim of this thesis was to address problems in measuring outcome after treatment for eating disorders, with an emphasis on methodological issues. Specific areas of investigation included non-participation in long-term follow-ups, the role of self-image in treatment dropout, outcome among patients who drop out, patients’ subjective perspectives of recovery, and the impact of different methods of measuring outcome.

    Method: Four quantitative studies (I, II, III and V) were conducted within the framework of a large Swedish multi-centre study of eating disorders, which adopted a prospective, longitudinal and naturalistic design. Study IV was a qualitative investigation encompassing interviews with former ex-patients who were considered recovered.

    Results: Study I suggested that the reasons for non-participation in research were mainly patient related (69%). Those declining further participation in follow-ups were reported significantly lower levels of obsession-compulsion and anxiety, while those not traceable reported significantly higher levels of hostility at admission. Study II suggested that patients who dropped out from treatment initially presented with less negative self-image and fewer psychological problems compared to those who remained in treatment. Low levels of self-blame discriminated dropouts from completers and remainers, and significantly predicted treatment dropout. Study III found no significant differences between dropouts and completers at follow-up, with the exception that dropouts were more dissatisfied with treatment. However, patterns of treatment response revealed that those who completed treatment made significantly greater changes in terms of reduced eating disorder symptoms, fewer psychological problems and a more positive self-image compared to dropouts. Study IV found that patients who had recovered from an eating disorder tended to describe other dimensions of outcome than those usually reported in follow-ups. Patients tended to view recovery in terms of being able to relate in a relaxed and accepting manner to food, their bodies, themselves as individuals, and their social environment. Some perceived recovery in terms of coping better with emotions, while others experienced themselves as healthier than people generally regarding food and weight. Study V applied some of the most frequently used outcome measures for eating disorders and found marked variations in the number of patients who could be considered in remission. Overall remission rates varied from 24.3% to 77.8%, depending on the outcome measure used.

    Discussion: The results suggest that non-participation and dropout are not unitary phenomena. There is also a need for greater consensus on how eating disorder outcome should be measured. This is necessary in order to make comparisons between different outcome studies meaningful, and to elucidate the overall picture of eating disorders outcome.

    List of papers
    1. Reasons for non-participation in follow-up research on eating disorders
    Open this publication in new window or tab >>Reasons for non-participation in follow-up research on eating disorders
    2006 (English)In: Eating and Weight Disorders, ISSN 1124-4909, E-ISSN 1590-1262, Vol. 11, no 3, p. 147-153Article in journal (Refereed) Published
    Abstract [en]

    OBJECTIVE: Lack of participation in follow-ups is thought to be a serious bias in outcome research on eating disorders; however, little systematic knowledge exists about the problem. The present study aimed to delineate non-participation in long-term follow-up research, and explore the reasons for non-participation.

    METHOD: Eating disorder patients (N=840) entering a naturalistic, longitudinal multi-centre study were divided into participators (N=508) and non-participators (N=332) in 36-month follow-ups. Non-participators were further classified as either active (i.e. refused participation or failed to attend scheduled appointments) or passive non-participators (i.e. could not be traced).

    RESULTS: Active non-participators exhibited significantly lower levels of general and eating disorder psychopathology at intake compared to participators, while passive non-participators reported higher levels of hostility.

    DISCUSSION: Systematic exploration of non-participation in longitudinal research can help to mitigate the problem of indistinct results due to missing data. Barriers to successful longitudinal research and how to overcome non-participation at endpoint are discussed.

    National Category
    Medical and Health Sciences
    Research subject
    Medicine
    Identifiers
    urn:nbn:se:oru:diva-2978 (URN)17075242 (PubMedID)
    Available from: 2008-05-05 Created: 2008-05-05 Last updated: 2017-12-14Bibliographically approved
    2. Self-image and treatment drop-out in eating disorders
    Open this publication in new window or tab >>Self-image and treatment drop-out in eating disorders
    Show others...
    2008 (English)In: Psychology and Psychotherapy: Theory, Research and Practice, ISSN 1476-0835, E-ISSN 2044-8341, Vol. 81, no 1, p. 95-104Article in journal (Refereed) Published
    Abstract [en]

    Introduction: Drop-out from treatment is a serious problem in eating disorders which remains poorly understood. The present study investigated whether self-image and interpersonal theory could help to explain why eating disorder patients drop out of treatment. Method: Intake data on eating disorder patients who terminated treatment prematurely (N=54) were compared with patients who had completed treatment (N=54) and those who were still in treatment after 12 months (N=54). Self-image was assessed using the structural analysis of social behaviour (SASB), and comparisons were made on demographic and clinical variables. Results: Patients who dropped out had initially presented with less negative self-image and fewer psychological problems compared with remainers. Low levels of SASB self-blame discriminated drop-outs from completers and remainers and significantly predicted treatment drop-out. Discussion: Drop-out in eating disorders appears to be a complex phenomenon, not necessarily as pathological as often assumed. There may be important differences in the treatment goals of drop-outs and therapists; patients who drop out may be choosing to disengage at a time when symptom improvement creates space for closer examination of interpersonal issues.

    Place, publisher, year, edition, pages
    Leicester, UK: British Psychological Society, 2008
    National Category
    Medical and Health Sciences
    Research subject
    Medicine
    Identifiers
    urn:nbn:se:oru:diva-2979 (URN)10.1348/147608307X224547 (DOI)
    Available from: 2008-05-05 Created: 2008-05-05 Last updated: 2017-12-14Bibliographically approved
    3. What happened to the ones who dropped out?: Outcome in eating disorder patients who complete or prematurely terminate treatment
    Open this publication in new window or tab >>What happened to the ones who dropped out?: Outcome in eating disorder patients who complete or prematurely terminate treatment
    Show others...
    2009 (English)In: European eating disorders review, ISSN 1072-4133, E-ISSN 1099-0968, Vol. 17, no 2, p. 109-119Article in journal (Refereed) Published
    Abstract [en]

    INTRODUCTION:

    There is a lack of knowledge about the outcome of eating disorder patients who terminate treatment prematurely. The present study followed-up eating disorder patients who had previously dropped out of treatment and examined clinical status 36 months after intake.

    METHOD:

    Dropouts (n = 30) were compared with treatment completers (n = 52) on diagnostic status, clinical symptoms, psychosocial adjustment and treatment satisfaction at follow-up. Patterns of change from intake to follow-up within groups, as well as between groups, were explored.

    RESULTS:

    No significant differences were found between groups at follow-up, except for more treatment dissatisfaction reported among dropouts. When patterns of change were examined between groups, patients who completed treatment were found to have made significantly greater changes (less eating disorder symptoms, less psychological problems and more positive self-image) compared to dropouts.

    DISCUSSION:

    Although no significant differences in outcome were found between dropouts and completers, greater clinical improvement was found among those who completed treatment. The dropouts examined in this study did well despite premature termination of treatment. Clinical and research implications are discussed.

    Place, publisher, year, edition, pages
    New York: John Wiley & Sons, 2009
    National Category
    Medical and Health Sciences
    Research subject
    Medicine
    Identifiers
    urn:nbn:se:oru:diva-2980 (URN)10.1002/erv.911 (DOI)000264357700004 ()19142975 (PubMedID)2-s2.0-66449117940 (Scopus ID)
    Available from: 2008-05-05 Created: 2008-05-05 Last updated: 2017-12-14Bibliographically approved
    4. The patient’s perception of having recovered from an eating disorder
    Open this publication in new window or tab >>The patient’s perception of having recovered from an eating disorder
    2008 (English)In: Health Care for Women International, ISSN 0739-9332, E-ISSN 1096-4665, Vol. 29, no 8-9, p. 926-944Article in journal (Refereed) Published
    Abstract [en]

    Our aim in this study was to describe how patients perceive having recovered from eating disorders. A qualitative method with a phenomenographic approach was used to identify various ways of experiencing recovery. Four categories emerged, describing how the subjects now relate in a relaxed and accepting manner to food, the body, themselves as individuals, and their social environment. Some perceived recovery as coping with emotions, while others experienced themselves as healthier than people in general regarding food and weight. Different aspects were emphasized as important for recovery. As long as patients perceive themselves as recovered, it is not necessary that they fulfill all conceivable criteria for recovery.

    National Category
    Medical and Health Sciences
    Research subject
    Medicine
    Identifiers
    urn:nbn:se:oru:diva-2981 (URN)10.1080/07399330802269543 (DOI)
    Available from: 2008-05-05 Created: 2008-05-05 Last updated: 2017-12-14Bibliographically approved
    5. The impact of using different outcome measures on remission rates in a three-year follow-up of eating disorders
    Open this publication in new window or tab >>The impact of using different outcome measures on remission rates in a three-year follow-up of eating disorders
    (English)Manuscript (Other academic)
    National Category
    Medical and Health Sciences
    Research subject
    Medicine
    Identifiers
    urn:nbn:se:oru:diva-2982 (URN)
    Available from: 2008-05-05 Created: 2008-05-05 Last updated: 2017-10-18Bibliographically approved
  • 3.
    Björk, Tabita
    et al.
    Örebro University, School of Health and Medical Sciences.
    Ahlström, Gerd
    The patient’s perception of having recovered from an eating disorder2008In: Health Care for Women International, ISSN 0739-9332, E-ISSN 1096-4665, Vol. 29, no 8-9, p. 926-944Article in journal (Refereed)
    Abstract [en]

    Our aim in this study was to describe how patients perceive having recovered from eating disorders. A qualitative method with a phenomenographic approach was used to identify various ways of experiencing recovery. Four categories emerged, describing how the subjects now relate in a relaxed and accepting manner to food, the body, themselves as individuals, and their social environment. Some perceived recovery as coping with emotions, while others experienced themselves as healthier than people in general regarding food and weight. Different aspects were emphasized as important for recovery. As long as patients perceive themselves as recovered, it is not necessary that they fulfill all conceivable criteria for recovery.

  • 4.
    Björk, Tabita
    et al.
    Örebro University, School of Health and Medical Sciences.
    Björck, Caroline
    Clinton, David
    Sohlberg, Staffan
    Norring, Claes
    What happened to the ones who dropped out?: Outcome in eating disorder patients who complete or prematurely terminate treatment2009In: European eating disorders review, ISSN 1072-4133, E-ISSN 1099-0968, Vol. 17, no 2, p. 109-119Article in journal (Refereed)
    Abstract [en]

    INTRODUCTION:

    There is a lack of knowledge about the outcome of eating disorder patients who terminate treatment prematurely. The present study followed-up eating disorder patients who had previously dropped out of treatment and examined clinical status 36 months after intake.

    METHOD:

    Dropouts (n = 30) were compared with treatment completers (n = 52) on diagnostic status, clinical symptoms, psychosocial adjustment and treatment satisfaction at follow-up. Patterns of change from intake to follow-up within groups, as well as between groups, were explored.

    RESULTS:

    No significant differences were found between groups at follow-up, except for more treatment dissatisfaction reported among dropouts. When patterns of change were examined between groups, patients who completed treatment were found to have made significantly greater changes (less eating disorder symptoms, less psychological problems and more positive self-image) compared to dropouts.

    DISCUSSION:

    Although no significant differences in outcome were found between dropouts and completers, greater clinical improvement was found among those who completed treatment. The dropouts examined in this study did well despite premature termination of treatment. Clinical and research implications are discussed.

  • 5.
    Björk, Tabita
    et al.
    Psychiatric Research Centre, Örebro County Council, Örebro, Sweden; Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institutet, Stockholm, Sweden.
    Brus, Ole
    Örebro University Hospital, Örebro, Sweden.
    Osika, Walter
    Stress Research Institute, Stockholm University, Stockholm, Sweden.
    Montgomery, Scott M.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Clinical Epidemiology Unit, Karolinska Institutet, Stockholm, Sweden; Department of Primary Care and Public Health, Charing Cross Hospital, Imperial College, London, UK.
    Laterality, hand control and scholastic performance: a British birth cohort study2012In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 2, no 2, article id e000314Article in journal (Refereed)
    Abstract [en]

    Objectives: To use simple measures of laterality and hand control that can identify a greater risk of poorer scholastic ability, potentially signalling suboptimal hemispheric lateralisation.

    Design: Analysis of material from a birth cohort study.

    Setting: Members of the National Child Development Study, a British birth cohort study following people born in 1958.

    Participants: 10 612 children who undertook tests at age 11 years.

    Primary outcome measures: Teacher-administered tests of non-verbal general ability, verbal general ability, reading comprehension and mathematics.

    Results: Linear regression produced associations (and 95% CIs) with tests of verbal general ability, non-verbal general ability, reading comprehension and mathematics scores for the lowest third (compared with highest) of a left-hand control test involving picking up matches of -1.21 (-1.73 to -0.68; p<0.001), -0.72 (-1.14 to -0.29; p=0.001), -0.70 (-1.06 to -0.35; p<0.001) and -1.32 (-1.90 to -0.73; p<0.001). Among those in the lowest third of the right-hand control test score, mixed-handedness compared with right-handedness was associated with poorer scholastic performance, with regression coefficients (and 95% CIs; p values) of 1.90 (-3.01 to -0.80; p=0.001), -1.25 (-2.15 to -0.35; p=0.007), -1.28 (2.04 to -0.53; p=0.001) and -1.33 (-2.53 to -0.13; p=0.030). The estimates are for a point change in the scholastic test scores, after adjustment for sex, left-hand motor function and social class. Statistically significant associations with mixed-handedness were only observed for the lowest third of right-hand motor function.

    Conclusions: Measures involving poorer left-hand motor function may represent useful markers of reduced cognitive function possibly reflecting suboptimal hemispheric lateralisation. Crude measures of laterality such as reported non-right-handedness may be more useful for research when combined with measures of motor function.

  • 6.
    Björk, Tabita
    et al.
    Örebro University, School of Health and Medical Sciences.
    Clinton, D.
    Norring, C.
    Reasons for non-participation in follow-up research on eating disorders2006In: Eating and Weight Disorders, ISSN 1124-4909, E-ISSN 1590-1262, Vol. 11, no 3, p. 147-153Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: Lack of participation in follow-ups is thought to be a serious bias in outcome research on eating disorders; however, little systematic knowledge exists about the problem. The present study aimed to delineate non-participation in long-term follow-up research, and explore the reasons for non-participation.

    METHOD: Eating disorder patients (N=840) entering a naturalistic, longitudinal multi-centre study were divided into participators (N=508) and non-participators (N=332) in 36-month follow-ups. Non-participators were further classified as either active (i.e. refused participation or failed to attend scheduled appointments) or passive non-participators (i.e. could not be traced).

    RESULTS: Active non-participators exhibited significantly lower levels of general and eating disorder psychopathology at intake compared to participators, while passive non-participators reported higher levels of hostility.

    DISCUSSION: Systematic exploration of non-participation in longitudinal research can help to mitigate the problem of indistinct results due to missing data. Barriers to successful longitudinal research and how to overcome non-participation at endpoint are discussed.

  • 7.
    Björk, Tabita
    et al.
    Örebro University, School of Health and Medical Sciences.
    Clinton, David
    Norring, Claes
    The impact of different outcome measures on estimates of remission in a 3-year follow-up of eating disorders2011In: European eating disorders review, ISSN 1072-4133, E-ISSN 1099-0968, Vol. 19, no 1, p. 2-11Article in journal (Refereed)
    Abstract [en]

    Objective: To examine the impact of using different outcome measures on estimates of remission rates in eating disorders (ED).

    Method: Adult ED patients (n = 334) included in a naturalistic, longitudinal project were assessed 3 years after intake. Remission was operationally defined using six different measures of outcome. Pairwise analyses of agreement between outcome measures were also calculated.

    Results: Remission rates for the entire group varied considerably from 24.3 to 77.8% depending on how remission was defined and who made the assessment (experts or patients). Outcome measures performed differently depending on diagnosis, and agreement between measures varied from none to very good.

    Conclusion: The impact of different definitions of outcome on remission estimates is considerable. There is a need to validate different estimates of remission by examining them in relation to multiple domains of outcome over time and by critically examining their relative merits both empirically and clinically.

  • 8.
    Björk, Tabita
    et al.
    Örebro University, School of Health and Medical Sciences.
    Clinton, David
    Norring, Claes
    The impact of using different outcome measures on remission rates in a three-year follow-up of eating disordersManuscript (Other academic)
  • 9.
    Björk, Tabita
    et al.
    Psychiatric Research Centre, Örebro, Sweden; Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden.
    de Santi, Miguel G
    Forensic Psychiatric Service, Örebro County Council, Örebro, Sweden.
    Kjellin, Lars
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Psychiatric Research Centre, Örebro, Sweden.
    Criminal recidivism and mortality among patients discharged from a forensic medium secure hospital2012In: Nordic Journal of Psychiatry, ISSN 0803-9488, E-ISSN 1502-4725, Vol. 66, no 4, p. 283-9Article in journal (Refereed)
    Abstract [en]

    Background: One of the goals in forensic psychiatric care is to reduce the risk of recidivism, but current knowledge about the general outcome of forensic psychiatric treatment is limited.

    Aims: To analyse the rate of criminal recidivism and mortality after discharge in a sample of patients sentenced to forensic psychiatric treatment in a Swedish county.

    Methods: All offenders in Örebro County, Sweden, sentenced to forensic psychiatric treatment and discharged during 1992-2007 were included: 80 males and eight females. Follow-up data was retrieved from the Swedish National Council for Crime Prevention, the National Cause-of-Death register and clinical files. Mean follow-up time was 9.4 years.

    Results: The mean age at discharge was 40 years. Schizophrenia, other psychoses and personality disorders were the most prevalent diagnoses. Thirty-eight percent of those still alive and still living in the country re-offended and were sentenced to a new period of forensic psychiatric treatment or incarceration during follow-up. Four male re-offenders committed serious violent crimes. Substance-related diagnosis was significantly associated with risk of recidivism and after adjustment for diagnoses, age and history of serious violent crime, the Hazard Ratio was 4.04 (95% CI 1.51-10.86, P = 0.006). Of all included patients, 23% had died at the end of follow-up (standardized mortality rate 10.4).

    Conclusions: Since repetition of serious violent crimes was unusual, results indicate a positive development subsequent to treatment for those alive at follow-up.

    Clinical implications: The high mortality rate suggests that more attention should be paid in evaluation of the patients' somatic and psychiatric health during and after care in order to prevent premature death.

  • 10.
    Björk, Tabita
    et al.
    Psychiatric Research Centre, University Hospital, Örebro.
    Lindqvist, Per
    Division of Forensic Psychiatry, Department of Clinical Neuroscience, Karolinska Institute, stockholm.
    Mortality among mentally disordered offenders: a community based follow-up study2005In: CBMH. Criminal behaviour and mental health, ISSN 0957-9664, E-ISSN 1471-2857, Vol. 15, no 2, p. 93-6Article in journal (Refereed)
    Abstract [en]

    Background: Follow-up information about outcome for hospitalized mentally disordered offenders (MDO) is necessary for evaluation and improvement in quality of forensic psychiatric care.

    Aim: A study was undertaken to estimate the standard mortality rate (SMR) of a population based sample of people sentenced to forensic psychiatric care.

    Method: All MDOs in Orebro County, Sweden, discharged from a forensic psychiatric treatment unit between 1992 and 1999 were identified (n = 46). The variables were gender, age, offence, diagnosis and duration of admission. Case linkage was made with the National Cause-of-Death register. Median follow-up time was 53 months (0-93).

    Results: The sample yielded a significantly elevated SMR 13.4 (95% CI 4.35-31.3) times higher than that in the general population, mostly due to suicide.

    Conclusion: The cohort size is small but representative, and it provides data from an additional country for the growing international pool confirming the high risk of premature, generally self-inflicted death among MDOs. Resettlement and rehabilitation services for them may need to take as much account of mortality risk as that of re-offending.

  • 11.
    Björk, Tabita
    et al.
    Dept Clin Neurosci, Karolinska Inst, Stockholm, Sweden.
    Skårberg, Kurt
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Örebro University Hospital.
    Engström, Ingemar
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Örebro University Hospital.
    Eating disorders and anabolic androgenic steroids in males: similarities and differences in self-image and psychiatric symptoms2013In: Substance Abuse Treatment, Prevention, and Policy, ISSN 1747-597X, E-ISSN 1747-597X, Vol. 8, no 30, p. 1-7Article in journal (Refereed)
    Abstract [en]

    Background: Body dissatisfaction is common among both females and males. Dissatisfaction with the body is a risk factor both for onset of eating disorders and for abuse of anabolic androgenic steroids (AAS). Few studies have however investigated if there are other similarities in respect to self-image or psychiatric symptoms between clinical samples of eating disordered males and males in treatment for negative effects of AAS use.

    Aim: The aim of this study was to compare two clinical samples, one of males with ED and one of males who used AAS, regarding self-image and psychiatric symptoms.

    Methods: This study compared males with eating disorders (n = 13) and males who recently stopped AAS use (n = 29) on self-image and psychiatric symptoms, using The Structural Analysis of Social Behavior self-questionnaire and a shortened version of The Symptom Check List.

    Results: The eating disorder group reported significantly lower scores for Self-emancipation and Active self-love and higher scores for Self-blame and Self-hate. Both groups reported serious psychiatric symptoms. The common denominator between groups was serious psychiatric symptomatology rather than negative self-image.

    Conclusions: The negative self-image profile, especially self-hate, found among males with Eating Disorders may indicate that the studied groups differ in aetiology of the underlying problems. The serious psychiatric symptoms in both groups call staff to pay attention to any thoughts of suicide due to severe depressive symptoms where by specialized psychiatric treatment may be needed.

  • 12.
    Björk, Tabita
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Psychiatric Research Centre, University Hospital, Örebro, Örebro, Sweden; Department of Clinical Neuroscience and Psychiatry, Karolinska Institute, Stockholm, Sweden.
    Wallin, Karin
    Department of Clinical Science, Child & Adolescent Psychiatry, Lund University, Lund, Sweden.
    Pettersen, Gunn
    Department of Health and Care Sciences, Faculty of Health Sciences, University of Tromsø, Tromsø, Norway.
    Male experiences of life after recovery from an eating disorder2012In: Eating Disorders, ISSN 1064-0266, E-ISSN 1532-530X, Vol. 20, no 5, p. 460-8Article in journal (Refereed)
    Abstract [en]

    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.

  • 13.
    Pettersen, Gunn
    et al.
    Department of Health and Care Science, University of Tromsø-The Artic University of Norway, Tromsø, Norway.
    Wallin, Karin
    Department of Clinical Science Lund, Child and Adolescent Psychiatry, Lund University, Lund, Sweden.
    Björk, Tabita
    Örebro University, School of Medical Sciences.
    How do males recover from eating disorders?: An interview study2016In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 6, no 8, article id e010760Article in journal (Refereed)
    Abstract [en]

    Objectives: The aim of the current study is to investigate what males experience as helpful in their recovery process from eating disorders (ED).

    Methods: Qualitative in-depth interviews within a phenomenological approach, and using content analysis to excavate overarching text themes.

    Setting: Norway and Sweden.

    Participants: Included were 15 males with an age range from 19 to 52 years. Duration of illness varied between 3 and 25 years of experience with anorexia nervosa (n=10), bulimia nervosa (n=4) or ED not otherwise specified (n=1).

    Results: The content analysis revealed four main categories, that is, 'the need for a change', 'a commitment to leave the eating disorder behind', 'interpersonal changes' and 'searching for a life without an eating disorder'. These categories comprise features like motivation to change, gaining structure in eating situations, a re-learning of personal and interpersonal skills as well as accepting losses and starting a reorientation of identity and meaning. We noted a rather goal-oriented approach to help seeking and a variation in how the males engaged their social network in resolving the challenges associated with the recovery process. Still, the overall nature of the recovery process highly accords with what has been reported for women.

    Discussion: A clinical implication from our findings is that symptom relief is important to facilitate good circles of improvement, but that the nature of the recovery process would require a wider perspective in treatment. Clinicians may also be informed about challenges related to an instrumental approach to help seeking reported in this study.

  • 14.
    Rytterström, Patrik
    et al.
    Department of Social and Welfare Studies, Linköping University, Linköping, Sweden.
    Lindeborg, Mirja
    Psychiatric Specialist Care, Örebro, Sweden.
    Korhonen, Sari
    Psychiatric Specialist Care, Örebro, Sweden.
    Björk, Tabita
    Örebro University, School of Medical Sciences. Örebro University Hospital. 3University Health Care Research Centre.
    Finding the Silent Message: Nurses’ Experiences of Non-Verbal Communication Preceding a Suicide2019In: Psychology, ISSN 2152-7180, E-ISSN 2152-7199, Vol. 10, no 1, p. 1-18Article in journal (Refereed)
    Abstract [en]

    Suicidal individuals often communicate their intention to commit suicide, but not necessarily verbally. Psychiatric nurses play a central role in the care of patients exhibiting suicidal behaviour or thoughts. Thus, the aim of this study was to explore nurses’ experiences of the indirect messages about forthcoming suicide from patients’ everyday life before they committed suicide. A qualitative design was used with a phenomenological hermeneutical approach. Seven nurses working in specialist psychiatric care were interviewed about their experience of the phenomenon communication about suicide. Results show how the nurses noticed changes in patients just before they committed suicide. These changes included rapid improvement, disguise of real feelings, and unreceptiveness to further treatment or encouragements. The nurses also described patients becoming aware of painful life conditions of losing hope and confidence in the future and experiencing feelings of powerlessness or an inability to influence the situation. Their last moments were characterised by a greater preoccupation with thoughts about death and finding ways to express farewells. This manifested itself in practical preparations and expressing gratitude to people, which was understood by the nurses as a way of saying goodbye. This study shows that it is possible for skilled staff to develop an understanding of a suicidal patient’s internal state and to recognise the non-verbal messages of someone who later committed suicide. The knowledge of how patients prepare and act before suicide could be used to complement a structural suicide risk assessment.

  • 15.
    Schröder, Agneta
    et al.
    Psychiatric Research Centre, Örebro County Council, Örebro, Sweden.
    Björk, Tabita
    Department of Clinical Neuroscience, Örebro University Hospital, Örebro, Sweden; Psychiatry, Karolinska Institutet, Stockholm, Sweden.
    Patients' judgements of quality of care in psychiatric observation and intensive inpatient care2013In: Journal of Psychiatric Intensive Care, ISSN 1742-6464, E-ISSN 1744-2206, Vol. 9, no 2, p. 91-100Article in journal (Refereed)
  • 16.
    Schückher, Fides
    et al.
    Örebro University, School of Medical Sciences. University Health Care Research Center.
    Sellin, Tabita
    Örebro University, School of Medical Sciences. Örebro University Hospital. University Health Care Research Center.
    Fahlke, Claudia
    Department of Psychology, University of Gothenburg, Göteborg, Sweden.
    Engström, Ingemar
    Örebro University, School of Medical Sciences. University Health Care Research Center.
    The Impact of Childhood Maltreatment on Age of Onset of Alcohol Use Disorder in Women2018In: European Addiction Research, ISSN 1022-6877, E-ISSN 1421-9891, Vol. 24, no 6, p. 278-285Article in journal (Refereed)
    Abstract [en]

    It is unclear whether exposure to childhood maltreatment is associated with the age of onset of alcohol use disorder (AUD). A group of socially stable women with AUD seeking treatment (n = 75) were interviewed using the Addiction Severity Index and the Mini International Neuropsychiatric Interview. They also filled out the Childhood Trauma Questionnaire-short form. Emotional abuse, sexual abuse and multiple childhood traumas were found to be associated with earlier onset of AUD. Multivariable linear regression analysis showed that independent predictors for an earlier onset of AUD were exposure to emotional abuse (beta = -7.44, SE = 2.83, adjusted p = 0.010) and mother's alcohol/substance problems (beta = -7.87, SE = 3.45, adjusted p = 0.026). These variables explained 18.9% of the variance of age of onset of AUD. These findings highlight a need for increased clinical attention to AUD subgroups who have experienced childhood maltreatment, especially emotional abuse, as well as a need for including support in the patient's own parental role in the treatment.

  • 17.
    Schückher, Fides
    et al.
    Örebro University, School of Medical Sciences.
    Sellin, Tabita
    Örebro University, School of Medical Sciences. Örebro University Hospital.
    Fahlke, Claudia
    Engström, Ingemar
    Örebro University, School of Medical Sciences.
    The Impact of Childhood Maltreatment on Onset Age of Alcohol Use Disorder in Women Seeking Treatment2018Conference paper (Refereed)
  • 18.
    Wallin, Karin
    et al.
    Department of Clinical Science Lund, Child and Adolescent Psychiatry, Lund University, Lund, Sweden.
    Pettersen, Gunn
    Department of Health and Care Sciences, University of Tromsø, The Arctic University of Norway, Tromsø, Norway.
    Björk, Tabita
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Department of Clinical Neuroscience, Psychiatry, Karolinska Institute, Stockholm, Sweden.
    Råstam, Maria
    Department of Clinical Science Lund, Child and Adolescent Psychiatry, Lund University, Lund, Sweden.
    A Qualitative Study of Males' Perceptions about Causes of Eating Disorder2014In: Psychology, ISSN 2152-7180, Vol. 5, no 15, p. 1813-1820Article in journal (Refereed)
    Abstract [en]

    Our knowledge about males’ perceptions about causes of eating disorder is very limited, but can be useful in the treatment planning for males. The aim of this study was to describe how male former patients perceived causes of onset of their eating disorder. Fifteen males previously treated for eating disorders and now considering themselves as recovered where interviewed at ages 19 - 52. All interviews were recorded and analyzed qualitatively using a phenomenographic approach. Three categories of perceived causes of onset of eating disorders were found. The first category: self-dissatisfaction, was presented with three conceptions: “High achievements and demands”, “Body-dissatisfaction” and “Low self-esteem”. The second category: family environment, comprised the two conceptions: “Difficulty in family interaction and communication” and “Excessive expectations from family members”. The third category was stressful events outside the family, and consisted of the three conceptions: “Bullying, bad situation at school”, “Moving to new places/separation from friends” and “Societal ideals”. Males’ perceptions of causes of onset of their eating disorder were in many aspects similar to those earlier described for women. In treatment, it is important that the clinicians show a sincere interest in perceived causes, since it may facilitate a good working alliance with the patient.

1 - 18 of 18
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