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  • 1.
    Bäck, Malin
    et al.
    Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden; Futurum: Academy for Health and Care, Jönköping, Region Jönköping County, Sweden.
    Falkenström, Fredrik
    Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden.
    Gustafsson, Sanna Aila
    Örebro University, School of Medical Sciences. Örebro University Hospital. University Health Care Research Center.
    Andersson, Gerhard
    Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden; Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden.
    Holmqvist, Rolf
    Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden.
    Reduction in depressive symptoms predicts improvement in eating disorder symptoms in interpersonal psychotherapy: results from a naturalistic study2020In: Journal of Eating Disorders, E-ISSN 2050-2974, Vol. 8, no 1, article id 33Article in journal (Refereed)
    Abstract [en]

    Background: Interpersonal psychotherapy (IPT) can be effective for both Bulimia Nervosa (BN) and co-occurring depression. While changes in symptoms of Eating disorder (ED) and depression have been found to correlate, it is unclear how they interact during treatment and in which order the symptoms decrease.

    Methods: Thirty-one patients with BN and depressive symptoms received IPT using the manual IPT-BNm in a naturalistic design. The outcome was measured with the Eating Disorder Examination Questionnaire (EDE-Q) and the Montgomery Åsberg Depression Rating Scale (MADRS-S). Symptom improvement at each session was measured with Repeated Evaluation of Eating Disorder Symptoms (REDS) and the Patient Health Questionnaire-9 (PHQ-9).

    Results: Significant improvements with large effect sizes were found on both ED symptoms and depression. The rates of change were linear for both BN and depression. A strong correlation between reduction of depressive symptoms and ED symptoms was found. Depressive symptom reduction at one session predicted improvement of ED symptoms at the next session.

    Conclusions: IPT-BNm had an effect on both BN and co-occurring depressive symptoms. The analyses indicated that reduction in depressive symptoms preceded reduction in bulimic symptoms.

  • 2.
    Bäck, Malin
    et al.
    Futurum, Academy for Health and Care, Region Jönköping County, Jönköping, Sweden; Department of Behavioural Research and Learning, Linköping University, Linköping, Sweden.
    Gustafsson, Sanna Aila
    Örebro University, School of Medical Sciences. Örebro University Hospital. University Health Care Research Center, Region Örebro County, Örebro, Sweden; Faculty of Medicine and Health, Örebro University, Örebro, Sweden; Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
    Holmqvist, Rolf
    Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden.
    Interpersonal psychotherapy for eating disorders with co-morbid depression: A pilot study2017In: European Journal of Psychotherapy, ISSN 1364-2537, E-ISSN 1469-5901, Vol. 19, no 4, p. 378-395Article in journal (Refereed)
    Abstract [en]

    Objective: Patients with eating disorders (ED) often suffer from co-morbid depression, which may complicate the ED treatment. Previous studies have found that ED interventions seem to have limited capacity to reduce depressive symptoms. Several studies of interpersonal psychotherapy (IPT), have found that when patients have been treated for depression, co-morbid symptoms have diminished. As depression and EDs are commonly co-occurring conditions, this pilot study aimed to examine the effect of an IPT treatment for these conditions, with the focus on the depressive symptoms.

    Method: In this multi-centre study, 16 patients with EDs and co-occurring major depression received 16 weeks of depression-focused IPT.

    Results: Significant improvements with substantial effect sizes were found for both depression (d = 1.48) and ED (d =.93). Symptom reduction in the two syndromes were strongly correlated (r = .625, p = .004). Patients with a restrictive ED did not improve on either depression or ED symptoms.

    Conclusion: These findings point to the usefulness of IPT for concurrent depression and ED with a bingeing/purging symptomatology. Working with negative affect and problem-solving related to current interpersonal problems may alleviate general psychological distress among these patients.

  • 3.
    Callio, Carina
    et al.
    University Health Care Research Center, Region Örebro County, Örebro, Sweden; Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Gustafsson, Sanna Aila
    Örebro University, School of Medical Sciences.
    Living with a sibling who suffers from an eating disorder: a pilot interview study2016In: Journal of Multidisciplinary Healthcare, ISSN 1178-2390, E-ISSN 1178-2390, Vol. 9, p. 615-622Article in journal (Refereed)
    Abstract [en]

    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.

  • 4.
    Fogelkvist, Maria
    et al.
    Örebro University, School of Medical Sciences. University Health Care Research Center.
    Gustafsson, Sanna Aila
    Örebro University, School of Medical Sciences. Örebro University Hospital. University Health Care Research Center.
    Kjellin, Lars
    University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Parling, Thomas
    Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Stockholm Health Care Services, Stockholm County Council, The Centre for Psychotherapy, Education & Research, Stockholm, Sweden.
    Acceptance and commitment therapy to reduce eating disorder symptoms and body image problems in patients with residual eating disorder symptoms: A randomized controlled trial2020In: Body image, ISSN 1740-1445, E-ISSN 1873-6807, Vol. 32, p. 155-166Article in journal (Refereed)
    Abstract [en]

    Body image problems are central aspects of eating disorders (ED), and risk factors both for the development of and relapse into an ED. Acceptance and commitment therapy (ACT) aims at helping patients accept uncomfortable internal experiences while committing to behaviors in accordance with life values. The aim of the present study was to compare the effectiveness of a group intervention, consisting of 12 sessions, based on ACT to treatment as usual (TAU) for patients with residual ED symptoms and body image problems. The study was a randomized controlled superiority trial. Patients with residual ED symptoms and body image problems were recruited from a specialized ED clinic in Sweden. The final sample consisted of 99 women, randomized to ACT or TAU. At the two-year follow-up, patients who received ACT showed a significant greater reduction in ED symptoms and body image problems and received less specialized ED care than patients in TAU. In conclusion, ACT was superior in reducing ED symptoms and body image problems.

  • 5.
    Fogelkvist, Maria
    et al.
    Örebro University, School of Medical Sciences. Örebro University Hospital. University Health Care Research Center.
    Gustafsson, Sanna Aila
    Örebro University Hospital. Örebro University, School of Law, Psychology and Social Work. University Health Care Research Center.
    Kjellin, Lars
    University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Parling, Thomas
    Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Stockholm Health Care Services, Region Stockholm, The Centre for Psychotherapy, Education and Research, Stockholm, Sweden.
    Predictors of outcome following a body image treatment based on acceptance and commitment therapy for patients with an eating disorder2022In: Journal of Eating Disorders, E-ISSN 2050-2974, Vol. 10, no 1, article id 90Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: It is important to target body image in individuals with an eating disorder (ED). Acceptance and commitment therapy (ACT) has been trialed in a few studies for individuals with an ED. Although ACT outcomes in ED patients hold promise, studies of predictors are scarce. The aim of the present study was to explore differences in ED symptom outcome at two-year follow-up in subgroups of participants attending either treatment as usual (TAU), or a group intervention based on ACT targeting body image. Additionally, we aimed to compare subjective recovery experiences between groups.

    METHODS: The study took place at a specialized ED outpatient clinic, and included patients diagnosed with an ED that had received prior treatment and achieved a somewhat regular eating pattern. Study participants were randomly assigned to continue TAU or to participate in a group intervention based on ACT for body image issues. Only participants that completed the assigned intervention and had completed follow up assessment by two-years were included. The total sample consisted of 77 women.

    RESULTS: In general, ACT participants showed more favorable outcomes compared to TAU, and results were more pronounced in younger participants with shorter prior treatment duration and lower baseline depression ratings. Participants with restrictive ED psychopathology had three times higher ED symptom score change if participating in ACT in comparison to TAU.

    CONCLUSIONS: An ACT group intervention targeting body image after initial ED treatment may further enhance treatment effects. There is a need for further investigation of patient characteristics that might predict response to body image treatment, particularly regarding ED subtypes and depression ratings.

  • 6.
    Fogelkvist, Maria
    et al.
    Örebro University, School of Medical Sciences. University Health Care Research Center.
    Gustafsson, Sanna Aila
    Örebro University, School of Medical Sciences. Örebro University Hospital. University Health Care Research Center.
    Kjellin, Lars
    University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Parling, Thomas
    Karolinska Institutet, Stockholm, Sweden; Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden.
    Predictors of outcome following a body image treatment based on acceptance and commitment therapy for patients with an eating disorderManuscript (preprint) (Other academic)
  • 7.
    Fogelkvist, Maria
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Kjellin, Lars
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Gustafsson, Sanna Aila
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Parling, Thomas
    Live with your body: Acceptance and commitment therapy to increase body acceptance in patients with eating disorders2015In: ECED 2015: Abstracts, 2015, p. 31-31, article id P9Conference paper (Other academic)
  • 8.
    Fogelkvist, Maria
    et al.
    Örebro University, School of Medical Sciences. Fac Med & Hlth, Univ Hlth Care Res Ctr, Univ Orebro, Orebro 16, Sweden.
    Parling, Thomas
    Department of Psychology, Uppsala University, Uppsala, Sweden.
    Kjellin, Lars
    Örebro University, School of Health Sciences. Örebro University Hospital.
    Gustafsson, Sanna Aila
    Örebro University, School of Medical Sciences. Örebro University Hospital.
    A qualitative analysis of participants' reflections on body image during participation in a randomized controlled trial of acceptance and commitment therapy2016In: Journal of Eating Disorders, E-ISSN 2050-2974, Vol. 4, article id 29Article in journal (Refereed)
    Abstract [en]

    Background: Negative 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.

    Method: Before 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.

    Results: Body 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.

    Conclusions: The 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.

  • 9.
    Fogelkvist, Maria
    et al.
    Örebro University, School of Medical Sciences. University Health Care Research Center.
    Parling, Thomas
    Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Sockholm, Sweden; Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden.
    Kjellin, Lars
    University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Gustafsson, Sanna Aila
    Örebro University, School of Medical Sciences. Örebro University Hospital. University Health Care Research Center.
    Live with your body - participants' reflections on an acceptance and commitment therapy group intervention for patients with residual eating disorder symptoms2021In: Journal of Contextual Behavioral Science, ISSN 2212-1447, Vol. 20, p. 184-193Article in journal (Refereed)
    Abstract [en]

    Acceptance and commitment therapy (ACT) is a transdiagnostic approach to human suffering that has been trialed in a range of different contexts. This study aimed to examine participants' view of helpful and hindering aspects of an in person ACT group intervention targeting body image in patients with residual eating disorder (ED) symptoms. Thirteen women who completed the intervention were interviewed, and transcripts were analyzed through thematic analysis. Nine themes were identified and sorted into three main themes. The first main theme, "Taking the plunge", pointed to the importance of participants own effort, and included subthemes of self-efficacy, self as description, and self-exploration. The second main theme, "A push towards valued ends", indicated that content of the intervention was helpful, and included subthemes of commitment and behavioral change processes, mindfulness and acceptance processes, and assignments in and between sessions. The third main theme, "The context matters", described the importance of the contexts of the intervention and life outside of treatment, and included subthemes of the group format, the context outside of treatment, and the timing of the intervention. Through the description of specific content, we conclude that ACT seems to help women with residual ED symptoms and body image issues by fostering motivation to engage in avoided situations and behaviors while striving to live a more valued life.

  • 10.
    Fogelkvist, Maria
    et al.
    Örebro University, School of Medical Sciences. University Health Care Research Center.
    Parling, Thomas
    Karolinska Institutet, Stockholm, Sweden; Stockholm Health Care Services, Stockholm County Council.
    Kjellin, Lars
    University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Gustafsson, Sanna Aila
    Örebro University, School of Medical Sciences. Örebro University Hospital. University Health Care Research Center.
    Live with your body – participants reflections on an Acceptance and commitment therapy group intervention for patients with residual eating disorder symptomsManuscript (preprint) (Other academic)
  • 11.
    Grundberg, Åke
    et al.
    Division of Neurogeriatrics, Karolinska Institutet, Stockholm, Sweden.
    Ebbeskog, Britt
    Division of Nursing, Department of Neurobiology, Care sciences and society, Karolinska Institutet, Stockholm, Sweden.
    Gustafsson, Sanna Aila
    Örebro University Hospital. Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Psychiatric Research Centre, Örebro University Hospital, Örebro, Sweden.
    Religa, Dorota
    Division of Neurogeriatrics, Karolinska Institutet, Stockholm, Sweden.
    Mental health-promoting dialogues from the perspective of community-dwelling seniors with multimorbidity.2014In: Journal of Multidisciplinary Healthcare, ISSN 1178-2390, E-ISSN 1178-2390, Vol. 7, p. 189-199Article in journal (Refereed)
    Abstract [en]

    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.

  • 12.
    Gustafsson, Sanna Aila
    Örebro University, School of Health and Medical Sciences.
    The importance of being thin: perceived expectations from self and others and the effect on self-evaluation in girls with disordered eating2010Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    The overall aims of this thesis were to examine personal standards, self-evaluation and attitudes to eating and weight in the development of disturbed eating in adolescent girls, and to examine how adolescent girls with a clinical eating disorder reflect upon and deal with perceived expectations in daily life.

    Studies I and II were quantitative studies, conducted in a population-based longitudinal study. Studies III and IV were qualitative interview studies of girls who were suffering from eating disorders and the data were analysed using a phenomenographic approach.

    Study I showed that high personal standards expressed in a competitive way were specific for the girls with disturbed eating. These girls also reported a negative physical self-evaluation and often believed that thinness would make them more popular. In study II variables concerning attitudes to eating and weight and physical self-evaluation emerged as risk factors for disturbed eating, 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. Three categories of perceived expectations were described in study III: expectations from others, self-imposed expectations and conflicting expectations. Many informants had problems identifying expectations that were not explicit and they interpreted them as self-imposed. In study IV the various ways in which the informants reflected on dealing with these expectations were summarized into three qualitatively different conceptions: being oneself, adapting to different situations and presenting oneself in a positive light. These conceptions were expressed in five patterns of action, which could have various functions for different individuals and in different situations.

    The results suggest that in order to prevent and treat eating disorders and related problems it is essential to integrate both intrapersonal and contextual factors that contribute to the development and maintenance of these conditions.

    List of papers
    1. Personal standards, self-evaluation and perceived benefits of thinness in girls and young women with disturbed eating
    Open this publication in new window or tab >>Personal standards, self-evaluation and perceived benefits of thinness in girls and young women with disturbed eating
    2008 (English)In: European eating disorders review, ISSN 1072-4133, E-ISSN 1099-0968, Vol. 16, no 6, p. 463-471Article in journal (Other academic) Published
    Abstract [en]

    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.

    Place, publisher, year, edition, pages
    John Wiley & Sons, 2008
    National Category
    Medical and Health Sciences Psychiatry
    Research subject
    Psychiatry
    Identifiers
    urn:nbn:se:oru:diva-3546 (URN)10.1002/erv.885 (DOI)000261128300007 ()18615843 (PubMedID)2-s2.0-58149357515 (Scopus ID)
    Available from: 2008-12-09 Created: 2008-12-09 Last updated: 2022-07-07Bibliographically approved
    2. Risk and protective factors for disturbed eating in adolescent girls: aspects of perfectionism and attitudes to eating and weight
    Open this publication in new window or tab >>Risk and protective factors for disturbed eating in adolescent girls: aspects of perfectionism and attitudes to eating and weight
    2009 (English)In: European eating disorders review, ISSN 1072-4133, E-ISSN 1099-0968, Vol. 17, no 5, p. 380-389Article in journal (Refereed) Published
    Abstract [en]

    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.

    Place, publisher, year, edition, pages
    Chichester: John Wiley & Sons, 2009
    Keywords
    eating disorders, perfectionism, protective factors, risk factors
    National Category
    Psychiatry
    Research subject
    Psychiatry
    Identifiers
    urn:nbn:se:oru:diva-10006 (URN)10.1002/erv.930 (DOI)000269964500007 ()2-s2.0-70449700392 (Scopus ID)
    Projects
    ingår i doktorsavhandling.
    Available from: 2010-03-19 Created: 2010-03-15 Last updated: 2021-05-17Bibliographically approved
    3. Perceived expectations in daily life among adolescent girls suffering from an eating disorder: A Phenomenographic Study
    Open this publication in new window or tab >>Perceived expectations in daily life among adolescent girls suffering from an eating disorder: A Phenomenographic Study
    Show others...
    2010 (English)In: Eating Disorders, ISSN 1064-0266, E-ISSN 1532-530X, Vol. 18, no 1, p. 25-42Article in journal (Refereed) Published
    Abstract [en]

    The aim of this study was to describe the variation of perceived expectations in daily life of adolescent girls suffering from eating disorders. Eighteen interviews with girls between the age of 15 and 19 years were analyzed according to the phenomenographic approach. The results could be summarized into three categories: expectations from others, self-imposed expectations, and conflicting expectations. Each of these could be further subdivided into two conceptions. Conflicting and unattainable expectations were severe stressors in the informants’ lives. Many informants had problems identifying expectations that were not explicit. The informants internalized these expectations and interpreted them to be self-imposed. Clinical implications are suggested.

    Place, publisher, year, edition, pages
    Philadelphia: Routledge, 2010
    National Category
    Psychiatry
    Research subject
    Psychiatry
    Identifiers
    urn:nbn:se:oru:diva-10100 (URN)10.1080/10640260903439524 (DOI)2-s2.0-77649168714 (Scopus ID)
    Projects
    Ingår i doktorsavhandling.
    Available from: 2010-03-19 Created: 2010-03-19 Last updated: 2023-12-08Bibliographically approved
    4. How to deal with perceived expectations in daily life: reflections of adolescent girls suffering from eating disorders
    Open this publication in new window or tab >>How to deal with perceived expectations in daily life: reflections of adolescent girls suffering from eating disorders
    Show others...
    (English)Manuscript (preprint) (Other academic)
    Abstract [en]

    The aim of this study was to investigate how adolescent girls with eating disorders reflect upon various ways of dealing with societal expectations in daily life. Eighteen interviews with girls in the age span 15-19 were analysed using the phenomenographic approach.

    The results could be summarized into three qualitatively different conceptions: A) being oneself, B) adapting to different situations and C) presenting oneself in a positive light. These conceptions were expressed in five courses of action.

    Keywords
    eating disorders, phenomenography, qualitative research, sociocultural expectations, sociocultural factors
    National Category
    Psychiatry
    Research subject
    Psychiatry
    Identifiers
    urn:nbn:se:oru:diva-10101 (URN)
    Projects
    Ingår i avhandlingsarbete
    Available from: 2010-03-19 Created: 2010-03-19 Last updated: 2021-05-17Bibliographically approved
    Download full text (pdf)
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  • 13.
    Gustafsson, Sanna Aila
    et al.
    Örebro University, School of Health and Medical Sciences.
    Edlund, Birgitta
    Institutionen för folkhälso- och vårdvetenskap, Uppsala Universitet.
    Davén, Josefine
    Kjellin, Lars
    Örebro University, School of Health and Medical Sciences.
    Norring, Claes
    Centrum för psykiatriforskning, KI.
    How to deal with perceived expectations in daily life: reflections of adolescent girls suffering from eating disordersManuscript (preprint) (Other academic)
    Abstract [en]

    The aim of this study was to investigate how adolescent girls with eating disorders reflect upon various ways of dealing with societal expectations in daily life. Eighteen interviews with girls in the age span 15-19 were analysed using the phenomenographic approach.

    The results could be summarized into three qualitatively different conceptions: A) being oneself, B) adapting to different situations and C) presenting oneself in a positive light. These conceptions were expressed in five courses of action.

  • 14.
    Gustafsson, Sanna Aila
    et al.
    Örebro University, School of Health and Medical Sciences.
    Edlund, Birgitta
    Institutionen för folkhälso- och vårdvetenskap, Uppsala universitet, Uppsala, Sweden.
    Davén, Josefine
    Kjellin, Lars
    Örebro University, School of Health and Medical Sciences.
    Norring, Claes
    Centrum för psykiatriforskning, Karolinska Institute, Stockholm, Sweden.
    How to deal with sociocultural pressures in daily life: reflections of adolescent girls suffering from eating disorders2011In: Journal of Multidisciplinary Healthcare, ISSN 1178-2390, E-ISSN 1178-2390, Vol. 18, no 4, p. 103-110Article in journal (Refereed)
    Abstract [en]

    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.

  • 15.
    Gustafsson, Sanna Aila
    et al.
    Örebro University, School of Health and Medical Sciences.
    Edlund, Birgitta
    Instituationen för folkhälso- och vårdvetensakp, Uppsala Universitet, Uppsala, Sweden.
    Davén, Josefine
    Kjellin, Lars
    Örebro University, School of Health and Medical Sciences.
    Norring, Claes
    Centrum för Psykiatriforskning, Karolinska Institute, Stockholm, Sweden .
    Perceived expectations in daily life among adolescent girls suffering from an eating disorder: A Phenomenographic Study2010In: Eating Disorders, ISSN 1064-0266, E-ISSN 1532-530X, Vol. 18, no 1, p. 25-42Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to describe the variation of perceived expectations in daily life of adolescent girls suffering from eating disorders. Eighteen interviews with girls between the age of 15 and 19 years were analyzed according to the phenomenographic approach. The results could be summarized into three categories: expectations from others, self-imposed expectations, and conflicting expectations. Each of these could be further subdivided into two conceptions. Conflicting and unattainable expectations were severe stressors in the informants’ lives. Many informants had problems identifying expectations that were not explicit. The informants internalized these expectations and interpreted them to be self-imposed. Clinical implications are suggested.

  • 16.
    Gustafsson, Sanna Aila
    et al.
    Örebro University, School of Health and Medical Sciences.
    Edlund, Birgitta
    Institutionen för folkhälso- och vårdvetenskap.
    Kjellin, Lars
    Örebro University, School of Health and Medical Sciences.
    Norring, Claes
    Personal standards, self-evaluation and perceived benefits of thinness in girls and young women with disturbed eating2008In: European eating disorders review, ISSN 1072-4133, E-ISSN 1099-0968, Vol. 16, no 6, p. 463-471Article in journal (Other academic)
    Abstract [en]

    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.

  • 17.
    Gustafsson, Sanna Aila
    et al.
    Örebro University, School of Health and Medical Sciences.
    Edlund, Birgitta
    Institutionen för folkhälso- och vårdvetenskap, Uppsala Universitet.
    Kjellin, Lars
    Örebro University, School of Health and Medical Sciences.
    Norring, Claes
    Center för psykiatriforskning, Karolinska institutet.
    Risk and protective factors for disturbed eating in adolescent girls: aspects of perfectionism and attitudes to eating and weight2009In: European eating disorders review, ISSN 1072-4133, E-ISSN 1099-0968, Vol. 17, no 5, p. 380-389Article in journal (Refereed)
    Abstract [en]

    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.

  • 18.
    Gustafsson, Sanna Aila
    et al.
    Örebro University Hospital. Örebro University, School of Law, Psychology and Social Work.
    Stenström, Karin
    Swedish Agency for Health Technology Assessment and Assessment of Social Services, Stockholm, Sweden; Sweden's Innovation Agency Vinnova, Stockholm, Sweden.
    Olofsson, Hanna
    Swedish Agency for Health Technology Assessment and Assessment of Social Services, Stockholm, Sweden.
    Pettersson, Agneta
    Swedish Agency for Health Technology Assessment and Assessment of Social Services, Stockholm, Sweden.
    Wilbe Ramsay, Karin
    Swedish Agency for Health Technology Assessment and Assessment of Social Services, Stockholm, Sweden.
    Experiences of eating disorders from the perspectives of patients, family members and health care professionals: a meta-review of qualitative evidence syntheses2021In: Journal of Eating Disorders, E-ISSN 2050-2974, Vol. 9, no 1, article id 156Article, review/survey (Refereed)
    Abstract [en]

    BACKGROUND: Eating disorders are serious conditions that cause major suffering for patients and their families. Better knowledge about perceptions of eating disorders and their treatment, and which factors that facilitate or hinder recovery, is desired in order to develop the clinical work. We aimed to explore and synthesise experiences of eating disorders from the perspectives of those suffering from an eating disorder, their family members and health care professionals through an overarching meta-review of systematic reviews in the field.

    METHODS: A systematic literature search was conducted in the databases PubMed, PsycInfo, Scopus, and CINAHL. Inclusion criteria were systematic reviews of qualitative research on experiences, perceptions, needs, or desires related to eating disorders from the perspective of patients, family members or health care professionals. Systematic reviews that fulfilled the inclusion criteria were assessed for relevance and methodological limitations by at least two researchers independently. The key findings were analysed and synthesised into themes.

    RESULTS: We identified 17 systematic reviews that met our inclusion criteria. Of these, 13 reviews reported on the patients' perspective, five on the family members' perspective, and three on the health care professionals' perspective. The study population in the reviews was predominantly girls and young women with anorexia nervosa, whilst systematic reviews focusing on other eating disorders were scarce. The findings regarding each of the three perspectives resulted in themes that could be synthesised into three overarching themes: 1) being in control or being controlled, 2) balancing physical recovery and psychological needs, and 3) trusting relationships.

    CONCLUSIONS: There were several similarities between the views of patients, family members and health care professionals, especially regarding the significance of building trustful therapeutic alliances that also included family members. However, the informants sometimes differed in their views, particularly on the use of the biomedical model, which was seen as helpful by health care professionals, while patients and family members felt that it failed to address their psychological distress. Acknowledging these differences is important for the understanding of anorexia nervosa and other eating disorders, and may help clinicians to broaden treatment approaches to meet the expectations of patients and family members.

  • 19.
    Holländare, Fredrik
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Psychiatric Research Centre, Örebro University Hospital, Örebro, Sweden.
    Gustafsson, Sanna Aila
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Berglind, Maria
    School of Law, Psychology and Social Work, Örebro University, Örebro, Sweden.
    Grape, Frida
    School of Law, Psychology and Social Work, Örebro University, Örebro, Sweden.
    Carlbring, Per
    Department of Psychology, Stockholm University, Stockholm, Sweden.
    Andersson, Gerhard
    Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden; Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
    Hadjistavropoulos, Heather
    Department of Psychology, University of Regina, Regina, Canada.
    Tillfors, Maria
    Örebro University, School of Law, Psychology and Social Work.
    Therapist behaviours in internet-based cognitive behaviour therapy (ICBT) for depressive symptoms2016In: Internet Interventions, ISSN 2214-7829, Vol. 3, p. 1-7Article in journal (Refereed)
    Abstract [en]

    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.

  • 20.
    Lindberg, Karolin
    et al.
    Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, Stockholm, Sweden; Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, Stockholm, Sweden.
    Nevonen, Lauri
    Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, Stockholm, Sweden; Praktikertjänst Psychiatry AB, Stockholm, Sweden; School of Medical Sciences, Örebro University, Örebro, Sweden.
    Gustafsson, Sanna Aila
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, Stockholm, Sweden.
    Nyman-Carlsson, Erika
    Örebro University, School of Health Sciences. Praktikertjänst Psychiatry AB, Stockholm, Sweden.
    Norring, Claes
    Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, Stockholm, Sweden; Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, Stockholm, Sweden.
    Validation of the Inventory of Interpersonal Problems (IIP-64): a comparison of Swedish female outpatients with anorexia nervosa or bulimia nervosa and controls2018In: Nordic Journal of Psychiatry, ISSN 0803-9488, E-ISSN 1502-4725, Vol. 72, no 5, p. 347-353Article in journal (Refereed)
    Abstract [en]

    AIM: The aim of the study was to explore the psychometric properties of the Inventory of Interpersonal Problems (IIP-64) and to compare levels of interpersonal distress in Swedish female outpatients with anorexia nervosa or bulimia nervosa with age- and gender-matched controls.

    METHODS: Totally, 401 participants were included; anorexia nervosa (n = 74), bulimia nervosa (n = 85) and controls (n = 242). All participants completed the IIP-64. The eating disorder (ED) patients also filled out the Eating Disorder Inventory-2/3 (EDI).

    RESULTS: Internal consistency of IIP-64 was acceptable to high. Principal component analyses with varimax rotation of the IIP-64 subscales confirmed the circumplex structure with two underlying orthogonal dimensions; affiliation and dominance. Significant correlations between EDI-3 composite scales ineffectiveness and interpersonal problems and IIP-64 were found. ED patients reported higher levels of interpersonal distress than controls on all but one subscale (intrusive/needy).

    CONCLUSIONS: IIP-64 can be considered to have acceptable to good reliability and validity in a Swedish ED sample. IIP-64 can be a useful complement in assessment of interpersonal problems in ED.

  • 21.
    Lindstedt, Katarina
    et al.
    Örebro University, School of Medical Sciences. Örebro University Hospital.
    Forss, E.
    Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Elwin, Marie
    Örebro University, School of Medical Sciences. Örebro University Hospital. University Health Care Research Center.
    Kjellin, L.
    University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Gustafsson, Sanna Aila
    Örebro University, School of Medical Sciences. Örebro University Hospital.
    Adolescents with full or subthreshold anorexia nervosa in a naturalistic sample: Treatment interventions and patient satisfaction2020In: Child and Adolescent Psychiatry and Mental Health, E-ISSN 1753-2000, Vol. 14, no 1, article id 16Article in journal (Refereed)
    Abstract [en]

    Background: Despite major research efforts, current recommendations of treatment interventions for adolescents with anorexia nervosa are scarce, and the importance of patient satisfaction for treatment outcome is yet to be established. The overall aim of the present study was to examine treatment interventions and patient satisfaction in a naturalistic sample of adolescents with anorexia nervosa or subthreshold anorexia nervosa and possible associations to outcome defined as being in remission or not at treatment follow-up.

    Methods: Participants were identified through the Swedish national quality register for eating disorder treatment (SwEat). The samples consisted of 1899 patients who were follow-up registered 1 year after entering treatment and 474 patients who had completed a 1-year patient satisfaction questionnaire. A two-step cluster analysis was used for identifying subgroups of patients who received certain combinations and various amounts of treatment forms.

    Results: Patients who received mainly family-based treatment and/or inpatient care were most likely to achieve remission at 1-year follow-up, compared to patients in the other clusters. They were also younger, in general. Individual therapy was the most common treatment form, and was most appreciated among the adolescents. At 1-year follow-up, many patients reported improvements in eating habits, but far fewer reported improvements regarding cognitive symptoms. Overall, the patients rated the therapist relationship in a rather positive way, but they gave quite low ratings to statements associated with their own participation in treatment.

    Conclusions: The results indicate that young adolescents who receive mainly family-based treatment and/or inpatient care respond more rapidly to treatment compared to older adolescents who receive mainly individual therapy or mixed treatment interventions. At 1-year follow-up, the adolescents reported improvements in behavioral symptoms and seemed quite satisfied with the therapist relationship.

  • 22.
    Lindstedt, Katarina
    et al.
    Örebro University, School of Medical Sciences. University Health Care Research Center.
    Forss, Emma
    Faculty of Medicine and Health, Örebro University, Sweden.
    Elwin, Marie
    Örebro University, School of Medical Sciences. Örebro University Hospital. University Health Care Research Center.
    Kjellin, Lars
    University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Sweden.
    Gustafsson, Sanna Aila
    Örebro University, School of Medical Sciences. Örebro University Hospital. University Health Care Research Center.
    Adolescents with full or subthreshold anorexia nervosa in a naturalistic sample: treatment interventions and patient satisfactionManuscript (preprint) (Other academic)
  • 23.
    Lindstedt, Katarina
    et al.
    Örebro University, School of Medical Sciences. University Health Care Research Center, Region Örebro County, Örebro, Sweden.
    Kjellin, Lars
    Örebro University, School of Health Sciences. Örebro University Hospital. University Health Care Research Center,, Region Örebro County, Örebro, Sweden.
    Gustafsson, Sanna Aila
    Örebro University, School of Medical Sciences. Örebro University Hospital. University Health Care Research Center, Region Örebro County, Örebro, Sweden.
    Adolescents with full or subthreshold anorexia nervosa in a naturalistic sample: characteristics and treatment outcome2017In: Journal of Eating Disorders, E-ISSN 2050-2974, Vol. 5, no 1, article id 4Article in journal (Refereed)
    Abstract [en]

    Background: Anorexia Nervosa (AN) destroys developmentally important early years of many young people and knowledge is insufficient regarding course, treatment outcome and prognosis. Only a few naturalistic studies have been conducted within the field of eating disorder (ED) research. In this naturalistic study we included adolescents with AN or subthreshold AN treated in outpatient care, and the overall aim was to examine sample characteristics and treatment outcome. Additional aims were to examine potential factors associated with remission as an outcome variable, and possible differences between three time periods for treatment onset.

    Methods: Participants were identified through the Swedish national quality register for eating disorder treatment (SwEat), in which patients are registered at treatment onset and followed up once a year until end of treatment (EOT). Inclusion criteria were: medical or self-referral to one of the participating treatment units between 1999 and 2014, 13-19 years of age at initial entry into SwEat and diagnosed with AN or subthreshold AN. The total sample consisted of 3997 patient from 83 different treatment units.

    Results: The results show that 55% of the participants were in remission and approximately 85% were within a healthy weight range at EOT. Of those who ended treatment according to plan, 70% were in remission and 90% within a healthy weight range. The average treatment duration was approximately 15 months. About one third of the patients terminated treatment prematurely, which was associated with a decreased chance of achieving remission. Remission rates and weight recovery increased over time, while treatment duration decreased. Considering treatment outcome, the results did not show any differences between patients with AN or subthreshold AN.

    Conclusions: The present study shows a relatively good prognosis for adolescent patients with AN or subthreshold AN in routine care and the results indicate that treatment for adolescents with ED in Sweden has become more effective over the past 15 years. The results of the present study contribute to the scope of treatment research and the large-scale naturalistic setting secures the generalizability to a clinical environment. However, more research is needed into different forms of evidence, new research strategies and diversity of treatment approaches.

  • 24.
    Lindstedt, Katarina
    et al.
    Örebro University, School of Medical Sciences. University Health Care Research Center.
    Neander, Kerstin
    Örebro University, School of Medical Sciences. Örebro University Hospital. University Health Care Research Center.
    Kjellin, Lars
    University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Gustafsson, Sanna Aila
    Örebro University, School of Medical Sciences. Örebro University Hospital. University Health Care Research Center.
    A life put on hold: adolescents' experiences of having an eating disorder in relation to social contexts outside the family2018In: Journal of Multidisciplinary Healthcare, ISSN 1178-2390, E-ISSN 1178-2390, Vol. 11, p. 425-437Article in journal (Refereed)
    Abstract [en]

    Background: As suffering from an eating disorder often entails restrictions on a person's everyday life, one can imagine that it is an important aspect of recovery to help young people learn to balance stressful demands and expectations in areas like the school environment and spare-time activities that include different forms of interpersonal relationships.

    Purpose: The aim of the present study was to investigate how adolescents with experience from a restrictive eating disorder describe their illness and their time in treatment in relation to social contexts outside the family.

    Patients and methods: This qualitative study is based on narratives of 15 adolescents with experience from outpatient treatment for eating disorders with a predominately restrictive symptomatology, recruited in collaboration with four specialized eating-disorder units. Data were explored through inductive thematic analysis.

    Results: The adolescents' descriptions of their illness in relation to their social contexts outside the family follow a clear timeline that includes narratives about when and how the problem arose, time in treatment, and the process that led to recovery. Three main themes were found: 1) the problems emerging in everyday life (outside the family); 2) a life put on hold and 3) creating a new life context.

    Conclusion: Young people with eating disorders need to learn how to balance demands and stressful situations in life, and to grasp the confusion that often preceded their illness. How recovery progresses, and how the young people experience their life contexts after recovery, depends largely on the magnitude and quality of peer support and on how school and sports activities affect and are affected by the eating disorder.

  • 25.
    Lindstedt, Katarina
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Psychiatric Research Centre.
    Neander, Kerstin
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Kjellin, Lars
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Gustafsson, Sanna Aila
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Being me and being us: adolescents' experiences of treatment for eating disorders2015In: Journal of Eating Disorders, E-ISSN 2050-2974, Vol. 3, no 9Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: This 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.

    METHODS: This 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.

    RESULTS: The 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.

    CONCLUSIONS: It 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.

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  • 26.
    Mac Donald, Benjamin
    et al.
    Department of Clinical Medicine, Aarhus University, Palle Juul Jensens-Boulevard 99, 8200, Aarhus, Denmark; Department of Child and Adolescent Psychiatry, Aarhus University Hospital, Palle Juul-Jensens Boulevard 175, Entrance K, 8200, Aarhus, Denmark.
    Gustafsson, Sanna A.
    Örebro University Hospital. Örebro University, School of Behavioural, Social and Legal Sciences.
    Bulik, Cynthia M.
    Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
    Clausen, Loa
    Department of Clinical Medicine, Aarhus University, Palle Juul Jensens-Boulevard 99, 8200, Aarhus, Denmark; Department of Child and Adolescent Psychiatry, Aarhus University Hospital, Palle Juul-Jensens Boulevard 175, Entrance K, 8200, Aarhus, Denmark.
    Living and leaving a life of coercion: a qualitative interview study of patients with anorexia nervosa and multiple involuntary treatment events2023In: Journal of Eating Disorders, E-ISSN 2050-2974, Vol. 11, no 1, article id 40Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: A small but significant group of patients with anorexia nervosa (AN) undergo multiple involuntary treatment (IT) events. To enhance our understanding of IT and potentially inform treatment, we explored experiences and perspectives on IT of these patients.

    METHODS: We designed a qualitative semi-structured interview study and used reflexive thematic analysis. Participants were at least 18 years of age, had multiple past IT events (≥ 5) related to AN over a period of at least one month of which the last IT event happened within the preceding five years. Participants had no current IT, intellectual disability, acute psychosis, or severe developmental disorder. We adopted an inductive approach and constructed meaning-based themes.

    RESULTS: We interviewed seven participants. The data portrayed a process of living and leaving a life of coercion with a timeline covering three broad themes: living with internal coercion, coercive treatment, and leaving coercion; and five subthemes: helping an internal battle, augmenting suffering, feeling trapped, a lasting imprint, and changing perspectives. We highlighted that patients with AN and multiple IT events usually experienced internal coercion from the AN prior to external coercion from the health care system. IT evoked significant negative affect when experienced, and often left an adverse imprint. Moreover, IT could help an internal battle against AN and perspectives on IT could change over time.

    CONCLUSIONS: Our study suggests that feeling internally coerced by AN itself sets the stage for IT. Clinicians should be conscious of the potential iatrogenic effects of IT, and reserve IT for potentially life-threatening situations.

  • 27.
    Molin, M.
    et al.
    Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Stockholm Centre for Eating Disorders, Research & Development, Stockholm, Sweden.
    von Hausswolff-Juhlin, Yvonne Linné
    Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Stockholm Centre for Eating Disorders, Research & Development, Stockholm, Sweden.
    Norring, Claes E. A.
    Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Stockholm Centre for Eating Disorders, Research & Development, Stockholm, Sweden.
    Hagberg, Lars Axel
    Örebro University, School of Health Sciences. Örebro University Hospital.
    Gustafsson, Sanna Aila
    Örebro University, School of Medical Sciences. Örebro University Hospital.
    Case management at an outpatient unit for severe and enduring eating disorder patients at Stockholm Centre for Eating Disorders: a study protocol2016In: International Journal of Eating Disorders, ISSN 0276-3478, E-ISSN 1098-108X, Vol. 4, article id 24Article in journal (Refereed)
    Abstract [en]

    Background: Patients with severe and enduring eating disorders (SEED) are seriously ill and have a low quality of life. Case management (CM), originally developed for adult patients with severe mental disabilities, has been shown to enhance social functioning and improve quality of life, while reducing the number and length of hospitalizations. In 2014, a special unit based on CM, for patients with SEED (the Eira unit) was started at Stockholm Centre for Eating Disorders, Sweden.

    Method/Design: This study aims to investigate if CM can improve SEED patients' quality of life, and reduce their eating disorder symptoms as well as their health care consumption. Methods for data collection are a semi-structured diagnostic interview, self-report questionnaires, and a qualitative interview. The diagnostic interview and the self-report assessments will be done at start of treatment and at follow-ups after 1, 2, and 3years. The qualitative interview will be conducted 1 year after start of treatment. The study is approved by the ethical review board in Stockholm in compliance with the Helsinki Declaration.

    Discussion: CM is a possible new contribution to the treatment methods for SEED. It does not aim at remission, but rather to accept life as it is, and to enhance quality of life in the presence of the ED. This study will investigate the potential benefits of this novel intervention in a special unit for SEED patients.

    Trail Registration: Clinicaltrials.gov Id: NCT02897622.

  • 28.
    Nyman-Carlsson, Erika
    et al.
    Örebro University, School of Health Sciences.
    Birgegård, Andreas
    Department of Clinical Neuroscience, Resource Centre for Eating Disorders, Karolinska Institute, Stockholm, Sweden.
    Engström, Ingemar
    Örebro University, School of Medical Sciences. University Health Care Research Centre.
    Gustafsson, Sanna Aila
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Clinical Neuroscience, Resource Centre for Eating Disorders, Karolinska Institute, Stockholm, Sweden; University Health Care Research Centre, Region Örebro County, Örebro, Sweden; Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Nevonen, Lauri
    Faculty of Medicine and Health, Örebro University, Örebro, Sweden; Praktikertjänst Psychiatry AB, Stockholm, Sweden.
    Predictors of outcome among young adult patients with anorexia nervosa in a randomised controlled trial2019In: European eating disorders review, ISSN 1072-4133, E-ISSN 1099-0968, Vol. 27, no 1, p. 76-85Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: The prognosis in cases of anorexia nervosa (AN) is unsatisfactory, and it is therefore important to examine pretreatment predictors of outcome.

    METHODS: Female AN patients (N = 74) included in a randomised controlled trial receiving individual cognitive behavioural therapy (CBT) or family-based treatment (FBT) were included. Predictors of the outcome were explored using pretreatment eating disorder psychopathology.

    RESULTS: In the CBT group, lower levels of emotional dysregulation and greater deficits in identifying and coping with inner states were predictors of weight increase, explaining 37.7% of the variance. In the FBT group, lower interoceptive deficits predicted an increase in weight (explaining 17.7% of the variance), whereas bulimic behaviour (32.4%) and problems with emotional regulation (23.3%) were predictors of increased diagnostic symptoms.

    CONCLUSIONS: Bulimic symptoms and the ability to identify and cope with emotional states appear to be important aspects that should be addressed in the treatment of young adult patients with AN.

  • 29.
    Nyman-Carlsson, Erika
    et al.
    Örebro University, School of Medical Sciences.
    Engström, Ingemar
    Örebro University, School of Medical Sciences. University Health Care Center, Örebro, Sweden.
    Gustafsson, Sanna Aila
    Örebro University, School of Medical Sciences. Örebro University Hospital. University Health Care Center, Region Örebro County, Örebro, Sweden; Center for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
    Nevonen, Lauri
    Department of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro; Aleris Psychiatry AB, Danderyds Hospital, Danderyd, Stockholm, Sweden.
    Recovered or not?: Measuring physical, behavioral, and psychological aspects of recovery among young adult patients with anorexia nervosaManuscript (preprint) (Other (popular science, discussion, etc.))
  • 30.
    Nyman-Carlsson, Erika
    et al.
    Örebro University, School of Medical Sciences.
    Norring, Claes
    Center for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
    Engström, Ingemar
    Örebro University, School of Medical Sciences. University Health Care Research Center.
    Gustafsson, Sanna Aila
    Örebro University, School of Medical Sciences. Örebro University Hospital. University Health Care Research Center.
    Lindberg, Karolin
    Center for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
    Paulson-Karlsson, Gunilla
    Center for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Sahlgrenska University Hospital, Gothenburg, Sweden.
    Nevonen, Lauri
    Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Individual cognitive behavioral therapy and combined family/individual therapy for young adults with Anorexia nervosa: A randomized controlled trial2020In: Psychotherapy Research, ISSN 1050-3307, E-ISSN 1468-4381, Vol. 30, no 8, p. 1011-1025Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: In this study, we evaluate the efficacy of outpatient individual cognitive behavioral therapy for young adults (CBT-YA) and combined family/individual therapy for young adults (FT-YA) for anorexia nervosa (AN).

    METHOD: Participants (aged 17-24 years) with AN in Sweden were recruited and assigned to 18 months of CBT-YA or FT-YA. Treatment efficacy was assessed primarily using BMI, presence of diagnosis, and degree of eating-related psychopathology at post-treatment and follow-up. Secondary outcomes included depression and general psychological psychopathology. The trial was registered at http://www.isrctn.com/, ISRCTN (25181390).

    RESULTS: Seventy-eight participants were randomized, and seventy-four of them received allocated treatment and provided complete data. Clinical outcomes from within groups resulted in significant improvements for both groups. BMI increased from baseline (CBT-YA 16.49; FT-YA 16.54) to post-treatment (CBT-YA 19.61; FT-YA 19.33) with high effect sizes. The rate of weight restoration was 64.9% in the CBT-YA group and 83.8% in the FT-YA group. The rate of recovery was 76% in both groups at post-treatment, and at follow-up, 89% and 81% had recovered in the CBT-YA and FT-YA groups respectively.

    CONCLUSIONS: Outpatient CBT-YA and FT-YA appear to be of benefit to young adults with AN in terms of weight restoration and reduced eating disorder and general psychopathology.

  • 31.
    Sandberg, Jonatan
    et al.
    Faculty of Medicine and health, University health care research center, University of Örebro, Örebro, Sweden.
    Gustafsson, Sanna Aila
    Örebro University, School of Medical Sciences.
    Holmqvist, Rolf
    Department of Behavioral Sciences and Learning, Linköping University, Linköping, Sweden.
    Interpersonally traumatised patients' view of significant and corrective experiences in the psychotherapeutic relationship2017In: European Journal of Psychotherapy, ISSN 1364-2537, E-ISSN 1469-5901, Vol. 19, no 2, p. 175-199Article in journal (Refereed)
    Abstract [en]

    Background: Clinical experience points to the importance of significant experiences in the therapy relationship for patients who have been interpersonally traumatised but the empirical research is limited.

    Aim: The aim was to gain increased knowledge about how significant and potentially corrective experiences within the therapeutic relationship were described by patients in trauma-focused therapy and how the participants thought such experiences might have affected the therapeutic work.

    Method: Five patients who were, or recently had been, in trauma-focused therapy were interviewed about their experiences of the therapy relationship. Thematic analysis was used to analyse the interviews.

    Results: Four themes were identified: 'Human contact', 'Validation', 'To face the painful' and 'Development of trust'. Positive experiences in the therapeutic relationship were sometimes seen as crucial for the therapeutic work and for patients' improvement.

    Conclusions: Previous findings about the significance of corrective experiences in psychotherapy were confirmed, particularly experiences of the therapist's accepting stance, personal and human contact and encouragement. The therapist's ability to evoke trust in the patient and her capacity to help patients to face painful material may be particularly important for traumatised patients.

  • 32.
    Strand, M.
    et al.
    Research and Development Unit, Stockholms Centre for Eating Disorders, Stockholm, Sweden.
    Bulik, C. M.
    Department of Medial Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    von Hausswolff-Juhlin, Y.
    Research and Development Unit, Stockholms Centre for Eating Disorders, Stockholm, Sweden.
    Gustafsson, Sanna Aila
    Örebro University, School of Medical Sciences.
    Self-admission to in-patient treatment: Patient experiences of a novel approach in the treatment of severe eating disorders2017In: European psychiatry, ISSN 0924-9338, E-ISSN 1778-3585, Vol. 41, p. S560-S560, article id EV0480Article in journal (Other academic)
  • 33.
    Strand, Mattias
    et al.
    Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden; Transcultural Centre, Northern Stockholm Psychiatry, Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden.
    Bulik, Cynthia M.
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill North Carolina, USA; Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill North Carolina, USA.
    Gustafsson, Sanna Aila
    Örebro University, School of Medical Sciences. Örebro University Hospital. University Health Care Research Center.
    von Hausswolff-Juhlin, Yvonne
    Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden.
    Welch, Elisabeth
    Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden; Stockholm Centre for Eating Disorders, Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden.
    Self-admission to inpatient treatment in anorexia nervosa: Impact on healthcare utilization, eating disorder morbidity, and quality of life2020In: International Journal of Eating Disorders, ISSN 0276-3478, E-ISSN 1098-108X, Vol. 53, no 10, p. 1685-1695Article in journal (Refereed)
    Abstract [en]

    Objective: Little evidence exists concerning the optimal model of inpatient care for patients with longstanding anorexia nervosa (AN). Self-admission has been developed as a treatment tool whereby patients with a history of high healthcare utilization are invited to decide for themselves when brief admission is warranted. The aim of this study was to evaluate the impact of a self-admission program on healthcare utilization, eating disorder morbidity, health-related quality of life (HRQoL), and sick leave for patients with AN.

    Method: In this cohort study, 29 participants with AN in a Swedish self-admission program were compared to 113 patients with longstanding illness but low previous utilization of inpatient treatment, matched based on age, illness duration, and body-mass index (BMI). Data on healthcare utilization, eating disorder morbidity, and sick leave were obtained from national population and eating disorder quality registers.

    Results: Participants displayed a >50% reduction in time spent hospitalized at 12-month follow-up, compared to nonsignificant changes in the comparison group. A sensitivity analysis comparing participants to a moderate-utilization comparison subgroup strengthened this observation. In contrast, the approach did not affect participants' BMI or eating disorder morbidity. Regarding HRQoL, mixed results were observed. In terms of sick leave, a beneficial but nonsignificant pattern was seen for participants.

    Discussion: These findings indicate that self-admission is a viable and helpful tool within a recovery model framework, even though it does not lead to symptom remission. In its proper context, self-admission could potentially transform healthcare from crisis-driven to pre-emptive, and promote autonomy for severely ill patients.

  • 34.
    Strand, Mattias
    et al.
    Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Stockholm, Sweden; Transkulturellt Centrum, Stockholm, Sweden.
    Bulik, Cynthia M.
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA; Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
    Gustafsson, Sanna Aila
    Örebro University, School of Medical Sciences. Örebro University Hospital. University Health Care Research Center.
    Welch, Elisabeth
    Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Stockholm, Sweden; Stockholm Centre for Eating Disorders, Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden.
    Self-admission in the treatment of eating disorders: an analysis of healthcare resource reallocation2021In: BMC Health Services Research, E-ISSN 1472-6963, Vol. 21, no 1, article id 465Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Self-admission to psychiatric inpatient treatment is an innovative approach to healthcare rationing, based on reallocation of existing resources rather than on increased funding. In self-admission, patients with a history of high healthcare utilization are invited to decide for themselves when brief admission is warranted. Previous findings on patients with severe eating disorders indicate that self-admission reduces participants' need for inpatient treatment, but that it does not alone lead to symptom remission.

    METHODS: The aim of this study was to evaluate if, from a service provider perspective, the resource reallocation associated with self-admission is justified. The analysis makes use of data from a cohort study evaluating the one-year outcomes of self-admission at the Stockholm Centre for Eating Disorders.

    RESULTS: Participants in the program reduced their need for regular specialist inpatient treatment by 67%. Thereby, hospital beds were made available for non-participants due to the removal of a yearly average of 13.2 high-utilizers from the regular waiting list. A sensitivity analysis showed that this "win-win situation" occurred within the entire 95% confidence interval of the inpatient treatment utilization reduction.

    CONCLUSIONS: For healthcare systems relying on rationing by waiting list, self-admission has the potential to reduce the need for hospitalization for patients with longstanding eating disorders, while also offering benefits in the form of increased available resources for other patients requiring hospitalization.

    TRIAL REGISTRATION: ClinicalTrials.gov ID: NCT02937259 (retrospectively registered 10/15/2016).

  • 35.
    Strand, Mattias
    et al.
    Stockholm Centre for Eating Disorders, Stockholm, Sweden; Karolinska Institutet, Stockholm, Sweden.
    Bulik, Cynthia M
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Department of Psychiatry, University of North Carolina, Chapel Hill NC, United States; Department of Nutrition, University of North Carolina, Chapel Hill NC, United States.
    von Hausswolff-Juhlin, Yvonne
    Stockholm Centre for Eating Disorders, Stockholm, Sweden; Karolinska Institutet, Stockholm, Sweden.
    Gustafsson, Sanna Aila
    Örebro University, School of Medical Sciences.
    Self-admission to inpatient treatment for patients with anorexia nervosa: The patient's perspective2017In: International Journal of Eating Disorders, ISSN 0276-3478, E-ISSN 1098-108X, Vol. 50, no 4, p. 398-405Article in journal (Refereed)
    Abstract [en]

    The aim of the present study was to explore patients' experiences of participating in a self-admission program at a specialist eating disorders clinic. Sixteen adult program participants with a diagnosis of anorexia nervosa were interviewed at 6 months about their experiences in the self-admission program. A qualitative content analysis approach was applied to identify recurring themes. Four themes were identified: Agency and Flexibility, Functions, Barriers, and Applicability. Participants used self-admission to boost healthy behaviors, to prevent deterioration, to forestall the need for longer periods of hospitalizations, and to get a break from overwhelming demands. Quick access to brief admissions provides a safety net that can increase feelings of security in everyday life, even for patients who do not actually make use of the opportunity to self-admit. It also provided relief to participants' relatives. Furthermore, participants experienced that self-admission may foster agency and motivation. However, the model also requires a certain level of maturity and an encouraging environment to overcome barriers that could otherwise hinder optimal use, such as ambivalence in asking for help. Informants experienced that self-admission could allow them to gain greater insight into their disease process, take greater responsibility for their recovery, and transform their health care from crisis-driven to proactive. By offering a shift in perspective on help-seeking and participation, self-admission may potentially strengthen participants' internal responsibility for their treatment and promote partnership in treatment.

  • 36.
    Strand, Mattias
    et al.
    Stockholm Centre for Eating Disorders, Stockholm, Sweden; Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden.
    Gustafsson, Sanna Aila
    Örebro University, School of Medical Sciences. Örebro University Hospital. University Health Care Research Center.
    Mukbang and Disordered Eating: A Netnographic Analysis of Online Eating Broadcasts2020In: Culture, Medicine and Psychiatry, ISSN 0165-005X, E-ISSN 1573-076X, Vol. 44, no 4, p. 586-609Article in journal (Refereed)
    Abstract [en]

    Mukbang is a recent Internet phenomenon in which video recordings of hosts eating large amounts of food are streamed on an online video platform. It originated in South Korea around 2014 and has since become a global trend. The aim of this study was to explore how viewers of mukbang videos relate their audience experiences to symptoms of disordered eating. A qualitative analysis of YouTube comments and Reddit posts on the topic of mukbang and disordered eating was performed, employing a netnographic approach. Two overarching themes were identified: a viewer perspective, by which users discuss mukbang without describing any personal involvement, and a participant perspective, by which users describe their own experiences of affects and behaviors in response to watching mukbang. Several topical categories emerged, describing how watching mukbang can both limit and increase eating, reduce loneliness and guilt, and become self-destructive. For some, mukbang appears to be a constructive tool in increasing food intake, preventing binge eating, or reducing loneliness; for others, it is clearly a destructive force that may motivate restrictive eating or trigger a relapse into loss-of-control eating. Notably, watching mukbang is not necessarily experienced as either helpful or destructive, but instead as simultaneously useful and hurtful.

  • 37.
    Strand, Mattias
    et al.
    Research and Development Unit, Stockholm Centre for Eating Disorders, Stockholm, Sweden; Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
    Gustafsson, Sanna Aila
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Bulik, Cynthia M.
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Department of Psychiatry, University of North Carolina, Chapel Hill NC, USA; Department of Nutrition, University of North Carolina, Chapel Hill NC, USA.
    von Hausswolff-Juhlin, Yvonne
    Research and Development Unit, Stockholm Centre for Eating Disorders, Stockholm, Sweden; Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
    Patient-controlled hospital admission: A novel concept in the treatment of severe eating disorders2015In: International Journal of Eating Disorders, ISSN 0276-3478, E-ISSN 1098-108X, Vol. 48, no 7, p. 842-844Article in journal (Refereed)
  • 38.
    Strand, Mattias
    et al.
    Stockholm Centre for Eating Disorders, Stockholm, Sweden; Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
    Gustafsson, Sanna Aila
    Örebro University, School of Medical Sciences. Stockholm Centre for Eating Disorders, Stockholm, Sweden.
    Bulik, Cynthia M.
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Department of Psychiatry, University of North Carolina, Chapel Hill NC, United States; Department of Nutrition, University of North Carolina, Chapel Hill NC, United States.
    von Hausswolff-Juhlin, Yvonne
    Stockholm Centre for Eating Disorders, Stockholm, Sweden; Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
    Self-admission to inpatient treatment in psychiatry: lessons on implementation2017In: BMC Psychiatry, E-ISSN 1471-244X, Vol. 17, article id 343Article in journal (Refereed)
    Abstract [en]

    Background: Interest has increased in programs offering self-admission to inpatient treatment for patients with severe psychiatric illness, whereby patients who are well-known to a service are afforded the opportunity to admit themselves at will for a brief period of time. The aim of the present study was to examine patient experiences of practical considerations during the start-up phase of a self-admission program in an eating disorder service.

    Methods: Sixteen adult participants in a self-admission program at a specialist eating disorders service were interviewed at 6 months about their experiences during the implementation phase. A qualitative content analysis approach was applied in order to identify recurring themes.

    Results: Six subcategories regarding implementation and logistics of self-admission were identified: "Start-up problems", "Problems associated with reserving a bed", "Lack of staff continuity", "Not enough emphasis on long-term goals", "Too demanding in terms of freedom and responsibility", and "Suggestions for alternative models".

    Conclusions: Practical recommendations can be offered for the implementation of future self-admission programs, such as thoroughly informing all participants about the rationale behind self-admission with particular emphasis on patient accountability, establishing a waiting list procedure for occasions when all designated beds are occupied, and assigning an individual contact staff member responsible for each self-admitted patient.

  • 39.
    Ghaderi, Ata (Contributor, Creator)
    Sektionen för psykologi, Institutionen för klinisk neurovetenskap, Karolinska Institutet, Stockholm, Sweden.
    Gustafsson, Sanna Aila (Contributor, Creator)
    Örebro University, School of Medical Sciences. Örebro University Hospital.
    Parling, Thomas (Contributor, Creator)
    Institutionen för psykologi, Uppsala universitet, Uppsala, Sweden.
    Råstam, Maria (Contributor, Creator)
    Institutionen för klinisk forskning, Lund, Barn- och ungdomspsykiatri, Lunds universitet, Lund, Sweden; Sektionen för psykiatri och neurokemi, Gillbergcentrum, Göteborgs universitet, Göteborg, Sweden.
    Behandling av hetsätningsstörning: en systematisk översikt och utvärdering av medicinska, hälsoekonomiska, sociala och etiska aspekter2016Report (Other academic)
1 - 39 of 39
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