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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.
    Bratland-Sanda, S.
    et al.
    Modum Bad Psychiat Ctr, Res Inst, Vikersund, Norway; Norwegian Sch Sports Sci, Dept Sports Med, Oslo, Norway.
    Rosenvinge, J. H.
    Univ Tromso, Dept Psychol, N-9037 Tromso, Norway.
    Vrabel, K. A. R.
    Modum Bad Psychiat Ctr, Res Inst, Vikersund, Norway.
    Norring, Claes
    Örebro University, Department of Behavioural, Social and Legal Sciences.
    Sundgot-Borgen, J.
    Norwegian Sch Sports Sci, Dept Sports Med, Oslo, Norway.
    Ro, O.
    Modum Bad Psychiat Ctr, Res Inst, Vikersund, Norway.
    Martinsen, E. W.
    Univ Oslo, Inst Psychiat, Oslo, Norway; Aker Univ Hosp, Clin & Mental Hlth, Oslo, Norway.
    Physical activity in treatment units for eating disorders: Clinical practice and attitudes2009In: Eating and Weight Disorders, ISSN 1124-4909, E-ISSN 1590-1262, Vol. 14, no 2-3, p. E106-E112Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: Physical activity (PA) in eating disorders (ED) may be harmful, but in a therapeutic setting also beneficial. The purpose of this survey was to examine these contradictory aspects of PA in ED specialist treatment settings. We examined whether 1) PA is assessed by the unit, 2) the units have guidelines for managing excessive PA, 3) the units have staff with higher education and special competence in PA and exercise science, 4) how units regard PA in ED, 5) whether regular PA is integrated in the treatment programs, and 6) how the units rate the role of PA in the treatment of ED compared with other mental disorders. METHODS: Of the 49 units located in Scandinavia and the United Kingdom, 41 (84%) responded to a questionnaire. RESULTS: In 28 units (68%) PA was assessed regularly. Excessive PA was considered a harmful symptom in ED, and most units reported guidelines to manage excessive PA. Thirty-two units included PA in their treatment programmes. Clinicians found PA most relevant in the treatment of obesity and, except for binge eating, less for ED. CONCLUSION: PA was more commonly integrated in treatment compared to previous studies. Future research should address how to manage excessive PA, and the potential beneficial role of PA in the treatment of ED. (Eating Weight Disord. 14: e106-e112, 2009). (C) 2009, Editrice Kurtis

  • 3.
    De Man Lapidoth, Joakim
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Ghaderi, A.
    Halvarsson-Edlund, K.
    Norring, Claes
    Örebro University, Department of Behavioural, Social and Legal Sciences.
    Psychometric properties of the Eating Disorders in Obesity questionnaire: Validating against the Eating Disorder Examination interview2007In: Eating and Weight Disorders, ISSN 1124-4909, E-ISSN 1590-1262, Vol. 12, no 4, p. 168-175Article in journal (Refereed)
    Abstract [en]

    Inconclusive results of how weight-loss treatment (WLT) results are affected by participants' eating disorders and/or binge eating are partly due to the variation caused by the multitude of assessment instruments used. The objective of the present study was to evaluate the psychometric properties of a short DSM-IV-based assessment instrument designed to be used specifically in WLT settings, the Eating Disorders in Obesity (EDO) questionnaire. Participants were 97 patients seeking WLT at four surgical and one non-surgical clinics. Participants were assessed by the EDO and the Eating Disorder Examination (EDE) interview . The validity and reliability of the EDO was measured as concordance with the EDE, and test-retest agreement of the EDO, respectively. Validity as well as reliability was found to be good for both eating disorders diagnoses and binge eating as a distinct symptom. Results suggest that the EDO is a short, easily administered instrument with good psychometric properties which makes it a suitable, economical method of assessing eating disorders and binge eating in clinical WLT settings. ©2007, Editrice Kurtis.

  • 4.
    de Man Lapidoth, Joakim
    et al.
    Örebro University, School of Health and Medical Sciences.
    Ghaderi, Ata
    Uppsala Universitet.
    Norring, Claes
    Karolinska Institutet.
    A comparison of eating disorders among patients receiving surgical vs non-surgical weight-loss treatments2008In: Obesity Surgery, ISSN 0960-8923, E-ISSN 1708-0428, Vol. 18, no 6, p. 715-720Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Little is known about differences between patients in surgical and non-surgical weight-loss treatments (WLT) regarding eating disorders, level of general psychopathology, and health-related quality of life (HRQL). Such differences could indicate different clinical needs in the management of surgical compared to non-surgical WLT patients. METHODS: Participants were a subset of 100 patients from a Swedish study investigating the long-term effects of eating disorders in WLT. Participants filled out the Eating Disorders in Obesity Questionnaire as well as self-rating questionnaires of general psychopathology and HRQL before initiating surgical (n = 54) or non-surgical (n = 46) WLT. RESULTS: Eating disorders were found to be more common among patients accepted for surgical treatments, whereas binge eating (as a symptom) was found to be equally common in both groups. Surgical patients also indicated higher levels of psychopathology compared to those receiving non-surgical treatment. CONCLUSION: Patients in surgical WLT are younger, more obese, and indicate higher levels of eating disorders and psychopathology than non-surgical WLT patients. Results highlight the importance of surgical WLT units having adequate knowledge, resources, and methods for detecting and addressing issues of eating disorders and psychopathology before and during the WLT. Future longitudinal studies need to ascertain to what extent eating and general psychopathology influence the outcome of WLT in terms of lapses, complications, weight gain, quality of life, etc.

  • 5.
    de Man Lapidoth, Joakim
    et al.
    Örebro University, School of Health and Medical Sciences.
    Ghaderi, Ata
    Department of Psychology, Uppsala University, Uppsala, Sweden.
    Norring, Claes
    Stockholm Centre for Eating Disorders, Stockholm, Sweden; Center for Psychiatry Research Stockholm, Karolinska Institutet, Stockholm County Council, Stockholm, Sweden.
    Binge eating in surgical weight-loss treatments: long-term associations with weight loss, health related quality of life (HRQL), and psychopathology2011In: Eating and Weight Disorders, ISSN 1124-4909, E-ISSN 1590-1262, Vol. 16, no 4, p. E263-E269Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Studies that have investigated the relationship between binge eating and the long-term outcome of bariatric surgery have shown mixed results. Does binge eating affect long-term BMI, health-related quality of life (HRQL), or psychopathology after surgery?

    METHODS: We assessed 173 bariatric patients before and three years after weight loss surgery with regard to weight, binge eating, HRQL, and psychopathology.

    RESULTS: Binge eating before and after weight loss surgery was unrelated to long-term BMI outcome. Binge eating after weight loss surgery was associated with more psychopathology and lower HRQL.

    CONCLUSIONS: Binge eating before or after weight loss surgery does not predict long-term BMI outcome. Therefore, exclusions from surgery for this reason alone are difficult to motivate. However, results show that binge eating after weight loss surgery is common and is associated with more psychopathology and lower HRQL, which might increase the vulnerability for future weight regain and complications beyond the follow-up period of the present study. The high rate of binge eating after surgery and its negative association with HRQL and psychopathology suggest that we need to be observant of the occurrence and potential effects of binge eating in the context of bariatric surgery.

  • 6.
    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.

  • 7.
    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.

  • 8.
    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.

  • 9.
    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.

  • 10.
    Nyman-Carlsson, Erika
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Capio Eating Disorder Centre, Stockholm, Sweden .
    Engström, Ingemar
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Psychiatric Research Centre.
    Norring, Claes
    Stockholm Center for Eating Disorders, R & D Unit, Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden .
    Nevonen, Lauri
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Praktikertjänst Psychiatry AB, Stockholm, Sweden .
    Eating Disorder Inventory-3, validation in Swedish patients with eating disorders, psychiatric outpatients and a normal control sample2015In: Nordic Journal of Psychiatry, ISSN 0803-9488, E-ISSN 1502-4725, Vol. 69, no 2, p. 142-151Article in journal (Refereed)
    Abstract [en]

    Background: The Eating Disorder Inventory-3 (EDI-3) is designed to assess eating disorder psychopathology and the associated psychological symptoms. The instrument has been revised and has not yet been validated for Swedish conditions in its current form.

    Aims: The aim of this study was to investigate the validity and reliability of this inventory and present national norms for Swedish females.

    Methods: Data from patients with eating disorders (n = 292), psychiatric outpatients (n = 140) and normal controls (n = 648), all females, were used to study the internal consistency, the discriminative ability, and the sensitivity and specificity of the inventory using preliminary cut-offs for each subscale and diagnosis separately. Swedish norms were compared with those from Denmark, USA, Canada, Europe and Australian samples.

    Results: The reliability was acceptable for all subscales except Asceticism among normal controls. Analysis of variance showed that the EDI-3 discriminates significantly between eating disorders and normal controls. Anorexia nervosa was significantly discriminated from bulimia nervosa and eating disorder not otherwise specified on the Eating Disorder Risk Scales. Swedish patients scored significantly lower than patients from other countries on the majority of the subscales. Drive for Thinness is the second best predictor for an eating disorder. The best predictor for anorexia nervosa was Interoceptive Deficits and Bulimia for the other diagnoses.

    Conclusions/clinical implications: The EDI-3 is valid for use with Swedish patients as a clinical assessment tool for the treatment planning and evaluation of patients with eating-related problems. However, it still exist some uncertainty regarding its use as a screening tool.

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