Women with bulimia nervosa and binge eating disorder often suffer for many years before they seek... more Women with bulimia nervosa and binge eating disorder often suffer for many years before they seek professional help. Evidence-based treatments like cognitive-behavioural therapy (CBT) might be poorly accessible, and about 50% of those who receive CBT respond to it. Such outcome may reflect the heterogeneous nature of eating disorders, and addressing this heterogeneity calls for expanding the portfolio of treatment options. In particular, it is important to explore such options' acceptability, tolerability and affordability expressed through experiences with the treatment. This protocol outlines the rationale and design of a qualitative study. It captures experiences from patients and therapists who were involved in a randomised controlled trial (RCT) exploring the efficacy of a new group-based treatment programme combining physical exercise and dietary therapy. 15 patients with bulimia nervosa or binge eating disorder, 10 therapists (physical trainers and dietitians) and 6-10 pa...
The aim of the current study is to explore how therapists running a guided physical exercise and ... more The aim of the current study is to explore how therapists running a guided physical exercise and dietary therapy programme (PED-t) experience their contribution to the treatment of patients with bulimia nervosa and binge eating disorder. Ten therapists running the PED-t were semistructurally interviewed and the transcribed interviews were analysed using a systematic text condensation approach. The study was run within the context of a randomised controlled trial at the Norwegian School of Sport Sciences. The therapists experienced their knowledge about physical exercise and nutrition as important and useful, and that they could share their knowledge with the patients in different ways and with confidence in their own role. They also believed that their knowledge could serve as tools for the patients' post-treatment recovery and management of their daily lives. Moreover, the therapists put much effort in adjusting their teaching to fit each individual participant. Finally, they r...
This qualitative study, using interviews with 38 subjects, explored how and why they conceal buli... more This qualitative study, using interviews with 38 subjects, explored how and why they conceal bulimic symptoms and the understanding of concealing in terms of social interaction. A "double life" was described as a dichotomy between being active and outgoing versus performing shameful bulimic behaviors and constantly living with fear of stigmatization, and striving against exposure. Concealing was well planned to avoid such fear, and to preserve dignity. Bulimia may be understood as volitional exertion of interaction control, not just as a result of poor impulse regulation. Understanding the meaning of secrecy and "double life" may facilitate help seeking behavior and guide treatment.
Scand J Caring Sci; 2013; 27; 92-98 Eating disorders: challenges in the later phases of the recov... more Scand J Caring Sci; 2013; 27; 92-98 Eating disorders: challenges in the later phases of the recovery process Little is known about how patients experience the later recovery phases of eating disorders. The aim of this study was to describe such experiences using an explorative and descriptive design based on content analysis. Thirteen female patients participated in qualitative interviews. The analysis resulted in four main categories, that is, (i) realising negative consequences, (ii) searching for alternative coping, (iii) searching for normality and identity and (iv) accepting the losses. The categories represent normal psychological processes related to grief, commitment and reconciliation. Such processes may be functionally or dysfunctionally resolved. The clinical implication is that patients in the later recovery phases may need professional help or counselling to accomplish a functional resolving. While in the initial phases of illness and recovery, a focus is on controlling symptoms and the changing of overvalued ideas about weight and shape, therapy in the later recovery phases should focus on the psychological management of the challenges represented in the four categories resulting from the present study.
ABSTRACT The previous papers in this series outlined a historical panorama and presented updated ... more ABSTRACT The previous papers in this series outlined a historical panorama and presented updated knowledge about putative risk factors and how eating disorders are distributed in various populations. In this final paper, we discuss in what way comorbidity findings and transdiagnostic issues may change our conceptions about ‘an epidemiological case’ from the current definition of eating disorders based on the recent version of the Diagnostic and Statistical Manual of Mental Disorders (i.e. the DSM-5), and to what extent an alternative definition may introduce new perspectives of prevention. The paper also provides an update on issues relevant for treatment dissemination.
This general population-based study examined associations between violence and mental health, mus... more This general population-based study examined associations between violence and mental health, musculoskeletal pain, and early disability pension. The prevalence and consequences of good vs. poor adjustment (resilience vs. vulnerability) following encounters with violence were also examined. Data were based on the sixth wave of the "Tromsø Study" (N = 12,981; 65.7% response rate, 53.4% women, M-age = 57.5 years, SD-age = 12.7 years). Self-reported data on psychological (threats) and physical violence (beaten/kicked), mental health (anxiety/depression), musculoskeletal pain (MSP), and granting of disability pension (DP) were collected. Men suffered more violent events during childhood than women did, and vice versa during adulthood. Psychological violence implied poorer mental health and slightly more MSP than physical violence. The risk of MSP was highest for violence occurring during childhood in women and during the last year for men. A dose-response relationship between an increasing number of violent encounters and poorer health was observed. About 58% of individuals reported no negative impact of violence (hence, resilience group), whereas 42% considered themselves as more vulnerable following encounters with violence. Regression analyses indicated comparable mental health but slightly more MSP in the resilience group compared to the unexposed group, whereas the vulnerable group had significantly worse health overall and a higher risk of early granting of DP. Resilience is not an all-or-nothing matter, as physical ailments may characterize individuals adapting well following encounters with violence.
ABSTRACT The present article is the second one of three about the epidemiology of eating disorder... more ABSTRACT The present article is the second one of three about the epidemiology of eating disorders. The first introductory article outlined basic epidemiological issues, approaches and concepts and provided a historical panorama of the epidemiology of eating disorders. The present paper presents an updated review about the incidence and prevalence of eating disorders and eating problems. A particular concern is to discuss the impact of using the DSM-5 for case definitions. Moreover, the current paper will discuss recent findings with respect to outcome distributions. Finally, advances within analytic epidemiology are discussed in terms of risk for onset and predictors of outcome and how recent evidence may increase the potentials for prevention or other social epidemiology strategies.
Studies in health technology and informatics, 2012
Videoconferencing may help reduce traveling and may save time and money for patients and the heal... more Videoconferencing may help reduce traveling and may save time and money for patients and the health care system. Despite the fact that studies have found videoconferencing as good as face-to-face interactions for certain therapies, few in northern Norway use this tool routinely for the assessment and treatment of patients. We examined clinicians' experiences with videoconferencing and their attitudes to using this tool for psychiatric consultations, and discussed the findings in light of the Technology Acceptance Model. Obstacles to use and how they may be overcome are discussed.
In the treatment of eating disorders, little is known about the role and impact of psychoeducativ... more In the treatment of eating disorders, little is known about the role and impact of psychoeducative programmes and whether patients experience such programmes as helpful in their healing processes. Examining these questions is the purpose of this study, using an explorative and descriptive design based on content analysis. Thirteen female patients participated in qualitative interviews. The analysis of healing processes experienced during the programme participation resulted in six main categories, i.e. 'Self-awareness', 'Setting boundaries', 'Feelings and self-mobilization', 'Self-regulation', 'Self-reflexivity' and 'Motivation and Self-improvement'. Our study clearly indicates that according to the patients' experiences, a psychoeducative programme may facilitate healing processes. The study also supports a possible indirect impact on healing processes in terms of more readiness to seek treatment. There is a need for more knowledge about how to bring about an effective interplay between treatment and psychoeducative programmes.
Scand J Caring Sci; 2013; 27; 92-98 Eating disorders: challenges in the later phases of the recov... more Scand J Caring Sci; 2013; 27; 92-98 Eating disorders: challenges in the later phases of the recovery process Little is known about how patients experience the later recovery phases of eating disorders. The aim of this study was to describe such experiences using an explorative and descriptive design based on content analysis. Thirteen female patients participated in qualitative interviews. The analysis resulted in four main categories, that is, (i) realising negative consequences, (ii) searching for alternative coping, (iii) searching for normality and identity and (iv) accepting the losses. The categories represent normal psychological processes related to grief, commitment and reconciliation. Such processes may be functionally or dysfunctionally resolved. The clinical implication is that patients in the later recovery phases may need professional help or counselling to accomplish a functional resolving. While in the initial phases of illness and recovery, a focus is on controlling symptoms and the changing of overvalued ideas about weight and shape, therapy in the later recovery phases should focus on the psychological management of the challenges represented in the four categories resulting from the present study.
Women with bulimia nervosa and binge eating disorder often suffer for many years before they seek... more Women with bulimia nervosa and binge eating disorder often suffer for many years before they seek professional help. Evidence-based treatments like cognitive-behavioural therapy (CBT) might be poorly accessible, and about 50% of those who receive CBT respond to it. Such outcome may reflect the heterogeneous nature of eating disorders, and addressing this heterogeneity calls for expanding the portfolio of treatment options. In particular, it is important to explore such options' acceptability, tolerability and affordability expressed through experiences with the treatment. This protocol outlines the rationale and design of a qualitative study. It captures experiences from patients and therapists who were involved in a randomised controlled trial (RCT) exploring the efficacy of a new group-based treatment programme combining physical exercise and dietary therapy. 15 patients with bulimia nervosa or binge eating disorder, 10 therapists (physical trainers and dietitians) and 6-10 pa...
The aim of the current study is to explore how therapists running a guided physical exercise and ... more The aim of the current study is to explore how therapists running a guided physical exercise and dietary therapy programme (PED-t) experience their contribution to the treatment of patients with bulimia nervosa and binge eating disorder. Ten therapists running the PED-t were semistructurally interviewed and the transcribed interviews were analysed using a systematic text condensation approach. The study was run within the context of a randomised controlled trial at the Norwegian School of Sport Sciences. The therapists experienced their knowledge about physical exercise and nutrition as important and useful, and that they could share their knowledge with the patients in different ways and with confidence in their own role. They also believed that their knowledge could serve as tools for the patients' post-treatment recovery and management of their daily lives. Moreover, the therapists put much effort in adjusting their teaching to fit each individual participant. Finally, they r...
This qualitative study, using interviews with 38 subjects, explored how and why they conceal buli... more This qualitative study, using interviews with 38 subjects, explored how and why they conceal bulimic symptoms and the understanding of concealing in terms of social interaction. A "double life" was described as a dichotomy between being active and outgoing versus performing shameful bulimic behaviors and constantly living with fear of stigmatization, and striving against exposure. Concealing was well planned to avoid such fear, and to preserve dignity. Bulimia may be understood as volitional exertion of interaction control, not just as a result of poor impulse regulation. Understanding the meaning of secrecy and "double life" may facilitate help seeking behavior and guide treatment.
Scand J Caring Sci; 2013; 27; 92-98 Eating disorders: challenges in the later phases of the recov... more Scand J Caring Sci; 2013; 27; 92-98 Eating disorders: challenges in the later phases of the recovery process Little is known about how patients experience the later recovery phases of eating disorders. The aim of this study was to describe such experiences using an explorative and descriptive design based on content analysis. Thirteen female patients participated in qualitative interviews. The analysis resulted in four main categories, that is, (i) realising negative consequences, (ii) searching for alternative coping, (iii) searching for normality and identity and (iv) accepting the losses. The categories represent normal psychological processes related to grief, commitment and reconciliation. Such processes may be functionally or dysfunctionally resolved. The clinical implication is that patients in the later recovery phases may need professional help or counselling to accomplish a functional resolving. While in the initial phases of illness and recovery, a focus is on controlling symptoms and the changing of overvalued ideas about weight and shape, therapy in the later recovery phases should focus on the psychological management of the challenges represented in the four categories resulting from the present study.
ABSTRACT The previous papers in this series outlined a historical panorama and presented updated ... more ABSTRACT The previous papers in this series outlined a historical panorama and presented updated knowledge about putative risk factors and how eating disorders are distributed in various populations. In this final paper, we discuss in what way comorbidity findings and transdiagnostic issues may change our conceptions about ‘an epidemiological case’ from the current definition of eating disorders based on the recent version of the Diagnostic and Statistical Manual of Mental Disorders (i.e. the DSM-5), and to what extent an alternative definition may introduce new perspectives of prevention. The paper also provides an update on issues relevant for treatment dissemination.
This general population-based study examined associations between violence and mental health, mus... more This general population-based study examined associations between violence and mental health, musculoskeletal pain, and early disability pension. The prevalence and consequences of good vs. poor adjustment (resilience vs. vulnerability) following encounters with violence were also examined. Data were based on the sixth wave of the "Tromsø Study" (N = 12,981; 65.7% response rate, 53.4% women, M-age = 57.5 years, SD-age = 12.7 years). Self-reported data on psychological (threats) and physical violence (beaten/kicked), mental health (anxiety/depression), musculoskeletal pain (MSP), and granting of disability pension (DP) were collected. Men suffered more violent events during childhood than women did, and vice versa during adulthood. Psychological violence implied poorer mental health and slightly more MSP than physical violence. The risk of MSP was highest for violence occurring during childhood in women and during the last year for men. A dose-response relationship between an increasing number of violent encounters and poorer health was observed. About 58% of individuals reported no negative impact of violence (hence, resilience group), whereas 42% considered themselves as more vulnerable following encounters with violence. Regression analyses indicated comparable mental health but slightly more MSP in the resilience group compared to the unexposed group, whereas the vulnerable group had significantly worse health overall and a higher risk of early granting of DP. Resilience is not an all-or-nothing matter, as physical ailments may characterize individuals adapting well following encounters with violence.
ABSTRACT The present article is the second one of three about the epidemiology of eating disorder... more ABSTRACT The present article is the second one of three about the epidemiology of eating disorders. The first introductory article outlined basic epidemiological issues, approaches and concepts and provided a historical panorama of the epidemiology of eating disorders. The present paper presents an updated review about the incidence and prevalence of eating disorders and eating problems. A particular concern is to discuss the impact of using the DSM-5 for case definitions. Moreover, the current paper will discuss recent findings with respect to outcome distributions. Finally, advances within analytic epidemiology are discussed in terms of risk for onset and predictors of outcome and how recent evidence may increase the potentials for prevention or other social epidemiology strategies.
Studies in health technology and informatics, 2012
Videoconferencing may help reduce traveling and may save time and money for patients and the heal... more Videoconferencing may help reduce traveling and may save time and money for patients and the health care system. Despite the fact that studies have found videoconferencing as good as face-to-face interactions for certain therapies, few in northern Norway use this tool routinely for the assessment and treatment of patients. We examined clinicians' experiences with videoconferencing and their attitudes to using this tool for psychiatric consultations, and discussed the findings in light of the Technology Acceptance Model. Obstacles to use and how they may be overcome are discussed.
In the treatment of eating disorders, little is known about the role and impact of psychoeducativ... more In the treatment of eating disorders, little is known about the role and impact of psychoeducative programmes and whether patients experience such programmes as helpful in their healing processes. Examining these questions is the purpose of this study, using an explorative and descriptive design based on content analysis. Thirteen female patients participated in qualitative interviews. The analysis of healing processes experienced during the programme participation resulted in six main categories, i.e. 'Self-awareness', 'Setting boundaries', 'Feelings and self-mobilization', 'Self-regulation', 'Self-reflexivity' and 'Motivation and Self-improvement'. Our study clearly indicates that according to the patients' experiences, a psychoeducative programme may facilitate healing processes. The study also supports a possible indirect impact on healing processes in terms of more readiness to seek treatment. There is a need for more knowledge about how to bring about an effective interplay between treatment and psychoeducative programmes.
Scand J Caring Sci; 2013; 27; 92-98 Eating disorders: challenges in the later phases of the recov... more Scand J Caring Sci; 2013; 27; 92-98 Eating disorders: challenges in the later phases of the recovery process Little is known about how patients experience the later recovery phases of eating disorders. The aim of this study was to describe such experiences using an explorative and descriptive design based on content analysis. Thirteen female patients participated in qualitative interviews. The analysis resulted in four main categories, that is, (i) realising negative consequences, (ii) searching for alternative coping, (iii) searching for normality and identity and (iv) accepting the losses. The categories represent normal psychological processes related to grief, commitment and reconciliation. Such processes may be functionally or dysfunctionally resolved. The clinical implication is that patients in the later recovery phases may need professional help or counselling to accomplish a functional resolving. While in the initial phases of illness and recovery, a focus is on controlling symptoms and the changing of overvalued ideas about weight and shape, therapy in the later recovery phases should focus on the psychological management of the challenges represented in the four categories resulting from the present study.
The versatile construct of perfectionism has been heavily debated, e.g., its nature or measuremen... more The versatile construct of perfectionism has been heavily debated, e.g., its nature or measurement constituents, how it influences performances or, most importantly, our health. Conventional linear analyses seem inadequate to address such challenges. Hence, we used a latent variable and a person-centered approach to identify different patterns of perfectionism, and their relationships with psychological health as outcome among early adolescents (13–14 years) attending conventional or elite sports-/performance-oriented lower secondary schools (14 schools, 832 students, 53% girls). All students completed two perfectionism scales, i.e., the child-adolescent perfectionism scale (CAPS) and the frost multidimensional perfectionism scale (FMPS). The criterion-related variables of psychological health included anxiety, depression, eating disorder problems, self-worth and resilience, respectively. Exploratory and confirmatory factor analyses yielded a four-factor representation of perfectionism. Using latent class analysis extracted five profiles of perfectionism, which were related to the criterion variables. Three profiles were clear indicators of either low or high perfectionism score patterns. Two profiles showed a mixed picture of high and low scores, whereas one represented a psychological healthy subgroup. About four of ten adolescents in the ordinary schools matched the two most debilitating perfectionism profiles compared to two of ten in the elite schools. How these results align with international findings is discussed along with the relevance for early interventions aimed at preventing the potential downsides of perfectionism. Longitudinal studies are neeed to explore profile trajectories as well as possible health consequences.
Introduction Women with bulimia nervosa and binge
eating disorder often suffer for many years bef... more Introduction Women with bulimia nervosa and binge eating disorder often suffer for many years before they seek professional help. Evidence-based treatments like cognitive–behavioural therapy (CBT) might be poorly accessible, and about 50% of those who receive CBT respond to it. Such outcome may reflect the heterogeneous nature of eating disorders, and addressing this heterogeneity calls for expanding the portfolio of treatment options. In particular, it is important to explore such options’ acceptability, tolerability and affordability expressed through experiences with the treatment. This protocol outlines the rationale and design of a qualitative study. It captures experiences from patients and therapists who were involved in a randomised controlled trial (RCT) exploring the efficacy of a new group-based treatment programme combining physical exercise and dietary therapy. Methods and analysis 15 patients with bulimia nervosa or binge eating disorder, 10 therapists (physical trainers and dietitians) and 6–10 patients who dropped out of the RCT will be semistructurally interviewed. All interviews will be analysed using a systematic text condensation approach. Ethics and dissemination Results will be presented in peer-reviewed international journals, and at relevant international conferences. Key findings will be available to study participants as well as to patient organisations and health authorities. The overall study meets the intent and requirements of the Health Research Act and the Declaration of Helsinki. It is approved by the regional committee for medical research ethics (2013/1871). Trial registration number NCT02079935; Pre-results.
Objectives The aim of the current study is to explore how
therapists running a guided physical ex... more Objectives The aim of the current study is to explore how therapists running a guided physical exercise and dietary therapy programme (PED-t) experience their contribution to the treatment of patients with bulimia nervosa and binge eating disorder. Methods Ten therapists running the PED-t were semistructurally interviewed and the transcribed interviews were analysed using a systematic text condensation approach. Setting The study was run within the context of a randomised controlled trial at the Norwegian School of Sport Sciences. Results The therapists experienced their knowledge about physical exercise and nutrition as important and useful, and that they could share their knowledge with the patients in different ways and with confidence in their own role. They also believed that their knowledge could serve as tools for the patients’ post-treatment recovery and management of their daily lives. Moreover, the therapists put much effort in adjusting their teaching to fit each individual participant. Finally, they reported their personal qualities as important to build trust and therapeutic alliance. Conclusions The terms ‘clinical confidence’ and ‘alliance’ may stand out as the overarching ‘metacategories’ covering the experiences revealed in this study. The clinical implication is that new groups of professionals may have an important role in the treatment of eating disorders.
Introduction: Women with bulimia nervosa and binge eating disorder often suffer for many years be... more Introduction: Women with bulimia nervosa and binge eating disorder often suffer for many years before they seek professional help. Evidence-based treatments like cognitive–behavioural therapy (CBT) might be poorly accessible, and about 50% of those who receive CBT respond to it. Such outcome may reflect the heterogeneous nature of eating disorders, and addressing this heterogeneity calls for expanding the portfolio of treatment options. In particular, it is important to explore such options’ acceptability, tolerability and affordability expressed through experiences with the treatment. This protocol outlines the rationale and design of a qualitative study. It captures experiences from patients and therapists who were involved in a randomised controlled trial (RCT) exploring the efficacy of a new group-based treatment programme combining physical exercise and dietary therapy. Methods and analysis: 15 patients with bulimia nervosa or binge eating disorder, 10 therapists (physical trainers and dietitians) and 6–10 patients who dropped out of the RCT will be semistructurally interviewed. All interviews will be analysed using a systematic text condensation approach. Ethics and dissemination: Results will be presented in peer-reviewed international journals, and at relevant international conferences. Key findings will be available to study participants as well as to patient organisations and health authorities. The overall study meets the intent and requirements of the Health Research Act and the Declaration of Helsinki. It is approved by the regional committee for medical research ethics (2013/1871). Trial registration number: NCT02079935; Pre-results.
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Papers by Gunn Pettersen
eating disorder often suffer for many years before they
seek professional help. Evidence-based treatments
like cognitive–behavioural therapy (CBT) might be
poorly accessible, and about 50% of those who receive
CBT respond to it. Such outcome may reflect the
heterogeneous nature of eating disorders, and addressing
this heterogeneity calls for expanding the portfolio of
treatment options. In particular, it is important to explore
such options’ acceptability, tolerability and affordability
expressed through experiences with the treatment. This
protocol outlines the rationale and design of a qualitative
study. It captures experiences from patients and therapists
who were involved in a randomised controlled trial (RCT)
exploring the efficacy of a new group-based treatment
programme combining physical exercise and dietary
therapy.
Methods and analysis 15 patients with bulimia nervosa
or binge eating disorder, 10 therapists (physical trainers
and dietitians) and 6–10 patients who dropped out of the
RCT will be semistructurally interviewed. All interviews
will be analysed using a systematic text condensation
approach.
Ethics and dissemination Results will be presented
in peer-reviewed international journals, and at relevant
international conferences. Key findings will be available
to study participants as well as to patient organisations
and health authorities. The overall study meets the intent
and requirements of the Health Research Act and the
Declaration of Helsinki. It is approved by the regional
committee for medical research ethics (2013/1871).
Trial registration number NCT02079935; Pre-results.
therapists running a guided physical exercise and dietary
therapy programme (PED-t) experience their contribution
to the treatment of patients with bulimia nervosa and
binge eating disorder.
Methods Ten therapists running the PED-t were
semistructurally interviewed and the transcribed
interviews were analysed using a systematic text
condensation approach.
Setting The study was run within the context of a
randomised controlled trial at the Norwegian School of
Sport Sciences.
Results The therapists experienced their knowledge
about physical exercise and nutrition as important and
useful, and that they could share their knowledge with the
patients in different ways and with confidence in their own
role. They also believed that their knowledge could serve
as tools for the patients’ post-treatment recovery and
management of their daily lives. Moreover, the therapists
put much effort in adjusting their teaching to fit each
individual participant. Finally, they reported their personal
qualities as important to build trust and therapeutic
alliance.
Conclusions The terms ‘clinical confidence’ and ‘alliance’
may stand out as the overarching ‘metacategories’
covering the experiences revealed in this study. The
clinical implication is that new groups of professionals may
have an important role in the treatment of eating disorders.
study. It captures experiences from patients and therapists who were involved in a randomised controlled trial (RCT) exploring the efficacy of a new group-based treatment programme combining physical exercise and dietary therapy.
Methods and analysis: 15 patients with bulimia nervosa or binge eating disorder, 10 therapists (physical trainers and dietitians) and 6–10 patients who dropped out of the RCT will be semistructurally interviewed. All interviews will be analysed using a systematic text condensation approach.
Ethics and dissemination: Results will be presented in peer-reviewed international journals, and at relevant international conferences. Key findings will be available to study participants as well as to patient organisations and health authorities. The overall study meets the intent and requirements of the Health Research Act and the Declaration of Helsinki. It is approved by the regional committee for medical research ethics (2013/1871).
Trial registration number: NCT02079935; Pre-results.