Socio-cultural context of eating disorders in Poland

Background: The goal of this study was to assess the relationship between sociocultural factors and clinical eating disorders during the intensive process of Westernisation in Poland that occurred after 1989. The study population included girls diagnosed with an eating disorder according to DSM-IV criteria (n = 47 anorexia nervosa restrictive type [ANR], n = 16 anorexia binge/purge type [ANBP], n = 34 bulimia nervosa [BN], n = 19 eating disorder not otherwise specified [EDNOS]) who received consultation for the first time between 2002 and 2004 in the Department of Clinical Child and Adolescent Psychiatry, University Hospital, Kraków, Poland. The study included an age-matched normal control group [NOR] of 85 schoolgirls from Kraków. Methods: Relationships between two given qualitative features were investigated using the chi-square test or Fisher’s exact test. Correspondence analysis was applied to graphically explore the relationship. The Kruskal-Wallis test with the Bonferroni was performed to compare quantitative results across groups. Results: Objective sociodemographic variables and responses to the 62-item Questionnaire of Socio-cultural Context were measured. The mothers of ANBP and BN patients were less professionally active than mothers of ANR patients and NOR subjects. Subjective socio-cultural factors were more relevant for the BN group than the ANR group. Questionnaire responses in the ANBP group were more similar to those in the BN group than to those in the ANR group. The most unambiguous and specific characteristic of the ANR group was a sense of belonging to the middle class. Variables that differentiated the BN group from the NOR group included the importance attached to thinness treated as an expression of power and control over one’s self, as well as a multifaceted negative evaluation of one’s own family, including a negative assessment of the position of women and parental lack of concern for appearance and principles of nutrition. All patients, regardless of diagnosis, identified with other people with similar problems and considered anorexia and bulimia to be a major issue of their generation and social environment. Conclusions: The results of this first in Poland exploratory study of socio-cultural context of eating disorders indicate the importance of both objective and subjective socio-cultural factors in eating disorders in the group studied

Specificity, rules and dilemmas of therapy in patients diagnosed with anorexia nervosa within the frames of the Adolescent Psychiatric Ward

Autorzy prezentują swoje dotychczasowe doświadczenia w terapii pacjentek z rozpoznaniem jadłowstrętu psychicznego hospitalizowanych w młodzieżowym wielodiagnostycznym oddziale psychiatrycznym. Opisując model opieki nad pacjentkami z zaburzeniami odżywiania się zwracają uwagę na trudności w pracy terapeutycznej, wynikające m.in. z gwałtowności narastania objawów i ich chroniczności, niskiej motywacji pacjentek do leczenia, wątpliwości zespołu leczącego co do zasadności łączenia metod behawioralno-poznawczych z podejściem psychodynamicznym, mnogości ról podejmowanych przez terapeutów.The present article attempts to summarize the authors’ experiences in the therapy of patients diagnosed with anorexia nervosa treated within the frames of the adolescent multi-diagnostic in-patient ward. One of the most important elements that determines our therapy offer is the specificity of the group of patients diagnosed with anorexia nervosa and hospitalized in the ward. Patients can be described as difficult-to-treat for many reasons, among others, because of sudden symptoms’ increase, their chronicity, or ineffectiveness of outpatients clinic treatment. Our comments and observations are made from the perspective of psychodynamic psychiatry and psychotherapy. In psychodynamic and psychoanalytical literature, anorexia nervosa is sometimes treated as a syndrome of a prepsychotic, personality or neurotic character. At least a dozen different understandings of dynamic causative mechanisms are mentioned in this context. An important supplement of dynamic theories that we have taken up is an attempt to understand the relations between individual psychopathology of a patient and functioning of the family system. Families of girls with the anorexia nervosa problem can be perceived as not helping their children in creating their own personality, one that is well-separated from the outside world. Therapy in the ward is based on therapeutic community, nutrition contract, family therapy, individual therapy, group therapy, artetherapy, and physiotherapy. None of the therapy forms can be deemed as dominating. They should rather be perceived as complementary. The model for treatment of patients with eating disorders that we have developed within the frames of the ward is accompanied with our numerous doubts, concerns and discussions, and it is not yet final

Outcome of Polish teenage patients with eating disorders

аim of the study. The aim of the study was to assess outcome of patients with eating disorders in a Polish socio-cultural context. Material and methods. Re-assessed after 6.72 years (SD 0.99 years, min 4.58 years, max 8.81 years), 47 of 112 patients consulted initially in the outpatient clinic of the Child and Adolescent Psychiatry Unit between 2002/2004 in Krakow, Poland with one of the eating disorders. Results. Complete remission (absence of symptoms for three months) took place in 55% of patients from the restrictive anorexia nervosa group and in 27.3% of patients from the bulimia nervosa group. A full range of symptoms was observed in 10% of patients from the restrictive anorexia nervosa group and in 36.4% of patients from the bulimia nervosa group. In both groups, the longer the follow-up study, the worse outcome observed. Discussion. Small size of group in the follow-up study caused a significant limitation. Conclusion. The remission rates indices for restrictive anorexia nervosa are similar to those presented in other follow-up studies. In the case of bulimia nervosa, they are lower than average. An analysis of diagnosis variability between the initial and the follow up assessment indicates low crossover rate from anorexia nervosa to the bulimia nervosa group