This article gives an updated review of the history, epidemiology, etiology, and evidence-based treatment of eating disorders (anorexia nervosa, bulimia nervosa, and binge eating disorder), with specific reference to the Norwegian situation. In order to improve clinical skills there is an emphasis on the need for more treatment resources, particularly for the most serious cases, better implementation of evidence-based treatment and on continuous medical education. Given the somatic manifestations of eating disorders, medical doctors are essential in assessment and treatment. Many patients can be successfully treated by general practitioners provided that the general practitioner takes an interest in and is knowledgeable about eating disorders. The need to increase the number of general practitioners participating in ongoing Norwegian educational programmes on eating disorders is stressed.
Body image disturbance is a central diagnostic criterion of anorexia nervosa (AN). To a great extent, previous studies have conceptualized body image disturbance as a relatively stable and trait-like characteristic of the patient. There is, however, growing evidence that body images fluctuate in different situations and contexts. The aim of the present study was to explore which everyday contexts that patients with AN themselves associate with fluctuations in body image. Thirty-two women (20-35 years) who had been diagnosed with AN (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition) within the last year participated. Semi-open and focused qualitative interviews were conducted, transcribed and analyzed using Grounded Theory techniques. The results suggest that body image is a dynamic phenomenon that may fluctuate in different situations and contexts. The participants linked such fluctuations to their own uncertainty about their real appearance. In lack of a stable and integrated experience of their own body, they were extremely sensitive towards body image threats and challenges in their daily life and reacted to these situations by fluctuations in their body image. Four contextual cues were found to trigger such changes in body image: these were eating food, being reminded of one's body appearance, relating to one's own emotional signals and interpreting other people's expressed and unexpressed opinions about oneself and one's appearance. Clinical and theoretical implications are discussed.
Individuals with anorexia nervosa may have quite varied body image experiences in different contexts. The contexts identified in this study may be a point of departure for clinicians in helping their patients to explore their subjective body image experiences and to connect these with emotional, cognitive and relational contexts in a psychologically meaningfully way.
European literature contains fictional descriptions of self-harm and self-punishment over a time span of almost 2 500 years. This article presents such descriptions, from Sofocles' tragedy about King Oedipus to contemporary literature. Particular interest is dedicated to the Austrian Nobel prize laureate Elfriede Jelinek and the Norwegian author Karl Ove Knausgård. In Jelinek's fictional universe, self-harm is particularly related to the topic of autonomy in a family context; while Knausgård describes the role of shame in triggering and sustaining self-harming behaviour.