Eating disorders in men: current features and childhood factors.

BACKGROUND: Disturbed interactions with one's body and with other persons are two major features in eating disorders. This study was designed to assess current and childhood characteristics of eating-disordered men. METHODS: The authors interviewed 32 men with eating disorders (anorexia nervosa: N=9, bulimia nervosa: N=15, eating disorders not otherwise specified: N=8) and 43 control participants with no such history similar in age and educational status. The Structured Clinical Interview for DSM-IV was used to assess Axis I disorders and a self-designed interview to assess actual social and sexual characteristics and childhood body-focused and social behaviors including sexual and physical abuse. RESULTS: The two groups differed significantly with regard to clinical, sexual and social features, with a three times higher rate of psychiatric disorders, fewer sexual and social relationships in the index group than in the controls. Eating-disordered men differed significantly from controls on most measures of body-focused and social behaviors, displaying higher rates of thumb sucking, nail biting, auto-aggressive behavior, and nudity as a familial taboo during childhood, as well as less parental bodily caressing than did controls. The index group reported significantly poorer relationships to their parents, fewer friends and persons of trust, and more often had adjustment problems at school than did their counterparts. CONCLUSIONS: Our data show that disturbed interactions with one's body and with other persons in eating-disordered men are associated with a body-denying and distant family climate and an auto-aggressive, anxious and inhibited social behavior during childhood.

Family background and sexual abuse associated with eating disorders.

OBJECTIVE: The authors examined the possible relationship of negative early familial experiences and childhood sexual abuse to the later development of eating disorders. METHODS: Three anonymous questionnaires--a sexual abuse screening checklist, the Biographic Inventory for Diagnosis of Behavioral Disturbances, and the Eating Disorder Inventory--were distributed to 350 female university students. RESULTS: Of the 202 women who completed the questionnaires, 44 (21.8%) were victims of childhood sexual abuse. There were no significant differences in the total or the subscale scores on the Eating Disorder Inventory among women with no, one, or repeated incidents of sexual abuse. However, women who reported an adverse family background displayed significantly higher Eating Disorder Inventory total and subscale scores than did women who assessed family background as a secure base. CONCLUSIONS: The data in this nonclinical female cohort suggest that childhood sexual abuse is neither necessary nor sufficient for the later development of an eating disorder, while an adverse family background may be an important etiological factor.

Psychotherapeutic treatment of morbidly obese patients after gastric banding.

BACKGROUND: Surgery is the most effective therapeutic option for weight reduction in carefully selected patients with morbid obesity resistant to conventional treatment. However, surgical treatment is not the solution but an important precondition for successful management of morbid obesity. METHODS: All patients undergo a psychiatric examination before laparoscopic gastric banding. At the first examination we inform all patients about the various forms of psychological support offered before and especially after gastric banding. RESULTS: A majority of the obese individuals are interested in psychological support postoperatively, but only a minority of this patient group (about one-quarter) ultimately enlists psychological support on a regular or irregular basis. Some specific psychological topics have proved to be particularly important such as change of self-esteem as a consequence of weight loss, problems in adopting new eating behaviors and the risk for developing a new eating disordered behavior, and problems involving adequate problem-solving. CONCLUSIONS: In many cases, some form of psychological support is necessary in order to cope with the new postoperative demands and to find more adequate coping strategies for underlying psychological, psychosocial and environmental problems. The different kinds of psychological support and psychotherapeutic treatment available at Innsbruck University Hospital for obese patients after gastric banding are discussed here.

Psychosocial consequences of weight loss following gastric banding for morbid obesity.

BACKGROUND: This study was performed to determine what consequences surgery for morbid obesity has on weight loss, problems in eating behavior, quality of life, physical appearance and mental state. METHOD: After a minimum follow-up of > 8 months (median follow-up 21 months, range 8-48 months), a questionnaire concerning extent of, satisfaction with and consequences of weight loss was mailed to 250 morbidly obese patients after laparoscopic Swedish adjustable gastric banding (SAGB). In addition, the partner's opinion regarding the operation was evaluated as well as the consequences of weight loss for partnership and sexual relationship. RESULTS: 160 patients (64%) completed and returned the questionnaire. Most patients (87%) were happy with the extent of weight loss. Weight loss, however, was connected with negative consequences for the body such as flabby skin (53%), abdominal skin overhang (47%) and pendulous breasts (42%). Patients who were satisfied with their postoperative physical appearance showed significantly less weight loss than did patients who were unhappy with their appearance (38 vs 54 kg). Most of the partners (91%) believed that the decision for SAGB was right. An improvement in partnership was reported by more than half of the partners (59%), and an improved sexual relationship by 45%. CONCLUSION: Laparoscopic SAGB is an effective surgical treatment for morbid obesity. However, the consequences of excess and rapid weight loss for physical appearance are negative in many cases. Well-directed information about the consequences of excess weight loss before SAGB and the possibilities and limits of plastic surgery must be given preoperatively to offset high and often unrealistic expectations.

Partnership, sexuality, and sexual disorders in morbidly obese women: consequences of weight loss after gastric banding.

BACKGROUND: A study was performed to determine what consequences surgery for morbid obesity has on sexual attitudes and partnership in obese female patients. METHOD: Semi-structured interviews concerning sociodemographic data, sexuality and relationship were conducted on 82 female patients preoperatively and at least 1 year postoperatively. RESULTS: Physical appearance played the main role in the decision to undergo weight reduction surgery in only 17% of the study patients. Postoperatively, half of the patients were satisfied with their physical appearance 1 year after surgery, the other half not. Preoperatively, 44% of the patients stated that sexuality with their partners was satisfying and the frequency of sexual intercourse was regular. Postoperatively, 63% of the patients stated that they enjoyed sex more, compared with 12% of the patients who enjoyed sex less than before surgery. Postoperatively, 20% of the patients reported that partnership had changed positively, 10% negatively. CONCLUSIONS: The results indicate that many of the sexual problems in obese individuals are the result of an underlying lack of self-esteem, unsatisfactory relationships, or collective stigmatization of obese individuals. Binge eating, often found in morbidly obese patients, seems to be less the result of or compensation for sexual problems but is more likely to stem from other psychosocial or psychological problems.

Denial of pregnancy: obstetrical aspects.

Between 1987 and 1990 27 women were observed who professed they did not know they were pregnant until term or until premature contractions set in. The aim of this study was to evaluate obstetric history and pregnancy outcomes and assess defence mechanisms and coping strategies which contribute to negation of pregnancy. In 11 women pregnancy was denied until delivery, five of these had breech presentations. In nine women denial ended between 27 and 36 weeks and in seven women between 21 and 26 weeks of gestation. Three of the four fetal deaths that occurred and two of the three cases of prematurity occurred in the last group. There was no infanticide but one woman delivered her infant alone and concealed. Most women reported irregular, sometimes menstruation-like bleedings during pregnancy, three women had taken oral contraceptives during pregnancy. Few women reported actual symptoms of pregnancy, such as nausea and weight gain. Denial of pregnancy is a heterogeneous condition with different meanings and different psychiatric diagnoses in different women. Stressors (e.g. separation from partner, interpersonal problems etc.) do play an important role as precipitating factors for the development of an adjustment disorder with maladaptive denial of pregnancy. There is a fluid transition between conscious coping strategies and unconscious defence mechanisms.

Long-term effects of incest: life events triggering mental disorders in female patients with sexual abuse in childhood.

The authors studied several psychosocial, psychosomatic, and psychodynamic factors in 33 female psychiatric patients who had been victims of incest. Abuse was almost exclusively severe and prolonged. Three quarters of the female patients had been abused by their biological fathers or stepfathers. Sexual abuse experiences in childhood are connected with feelings of anxiety, helplessness, and powerlessness. Together with a lack of support on the part of the mother, these experiences lead to ego weakness, an autoplastic mode of coping with aggression and to patterns of objectal relationships which predispose them to object loss. The links between a girl's traumatic experiences in relationships and her vulnerability to separation in later life and their importance for the incidence of mental disorders will be discussed on the basis of Bowlby's attachment theory.

Sexual dysfunctions: relationship to childhood sexual abuse and early family experiences in a nonclinical sample.

Studies investigating a possible relationship between childhood sexual abuse and adult sexual dysfunction have reported highly discrepant results. The purpose of the present study was to examine 202 female university students for early familial experience and childhood sexual abuse in relation to adult sexual disorders. Each student was asked to complete three questionnaires on victimization, sexual dysfunction, early familial experiences. Results indicated that: (a) victims of multiple CSA more frequently reported sexual desire disorders and orgasm disorders than did single-incident victims and nonvictims; (b) single-incident victims and nonvictims reported no significantly different rates for any kind of sexual dysfunction; (c) negative early familial experiences were significantly related to any kind of sexual disorder; and (d) women who reported orgasm disorders more often reported an inadequate sex education than did women with another or no sexual dysfunction. The data suggest that both family dysfunction and sexual victimization contribute to sexual disorders in adulthood, and that later sexual disorders are to a large extent the result of sexual abuse-related factors in particular and family dysfunction in general.

Sexual dysfunction in males: significance of adverse childhood experiences.

This paper examines the impact of childhood sexual victimization, physical abuse, and dysfunctional family background on sexual dysfunctions in adulthood in a nonclinical male student sample. The current analysis is based on data from a survey by questionnaire from 301 males. Our findings show that (a) occasional sexual dysfunctions, especially premature ejaculation and sexual desire disorder, are frequent in young male adults; and (b) long-lasting adverse familial relationship to attachment figures are more influential to later sexual dysfunction than are childhood sexual abuse experiences.

Vulnerable phases in adolescence represented by means of committed suicide.

This study deals with suicides of children and adolescents in the region of Tyrol, Austria from 1976-1984. The upper age limit was set at 19 years. During the time period stated above, 54 suicides were registered for the relevant age group, using police records as a source of information. Special attention was paid to the distribution of age, sex and occupation, as well as to the suicide methods. As far as age distribution is concerned, a significant increase of suicides was registered at the age of 15 and again at the age of 19. According to the authors, the reason for this increase is pronounced psychosocial changes which occur especially in these age groups and weaken social integration. The various implications ensuing from the available data are discussed.

[A pilot study of fathers on parental leave in Tirol.]. / Une étude pilote sur le congé parental de pères au Tirol.

The current study examines fathers in parental leave in Tirol. The authors have come to realise that systematic reflections concerning fathers on leave of their work are rare. The authors attempt to answer the following question: does parental leave have implications on child/father attachment? The pilot study examines a small sample of 15 father/child couples. The description and analysis of father/child interactions was elaborated with the Child Adult Relationship Index (CARE-Index) designed by Crittenden (1988, 2000).

[Burnout and stress disorders in intensive care doctors]. / Burnout und Belastungsstörungen bei Intensivmedizinern.

BACKGROUND AND OBJECTIVE: The various acute and chronic demands and burdens put ICU staff at greater risk for developing psychological and stress disorders. It was the aim of this study to assess the prevalence rates of burnout-syndrome in anesthetists, and to evaluate the contribution of working conditions to the development of burnout. METHODS: Self-reporting questionnaires were used to assess emotional well-being and physical health, burnout-syndrome (Maslach Burnout Inventory), and working conditions (Instrument for Stress-Oriented Task Analysis) in 89 anaesthetists (56 males, 33 females). RESULTS: One quarter of the anaesthetists show high values on the subscales "emotional exhaustion" or "depersonalization", and one fifth low values on the subscale "lack of personal accomplishment". About one quarter of the probands may be seen as "at risk for burnout". Feelings of ill-health are relatively frequent in both sexes. Long working hours and night duties, the cooperation with members of different occupational groups, and small working place resources are seen as particular stresses. CONCLUSION: Burnout-syndrome and psychosomatic symptoms are frequent in intensive care doctors. But preventive measures such as adequate resources at the work place and supervision can influence personal behavior and working conditions, and thus reduce the risk of burnout.

Sexual abuse of girls: aspects of the genesis of mental disorders and therapeutic implications.

We studied the mental disorders of 33 women with a history of intrafamilial sexual abuse as a child and found a wide range of psychopathological symptoms, but no typical incest syndrome. Several psychosocial factors are presented and the psychodynamics of and the causative circumstances initiating the mental disorders are discussed. These circumstances were mainly situations of separation, which led to ego instability and gave rise to a feeling of helplessness and impotence. The necessity to take into consideration the possibility of sexual abuse during childhood in all cases of mental disorders as well as therapeutic guidelines are discussed.

[The significance of incest experience for the development of psychiatric and psychosomatic diseases]. / Die Bedeutung von Inzesterlebnissen für die Entstehung psychiatrischer und psychosomatischer Erkrankungen.

A history intrafamilial sexual child abuse was dicited from 33 patients (20%), admitted to the Psychiatric Department (Psychosomatic Unit) of the University Clinics of Innsbruck in 1989. They exhibited quite different psychopathologies, with no typical incest syndrome, however, self-destructive behaviours of different kinds appeared to be characteristic of sexually abused patients. Experiences of separation and loss could be seen as the most frequent trigger for mental and psychosomatic disorders. The importance of child sexual abuse as a vulnerability factor, the necessity to consider the possibility of sexual abuse during childhood in all cases of mental disorder and the importance of the therapist's empathy as a precondition for the patient's ability to speak about the traumatic experience are discussed.