Finn Skårderud

• Professor
• Professor at Institute of Eating Disorders

Background During pregnancy and early motherhood, risks of relapse and worsening are high for women with a history of eating disorders (EDs), as are adverse sequelae for their babies. However, systematic descriptions of the processes that these women undergo through pregnancy, birth, and early motherhood are lacking, as are good descriptions of the...

Background There is a higher prevalence of eating disorders among women seeking in vitro fertilization (IVF). Women with a history of eating disorders may be particularly vulnerable to eating disorder relapse during IVF, pregnancy, and early motherhood. The experience of these women during this process has hardly been studied scientifically, despit...

Background Being pregnant is a vulnerable period for women with a history of eating disorders. A central issue in eating disorders is searching control of one’s body and food preferences. Pregnancy implies being increasingly out of control of this. Treatment and targeted prevention start with the patient’s experience. Little is known about how wome...

In this chapter, we will describe psychoeducational work with eating disorders. Introduction to MBT (MBT-I) is essentially an educational group in which people are told about mentalizing and its relevance to eating disorders, invited to share experiences, and do exercises that elicit its different aspects. The emphasis is on a pedagogical stance, w...

In this chapter we will explore how a mentalizing team can be established in order to provide an effective community approach to severe eating disorders. An effective treatment limits the use of institutional care to patients who are very severely compromised, so that the patient can be freer to explore, with help, her or his own physical and menta...

How can the mentalizing model be applied to describe symptoms and the central pathology in eating disorders? In this chapter we will further present the theoretical model and elucidate central concepts through clinical examples. Mentalizing is both about oneself and others. Minding oneself—“know thyself”—is often one of the major impairments in sev...

In this chapter we will presents an overview of the structures and trajectories of treatment involving for patients using the model of MBT for eating disorders. The structures are psychoeducation in groups, individual therapy, mentalizing group therapy, case formulation and crisis plan. We will then elaborate each structure in separate chapters.

A family with a member with a severe eating disorder will most often be a family in long-term crisis. Tailoring of interventions means, in this context, finding a balance between an organizing structure and improvising within this structure due to the clinical situation. We have an active approach concerning inviting family members to extra session...

“The enhancement of mentalizing is important, not simply because of the close links between a mental state understanding of others and self-regulation, but because mentalizing improves the individual’s capacity to negotiate the social world. Mentalizing enables connection to others”. This is a quote from Peter Fonagy’s preface in this book. We woul...

In this chapter, we describe the main qualities and competences expected of an MBT-ED therapist. The competences for the therapist are the same as described in the original MBT model for borderline personality disorder. All these competences are highly relevant for psychotherapeutic enterprises with eating disorders. Such competences have further b...

Working with severe eating disorders in an inpatient setting represents specific challenges for both patients and staff. Gathering a number of people with severe eating disorders and interpersonal challenges within four walls 24/7 is a high-risk activity. Collegial work is important parts of management and of the working milieu. First we will prese...

In the work with eating disorders, we put great emphasis on the elaboration of co-written case formulation and crisis plan towards the beginning of the treatment. The documents should be the product of collaborative work, with both the patient and the therapists involved. Hence, we try to stimulate mentalizing in both the patient and therapists. Th...

The aim of this book is to promote the understanding of and the treatments for eating disorders. We combine the clinical field of eating disorders with the intellectual model of mentalizing. Mentalization-based treatments—MBT—originate from and are effective working with borderline personality disorder. We, the authors of this book, have over the y...

MBT-ED is structured with the explicit intention of stimulating mentalizing through a combination of treatment formats. In this chapter we will present the structure and aims in the mentalizing group (MBT-G) for eating disorders and discuss how the group can work as a training ground for interpersonal mentalizing. The specific challenges in group w...

Which specific competences should the MBT-ED therapist have? As stated numerous times, mentalization-based therapy (MBT) was originally developed for borderline personality disorders. The pivotal question is in what way should therapeutic approaches originally developed for borderline patients be modified to be optimal for persons with different su...

In this chapter, we present research findings relevant for the topic of this book. Aspects of mentalizing are investigated through different research instruments. This involves emotional Theory of mind (eTOM), cognitive style, reflective function, object relations, emotion recognition and expression and attachment. Persons with eating disorders are...

In the previous chapter, we described the implementation of the MBT-ED teams. Here we take a step further. Many will not have the capacity to set up such teams, due to ideological, practical and economic reasons. Still, we propose that mentalizing as an intellectual and therapeutic model can stimulate all clinicians working with severe cases of eat...

In this chapter we describe how to integrate supervision within the structure of MBT-ED. The model of mentalizing is not only about them but also about us. In the context of major therapeutic challenges, the therapists’ mentalizing may collapse. To ensure that we maintain our stance and to be able to recognize our own mentalizing lapses and difficu...

This work presents the adaptation of mentalization-based therapy for use in Eating Disorders (MBT-ED). The book starts with a presentation of the theoretical concept of mentalization and describes eating disorders from this perspective. This is followed by a discussion of the place of MBT-ED in eating disorders practice. MBT is first presented as t...

Mothers with a substance use disorder (SUD) are at risk for maladaptive parenting practices, and have heightened likelihood of having experienced childhood adversity themselves. In addition, parental reflective functioning (PRF), a capacity underlying sensitive caregiving, is often low in mothers with SUD. This study examines the relationship betwe...

Introduction: Although pharmacological interventions have been the mainstay of treatment for schizophrenia, there has been a growing recognition of the importance of psychotherapy. Aims: To investigate whether a novel psychotherapeutic approach, dialog therapy (DT), has an effect beyond standard psychiatric treatment (ST) in schizophrenia. Method...

Having a substance use disorder (SUD) may adversely affect caregiving capacities. Reflective functioning (RF) and executive functioning (EF) are both important capacities for sensitive parenting, and are often impaired in a SUD. Only a few studies have explored the possible association between the two phenomena. In this study, we used a neuropsycho...

Background In this multi-centre randomized controlled trial (RCT) we compared modified mentalisation-based treatment (MBT-ED) to specialist supportive clinical management (SSCM-ED) in patients with eating disorders (EDs) and borderline personality disorder symptoms (BPD). This group of patients presents complex challenges to clinical services, and...

BACKGROUND: In this multi-centre RCT we compared modified Mentalization Based Therapy (MBT-ED) to Specialist Supportive Clinical Management (SSCM-ED) in patients with Eating disorders (ED) and Borderline Personality Disorder symptoms (BPD). This group of patients presents complex challenges to clinical services and a treatment which addresses their...

Background: In this multi-centre randomized controlled trial (RCT) we compared modified mentalisation-based treatment (MBT-ED) to specialist supportive clinical management (SSCM-ED) in patients with eating disorders (EDs) and borderline personality disorder symptoms (BPD). This group of patients presents complex challenges to clinical services, and...

Introduction: Studies show that patients' perception of their illness has a direct influence both on their utilization of health services and their adherence to treatment plans. This may be particularly relevant to the treatment of Anorexia Nervosa (AN). Previous studies on AN have typically explored single psycho-social factors that patients with...

Aim To examine the prevalence of disordered eating (DE) among the total population of Norwegian female cross-country skiers and biathletes at the junior level, and to determine whether sociodemographic characteristics predict DE among athletes. Methods A cross-sectional population study of Norwegian female junior cross-country skiers and biathlete...

Although it is well documented that maternal substance abuse has a negative effect on the mother-child interaction, less is known about the pathways through which the interaction is compromised. The main objective of this research proposal is to describe an ongoing research project that focuses on associations between maternal executive function an...

In this study we explored circumstances, reflections, and reactions to first treatment contact in 34 women (aged 18-51) diagnosed with anorexia nervosa (AN) (DSM-IV). Using methods from grounded theory we identified how the meeting came about, what motivated the patients, and how they reacted to the conversation. The results suggest that (a) health...

The aim of this study is to measure and describe symptoms of eating disorders among females in treatment for drug addiction in Norway. Previous clinical and epidemiological studies have revealed coprevalence between eating disorders and substance use or abuse. However, few studies have measured eating disorders in drug-using samples and even fewer...

Recently there has been emerging clinical and research interest in the application of deep brain stimulation (DBS) and repetitive transcranial magnetic stimulation (rTMS) to the treatment of anorexia nervosa (AN). To our knowledge, few studies have discussed ethical aspects associated with the increased use of neuromodulation in AN, some of which a...

The use and understanding of anabolic steroids and other doping agents have changed in recent years. Associations between illicit drug use and the use of doping agents have been highlighted, but less attention has been given to the relationship between drug abuse treatment and associated body practices. In this study we looked at different experien...

In this article, we aim to explore patient perspectives regarding the etiology of anorexia nervosa (AN) in the context of participating in brain research for AN. This is a qualitative study using semistructured interviews with 12 young AN patients. Data were analyzed according to thematic analysis method. This study shows that patients' language us...

Are we forgetting the wisdoms of the seminal figure in the field of anorexia nervosa, Hilde Bruch? This text is based on rereading many of her central works on eating disorders. She is presented through a brief biographical sketch, and her work is discussed with reference to both her conceptual model on anorexia nervosa and her model for psychother...

Parental substance abuse undermines caregiving competency and increases the likelihood of abuse and neglect of children. Both research and clinical interventions focus disproportionally on maternal substance abuse, whereas the role of fathers with addictions is largely ignored. The study used a qualitative design to investigate fatherhood from the...

Previous research in eating disorders suggests that treatment satisfaction is closely related to the manner in which care is delivered. The present research is a systematic in depth study of health professional characteristics preferred by AN-patients. Thirty-eight women with AN aged 18–51 were interviewed in depth using a phenomenological study de...

Background: Several theoretical models suggest that deficits in emotional regulation are central in the maintenance of anorexia nervosa (AN). Few studies have examined how patients view the relationship between negative affect and anorectic behaviour. We explored how patients with AN manage the aversive emotions sadness, anger, fear and disgust, a...

Unlabelled: 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 a...

Only 17% of Norwegian children and adolescents with diabetes achieve international treatment goals measured by glycated hemoglobin (HbA(1c)). Classic patient-physician consultations seem to be poorly adapted to young children. New strategies that are better attuned to young people to improve support of adolescents' self-management of diabetes need...

Reluctance to recover may explain poor treatment outcome and high dropout and relapse rates in the treatment of anorexia nervosa (AN). This study systematically explored what AN patients describe as interfering with their wish to recover. Two independent samples of women with AN (total N = 36) were interviewed in-depth using a phenomenological stud...

Studies of attachment and eating disorders use different types of measures, including different coding procedures for the Adult Attachment Interview (AAI). Generalizability of findings across studies is therefore uncertain. We compare the Main & Goldwyn procedure with the Dynamic Maturational Method, the two most common procedures for classifying A...

We explored the concept body image disturbance (BID) by utilizing the subjective experience of 32 women (aged 20-39 years) diagnosed with AN (DSM-V). Using methods from Grounded Theory we identified four phenotypes of BID-"Integration," "Denial," "Dissociation," and "Delusion"-which differed according to whether the patients overestimated their own...

With the beautiful and dark film "The white ribbon", from 2009, the Austrian film director Michael Haneke consolidated his status as an international success. A central theme in his films is evilness and its roots. But just as important is his ambition to develop films where evil is not only portrayed, but where spectators are challenged to relate...

Attachment theory has received increasing attention from clinicians and researchers in the field of eating disorders. This paper is an updated review on theoretical approaches in the field, and of studies employing the Adult Attachment Interview. We searched the major databases such as PsycInfo and Science Direct for empirical and theoretical studi...

The primary aim of this article is to give a theoretical and empirical background for clinical interventions in family-oriented treatment for substance use disorders. The article refers to an ongoing research project, which is based on the concepts of mentalization and parental reflective functioning. Theory of mentalization and attachment theory i...

Depression was a recurrent phenomenon in the life of the American painter Edward Hopper (1882-1967). He is known as one of the artists who portrays modern melancholy most convincingly. The article uses his original artwork to reflect upon sleep, awakeness and melancholy. Hopper brings nightmares into the day and the light, and insomnia into the rev...

Martin Scorsese's film "Taxi Driver" from 1976 is a cinematic masterpiece. The main character cannot sleep. His condition is caused by inner restlessness and external commotion. The film shows us New York City's brutal nightlife through the distorted mind of a taxi driver.

Dorothy Parker (1893-1967) was an American poet and author, known for her wicked wittiness, tender verses and sharp eye for the foibles of modern urban humans. She writes about her insomnia, and the time of day when despair is greatest and self-esteem lowest.

The aim with this article is to provide an introduction to self-harm as a clinical phenomenon, with phenomenological descriptions and definitions, and by presenting risk factors, epidemiological data and functions of self-harm. The basis for the article is a non-systematic literature search of the electronic databases Medline, PsychInfo and EMBASE...

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 Ka...

The aim of this article is to give an overview over the associations between self-harm and eating disorders, and to present theoretical models to interpret such associations. Common phenomenological characteristics between these conditions are emphasized. The article is based on a non-systematic literature search of Medline, PsychInfo and EMBASE (1...

The aim of this article is to demonstrate how movies can enhance our understanding of the phenomenology of self-destructive behaviour. Various aspects of self-harm, including psychological individual characteristics and cultural trends, have been elucidated through a strategic selection of movies. As movies represent a popular rather than a medical...

BACKGROUND: The aim with this article is to provide an introduction to self-harm as a clinical phenomenon, with phenomenological descriptions and definitions, and by presenting risk factors, epidemiological data and functions of self-harm. MATERIAL AND METHOD: The basis for the article is a non-systematic literature search of the electronic databas...

The aim of this article is to demonstrate how movies can enhance our understanding of the phenomenology of self-destructive behaviour. Various aspects of self-harm, including psychological individual characteristics and cultural trends, have been elucidated through a strategic selection of movies. As movies represent a popular rather than a medical...

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 Ka...

BACKGROUND: The aim of this article is to give an overview over the associations between self-harm and eating disorders, and to present theoretical models to interpret such associations. Common phenomenological characteristics between these conditions are emphasized. MATERIAL AND METHODS: The article is based on a non-systematic literature search o...

The aim of this text is to remind the clinical and scientific field of eating disorders of the seminal figure Hilde Bruch. Her work is highly original, but is it sinking into the mists of oblivion? The contemporary overemphasis on cognitive behavioural therapy may indicate that. Hilde Bruch's contribution was a descriptive and theoretical model def...

The paper presents a literary work unknown to most readers. The Russian author Leonid Tsypkin (1926 - 82) is among those who were discovered and even declared literary geniuses after their dead. He never saw a line of his own fiction published. Tsypkin studied medicine in Minsk in Belarus and later practiced as a pathologist in Moscow where he obta...

Motivational approaches to anorexia nervosa (AN) have mainly concerned motivational quality and quantity. We investigated the content of patients' wish to recover. Eighteen women, aged 18-39, with AN were interviewed in depth using a phenomenological study design. Interviews were tape-recorded, transcribed, and analyzed using the QSR-N*Vivo softwar...

Mentalisation is a new concept within mental health. It refers both to self-reflection and understanding of others, and is central to human relationships and communication. Mentalising capacity to understand oneself and others is a key determinant of self-organisation and affect regulation. Impaired mentalisation and different kinds of psychopathol...

This paper presents a new outline for psychotherapy with persons with anorexia nervosa. 'Model on mentalisation' is the intellectual and empirical framework for this contribution. Mentalisation is defined as the ability to understand feelings, cognitions, intentions and meaning in oneself and in others. The capacity to understand oneself and others...

Anorexia nervosa as a psychiatric disorder presents itself through the concreteness of symptoms. Emotions are experienced as a corporeality here-and-now. In a companion article, Part I, different 'body metaphors' are described and categorised. The human body functions as metaphor, and in anorexia nervosa there is a striking closeness between emotio...

Anorexia nervosa still qualifies for the designation as an enigma, with an unclear aetiology and a psychopathology poorly understood. A striking clinical feature is the concreteness of symptoms. The concept 'concretised metaphor' refers to instances where there is a psychic equivalence between physical and psychic reality. Emotions are concretised....

During the last decades, there has been a rising interest in the role of shame in psychiatric disorders. To define shame and describe types and subtypes of shame and their relations to symptoms and meaning in anorexia nervosa. The study will also describe the possible role of pride, as a contrasting emotional and cognitive experience. Thirteen fema...

This text explores the phenomenon of affect attunement, elucidated through a musical improvisation with a young man suffering from an eating disorder. The empirical data stems from a qualitative research study, based on a phenomenologically inspired procedure for data analysis. Affect attunement is a term to elucidate the sharing of inner feelings...

This text explores the phenomenon of affect attunement, elucidated through a musical improvisation with a young man suffering from an eating disorder. The empirical data stems from a qualitative research study, based on a phenomenologically inspired procedure for data analysis. Affect attunement is a term to elucidate the sharing of inner feelings...

Anorexia nervosa (AN) patients tend to place a positive value on their symptoms. Many clinicians believe that this plays a central role in maintaining the disorder. However, empirical research on how patients attribute meaning to their symptoms is lacking. This study aims at systematically exploring the meaning that the patients with AN attribute t...

A B S T R A C T Children residing in care (hereafter referred to as childcare residents) are a risk-group for emotional disturbances and behaviour problems. Based on existing knowledge of risk factors one would also expect this population to be a high-risk group for eating disorders and related body-image disorders. The objective of this study was...

IntroductionDefinitionsPrevalence of Eating DisordersEating Disorders among AthletesEating Disorders among DancersRisk Factors for the Development of Eating DisordersMedical IssuesIdentifying Athletes with Eating DisordersTreatmentPrognosisPrevention of Eating DisordersConclusion References

What is "culture" in eating disorders as culture-bound syndromes? The human body is a flesh-and-blood entity, but it also functions as a symbolic instrument. The body communicates about culture itself, about norms and boundaries. In this paper one central aspect in the phenomenology of eating disorders is emphasised: The subjective experience of la...

An eating disorder apart from anorexia nervosa and bulimia nervosa is "binge eating disorder" (BED): eating in a short period of time a large quantity of food and a feeling of lack of control over food intake. There is also an atypical rest category, "eating disorders not otherwise specified" (EDNOS). Diagnostic criteria for BED and EDNOS are incom...

Over the past 20 years, a number of studies have been published that generally suggest a higher frequency of eating disorders among athletes than among non-athletes. Participation in competitive sport has also been considered an important factor related to the development of eating disorders. Taken together, most studies have suggested that eating...

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, particula...

This paper describes the structure and content of a Norwegian educational programme—‘Body and self-esteem’—to raise clinical competence among health professionals treating patients with eating disorders. Apart from the individual competence, the aim of the programme is also to increase system-based competence by forming network groups. Using a pre–...

No abstract

Anorexia nervosa represents an over-concern with body shape and weight. This article describes seven female patients with severe anorexia nervosa who were given a time-limited program of Adapted Physical Activity (APA). The aim was to investigate how social interaction in activities could move negative attention from the objectified anorectic body...

The history of eating disorders in Norway is described in four phases: (1) early case histories of eating disorder symptoms in the late 19th century Norwegian medical literature, (2) the pioneers of the post-World War 2 decades, (3) the 1980s when eating disorders became visible to the public and a focus of interest among professionals, and (4) the...

Is shame out of fashion? The first part of this article discusses how the concept of shame has changed in modern western culture, with a shift from collective definitions of norms towards personal experience. The second part is a phenomenological description of shame and how shame can be expressed and experienced in therapeutic relationships. Shame...