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(1) Diplomarbeit Frau cand med. Mandana Adambegan
Background. We investigated internalizing and externalizing psychopathology and nonshared peer-group-perceptions retrospectively among sister-pairs with a forthcoming eating disorder (Anorexia Nervosa, Bulimia Nervosa or EDNOS) in one sister versus unaffected sister, in actually affected adolescents with an eating disorder and unaffected control subjects with following questions: 1. Is there any clinically relevant behavioural psychopathology and do we find unfavourable peer-group-perceptions in patients before onset of an eating disorder, compared with their sisters? 2. Do currently ill patients perceive their peer-environment differently from unaffected subjects? 3. Do we find differences in internalizing and externalizing psychopathology and peer-group perceptions in currently ill patients versus patients before onset of their disease?
Method. Behavioural psychopathology was examined by parental report using the Child Behaviour Checklist (CBCL) retrospectively in 95 discordant sister-pairs and in 57 patients with actual diagnosis of Anorexia Nervosa, Bulimia Nervosa or EDNOS. Peer-Group-Perceptions were investigated using the Sibling Inventory of Differential Experiences (SIDE) in 143 discordant sister-pairs, 22 actually ill patients and 62 unaffected female high school-students.
Results. About 60% of the girls show important clinical and subclinical internalizing psychopathology before the onset of the disease and differ in this significantly from their unaffected sisters. Currently ill patients show even more clinically relevant internalizing psychopathology (ca. 75%). There are very low rates of externalizing problems in both groups, but the rates are significantly higher than in unaffected sisters. Patients before onset of the disease perceive their peer-group as more college-oriented, but less popular compared with their unaffected sisters. Currently ill patients report their peer-group to be even more college-oriented than do patients before onset of their disease and in average as more popular than
Conclusions. Internalizing problems (anxiety, depression, somatization) play an important role before onset and during the course of an eating disorder. In non-shared peer-group perceptions college-orientation has a growing importance before onset and during the disease.
(2) Diplomarbeit Frau cand med. Astrid Eisenkölbl
Die Prävalenz von Essstörungen und gestörtem Essverhalten sowie Lebensqualität bei Jugendlichen mit Zöliakie im Vergleich zu Jugendlichen mit Diabetes mellitus Typ 1 (approbiert Oktober 2007)
Betreuer: Univ.-Prof. Dr Andreas Karwautz, MUW
The overall aim of this paper is to analyse the prevalence of eating disorders and problematic eating habits as well as the quality of life among adolescents suffering from a celiac disease in comparison to adolescents with Diabetes mellitus Type 1.
For this reason 283 adolescents – after having passed certain inclusion criteria – between the ages of 10 to 20 years (210 girls with an average age of 14,8 years; 73 boys with an average age of 13,9 years) were screened for an eating disorder with the help of a quantitative questionnaire. After the screening an eating disorder was diagnosed according to the diagnosis criteria of the DSM-IV with the help of interviews.
3,9% of the girls with a celiac disease suffered from an eating disorder according to the DSMIV criteria. Additionally 10,7% suffered from a subclinical eating disorder. None of the boys met the criteria of an eating disorder. The quality of life of those adolescents suffering from a celiac disease was – in comparison to a healthy control group – not constrained. Still the subjective quality of life was valued lower by those adolescents with an eating disorder than by those without an eating disorder. The comparison with the girls with diabetes showed a higher prevalence of eating disorders according to the DSM-IV criteria, but little differences of subclinical disorders (11,5% eating disorders according to DSM-IV; 13,5% subclinical eating disorders). The quality of life of the diabetics was found to be similar to the quality of life of those adolescents suffering from a celiac disease. If an eating disorder was added, then also the diabetics experienced their quality of life with considerable loss. Conclusio Suffering from a celiac disease apparently is no risk factor for the development of an eating disorder. Moreover, the quality of life of those adolescents with celiac disease is barely different from the quality of life of a healthy population group. Yet if an eating disorder is diagnosed, the quality of life of those patients with a celiac disease as well as the quality of life of the diabetics is constrained. Therefore symptoms of eating disorders should be noticed and measures should be taken at an early stage.
(3) Diplomarbeit Frau cand. med. Helga Hürner
Subjektives Wohlbefinden und Belastung der Familie bei Jugendlichen mit Zöliakie im Vergleich zu Jugendlichen mit Diabetes mellitus Typ 1 unter Berücksichtigung von pathologischem Essverhalten – (approbiert März 2008)
Betreuer: Univ.-Prof. Dr Andreas Karwautz, MUW
Background Due to the improving medical care there is a rising number of people and their relatives who have to cope with a chronic disease in daily life. For that reason the assessment of quality of life in this area has become increasingly important. Celiac disease and Diabetes type 1 are common chronic conditions in childhood and adolescence. The results of former quality of life studies in adult celiac patients have not been conclusive und information about the well-being of the children and the impact on their families can hardly be found in the literature. Furthermore there is a lack of research about the effect of eating pathologies on the well-being of the adolescents with this disease or on the burden of the family.
Method 283 children and adolescents (210 girls, 73 boys, mean age 14,6 years) with celiac disease from Austria and Germany participated in this study. The data of 198 young patients with diabetes type 1 (102 boys, 96 girls, mean age 14,3 years) was available for comparison. To measure the well-being of the children the Berne Questionnaire of Subjective Well-being/Youth Form (BFW/J) was used. The parents completed the German version of the Impact on Family Scale (IOFS).
Results There is no considerable difference between the well-being of the celiac and diabetes patients. Compared to a representative sample of healthy peers both groups have even better scores of well-being with the exception of a higher prevalence of physical complaints. Girls with celiac disease experience poorer well-being in some scores of the BFW/J. Adolescents with celiac disease and an additional diagnosis of an eating pathologies reported significant lower well-being than celiac patients with normal eating behaviour. In contrast to this finding, negative consequences of eating disorders of the children on their families could not be identified. The families of children with diabetes type 1 sense a higher level of family burden than the relatives of celiac patients. A correlation between the well-being of the child and the impact of celiac disease on the family was found: “The happier the children are, the lower is the stress of their parents”.
(4) Diplomarbeit Frau cand. med. Martina Cislakova
Jugendliche mit Typ 1 Diabetes und Essstörungen & gestörtem Essverhalten: Entwicklung eines Screeninginstrumentes (approbiert Nov 2008) Betreuer: Univ.-Prof. Dr Andreas Karwautz, MUW
Introduction. Type 1 Diabetes Mellitus is one of the most frequent chronic illnesses among children and adolescents. Changes in eating-behavior or eating-related problems are phenomena, which can be observed quite often in young women in puberty. Studies of the last years have shown that the prevalence of eating disorders (ED) among young diabetic women is more than twice as high as in the non-diabetic population. Riskfactors for EDs in adolescents with diabetes include dietary restraint and focus on eating, difficulties with diabetes management, as well as the possibility of insulin purging to loose weight. To avoid the serious complications arising from the comorbidity and implement therapeutic interventions at an early stage, an early ED diagnosis should be obtained. We therefore aimed to develop a valid screening instrument to detect the first signs of eating pathology in a young population with type 1 diabetes.
Method. In order to develop the new screening-instrument, two standardized eating disorder-specific questionnaires were used. The Eating Disorder Inventory (EDI-2) and the Eating Disorder Examination- Questionnaire (EDE-Q), were administered to 203 diabetes mellitus type 1 patients aged from 10 to 22 years. To assure an exact eating disorder diagnosis, the “Gold Standard” in today’s diagnostic, the Eating Disorder Examination- Interview was performed. Among the items of both of the standardized questionnaires, those were selected, which had the strongest ability to distinguish between an eating disorder and none.
Results. The diagnosis of an eating disorder (including subclinical ED) was present in 30,1 % of the diabetes patients who fulfilled all inclusion-criteria for this study. Out of 91+6 EDI-2 Items and 44 EDE-Q Items, finally 18 Items were selected, which gave the strongest evidence about the eating disorder status. 11 Items originated from the EDI-2 and 7 from the EDE-Q. The new instrument formed this way shows high specificity (87,0%), sensitivity (93,9%), positive predictive value (76,7%), negative predictive value (96,9%) and effectiveness (89,2%).
Conclusion. The newly formed screening instrument shows highly acceptable psychometric properties to help discriminate youth with eating disorders in the diabetic cohort.
(5) Diplomarbeit Frau cand. med. Johanna Pichler
Essstörungen bei Jugendlichen mit Zöliakie und Diabetes Typ 1 Kontrollierte Studie zur Relevanz von Copingstrategien – (approbiert Dez 2008) Betreuer: Univ.-Prof. Dr Andreas Karwautz, MUW
Background: Huge contingents of people with a chronic illness are people with celiac disease or diabetes mellitus type 1. More and more children and adolescents are victims of one of these clinical pictures. Because of the permanent preoccupation with eating and food the persons concerned tend to get an eating disorder. The patients have do deal with their illness, and so they develop different coping-styles.
Method: 283 children and adolescents (210 girls and 73 boys) with celiac disease from Austria and Germany, and 198 children and adolescents with diabetes mellitus type 1 (102 boys and 96 girls) between 10-20 years were interviewed for this study. For the comparison group 80 young and healthy subjects (60 girls and 20 boys) got recruited. To measure the depression-score the Depression-Inventory for Children and Adolescents (DIKJ), and for the coping-styles the KIDCOPE was used.
Results: There is no difference concerning the frequency of eating disorders (ED) within the 3 checked groups. ED were equal common in the groups that is there is no relation between ED and celiac disease respectively diabetes mellitus type 1. Centralized this study delivered the result, that 60-70% of the subjects used coping-strategies (Independent of their group membership). Patients with celiac disease used frequently “resignation” and classified “problemsolving” and “resignation” as high effective. Young patients with diabetes mellitus type 1used frequently “wishful thinking” and “social support” and classified “social withdrawal” and “wishful thinking” as efficient. Patients with an eating disorder adopted frequently “self-blaming” and named “emotional regulation” and “wishful thinking” as high effective. The study also showed that children and adolescents with diabetes mellitus type 1 are subjected to get depression, in contrast to the patients with celiac disease and the healthy control group.
(6) Diplomarbeit Frau cand. med. Verena Puhr
Essstörungen bei Jugendlichen mit Zöliakie und Diabetes mellitus Typ 1 - Eine kontrollierte Studie zum Einfluss von Persönlichkeit und Depression (approbiert Mai 2009) Betreuer: Univ.-Prof. Dr Andreas Karwautz, MUW
Objective: In this study children and adolescents with diabetes type 1, celiac disease and healthy controls were compared concerning depression and personality traits. Particular attention was placed on the additional appearance of eating disorders. The aim was the identification of the personality profile, which eventually promotes the development of an eating disorder of children and adolescents with chronic illnesses and to investigate the influence of depression.
Method: The data of 197 patients with type 1 diabetes (95 girls, 102 boys) and of 283 patients with celiac disease (210 girls, 73 boys) were compared with 72 healthy controls (53 girls, 19 boys). The probands were aged between 10 and 20 years. For the assessment of personality traits the Junior Temperament and Character Inventory (JTCI 12-18/R) was used. To assess the level of depression the Depression Inventory for Children and Adolescents (DIKJ) was applied.
Results: The diabetes and celiac disease patients with an additional eating disorder had a significantly higher score on the DIKJ than the patients without eating disorders and the healthy controls. Furthermore they reached significantly more often clinically relevant depression scores. Celiac disease patients with eating disorders had significantly lower scores on the character dimension self-directedness. Diabetics with eating disorders were characterized by significantly higher scores on the temperament dimension harm avoidance. Celiac disease patients without eating disorders had a higher harm avoidance, whereas diabetics without eating disorders showed a lower self-directedness. Regarding the temperament dimension persistence celiac disease patients with eating disorders scored lower than diabetics with eating disorders.
Conclusion: Depression as well as high harm avoidance of diabetics and low self-directedness of celiac disease patients are associated with the appearance of eating disorders of children and adolescents with these chronic diseases. This coherence is of special importance for clinical works.
(7) Diplomarbeit Frau cand. med. Alma Bihorac
Der Einfluss von innerfamiliären Beziehungen auf metabolische Kontrolle und Essstörungen bei weiblichen Jugendlichen mit Diabetes mellitus Typ 1 – (approbiert Mai 2009) Betreuer: Univ.-Prof. Dr Andreas Karwautz, MUW
Background Current research about the coherence between glycemic control in adolescent type 1 diabetics and family shows that there is an association between dysfunctional familial interactions and HbA1c values. Furthermore, it was found that eating disorders in adolescents with type 1 diabetes go along with poor metabolic control and dysfunctions in family. These findings are important for clinical practice, because prognosis depends on glycemic control and is worse in adolescent diabetics with an eating disorder. We aimed to investigate the coherence between internal familial relations and eating disorders as well as between internal familial relations and glycemic control in female adolescents with type 1 diabetes compared to a age-matched, female “healthy” control group.
Methods The data of 159 female type 1 diabetics (mean age 14.98 years) and 63 female controls (mean age 14.75 years) were collected. Standardized questionnaires and the expert interview EDE, gold standard in diagnostic investigation of eating disorders, provided all the information we required for diagnoses based on DSM-IV criteria. The data of the “Subjective
family image test”, which was filled in by all participants, enabled to analyise the internal familial relations. Metabolic control was assessed by the measurement of HbA1c.
Results 20.1 % of the female type 1 diabetics had a subthreshold eating disorder and 9.5 % met DSM-IV criteria for eating disorders. The eating disorders consited of 5.7 % EDNOS, 2.5 % binge eating disorder and 1.3 % bulimia. In the control group, 9.5 % had a subthreshold eating disorder and 1.6 % met DSM-IV criteria for bulimia. Obviously, eating disorders based on DSM-IV criteria as well as subthreshold eating disorders are more frequent with the female type 1 diabtics. Regarding family relationships, there was lower perceived emotional connectedness and lower perceived individual autonomy in female diabetics with an eating disorder compared to female diabetics without an eating disorder and controls, although this finding was not statistically significant. Female diabetics with poor metabolic control were found to perceive significantly lower emotional connectedness compared to female diabetics with a good metabolic control and control group. This resulted mainly from the relationships with their fathers, where female diabetics with poor metabolic control perceived significantly lower emotional connectedness than the other two groups. Positive conditions of development were also significantly worst with female diabetics with poor metabolic control.
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Univ.-Prof. Dr. Andreas Karwautz
Diplomarbeiten zu Essstörungen (MUW)