BackgroundOnly 17% of Norwegian children and adolescents with diabetes achieve international treatment goals measured by glycated hemoglobin (HbA1c). 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 to be tested and evaluated.Objective(1) To explore how applications for mobile phones can be used in follow-up of adolescents with type 1 diabetes, and (2) to use the findings to guide further development of the applications and as a basis for future studies.MethodWe pilot tested two mobile phone applications: (1) an application that contained a picture-based diabetes diary to record physical activity and photos taken with the phone camera of food eaten, where the phone also communicated with the glucometer by Bluetooth technology to capture blood glucose values, and (2) a Web-based, password-secured and encrypted short message service (SMS), based on access using login passwords received via SMS to be used by participants to send messages to their providers when they faced obstacles in everyday life, and to send educational messages to the participants. At the end of the 3-month pilot study, 12 participants (7 girls and 5 boys ) aged 13–19 years completed semistructured interviews. The participants had a mean HbA1c value of 8.3 (SD 0.3), mean age of 16.2 (SD 1.7) years, mean body mass index of 23.3 (SD 3.2) kg/m2, and mean diabetes duration of 7.5 (SD 4.6) years. We applied three additional measurements: change in metabolic control as measured by HbA1c, the System Usability Scale, and diabetes knowledge.ResultsFrom the interviews, three main categories emerged: visualization, access, and software changes. Participants appreciated the picture-based diary more than the SMS solution. Visualization of cornerstones in diabetes self-care (ie, diet, insulin dosage, physical activity, and pre- and postprandial glucose measurements all transformed into one picture) in the mobile diary was found to be an important educational tool through reflections in action. This led to a change in participants’ applied knowledge about the management of their disease. Additional measurements supplemented and supported the qualitative findings. However, changes in HbA1c and participants’ theoretical knowledge as tested by a 27-item questionnaire, based on a national health informatics’ diabetes quiz, before and after the intervention were not statistically significant (P = .38 and P = .82, respectively, paired-samples t test). Participants suggested additional functionality, and we will implement this in the design of the next software generation.ConclusionParticipants reported an increased understanding of applied knowledge, which seem to positively affect diabetes self-care. Visual impressions seem well adapted to the maturation of the adolescent brain, facilitating the link between theoretical knowledge and executive functions. SMS gave the adolescents a feeling of increased access ...

The eight constructs may have central functions in the maintenance of AN and should be regarded when patients' motivation and goals for treatment are assessed. Further study of the possible functions of the constructs in maintaining AN is warranted.

Treatment models of eating disorders highlight the significance of working with emotional acceptance and coping in this patient group. Knowledge about how patients understand the relationships between their negative emotions and their anorectic behaviour may be an important addition to treatment programmes for AN.

The theoretical approaches vary in their theoretical grounding, specificity and empirical support. AAI-based research on attachment and eating disorders is still at an early stage. More advanced studies are required for the field to move forward.

The occurrence of various 'concretised metaphors' in these cases suggests reduced symbolic capacity and impaired reflective function as a core psychopathological trait in anorexia nervosa. This is the first of three companion papers. Part II develops theory on reflective function in anorexia nervosa. Part III presents an outline for psychotherapy for anorexia nervosa.

The use of shame, as well as pride, as concepts in regard to anorexia nervosa may improve our understanding of the nature of this disorder, as well as being a guideline for therapists.

Objective: 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. Method: Two independent samples of women with AN (total N = 36) were interviewed in-depth using a phenomenological study design. Interviews were tape recorded, transcribed and analysed using QSR-NVIVO7 (QSR International, Melbourne, Australia) software. Results: Seven core obstacles were found to interfere with informants' wish to recover as follows: (i) 'perceiving judgements'; (ii) 'feeling stuck'; (iii) 'feeling distressed'; (iv) 'denying AN'; (v) 'eating'; (vi) 'gaining weight'; and (vii) 'appreciating the benefits'. Conclusion: The wish to recover is an autonomously based, fundamental motivational requirement for becoming ready to change. Understanding factors that contribute to this wish adds to the clinician's toolbox in motivational work with AN patients.

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 emotions and different bodily experiences. This is interpreted as impaired 'reflective function', referring to the capacity to make mental representations, and is proposed as a central psychopathological feature. The psychodynamic concepts 'concretised metaphors' and 'psychic equivalence' are discussed as useful tools to better understand such compromised symbolic capacity. Psychotherapy in anorexia nervosa can be described as a relational process where concretised metaphors will be developed into genuine linguistic ones. Part III in this series of articles presents an outline for psychotherapy for anorexia nervosa.