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LaMarre A, Hellner M, Silverstein S, Baker JH, Urban B, Yourell J, Wolfe H, Perry T, Steinberg D. "It's like building a new person": lived experience perspectives on eating disorder recovery processes. J Eat Disord 2024; 12:96. [PMID: 38978034 PMCID: PMC11232212 DOI: 10.1186/s40337-024-01045-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 06/13/2024] [Indexed: 07/10/2024] Open
Abstract
BACKGROUND Deeply engaging with the expertise of those who have experienced or supported someone with an eating disorder can add to a growing body of knowledge about recovery processes. In this qualitative study, we sought to explore and generate nuanced understandings of recovery experiences of people with a lived ED experience (first hand or as a caregiver) who were working as mentors in the field. To do this, we focused on changes that occur in personality, traits, and interests over the course of an eating disorder and into recovery. METHOD We conducted semi-structured interviews with 27 people with an eating disorder history, either through personal lived experience (n = 14) or as a caregiver of a loved one with an eating disorder (n = 13). We undertook a reflexive thematic analysis of the data through a critical realist lens. RESULTS We developed three themes, which illustrate the nonlinearity, relationality, and systemically linked nature of changes across experiences of having and recovering from an eating disorder. The first theme focuses on expansion; participants described how their worlds got bigger as they explored who they were becoming and discovered new ways of living in line with their values. The second theme emphasizes the balance between support and autonomy participants described as important for enabling change to occur across the recovery process. The last theme highlights the ways in which changes throughout the recovery process entwined with systemic factors, including actively pushing back against diet culture and weight stigma. CONCLUSIONS Participants' stories highlight interactions between individual, relational, and societal shifts that occur throughout the course of an ED and into recovery. They support ongoing calls to orient to ED recovery as situated within a broader social milieu, which invites us to build supportive environments to enable expansion and flourishing.
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Affiliation(s)
| | - Megan Hellner
- Equip Health, 2659 State Street Suite 100 #1012, Carlsbad, CA, 92008, USA
| | - Scout Silverstein
- Equip Health, 2659 State Street Suite 100 #1012, Carlsbad, CA, 92008, USA
| | - Jessica H Baker
- Equip Health, 2659 State Street Suite 100 #1012, Carlsbad, CA, 92008, USA
| | - Bek Urban
- Equip Health, 2659 State Street Suite 100 #1012, Carlsbad, CA, 92008, USA
| | - Jacqlyn Yourell
- Equip Health, 2659 State Street Suite 100 #1012, Carlsbad, CA, 92008, USA
| | - Hannah Wolfe
- Equip Health, 2659 State Street Suite 100 #1012, Carlsbad, CA, 92008, USA
| | - Taylor Perry
- Equip Health, 2659 State Street Suite 100 #1012, Carlsbad, CA, 92008, USA
| | - Dori Steinberg
- Equip Health, 2659 State Street Suite 100 #1012, Carlsbad, CA, 92008, USA.
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2
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Robinson L, Flynn M, Cooper M. Individual differences in motivation to change in individuals with eating disorders: A systematic review. Int J Eat Disord 2024; 57:1069-1087. [PMID: 38436481 DOI: 10.1002/eat.24178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 02/14/2024] [Accepted: 02/14/2024] [Indexed: 03/05/2024]
Abstract
OBJECTIVE Motivation to change has been suggested to significantly impact treatment outcomes in eating disorders (EDs). This review will investigate factors associated with motivation to change in EDs with the aim of supporting clinicians to be aware and sensitive to factors that might obstruct recovery and to inform motivation-based interventions. METHOD Using PRISMA guidelines, this article identified 24 studies through database searches meeting eligibility criteria. Only correlates of motivation were identified, limiting the ability of this review to identify causal relationships. Factors that changed alongside changes in motivation were identified from longitudinal studies. RESULTS This review identified factors such as individual characteristics, co-morbid psychopathology, lack of treatment autonomy and relationships with others to be associated with motivation to change in individuals with EDs. In addition, motivation to change significantly increased alongside self-esteem and identity re-negotiation when measured longitudinally. DISCUSSION Motivational interviewing can typically focus on exploring ambivalence to treatment, identifying goals and values, and increasing self-efficacy. However, this review identifies individual and relational factors to be particularly significant and may obstruct recovery from an ED. As such, evidence-based targets have been identified to inform clinicians and motivation-based interventions. PUBLIC SIGNIFICANCE Knowledge of factors associated with motivation to change in EDs is important to understand those who may have poorer treatment outcomes. Motivation may be improved by supporting individuals' relationship with others and tailoring interventions according to temperament and personality traits. Utilizing an individual's social support as they enter ED treatment may be effective in maximizing motivation to recover.
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Affiliation(s)
- Lauren Robinson
- Oxford Institute of Clinical Psychology Training and Research, Oxford University, Oxford, UK
| | - Michaela Flynn
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Myra Cooper
- Oxford Institute of Clinical Psychology Training and Research, Oxford University, Oxford, UK
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3
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Laboe AA, McGinnis CG, Fennig M, Zucker K, Wu E, Shah J, Levitan J, Firebaugh ML, Bardone-Cone AM, Pike KM, Taylor CB, Wilfley DE, Fitzsimmons-Craft EE. Development and usability testing of a cognitive-behavioral therapy-guided self-help mobile app and social media group for the post-acute treatment of anorexia nervosa. Eat Behav 2024; 53:101865. [PMID: 38461772 DOI: 10.1016/j.eatbeh.2024.101865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 01/23/2024] [Accepted: 02/27/2024] [Indexed: 03/12/2024]
Abstract
OBJECTIVE Anorexia nervosa (AN) is often treated in the acute setting, but relapse after treatment is common. Cognitive-behavioral therapy (CBT) is useful in the post-acute period, but access to trained providers is limited. Social support is also critical during this period. This study utilized a user-centered design approach to develop and evaluate the usability of a CBT-based mobile app and social networking component for post-acute AN support. METHOD Participants (N = 19) were recently discharged from acute treatment for AN. Usability testing of the intervention was conducted over three cycles; assessments included the System Usability Scale (SUS), the Usefulness, Satisfaction, and Ease of Use Questionnaire (USE), the Mobile Application Rating Scale (MARS), a social media questionnaire, and a semi-structured interview. RESULTS Interview feedback detailed aspects of the app that participants enjoyed and those needing improvement. Feedback converged on three themes: Logistical App Feedback, boosting recovery, and Real-World App/Social Media Use. USE and MARS scores were above average and SUS scores were "good" to "excellent" across cycles. CONCLUSION This study provides evidence of feasibility and acceptability of an app and social networking feature for post-acute care of AN. The intervention has potential for offering scalable support for individuals with AN in the high-risk period following discharge from acute care.
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Affiliation(s)
- Agatha A Laboe
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA.
| | - Claire G McGinnis
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Molly Fennig
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Kianna Zucker
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Ellis Wu
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Jillian Shah
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Julie Levitan
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Marie-Laure Firebaugh
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Anna M Bardone-Cone
- Department of Psychology & Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Kathleen M Pike
- Departments of Psychiatry, Epidemiology and Psychology, Columbia University, New York City, NY, USA
| | - C Barr Taylor
- Center for m2Health, Palo Alto University, Palo Alto, CA, USA; Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Denise E Wilfley
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
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4
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McCombie C, Ouzzane H, Schmidt U, Lawrence V. 'Physically it was fine, I'd eat what normal people do. But it's never like this in my head': A qualitative diary study of daily experiences of life in recovery from an eating disorder. EUROPEAN EATING DISORDERS REVIEW 2024; 32:46-55. [PMID: 37556406 PMCID: PMC10952333 DOI: 10.1002/erv.3018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 07/06/2023] [Accepted: 07/29/2023] [Indexed: 08/11/2023]
Abstract
OBJECTIVE High eating disorder (ED) relapse rates stress the need for clearer understanding around how recovery is experienced and maintained. Recent research endorses the concept of recovery as a process rather than an endpoint. This study aimed to investigate daily experiences of living in recovery from an ED. METHOD Fourteen participants who self-identified as recovered from a formally diagnosed ED were recruited online. A qualitative diary app was used for data collection. Participants completed written or audio open-ended diary entries every other day for 2 weeks describing their experiences, thoughts, and feelings. Diaries were analysed using reflexive thematic analysis. RESULTS Four themes were developed. 'Ever-present eating disordered thoughts' highlights how pervasive these thoughts remain for participants. 'Impact of social discourses' unpacks the challenges of maintaining recovery while surrounded by unhelpful social discourses about food and body image. 'Recovery is precarious' highlights how a combination of stressors can build up to threaten recovery. 'Finding balance in recovery' illustrates the many ways participants try to manage their recovery each day. CONCLUSIONS The findings make it clear that living in recovery from an ED is a complex process that must be navigated daily. Recommendations for treatment and recovery support are discussed.
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Affiliation(s)
- Catherine McCombie
- Department of Health Services and Population ResearchInstitute of Psychiatry, Psychology & NeuroscienceKing's College LondonLondonUK
| | - Hannah Ouzzane
- Department of Health Services and Population ResearchInstitute of Psychiatry, Psychology & NeuroscienceKing's College LondonLondonUK
| | - Ulrike Schmidt
- Section of Eating DisordersDepartment of Psychological MedicineInstitute of Psychiatry, Psychology & NeuroscienceKing's College LondonLondonUK
- South London and Maudsley NHS Foundation TrustLondonUK
| | - Vanessa Lawrence
- Department of Health Services and Population ResearchInstitute of Psychiatry, Psychology & NeuroscienceKing's College LondonLondonUK
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Tesselaar JM, Mendoza RR, Siegel JA, Elbe CI, Caravelli NS, DeJesus J, Fenton M, Victoria BS, Blashill AJ. A qualitative analysis of relationship advice from the perspective of people living with and recovering from eating disorders while in diverse romantic relationships. Eat Disord 2023; 31:632-650. [PMID: 37194296 DOI: 10.1080/10640266.2023.2206753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
Eating disorders (EDs) have adverse consequences across life domains, ranging from physical health to interpersonal relationships. While research suggests that romantic partners have the potential to support ED recovery, partners to those with EDs often report feeling confused and helpless in the face of the condition. The extant literature on EDs in relationships centers on the experiences of cisgender, heterosexual women. The present study aimed to garner a more comprehensive understanding of the types of support people with EDs believe are most helpful from romantic partners by analyzing relationship advice from a diverse group of individuals with EDs who were in romantic relationships. As part of a larger study on romantic relationships in ED recovery, we analyzed responses to the question, "If you had to give one piece of advice to someone who learns that their partner has an ED, what would it be?" Through Consensual Qualitative Research-Modified, we identified 29 themes, which we grouped into 7 domains: Foster Open Communication, Create an Environment of Emotional Intimacy, Let Your Partner Guide You, Educate Yourself, Be Compassionate with Yourself, Use Caution when Discussing Food and Bodies, and a Miscellaneous domain. These findings highlight the importance of patience, flexibility, psychoeducation, and self-compassion for individuals working to support their partner's ED recovery, and can inform future couples-based treatments and interventions for EDs.
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Affiliation(s)
- Juliana M Tesselaar
- Department of Psychology, San Diego State University, San Diego, California, USA
| | - Rebecca R Mendoza
- Department of Psychology, San Diego State University, San Diego, California, USA
| | - Jaclyn A Siegel
- Department of Psychology, San Diego State University, San Diego, California, USA
| | - Connor I Elbe
- Department of Psychology, San Diego State University, San Diego, California, USA
| | - Nicolas S Caravelli
- Department of Psychology, San Diego State University, San Diego, California, USA
| | - Jennifer DeJesus
- Department of Psychology, San Diego State University, San Diego, California, USA
| | - Margo Fenton
- Department of Psychology, San Diego State University, San Diego, California, USA
| | - Brianna S Victoria
- Department of Psychology, San Diego State University, San Diego, California, USA
| | - Aaron J Blashill
- Department of Psychology, San Diego State University, San Diego, California, USA
- SDSU/UC San Diego Joint Doctoral Program in Clinical Psychology, San Diego, California, USA
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Rozgonjuk D, Ignell J, Mech F, Rothermund E, Gündel H, Montag C. Smartphone and Instagram use, body dissatisfaction, and eating disorders: investigating the associations using self-report and tracked data. J Eat Disord 2023; 11:149. [PMID: 37667321 PMCID: PMC10478361 DOI: 10.1186/s40337-023-00865-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 08/08/2023] [Indexed: 09/06/2023] Open
Abstract
BACKGROUND Previous research has linked smartphone and Instagram use to higher body dissatisfaction (BD) as well as eating disorder (ED) symptomatology. However, these studies have typically been limited to using self-report measures for technology use which, as shown by scientific literature, might not be reliable. In the present work, we combine self-reported assessments as well as tracked smartphone and Instagram use. METHODS The effective sample comprised N = 119 women (34 with ED diagnosis history) who were queried about BD and ED symptomatology, and who provided the data about their smartphone and Instagram use duration for each day of the previous week. RESULTS The study results show that women with an ED diagnosis history scored higher on both BD as well as ED scales. Although women with an ED diagnosis history had higher smartphone screen time, there were no statistically significant differences in Instagram screen time. Tracked smartphone use duration was positively correlated with both BD and ED symptomatology, but the role of Instagram use needs to be further elucidated. CONCLUSIONS The results of this study show that while BD and ED symptomatology are correlated with smartphone use, it may be that Instagram use is not the main contributor to that relationship.
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Affiliation(s)
- Dmitri Rozgonjuk
- Department of Molecular Psychology, Institute of Psychology and Education, Ulm University, Helmholtzstraße 8/1, 89081, Ulm, Germany.
- Institute of Mathematics and Statistics, University of Tartu, Tartu, Estonia.
- Institute of Computer Science, University of Tartu, Tartu, Estonia.
| | - Johanna Ignell
- Department of Molecular Psychology, Institute of Psychology and Education, Ulm University, Helmholtzstraße 8/1, 89081, Ulm, Germany
| | - Franziska Mech
- Department of Molecular Psychology, Institute of Psychology and Education, Ulm University, Helmholtzstraße 8/1, 89081, Ulm, Germany
| | - Eva Rothermund
- Ulm University Medical Center, Department of Psychosomatic Medicine and Psychotherapy, Ulm University, Ulm, Germany
| | - Harald Gündel
- Ulm University Medical Center, Department of Psychosomatic Medicine and Psychotherapy, Ulm University, Ulm, Germany
| | - Christian Montag
- Department of Molecular Psychology, Institute of Psychology and Education, Ulm University, Helmholtzstraße 8/1, 89081, Ulm, Germany.
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Greene AK, Norling HN. "Follow to *actually* heal binge eating": A mixed methods textual content analysis of #BEDrecovery on TikTok. Eat Behav 2023; 50:101793. [PMID: 37633221 DOI: 10.1016/j.eatbeh.2023.101793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 06/26/2023] [Accepted: 08/11/2023] [Indexed: 08/28/2023]
Abstract
Binge eating disorder (BED) has been relatively overlooked in research on eating disorders and social media. Existing literature suggests that time spent on social media may be associated with increased binge eating. However, more granular details of social media experiences such as the consumption of pro-recovery content have not received sufficient scholarly attention. The present study begins to address this gap through analysis of 1074 captions from public posts on TikTok, a video-based social media platform, tagged with #BEDrecovery between July 2021-2022. We generated six themes by examining word frequencies in the data and engaging in reflexive categorization of commonly used words within the context of different posts. These themes were: (1) diets and eating approaches, (2) help and support, (3) mental health, (4) diet culture critique, (5) body monitoring, and (6) fitness. To understand which videos in the BED recovery community had the broadest reach, we also examined how themes were associated with user engagement - concretely, the number plays (times the post was watched) and shares (times users shared a link to the post with other TikTok users). Notably, we found that the number of shares was significantly lower in posts that included diet culture critique than in those that did not. By contrast plays and shares were higher in posts with body monitoring than in those without. Our findings suggest that highly engaged with #BEDrecovery TikTok content may include the promotion of diet culture and potentially create an unproductive environment for individuals seeking BED recovery support.
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Affiliation(s)
- Amanda K Greene
- University of Michigan Medical School, Center for Bioethics and Social Sciences in Medicine (CBSSM), 2800 Plymouth Road, Ann Arbor, MI 48104, United States of America.
| | - Hannah N Norling
- University of Denver, Morgridge College of Education, Department of Counseling Psychology, 1999 East Evans Avenue, Denver, CO 80208-1700, United States of America.
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8
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Rankin R, Conti J, Ramjan L, Hay P. A systematic review of people's lived experiences of inpatient treatment for anorexia nervosa: living in a "bubble". J Eat Disord 2023; 11:95. [PMID: 37296440 DOI: 10.1186/s40337-023-00820-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 06/06/2023] [Indexed: 06/12/2023] Open
Abstract
BACKGROUND Treatment for anorexia nervosa (AN) is typically delivered on a continuum of care, starting with outpatient treatment, and moving onto intensive outpatient, day or residential treatment and/or inpatient hospitalisation. However, minimal attention has been afforded to the lived experiences of persons undergoing inpatient treatment for AN. In particular, qualitative literature pertaining to the lived experiences of specialist inpatient or residential treatment of AN remains fragmented and incomplete. The aim of this review was to synthesise current literature exploring patients' lived experiences of residential and inpatient treatment for AN within eating disorder-specific treatment services. METHODS Five databases were searched and a qualitative thematic systematic review and meta-synthesis of 11 studies were conducted. RESULTS Eleven studies of 159 participants were included. Four meta-themes were constructed from the data: (1) a medical discourse-"I don't think it's individualised here"; (2) restrictive practice-living in a "bubble"; (3) myself, others and "a similar demon"; and (4) I am "not just another anorexic". The data also revealed two cross-cutting themes: (1) more than a single experience; and (2) meaning making and identity. CONCLUSIONS These findings highlight the complex and multifaceted nature of the inpatient treatment experience as well as the inherent conflicts in balancing the necessity of medical and psychological intervention with person-centred treatment approaches in the treatment of AN.
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Affiliation(s)
- Rebekah Rankin
- Translational Health Research Institute, School of Medicine, Western Sydney University, Sydney, Australia.
| | - Janet Conti
- Translational Health Research Institute, School of Medicine, Western Sydney University, Sydney, Australia
- School of Psychology, Western Sydney University, Sydney, Australia
| | - Lucie Ramjan
- Translational Health Research Institute, School of Medicine, Western Sydney University, Sydney, Australia
- School of Nursing and Midwifery, Western Sydney University, Sydney, Australia
| | - Phillipa Hay
- Translational Health Research Institute, School of Medicine, Western Sydney University, Sydney, Australia
- Campbelltown Hospital, South West Sydney Local Health District (SWSLHD), Sydney, Australia
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9
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Haas A, Laboe AA, McGinnis CG, Firebaugh ML, Shah J, Bardone-Cone AM, Pike KM, Taylor CB, Wilfley DE, Fitzsimmons-Craft EE. Adapting a mobile app to support patients with anorexia nervosa following post-acute care: perspectives from eating disorder treatment center stakeholders. Front Digit Health 2023; 5:1099718. [PMID: 37274762 PMCID: PMC10235779 DOI: 10.3389/fdgth.2023.1099718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 05/05/2023] [Indexed: 06/06/2023] Open
Abstract
Introduction Anorexia nervosa (AN) is a harmful, life-threatening illness. Patients with severe AN often receive acute treatment but, upon discharge, experience high relapse rates. Evidence-based, outpatient treatment following acute care is critical to preventing relapse; however, numerous barriers (e.g., location, financial limitations, low availability of providers) preclude individuals from accessing treatment. mHealth technologies may help to address these barriers, but research on such digital approaches for those with AN is limited. Further, such technologies should be developed with all relevant stakeholder input considered from the outset. As such, the present study aimed to garner feedback from eating disorder (ED) treatment center providers on (1) the process of discharging patients to outpatient services, (2) their experiences with technology as a treatment tool, and (3) how future mHealth technologies may be harnessed to offer the most benefit to patients in the post-acute period. Methods Participants (N = 11, from 7 ED treatment centers across the United States) were interviewed. To analyze the data for this study, each interview was manually transcribed and analyzed using components of Braun and Clarke's six-phase thematic analysis framework (Braun & Clarke, 2006). Results Participants indicated proactively securing outpatient care for their patients, but mentioned several barriers their patients face in accessing evidence-based ED treatment. All participants had some experience using various technologies for treatment (e.g., teletherapy, self-monitoring apps), and mentioned a high level of interest in the development of a new app to be used by patients recently discharged from acute treatment for AN. Participants also offered suggestions of effective and relevant content for a potential app and adjunctive social networking component for post-acute care of AN. Discussion Overall, participants expressed positive attitudes toward the integration of an app into the care flow, suggesting the high potential benefit of harnessing technology to support individuals recovering from AN.
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Affiliation(s)
- Anneliese Haas
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, United States
| | - Agatha A. Laboe
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, United States
| | - Claire G. McGinnis
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, United States
| | - Marie-Laure Firebaugh
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, United States
| | - Jillian Shah
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, United States
| | - Anna M. Bardone-Cone
- Department of Psychology, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Kathleen M. Pike
- Department of Psychiatry, Columbia University, New York, NY, United States
| | - C. Barr Taylor
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, United States
- Center for m2Health, Palo Alto University, Palo Alto, CA, United States
| | - Denise E. Wilfley
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, United States
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10
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Kenny TE, Lewis SP. More than an outcome: a person-centered, ecological framework for eating disorder recovery. J Eat Disord 2023; 11:45. [PMID: 36949489 PMCID: PMC10032254 DOI: 10.1186/s40337-023-00768-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 03/08/2023] [Indexed: 03/24/2023] Open
Abstract
BACKGROUND Eating disorder recovery is a complex phenomenon. While historical understandings focused on weight and behaviours, the importance of psychological factors is now widely recognized. It is also generally accepted that recovery is a non-linear process and is impacted by external factors. Recent research suggests a significant impact of systems of oppression, though these have not yet been named in models of recovery. BODY: In this paper, we propose a research-informed, person-centered, and ecological framework of recovery. We suggest that there are two foundational tenets of recovery which apply broadly across experiences: recovery is non-linear and ongoing and there is no one way to do recovery. In the context of these tenets, our framework considers individual changes in recovery as determined by and dependent on external/personal factors and broader systems of privilege. Recovery cannot be determined by looking solely at an individual's level of functioning; one must also consider the broader context of their life in which changes are being made. To conclude, we describe the applicability of the proposed framework and offer practical considerations for incorporating this framework in research, clinical, and advocacy settings.
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Affiliation(s)
- Therese E Kenny
- Department of Psychology, University of Guelph, 50 Stone Road E., Guelph, ON, N1G 2W1, Canada.
| | - Stephen P Lewis
- Department of Psychology, University of Guelph, 50 Stone Road E., Guelph, ON, N1G 2W1, Canada
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11
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Jewell T, Apostolidou E, Sadikovic K, Tahta-Wraith K, Liston S, Simic M, Eisler I, Fonagy P, Yorke I. Attachment in individuals with eating disorders compared to community controls: A systematic review and meta-analysis. Int J Eat Disord 2023; 56:888-908. [PMID: 36916409 DOI: 10.1002/eat.23922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 02/03/2023] [Accepted: 02/06/2023] [Indexed: 03/16/2023]
Abstract
OBJECTIVE Individuals with eating disorders are known to have higher rates of insecure attachment compared to community controls, but the factors underlying this finding are poorly understood. We conducted the first meta-analysis comparing attachment in eating disorder samples compared to community controls that included quality assessment, publication bias and moderation analysis. METHOD We pre-registered our meta-analysis (CRD42019146799) and followed PRISMA guidelines. We searched PsychINFO, Embase, Medline, CINAHL, and Scopus for publications. Attachment scores were extracted, and Cohen's d calculated for each study using a random effects model. RESULTS In total, 35 studies were included in the meta-analysis and six studies were summarized in a narrative review. Eating disorder samples showed higher rates of insecure attachment compared to community controls, with a large effect size, across measurement methods and different attachment dimensions. Blinding of assessors moderated effect sizes for attachment interview studies, but no other moderators were significant. DISCUSSION Risk of insecure attachment is elevated in individuals with eating disorders, albeit heterogeneity is high and largely unexplained. Clinicians may need to take this into account in their work, particularly given the association between attachment insecurity and challenges to therapeutic alliance. Future studies comparing eating disorder samples with community samples should control for general psychopathology. PUBLIC SIGNIFICANCE Attachment is a broad concept referring to a person's thoughts, feelings and behaviors in relation to close others. This systematic review and meta-analysis found that individuals with eating disorders are lower in attachment security than community controls, regardless of attachment construct or measurement approach. Attachment may be relevant in influencing eating disorder recovery, the development of therapeutic alliance, and potentially clinical outcomes, although more research is needed.
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Affiliation(s)
- Tom Jewell
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK.,Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Eleni Apostolidou
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Kevser Sadikovic
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
| | | | - Sarah Liston
- Leicestershire Partnership NHS Foundation Trust, Leicester, UK
| | - Mima Simic
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Ivan Eisler
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Peter Fonagy
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK.,Anna Freud Centre, London, UK
| | - Isabel Yorke
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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12
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Fitzsimmons-Craft EE, Laboe AA, McGinnis C, Firebaugh ML, Shah J, Wallendorf M, Jacobi C, Bardone-Cone AM, Pike KM, Taylor CB, Wilfley DE. A pilot randomized controlled trial of a cognitive-behavioral therapy guided self-help mobile app for the post-acute treatment of anorexia nervosa: A registered report. Int J Eat Disord 2023; 56:654-661. [PMID: 36609861 PMCID: PMC10019771 DOI: 10.1002/eat.23891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 12/21/2022] [Accepted: 12/21/2022] [Indexed: 01/09/2023]
Abstract
INTRODUCTION Relapse following acute treatment for anorexia nervosa (AN) is common. Evidence suggests cognitive-behavioral therapy (CBT) may be useful in the post-acute period, but few patients have access to trained providers. mHealth technologies have potential to increase access to high-quality care for AN, including in the post-acute period. The aim of this study is to estimate the preliminary feasibility and effectiveness of a CBT-based mobile intervention plus treatment as usual (TAU), offered with and without an accompanying social networking feature. METHOD In the current pilot randomized controlled trial, women with AN who have been discharged from acute treatment in the past 2 months (N = 90) will be randomly assigned to a CBT-based mobile intervention plus treatment as usual (TAU), a CBT-based mobile intervention including social networking plus TAU, or TAU alone. We will examine feasibility, acceptability, and preliminary effectiveness of the three conditions in terms of reducing eating disorder psychopathology, reducing frequency of eating disorder behaviors, achieving weight maintenance, reducing depression and suicidal ideation, and reducing clinical impairment. We will examine rehospitalization and full recovery rates in an exploratory fashion. We will also examine whether the mobile intervention and social networking feature change the proposed targets and whether changes in targets are associated with benefit, as well as conduct exploratory analyses to identify within-mobile intervention predictors and moderators of outcome. DISCUSSION Ultimately, this research may lead to increased access to evidence-based treatment for individuals with AN and prevention of the extreme negative consequences that can result from this serious disorder. PUBLIC SIGNIFICANCE Relapse after acute treatment for anorexia nervosa is common, and few patients have access to trained providers to support them following acute care. This study will pilot a coached mobile app, including a social networking component, for this population. If ultimately successful, our approach could greatly increase access to evidence-based treatment for individuals with anorexia nervosa and ultimately prevent the extreme negative consequences that can result from this serious disorder.
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Affiliation(s)
| | - Agatha A. Laboe
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Claire McGinnis
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Marie-Laure Firebaugh
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Jillian Shah
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Michael Wallendorf
- Division of Biostatistics, Washington University School of Medicine, St. Louis, MO, USA
| | - Corinna Jacobi
- Department of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany
| | - Anna M. Bardone-Cone
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Kathleen M. Pike
- Department of Psychiatry, Columbia University, New York, NY, USA
| | - C. Barr Taylor
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
- Center for mHealth, Palo Alto University, Palo Alto, CA, USA
| | - Denise E. Wilfley
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
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13
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Pegram G, Craddock N, Lewis-Smith H. "Like putting on an old pair of gloves" or "realising i am actually over it": a qualitative study exploring the impact of the COVID-19 pandemic lockdown restrictions on eating disorder recovery in the UK. CURRENT PSYCHOLOGY 2023:1-12. [PMID: 36845206 PMCID: PMC9944788 DOI: 10.1007/s12144-023-04353-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 11/17/2022] [Accepted: 01/31/2023] [Indexed: 02/24/2023]
Abstract
The COVID-19 pandemic lockdown restrictions posed unique challenges for people living with eating disorders (EDs), particularly relating to social isolation and changes in treatment access. However, less is known about the experience of lockdown for people 'in recovery' from EDs or disordered eating (DE) (i.e., with an ED/DE history). This study explored: (i) how people with a self-reported ED/DE history responded to and managed the experience of lockdown, specifically in relation to their recovery, and (ii) coping strategies for the management of recovery. Semi-structured interviews were conducted between June and August 2020 with 20 adults with a self-reported ED/DE history living in the UK. Data were analysed using inductive thematic analysis within a critical realist framework. Three overarching themes were identified: (1) Seeking safety and stability during a pandemic, (2) Lockdown prompting realisations about recovery, and (3) Exploring self-compassion as a more adaptive approach. While most participants experienced a resurgence in ED symptoms during lockdown, many reflected on the successful management of these as reinforcing their recovery. These findings have important implications for understanding ED recovery, in addition to informing interventions to better promote recovery during the COVID-19 pandemic and beyond. Supplementary information The online version contains supplementary material available at 10.1007/s12144-023-04353-2.
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Affiliation(s)
- Georgina Pegram
- Centre for Appearance Research, University of the West of England, Coldharbour Lane, BS16 1QY Bristol, UK
| | - Nadia Craddock
- Centre for Appearance Research, University of the West of England, Coldharbour Lane, BS16 1QY Bristol, UK
| | - Helena Lewis-Smith
- Centre for Appearance Research, University of the West of England, Coldharbour Lane, BS16 1QY Bristol, UK
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14
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LaMarre A, Gilbert K, Scalise PA. What are we aiming for? Exploring tensions in healthcare provider perspectives on and communications about eating disorder recovery. FEMINISM & PSYCHOLOGY 2022. [DOI: 10.1177/09593535221141712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Eating disorder recovery is differently understood in multi-disciplinary healthcare contexts. In this study, we sought to better understand how healthcare providers (HCPs) describe recovery and communicating about recovery. We conducted an anonymous, online, qualitative survey with 41 eating disorder HCPs. In their responses, HCPs noted that communicating about recovery was core to their practice of establishing collaboration and communication with clients, as well as enabling “realistic hope” in clinical encounters. Recovery was described as related to the concept of attaining “normalcy” in life. We identified several tensions across HCP accounts, including what “normalcy” might look like, differences in the role of diagnostic and other contextual factors in determining recovery and different perspectives on how symptom remission figures in recovery. Our findings suggest that attending to differences in communication about recovery is an important direction for eating disorders research and treatment.
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15
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Fox DE, Donald M, Chong C, Quinn RR, Ronksley PE, Elliott MJ, Lam NN. A Qualitative Content Analysis of Comments on Press Articles on Deemed Consent for Organ Donation in Canada. Clin J Am Soc Nephrol 2022; 17:1656-1664. [PMID: 36288931 PMCID: PMC9718046 DOI: 10.2215/cjn.04340422] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 09/16/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND OBJECTIVES In 2019, two Canadian provinces became the first jurisdictions in North America to pass deemed consent legislation to increase deceased organ donation and transplantation rates. We sought to explore the perspectives of the deemed consent legislation for organ donation in Canada from the viewpoint of individuals commenting on press articles. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS In this qualitative descriptive study, we extracted public comments regarding deemed consent from online articles published by four major Canadian news outlets between January 2019 and July 2020. A total of 4357 comments were extracted from 35 eligible news articles. Comments were independently analyzed by two research team members using a conventional content analysis approach. RESULTS Commenters' perceptions of the deemed consent legislation for organ donation in Canada predominantly fit within three organizational groups: perceived positive implications of the bills, perceived negative implications of the bills, and key considerations. Three themes emerged within each group that summarized perspectives of the proposed legislation. Themes regarding the perceived positive implications of the bills included majority rules, societal effect, and prioritizing donation. Themes regarding the perceived negative implications of the bills were a right to choose, the potential for abuse and errors, and a possible slippery slope. Improving government transparency and communication, clarifying questions and addressing concerns, and providing evidence for the bills were identified as key considerations. CONCLUSIONS If deemed consent legislation is meant to increase organ donation and transplantation, addressing public concerns will be important to ensure successful implementation.
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Affiliation(s)
- Danielle E. Fox
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Maoliosa Donald
- Division of Nephrology, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Christy Chong
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Robert R. Quinn
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- Division of Nephrology, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Paul E. Ronksley
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Meghan J. Elliott
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- Division of Nephrology, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Ngan N. Lam
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- Division of Nephrology, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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16
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Kenny TE, Trottier K, Lewis SP. Lived experience perspectives on a definition of eating disorder recovery in a sample of predominantly white women: a mixed method study. J Eat Disord 2022; 10:149. [PMID: 36224653 PMCID: PMC9558402 DOI: 10.1186/s40337-022-00670-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Accepted: 08/24/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND There has recently been a push for recovery-focused research in the eating disorder (ED) field, starting with a consensus definition of recovery. One definition, in particular, proposed by Bardone-Cone et al. [21] has received considerable attention given its transdiagnostic nature and validation studies. However, no studies to date have elicited lived experience views of this definition. The goal of the current study was to examine perspectives on this definition of recovery from individuals with a past or present ED and to determine whether participant agreement with the model differed based on diagnostic history or current symptom severity. METHODS Sixty-two individuals (95.2% women; 91.9% White/European) participated in a 1-2 h interview aimed at capturing their perspectives on ED recovery. Transcripts were analyzed using qualitative content analysis and codebook thematic analysis to examine agreement with and thoughts on Bardone-Cone's definition of recovery, respectively. Chi-squared tests of independence and binary logistic regression were computed to determine whether agreement with the definition differed across diagnostic history and self-reported symptoms. RESULTS Although some participants indicated acceptance of the definition, the majority expressed concerns related to its categorical nature, proposed criteria, feasibility, language, and applications. There were no differences in acceptance based on diagnostic history or current symptom severity. CONCLUSION A single definition of recovery does not seem to fit individuals' lived ED experience. Future research may benefit from distinguishing between recovery as an individually-defined phenomenon and related constructs such as remission (i.e., loss of diagnosis or absence of clinical symptoms). A more comprehensive multi-faceted, and person-centered model of recovery may have merit in clinical settings.
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Affiliation(s)
- Therese E Kenny
- Department of Psychology, University of Guelph, 50 Stone Road E., Guelph, ON, N1G 2W1, Canada
| | - Kathryn Trottier
- University Health Network, 200 Elizabeth Street, Toronto, ON, M5G 2C4, Canada. .,Department of Psychiatry, University of Toronto, Toronto, ON, Canada.
| | - Stephen P Lewis
- Department of Psychology, University of Guelph, 50 Stone Road E., Guelph, ON, N1G 2W1, Canada
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17
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Jones ME, Salafia EHB, Leonard KC. Users' perceptions of how an unmoderated eating disorder community may benefit or harm their recovery. J Eat Disord 2022; 10:129. [PMID: 36045448 PMCID: PMC9428873 DOI: 10.1186/s40337-022-00653-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 08/15/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND While the negative and positive outcomes of pro-eating disorder groups have been well-documented, more research is needed on the effects of pro-recovery communities. In particular, a gap in knowledge remains surrounding users' feelings about their experiences in such communities. Using open-ended questions, we surveyed those involved in the recovery community on the social media site Tumblr, to determine how the community helped/did not help with recovery, and how it made them feel about recovery. METHODS Participants (n = 29) answered a series of Likert and open-ended questions. The open-ended questions were examined using thematic analysis to learn about users' lived experiences. RESULTS Themes identified included connection/acceptance, motivation/encouragement, content, and competition/comparisons. Participants overall felt that the community helped them feel connected to others and accepted for their struggles and their successes, though a minority did note that such acceptance could sometimes reinforce negative behaviors, and connection could lead to pressure to help others. Participants found both direct advice and indirect support (e.g., encouraging posts) to be motivating for their recovery. Feelings of competition and comparison were mixed; some felt that comparing to others made them feel less than, while others used such comparisons as reminders to stay strong in recovery. Participants indicated that the content within the community varies; sometimes there is a large presence of pro eating disorder posts, while at other times, posts are more positive, motivational, and encouraging. CONCLUSIONS Participants overall indicated that the community had many helpful aspects and made them feel better about recovery. However, the presence of triggering content and competition in particular were notable drawbacks of the community. Overall, recovery communities on unmoderated sites or social media applications may be useful tools during the recovery process, despite some important limitations.
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Affiliation(s)
- Maegan E Jones
- Department of Psychology, St. Cloud State University, 103 Stewart Hall, 720 Fourth Ave. S., St. Cloud, MN, 56301-4498, USA. .,Human Development and Family Science, North Dakota State University, Fargo, USA.
| | | | - Kerrie C Leonard
- Human Development and Family Science, North Dakota State University, Fargo, USA
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18
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Au ES, Cosh SM. Social media and eating disorder recovery: An exploration of Instagram recovery community users and their reasons for engagement. Eat Behav 2022; 46:101651. [PMID: 35760017 DOI: 10.1016/j.eatbeh.2022.101651] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 06/06/2022] [Accepted: 06/15/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVE Online recovery communities offer support for people with eating disorders who may not otherwise seek professional help. Instagram is a popular platform that is widely used for eating disorder recovery, but little is known about the population that uses it or its potential benefits. METHOD A mixed-methods study surveyed 163 users of the Instagram recovery community to identify their descriptive characteristics, their reasons for using the community, and what they perceived to be helpful or unhelpful about the platform. RESULTS The community included users who were diverse in gender, ethnicity and eating disorder presentation and severity, with cases of potential anorexia nervosa, bulimia nervosa and binge eating disorder identified. Reasons for engaging in the community included to see representations of diverse individuals and as an alternative to professional treatment. Results indicate that the community may provide benefits for recovery such as social support and validation, but that its lack of moderation and potential for harmful content can also prevent recovery. CONCLUSIONS These findings highlight the need for better recognition of diverse eating disorder presentations and improved accessibility to professional treatment in the wider community. Moderated use of the platform should be considered in order to minimize risks and increase benefits.
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Affiliation(s)
- Emily S Au
- School of Psychology, University of New England, Armidale, NSW 2351, Australia
| | - Suzanne M Cosh
- School of Psychology, University of New England, Armidale, NSW 2351, Australia.
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19
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Saul J, Rodgers RF, Saul M. Adolescent Eating Disorder Risk and the Social Online World: An Update. Child Adolesc Psychiatr Clin N Am 2022; 31:167-177. [PMID: 34801153 DOI: 10.1016/j.chc.2021.09.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
The role of traditional media (television and magazines) in creating eating disorder risk has long been a topic of discussion and research, but the proliferation of social media and rapid increase in the use of the Internet by adolescents generates new dynamics and new risks for the development and maintenance of eating disorders. Recent research describes the relationship between Internet and social media use and eating disorders risk, with the greatest associations found among youth with high levels of engagement and investment in photo-based activities and platforms. Here, we review different types of online content and how they are relevant to eating disorders and consider the theoretical frameworks predicting relationships between Internet and social media and eating disorders, before examining the empirical evidence for the risks posed by the online content in the development and maintenance of eating disorders. We describe proeating disorder content specifically and examine the research related to it; we then consider the implications of such content, highlight directions for future research, and discuss possible prevention and intervention strategies.
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Affiliation(s)
- Jenna Saul
- Rogers Behavioral Health, 34700 Valley Road, Oconomowoc, WI 53066, USA; Child and Adolescent Psychiatry Consulting, Marshfield, WI, USA.
| | - Rachel F Rodgers
- 404 INV, Department of Applied Psychology Northeastern University, 360 Huntington Avenue, Boston, MA 02115, USA; Department of Psychiatric Emergency & Acute Care, Lapeyronie Hospital, CHRU Montpellier, France
| | - McKenna Saul
- University of Wisconsin, Parkside, 900 Wood Road, Advising and Career Center, Kenosha, WI 53144, USA
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20
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Jewell T, Herle M, Serpell L, Eivors A, Simic M, Fonagy P, Eisler I. Attachment and mentalization as predictors of outcome in family therapy for adolescent anorexia nervosa. Eur Child Adolesc Psychiatry 2021:10.1007/s00787-021-01930-3. [PMID: 34967934 DOI: 10.1007/s00787-021-01930-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 12/17/2021] [Indexed: 11/26/2022]
Abstract
Anorexia nervosa-focussed family therapy (FT-AN) is the first-line treatment for adolescent anorexia nervosa (AN), but the predictors of poor treatment response are not well understood. The main aim of this study was to investigate the role of attachment and mentalization in predicting treatment outcome. The secondary aims of the study were to investigate therapeutic alliance at 1 month as a predictor of outcome, and to test the associations between alliance and baseline attachment and mentalization. 192 adolescents with AN and their parents were recruited as they began family therapy in out-patient specialist eating disorder services. Self-report measures of attachment, mentalization, and emotion regulation were completed at the start of treatment by adolescent patients and one of their parents. Self-reported alliance scores were collected at one month. Higher scores on the Certainty Scale of the Reflective Functioning Questionnaire, completed by parents, which indicate over-certainty about mental states, were the strongest predictor of poor outcome (Odds Ratio: 0.42, CI: 0.20-0.87). Similarly, for adolescents, higher Lack of Clarity scores on the Difficulties in Emotion Regulation Scale, representing being unclear about one's feelings, were predictive of positive treatment outcome (OR: 1.10, CI: 1.00-1.21). Higher alliance scores at 1 month predicted positive outcome, and were associated with attachment security and mentalization. These novel findings suggest that, particularly in parents, a tendency towards excessive certainty about mental states in others may predict poor outcome in FT-AN. Further research is warranted to replicate the finding and characterise families at risk of poor outcome.
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Affiliation(s)
- Tom Jewell
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK.
- Great Ormond Street Hospital NHS Foundation Trust, London, UK.
| | - Moritz Herle
- Department of Biostatistics and Health Informatics, King's College London, London, UK
| | - Lucy Serpell
- North East London NHS Foundation Trust, London, UK
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Alison Eivors
- Leicestershire Partnership NHS Foundation Trust, Leicester, UK
| | - Mima Simic
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Peter Fonagy
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
- Anna Freud Centre, London, UK
| | - Ivan Eisler
- South London and Maudsley NHS Foundation Trust, London, UK
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21
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Hallward L, Duncan LR. "Compulsive exercise is a socially acceptable prison cell": Exploring experiences with compulsive exercise across social media. Int J Eat Disord 2021; 54:1663-1671. [PMID: 34254699 DOI: 10.1002/eat.23577] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Revised: 06/30/2021] [Accepted: 07/01/2021] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Investigations into online eating disorder (ED) communities have allowed for a rich exploration of lived experiences focused on a number of aspects, such as recovery and support groups. There is a lack of understanding around compulsive exercise (CE), which is often a characterizing condition of EDs. Exploring the lived experiences of CE as discussed online could provide helpful insight towards a better understanding of CE. Therefore, the purpose of this study was to explore experiences around CE and EDs shared on social media sites. METHOD Social media posts related to CE and EDs from Reddit, Twitter, Instagram, and forums were collected for 12 months. A thematic analysis of 881 posts was used to identify common themes among individuals' lived experiences with CE. RESULTS Five themes (and three subthemes) were identified across the social media posts: (1) seeking control, but ultimately CE takes hold, (2) burning off binges, but at what expense?, (3) recovery is a battle, but worth it, (4) is my exercise healthy?, and (5) frustration with comments about CE. DISCUSSION The lived experiences of CE among individuals with EDs have provided support for current definitions of CE and shared novel insight into the recovery experience. Individuals online also highlighted the need for improvement in treatment around CE specifically, and greater awareness around CE for the general public and healthcare providers.
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Affiliation(s)
- Laura Hallward
- Department of Kinesiology and Physical Education, McGill University, Montreal, Quebec, Canada
| | - Lindsay R Duncan
- Department of Kinesiology and Physical Education, McGill University, Montreal, Quebec, Canada
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22
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McDonald S, Williams AJ, Barr P, McNamara N, Marriott M. Service user and eating disorder therapist views on anorexia nervosa recovery criteria. Psychol Psychother 2021; 94:721-736. [PMID: 33761183 PMCID: PMC8451855 DOI: 10.1111/papt.12340] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 03/04/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Recovery from anorexia nervosa (AN) is difficult to define, and efforts to establish recovery criteria have led to several versions being proposed. Using the perspectives of people with histories of AN and therapists working in the field, we sought to explore the face validity of Khalsa et al (2017) as one of the most recent examples of proposed systematic recovery criteria. DESIGN We interviewed 11 health service users (SUs) with histories of AN who had previously received treatment alongside 8 eating disorder therapists (EDTs), exploring their views on the proposed AN recovery criteria. METHODS Data from verbal and written interviews were analysed thematically. Separate thematic analyses of SU and EDT interviews highlighted where concerns converged and diverged across participants. RESULTS Both groups saw some merits of having universally recognized recovery criteria, and the multidimensional approach was welcomed, but EDTs were uncomfortable with considering their use in therapy and SUs felt key components were missing around emotional coping and life quality. SUs disliked the prominence of body mass index (BMI) in the criteria, and all struggled with the proposed duration for recovery. Conceptually, the notion of recovery as an endpoint rather than a journey was contested. CONCLUSIONS Our findings indicate disparities between academically derived recovery criteria and lived experiences and indicate perceived challenges in using such criteria in therapeutic settings. Including SUs and EDTs in the development of criteria may improve the likelihood of consolidating AN recovery criteria, but conceptual challenges remain. PRACTITIONER POINTS AN recovery is complex, and the use of research-based AN recovery criteria in therapeutic settings could have a detrimental effect on SUs' outcomes. EDTs should be aware of efforts to define AN recovery criteria. EDTs should engage with debates on defining AN recovery and seek to promote participation in such debates to SUs.
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Affiliation(s)
- Sarah McDonald
- Department of PsychologyNottingham Trent UniversityUK,Eating Disorder ServiceNottinghamshire Healthcare Foundation NHS TrustUK
| | - A. Jess Williams
- Department of PsychologyNottingham Trent UniversityUK,University of BirminghamUK
| | - Phoebe Barr
- Department of PsychologyNottingham Trent UniversityUK
| | | | - Mike Marriott
- Department of PsychologyNottingham Trent UniversityUK
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23
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Kenny TE, Lewis SP. Reconceptualizing Recovery: Integrating Lived Experience Perspectives Into Traditional Eating Disorder Recovery Frameworks. Psychiatr Serv 2021; 72:966-968. [PMID: 33502221 DOI: 10.1176/appi.ps.202000447] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Eating disorder recovery has long been conceptualized as comprising the domains of weight, behaviors, and thoughts. Criteria for these domains are generally absolute (e.g., no specified behaviors in a set time frame) and determined by researchers and/or clinicians. This Open Forum draws on the knowledge of experts with lived experience to situate their perspectives against existing models of eating disorder recovery. Definitions of eating disorder recovery could be improved by deemphasizing a single weight target in recovery and acknowledging the nonlinear nature of thoughts and behaviors. The authors provide examples of ways that clinicians and researchers can integrate these improvements into their practice.
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Affiliation(s)
- Therese E Kenny
- Department of Psychology, University of Guelph, Guelph, Ontario
| | - Stephen P Lewis
- Department of Psychology, University of Guelph, Guelph, Ontario
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24
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Arillotta D, Guirguis A, Corkery JM, Scherbaum N, Schifano F. COVID-19 Pandemic Impact on Substance Misuse: A Social Media Listening, Mixed Method Analysis. Brain Sci 2021; 11:brainsci11070907. [PMID: 34356142 PMCID: PMC8303488 DOI: 10.3390/brainsci11070907] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 07/02/2021] [Accepted: 07/05/2021] [Indexed: 12/23/2022] Open
Abstract
The restrictive measures adopted during the COVID-19 pandemic modified some previously consolidated drug use patterns. A focus on social networks allowed drug users to discuss, share opinions and provide advice during a worldwide emergency context. In order to explore COVID-19-related implications on drug trends/behaviour and on most popular psychotropic substances debated, the focus here was on the constantly updated, very popular, Reddit social platform’s posts and comments. A quantitative and qualitative analysis of r/Drugs and related subreddits, using a social media listening netnographic approach, was carried out. The post/comments analysed covered the time-frame December 2019–May 2020. Between December 2019 and May 2020, the number of whole r/Drugs subreddit members increased from 619,563 to 676,581 members, respectively, thus increasing by 9.2% by the end of the data collection. Both the top-level r/Drugs subreddit and 92 related subreddits were quantitatively analysed, with posts/comments related to 12 drug categories. The drugs most frequently commented on included cannabinoids, psychedelics, opiates/opioids, alcohol, stimulants and prescribed medications. The qualitative analysis was carried out focussing on four subreddits, relating to some 1685 posts and 3263 comments. Four main themes of discussion (e.g., lockdown-associated immunity and drug intake issues; drug-related behaviour/after-quarantine plans’ issues; lockdown-related psychopathological issues; and peer-to-peer advice at the time of COVID-19) and four categories of Redditors (e.g., those continuing the use of drugs despite the pandemic; the “couch epidemiologists”; the conspirationists/pseudo-science influencers; and the recovery-focused users) were tentatively identified here. A mixed-methods, social network-based analysis provided a range of valuable information on Redditors’ drug use/behaviour during the first phase of the COVID-19 pandemic. Further studies should be carried out focusing on other social networks as well as later phases of the pandemic.
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Affiliation(s)
- Davide Arillotta
- Psychopharmacology, Drug Misuse, and Novel Psychoactive Substances Research Unit, School of Life and Medical Sciences, University of Hertfordshire, Hatfield AL10 9AB, UK; (D.A.); (A.G.); (J.M.C.); (F.S.)
| | - Amira Guirguis
- Psychopharmacology, Drug Misuse, and Novel Psychoactive Substances Research Unit, School of Life and Medical Sciences, University of Hertfordshire, Hatfield AL10 9AB, UK; (D.A.); (A.G.); (J.M.C.); (F.S.)
- Swansea University Medical School, Institute of Life Sciences 2, Swansea University, Singleton Park, Swansea SA2 8PP, UK
| | - John Martin Corkery
- Psychopharmacology, Drug Misuse, and Novel Psychoactive Substances Research Unit, School of Life and Medical Sciences, University of Hertfordshire, Hatfield AL10 9AB, UK; (D.A.); (A.G.); (J.M.C.); (F.S.)
| | - Norbert Scherbaum
- Department of Psychiatry and Psychotherapy, Medical Faculty, LVR-Hospital Essen, University of Duisburg-Essen, Virchowstraße 174, 45147 Essen, Germany
- Correspondence:
| | - Fabrizio Schifano
- Psychopharmacology, Drug Misuse, and Novel Psychoactive Substances Research Unit, School of Life and Medical Sciences, University of Hertfordshire, Hatfield AL10 9AB, UK; (D.A.); (A.G.); (J.M.C.); (F.S.)
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25
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Venturo-Conerly KE, Wasil AR, Dreier MJ, Lipson SM, Shingleton RM, Weisz JR. Why I recovered: A qualitative investigation of factors promoting motivation for eating disorder recovery. Int J Eat Disord 2020; 53:1244-1251. [PMID: 32691930 DOI: 10.1002/eat.23331] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 06/08/2020] [Accepted: 06/08/2020] [Indexed: 01/20/2023]
Abstract
OBJECTIVE It is difficult for individuals with eating disorders (EDs) to build and maintain motivation to recover. This challenge contributes to high rates of treatment dropout and relapse. To date, motivational interventions have been largely ineffective, and there is little research on factors that affect recovery motivation. To better understand recovery motivation and identify potential intervention targets, this study examines factors that affect recovery motivation in individuals with EDs. METHOD N = 13 participants completed qualitative interviews. All had been recovered from their diagnosed and treated ED for at least 1 year. We applied thematic analysis to interview transcripts in order to identify factors that had influenced recovery motivation and to classify their effects as helpful, harmful, or mixed. RESULTS Six main themes were identified, with subthemes detailed under each: (a) important people and groups (e.g., social circle, mentor), (b) actions and attitudes of others (e.g., judgmental responses, failure to intervene), (c) treatment-related factors (e.g., therapeutic skills, therapeutic alliance), (d) influential circumstances (e.g., removing triggers, pregnancy/children), (e) personal feelings and beliefs (e.g., obligation to others, hope for the future), and (f) the role of epiphanies (i.e., sudden insights or moments of change). DISCUSSION In this study, we identified potentially malleable factors that may affect ED recovery motivation (e.g., removing triggers, focusing on obligation to others, getting involved in meaningful causes, securing non-judgmental support, building hope for the future). These factors may be investigated as potential targets or strategies in motivational interventions for EDs.
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Affiliation(s)
| | - Akash R Wasil
- Department of Psychology, Harvard University, Cambridge, Massachusetts, USA.,Department of Psychology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Melissa J Dreier
- Department of Psychology, Harvard University, Cambridge, Massachusetts, USA.,Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Sarah M Lipson
- Department of Psychology, Harvard University, Cambridge, Massachusetts, USA
| | | | - John R Weisz
- Department of Psychology, Harvard University, Cambridge, Massachusetts, USA
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26
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Nilsen JV, Hage TW, Rø Ø, Halvorsen I, Oddli HW. External support and personal agency - young persons' reports on recovery after family-based inpatient treatment for anorexia nervosa: a qualitative descriptive study. J Eat Disord 2020; 8:18. [PMID: 32391150 PMCID: PMC7197126 DOI: 10.1186/s40337-020-00293-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Accepted: 03/31/2020] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Recommended treatment for adolescent anorexia nervosa (AN) is usually family-based and an overarching treatment aim is to empower the parents to manage the difficult meals and aid their child toward recovery. While family-based treatment prioritize collaborating with the parents, understanding the young persons' views on recovery is also important. Understanding the young person's views and ideas is relevant as this may facilitate the therapeutic alliance and thus aid the therapeutic process. The purpose of the present study was to investigate the reflections of young persons with a lived experience of anorexia nervosa, and what factors they consider important for the recovery process. All participants had been provided with a family-based inpatient treatment program, a program inspired by the core features of outpatient family-based treatment. METHODS Participants (n = 37) presented with an extensive treatment history, including outpatient and inpatient treatment for AN. Interview transcripts were analyzed by applying a predominantly inductive thematic approach to generate themes across participants. RESULTS The qualitative analysis generated a thematic structure entailing three levels. The superordinate theme, "Recovery is a long and winding journey: recognizing the need for support and highlighting the need for action", captured three main themes, "Realizing you have a problem", "Being involved in important relationships", and "Giving treatment a real chance". CONCLUSIONS Our results demonstrated that although young persons with a lived experience of anorexia nervosa recognized the importance of support from others, they placed a distinctive emphasis on self-responsibility and determination. We recommend clinicians working within the recommended family-based treatment frameworks be curious about young patient's subjective perspectives of the recovery process, as connecting with their views can potentially strengthen therapeutic relationships and facilitate change. PLAIN ENGLISH SUMMARY Recommended treatment for adolescent anorexia nervosa is usually family-based. These recommendations are supported by decades of research. In family-based treatment the overarching aim is to empower the young person's parents to manage and take charge of the difficult situation caused by the eating disorder. As recommended family-based treatments usually prioritize collaborating with the parents, it is important to be curious on the adolescents own views of what is regarded as important for the recovery process. The present study offers insights into factors considered important to the recovery process by young persons with lived experience of AN. Although voicing the importance of enlisting support from families, friends, and loved ones, the young participants distinctly emphasized their own responsibility, motivation and self-determination as critical factors for recovery. Inspired by our findings, we recommend that clinicians address the young patient's own preferred ideas for recovery during treatment.
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Affiliation(s)
- Jan-Vegard Nilsen
- 1Department of Psychology, University of Oslo, Oslo, Norway.,2Regional Department for Eating Disorders, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Trine Wiig Hage
- 2Regional Department for Eating Disorders, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Øyvind Rø
- 2Regional Department for Eating Disorders, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway.,3Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Inger Halvorsen
- 2Regional Department for Eating Disorders, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
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