Do different psychopathological pathways into eating disorder necessitate different therapeutic goals and/or approaches?

Four Pathways to Anorexia Nervosa: Patients' Perspective on the Emergence of AN

INTRODUCTION

Studies show that patients' perception of their illness has a direct influence both on their utilization of health services and their adherence to treatment plans. This may be particularly relevant to the treatment of Anorexia Nervosa (AN). Previous studies on AN have typically explored single psycho-social factors that patients with AN relate to the emergence of their illness. There is a need for more coherent systematic descriptions of the complexity of the patients' narratives about how their illness emerged. In this study, we sought to identify common components in the participants' narratives. By identifying different combinations of these components in the narratives, we sought to describe differences in patients' perceived pathways to AN.

METHODS

Participants were 36 women aged 18-51 years who had been treated for AN within the past 2 years at five clinical institutions in Norway. Semi-open qualitative interviews were conducted, tape-recorded, transcribed and analysed using grounded theory techniques.

RESULTS

We identified the following four distinct perceived pathways into AN: 'The Avoidant', 'The Achiever', 'The Transformer' and 'The Punisher'. The pathways could be regarded as four different projects for mastering life's challenges.

DISCUSSION

Our results suggest that there seem to be at least four pathways into AN. This indicates that a common array of symptoms might cover very different psychological dynamics. These might need to be treated therapeutically in different ways and should probably be taken into account during the refinement of diagnostic tools. Copyright © 2016 John Wiley & Sons, Ltd.

KEY PRACTITIONER MESSAGE

Although patients with AN might present similar symptoms, patients' perspectives on the emergence of their problems indicate that a common array of symptoms cover a variety of subjective psychological dynamics. From the experienced patient's stance, there are at least four distinct pathways to the emergence of AN. Attempts to master the challenges of life were found to be a common denominator in the emergence of AN. Recognition and integration of the patient's understanding of her or his problems should be given high priority in treatment of AN.

The journey from opposition to recovery from eating disorders: multidisciplinary model integrating narrative counseling and motivational interviewing in traditional approaches

BACKGROUND

In the world of today's of ever-briefer therapies and interventions, people often seem more interested in outcome than process. This paper focuses on the processes used by a multidisciplinary team in the journey from opposition to change to recovery from eating disorders. The approach outlined is most relevant to those with severe and enduring illness.

METHODS

This paper describes a five-phase journey from eating-disorder disability and back to health as it occurs for patients in a community-based facility. This integrative model uses narrative and motivational interviewing counseling weaved into traditional approaches. It approaches illness from a transdiagnostic orientation, addressing the dynamics and needs demanded by the comorbidities and at the same time responding effectively in a way that reduces the influence of the eating disorder. The treatment described involves a five-phase journey: Preliminary phase (choosing a shelter of understanding); Phase 1: from partial recognition to full acknowledgment; Phase 2: from acknowledgment to clear cognitive stance against the eating disorder; Phase 3: towards clear stance against the "patient" status; Phase 4: towards re-authoring life and regaining self-agency; Phase 5: towards recovery and maintenance.

RESULTS

In a longitudinal study of patients with a severe and debilitating eating disorder treated with this approach. The drop-out rate was less than 10%. This was during the first two months of treatment for those diagnosed with bulimia nervosa, and this was higher than in those diagnosed with anorexia nervosa. At the end of treatment (15 months to 4 years later) 65% of those treated with anorexia nervosa and 81% of those treated with bulimia nervosa were either in a fully recovered state or in much improved. At the four-year follow-up, 68% of those diagnosed with anorexia nervosa and 83% of those diagnosed with bulimia nervosa were categorized as either fully recovered or much improved. All patients who completed the program were gainfully employed.

CONCLUSIONS

The collaborative work, which is the heart of the described model increases the patient's and family's ownership of treatment and outcome and strengthen the therapeutic bond, thus enhances recovery.

Masculinity and femininity in the divergence of male body image concerns

BACKGROUND

Given recent assertions suggesting that gender role endorsement may be relevant in the divergence of male body image concerns, this study examined the self-reported gender role endorsement in opposing dimensional extremes of male body image disorders, namely, muscle dysmorphia and anorexia nervosa. This study further examined the relationship between gender role endorsement and eating disordered and muscle dysmorphia disorder pathology.

METHODOLOGY

Participants were 21 male muscle dysmorphia patients, 24 male anorexia nervosa patients, and 30 male gym-using controls from Australia, the United Kingdom, and the United States. All participants completed multidimensional measures of masculinity and femininity, and measures of eating disorder and muscle dysmorphia symptomatology.

RESULTS

Patients with muscle dysmorphia reported significantly elevated adherence to masculine (but not feminine) norms relative to control gym-using men and men with anorexia nervosa, whereas patients with anorexia nervosa exhibited elevated feminine (but not masculine) gender role endorsement relative to control gym-using men and men with muscle dysmorphia.

CONCLUSIONS

Masculine and feminine gender role endorsement appear to be associated with the divergence of body image concerns towards muscularity and thinness-oriented ideals respectively.