The tipping point of change in Anorexia Nervosa (AN): Qualitative findings from an online study

Social support for young people with eating disorders-An integrative review

Eating disorder treatment should be underpinned by a recovery-oriented approach, be therapeutic, personalised and trauma informed. Within such models of care, social support is an important factor to explore in terms of its influence in supporting hope for recovery, reducing stigma, and mitigating life stressors. Limited research has been conducted to understand the types of social support that are available to young people formally diagnosed with an eating disorder, their feasibility and acceptability and the positive outcomes. This integrative review sought to explore the positive outcomes of social support or social support programs for young people with eating disorders. An integrative review was conducted based on a search of five electronic databases from inception to 31 March 2023. Methodological quality was assessed using the Joanna Briggs Institute Critical Appraisal Tools and findings have been narratively synthesised and presented in accordance with the review's aims and questions. Seven studies (total 429 individuals, range 3-160) published between 2001 and 2023 were included in the final synthesis. Overall social support interventions showed promising preliminary evidence as a feasible and acceptable adjunct to treatment for young people with an eating disorder motivated to change, with some clinical improvements in psychopathology. Social support augmented existing relationships, providing a human element of open dialogue, friendship and a sense of hope for recovery. Despite the small number and heterogeneity of the studies, this review has highlighted some promising preliminary benefits. Future treatment for eating disorders should embrace adjunct modalities that enhance psychosocial recovery for young people with eating disorders.

The experience of methamphetamine use disorder and the negative consequences of relapse - a qualitative study

BACKGROUND

The rate of relapse for people in recovery for substance use disorder is as high as 85% within the first 12 months of recovery, however, research on the lived experience of relapse is limited.

OBJECTIVE

The present qualitative study investigated the experience of relapse with people who have Methamphetamine use disorder and the reasons why they returned to recovery.

METHODS

The exploratory study recruited five (n = 5) adults who identified as having Methamphetamine use disorder. All participants had sought treatment for more than 12 months, they were attending an addiction support service, and had experienced a relapse within the past 15 months. Interviews were conducted in which participants were asked an open-ended question about their most recent relapse and the negative consequences associated with their drug use. Data were analyzed using thematic analysis.

RESULTS

A return to daily drug use led to negative consequences such as relationship breakdowns, poor mental health and acting in ways that went against the participant's morals and values. This study provides an insight into the types of experiences people who relapse after seeking treatment for Methamphetamine use disorder may have and how these experiences can influence their decision to return to recovery.

CONCLUSIONS

People who regularly attend a recovery program are still susceptible to relapse. Those who have maintained abstinence for a period of time prior to relapse may be able to assess the negative consequences of their drug use more easily. This prior experience of recovery might influence their decision to stop using again.

A systematic review of people's lived experiences of inpatient treatment for anorexia nervosa: living in a "bubble"

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.

Women's perspectives toward their nutritional counseling for eating disorders: a qualitative internet-based study in Israel

Nutritional counseling is a central part of eating disorder (ED) treatment. However, the nature of this treatment has not yet been described from women's perspectives. We conducted two studies exploring views of women regarding their ED nutritional counseling. In the first study, we used content analysis to reveal practices that registered dietitians (RDs) use in ED treatment. In the second study, we used phenomenological analysis to explore the nature of the client-dietitian collaboration. Data included 1,897 posts and 8,673 responses from 414 distinct female users, retrieved from a moderated ED Internet community website in Israel. Content analysis demonstrated six practices used by RDs: meal planning, weight monitoring, health assessment/consultation, establishing rapports, food logs, joint eating. Phenomenological analysis produced four positions demonstrating client-dietitian collaborations: "Silent dialogue," "Cancelation and deception," "Tough love," "Containment." Findings revealed women's efforts to continue treatment despite their ambivalence about goals and recovery, and RDs' efforts to help women, despite the women's ambivalence, to move forward toward recovery.

Personal recovery of young adults with severe anorexia nervosa during adolescence: a case series

PURPOSE

Despite the emergence of a growing qualitative literature about the personal recovery process in mental disorders, this topic remains little understood in anorexia nervosa (AN), especially severe AN during adolescence. This cases series is a first step that aims to understand recovery after severe AN among adolescents in France, from a first-person perspective.

METHODS

This cases series applied the interpretative phenomenological analysis (IPA) method to data collected in semi-structured face-to-face interviews about the recovery process of five young women who had been hospitalized with severe AN 10 years earlier during adolescence.

RESULTS

A model of recovery in four stages (corseted, vulnerable, plastic, and playful) crossing seven dimensions (struggle and path of initiation; work on oneself; self-determination and help; body; family; connectedness; and timeline) emerged from the analysis. New features of the AN personal recovery process were characterized: bodily well-being and pleasure of body; stigmatization; the role of the group; relation to time; and importance of narratives. We suggest a new shape to model the AN recovery process, one that suggests several tipping points. Recruitment must now be widened to different AN contexts.

CONCLUSIONS

The personal recovery paradigm may provide a new approach to care, complementary to medical paradigm.

REGISTRATION OF CLINICAL TRIAL

No. NCT03712384. Our study was purely observational, without assignment of medical intervention. As a consequence, this clinical trial was registered retrospectively.

LEVEL OF EVIDENCE

Level V, descriptive study.

"It also taught me a lot about myself": A qualitative exploration of how men understand eating disorder recovery

BACKGROUND

Eating Disorders (ED) are relatively common in the general population. However, perceived as "female disorders", EDs in men are often overlooked. Although recovery is often seen as the ideal end goal of ED, there is no single universal definition of recovery. Recovery can be defined in terms of: physical changes, behavioural changes, psychological (cognitive and emotional) and improved quality of life. There is very little research exploring how people with ED define/ understand what recovery is and there is even less research involving men with ED. Therefore, the aim of this study was to explore recovery from men's perspectives.

METHODS

In this qualitative study, eight men from Australia, New Zealand and the United States participated in a semi-structured interview. Data collected on the men's experiences of recovery were analysed in detail to create a thematic map of their understanding of recovery.

RESULTS

The thematic analysis generated two overarching themes. The first theme focused on psychological recovery in terms of diminished preoccupations with food and disordered eating behaviours, allowing them to eat more freely. They also experienced growth of self-confidence, insight and interpersonal relationships. The second theme viewed recovery as a recursive process without a definite endpoint. The men positioned themselves at different points of the recovery journey and emphasised the importance of support systems and improved resilience to deflect triggers that would otherwise cause relapse.

CONCLUSIONS

Recovery was recognised as an improvement in the men's psychosocial wellbeing from a previous level of functioning. It was a journey which was with no definite endpoint but one that provided benefits such as inner peace, confidence, greater empathy and stronger connections with others around them.