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Elwyn R, Adams M, Sharpe SL, Silverstein S, LaMarre A, Downs J, Burnette CB. Discordant conceptualisations of eating disorder recovery and their influence on the construct of terminality. J Eat Disord 2024; 12:70. [PMID: 38831456 PMCID: PMC11145809 DOI: 10.1186/s40337-024-01016-w] [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: 01/25/2024] [Accepted: 05/08/2024] [Indexed: 06/05/2024] Open
Abstract
Eating disorders (EDs) are complex, multifaceted conditions that significantly impact quality-of-life, often co-occur with multiple medical and psychiatric diagnoses, and are associated with a high risk of medical sequelae and mortality. Fortunately, many people recover even after decades of illness, although there are different conceptualisations of recovery and understandings of how recovery is experienced. Differences in these conceptualisations influence categorisations of ED experiences (e.g., longstanding vs. short-duration EDs), prognoses, recommended treatment pathways, and research into treatment outcomes. Within recent years, the proposal of a 'terminal' illness stage for a subset of individuals with anorexia nervosa and arguments for the prescription of end-of-life pathways for such individuals has ignited debate. Semantic choices are influential in ED care, and it is critical to consider how conceptualisations of illness and recovery and power dynamics influence outcomes and the ED 'staging' discourse. Conceptually, 'terminality' interrelates with understandings of recovery, efficacy of available treatments, iatrogenic harm, and complex co-occurring diagnoses, as well as the functions of an individual's eating disorder, and the personal and symbolic meanings an individual may hold regarding suffering, self-starvation, death, health and life. Our authorship represents a wide range of lived and living experiences of EDs, treatment, and recovery, ranging from longstanding and severe EDs that may meet descriptors of a 'terminal' ED to a variety of definitions of 'recovery'. Our experiences have given rise to a shared motivation to analyse how existing discourses of terminality and recovery, as found in existing research literature and policy, may shape the conceptualisations, beliefs, and actions of individuals with EDs and the healthcare systems that seek to serve them.
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Affiliation(s)
- Rosiel Elwyn
- Neuroscience and psychiatry, Thompson Institute, Birtinya, QLD, Australia
- University of the Sunshine Coast, Birtinya, QLD, Australia
| | | | - Sam L Sharpe
- Fighting Eating Disorders in Underrepresented Populations (FEDUP, Collective), West Palm Beach, FL, USA
| | | | | | | | - C Blair Burnette
- Department of Psychology, Michigan State University, Lansing, MI, USA.
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Kinnaird E, Cooper M. Exploring the relationship between clinical and personal models of recovery in anorexia nervosa: A mixed methods study. EUROPEAN EATING DISORDERS REVIEW 2024; 32:244-256. [PMID: 37840375 DOI: 10.1002/erv.3037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 09/13/2023] [Accepted: 09/27/2023] [Indexed: 10/17/2023]
Abstract
OBJECTIVE There is increasing interest around the relationship between clinically defined recovery from Anorexia nervosa (AN), based on a reduction of symptoms and weight normalisation, and personal models of recovery which emphasise factors such as personal growth. The purpose of this mixed methods study was to evaluate the hypothesis that these two approaches are complimentary, with reduced symptoms associated with higher achievement in personal domains. METHODS Eighty-one adults who self-defined as fully or partially recovered from AN were recruited into an online study and completed self-report measures of clinical and personal recovery. Participants were also asked questions about their views on the clinical criteria, and this data was analysed using thematic analysis. RESULTS People who were clinically defined as fully recovered scored significantly higher on measures of personal recovery compared to those defined as not recovered, and there were strong positive associations between lower behavioural and cognitive symptoms, and personal recovery. There was a weaker relationship between personal recovery measures and BMI. Qualitative data indicated that most participants felt that the clinical criteria were not a sufficient definition of recovery. CONCLUSIONS Implications for the usage of clinical criteria for recovery from AN in research trials and clinical practice are discussed.
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Affiliation(s)
- Emma Kinnaird
- Oxford Institute of Clinical Psychology Training and Research, Oxford University, Oxford, UK
| | - Myra Cooper
- Oxford Institute of Clinical Psychology Training and Research, Oxford University, Oxford, UK
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Livanou M, Bull M, Manitsa I, Hunt J, Lane R, Heneghan A. Co-producing a complex psychosocial intervention during COVID-19 with young people transitioning from adolescent secure hospitals to adult services in England: Moving Forward intervention (MFi). Child Adolesc Ment Health 2024; 29:43-55. [PMID: 37455024 DOI: 10.1111/camh.12667] [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] [Accepted: 05/09/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND Young people moving from adolescent secure hospitals to adult care present with multiple and complex needs which often remain unmet during transition periods. This paper delineates the process of developing and co-producing the moving forward intervention (MFi), which aims to address the psychosocial needs of transitioning youth who have limited access to well-researched and tailored service provisions. METHOD An extensive search of the relevant literature was conducted to generate themes and guide the co-production phase. Fourteen Advisory Group Meetings were held virtually during COVID-19 to design the MFi module content with 17 keyworkers, 2 parents and 13 young people aged 17-18 years across six adolescent secure hospitals in England. Thematic analysis was used to reflect on the field notes discussed in the Advisory Groups. RESULTS Co-produced themes from the literature and the Advisory Groups informed the development of the proposed intervention. Three overarching themes pertinent to expectations in adult services, improving communication gaps between services and facilitating the letting go period emerged from the co-production phase. It was suggested the MFi is co-delivered by a peer with lived experience to build trust and create hopefulness among young people. The importance of promoting graded transitions through standardised procedures was highlighted. CONCLUSIONS The current findings promote evidence-based initiatives and build robust practice frameworks that inform treatment and policy guidelines. The young people, parents and keyworkers found the MFi supportive and valued the co-production experience. As such, co-production has been a vital tool in promoting patient engagement and empowerment, and reducing service inequalities, especially in adolescent secure hospitals.
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Affiliation(s)
- Maria Livanou
- Department of Psychology, School of Mental Health & Psychological Sciences, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- Kingston University Department of Psychology, School of Law, Social and Behavioural Sciences, Kingston University London, Kingston Upon Thames, UK
| | - Marcus Bull
- Kingston University Department of Psychology, School of Law, Social and Behavioural Sciences, Kingston University London, Kingston Upon Thames, UK
| | - Ifigeneia Manitsa
- Institute for Mental Health, School of Psychology, University of Birmingham, Birmingham, UK
| | - Jodie Hunt
- Kingston University Department of Psychology, School of Law, Social and Behavioural Sciences, Kingston University London, Kingston Upon Thames, UK
| | - Rebecca Lane
- Norwich Medical School, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
- Cambridge and Peterborough NHS Foundation Trust, Cambridge, UK
| | - Anya Heneghan
- Department of Psychology, School of Mental Health & Psychological Sciences, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
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Heywood L, Conti J, Touyz S, Madden S, Hay P. Key-in-session identity negotiations in a first line treatment for adult anorexia nervosa. J Eat Disord 2024; 12:20. [PMID: 38297339 PMCID: PMC10832269 DOI: 10.1186/s40337-024-00979-0] [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: 09/02/2023] [Accepted: 01/24/2024] [Indexed: 02/02/2024] Open
Abstract
BACKGROUND Exploration of client identity negotiations during treatment for Anorexia Nervosa (AN) is a relatively new area of research. Research suggests that difficulties with identity negotiations may present as a barrier to treatment. This study sought to explore individuals' identity negotiations during therapy sessions using Compulsive Exercise Activity Therapy (LEAP) combined with Cognitive Behaviour Therapy for Anorexia Nervosa (CBT-AN). Analysis focused on moments in therapy where individuals' identities were dominated or defined by AN and where alternative identities could be generated. METHOD 40 in-session transcripts from sessions at early, mid and end points of the CBT-AN (with LEAP) treatment were qualitatively analysed for nine of the 78 participants in the original randomised control trial. Through a constructivist framework, thematic analysis was used to identify surface and latent meanings and discursive material participants used to negotiate their identities in the context of therapy sessions. RESULTS Analysis of in-therapy transcripts generated two themes pertaining to identity negotiations: (1) troubled identities and (2) rebuilding identities and lives outside of AN. Early therapy sessions explored fragmented and AN dominated identities, including how AN was troubling to participants' sense of self, contributed to conflicted identities, positioned them outside of normality, and was associated with isolated and othering identities. Within therapy sessions, participants engaged in a recursive process of shifting relationships with AN and themselves and building identities and lives outside of the AN identity. This included generating hopes for recovery and the future more frequently in mid- to late- therapy sessions. CONCLUSION Identity negotiations evident in the therapeutic conversations aligned with the key components of the CBT-AN intervention, including addressing (1) the characterisation of oneself as 'an anorexic' and (2) the diversification of roles and activities to broaden and enhance self-concepts. Future developments of therapeutic interventions for AN would benefit from greater consideration of ways to assist individuals to more comprehensively address problematic identities, including uncovering identities hidden by the AN identity and generating preferred identities. TRIAL REGISTRATION Ethics approval was obtained at the time of the initial study and for this embedded research by the HREC at the Western Sydney University (HR777332).
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Affiliation(s)
- Lauren Heywood
- School of Psychology, Western Sydney University, Sydney, Australia
| | - Janet Conti
- School of Psychology, Western Sydney University, Sydney, Australia.
- Translational Health Research Institute, Western Sydney University, Sydney, Australia.
| | - Stephen Touyz
- Inside Out Institute, University of Sydney and Sydney Local Health District, Sydney, Australia
| | - Sloan Madden
- School of Medicine and Heath, University of Sydney, Ramsay Clinic Northside, Sydney, Australia
| | - Phillipa Hay
- Translational Health Research Institute, Western Sydney University, Sydney, Australia
- School of Medicine, Western Sydney University, Sydney, Australia
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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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Scanferla E, Seryer S, Pachoud B, Gorwood P. Transition from an adolescent to an adult eating disorder treatment centre: A qualitative investigation of the experience of inpatients with anorexia nervosa and their carers using interpretative phenomenological analysis. EUROPEAN EATING DISORDERS REVIEW 2023. [PMID: 37658485 DOI: 10.1002/erv.3030] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 07/22/2023] [Accepted: 08/19/2023] [Indexed: 09/03/2023]
Abstract
AIMS To capture the subjective experience of eating disorder patients and their immediate family members in the transition between adolescent and adult treatment services and to explore how both groups make sense of this specific experience. DESIGN Qualitative study in the form of in-depth interviews using interpretative phenomenological analysis. SETTINGS Participants were recruited from a university department of a large psychiatric hospital specialising in eating disorders between July 2021 and September 2022. PARTICIPANTS A convenience sample of 18 participants was recruited, including 12 patients aged 19-30 years (m = 22.5, SD = 3.8) and six of their respective caregivers. RESULTS Four main themes were identified in relation to the participants' experience of transition to adult care: (1) the detailed description of the transition process, (2) the emotions associated with this experience, (3) the challenges encountered and (4) recommendations for improving the process. Two fundamental meaning-making processes emerged: the feeling of being "lost in transition" and the opportunity to "become an adult". The results highlighted the factors that characterise this experience for patients and their families, and the need for practical and psychological support during the transition process. CONCLUSIONS This study provides a unique insight into the experience of patients and their immediate family members regarding the transition from adolescent to adult care. It reveals the multidimensional impact of the transition experience and highlights the need for increased support for family members. These findings may provide new insights into interventions that promote successful transition and encourage rethinking the organisation of this crucial stage of the care pathway.
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Affiliation(s)
- Elisabetta Scanferla
- Clinique des Maladies Mentales et de l'Encéphale, Hôpital Sainte-Anne, GHU Paris Psychiatrie et Neurosciences, Paris, France
- Université Paris Cité, ED 450, Paris, France
| | - Sabrina Seryer
- Clinique des Maladies Mentales et de l'Encéphale, Hôpital Sainte-Anne, GHU Paris Psychiatrie et Neurosciences, Paris, France
| | | | - Philip Gorwood
- Clinique des Maladies Mentales et de l'Encéphale, Hôpital Sainte-Anne, GHU Paris Psychiatrie et Neurosciences, Paris, France
- Université Paris Cité, Institut de Psychiatrie et Neurosciences de Paris (IPNP), INSERM, Paris, France
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Kiely L, Conti J, Hay P. Conceptualisation of severe and enduring anorexia nervosa: a qualitative meta-synthesis. BMC Psychiatry 2023; 23:606. [PMID: 37596588 PMCID: PMC10439651 DOI: 10.1186/s12888-023-05098-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 08/09/2023] [Indexed: 08/20/2023] Open
Abstract
BACKGROUND Severe and enduring anorexia nervosa (SE-AN) is amongst the most impairing of all mental illnesses. Collective uncertainties about SE-AN nosology impacts treatment refinement. Qualitative research, particularly lived experience literature, can contribute to a process of revision and enrichment of understanding the SE-AN experience and further develop treatment interventions. Poor outcomes to date, as evidenced in clinical trials and mortality for people with SE-AN (1 in 20) demonstrate the need for research that informs conceptualisations and novel treatment directions. This interpretative, meta-ethnographic meta-synthesis aimed to bridge this gap. METHODS A systematic search for qualitative studies that explored the AN experiences of people with a duration of greater than 3 years was undertaken. These studies included those that encompassed phenomenology, treatment experiences and recovery. RESULTS 36 papers, comprising 382 voices of SE-AN experiences informed the meta-ethnographic findings. Four higher order constructs were generated through a synthesis of themes and participant extracts cited in the extracted papers: (1) Vulnerable sense of self (2) Intra-psychic processes (3) Global impoverishment (4) Inter-psychic temporal processes. Running across these meta-themes were three cross cutting themes (i) Treatment: help versus harm, (ii) Shifts in control (iii) Hope versus hopelessness. These meta-themes were integrated into conceptualisations of SE-AN that was experienced as a recursive process of existential self-in-relation to other and the anorexia nervosa trap. CONCLUSIONS The alternative conceptualisation of SE-AN proposed in this paper poses a challenge to current conceptualisations of AN and calls for treatments to engage with the complex intra and inter-psychic processes of the SE-AN, more fully. In doing so, clinicians and researchers are asked to continue to be bold in testing novel ideas that may challenge our own rigidity and attachment to dominant paradigms to best serve the individual person with SE-AN. The 'global impoverishment of self', found in this synthesis of AN experiences, should inform proposed diagnostic criteria for SE-AN.
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Affiliation(s)
- Laura Kiely
- School of Medicine, Translational Health Research Institute, Western Sydney University, Sydney, NSW, Australia.
| | - Janet Conti
- School of Psychology, Translational Health Research Institute, Western Sydney University, Sydney, NSW, Australia
| | - Phillipa Hay
- School of Medicine, Translational Health Research Institute, Western Sydney University. Mental Health Services, Camden and Campbelltown Hospitals, SWSLHD, Campbeltown, NSW, Australia
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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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Krishnamoorthy G, Shin SM, Rees B. Day Programs for children and adolescents with eating disorders: A systematic review. EUROPEAN EATING DISORDERS REVIEW 2023; 31:199-225. [PMID: 36351879 PMCID: PMC10099450 DOI: 10.1002/erv.2953] [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: 11/29/2021] [Revised: 08/07/2022] [Accepted: 10/15/2022] [Indexed: 11/11/2022]
Abstract
Day programs have received significant consideration within psychological literature as part of a continuum of mental health services. With increasing attention on the prevalence of eating disorders in children and adolescents, and the need for early intervention to minimize the costs and burden of the disorder, eating disorder day programs (also referred as partial hospitalization) have begun to emerge around the world. Despite their widespread use, no reviews to date have examined the efficacy of day programs for the treatment of eating disorders in children and adolescents. The current narrative literature review aims to describe and evaluate the efficacy of day programs for children and adolescents. The literature review was conducted according to the PRISMA guidelines and aimed to explore the outcomes and common program elements of day programs to guide clinical practice and service development. The review found variations amongst the day programs related to program elements, measures utilized and outcomes. Overall, the results suggest that day programs for children and adolescents are effective at restoring body weight, reducing eating disorder symptoms and addressing comorbid mental health concerns.
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Affiliation(s)
- Govind Krishnamoorthy
- School of Psychology and Wellbeing, Centre for Health Research, University of Southern Queensland, Ipswich, Queensland, Australia
| | - So Min Shin
- School of Psychology and Wellbeing, Centre for Health Research, University of Southern Queensland, Ipswich, Queensland, Australia
| | - Bronwyn Rees
- Young Minds Psychology, Ipswich, Queensland, Australia
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Elwyn R. A lived experience response to the proposed diagnosis of terminal anorexia nervosa: learning from iatrogenic harm, ambivalence and enduring hope. J Eat Disord 2023; 11:2. [PMID: 36604749 PMCID: PMC9815687 DOI: 10.1186/s40337-022-00729-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 12/28/2022] [Indexed: 01/07/2023] Open
Abstract
The ethical approach to treatment non-response and treatment refusal in severe-enduring anorexia nervosa (SE-AN) is the source of significant ethical debate, particularly given the risk of death by suicide or medical complications. A recent article proposed criteria to define when anorexia nervosa (AN) can be diagnosed as 'terminal' in order to facilitate euthanasia or physician-assisted suicide (EAS), otherwise known as medical assistance in dying, for individuals who wish to be relieved of suffering and accept treatment as 'futile'. This author utilises their personal lived experience to reflect on the issues raised, including: treatment refusal, iatrogenic harm, suicidality and desire to end suffering, impact of diagnosis/prognosis, schemas, alexithymia, countertransference, ambivalence, and holding on to hope. Within debates as critical as the bioethics of involuntary treatment, end-of-life and EAS in eating disorders, it is crucial that the literature includes multiple cases and perspectives of individuals with SE-AN that represent a wide range of experiences and explores the complexity of enduring AN illness, complex beliefs, communication patterns and relational dynamics that occur in SE-AN.
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Affiliation(s)
- Rosiel Elwyn
- Thompson Institute, University of the Sunshine Coast, Birtinya, QLD, Australia.
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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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Filipponi C, Visentini C, Filippini T, Cutino A, Ferri P, Rovesti S, Latella E, Di Lorenzo R. The Follow-Up of Eating Disorders from Adolescence to Early Adulthood: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16237. [PMID: 36498309 PMCID: PMC9736479 DOI: 10.3390/ijerph192316237] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 11/30/2022] [Accepted: 12/01/2022] [Indexed: 06/17/2023]
Abstract
Eating disorders (EDs) are common among children and adolescents and are characterized by excessive concerns for physical appearance, distorted body image, and fear of gaining weight. The purpose of this review is to evaluate the follow-up of EDs from adolescence to adulthood, analyzing persistence, relapses, and associated comorbidities. We searched scientific articles in PubMed, PsycInfo, Scopus, and Embase through two research strings, one for quantitative outcomes (recovery/persistence, relapse, and remission) and one for the other outcomes (psychiatric and medical comorbidities, substance use, and social-relational complications). From a total of 8043 retrieved articles, we selected 503 papers after exclusion of duplicates and title/abstract screening. After a full-text evaluation, we included 16 studies eligible for this review. We performed a meta-analysis describing the quantitative results, and we created a narrative synthesis for the qualitative outcomes. Results: Our results confirm that EDs can persist in early adulthood in 40.7% of cases with a relapse percentage of 24.5%. Individuals with an ED more frequently present with an empathy deficit and comorbid anxiety and depressive disorders. EDs are chronic and complex disorders, more frequent in females. In most cases, EDs reduce the autonomy of individuals who present many difficulties in affirming their independence from parental family.
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Affiliation(s)
- Caterina Filipponi
- School of Nursing, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, 41125 Modena, Italy
| | - Chiara Visentini
- Service of Psychiatric Diagnosis and Care (SPDC), Department of Mental Health and Drug Abuse, AUSL, 41126 Modena, Italy
| | - Tommaso Filippini
- Environmental, Genetic and Nutritional Epidemiology Research Center (CREAGEN), Section of Public Health, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, 41125 Modena, Italy
- School of Public Health, University of California Berkeley, Berkeley, CA 94704, USA
| | - Anna Cutino
- School of Psychiatry, University of Modena and Reggio Emilia, 41125 Modena, Italy
| | - Paola Ferri
- School of Nursing, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, 41125 Modena, Italy
| | - Sergio Rovesti
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, 41125 Modena, Italy
| | - Emanuela Latella
- School of Psychiatry, University of Modena and Reggio Emilia, 41125 Modena, Italy
| | - Rosaria Di Lorenzo
- Service of Psychiatric Diagnosis and Care (SPDC), Department of Mental Health and Drug Abuse, AUSL, 41126 Modena, Italy
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, 41125 Modena, Italy
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Hower H, LaMarre A, Bachner-Melman R, Harrop EN, McGilley B, Kenny TE. Conceptualizing eating disorder recovery research: Current perspectives and future research directions. J Eat Disord 2022; 10:165. [PMID: 36380392 PMCID: PMC9664434 DOI: 10.1186/s40337-022-00678-8] [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: 09/05/2022] [Accepted: 10/25/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND How we research eating disorder (ED) recovery impacts what we know (perceive as fact) about it. Traditionally, research has focused more on the "what" of recovery (e.g., establishing criteria for recovery, reaching consensus definitions) than the "how" of recovery research (e.g., type of methodologies, triangulation of perspectives). In this paper we aim to provide an overview of the ED field's current perspectives on recovery, discuss how our methodologies shape what is known about recovery, and suggest a broadening of our methodological "toolkits" in order to form a more complete picture of recovery. BODY: This paper examines commonly used methodologies in research, and explores how incorporating different perspectives can add to our understanding of the recovery process. To do this, we (1) provide an overview of commonly used methodologies (quantitative, qualitative), (2) consider their benefits and limitations, (3) explore newer approaches, including mixed-methods, creative methods (e.g., Photovoice, digital storytelling), and multi-methods (e.g., quantitative, qualitative, creative methods, psycho/physiological, behavioral, laboratory, online observations), and (4) suggest that broadening our methodological "toolkits" could spur more nuanced and specific insights about ED recoveries. We propose a potential future research model that would ideally have a multi-methods design, incorporate different perspectives (e.g., expanding recruitment of diverse participants, including supportive others, in study co-creation), and a longitudinal course (e.g., capturing cognitive and emotional recovery, which often comes after physical). In this way, we hope to move the field towards different, more comprehensive, perspectives on ED recovery. CONCLUSION Our current perspectives on studying ED recovery leave critical gaps in our knowledge about the process. The traditional research methodologies impact our conceptualization of recovery definitions, and in turn limit our understanding of the phenomenon. We suggest that we expand our range of methodologies, perspectives, and timeframes in research, in order to form a more complete picture of what is possible in recovery; the multiple aspects of an individual's life that can improve, the greater number of people who can recover than previously believed, and the reaffirmation of hope that, even after decades, individuals can begin, and successfully continue, their ED recovery process.
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Affiliation(s)
- Heather Hower
- Department of Psychiatry, Eating Disorders Center for Treatment and Research, University of California at San Diego School of Medicine, 4510 Executive Drive, San Diego, CA, 92121, USA. .,Department of Health Services, Policy, and Practice, Hassenfeld Child Innovation Institute, Brown University School of Public Health, 121 South Main Street, Providence, RI, 02903, USA.
| | - Andrea LaMarre
- School of Psychology, Massey University, North Shore, Private Bag 102-904, Auckland, 0632, New Zealand
| | - Rachel Bachner-Melman
- Clinical Psychology Graduate Program, Ruppin Academic Center, 4025000, Emek-Hefer, Israel.,School of Social Work, Hebrew University of Jerusalem, Mt. Scopus, 9190501, Jerusalem, Israel
| | - Erin N Harrop
- Graduate School of Social Work, University of Denver, 2148 S High Street, Denver, CO, 80208, USA
| | - Beth McGilley
- University of Kansas School of Medicine, 1010 N Kansas St, Wichita, KS, 67214, USA
| | - Therese E Kenny
- Department of Psychology, Clinical Child and Adolescent Psychology, University of Guelph, 50 Stone Road East, Guelph, ON, N1G 2W1, Canada
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14
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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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15
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García-Anaya M, Caballero-Romo A, González-Macías L. Parent-Focused Psychotherapy for the Preventive Management of Chronicity in Anorexia Nervosa: A Case Series. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19159522. [PMID: 35954879 PMCID: PMC9368715 DOI: 10.3390/ijerph19159522] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 06/26/2022] [Accepted: 06/27/2022] [Indexed: 02/06/2023]
Abstract
Background: Anorexia nervosa (AN) is a complex eating disorder where involvement of family plays a central role in first line treatment in adolescents, but which is not so for adults where poor response to treatment is frequent. Given the reluctance of some patients to receive treatment, we set out to explore the hypothesis that certain family dynamics may be involved in the maintenance of the disorder. Methods: We aimed to understand what is underlying in the cases of patients who present clinical improvement with their parents, but not the ones who received a parent-focused psychotherapeutic intervention. We conducted a mixed methods study. On the one hand we performed a case series of 14 patients who dropped out of treatment while their parents actively attended the intervention, and on the other hand, we followed the evolution of the parents of those patients reluctant to continue treatment, through non-participant observation. Results: We present preliminary evidence where we found the parent-focused psychotherapeutic intervention was able to elicit a reflective function of the parents. We also observed that the intervention modified certain family dynamics that could be related to maintaining factors of the disorder. In patients, we found that in parallel to the assistance of their parents to psychotherapeutic treatment, and even when they were receiving no intervention, they showed significant clinical improvement of symptomatology and global functioning; we observed 9 of 14 of them who voluntarily decided to return to pharmacological treatment. Conclusions: This parent-focused intervention elicited changes in reflective functioning of participant parents; the intervention produced favorable changes in family dynamics, which we believe is probably related to improvement of global functioning, symptomatology, and insight of patients.
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Affiliation(s)
- María García-Anaya
- Clinical Research Division, National Institute of Psychiatry Ramón de la Fuente Muñiz, Mexico City 14370, Mexico
- Correspondence: (M.G.-A.); (L.G.-M.)
| | - Alejandro Caballero-Romo
- Eating Disorders Clinic at Clinical Services Division, National Institute of Psychiatry Ramón de la Fuente Muñiz, Mexico City 14370, Mexico;
| | - Laura González-Macías
- Eating Disorders Clinic at Clinical Services Division, National Institute of Psychiatry Ramón de la Fuente Muñiz, Mexico City 14370, Mexico;
- Correspondence: (M.G.-A.); (L.G.-M.)
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16
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Bachner-Melman R, Lev-Ari L, Zohar AH, Linketsky M. The Eating Disorders Recovery Questionnaire: psychometric properties and validity. Eat Weight Disord 2021; 26:2633-2643. [PMID: 33582972 DOI: 10.1007/s40519-021-01139-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Accepted: 01/29/2021] [Indexed: 01/07/2023] Open
Abstract
PURPOSE There is no standardized measurement of recovery from an eating disorder (ED). We examined the psychometric properties and construct validity of the "Eating Disorders Recovery Questionnaire" (EDRQ), which defines recovery beyond symptoms to include self-acceptance, social emotional and physical health. METHODS Twenty-eight recovery-related items were administered to 978 people (9.5% men) aged 18-76. 172 participants had a current ED diagnosis (AN, BN or BED), 104 had a past ED diagnosis (AN, BN, BED or > one diagnosis), 105 had another past or present ED, and 579 had no lifetime ED. Participants also completed the Eating Disorders Examination Questionnaire, Dresden Body Image Questionnaire-35, Positive and Negative Affect Schedule-Short Form, Patient Health Questionnaire-9, Satisfaction with Life Scale and Positive Eating Scale. RESULTS Exploratory and confirmatory factor analyses yielded four factors (CFI = 0.93, RMSEA = 0.07): lack of symptomatic behavior, acceptance of self and body, social and emotional connection, and physical health. Group comparisons showed that currently ill women scored lower on EDRQ and positive indices and higher on negative indices than controls and previously ill women. Previously ill women scored similarly to controls on ED symptomatology, positive body experiences, depression, and positive and negative affect but had lower BMI, life satisfaction and positive eating. The EDRQ-EDEQ correlation was r = 0.67, indicating both overlap and distinct variance. CONCLUSION The EDRQ is a valid, reliable measure of ED recovery, defined more broadly than symptom remission. We recommend its incorporation into a standardized operationalization of recovery and its use by consumers, carers and service providers to monitor ED recovery status. LEVEL OF EVIDENCE Level III, case-control analytic study.
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Affiliation(s)
- Rachel Bachner-Melman
- Ruppin Academic Center (Clinical Psychology Graduate Program), Emek Hefer, Israel. .,Hebrew University of Jerusalem (School of Social Work), Jerusalem, Israel.
| | - Lilac Lev-Ari
- Ruppin Academic Center (Clinical Psychology Graduate Program), Emek Hefer, Israel.,The Lior Tsfaty Center for Suicide and Mental Pain Studies, Ruppin Academic Center, Emek Hefer, Israel
| | - Ada H Zohar
- Ruppin Academic Center (Clinical Psychology Graduate Program), Emek Hefer, Israel.,The Lior Tsfaty Center for Suicide and Mental Pain Studies, Ruppin Academic Center, Emek Hefer, Israel
| | - Michal Linketsky
- Ruppin Academic Center (Clinical Psychology Graduate Program), Emek Hefer, Israel
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17
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Abstract
Attending to the shades of grey in eating disorder recovery may help to illuminate possibilities for navigating recoveries in their full complexity and diversity. There is a need for more complexity and flexibility in understandings of the timelines, processes, endpoints, and versions of eating disorder recoveries. In this article, we explore eating disorder recovery as a dynamic, intercorporeal, and non-linear process. Drawing on interviews with 20 people doing significantly better than they were during a time of acute distress around food and body, we articulate "recoveries" in relation to four themes: Fuzzy Logics of Time, Not Only Recovered, Recovery is Not All Sunshine and Rainbows, and The Life of Recovery. These themes speak to the ways in which participants struggled to articulate the temporalities of their recoveries, situated recovery as one among many events and processes that shaped their being in the world, resisted "too perfect" articulations of recovery journeys/ endpoints, and described preferred versions of and open-ended guidelines for recovery. We argue that eating disorder recoveries are as complicated and messy as lives themselves and are equally entangled in social contexts. We suggest that articulations of recovery be attuned to power dynamics as they operate in dictating which performances of eating disorders and recovery will be honoured as "legitimate" and whose pathways to recovery will be respected.
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Affiliation(s)
- Andrea LaMarre
- School of Psychology, Massey University Albany Campus, Auckland, New Zealand.
| | - Carla Rice
- Department of Family Relations and Applied Nutrition, University of Guelph, Guelph, ON, Canada
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18
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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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19
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Strand M, Bulik CM, Gustafsson SA, Welch E. Self-admission in the treatment of eating disorders: an analysis of healthcare resource reallocation. BMC Health Serv Res 2021; 21:465. [PMID: 34001113 PMCID: PMC8130160 DOI: 10.1186/s12913-021-06478-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 05/05/2021] [Indexed: 01/02/2023] Open
Abstract
Background Self-admission to psychiatric inpatient treatment is an innovative approach to healthcare rationing, based on reallocation of existing resources rather than on increased funding. In self-admission, patients with a history of high healthcare utilization are invited to decide for themselves when brief admission is warranted. Previous findings on patients with severe eating disorders indicate that self-admission reduces participants’ need for inpatient treatment, but that it does not alone lead to symptom remission. Methods The aim of this study was to evaluate if, from a service provider perspective, the resource reallocation associated with self-admission is justified. The analysis makes use of data from a cohort study evaluating the one-year outcomes of self-admission at the Stockholm Centre for Eating Disorders. Results Participants in the program reduced their need for regular specialist inpatient treatment by 67%. Thereby, hospital beds were made available for non-participants due to the removal of a yearly average of 13.2 high-utilizers from the regular waiting list. A sensitivity analysis showed that this “win-win situation” occurred within the entire 95% confidence interval of the inpatient treatment utilization reduction. Conclusions For healthcare systems relying on rationing by waiting list, self-admission has the potential to reduce the need for hospitalization for patients with longstanding eating disorders, while also offering benefits in the form of increased available resources for other patients requiring hospitalization. Trial Registration ClinicalTrials.gov ID: NCT02937259 (retrospectively registered 10/15/2016).
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Affiliation(s)
- Mattias Strand
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, 171 77, Stockholm, Sweden. .,Transkulturellt Centrum, Solnavägen 4, 113 65, Stockholm, Sweden.
| | - Cynthia M Bulik
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.,Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Sanna A Gustafsson
- University Health Care Research Center, Faculty of Medicine and Health, Örebro University, 701 82, Örebro, Sweden
| | - Elisabeth Welch
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, 171 77, Stockholm, Sweden.,Stockholm Centre for Eating Disorders, Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
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20
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LaMarre A, Rice C. Healthcare providers' engagement with eating disorder recovery narratives: opening to complexity and diversity. MEDICAL HUMANITIES 2021; 47:78-86. [PMID: 32122937 DOI: 10.1136/medhum-2019-011723] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/04/2019] [Indexed: 06/10/2023]
Abstract
Interdisciplinary healthcare providers (HCPs) receive only minimal training in identifying, referring for and treating eating disorders and may feel ill-prepared to manage them. There is a need for brief interventions that prepare HCPs for work with people with eating disorders, particularly when they do not fit stereotypes about who might experience an eating disorder. One method for enacting brief interventions that make change in this realm is using digital stories (short videos) to generate awareness and knowledge. In this article, we discuss the results of a pilot study exploring the impact of viewing digital stories created by people in eating disorder recovery and their supporters on an interdisciplinary group of HCPs. We showed five stories to 22 HCPs who filled out qualitative prequestionnaires and postquestionnaires about their experiences of viewing the films and how they conceptualised recovery. Providers found the stories evocative; the stories appear to have complexified their perspectives on recovery. HCPs desired more diverse, detailed and lengthy stories, indicating that pursuing digital storytelling for HCP education and awareness may hold promise. Through centring the voices of people with eating disorders and in recovery, digital stories may also provide new ways of talking about recovery that open up possibilities for embracing difference.
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Affiliation(s)
- Andrea LaMarre
- Family Relations and Applied Nutrition, University of Guelph, Guelph, Ontario, Canada
| | - Carla Rice
- Family Relations and Applied Nutrition, University of Guelph, Guelph, Ontario, Canada
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21
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Abstract
This study aims to investigate dietary changes, psychological well-being, symptoms of anxiety and depression occurring during the 2019 novel coronavirus disease (COVID-19) and their associations with symptoms of eating disorders. A sample of 316 Hong Kong Chinese was assessed using standardized instruments from March to April 2020. 86.1% of participants indicated that they had made at least one dietary change due to the pandemic. 26.5% of participants have a possible case of eating disorders. Participants with a possible case of eating disorders reported significantly higher levels of depression and anxiety symptoms and lower levels of three dimensions of psychological well-being (environmental mastery, purpose in life and self-acceptance). The result pointed to the need for more clinical attention to eating disorders during the COVID-19 Pandemic.
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Affiliation(s)
- Chui Yi Chan
- The Felizberta Lo Padilla Tong School of Social Sciences, Caritas Institute of Higher Education, Hong Kong, China
| | - Cheuk Ying Chiu
- The Felizberta Lo Padilla Tong School of Social Sciences, Caritas Institute of Higher Education, Hong Kong, China
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22
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Conti JE, Joyce C, Hay P, Meade T. "Finding my own identity": a qualitative metasynthesis of adult anorexia nervosa treatment experiences. BMC Psychol 2020; 8:110. [PMID: 33092638 PMCID: PMC7583290 DOI: 10.1186/s40359-020-00476-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 10/12/2020] [Indexed: 11/15/2022] Open
Abstract
Background The aim of this metasynthesis was to explore adult anorexia nervosa (AN) treatment experiences, including facilitators and barriers to treatment engagement and ways that questions of identity and personal agency were negotiated in treatment contexts.
Methods From 14 qualitative studies that met the search criteria, this thematic synthesis analyzed the sensitized concept of identity in the participants’ experiences of AN treatments, including their sense of personal agency, and implications for their recovery. The study was registered with Prospero (ID: CRD42018089259) and is reported according to PRISMA guidelines. Results Three meta-themes were generated with the following key findings: grappling with identity, where collaborative and tailored interventions were positively experienced; the quality of the therapeutic relationship, which existed in a recursive relationship; and, rebuilding identity that included therapists standing with the person in recovering a sense of identity outside the anorexic identity. Importantly, interventions that failed to be negotiated with the person were experienced as disempowering however, where a two-way trust existed in the therapeutic relationship, it critically empowered and shaped participants’ sense of identity, and broadened the perception that they were valuable as a person. Conclusions There was consensus across the range of treatment contexts that individuals with a lived AN experience preferred treatments where they experienced (1) a sense of personal agency through tailored interventions; and (2) therapists who treated them as a person who, in the face of their struggles, had skills and capacities in the processes of recovering and rebuilding sustainable and preferred identities outside the AN identity.
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Affiliation(s)
- Janet E Conti
- School of Psychology, Western Sydney University, Locked Bag 1797, Penrith, 2751, Australia. .,Translational Health Research Institute, Western Sydney University, Penrith, Australia.
| | - Caroline Joyce
- School of Medicine, Western Sydney University, Penrith, Australia
| | - Phillipa Hay
- School of Medicine, Western Sydney University, Penrith, Australia.,Translational Health Research Institute, Western Sydney University, Penrith, Australia
| | - Tanya Meade
- School of Psychology, Western Sydney University, Locked Bag 1797, Penrith, 2751, Australia
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23
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Strand M, Bulik CM, Gustafsson SA, von Hausswolff-Juhlin Y, Welch E. Self-admission to inpatient treatment in anorexia nervosa: Impact on healthcare utilization, eating disorder morbidity, and quality of life. Int J Eat Disord 2020; 53:1685-1695. [PMID: 32666605 DOI: 10.1002/eat.23346] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 06/26/2020] [Accepted: 06/27/2020] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Little evidence exists concerning the optimal model of inpatient care for patients with longstanding anorexia nervosa (AN). Self-admission has been developed as a treatment tool whereby patients with a history of high healthcare utilization are invited to decide for themselves when brief admission is warranted. The aim of this study was to evaluate the impact of a self-admission program on healthcare utilization, eating disorder morbidity, health-related quality of life (HRQoL), and sick leave for patients with AN. METHOD In this cohort study, 29 participants with AN in a Swedish self-admission program were compared to 113 patients with longstanding illness but low previous utilization of inpatient treatment, matched based on age, illness duration, and body-mass index (BMI). Data on healthcare utilization, eating disorder morbidity, and sick leave were obtained from national population and eating disorder quality registers. RESULTS Participants displayed a >50% reduction in time spent hospitalized at 12-month follow-up, compared to nonsignificant changes in the comparison group. A sensitivity analysis comparing participants to a moderate-utilization comparison subgroup strengthened this observation. In contrast, the approach did not affect participants' BMI or eating disorder morbidity. Regarding HRQoL, mixed results were observed. In terms of sick leave, a beneficial but nonsignificant pattern was seen for participants. DISCUSSION These findings indicate that self-admission is a viable and helpful tool within a recovery model framework, even though it does not lead to symptom remission. In its proper context, self-admission could potentially transform healthcare from crisis-driven to pre-emptive, and promote autonomy for severely ill patients.
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Affiliation(s)
- Mattias Strand
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden.,Transcultural Centre, Northern Stockholm Psychiatry, Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
| | - Cynthia M Bulik
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.,Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Sanna A Gustafsson
- University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Yvonne von Hausswolff-Juhlin
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
| | - Elisabeth Welch
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden.,Stockholm Centre for Eating Disorders, Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
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24
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Kenny TE, Boyle SL, Lewis SP. #recovery: Understanding recovery from the lens of recovery-focused blogs posted by individuals with lived experience. Int J Eat Disord 2020; 53:1234-1243. [PMID: 31886573 DOI: 10.1002/eat.23221] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 12/05/2019] [Accepted: 12/19/2019] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Definitions of eating disorder (ED) recovery have primarily focused on symptom management (i.e., weight regain, reduced/absent ED behaviors, and normalized ED thoughts). Notwithstanding the importance of these approaches, there are arguably additional considerations in ED recovery. In order to get a more comprehensive understanding of recovery, it is necessary to turn to individuals with lived experience. Here, we examine how individuals with lived experience of an ED conceptualize and define recovery in narrative, recovery-focused blogs and consider how this understanding may contribute to definitions of recovery in the field. METHOD Inductive thematic analysis was used to examine 168 blogs posted by at least 120 unique authors (95% women; 36% reporting anorexia nervosa diagnosis) to 10 moderated, ED websites. RESULTS Results from the thematic analysis yielded seven themes: recovery as (1) existing in contrast to the ED, (2) existing in a broader context, (3) subjective, (4) a choice, (5) a complex, nonlinear process, (6) transformative, and (7) overcoming. DISCUSSION The present findings are consistent with previous qualitative research, suggesting that recovery is multifaceted and encompasses more than just symptom management. Notably, bloggers highlighted that recovery may not be equally attainable for all individuals, citing numerous social justice issues in the conceptualization of recovery. This multifaceted and intersectional view of recovery is consistent with consumer models of recovery. We argue that a dimensional model of recovery may be a good starting framework for researchers and clinicians to develop a more comprehensive definition of recovery.
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Affiliation(s)
- Therese E Kenny
- Department of Psychology, University of Guelph, Guelph, Ontario, Canada
| | - Sarah L Boyle
- Department of Psychology, University of Guelph, Guelph, Ontario, Canada
| | - Stephen P Lewis
- Department of Psychology, University of Guelph, Guelph, Ontario, Canada
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25
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Wetzler S, Hackmann C, Peryer G, Clayman K, Friedman D, Saffran K, Silver J, Swarbrick M, Magill E, van Furth EF, Pike KM. A framework to conceptualize personal recovery from eating disorders: A systematic review and qualitative meta-synthesis of perspectives from individuals with lived experience. Int J Eat Disord 2020; 53:1188-1203. [PMID: 32181532 DOI: 10.1002/eat.23260] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 01/25/2020] [Accepted: 01/28/2020] [Indexed: 11/08/2022]
Abstract
BACKGROUND An extensive literature exists describing treatment interventions and recovery from eating disorders (EDs); however, this body of knowledge is largely symptom-based and from a clinical perspective and thus limited in capturing perspectives and values of individuals with lived experience of an ED. In this study, we performed a systematic review to coproduce a conceptual framework for personal recovery from an ED based on primary qualitative data available in published literature. METHODS A systematic review and qualitative meta-synthesis approach was used. Twenty studies focusing on ED recovery from the perspective of individuals with lived experience were included. The studies were searched for themes describing the components of personal recovery. All themes were analyzed and compared to the established connectedness; hope and optimism about the future; identity; meaning in life; and empowerment (CHIME) and Substance Abuse and Mental Health Services Administration (SAMHSA) frameworks of recovery, which are applicable to all mental disorders. Themes were labeled and organized into a framework outlining key components of the ED personal recovery process. RESULTS Supportive relationships, hope, identity, meaning and purpose, empowerment, and self-compassion emerged as the central components of the recovery process. Symptom recovery and its relationship to the personal recovery process are also significant. DISCUSSION Individuals with lived experience of EDs noted six essential elements in the personal ED recovery process. This framework is aligned with several of the key components of the CHIME and SAMHSA frameworks of recovery, incorporating person-centered elements of the recovery process. Future research should validate these constructs and develop instruments (or tools) that integrate the lived experiences into a measurement of recovery from an ED.
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Affiliation(s)
- Sara Wetzler
- Department of History of Science, Harvard University, Cambridge, Massachusetts, USA
| | - Corinna Hackmann
- Department of Research and Development, Norfolk and Suffolk Foundation Trust, Norfolk, UK.,Norwich Medical School, University of East Anglia, Norfolk, UK
| | - Guy Peryer
- School of Health Sciences, University of East Anglia, Norfolk, UK.,St. Nicholas Hospice Care, Suffolk, UK
| | - Kelsey Clayman
- Vagelos College of Physicians & Surgeons, Columbia University, New York City, New York, USA
| | - Donna Friedman
- Project Heal, East Cooper Behavioral Health, Mount Pleasant, South Carolina, USA
| | - Kristina Saffran
- Project Heal, Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California, USA
| | - Jody Silver
- Collaborative Support Programs of New Jersey, Freehold, New Jersey, USA
| | - Margaret Swarbrick
- Collaborative Support Programs of New Jersey, Rutgers Health University Behavioral Health Care, Piscataway, New Jersey, USA
| | - Elizabeth Magill
- Global Mental Health WHO Collaborating Centre, Columbia University Irving Medical Center, New York City, New York, USA
| | - Eric F van Furth
- Leiden University Medical Center, Leiden, The Netherlands.,Rivierduinen Eating Disorders Ursula, Leiden, The Netherlands
| | - Kathleen M Pike
- Global Mental Health WHO Collaborating Centre, Columbia University Irving Medical Center, New York City, New York, USA
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Strand M, Sjöstrand M, Lindblad A. A palliative care approach in psychiatry: clinical implications. BMC Med Ethics 2020; 21:29. [PMID: 32306966 PMCID: PMC7168959 DOI: 10.1186/s12910-020-00472-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 04/08/2020] [Indexed: 12/05/2022] Open
Abstract
Background Traditionally, palliative care has focused on patients suffering from life-threatening somatic diseases such as cancer or progressive neurological disorders. In contrast, despite the often chronic, severely disabling, and potentially life-threatening nature of psychiatric disorders, there are neither palliative care units nor clinical guidelines on palliative measures for patients in psychiatry. Main text This paper contributes to the growing literature on a palliative approach in psychiatry and is based on the assumption that a change of perspective from a curative to a palliative approach could help promote patient-centeredness and increase quality of life for severely ill patients in psychiatry as well as in somatic medicine. To exemplify this, we offer three different clinical scenarios: severe and enduring anorexia nervosa, treatment-refractory schizophrenia, and chronic suicidality and persistent self-injury in borderline personality disorder. Conclusion We emphasize that many typical interventions for treatment-refractory psychiatric disorders may indeed be of a palliative nature. Furthermore, introducing traditional features of palliative care, e.g. so-called goals of care conversations, could aid even further in ensuring that caregivers, patients, and families agree on which treatment goals are to be prioritized in order to optimize quality of life in spite of severe, persistent mental disorder.
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Affiliation(s)
- Mattias Strand
- Stockholm Centre for Eating Disorders, Wollmar Yxkullsgatan 27B, 118 50, Stockholm, Sweden. .,Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Stockholm County Council, 171 77, Stockholm, Sweden.
| | - Manne Sjöstrand
- Stockholm Centre for Healthcare Ethics, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, 171 77, Stockholm, Sweden
| | - Anna Lindblad
- Stockholm Centre for Healthcare Ethics, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, 171 77, Stockholm, Sweden
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28
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Medway M, Rhodes P, Dawson L, Miskovic-Wheatley J, Wallis A, Madden S. Adolescent development in family-based treatment for anorexia nervosa: Patients' and parents' narratives. Clin Child Psychol Psychiatry 2019; 24:129-143. [PMID: 30080102 DOI: 10.1177/1359104518792293] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Maudsley Family-Based Treatment (FBT) is currently the best supported treatment for adolescents with anorexia nervosa (AN); however, little is known about whether it achieves its stated aim in the final phases of promoting the patient's return to an expected developmental trajectory. This study aimed to explore the perspectives of young people and their parents regarding the developmental impact of AN, and the role of FBT in addressing developmental challenges. Young people ( N = 12) who ceased FBT a minimum 1 year prior, and their parents ( N = 12), completed face-to-face semi-structured interviews, and data were analysed using a narrative inquiry method. All the participants described AN as highly disruptive to adolescent development, with phase one of FBT accentuating this experience. In phases two and three, FBT helped facilitate adolescent development in three key ways: Supporting return to adolescent pursuits, facilitating autonomy and providing freedom to develop post-FBT. This study offers preliminary insights into the variety of developmental challenges and needs experienced by families, as well as approaches clinicians can take to supporting development in phases two and three of FBT.
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Affiliation(s)
- Meredith Medway
- 1 Clinical Psychology Unit, The University of Sydney, Australia
| | - Paul Rhodes
- 1 Clinical Psychology Unit, The University of Sydney, Australia
| | - Lisa Dawson
- 2 Eating Disorder Service, Department of Psychological Medicine and Department of Adolescent Medicine, The Children's Hospital at Westmead, Australia
| | - Jane Miskovic-Wheatley
- 2 Eating Disorder Service, Department of Psychological Medicine and Department of Adolescent Medicine, The Children's Hospital at Westmead, Australia
| | - Andrew Wallis
- 2 Eating Disorder Service, Department of Psychological Medicine and Department of Adolescent Medicine, The Children's Hospital at Westmead, Australia
| | - Sloane Madden
- 2 Eating Disorder Service, Department of Psychological Medicine and Department of Adolescent Medicine, The Children's Hospital at Westmead, Australia
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Bachner-Melman R, Lev-Ari L, Zohar AH, Lev SL. Can Recovery From an Eating Disorder Be Measured? Toward a Standardized Questionnaire. Front Psychol 2018; 9:2456. [PMID: 30618916 PMCID: PMC6297874 DOI: 10.3389/fpsyg.2018.02456] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Accepted: 11/20/2018] [Indexed: 01/12/2023] Open
Abstract
Background: There is a clear need for a standardized definition of recovery from eating disorders (EDs) and for self-report instruments to assess where individuals with an ED are situated at a given point of time along their process of illness and recovery. It has been acknowledged that psychological and cognitive symptoms are important to recovery in addition to physical and behavioral indices. This study proposes a 28-item multidimensional questionnaire encompassing the main features of recovery from ED, derived from the endorsement of different criteria by people with a lifetime ED diagnosis, family members and ED clinicians. Methods: Participants were 213 volunteers over the age of 18 (118 people with a lifetime ED diagnosis, 58 healthy family members of people with EDs and 37 ED clinicians), who completed the ED-15 and indicated online how important they thought each of 56 criteria were for recovery from an ED. Results: Four factors were identified in an exploratory factor analysis: Lack of Symptomatic Behavior (LSB), Acceptance of Self and Body (ASB), Social and Emotional Connection (SEC), and Physical Health (PH). Confirmatory factor analysis using the seven highest loading items from each subscale confirmed the structure validity of a shortened version of this questionnaire, the Eating Disorders Recovery Endorsement Questionnaire (EDREQ), which had excellent goodness-of-fit indices. Despite a few between-group differences, there was general agreement that LSB was most salient to recovery, followed by ASB, SEC, and PH in that order. Conclusion: Despite the absence of a standardized definition of recovery from ED, there is a general consensus about its components. The EDREQ is a psychometrically sound questionnaire containing items that people with an ED history, their family members and therapists all define as important components of recovery. The inclusion of emotional and psychosocial aspects of recovery in addition to symptomatic and medical aspects is important to expand treatment goals and the concept of recovery from EDs beyond symptom relief and the absence of disease markers. As a clinical tool, the EDREQ stands to assist in setting and refining therapeutic goals throughout therapy, and in establishing standardized, comparable norms for recovery levels in research.
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Affiliation(s)
- Rachel Bachner-Melman
- Clinical Psychology Graduate Program, Ruppin Academic Center, Hadera, Israel
- The Paul Baerwald School of Social Work and Social Welfare, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Lilac Lev-Ari
- Clinical Psychology Graduate Program, Ruppin Academic Center, Hadera, Israel
| | - Ada H. Zohar
- Clinical Psychology Graduate Program, Ruppin Academic Center, Hadera, Israel
| | - Shay Lee Lev
- Clinical Psychology Graduate Program, Ruppin Academic Center, Hadera, Israel
- Student Counselling Service, University of Haifa, Haifa, Israel
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Manualised Cognitive Behaviour Therapy for Anorexia Nervosa: Use of Treatment Modules in the ANTOP Study. J Clin Med 2018; 7:jcm7110398. [PMID: 30380658 PMCID: PMC6262271 DOI: 10.3390/jcm7110398] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 10/25/2018] [Accepted: 10/26/2018] [Indexed: 11/17/2022] Open
Abstract
Standardised treatment manuals facilitate therapy planning and enhance comparability for research purposes. Within the Anorexia Nervosa Treatment of Out Patients (ANTOP) study, the largest multisite outpatient intervention trial in anorexia nervosa (AN) to date, manualised enhanced cognitive-behavioural therapy (CBT-E) was offered as one treatment modality. The manual consisted of 9 modules, of which Motivation, Nutrition, Formulation and Relapse Prevention were compulsory. Homework worksheets were provided, to ensure the transfer of therapeutic improvements to daily life. This study investigated the use of modules and worksheets in order to explore practice styles of trained therapists in the treatment of AN. This secondary analysis was based on log-sheets (n = 2604) CBT-E therapists completed after each session. Frequencies of modules and worksheets used across all sessions were calculated. Relationships, such as that between use of module and duration of illness, were examined. The most commonly used module was Motivation. In patients with longer illness duration, the module Self Esteem seemed to be particularly important. The worksheet Scales, balancing the pros and cons of AN, was prioritised by therapists. The results underline the importance of motivational work in the treatment of AN, including validating the ambivalence experienced by most AN patients. With increasing duration of illness, resource-oriented elements, such as self esteem stabilisation, should be of focus.
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Kim YR, Cardi V, Lee GY, An S, Kim J, Kwon G, Kim JW, Eom JS, Treasure J. Mobile Self-Help Interventions as Augmentation Therapy for Patients with Anorexia Nervosa. Telemed J E Health 2018; 25:740-747. [PMID: 30325700 DOI: 10.1089/tmj.2018.0180] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Background: It has been suggested that patients with anorexia nervosa (AN) who are resistant to first-line treatment would benefit from second-level interventions targeting specific features, an adaptive form of intervention. Guided self-help programs administered via mobile technology have the dual focus of instigating behavior change and managing anxiety associated with eating disorders in the moment and in users' naturalistic environments. Introduction: We evaluated the feasibility, acceptability, and preliminary augmentative effects of mobile-based, guided self-help interventions (Recovery vodcasts) after initial unsuccessful first-line treatments for patients with AN. Materials and Methods: Patients with AN who were unsuccessful in their treatments were recruited to access Recovery vodcasts as augmentation treatment for 3 weeks in Korea. Acceptability and feasibility of the intervention were evaluated, and qualitative feedback was collected. Preliminary treatment effects of adding the Recovery vodcasts were assessed, including eating disorder pathology, anxiety and depression symptoms, and body mass index. Results: The Recovery vodcasts were acceptable for patients with AN. The patients' psychopathologies of eating disorders improved with augmentation of the vodcasts in their first-line treatments. In addition, there was a tendency toward improvement of affective symptoms. The participants' feedback suggested that the intervention could be improved. Conclusions: The study demonstrated that the Recovery vodcasts were well accepted by Korean patients with AN. Moreover, augmentation of the Recovery vodcasts could facilitate improvements in psychopathology of eating disorders, anxiety, and mood symptoms for patients with AN.
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Affiliation(s)
- Youl-Ri Kim
- 1Department of Neuropsychiatry, Seoul Paik Hospital, Inje University, Seoul, South Korea.,2Institute of Eating Disorders and Mental Health, Inje University, Seoul, South Korea
| | - Valentina Cardi
- 3Section of Eating Disorders, Department of Psychological Medicine, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom
| | - Gi Young Lee
- 2Institute of Eating Disorders and Mental Health, Inje University, Seoul, South Korea
| | - Sohyun An
- 2Institute of Eating Disorders and Mental Health, Inje University, Seoul, South Korea
| | - Jione Kim
- 2Institute of Eating Disorders and Mental Health, Inje University, Seoul, South Korea
| | - Gemma Kwon
- 2Institute of Eating Disorders and Mental Health, Inje University, Seoul, South Korea
| | - Jong Won Kim
- 4Department of Healthcare Information Technology, Inje University, Gimhae, South Korea
| | - Jin-Sup Eom
- 5Department of Psychology, Chungbuk National University, Cheongju, South Korea
| | - Janet Treasure
- 3Section of Eating Disorders, Department of Psychological Medicine, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom
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Enrique A, Bretón-López J, Molinari G, Roca P, Llorca G, Guillén V, Fernández-Aranda F, Baños RM, Botella C. Implementation of a Positive Technology Application in Patients With Eating Disorders: A Pilot Randomized Control Trial. Front Psychol 2018; 9:934. [PMID: 29942272 PMCID: PMC6004415 DOI: 10.3389/fpsyg.2018.00934] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 05/22/2018] [Indexed: 01/31/2023] Open
Abstract
Background: Positive psychological interventions (PPIs) have been suggested to produce benefits in patients with eating disorders (ED) by improving well-being, which might act as a buffer of the harmful effects caused by the disorder. Best Possible Self (BPS) is a PPI which consists of writing and envisioning a future where everything has turned out in the best possible way. In this regard, positive technology (PT) can be of considerable benefit as it allows to implement specific PPIs that have already shown efficacy. Objective: This study tested the preliminary efficacy of the BPS exercise implemented through a PT application and carried out for 1 month, in improving positive functioning measures, compared to a control condition, in patients with ED. Follow-up effects were also explored at 1 and 3 months later. Methods: This is a pilot randomized controlled trial, with two experimental conditions. Participants were 54 outpatients, who were receiving ongoing specialized treatment in ED services. 29 participants were randomly allocated to the BPS intervention and 25 to the control exercise. The sample was composed mostly by females and the mean age was 27 years. In the intervention group, participants had to write about their BPS. In the control group participants had to write about their daily activities. The exercise was conducted through the Book of Life, which is a PT application that allows users to add multimedia materials to the written content. Measures of future expectations, affect, dispositional optimism, hope and self-efficacy were assessed at different time frames. Results: Findings showed that all participants improved over time and there were no statistically significant differences between conditions on the specific measures. These effects were not influenced by prior levels of ED severity. Within-group effect sizes indicate a greater benefit for the participants in the BPS condition, compared to the control condition, on nearly all the measures. Conclusion: Results indicated that PT produced modest improvements in patients with EDs that are receiving current treatment for ED. More empirical attention is needed to explore the potential benefits of PPIs as supporting tools in the prevention and treatment of EDs. Trial registration: clinicaltrails.gov Identifier: NCT03003910, retrospectively registered December 27, 2016.
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Affiliation(s)
- Angel Enrique
- Department of Basic, Clinical Psychology and Psychobiology, Universitat Jaume I, Castellón de la Plana, Spain
| | - Juana Bretón-López
- Department of Basic, Clinical Psychology and Psychobiology, Universitat Jaume I, Castellón de la Plana, Spain.,CIBER de Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Madrid, Spain
| | - Guadalupe Molinari
- Department of Basic, Clinical Psychology and Psychobiology, Universitat Jaume I, Castellón de la Plana, Spain
| | - Pablo Roca
- Department of Personality, Assessment and Psychological Treatment, Complutense University of Madrid, Madrid, Spain
| | - Ginés Llorca
- Psychiatry Service, Consorcio Hospitalario Provincial de Castellón, Castellón de la Plana, Spain
| | - Verónica Guillén
- Department of Personality, Evaluation and Psychological Treatment, University of Valencia, Valencia, Spain
| | - Fernando Fernández-Aranda
- CIBER de Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Madrid, Spain.,Department of Psychiatry, University Hospital of IDIBELL - Bellvitge Biomedical Research Institute, Barcelona, Spain
| | - Rosa M Baños
- CIBER de Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Madrid, Spain.,Department of Personality, Evaluation and Psychological Treatment, University of Valencia, Valencia, Spain
| | - Cristina Botella
- Department of Basic, Clinical Psychology and Psychobiology, Universitat Jaume I, Castellón de la Plana, Spain.,CIBER de Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Madrid, Spain
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Lord VM, Reiboldt W, Gonitzke D, Parker E, Peterson C. Experiences of recovery in binge-eating disorder: a qualitative approach using online message boards. Eat Weight Disord 2018; 23:95-105. [PMID: 27796846 DOI: 10.1007/s40519-016-0335-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Accepted: 10/07/2016] [Indexed: 11/29/2022] Open
Abstract
PURPOSE In this study, qualitative methods were employed to analyze secondary data from the anonymous postings of a pro-recovery website in an effort to investigate the changes in thinking of binge-eating disorder (BED) sufferers who were able to recover from the disorder, understand more fully how guilt and self-blame affect recovery, and explore the perceived motivators and challenges to recovery. METHOD 681 messages from 65 participants pertaining to BED were analyzed from January 1, 2014-January 1, 2015 through thematic analysis. Coding strategies were employed to reveal patterns within the experiences of the participants. RESULTS The researchers identified three themes surrounding "changes in thinking" from analysis of the message board postings: admitting the disorder, recognizing unhealthy coping behaviors, and seeing recovery. Further analysis of postings suggested that guilt and self-blame hinder recovery by promoting a feedback cycle of binging, which leads to further guilt and self-blame. The data ultimately identified experiences that resulted in or hindered recovery. The experience of validation appeared to result in recovery; those who experienced validation were less inclined to engage in disordered eating behaviors. Conversely, weight loss or attempts at weight loss hindered recovery by ultimately promoting more disordered eating behaviors. CONCLUSION This qualitative analysis of message board postings offers authentic, credible data with a unique perspective. Practitioners working in the field of eating disorders such as registered dietitian nutritionists or therapists might use evidence from the data to guide their practice.
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Affiliation(s)
- Vanessa M Lord
- Department of Family and Consumer Sciences, California State University, Long Beach, Long Beach, CA, 90840, USA
| | - Wendy Reiboldt
- Department of Family and Consumer Sciences, California State University, Long Beach, Long Beach, CA, 90840, USA
| | - Dariella Gonitzke
- Department of Family and Consumer Sciences, California State University, Long Beach, Long Beach, CA, 90840, USA
| | - Emily Parker
- Department of Family and Consumer Sciences, California State University, Long Beach, Long Beach, CA, 90840, USA
| | - Caitlin Peterson
- Department of Family and Consumer Sciences, California State University, Long Beach, Long Beach, CA, 90840, USA.
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Dawson L, Mullan B, Touyz S, Rhodes P. Are recovery stories helpful for women with eating disorders? A pilot study and commentary on future research. J Eat Disord 2018; 6:21. [PMID: 30128153 PMCID: PMC6092853 DOI: 10.1186/s40337-018-0206-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 07/04/2018] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Anecdotally it is well known that eating disorder memoirs are popular with people with anorexia nervosa and recovery stories are readily available online. However, no research to date has empirically explored whether such stories are helpful for current sufferers. The aim of the current pilot study was to explore the efficacy of recovery narratives as a means of improving motivation and self-efficacy and to qualitatively explore patient perspectives of such stories. METHOD Fifty-seven women with anorexia nervosa and subclinical anorexia nervosa participated in this online study. Participants were randomised to either receive recovery stories or to a wait-list control group. After completing baseline measures, participants read five stories about recovery, and completed post-intervention measures two weeks later. RESULTS The quantitative results indicated that reading stories of recovery had no effect on motivation and self-efficacy over a two-week period. In contrast, the qualitative results showed that the stories generated thoughts about the possibility of recovery and the majority indicated they would recommend them to others. CONCLUSIONS This study adds to a growing body of research exploring the integration of voices of lived experience into treatment approaches. Future research should focus on 1) identifying for whom and at which stage of illness recovery stories might be helpful; 2) the mechanism via which they might operate; and 3) the most helpful way of presenting such stories.
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Affiliation(s)
- Lisa Dawson
- Eating Disorder Service, The Sydney Children's Hospital Network, Westmead Campus, Sydney, Australia.,2Centre for Family Based Mental Health Care, St Vincent's Private Hospital, Sydney, Australia
| | - Barbara Mullan
- 3School of Psychology and Speech Pathology, Curtin University, Perth, WA Australia
| | - Stephen Touyz
- 4School of Psychology, The University of Sydney, Sydney, Australia
| | - Paul Rhodes
- 4School of Psychology, The University of Sydney, Sydney, Australia
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Haracz K, Robson E. A bidirectional relationship between eating disorder symptoms and quality of life supports a recovery focussed approach to treatment. Aust Occup Ther J 2017; 64:345-347. [PMID: 28836332 DOI: 10.1111/1440-1630.12413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Kirsti Haracz
- School of Health Science, University of Newcastle, Callaghan, New South Wales, Australia
| | - Emma Robson
- School of Health Science, The University of Newcastle, Callaghan, New South Wales, Australia
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Musolino C, Warin M, Wade T, Gilchrist P. Developing shared understandings of recovery and care: a qualitative study of women with eating disorders who resist therapeutic care. J Eat Disord 2016; 4:36. [PMID: 28018596 PMCID: PMC5159948 DOI: 10.1186/s40337-016-0114-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Accepted: 08/04/2016] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND This paper explores the differing perspectives of recovery and care of people with disordered eating. We consider the views of those who have not sought help for their disordered eating, or who have been given a diagnosis but have not engaged with health care services. Our aim is to demonstrate the importance of the cultural context of care and how this might shape people's perspectives of recovery and openness to receiving professional care. METHOD This study utilised a mixed methods approach of ethnographic fieldwork and psychological evaluation with 28 women from Adelaide, South Australia. Semi-structured interviews, observations, field notes and the Eating Disorder Examination were the primary forms of data collection. Data was analysed using thematic analysis. RESULTS & DISCUSSION Participants in our study described how their disordered eating afforded them safety and were consistent with cultural values concerning healthy eating and gendered bodies. Disordered eating was viewed as a form of self-care, in which people protect and 'take care' of themselves. These subjectively experienced understandings of care underlie eating disorder behaviours and provide an obstacle in seeking any form of treatment that might lead to recovery. CONCLUSION A shared understanding between patients and health professionals about the function of the eating disorder may avoid conflict and provide a pathway to treatment. These results suggest the construction of care by patients should not be taken for granted in therapeutic guidelines. A discussion considering how disordered eating practices are embedded in a matrix of care, health, eating and body practices may enhance the therapeutic relationship.
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Affiliation(s)
- Connie Musolino
- Gender Studies & Social Analysis, School of Social Sciences, Faculty of Arts, University of Adelaide, Napier Building, Adelaide, South Australia 5005 Australia
| | - Megan Warin
- Gender Studies & Social Analysis, School of Social Sciences, Faculty of Arts, University of Adelaide, Napier Building, Adelaide, South Australia 5005 Australia
| | - Tracey Wade
- School of Psychology, Flinders University, Adelaide, South Australia Australia
| | - Peter Gilchrist
- Psychiatrist in private practice, Adelaide, South Australia Australia
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Quality of life as a vulnerability and recovery factor in eating disorders: a community-based study. BMC Psychiatry 2016; 16:328. [PMID: 27724943 PMCID: PMC5057465 DOI: 10.1186/s12888-016-1033-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Accepted: 09/07/2016] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Emerging evidence suggests that changes in quality of life (QoL) predicts later changes in eating disorder (ED) symptoms. The objective of this study was to explore individual sufferers' perspectives on the influence of QoL on the onset, maintenance, and/or remission of ED symptoms. METHOD 19 women from the community with a history of eating disorders (n = 13 currently symptomatic; n = 6 recovered) were interviewed about their observations on the relationship between QoL and ED symptoms over time in their own lives. Interviews were audio-taped and transcribed, and then thematically analysed. RESULTS Thematic analysis uncovered two major themes: 1. QoL as a Vulnerability Factor, and 2. QoL as a Recovery Factor. In relation to the first theme, onset of ED symptoms was discussed by women in this study as having been triggered by impairment in QoL, including a general sense of lacking control in life, stress, abusive intimate relationships, poor role modelling from family, physical impairment related to obesity, peer pressure, and weight-related teasing. On the other hand, and in relation to the second theme, subsequent improvement in QoL was nominated as central to symptom improvement and recovery. QoL improvement was described by participants differently, but included increased general satisfaction in life, emotional maturation, prioritising and improving physical health, the development of a supportive intimate relationship and social relationships, and having children. CONCLUSIONS Impairment in QoL may act as a trigger for the onset and maintenance of ED symptoms, whereas improvement in QoL may be central to eating disorder improvement and eventual recovery. Treatment should involve consideration of a core focus on QoL improvement as a potential 'backdoor' approach to improving ED symptoms.
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Robinson PH, Kukucska R, Guidetti G, Leavey G. Severe and enduring anorexia nervosa (SEED-AN): a qualitative study of patients with 20+ years of anorexia nervosa. EUROPEAN EATING DISORDERS REVIEW 2016; 23:318-26. [PMID: 26059633 DOI: 10.1002/erv.2367] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Revised: 01/28/2015] [Accepted: 03/05/2015] [Indexed: 11/10/2022]
Abstract
Little is known about how patients with long-term eating disorders manage their clinical problems. We carried out a preliminary qualitative study (using Thematic Analysis) of patients with severe and enduring anorexia nervosa (SEED-AN) in which we undertook recorded interviews in eight participants whose conditions had lasted 20-40 years. We found 15 principle features in physical, psychological, social, family, occupational and treatment realms. Psychological and social realms were most affected. Severe physical problems were reported. They described feelings of unworthiness, frugality regarding money and obsessive time-keeping. Persisting with negligible social networks, participants described depression and hopelessness, while somehow achieving a sense of pride at their endurance and survival in spite of the eating disorder. They emphasized the importance of professional help in managing their care. The severe and enduring description, often reserved for people with psychotic illness, is appropriately applied to SEED-AN, which has major impacts in all realms.
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Affiliation(s)
- Paul H Robinson
- Barnet Enfield and Haringey Mental Health Trust, UK.,University College London, UK
| | | | | | - Gerard Leavey
- University College London, UK.,Ulster University, UK
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Abstract
PURPOSE OF REVIEW Severe and enduring eating disorder is a new concept to the field that has potential to aid assessment and inform treatment. The aim of this review is to report recent developments in the conceptualization and treatment of people with severe and enduring eating disorder. RECENT FINDINGS A systematic search identified 28 included papers. These addressed conceptualization of recovery and staging models (4 studies), clinical care, presentations and treatment experiences (7 studies), four new randomized controlled trials of treatment (9 studies), two open trials of novel approaches (2 studies) and problems of treatment resistance and involuntary care (6 studies). SUMMARY The staging model appears to have validity and clinical utility in anorexia nervosa, but this is less clear in other eating disorders. Most literature on treatment, including new randomised controlled trials, is on underweight individuals, and there is a small literature on emerging psychological therapies that may improve outcomes. There is an expectation that with better treatment engagement, there may also be a reduced need for involuntary interventions.
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Buckett G, Vollmer-Conna U. Clinical practice guidelines for eating disorders - Comments from the front line. Aust N Z J Psychiatry 2015; 49:844-6. [PMID: 26228730 DOI: 10.1177/0004867415598010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Geoffrey Buckett
- Eating Disorders Service, Northside West Clinic, Sydney, NSW, Australia
| | - Uté Vollmer-Conna
- Department of Human Behaviour, School of Psychiatry, University of New South Wales, Sydney, NSW, Australia
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Sharma MP, Kar SK. Surreptitious metformin abuse in anorexia nervosa presenting as periodic hypoglycaemia. Aust N Z J Psychiatry 2015; 49:851-2. [PMID: 25916797 DOI: 10.1177/0004867415584642] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Maha Prakash Sharma
- Department of Psychiatry, King George's Medical University (KGMU), Lucknow, India
| | - Sujit Kumar Kar
- Department of Psychiatry, King George's Medical University (KGMU), Lucknow, India
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Touyz S, Hay P. Severe and enduring anorexia nervosa (SE-AN): in search of a new paradigm. J Eat Disord 2015; 3:26. [PMID: 26236477 PMCID: PMC4521346 DOI: 10.1186/s40337-015-0065-z] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Accepted: 07/22/2015] [Indexed: 12/22/2022] Open
Affiliation(s)
- Stephen Touyz
- School of Psychology, Faculty of Science, University of Sydney, Sydney, Australia
| | - Phillipa Hay
- Centre for Health Research School of Medicine, University of Western Sydney, Sydney, Australia
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