Treatment providers with a personal history of eating pathology: a qualitative examination of common experiences

Treating eating disorders by professionals with similar experiences: A systematic review

OBJECTIVE

Although a significant number of professionals who provide eating disorder (ED) treatment have lived experience with an ED in the past, there is no consensus on whether these professionals should use these experiences in treatment. This review aims to evaluate current literature on recovered professionals with an ED past treating ED patients, unravelling advantages and disadvantages in treatment, the impact on professionals and their surroundings, and implications for practice.

METHOD

A systematic literature search was conducted which included 10 articles. We analysed qualitative data through a systematic synthesis. Strength of evidence was calculated for each subtheme.

RESULTS

Three themes and 14 subthemes were divided into categories. The category 'treatment (patient-professional interaction)' was divided into: advantages, disadvantages and other implications for treatment. Additionally, the category 'professionals themselves' included subthemes that directly impact or relate to ED professionals: recovery as a non-linear process, the significant role of self-care and adverse feelings of professionals. Finally, the category 'work settings' included: company culture and training, supervision and professional development.

DISCUSSION

Recovered ED professionals are a promising addition to ED treatment due to the enhanced expertise of the professional. However, attention should be paid to the risk of distorted boundaries between patient and professional.

Factors Affecting Mental Health Professionals' Sharing of Their Lived Experience in the Workplace: A Scoping Review

OBJECTIVE

Research has suggested that some mental health professionals (MHPs) continue to hold stigmatized beliefs about persons with emotional distress. These beliefs may be amenable to contact-based interventions with similar peers. To inform future interventions, policy, and research, this scoping review examined existing literature to identify factors that affect disclosure of lived experience by MHPs to colleagues and supervisors.

METHODS

A systematic search was conducted of four online databases, gray literature, and the reference lists of included articles. Primary research studies of any design conducted with MHPs with lived experience of emotional distress and their colleagues were included. The findings of included studies were inductively coded within the themes of enabling, constraining, and intrapersonal factors influencing disclosure.

RESULTS

A total of 23 studies were included in data extraction and synthesis. Factors that influenced MHPs' sharing of their lived experience in the workplace were categorized into five overarching themes: the "impaired professional," the "us and them" divide, the "wounded healer," belief in the continuum of emotional distress, and negotiating hybrid identities. MHPs with lived experience described feeling conflict between professional and service user identities that affected the integration and use of their clinical and experiential knowledge. Enabling factors reflected best-practice human resource management, such as organizational leadership, access to supervision and training, inclusive recruitment practices, and the provision of reasonable accommodations.

CONCLUSIONS

Findings of this scoping review suggest that organizational interventions to support MHPs in order to share their lived experience may improve workplace diversity and well-being, with implications for service users' experience.

Eating disorders "mental health literacy": a scoping review

Background: While it is apparent that much has been learned about "mental health literacy" (MHL) relating to certain mental health problems, such as depression, in recent years, what has been learned about MHL relating to eating disorders (ED-MHL) is unclear.Aims: A scoping review was conducted to inform the current state of knowledge in this field.Methods: A systematic search of relevant literature published between 1997 and 2017 was followed by a narrative synthesis of the findings.Results: The number of eligible studies increased from 32 in 1997-2001 to 98 in 2012-2017 (total = 264). Most studies originated from North America or Europe, recruited individuals with EDs receiving treatment or college students and included both female and male or only female participants. The majority of studies examined MHL relating to anorexia nervosa or bulimia nervosa and examined attitudes which facilitate recognition and appropriate help-seeking and knowledge and beliefs about professional help available.Conclusion: Interest in ED-MHL is increasing and there is now a considerable body of research addressing some aspects of ED-MHL in a range of study populations. Notable gaps in the literature exist, including a paucity of information about ED-MHL relating to EDs other than anorexia nervosa and bulimia nervosa, ED behaviour in males and the use of self-help interventions. We hope the findings will provide an incentive to further research in these and other aspects of ED-MHL.

Orthorexia Nervosa and Eating Disorder Symptoms in Registered Dietitian Nutritionists in the United States

BACKGROUND

Registered dietitian nutritionists are trained to identify optimal food choices for clients based on medical state and lifestyle. Orthorexia nervosa (ON) is a proposed disorder related to obsessions about eating healthfully. Eating disorders (EDs) are serious mental illnesses with symptoms related to eating, body image, and self-esteem. Both ON and EDs are more common among RDNs than the general population.

OBJECTIVE

This study examined the prevalence of ON and EDs in RDNs in the United States and, among this sample, assessed whether the presence of ON symptoms related to symptoms of EDs, including weight, shape, eating, and restraint.

DESIGN

A cross-sectional design compared responses for participants after dividing into three groups: those scoring at-risk for ON, those with a current or past ED, and a comparison group.

PARTICIPANTS

A sample of 2,500 RDNs were invited to complete surveys electronically; 636 responses were received.

MAIN OUTCOME MEASURES

Scores on the Orthorexia Nervosa Questionnaire (ORTO-15) and Eating Disorder Examination Questionnaire (EDE-Q) determined prevalence of ON and EDs. Differences in these measures, and body mass index were compared among the three groups.

STATISTICAL ANALYSES

Analysis of variance and χ² analyses were used to compare the groups.

RESULTS

For the entire sample, scores on the ORTO-15 suggested 49.5% were at risk for ON, and scores on the EDE-Q suggested 12.9% were at risk for an ED, with 8.2% of RDNs self-disclosing treatment for an ED. Both the group disclosing ED treatment and the group at risk for ON had a lower mean body mass index, lower scores on the ORTO-15, and higher scores on the EDE-Q and all its subscales than the comparison group.

CONCLUSIONS

Clarifying the relationship between ON and EDs is warranted because ON symptoms appear to be associated not only with disturbances in eating, but also with elevated shape and weight concerns.

Eating attitudes and behaviours of students enrolled in undergraduate nutrition and dietetics degrees

AIM

The prevalence of disordered eating has been frequently reported in university students; however, the prevalence amongst Australian undergraduate students studying degrees with a focus on nutrition is uncertain. The aims of this study were to: (i) assess eating attitudes and behaviours of students enrolled in nutrition and dietetics, (ii) compare those to students enrolled in another health degree of occupational therapy (OT) and (iii) explore possible relationships between eating attitudes and behaviours and other characteristics of both cohorts.

METHODS

This cross-sectional observational study investigated self-reported anthropometric characteristics, eating attitudes and behaviours and self-esteem using a series of questionnaires.

RESULTS

Participants included 137 students (119 females, 18 males) with a mean age of 27.1 ± 8.7 years. Fourteen percent of nutrition and dietetics and 11% of OT students had disordered eating attitudes scores that were symptomatic of an eating disorder. Mean eating attitude scores did not differ between the degrees of study. Students in nutrition and dietetics showed significantly higher levels of cognitive restraint and less emotional eating than OT students. Enrolment in the first year of study was the strongest predictor of symptomatic eating attitudes.

CONCLUSIONS

These findings support previously expressed concern about presence of disordered eating in nutrition and dietetics undergraduates. Collaboratively developed support mechanisms for preventing and managing disordered relationships with food would be of benefit to students enrolled in nutrition degrees to ensure ongoing professional integrity.

Recovered eating disorder therapists using their experiential knowledge in therapy: A qualitative examination of the therapists' and the patients' view

In the eating disorder (ED) field there is a lack of guidelines regarding the utilization of recovered therapists and the experiential knowledge they can bring to therapy. In this study, a qualitative design was used to examine recovered eating disorder therapists using their experiential knowledge and how this influences therapy and the patients they treat. Respectively, 205 patients (response rate 57%), and 26 recovered therapists (response rate 75%) completed a questionnaire about advantages and disadvantages of the utilization of experiential knowledge in therapy. Results showed that using experiential knowledge can have several advantages and disadvantages in therapy. Therapists can use this knowledge as a therapeutic intervention with specific goals, such as providing the patient with insight into the recovery process, establishing a working relationship, and enhancing hope for recovery. To be effective, self-disclosure and experiential knowledge need to be shared thoughtfully, and should not include specific details about ED symptoms. Other factors noted that enhanced the benefits of experiential knowledge included therapist self-insight and self-care, adequate training and guidance, and a safe work environment. Patients stated that being treated by a recovered therapist had a positive effect on their recovery process. It is advised to establish guidelines in the ED field about working with recovered therapists and the experiential knowledge they might use in therapy. Further research is needed on the process of when, how, and which experiential knowledge is shared by recovered therapists in therapy, and the effects of these interventions on patients and their treatment outcomes.

Eating disorder therapists' personal eating disorder history and professional ethics: an interpretive description

This qualitative study sought to explore and understand eating disorder (ED) therapists' perceptions of whether and how their personal ED histories had professional ethical relevance. Analysis of multiple interviews with 11 therapist-participants indicated that they perceived their personal ED histories as having substantial ethical relevance in their day-to-day practice with ED clients. The major categories of ethics experiences that emerged were: boundaries, therapist wellness, helpfulness of personal ED history, and openness regarding therapists' personal ED histories. The findings have practical utility for the education, training, and continuing education of ED-historied practitioners.