1
|
Marffy MJ, Fox J, Williams M. An exploration of the relationship between loneliness, the severity of eating disorder-related symptoms and the experience of the 'anorexic voice'. Psychol Psychother 2024; 97:122-137. [PMID: 37792343 DOI: 10.1111/papt.12502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Accepted: 09/22/2023] [Indexed: 10/05/2023]
Abstract
OBJECTIVES Many individuals with eating disorders (EDs) report the experience of an 'Anorexic voice' (AV). Negative experiences of loneliness are also often associated with EDs. This study sought to explore the relationship between experiences of loneliness, the frequency of the AV and the impact of this on ED symptom severity. DESIGN 165 individuals (mean age 27.54 years) who accessed online forums relating to EDs participated in this study. The sample included individuals who have experienced an AV [AV group (N = 141)] and those who have not [non-AV group (N = 23)]. METHODS The study utilised self-report measures via an online questionnaire to explore the predictive validity of loneliness and frequency of the AV on ED symptom severity. RESULTS Confirmatory analysis (AV group only) demonstrated the significance of the independent variables individually predicting ED symptom severity. However, a significant interaction was not found between the two primary variables in predicting ED symptom severity, more significantly than the influence of either variable alone. Exploratory analysis considered the differences between the two groups (AV and Non-AV), as well as considering alternate predictors. CONCLUSIONS The findings offer insight into possible drivers behind engagement with the AV, as part of ED presentations in the community.
Collapse
Affiliation(s)
| | - John Fox
- DClinPsy, Cardiff University, Cardiff, UK
| | | |
Collapse
|
2
|
Theodoropoulou O, Holyoak L, Caswell N, Gardner KJ. The continuation of non-physical abuse from childhood to adulthood in eating disorder patients: An interpretative phenomenological analysis. CHILD ABUSE & NEGLECT 2024; 149:106661. [PMID: 38295605 DOI: 10.1016/j.chiabu.2024.106661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 01/12/2024] [Accepted: 01/19/2024] [Indexed: 02/02/2024]
Abstract
BACKGROUND The ED literature has focused on the physical forms of childhood abuse with respect to eating disorders, overlooking non-physical abuse even though eating disorder patients report the latter either as primary experiences or as a revival of their childhood experiences. Additionally, there is no literature exploring whether adult eating disorder patients who have experienced childhood non-physical abuse continue to experience abuse as adults, and if they do, how well-being is impacted or linked with eating pathology. OBJECTIVE This study explored the lived experiences of eating disorders patients who have experienced non-physical childhood abuse in childhood and adulthood. PARTICIPANTS AND SETTINGS Six adult female eating disorder outpatients each took part in a semi-structured interview. METHODS This study used the Interpretative Phenomenological Analysis framework. RESULTS Three master themes and eleven superordinate themes were drawn from the analysis, addressing the research question: continuation of non-physical abuse across a lifetime, developmental factors and non-physical abuse, and non-physical abuse and eating pathology. CONCLUSIONS The participants' accounts indicate that childhood non-physical abuse is related to eating disorder onset, and abuse continuation in adulthood contributes to the disorder's maintenance. Moreover, the lifelong consequences of non-physical childhood abuse impact psychological factors, such as self-esteem, attachment and emotion regulation, affecting the individuals' adult lives and keeping participants inside a vicious cycle of trauma re-enactment. Low self-esteem is considered by the participants as the key factor for their disturbed relationship with food.
Collapse
Affiliation(s)
- Olga Theodoropoulou
- School of Psychology and Computer Science, University of Central Lancashire, Preston, Lancashire PR1 2HE, UK.
| | - Lynda Holyoak
- School of Psychology and Computer Science, University of Central Lancashire, Preston, Lancashire PR1 2HE, UK.
| | - Noreen Caswell
- School of Psychology and Computer Science, University of Central Lancashire, Preston, Lancashire PR1 2HE, UK.
| | - Kathryn Jane Gardner
- School of Psychology and Computer Science, University of Central Lancashire, Preston, Lancashire PR1 2HE, UK
| |
Collapse
|
3
|
Dunlop R, Simonds LM, John M. Self-disclosure by adolescents in therapy for eating difficulties: A Q-Methodology study. Clin Child Psychol Psychiatry 2024; 29:90-102. [PMID: 37879067 PMCID: PMC10748442 DOI: 10.1177/13591045231209648] [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] [Indexed: 10/27/2023]
Abstract
Facilitating client self-disclosure is essential to therapeutic effectiveness. Given the long-term consequences of eating difficulties for adolescents, there is a need for more research on self-disclosure in this group. This study investigated factors likely to influence adolescents' decisions to self-disclose during psychological therapy for eating difficulties using Q-methodology. Participants (n = 28), recruited through child and adolescent mental health services in the UK, completed a task that involved sorting 47 statements to represent their viewpoint on self-disclosure. The 28 completed sorts were subjected to a by-participant factor analysis in order to identify distinct viewpoints in the sample. Three distinct factors were extracted. One factor emphasised the importance of therapist self-disclosure on decisions to disclose. In contrast, another factor placed more emphasis on the influence of eating disorder identity and readiness to change on disclosure decisions. The third factor placed emphasis on the quality of the therapeutic relationship and readiness to change as having most influence. Given the absence of a unifying factor representing what influences the decision to disclose, clinicians should ensure they explore with young people what might influence their decision to disclose.
Collapse
Affiliation(s)
- Rhiannon Dunlop
- Department of Psychological Interventions, University of Surrey, UK
- Solent East CAMHS Eating Disorder Service, Solent NHS Trust, UK
| | - Laura M Simonds
- Department of Psychological Interventions, University of Surrey, UK
| | - Mary John
- Department of Psychological Interventions, University of Surrey, UK
| |
Collapse
|
4
|
Thompson A, Calissano C, Treasure J, Ball H, Montague A, Ward T, Cardi V. A case series to test the acceptability, feasibility and preliminary efficacy of AVATAR therapy in anorexia nervosa. J Eat Disord 2023; 11:181. [PMID: 37833732 PMCID: PMC10571357 DOI: 10.1186/s40337-023-00900-1] [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: 03/28/2023] [Accepted: 09/26/2023] [Indexed: 10/15/2023] Open
Abstract
BACKGROUND Patients with anorexia nervosa tend to experience an inner "eating disorder" voice. They struggle to recognise and assert their own identity over the illness's identity and relate to it from a powerless and subordinate position. AVATAR therapy was developed to help patients with psychosis to gain greater power and control over distressing voices. The goal of this study was to test the feasibility, acceptability, safety and preliminary efficacy of an adaptation of AVATAR therapy for anorexia nervosa. METHODS Twelve adult patients with anorexia nervosa were recruited. Ten completed an assessment session and between five to seven therapy sessions. The assessment session consisted in the creation of an avatar to represent the "eating disorder". This was accomplished by manipulating auditory and visual characteristics through a specialist computer software. During the therapy sessions, patients interacted with the avatar to assert their own desires and will. Patients completed baseline, end of intervention and follow-up (4-week) online questionnaires. A non-concurrent multiple baselines single case experimental design (SCED) was used (A1BA2). Feasibility, acceptability, safety and preliminary efficacy of the intervention were assessed. RESULTS The therapy met pre-specified criteria relating to (1) Feasibility: sample recruited within three months; retention rate at the end of the treatment phase = 81.9%; therapy completion rate = 90.1%. (2) Safety: no serious adverse events associated with the intervention. (3) Acceptability: mean ratings = 7.5 (SD = 2.61) out of ten, on a 0-10 scale of acceptability (10 = complete satisfaction). With regards to efficacy, participants reported significantly lower levels of distress associated with the eating disorder voice and higher levels of self-compassion at the end of treatment. No other significant changes were observed in frequency of the eating disorder voice, voice's characteristics, such as omnipotence and malevolence, eating disorder symptoms and symptoms of anxiety, depression and stress. Patients' feedback indicated that the therapy had helped with their ability to stand up to the illness, make positive changes around eating, and increase their motivation to recover and self-compassion. CONCLUSION AVATAR therapy for anorexia nervosa is feasible, acceptable and safe for patients. Larger studies are needed to test clinical efficacy. TRIAL REGISTRATION The study was pre-registered on the clinicaltrials.gov registry (https://clinicaltrials.gov/ct2/show/NCT04778423).
Collapse
Affiliation(s)
| | | | - Janet Treasure
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, SE5 8AF, UK
| | - Hannah Ball
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, M13 9NT, UK
- Manchester Mental Health NHS Foundation Trust, Manchester, M25 3BL, UK
| | - Alice Montague
- North East London Foundation NHS Trust, London, E17 3HP, UK
- Department of Psychology, Department of Clinical, Educational, and Health Psychology, University College London, London, WC1E 7HB, UK
| | - Thomas Ward
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, SE5 8AF, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Valentina Cardi
- Department of General Psychology, University of Padova, Padova, Italy.
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, SE5 8AF, UK.
| |
Collapse
|
5
|
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.
Collapse
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
| |
Collapse
|
6
|
Howard TLM, Williams MO, Woodward D, Fox JRE. The relationship between shame, perfectionism and Anorexia Nervosa: A grounded theory study. Psychol Psychother 2023; 96:40-55. [PMID: 36161754 PMCID: PMC10087809 DOI: 10.1111/papt.12425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 07/05/2022] [Accepted: 08/24/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The aim of this study was to explore the potential relationship between shame, perfectionism and Anorexia Nervosa (AN) and their impact on recovery from AN. METHOD Semi-structured interviews were conducted with 11 people currently accessing services for AN. Interviews were transcribed and analysed using constructivist-grounded theory methodology. RESULTS A model was developed which found a vicious cycle between shame and perfectionism. Participants tried to alleviate their feelings of shame by striving for perfectionism, however failing caused them more shame. Participants who disclosed childhood trauma believed their shame preceded their perfectionism. Participants who did not disclose trauma either believed their perfectionism preceded shame or they were unsure of which occurred first. Participants' responses suggested the following pathways from perfectionism to AN: needing goals; the need for a perfect life including a perfect body and AN being something they could be perfect at. The pathways identified between shame and AN entailed mechanisms via which AN could be used to escape shame, either by seeking pride through AN, seeking to numb shame through AN, seeking to escape body shame and punishing the self. AN was found to feed back into shame in two ways: when people had AN they felt ashamed when they broke their dietary rules, and also simultaneously people felt ashamed of their AN as they were not able to recover. Shame and perfectionism influenced one another in a cyclical pattern, in which shame drove perfectionism and not attaining high standards led to shame. Shame and perfectionism also impacted on recovery in several ways. AN functioned to numb participants' emotions, becoming part of their identity over time. AN also brought respite from a constant striving towards perfectionism. The need for a perfect recovery also influenced their motivation to engage in treatment, and fear of a return of strong emotions was another deterrent to recovery. CONCLUSION The findings of this paper show perfectionism and shame to both be important in the aetiology and maintenance of AN and to have an impact on recovery from AN.
Collapse
Affiliation(s)
- Tina L. M. Howard
- Clinical Psychology, School of PsychologyCardiff UniversityCardiffUK
- Cardiff and Vale University Health BoardCardiffUK
| | - Marc O. Williams
- Clinical Psychology, School of PsychologyCardiff UniversityCardiffUK
- Cardiff and Vale University Health BoardCardiffUK
| | | | - John R. E. Fox
- Clinical Psychology, School of PsychologyCardiff UniversityCardiffUK
- Cardiff and Vale University Health BoardCardiffUK
| |
Collapse
|
7
|
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.
Collapse
Affiliation(s)
- Rosiel Elwyn
- Thompson Institute, University of the Sunshine Coast, Birtinya, QLD, Australia.
| |
Collapse
|
8
|
Griffin C, Fenner P, Landorf KB, Cotchett M. Art therapy and eating disorders: a mixed methods feasibility study. ARTS IN PSYCHOTHERAPY 2023. [DOI: 10.1016/j.aip.2023.101994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
|
9
|
Morrison J, Williams MO, Fox JRE. Negative childhood events and the development of the anorexic voice: A grounded theory. Psychol Psychother 2022; 95:1018-1035. [PMID: 35894418 PMCID: PMC9796900 DOI: 10.1111/papt.12416] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 06/14/2022] [Accepted: 06/25/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND Many individuals diagnosed with anorexia nervosa (AN) describe their disorder as being represented by an internal 'anorexic voice' (AV). Previous studies have identified associations between eating psychopathology and multifarious forms of adverse life experiences. AIMS This study explores the relationship between adverse experiences in childhood and the development of the AV. MATERIALS AND METHODS Twelve women who had the experience of the AV in the context of a diagnosis of AN took part in semi-structured interviews. The interview data were analysed using a constructivist grounded theory methodology. RESULTS Participants recalled feeling unsafe in a variety of relationships and a theory was constructed in which the AV provides a sense of conditional safety, becoming increasingly hostile and belittling when it is disobeyed, revealing similar characteristics to abusers and bullies in childhood. DISCUSSION Findings are related to the broader literature on the link between trauma and eating disorders, and to existing theories of internal voices. CONCLUSIONS The findings have implications for a trauma-focused approach when working with the AV.
Collapse
|
10
|
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.
Collapse
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
| |
Collapse
|
11
|
Barriers and Enablers to Help-Seeking Behaviour for Mental Health Reasons Among Community Dwelling Older Adults With Anxiety: Mixed-Methods Systematic Review. JOURNAL OF AFFECTIVE DISORDERS REPORTS 2022. [DOI: 10.1016/j.jadr.2022.100440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
|
12
|
Vinchenzo C, Lawrence V, McCombie C. Patient perspectives on premature termination of eating disorder treatment: a systematic review and qualitative synthesis. J Eat Disord 2022; 10:39. [PMID: 35296356 PMCID: PMC8928624 DOI: 10.1186/s40337-022-00568-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 03/06/2022] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND High rates of premature treatment termination are a well-reported issue in eating disorder treatment, and present a significant barrier for treatment effectiveness and longer term health outcomes of patients with eating disorders. Understanding patient perspectives on this phenomenon is essential in improving treatment completion rates and informing research and intervention development. The aim of this review is to synthesise qualitative literature on patient perspectives of premature termination of eating disorder treatment and to summarise the key issues leading to discontinuation of treatment. METHODS A systematic review of 1222 articles was conducted to identify studies using qualitative methods to investigate patient experiences of prematurely terminating eating disorder treatment. Ten articles were included in the review, with thematic synthesis used to analyse the primary research and develop overarching analytical themes. RESULTS Conflict around enmeshment of eating disorder with identity, and lack of support with reconstructing a sense of self without the eating disorder; challenges of managing pressures of social and clinical relationships while feeling unheard and misunderstood by both; expectations and disappointments around treatment; and dissatisfaction with progress were key themes behind premature termination of treatment. CONCLUSIONS The findings of this review demonstrate the key issues influencing the decision to end treatment early, highlighting the contribution of individual, environmental, and service-level factors. Implications of these factors are discussed and suggestions raised for future research and service development.
Collapse
Affiliation(s)
- Cecilia Vinchenzo
- Department of Health Services and Population Research, Institute of Psychiatry, Psychology and Neuroscience, King's College London, The David Goldberg Centre, De Crespigny Lane, PO26, London, SE5 8AF, UK
| | - Vanessa Lawrence
- Department of Health Services and Population Research, Institute of Psychiatry, Psychology and Neuroscience, King's College London, The David Goldberg Centre, De Crespigny Lane, PO26, London, SE5 8AF, UK
| | - Catherine McCombie
- Department of Health Services and Population Research, Institute of Psychiatry, Psychology and Neuroscience, King's College London, The David Goldberg Centre, De Crespigny Lane, PO26, London, SE5 8AF, UK.
| |
Collapse
|
13
|
Bryant E, Aouad P, Hambleton A, Touyz S, Maguire S. 'In an otherwise limitless world, I was sure of my limit.' † Experiencing Anorexia Nervosa: A phenomenological metasynthesis. Front Psychiatry 2022; 13:894178. [PMID: 35978851 PMCID: PMC9376373 DOI: 10.3389/fpsyt.2022.894178] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 07/07/2022] [Indexed: 11/13/2022] Open
Abstract
Anorexia Nervosa (AN) has the highest mortality rate of the mental disorders, with still less than 50% of affected individuals achieving recovery. Recent calls to bring innovative, empirical research strategies to the understanding of illness and its core psychopathological features highlight the need to address significant paucity of efficacious treatment. The current study brings a phenomenological approach to this challenge, synthesizing lived experience phenomena as described by qualitative literature. Fifty-three studies published between the years 1998 and 2021 comprising a total of 1557 participants aged 12-66 suffering from AN or sub-threshold AN are included. Reciprocal and refutational analysis generated six key third-order constructs: "emotion experienced as overwhelming," "identity," "AN as a tool," "internal conflict relating to Anorexia," "interpersonal communication difficulties" and "corporeality." Twenty-six sub-themes were identified, the most common being fear, avoidance, AN as guardian/protector, and AN as intertwined with identity. Some themes associated with current treatment models such as low self-esteem, need for social approval and feelings of fatness were less common. We highlight the significant role of intense and confusing emotion in AN, which is both rooted in and engenders amplified fear and anxiety. Restrictive eating functions to numb these feelings and withdraw an individual from a chaotic and threatening world whilst providing a sense of self around which to build an illness identity. Results have implications for therapeutic practice and overly protective weight and shape focused medical treatment models, which may serve to reinforce the disease.
Collapse
Affiliation(s)
- Emma Bryant
- InsideOut Institute for Eating Disorders, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
| | - Phillip Aouad
- InsideOut Institute for Eating Disorders, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
| | - Ashlea Hambleton
- InsideOut Institute for Eating Disorders, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
| | - Stephen Touyz
- InsideOut Institute for Eating Disorders, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia.,Sydney Local Health District, Sydney, NSW, Australia
| | - Sarah Maguire
- InsideOut Institute for Eating Disorders, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia.,Sydney Local Health District, Sydney, NSW, Australia
| |
Collapse
|
14
|
Effectiveness of art therapy for people with eating disorders: A mixed methods systematic review. ARTS IN PSYCHOTHERAPY 2021. [DOI: 10.1016/j.aip.2021.101859] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
|
15
|
Karlsson S, Friberg W, Rask M, Tuvesson H. Patients' Experiences and Perceptions of Recovering from Anorexia Nervosa While Having Contact with Psychiatric Care: A Literature Review and Narrative Synthesis of Qualitative Studies. Issues Ment Health Nurs 2021; 42:709-719. [PMID: 33290125 DOI: 10.1080/01612840.2020.1847222] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Anorexia nervosa (AN) is a serious disease which is difficult to treat. Little is known about the recovery from AN, and therefore, this review's aim was to review and synthesise patients' experiences and perceptions of what is meaningful for recovery from anorexia nervosa while having contact with psychiatric care. Cinahl, PubMed, and PsycINFO were systematically searched, and 24 studies met the inclusion criteria and were included in the review. Three themes were identified: Being in a trustful and secure care relationship, Finding oneself again, and Being in an engaging and personal treatment. Efforts supporting staff learning and person-centred care should be emphasised and researched further.
Collapse
Affiliation(s)
| | | | - Mikael Rask
- Department of Health and Caring Sciences, Linnaeus University, Växjö, Sweden
| | - Hanna Tuvesson
- Department of Health and Caring Sciences, Linnaeus University, Växjö, Sweden
| |
Collapse
|
16
|
Ling NCY, Serpell L, Burnett-Stuart S, Pugh M. Interviewing anorexia: How do individuals given a diagnosis of anorexia nervosa experience Voice Dialogue with their eating disorder voice? A qualitative analysis. Clin Psychol Psychother 2021; 29:600-610. [PMID: 34269497 DOI: 10.1002/cpp.2652] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 07/08/2021] [Accepted: 07/13/2021] [Indexed: 11/11/2022]
Abstract
A proportion of individuals given an eating disorder diagnosis describe the experience of an eating disorder 'voice' (EDV). However, methods for working with this experience are currently lacking. Voice Dialogue (Stone & Stone, 1989) involves direct communication between a facilitator and parts of the self to increase awareness, understanding, and separation from inner voices. Adapted forms of this method have shown promise in working with voices in psychosis. This study aimed to explore the experience and acceptability of Voice Dialogue amongst individuals with anorexia nervosa who experience an EDV. Nine women participated in a semistructured interview following a single Voice Dialogue session. Interview transcripts were analysed using interpretative phenomenological analysis (IPA). Three overarching themes were identified as follows: (i) "separating from the EDV"; (ii) "better understanding of the EDV"; and (iii) "hopeful, motivated, and afraid of recovery". The majority of participants found Voice Dialogue acceptable and helpful for exploring their EDV. Whilst preliminary, the results suggest that Voice Dialogue has potential in terms of helping individuals establish a more constructive relationship with their EDV and motivating change. Further research is needed to build upon these findings. Implications for addressing the EDV using voice-focused interventions are explored.
Collapse
Affiliation(s)
- Natalie Chua Yi Ling
- Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Lucy Serpell
- Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Sarah Burnett-Stuart
- Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Matthew Pugh
- Central and North West London NHS Foundation Trust, London, UK
| |
Collapse
|
17
|
Renjith V, Yesodharan R, Noronha JA, Ladd E, George A. Qualitative Methods in Health Care Research. Int J Prev Med 2021; 12:20. [PMID: 34084317 PMCID: PMC8106287 DOI: 10.4103/ijpvm.ijpvm_321_19] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2019] [Accepted: 12/23/2019] [Indexed: 12/05/2022] Open
Abstract
Healthcare research is a systematic inquiry intended to generate robust evidence about important issues in the fields of medicine and healthcare. Qualitative research has ample possibilities within the arena of healthcare research. This article aims to inform healthcare professionals regarding qualitative research, its significance, and applicability in the field of healthcare. A wide variety of phenomena that cannot be explained using the quantitative approach can be explored and conveyed using a qualitative method. The major types of qualitative research designs are narrative research, phenomenological research, grounded theory research, ethnographic research, historical research, and case study research. The greatest strength of the qualitative research approach lies in the richness and depth of the healthcare exploration and description it makes. In health research, these methods are considered as the most humanistic and person-centered way of discovering and uncovering thoughts and actions of human beings.
Collapse
Affiliation(s)
- Vishnu Renjith
- School of Nursing and Midwifery, Royal College of Surgeons Ireland - Bahrain (RCSI Bahrain), Al Sayh Muharraq Governorate, Bahrain
| | - Renjulal Yesodharan
- Department of Mental Health Nursing, Manipal College of Nursing Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Judith A Noronha
- Department of OBG Nursing, Manipal College of Nursing Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Elissa Ladd
- School of Nursing, MGH Institute of Health Professions, Boston, USA
| | - Anice George
- Department of Child Health Nursing, Manipal College of Nursing Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| |
Collapse
|
18
|
Hampshire K, Tierney S, Varese F, Haddock G, Saeidi S, Fox JRE. The development and assessment of a scale to measure the experience of an anorexic voice in anorexia nervosa. Clin Psychol Psychother 2020; 27:940-954. [PMID: 32455482 DOI: 10.1002/cpp.2481] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 05/22/2020] [Accepted: 05/23/2020] [Indexed: 11/09/2022]
Abstract
The anorexic voice (AV) is defined as a critical internal dialogue, which has been implicated in the development and maintenance of anorexia nervosa (AN). Systematic research to explore this further requires a valid and reliable measurement tool. This study aimed to develop and assess the validity of the Experience of an Anorexic VoicE Questionnaire (EAVE-Q). EAVE-Q items were developed and checked for face and content validity through cognitive interviews with seven individuals diagnosed with AN. Participants with a diagnosis of AN (N = 148) completed the EAVE-Q, sociodemographic questions and measures of mood and quality of life to assess internal consistency and construct validity. Forty-nine participants completed the EAVE-Q twice more to assess test-retest reliability. The EAVE-Q had good face and content validity and good acceptability. Principal axis factoring resulted in an 18-item scale organized into five domains with high internal consistency (α = 0.70 to α = 0.85). Domains correlated significantly with eating disorder symptoms, psychological distress, and quality of life. The EAVE-Q did not discriminate between participants on the basis of body mass index. Test-retest reliability was moderate. Although the factor structure of the EAVE-Q requires replication in other AN samples, the EAVE-Q is the first measure of a critical internal dialogue in AN. It is hoped that it will aid future research to increase understanding of AN and the continued development of person-centred treatments.
Collapse
Affiliation(s)
- Kay Hampshire
- Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Stephanie Tierney
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Filippo Varese
- Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK.,Greater Manchester Mental Health NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Gillian Haddock
- Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK.,Greater Manchester Mental Health NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Saeideh Saeidi
- Clinical Audit and Service Evaluation, Leeds and York Partnership NHS Foundation Trust, Leeds
| | - John R E Fox
- Department of Psychology, Cardiff University, Prifysgol Caerdydd and Cardiff and Vale NHS board, Cardiff, UK
| |
Collapse
|
19
|
Murphy K, Simonds LM, Spokes N. Disclosure in therapy by clients with eating difficulties: a Q-Methodology study. Eat Disord 2020; 28:32-46. [PMID: 30676885 DOI: 10.1080/10640266.2018.1560239] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Disclosure by those with eating difficulties is of considerable importance to clinicians and researchers. The aim of the present study was to explore variability in factors considered likely to influence the decision to disclose during psychological therapy by people who experience such difficulties. Thirty-seven participants recruited through a UK-based eating disorder charity completed a Q-sort task. This invited them to sort 47 statements onto a grid reflecting what would make them more or less likely to disclose in therapy. The thirty-seven Q-sorts were analysed using PQ method software. This resulted in the extraction of three factors explaining 41 percent of the variance. Participants loading on the first factor considered maintaining an eating disorder identity as most influential whilst participants loading on the second factor considered the therapeutic relationship as most influential. Those loading on the third factor considered personal readiness and feelings of security as most influential. This study suggests that clinicians need to assess influences on the decision to disclose for individual clients and to modify the early stages of intervention accordingly. Future research could assess the utility of using the Q-sort process and materials in this study as a way to elicit influences on disclosure decisions.
Collapse
Affiliation(s)
- Karen Murphy
- School of Psychology, University of Surrey, Guildford UK.,Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | | | - Naomi Spokes
- Tavistock and Portman NHS Foundation Trust, City and Hackney Primary Care Psychotherapy Consultation Service (PCPCS), London, UK
| |
Collapse
|
20
|
Graham MR, Tierney S, Chisholm A, Fox JRE. Perceptions of the "anorexic voice": A qualitative study of health care professionals. Clin Psychol Psychother 2019; 26:707-716. [PMID: 31368595 DOI: 10.1002/cpp.2393] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 07/07/2019] [Accepted: 07/11/2019] [Indexed: 12/27/2022]
Abstract
People with anorexia nervosa (AN) often report experiencing a highly critical inner voice (AV) focused on their eating, shape, and weight. There are promising preliminary findings for its role in the treatment of AN, and the support of staff is vital for the AV to be embedded in treatment, but their views remain unknown. The aims of this study were to undertake a qualitative exploration of the perceptions of the AV among health care professionals (HCPs) in specialist eating disorder services. A thematic analysis was applied to interviews with 15 HCPs, including nurses, therapists, psychiatrists, health care assistants, psychologists, and dietitians. Two overarching themes were identified: "The AV is a vehicle for increasing compassion" and "It's not a one-size-fits-all." The AV was seen as a means of developing and sustaining compassion, but participants noted that it does not resonate for all clients. All HCPs in this study believed that there was potential benefit in utilizing the AV in their work with people with AN, and it is likely that doing so would help to reduce burnout and frustration within clinical teams.
Collapse
Affiliation(s)
- Meghan R Graham
- Department of Psychology, Royal Holloway, University of London, Egham, UK
| | - Stephanie Tierney
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Amy Chisholm
- Vincent Square Eating Disorders Service, London, UK
| | - John R E Fox
- School of Psychology, Cardiff University, Cardiff, UK
| |
Collapse
|
21
|
Stockford C, Stenfert Kroese B, Beesley A, Leung N. Women's recovery from anorexia nervosa: a systematic review and meta-synthesis of qualitative research. Eat Disord 2019; 27:343-368. [PMID: 30247988 DOI: 10.1080/10640266.2018.1512301] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Anorexia nervosa (AN) is a complex and challenging condition and recovery can be a slow and difficult process. Predicting factors remain largely unknown. This paper aims to systematically review qualitative studies which have investigated female service users' experiences of recovering from AN and carry out a meta-synthesis of the themes they identified. Meta-ethnography was used to select and synthesize the studies. Articles published between 2002 and 2017 were searched in PsycInfo, EMBASE, CINAHL and Medline. Studies were included if they explored recovery from AN using a qualitative methodology. The methodological quality of the studies was systematically and critically appraised. Fourteen studies were selected for inclusion. Common themes reported by participants describe the process of recovery from AN as dealing with a fragmented sense of self, a turning point where insight and commitment to recovery is developed, and, in recovery, a reclamation of self through meaningful relationships, rebuilding identity and self-acceptance. Recovery from AN is experienced as a complex psychological process with many contributing factors. Findings highlight the need to reconsider clinical practice and treatment provision to incorporate the psychological components of self-identity into recovery programs.
Collapse
Affiliation(s)
- Clare Stockford
- a School of Psychology , University of Birmingham , West Midlands , United Kingdom
| | - Biza Stenfert Kroese
- a School of Psychology , University of Birmingham , West Midlands , United Kingdom
| | - Adam Beesley
- a School of Psychology , University of Birmingham , West Midlands , United Kingdom
| | - Newman Leung
- a School of Psychology , University of Birmingham , West Midlands , United Kingdom
| |
Collapse
|
22
|
Oldershaw A, Startup H, Lavender T. Anorexia Nervosa and a Lost Emotional Self: A Psychological Formulation of the Development, Maintenance, and Treatment of Anorexia Nervosa. Front Psychol 2019; 10:219. [PMID: 30886593 PMCID: PMC6410927 DOI: 10.3389/fpsyg.2019.00219] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Accepted: 01/22/2019] [Indexed: 12/17/2022] Open
Abstract
In this paper, we argue that Anorexia Nervosa (AN) can be explained as arising from a 'lost sense of emotional self.' We begin by briefly reviewing evidence accumulated to date supporting the consensus that a complex range of genetic, biological, psychological, and socio-environmental risk and maintenance factors contribute to the development and maintenance of AN. We consider how current interventions seek to tackle these factors in psychotherapy and potential limitations. We then propose our theory that many risk and maintenance factors may be unified by an underpinning explanation of emotional processing difficulties leading to a lost sense of 'emotional self.' Further, we discuss how, once established, AN becomes 'self-perpetuating' and the 'lost sense of emotional self' relentlessly deepens. We outline these arguments in detail, drawing on empirical and neuroscientific data, before discussing the implications of this model for understanding AN and informing clinical intervention. We argue that experiential models of therapy (e.g., emotion-focused therapy; schema therapy) be employed to achieve emergence and integration of an 'emotional self' which can be flexibly and adaptively used to direct an individual's needs and relationships. Furthermore, we assert that this should be a primary goal of therapy for adults with established AN.
Collapse
Affiliation(s)
- Anna Oldershaw
- Salmons Centre for Applied Psychology, Canterbury Christ Church University, Canterbury, United Kingdom
- Kent and Medway All Age Eating Disorder Service, North East London NHS Foundation Trust, London, United Kingdom
| | - Helen Startup
- Sussex Eating Disorders Service and Research and Development Department, Sussex Partnership NHS Foundation Trust, Sussex, United Kingdom
| | - Tony Lavender
- Salmons Centre for Applied Psychology, Canterbury Christ Church University, Canterbury, United Kingdom
| |
Collapse
|
23
|
Lester RJ. Ground zero: Ontology, recognition, and the elusiveness of care in American eating disorders treatment. Transcult Psychiatry 2018; 55:516-533. [PMID: 27777280 DOI: 10.1177/1363461516674874] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This paper reflects upon questions of ontological contingency when the stark, visceral reality of a person's relentless self-destruction unfolds within institutional mechanisms that systematically withhold certain kinds of care. I consider these issues through the lens of "manipulation" as it is elaborated within an American eating disorders treatment center, where the notion of manipulation does particular kinds of affective and pragmatic work. Specifically, it serves to render clients as, paradoxically, both hyper-agentic and "agentically challenged" in ways that legitimate the withholding of their recognition as full subjects and therefore deserving of care. I propose that the ontological perspectives of the treatment center are ill-equipped for accounting for such dynamics and, in fact, carry certain risks when employed in the consideration of psychiatric conditions where they can even become coopted in unintended ways. This carries special importance when working with people whose ontological status is, in a very real (and not just theoretical) sense, teetering on the brink of the void.
Collapse
|
24
|
Stockford C, Stenfert Kroese B, Beesley A, Leung N. Severe and Enduring Anorexia Nervosa: The personal meaning of symptoms and treatment. WOMENS STUDIES INTERNATIONAL FORUM 2018. [DOI: 10.1016/j.wsif.2018.03.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
25
|
Fogarty S, Ramjan LM. The tipping point of change in Anorexia Nervosa (AN): Qualitative findings from an online study. Women Health 2017; 58:1050-1061. [PMID: 28922078 DOI: 10.1080/03630242.2017.1372846] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
The aim of this study was to understand factors related to treatment and/or recovery from self-reported Anorexia Nervosa (AN), including 'the tipping point of change'. An online questionnaire was developed and administered from December 2014 to December 2015 to individuals ≥18 years of age with AN in the past or currently who were recruited through eating disorder organizations in Australia and the United Kingdom. Responses to a specific qualitative question on 'the tipping point of change' were analyzed using conventional content analysis (CCA). One hundred sixty-one participants completed some or all of the questionnaire; only 67 women (41.61%) answered Question six on 'the tipping point of change', and analyses were restricted to data from these women. The themes identified were: 1) realizing the loss of something valuable, 2) the risk of losing something valuable, and 3) something to live for/stay well for. These results are important for health-care providers as they work with patients to identify life experiences, including 'loss/potential loss' and 'the need for preservation', that have personal significance. Some patients may realize that 'enough is enough'; something needs to change. These intrinsic motivating factors may also be the impetus for eventual recovery for some individuals.
Collapse
Affiliation(s)
- Sarah Fogarty
- a School of Medicine , Western Sydney University, Campbelltown, New South Wales, Australia.,b National Institute of Complementary Medicine , Western Sydney University , Campbelltown , New South Wales , Australia
| | - Lucie M Ramjan
- c School of Nursing and Midwifery , Western Sydney University , Parramatta , New South Wales , Australia.,d Centre for Applied Nursing Research , Ingham Institute of Applied Medical Research , Penrith , New South Wales , Australia
| |
Collapse
|
26
|
Conti JE. Recovering Identity from Anorexia Nervosa: Women's Constructions of Their Experiences of Recovery from Anorexia Nervosa Over 10 Years. JOURNAL OF CONSTRUCTIVIST PSYCHOLOGY 2016. [DOI: 10.1080/10720537.2016.1251366] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Janet E. Conti
- Department of Psychology, Macquarie University, New South Wales, Australia, and School of Social Sciences and Psychology, Western Sydney University, Penrith, Australia
| |
Collapse
|
27
|
Pugh M, Waller G. Understanding the 'Anorexic Voice' in Anorexia Nervosa. Clin Psychol Psychother 2016; 24:670-676. [PMID: 27435632 DOI: 10.1002/cpp.2034] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Revised: 06/12/2016] [Accepted: 06/30/2016] [Indexed: 02/05/2023]
Abstract
In common with individuals experiencing a number of disorders, people with anorexia nervosa report experiencing an internal 'voice'. The anorexic voice comments on the individual's eating, weight and shape and instructs the individual to restrict or compensate. However, the core characteristics of the anorexic voice are not known. This study aimed to develop a parsimonious model of the voice characteristics that are related to key features of eating disorder pathology and to determine whether patients with anorexia nervosa fall into groups with different voice experiences. The participants were 49 women with full diagnoses of anorexia nervosa. Each completed validated measures of the power and nature of their voice experience and of their responses to the voice. Different voice characteristics were associated with current body mass index, duration of disorder and eating cognitions. Two subgroups emerged, with 'weaker' and 'stronger' voice experiences. Those with stronger voices were characterized by having more negative eating attitudes, more severe compensatory behaviours, a longer duration of illness and a greater likelihood of having the binge-purge subtype of anorexia nervosa. The findings indicate that the anorexic voice is an important element of the psychopathology of anorexia nervosa. Addressing the anorexic voice might be helpful in enhancing outcomes of treatments for anorexia nervosa, but that conclusion might apply only to patients with more severe eating psychopathology. Copyright © 2016 John Wiley & Sons, Ltd. KEY PRACTITIONER MESSAGE Experiences of an internal 'anorexic voice' are common in anorexia nervosa. Clinicians should consider the role of the voice when formulating eating pathology in anorexia nervosa, including how individuals perceive and relate to that voice. Addressing the voice may be beneficial, particularly in more severe and enduring forms of anorexia nervosa. When working with the voice, clinicians should aim to address both the content of the voice and how individuals relate and respond to it.
Collapse
Affiliation(s)
- Matthew Pugh
- Vincent Square Eating Disorders Service, London, UK
| | - Glenn Waller
- Department of Psychology, University of Sheffield, Sheffield, UK
| |
Collapse
|
28
|
Amianto F, Northoff G, Abbate Daga G, Fassino S, Tasca GA. Is Anorexia Nervosa a Disorder of the Self? A Psychological Approach. Front Psychol 2016; 7:849. [PMID: 27378967 PMCID: PMC4906654 DOI: 10.3389/fpsyg.2016.00849] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Accepted: 05/20/2016] [Indexed: 01/26/2023] Open
Abstract
The debate concerning the pathogenesis and the maintaining factors of eating disorders, anorexia nervosa in particular, is ongoing especially since therapeutic interventions do not result in satisfactory and enduring rates of remission. This paper presents a model for the pathogenesis of eating disorders, based on the hypothesis of a deficiency in the development of the self. We present the theory in light of new evidence concerning the role of attachment insecurity in the development and maintenance of eating disorders. In particular, we define the self in eating disorders in a comprehensive way by taking into account recent evidence from experimental psychology and neurobiology. The paper considers the development of the self in terms of its synchronic (i.e., experienced in the moment) and diachronic (i.e., experienced as continuous over time) aspects. Both synchronic and diachronic aspects of the self are relevant to the expression of eating disorder symptoms. Further, the maturation of the self is interwoven with the development of attachment functioning from infancy to adolescence. This interplay between these developmental processes of the self and of attachment could be crucial in understanding the pathogenesis of eating disorders. The final part of the paper suggests a neurobiological link between the theory of the self in the eating disorders and the spatiotemporal functioning of the brain. Disturbances in spatiotemporal functioning may represent the neurobiological pathway by which deficiencies in the self is related to attachment functions in individuals with eating disorders.
Collapse
Affiliation(s)
- Federico Amianto
- Regional Expert Centre for Eating Disorders, Neurosciences Department, Psychiatry Section, University of Turin Turin, Italy
| | - Georg Northoff
- Mind, Brain Imaging and Neuroethics Research Unit, The Royal's Institute of Mental Health Research, University of Ottawa, Ottawa ON, Canada
| | - Giovanni Abbate Daga
- Regional Expert Centre for Eating Disorders, Neurosciences Department, Psychiatry Section, University of Turin Turin, Italy
| | - Secondo Fassino
- Regional Expert Centre for Eating Disorders, Neurosciences Department, Psychiatry Section, University of Turin Turin, Italy
| | - Giorgio A Tasca
- Psychology, The Ottawa Hospital, University of Ottawa, Ottawa ON, Canada
| |
Collapse
|
29
|
|