'Feelings stronger than reason': conflicting experiences of exercise in women with anorexia nervosa

Exercise and mind-body exercise for feeding and eating disorders: a systematic review with meta-analysis and meta-regressions

PURPOSE

To develop a systematic review with meta-analysis to summarize the effectiveness of exercise, regular physical activity, and mind-body exercise on harmful exercise habits, psychological factors, and quality of life in people clinically diagnosed with feeding and eating disorders.

MATERIAL AND METHODS

Randomized clinical trials and pilot randomized clinical trials were considered.

RESULTS

Twelve studies were included. No studies evaluated athletes. No studies examined regular physical activity as the targeted intervention. Quality of life could not be meta-analyzed. Overall, meta-analyses showed that exercise or mind-body exercise was not more effective than controls in reducing depression symptoms, harmful exercise habits, eating behaviors, or emotional regulation skills. However, important methodological and clinical issues were detected in the included studies. This affected the certainty of evidence of the meta-analyzed outcomes which ranged from low to very low. No studies reported in sufficient detail their interventions to be replicated.

CONCLUSIONS

Overall, exercise and mind-body exercise may be ineffective in improving meta-analyzed outcomes. However, the certainty of evidence ranged from low to very low and the body of knowledge in this field needs to be increased to reach robust conclusions.

Conceptualisation of severe and enduring anorexia nervosa: a qualitative meta-synthesis

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.

Perceived Body Image towards Disordered Eating Behaviors and Supplement Use: A Study of Mauritian Gym-Goers

Purpose: Individuals with body image distortions tend to develop an obsession with calorie intake and weight, leading to compounded coping strategies such as modified eating behaviors, supplement use, and excessive exercise. In the local context, little is known about the equation connecting body image to improper eating behaviors and other potential coping mechanisms. This study primarily aims at critically identifying the nexus between features of disordered eating behavior including supplement use, and body image. Methodology: A probabilistic randomized sample of 305 gym members was assessed based on their level of body satisfaction and its influence on their eating habits and supplement use through a structured survey. Findings: Only 37% of the participants were satisfied with their body image. The results concurred with the notion of a poor body image influencing body esteem (χ2 (10) = 137.21, p < 0.05; Cramer V = 0.474). While exercise motivated the use of supplements, a significant relationship was also observed between disordered eating habits and supplement use (χ2 (4) = 48.63, p < 0.05; Cramer V = 0.399). A predictive model was successfully drawn inclusive of the disordered eating behaviors dimensions as a potent predictor of body image (χ2 (56) = 397.12, p < 0.001. Implications: This study presents an in-depth analysis of the magnitude of disordered eating behaviors with respect to individuals in the local fitness industry, and the need for professional support programs toward the re-alignment of body image in an effort to curtail the development of eating disorders in Mauritian gym-goers.

A preliminary exploration of experiences of integrating the body in the self in two women with anorexia nervosa in view of phenomenological conceptualisations

BACKGROUND

People with anorexia nervosa often present with confusions around bodily sensations and difficulties in experiencing their body as a place of their own. Many existing models understand anorexia nervosa as a disorder of behaviour and thoughts about eating and body size, and treatments typically focus on modifying thoughts and psychological processes. They leave aside the subject as she experiences the body from a first-person perspective. Inspired by phenomenology and the embodied mind thesis, this explorative study examines in depth the experiences of individuals with anorexia nervosa as they engage in Norwegian psychomotor physiotherapy. Through release of bodily tension and restricted breathing, this method aims to help subjects tune into the body and accept that difficult experiences, relationships and feelings are also bodily.

METHODS

Qualitative in-depth interviews were conducted with two women who had been attending Norwegian psychomotor physiotherapy for more than two years. Thematic analysis was used to identify, analyse and interpret themes within the data.

RESULTS

Three main overarching themes that structure the subjects' experiences were identified: the meaning of the therapeutic relationship, changes in bodily connectedness and ways of moving, and improved ability to articulate and reflect on feelings.

CONCLUSION

The subjects described a greater tendency to experience the body in the self and as a place of their own, a more flexible and vital body, and an increased capacity to identify, express and make sense of feelings. These changes enriched their interactions with the social world. Feeling acknowledged and accepted by the therapist throughout the process was essential. The study illustrates how difficult experiences, thoughts and feelings can, over time, manifest in the body as withheld breathing and diverse bodily constraints affecting both self- and body awareness. The study endorses the phenomenological concepts that our experiences of the self and the world are essentially bodily, and emphasizes the importance of the first-person perspective when investigating the contribution of the body to the self and to our interactions with the social world. Physio- and body awareness therapies that help patients relate to, understand and integrate bodily experiences may complement other treatment approaches and help patients with anorexia proceed with the recovery process. Having anorexia nervosa involve changes in the way one experiences the body. The condition has been linked to confusions around bodily sensations and reduced experience of the body as an integrated place of their own. The purpose of this study was to gain a richer understanding of bodily experiences in subjects with anorexia nervosa having attended a specialized physiotherapy approach. In depth interviews were conducted with two women who had anorexia nervosa and who had engaged in Norwegian Psychomotor Physiotherapy for more than two years. Three themes that structure the subjects' experiences were identified: the meaning of the therapeutic relationship, changes in bodily connectedness and ways of moving, and improved ability to articulate and reflect on feelings. The subjects described a greater tendency to experience the body in the self and as a place of their own, a more flexible and vital body, and an increased capacity to identify, express and make sense of feelings. Feeling acknowledged and accepted by the therapist throughout the process was essential. The study illustrates how difficult experiences, thoughts and feelings can manifest in the body as withheld breathing and diverse bodily constraints affecting both self- and body awareness in people with anorexia nervosa.

Brain default mode network mediates the association between negative perfectionism and exercise dependence

BACKGROUND AND AIMS

Perfectionism is correlated with the occurrence of exercise dependence. We aim to reveal the role of functional connectivity (FC) between gray matter (GM) and white matter (WM) networks in the association between perfectionism and exercise dependence.

METHODS

In this cross-sectional study, one hundred ten participants with exercise dependence underwent behavioral evaluation and resting-state functional magnetic resonance imaging. Perfectionism and exercise dependence were quantified using the Frost Multidimensional Perfectionism Scale (FMPS) and Exercise Dependence Scale (EDS). We used a K-means clustering algorithm to identify functional GM and WM networks and obtained the FCs of the GM-GM, GM-WM, and WM-WM networks. Partial correlation and mediation analyses were performed to explore the relationships among FCs, FMPS, and EDS.

RESULTS

We identified ten stable GM networks and nine WM networks. Of these, FCs existed between the corona radiata network (WM1) and default mode network (DMN, GM8), WM1 network and WM DMN (WM4), WM1 network and midbrain WM network (WM7), and WM4 network and inferior longitudinal fasciculus network (WM9). The WM1-GM8 and WM1-WM4 FCs were positively correlated with the EDS and negative FMPS. The mediating effects of the WM1-GM8 and WM1-WM4 FCs were established in the association between the negative dimensional FMPS and EDS.

DISCUSSION AND CONCLUSIONS

The WM1 network anatomically linked the subregions within the GM8 and WM4 networks, and WM1-GM8 and WM1-WM4 FCs mediated the association between negative dimensional FMPS and EDS. These findings indicated that DMN function might be involved in the increased risks of exercise dependence promoted by negative perfectionism.

Behavioral reinforcement of pathological exercise in anorexia nervosa

Pathological exercise in anorexia nervosa (AN) is a harmful behavior associated with a chronic course and poor prognosis. To date, no comprehensive theoretical model exists to describe pathological exercise in the context of AN, and as such, few treatments are effective at promoting direct and sustained pathological exercise extinction. Using a framework put forth by Wise & Koob (2014), debating the relative importance of positive and negative reinforcement in substance use, we present three hypotheses of behavioral reinforcement of exercise, encompassing biological, psychological, and environmental influences. Specifically, we argue that exercise is positively reinforced through receipt of biological and behavioral rewards, negatively reinforced through avoidance of aversive emotions, and that these two systems work in tandem over time to engrain pathological exercise as a habit. We then present suggestions for testing each of these hypotheses as future directions for the field.

Attitudes toward physical activity as a treatment component for adolescents with anorexia nervosa: An exploratory qualitative study of patient perceptions

OBJECTIVE

Anorexia nervosa (AN) with compulsive exercise is associated with poor treatment outcomes. This study sought to understand the attitudes of adolescents with AN from various stages of treatment, toward physical activity research practices and physical activity as a component of treatment.

METHOD

Seventeen adolescents 12-18 years old (15 female) with AN (10 with acknowledged history of compulsive exercise) were recruited from a Canadian Tertiary Care Hospital's Eating Disorder Program. Six inpatients, 5-day program patients, and six outpatients treated by either the inpatient and/or day treatment program in the past 2 years completed individual, semi-structured interviews that were audio-recorded and transcribed. Results were analyzed deductively using qualitative techniques.

RESULTS

Participants recognized both benefits (psychological, sociological, and physiological) and risks (trigger negative thoughts, increase competitive behavior) of implementing physical activity into acute AN treatment. Patient characteristics, such as stage of treatment and exercise history, had an impact on participants' perceptions toward physical activity in AN. Participants suggested that the ideal physical activity program would be focused on fun, individualized and progressively integrated, group-based, and directly supported by staff. Although the majority of participants stated that they would wear an activity monitor for research purposes, concerns were voiced regarding compliance and the potential impact on eating disorder symptomatology.

DISCUSSION

Participants overwhelmingly supported the careful implementation of structured physical activity and physical activity psychoeducation into the acute treatment of adolescents with AN. This study allows for the inclusion of patient voices in the conversation surrounding the role of physical activity in AN treatment.

Physical activity behaviors and attitudes among women with an eating disorder: a qualitative study

BACKGROUND

Physical activity (PA) is an integral part of healthcare for the general population and individuals with psychiatric disorders. However, PA is significantly more complex for and related to both healthy (e.g., reduced anxiety and depressive symptoms) and unhealthy outcomes (e.g., intrusive, repetitive thoughts that lead to abnormally high levels of PA) among women with an eating disorder (ED). Consequently, many healthcare professionals recommend abstinence from PA during ED treatment. Despite this, women may remain engaged in PA during ED treatment or resume PA shortly thereafter. Little has been done to understand women's PA behaviors and attitudes and to explore how they integrate PA into their lives during and after ED treatment. Thus, this study sought to explore PA behaviors and attitudes among women with an ED.

METHODS

Nine women who self-reported receiving an ED diagnosis participated in semi-structured interviews, which were transcribed and analysed thematically.

RESULTS

Six interrelated themes were constructed to represent participants' PA experiences: PA as a lifestyle, PA can be beneficial, How I feel when I can't do PA, Being cautious about PA, Reactions to healthcare professionals' practice of recommending abstinence from PA during ED treatment, and PA programming thoughts.

CONCLUSIONS

Overcoming dysfunctional PA behaviors (e.g., engaging in abnormally high levels of PA) and attitudes (e.g., associating PA with caloric expenditure) can be a long and complicated journey for women with an ED. Nevertheless, women with an ED want PA to be integrated into their ED treatment protocol for two key reasons, namely to accrue the benefits associated with PA and to learn how to engage in PA in adaptive and healthy ways.

Re-inhabiting one's body: A pilot study on the effects of dance movement therapy on body image and alexithymia in eating disorders

BACKGROUND

Body image disturbance and alexithymia are two core aspects of Eating Disorders (EDs). However, standard treatments for EDs do not include specific techniques to approach these issues on a bodily level. This pilot study evaluated the effects of a Dance Movement Therapy (DMT) intervention on body image and alexithymia in patients with EDs, and also explored their experience of the therapeutic process.

METHOD

14 patients with EDs were recruited from a private clinic. Seven were assigned via quasi-randomization to the DMT group and the others (n = 5) continued their treatment as usual. The length of the intervention was 14 weeks. All participants completed the Multidimensional Body Self Relations Questionnaire (MBSRQ) and the Toronto Alexithymia Scale (TAS-20) at the beginning and at the end of the intervention. Additionally, the DMT group wrote reflective diaries about their experience at the end of each session, which were analyzed using qualitative methods.

RESULTS

Between the pre- and post-intervention, the participants of the DMT group significantly improved in Body Areas Satisfaction (effect size: 0.95) and Appearance Evaluation (effect size: 1.10), and they decreased significantly in Appearance Orientation (effect size: 1.30). A decrease in Overweight Preoccupation was observed (effect size: 0.75), however this was not statistically significant. The control group did not show significant changes in any of the MBSRQ subscales. Neither the DMT group nor the control group improved significantly in the alexithymia scores. The qualitative analysis revealed valuable insights into the participants' processes throughout the sessions. In general, participants received the DMT intervention positively. They reported improvements in their mood states and an increase in their self-awareness. They also appreciated the relationship with the group and the therapist.

CONCLUSION

These results indicate that DMT might be a complementary treatment option for EDs, as it may be able to address body image issues more effectively than verbal therapies. More studies with larger samples are needed to confirm these promising preliminary results.

Excessive Exercise-A Meta-Review

Background and Aims: While a number of studies have reported on individuals who exercise excessively, and feel unable to stop despite negative consequences, there is still insufficient evidence to categorize exercise as an addictive disorder. The aim of this meta-review is to summarize the published articles and to compile a list of symptoms reported in the qualitative literature in conjunction with excessive exercise. This list is compared with the DSM-5 criteria for gambling disorder, and initial diagnostic criteria for exercise addiction are suggested. Methods: The databases MEDLINE, Web of Science and PsycInfo were searched for qualitative studies or case reports, in which excessive exercise was the main focus. All symptoms reported in conjunction with excessive exercise were extracted from each study and documented. Symptoms were also compared to the diagnostic criteria for gambling disorder. Results: Seventeen studies were included in the review, yielding 56 distinct symptoms. The Critical Appraisal Skills Program tool showed that the majority of the studies were of acceptable quality. Exercise-related symptoms corresponded with seven of the nine DSM-5 criteria for gambling disorder. The ten suggested criteria for exercise addiction are: increasing volume, negative affect, inability to reduce, preoccupation, exercise as coping, continuation despite illness/injury, minimization, jeopardized relationships, continuation despite recognizing consequences, guilt when exercise is missed. Discussion: Our results suggest that excessive exercise may constitute a behavioral addiction, based on the criteria of the DSM-5. Conclusions: Subsequent studies should aim to systematically classify symptoms of excessive exercise; in addition, it should be noted that basic questionnaires may be need to be supplemented with detailed clinical examinations.

Accuracy of self-reported physical activity in patients with anorexia nervosa: links with clinical features

BACKGROUND

High levels of physical activity (PA) have long been described in patients with Anorexia Nervosa (AN). Despite the importance of measuring PA in this population, there are two important factors that remain unknown. First, it is not clear how accurate self-report measures of PA are among patients. Second, little is known about how clinical characteristics are associated with the accuracy of self-reported PA. Therefore, this study aimed to examine the accuracy of self-reported PA compared to an objective measure of PA in patients with AN. It also investigated whether levels of accuracy/inaccuracy were associated with compulsive exercise, motivation to change, and psychological distress.

METHOD

Data were analysed from 34 adult outpatients with AN. Patients wore an accelerometer device (ActiGraph) for 4 days and completed a retrospective self-report measure of exercise (Exercise Participation Screening Questionnaire). They also completed measures of compulsive exercise (Compulsive Exercise Test), motivation to change (The Anorexia Nervosa Stages of Change Questionnaire), and psychological distress (Kessler-10).

RESULTS

On the self-report measure, patients accurately reported their time spent in moderate and vigorous intensity PA, however, they significantly under-reported their light physical activity (compared to the accelerometer data). Accurate reporting of total PA was positively associated with higher levels of compulsive exercise. There was evidence to suggest that clinical features, such as motivation to change and psychological distress, may be associated with inaccurate reporting at some levels of PA intensity and not others.

CONCLUSIONS

Results indicate that patients with AN are likely to under-report their light intensity PA. We also found preliminary evidence for how compulsive exercise, motivation to change, and distress are associated with self-reported PA accuracy. Clinical implications and directions for future research are considered.

TRIAL REGISTRATION

ACTRN12610000585022. Taking a LEAP forward in the treatment of anorexia nervosa: a randomized controlled trial. NHMRC grant: 634922.

A life put on hold: adolescents' experiences of having an eating disorder in relation to social contexts outside the family

BACKGROUND

As suffering from an eating disorder often entails restrictions on a person's everyday life, one can imagine that it is an important aspect of recovery to help young people learn to balance stressful demands and expectations in areas like the school environment and spare-time activities that include different forms of interpersonal relationships.

PURPOSE

The aim of the present study was to investigate how adolescents with experience from a restrictive eating disorder describe their illness and their time in treatment in relation to social contexts outside the family.

PATIENTS AND METHODS

This qualitative study is based on narratives of 15 adolescents with experience from outpatient treatment for eating disorders with a predominately restrictive symptomatology, recruited in collaboration with four specialized eating-disorder units. Data were explored through inductive thematic analysis.

RESULTS

The adolescents' descriptions of their illness in relation to their social contexts outside the family follow a clear timeline that includes narratives about when and how the problem arose, time in treatment, and the process that led to recovery. Three main themes were found: 1) the problems emerging in everyday life (outside the family); 2) a life put on hold and 3) creating a new life context.

CONCLUSION

Young people with eating disorders need to learn how to balance demands and stressful situations in life, and to grasp the confusion that often preceded their illness. How recovery progresses, and how the young people experience their life contexts after recovery, depends largely on the magnitude and quality of peer support and on how school and sports activities affect and are affected by the eating disorder.

Compulsive exercise in eating disorders: proposal for a definition and a clinical assessment

BACKGROUND

Compulsive exercise has been recognized as a highly prevalent symptom in eating disorders (ED) for over 100 years and is associated with poor short-term and long-term treatment outcome. Progress in understanding and treatment of compulsive exercise will remain limited as long as no consensus framework for definition and assessment of compulsive exercise exists, as results cannot be compared across clinical studies.Based on existing literature, it was our aim to propose a transdiagnostic definition and a clinical assessment for compulsive exercise, that can be applied to adolescent and adult patients with ED.

METHOD

During a series of meetings of experienced clinicians at a highly specialized hospital for eating disorders, we elaborated a transdiagnostic definition of compulsive exercise in ED. Additionally, we derived a clinical interview for the assessment of compulsive exercise and its different subtypes.

RESULTS

The core criterion when defining and assessing compulsive exercise is a pathologically increased exercise pattern characterized by 1) excessive exercise that a patient feels driven to perform in response to an obsession or according to rules that must be applied rigidly, and 2) exercise that is aimed at preventing or reducing distress or at preventing some dreaded consequence. A second necessary criterion is the physical or psychological burden caused by compulsive exercise, i.e., that it is time-consuming, significantly interferes with the patient's daily routine, occupational functioning or social relationships or is continued despite medical injury, illness, or lack of enjoyment. Insight that compulsive exercise is excessive or unreasonable was added as an optional criterion.Compulsive exercise manifests itself in three different subtypes: 1) vigorous exercise, 2) marked increase in daily movement, or 3) motor restlessness.The above criteria must be met during the past 6 months, together with one of the three subtypes of compulsive exercise.

CONCLUSIONS

The proposed criteria aim to foster the discussion around definition and assessment of compulsive exercise with the goal of reaching an international consensus in the near future.Providing a consistent framework for researchers and clinicians would considerably advance understanding and treatment of compulsive exercise in ED patients.

Creating an Opportunity to Reflect: Ear Acupuncture in Anorexia Nervosa - Inpatients' Experiences

The aim of this study was to elucidate the meaning of receiving acupuncture as a complement in the treatment of anorexia nervosa at a specialist unit. Nine inpatients were interviewed, one to three times. The sixteen interviews were analysed with a phenomenological hermeneutic method. The main theme found was "Creating a pause, a framework for rest and reflection." The participants described acupuncture to be an attractive part of the treatment, offering a pause in a very stressful situation. The relaxing effect was palpable. They described unusual calmness and a meditative state allowing them to think clearly and to reflect, and also positive physical sensations like getting warm. Anxiety decreased and gaining weight became easier to endure. Participants appreciated acupuncture as an optional treatment that they could influence. The given frame for reflection allowed processing emotions, releasing control and seeing themselves as capable to relax. Where symptoms are intense and pharmacological treatments have modest effect, like in anorexia nervosa, adjunctive therapies that help manage symptoms deserve greater attention.

Exercise and physical therapy help restore body and self in clients with severe anorexia nervosa

Exercise in the context of anorexia nervosa is a multifaceted endeavour surrounded by controversy and uncertainty. A broader comprehension of this poorly understood phenomenon is required. Informed by the findings of a body examination of six individuals with anorexia nervosa, as well as exercise science, phenomenology and neurocognition, the purpose of this article is to elaborate on the potential role of exercise and physical therapy in the treatment of anorexia nervosa. The findings of the body assessment include constriction of posture, muscles and pattern of breathing. These bodily restraints are not necessarily merely associated with high levels of exercise, they may also reflect psychological strain accompanying the illness. The restricted breathing in particular is assumed to be associated with difficult thoughts and suppressed feelings. Based on the results of the body examination, as well as medical and psychological considerations accompanying the illness, it is suggested that interventions should focus on improving postural stability and restoring related muscular function. Integral to engaging in these activities, the potential to integrate proprioceptive information in this process may generate a more coherent experience of the body, as well as of the self, in these clients. Accordingly, constrictions of the body may have a vital role in constraining the experience of the self. As such, addressing bodily restraints in these clients may facilitate the experience of being the subject causing and controlling the movements. This is in marked contrast to clients' previous exercise experiences, which were associated with compulsion, rigidity and the absence of coherence and control.

A balancing act: a phenomenological exploration of medical students' experiences of using mobile devices in the clinical setting

OBJECTIVE

The aims of this study were to describe the experiences of senior students using mobile devices in a clinical setting while learning and interacting with clinical teachers, patients and each other, and to identify challenges that facilitated or impeded the use of such devices in the hospital.

DESIGN

Interpretative phenomenology was chosen to guide our enquiry. Semi-structured interviews were conducted to examine the experiences of five senior medical students using mobile devices in the clinical setting.

SETTING AND PARTICIPANTS

Senior medical students at an international medical school in the Middle East.

RESULTS

Three main themes emerged from the data analysis: learning; professional identity and transitioning from student to doctor. The findings showed that using mobile devices in the clinical area as a learning tool was not a formalised process. Rather, it was opportunistic learning at the bedside and on occasion a source of distraction from clinical teaching. Students needed to negotiate relationships between themselves, the clinical teacher and patients in order to ensure that they maintained an acceptable professional image. Participants experienced and negotiated the change from student to doctor making them mindful of using their devices at the bedside.

CONCLUSIONS

Mobile devices are part of daily life for a medical student and there is a need to adapt medical education in the clinical setting, to allow the students to use their devices in a sensitive manner.

Factors impacting treatment and recovery in Anorexia Nervosa: qualitative findings from an online questionnaire

BACKGROUND

Anorexia nervosa (AN) is characterised by restriction of energy intake, fear of gaining weight and severe disturbances in weight or shape. Recovery from AN is a complicated and often multifaceted experience that can take many years to achieve. Qualitative research has found that support, being understood, hope, desire for recovery, positive experiences in treatment, self-efficacy, motivation and relationships are important in recovery from AN. The experience of treatment for patients with an eating disorder is an important aspect of recovery with the potential to enhance recovery or hinder it. The aim of the questionnaire was to better understand factors impacting the care experiences during treatment and or recovery from self-reported Anorexia Nervosa (AN).

METHOD

An online questionnaire was developed and administered to past or current sufferers of Anorexia Nervosa, ≥18 years of age. Participants were recruited through eating disorder organisations both in Australia and the United Kingdom. The questionnaire was a mixture of quantitative and qualitative questions. The quantitative data was analysed using descriptive statistics and the qualitative data was analysed using conventional content analysis (CCA).

RESULTS

Of those who responded, most currently experienced self-reported AN. The quantitative results identified that most participants had trust and confidence in their health care provider and felt listened to and supported yet on the subject of the suitability of treatment this had varied opinions. Being understood, hope (life after AN) and self-acceptance were considered the top three important factors in the treatment and recovery from Anorexia Nervosa. The qualitative results revealed the factors hindering or benefiting treatment and recovery, and individuals' needs during the four phases of recovery.

CONCLUSION

Factors were identified that could either hinder or benefit treatment and recovery and these included whether treatment supported the individual to cope with change, whether the individual found the treatment to be appropriate for their personal needs and whether treatment addressed underlying factors. Individuals' needs differed during the four phases of recovery. The findings of the study may help treatment providers address key factors involved in recovery at the right stage of treatment however by the nature of the qualitative methodology conclusions are putative and further definitive research is indicated.