Life is different now - impacts of eating disorders on Carers in New Zealand: a qualitative study

"I don't know how, if, it's ever going to end": narratives of caring for someone with an enduring eating disorder

BACKGROUND

Families and carers are pivotal in supporting loved ones experiencing eating disorders. This role can bring immense distress and burden, yet the experience of caring for someone with an enduring eating disorder has had minimal research focus. Thus, the purpose of this study is to give voice to carers empowering their stories to increase awareness and understanding, which could inform support to carers and consequently people with a lived and/or living experience of eating disorders.

METHODS

Semi-structured interviews were conducted with 9 carers supporting individuals who had been experiencing an eating disorder for 7 or more years. Data were collected and analysed using narrative inquiry approach.

RESULTS

Carers' narratives revealed feelings of guilt and personal failure; a profound sense of disillusion with current treatment approaches; and immense grief and anguish. As they negotiated a tenuous relationship with hope and the uncertainty of their loved one's future, carers spoke to a complex myriad of feelings of acceptance, letting go, and forging on.

CONCLUSION

Carers deserve to have their voices heard where they are too often silenced. Their narratives provide an urgent call for transformation in our treatments for eating disorders and further involvement of carers within the treatment journey, and their lived experience perspectives have great potential to guide this endeavour.

LEVEL OF EVIDENCE

Level V, qualitative interviews.

Peer Support and Beyond: The Role of Lived Experience in a New Era of Eating Disorder Treatment

When valued and recognized for the insights gained through direct lived experience, people in eating disorder recovery and their caregivers can improve treatment outcomes. From direct care delivery-in the form of peer support-to roles in leadership, program development, and research, individuals with lived experience can positively impact patient well-being, treatment outcomes, and the field as a whole. Peer supporters can inspire hope, build connections, share diverse experiences, and disseminate clinical insight and skills through a lived experience lens. These tools and the value of expertise by experience can lead to further clinical innovation when integrated into program development, research, and leadership roles in the eating disorder field. As rates of eating disorders continue to rise, it is more important than ever to integrate the voices of lived experience to enhance and strengthen existing treatment-and help create new approaches that could transform the healing process for countless individuals.

Parents' illness representations of their child with anorexia nervosa: A systematic review of qualitative studies using the common-sense model

OBJECTIVE

Research indicates that parents experience distress while caring for a child with anorexia nervosa. Applying the Common Sense Model of Self-Regulation (CSM), a framework to describe responses to illness may help to understand the antecedents of parental distress, which could inform how to support parents in treatment. The aim of this systematic review was to synthesize outcomes from qualitative research in relation to parents' experiences of caring for a child with anorexia nervosa using the CSM.

METHOD

Systematic search of four electronic databases (psychINFO, MEDLINE, EMBASE, ProQuest Dissertation, and Theses Database) alongside a two-way screening process was used to identify eligible studies. Qualitative themes were synthesized using a "best fit" framework analysis and reported according to CSM dimensions of cognitive and emotional illness representations.

RESULTS

A total of 32 studies published between 1970 and 2023 were eligible for inclusion for review. Parents perceived their child's anorexia nervosa as a major health threat observable by illness representations that anorexia nervosa was uncontrollable, incomprehensible, chronic, and associated with negative consequences. The themes also suggested parents take responsibility for causing anorexia nervosa. These illness representations were linked with emotional representations of fear, anxiety, shame, guilt, loneliness, and depression.

CONCLUSIONS

The findings provide evidence of the utility of using the CSM to understand the antecedents of parents' distress and negative impacts of caring for a child with anorexia nervosa. Recommendations for future research and clinical practice are discussed emphasizing the need to understand parents' perceptions of their child's illness to putatively maximize treatment benefits for families.

PUBLIC SIGNIFICANCE

This review emphasizes the salience of understanding parents distress while caring for a child with anorexia nervosa. The findings present opportunities to best support parents in treatment, with a focus on addressing their cognitive and emotional representations of their child's illness. A multicomponent treatment regimen may be required to support parents if they present with illness representations that negatively affect their well-being and ability to cope with distress.

Listening, learning, caring: exploring assemblages of, ethics of and pathways to care for avoidant restrictive food intake disorder (ARFID)

Care has been theorised in relationship to eating disorders as a central consideration across diagnoses. In the context of avoidant restrictive food intake disorder (ARFID) specifically, there is room to further develop the nuances around layers of care involved in working towards well-being. In this paper, we engage with the stories of 14 caregivers of people with ARFID, exploring their pathways to care (or lack thereof) through the healthcare system in Aotearoa New Zealand. We explore the material, affective and relational aspects of care and care-seeking, engaging with the power and politics of care as it flows through care-seeking assemblages. Using postqualitative methods of analysis, we discuss how while participants were seeking care, they received (or, at times, did not receive) treatment, and unpack how care and treatment are not always synonymous. We work up extracts from parents' stories surrounding their caring for their children and how their actions were, at times, interpreted in ways that made them feel blame and shame rather than care. Participants' stories also offer glimmers of care within a resource-strapped healthcare system, which invite us to consider the potentiality of a relational ethics of care as an assemblage-shifting moment.

Psychosocial and financial impacts for carers of those with eating disorders in New Zealand

BACKGROUND

Eating disorders (ED) can have profound effects on family members and carers. These impacts can be experienced across multiple domains and may contribute to the maintenance of ED symptoms. In the absence of any New Zealand studies quantifying this, and given country-specific differences in access to care and treatment, this study explores the psychosocial and economic impacts on those caring for someone with an ED in New Zealand.

METHODS

Carers (N = 121) of those who had, or still had, a self-reported ED (82.6% anorexia nervosa) completed an online survey open between December 2016 and October 2020, adapted to the New Zealand context. Questions addressed ED recency and recovery status of the individual cared for, treatment access, and the financial and psychosocial impact on the carer. Data analysis included descriptive statistics, with financial cost data converted to the equivalent of 2020 New Zealand dollars.

RESULTS

Most (88.6%) recruited carers reported still caring for someone with ED symptoms of varying severity. A majority reported difficulty accessing treatment for the person they cared for, with a sizable minority (45%) paying for private treatment, despite few having private insurance. Carer losses typically included reduced income and productivity, travel costs, and other miscellaneous costs. Carers reported significant psychosocial impacts across a range of dimensions including family life, interpersonal relationships, and their own personal well-being.

CONCLUSIONS

Carers in New Zealand report impacts which are far reaching and longstanding, covering their own personal and interpersonal well-being and that of those around them. While most of those they care for get access to public (free) treatment at some time or another, the wider financial and economic impacts on carers are significant, and likely to take years to recoup. Though not unique to EDs, interventions and supports for carers are much needed in New Zealand, alongside more comprehensive research methodology to further determine positive and other impacts of EDs over the long course of the caregiving role.

HIGHLIGHTS

A majority reported difficulty accessing treatment for the person they cared for 45% paid for private treatment, despite few having private insurance Carers reported reduced income and productivity, travel costs, and other costs. Carers reported significant psychosocial impacts on family life, interpersonal relationships, and their own personal well-being. Carers provide a pivotal role in supporting treatment and recovery in their family member with the These findings will be relevant for funders and service providers in developing further approaches to address barriers and gaps in service provision to reduce impacts on carers, and as a result, those with eating disorders.