scholarly journals Clinicians’ perspectives on supporting individuals with severe anorexia nervosa in specialist eating disorder intensive treatment settings

2022 ◽  
Vol 10 (1) ◽  
Author(s):  
Hannah Webb ◽  
Bethan Dalton ◽  
Madeleine Irish ◽  
Daniela Mercado ◽  
Catherine McCombie ◽  
...  
Keyword(s):  
Anorexia Nervosa ◽  
Eating Disorder ◽  
Intensive Treatment ◽  
Future Research ◽  
Structured Interviews ◽  
Resource Limited ◽  
Challenges And Opportunities ◽  
Treatment Data ◽  
Relationship Of ◽  
Treatment Settings

Abstract Background Admissions to intensive treatment (i.e., inpatient [IP] and/or day patient [DP]) for individuals with severe anorexia nervosa (AN) are common. Growing literature indicates potential risks and benefits of each intensive treatment approach; however, existing research has focused on patient and carer perspectives of these treatments. Also, there is scant empirical evidence available for guiding the parameters of intensive treatments for AN. We therefore explored clinicians’ perspectives and experience of supporting adults with severe AN in intensive settings. Methods We conducted twenty one semi-structured interviews with clinicians who deliver intensive treatments (i.e., IP and/or DP) for individuals with severe AN across four specialist Eating Disorder Services in the United Kingdom between May 2020 and June 2021. We asked clinicians about their views and experiences of supporting individuals with severe AN in intensive treatment settings and the challenges and opportunities associated with IP and DP treatment. Data were analysed using reflexive thematic analysis supported by NVivo software. Results Five broad and interrelated themes were identified: (1) Intensive Support; (2) The Severity of Patients’ Illnesses; (3) Hope and Recovery; (4) Which Treatment When; (5) Limited Resources; and (6) Carer Burden. We identified various similarities between the two intensive treatment approaches, including the value of intensive and multidisciplinary support and carer involvement, and the challenge of managing complex and unique needs in resource-limited intensive settings. We also found differences in the relationship of treatment to patients’ home environments, the necessity of patient motivation, and the management of risk. Conclusions Both intensive treatment settings are valued by clinicians; however, there are unique challenges and opportunities for supporting individuals with severe AN within each. Our findings suggest DP treatment may be used as an alternative to IP treatment for individuals with severe AN. However, clear questions remain over which intensive treatment setting is best suited to which patient when and should be the focus of future research.

scholarly journals Adapting a neuroscience-informed intervention to alter reward mechanisms of anorexia nervosa: a novel direction for future research

2021 ◽  
Vol 9 (1) ◽  
Author(s):  
Ann F. Haynos ◽  
Lisa M. Anderson ◽  
Autumn J. Askew ◽  
Michelle G. Craske ◽  
Carol B. Peterson
Keyword(s):  
Anorexia Nervosa ◽  
Eating Disorder ◽  
Anxiety Disorders ◽  
Reward Processing ◽  
Future Research ◽  
Restrictive Eating ◽  
Eating Disorder Symptoms ◽  
Mood And Anxiety Disorders ◽  
Reward Responsivity ◽  
Eating Disorder Behaviors

AbstractAccumulating psychobiological data implicate reward disturbances in the persistence of anorexia nervosa (AN). Evidence suggests that individuals with AN demonstrate decision-making deficits similar to those with mood and anxiety disorders that cause them to under-respond to many conventionally rewarding experiences (e.g., eating, interacting socially). In contrast, unlike individuals with other psychiatric disorders, individuals with AN simultaneously over-respond to rewards associated with eating-disorder behaviors (e.g., restrictive eating, exercising). This pattern of reward processing likely perpetuates eating-disorder symptoms, as the rewards derived from eating-disorder behaviors provide temporary relief from the anhedonia associated with limited responsivity to other rewards. Positive Affect Treatment (PAT) is a cognitive-behavioral intervention designed to target reward deficits that contribute to anhedonia in mood and anxiety disorders, including problems with reward anticipation, experiencing, and learning. PAT has been found to promote reward responsivity and clinical improvement in mood and anxiety disorders. This manuscript will: (1) present empirical evidence supporting the promise of PAT as an intervention for AN; (2) highlight nuances in the maintaining processes of AN that necessitate adaptations of PAT for this population; and (3) suggest future directions in research on PAT and other reward-based treatments that aim to enhance clinical outcomes for AN.

scholarly journals Exploring the experience of being viewed as “not sick enough”: a qualitative study of women recovered from anorexia nervosa or atypical anorexia nervosa

2021 ◽  
Vol 9 (1) ◽  
Author(s):  
Kari Eiring ◽  
Trine Wiig Hage ◽  
Deborah Lynn Reas
Keyword(s):  
Anorexia Nervosa ◽  
Eating Disorder ◽  
Qualitative Study ◽  
Help Seeking ◽  
Severity Of Illness ◽  
Physical Sign ◽  
Structured Interviews ◽  
Restrictive Eating ◽  
Eating Disorder Symptoms ◽  
Atypical Anorexia Nervosa

Abstract Background Despite common misconceptions, an individual may be seriously ill with a restrictive eating disorder without an outwardly recognizable physical sign of the illness. The aim of this qualitative study was to investigate the perspectives of individuals who have previously battled a restrictive eating disorder who were considered “not sick enough” by others (e.g., peers, families, healthcare professionals) at some point during their illness, and to understand the perceived impact on the illness and recovery. Such misconceptions are potentially damaging, and have been previously linked with delayed help-seeking and poorer clinical outcomes. Methods Seven women who had recovered from anorexia nervosa or atypical anorexia nervosa participated in semi-structured interviews. Interviews were transcribed and interpretive phenomenological analysis was used. Results Three main themes emerged: (1) dealing with the focus upon one’s physical appearance while battling a mental illness, (2) “project perfect”: feeling pressure to prove oneself, and (3) the importance of being seen and understood. Participants reported that their symptoms were occasionally met with trivialization or disbelief, leading to shame, confusion, despair, and for some, deterioration in eating disorder symptoms which drove further weight loss. In contrast, social support and being understood were viewed as essential for recovery. Conclusion To facilitate treatment seeking and engagement, and to optimize chances of recovery, greater awareness of diverse, non-stereotypical presentations of restrictive eating disorders is needed which challenge the myth that weight is the sole indicator of the presence or severity of illness.

Power and Influence Strategies in Violent and Nonviolent Marriages

1992 ◽  
Vol 16 (4) ◽  
pp. 449-465 ◽  
Author(s):  
Irene Hanson Frieze ◽  
Maureen C. McHugh
Keyword(s):  
Decision Making ◽  
Close Relationships ◽  
Physical Violence ◽  
Balance Of Power ◽  
Future Research ◽  
Influence Strategies ◽  
Structured Interviews ◽  
Negative Dimension ◽  
Relationship Of ◽  
The Relationship

How important is the use of physical violence in determining the balance of power within marriage? Do women in violent marriages make more use of indirect strategies in attempting to persuade their husbands than do women in nonviolent marriages? Is marital satisfaction related to influence styles? These questions are investigated by looking at decision making in couples and how this is related to the forms of influence strategies used by wives and husbands in violent and nonviolent marriages. Data from in-depth structured interviews with 137 self-identified battered wives and 137 comparison wives, some of whom were also found to have experienced violence from their husbands, are used to answer these questions. Results indicated that women with violent husbands used more influence strategies overall, although these women had less overall power in terms of decision making than did women with nonviolent husbands. The relationship of influence strategies to decision making was different for women with violent husbands than for those whose husbands were not violent. As expected, the use of coercive strategies related negatively to marital happiness, whereas positive strategies were positively predictive. Violence and other negative strategies should be included in future research on influence strategies in close relationships, and a positive–negative dimension should be included as a way of categorizing influence strategies.

scholarly journals Emotion regulation difficulties in anorexia nervosa: associations with improvements in eating psychopathology

2021 ◽  
Author(s):  
Marsha Rowsell ◽  
Danielle E. MacDonald ◽  
Jacqueline C. Carter
Keyword(s):  
Emotion Regulation ◽  
Anorexia Nervosa ◽  
Eating Disorder ◽  
Intensive Treatment ◽  
Self Report ◽  
Eating Psychopathology ◽  
Eating Disorder Symptoms ◽  
Core Deficit ◽  
Eating Disorder Psychopathology ◽  
Regulation Strategies

Background Difficulties with emotion regulation have been established as a core deficit in anorexia nervosa (AN). However, limited research has evaluated whether weight gain is associated with improvements in emotion regulation difficulties in AN and whether improvements in emotion regulation are associated with reductions in eating disorder psychopathology. The aims of this study were threefold: 1) to examine the nature and extent of emotion regulation difficulties in AN; 2) to determine whether these difficulties improved during intensive treatment for the eating disorder; and 3) to study whether improvements in emotion regulation were associated with improvements in eating disorder psychopathology. Method The participants were 108 patients who met DSM-IV-TR criteria for AN and were admitted to a specialized intensive treatment program. Self-report measures of eating disorder symptoms and difficulties with emotion regulation were administered at admission to and discharge from the program. Results Patients with the binge-purge subtype of AN reported greater difficulties with impulse control when upset and more limited access to emotion regulation strategies when experiencing negative emotions than those with the restricting subtype. Among those who completed treatment and became weight restored, improvements in emotion regulation difficulties were observed. Greater pre-to-post treatment improvements in emotional clarity and engagement in goal directed behaviours when upset were associated with greater reductions in eating disorder psychopathology during treatment. Conclusions These findings add to growing evidence suggesting that eating disorder symptoms may be related to emotion regulation difficulties in AN and that integrating strategies to address emotion regulation deficits may be important to improving treatment outcome in AN.

Future strategic considerations and development priorities for national museum libraries

2018 ◽  
Vol 74 (6) ◽  
pp. 1204-1225 ◽  
Author(s):  
Rupert Nicholas Williams
Keyword(s):  
Quantitative Research ◽  
Online Survey ◽  
Future Research ◽  
National Museum ◽  
Structured Interviews ◽  
Content Type ◽  
Sequential Mixed Methods ◽  
Challenges And Opportunities ◽  
Future Challenges ◽  
Qualitative Phase

Purpose The purpose of this paper is to explore the main strategic considerations facing the libraries of national museums over the next decade, and to examine anticipated future service and resource development priorities. Design/methodology/approach An explanatory sequential mixed-methods study was undertaken, consisting of a quantitative research phase followed by a qualitative phase. An online survey was sent to the head librarians of two hundred national museum libraries for the quantitative phase. Semi-structured interviews were undertaken with the head librarians at seven national museum libraries for the qualitative phase. The survey data were analysed using descriptive statistics and the interview data were analysed through use of recursive abstraction. Mixing of the data occurred following the qualitative phase. Findings National museum libraries are facing a complex array of future challenges and opportunities as a result of a rapidly changing socio-technical landscape, evolving organisational needs and priorities and ongoing operational constraints. The main strategic considerations for many national museum libraries relate to their preparedness for these issues, and their ability to deliver services and resources that are relevant, required, and responsive to the future research needs of internal and external users. It seems likely that development priorities will focus on consolidating high impact services and resources, whilst also expanding provision into new areas that have the greatest potential for growth. Originality/value This study identifies issues of strategic importance for national museum libraries and examines the main priority areas being considered by museum librarians as they prepare to develop their libraries into the third decade of the twenty-first century.

scholarly journals Family members’ reflections upon a family-based inpatient treatment program for adolescent anorexia nervosa: a thematic analysis

2021 ◽  
Vol 9 (1) ◽  
Author(s):  
Jan-Vegard Nilsen ◽  
Øyvind Rø ◽  
Inger Halvorsen ◽  
Hanne Weie Oddli ◽  
Trine Wiig Hage
Keyword(s):  
Anorexia Nervosa ◽  
Eating Disorder ◽  
Treatment Program ◽  
Inpatient Treatment ◽  
Treatment Approach ◽  
Family Members ◽  
Adolescent Anorexia Nervosa ◽  
Family Based Treatment ◽  
Family Based ◽  
Treatment Settings

Abstract Background Family-based outpatient treatment is usually recommended as the treatment of choice when a child develops anorexia nervosa. However, some young persons will inevitably require higher levels of care. Qualitative research on family perspectives may help inform strategies to adapt family-based practices into intensified treatment settings. Our overarching aim was to investigate family members’ perspectives following a family-based inpatient treatment program for adolescent anorexia nervosa and to discuss clinical implications for treatment providers. Methods A subsample of eight families taking part in a naturalistic outcome study at a specialized eating disorder unit participated in the study (8 patients, 14 parents, and 10 siblings). The thematic analyses were inductive, predominantly descriptive, and guided by a multi-perspective framework. Results Five main themes were identified: 1: Expectations and evaluation of needs. Entering treatment from different vantage points, 2: Interactions with peers during the admission as highly beneficial or problematic, 3: Perspectives on staff expertise and the eating disorder unit’s structure, 4: Influencing within family relationships in different ways, and 5: Being admitted is at best only half the job: reflections on leaving the eating disorder unit. Conclusions Our study offers insight into how former inpatients and their family members experienced an inpatient treatment program designed to align treatment with the central elements of an outpatient family-based treatment approach for adolescent anorexia nervosa. Overall, the findings support emerging research underlining the necessity of strengthening the family-based treatment approach within intensified treatment settings. Moreover, the results emphasized the need for more knowledge on how to optimize inpatient treatment as well as the importance of providing smooth transitions between care settings.

An Overview of Anorexia Nervosa, Bulimia Nervosa, and Binge Eating Disorders: Implications for Rehabilitation Professionals

2004 ◽  
Vol 35 (4) ◽  
pp. 26-34
Author(s):  
Ebony M. Hogan ◽  
Connie J. McReynolds
Keyword(s):  
Eating Disorders ◽  
Anorexia Nervosa ◽  
Eating Disorder ◽  
Bulimia Nervosa ◽  
Binge Eating ◽  
Current Treatment ◽  
Treatment Modalities ◽  
Future Research ◽  
Additional Information ◽  
Binge Eating Disorders

This article addresses anorexia nervosa (AN), bulimia nervosa (BN), and binge eating disorders (BED) through the discussion of demographic information, symptomatology, DSM IV criteria for diagnosis, etiology, current treatment modalities, and the potential prognosis of each of these disorders. Additional information about an eating disorder that exclusively affects men is also provided. Intervention strategies for each eating disorder, as well as the relapse phenomenon affecting recovery from eating disorders, are discussed. Specific suggestions are provided for rehabilitation counselors as well as suggestions for future research.

scholarly journals ‘It’s not that they don’t want to access the support . . . it’s the impact of the autism’: The experience of eating disorder services from the perspective of autistic women, parents and healthcare professionals

Autism ◽  
2021 ◽  
pp. 136236132199125
Author(s):  
Charli Babb ◽  
Janina Brede ◽  
Catherine R G Jones ◽  
Mair Elliott ◽  
Cathy Zanker ◽  
...  
Keyword(s):  
Anorexia Nervosa ◽  
Eating Disorder ◽  
Healthcare Professionals ◽  
Autistic Traits ◽  
Future Research ◽  
Diagnostic Features ◽  
Women’S Experiences ◽  
Women's Experiences ◽  
The Impact ◽  
Depth Interviews

This study explores autistic women’s experiences of eating disorder services. Estimates suggest that 20%–30% of women in treatment for anorexia nervosa display diagnostic features characteristic of autism. Research suggests that autistic individuals’ needs are not being met by standard anorexia nervosa treatments. In the current study, in-depth interviews were conducted with 15 autistic women with experience of anorexia nervosa, 12 parents of autistic women with anorexia nervosa, and 11 eating disorder healthcare professionals. Using thematic analysis, three overarching themes were identified: misunderstanding autism and autistic traits, one treatment does not fit all, and improving accessibility and engagement within services. We found that there were diverse barriers facing autistic women when in treatment for anorexia nervosa, and these were accentuated by a lack of autism understanding within eating disorder services. Future research should focus on developing interventions that are tailored to the specific needs of autistic individuals with anorexia nervosa. Lay Abstract This study explores autistic women’s experiences of eating disorder services. About 20%–30% of people with anorexia nervosa are also autistic, and current treatments seem not to work as well for them. We interviewed 15 autistic women with experience of anorexia nervosa, 12 parents of autistic women with anorexia nervosa, and 11 healthcare professionals working in eating disorder services. We asked autistic women and parents about their experiences of eating disorder services, and we asked healthcare professionals about their experiences treating autistic women with anorexia nervosa. Participants’ views were represented by three overall themes: misunderstanding autism and autistic traits, one treatment does not fit all, and improving accessibility and engagement within services. We found that autistic women face many barriers when in treatment for anorexia nervosa, often because of a lack of autism understanding within eating disorder services. Future research should look at developing anorexia nervosa treatments that can specifically help autistic individuals.

Recovery from Anorexia Nervosa in Contemporary Taiwan: A Multiple-Case Qualitative Investigation from a Cultural-Contextual Perspective

2020 ◽  
pp. 136346152092032
Author(s):  
Yunung Lee ◽  
Ben C. H. Kuo ◽  
Ping-Hwa Chen ◽  
Nien-Hwa Lai
Keyword(s):  
Anorexia Nervosa ◽  
Filial Piety ◽  
Recovery Process ◽  
Future Research ◽  
Sociocultural Factors ◽  
Structured Interviews ◽  
Dynamic Interactions ◽  
Multiple Case ◽  
Recovery Pathways ◽  
Cross Case Analysis

Grounded in a cultural and contextual perspective, the current study examined the lived experiences and the recovery pathways of three Taiwanese women diagnosed with various subtypes of anorexia nervosa, at varying stages of their recovery. Specifically, using a multiple-case qualitative method, this study explored the complex, dynamic interactions of sociocultural factors and forces (i.e., cultural, familial, and societal influences) that impinge upon the three Taiwanese female participants in relation to living with anorexia nervosa in contemporary Taiwan. Data were collected based on in-depth, semi-structured interviews with the participants and relevant written materials and journal entries provided by these participants. The data were first analyzed within each case and then again across all cases. Accordingly, we present the results of the study by illustrating each participant’s story and narrative of struggling with and recovering from anorexia. We then describe three main culturally-related themes that emerged from the cross-case analysis, which pertain specifically to the recovery process of the participants under the East-West ‘biculturalism’ in Taiwan: 1) anorexia as a function of the conflictual bicultural self; 2) recovery as a pathway towards an integrated bicultural self; and 3) the paradoxical roles of Chinese cultural heritage in anorexia and recovery. Findings of the study highlight the role of local cultural factors/forces, including Chinese familism, Confucianism, filial piety, face-saving, gender role prescriptions, biculturalism, Westernization, and self-relation-coordination, in affecting and shaping Taiwanese women’s struggling with anorexia. Implications and recommendations for future research and clinical interventions are discussed.

Repetitive Transcranial Magnetic Stimulation in Anorexia Nervosa: a Pilot Study

2011 ◽  
Vol 28 (2) ◽  
pp. 98-101 ◽  
Author(s):  
F. Van den Eynde ◽  
S. Guillaume ◽  
H. Broadbent ◽  
I.C. Campbell ◽  
U. Schmidt
Keyword(s):  
Anorexia Nervosa ◽  
Eating Disorder ◽  
Transcranial Magnetic Stimulation ◽  
Pilot Study ◽  
Repeated Measures ◽  
Magnetic Stimulation ◽  
Therapeutic Potential ◽  
Repetitive Transcranial Magnetic Stimulation ◽  
Future Research ◽  
Subjective Experiences

AbstractThe search for new treatments to improve outcome in people with anorexia nervosa continues. This pilot study investigated whether one session of high frequency repetitive transcranial magnetic stimulation (rTMS) delivered to the left dorsolateral prefrontal cortex reduces eating disorder related symptoms following exposure to visual and real food stimuli. Safety and tolerability were also assessed. Ten right-handed people with anorexia nervosa underwent one session of rTMS. Subjective experiences related to the eating disorder (e.g. urge to restrict, feeling full etc.) were assessed before and after rTMS. Non-parametric repeated measures tests were used. rTMS was safe and well-tolerated, and resulted in reduced levels of feeling full, feeling fat and feeling anxious. Thus, rTMS may reduce core symptoms of anorexia nervosa. Future research should establish the therapeutic potential of rTMS in anorexia nervosa.

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