Research suggests that approximately 50 per cent of patients drop out prematurely from services for anorexia nervosa. This research set out to investigate the possible reasons for this high drop‐out rate. The experiences of eight women were explored through written accounts and semi‐structured interviews. The information was analysed using a social constructionist revision of grounded theory. A central theme of control emerged which was affected by interactions with the wider social system. The cumulative battle for control between the anorectic and others appeared to result in the act of dropping out as the treatment approach, timing and context recreated the setting conditions of lost control. The organizational and clinical implications of this model are discussed. Copyright © 2002 John Wiley & Sons, Ltd and Eating Disorders Association.
Background: To date minimal research has investigated adolescent psychiatric inpatient care from a service‐user perspective. Method: Semi‐structured interviews were conducted with 10 adolescents with experience of psychiatric inpatient care. Interviews were analysed using the grounded theory method (Glaser & Strauss, 1967). Results: A core category, ‘Living in an Alternative Reality’, reflected the unusual nature of the hospitalisation experience. Adolescents reported feelings of restriction and disconnection and used various relational and practical strategies to cope with hospitalisation. Conclusions: Results suggest that psychiatric hospitalisation can cause strong affective reactions in adolescents, and may affect psychological constructs such as identity and self‐esteem.
Anorexia nervosa-focussed family therapy (FT-AN) is the first-line treatment for adolescent anorexia nervosa (AN), but the predictors of poor treatment response are not well understood. The main aim of this study was to investigate the role of attachment and mentalization in predicting treatment outcome. The secondary aims of the study were to investigate therapeutic alliance at 1 month as a predictor of outcome, and to test the associations between alliance and baseline attachment and mentalization. 192 adolescents with AN and their parents were recruited as they began family therapy in out-patient specialist eating disorder services. Self-report measures of attachment, mentalization, and emotion regulation were completed at the start of treatment by adolescent patients and one of their parents. Self-reported alliance scores were collected at one month. Higher scores on the Certainty Scale of the Reflective Functioning Questionnaire, completed by parents, which indicate over-certainty about mental states, were the strongest predictor of poor outcome (Odds Ratio: 0.42, CI: 0.20–0.87). Similarly, for adolescents, higher Lack of Clarity scores on the Difficulties in Emotion Regulation Scale, representing being unclear about one’s feelings, were predictive of positive treatment outcome (OR: 1.10, CI: 1.00–1.21). Higher alliance scores at 1 month predicted positive outcome, and were associated with attachment security and mentalization. These novel findings suggest that, particularly in parents, a tendency towards excessive certainty about mental states in others may predict poor outcome in FT-AN. Further research is warranted to replicate the finding and characterise families at risk of poor outcome.
Purpose There is a dearth of research on what constitutes effective transfer of care from children’s and young people services to adult services for patients with eating disorders (EDs) in the UK. Transition has implications for continuity of care and particularly for early intervention which has the best prognosis. The purpose of this paper is to understand the experience of transition and identify facilitators and barriers to this. Design/methodology/approach Qualitative methodology was used. Focus groups (n = 4) were held with clinicians (n = 22) working in Child and Adolescent Mental Health Services or adult ED services. Individual interviews were conducted with patients (n = 5) who had commenced/completed transition to adult services and with parents/carers (n = 6) of patients invited for interview. Findings A number of factors may facilitate or impede transition and can be grouped into the broad themes of communication, managing the differences between services and timing of transition. Improvements in communication, clear explanation of service differences and flexibility around the timing of transitions may enhance the experience for patients and parents/carers. Research limitations/implications The service evaluation was limited to transition between two specialist ED services in one geographical location. The findings provide the basis for a wider research study to examine which factors are most important when planning transition from the perspectives of patients, parents/carers and clinicians. Originality/value This is the first study examining ED transitions in the UK. It provides valuable insight of the experience of service users and carers and highlights potential improvements when planning transitions for this patient group.
Objective: Anorexia nervosa focussed family therapy (FT-AN) is the first-line treatment for adolescent anorexia nervosa (AN), but the predictors of poor treatment response are not well-understood. The main aim of this study was to investigate the role of attachment and mentalization in predicting treatment outcome at nine months. Therapeutic alliance at one month was tested as a potential mediator of the effect of attachment and mentalization at baseline on outcome at nine months.Method: 192 adolescents with AN and their parents were recruited as they began family therapy in out-patient specialist eating disorder services. Self-report measures of attachment, mentalization and emotion regulation were completed at the start of treatment by adolescent patients and one of their parents. Self-reported alliance scores were collected at one month. Results: Higher scores on the Certainty Scale of the Reflective Functioning Questionnaire, completed by parents, which indicate over-certainty about mental states, were the strongest predictor of poor outcome (Odds Ratio: .42, CI: .20 to .87). Similarly, for adolescents, higher Lack of Clarity scores on the Difficulties in Emotion Regulation Scale, representing being unclear about one’s feelings, were predictive of positive treatment outcome (OR: 1.10, CI: 1.00 - 1.21). Alliance scores at one month were predictive of success but did not play a mediating role in relation to baseline predictors.Conclusion: These novel findings suggest that, particularly in parents, a tendency towards inappropriate certainty about mental states in others may predict poor outcome in family therapy for adolescent AN. Further research is warranted to replicate the finding and characterise families at risk of poor outcome.
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