Anorexia Nervosa’s Meaning to Patients: A Qualitative Synthesis

Abstract

Background: We carried out a qualitative synthesis of international literature to provide insight into the patient’s experience as a means to help clinicians recognize symptoms of anorexia nervosa. Method: International publications from 1990 to 2005 were searched for relevant qualitative investigations, and meta-ethnography was employed to identify common themes across studies. Databases included were PubMed, ISI, PsycINFO, EMBASE, LILACS and SciELO. Results: 24 studies were included from a total of 3,415 papers. The second-order interpretation process using reciprocal translation allowed the identification of two concepts: (1) symptom identification (disease representation, self-concept, development of anorexia) and (2) disease interpretation (positive aspects, negative aspects, areas of life affected). Third-order constructs emerged revealing the disease as connected with identity and control. Conclusion: Knowledge of patients’ efforts to interpret the illness as a part of their own identity and sense of control have a key role in physician understanding of the disorder by allowing physicians to bring structure to the patients’ lives generally and to their help-seeking behavior specifically. The study has some limitations. Most of the results come from B-grade studies (as classified by the Critical Appraisal Skills Programme) that used qualitative methodology, implying the need for caution in data interpretation. Moreover, study populations were almost exclusively female, and no comparison was attempted concerning the severity of the condition between studies.

The lived experience of working with people with eating disorders: A meta‐ethnography

“…The overall score and classification for each study are included in Table . Given that all studies were rated B or above, and in line with other meta‐syntheses in the field (Espindola & Blay, ; Sibeoni et al, ), no studies were excluded on the basis of the quality ratings.…”

“…To provide a guide as to their relative rigor, the methodological quality of the included studies was assessed by M.G. using the Critical Appraisal Skills Programme (CASP, ) checklist for qualitative research, a tool employed in previous syntheses of qualitative ED studies (e.g., Espindola & Blay, ; Fox, Dean, & Whittlesea, ). The checklist has 10 criteria, so each study was awarded a score out of 10, with half‐points granted if a criterion were partially fulfilled.…”

The Maudsley Model of Anorexia Nervosa Treatment for Adults (MANTRA): Development, Key Features, and Preliminary Evidence

“…We get patients to think about values that are highly important now and also get them to look at how their values may have changed since the onset of AN and how AN may have made it hard for them to live according to certain values or has brought some values into conflict with each other. We also use exercises that externalize AN to help dislodge the idea that AN is part of the person's identity (Espíndola & Blay, 2009;Sternheim, Konstantellou, Startup, & Schmidt, 2011;Tan, Hope, & Stewart, 2003).…”

The meaning of compulsive exercise in women with anorexia nervosa: An interpretative phenomenological analysis

“…Participants with anorexia nervosa in Dignon et al (2006) reported increased anxiety when confronted with the meal structure in treatment and associated feelings of losing control over the single aspect over which they used to remain in control. The sense of control offered by anorexia over food and their bodies has been discussed as a ´functional tool´ that offers a feeling of being in greater control and helps with building a sense of self (e.g., Dignon et al, 2006;Espindola & Blay, 2009;Nordbo et al, 2006;Williams & Reid, 2012). Nordbo et al (2006) contend that anorectic behaviours help patients organize and structure their everyday life, by providing a sense of predictability, mastery and self-control in order to counteract feelings of confusion and disorganization.…”