“Finding my own identity”: a qualitative metasynthesis of adult anorexia nervosa treatment experiences

Abstract

Background The aim of this metasynthesis was to explore adult anorexia nervosa (AN) treatment experiences, including facilitators and barriers to treatment engagement and ways that questions of identity and personal agency were negotiated in treatment contexts. Methods From 14 qualitative studies that met the search criteria, this thematic synthesis analyzed the sensitized concept of identity in the participants’ experiences of AN treatments, including their sense of personal agency, and implications for their recovery. The study was registered with Prospero (ID: CRD42018089259) and is reported according to PRISMA guidelines. Results Three meta-themes were generated with the following key findings: grappling with identity, where collaborative and tailored interventions were positively experienced; the quality of the therapeutic relationship, which existed in a recursive relationship; and, rebuilding identity that included therapists standing with the person in recovering a sense of identity outside the anorexic identity. Importantly, interventions that failed to be negotiated with the person were experienced as disempowering however, where a two-way trust existed in the therapeutic relationship, it critically empowered and shaped participants’ sense of identity, and broadened the perception that they were valuable as a person. Conclusions There was consensus across the range of treatment contexts that individuals with a lived AN experience preferred treatments where they experienced (1) a sense of personal agency through tailored interventions; and (2) therapists who treated them as a person who, in the face of their struggles, had skills and capacities in the processes of recovering and rebuilding sustainable and preferred identities outside the AN identity.

"I’m Still Here, But No One Hears You": A Qualitative Study of Young Women’s Experiences of Persistent Distress Post Maudsley and Family-Based Therapy for Adolescent Anorexia Nervosa

“…These included parental understanding of their AN experience and standing for them as a person, being treated outside of an inpatient setting and clarifying a sense of identity outside of the AN identity or " nd(ing) out who I was" (Phoenix). These participant experiences highlight the importance of addressing questions of identity in AN treatments (27,38) and how externalization as an intervention may, in some contexts, facilitate this process. On the other hand, in contexts where the adolescent themselves was excluded from the process of discernment and naming of the AN, externalisation was experienced as invalidating rather than having the intended effect of empowering the person to reclaim their identity from AN (39).…”

“…Less helpful was the neglect of issues other than AN (24,26) and the adolescents' unmet preferences for individual therapy (24). Furthermore, there is increasing evidence to support the need for ED treatment interventions to more comprehensively focus on questions of identity, including ways to address the person's ED identity investments and reclaiming identity outside the ED identity (27).…”

Externalizing Your Eating Disorder: A Qualitative Interview Study

“…Personal views on how AN related to identity could vary within the person, per moment and per situation. Although patient perceptions on the relation between AN and identity were previously researched, 4,7,10,14,15 this study adds to the existing literature as it operationalizes identity as narrative identity and places all varying experiences on a spectrum. What is consistent with previous research is the fact that views on the relation between AN and identity can change over time.…”

“…Extensive literature on experiences with regard to an externalizing approach is missing, but previous research shows that patients with AN value a non-judgmental, respectful and supportive therapist, 14,44 as well as being seen as a whole person, rather than just a diagnosis. 16,19 This study thus adds to the literature by elucidating patients' experiences of an externalizing approach in the treatment of AN and from its results the tentative conclusion that such an approach may result in epistemic injustice, can be drawn.…”

“…On the subject how patients experience treatment for AN, many studies have been conducted and recently a qualitative metasynthesis has been published. 14 However, none of the studies has focussed speci cally on the experience of an externalizing approach within treatment. 5,15−19 One study on FBT discusses how parents experience externalization within treatment, but patients' experiences were not investigated.…”