Reclamation of power and self: a meta-synthesis exploring the process of recovery from anorexia nervosa

Duncan, Tristan; Sebar, Bernadette; Lee, Jessica

doi:10.1080/21662630.2014.978804

Cited by 43 publications

(70 citation statements)

References 46 publications

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“…The CASP method is a standardized tool to help researchers to systematically examine qualitative studies. CASP is a commonly used method within qualitative meta-analysis, or -synthesis studies to assess credibility, value and relevance of the selected studies [ 47 , 57 – 59 ]. In accordance with the CASP method and study [ 47 ], the quality of the studies was assessed on 10 themes, and classified as “A”, low risk of bias (studies meeting 9 or 10 of the questions) or “B” moderate risk of bias (studies meeting at least 5 of the questions, but not more then 8).…”

Section: Methodsmentioning

confidence: 99%

“…Noordenbos and Seubring [ 25 ] and Emmanuelli and colleagues [ 26 ] used a pre-fixed set of statements, making their study susceptible to missing criteria which might have been endorsed by ex-patients or clinicians had they been articulated in the design of the study. Several qualitative studies show criteria for recovery that were not present in the consensus studies with the pre-fixed statements [ 25 , 26 ], such as improved self-acceptance, identity development, feelings of purpose and meaning in life, self-management and empowerment [ 45 – 47 ]. Other studies only focused on AN or did not take the perspective of recovered individuals into account.…”

Section: Introductionmentioning

confidence: 99%

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Identifying fundamental criteria for eating disorder recovery: a systematic review and qualitative meta-analysis

et al. 2017

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BackgroundOutcome studies for eating disorders regularly measure pathology change or remission as the only outcome. Researchers, patients and recovered individuals highlight the importance of using additional criteria for measuring eating disorder recovery. There is no clear consensus on which additional criteria are most fundamental. Studies focusing on the perspectives of recovered patients show criteria which are closely related to dimensions of positive functioning as conceptualized in the complete mental health model. The aim of this study was to identify fundamental criteria for eating disorder recovery according to recovered individuals.MethodsA systematic review and a qualitative meta-analytic approach were used. Eighteen studies with recovered individuals and meeting various quality criteria were included. The result sections of the included papers were searched for themes that were stated as criteria for recovery or ‘being recovered’. All themes were analyzed using a meta-summary technique. Themes were labeled into criteria for recovery and the frequency of the found criteria was examined.ResultsIn addition to the remission of eating disorder pathology, dimensions of psychological well-being and self-adaptability/resilience were found to be fundamental criteria for eating disorder recovery. The most frequently mentioned criteria were: self-acceptance, positive relationships, personal growth, decrease in eating disorder behavior/cognitions, self-adaptability/resilience and autonomy.ConclusionsPeople who have recovered rate psychological well-being as a central criterion for ED recovery in addition to the remission of eating disorder symptoms. Supplementary criteria, besides symptom remission, are needed to measure recovery. We recommend including measurements of psychological well-being and self-adaptability/resilience in future research, such as outcome studies and in routine outcome measurement.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Identifying fundamental criteria for eating disorder recovery: a systematic review and qualitative meta-analysis

et al. 2017

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“…In addition, the long-term outcomes of patients with AN complicated with mood comorbidity were reduced [90]. Consequently, psychological well-being, positive supportive relationships, hope, identity, meaning, and purpose are important markers of recovery [91,92].…”

Section: Chronic Stress Response: Co-morbidity With Depression and Anmentioning

confidence: 99%

Cognitive Interpersonal Model for Anorexia Nervosa Revisited: The Perpetuating Factors that Contribute to the Development of the Severe and Enduring Illness

Treasure

Willmott

Ambwani

et al. 2020

JCM

135

122

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The cognitive interpersonal model was outlined initially in 2006 in a paper describing the valued and visible aspects of anorexia nervosa (Schmidt and Treasure, 2006). In 2013, we summarised many of the cognitive and emotional traits underpinning the model (Treasure and Schmidt, 2013). In this paper, we describe in more detail the perpetuating aspects of the model, which include the inter- and intrapersonal related consequences of isolation, depression, and chronic stress that accumulate in the severe and enduring stage of the illness. Since we developed the model, we have been using it to frame research and development at the Maudsley. We have developed and tested interventions for both patients and close others, refining the model through iterative cycles of model/intervention development in line with the Medical Research Council (MRC) framework for complex interventions. For example, we have defined the consequences of living with the illness on close others (including medical professionals) and characterised the intense emotional reactions and behaviours that follow. For the individual with an eating disorder, these counter-reactions can allow the eating disorder to become entrenched. In addition, the consequent chronic stress from starvation and social pain set in motion processes such as depression, neuroprogression, and neuroadaptation. Thus, anorexia nervosa develops a life of its own that is resistant to treatment. In this paper, we describe the underpinnings of the model and how this can be targeted into treatment.

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“…In the absence of further empirical testing of this putative temporal relationship whereby QoL imposes an effect on eating disorder severity, we turn to findings from qualitative research. In particular, studies conducted with recovered patients have highlighted the importance of life satisfaction and functioning in reducing eating disorder symptoms (for a meta-synthesis see [ 14 ]). For instance, participants in these studies have attributed recovery to social support and development of healthy relationships [ 15 – 20 ], satisfaction with study and the home environment [ 18 ], engagement in leisure activities (e.g., work, hobbies, travelling, sport) [ 18 , 19 , 21 ], and having children [ 20 , 21 ], which are all important domains of QoL.…”

Section: Introductionmentioning

confidence: 99%

“…However important limitations have constrained the generalisation of these findings. For instance, samples have been largely constrained to anorexia nervosa (e.g., [ 15 – 20 ]) [ 14 ], and in particular those who have sought treatment. Anorexia nervosa represents a minority of eating disorder cases in the general population [ 22 – 24 ], and is characterised by often ego-syntonic symptoms, such as dieting and weight loss, that has been suggested by some to buffer against perceptions of QoL impairment [ 25 ].…”

Section: Introductionmentioning

confidence: 99%

Quality of life as a vulnerability and recovery factor in eating disorders: a community-based study

et al. 2016

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BackgroundEmerging evidence suggests that changes in quality of life (QoL) predicts later changes in eating disorder (ED) symptoms. The objective of this study was to explore individual sufferers’ perspectives on the influence of QoL on the onset, maintenance, and/or remission of ED symptoms.Method19 women from the community with a history of eating disorders (n = 13 currently symptomatic; n = 6 recovered) were interviewed about their observations on the relationship between QoL and ED symptoms over time in their own lives. Interviews were audio-taped and transcribed, and then thematically analysed.ResultsThematic analysis uncovered two major themes: 1. QoL as a Vulnerability Factor, and 2. QoL as a Recovery Factor. In relation to the first theme, onset of ED symptoms was discussed by women in this study as having been triggered by impairment in QoL, including a general sense of lacking control in life, stress, abusive intimate relationships, poor role modelling from family, physical impairment related to obesity, peer pressure, and weight-related teasing. On the other hand, and in relation to the second theme, subsequent improvement in QoL was nominated as central to symptom improvement and recovery. QoL improvement was described by participants differently, but included increased general satisfaction in life, emotional maturation, prioritising and improving physical health, the development of a supportive intimate relationship and social relationships, and having children.ConclusionsImpairment in QoL may act as a trigger for the onset and maintenance of ED symptoms, whereas improvement in QoL may be central to eating disorder improvement and eventual recovery. Treatment should involve consideration of a core focus on QoL improvement as a potential ‘backdoor’ approach to improving ED symptoms.Electronic supplementary materialThe online version of this article (doi:10.1186/s12888-016-1033-0) contains supplementary material, which is available to authorized users.

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Reclamation of power and self: a meta-synthesis exploring the process of recovery from anorexia nervosa

Cited by 43 publications

References 46 publications

Identifying fundamental criteria for eating disorder recovery: a systematic review and qualitative meta-analysis

Identifying fundamental criteria for eating disorder recovery: a systematic review and qualitative meta-analysis

Cognitive Interpersonal Model for Anorexia Nervosa Revisited: The Perpetuating Factors that Contribute to the Development of the Severe and Enduring Illness

Quality of life as a vulnerability and recovery factor in eating disorders: a community-based study

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