Academic journal article Journal of Eating Disorders

Being Me and Being Us - Adolescents' Experiences of Treatment for Eating Disorders

Academic journal article Journal of Eating Disorders

Being Me and Being Us - Adolescents' Experiences of Treatment for Eating Disorders

Article excerpt

Author(s): Katarina Lindstedt[sup.1], Kerstin Neander[sup.1], Lars Kjellin[sup.1] and Sanna Aila Gustafsson[sup.1]

Background

This study addresses adolescents' perception of treatment for eating disorders. Eating disorders often start in the later teenage years and affect mainly girls and young women [1,2], however increasingly boys and young men as well [1,3]. It may affect young people during key stages in life [4,5] and early treatment interventions have proved to be important for a favourable prognosis [6]. The importance of involving parents in treatment, primarily treatment of adolescents with Anorexia Nervosa, is emphasized in a number of studies, e.g. [7-10], as well as in the NICE treatment guidelines [11]. However Fairburn [12], Gardner & Wilkinson [13], Gowers et al. [14] and Strober [15] among others argue that family-based treatment does not have the strong empirical support as proposed from various quarters. It has for instance been suggested that in family-based therapy eating and weight are being given too much emphasis and that patients improve their eating habits during treatment in order to please family and therapists. The symptoms may be reduced in that way, but there is a risk that cognitive and affective symptoms persist [16].

Previous research has revealed that many young people are not entirely satisfied with the treatment received and the contact experienced during treatment [17-20]. Even people who experienced a positive outcome of treatment, as defined by clinically established criteria describe that they have not been understood or that the therapist could not help them [17,18]. Dissatisfaction with treatment has for instance been linked to treatment delay, to the fact that treatment interventions have not had the desired outcome, and to a premature cessation of treatment [17,21]. According to Federici & Kaplan [22] negative thoughts and feelings of depression or anxiety often remain in people who were dissatisfied with the on-going treatment, something which reduces their ability to maintain normal weight after completion of treatment and increases the risk of relapse. Against this background it is important to incorporate different perspectives when investigating which treatment factors can possibly result in a good or poor outcome. In addition to dealing with outcome measures as reported by therapists, which today form the basis for most of what we know in this area [21,23,24] it is essential also to focus on former patients' perspective of "what works".

Studies exploring which aspects of treatment for eating disorders that are considered by former patients to be helpful have identified factors as participation and control in treatment [25,26], social support from friends and family during the treatment process [4,17,19,22,25,27,28], specialized treatment conducted by therapists with extensive expertise [19,26-28], interventions focusing on cognitive symptoms [4,26,28] and individual therapy in combination with family-based therapy [18,19]. However, there is a lack of knowledge concerning the perspectives of adolescents in outpatient treatment, whose treatment often involves family and is made up of different methods and interventions integrated with each other [29,30].

The aim of the present qualitative study was to investigate how young people with experience from adolescent outpatient treatment for eating disorders, involving family-based and individual based interventions, perceive their time in treatment.

Methods

The study was conducted using a hermeneutic phenomenological approach influenced by Max van Manen [31]. The phenomenological aspect involves an attempt to understand how people give meaning to their experiences of significant events. The interpretive hermeneutic aspect implies putting these narratives in their context, trying to make them understandable from a social and psychological perspective [32]. An important argument for this approach is that it takes into account the complexity of the lifeworld, which means one can speak about multiple and different human lifeworlds that belong to different human existences and realities [31]. …

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