Breaking the Silence of Eating Disorders with the Hope of an Online Self-Help Programme
Leung, Sau Fong, Ma, Joyce, Russell, Janice, Contemporary Nurse : a Journal for the Australian Nursing Profession
Eating disorders are a serious debilitating health problem, causing impairments in physical and psychosocial functioning and significantly affecting sufferers' quality of life. New technologies are being developed to meet the diverse treatment needs of people with eating disorders. This qualitative study examined participants' views of an Internet-based self-help programme developed in the Asia-Pacific region for people with eating disorders. The aim of the study was to explore how the self-help programme facilitated individuals' recovery and identify the factors that contribute to the success in the programme.
A purposive sample of 12 people with anorexia nervosa (N = 4), bulimia nervosa (N = 2), binge eating disorder (N = 1) and eating disorder not otherwise specified (N = 5) participated in the study. The data were collected primarily by telephone interview. The programme was found to improve individuals' awareness of eating disorders, their motivation, eating disorder symptoms and health. Recovery was enhanced by individuals' determination and motivation to get better, the support available, their perseverance, sense of control, and personal confidence, and facilitating living environment.
Keywords: eating disorders; self-help; online self-help programme; recovery
INTRODUCTION AND BACKGROUND
Eating disorders are a global health problem. Female adolescents and young women are most at risk of developing these conditions, characterised by significant disturbances in eating habits or weight-control behaviour resulting in a clinically significant impairment of physical or psychosocial functioning (Fairburn & Harrison, 2003). They are amongst the most serious psychiatric disorders (Klump, Bulik, Kaye, Treasure, & Tyson, 2009) and can cause substantial morbidity and mortality. In a meta-analysis of research into the mortality of mental disorders in the 1990s, eating disorders were shown to have the highest risk of premature death from both natural and unnatural causes (Harris & Barraclough, 1998). Death from suicide and complications are common amongst individuals with anorexia nervosa (Millar et al., 2005; Sullivan, 1995). The major complications include cardiac arrhythmia, metabolic disturbance, electrolyte imbalance, hypoglycaemia, dehydration, and renal failure.
Eating disorders often become a chronic illness with a significant effect on individuals' quality of life. The severity and chronic nature of the illness exert negative effects on various life domains such as physical functioning, employment, finances, interpersonal relationships, and social and role functioning (Herzog, Norman, Rigotti, & Pepose, 1986; Mitchell, Hatsukami, Eckert, & Pyle, 1985). Sufferers of eating disorders report more impaired quality of life than those with other psychiatric disorders (e.g., alcohol abuse and somatoform disorder) and physical illnesses (e.g., angina and cystic fibrosis), even after recovery of symptoms (Jenkins, Hoste, Meyer, & Blissett, 2011; Spitzer et al., 1995).
The treatment of eating disorders is complex and expensive. Sufferers have little access to treatment (Hoek & van Hoeken, 2003), and the obstacles to treatment may be related to shame, guilt, denial, fear of stigmatisation, poor motivation to change, geographical isolation, inadequate health care resources, and unaffordable treatment. Shame and stigma can encourage individuals with eating disorders to avoid or postpone treatment (Becker, Arrindell, Perloe, Fay, & Striegel-Moore, 2010). Poor motivation often leads to low volition to engage in treatment (Darcy et al., 2010). The geographical and financial constraints on individuals can impede their access to care (Becker et al., 2010; Cachelin et al., 2001). Internet-based intervention offers a valuable opportunity to enable wider access to healthcare services, improve sufferers' self-management and enhance health outcomes (Forkner-Dunn, 2003). …