Background
Review questions
Methods
Inclusion criteria
Search strategy
Methodology for evidence synthesis
Author Date | Heading | Descriptor (authors words) | Exemplar (participant quote) | 3rd order construct(s)* | pg |
---|---|---|---|---|---|
Hannon et al. 2017 | Treatment experience | Novel intensive community treatment was preferred to the inpatient care – more reflective of real world, therapeutic alliance being held and the slow pace no pressure was key | everyone in the team was so compassionate, nobody judged me…I think until you’ve built up trust with anyone its hard to make the changes… if I hadn't had X who knew me… helping me carry on, then I couldn’t have got so far | Treatment help versus harm Hope | 287 |
Function of AN | a positive presence in an unhappy life… helpful… feel better.. pride… comfort / safety..distraction from uncomfortable feelings More acceptable… less isolated | Really low… lose a bit of weight feel better about myself for just a second | Theme 2a meaning of AN to Self | 288 | |
Self criticism v’s self acceptance | self blame and guilt for having AN versus caring, accepting and compassionate towards self | ..my own fault… wasn't good enough… im the problem At first that was so alien to me (self-kindness)… never thought about doing anything nice for myself…do for other people… but not for me | Theme 4b | 288 | |
Isolation versus connection | isolated, empty and lonely because unable to trust others | I remember feeling quite lonely…felt I didn't want to be around anybody else… like I had caused all the problems… im scared of being alone all my life | Theme 3 | 288 | |
Hopelessness versus Hope | long time in treatment with little change reduced hope more hopeful if specific obtainable goals | I feel like really, really hopeless and its like soul destroying. Because I can't see anything changing | Theme 2b Hope | 290 | |
Stuckness versus Change | stuck, trapped, afraid and conflicted, frustrating and tormenting place. A tipping point | …its really, really frustrating to understand… at the stage I don’t want to change. I want to change…. No I don’t want to change… I want to get better..but don’t want anything to change… its just infuriating | Theme 2b | 290–1 |
Reflexivity
Results
Procedure for extraction
Study characteristics
Source Paper & Foci | Year | Country Setting | Sample: size (N), %Female(F) /male (m), mean age (M) and range (R) (years) | Illness duration (yrs), diagnosis (Dx)—self or method), author stipulation | Treatment Status (TS:Y/N sought treatment) Treatment Type (T), Description (D), number (N) | Recruitment | Data Analysis | CASP RATING *** = HIGH QUALITY |
---|---|---|---|---|---|---|---|---|
Arkell & Robinson (P) | 2008 | UK | N = 11 F = 91% age = 37.7yrs | > 10yrs, Dx ICD-10, SEED-AN | TS = Y (all) T,D,N unknown | Community treatment setting | ‘coding’ (Serpell 1999) | * |
Antoine et al. (P) | 2018 | France | N = 5, F = 100% age = 35ys (R = 29-46yrs) | M = 14.4y (R = 10-18yrs), Dx = U, chronic AN | Unknown | Clinical | IPA | *** |
Broomfield et al. (P) | 2021 | Australia | N = 11, F = 100%, age M = 41.6 (R = 29-66yrs) | M = 26.2yrs (R = 7-53yrs) Longstanding AN | TS = 10/11 | Community | Narrative TA | *** |
Blackburn & O’Çonnor (P & TE) | 2020 | Ireland | N = 6, F = 100%, age M = 39.4yrs (22-44yrs) | R = 8-28yrs, formal Dx, Longstanding AN | TS = All > 2 treatments, all = OP, 5/6 = IP | Community | Not specified | *** |
Chinello et al. (P) | 2019 | Italy | N = 5, F = 100%, age M = 46yrs (40-54yrs) | Dx = DSM-5, M = 29.2yrs (R = 23-37yrs) | n/a | Community | IPA | ** |
Cardi et al. (P) | 2018 | UK | N = 90, F = 97.8% | Dx = DSM-5, M = 8.4y, R = 0-46yrs | TS Y (all), 37% IP, 100% OP | Community | TA | * |
Dalton et al. (TE) | 2022 | UK | N = 15, | M = 15.05yrs, Dx = DSM-V, SE-AN | TS Y (all > 2prior treatments, M = 2.47, IP N = 2.31stays), rTMS | Clinical | Inductive—Elo and Kyngas (2008) | * |
Dawson, Rhodes & Adams (R) | 2014 | Australia | N = 8, F = 100%, R = 31-64yrs | M = 15.5yrs, R = 9-44yrs, Dx = DSM4 | TS 100% = Y, | Community | Narrative TA | *** |
Eivors et al. (TE) | 2003 | UK | N = 8, F = 100%, M = 25.75yrs, R = 21–43 yrs | M = 6.75, R = 3-20yrs | TS 100% = Y, IP = 50%, OP = 100% | Clinical | Social Constructivist GT | ** |
Espeset et al. (P) | 2012 | Norway | N = 14, M = 29.1yrs, R = 19-39yrs | M = 10yrs, Range 3-25yrs Dx = 100% DSM-4, | TS 100% = Y, IP = 57%, OP = 100% | Clinical | GT (Corbin and Stauss) | ** |
Fox & Diab (P) (TE) | 2015 | UK | N = 6, F = 100% Age M = 29.5yrs R = 19 to 50yrs | M = 7yrs, R = 6-23yrs. Dx = DSM-4, Chronic AN | TS = 100% > 2 psychological therapies | Clinical, Two eating disorder services | IPA | *** |
Foye et al. (P) | 2019 | UK | N = 5, F = 80% | R = 5-20yrs, Dx = 4/5 formally, SEED-AN | TS = 4/5, IP = 60%, OP = 80% | Clinical | TA | *** |
Hannon et al.(P) (TE) | 2017 | UK | N = 5 R = 23 -30 yrs, F = 100% | R = 4-11yrs, Dx 100% ICD 10, SE-AN | AN Intensive Treatment Team model: intensive community-based care (> 2years) | Clinical Treatment settings | IPA | *** |
Joyce et al. (P) (TE) | 2019 | UK | N = 8, F = 87.5%, M = 44yrs, R = 20-64yrs | R = 10-40yrs, SE-AN | TS 100% > 2, IP = 62.5%, OP = 100% | Clinical | NA | *** |
King-Murphy (P) | 1997 | Canada | N = 6, F = 100%, | M = 12.8yrs, R = 6-18y | TS = 100% > 2, IP = 67%, OP = 100% | Clinical | Van Mannen’s phenomenology | *** |
Kolnes (P) | 2016 | Norway | N = 6, F = 100%, M = 32.5y, R = 23-50yrs | M = 12.8yrs, R = 6-18yrs | TS = 100% Y, | Clinical residential | IPA | *** |
Kyriacou et al. (LE) | 2009 | N = 6 F = 100% M = 26.8yrs R-20-36yrs | M = 10.7yrs, R = 4-22yrs | TS 100% Y | Clinical | TA | ** | |
Marchant & Payne (TE) | 2002 | UK | N = 5, F = 100%, R = 22-38yrs | R = 4-20yrs | TS = 100%, IP = 20%, OP = 100%, psychodynamic, Gestalt, CBT, PCT | Community | Heuristic (Moustakas 1990) | * |
Marzole et al. (P) | 2015 | Italy | N = 34, F = 100%, M = 25,6yrs, R = 18-40yrs | M = 9yrs, R = 4-14yrs, Dx 100% = DSM | Psychodynamic, DP | Clinical DP | Coding (Serpell, 1999) | * |
McCallum & Alaggia (P)(R) | 2021 | Canada | N = 19, F = 95%, M = 50.6yrs, R = 40-64yrs | M = 19.2yrs, R = 11-40yrs, | TS = 100% Y | Community | GT | *** |
Musolino et al. (P) | 2020 | Australia | N = 5, F = 100%, M = 25.8yrs, R = 27-52yrs | M = 18yrs, R = 10-30yrs, Dx formal (100%), SE-AN | TS = 100%Y | Community | GT | ** |
Lyons (P) | 2018 | UK | N = 7, F = 0%, M = 28yrs, R = 23-34Yrs | M = 11, R = 4-19yrs | TS = 100% Y, CBT, Schema, Psychodynamic, OT, Dietetics | Community | Narrative | *** |
Ostermann et al. (T) | 2019 | Germany | N = 1,(F), Age 38yrs, | Duration 30 years, | IP > 4, Yoga | Treatment sample | Not-specified | * |
Patching & Lawler ® | 2009 | Australia | N = 20, F = 100%, R = 24-52yrs | R = 4-17yrs, Dx formal = 55%, | formal treatment IP or OP = 55%, self-help = 45% | Community | Narrative TA | * |
Ramjan et al. (TE) | 2017 | Australia | N = 6, F = 100%,M = 26.8yrs, R = 18-38yrs | M = 5.4y, R = 1-10yrs (1 pt < 3yrs) Dx = Self report | Unknown | Community Treatment – Peer Support | TA | *** |
a. Rance st al. (R) | 2017 | UK | N = 12, F = 100%, M = 31.5yrs, R = 18-50yrs | M = 13.29yrs, R = 2-28yrs (91.6% > 4yrs) | CBT, Analytic, Psychodynamic, Integrative | Purposive community | TA | *** |
b. Rance et al. (TE) | 2017 | UK | As above | As Above | CBT, Analytic, Psychodynamic, Integrative | Purposive, Community | TA | *** |
Robinson et al. (P) | 2015 | UK | N = 7, F = 71.4%, M = 50yrs, R = 40-59yrs | M = 32.1yrs, R = 20-40yrs, Dx DSM5, SEED-AN | IP = 86%, OP > × 2, | Clinical | TA | *** |
Ross & Green (P)(TE) | 2011 | UK | N = 2 Age: 18 + years F = 100% | Duration > 5yrs, Chronic AN | Psychodynamic inpatient treatment | Clinical (ED service) | Narrative TA | *** |
Strand et al. (P) (TE) | 2018 | Sweden | N = 16, F = 94%, M = 31Yrs, R = 18-56yrs | M = 15yrs, R = 3-42yrs, Dx DSM-5, | TS = 100Y Unspecified | Clinical | Inductive (unspecified) | *** |
Stockford et al. (P) (TE) | 2018 | UK | N = 6, F = 100%, M = 36yrs, R = 33-48yrs | M = 20.6yrs, R = 14-28yrs, Dx ICD-10 (all), SE-AN | TS = 100%Y | Clinical | IPA | *** |
Thoresen et al. (TE) | 2021 | Norway | N = 1 (F), Age = 23yrs | Duration 7yrs, Dx = formal | Symptom-focused treatments (7yrs) Psychodynamic (12 sessions) | Treatment setting | IPA | * |
Trondalen (TE) | 2003 | Norway | N = 1(F), Age = 26yrs, | Duration 6 yrs, | Prior treatments = Y, IP × 2, OP 2.5 yrs, Music Therapy | Treatment setting | Not Specified | ** |
Williams et al. (P) | 2016 | UK | N = 11, F = 100%, M = 28yrs, R = 18-60yrs | M = 13.5yrs, R = 5-48yrs, Dx = DSM5 (all), | Unknown | Community plus 2 ED clinics Theoretical sampling | GT | *** |
Wright & Hacking (TE) | 2012 | UK | N = 6, F = 100%, R = 21-44yrs | M = 11yrs, Dx formal | OP = 100%, treatment M = 11 years | Day care services, | Van Manen 1990 | * |
Quality assessment of selected studies
Synthesis of results
CROSS CUTTING THEME | THEME # | META THEMES TITLE | (N) | CROSS CUTTING THEMES | |
---|---|---|---|---|---|
SHIFTS IN CONTROL | 1 | VULNERABLE SENSE OF SELF: ‘Hesitance to Exist’ | 28 | HOPE vs HOPELESSNESS | TREATMENT – HARM Vs HELP |
2 | INTRA-PSYCHIC PROCESSES | ||||
2a | Meaning of AN to Self: ‘Double Masquerade’ | 19 | |||
2b | The Disappearing Self | 25 | |||
3 | GLOBAL IMPOVERISHMENT | 24 | |||
4 | INTER-PSYCHIC, TEMPORAL PROCESSES: CHANGE AND RECOVERY | ||||
4a | Opening the Self to Other(s) | 19 | |||
4b | Re-integrating Self | 18 |
Themes
Meta-theme 1: interpersonal phenomenology
1a Vulnerable sense of self: hesitance to exist
All my life I was made to feel like a nobody. I was moulded by my parent’s little world[...] with my first husband it was the same (King-Murphy et al. p 90 [53])…as long as people know I have anorexia I see a difference in the way they look at me[...] Judgement, prejudice, distance right away[...] treat me as a person with brain damage (Schut et al p 9 [66])I felt like his (husband’s) puppy dog on a leash and every time he would tug me back when I would be out too far[...] I realized I was slowly killing myself to let him live[...] He took my freedom[...] Then he almost took my life (King-Murphy p 82 [53])
Suppose mainly it's just my own self-worth my own self-esteem and just like my, the way that I view myself and the value that I've got in my life I suppose is just like really low, so it's hard to look after myself properly, I guess. When you don't think that you deserve anything or, yes, it's really hard to just take care of yourself and say you are worth looking after and feeding yourself (Stockford 2017, p 132 [67])I’m not allowed to be here. That I’m[…] I shouldn’t really have been like, born. In a way I’m, I’m just a burden to the world (Blackburn et al. p 435 [42])
Anything that passed the due date in the fridge I wouldn’t give it to anybody else, but I would have it for me. I used to have this attitude like rubbish for rubbish (Robinson et al. pg 320 [64])I need to go through a lot of hurt [...] to be a better person (Blackburn et al p 435 [42])
I was invisible to the world; I was a ghost, voiceless. No matter how bad it got I couldn’t get it out or show it [...] Whether it was visible ribs or scars on my skin, I just didn’t know how else to express it and this was my way of showing that I was hurting (Foye et al 2019 p 332 [50])Live in this kind of ethereal world[…]pure[…]holy[…]detached from bodily concerns and needs. Rance et al. 2017 p 132 [62]
We hold ourselves back from that [creating relationships]; won’t allow ourselves (Foye et al. p 335 [40])Think it's kind of a BMI thing is quite deceptive in terms of its use by medical professions in terms of determining who needs help and therefore it contributes to the anorexic thinking that ‘oh well I'm not actually ill enough I don't actually deserve the help, I need to go out and be more anorexic to get more deserving and achieve more whatever (Stockford et al. p 135 [67]).
I had dozens of hospital admissions with no success [...] treatment [...] like banging my head against a brick wall [....] Scare tactics [....] if the clinicians told me what to do id think well screw you I’m not doing that [...] us and them staff was telling me there was no hope for me [...] thought I was stupid and ignorant. Dawson et al p 499 [46]
Male doctors very abusive and in a sexual way and that doesn't help they let me down. (Joyce et al 2019 p 2078 [52])
So it was refreshing to have people that actually did present as caring and I think for an illness like this where people have really low self-esteem anyway and feel, most of them feel not worthy of receiving treatment and that they're being a burden on other people and they feel they've brought it all on themselves and actually it's probably not helpful to have that reinforced [...] more important than the food to be honest to have people that care for you and accept you and that don't look down their nose at you and ‘ya know see you as a worthy human being that's an individual and that can spend time with you not just go shovel you full of cheese and fattening foods with no humanity (Stockford et al. 2018 p135 [67])
Meta-theme 2 – intra-psychic processes
Theme 2a: meaning of an to self: double masquerade
I use it [AN] to keep life ticking over and keep the happy smiley face on [...] Competent image [...] I didn't use that then I think I’d be in the point where I can’t get out of bed in the morning depression wins so it’s the lesser of two evils really (Rance et al 2017 p 132)it’s like a protective thing and it feels like round my heart [...] it made you feel more erm, secluded from the world really, in this like, in this total bubble of your own making [...] if you were to take them all down, I don’t know, I think I’d feel really, really vulnerable […] you feel safe if you know what to expect if you stay on this sort of a routine (Musolino et al p 6 [73])Anorexia offered this really clean, pure, serene, space that really contrasted to all that messy, ugly, nasty, out of control stuff…it’s a safer place to be (Broomfield et al. p 6 [41])
It gives you like a split personality. Good and bad, positive yeah, it’s like, it’s like your evil twin type of thing[…] I guess the only way I can describe it is as an abusive relationship, you often think why do you stay in that relationship but because you almost feel helpless without it. Yeah, it’s like an abusive partner, you, you know, you don’t like it but it’s, they promise to look after you so you believe them (Williams, King and Fox p 221 [70])builds a web so no one can come close to the real him, because alone he stands[...] wary[...] yes, its not enough with just the spider[.…] needs to have something around himself (Thoresen et al 2021 p 187 [68] )[...]. It is a sniper who approached me slowly and before I knew it, it was ingrained in my life (Schut et al. p 7 [66])
there probably is an atavistic sense of self-punishment and lack of worth associated with ED, that the structure and nature of inpatient treatment exacerbates. (Joyce et al., 2019. p 2075 [52])When you are in hospital you can battle it because it’s not just one-on-one you’ve got you and a whole team against anorexia, you are all fighting it but as soon as you leave hospital, and you get home it’s just one-on-one again and you are bound to lose kind of thing[…] it’s one extreme to another you need that integration probably less time inpatient more time ya know half way there[…]half way house kind of thing. Stockford et al. 2018. p 135 [67]I felt like they were ganging up on me. Bringing me places I did not want to go. Forcing me to eat, forcing me. That was really, really bad. They could not understand. (King-Murphy 1997, p 86 [53])
Theme 2b: the disappearing self
Like you’re slipping into a whole different world[…].like you’re stepping out of your body, you’re looking at yourself and you’re doing these things and like even though I felt like I had control over it there were times when I really didn’t think I had any control of it at all (Rance et al. p129 [62])insignificant and without value. And that I don’t, that it makes me feel invisible maybe (Thoresen et al. 2021 p 188 [68])
Living with AN is like having a monster inside of you. It consumes you[…]Can’t escape[…] Complete control of your whole life[…] This monster takes over[…] It has all the control; you have none. (King-Murphy p 82 [53]).
[.…]that’s when I wanted to die […] I was a slave, I wasn’t in charge any more, didn’t dare stand up was afraid of everything. I was so tired[...] I had to eat vomit eat vomit that’s how my days passed (Schut et al 2022 p7 [66])was devastated, I couldn’t go on like this [living with an eating disorder]. It was scary but I gave myself one more chance at recovery. If that didn’t work I couldn’t continue living like this [suicide]. Patching & Lawler 2009, p 16 [61]
like a prison[…] loss of liberty[…]. Freedom to make decisions taken away [….] Being on a unit was the worst experience of my life ever (Lyons 2019 p 106 [59])
It felt quite rigid and it was like ‘If you understand you have your thoughts and your feelings are reflecting [them] and challenging your negative thoughts then you will get better, and if you’re not getting better you’re just not trying hard enough[…]diagnostic tick box a thing with problems [.…] an object. Rance,Moller & Clarke p 588–89 [63]he was like oh you can't be that bad because you’re not throwing up in bags, you’re not hiding it […] when I started seeing him I was bingeing and being sick about twice a week […] by the time I finished with him I was throwing up all day everyday. Rance, Moller& Clarke p 589 [63]
she showed me one of the patient bedrooms and she was talking about the spy hole in the bedroom […] and supervision after meals […] and I remember saying something about ‘Oh well […] I don’t make myself sick I just restrict’ and she said well “by the time we are finished feeding you, you might start!” and I drove off like a scene out of the dukes of hazard—there was like dust coming out of from behind (laughs. pauses). Needless to say I didn’t get admitted. I was petrified. Joyce et al 2019 p 2078 [52]I’ll always be a little scared, since my very first experience was that I wasn’t actually allowed to discharge when I wanted to. So I’ll always have that fear, unfortunately (Strand et al. 2017. p 403 [74]
To get just a few days at the ward—shutting the rest of the world out, handing over choices and letting go of control. Strand et al. 2017. p 40 [74]After I had made the conscious decision to get better, I started to do what the staff told me to do. It was absolute hell. I kept telling myself, though, that the devil was a sickness that was trying to take a hold of me, and I wasn’t going to let it, otherwise I would die Dawson et al. 2014 p 501 [46]
Meta-theme 3: global impoverishment
I could not even talk clearly… I was not allowed to answer the phones any longer because the customers could not understand what I was saying. ( King-Murphy p 75 [53])
[…] lost my job […] my flat […] just gone bankrupt […] I’m living with my parents now […] Anorexia a better substitute […] I have lost everything through the eating disorder absolutely everything…. (Stockford et al. p 133 [67])[predisposing unsuccessful suicide attempt]: I had no quality of life left (Musolino et al. p 6 [73])
I think just that anorexia gives you a sense of being that you wouldn’t have otherwise […] and I think without that you wouldn’t be, well, I wouldn’t feel like a person at all. (Williams et al p 221 [70])
[...]in that way kind of the anorexia thing is self-perpetuating because [… ] I can't work because of Anorexia and low mood and so I don't have any kind of defining things when people ask you what you do, well not a lot really. I don't really do a lot and so it's almost like that allows the illness to become stronger because it feels like it's therefore quite an important role because you don't have another role and then it has it has to kind of compensate for all the things that aren't in your life like ya know a family or children, an academic career or any of those things ya know if you can't be really really any good at those things then being really really good at Anorexia would be a better substitute (Stockford et al. p133 [67])
Meta-theme 4: inter-psychic, temporal processes: change and recovery
Sub theme 4a. Opening the self and to other (s)
compassionate, not judged [….] until you’ve built up trust with anyone it’s hard to make the changes […] knew me […] helping me carry on( Hannon et al p 287 [51])need time to build trust in your therapist [….] I found that relatively easy to do, it was probably in six months or a year[...]I was able to feel that (Rance, Moller & Clarke p 588 [63])
I eventually found two amazing therapists who I stayed with until the end of treatment. One of them had had an eating disorder herself, and she was by far the most important therapist I had ever seen. It felt like she was reading my mind. She understood it and she instilled hope that I could get over it (Dawson et al p 501 [46])she’s like a little support angel on your shoulder […] she just makes you feel safe somehow. She makes you feel like she can hold you and the disorder, and no matter what happens she’s got hold of you and don’t worry ‘cos there is somebody there. (Wright & Hacking 201 p 111 [71])
Then I found myself in a situation where I didn’t eat food, only liquid supplements. So I admitted myself for a week [Self-admission program] just to get out of that supplement swamp and start eating regular meals again. […] That was really a good admission, probably my first sound admission where I’ve felt like I was actually ‘on board’ myself. I’ve been treated against my will a lot, but this time I really set a goal, totally focused on it and used this week to get back to regular meals again. don’t need to be there for eleven months—if I just ask for it in time, it can be eleven days instead. […] If you just sacrifice two weeks, you gain ten months of freedom. It’s a pretty big thing Strand et al. p 402
Sub-theme 4b: re-integrating self
formulating things in that way really helped me to start to put the pieces together a bit more. Putting the pieces together in my own way (Joyce et al p 2077 [52] )Everything is still fragmented; things are still in boxes but its slowly coming together so I feel more Helen that I did a few months ago… I know who Helen is but where does the anorexia and the negativity fit? I know it’s there but where does it fit in to make the whole person? (Ross and Green p115 [65])...when you’re well or when it’s gone, you’ll just be you, you won’t be anorexic, you’ll be you (Williams et al. p 222 [70])
“…feel assertive enough to meet their [my] own needs and feel entitled to meet [my] own needs and accept responsibility for doing that, rather than meet someone else’s needs” (Blackburn p 435 [42])
In my forties, at a time in my life when I was relaxed and happy, I started to have flashbacks and I realized that I had been raped as a young child. I finally realized what had happened and I had a reason for the anorexia. With this understanding came some closure and I could get on with my life now […] this revelation was very distressing and intense for me. My need for control made a lot more sense. It seemed clearer to me why I wanted to torture myself and why I felt so controlled and angry as a child. (Dawson et al p 500-502 [46])
Visual expression of the synthesis—greater than the sum of its parts
Discussion
Discussion of themes / thematic map
Clinical applications and considerations
Therapeutic Stance |
---|
The therapist sees the person: |
▪ as a unique individual |
▪ outside the illness |
▪ without preconceptions of how AN is for them |
▪ struggling to find value in themselves and their life |
Therapeutic Relationship |
▪ allows time to build trust |
▪ recognises relational struggles |
▪ instils trust in self-efficacy, helps me to trust myself |
▪ accepts me for who I am, especially the bits I ‘disown’ and see as unacceptable |
▪ provides security with a boundary of treatment non-negotiables that prioritise my safety, and includes me in the process |
▪ recognises that food may be a literal manifestation of being starved, a red herring |
Treatment |
▪ Helps me to understand my illness before I am expected to give it up |
▪ Recognises that my illness really works for me and is the best way I know how to survivea |
▪ Recognises my illness is compatible with the low value I place on myselfa |
▪ Helps me to build meaning about what AN is in my life |
▪ Allows space in treatment, to address my unique concerns beyond the treatment manual |
▪ offers me choices and maximises my autonomy so I can build my own self-efficacy |
▪ Measures me not by my weight |
▪ Allows me the freedom to create the terms for my life |
▪ Helps me to connect to all aspects of my being and offers a variety of treatment adjuncts |
▪ If I need to go to hospital, offers me emotional support as well. Recognising when I am terrified and that I may have past trauma from previous admissions too |
▪ Recognises the broader context of living with SE-AN, including; |
- Judgement and misunderstanding of my illness |
- Being enslaved to AN, it is the ‘master’ |
- Appreciation of my profound losses to SE-AN |
- Helps me to make peace with my life I have made alongside AN |
- Offers me the care that I need in line with my stage of my illness. I’m not an adolescent |