A pilot case series using qualitative and quantitative methods: Biological, psychological and social outcome in severe and enduring eating disorder (anorexia nervosa)

Department of Mental Health Sciences, Royal Free and University College Medical School, London, United Kingdom.
International Journal of Eating Disorders (Impact Factor: 3.13). 11/2008; 41(7):650-6. DOI: 10.1002/eat.20546
Source: PubMed


We explore the level of disability and quality of life in participants with severe and enduring eating disorder (anorexia nervosa).
We use qualitative and quantitative methods to assess in detail eleven participants with a 10-year history of anorexia nervosa. Outcomes for quality of life are compared with those of a sample of primary care patients with moderate-severe depression. Outcomes for living skills are compared with a standardized community sample of patients with schizophrenia.
Despite scoring highly for communication skills and levels of responsibility, participants were as impaired as the sample of patients with schizophrenia for self-care and social contact. Participants were severely depressed and scores for quality of life mirrored those of the primary care population. Qualitative data illustrate intrapersonal and interpersonal avoidance leading to self-neglect and social isolation despite social skills.
Quality of life and living skills are as impaired as those of other severe and enduring mental illnesses.

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Available from: Paul Hyman Robinson, Aug 27, 2014
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    • "However, in a Delphi study of professionals (Tierney & Fox, 2009), no consensus on duration of illness for the definition of SEED was reached, and Bamford and Sly (2010) in a quantitative study found that duration of illness did not predict quality of life in AN. Nevertheless, few studies have investigated the psychological and social consequences of living with AN for a long time (Arkell & Robinson, 2008). In order to better understand SEED, we interviewed individual men and women with AN of long duration and undoubted severity, systematically detailing symptoms, behaviours and experiences. "
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    ABSTRACT: Little is known about how patients with long-term eating disorders manage their clinical problems. We carried out a preliminary qualitative study (using Thematic Analysis) of patients with severe and enduring anorexia nervosa (SEED-AN) in which we undertook recorded interviews in eight participants whose conditions had lasted 20-40 years. We found 15 principle features in physical, psychological, social, family, occupational and treatment realms. Psychological and social realms were most affected. Severe physical problems were reported. They described feelings of unworthiness, frugality regarding money and obsessive time-keeping. Persisting with negligible social networks, participants described depression and hopelessness, while somehow achieving a sense of pride at their endurance and survival in spite of the eating disorder. They emphasized the importance of professional help in managing their care. The severe and enduring description, often reserved for people with psychotic illness, is appropriately applied to SEED-AN, which has major impacts in all realms. Copyright © 2015 John Wiley & Sons, Ltd and Eating Disorders Association. Copyright © 2015 John Wiley & Sons, Ltd and Eating Disorders Association.
    European Eating Disorders Review 07/2015; 23(4):318-26. DOI:10.1002/erv.2367 · 2.46 Impact Factor
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    • "One clinical implication is that follow-up treatments involving rehabilitation of social skills may be required for those in recovery who continue to experience clinical levels of social anhedonia. People with severe and enduring EDs are reported to experience similar levels of social debilitation to people with schizophrenia (Arkell and Robinson, 2008) and this is supported by social anhedonia data, such that the scores of these ED sufferers (AN ¼16.16, S.D. ¼8.76; BN¼ 15.26, S.D. ¼8.39) are similar to those reported for patients with schizophrenia by Blanchard et al. (1998) (mean ¼15.11, "
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    ABSTRACT: Interpersonal difficulties are proposed to maintain eating disorders (EDs). This study explored whether social anhedonia (SA) was an additional social emotional maintenance factor which might also explain work/social problems in EDs. Additionally, the study explored SA and work and social adjustment in recovered participants. Women with anorexia nervosa (AN; n=105), bulimia nervosa (BN; n=46), recovered from AN (RAN; n=30) and non-ED controls (n=136) completed the Work and Social Adjustment Scale (WSAS) and the Revised Social Anhedonia Scale. ED participants reported greater SA and WSAS scores than non-ED controls; the RAN group reported an intermediate profile. AN participants had poorer work/social adjustment than BN participants. SA was associated with longer illness duration. SA, current severity (BMI) and lifetime severity (lowest adult BMI) significantly predicted work/social difficulties. Recovered participants scoring in the clinical range for SA experienced significantly greater work/social difficulties than recovered participants scoring outside the clinical range for SA. EDs are associated with clinical levels of SA and poor work/social functioning which reduce in recovery. SA may maintain the interpersonal functioning difficulties.
    04/2014; 218(1-2). DOI:10.1016/j.psychres.2014.04.007
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    • "En 2009, Tierney et Fox ont proposé de définir le passage à la chronicité par les critères cliniques suivant [7] : la répétition des échecs des interventions thérapeutiques ; un indice de masse corporelle (IMC) inférieur à 17,5 ; la limitation extrême de la vie sociale et un affaiblissement significatif de la qualité de vie ; enfin la persistance de certains schémas comportementaux et cognitifs. Il est important de noter que dans ces formes cliniques , les compétences sociales et la qualité de vie sont aussi altérées que dans d'autres maladies psychiatriques sévères comme la schizophrénie [8]. Wonderlich et al. insistent sur la difficulté de déterminer une durée d'évolution des troubles, de fixer un nombre, un type et une durée de traitement, ainsi qu'un âge au-delà duquel la chronicité serait établie, compte tenu de l'importante diversité des présentations cliniques [6]. "
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    ABSTRACT: Although many patients face a long and severe evolution, there is no consensus regarding the definition of chronic and/or refractory anorexia nervosa. The multiplication of treatments and therapies lead to what could be called a total resistance to treatment in these patients. Cognitive impairment in anorexia nervosa, known to be worsened by deep denutrition, is a striking issue as it could limit the ability of the patients to consent to needed care. Constrained admission ruled by French July 5th 2011 psychiatric law could be decided given the aforementioned consent issues. When care given to patients involuntarily admitted are unsuccessful, supportive and palliative care could be an alternative in chronic and refractory anorexia nervosa. The goals of care would be shifted at this point to active comfort measures and better quality of life.
    La Presse Médicale 07/2013; 43(3). DOI:10.1016/j.lpm.2013.03.009 · 1.08 Impact Factor
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