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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    • "chart 1. continuation author and year country Cia; Barham, 2009 29 Brazil Silva; Murta, 2009 24 Brazil Bolsoni-Silva et al., 2010 25 Brazil Fitzsimmons; Bardone- Cone, 2011 59 USA Toral; Slater, 2007 50 Brazil Sarmento et al., 2010 40 Brazil Aubalat; Marcos, 2012 51 Spain Nilsson et al., 2007 30 Switzerland Arkell; Robinson, 2008 31 London Aime et al., 2008 55 Canada Grilo et al., 2012 41 USA Lam; McHale, 2012 52 USA Hartmann et al., 2010 42 Germain Davey; Chapman, 2009 32 London aims of the study To relate children's socialemotional development to their academic development To present a program of training in social skills for adolescents To evaluate children with behavior or social skill problems To assess the relationship between social support and the ability to resist/avoid eating disorders To obtain a deeper understanding of the factors determining eating habits and how they are formed To investigate emotional and behavioral symptoms in obese adolescents To analyze strategies for dealing with and overcoming eating disorders in adolescents To evaluate the causes of anorexia nervosa To analyze the quality of life of patients with AN To assess dietary history, risk factors and emotional factors in eating disorders To analyze history of BN and behavioral eating disorders, in relation to stress To examine concern about weight during adolescence To relate interpersonal problems with eating disorders Relation between disgust and eating disorders type of article Original article Original article Original article Original article Review of the literature Original article Original article Original article Original article Original article Original article Original article Original article Original article Variables analyzed Social skills and school performance Training of social skills in groups of adolescents Social skills and problems of behavior Anxiety, difficulty of confrontation and eating disorders Eating behavior, nutritional education, trans-theoretical model Social skills and problems of behavior Strategies for confrontation in eating disorders Causes of eating disorders Quality of life, depression and social skills Depression, use of drugs and alcohol, eating disorders, emotions Remission of eating disorders, personal characteristics Concerns with weight and parental relationships Interpersonal problems and eating disorders Disgust and eating disorders it continues chart 1. continuation author and year country Groleau et al., 2012 43 Canada Fox, 2009 26 London Presnell et al., 2009 33 USA Limbert, 2010 34 London Vale et al., 2011 44 Brazil Lavender; Anderson, 2010 45 USA Markey, 2010 46 USA Ioannou; Fox, 2009 35 London "
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    ABSTRACT: The purpose of this study is to provide a review of the literature on the relationship between eating disorders and social skills in adolescents. A search was made on the Medline, SciELO and Lilacs databases, for items combining the terms ‘eating disorders’, ‘anorexia nervosa’, ‘bulimia nervosa’ and ‘food behavior’, with the terms ‘social psychology’ and ‘social isolation’, and with the keywords ‘social competence’, ‘social skill’ and ‘interpersonal relations’. The following were included: studies on adolescents; in Portuguese, English and Spanish; published in the years 2007 through 2012. The search resulted in 63 articles, and 50 were included in this review. The majority of the studies were made in Brazil and the United States. Of the total, 43 were original articles. The studies aimed to understand how emotional state could influence the establishment of eating disorders, interpersonal relationships and peer relationship. The articles also discussed the influence of the media and of society in this process. Based on the analysis of the studies, it was observed that the greater an adolescent’s repertory of social skills, the greater his or her factor of protection against the development of eating disorders.
    Preview · Article · Nov 2015 · Ciencia & saude coletiva
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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.
    Full-text · Article · Jul 2015 · European Eating Disorders Review
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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.
    Full-text · Article · Apr 2014
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