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BMC Psychiatry
Published in: BMC Psychiatry 1/2023

Open Access 01-12-2023 | Anorexia Nervosa | Research

Conceptualisation of severe and enduring anorexia nervosa: a qualitative meta-synthesis

Authors: Laura Kiely, Janet Conti, Phillipa Hay

Published in: BMC Psychiatry | Issue 1/2023

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Abstract

Background

Severe and enduring anorexia nervosa (SE-AN) is amongst the most impairing of all mental illnesses. Collective uncertainties about SE-AN nosology impacts treatment refinement. Qualitative research, particularly lived experience literature, can contribute to a process of revision and enrichment of understanding the SE-AN experience and further develop treatment interventions. Poor outcomes to date, as evidenced in clinical trials and mortality for people with SE-AN (1 in 20) demonstrate the need for research that informs conceptualisations and novel treatment directions. This interpretative, meta-ethnographic meta-synthesis aimed to bridge this gap.

Methods

A systematic search for qualitative studies that explored the AN experiences of people with a duration of greater than 3 years was undertaken. These studies included those that encompassed phenomenology, treatment experiences and recovery.

Results

36 papers, comprising 382 voices of SE-AN experiences informed the meta-ethnographic findings. Four higher order constructs were generated through a synthesis of themes and participant extracts cited in the extracted papers: (1) Vulnerable sense of self (2) Intra-psychic processes (3) Global impoverishment (4) Inter-psychic temporal processes. Running across these meta-themes were three cross cutting themes (i) Treatment: help versus harm, (ii) Shifts in control (iii) Hope versus hopelessness. These meta-themes were integrated into conceptualisations of SE-AN that was experienced as a recursive process of existential self-in-relation to other and the anorexia nervosa trap.

Conclusions

The alternative conceptualisation of SE-AN proposed in this paper poses a challenge to current conceptualisations of AN and calls for treatments to engage with the complex intra and inter-psychic processes of the SE-AN, more fully. In doing so, clinicians and researchers are asked to continue to be bold in testing novel ideas that may challenge our own rigidity and attachment to dominant paradigms to best serve the individual person with SE-AN. The ‘global impoverishment of self’, found in this synthesis of AN experiences, should inform proposed diagnostic criteria for SE-AN.
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Metadata
Title
Conceptualisation of severe and enduring anorexia nervosa: a qualitative meta-synthesis
Authors
Laura Kiely
Janet Conti
Phillipa Hay
Publication date
01-12-2023
Publisher
BioMed Central
Published in
BMC Psychiatry / Issue 1/2023
Electronic ISSN: 1471-244X
DOI
https://doi.org/10.1186/s12888-023-05098-9

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