Evaluating services for patients with chronic anorexia nervosa
Around 20% of patients who develop anorexia nervosa will have an illness that takes a chronic course, and has not resolved after 10 years or more. Treatment approaches for these individuals tends to be overlooked in the research literature, which has focused on attempts to identify who is likely to develop chronic anorexia nervosa, rather than how-to most appropriately work with those who do. This paper suggests that currently used treatment approaches should be evaluated, and the results of such evaluations used to guide the design and implementation of new interventions, tailored to the substantial needs of this patient group. The first study examined the utility of five hypothesised prognostic factors in differentiating patients with a mediun and long-term course of anorexia nervosa, and found that high age of onset, and long duration of illness before treatment appeared to differentiate the two groups. These factors may facilitate identification of these patients at initial presentation, such that tailored treatments could be implemented at this point. In the second study, patients with chronic anorexia nervosa were interviewed to explore their experiences of helpful and unhelpful treatment, and their recommendations for treatment. A thematic analysis was conducted on the transcribed interviews. Identified themes suggested that helpful aspects of treatment were characterised by collaborative, and normalising approaches, supportive contact with other patients, and experienced and understanding clinicians. Unhelpful treatments were characterised by frightening inpatient admissions, abnormal treatment, competitive contact with other patients, and inexperienced or disinterested clinicians. The implications of these results for future research and treatment in this area are discussed.