How young people perceive change to occur in family therapy for anorexia nervosa: a qualitative study

Julian Baudinet; Ivan Eisler; Anna Konstantellou; Mima Simic; Ulrike Schmidt

doi:10.1186/s40337-024-00971-8

How young people perceive change to occur in family therapy for anorexia nervosa: a qualitative study

J Eat Disord. 2024 Jan 22;12(1):11. doi: 10.1186/s40337-024-00971-8.

Authors

Julian Baudinet^{1

2}, Ivan Eisler^{3

4}, Anna Konstantellou⁴, Mima Simic⁴, Ulrike Schmidt^{3

5}

Affiliations

¹ Centre for Research in Eating and Weight Disorders, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, SE5 8AZ, UK. [email protected].
² Maudsley Centre for Child and Adolescent Eating Disorders, South London and Maudsley NHS Foundation Trust, De Crespigny Park, Denmark Hill, London, SE5 8AZ, UK. [email protected].
³ Centre for Research in Eating and Weight Disorders, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, SE5 8AZ, UK.
⁴ Maudsley Centre for Child and Adolescent Eating Disorders, South London and Maudsley NHS Foundation Trust, De Crespigny Park, Denmark Hill, London, SE5 8AZ, UK.
⁵ Adult Eating Disorders Service, South London and Maudsley NHS Foundation Trust, Denmark Hill, London, SE5 8AZ, UK.

Abstract

Background: Family therapy for anorexia nervosa (FT-AN) is the first line recommended treatment for child and adolescent anorexia nervosa. Despite evidence of its efficacy, little is understood about the treatment mechanisms. This study aimed to understand how young people who have received FT-AN perceive change to occur across treatment.

Method: Fifteen adolescents (age 12-18 years) completed individual semi-structured interviews online. Recordings were transcribed verbatim and analysed using reflexive thematic analysis.

Results: Four inter-connected themes describing the process of change during treatment were generated; (1) relationships as the vehicle for change, (2) an awakening, (3) through, not around - no way out, (4) the life beyond.

Conclusions: Current data match relatively closely with theoretical models of FT-AN and emphasise the importance of building trust with all family members, including the young person. Additionally, supporting the family to create a trusting context in which there is a sense that the only way out of the illness is by going through it (rather than avoiding it) is critical. Empirical investigation of each of the described mechanisms is needed.

Keywords: Adolescents; Anorexia nervosa; Family based treatment; Family therapy; Maudsley family therapy; Qualitative.

Plain language summary

Family therapy for anorexia nervosa (FT-AN) is the first line recommended treatment for child and adolescent anorexia nervosa. While outcomes are generally good, little is understood about how the treatment works. This study aimed to understand how young people who have received FT-AN perceive change to occur across treatment. Fifteen adolescents (age 12–18 years) completed individual interviews online. All interviews followed a similar structure, with recordings transcribed word-for-word and analysed using a methodology called reflexive thematic analysis. Four inter-connected themes were generated from the interviews; (1) relationships as the vehicle for change, (2) an awakening, (3) through, not around – no way out, (4) the life beyond. These themes match relatively closely with descriptions of FT-AN theory and emphasise the importance of building trust with all family members in treatment, including the young person. Additionally, supporting the family to create a trusting context in which there is a sense that the only way out of the illness is by going through it (rather than avoiding it). More data are needed to test these ideas empirically and with other populations.