Family-based treatment for transition age youth: parental self-efficacy and caregiver accommodation.

BACKGROUND: Family-Based Treatment (FBT) is the first line of care in paediatric treatment while adult programs focus on individualized models of care. Transition age youth (TAY) with Anorexia Nervosa (AN) are in a unique life stage and between systems of care. As such, they and their caregivers may benefit from specialized, developmentally tailored models of treatment. METHODS: The primary purpose of this study was to assess if parental self-efficacy and caregiver accommodation changed in caregivers during the course of FBT-TAY for AN. The secondary aim was to determine if changes in parental self-efficacy and caregiver accommodation contributed to improvements in eating disorder behaviour and weight restoration in the transition age youth with AN. Twenty-six participants (ages 16-22) and 39 caregivers were recruited. Caregivers completed the Parents versus Anorexia Scale and Accommodation and Enabling Scale for Eating Disorders at baseline, end-of-treatment (EOT), and 3 months follow-up. RESULTS: Unbalanced repeated measures designs for parental self-efficacy and caregiver accommodation towards illness behaviours were conducted using generalized estimation equations. Parental self-efficacy increased from baseline to EOT, although not significantly (p = .398). Parental self-efficacy significantly increased from baseline to 3 months post-treatment (p = .002). Caregiver accommodation towards the illness significantly decreased from baseline to EOT (p = 0.0001), but not from baseline to 3 months post-treatment (p = 1.000). Stepwise ordinary least squares regression estimates of eating disorder behaviour and weight restoration did not show that changes in parental-self efficacy and caregiver accommodation predict eating disorder behaviour or weight restoration at EOT or 3 months post-treatment. CONCLUSIONS: Our findings demonstrate, albeit preliminary at this stage, that FBT-TAY promotes positive increases in parental self-efficacy and assists caregivers in decreasing their accommodation to illness behaviours for transition age youth with AN. However, changes in the parental factors did not influence changes in eating and weight in the transition age youth.

"I would love to have online support but I don't trust it": Positive and negative views of technology from the perspective of those with eating disorders in Canada.

This qualitative study aims to explore how individuals who are seeking help and support for eating disorders use various forms of technology. Fifteen participants, recruited from an Eating Disorder Program in a hospital setting and an eating disorder community support centre, voluntarily participated in focus groups and individual interviews in 2015. The authors used thematic analysis to code and analyse the qualitative data, and three themes were identified: safety, connection and technology development. This study identifies the need for technology use to be addressed and integrated into clinical services for eating disorders, as well as for safe and helpful technology tools to be developed for this population.

The Effects of Stigma on Recovery Attitudes in People With Anorexia Nervosa in Intensive Treatment.

Self-stigma in individuals with anorexia nervosa (AN) may affect engagement in intensive treatment. The objective of this study was to test a Model of Self-Stigma to identify the influence of public stigma, internalized stigma, self-esteem, and self-efficacy on recovery attitudes in individuals in inpatient treatment for AN. Using a cross-sectional design, 36 female participants with AN completed questionnaires during the first week of intensive inpatient treatment. Better attitude towards recovery was positively correlated with higher self-esteem and self-efficacy and negatively correlated with greater internalized stigma and perceptions of others devaluing families of individuals with AN. Together, these factors accounted for 63% of the variance in recovery attitudes. Findings demonstrate the adverse effects perceived stigma towards families, self-stigma, and self-esteem have on recovery attitudes in individuals with AN. Clinical interventions are needed to challenge internalized stigma and bolster self-esteem to enhance individuals' recovery efforts.

The perceptions of individuals with anorexia nervosa regarding their family's understanding of their illness, treatment, and recovery.

The current study explores how affected individuals understand their family's perceptions of anorexia nervosa (AN). Perceptions of individuals with AN regarding their family's understanding of the illness may influence their ability to accept family support. Thematic analysis was used on qualitative data of 19 individuals with AN undergoing inpatient treatment. Participants perceived that families: (a) considered AN a problem with food rather than a mental illness; and (b) viewed treatment as time limited, and complete recovery as achievable. Family-based interventions are needed to facilitate understanding about AN, as well as the behavioral and psychological adjustments required during treatment and recovery.

"You don't have anorexia, you just want to look like a celebrity": perceived stigma in individuals with anorexia nervosa.

BACKGROUND: Minimal research has been conducted on how individuals with Anorexia nervosa (AN) undergoing treatment perceive public stigma. AIM: Explore how affected individuals with AN believe the general public perceives AN. METHOD: Using thematic analysis, 19 participants with AN were interviewed at the beginning of treatment. RESULTS: Three interrelated themes were ascertained: (1) AN is not an illness; (2) eating disorder behaviours are volitional and the public endorses a socio-cultural explanation for the disorder; 3) affected individuals delay disclosing their illness and experience shame engaging in intensive treatment for AN as a result of their perception of stigma. CONCLUSIONS: Individuals with AN viewed the public as trivializing AN by viewing behaviours as within their control and by attributing eating disorder behaviours solely to socio-cultural factors. Participants believed that the public minimizes the challenges associated with treatment. Findings suggest that clinical interventions targeting stigma are required to counteract perceptions held by service users regarding how others view their illness. "Mental health literacy" interventions are needed for health professionals working with high risk groups likely to avoid seeking help due to fears of stigmatization.

Family-based treatment with transition age youth with anorexia nervosa: a qualitative summary of application in clinical practice.

BACKGROUND: Family based treatment (FBT) has been empirically investigated in adolescents between the ages of 12 and 19 years of age. Although parental control over eating symptoms and the weight gain process are temporary and necessary due to serious medical complications, FBT may be developmentally inappropriate when working with older adolescents. To date, there are no studies identifying how the principles of this model are used differentially across different stages of adolescence. This study aimed to identify how clinicians informed by FBT employ this model with transition age youth (TAY) (16-21) with an eating disorder. METHODS: Using content analysis, seven individual interviews and six focus groups were conducted with 34 clinicians from specialized Eating Disorder Treatment programs across Ontario, Canada. RESULTS: Participants consistently reported modifying FBT to increase its developmental appropriateness with TAY in the following ways: working more collaboratively with the patient, increasing individual time spent with the patient prior to the family meeting, providing greater opportunities for the individual to practice eating without parental support and introducing relapse prevention in the latter phase of the treatment. CONCLUSIONS: In all adaptations of the model, participants in focus groups and individual interviews cited the age of the individual with the eating disorder, their level of autonomy and independence in all areas of their lives, and their pending transfer of care from paediatric to adult eating disorder programs as main factors that influenced the modification of FBT with TAY. While adaptations were made across all three phases of FBT, adherence to the model progressively declined over the course of treatment with adaptations increasing significantly in the later phases. Future research is needed to evaluate the effectiveness of an adapted version of FBT with TAY.

Inpatients with severe anorexia nervosa and their siblings: non-shared experiences and family functioning.

OBJECTIVES: The aims of this study were the following: to identify perceptions of patients with anorexia nervosa (AN) and their siblings regarding differential experiences within and external to the family including sibling interactions, parental treatment, relationships with peers and events that are unique to each sibling; (2) to compare how patients and their siblings perceive eating disorder symptoms, parental affection/control, social support and stigma; and (3) to test associations with family functioning for patients with AN and their siblings. METHOD: A total of 26 patients paired with their siblings were recruited from an Eating Disorder Program and administered standardized instruments measuring different experiences within and external to the family, the impact of eating disorder behaviours, stigma, social support and family functioning. RESULTS: Patients rated high on the differential experience of jealousy in contrast to their siblings. Patients scored higher than their siblings on eating symptoms, whereas siblings scored higher on social support. The impact of AN on the family, stigma towards the individual and family, and social support accounted for 37% of the variance in family functioning from the sibling perspective after controlling for age and gender. Of these variables, impact of AN on the family made the largest contribution. DISCUSSION: Family-based and sibling-based interventions that aim to reduce the effects of the illness on the sibling relationship and the family are recommended.