Abstract
BackgroundAnorexia nervosa (AN) is a difficult to treat disorder characterized by ambivalence towards recovery and high mortality. Eating symptomatology has a sort of adaptive function for those who suffer from AN but no studies have to date investigated the relationship between the reported meanings of AN and patients’ clinical characteristics. Therefore, we aimed to perform a factor analysis of a new measure testing its psychometric properties in order to clarify whether subjective meanings of AN can be related to AN severity, to ascertain if some personality traits correlate with the meanings attributed to AN by patients, and finally to verify to what extent such meanings relate to patients’ duration of both illness and treatment.MethodsEighty-one inpatients affected by AN were recruited for this study and clinical data were recorded. Participants were asked to complete a novel instrument, the Meanings of Anorexia Nervosa Questionnaire (MANQ) focused on the measurement of values that patients attribute to AN and other measures as follows: Eating Disorders Inventory-2, Beck Depression Inventory, Temperament and Character Inventory, and Anorexia Nervosa Stages of Change Questionnaire.ResultsAs measured by the MANQ, body dissatisfaction, problems of adolescence, and distress at school or work mainly triggered the onset of AN. Balance and self-control were mostly reported as meanings of AN while the most frequent negative effects were: being controlled by the illness, obsessive thoughts about body shape, and feeling alone. Differences were found between diagnostic subtypes. When a factorial analysis was performed, three factors emerged: intrapsychic (e.g., balance/safety, self-control, control/power, way to be valued), relational (e.g., communication, way to be recognized), and avoidant (e.g., the avoidance of negative feelings, emotions, and experiences). These factors correlated with patients’ personality and motivation to treatments but were unrelated to duration of both illness and treatments.ConclusionsGiven the ego-syntonic nature of AN, the understanding of patients’ value of their disorder could be relevant in treatment; moreover, the positive value of AN resulted to be unrelated to the duration of both illness and treatments. Future research is warranted to replicate these findings and test their clinical implications.Electronic supplementary materialThe online version of this article (doi:10.1186/s12888-016-0894-6) contains supplementary material, which is available to authorized users.
Highlights
Anorexia nervosa (AN) is a difficult to treat disorder characterized by ambivalence towards recovery and high mortality
Notwithstanding the increased knowledge achieved in recent years on eating disorders, anorexia nervosa (AN) still represents a difficult to treat disorder
Consensus has been reached on the adaptive function of eating symptomatology; starvation would help patients avoid negative emotionality [5, 6], reinforce their identity [7, 8], and express their distress [9]
Summary
Anorexia nervosa (AN) is a difficult to treat disorder characterized by ambivalence towards recovery and high mortality. The aforementioned hypotheses are in line with cognitive-behavioral models of AN maintenance [10,11,12] as well as with psychodynamic models that assess defense mechanisms, ego-syntonicity, and compensation for eating symptoms [13,14,15,16,17] Such theoretical models [10, 14] rely on a handful of studies investigating patients’ meaning of AN [7, 12, 18, 19]; the majority of these papers used either qualitative, descriptive, or phenomenological methods. This paper identified some factors that are linked to the meaning of AN and grouped them into two meta-categories: need of control and identity [8]
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