Exploration of Friendship Experiences, before and after Illness Onset in Females with Anorexia Nervosa: A Qualitative Study.

Heather Westwood,Caroline Fleming,Vanessa Lawrence,Kate Tchanturia,Michel Botbol

doi:10.1371/journal.pone.0163528

Heather Westwood, Caroline Fleming + Show 3 more

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https://doi.org/10.1371/journal.pone.0163528

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Abstract

BackgroundDifficulties with social relationships have been implicated in both the development and maintenance of Anorexia Nervosa (AN) but the friendship experiences of individuals with AN have not been explored in depth.MethodTen adults with AN took part in a semi-structured interview about their friendship experiences both before and since the onset of their illness.ResultsFive principle themes were identified through thematic analysis: Social Concern; Impact of AN; Social Connectedness; Inflexibility and Preferred Social Activity. Difficulties with friendship were present prior to the onset of AN in all cases, with participants experiencing anxiety in relation to various aspects of their friendships. Participants described mixed experiences of how their AN has affected their friendships but most participants described having less contact with their friends since becoming unwell.ConclusionThis research highlights the role that social difficulties may play in the development of AN, whilst also emphasising the importance of addressing problems with friendship in the course of inpatient treatment.

Highlights

Anorexia Nervosa (AN) is a severe eating disorder (ED), characterised by restricted energy intake relative to requirements; undue influence of weight and shape on self-evaluation and fear of gaining weight despite being significantly underweight [1]
Five principle themes were identified through thematic analysis: Social Concern; Impact of AN; Social Connectedness; Inflexibility and Preferred Social Activity
In a qualitative examination of the friendship experiences of females with AN and suspected Autism Spectrum Disorder (ASD), themes arose around: limited social network; difficulty in understanding friendship; lack of communication with friends and focus of attention away from the self [17]. These themes reflect what is reported in the ASD literature but as this study focused on participants suspected to have both AN and ASD, it is not known whether these friendship difficulties are experienced more broadly in AN

Summary

Introduction

Anorexia Nervosa (AN) is a severe eating disorder (ED), characterised by restricted energy intake relative to requirements; undue influence of weight and shape on self-evaluation and fear of gaining weight despite being significantly underweight [1]. Girls who believe that being thin will improve their friendships are more likely to be concerned about their weight [6], highlighting the socio-cultural risk factors of disordered eating, which may lead to clinical EDs. Bullying is associated with an increased risk of developing AN [7] and peer environment may impact on body image concern and dieting behaviour; in early adolescence, girls share similarities in dietary restraint and extreme weight loss behaviour with their friends [8]. Bullying is associated with an increased risk of developing AN [7] and peer environment may impact on body image concern and dieting behaviour; in early adolescence, girls share similarities in dietary restraint and extreme weight loss behaviour with their friends [8] This highlights the role that friendship experiences may play in the development of an ED but to date, research has not focused on the lived-experience of individuals with AN in terms of their friendships. Difficulties with social relationships have been implicated in both the development and maintenance of Anorexia Nervosa (AN) but the friendship experiences of individuals with AN have not been explored in depth

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