Abstract
BackgroundAnorexia nervosa (AN) is a psychiatric disorder with an ego-syntonic nature, causing many patients to perceive their AN as part of their personal identity. Therefore, an important part of treatment is the externalization of the eating disorder, in order to help patients to perceive AN as an external influence. Studies on patient experiences of externalization in treatment for AN are sadly missing. The aims of this study were to investigate, first, patients’ perspectives on the relation between identity and anorexia nervosa (AN) and second, their experiences of an externalizing approach during treatment.MethodA qualitative interview study was conducted including fourteen patients with AN in either Family Based Treatment, the Maudsley Model for Anorexia Nervosa Treatment for Adults, Specialist Supportive Clinical Management-Severe Enduring or Cognitive Behavioural Therapy-Enhanced.ResultsThere are important differences in participants’ perceptions on how AN is related to identity. AN was perceived as part of identity, as alien or as a different side of the self. Patients’ experiences towards an externalizing approach were ambivalent. Externalization was considered helpful, whilst also evoking a negative response. Participants reported feeling as if all their behaviour was referred to as part of AN, which elicited feelings of not being taken seriously or being wrongfully accused of being dishonest.ConclusionsFirst, there is considerable variation in the perceived relation between AN and identity. Second, an externalizing approach within treatment may lead to so called epistemic injustice. Awareness of these two facts is of importance for clinicians and the therapeutic relationship because that will help them to refrain from actions that can be perceived as epistemic injustice.
Highlights
Anorexia nervosa (AN) is known for being a psychiatric disorder that is difficult to treat
An externalizing approach within treatment may lead to so called epistemic injustice
Awareness of these two facts is of importance for clinicians and the therapeutic relationship because that will help them to refrain from actions that can be perceived as epistemic injustice
Summary
Anorexia nervosa (AN) is known for being a psychiatric disorder that is difficult to treat. A possible reason for these low recovery rates is the fact that, often, AN has an ego-syntonic nature [3,4,5] What characterizes this ego-syntonic nature is that patients will perceive AN as part of their true self, and not as an illness that requires treatment [6]. The aim of externalizing a psychiatric disorder is to help patients to perceive the disorder as something separate, rather than as a part of the self [8]. Perceiving AN not as part of the self, but as an illness that has great negative influence on life and requires treatment, could help patients to accept treatment [9]. Anorexia nervosa (AN) is a psychiatric disorder with an ego-syntonic nature, causing many patients to perceive their AN as part of their personal identity. The aims of this study were to investigate, first, patients’ perspectives on the relation between identity and anorexia nervosa (AN) and second, their experiences of an externalizing approach during treatment
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