Abstract
BackgroundAtypical anorexia nervosa (AN) has received minimal empirical attention regarding effective diagnosis and treatment. Family-based treatment (FBT) might be a promising treatment for atypical AN, yet it is unclear as to what adaptations are needed to the current manualized FBT for AN model. The objective of the current study was to identify how FBT practitioners applied FBT for atypical AN for adolescents in their clinical practice, and if there were any implementation challenges and adaptations to the model for this population.MethodsThe current study employed fundamental qualitative description, with the aim of capturing practitioners’ reflections on working with adolescents with atypical AN in clinical practice. A purposeful sample of practitioners with training in FBT were recruited and each participant completed an individual, semi-structured interview. Data was analyzed using conventional content analysis.ResultsA total of 23 practitioners participated in this study. The results indicate that practitioners maintained some fidelity to manualized FBT in treating atypical AN, but they differed in their discussions around target weights, what constitutes weight restoration, and the dosage for FBT phases. Salient practice challenges included operationalizing the Diagnostic and Statistical Manual of Mental Disorders – 5th Edition (DSM-5) definition of atypical AN, identifying a ‘goal weight’ for adolescents and activating parents to take charge of the re-nourishment process.ConclusionsThe results of this qualitative study demonstrate practitioner reflections on the delivery and adaptations of FBT for adolescents with atypical AN. These reflections highlight the need to establish the delivery of coherent and consistent treatment and messaging with patients and families. Further, practitioners’ reflections highlight common strategies to increase the sense of urgency in parents to support their child with atypical AN.
Highlights
Atypical anorexia nervosa (AN) has received minimal empirical attention regarding effective diagnosis and treatment
* Correspondence: gdimit@ucalgary.ca 1Faculty of Social Work, University of Calgary, 2500 University Drive NW, Calgary, Alberta T2N 1N4, Canada Full list of author information is available at the end of the article of treatment for adolescents with AN, the objective of the current study was to identify how Family-based treatment (FBT) practitioners applied FBT for atypical AN for adolescents in their clinical practice, and whether any adaptations were made to the FBT model for this population
We will refer to cases which: (a) meet DSM-5 diagnostic criteria for atypical AN, and; (b) manifest eating disturbances that were once classified as Eating Disorder Not Otherwise Specified (EDNOS) but have been re-conceptualized as atypical AN based on current understanding
Summary
Atypical anorexia nervosa (AN) has received minimal empirical attention regarding effective diagnosis and treatment. Since the publication of the DSM-5, individuals with these criteria have been classified under atypical AN, making it difficult to disentangle whether literature prior to the DSM-5 included cases true to atypical AN or other eating disturbances more broadly In this manuscript, we will refer to cases which: (a) meet DSM-5 diagnostic criteria for atypical AN, and; (b) manifest eating disturbances that were once classified as EDNOS but have been re-conceptualized as atypical AN based on current understanding. Individuals with typical and atypical AN present with similar cardiovascular complications and laboratory results when hospitalized [6, 7] Those with atypical AN tend to report significant eating disorder cognitions, body dissatisfaction and distress about shape/ weight [6] and psychosocial impairment [8,9,10,11,12,13]. There are minimal studies evaluating interventions for adolescent populations with atypical AN [2, 14,15,16], as such, treatment recommendations specific to atypical AN have yet to be developed which would allow practitioners working with this population to effectively adapt within current evidence based practice
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