Severe Anorexia Nervosa Personal Recovery
Condition: Anorexia Nervosa; Eating Disorder
MeSH terms: Anorexia; Feeding and Eating Disorders; Anorexia Nervosa
Study type: Observational

Summary: 
      A growing qualitative literature about personal recovery process in mental disorders emerges.
      However in Anorexia Nervosa (AN), it remains few understood, especially in severe AN during
      adolescence.

      This pilot study seeks to enhance understanding of recovery from AN in France and support the
      dissemination of the PR paradigm among the French mental health community working with AN, as
      a complement to the medical approach.

      A qualitative research according to Interpretative Phenomenological Analysis (IPA) method was
      conducted .Five young women hospitalized ten years before for a severe AN during their
      adolescence were interviewed with a semi-structured face-to-face interview on recovery
      process.
    

Detailed description: 
      Anorexia Nervosa (AN) is one of the most severe mental disorders with a mortality and high
      risk of developing chronicity. Lifetime prevalence is evaluated among women between 1.2% and
      2.2%, with the higher incidence during adolescence. Recovery process remains poorly
      understood.

      In scientific literature, recovery process of mental disorders can be seen in two different
      ways: the medical and the personal recovery (PR). The medical recovery is based on objective
      criteria, including cure (symptom disappearance), remission (symptom suspension) or
      therapeutic response (change of values after treatment). This medical recovery is generally
      studied in quantitative outcome studies. The experiential or PR is based on first person
      qualitative research or consensus methods, starting from patients' struggle for regaining
      place in their own recovery. It has become the paradigm orientation of mental health policy
      in anglophone countries.

      A recent systematic review summeries relapse, remission or recovery criteria used in a AN
      outcome studies in 1-weigh measurement only; 2-symptoms reported only; 3-on both. In addition
      to weigh, other criteria are noticed: menstruations, psychological and behavioral features,
      disparities of time remission/recovery.

      However, despite numerous quantitative studies, reasons for recovery, relapse or following
      struggle steal unclear. Medical framework is sometimes considered as reductive Moreover,
      those researches usually focus on risk factors, hiding protector's factors that are central
      for supporting recovery. Furthermore, symptom improvement is not always priority of
      patients(9), while improvement might happen despite symptoms persistence. Discrepancies are
      described in the negotiated link clinicians-patients: patient might wait for more singular
      and subjective approach whereas clinicians would be more invested in objective and rigorous
      features.

      A recent systematic review offers a theorical framework to study PR in mental disorders. It
      is defines as an active, individual, unique, non-linearn, multidimensional and gradual
      process. It can be described as phase or stage, as struggle, as a life-changing experience or
      even as a trial or error process. It may be structured by a turning point, after when there
      are no turning back. It is aided by supporting and healing environment, and might occur
      without cure. Starting from first person narratives of mental disorders recovery, five
      factors supporting recovery are described: connectedness, hope and optimism about the future,
      identity, meaning in life, empowerment. One meta-ethnography review was published on
      qualitative research about PR in AN, concerning 8 studies. It provides elements on process of
      change, factors supporting PR and notion of empowerment and self-reconciliation.

      Finally, most of PR studies come from USA, UK, Australia and Canada. Further research are
      needed to ground PR including cultural context. In France, AN PR has been rarely studied.
      These study tries to enhance understanding AN recovery in French context, to support
      implementation of PR paradigm among French mental health AN community; complementary to
      medical approach.

      Study questions are: how people who suffered of severe AN and experienced hospitalization
      during adolescence feel and make sense to their recovery?

      METHODS This study is a qualitative research with IPA, supplemented by quotation of ICD 10
      criteria. We reported COREQ 32 guidelines.

      Setting and participants IPA recommends homogeneous and short sampling so as to better
      appreciate convergences and divergences of phenomena. To maximize homogenization, very
      precise criteria (presented in box 1) were first chosen in order to focus on studied
      phenomena with in-depth way, before opening to wider study on AN recovery. Recruitment was
      restrained to the same hospital (Institut Mutualiste Montsouris) at the same year of
      hospitalization, so as to homogenize experience of care. Period of 10 years was chosen for
      being widely beyond largest literature mean criteria of medical recovery fixed at seven
      years, to get some distance with recovery process.
    

Intervention name(s): Semi structured face to face interview
Intervention type(s): Other
Intervention description(s): Face-to-face semi-structured interview conducted in the hospital, where young adults were hospitalized 10 years before, in a quiet and isolated office. The topic guide was built according to literature review, without further change after pilot test. Interviews where audio-recorded and transcribed
Observational model: Cohort
Time perspective: Retrospective
Sampling method: Non-Probability Sample
Study population: 
        Young people who suffered of severe AN and experienced hospitalization during adolescence
        feels recovered
      
Keywords: Recovery; Qualitative research; Personal narratives