BackgroundMaudsley Family Therapy (MFT), and its manualised version, Family-Based Therapy (FBT), are the only well-established treatment interventions for adolescent anorexia nervosa (AN), with treatment efficacy primarily measured by improvements in eating behaviours and weight restoration. A crucial component of this therapy is an intensive home-based refeeding intervention that requires a substantial commitment from parents for up to one year. While this treatment works to restore weight in a proportion of adolescents, very little is known about its impacts on family distress, relationships and identity, including in the 40% of families where the adolescent experiences ongoing eating disorder (ED) symptomatology and/or psychological distress during and post-treatment. Specifically, few studies have investigated the impacts of MFT/FBT treatment on family functioning or on how parents negotiate their identities, or who they understand themselves to be, in the context of this treatment intervention. This is a significant omission, given the substantive role assigned to parents to take responsibility for their child’s eating restoration in the first treatment phase. This study seeks to address this gap through a qualitative exploration of parents’ experiences of MFT/FBT, in cases where treatment was discontinued and/or their child continued to experience psychological distress post-treatment.Methods13 parents participated in in-depth semi-structured interviews that scaffolded between their experiences and ways they negotiated and sustained their identities as parents within the context of MFT/FBT for their child. Interview data was analysed through a framework of critical discursive analysis to generate themes centred on these parents’ experiences and identity negotiation.ResultsKey findings are that MFT/FBT: (1) provided a map for therapy that initially relieved parents’ anxieties for their child and facilitated improvements in family functioning; (2) inadequately addressed parental guilt and blame with a form of externalisation of the illness; (3) perpetuated parental guilt by raising anxiety about AN and allocating responsibility for refeeding their child in phase 1 of the treatment; and (4) when ceased, left these parents struggling with an uncertain future, and fears for the wellbeing of their children.ConclusionsThe structure of MFT/FBT provided initial relief with some improvements in family communication patterns, however, when the adolescent experienced protracted ED symptoms and/or ongoing psychological distress post-treatment, these parents were left with uncertainty as to how to navigate their shifting roles and their child’s ongoing struggles. This research highlights the need for treatments for adolescent AN that more comprehensively address both the adolescent and parents’ psychological distress and also (re)build their senses of identity that have been challenged by AN and its effects.

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The Maudsley and more recent family‐based therapy manualised approaches are positioned by some as the gold standard, evidence‐based therapy for adolescent anorexia nervosa (AN). However, a significant proportion of adolescents and their families either discontinue this therapy and/or find that it simply does not work for them. These adolescents and families are under‐represented in the literature on therapeutic interventions for adolescent AN. This paper begins to address this gap with an in‐depth qualitative case study that explores the lived experience of Maudsley family therapy (MFT)/family‐based therapy (FBT) for one female adolescent (age 14 years) and her family over the period of 3 years (ages 11–14). Although initially handing over the responsibility for her eating was comforting and reinstated a sense of control in the family system, these experiences were not maintained. When she did not progress past the first phase of FBT, she and her family experienced the approach as blaming. She felt silenced and family alliances were weakened. This paper analyses how the family members negotiated and preserved their identities within this disabling context.

There is little consensus about the meaning of recovery in anorexia nervosa with most studies focusing on researcher selected variables of weight gain and improvement in eating disorder symptomatology. There is also a paucity of research that focuses on how the experiencing person themselves define recovery and whether this term is useful to them to depict their journey of reclaiming their life and identity from anorexia nervosa. This article explores 21 Australian women's experiences of anorexia nervosa (AN) over 10 years and the ways they negotiated their identities in relation to the question of recovery. The research interviews sought to provide a context for these women to speak on their own terms, terms not confined to the medical discourse. The discursively constructed category of recovery was troublesome for the majority of these women, despite the researcher inadvertently taking up this category in lines of questioning, particularly in the earlier interviews. Most troubling for the women was the assumption that recovery erased their experiences with the expectation that they should return to a pre-illness state. On the other hand, speaking on their own terms-including the use of metaphor and (re)authoring their experiences as an identity journey-was significant in scaffolding the women toward narratives of reclaiming their lives and identities from AN and its effects. The women in this study refused to confine the terms of their speaking to a recovery discourse; instead, they honored the narratives of their experiences and histories as profound in their identity formation. The implications of this research are significant given that the majority of research and many treatments to date confine the terms of speaking to the "anorexia" discourse.Recovery isn't so much about the disease process, or recovering from it, it's about recovering yourself; it's about reclaiming your place in the world. (Avalon)This article opens with a quote from Avalon (a participant in this research study), who, in authoring shifts in her relationship with anorexia over time, used the notion of "reclaiming" identity through a sense of "place in the world" rather than recovery. This research study began

Postnatal distress is associated with body weight and shape concerns, with disordered eating before and during pregnancy, and with vomiting during pregnancy. The protective role of low-intensity exercise during early pregnancy needs to be explored. Women with eating disorders should be considered at risk for postnatal problems.