A systematic review of people’s lived experiences of inpatient treatment for anorexia nervosa: living in a “bubble”

Abstract

Background Treatment for anorexia nervosa (AN) is typically delivered on a continuum of care, starting with outpatient treatment, and moving onto intensive outpatient, day or residential treatment and/or inpatient hospitalisation. However, minimal attention has been afforded to the lived experiences of persons undergoing inpatient treatment for AN. In particular, qualitative literature pertaining to the lived experiences of specialist inpatient or residential treatment of AN remains fragmented and incomplete. The aim of this review was to synthesise current literature exploring patients’ lived experiences of residential and inpatient treatment for AN within eating disorder-specific treatment services. Methods Five databases were searched and a qualitative thematic systematic review and meta-synthesis of 11 studies were conducted. Results Eleven studies of 159 participants were included. Four meta-themes were constructed from the data: (1) a medical discourse—“I don’t think it’s individualised here”; (2) restrictive practice—living in a “bubble”; (3) myself, others and “a similar demon”; and (4) I am “not just another anorexic”. The data also revealed two cross-cutting themes: (1) more than a single experience; and (2) meaning making and identity. Conclusions These findings highlight the complex and multifaceted nature of the inpatient treatment experience as well as the inherent conflicts in balancing the necessity of medical and psychological intervention with person-centred treatment approaches in the treatment of AN.

“I Need Someone to Help Me Build Up My Strength”: A Meta-Synthesis of Lived Experience Perspectives on the Role and Value of a Dietitian in Eating Disorder Treatment

“…. in understanding their own symptoms" [53]. However, the ED field has recently seen an increasing presence of lived experience advocacy, with benefits to research including improved study design, implementation, and dissemination [11].…”

Every mistake is a treasure: Lessons learned from the TRIANGLE trial for anorexia nervosa

“…There may also be opportunities to explore novel psychopharmacological (e.g., ketamine, psilocybin) and psychotherapeutic (e.g., cognitive remediation, exposure) approaches that could mitigate neuroplasticity deficiencies resulting from AN (Keeler et al, 2023). Efforts to individualize care may empower patients, giving them an opportunity to have more voice in their treatment and to draw upon their own lived experience to conceptualize their illness and recovery (Rankin et al, 2023).…”

“…We also learned some important lessons about clinical practice over the course of the TRIANGLE trial. For instance, when transitioning out of inpatient care for AN, patients may experience a sense of loss for the safety and intense connection forged in an inpatient setting (Rankin et al, 2023). A qualitative study of people receiving inpatient care for severe, longstanding AN highlighted the value of those connections, with participants sharing "It's not just the staff is incredibly nice… my peers are very nice.…”

Qualitative study of the impact on recovery of peer relationships between female inpatients during treatment for anorexia nervosa in the United Kingdom

“…The mean length of stay in hospital globally for someone with AN is 76 days, during which time patients share significant time and space others (Kan et al, 2021). Bezance and Holliday (2013) and Rankin et al (2023) reviewed literature which explored experiences of AN treatment using the qualitative approach. Inter-patient relationships were identified by both as key to admission experience.…”

“…Literature suggests that for people with AN, these relationships have both positive and negative effects in the inpatient setting. Close association with peers can be helpful for learning coping mechanisms and reducing social isolation (Bezance & Holliday, 2013; Colton & Pistrang, 2004; Rance et al, 2017; Rankin et al, 2023; Smith et al, 2016). Thabrew et al (2020) found that patients benefitted from strong emotional support based upon mutual understanding, which could be accessed even over short admissions.…”