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In this study we explored circumstances, reflections, and reactions to first treatment contact in 34 women (aged 18-51) diagnosed with anorexia nervosa (AN) (DSM-IV). Using methods from grounded theory we identified how the meeting came about, what motivated the patients, and how they reacted to the conversation. The results suggest that (a) health care professionals need to demonstrate effective professional communication skills and proficient knowledge about eating disorders in early contacts; (b) treatment goals other than recovery from AN should be explored; and, ((c) patients' view of AN as a strategy for increased control and mastery in life may be a topic for discussion in the early contacts.)

Objective: Previous research in eating disorders suggests that treatment satisfaction is closely related to the manner in which care is delivered. The present research is a systematic in depth study of health professional characteristics preferred by AN-patients., Method: Thirty-eight women with AN aged 18-51 were interviewed in depth using a phenomenological study design. Interviews were tape-recorded, transcribed, and analyzed using the QSR-NVivo7 software program., Results: Four factors associated with patients' satisfaction with their therapists were identified: "acceptance," "vitality," "challenge," and "expertise." Patients' responses suggested that treatment of AN requires therapists who are capable of using a complex set of behaviors when interacting with their patients., Discussion: There is accumulating evidence that across treatment modality, the manner in which treatment is delivered is critical to therapeutic change. Our findings increase the understanding of factors that may be associated with treatment retention, further help seeking, and overall treatment outcome. These exploratory and informant-centered results could guide clinicians in developing a strong therapeutic alliance with AN-patients and promote increased knowledge about the mechanisms that engage this population., (Copyright © 2012 Wiley Periodicals, Inc.)

Background: Several theoretical models suggest that deficits in emotional regulation are central in the maintenance of anorexia nervosa (AN). Few studies have examined how patients view the relationship between negative affect and anorectic behaviour. We explored how patients with AN manage the aversive emotions sadness, anger, fear and disgust, and how they link these experiences to their eating disorder behaviours., Methods: Qualitative data were collected through semi-structured interviews with 14 women aged 19-39 years diagnosed with AN (DSM-IV). Interviews were analyzed using Grounded Theory methods., Results: The participants tended to inhibit expression of sadness and anger in interpersonal situations and reported high levels of anger towards themselves, self-disgust and fear of becoming fat. Different emotions were managed by means of specific eating disorder behaviours. Sadness was particularly linked to body dissatisfaction and was managed through restrictive eating and purging. Anger was avoided by means of restrictive eating and purging and released through anorectic self-control, self-harm and exercising. Fear was linked to fear of fatness and was managed through restrictive eating, purging and body checking. Participants avoided the feeling of disgust by avoiding food and body focused situations., Conclusion: Treatment models of eating disorders highlight the significance of working with emotional acceptance and coping in this patient group. Knowledge about how patients understand the relationships between their negative emotions and their anorectic behaviour may be an important addition to treatment programmes for AN., (Copyright © 2012 John Wiley & Sons, Ltd and Eating Disorders Association.)

Unlabelled: Body image disturbance is a central diagnostic criterion of anorexia nervosa (AN). To a great extent, previous studies have conceptualized body image disturbance as a relatively stable and trait-like characteristic of the patient. There is, however, growing evidence that body images fluctuate in different situations and contexts. The aim of the present study was to explore which everyday contexts that patients with AN themselves associate with fluctuations in body image. Thirty-two women (20-35 years) who had been diagnosed with AN (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition) within the last year participated. Semi-open and focused qualitative interviews were conducted, transcribed and analyzed using Grounded Theory techniques. The results suggest that body image is a dynamic phenomenon that may fluctuate in different situations and contexts. The participants linked such fluctuations to their own uncertainty about their real appearance. In lack of a stable and integrated experience of their own body, they were extremely sensitive towards body image threats and challenges in their daily life and reacted to these situations by fluctuations in their body image. Four contextual cues were found to trigger such changes in body image: these were eating food, being reminded of one's body appearance, relating to one's own emotional signals and interpreting other people's expressed and unexpressed opinions about oneself and one's appearance. Clinical and theoretical implications are discussed., Key Practitioner Message: Individuals with anorexia nervosa may have quite varied body image experiences in different contexts. The contexts identified in this study may be a point of departure for clinicians in helping their patients to explore their subjective body image experiences and to connect these with emotional, cognitive and relational contexts in a psychologically meaningfully way., (Copyright © 2011 John Wiley & Sons, Ltd.)

Objective: Reluctance to recover may explain poor treatment outcome and high dropout and relapse rates in the treatment of anorexia nervosa (AN). This study systematically explored what AN patients describe as interfering with their wish to recover., Method: Two independent samples of women with AN (total N = 36) were interviewed in-depth using a phenomenological study design. Interviews were tape recorded, transcribed and analysed using QSR-NVivo7 (QSR International, Melbourne, Australia) software., Results: Seven core obstacles were found to interfere with informants' wish to recover as follows: (i) 'perceiving judgements'; (ii) 'feeling stuck'; (iii) 'feeling distressed'; (iv) 'denying AN'; (v) 'eating'; (vi) 'gaining weight'; and (vii) 'appreciating the benefits'., Conclusion: The wish to recover is an autonomously based, fundamental motivational requirement for becoming ready to change. Understanding factors that contribute to this wish adds to the clinician's toolbox in motivational work with AN patients., (Copyright © 2011 John Wiley & Sons, Ltd and Eating Disorders Association.)

We explored the concept body image disturbance (BID) by utilizing the subjective experience of 32 women (aged 20-39 years) diagnosed with AN (DSM-V). Using methods from Grounded Theory we identified four phenotypes of BID-"Integration," "Denial," "Dissociation," and "Delusion"-which differed according to whether the patients overestimated their own body size ("Subjective reality"), and whether they acknowledged the objective truth that they were underweight ("Objective reality"). The results suggest that BID should be conceptualized as a dynamic failure to integrate subjective experiences of one's own body appearance with an objective appraisal of the body. Conceptual, diagnostic and clinical implications are discussed.

Objective: Motivational approaches to anorexia nervosa (AN) have mainly concerned motivational quality and quantity. We investigated the content of patients' wish to recover., Method: Eighteen women, aged 18-39, with AN were interviewed in depth using a phenomenological study design. Interviews were tape-recorded, transcribed, and analyzed using the QSR-N*Vivo software program., Results: Four motivational content areas characterized informants' wishes to recover: "Sense of vitality" (e.g., joy, concentration, spontaneity, energy); "Sense of autonomy" (e.g., choosing to recover, new methods of mastery, self-determination); "Sense of insight" (e.g., awareness, seeing nuances, limitation of goals, self-knowledge); and "Negative consequences" (e.g., loss of future, costs to own children, feeling sick or thin, social costs, physical costs)., Conclusion: Our sample of AN patients' motivation to recover may be described using three dimensions: content, quality, and quantity, and may also include motives with no behavioral intention. Sustained therapeutic success may rest upon the therapist's ability to identify and ally with the patient's motives to recover.

Objective: Anorexia nervosa (AN) patients tend to place a positive value on their symptoms. Many clinicians believe that this plays a central role in maintaining the disorder. However, empirical research on how patients attribute meaning to their symptoms is lacking. This study aims at systematically exploring the meaning that the patients with AN attribute to their anorectic behavior., Method: A qualitative, descriptive, phenomenological design was used. Eighteen women aged 20-34 with AN (DSM-IV) were interviewed with an informant-centered interview. The interviews were tape-recorded, verbatim transcribed, coded, and analyzed phenomenologically, using a QSR-N*Vivo software program., Results: The psychological meanings that the informants attributed to their anorectic behavior could be summarized in eight constructs: "Security" (feeling of stability and security), "Avoidance" (avoiding negative emotions), "Mental strength" (inner sense of mastery), "Self-confidence" (feeling acknowledged and worthy of compliments); "Identity" (achieving new identity), "Care" (eliciting care from others), "Communication" (communicating difficulties), and "Death" (wishing to starve oneself to death)., Conclusion: The eight constructs may have central functions in the maintenance of AN and should be regarded when patients' motivation and goals for treatment are assessed. Further study of the possible functions of the constructs in maintaining AN is warranted., ((c) 2006 by Wiley Periodicals, Inc.)