How and why does the disease progress? A qualitative investigation of the transition into long-standing anorexia nervosa.

Despite an increased interest in understanding characteristics of long-standing anorexia nervosa (AN), there is a lack of knowledge into the processes that occur with the development and maintenance of the disease. This has impeded the development of novel treatment approaches that may prove more effective than traditional medical models of therapy. To improve the prognosis of these long-standing presentations, an understanding as to how and why the AN disease progresses is required. It was therefore the aim of the current study to investigate the transition of AN from earlier to later stages. The study adopted a narrative inquiry approach and a total of 11 women with long-standing AN participated in an interview. The newly developed photovoice method assisted in data collection with typologies of chronic illness facilitating the emergence of salient themes. The qualitative analysis resulted in the identification of five themes: (a) transition, (b) trauma, (c) functionality, (d) identity, and (e) failure of current models of treatment. Together with identifying key themes, the study provides insight into some possible reasons why current treatment models are failing to promote recovery. Future research examining the effectiveness of treatment that targets underlying causes and maintaining factors of the illness are suggested. Additional education for health professionals is also recommended in order to reduce the trauma that is currently being experienced by some patients with a long-standing illness. Anorexia nervosa (AN) is a complex illness that has the potential to develop into a long-term presentation. When this occurs, the best way of treating this stage of the disease is currently being debated with new models of care being investigated and compared to more traditional approaches to treatment. One of the difficulties in developing more effective treatment is the lack of understanding into how and why the AN illness transitions from an earlier to later stage. It was the aim of the current study to discover the changes that occur as the AN illness progresses. A total of 11 women were interviewed to discuss their experience of AN as it progressed into a long-term illness. It was discovered that across participants, five themes emerged: (a) transition, (b) trauma, (c) functionality, (d) identity, and (e) failure of current models of treatment. Possible reasons as to why current treatment approaches are not working for long-term AN are discussed. Recommendations are made for improving education for health professionals so as to reduce the trauma that is currently being experienced by some individuals with a long-standing illness.