Self-injurious behaviour in patients with anorexia nervosa: a quantitative study.

BACKGROUND: Many patients with an eating disorder report difficulties in regulating their emotions and show a high prevalence of self-injurious behaviour. Several studies have stated that both eating disorder and self-injurious behaviour help emotion regulation, and are thus used as coping mechanisms for these patients. We aimed to determine the prevalence of self-injurious behaviour, its characteristics and its emotion-regulation function in patients with anorexia nervosa or an eating disorder not otherwise specified (n = 136). METHODS: A cross-sectional design using a self-report questionnaire. Mann-Whitney U-tests were conducted to compare the background and clinical variables between patients with self-injurious behaviour and patients without this type of behaviour. Changes in emotional state before and after self-injurious behaviour were tested by Wilcoxon signed rank tests. RESULTS: Our results showed a 41% prevalence of self-injurious behaviour in the previous month. Patients who performed self-injurious behaviour had a statistically significant longer treatment history for their eating disorder than those who did not. Whereas 55% of self-injuring patients had a secondary psychiatric diagnosis, only 21% of participants without self-injurious behaviour did. Regarding the impact of self-injurious behaviour, our results showed a significant increase in "feeling relieved" and a significant decrease in "feeling angry at myself", "feeling anxious" and "feeling angry at others". This indicates that self-injurious behaviour can be regarded as an emotion-regulation behaviour. Participants were usually aware of the causes of their self-injurious behaviour acts. CONCLUSIONS: Professionals should systematically assess the occurrence of self-injurious behaviour in eating disorder patients, pay special attention to patients with more severe and comorbid psychopathology, and those with a long treatment history. This assessment should be followed by a functional analysis of the self-injurious behaviour and by effective therapeutic interventions alongside the eating disorder treatment.

Relapse in anorexia nervosa: a systematic review and meta-analysis.

PURPOSE OF REVIEW: Relapse is common in patients with anorexia nervosa. The aim of this study is to systematically review the existing literature on relapse in anorexia nervosa. RECENT FINDINGS: A systematic literature search was conducted in PubMed, PsychInfo and CINAHL published up to April 2018. Of the 1527 studies screened, 16 studies were included in the present review. SUMMARY: This analysis shows that, of the patients included in this review, 31% relapsed after treatment. The highest risk of relapse is during the first year after discharge and this risk continues for up to 2 years. An overview was made of all factors significantly associated with a higher risk of relapse, resulting in the following four clusters: eating disorder variables, comorbidity symptoms, process treatment variables and demographic variables. Future research on relapse prevention is necessary to further unravel the mechanisms that might lead to relapse.

Relapse prevention in anorexia nervosa: Experiences of patients and parents.

One of the main aims of treatment after successful recovery from anorexia nervosa (AN) is to prevent a relapse. The Guideline Relapse Prevention (GRP) Anorexia Nervosa offers a structured approach to relapse prevention. This study explores how patients and their parents experience working with the guideline. It also describes the factors that support or hinder successful application of the guideline. A descriptive qualitative research design was chosen involving in-depth interviews with seventeen patients with anorexia nervosa and six sets of parents. Patients and family members were generally satisfied with the support provided by the GRP. It contributed significantly to a better understanding of the personal process of relapse. Patients and families valued being able to keep in touch with their professional during the aftercare programme. The GRP supports the patient's use of self-management strategies for relapse prevention.

Rate, timing and predictors of relapse in patients with anorexia nervosa following a relapse prevention program: a cohort study.

BACKGROUND: Relapse is common among recovered anorexia nervosa (AN) patients. Studies on relapse prevention with an average follow-up period of 18 months found relapse rates between 35 and 41 %. In leading guidelines there is general consensus that relapse prevention in patients treated for AN is a matter of essence. However, lack of methodological support hinders the practical implementation of relapse prevention strategies in clinical practice. For this reason we developed the Guideline Relapse Prevention Anorexia Nervosa. In this study we examine the rate, timing and predictors of relapse when using this guideline. METHOD: Cohort study with 83 AN patients who were enrolled in a relapse prevention program for anorexia nervosa with 18 months follow-up. Data were analyzed using Kaplan-Meijer survival analyses and Cox regression. RESULTS: Eleven percent of the participants experienced a full relapse, 19 % a partial relapse, 70 % did not relapse. Survival analyses indicated that in the first four months of the program no full relapses occurred. The highest risk of full relapse was between months 4 and 16. None of the variables remained a significant predictor of relapse in the multivariate Cox regression analysis. CONCLUSION: The guideline offers structured procedures for relapse prevention. In this study the relapse rates were relatively low compared to relapse rates in previous studies. We recommend that all patients with AN set up a personalized relapse prevention plan at the end of their treatment and be monitored at least 18 months after discharge. It may significantly contribute to the reduction of relapse rates.

Restoring normal eating behaviour in adolescents with anorexia nervosa: A video analysis of nursing interventions.

An important part of inpatient treatment for adolescents with anorexia nervosa is to restore normal eating behaviour. Health-care professionals play a significant role in this process, but little is known about their interventions during patients' meals. The purpose of the present study was to describe nursing interventions aimed at restoring normal eating behaviour in patients with anorexia nervosa. The main research question was: 'Which interventions aimed at restoring normal eating behaviour do health-care professionals in a specialist eating disorder centre use during meal times for adolescents diagnosed with anorexia nervosa? The present study was a qualitative, descriptive study that used video recordings made during mealtimes. Thematic data analysis was applied. Four categories of interventions emerged from the data: (i) monitoring and instructing; (ii) encouraging and motivating; (iii) supporting and understanding; and (iv) educating. The data revealed a directive attitude aimed at promoting behavioural change, but always in combination with empathy and understanding. In the first stage of clinical treatment, health-care professionals focus primarily on changing patients' eating behaviour. However, they also address the psychosocial needs that become visible in patients as they struggle to restore normal eating behaviour. The findings of the present study can be used to assist health-care professionals, and improve multidisciplinary guidelines and health-care professionals' training programmes.

Patients with anorexia nervosa who self-injure: a phenomenological study.

PURPOSE: This study investigates self-injury from the perspective of patients with anorexia nervosa. DESIGN AND METHODS: A phenomenological design was used. Twelve patients participated. Data were collected using a semi-structured interview guide. FINDINGS: Participants display self-injurious behavior predominantly in situations when they are forced to eat. They are terrified of gaining weight and use self-injurious behavior to cope with their anxiety. Self-injury is envisioned as a technique to regain control of their own eating pattern without bothering anyone. They feel shame for not controlling their emotions more constructively. PRACTICE IMPLICATIONS: Healthcare professionals should systematically observe signals and explore less harmful strategies that help to regulate overwhelming feelings.

The Anorexia Relapse Prevention Guidelines in practice: a case report.

PURPOSE: The purpose of this case report is to illustrate the application of the Anorexia Relapse Prevention Guidelines in nursing practice. DESIGN AND METHODS: In a single case report, the implementation of the intervention was described. FINDINGS: A purposive use of the Anorexia Relapse Prevention Guidelines provides insight into the actual process of relapse, which contributes to an early recognition of relapse symptoms and permits early intervention aimed at recovery. NURSING IMPLICATIONS: Use of the Guidelines will lead to the implementation of well-structured professional procedures which are likely to support the patient's recovery.