The lived experience of working with people with eating disorders: A meta-ethnography.

OBJECTIVE: Working with people with eating disorders (EDs) is known to elicit strong emotional reactions, and the therapeutic alliance has been shown to affect outcomes with this clinical population. As a consequence, it is important to understand healthcare professionals' (HCPs') experiences of working with this client group. METHOD: A meta-synthesis was conducted of qualitative research on HCPs' lived experiences of working with people with EDs. The results from the identified studies were analyzed using Noblit and Hare's meta-ethnographic method. Data were synthesized using reciprocal translation, and a line of argument was developed. RESULTS: Thirty-seven studies met the inclusion criteria. Reciprocal translation resulted in a key concept: "Coping with caring without curing." This was underpinned by the following third-order concepts: (a) "The dissonance and discomfort of being a helper struggling to help," (b) "Defending against the dissonance," and (c) "Accepting the dissonance to provide safe and compassionate care." These concepts were used to develop a line-of-argument synthesis, which was expressed as a new model for understanding HCPs' experiences of working with people who have an ED. DISCUSSION: Although the conflict associated with being a helper struggling to help led some HCPs to avoid and blame people with EDs, others adopted a compassionate stance characterized by humanity, humility, balance, and awareness.

Perceptions of the "anorexic voice": A qualitative study of health care professionals.

People with anorexia nervosa (AN) often report experiencing a highly critical inner voice (AV) focused on their eating, shape, and weight. There are promising preliminary findings for its role in the treatment of AN, and the support of staff is vital for the AV to be embedded in treatment, but their views remain unknown. The aims of this study were to undertake a qualitative exploration of the perceptions of the AV among health care professionals (HCPs) in specialist eating disorder services. A thematic analysis was applied to interviews with 15 HCPs, including nurses, therapists, psychiatrists, health care assistants, psychologists, and dietitians. Two overarching themes were identified: "The AV is a vehicle for increasing compassion" and "It's not a one-size-fits-all." The AV was seen as a means of developing and sustaining compassion, but participants noted that it does not resonate for all clients. All HCPs in this study believed that there was potential benefit in utilizing the AV in their work with people with AN, and it is likely that doing so would help to reduce burnout and frustration within clinical teams.

Food volume effects on intake and appetite in women with binge-eating disorder and weight-matched controls.

OBJECTIVE: Our study examined the effect of food volume on later intake and appetite ratings in 15 women with binge eating disorder (BED) and 15 healthy control women. METHOD: On nonconsecutive days, lower-volume (250 ml/171 kcal) and higher-volume milk-based preloads (500 ml/171 kcal) were served in counterbalanced order. Thirty minutes later, appetite ratings and intake at a buffet-style test-lunch were assessed. RESULTS: Higher-volume preloads decreased hunger, desire to eat, excitement about eating, desire for dessert, and loss of control over eating at test meals, relative to lower-volume preloads. Test-meal intake was greater among BED participants than controls; intake did not differ by preload volume. BED participants' desire to eat, prospective consumption, excitement about eating, and desire for meals and desserts were higher than controls' ratings. CONCLUSION: Higher-volume foods decreased hunger and related appetite ratings. Differences in food intake and appetite between BED and control participants provide further evidence for the validity of test meals to assess binge eating.

Energy density effects on food intake, appetite ratings, and loss of control in women with binge eating disorder and weight-matched controls.

Individuals with binge eating disorder have increased gastric capacity and may require excessive food intake and increased volume in the stomach to produce satiation. The present study examined whether lower energy density (ED) meals lead to lower energy intake more than higher-ED meals in women with binge eating disorder (BED) and weight-matched controls. Women with BED (n=15) and healthy weight-matched controls (n=15) were instructed to consume as much as they wished during two test meals on non-consecutive days. Participants were served two hedonically similar versions of a pasta salad (19% protein, 50% carbohydrate, 31% fat): low-ED (1.0 kcal/g) and high-ED (1.6 kcal/g), and food intake and appetite ratings were assessed. Energy intake was significantly lower in the low-ED condition than in the high-ED condition across all participants. BED participants were more likely to report greater prospective consumption, desire for dessert, loss of control over eating, and less enjoyment after meals. Decreasing the energy density of food consumed may help target disturbances in satiation in women with frequent binge eating.

Loss of control over eating reflects eating disturbances and general psychopathology.

This study examined the clinical significance of the loss of control over eating as a key component of eating disorders. It investigated the association of eating-related psychopathology and general psychopathology with objective bulimic episodes (OBEs; experiencing a loss of control while consuming large amounts of food) and subjective bulimic episodes (SBEs; experiencing a loss of control while consuming small/moderate amounts). A community sample of 81 women with a range of disordered eating was recruited: binge-eating disorder, bulimia nervosa, subclinical eating disturbances, or no eating disorders. They were interviewed using the Eating Disorder Examination and completed measures of eating-related and general psychopathology. Both OBE and SBE frequencies correlated significantly with measures of eating-related and general psychopathology, and no significant differences were found between the magnitudes of the correlations with either binge episode type. SBE frequency significantly and independently predicted global eating disorder psychopathology. The loss of control over eating, without consuming large amounts of food, was as closely associated with specific eating disorder psychopathology and general mental health as were traditionally defined OBEs. SBEs may be an important target of treatment and should be considered for future diagnostic classifications of eating disorders.