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Samuel Thomson, ST6 Child and Adolescent Psychiatry

Adolescents with a diagnosis of Anorexia Nervosa (AN): primary caregivers’ experience of recognition and decisions around initial help-seeking. Samuel Thomson, ST6 Child and Adolescent Psychiatry Collaborators Michael Marriott, Jo McLaughlin, Katherine Telford, Hou Law, Kapil Sayal.

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Samuel Thomson, ST6 Child and Adolescent Psychiatry

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  1. Adolescents with a diagnosis of Anorexia Nervosa (AN): primary caregivers’ experience of recognition and decisions around initial help-seeking Samuel Thomson, ST6 Child and Adolescent Psychiatry Collaborators Michael Marriott, Jo McLaughlin, Katherine Telford, Hou Law, Kapil Sayal

  2. Idea development • Rarely present themselves • Onus on parents • Duration of illness related to outcome (Rosenvinge & Mouland, 1990; Steinhausen, 2002; Ratnasuriya et al., 1991) • DUED, c.f. DUP

  3. Springboard • Childhood Onset Anorexia Nervosa: The Experience of Parents (Bryant-Waugh et al., 2004). • Theme > ‘slow recognition’

  4. Aim • Main caregivers’ experiences of: • Recognition • Decision to seek help

  5. Methodology • 8 retrospective semi-structured interviews with primary caregiver • 1 hour • Audio-recorded • Transcribed verbatim

  6. Inclusion criteria • 11-18 years at time of referral to CAMHS • Broadly defined anorexia nervosa in past 3 years • Great Ormond Street (GOS) Diagnostic Checklist* (Bryant-Waugh & Kaminski 1996)

  7. Analysis • Themes systematically identified from data • Inductive (IPA) • No a priori assumptions • Credibility checks

  8. Participant demographics

  9. Results • Normalisation • Ambivalence/Ambiguity • Decision Point • Relationships

  10. Normalisation • Initial weight loss positive or related to normal adolescent development • Noticed child’s rigidity around food • Cautious not to pressure their children • Expected weight loss to be short-lived

  11. Ambivalence/Ambiguity • Denial • Incomprehensible • Suspicions grew → watched closely • Build up evidence • Secrecy • Research

  12. Decision Point • Unsuccessful attempts to reason with or reward their children • Chronic failure → help-seeking • Holidays exposed pathology • Wanted acknowledgement of the seriousness of the situation and prompt action since they feared for their child’s life • Disappointed by further attempts to contain • Catch 22

  13. Relationships • Avoidance of conflict • Betrayal • Powerlessness • Positive and negative effects on family • Isolated by negative + simplistic responses of others • Stigma

  14. Conclusions • Parents require advice and support to confirm their suspicions. • Otherwise parents are left to accumulate concerns and often approach professional help at a late stage • Reliable information sources may help equip parents to clarify early concerns • Since parents commonly approached the Internet for guidance, improving awareness of useful and accurate web-sites could reduce delays in help seeking

  15. References • Bryant-Waugh, R., Cottee-Lane, D. & Pistrang N. (2004). Childhood Onset Anorexia Nervosa: The Experience of Parents. European Eating Disorders Review, 12, 169-177. • Ratnasuriya, R. H., Eisler, I., Szmukler G. I. & Russell G. F. (1991). Anorexia nervosa: outcome and prognostic factors after 20 years. The British Journal of Psychiatry, 158, 495-502. • Rosenvinge, J. H. & Mouland S. O. (1990). Outcome and prognosis of anorexia nervosa. A retrospective study of 41 subjects. The British Journal of Psychiatry, 156, 92-97. • Steinhausen, H-C. (2002). The Outcome of Anorexia Nervosa in the 20th Century. American Journal of Psychiatry, 159:8, 1284-1293.

  16. Thanks • samuelthomson@live.co.uk

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