What Do Patients Expect
from Treatment for AN?

Young adult patients with anorexia nervosa (AN) have a reputation of being difficult to treat because of their reluctance to enter treatment and resistance to change; many often have very low expectations of recovery. Two Swedish eating disorders experts found very different results when they asked a group of potential AN patients about their expectations of treatment (J Multidiscip Heathc 2012; 5: 169).

Drs. Gunilla Paulson-Karlsson and Lauri Nevonen of the Anorexia-Bulimia Unit at Queen Silvia Children’s Hospital, Göteborg, and Örebro University, Örebro, Sweden, asked a group of women who were on a waiting list for treatment for AN a number of questions about their expectations of treatment for their disorder. The women were young adults between 18 and 25 years of age, and were seeking help for anorexic problems after being referred by the health services. The women were first contacted by telephone and briefly informed about the study, and were then asked to participate in an interview study at the eating disorder unit; 15 agreed.

The mean age of those who participated in the study was 21.7 years (range: 15 years to 19.6 years) and the mean body mass index (BMI) was 17.2 kg/m2. The women reported having symptoms for from 1 to 10 years (mean: 4.86 years). The women’s treatment expectations fell into three main categories: treatment content, treatment professionals, and treatment focus.

One of the main findings by the authors was that all participants expressed various expectations of reducing AN symptoms, getting help, and then getting well. Their expressed motivation pointed to a positive attitude toward attending treatment sessions and an intention to recover from the disorder. This contrasted with a more common impression that motivation is low among eating disorder patients in general in general and AN patients in particular, especially at the beginning of treatment. Many patients view their illness as a chronic condition with negative physical and psychological consequences, and have low expectations of recovery. In the authors’ study, however, the 15 participants stated positive and hopeful expectations at the time of their first interview, and had a high degree of confidence that they would receive good care, have fewer negative physical and psychological symptoms, and that they would recover. The authors are quick to add that expressed motivation before assessment treatment cannot indicate what the motivation to change their eating behavior will be once they are in treatment.

The prospective patients also expected to be rated professionally by a person with knowledge and experience with eating disorders. Many expect to get adequate information and to be able to ask questions about how treatment works. They felt they needed support and help during the process from their family and friends. They expressed a strong desire to get well so they can work and study and to have changes in their lives that will help them have “normal” lives. They also expected and preferred to be treated by an eating disorders specialist.

Applications in clinical care

Drs. Paulson-Karlsson and Nevonen felt that the overly positive expectations expressed by these potential patients could be partly attributed to the fact that 8 of the women contacted the eating disorders unit on their own, and 3 had previous treatment experience. They were young adults with negative experiences of the disease affecting their everyday life and relationships with friends and family. Thus, they may have had a certain level of motivation to seek help and belief there is still hope of recovering from AN and leading a normal life.

The results of their study may have some implications for clinical work, say the authors. In clinical work, patients’ expectations can be discussed at the beginning of treatment, and continually thereafter, to reveal any discrepancies and to negotiate treatment goals, which could enhance the therapeutic relationship. The authors also suggest that patients might be assigned the task of writing a list of their expectations at the start of treatment and, as therapy proceeds, the patient’s experiences of both the treatment and working with the therapist will most likely have an impact on the patient’s expectations. A short questionnaire might also be used to map AN patients’ expectations before treatment. This would be a quantitative validation of current qualitative results, and together the results could form the basis for assessments of expectations in clinical work—the questionnaire could be used to examine all patients’ expectations in order to find similarities and differences linked to eating disorder symptoms.