Dimitropoulos Gina, Kimber Melissa, Singh Manya, Williams Emily P, Loeb Katharine L, Hughes Elizabeth K, Garber Andrea, Elliott April, Vyver Ellie, Le Grange Daniel
1Faculty of Social Work, University of Calgary, 2500 University Drive NW, Calgary, Alberta T2N 1N4 Canada.
2Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Canada.
J Eat Disord. 2019 Apr 25;7:10. doi: 10.1186/s40337-019-0240-8. eCollection 2019.
Atypical anorexia nervosa (AN) has received minimal empirical attention regarding effective diagnosis and treatment. Family-based treatment (FBT) might be a promising treatment for atypical AN, yet it is unclear as to what adaptations are needed to the current manualized FBT for AN model. The objective of the current study was to identify how FBT practitioners applied FBT for atypical AN for adolescents in their clinical practice, and if there were any implementation challenges and adaptations to the model for this population.
The current study employed fundamental qualitative description, with the aim of capturing practitioners' reflections on working with adolescents with atypical AN in clinical practice. A purposeful sample of practitioners with training in FBT were recruited and each participant completed an individual, semi-structured interview. Data was analyzed using conventional content analysis.
A total of 23 practitioners participated in this study. The results indicate that practitioners maintained some fidelity to manualized FBT in treating atypical AN, but they differed in their discussions around target weights, what constitutes weight restoration, and the dosage for FBT phases. Salient practice challenges included operationalizing the (DSM-5) definition of atypical AN, identifying a 'goal weight' for adolescents and activating parents to take charge of the re-nourishment process.
The results of this qualitative study demonstrate practitioner reflections on the delivery and adaptations of FBT for adolescents with atypical AN. These reflections highlight the need to establish the delivery of coherent and consistent treatment and messaging with patients and families. Further, practitioners' reflections highlight common strategies to increase the sense of urgency in parents to support their child with atypical AN.
非典型神经性厌食症（AN）在有效诊断和治疗方面受到的实证关注极少。基于家庭的治疗（FBT）可能是治疗非典型AN的一种有前景的方法，但目前针对AN的手册化FBT模式需要做出哪些调整尚不清楚。本研究的目的是确定FBT从业者在临床实践中如何将FBT应用于青少年非典型AN患者，以及针对该人群在实施该模式时是否存在任何挑战和调整。
本研究采用基本的定性描述，旨在捕捉从业者对在临床实践中与青少年非典型AN患者合作的反思。招募了有FBT培训经历的从业者作为有目的的样本，每位参与者完成一次单独的半结构化访谈。使用常规内容分析法对数据进行分析。
共有23名从业者参与了本研究。结果表明，从业者在治疗非典型AN时对手册化FBT保持了一定的忠诚度，但他们在目标体重、体重恢复的构成以及FBT各阶段的剂量等方面的讨论存在差异。突出的实践挑战包括落实非典型AN的（《精神疾病诊断与统计手册》第5版）定义、为青少年确定“目标体重”以及促使家长负责重新喂养过程。
这项定性研究的结果展示了从业者对为青少年非典型AN患者提供FBT及调整的反思。这些反思凸显了与患者及其家庭建立连贯一致的治疗和信息传递的必要性。此外，从业者的反思突出了提高家长支持其患有非典型AN的孩子的紧迫感的常见策略。
