Voswinkel Marthe M, Rijkers Cleo, van Delden Johannes J M, van Elburg Annemarie A
Altrecht Eating Disorders Rintveld, Wenshoek 4, 3705 WE, Zeist, The Netherlands.
Eating Disorders Center, PsyQ Haaglanden, Lijnbaan 4, The Hague, The Netherlands.
J Eat Disord. 2021 Oct 15;9(1):128. doi: 10.1186/s40337-021-00486-6.
Anorexia nervosa (AN) is a psychiatric disorder with an ego-syntonic nature, causing many patients to perceive their AN as part of their personal identity. Therefore, an important part of treatment is the externalization of the eating disorder, in order to help patients to perceive AN as an external influence. Studies on patient experiences of externalization in treatment for AN are sadly missing. The aims of this study were to investigate, first, patients' perspectives on the relation between identity and anorexia nervosa (AN) and second, their experiences of an externalizing approach during treatment.
A qualitative interview study was conducted including fourteen patients with AN in either Family Based Treatment, the Maudsley Model for Anorexia Nervosa Treatment for Adults, Specialist Supportive Clinical Management-Severe Enduring or Cognitive Behavioural Therapy-Enhanced.
There are important differences in participants' perceptions on how AN is related to identity. AN was perceived as part of identity, as alien or as a different side of the self. Patients' experiences towards an externalizing approach were ambivalent. Externalization was considered helpful, whilst also evoking a negative response. Participants reported feeling as if all their behaviour was referred to as part of AN, which elicited feelings of not being taken seriously or being wrongfully accused of being dishonest.
First, there is considerable variation in the perceived relation between AN and identity. Second, an externalizing approach within treatment may lead to so called epistemic injustice. Awareness of these two facts is of importance for clinicians and the therapeutic relationship because that will help them to refrain from actions that can be perceived as epistemic injustice.
神经性厌食症（AN）是一种具有自我和谐性质的精神障碍，导致许多患者将其神经性厌食症视为个人身份的一部分。因此，治疗的一个重要部分是将饮食失调外化，以帮助患者将神经性厌食症视为一种外部影响。遗憾的是，关于患者在神经性厌食症治疗中外化体验的研究缺失。本研究的目的，一是调查患者对身份与神经性厌食症（AN）之间关系的看法，二是调查他们在治疗期间对外化方法的体验。
进行了一项定性访谈研究，包括14名接受家庭治疗、成人神经性厌食症莫兹利治疗模式、严重持久型专业支持性临床管理或强化认知行为疗法的神经性厌食症患者。
参与者对神经性厌食症与身份之间关系的认知存在重要差异。神经性厌食症被视为身份的一部分、异类或自我的不同侧面。患者对外化方法的体验是矛盾的。外化被认为是有帮助的，但同时也引发了负面反应。参与者报告说，感觉自己所有的行为都被视为神经性厌食症的一部分，这引发了不被认真对待或被错误地指责不诚实的感觉。
第一，神经性厌食症与身份之间的感知关系存在相当大的差异。第二，治疗中的外化方法可能导致所谓的认知不公正。认识到这两个事实对临床医生和治疗关系很重要，因为这将帮助他们避免可能被视为认知不公正的行为。
