Burke Freddy, Higgins Maree, MacGinley Maureen
School of Social Sciences, Arts Design and Architecture, University of New South Wales, Sydney, Australia.
J Eat Disord. 2024 Dec 22;12(1):208. doi: 10.1186/s40337-024-01164-z.
To examine autonomy within treatment and recovery from longstanding and severe eating disorders (EDs).
The typically early age of onset, high incidence, and prolonged duration of EDs, has a high personal, relational, and financial burden for people who experience them. Current treatment practices rely on the exertion of external control and influence which has profound impacts on people living with EDs as well as the relationship and interactions between them and their treating professionals. Yet scant research focuses specifically on how people with EDs, especially longstanding and severe presentations, experience autonomy. Centring the lived experience voice is essential to deconstruct power imbalances and develop more effective recovery pathways.
A Rapid Evidence Review answered the research question, How do people with longstanding and severe eating disorders experience autonomy and recovery? Five electronic databases, the International Journal of Eating Disorders, and topic-specific grey literature from 2000-2021 were systematically searched. Twenty articles met the inclusion criteria. All findings and primary lived experience quotations relevant to the review topic were extracted, charted, and analysed. Reflexive Thematic Analysis (Braun and Clarke in Qual Psychol 9:3-26, 2021; Braun and Clarke in Qual Res Psychol 3:77-101, 2006;) was undertaken to inform the key findings and discussion.
The researchers identified four central themes that characterise the experience of autonomy in treatment and recovery for people with longstanding and severe EDs: Self versus ED, Self in Treatment, Self in Recovery, and Others in Relation to Self. Novel theoretical contributions to understanding longstanding and severe EDs include the 'Lack of Autonomy' Loop, 'Relational Autonomy' and the diversity of definitions of recovery.
This review highlights the critical role of autonomy in the treatment and recovery of individuals with longstanding and severe EDs. It underscores the importance of addressing past trauma and integrating trauma-focused therapy within ED treatment. The findings advocate for collaborative, tailored, and autonomy-supportive approaches that empower individuals to break the cycle of disempowerment and promote sustained recovery.
The review highlights the need for conceptual and practice development to leverage desire-focused, relational approaches for effective healing and recovery.
探讨长期严重饮食失调症（EDs）患者在治疗及康复过程中的自主性。
饮食失调症通常发病年龄较早、发病率高且病程漫长，给患者带来了沉重的个人、人际关系及经济负担。当前的治疗方法依赖外部控制和影响的施加，这对饮食失调症患者及其与治疗专业人员之间的关系和互动产生了深远影响。然而，很少有研究专门关注饮食失调症患者，尤其是长期严重患者的自主性体验。以患者的生活体验为核心对于解构权力失衡以及开发更有效的康复途径至关重要。
一项快速证据综述回答了研究问题：长期严重饮食失调症患者如何体验自主性和康复？系统检索了五个电子数据库、《国际饮食失调症杂志》以及2000年至2021年的特定主题灰色文献。二十篇文章符合纳入标准。提取、梳理并分析了所有与综述主题相关的研究结果及主要生活体验引述。采用反思性主题分析（布劳恩和克拉克，《定性心理学》9:3 - 26，2021；布劳恩和克拉克，《定性研究心理学》3:77 - 101，2006）为关键发现和讨论提供依据。
研究人员确定了四个核心主题，这些主题表征了长期严重饮食失调症患者在治疗及康复过程中的自主性体验：自我与饮食失调症、治疗中的自我、康复中的自我以及与自我相关的他人。对理解长期严重饮食失调症的新理论贡献包括“自主性缺失”循环、“关系自主性”以及康复定义的多样性。
本综述强调了自主性在长期严重饮食失调症患者治疗及康复中的关键作用。它强调了处理过去创伤以及将以创伤为重点的治疗纳入饮食失调症治疗的重要性。研究结果倡导采用协作、量身定制且支持自主性的方法，使个体能够打破无权状态的循环并促进持续康复。
该综述强调了概念和实践发展的必要性，以利用以欲望为重点的关系方法实现有效的治愈和康复。
