Moberg Jennie
Department of Social Work, Stockholm University, Albanovägen 18, Stockholm, 11419, Sweden.
J Eat Disord. 2025 May 27;13(1):92. doi: 10.1186/s40337-025-01283-1.
Individuals with both anorexia nervosa (AN) and post-traumatic stress disorder (PTSD) often experience significant challenges in psychiatric inpatient care, particularly when coercive measures are used. While the comorbidity of AN and PTSD is well-documented, their interplay in the context of compulsory care and from a lived experience and trauma-informed perspective remains underexplored, despite its critical impact on treatment outcomes. This autoethnographic study aims to shed light on how coercion is experienced in this context, highlighting the need for a trauma-informed approach that acknowledges patients' histories rather than solely viewing their behaviors as pathological. The Power Threat Meaning Framework (PTMF) provides a theoretical lens for understanding how trauma affects individuals with AN and PTSD, emphasizing the importance of viewing these conditions not just as symptoms to be treated but as survival strategies linked to broader trauma histories.
An autoethnographic approach was used to analyze blog posts, clinical notes, and diary entries from 2010 to 2019, focusing on experiences of AN, coercion, and trauma.
One overarching theme, 'Life in inpatient care', and four subthemes emerged: (1) 'Being sucked into the vortex of hunger', (2) 'Relapse no. 5 and admission procedure - state of emergency', (3) 'Encountering coercion and losing control - living in constant fear', and (4) 'Managing the aftermaths of eating'.
This autoethnography highlights the interplay between AN and PTSD in compulsory inpatient care, showing how AN served as a coping mechanism for trauma, with starvation as emotional avoidance. The PTMF framework challenges diagnostic-based models, viewing these behaviors as survival strategies rather than pathology. Key findings highlight the impact of coercive treatments such as forced feeding and restraint, which can intensify fear and retraumatization. A trauma-informed approach prioritizing trust, autonomy, and trauma acknowledgment is essential for effective, compassionate care. Recovery should go beyond renourishment to include psychological healing and body-self reintegration, emphasizing a holistic, patient-centered approach for improved treatment outcomes.
患有神经性厌食症（AN）和创伤后应激障碍（PTSD）的个体在精神科住院治疗中常常面临重大挑战，尤其是在使用强制手段时。虽然AN和PTSD的共病情况已有充分记录，但它们在强制治疗背景下以及从生活经历和创伤知情的角度的相互作用仍未得到充分探索，尽管这对治疗结果具有关键影响。这项自我民族志研究旨在揭示在这种背景下强制手段是如何被体验的，强调需要一种创伤知情的方法，该方法承认患者的病史，而不是仅仅将他们的行为视为病态。权力威胁意义框架（PTMF）为理解创伤如何影响患有AN和PTSD的个体提供了一个理论视角，强调不仅要将这些病症视为待治疗的症状，还要将其视为与更广泛创伤史相关的生存策略的重要性。
采用自我民族志方法分析2010年至2019年的博客文章、临床记录和日记条目，重点关注AN、强制手段和创伤的经历。
出现了一个总体主题“住院治疗中的生活”和四个子主题：（1）“被卷入饥饿的漩涡”，（2）“第5次复发和入院程序——紧急状态”，（3）“遭遇强制手段并失去控制——生活在持续恐惧中”，以及（4）“应对进食后的后果”。
这项自我民族志研究突出了AN和PTSD在强制住院治疗中的相互作用，表明AN如何作为一种创伤应对机制，饥饿成为情感逃避的方式。PTMF框架挑战了基于诊断的模型，将这些行为视为生存策略而非病态。主要发现突出了强制治疗（如强制喂食和约束）的影响，这些治疗可能会加剧恐惧和再次创伤。一种以信任、自主性和创伤认知为优先的创伤知情方法对于有效、富有同情心的护理至关重要。康复不应仅仅局限于重新营养，还应包括心理治愈和身体自我重新整合，强调采用整体的、以患者为中心的方法以改善治疗结果。
