Heal-Cohen Natasha, Allan Sophie M, Gauvain Nieve, Nabirinde Rachel, Burgess Aaron
Cambridgeshire and Peterborough NHS Foundation Trust.
Department of Clinical Psychology and Psychological Therapies, Norwich Medical School, University of East Anglia, Norwich, UK.
Clin Psychol Psychother. 2025 Jul-Aug;32(4):e70101. doi: 10.1002/cpp.70101.
Relapse is common in eating disorders (EDs); however, it has received significantly more attention within quantitative research. This systematic review aimed to synthesize qualitative findings regarding the experiences of relapse for people with EDs.
A search for studies reporting qualitative data that included experiences of relapse in individuals with EDs was conducted. This included a systematic search of MEDLINE, CINAHL, PsycInfo, Scopus, SSCI, and PQDT Global along with supplementary searching. A total of 1594 titles and abstracts and 168 full texts were screened for eligibility. Sixteen studies were included in the review. Quality appraisal was conducted using the CASP checklist. Data were extracted from each paper and thematic synthesis of relevant data from study findings/discussion was completed in NVivo.
Most included studies involved female participants in the United States, Canada, and United Kingdom with anorexia and bulimia nervosa. Five analytical themes were generated: 1) "I wasn't letting go": Relapse as enticing; 2) "Bound to lose": Relapse as unstoppable; 3) "If the going gets tough I've always got this": Relapse as protective; 4) "Coming back with your tail between your legs": Relapse as destructive; 5) "So much of this journey … is learning": Relapse as instructive.
Findings highlight the gap between psychological and behavioral improvements that precede relapse, and the contrasting ways relapse is described and experienced. They support a focus on motivational factors and underlying psychological difficulties in treatment, extending beyond a behavioral focus. Further research is needed to understand relapse experiences among males and individuals from the global majority.
Individuals with EDs who relapsed described desiring or feeling powerless to control relapse. Findings suggest the need for greater emphasis on developing intrinsic motivation and self-efficacy in order to sustain recovery. Residual ED cognitions and unaddressed psychological vulnerabilities were implicated in relapse. Findings caution against premature discharge before sufficient cognitive and emotional progress has been made. In response to relapse, clinicians should aim to foster hope, compassion and tailor treatment to address the recovery needs revealed by relapse.
复发在饮食失调（EDs）中很常见；然而，它在定量研究中受到的关注要多得多。本系统综述旨在综合关于饮食失调患者复发经历的定性研究结果。
对报告定性数据的研究进行检索，这些数据包括饮食失调个体的复发经历。这包括对MEDLINE、CINAHL、PsycInfo、Scopus、SSCI和PQDT Global进行系统检索以及补充检索。共筛选了1594篇标题和摘要以及168篇全文以确定其是否符合要求。16项研究被纳入综述。使用CASP清单进行质量评估。从每篇论文中提取数据，并在NVivo中完成对研究结果/讨论中相关数据的主题综合。
大多数纳入研究涉及美国、加拿大和英国患有神经性厌食症和神经性贪食症的女性参与者。生成了五个分析主题：1）“我不想放手”：复发具有吸引力；2）“注定会失败”：复发不可阻挡；3）“如果情况变得艰难，我总会有这个”：复发具有保护作用；4）“夹着尾巴回来”：复发具有破坏性；5）“这段旅程的很多……是学习”：复发具有启发性。
研究结果凸显了复发前心理和行为改善之间的差距，以及描述和体验复发的不同方式。它们支持在治疗中关注动机因素和潜在的心理困难，而不仅仅局限于行为方面。需要进一步研究以了解男性和全球大多数人群的复发经历。
复发的饮食失调患者表示渴望控制复发或感到无力控制复发。研究结果表明需要更加强调培养内在动机和自我效能感以维持康复。残留的饮食失调认知和未解决的心理脆弱性与复发有关。研究结果告诫不要在取得足够的认知和情感进展之前过早出院。针对复发，临床医生应旨在培养希望、同情心，并根据复发所揭示的康复需求调整治疗。
