Severe Anorexia Nervosa Personal Recovery (ANAPR)

February 11, 2019 updated by: Institut Mutualiste Montsouris

Personal Recovery of Young Adults With Severe Anorexia Nervosa During Adolescence: a Pilot Qualitative Study

A growing qualitative literature about personal recovery process in mental disorders emerges. However in Anorexia Nervosa (AN), it remains few understood, especially in severe AN during adolescence.

This pilot study seeks to enhance understanding of recovery from AN in France and support the dissemination of the PR paradigm among the French mental health community working with AN, as a complement to the medical approach.

A qualitative research according to Interpretative Phenomenological Analysis (IPA) method was conducted .Five young women hospitalized ten years before for a severe AN during their adolescence were interviewed with a semi-structured face-to-face interview on recovery process.

Study Overview

Status

Completed

Conditions

Intervention / Treatment

Detailed Description

Anorexia Nervosa (AN) is one of the most severe mental disorders with a mortality and high risk of developing chronicity. Lifetime prevalence is evaluated among women between 1.2% and 2.2%, with the higher incidence during adolescence. Recovery process remains poorly understood.

In scientific literature, recovery process of mental disorders can be seen in two different ways: the medical and the personal recovery (PR). The medical recovery is based on objective criteria, including cure (symptom disappearance), remission (symptom suspension) or therapeutic response (change of values after treatment). This medical recovery is generally studied in quantitative outcome studies. The experiential or PR is based on first person qualitative research or consensus methods, starting from patients' struggle for regaining place in their own recovery. It has become the paradigm orientation of mental health policy in anglophone countries.

A recent systematic review summeries relapse, remission or recovery criteria used in a AN outcome studies in 1-weigh measurement only; 2-symptoms reported only; 3-on both. In addition to weigh, other criteria are noticed: menstruations, psychological and behavioral features, disparities of time remission/recovery.

However, despite numerous quantitative studies, reasons for recovery, relapse or following struggle steal unclear. Medical framework is sometimes considered as reductive Moreover, those researches usually focus on risk factors, hiding protector's factors that are central for supporting recovery. Furthermore, symptom improvement is not always priority of patients(9), while improvement might happen despite symptoms persistence. Discrepancies are described in the negotiated link clinicians-patients: patient might wait for more singular and subjective approach whereas clinicians would be more invested in objective and rigorous features.

A recent systematic review offers a theorical framework to study PR in mental disorders. It is defines as an active, individual, unique, non-linearn, multidimensional and gradual process. It can be described as phase or stage, as struggle, as a life-changing experience or even as a trial or error process. It may be structured by a turning point, after when there are no turning back. It is aided by supporting and healing environment, and might occur without cure. Starting from first person narratives of mental disorders recovery, five factors supporting recovery are described: connectedness, hope and optimism about the future, identity, meaning in life, empowerment. One meta-ethnography review was published on qualitative research about PR in AN, concerning 8 studies. It provides elements on process of change, factors supporting PR and notion of empowerment and self-reconciliation.

Finally, most of PR studies come from USA, UK, Australia and Canada. Further research are needed to ground PR including cultural context. In France, AN PR has been rarely studied. These study tries to enhance understanding AN recovery in French context, to support implementation of PR paradigm among French mental health AN community; complementary to medical approach.

Study questions are: how people who suffered of severe AN and experienced hospitalization during adolescence feel and make sense to their recovery?

METHODS This study is a qualitative research with IPA, supplemented by quotation of ICD 10 criteria. We reported COREQ 32 guidelines.

Setting and participants IPA recommends homogeneous and short sampling so as to better appreciate convergences and divergences of phenomena. To maximize homogenization, very precise criteria (presented in box 1) were first chosen in order to focus on studied phenomena with in-depth way, before opening to wider study on AN recovery. Recruitment was restrained to the same hospital (Institut Mutualiste Montsouris) at the same year of hospitalization, so as to homogenize experience of care. Period of 10 years was chosen for being widely beyond largest literature mean criteria of medical recovery fixed at seven years, to get some distance with recovery process.

Study Type

Observational

Enrollment (Actual)

5

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

  • France
      • Paris, France, 75014
        • Institut Mutualiste Montsouris

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

20 years to 30 years (Adult)

Accepts Healthy Volunteers

No

Genders Eligible for Study

Female

Sampling Method

Non-Probability Sample

Study Population

Young people who suffered of severe AN and experienced hospitalization during adolescence feels recovered

Description

Inclusion Criteria:

  • woman
  • Adult between 20 and 30 years old
  • With history of restrictive AN (CIM 10: F50)
  • Without no other comorbidity
  • Hospitalized for AN during adolescence (10-19 years old) ten years ago, in adolescent psychiatry at Institute Mutualiste Montsouris (France)
  • Native French speaker
  • Considers herself recovered
  • Agreement

Exclusion Criteria:

  • Presence of AN criteria (ICD-10: F50) during research interview,
  • Absence of all recovery qualitative criteria after qualitative analysis

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Observational Models: Cohort
  • Time Perspectives: Retrospective

Cohorts and Interventions

Group / Cohort
Intervention / Treatment
Young adult with severe anorexia
Young adult with severe Anorexia hospitalized during adolescence at Institut Mutualiste Montsouris
Other: Semi structured face to face interview
Face-to-face semi-structured interview conducted in the hospital, where young adults were hospitalized 10 years before, in a quiet and isolated office. The topic guide was built according to literature review, without further change after pilot test. Interviews where audio-recorded and transcribed

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Recovery process of AN
Time Frame: Semi structured face to face interview, 10 years after hospitalization for AN.

Initial interview topic guide domain

  1. How have you spent your life for the first hospitalization for AN?
  2. What are the factors that help or prevent from going ahead?
  3. All this way long, how did feel talking about yourself?
  4. How did evolve your relationships?
  5. How have you felt your body all this way long?
  6. How do you define recovery of AN during adolescence?
  7. How would you define yourself?
  8. What kind of stories do you tell yourself about AN?
  9. If you would be faced with someone with current AN, what would you advice him/her?
Semi structured face to face interview, 10 years after hospitalization for AN.

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Institut Mutualiste Montsouris

Investigators

  • Principal Investigator: Marie-Aude PIOT, Institut Mutualiste Montsouris

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

June 20, 2014

Primary Completion (Actual)

July 5, 2014

Study Completion (Actual)

July 5, 2014

Study Registration Dates

First Submitted

October 15, 2018

First Submitted That Met QC Criteria

October 18, 2018

First Posted (Actual)

October 19, 2018

Study Record Updates

Last Update Posted (Actual)

February 15, 2019

Last Update Submitted That Met QC Criteria

February 11, 2019

Last Verified

February 1, 2019

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • PSY-2014-04

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

No

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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