International Journal of Behavioral Sciences

International Journal of Behavioral Sciences

Challenges and Needs of Iranian Parents While Seeking Help for their Adolescent with Anorexia Nervosa: An Interpretative Phenomenological Analysis

Document Type : Original Article

Authors
Fatemeh Seifi 1
Javad Molazadeh 1
Abdulaziz Aflakseir 1
Changiz Rahimi Taghanaki 1
Susan Simpson 2
1 Department of Clinical Psychology, Shiraz University, Shiraz, Iran
2 1.NHS Forth Valley, Eating Disorders Service, Scotland, United Kingdom 2. Department of Justice and Society, University of South Australia, Adelaide, SA, Australia
10.30491/ijbs.2023.384714.1908
Abstract
Introduction: Early diagnosis and treatment are crucial for the recovery of adolescents with Anorexia Nervosa (AN), and parental involvement plays a pivotal role in early intervention. Therefore, the present study aimed to explore Iranian parents’ challenges before and after seeking out professional help for the treatment of their adolescent with AN and what they required during this process. 
Method: Through purposeful sampling, 15 parents of adolescents with AN from several cities of Iran participated in this qualitative study. Data was gathered through online in-depth semi-structured interviews in Google Meet platform between July 2022 and October 2022, and was analyzed using Interpretative Phenomenological Analysis.
Results: Overall, seven group experiential themes emerged from the interviews. The challenges included four main themes: lack of mental health literacy, misdiagnosis or delays in eating disorders recognition, lack of eating disorder specialists and centers, and parental burnout. In addition, the needs consisted of three main themes: familiarity with eating disorders, parent management training, emotional and societal support.
Conclusion: Iranian healthcare providers can consider the challenges and the needs of parents identified in this study to provide the best practice for the diagnosis and treatment of pediatric AN with minimum potential deficits.
Keywords
Adolescent
Anorexia Nervosa
Parents
Qualitative Research
  1. Peterson, K. and R. Fuller, Anorexia nervosa in adolescents: An overview. Nursing2021, 2019. 49(10): 24-30. 10.1097/01.NURSE.0000580640.43071.15
  2. Suarez-Albor, C.L., M. Galletta, and E.M. Gómez-Bustamante, Factors associated with eating disorders in adolescents: A systematic review. Acta Bio Medica: Atenei Parmensis, 2022. 93(3). 10.23750/abm.v93i3.13140
  3. Van Eeden, A.E., D. van Hoeken, and H.W. Hoek, Incidence, prevalence and mortality of anorexia nervosa and bulimia nervosa. Current opinion in psychiatry, 2021. 34(6): 515. 10.1097/YCO.0000000000000739
  4. Mohammadi, M.R., et al., Prevalence, correlates and comorbidities of feeding and eating disorders in a nationally representative sample of Iranian children and adolescents. International Journal of Eating Disorders, 2020. 53(3): 349-361. https://onlinelibrary.wiley.com/doi/abs/10.1002/eat.23197
  5. Sahlan, R.N., et al., Eating disorder symptoms among adolescent boys and girls in Iran. International Journal of Eating Disorders, 2021. 54(1): 19-23. https://onlinelibrary.wiley.com/doi/abs/10.1002/eat.23365
  6. Schaumberg, K., et al., The science behind the academy for eating disorders' nine truths about eating disorders. European Eating Disorders Review, 2017. 25(6): 432-450. https://doi.org/10.1002/erv.2553
  7. Nicula, M., et al., Help-seeking attitudes and behaviours among youth with eating disorders: a scoping review. Journal of Eating Disorders, 2022. 10(1): 21. https://doi.org/10.1186/s40337-022-00543-8
  8. Voswinkel, M.M., et al., Externalizing your eating disorder: a qualitative interview study. Journal of Eating Disorders, 2021. 9(1): 1-12. https://doi.org/10.1186/s40337-021-00486-6
  9. Clerc, E., et al. Therapeutic groups for parents of patients with anorexia nervosa: A systematic review of subjective experiences and state of current practices in France. in Annales Médico-psychologiques, revue psychiatrique. 2022. Elsevier. https://doi.org/10.1016/j.amp.2022.09.011
  10. Chew, K.K. and H.S. Temples, Adolescent Eating Disorders: Early Identification and Management in Primary Care. Journal of Pediatric Health Care, 2022. 36(6): 618-627. https://doi.org/10.1016/j.pedhc.2022.06.004
  11. Coelho, J.S., et al., Parental experiences with their child’s eating disorder treatment journey. Journal of Eating Disorders, 2021. 9: 1-14. https://doi.org/10.1186/s40337-021-00449-x
  12. Mitrofan, O., et al., Care experiences of young people with eating disorders and their parents: qualitative study. BJPsych open, 2019. 5(1): e6. https://doi.org/10.1192/bjo.2018.78
  13. Waller, G., N. Micali, and A. James, General Practitioners are poor at identifying the eating disorders. Advances in Eating Disorders: Theory, Research and Practice, 2014. 2(2): 146-157. https://doi.org/10.1080/21662630.2013.859437
  14. Treasure, J. and B.P. Nazar, Interventions for the carers of patients with eating disorders. Current Psychiatry Reports, 2016. 18: 1-7. https://doi.org/10.1007/s11920-015-0652-3
  15. Lock, J. and D. Le Grange, Treatment manual for anorexia nervosa: A family-based approach. 2015: Guilford publications. 1462523463
  16. Socholotiuk, K.D. and R.A. Young, Weight restoration in adolescent anorexia: parents’ goal-directed processes. Journal of Eating Disorders, 2022. 10(1): 190. https://doi.org/10.1186/s40337-022-00676-w
  17. Allan, E., et al., Parental expressed emotion during two forms of family‐based treatment for adolescent anorexia nervosa. European Eating Disorders Review, 2018. 26(1): 46-52. https://doi.org/10.1002/erv.2564
  18. Van Huysse, J.L., et al., Weight gain and parental self-efficacy in a family-based partial hospitalization program. Journal of Eating Disorders, 2022. 10(1): 116. https://doi.org/10.1186/s40337-022-00634-6
  19. Ansari, S., et al., Effectiveness of schema therapy in psychological distress, body image, and eating disorder beliefs in patients with anorexia nervosa. Avicenna Journal of Neuro Psycho Physiology, 2020. 7(3): 184-189. 10.32592/ajnpp.2020.7.3.107
  20. Babaee Heydarabadi, M., M. Ghamari, and S. Hossenian, The Effectiveness of Family Based Therapy on Body Image and Identity Styles of Female Adolescent with Anorexia Nervosa. Journal of Psychological Studies, 2022. 17(4): 33-55. https://doi.org/10.22051/psy.2022.36743.2476
  21. Garrusi, B. and M.R. Baneshi, Eating disorders and their associated risk factors among Iranian population–a community based study. Global Journal of Health Science, 2013. 5(1): 193. 10.5539/gjhs.v5n1p193
  22. Thomson, S., et al., Adolescents with a diagnosis of anorexia nervosa: Parents’ experience of recognition and deciding to seek help. Clinical child psychology and psychiatry, 2014. 19(1): 43-57. https://doi.org/10.1177/1359104512465741
  23. Williams, E.P., et al., “My whole world fell apart”: parents discovering their child has anorexia nervosa. Qualitative Health Research, 2020. 30(12): 1821-1832. https://doi.org/10.1177/1049732320939508
  24. Johns, G., et al., Current eating disorder healthcare services–the perspectives and experiences of individuals with eating disorders, their families and health professionals: systematic review and thematic synthesis. BJPsych open, 2019. 5(4): e59. https://doi.org/10.1192/bjo.2019.48
  25. Carpinelli, L., T. Marinaci, and G. Savarese. Caring for Daughters with Anorexia Nervosa: A Qualitative Study on Parents’ Representation of the Problem and Management of the Disorder. in Healthcare. 2022. MDPI. https://doi.org/10.3390/healthcare10071353
  26. Matthews, A., et al., Caregiver burden and illness perceptions in caregivers of medically hospitalized youth with anorexia nervosa. Eating Behaviors, 2018. 29: 14-18. https://doi.org/10.1016/j.eatbeh.2018.01.003
  27. van Hoeken, D. and H.W. Hoek, Review of the burden of eating disorders: mortality, disability, costs, quality of life, and family burden. Current Opinion in Psychiatry, 2020. 33(6): 521. https://doi.org/10.1097%2FYCO.0000000000000641
  28. Fukutomi, A., et al., First episode rapid early intervention for eating disorders: A two‐year follow‐up. Early Intervention in Psychiatry, 2020. 14(1): 137-141. https://doi.org/10.1111/eip.12881
  29. Marcon, T.D., et al., Parental involvement and child and adolescent eating disorders: perspectives from residents in psychiatry, pediatrics, and family medicine. Journal of the Canadian Academy of Child and Adolescent Psychiatry, 2017. 26(2): 78. J Can Acad Child Adolesc Psychiatry
  30. First, M.B., DSM-5 handbook of differential diagnosis. 2013: American Psychiatric Pub. 1585624624
  31. Smith, J.A. and I.E. Nizza, Essentials of interpretative phenomenological analysis. 2022: American Psychological Association. https://doi.org/10.1037/0000259-000
  32. Eatough, V. and J.A. Smith, Interpretative phenomenological analysis. The Sage handbook of qualitative research in psychology, 2017: p. 193-209. 9781526422866
  33. Larkin, M., P. Flowers, and J.A. Smith, Interpretative phenomenological analysis: Theory, method and research. Interpretative phenomenological analysis, 2021: 1-100. 5282221
  34. Creswell, J.W. and C.N. Poth, Qualitative inquiry and research design: Choosing among five approaches. 2016: Sage publications. 1506330193
  35. Jorm, A.F., Mental health literacy: empowering the community to take action for better mental health. American psychologist, 2012. 67(3): 231. https://doi.org/10.1037/a0025957
  36. Hornberger, L.L., et al., Identification and management of eating disorders in children and adolescents. Pediatrics, 2021. 147(1). https://doi.org/10.1542/peds.2020-040279
  37. Criscuolo, M., et al., How do families of adolescents with anorexia nervosa coordinate parenting? Journal of Child and Family Studies, 2020. 29(9): 2542-2551. https://doi.org/10.1007/s10826-020-01740-2
  38. Le Grange, D., et al., Enhanced cognitive-behavior therapy and family-based treatment for adolescents with an eating disorder: a non-randomized effectiveness trial. Psychological Medicine, 2022. 52(13): 2520-2530. https://doi.org/10.1017/S0033291720004407
  39. Rhind, C., et al., The objective and subjective caregiving burden and caregiving behaviours of parents of adolescents with anorexia nervosa. European Eating Disorders Review, 2016. 24(4): 310-319. https://doi.org/10.1002/erv.2442
  40. Eshkevari, E., et al., Group skills training for parents of adolescents with anorexia nervosa: a pilot evaluation. Clinical Psychologist, 2022. 26(3): 288-295. https://doi.org/10.1080/13284207.2022.2072196

 

 

International Journal of Behavioral Sciences
Volume 17, Issue 2
Summer 2023
Pages 82-88