Gabriel Lubieniecki, Isabella McGrath, Gemma Sharp
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引用次数: 0
Abstract
Objective: An estimated 20 to 30% of individuals with eating disorders (EDs) experience protracted illness trajectories, often referred to as severe and enduring eating disorders (SEED). Research examining the systemic, relational, and experiential factors that influence access to and engagement with care in this population remains limited. This mixed-methods study aimed to explore the structural, clinical, and interpersonal barriers and facilitators shaping treatment experiences among individuals with longstanding EDs.
Method: An explanatory sequential mixed-methods design was employed with 41 participants. Stage One involved an online survey assessing demographic characteristics, diagnostic history, treatment exposure, and symptom severity, with descriptive statistics used to characterise the sample. Stage Two comprised of in-depth semi-structured interviews exploring lived experiences of treatment access and engagement. Qualitative data were analysed using reflexive thematic analysis informed by transcendental phenomenology.
Results: All participants reported an illness duration of seven years or more, with heterogeneity observed in diagnostic profiles, overall duration of illness, self-reported recovery stage, and treatment exposure. Two higher-order qualitative themes were identified; "Barriers to Care" included diagnostic and conceptual exclusion, weight-based bias, systemic access constraints, coercive practices, and misalignment between treatment models and patient needs. "Facilitators of Engagement and Recovery" comprised compassionate, individualised, and trauma-informed care, peer connection, and the integration of lived experience and advocacy.
Discussion: Individuals with SEED are a diverse population who report frequent exposure to structural, relational, and treatment-related barriers, while also identifying salient facilitators that support therapeutic engagement and recovery. Findings from this exploratory study suggest that more responsive, inclusive, and person-centred models of care may help address the complex needs of individuals with SEED. Trauma-informed and neurodiversity-affirming approaches, particularly those that integrate lived experience, may help mitigate the systemic and clinical barriers identified across both access and treatment contexts.
期刊介绍:
Journal of Eating Disorders is the first open access, peer-reviewed journal publishing leading research in the science and clinical practice of eating disorders. It disseminates research that provides answers to the important issues and key challenges in the field of eating disorders and to facilitate translation of evidence into practice.
The journal publishes research on all aspects of eating disorders namely their epidemiology, nature, determinants, neurobiology, prevention, treatment and outcomes. The scope includes, but is not limited to anorexia nervosa, bulimia nervosa, binge eating disorder and other eating disorders. Related areas such as important co-morbidities, obesity, body image, appetite, food and eating are also included. Articles about research methodology and assessment are welcomed where they advance the field of eating disorders.