Seeing Beyond the Eating Disorder: The Complexities of Eating Disorder Care in New Brunswick, Canada
AUTHORS
Tanya Wilson, Senior Health Consultant, Government of New Brunswick, Canada
Kathryn Weaver, Professor, Faculty of Nursing, University of New Brunswick, Canada
ABSTRACT
Health professionals struggle in caring for individuals with eating disorders, especially in New Brunswick, Canada where there is no recognized eating disorder treatment center. Using a narrative approach, this study explored the perceptions and experiences of professionals from seven regulated health professions that are most commonly involved in eating disorder care - medicine, dentistry, nursing, social work, occupational therapy, dietetics, and psychology. The findings bring to light the complexities of eating disorder care and the process that professionals go through in seeing beyond the eating disorder to understanding the often subtle subtexts that impede eating disorder identification and treatment. Looking at eating disorder care from an interprofessional perspective provides unique insight into common needs and challenges of practitioners and may ultimately inform treatment and prevention initiatives.
KEYWORDS
Eating disorder, Health professional, Narrative analysis, Interdisciplinary perspective
REFERENCES
[1] J. Arcelus, A.J. Mitchell, J. Wales, and S. Nielsen, “Mortality rates in patients with anorexia nervosa and other eating disorders: A meta-analysis of 36 studies,” Arch Gen Psychiatry, vol.68, no.7, pp.724-731, (2011)
[2] American Psychiatric Association, “Feeding and eating disorders,” Diagnostic and statistical manual of mental disorders, Washington, DC: Author 5th ed., pp.329-354, (2013)
[3] M. Nagl, C. Jacobi, M. Paul, K. Beesdo-Baum, M. Höfler, R. Lieb, and H.-U. Wittchen, “Prevalence, incidence, and natural course of anorexia and bulimia nervosa among adolescents and young adults,” Eur Child Adolesc Psychiatry, vol.25, no.8, pp.903-918, (2016)
[4] Canada Parliament House of Commons. “Eating disorders among girls and women in Canada / Hélène LeBlanc, Chair.” Report of the Standing Committee on the Status of Women, Fourth report, 41st Parliament, 2nd session Ottawa, Ontario: House of Commons, (2014)
[5] C. Laird Birmingham and J. Treasure, “Medical management of eating disorders,” Cambridge, New York: Cambridge University Press, (2010)
[6] M. I. Lapid, M. C. Prom, M. C. Burton, D. E. McAlpine, B. Sutor, and T. A. Rummans, “Eating disorders in the elderly,” Int Psychogeriatr, vol.22, no.4, pp.523-536, (2010)
[7] K. A. Langlois, A. V. Samokhvalov, J. Rehm, S. T. Spence, and S. Connor Gorber, “Health state descriptions for Canadians: mental illness,” Ottawa, ON: Statistics Canada, (2012)
[8] G. Raveneau, R. Feinstein, L. M. Rosen, and M. Fisher, “Attitudes and knowledge levels of nurses and residents caring for adolescents with an eating disorder,” IJAMH, vol.26, no.1, pp.131-136, (2014)
[9] S. A. Trent, M. E. Moreira, C. B. Colwell, and P. S. Mehler, “ED management of patients with eating disorders,” Am J Emerg Med., vol.31, no.5, pp.859-865, (2013)
[10] K. M. Frimenko, C. A. Murdoch-Kinch, and M. R. Inglehart, “Educating dental students about eating disorders: Perceptions and practice of interprofessional care,” J Dent Educ., vol.81, no.11, pp.1327-1337, (2017)
[11] R. D. DeBate, L. A. Tedesco, and W. Kerschbaum, “Knowledge of oral and physical manifestations of anorexia and bulimia nervosa among dentists and dental hygienists,” J Dent Educ, vol.69, no.3, pp.346-354, (2005)
[12] R. D. DeBate, S. B. Plichta, L. A. Tedesco, and W. Kerschbaum, “Integration of oral health care and mental health services: Dental hygienists’ readiness and capacity for secondary prevention of eating disorders,” J Behav Health Ser R., vol.33, no.1, pp.113-125, (2006)
[13] E. Kloczko, and M. N. Ikiugu, “The role of occupational therapy in the treatment of adolescents with eating disorders as perceived by mental health therapists,” Occup Ther Ment Health, vol.22, no.1, pp.63-83, (2006)
[14] M. Clark, and S. Nayar, “Recovery from eating disorders: A role for occupational therapy,” NZJOT, vol.59, no.1, pp.13-17, (2012)
[15] D. Boughtwood, and C. Halse, “Other than obedient: Girls’ constructions of doctors and treatment regimens for anorexia nervosa,” J Community Appl Soc, vol.20, no.2, pp.83-94, (2010)
[16] N. Davies, “The role of the nurse in eating disorder recovery,” Independent Nurse., March, (2017)
[17] R. Bakker, B. van Meijel, L. Beukers, J. van Ommen, E. Meerwijk, and A. van Elburg, “Recovery of normal body weight in adolescents with anorexia nervosa: The nurses' perspective on effective interventions,” J Child Adolesc Psychiatr Nurs, vol.24, no.1, pp.16-22, (2011)
[18] J. Carroll, “Eating disorders: A resource for practitioners providing community based care,” Provincial Eating Disorder Prevention and Recovery Program (PEDPRP) Women’s Health Clinic, Winnipeg, MB, (2014)
[19] S. Hart, J. Russell, and S. Abraham, “Nutrition and dietetic practice in eating disorder management,” J Hum Nutr Diet., vol.24, no.2, pp.144-153, (2011)
[20] A. M. Mittnacht, and C. M. Bulik, “Best nutrition counseling practices for the treatment of anorexia nervosa: A Delphi study,” Int J Eat Disorder, vol.48, no.1, pp.111-122, (2015)
[21] A. Cockfield, and U. Philpot, “Managing anorexia from a dietitian’s perspective,” Proc Nutr Soc, vol.68, no.3, pp.281-288, (2009)
[22] R. D. Rienecke, “Family-based treatment of eating disorders in adolescents: current insights,” Adolesc Health Med Ther., 8, pp.69-79, (2017)
[23] [23] S. Bond, “Couple and family therapy: The evolution of the profession with social work at its core,” OTSTCFQ 131, hiver, pp.128-138, (2009)
[24] E. Martinez, “Attitudes and perspectives of social work students on binge eating disorder treatments for adult females,” California State University, San Bernardino, Electronic Theses, Projects, and Dissertations, (2017)
[25] V. W. Gurney, and K. A. Halmi, “An eating disorder curriculum for primary care providers,” Int J Eat Disorder, vol.30, no.2, pp.209-212, (2001)
[26] H. Green, O. Johnston, S. Cabrini, G. Fornai, and T. Kendrick, “General practitioner attitudes towards referral of eating-disordered patients: A vignette study based on the theory of planned behavior,” Ment Health Fam Med, vol.5, no.4, pp.213-218, (2008)
[27] F. McNicholas, C. O’Connor, L. A. O’Hara, and N. McNamara, “Stigma and treatment of eating disorders in Ireland: Healthcare professionals’ knowledge and attitudes,” Ir J Psychol Med, vol.33, no.1, pp.21-31, (2016)
[28] D. A. Banas, R. Redfern, S. Wanjiku, R. Lazebnik, and E. S. Rome, “Eating disorder training and attitudes among primary care residents,” Clin Pediatr, vol.52, no.4, pp.355-361, (2013)
[29] A. Bannatyne, and P. Stapleton, “Educating medical students about anorexia nervosa: A potential method for reducing the volitional stigma associated with the disorder,” Eat Disord., vol.23, pp.115-133, (2015)
[30] L. Girz, A. Lafrance Robinson, and C. Tessier, “Is the next generation of physicians adequately prepared to diagnose and treat eating disorders in children and adolescents?” Eat Disord., vol.22, no.5, pp.375-385, (2014)
[31] A. Lafrance Robinson, A. Boachie, and G. A. Lafrance, “'I want help!': Psychologists’ and physicians’ competence, barriers, and needs in the management of eating disorders in children and adolescents in Canada,” Can Psychol, vol.54, no.3, pp.160-165, (2013)
[32] D. Linville, T. Brown, and M. O'Neil, “Medical providers’ self perceived knowledge and skills for working with eating disorders: A national survey,” Eat Disord., vol.20, no.1, pp.1-13, (2012)
[33] W. Jones, S. Saeidi, and J. Morgan, “Knowledge and attitudes of psychiatrists towards eating disorders,” Eur Eat Disord Rev, vol.21, pp.84-88, (2013)
[34] L. Currin, G. Waller, and U. Schmidt, “Primary care physicians' knowledge of and attitudes toward the eating disorders: Do they affect clinical actions?” Int J Eat Disord, vol.42, no.5, pp.453-458, (2009)
[35] T. Brockmeyer, H. Friederich, and U. Schmidt, “Advances in the treatment of anorexia nervosa: A review of established and emerging interventions,” Psychol. Med., vol.48, no.8, pp.1228-1256, (2018)
[36] A. E. Kazdin, E. E. Fitzsimmons-Craft, and D. E. Wilfley, “Addressing critical gaps in the treatment of eating disorders,” Int J Eat Disord., vol.50, no.3, 170-189, (2017)
[37] Canadian Psychology Association, “Psychology works,” fact sheet: Eating Disorders, (2015)
[38] K. Weaver, “An exploration of the role of social support in health promotion for eating disorders,” Virginia Henderson Global Repository, Sigma Theta Tau International Nursing Honor Society, (2013)
[39] M. Weber, and K. Davis, “Food for thought: Enabling and constraining factors for effective rural eating disorder service delivery,” Aust J Rural Health, vol.20, pp.208-212, (2012)
[40] J. H. Rosenvinge, and G. Pettersen, “Do interprofessional educational programs on eating disorders provide proximal and distal benefits? Findings from a national cohort collected from 1998 to 2010,” J Res Interprof Pract Educ, vol.6, no.1, (2016)
[41] World Health Organization, “World health report: Framework for action on interprofessional education and collaborative practice,” Geneva, Switzerland: WHO, (2010)
[42] M. A. Craven, and R. Bland, “Better practices in collaborative mental health care: An analysis of the evidence base,” Can J Psychiatry, vol.51(Suppl. 1), pp.1S-72S, (2006)
[43] O. Heath, D. English, J. Simms, P. Ward, A. Hollett, and A. Dominic, “Improving collaborative care in managing eating disorders: A pilot study,” J Contin Educ Health Prof, vol.33, no.4, pp.235-243, (2013)
[44] H. Thompson-Brenner, D. A. Satir, D. L. Franko, and D. B. Herzog, “Clinician reactions to patients with eating disorders: A review of the literature,” Psychiatr Serv., vol.63, no.1, pp.73-78, (2012)
[45] A. C. Ciao, K. Loth, and D. Neumark-Sztainer, “Preventing eating disorder pathology: Common and unique features of successful eating disorders prevention programs,” Curr Psychiatry Rep., vol.16, no.7, pp.453, (2014);
[46] M. Strober, and C. Johnson, “The need for complex ideas in anorexia nervosa: Why biology, environment, and psyche all matter, why therapists make mistakes, and why clinical benchmarks are needed for managing weight correction,” Int J Eat Disord, vol.45, no.2, pp.155-178, (2012)
[47] K. Weaver, “Loving her into well-being one day at a time: Narratives of caring for daughters with eating disorders,” OJN. 2, pp.406-419, (2012)
[48] M. Levine and L. Smolak, “Toward a model of the developmental psychopathology of eating disorders: The example of early adolescence,” In: J.H. Crowter, S.E. Hobfol, M.A. Stephens,and D.L. Tennenbaum (eds), The Etiology of Bulimia Nervosa: The Individual and Familial Context, pp.59-80, Washington: Taylor and Francis, (2013)
[49] M. J. Zabala, P. Macdonald, and J. Treasure, “Appraisal of caregiving burden, expressed emotion and psychological distress in families of people with eating disorders: A systematic review,” Eur Eat Disord Rev, vol.17, pp.338-349, (2009)
[50] E. Hughes, D. Le Grange, A. Court, M. Yeo, S. Campbell, M. Whitelaw, L. Atkins, and S. Sawyer, “Implementation of family-based treatment for adolescents with anorexia nervosa,” J Pediatr Health Care, vol.28, no.4, pp.322-330, (2014)
[51] Yager, J., “Eating disorders: Overview of prevention and treatment,” https://www.uptodate.com/contents-/eating-disorders-overview-of-prevention-and-treatment, (2019)
[52] G. Dimitropoulos, A.F. Tran, P. Agarwal, B. Sheffield, and B. Woodside, “Challenges in making the transition between pediatric and adult eating disorder programs: A qualitative study from the perspective of service providers,” Eat Disord, vol.21, pp.1-15, (2013)
[53] Statistics Canada, Census Profile, 2016, Parish, New Brunswick and New Brunswick Province, (2016)
[54] C. Esin, M. Fathi, and C. Squire, “Narrative analysis: the constructionist approach,” In U. Flick, The SAGE handbook of qualitative data analysis, pp.203-216, London: SAGE, (2014)
[55] M. Tebogo, “Applicability of constructivist theory in qualitative educational research,” Am Int J Contemp Res, vol.4, no.7, pp.51-59, (2014)
[56] M. Connelly, and D.J. Clandinin, “Stories of experience and narrative inquiry,” ER, vol.19, no.5, pp.2-14, (1990)
[57] S. Chase, “Narrative inquiry: Multiple lenses, approaches, voices,” In N. Denzin, and Y. Lincoln, (Eds.), The Sage Handbook of Qualitative Research (3rd ed.) Thousand Oaks, CA: Sage, (2005)
[58] C. Emden, “Conducting a narrative analysis, collegian,” vol.5, no.3, pp.34-39, (1998)
[59] W. Austin, V. Bergum, and L. Goldberg, “Unable to answer the call of our patients: mental health nurses experience of moral distress,” Nurs. Inq., vol.10, no.3, pp.177-183, (2003)
[60] M. Weinberg and Moral distress, “A missing but relevant concept for ethics in social work,” CSWR, vol.26, no.2, pp.139-151, (2009)
[61] W. Austin, M. Rankel, L. Kagan, V. Bergum, and G. Lemermeyer, “To stay or to go, to speak or to stay silent, to act or not to act: Moral distress as experienced by psychologists,” Ethics & Behavior, vol.15, no.3, pp.197-212, (2005)
[62] W. Austin, “Moral distress and the contemporary plight of health professionals,” HEC Forum, vol.24, pp.27-38, (2012)