背景:严重和持久的神经性厌食症(SE-AN),是一种严重而持久的疾病,尽管“最先进的治疗”。理论上已经提出了标准,但没有经过测试,并且可能无法充分捕捉到疾病的复杂性,这可能会抑制治疗改进。对于一些经历SE-AN(20分之一)的人来说,死亡的临床现实是一种结果,并扩大了自愿辅助死亡的机会,进一步复杂的领域,关于更基本的概念,如nosology,治疗,SE-AN的恢复定义和替代概念化。本文就是对此的回应,旨在建立在定性文献的基础上,以增强对致命SE-AN的现象学理解。
方法:一本出版的书,作为一位32岁的专业艺术家的遗产,丰富了与AN一起生活的生活,连续治疗18年。通过解释性现象学分析(IPA)翻译了通过艺术家的文字和视觉艺术的语言之间的相互关系的多义性叙事,提供对SE-AN体验的丰富见解。
结果:分析过程引发了三个上级主题(1)自我消失(2)辩证困境(3)死亡和死亡:寻找意义。两个贯穿这些主题的交叉主题:(a)颜色和(b)改变希望,其中前者通过\'SE-AN万花筒\'产生了可视化表示。这些主题共同产生了SE-AN的概念,扎根于数据中,并通过艺术家的绘画在视觉上描绘。
结论:分析中揭示的SE-AN图片扩展到SE-AN的概念化,强调迄今为止正在探索的关键进程。这些因素与疾病的持久性有关,这引发了进一步研究测试的机会,包括诊断考虑和治疗方向。在SE-AN,扭曲的身体形象延伸到自我感知的全局扭曲。提出了与(1)自我和身份过程有关的严重和持久疾病阶段的其他标准(2)跨生命领域的“全球贫困”措施,以供将来对SE-AN的假定定义特征进行测试时考虑。
神经性厌食症(AN)是一种严重且危及生命的疾病。有必要更多地了解为什么AN会持续对某些人变得严重和持久(SE-AN)。建立对疾病的理解的一种方法是通过经历它的人的故事。这项研究利用一个人独特的艺术语言来做到这一点。这有可能产生新的想法,尤其是那些对某些人来说可能无法言喻的人,因此为了研究和治疗目的而对SE-AN进行了分类。本研究中的艺术家贡献了一个独特的视角,为潜在的研究提供了新的领域,例如被充分研究的复杂心理过程,例如羞耻,解离,“自我”,情感素养,和厌食症作为一种身份。此外,提出了在对AN的长期病例进行评估和分类时要考虑的其他因素,以及对AN持久性的另一种理解。超越了“身体形象紊乱”的概念。指出了替代治疗方法,例如艺术疗法。
BACKGROUND: Severe and enduring anorexia nervosa (SE-AN), is a serious and persistent illness, despite \'state of the art\' treatment. Criteria have been theoretically proposed, but not tested, and may not adequately capture illness complexity, which potentially inhibits treatment refinements. The clinical reality of death as an outcome for some people who experience SE-AN (1 in 20) and broadening access to voluntary assisted dying, further complicates the field, which is undeveloped regarding more fundamental concepts such as nosology, treatment, recovery definitions and alternative conceptualisations of SE-AN. The present paper is in response to this and aims to build upon qualitative literature to enhance phenomenological understandings of fatal SE-AN.
METHODS: A published book, being the legacy of a 32-year-old professional artist offers a rich account of a life lived with AN, for 18 years with continuous treatment. A polysemous narrative via the interrelationship between the languages of the artist\'s words and visual art is translated via interpretative phenomenological analysis (IPA), offering rich insight into the SE-AN experience.
RESULTS: The process of analysis induced three superordinate themes (1) Disappearing Self (2) Dialectical Dilemma (3) Death and Dying: Finding Meaning. Two cross cutting themes traversed these themes: (a) Colour and (b) Shifting Hope, where the former produced a visual representation via the \'SE-AN Kaleidoscope\'. Collectively the themes produce a concept of SE-AN, grounded in the data and depicted visually through the artist\'s paintings.
CONCLUSIONS: The picture of SE-AN revealed in the analysis extends upon conceptualisations of SE-AN, highlighting key processes which are thus far under explored. These factors are implicated in illness persistence eliciting opportunities for further research testing including diagnostic considerations and treatment directions. In SE-AN, distorted body image extends to a global distortion in the perception of self. Additional criteria for the severe and enduring stages of illness related to (1) self and identity processes (2) measures of \'global impoverishment\' across life domains are proposed for consideration in the future testing of putative defining features of SE-AN.
Anorexia Nervosa (AN) is a serious and life-threatening illness. There is a need to understand more about why AN persists in becoming severe and enduring (SE-AN) for some people. One such way to build understanding of a condition is via the stories of those who experience it. This study utilizes a person’s unique artistic language to do so. This has the potential to generate new ideas about a condition, especially those that may be beyond words for some people and therefore progress classifications for SE-AN for research and treatment purposes. The artist in this study contributes a unique perspective offering new areas for potential research such as understudied complex psychological processes for example shame, dissociation, ‘self’, emotional literacy, and anorexia as an identity. Additionally, other factors to be considered in the assessment and classifications of long-term cases of AN as well as an alternative understanding of AN persistence is proposed, beyond the concept of ‘body image disturbance’. Alternative treatment approaches such as art therapy are indicated.