First do no harm: iatrogenic maintaining factors in anorexia nervosa

Area of Science:

• Clinical Psychology
• Psychiatry
• Healthcare Management

Background:

• Eating disorders, particularly anorexia nervosa (AN), are complex conditions influenced by various factors.
• The maintenance model of AN highlights interpersonal, cognitive, and emotional domains contributing to the disorder.
• Clinician interactions and service structures can inadvertently impact patient recovery.

Purpose of the Study:

• To examine the inadvertent role clinicians may play in perpetuating eating disordered behaviors.
• To analyze how clinical practices and service environments align with or counteract the maintenance model of AN.
• To identify strategies for preventing iatrogenic harm in eating disorder treatment.

Main Methods:

• Theoretical reflection based on Schmidt and Treasure's maintenance model of anorexia nervosa.
• Analysis of interpersonal factors, pro-AN beliefs, emotional style, and thinking style in clinical settings.
• Consideration of service provision, including inpatient and outpatient environments.

Main Results:

• Clinicians' high expressed emotion and coercive approaches can reinforce eating disorder behaviors.
• Overly protective or highly structured services may inadvertently foster dependence and avoidance.
• Negative schemas (e.g., low self-esteem, perfectionism) can be exacerbated within treatment settings.
• Iatrogenic harm can occur due to unreflective clinical practices and service design.

Conclusions:

• Clinicians must be aware of their potential to perpetuate eating disorders.
• Service provision requires careful planning, reflective practice, and supervision to mitigate iatrogenic effects.
• Addressing interpersonal dynamics and environmental factors is key to effective anorexia nervosa treatment.