Accommodation of Symptoms in Anorexia Nervosa: A Qualitative Study.

Anorexia nervosa (AN) continues to remain poorly understood within eating disorders. Recent research and theory have moved away from understanding its aetiological causes, addressing instead potential maintaining factors. This study is focused on interpersonal maintenance factors: the response of close others. Relatives of those with AN typically carry the main burden of care, and research has found high levels of carer distress and unmet needs. Recent theories have proposed this emotional impact to contribute to expressed emotion and other unhelpful caregiver interactions which inadvertently maintain AN. One such understudied response is accommodation, described as a 'process' whereby caregivers 'assist or participate' in symptomatic behaviours of the cared for individual. There is a dearth of research relating to accommodation within eating disorders, particularly qualitative accounts. This study utilized a grounded theory methodology to explore caregivers' responses to managing AN, focusing particularly on carers' experience of accommodation. Eight participants with experience of caring for an individual diagnosed with AN were interviewed. Participants were recruited from a national eating disorder charity and regional eating disorder service. A number of themes emerged, including the importance of caregivers' emotional resources in mediating accommodation responses. Low-perceived efficacy over AN contributed to caregiver burnout. Decreased emotional resources influenced a shift in caregiving aims conducive with accommodation. Nevertheless, carers perceived accommodation as counterproductive to recovery and consequently experienced internal conflict (cognitive dissonance). Dissonance was reduced using a number of cognitive and behavioural strategies. The implications of these findings are discussed with reference to existing literature. Copyright © 2016 John Wiley & Sons, Ltd.

KEY PRACTITIONER MESSAGE: Anorexia nervosa (AN) can be difficult to manage. Over time, carers can feel powerless, and their emotional resources diminish. Diminished resources led to a shift in caregiving aims and responses. Subsequently, carers accommodated AN-related behaviours. Carers recognized accommodation as counterproductive and experienced internal conflict (dissonance). This was reduced using a number of strategies. Skill-based interventions designed to empower carers to manage difficult AN behaviours are recommended. Motivational interviewing to develop discrepancies between caregiving aims and responses may promote a shift in the caregiving approach.