An Interpretative Phenomenological Analysis of Premature Treatment Termination Experienced by Service Providers with Lived or Living Experience of Anorexia Nervosa who have been Service Users

Background: Anorexia nervosa (AN) is a pervasive eating disorder that is associated with significant morbidity, mortality, and poor prognosis. Individuals with anorexia nervosa (IwAN) have high rates of treatment not being completed as planned – often referred to in literature as ‘premature treatment termination’ (PTT) – which has been found to significantly hinder AN prognosis. Studies have called for the elucidation of this phenomenon alongside the centring of voices of lived experience in AN research more broadly. The dualexperienced population of AN service providers with lived or living experience of AN who have been service users is under researched. This population’s personal experiences of PTT and the meaning that they give to them has yet to be explored. Aims: The present United Kingdom-based study aimed to explore experiences of PTT and the meaning given to them by individuals with dual experience of AN. Method: Interpretative Phenomenological Analysis (IPA) was applied to eight participant interview transcripts collected via individual semi-structured interviews to inform the development of group level experiential themes. Results: Four group experiential themes were identified: systemic barriers: becoming lost; the systemic feeding of anorexia; being hurt by the helpers; and the gifts of dual experience of anorexia. These findings suggest that PTT is a systemic phenomenon, contrasting with some existing literature suggesting that PTT is inherently self-initiated by IwAN. The present participants’ experiences of PTT left them feeling abandoned to their AN, lost in between treatment settings and within diagnostic margins, powerless and neglected around PTT events, feeling as though they were screaming and shouting to be heard, and lucky when receiving a good standard of care. Implications: The present study’s participants called for urgent systemic and cultural change within United Kingdom-based AN-treating systems with a view to reducing instances of PTT, better managing transition processes between- and out of- treatment settings, reducing professionals’ misunderstandings of AN, and improving AN prognoses.