Inclusion Criteria
The study included 19 adolescents aged between 12 and 17 years old who had been diagnosed by their consultant psychiatrist as having primary anorexia nervosa. Although boys do get AN and are sometimes admitted for in-patient treatment, it is still a rare occurrence (there was only one male on one of the units and none on the other during the
course of the study). Thus for the purposes of this study only female adolescents with AN were included.
All participants had to be current in-patients on one of the two adolescent eating disorder units from which participants were recruited. However, one participant was interviewed twelve days after she was discharged as she and her family had decided that they wished to celebrate immediately following her discharge meeting, which was the original time of our interview. One other participant was classified as a ‘day patient’ which meant that she lived close enough to the unit to sleep at home. This was all that she did at home, as she ate every meal on the unit, arriving at 7.45 a.m. and going home at 8.00 p.m., an hour after the end of dinner and her treatment regime was exactly the same as the other patients on this unit. She was therefore included in the study.
Recruitment Procedures
Participants at the two units were approached differently due to differences in existing research procedures at the units. Unit 2 carried out much research and so had research assistants whose job it was to recruit participants for any research done at the unit. In contrast. Unit 1 did little research, and so I recruited all of the participants from Unit 1. For both units, however, consent was obtained from the participants before parents were contacted. This was due to the ethical reasons mentioned above, and to minimise potential confusion that could be caused by parents giving consent, but their children not wishing to be interviewed.
Chapter Two ~ Method
Unit 1: Having initially spoken to the consultant psychiatrist and clinical nurse specialist
about the project, I visited the unit to attend a meeting with the patients. The meeting had been set up by the clinical nurse specialist for my visit, as she advised that the patients had formed a cohesive group and would therefore be best approached as a group. At the meeting with the patients I explained the study, answered any questions that were raised, gave potential participants information sheets (see Appendix 2) and discussed each point in the information sheet. Participants were assured of the confidentiality of the interviews and of their anonymity. Consent (see Appendix 2 for consent form) was obtained from five patients who were, at that time, willing to be interviewed. The information sheet contained my telephone number, and participants were told that they could contact me at any time. After this initial meeting further recruitment was done on an individual basis whenever I was at the unit interviewing participants.
Having obtained consent from participants, I then obtained the contact details of the parents of the patients who had agreed to participate, from the medical or nursing notes. All participants were informed that their parents would be contacted and their consent obtained prior to the interview, and all were agreeable. A letter explaining the study, a parent information sheet and a parental consent form (see Appendix 2) was then sent to parents, along with a stamped addressed envelope in which they could return the consent form. Both the letter and the information sheet contained my telephone number so that parents were able to ask any questions that they might have. If parents returned the consent form within one week they were not contacted by telephone. If they had not contacted me, or returned the consent form within one week, then they were contacted to
enquire whether they had received the study information and whether they had any questions.
Unit 2: As mentioned above, Unit 2 had research assistants who knew patients well and
who therefore discussed the research with them and obtained their consent. This was done on an individual basis and in close collaboration with me. Again, once participants’ consent had been obtained parents were contacted in the same way as with Unit 1.
Characteristics o f the Sample
Nineteen female patients with AN agreed to participate in the study. In Unit 1, eighteen patients were approached, ten agreed to participate and eight declined. It is not known how many patients in Unit 2 declined to participate because the initial recruitment, as described above, was conducted by the unit’s research assistants. The age range of the sample was 12 to 17 years, with a mean age of 15.4 years. Only two participants, however were younger than 14. Seventeen participants (89%) were white British, 1 (5%) was white Irish and 1 (5%) was British but of Afro-Caribbean origin. The mean illness duration was 23 months (SD 12.4 months) from the onset of anorexia, with a range of 10 to 60 months. Only one patient’s anorexia had lasted for more than 36 months; excluding her, the mean illness duration was 21 months (SD 8.9 months). One (5%) participant was under a section and the rest (95%) were informal patients. 4 (21%) participants had had no previous admissions, 6 (32%) had had one admission to a paediatric ward of a general hospital, 7 (37%) had had more than one previous admission to an eating disorder, or
Chapter Two ~ Method
paediatric unit. Participants had a range of other problems including co-morbid depression, obsessive compulsive symptoms, deliberate self-harm and suicidal ideation. 8 (42%) were taking anti-depressant medication, 2 of whom (10.5%) were also taking other psychotropic medications. Additional data on participants’ perceptions of the ward atmosphere and participants’ stages of change will be presented in the results chapter.