Autonomy in Eating Disorder Treatment and Recovery (CINAHL).

Purpose: This study has two aims: the first is to develop a rich and nuanced understanding of autonomy informed by lived experience data from peer-reviewed studies in the Eating Disorder literature; the second is to examine how experiences of autonomy influence treatment and recovery. Background: Eating Disorders are of significant concern, affecting approximately 9% of the global population and have the highest mortality rate of any mental health disorder (Arcelus, Mitchell, Wales and Nielsen 2011). Even the most effective interventions fail to benefit a substantial number of people, with a projected trajectory of enduring disability in 20-30% of Eating Disorder cases internationally (Strand 2021: 19). On average, recovery from an Eating Disorder lasts from one to six years (Butterfly Foundation 2015: 16). Despite these concerning statistics, current understandings of autonomy are individualistic, with treatment practices exerting external control and influence, rather than supporting autonomy. Furthermore, the absence of trauma acknowledgment likely affects how people with lived experience of an Eating Disorder, and their treatment providers, negotiate treatment and recovery goals. Research Design: A rapid evidence assessment was conducted to answer the research question: How do we understand the autonomy of people with lived experience of an Eating Disorder, and what does this mean for their treatment and recovery?. A systematic search of five electronic databases, the International Journal of Eating Disorders, and topic-specific grey literature from 2000-2021 was undertaken. Twenty articles were deemed eligible for inclusion in the study. Interpretive phenomenological analysis was undertaken to inform the key findings and discussion. Findings and Discussion: The researcher identified four central themes: Self versus Eating Disorder, Self in Treatment, Self in Recovery, and Others in Relation to Self. These themes enabled rich re-conceptualisation of autonomy, identifying a recursive Lack of Autonomy Loop affecting many clients currently being treated for Eating Disorders, and under-researched aspects of autonomy including relational factors and the absence of trauma-informed approaches for (re) establishing autonomy. Conclusion: Research findings illuminate the shortcomings of current treatment models, provide options for alternate models, generate implications for social work practice and offer direction for future research and necessary policy change.