A qualitative investigation into anorexia nervosa: The inner perspective

Figures & data

Table 1. Pro-codes used to evaluate patients’ letters

Pro-codes	Description
1. Identity	Used when patients describe themselves as totally represented by their illness; they describe themselves as a whole with AN. “I could not live without you (AN).”
2. Avoidance	For statements describing how the disorder can help patients to avoid some uncomfortable situations. “When I starve I feel allowed to avoid thinking about hurting stuff.”
3. Difference	Used to code feeling of being different from others, special or superior because of the disorder. For statements that describe the disorder as something patients are good at or which others cannot do as well. “You (AN) make me feel so special.”
4. Control	Used where the disorder appears to provide control or structure to patients’ life. “With you (AN) I know exactly what I am going to do and feel next.”
5. Denial	For statements that do not consider at all the illness; when patients deny their illness, living as if it never happened. “You (AN) are just a healthy way of living.”
6. Gratitude	Used when patients appear grateful to their disorder. “Thank you, AN.”
7. Irresponsivity	For statements describing the illness as able to ease patients from their responsibilities in life. “You (AN) are always there for me when I feel I cannot accomplish my goals.”
8. Communicate	Used when patients describe their subjective experience of expressing their emotions through their bodies and illnesses; when patients use their illness as communication channel. “Finally my parents got worried about my suffering.”
9. Company	For statements involving ideas of being looked after, kept safe, and protected. Used when patients describe the disorder as always there or supporting their life. “Nobody can protect me as you (AN) can do.”
10. Addiction/anxiolysis	For statements describing how AN can be useful to get relief from anxiety and how patients cannot think about not being ill. “When I starve I feel high and finally in peace.”

Table 2. Anti-codes used to evaluate patients’ letters

Anti-codes	Description
1. Anger/Hate	Used when patients express their anger towards their illness. “I hate you, AN.”
2. Health	Used to code current or future health problems (including bone and fertility problems) considered as a result from the disorder. “I know could not be able to have children one day because of you (AN).”
3. Emotion avoidance	For statements involving ideas of the disorder as silencing patients’ feelings and emotions (usually considered as pro). “You (AN) paralyzed my heart and my emotions.”
4. Devaluation	Used when patients describe themselves as devaluated by others/themselves because of their disorder. “Because of you (AN) I have been sometimes judges as a freak.”
5. Social impairment	Used for statement that describe how AN impaired patients’ social abilities and environment, leading to progressive isolation. “I scare people/Nobody wants me as a friend.”
6. Shame/take over	Used when patients feel ashamed or taken over by the disorder. Also used to code feeling of not being a person without the disorder. “I feel so ashamed.”
7. Fear/distress	Used when patients describe feelings of fear/distress/anxiety towards their illness; “I am afraid of you (AN)/You (AN) are my worst nightmare.”
8. Annihilation	Used for statements describing patients who think not to live their lives anymore because of the presence of AN. “I am nothing if I do not have you (AN).”
9. Betrayal/pretend	Used to highlight the aspects of feeling cheated by the disorder, of being aware of its false promises. “You (AN) made me only broken promises.”
10. Loss/waste	This code describes a feeling of life being wasted by the disorder and that the disorder has hampered the patient doing things. “I could not enjoy my holidays because of you (AN).”
11. Food obsession	For statements describing patients being tired of thinking about /being controlled by food all the time. “Thinking about food all the time is just exhausting.”
12. Others	Used where patient describes the disorders as worrying/hurting other people such as family members. “You made my parents feel desperate and completely overwhelmed.”
13. Emptiness	For statements describing how patients sometimes feel empty because of completely identified with their illness. “I feel nothing if you (AN) are not with me.”

Table 3. Clusters of pro-codes

	Need for excellence group		Safe-seeking group		Entrenched AN group		χ^2	p
	(N = 12)		(N = 10)		(N = 12)
	%	N	%	N	%	N
Identity	50	6	70	7	100	12	7.79	0.02
Avoidance	41.7	5	0	0	75	9	12.66	0.002
Difference	91.7	11	60	6	75	9	3.06	0.21
Control	41.7	5	0	0	58.3	7	8.45	0.01
Denial	66.7	8	0	0	16.7	2	13.12	0.001
Gratitude	8.3	1	20	2	83.3	10	16.28	0.001
Irresponsivity	58.3	7	50	5	66.7	8	0.62	0.73
Communicate	41.7	5	0	0	33.3	4	5.31	0.07
Company	33.3	4	100	10	83.3	10	13.12	0.001
Addiction/anxiolysis	41.7	5	40	4	41.7	5	0.008	0.99