4 - (SYM 132) I Just Wanted the Same Treatment as Everybody Else: Patients with Atypical Anorexia Reflect on Their Experiences in Higher Levels of Care

Background: Eating disorders (EDs) often require multiple interventions, including nutritional rehabilitation, psychotherapy, and at times, medical stabilization. Higher levels of care (HLOC) become essential when patients need medical stabilization or support in interrupting deeply engrained behaviors. Paradoxically, HLOC can have negative consequences, including decreases in patient autonomy and exposure to disordered peers; additionally, patients with marginalized identities may feel further ostracized. This study examined the experiences of patients with atypical anorexia (AAN) in HLOC.

Methods: Seventeen adult patients (Mean age= 32.4, SD=8.8; 88% cisgender women, 1 trans man, 1 nonbinary; 29% People of Color, 41% heterosexual, 35% low income) with AAN completed in-depth, semi-structured, arts-based interviews regarding treatment in HLOC for EDs. Interviews were audio-recorded, transcribed, de-identified, and validated. Interview transcripts and participant artwork were coded using Dedoose software, following thematic analysis methods to identify common themes.

Results: We identified six themes regarding AAN patients’ experiences of HLOC: 1) Difficulty with admission, 2) Inadequate nutritional care, 3) Unhelpful treatment interventions, milieu, and norms, 4) Non-affirming providers, 5) Providers encouraging disordered behaviors, and 6) Systemic issues of weight bias. Regarding admission, patients reported difficulties with insurance approvals, inaccurate diagnoses, and uncooperative outpatient providers. Regarding nutritional care, participants reported low meal plans and limited weight restoration. Regarding interventions, patients reported activities centering thin clients and fatphobia in milieus. Regarding providers, patients reported providers minimizing their EDs and encouraging disordered behaviors. Finally, regarding systemic issues, patients reported difficulty affording treatment and insurance coverage ending prematurely, resulting in readmissions.

Conclusion: These results suggest that weight stigma at the systemic (e.g., insurance and treatment center policies) and interpersonal levels (e.g., provider and peer interactions) may be negatively impacting AAN patient care. In addition to systemic change, patients with AAN may benefit from increased provider advocacy with insurance companies, strengthened nutritional rehabilitation and weight restoration, weight-inclusive care practices, and interventions that address weight stigma in HLOC milieus.