title: Anorexia nervosa's meaning to patients: a qualitative synthesis.
abstract: BACKGROUND
  We carried out a qualitative synthesis of international literature to provide insight into the patient's experience as a means to help clinicians recognize symptoms of anorexia nervosa.
  
  
  METHODS
  International publications from 1990 to 2005 were searched for relevant qualitative investigations, and meta-ethnography was employed to identify common themes across studies. Databases included were PubMed, ISI, PsycINFO, EMBASE, LILACS and SciELO.
  
  
  RESULTS
  24 studies were included from a total of 3,415 papers. The second-order interpretation process using reciprocal translation allowed the identification of two concepts: (1) symptom identification (disease representation, self-concept, development of anorexia) and (2) disease interpretation (positive aspects, negative aspects, areas of life affected). Third-order constructs emerged revealing the disease as connected with identity and control.
  
  
  CONCLUSIONS
  Knowledge of patients' efforts to interpret the illness as a part of their own identity and sense of control have a key role in physician understanding of the disorder by allowing physicians to bring structure to the patients' lives generally and to their help-seeking behavior specifically. The study has some limitations. Most of the results come from B-grade studies (as classified by the Critical Appraisal Skills Programme) that used qualitative methodology, implying the need for caution in data interpretation. Moreover, study populations were almost exclusively female, and no comparison was attempted concerning the severity of the condition between studies.
authors.affiliation: Department of Psychiatry, Federal University of São Paulo/UNIFESP, São Paulo, Brazil. cybelepsi@bol.com.br
authors.forename: Cybele Ribeiro
authors.initials: CR
authors.lastname: Espíndola
authors.forename: Sergio Luís
authors.initials: SL
authors.lastname: Blay
mesh_terms: D000339:Affect; D000856:Anorexia Nervosa / Q000175:diagnosis / Q000523:psychology*; D001294:Attitude to Health; D039721:Diagnostic and Statistical Manual of Mental Disorders; D006801:Humans; D007398:Interpersonal Relations; D010353:Patient Education as Topic; D012649:Self Concept