title: The Experience of Caring For or Living with an Individual with an Eating Disorder: A Meta-Synthesis of Qualitative Studies.
abstract: Eating disorders (ED) has the highest mortality rate of psychiatric disorders and a high incidence of comorbidity. Because of the average age of onset, care typically befalls family members. However, despite the severity of the disorder and the burden placed on the family, research into the caregiving experience is still developing. Studies have shown caregivers of individuals with ED to experience high levels of distress, burden and expressed emotion. Recent theoretical models have underscored the importance of caregivers' responses as a maintenance factor for the ED, and family therapy has proved efficacious. However, the literature pertaining to the experience of family members living with or caring for an individual with an ED has not been systematically reviewed. This review aimed to synthesize qualitative studies relating to the caring experience and its impact, thereby gaining an understanding from the perspective of the individuals themselves. Relevant search terms were utilized to systematically search key databases. Twenty studies, with a total sample of 239 participants, met the inclusion criteria. Nine core themes emerged from the synthesis, forming the basis of an explanatory theory. The ED was found to have a pervasive impact upon family members, mediated by a number of factors. Cognitive appraisals affected the caregiving experience and responses to the individual. The experience of caregiving was continually reappraised leading to a process of adaptation. The majority of studies identified unmet carer needs. The implications of the findings are discussed with reference to existing theoretical models and in terms of clinical practice. Copyright © 2015 John Wiley & Sons, Ltd.
  
  
  CONCLUSIONS
  Carers experience a significant amount of guilt and distress once they have found out about their loved one's eating disorder. Across the studies, there were many themes of unmet need for carers. Siblings have often been overlooked by both clinicians and researchers. Interventions for people with eating disorders should also acknowledge carers and close family members.
authors.affiliation: Department of Psychology, Royal Holloway, University of London, Surrey, UK.|Enfield Complex Care Team, Barnet, Enfield and Haringey NHS Trust, London, UK.
authors.forename: John Re
authors.initials: JR
authors.lastname: Fox
authors.affiliation: Enfield Complex Care Team, Barnet, Enfield and Haringey NHS Trust, London, UK.
authors.forename: Madeleine
authors.initials: M
authors.lastname: Dean
authors.affiliation: School of Psychological Sciences, University of Manchester, Manchester, UK.
authors.forename: Anna
authors.initials: A
authors.lastname: Whittlesea
mesh_terms: D000223:Adaptation, Psychological; D000856:Anorexia Nervosa / Q000175:diagnosis / Q000523:psychology* / Q000628:therapy; D017028:Caregivers / Q000523:psychology*; D017281:Cost of Illness; D003469:Culture; D019260:Expressed Emotion; D005196:Family Therapy; D006301:Health Services Needs and Demand; D006801:Humans; D016487:Parenting / Q000523:psychology; D036301:Qualitative Research; D035781:Siblings / Q000523:psychology
keywords: Caring; Eating Disorders; Meta Synthesis