title: Four Pathways to Anorexia Nervosa: Patients' Perspective on the Emergence of AN.
abstract: BACKGROUND
  Studies show that patients' perception of their illness has a direct influence both on their utilization of health services and their adherence to treatment plans. This may be particularly relevant to the treatment of Anorexia Nervosa (AN). Previous studies on AN have typically explored single psycho-social factors that patients with AN relate to the emergence of their illness. There is a need for more coherent systematic descriptions of the complexity of the patients' narratives about how their illness emerged. In this study, we sought to identify common components in the participants' narratives. By identifying different combinations of these components in the narratives, we sought to describe differences in patients' perceived pathways to AN.
  
  
  METHODS
  Participants were 36 women aged 18-51 years who had been treated for AN within the past 2 years at five clinical institutions in Norway. Semi-open qualitative interviews were conducted, tape-recorded, transcribed and analysed using grounded theory techniques.
  
  
  RESULTS
  We identified the following four distinct perceived pathways into AN: 'The Avoidant', 'The Achiever', 'The Transformer' and 'The Punisher'. The pathways could be regarded as four different projects for mastering life's challenges.
  
  
  CONCLUSIONS
  Our results suggest that there seem to be at least four pathways into AN. This indicates that a common array of symptoms might cover very different psychological dynamics. These might need to be treated therapeutically in different ways and should probably be taken into account during the refinement of diagnostic tools. Copyright © 2016 John Wiley & Sons, Ltd.
  
  
  CONCLUSIONS
  Although patients with AN might present similar symptoms, patients' perspectives on the emergence of their problems indicate that a common array of symptoms cover a variety of subjective psychological dynamics. From the experienced patient's stance, there are at least four distinct pathways to the emergence of AN. Attempts to master the challenges of life were found to be a common denominator in the emergence of AN. Recognition and integration of the patient's understanding of her or his problems should be given high priority in treatment of AN.
authors.affiliation: Division of Mental Health, Norwegian Institute of Public Health, Oslo, Norway.|Department of Eating Disorders Gaustad, Oslo University Hospital, Oslo, Norway.
authors.forename: Kjersti S
authors.initials: KS
authors.lastname: Gulliksen
authors.affiliation: Division of Mental Health, Norwegian Institute of Public Health, Oslo, Norway.
authors.forename: Ragnfrid H S
authors.initials: RHS
authors.lastname: Nordbø
authors.affiliation: Division of Mental Health, Norwegian Institute of Public Health, Oslo, Norway.
authors.forename: Ester M S
authors.initials: EMS
authors.lastname: Espeset
authors.affiliation: Department of Special Needs Education, University of Oslo, Oslo, Norway.|Institute for Eating Disorders, Oslo, Norway.
authors.forename: Finn
authors.initials: F
authors.lastname: Skårderud
authors.affiliation: Division of Mental Health, Norwegian Institute of Public Health, Oslo, Norway.|Modum Bad Research Institute, Vikersund, Norway.|Department of Psychology, University of Oslo, Oslo, Norway.
authors.forename: Arne
authors.initials: A
authors.lastname: Holte
mesh_terms: D000293:Adolescent; D000328:Adult; D000856:Anorexia Nervosa / Q000523:psychology*; D001294:Attitude to Health; D005260:Female; D006801:Humans; D008875:Middle Aged; D033262:Narration; D009664:Norway; D055815:Young Adult
keywords: anorexia nervosa; emergence of illness; illness perception; patient perspective