Mealtime challenges from the perspectives of adolescents with anorexia nervosa and atypical anorexia nervosa and their caregivers enrolled in family-based treatment.

Objective: This study identified mealtime challenges and emotions experienced during challenges among adolescents with anorexia nervosa (AN) or atypical anorexia nervosa (AAN) and their caregivers during the early phase of family-based treatment (FBT).

Method: Caregivers with high expressed emotion (i.e., Five-Minute Speech Sample) and their adolescents with AN/AAN completed a joint interview to discuss a recent challenging meal/snack they had together. Interviews were analyzed using thematic and content analyses. Differences in the challenges and emotions experienced between families of adolescents with AN and adolescents with AAN were explored.

Results: Twenty FBT-enrolled (M = 3.2 sessions completed; SD = 1.9) adolescents (M = 15.0 years, SD = 1.6) diagnosed with AN (n = 12) and AAN (n = 8) and their primary caregivers completed interviews. Six mealtime challenge themes were identified. Families with youth with AN were more likely to endorse challenges related to difficulties with FBT, food refusal, food health concerns, stress on family dynamics (i.e., lack of communication, pressure to meet expectations), and mealtime stimuli (i.e., challenging emotions). Families with youth with AAN were more likely to endorse challenges related to body, weight shape concerns and desire for control and consistency. Despite differences, both groups broadly endorsed all mealtime challenge themes.

Conclusions: Mealtimes for FBT-enrolled families are multifaceted and emotionally challenging. Families' experiences during the early phase of FBT should be assessed to provide additional support for challenges.