A meta-ethnography of autistic people’s experiences of social camouflaging and a Delphi study about improving eating disorder treatment for autistic women with Anorexia Nervosa

Field, Sarah 2022. A meta-ethnography of autistic people’s experiences of social camouflaging and a Delphi study about improving eating disorder treatment for autistic women with Anorexia Nervosa. ClinPsy Thesis, Cardiff University. Item availability restricted.

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Abstract

This thesis presents two papers on topics which are relevant to the mental health of autistic adults. Autism is difference in the development of the brain. Autistic people may have differences in how they communicate and interact, may do the same things repeatedly, and have a preference for particular routines or interests. Research suggests autistic people might be more likely to have some mental health problems, and research into the mental health of autistic people is a priority for autistic people and their supporters. Paper one discusses social camouflaging, a concept which has been associated with mental health difficulties in autistic people. Paper two investigates treatment for autistic women with anorexia nervosa, an eating disorder which research suggests is more common in autistic people. Paper one reviews the literature on social camouflaging. Social camouflaging is a process where autistic people might try and hide their autistic behaviour and appear more socially capable. Previous research has linked social camouflaging with mental health difficulties such as anxiety and depression in autistic adults. The relationship between social camouflaging and mental health difficulties is not fully understood. Meta-ethnography allows the findings of several papers discussing people’s experiences to be considered together and used to develop new theories and ideas. Paper one systematically identified research about autistic people’s experiences of camouflaging and synthesised them using an approach called meta-ethnography. The purpose of conducting a meta-ethnography about autistic people’s experiences of social camouflaging was to identify what might cause the relationship between social camouflaging and poor mental health. Paper one identified, evaluated, and synthesised a total of 13 studies. The results of the meta-ethnography describe how autistic people may use social camouflaging as a way of coping with stress from social situations and the wider society around them which can be unaccepting of autistic behaviour. The social context itself can lead to stress and poor mental health for autistic people. The meta-ethnography describes how many autistic people find their camouflaging strategies have negative unintended consequences which paradoxically makes the context around them more stressful. Some autistic people find they do not have negative unintended consequences from camouflaging, or that the negative consequences are not as severe as tolerating the context without camouflaging. The results of paper one describe a theory for understanding the relationship between social camouflaging and poor mental health. Paper one has implications for how clinicians support autistic people with mental health difficulties. It is important that clinicians consider the relative costs and benefits of camouflaging for autistic people. Clinicians can work sensitively with autistic people to formulate the ways that their camouflaging strategies might increase the stress they are experiencing, and enable autistic people to make informed decisions about when, where, and how they camouflage. Paper two investigates how to improve treatment for autistic women with anorexia nervosa (AN). Research suggests that AN is more common in autistic women, and autistic women have worse outcomes from eating disorder treatment compared to non-autistic women. Despite this, there is little research into how to improve eating disorder treatment for autistic women with AN. When guidelines have been developed, this has been in the context of a service improvement project within a single service, with little detail about how recommendations were developed. There is a need for systematic research into how to improve AN treatment for autistic women. Paper two describes a Delphi study investigating how best to support autistic women with AN. Delphi studies allow the calculation of how much a group of experts agree on a topic without requiring them to meet and make a decision. A group of 49 researchers, clinicians, and people with lived experience of autism and eating disorders were asked what they thought would help autistic women with AN. Their responses were used to generate 56 suggestions that the experts agreed on. The results give a wide range of suggestions about how to support autistic women with AN. Many of the recommendations highlight the importance for staff and services to be able to tell the 4 difference between autism- and AN-related behaviours so they can avoid setting treatment targets which try and change autistic behaviour. Treatment for autistic women with AN may need to target a broader and different range of areas compared to non-autistic women with AN. In addition, the results suggest it is important for eating disorder treatment to accommodate autistic traits such as differences in communication and sensory sensitivities. Finally, the suggestions highlight the importance of involving autistic people in the development of services and contributing to their own care. The recommendations from the Delphi study could be used to develop a training package for staff

Item Type:	Thesis (DClinPsy)
Date Type:	Completion
Status:	Unpublished
Schools:	Schools > Psychology
Subjects:	B Philosophy. Psychology. Religion > BF Psychology
Date of First Compliant Deposit:	22 September 2022
Last Modified:	05 Jan 2024 08:26
URI:	https://orca.cardiff.ac.uk/id/eprint/152764

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