Parental engagement in an early intervention program for anorexia nervosa: a qualitative study

Anorexia nervosa (AN) is a severe chronic condition requiring early and effective intervention. Family involvement is considered a cornerstone of adolescent treatment, yet the specific dynamics of early parental engagement into care remain poorly understood. This study aimed to explore the processes underlying parental involvement in early care for adolescents with AN, within the context of a family-based day program (EVAFAM) in France. We conducted a qualitative study using semi-structured interviews with 15 parents (7 fathers, 8 mothers) whose adolescents participated in the EVAFAM program between January 2023 and June 2024. We identified three main processes that lead to parental engagement in care: (1) a grieving process, where parents recognized the chronic nature of the illness and their emotional responses to the diagnosis; (2) an active reconstruction process, where parents adapted their attitudes and behaviors to become therapeutic partners; and (3) the relationship to the institutional care framework, which provided both authority and support, while sometimes generating ambivalence. Engagement was supported by increased knowledge and structured interventions but challenged by emotional strain and uncertainty. Notably, early intervention enabled families to shift from denial to active participation, suggesting that engagement is a progressive construction, not an initial precondition. Understanding the trajectories of parental engagement during early intervention highlights key levers for supporting families, including acknowledging emotional transitions, providing practical tools, and reinforcing institutional alliances. These insights can inform tailored interventions and enhance family-centered care for adolescents with AN.