Recovery from disordered eating: What life histories reveal

A Tale of Childhood Loss, Conditional Acceptance and a Fear of Abandonment: A Qualitative Study Taking a Narrative Approach to Eating Disorders

Eating disorders (EDs) are serious mental health illnesses, yet there is a need to better understand the illness experience to improve treatment outcomes. Qualitative research, and narrative approaches in particular, can elicit life stories that allow for the whole illness journey to be explored. This study aimed to explore the experiences of women with a history of an ED, identifying the life events they perceived were relevant to the onset of their ED through to recovery. Interviews were conducted with 18 women with lived experience of an ED. Through structural narrative analysis, an overarching storyline of childhood loss contributing to a belief of conditional acceptance, fear of abandonment and struggle to seek emotional support due to the fear of being a burden was identified. Negative experiences with the health sector were common. These findings have implications for the way medical professionals respond to help seeking and deliver treatment.

It's not all about control: challenging mainstream framing of eating disorders

BACKGROUND

The concept of control has long been suggested as a central factor in eating disorder (ED) aetiology. The concept is now so mainstream that it risks being used in a potentially reductionist, stigmatising or otherwise harmful manner. In this paper, we explore and discuss our positions on the use of control-related terminology for EDs.

METHODS

The authors of this auto-ethnographic position paper include academic researchers, individuals with lived experience and clinicians (not mutually exclusive). In sharing our experiences and observations, we aim to raise awareness of the wider impacts that control framing can have on ED perceptions, treatment, recovery and individuals' lived experience.

RESULTS

We argue that although control can play a role in some ED experiences, an overemphasis upon this factor to the exclusion of other conceptualisations is not beneficial.

CONCLUSIONS

To mitigate against pathologisation of an individual, it is important to challenge a discourse that can lead to EDs being perceived as something 'wrong' with the individual, rather than a consequence of life events or other environmental influences. We identify priorities for the future for researchers, clinicians, policy makers and the wider public.

Conceptualizing eating disorder recovery research: Current perspectives and future research directions

BACKGROUND

How we research eating disorder (ED) recovery impacts what we know (perceive as fact) about it. Traditionally, research has focused more on the "what" of recovery (e.g., establishing criteria for recovery, reaching consensus definitions) than the "how" of recovery research (e.g., type of methodologies, triangulation of perspectives). In this paper we aim to provide an overview of the ED field's current perspectives on recovery, discuss how our methodologies shape what is known about recovery, and suggest a broadening of our methodological "toolkits" in order to form a more complete picture of recovery. BODY: This paper examines commonly used methodologies in research, and explores how incorporating different perspectives can add to our understanding of the recovery process. To do this, we (1) provide an overview of commonly used methodologies (quantitative, qualitative), (2) consider their benefits and limitations, (3) explore newer approaches, including mixed-methods, creative methods (e.g., Photovoice, digital storytelling), and multi-methods (e.g., quantitative, qualitative, creative methods, psycho/physiological, behavioral, laboratory, online observations), and (4) suggest that broadening our methodological "toolkits" could spur more nuanced and specific insights about ED recoveries. We propose a potential future research model that would ideally have a multi-methods design, incorporate different perspectives (e.g., expanding recruitment of diverse participants, including supportive others, in study co-creation), and a longitudinal course (e.g., capturing cognitive and emotional recovery, which often comes after physical). In this way, we hope to move the field towards different, more comprehensive, perspectives on ED recovery.

CONCLUSION

Our current perspectives on studying ED recovery leave critical gaps in our knowledge about the process. The traditional research methodologies impact our conceptualization of recovery definitions, and in turn limit our understanding of the phenomenon. We suggest that we expand our range of methodologies, perspectives, and timeframes in research, in order to form a more complete picture of what is possible in recovery; the multiple aspects of an individual's life that can improve, the greater number of people who can recover than previously believed, and the reaffirmation of hope that, even after decades, individuals can begin, and successfully continue, their ED recovery process.

Turning the Corner: A Comparison of Collegiate Athletes’ and Non-Athletes’ Turning Points in Eating Disorder Recovery

The purpose of this qualitative study was to identify turning points in eating disorder recovery in collegiate female athletes compared to non-athletes. The sample included 12 varsity athletes and 17 non-athlete college students who previously met criteria for Anorexia Nervosa (AN; n = 17); Bulimia Nervosa (BN; n = 3); Binge Eating Disorder (n = 1); or both AN and BN (n = 8). Participants completed individual interviews and responses were analyzed inductively. There was some commonality in the athletes’ and non-athletes’ experiences. For example, the most frequent turning point for both groups was Insight/Self Realization. Regarding the next three most frequent turning points, athletes reported Sport Performance, Confrontation, and Support/Concern from Others, whereas non-athletes reported Professional Treatment, Hitting a Low, and Support/Concern from Others. This study contributes to the sparse literature on competitive athletes’ recovery. Results indicated that athletes’ turning points differed from non-athletes; therefore, findings are discussed concerning athlete-specific treatment recommendations and suggestions for coaches.

The recovery model and anorexia nervosa

OBJECTIVE

Treatments in anorexia nervosa (AN) have not been wholly effective and, accordingly, practices need to be reviewed. The recovery model is an approach to treatment that has become a guiding principle for mental health policy worldwide that might provide promise for AN treatment. The model has received much attention in recent years; however, there is a dearth of literature exploring how useful this model is for AN. The aim of the current article was to consider the relevance of this model in AN.

METHODS

This article provides a summary of the recovery model and reviews the literature to establish whether it is compatible with AN. The possible utility of the approach in AN is explored and suggestions are made as to how the model might be implemented in treatment.

RESULTS

Qualitative studies examining the patient's perspective of AN support the recovery model. Many evidenced-based treatments currently used in AN have elements that are consistent with a recovery model approach. Treatments that are most consistent with recovery approaches have been effective for those with chronic AN.

CONCLUSION

It is proposed that the model might offer a way in which to add to current practice and might have particular relevance for those with chronic AN. Future research is required to better understand how the model can best be utilised in AN.

Male experiences of life after recovery from an eating disorder

The aim of this study was to describe how former male patients perceive life after recovery from an eating disorder. A qualitative method with a phenomenographic approach was used to identify ways of experiencing recovery. Two descriptive categories were developed: body acceptance and self-worth. Six conceptions describe how recovered patients now relate in a balanced way to exercise and food, using strategies to avoid relapse. With a sense of self-acceptance and autonomy, they now appreciate their social life. Some perceive recovery as coping with remaining impulses to diet or exercise. Others experience themselves as totally free from the eating disorder.

Treatment results of anorexia nervosa and bulimia nervosa in a residential treatment program

Data on the effectiveness of residential treatment for patients with anorexia nervosa (AN) and bulimia nervosa (BN) are limited. We analyzed patient survey results at admission and discharge from Monte Nido Residential Treatment Program. Of 287 consecutive admissions, 80% (231) "graduated" (completed ≥ 30 days of treatment), and of these (all of whom gave consent), only patients with AN (N = 120) or BN (N = 95) were included (215 of 231, 93%) in this study. Analyses included a comparison of admission vs. discharge variables (paired t-tests) for each diagnosis. At each assessment, graduates completed the Eating Disorders Inventory-2 (EDI-2), the Beck Depression Inventory (BDI), and a structured eating disorder assessment questionnaire. For patients with AN, there were statistically significant improvements in mean BMI. In addition, for both AN and BN patients, there were statistically significant improvements in BDI scores, all 11 EDI-2 subscales, and frequencies of bingeing, vomiting, laxative abuse, chewing and spitting, stimulant abuse, and restricting behavior. The great majority of patients completing treatment showed significant improvement at discharge from intensive residential treatment.

Rethinking recovery from eating disorders: spiritual and political dimensions

In this article, we portray women's experiences of long-term recovery from anorexia and compulsive overeating. Semistructured interviewing and an interpretive biographical method were used to coconstruct accounts of each participant's transition to wellness. Thick descriptions of self-identified turning points on the path to recovery are framed in terms of the concept of personal positioning in relation to cultural master narratives. The narratives suggest that long-term recovery involves spiritual or political commitment and purposeful engagement with communities larger than the self.

Bulimia e transtorno da compulsão alimentar periódica: revisão sistemática e metassíntese

OBJETIVO: Esta revisão sistemática teve como objetivo organizar o conjunto das informações disponibilizadas pelos estudos qualitativos sobre a vivência dos pacientes portadores de bulimia e transtorno da compulsão alimentar periódica. METODOLOGIA: Pesquisas foram conduzidas nas seguintes bases de dados: PubMed, ISI, PsycINFO, EMBASE, LILACS e SciELO, no período de 1990 a 2005. Critérios de inclusão: 1) artigos com foco principal na bulimia ou transtorno da compulsão alimentar periódica; 2) pesquisas originais em inglês, espanhol, francês ou português; 3) uso de qualquer método qualitativo, como entrevista, grupo focal ou observação de campo. Critérios de exclusão: artigos exclusivamente teóricos ou que utilizam população infantil ou da terceira idade. Utilizou-se a abordagem meta-etnográfica para sintetizar os dados. Cada estudo foi lido, e as categorias centrais de cada um foram comparadas e interpretadas com as categorias de todos os outros estudos. RESULTADOS: Foram incluídos 15 estudos de um total de 3.415 artigos. Sete temas centrais que se sobrepõem foram identificados: representação da doença; sentimentos negativos (medo, culpa, raiva, solidão, perda de controle); sentimentos positivos (auto-controle; poder; função do sintoma; relacionamentos interpessoais; história pessoal; contexto sociocultural; recuperação). CONCLUSÕES: Embora muitos aspectos sejam negativos, a experiência, como um todo, não é referida apenas como má. Alguns aspectos dos transtornos alimentares são sentidos como benéficos, segundo os pacientes.