Qualitative
This category contains 27 posts

Unpacking Recovery Part 5: Clinical Recovery Without a Clinic?

It can be somewhat controversial to suggest that untreated recovery from eating disorders is possible. Certainly, people have varied opinions about whether someone can enact the difficult behavioral and attitudinal changes necessary to recover without the help of (at the very least) a therapist and a dietitian. Nonetheless, we still hear stories about individuals who consider themselves recovered without having sought out external sources of professional support.

When I think about untreated (or “spontaneous”) recovery from eating disorders, two studies in particular come to mind. The first study I am thinking about was written by Vandereycken (2012) and explores self-change, providing an overview of community studies of individuals who have not sought treatment for their eating disorders and implications for treatment and recovery. The second, by Woods (2004) is a qualitative study looking at the experiences of 16 women and 2 men who report recovering from AN and BN without having sought treatment. Vandereycken identifies some difficulties associated with trying to study untreated recovery, and Woods’ study highlights some possible mechanisms through which untreated recovery might …

Unpacking Recovery Part 3: Can Patients Imagine Recovery?

Today I have the distinct pleasure of writing about one of my favourite articles about eating disorder recovery by Malson et al. (2011) exploring how inpatients talk about eating disorder recovery. I have personally found this article to be very helpful in understanding some of the difficulties of understanding and achieving recovery in our social context.

As Malson and colleagues explain (and as we’ve established), eating disorder recovery is elusive. Often, poor prognosis is described in relation to individual factors, including:

  • Treatment resistance
  • Hostility
  • Opposition
  • Ambivalence about change
  • Ambivalence about the possibility of change

Problematically, seeing these as the primary reasons for which patients do not recover can make individuals with eating disorders themselves feel as though they are to blame for their “inability to recover,” which help approximately no one. How do patients internalize these kinds of framings, and what impact does it have on how possible they feel recovery is?

Malson et al. used discourse analysis to explore patients’ perspectives, looking at how these participants felt about themselves currently and imagined their future “in recovery.”

METHOD

Unpacking Eating Disorder Recovery Part 1: The Recovery Model

What does eating disorder recovery really look like? When you say the word “recovery,” differences of opinion loom large. The lack of definitional clarity around the concept of recovery came up many times at ICED, and continues to surface in discussions among researchers, clinicians, and individuals with eating disorders themselves. We’ve looked at recovery on the blog before (for example, Gina looked at how patients define recovery here; Tetyana surveyed readers about their perspectives on whether or not they thought of themselves as being in recovery and wrote about it here; I wrote about men’s experiences after recovery here). It’s something of a hot topic in the research literature, too.

My Master’s thesis focused primarily on recovery, with one “take home message” being that there can be a disconnect between what recovery means in treatment settings, in popular understanding, and among individuals who have experienced eating disorders. Of course, my study was qualitative and from a critical feminist standpoint, so it is still unclear how well my findings map onto the larger dynamics of recovery. Still, understanding …

Of Family Dynamics and Eating Disorders: Parents’ Experiences of Skills-Based Training

Parents of children with eating disorders face an extraordinarily difficult challenge; the work that they put into caring for their loved ones cannot be discounted. This can be especially challenging in the face of a social environment that tends toward parent-blaming for disorders. Further, the kinds of behaviors caregivers are obliged to encourage in the individual with an eating disorder (for example, eating calorically-dense foods in order to gain weight) are frowned upon, to say the least, in our “anti-obesity” oriented society.

There is a rich body of literature exploring caregiver well-being, including studies suggesting that increasing the availability of support in various forms from social to practical may help caregivers to navigate a complicated path toward supporting a loved one with an eating disorder. Researchers are asking key questions around what we can do to better support parents and other caregivers.

Along these lines, Goodier et al. (2014) talked to parents who had participated in a skills-based training intervention. They were interested in finding out more about whether this intervention helped to bolster against the potential negative …

Walking a Mile in Your Shoes: Treating Eating Disorders with a Personal History of Eating Problems

A big topic at ICED, and one that seems to continually resurface, is treatment professionals in recovery. One the one hand, many see healthcare professionals with a history of eating disorders as possessing a kind of empathy that may be inaccessible to those who have not “been there.” On the other, some argue that this history complicates the patient-professional relationship in potentially detrimental ways.

You’ll find proponents of both sides of this debate from both professional and patient communities, and there are compelling arguments to be made on both sides of the coin. As an eating disorder researcher with a history of eating disorders, I don’t think you will be surprised that I lean toward the “it’s totally fine” side of the debate.

One thing that stood out to me about the larger discussion on this topic at the conference, however, was how we need to be careful about not stigmatizing those who either do or do not have a history of eating disorders. For some, becoming a professional treating eating disorders might be a great way of making sense …

Gendering the Pro-Anorexia Paradox: Men in Pro-Ana Spaces

When someone says “pro-ana,” what comes to mind? Likely, given the strong reactions pro-anorexia websites provoke, you may be able to conjure up an image of what would take place in such a forum. Thoughts of “thinspiration,” emaciated and waif-like images, and starving tips likely spring to mind, alongside considerations of the dangers of a community that would encourage behaviors that can be very harmful to health.

I’d venture to say that it is unlikely that you have pictured a man participating in these sites. Given that we know that men get eating disorders too, and that they may feel alienated in their struggles, is it surprising that some might seek out online communities, including pro-ana?

As Tetyana noted in previous posts on pro-ana (here and here), these sites can serve a harm reduction purpose and/or provide a space for sufferers to openly and honestly share their struggles and seek support from a community of understanding others. Is it possible that men, who may feel even more stigmatized than women with eating disorders (see this post, too), …

Polar Opposites? The Social Construction of Bulimia and Anorexia Nervosa

Some might argue that bulimia nervosa is more “hidden” than anorexia nervosa — it is not always obvious that someone is suffering from bulimia (though, I would argue, it is not always obvious that someone is suffering from any eating disorder). Even when it is “discovered,” BN is often placed in opposition with AN — as if the two were polar opposites.

Indeed, attempts to define a phenotype (a set of observable traits or characteristics) for AN and BN tend to oppose the two and to suggest that the people who develop AN are inherently different from those who develop BN. While I believe there is some scientific evidence for personality differences between the two, the degree of diagnostic crossover and symptom variability in eating disorders makes me feel like this split is at the very least overly simplistic.

What is interesting is how BN has come to occupy a very different place in our collective social imagination than AN. We know that preconceived notions about what it means to be an individual with an eating disorder in general can …

Good Clinicians, Helpful Comments, & Unpopular Opinions: SEDs Readers’ Responses – Part II

A few weeks ago, I asked SEDs readers a bunch of questions about their experiences with an eating disorder. Then, pretending to be a qualitative researcher, I went through the answers to see if I could find trends. I blogged about people’s responses to the first half of the question here; this post will be about the second half of the questions. (Here’s a ED survey results – Parts I and II to the pdf with all of the raw data).

Please note that this analysis was not rigorous, so in grouping and identifying themes (or how many times a theme/word was mentioned), I will use words like “approximately.”

[The breakdown for the last half of the respondents is:

6. What are characteristics of good eating disorder clinicians?

By far the two most comment themes, mentioned ~13 times each were “understanding” and variations of “willing to challenge,” “confront,” and have a “no bullshit” attitude. Other qualities mentioned were patience, good listening skills, nonjudgemental, empathetic and compassionate, not dismissive, patronizing or condescending, and firm but flexible.

Two individuals mentioned the …

I Asked, “Are You In Recovery? Why or Why Not?” Here’s What You Answered (And More): Exploring SEDs Readers’ Experiences

Are you in recovery right now? Why or why not?” That’s one of the questions I’ve been asking on the SEDs Tumblr every once in a while. It is interesting for me to find out about the people who read the blog/Tumblr. But more importantly, it gives me an opportunity to show diversity of experiences (and feelings).

Last week I decided to formalize this a little bit and to open the floor to non-Tumblr users; I made a survey with over a dozen questions. I received a lot of responses  and I wanted to share them in the hopes that some of you will, perhaps, find them reassuring. I won’t get to cover all the questions I asked, so this will be part I of, well, I don’t know how many posts.

Please note that this survey is not scientific, not comprehensive, and not necessarily representative of the general population of ED sufferers. Here’s a PDF of all the “raw” data for the questions covered in this post: ED survey results – Part I. Some of the …

Matters of Appearance: Eating Disorder Patients’ Interpretations of Therapists’ Bodies

Therapeutic alliance is often highlighted in studies looking at treatment effectiveness, both in and beyond the realm of eating disorder therapy. Evidently, there are a number of factors that can impact how well we get along with our therapists, ranging from disagreements with the course of treatment or type of therapy to a simple, unnamable dislike for the person. But what about their appearance? What kind of impact could a therapist’s body size have on the therapy relationship?

Rance, Clarke & Moller (2014) sought out to investigate this issue, looking specifically at how clients evaluate therapists’ body size and speculate on their relationship with food, with an eye to determine what impact this might have on the therapeutic process.

I was immediately drawn to this study when I was browsing the latest literature; I wondered why this hadn’t been studied before. In some ways it seems obvious; we’re bound to compare ourselves with others, social beings that we are. So when looking at the therapeutic alliance, it would be illogical to assume that physical appearance could be …

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