Key-in-session identity negotiations in a first line treatment for adult anorexia nervosa.
Anorexia nervosa (AN)
CBT-AN
Compulsive exercise activity therapy
Eating disorders
Identity negotiations
Narrative therapy
Journal
Journal of eating disorders
ISSN: 2050-2974
Titre abrégé: J Eat Disord
Pays: England
ID NLM: 101610672
Informations de publication
Date de publication:
31 Jan 2024
31 Jan 2024
Historique:
received:
02
09
2023
accepted:
24
01
2024
medline:
1
2
2024
pubmed:
1
2
2024
entrez:
31
1
2024
Statut:
epublish
Résumé
Exploration of client identity negotiations during treatment for Anorexia Nervosa (AN) is a relatively new area of research. Research suggests that difficulties with identity negotiations may present as a barrier to treatment. This study sought to explore individuals' identity negotiations during therapy sessions using Compulsive Exercise Activity Therapy (LEAP) combined with Cognitive Behaviour Therapy for Anorexia Nervosa (CBT-AN). Analysis focused on moments in therapy where individuals' identities were dominated or defined by AN and where alternative identities could be generated. 40 in-session transcripts from sessions at early, mid and end points of the CBT-AN (with LEAP) treatment were qualitatively analysed for nine of the 78 participants in the original randomised control trial. Through a constructivist framework, thematic analysis was used to identify surface and latent meanings and discursive material participants used to negotiate their identities in the context of therapy sessions. Analysis of in-therapy transcripts generated two themes pertaining to identity negotiations: (1) troubled identities and (2) rebuilding identities and lives outside of AN. Early therapy sessions explored fragmented and AN dominated identities, including how AN was troubling to participants' sense of self, contributed to conflicted identities, positioned them outside of normality, and was associated with isolated and othering identities. Within therapy sessions, participants engaged in a recursive process of shifting relationships with AN and themselves and building identities and lives outside of the AN identity. This included generating hopes for recovery and the future more frequently in mid- to late- therapy sessions. Identity negotiations evident in the therapeutic conversations aligned with the key components of the CBT-AN intervention, including addressing (1) the characterisation of oneself as 'an anorexic' and (2) the diversification of roles and activities to broaden and enhance self-concepts. Future developments of therapeutic interventions for AN would benefit from greater consideration of ways to assist individuals to more comprehensively address problematic identities, including uncovering identities hidden by the AN identity and generating preferred identities. Ethics approval was obtained at the time of the initial study and for this embedded research by the HREC at the Western Sydney University (HR777332). Current psychological therapies for Anorexia Nervosa (AN) have recently identified that the sense of AN as part of a person’s identity, or who they understand themselves to be, may pose barriers for treatment. In this study, therapy session transcripts from previous research using Compulsive Exercise Activity Therapy (LEAP) combined with Cognitive Behaviour Therapy for AN (CBT-AN) were thematically analysed to explore participants’ experiences of identity shifts in-session. Particular attention was paid to moments in therapy where individuals’ identities were heavily influenced by AN and moments where alternative and preferred identities were generated. Outcomes from this study suggested that the process of participants negotiating their identities outside of AN was a gradual and repeated one throughout treatment, which involved building hopes for recovery and a future less dominated by AN. Findings from this research support the need for future treatments to broaden their scope to more comprehensively explore changes in identity during intervention, particularly in building new identities outside of the AN identity.
Sections du résumé
BACKGROUND
BACKGROUND
Exploration of client identity negotiations during treatment for Anorexia Nervosa (AN) is a relatively new area of research. Research suggests that difficulties with identity negotiations may present as a barrier to treatment. This study sought to explore individuals' identity negotiations during therapy sessions using Compulsive Exercise Activity Therapy (LEAP) combined with Cognitive Behaviour Therapy for Anorexia Nervosa (CBT-AN). Analysis focused on moments in therapy where individuals' identities were dominated or defined by AN and where alternative identities could be generated.
METHOD
METHODS
40 in-session transcripts from sessions at early, mid and end points of the CBT-AN (with LEAP) treatment were qualitatively analysed for nine of the 78 participants in the original randomised control trial. Through a constructivist framework, thematic analysis was used to identify surface and latent meanings and discursive material participants used to negotiate their identities in the context of therapy sessions.
RESULTS
RESULTS
Analysis of in-therapy transcripts generated two themes pertaining to identity negotiations: (1) troubled identities and (2) rebuilding identities and lives outside of AN. Early therapy sessions explored fragmented and AN dominated identities, including how AN was troubling to participants' sense of self, contributed to conflicted identities, positioned them outside of normality, and was associated with isolated and othering identities. Within therapy sessions, participants engaged in a recursive process of shifting relationships with AN and themselves and building identities and lives outside of the AN identity. This included generating hopes for recovery and the future more frequently in mid- to late- therapy sessions.
CONCLUSION
CONCLUSIONS
Identity negotiations evident in the therapeutic conversations aligned with the key components of the CBT-AN intervention, including addressing (1) the characterisation of oneself as 'an anorexic' and (2) the diversification of roles and activities to broaden and enhance self-concepts. Future developments of therapeutic interventions for AN would benefit from greater consideration of ways to assist individuals to more comprehensively address problematic identities, including uncovering identities hidden by the AN identity and generating preferred identities.
TRIAL REGISTRATION
BACKGROUND
Ethics approval was obtained at the time of the initial study and for this embedded research by the HREC at the Western Sydney University (HR777332).
Current psychological therapies for Anorexia Nervosa (AN) have recently identified that the sense of AN as part of a person’s identity, or who they understand themselves to be, may pose barriers for treatment. In this study, therapy session transcripts from previous research using Compulsive Exercise Activity Therapy (LEAP) combined with Cognitive Behaviour Therapy for AN (CBT-AN) were thematically analysed to explore participants’ experiences of identity shifts in-session. Particular attention was paid to moments in therapy where individuals’ identities were heavily influenced by AN and moments where alternative and preferred identities were generated. Outcomes from this study suggested that the process of participants negotiating their identities outside of AN was a gradual and repeated one throughout treatment, which involved building hopes for recovery and a future less dominated by AN. Findings from this research support the need for future treatments to broaden their scope to more comprehensively explore changes in identity during intervention, particularly in building new identities outside of the AN identity.
Autres résumés
Type: plain-language-summary
(eng)
Current psychological therapies for Anorexia Nervosa (AN) have recently identified that the sense of AN as part of a person’s identity, or who they understand themselves to be, may pose barriers for treatment. In this study, therapy session transcripts from previous research using Compulsive Exercise Activity Therapy (LEAP) combined with Cognitive Behaviour Therapy for AN (CBT-AN) were thematically analysed to explore participants’ experiences of identity shifts in-session. Particular attention was paid to moments in therapy where individuals’ identities were heavily influenced by AN and moments where alternative and preferred identities were generated. Outcomes from this study suggested that the process of participants negotiating their identities outside of AN was a gradual and repeated one throughout treatment, which involved building hopes for recovery and a future less dominated by AN. Findings from this research support the need for future treatments to broaden their scope to more comprehensively explore changes in identity during intervention, particularly in building new identities outside of the AN identity.
Identifiants
pubmed: 38297339
doi: 10.1186/s40337-024-00979-0
pii: 10.1186/s40337-024-00979-0
doi:
Types de publication
Journal Article
Langues
eng
Pagination
20Informations de copyright
© 2024. Crown.
Références
American Psychiatric Association D, Association AP. Diagnostic and statistical manual of mental disorders. 5th ed. Washington, DC: American Psychiatric Association; 2013.
doi: 10.1176/appi.books.9780890425596
Galmiche M, Déchelotte P, Lambert G, Tavolacci MP. Prevalence of eating disorders over the 2000–2018 period: a systematic literature review. Am J Clin Nutr. 2019;109(5):1402–13. https://doi.org/10.1093/ajcn/nqy342 .
doi: 10.1093/ajcn/nqy342
pubmed: 31051507
Nicholls D, Bryant-Waugh R. Eating disorders of infancy and childhood: definition, symptomatology, epidemiology, and comorbidity. Child Adolesc Psychiatr Clin N Am. 2009;18(1):17–30. https://doi.org/10.1016/j.chc.2008.07.008 .
doi: 10.1016/j.chc.2008.07.008
pubmed: 19014855
Rodrigues AK, Kennedy J, Turrini T, Katzman DK. Resolution of Medical Instability in adolescents with anorexia nervosa and excessive exercise. J Adolesc Health. 2017;60(2):S50. https://doi.org/10.1186/s40337-023-0079-y .
doi: 10.1186/s40337-023-0079-y
Thien V, Thomas A, Markin D, Birmingham CL. Pilot study of a graded exercise program for the treatment of anorexia nervosa. Int J Eat Disord. 2000;28(1):101–6. https://doi.org/10.1002/(sici)1098-108x(200007)28:1%3c101::aid-eat12%3e3.0.co;2-v .
doi: 10.1002/(sici)1098-108x(200007)28:1<101::aid-eat12>3.0.co;2-v
pubmed: 10800019
Klein DA, Mayer LE, Schebendach JE, Walsh BT. Physical activity and cortisol in anorexia nervosa. Psychoneuroendocrinology. 2007;32(5):539–47. https://doi.org/10.1016/j.psyneuen.2007.03.007 .
doi: 10.1016/j.psyneuen.2007.03.007
pubmed: 17462830
Hay P, Touyz S, Arcelus J, Pike K, Attia E, Crosby RD, et al. A randomized controlled trial of the compuLsive Exercise Activity TheraPy (LEAP): a new approach to compulsive exercise in anorexia nervosa. Int J Eat Disord. 2018;51(8):999–1004. https://doi.org/10.1002/eat.22920 .
doi: 10.1002/eat.22920
pubmed: 30051623
Meyer C, Taranis L, Goodwin H, Haycraft E. Compulsive exercise and eating disorders. Eur Eat Disord Rev. 2011;19(3):174–89. https://doi.org/10.1002/erv.1122 .
doi: 10.1002/erv.1122
pubmed: 21584911
Fairburn CG, Wilson GT, Schleimer K. Binge eating: nature, assessment, and treatment. New York: Guilford Press; 1993.
Fox AP, Larkin M, Leung N. The personal meaning of eating disorder symptoms: an interpretative phenomenological analysis. J Health Psychol. 2011;16(1):116–25. https://doi.org/10.1177/1359105310368449 .
doi: 10.1177/1359105310368449
pubmed: 20733015
Fairburn CG, Cooper Z, Shafran R. Cognitive behaviour therapy for eating disorders: a “transdiagnostic” theory and treatment. Behav Res Ther. 2003;41(5):509–28. https://doi.org/10.1016/s0005-7967(02)00088-8 .
doi: 10.1016/s0005-7967(02)00088-8
pubmed: 12711261
Kolnes L-J, Rodriguez-Morales L. The meaning of compulsive exercise in women with anorexia nervosa: an interpretative phenomenological analysis. Ment Health Phys Act. 2016;10:48–61. https://doi.org/10.1016/j.mhpa.2015.12.002 .
doi: 10.1016/j.mhpa.2015.12.002
Serpell L, Treasure J, Teasdale J, Sullivan V. Anorexia nervosa: Friend or foe? Int J Eat Disord. 1999;25(2):177–86. https://doi.org/10.1002/(sici)1098-108x(199903)25:2%3c177::aid-eat7%3e3.0.co;2-d .
doi: 10.1002/(sici)1098-108x(199903)25:2<177::aid-eat7>3.0.co;2-d
pubmed: 10065395
Conti JE, Joyce C, Hay P, Meade T. “Finding my own identity”: a qualitative metasynthesis of adult anorexia nervosa treatment experiences. BMC Psychol. 2020;8(1):1–110. https://doi.org/10.1186/s40359-020-00476-4 .
doi: 10.1186/s40359-020-00476-4
Hardin PK. Shape-shifting discourses of anorexia nervosa: Reconstituting psychopathology. Nurs Inq. 2003;10(4):209–17. https://doi.org/10.1046/j.1440-1800.2003.00189.x .
doi: 10.1046/j.1440-1800.2003.00189.x
pubmed: 14622367
Espindola CR, Blay SL. Anorexia nervosa treatment from the patient perspective: a metasynthesis of qualitative studies. Ann Clinical Psychiatry. 2009. https://doi.org/10.1159/000203339 .
doi: 10.1159/000203339
Burr V, Dick P. Social constructionism. In: Gough B, editors. The Palgrave handbook of critical social psychology. London: Palgrave Macmillan UK; 2017. pp. 59–80. https://doi.org/10.1057/978-1-137-51018-1_4 .
Conti C, Di Francesco G, Severo M, Lanzara R, Richards K, Guagnano MT, et al. Alexithymia and metabolic syndrome: the mediating role of binge eating. Eat Weigh Disord. 2021;26:1813–23. https://doi.org/10.1007/s40519-020-00964-x .
doi: 10.1007/s40519-020-00964-x
Yates A. Compulsive exercise and the eating disorders: toward an integrated theory of activity. London: Routledge; 2013. https://doi.org/10.4324/9780203776797 .
doi: 10.4324/9780203776797
Pike KM, Carter JC, Olmsted MP. Cognitive-behavioral therapy for anorexia nervosa. The treatment of eating disorders: a clinical handbook. The Guilford Press. 2010:83–107. Accessed from: https://psycnet.apa.org/record/2009-21675-005 .
Zeeck A, Herpertz-Dahlmann B, Friederich H-C, Brockmeyer T, Resmark G, Hagenah U, et al. Psychotherapeutic treatment for anorexia nervosa: a systematic review and network meta-analysis. Front Psychiatry. 2018;9:158. https://doi.org/10.3389/fpsyt.2018.00158 .
doi: 10.3389/fpsyt.2018.00158
pubmed: 29765338
pmcid: 5939188
Solmi M, Radua J, Olivola M, Croce E, Soardo L, Salazar-de Pablo G, et al. Age at onset of mental disorders worldwide: large-scale meta-analysis of 192 epidemiological studies. Mol Psychiatry. 2022;27(1):281–95. https://doi.org/10.1038/s41380-021-01161-7 .
doi: 10.1038/s41380-021-01161-7
pubmed: 34079068
Monteleone AM, Pellegrino F, Croatto G, Carfagno M, Hilbert A, Treasure J, et al. Treatment of eating disorders: a systematic meta-review of meta-analyses and network meta-analyses. Neurosci Biobehav Rev. 2022. https://doi.org/10.1016/j.neubiorev.2022.104857 .
doi: 10.1016/j.neubiorev.2022.104857
pubmed: 36084848
pmcid: 9813802
Zipfel S, Giel KE, Bulik CM, Hay P, Schmidt U. Anorexia nervosa: aetiology, assessment, and treatment. Lancet Psychiatry. 2015;2(12):1099–111. https://doi.org/10.1016/S2215-0366(15)00356-9 .
doi: 10.1016/S2215-0366(15)00356-9
pubmed: 26514083
Lock J, Le Grange D. Can family-based treatment of anorexia nervosa be manualized? J Psychother Pract Res. 2001;10(4):253.
pubmed: 11696652
pmcid: 3330678
Levinson CA, Hunt RA, Keshishian AC, Brown ML, Vanzhula I, Christian C, et al. Using individual networks to identify treatment targets for eating disorder treatment: a proof-of-concept study and initial data. J Eat Disord. 2021;9(1):1–147. https://doi.org/10.1186/s40337-021-00504-7 .
doi: 10.1186/s40337-021-00504-7
Steinhausen H-C. The outcome of anorexia nervosa in the 20th century. Am J Psychiatry. 2002;159(8):1284–93. https://doi.org/10.1176/appi.ajp.159.8.1284 .
doi: 10.1176/appi.ajp.159.8.1284
pubmed: 12153817
Attia E, Walsh BT. Behavioral management for anorexia nervosa. N Engl J Med. 2009;360(5):500–6. https://doi.org/10.1056/NEJMct0805569 .
doi: 10.1056/NEJMct0805569
pubmed: 19179317
White M. Narrative practice: continuing the conversations. New York: WW Norton & Company; 2011.
Conti JE. Recovering identity from anorexia nervosa: Women’s constructions of their experiences of recovery from anorexia nervosa over 10 years. J Constr Psychol. 2018;31(1):72–94. https://doi.org/10.1080/10720537.2016.1251366 .
doi: 10.1080/10720537.2016.1251366
Tan J, Hope T, Stewart A. Competence to refuse treatment in anorexia nervosa. Int J Law Psychiatry. 2003;26(6):697–707. https://doi.org/10.1016/j.ijlp.2003.09.010 .
doi: 10.1016/j.ijlp.2003.09.010
pubmed: 14637209
Ali K, Farrer L, Fassnacht DB, Gulliver A, Bauer S, Griffiths KM. Perceived barriers and facilitators towards help-seeking for eating disorders: a systematic review. Int J Eat Disord. 2017;50(1):9–21. https://doi.org/10.1002/eat.22598 .
doi: 10.1002/eat.22598
pubmed: 27526643
Dawson L, Rhodes P, Touyz S. The recovery model and anorexia nervosa. Aust N Z J Psychiatry. 2014;48(11):1009–16. https://doi.org/10.1177/0004867414539398 .
doi: 10.1177/0004867414539398
pubmed: 24927735
Touyz S, Le Grange D, Lacey H, Hay P, Smith R, Maguire S, et al. Treating severe and enduring anorexia nervosa: a randomized controlled trial. Psychol Med. 2013;43(12):2501–11. https://doi.org/10.1017/S0033291713000949 .
doi: 10.1017/S0033291713000949
pubmed: 23642330
Bamford B, Barras C, Sly R, Stiles-Shields C, Touyz S, Le Grange D, et al. Eating disorder symptoms and quality of life: where should clinicians place their focus in severe and enduring anorexia nervosa? Int J Eat Disord. 2015;48(1):133–8. https://doi.org/10.1002/eat.22327 .
doi: 10.1002/eat.22327
pubmed: 25049195
Conti J, Rhodes P, Adams H. Listening in the dark: why we need stories of people living with severe and enduring anorexia nervosa. Int J Eat Disord. 2016;4(1):1–7. https://doi.org/10.1186/s40337-016-0117-z .
doi: 10.1186/s40337-016-0117-z
Rankin R, Conti J, Touyz S, Arcelus J, Meyer C, Hay P. Dancing with change: a qualitative exploration of in-session motivation to change in the treatment of anorexia nervosa. Aust Psychol. 2023. https://doi.org/10.1080/00050067.2022.2151338 .
doi: 10.1080/00050067.2022.2151338
Ross JA, Green C. Inside the experience of anorexia nervosa: a narrative thematic analysis. Couns Psychother Res. 2011;11(2):112–9. https://doi.org/10.1080/14733145.2010.486864 .
doi: 10.1080/14733145.2010.486864
White M, Epston D. Narrative means to therapeutic ends. New York: WW Norton & Company; 1990.
Dallos R. ANT-attachment narrative therapy. J Fam Psychother. 2001;12(2):43–72. https://doi.org/10.1300/J085v12n02_04 .
doi: 10.1300/J085v12n02_04
Lonergan K, Whyte A, Ryan C. Externalisation in family-based treatment of anorexia nervosa: the therapist’s experience. J Fam Therapy. 2022;44(3):351–69. https://doi.org/10.1111/1467-6427.12380 .
doi: 10.1111/1467-6427.12380
Wufong E, Rhodes P, Conti J. “We don’t really know what else we can do”: parent experiences when adolescent distress persists after the Maudsley and family-based therapies for anorexia nervosa. J Eat Disord. 2019;7(1):5. https://doi.org/10.1186/s40337-019-0235-5 .
doi: 10.1186/s40337-019-0235-5
pubmed: 30805186
pmcid: 6373134
Eisler I. Family-based treatment increases full remission at 1-year follow-up compared with adolescent-focused individual therapy in adolescents with anorexia nervosa. Evid Based Ment Health. 2011;14(1):27. https://doi.org/10.1136/ebmh.14.1.27 .
doi: 10.1136/ebmh.14.1.27
pubmed: 21266624
Conti J, Joyce C, Natoli S, Skeoch K, Hay P. “I’m still here, but no one hears you”: a qualitative study of young women’s experiences of persistent distress post family-based treatment for adolescent anorexia nervosa. J Eat Disord. 2021;9(1):1–151. https://doi.org/10.1186/s40337-021-00496-4 .
doi: 10.1186/s40337-021-00496-4
White M. Maps of narrative practice. New York: WW Norton & Company; 2007.
Fox JR, Diab P. An exploration of the perceptions and experiences of living with chronic anorexia nervosa while an inpatient on an Eating Disorders Unit: an Interpretative Phenomenological Analysis (IPA) study. J Health Psychol. 2015;20(1):27–36. https://doi.org/10.1177/1359105313497526 .
doi: 10.1177/1359105313497526
pubmed: 23933950
Gergen KJ, McNamee S. From disordering discourse to transformative dialogue. In: Constructions of disorder: Meaning-making frameworks for psychotherapy. Washington: American Psychological Association; 2000; p. 333–49. https://doi.org/10.1037/10368-014
Nordbø RH, Espeset EM, Gulliksen KS, Skårderud F, Holte A. The meaning of self-starvation: qualitative study of patients’ perception of anorexia nervosa. Int J Eat Disord. 2006;39(7):556–64. https://doi.org/10.1002/eat.20276 .
doi: 10.1002/eat.20276
pubmed: 16845678
Stockford C, Stenfert Kroese B, Beesley A, Leung N. Women’s recovery from anorexia nervosa: a systematic review and meta-synthesis of qualitative research. Eat Disord. 2019;27(4):343–68. https://doi.org/10.1080/10640266.2018.1512301 .
doi: 10.1080/10640266.2018.1512301
pubmed: 30247988
Conti JE. Recovering Identity from Anorexia Nervosa—women’s constructions of their experiences of recovery from anorexia nervosa over 10 years. J Constr Psychol. 2018;31(1):72–94. https://doi.org/10.1080/10720537.2016.1251366 .
doi: 10.1080/10720537.2016.1251366
Dawson L, Rhodes P, Touyz SW. “Doing the impossible”: the process of recovery from chronic anorexia nervosa. Qual Health Res. 2014;24(4):494–505. https://doi.org/10.1177/104973231454029 .
doi: 10.1177/104973231454029
pubmed: 24594747
Rieger E, Touyz SW, Beumont PJ. The Anorexia Nervosa Stages of Change Questionnaire (ANSOCQ): information regarding its psychometric properties. Int J Eat Disord. 2002;32(1):24–38. https://doi.org/10.1002/eat.10056 .
doi: 10.1002/eat.10056
pubmed: 12183943
Fairburn CG, Beglin S. Eating disorder examination questionnaire. Cogn Behav Ther Eat Disord. 2008;309:313.
Braun V, Clarke V. Using thematic analysis in psychology. Qual Research Psychol. 2006;3(2):77–101. https://doi.org/10.1191/1478088706qp063oa .
doi: 10.1191/1478088706qp063oa
Braun V, Clarke V. Conceptual and design thinking for thematic analysis. Qual Psychol. 2022;9(1):3. https://doi.org/10.1037/qup0000196 .
doi: 10.1037/qup0000196
Charmaz K, Belgrave L. Qualitative interviewing and grounded theory analysis. SAGE Handb Interview Res Complex Craft. 2012;2:347–65. https://doi.org/10.4135/9781452218403.N25 .
doi: 10.4135/9781452218403.N25
Dwyer SC, Buckle JL. The space between: On being an insider-outsider in qualitative research. Int J Qual Methods. 2009;8(1):54–63. https://doi.org/10.1177/160940690900800105 .
doi: 10.1177/160940690900800105
Berger R. Now I see it, now I don’t: researcher’s position and reflexivity in qualitative research. Qual Res. 2015;15(2):219–34. https://doi.org/10.1177/1468794112468475 .
doi: 10.1177/1468794112468475
Gill A. Reflexivity and lived experience of out-of-home care: Positionality as an early parenthood researcher. Affilia. 2022;37(4):664–83. https://doi.org/10.1177/08861099211061210 .
doi: 10.1177/08861099211061210
Conti JE. “It’s part of what makes me.” Women’s constructions of ‘anorexia nervosa’ in their identity journeys over ten years. [Unpublished Doctoral Dissertation]. Sydney: Macquarie University; 2013.
LaMarre A, Rice C. Normal eating is counter-cultural: embodied experiences of eating disorder recovery in context. J Community Appl Soc Psychol. 2016;26(2):136–49. https://doi.org/10.1002/casp.2240 .
doi: 10.1002/casp.2240
LaMarre A, Rice C. Recovering uncertainty: exploring eating disorder recovery in context. Cult Med Psychiatry. 2021;45(4):706–26. https://doi.org/10.1007/s11013-020-09700-7 .
doi: 10.1007/s11013-020-09700-7
pubmed: 33389444
Pettersen G, Thune-Larsen K-B, Wynn R, Rosenvinge JH. Eating disorders: challenges in the later phases of the recovery process. Scand J Caring Sci. 2013;27(1):92–8. https://doi.org/10.1111/j.1471-6712.2012.01006.x .
doi: 10.1111/j.1471-6712.2012.01006.x
pubmed: 22676456
LaMarre A, Gilbert K, Scalise PA. What are we aiming for? Exploring tensions in healthcare provider perspectives on and communications about eating disorder recovery. Fem Psychol. 2022;33(4):622–46. https://doi.org/10.1177/09593535221141712 .
doi: 10.1177/09593535221141712
Malson H, Clarke S, Finn M. I don’t think that’s normal’: a reflection on accounts of experiences of treatment for eating disorders. Fem Psychol. 2008;18(3):417–24. https://doi.org/10.1177/0959353507083097 .
doi: 10.1177/0959353507083097
Steiger H, Gauvin L, Jabalpurwala S, Séguin JR, Stotland S. Hypersensitivity to social interactions in bulimic syndromes: relationship to binge eating. J Consult Clin Psychol. 1999;67(5):765. https://doi.org/10.1037//0022-006x.67.5.765 .
doi: 10.1037//0022-006x.67.5.765
pubmed: 10535243
Rance N, Moller NP, Clarke V. ‘Eating disorders are not about food, they’re about life’: client perspectives on anorexia nervosa treatment. J Health Psychol. 2017;22(5):582–94. https://doi.org/10.1177/1359105315609088 .
doi: 10.1177/1359105315609088
pubmed: 26446375
Malson H, Bailey L, Clarke S, Treasure J, Anderson G, Kohn M. Un/imaginable future selves: a discourse analysis of in-patients’ talk about recovery from an ‘eating disorder.’ Eur Eat Disord Rev. 2011;19(1):25–36. https://doi.org/10.1002/erv.1011 .
doi: 10.1002/erv.1011
pubmed: 21182163
Maisel R, Epston D, Borden A. Biting the hand that starves you: inspiring resistance to anorexia/bulimia. New York: WW Norton & Co; 2004.
Anthony WA. Recovery from mental illness: the guiding vision of the mental health service system in the 1990s. Int J Psychosoc Rehabilitation. 1993;16(4):11. https://doi.org/10.1037/h0095655 .
doi: 10.1037/h0095655
Higbed L, Fox JR. Illness perceptions in anorexia nervosa: a qualitative investigation. Br J Clin Psychol. 2010;49(3):307–25. https://doi.org/10.1348/014466509X454598 .
doi: 10.1348/014466509X454598
pubmed: 19580703
Hewson D. From laboratory to therapy room: prediction questions for reconstructing the" new-old" story. Dulwich Centre Newsl. 1991;1991(3):5–12.
Sibeoni J, Orri M, Colin S, Valentin M, Pradère J, Revah-Levy A. The lived experience of anorexia nervosa in adolescence, comparison of the points of view of adolescents, parents, and professionals: a metasynthesis. Int J Nurs Stud. 2017;65:25–34. https://doi.org/10.1016/j.ijnursty.2016.10.006 .
doi: 10.1016/j.ijnursty.2016.10.006
pubmed: 27815986