Eating disorders are currently often approached as biopsychosocial problems. But the social or cultural aspects of the equation are frequently marginalised in treatment – relegated to mere contributory or facilitating factors. In contrast, feminist and socio-cultural approaches are primarily concerned with the relationship between eating disorders and the social/cultural construction of gender. Yet, although such approaches emerged directly from the work of feminist therapists, the feminist scholarship has increasingly observed, critiqued and challenged the biomedical model from a scholarly distance. As such, this article draws upon data from 15 semi-structured interviews with women in the UK context who have experience of anorexia and/or bulimia in order to explore a series of interlocking themes concerning the relationship between gender identity and treatment. In engaging the women in debate about the feminist approaches (something that has been absent from previous feminist work), the article examines how gender featured in women’s understandings of their problem, and the ways in which it was – or was not – addressed in treatment. The article also explores the women’s evaluations of the feminist discourse, and their discussions of how it might be implemented within therapeutic and clinical contexts.

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Eating disorders (EDs) are now often approached as biopsychosocial problems, and are widely recognised as multifactorial in origin. But it has been suggested -particularly by feminist scholars -that all is not equal within this biospsychosocial framework, with the 'social' aspects of the equation relegated to secondary or facilitating factors in treatment contexts. Drawing on data from 12 qualitative interviews with health professionals in a UK region, this article examines the extent to which socio-cultural perspectives on eating disorders (EDs) are valued and explored in ED treatment, with a particular focus on questions of gender (and femininity).Given that girls/women are disproportionately affected by EDs, the article explores to what extent the relationship between EDs and cultural constructions of femininity is actively 2 addressed within treatment. The study revealed high levels of inconsistency in this regard, in so far as some health professionals thought that such issues should be central to treatment, whereas others had 'never really considered' them before. In addition, the study examines the potential limitations to the ways in which such socio-cultural issues are perceived and addressed. Not only was the onus often on the patient to flag the relevance of such issues (rather than these being anticipated and embedded within treatment), but socio-cultural perspectives on EDs were covered little in training, making it potentially difficult for health professionals to know when such concerns were being raised. Furthermore, in drawing on the interview data, the article explores why the often 'obvious' relationship between femininity and EDs may currently be marginalised in treatment, building on a feminist critique of what counts as 'evidence-based' treatment and why.

BackgroundEating disorders (EDs) are now often approached as biopsychosocial problems. But it has been suggested by scholars interested in sociocultural factors that all is not equal within this biospsychosocial framework, with the ‘social’ aspects of the equation relegated to secondary factors within ED treatment contexts. Although sociocultural influences are well-established as risk factors for EDs, the exploration of whether or how such perspectives are useful in treatment has been little explored. In responding to this context, this article seeks to discuss and evaluate a 10 week closed group intervention based on feminist approaches to EDs at a residential eating disorder clinic in the East of England.MethodsThe data was collected via one-to-one qualitative interviews and then analysed using thematic discourse analysis.ResultsThe participants suggested that the groups were helpful in enabling them to situate their problem within a broader cultural and group context, that they could operate as a form of ‘protection’ from ideologies regarding femininity, and that a focus on the societal contexts for EDs could potentially reduce feelings of self-blame. At the same time, the research pointed to the complexities of participants considering societal rather than individualised explanations for their problems, whilst it also confronted the implications of ambivalent responses toward feminism.ConclusionsHighly visible sociocultural factors in EDs – such as gender - may often be overlooked in ED clinical contexts. Although based on limited data, this research raises questions about the marginalisation of sociocultural factors in treatment, and the benefits and challenges including the latter may involve.