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

Abstract

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.

Discordant conceptualisations of eating disorder recovery and their influence on the construct of terminality

“…In EDs, chronicity or possible ‘terminality’ must not be conflated with or defined by low motivation for treatment previously experienced as ineffective or traumatic, co-occurring psychiatric disorders, decreased quality-of-life, suicidality, and untreated malnutrition [ 186 – 188 ]. Many of these feelings or states are common among people with EDs regardless of illness duration or ED diagnosis [ 173 , 189 – 191 ], and some are regarded as ‘hallmarks’ of an ED [ 192 ]. People with EDs may have a relationship to death broadly and death from an ED in particular [ 12 , 193 – 195 ] that may be unfathomable to non-ED populations, and this must be appropriately understood and factored into any assessment of or criteria for ED ‘terminality.’ People with EDs commonly express feelings of treatment unworthiness [ 196 , 197 ], guilt for the impact of their ED on others [ 12 , 198 ] and endorsement of the necessity of presenting in a physical state of extreme severity to feel their suffering is valid and deserving of help [ 188 , 197 , 199 ].…”

“…In EDs, chronicity or possible 'terminality' must not be conflated with or defined by low motivation for treatment previously experienced as ineffective or traumatic, co-occurring psychiatric disorders, decreased quality-oflife, suicidality, and untreated malnutrition [186][187][188]. Many of these feelings or states are common among people with EDs regardless of illness duration or ED diagnosis [173,[189][190][191], and some are regarded as 'hallmarks' of an ED [192]. People with EDs may have a relationship to death broadly and death from an ED in particular [12,[193][194][195] that may be unfathomable to non-ED populations, and this must be appropriately understood and factored into any assessment of or criteria for ED 'terminality. '…”

“Once Again It Becomes a Friend in Times of Adversity”: A Qualitative Exploration of Interrelationships between Anorexia Nervosa and Trauma over Ten Years

“…To better understand the complexities of a combined AN and trauma profile, some researchers have utilised a qualitative research approach, seeking to provide novel insights into trauma-related factors that are maintaining AN through exploring the experiences of people with a lived experience [18]. These researchers adopted a broad perspective on what constitutes trauma, recognising the diversity and subjectivity of traumatic experiences and their complex inter-relationships with AN [20]. In doing so, they capture "big T traumas" which are covered in medical definitions of trauma (i.e., direct or indirect exposure to serious injury, death, or sexual violence) [21] as well as "hidden traumata" or "little t trauma" such as grief, loss, bullying, critical parenting, neglect, and emotional abuse [22] (p. xxii).…”