Anorexia nervosa: A fresh perspective

Abstract

Anorexia nervosa is currently presented as a pathologised, psycho-medical feminine phenomenon through aetiological rationalisations and theories. Research results indicate that there have been no improvements in treatment outcomes for anorexia for over 50 years, except, possibly, with forms of family therapy for adolescents. This situation can be seen as critical and calls for alternative ways of understanding anorexia, and consequent different approaches to psychotherapy for persons in relationship with anorexia. This article critically explores these issues, and suggests that such circumstances offer opportunities for alternative post-structuralist approaches for informing different understandings of and working with anorexia in collaborative relational arrangements where the voices of persons in relationship with anorexia are honoured and heard.This article examines modernist, structuralist understandings of, treatment approaches for, and discourses about anorexia nervosa that have prevailed over the past half century, and their objectifying, pathologising, normative practices. 1 It offers a brief account of research outcomes of treatment for persons in relationship with anorexia, essentially indicating a cause for significant concern in the use of the medical model that has sustained ways of understanding the nature of anorexia, and psychotherapeutic ways of working.However, a relatively recent shift, from individual therapy to particular forms of family therapy used in outpatient settings for adolescents with a shorter duration of relationship with anorexia, has contributed towards improvements in clinical outcomes. This is discussed and developed with explorations of a post-constructionist approach to

Beyond the Revolving Door: Long-Term Lived Experience of Eating Disorders and Specialist Service Provision

“…Much research and theoretical debate surround the experience of anorexia nervosa (AN), the most salient ED, for which standardized “causes” remain elusive. There have been minimal improvement in treatment outcomes in EDs over the last 50 years (Botha, 2015; Steinhausen, 2002), high drop-out rates (Fassino, Pierò, Tomba, & Abbate-Daga, 2009), and low levels of service-user satisfaction (Botha, 2015). By considering AN as an inherently gendered phenomenon situated within a gendered culture and political system (Orbach, 1986), we can start to make sense of these outcomes in terms of their relationship to feelings of powerlessness and issues of control.…”

“…Correspondingly, growing prevalence and poor outcome rates associated with EDs, and the disproportionate amount of funding allocated to research in this area, reflect how dominant models of understanding and delivery of services are worryingly insufficient (Schmidt et al, 2016). There has been a call for “fresh perspectives” (Botha, 2015, p. 328) and “a new paradigm” (Touyz & Hay, 2015, p. 1) in the way we conceptualize, research, and develop interventions for EDs. Nevertheless, despite their association with topical discourses around treatment resistance and low “recovery” rates (Botha, 2015; Hay & Touyz, 2015), long-term experiences of EDs have received relatively little attention in research to date (Hay & Touyz, 2015; Hay, Touyz, & Sud, 2012; Schmidt et al, 2016).…”

“…There has been a call for “fresh perspectives” (Botha, 2015, p. 328) and “a new paradigm” (Touyz & Hay, 2015, p. 1) in the way we conceptualize, research, and develop interventions for EDs. Nevertheless, despite their association with topical discourses around treatment resistance and low “recovery” rates (Botha, 2015; Hay & Touyz, 2015), long-term experiences of EDs have received relatively little attention in research to date (Hay & Touyz, 2015; Hay, Touyz, & Sud, 2012; Schmidt et al, 2016). Recent qualitative research has started to explore the lived experience of those with “severe and enduring” presentations (Robinson, Kukucska, Guidetti, & Leavey, 2015) and is beginning to challenge the dominant more hopeless narratives by finding that full recovery in such presentations is possible where hope, support, motivation, and self-efficacy can be nurtured (Dawson, Rhodes, & Touyz, 2014).…”

Just Desserts? Exploring Constructions of Food in Women’s Experiences of Bulimia

“…As such, individual and internal factors, such as genes, cognitions, and early life experiences, have been implicated in the development of bulimia (Culbert et al, 2015). Research into such causal mechanisms and the practice of clinical diagnosis, have, however, been criticized for reifying eating disorders as an internal and individual phenomenon, which serves to pathologize the person who engages in such eating behaviors (Botha, 2015). Moreover, the attention to individual risk factors, without consideration of the broader role of sociocultural, political, and gender issues beyond the thin ideal, negates potential alternative explanations of eating disorders (Malson & Burns, 2009).…”

Analysing Anorexia Nervosa: Digital Logic Provides Alternative Meanings of Its Nature, Leading to Alternative Forms of Psychotherapy

“…Orientation alongside the persons ' hopes, dreams, visions, purposes, etc Centered position of the therapist as expert Decentered position of the therapist as coresearcher For persons in relationship with anorexia, in their specific circumstances, the use of a poststructuralist therapeutic approach, namely narrative therapy, has provided an orientation that concentrates on the specific needs and problems of each person who exhibits such archetypal images and patterns of behavior (Botha, 2015(Botha, , 2019Epston, 2020;Epston & Maisel, 2009;Ingamells, 2016aIngamells, , 2016bKronbichler, 2004;Lock et al, 2004;Madigan & Goldner, 1998;Maisel et al, 2004;Vromans & Schweitzer, 2011;Weber et al, 2006;White, 2011). For instance, a recent article (Botha, 2019) explained an innovative and amended form of narrative therapy that addressed these circumstances.…”