Conceptualizing eating disorder recovery research: Current perspectives and future research directions

Abstract

Background How we research eating disorder (ED) recovery impacts what we know (perceive as fact) about it. Traditionally, research has focused more on the “what” of recovery (e.g., establishing criteria for recovery, reaching consensus definitions) than the “how” of recovery research (e.g., type of methodologies, triangulation of perspectives). In this paper we aim to provide an overview of the ED field’s current perspectives on recovery, discuss how our methodologies shape what is known about recovery, and suggest a broadening of our methodological “toolkits” in order to form a more complete picture of recovery. Body This paper examines commonly used methodologies in research, and explores how incorporating different perspectives can add to our understanding of the recovery process. To do this, we (1) provide an overview of commonly used methodologies (quantitative, qualitative), (2) consider their benefits and limitations, (3) explore newer approaches, including mixed-methods, creative methods (e.g., Photovoice, digital storytelling), and multi-methods (e.g., quantitative, qualitative, creative methods, psycho/physiological, behavioral, laboratory, online observations), and (4) suggest that broadening our methodological “toolkits” could spur more nuanced and specific insights about ED recoveries. We propose a potential future research model that would ideally have a multi-methods design, incorporate different perspectives (e.g., expanding recruitment of diverse participants, including supportive others, in study co-creation), and a longitudinal course (e.g., capturing cognitive and emotional recovery, which often comes after physical). In this way, we hope to move the field towards different, more comprehensive, perspectives on ED recovery. Conclusion Our current perspectives on studying ED recovery leave critical gaps in our knowledge about the process. The traditional research methodologies impact our conceptualization of recovery definitions, and in turn limit our understanding of the phenomenon. We suggest that we expand our range of methodologies, perspectives, and timeframes in research, in order to form a more complete picture of what is possible in recovery; the multiple aspects of an individual’s life that can improve, the greater number of people who can recover than previously believed, and the reaffirmation of hope that, even after decades, individuals can begin, and successfully continue, their ED recovery process.

More than an outcome: a person-centered, ecological framework for eating disorder recovery

“…Researchers have examined eating disorder (ED) recovery using diverse methodological approaches [ 1 ], which has yielded a complex and nuanced body of research. While early conceptualizations of recovery focused on physical and behavioural markers such as weight gain and behavioural abstinence (e.g., [ 2 ]), the importance of psychological factors in recovery is now widely accepted [ 3 ].…”

“…From this perspective, we view recovery as an individualized and personal experience. What recovery ‘is’ depends on: (1) treatment approach and assumptions about aetiology in clinical practice [ 52 ]; (2) epistemological and ontological stances in research [ 1 ]; and (3) the multi-faceted lived experiences of individuals navigating recovery. This is different from clinical remission which focuses on the presence or absence of symptoms.…”

A call for autism‐led research exploring definitions of recovery in Autistic individuals with an eating disorder

“…Studies should seek to utilize multiperspectives, focusing on the lived/living experience of Autistic individuals with EDs but also including the perspectives of family members, friends, and ED healthcare professionals. This approach acknowledges that these perspectives will inform the individuals definitions of and priorities in recovery and will hopefully work toward achieving consensus across all those involved in the recovery process (Hower et al, 2022). These approaches should be informed by both quantitative and qualitative data, adopting multi‐ and mixed‐method approaches to explore recovery outcomes and perspectives, integrating clinically measurable outcomes with lived/living experience perspectives.…”

“…Eating disorders (EDs), such as anorexia nervosa (AN), bulimia nervosa (BN) and binge‐eating disorder (BED), are serious mental health conditions that typically have poor recovery outcomes (Linardon et al, 2017; Murray et al, 2018; Peat et al, 2017). A recent paper exploring the design and methodologies of recovery research in EDs suggested several novel approaches to capture a broader, more comprehensive account of recovery, including multimethod and multiperspective study designs across longer spans on time (see Hower et al, 2022). There remain stark gaps in knowledge regarding recovery in subgroups of individuals with EDs, including those with commonly co‐occurring conditions such as autism, where a similar application of such innovative methodologies and designs is urgently required.…”

“…Recent evidence emphasizes the importance of psychosocial factors (de Vos et al, 2017; Richmond et al, 2020; Stockford et al, 2018), with several studies suggesting that these factors are often sufficient for personal definitions of recovery, despite continued presentation of ED behaviors (e.g., Slof‐Op't et al, 2019; Wetzler et al, 2020). It is therefore now well‐established that definitions of recovery from EDs should incorporate physical, behavioral, and psychological criteria that are underpinned by the perspectives of those with lived/living experience (Hower et al, 2022).…”