‘Feelings stronger than reason’: conflicting experiences of exercise in women with anorexia nervosa

Abstract

BackgroundIndividuals with anorexia nervosa frequently feel ambivalent about treatment and weight restoration, and drop out and relapse rates in treatment are high. Increased insight into the function of the eating disorder is considered essential for achieving long-lasting, meaningful change. However, research investigating the functions of anorexia nervosa tends to focus on the role of the disease per se. Distinctions are rarely made across features. In particular, the subjective experience, understanding and sense making of the engagement in compulsive exercise in individuals with anorexia nervosa has received little attention. By using a qualitative methodological approach, this paper aims to expand on prior findings by examining how patients with anorexia nervosa understand and make sense of the experience of exercise in the context of their lives and treatment programme.MethodsSemi-structured interviews were conducted with six females, four of whom were former athletes. Transcripts were subjected to interpretative phenomenological analysis (IPA).ResultsTwo overarching themes emerged in the analysis of the larger study of which this paper is a part; ‘paradoxical functions of exercise’ and ‘diverging experiences of exercise’. Diverging experiences of exercise is the focus of this paper. Firstly, in spite of being severely underweight and suffering from exhaustion, as well as having a clear awareness of the associated negative health effects, participants were engaged in a continuous cycle of rigorous and excessive exercise, which consumed extensive amounts of time and energy. Secondly, the results demonstrate how exercise routines negatively control and interfere with the participants’ involvement in the social world. Thirdly, the manner in which participants speak about their exercise reveals their wording to be characterized by efforts to downplay the extent of their actual immersion in exercise. Issues of control and ambivalence about treatment and recovery can be considered potential triggers for the participants’ engagement with exercise. Implicit meanings are elaborated upon and discussed in relation to existing literature.ConclusionsThe material provides increased insight into the multi-layered meanings of exercise for individuals with anorexia nervosa. It also suggests alternatives to current ways of understanding and approaching exercise that may enable this issue to be addressed in a more meaningful way in therapy. Qualitative approaches can make a valuable contribution to furthering such understanding.

A life put on hold: adolescents' experiences of having an eating disorder in relation to social contexts outside the family

“…For others, sports activities were anxiety-alleviating and more obviously used as an escape from difficult thoughts or demanding relationships. Because compulsive training is a common part of eating-disorder symptomatology and an important component in the causes and maintenance of the illness, 53 it is an important area to deal with in treatment.…”

Exercise and physical therapy help restore body and self in clients with severe anorexia nervosa

“…Engaging in a way of acting that involves a sense of having intentionally caused (sense of being the subject of) a movement and a feeling of having some control of that movement (sense of agency), as opposed to being controlled or driven by the activity, might need to be re-learned in these clients. In essence, such a process differs qualitatively from the rigourous and compulsive exercise in which clients with restrictive anorexia nervosa frequently engage (Bewell-Weiss and Carter, 2010;Dalle Grave et al, 2008;Davis et al, 1999;Kolnes, 2016).…”

“…The participants were recruited to take part in a broader study employing qualitative interviews with the aim of exploring experiences and making sense of their engagement in compulsive exercise; two papers from this study have recently been published (Kolnes and RodriguezMorales, 2016;Kolnes, 2016). After the interview, the women were assessed using the body examination derived from NPMP, which is described in detail in the method section.…”

Creating an Opportunity to Reflect: Ear Acupuncture in Anorexia Nervosa – Inpatients' Experiences

“…Resting is a central component of the treatment of AN. Beside starvation, excessive work out is a strategy to cope with angst (Kolnes, 2016). Our participants, used to being in constant movement to maximise burning of calories, compared the sense of well-being after acupuncture to that after working out and were thereby shown a way to exchange over-exercise with acupuncture.…”