‘In an otherwise limitless world, I was sure of my limit.’† Experiencing Anorexia Nervosa: A phenomenological metasynthesis

Abstract

Anorexia Nervosa (AN) has the highest mortality rate of the mental disorders, with still less than 50% of affected individuals achieving recovery. Recent calls to bring innovative, empirical research strategies to the understanding of illness and its core psychopathological features highlight the need to address significant paucity of efficacious treatment. The current study brings a phenomenological approach to this challenge, synthesizing lived experience phenomena as described by qualitative literature. Fifty-three studies published between the years 1998 and 2021 comprising a total of 1557 participants aged 12–66 suffering from AN or sub-threshold AN are included. Reciprocal and refutational analysis generated six key third-order constructs: “emotion experienced as overwhelming,” “identity,” “AN as a tool,” “internal conflict relating to Anorexia,” “interpersonal communication difficulties” and “corporeality.” Twenty-six sub-themes were identified, the most common being fear, avoidance, AN as guardian/protector, and AN as intertwined with identity. Some themes associated with current treatment models such as low self-esteem, need for social approval and feelings of fatness were less common. We highlight the significant role of intense and confusing emotion in AN, which is both rooted in and engenders amplified fear and anxiety. Restrictive eating functions to numb these feelings and withdraw an individual from a chaotic and threatening world whilst providing a sense of self around which to build an illness identity. Results have implications for therapeutic practice and overly protective weight and shape focused medical treatment models, which may serve to reinforce the disease.

“Your mind doesn’t have room for anything else”: a qualitative study of perceptions of cognitive functioning during and after recovery from anorexia nervosa

“…Whilst the first suggestion cannot be supported by the methodology and findings of the present study, the second and third suggestions can be somewhat facilitated (albeit not proven) by the poor information processing and concentration, attentional bias towards AN content, and fatigue reported by respondents. Extended duration of illness may worsen this process; those with longer illness duration (> 9 years) in the current study reported noticing their memory and wider cognitive problems worsening over the course of the illness, aligning with other phenomenological findings [ 23 ].…”

“…In particular, several respondents described how inflexible behaviour minimised the chances of being in situations where their mood or anxiety could be worsened; inflexibility may be used as an emotion regulation strategy. This aligns with phenomenological findings whereby control and inflexibility represent tools for emotional avoidance and numbing [ 23 ], and quantitative findings linking inflexibility to heightened eating disorder symptoms and behaviours [ 38 ], in people with AN. In this way, there may be utility in both targeting the low mood and high anxiety associated with AN, formulating interventions in aiding sufferers to experience and regulate emotions as well as to introduce more flexibility [ 38 ].…”

“…Overall, the findings of this study indicate that although people with AN often appear to be high-functioning in the acute stages of illness, there are significant cognitive difficulties that are experienced, which lead to distress, problems with engaging in daily life and may represent barriers to recovery [ 33 ]. Many of the findings converge with a prior phenomenological meta-synthesis by Bryant and colleagues [ 23 ], although others relating to specific cognitive difficulties build on their findings, most notably in their identified domain of “functional impairment”. Some of the reported cognitive difficulties were features of AN identified in prior research (e.g.…”

“…As noted by Feyaerts and colleagues, the way to unite the subjective experience of psychiatric symptoms with empirical findings, is to “return to the things themselves” [ 21 , 22 ]. A research phenomenological meta-synthesis conducted by Bryant and colleagues [ 23 ], incorporating data from 1,557 people with AN, highlighted the role of restrictive eating in mitigating difficult and confusing emotions to aid the individual in navigating a threatening world, as well as providing a sense of self and identity. The authors remarked on the lack of qualitative data on cognitive difficulties and traits associated with AN, and how this impedes interpretive potential [ 23 ].…”

“…A research phenomenological meta-synthesis conducted by Bryant and colleagues [ 23 ], incorporating data from 1,557 people with AN, highlighted the role of restrictive eating in mitigating difficult and confusing emotions to aid the individual in navigating a threatening world, as well as providing a sense of self and identity. The authors remarked on the lack of qualitative data on cognitive difficulties and traits associated with AN, and how this impedes interpretive potential [ 23 ]. Thus, although functional impairment is identified as a sub-theme in this study, the studies available for the synthesis did not enable a more specific exploration of subjective cognitive function in AN.…”