Eating Disorder Recovery: A Metaethnography

Abstract

BACKGROUND: Eating disorders seriously affect both physical health and psychosocial functioning. Breaking the confines of an eating disorder requires engagement in a multifaceted recovery process. OBJECTIVE: This article provides a synthesis of 12 qualitative research studies with various eating disordered populations (anorexia nervosa, bulimia nervosa, binge eating disorder, eating disorder not otherwise specified, and other specified feeding and eating disorders) to elucidate the recovery process from the perspective of those who have overcome the disease. METHOD: A metasynthesis of qualitative studies was conducted using Noblit and Hare’s metaethnographic methodology. RESULTS: Five overarching themes emerged from the data: (1) the eating disorder as a life jacket, (2) drowning: recognizing consequences, (3) treading the surface: contemplating recovery, (4) swimming: the path toward recovery, and (5) reaching recovery: a sense of freedom. CONCLUSIONS: Eating disorder treatment often entails a cycle of transitions before recovery occurs. Synthesizing the experiences from the perspective of individuals who have overcome an eating disorder presents a unique understanding of the treatment and recovery process.

Keywords

eating disorder recovery qualitative

Get full access to this article

View all access options for this article.

References

Abbate-Daga

Amianto

Delsedime

De-Bacco

Fassino

(2013). Resistance to treatment and change in anorexia nervosa: A clinical overview. BMC Psychiatry, 13(1), 294. doi:10.1186/1471-244X-13-294

American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., Text revision). Washington, DC: Author.

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.

Arcelus

Mitchell

A. J.

Wales

Nielsen

(2011). Mortality rates in patients with anorexia nervosa and other eating disorders: A meta-analysis of 36 studies. Archives of General Psychiatry, 68, 724-731. doi:10.1001/archgenpsychiatry.2011.74

Arthur-Cameselle

Burgos

Burke

Cairo

Colon

Pina

M. E.

(2018). Factors that assist and hinder efforts towards recovery from eating disorders: A comparison of collegiate female athletes and on-athletes. Eating Disorders, 26, 538-555.

Bannatyne

A. J.

Abel

L. M.

(2015). Can we fight stigma with science? The effect of aetiological framing on attitudes towards anorexia nervosa and the impact on volitional stigma. Australian Journal of Psychology, 67, 38-46. doi:10.1111/ajpy.12062

Bardone-Cone

A. M.

Harney

M. B.

Maldonado

C. R.

Lawson

M. A.

Robinson

D. P.

Smith

Tosh

(2010). Defining recovery from an eating disorder: Conceptualization, validation, and examination of psychosocial functioning and psychiatric comorbidity. Behaviour Research and Therapy, 48, 194-202. doi:10.1016/j.brat.2009.11.001

Björk

Wallin

Pettersen

(2012). Male experiences of life after recovery from an eating disorder. Eating Disorders, 20, 460-468. doi:10.1080/10640266.2012.715529

Brewerton

T. D.

Costin

(2011). Long-term outcome of residential treatment for anorexia nervosa and bulimia nervosa. Eating Disorders, 19, 132-144. doi:10.1080/10640266.2011.551632

10.

Carroll

(1865). Alice’s adventures in Wonderland. London, England: Macmillan.

11.

Castellini

Lo Sauro

Mannucci

Ravaldi

Rotella

C. M.

Faravelli

Ricca

(2011). Diagnostic crossover and outcome predictors in eating disorders according to DSM-IV and DSM-V proposed criteria: A 6-year follow-up study. Psychosomatic Medicine, 73, 270-279. doi:10.1097/PSY.0b013e31820a1838

12.

Chesney

Goodwin

G. M.

Fazel

(2014). Risks of all-cause and suicide mortality in mental disorders: A meta-review. World Psychiatry, 13, 153-160. doi:10.1002/wps.20128

13.

Critical Appraisal Skills Programme. (2014). CASP checklists. Retrieved from http://www.casp-uk.net

14.

Crow

S. J.

Swanson

S. A.

Peterson

C. B.

Crosby

R. D.

Wonderlich

S. A.

Mitchell

J. E.

(2012). Latent class analysis of eating disorders: Relationships to mortality. Journal of Abnormal Psychology, 121, 225-231. doi:10.1037/a0024455

15.

Dawson

Rhodes

Touyz

(2014). “Doing the impossible”: The process of recovery from chronic anorexia nervosa. Qualitative Health Research, 24, 494-505. doi:10.1177/1049732314524029

16.

Dawson

Rhodes

Touyz

(2014). Defining recovery from anorexia nervosa: A Delphi study to determine expert practitioners’ views. Advances in Eating Disorders, 3, 165-176.

17.

Dejong

Broadbent

Schmidt

(2012). A systematic review of dropout from treatment in outpatients with anorexia nervosa. International Journal of Eating Disorders, 45, 635-647. doi:10.1002/eat.20956

18.

Duncan

T. K.

Sebar

Lee

(2015). Reclamation of power and self: A meta-synthesis exploring the process of recovery from anorexia nervosa. Advances in Eating Disorders, 3, 177-190.

19.

Easter

M. M.

(2012). “Not all my fault”: Genetics, stigma, and personal responsibility for women with eating disorders. Social Science & Medicine, 75, 1408-1416. doi:10.1016/j.socscimed.2012.05.042

20.

Espíndola

Blay

(2009). Anorexia nervosa’s meaning to patients: A qualitative synthesis. Psychopathology, 42, 69-80.

21.

Espíndola

C. R.

Blay

S. L.

(2013). Long term remission of anorexia nervosa: Factors involved in the outcome of female patients. PLoS One, 8(2), e56275. doi:10.1371/journal.pone.0056275

22.

Farrell

N. R.

Lee

A. A.

Deacon

B. J.

(2015). Biological or psychological? Effects of eating disorder psychoeducation on self-blame and recovery expectations among symptomatic individuals. Behaviour Research and Therapy, 74, 32-37. doi:10.1016/j.brat.2015.08.011

23.

France

Wells

Lang

Williams

(2016). Why, when and how to update a meta-ethnography qualitative synthesis. Systematic Reviews, 5, 44.

24.

Grilo

C. M.

Pagano

M. E.

Stout

R. L.

Markowitz

J. C.

Ansell

E. B.

Pinto

. . . Skodol

A. E.

(2012). Stressful life events predict eating disorder relapse following remission: Six-year prospective outcomes. International Journal of Eating Disorders, 45, 185-192. doi:10.1002/eat.20909

25.

Hay

P. J.

Cho

(2013). A qualitative exploration of influences on the process of recovery from personal written accounts of people with anorexia nervosa. Women & Health, 53, 730-740. doi:10.1080/03630242.2013.821694

26.

Herpertz-Dahlmann

(2009). Adolescent eating disorders: Definitions, symptomatology, epidemiology and comorbidity. Child and Adolescent Psychiatric Clinics of North America, 18, 31-47. doi:10.1016/j.chc.2008.07.005

27.

Jenkins

Ogden

(2012). Becoming “whole” again: A qualitative study of women’s views of recovering from anorexia nervosa. European Eating Disorders Review, 20, e23-e31. doi:10.1002/erv.1085

28.

Lindgren

B. M.

Enmark

Bohman

Lundström

(2015). A qualitative study of young women’s experiences of recovery from bulimia nervosa. Journal of Advanced Nursing, 71, 860-869. doi:10.1111/jan.12554

29.

Linville

Brown

Sturm

McDougal

(2012). Eating disorders and social support: Perspectives of recovered individuals. Eating Disorders, 20, 216-231. doi:10.1080/10640266.2012.668480

30.

Lipson

S. K.

Sonneville

K. R.

(2017). Eating disorders symptoms among undergraduate and graduate students at 12 U.S. colleges and universities. Eating Behaviors, 24, 81-88.

31.

Lock

Argras

W. S.

Le Grange

Couturier

Safer

Bryson

S. W.

(2013). Do end of treatment assessments predict outcome at follow-up in eating disorders? International Journal of Eating Disorders, 46, 771-778.

32.

Malson

Bailey

Clarke

Treasure

Anderson

Kohn

(2011). Un/imaginable future selves: A discourse analysis of in-patients’ talk about recovery from an “eating disorder.” European Eating Disorders Review, 19, 25-36. doi:10.1002/erv.1011

33.

Noblit

G. W.

Hare

R. D.

(1988). Meta-ethnography: Synthesizing qualitative studies. Newbury Park, CA: Sage.

34.

Pettersen

Thune-Larsen

Wynn

Rosenvinge

J. H.

(2013). Eating disorders: Challenges in the later phases of the recovery process. Scandinavian Journal of Caring Sciences, 27, 92-98. doi:10.1111/j.1471-6712.2012.01006.x

35.

Pettersen

Wallin

Björk

(2016). How do males recover from eating disorders? An interview study. BMJ Open, 6(8). doi:10.1136/bmjopen-2015-010760

36.

Rodgers

R. F.

Paxton

S. J.

McLean

S. A.

Massey

Mond

J. M.

Hay

P. J.

Rodgers

(2015). Stigmatizing attitudes and beliefs toward bulimia nervosa: The importance of knowledge and eating disorder symptoms. Journal of Nervous and Mental Disease, 203, 259-263. doi:10.1097/NMD.0000000000000275

37.

Root

T. L.

Pinheiro

A. P.

Thornton

Strober

Fernandez-Aranda

Brandt

. . . Bulik

C. M.

(2010). Substance use disorders in women with anorexia nervosa. International Journal of Eating Disorders, 43, 14-21. doi:10.1002/eat.20670

38.

Schlegl

Diedrich

Neumayr

Fumi

Naab

Voderholzer

(2016). Inpatient treatment for adolescents with anorexia nervosa: Clinical significance and predictors of treatment outcome. European Eating Disorders Review, 24, 214-222. doi:10.1002/erv.2416

39.

Smith

Chouliara

Morris

P. G.

Collin

Power

Yellowlees

. . . Cook

(2014). The experience of specialist inpatient treatment for anorexia nervosa: A qualitative study from adult patients’ perspectives. Journal of Health Psychology, 21, 16-27. doi:10.1177/1359105313520336

40.

Steinhausen

H. C.

(2009). Outcome of eating disorders. Child and Adolescent Psychiatric Clinics of North America, 18, 225-242. doi:10.1016/j.chc.2008.07.013

41.

Toto-Moriarty

(2013). A retrospective view of psychodynamic treatment: Perspectives of recovered bulimia nervosa patients. Qualitative Social Work, 12, 833-848. doi:10.1177/1473325012460077

42.

Ulian

M. D.

Unsain

R. F.

Sato

P. M.

Pereira

P. R.

Stelmo

I. C.

Sabatini

Scagliusi

F. B.

(2013). Current and previous eating practices among women recovered from anorexia nervosa: A qualitative approach. Jornal Brasileiro De Psiquiatria, 62, 275-284. doi:10.1590/S0047-20852013000400005

43.

Vall

Wade

T. D.

(2015). Predictors of treatment outcome in individuals with eating disorders: A systematic review and meta-analysis. International Journal of Eating Disorders, 48, 946-971. doi:10.1002/eat.22411

44.

Wales

Brewin

Cashmore

Haycraft

Baggott

Cooper

Arcelus

(2016). Predictors of positive treatment outcome in people with anorexia nervosa treated in a specialized inpatient unit: The role of early response to treatment. European Eating Disorders Review, 24, 417-424. doi:10.1002/erv.2443

45.

Wright

K. M.

(2015). Maternalism: A healthy alliance for recovery and transition in eating disorder services. Journal of Psychiatric and Mental Health Nursing, 22, 431-439. doi:10.1111/jpm.12198