Sense of self and anorexia nervosa: A grounded theory

The aim of this study was to explore the nature of the relationship between the self and the eating disorder in individuals with a lifetime history of anorexia nervosa (AN).

A qualitative design was used, given the exploratory nature of the study and the need to gain rich and in-depth data regarding the topic under investigation.

Semi-structured interviews were conducted with 11 women with a lifetime history of AN. Interview transcripts were analysed using constructivist grounded theory methodology.

A theoretical framework of the nature of the relationship between the self and AN was developed, which included five related categories: AN taking over the self, AN protecting the self, sharing the self with AN, being no one without AN, and discovering the real me (accepting the fear).

Participants described a process of the self being taken over by AN to the point where it was shared with the eating disorder. This led participants to fear being no one without AN and to be unable to let go of the disorder, appreciating AN's ability to protect the self. To recover from AN, participants had to discover the real self, by accepting the fear of the unknown and separating the self from AN. The findings have important implications for the target of therapeutic interventions to improve recovery rates.

The self is shared with the eating disorder in AN, and separating the self from AN is crucial to recover from the disorder. Therapeutic interventions for AN need to target the enmeshed relationship between the self and the eating disorder, as opposed to focusing exclusively on weight and shape concerns.