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Externalizing your eating disorder: a qualitative interview study.

Marthe M Voswinkel1, Cleo Rijkers1,2, Johannes J M van Delden3

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Summary

Patients with anorexia nervosa (AN) view their identity and AN differently. Externalizing AN in treatment can be helpful but may also lead to feelings of injustice, requiring clinical awareness.

Keywords:
Anorexia nervosaEpistemic injusticeExternalizationPatient experience

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Area of Science:

  • Psychiatry
  • Clinical Psychology
  • Eating Disorders

Background:

  • Anorexia nervosa (AN) is often ego-syntonic, with patients internalizing the disorder as part of their identity.
  • Externalizing AN is a therapeutic strategy to help patients view it as an external influence.
  • Limited research exists on patient experiences with externalization in AN treatment.

Purpose of the Study:

  • To explore patients' perspectives on the relationship between identity and anorexia nervosa.
  • To investigate patient experiences with an externalizing approach during AN treatment.

Main Methods:

  • A qualitative interview study was conducted.
  • Fourteen patients diagnosed with anorexia nervosa participated.
  • Participants were undergoing various treatment modalities, including Family Based Treatment and Cognitive Behavioural Therapy-Enhanced.

Main Results:

  • Participants held diverse views on how AN relates to identity: as part of self, alien, or a different facet of self.
  • Patient experiences with externalization were ambivalent; it was perceived as helpful yet evoked negative responses.
  • Some patients felt their behaviors were solely attributed to AN, leading to feelings of not being taken seriously or being wrongly accused.

Conclusions:

  • Significant variation exists in how patients perceive the connection between their identity and anorexia nervosa.
  • An externalizing approach in AN treatment can potentially result in epistemic injustice.
  • Clinicians should be aware of these variations and potential injustices to foster a better therapeutic relationship.