Perceptions of Anorexia Nervosa and Presumptions of Recovery

Abstract

Sociocultural theorists of eating disorders recurrently investigate anorexia nervosa (AN) through a macro lens of inequality, underscoring thinness as a social construction of beauty and form of cultural capital. Conversely, other scholars attest that focus on AN as a manifestation of idealized body image may, instead, function as a red herring in illness understanding. Taken together, it becomes unclear how to best advance AN research and treatment practices when etiology is uncertain. While researchers largely depend on eating disorder professionals to elucidate AN healing complexities, as an alternative, I utilized a feminist epistemological approach to inquiry in centering individuals with personal AN experience, as another type of AN expert, from whom there is much for researchers to learn. With recognition of health and illness as both private and social experiences, I sought to understand how individuals experience AN and recovery in their everyday lives. I conducted 25 in-depth interviews (article one) and 150 open-ended surveys (articles two, three, and four) with individuals who identified as having had experience with AN. I explored: 1) how respondents understand AN and recovery, and 2) what respondents most want researchers to know about AN and recovery. My aim was not to explain why AN happens, as much as to phenomenologically explore how. In article one, I focused on how individuals experience AN and recovery in everyday self-presentation. A central implication is that AN and recovery can be recognized as interactional accomplishments that are un/successfully “done.” Thus, while conventional portrayals of AN often depict a person with AN looking into a mirror and seeing a distorted perception of their own body, respondents demonstrated how they relied on the interpretations of others to inform their impressions. In article two, I investigated how respondents evaluate weight as a metric of AN recovery. Respondents portrayed weight as a weak criterion, underscoring how it is a physical measure for a mental illness. Yet, respondents simultaneously stressed how weight matters for recovery, given low weight is requisite for support. In effect, respondents pivoted emphasis from weight as a catalyst for AN, to weight as an obstacle to recovery. In article three, respondents articulated how others’ expectations for healing did not always resonate with personal experience. This disjuncture led to treatment strategies that were often incompatible with respondents’ recovery realities. While a single definition of recovery may be useful to researchers, it may paradoxically present disempowering effects for individuals with AN, constituting or exacerbating iatrogenic harm. In article four, respondents further illuminated juxtapositions between clinical and personal definitions of AN healing. Notably, respondents positioned the development of positive relationships with others as among the most efficacious ways to heal. In addition, respondents advocated for recovery criteria that centered personal agency for more individualized and integrative AN healing. Collectively, the article themes overlapped, with AN manifesting as: an identity, role, entity, experience, and status. Ultimately, some respondents felt they had fully recovered from AN. However, most respondents, regardless of illness status, spoke about others’ misunderstandings of AN, which, from their perspectives, collaborated to fashion a masquerade of recovery that immobilized healing. The voices of respondents in the dissertation are profound, as they expose how the validity and legitimacy of their illness experience, as uncertain and negotiable, become the definition of the AN situation. Consequently, AN history remains a composite of social constructions that continually reposition questions of cause, meaning, and blame. The answers to these inquiries,which mold into illness etiologies, shape academic, clinical, conventional, personal, and professional responses.