Sense of self and body image in anorexia nervosa: Call for participants

My story with eating disorders began at my first full-time job. I was two years out of university when offered a position with the Eating Disorders Service at the Royal Children’s Hospital, Melbourne. I felt a thrill to be starting in a new, challenging role as a research coordinator, but the nerves hit with the scheduling of my first interview.

I was to meet with a 17-year-old girl who had finished treatment six months previously for anorexia nervosa. I called the family, and the girl’s mother explained her daughter would like to see me but with one request. We would need to meet away from the consulting rooms where her treatment had taken place due to the significant anxiety that would be caused by being near there. I was a bit surprised by this request but after making arrangements to ensure the interview would be the least distressing it could be, I met with the girl. Over the course of the interview, she explained her experience of anorexia and of treatment. Her story shocked me and I quickly realised that my knowledge about eating disorders was limited.

The more interviews I conducted with the many different families and young people who came in for treatment, the more my understanding and sense of admiration grew. The journeys described by these incredible individuals and their families was awe inspiring but also profoundly saddening. Although each story was unique, over and over again I saw the same themes emerge ─ of loss, uncertainty, and worthiness. Alongside these themes was the constant and pressing message in our team meetings that we didn’t know enough about eating disorders ─ enough about development, enough about illness course, enough about recovery. The Eating Disorders Service team itself was made up of brilliant, caring, and above all kind individuals. I was continuously inspired by their dedication to helping the families and young people in need despite the challenge our lack of knowledge posed.

When it came time then for me to decide the next step in my career, the decision was obvious ─ undertake a PhD investigating anorexia.

Research project will investigate the role of identity in anorexia

Once I decided on undertaking this PhD, I was fortunate to be put in contact with Associate Professor Andrea Phillipou who agreed to become my supervisor along with Dr Amy Malcolm and Dr Christina Ralph-Nearman. Together, we developed a research plan to explore the key factor of identity.

The research suggests that identity (i.e., one’s sense of self or how well you know yourself) is an important aspect of anorexia, but our understanding of the role of identity is still very much limited. Findings from both qualitative and quantitative studies indicate identity may be a key characteristic of anorexia, involved in maintaining the disorder and conversely, in achieving recovery (e.g., Stein & Corte, 2007; Verschueren et al., 2017; Conti, 2018; Williams et al., 2016; Weaver et al., 2005). Historically, many theories on the nature of anorexia also suggested identity to be a core driving factor such as in the works of Bruch (1981, 1982), Casper (1983), Garfinkel & Garner (1983), and Goodsitt (1997). Bruch (1981, 1982) even went so far as to say anorexia was “a disorder of identity”.

Yet despite these theories and research, identity remains a relatively neglected factor today with limited studies investigating the role of identity in anorexia directly. As such, many questions around identity in anorexia remain, including what potential mechanisms or processes connect identity to anorexia symptoms. In particular, the potential connection between identity and the core symptom of body image disturbances is of interest as research suggests body image is strongly linked to one’s sense of identity (Kling, 2019).

As such, this research project aims to investigate the role of identity in anorexia by examining the relationship between identity and body image. We hope by examining the relationship between these factors, we can gain a better understanding of how exactly identity is linked with anorexia.

To investigate this research question, we have created an online study comprised of questionnaires to collect information on identity and body image:

Who can participate?

Anyone over the age of 18 can participate in this online study. In particular, I am keen to hear from people who are recovered or are on their recovery journey from anorexia. Please note however that participants can be people with any type of eating disorder or those with no history of any eating disorder ─ everyone is welcome.

What will I be asked to do?

This online study will ask you questions about yourself, your mental health history, and eating disorder symptoms. There will also be questions asking about your feelings around your body image, your feelings around your sense of self, and your mood and personality. Throughout this study, some questions will ask you to type in information, while others will simply ask you to select an option from a list.

As an optional reimbursement for your time completing the study you can choose to enter a lottery for a chance to win one of five $100 Coles gift vouchers. Please note that these gift cards are in Australian currency so may not be usable outside of Australia.

How can I participate?

Visit this link to participate: https://swinuw.au1.qualtrics.com/jfe/form/SV_8eMsl7oFE7axYc6

This study, which is open until 1st December 2022, has been approved by the HREC of Swinburne University of Technology (#20216021).

If you have a question about this study, you are encouraged to contact me (Scarlett) at scroce@swin.edu.au

References

Bruch, H. (1981). Developmental Considerations of Anorexia Nervosa and Obesity. The Canadian Journal of Psychiatry, 26(4), 212-217. https://doi.org/10.1177/070674378102600402

Bruch, H. (1982). Anorexia Nervosa: therapy and theory. The American journal of psychiatry., 139(12), 1531-1538. https://doi.org/10.1176/ajp.139.12.1531

Casper, R. C. (1983). Some Provisional ldeas Concerning the Psychologic Structure in Anorexia Nervosa and. Anorexia Nervosa: recent developments in research.

Conti, J. E. (2018). Recovering Identity from Anorexia Nervosa: Women’s Constructions of Their Experiences of Recovery from Anorexia Nervosa Over 10 Years. Journal of Constructivist Psychology, 31(1), 72-94. https://doi.org/10.1080/10720537.2016.1251366

Garfinkel, P., & Garner, D. (1983). The multidetermined nature of anorexia nervosa. In P. L. Darby, P. E. Garfinkel, D. M. Garner, & D. V. Coscina (Eds.), Anorexia Nervosa: recent developments in research (pp. 3-14). Liss, A. R.

Goodsitt, A. (1997). Eating disorders: A self-psychological perspective. In Handbook of treatment for eating disorders, 2nd ed. (pp. 205-228). The Guilford Press.

Kling, J. (2019). Being at home in one’s body. Body image in light of identity development.

Stein, K. F., & Corte, C. (2007). Identity impairment and the eating disorders: content and organization of the self-concept in women with anorexia nervosa and bulimia nervosa. European Eating Disorders Review, 15(1), 58-69. https://doi.org/10.1002/erv.726

Verschueren, M., Luyckx, K., Kaufman, E. A., Vansteenkiste, M., Moons, P., Sleuwaegen, E., Berens, A., Schoevaerts, K., & Claes, L. (2017). Identity Processes and Statuses in Patients with and without Eating Disorders. European Eating Disorders Review, 25(1), 26-35. https://doi.org/10.1002/erv.2487

Weaver, K., Wuest, J., & Ciliska, D. (2005). Understanding Women’s Journey of Recovering From Anorexia Nervosa. Qualitative Health Research, 15(2), 188-206. https://doi.org/10.1177/1049732304270819

Williams, K., King, J., & Fox, J. R. E. (2016). Sense of self and anorexia nervosa: A grounded theory. Psychology and Psychotherapy: Theory, Research and Practice, 89(2), 211-228. https://doi.org/10.1111/papt.12068

About Scarlett Croce

I’m a PhD student at Swinburne University of Technology, Melbourne, Australia. I am interested in eating disorders and how our sense of identity is connected to mental health. I completed a Bachelor of Arts and Honours degree in Psychology at Deakin University during which I developed a passion for psychological research. I began my PhD in 2021 and am thoroughly enjoying the experience. As of this year, I have also commenced a Masters in Clinical Psychology alongside my PhD with the goal of becoming a researcher-clinician ─ someone who is able to use their work with clients to inform their research and vice versa to improve both. Outside of psychology, I have a deep love of philosophy, baking, and my two cats, Bella and Tabitha. I have also been studying Japanese for the past three years which is a challenging but highly rewarding hobby!

All articles by Scarlett Croce

2 Responses

  1. Dear Scarlett,

    Your article is, unfortunately, close to home for many suffering from this illness and the anxieties and distress around the lack of treatment provided. I commend you on a statement with such an open mind and for throwing yourself into this study. This ED field will benefit from your research and advocacy and give hope to people like myself who have been dismissed and treated so poorly. As I have mentioned in previous articles on The Diary Healer, June has given me something to live and strive for towards recovery and advocacy. You are a goal where I would love to see myself one day. I want to commend and praise you for your individualised interview with working collaboratively with that young lady that would have had an impact you may not truly understand for her; you used the words “unique and individualised” which are left in the dark with eating disorders. To that I want to say a personal thank you for recognising that within this area, you have more knowledge than most by using those two words alone, I feel. I congratulate you in your endeavour as you try to seek out the role of identities and anorexia. I know anorexia leaves me searching for this connection within myself daily. Like you in your study, I will not quit my search because together, this here is what starts to change. I am willing to give you anything needed to help this study lead to early intervention and individualised treatment plans for all lost in this illness.

    Sarah Bailey

    • Scarlett says:

      Dear Sarah,
      Thank you for your beautiful reply to my post. It’s so humbling to hear that my research speaks to you and is meaningful. Yes, I couldn’t agree more that we must work towards “unique and individualized” as words which govern treatment and care. In a small way, I hope this research can contribute to this goal. I’ll remember your words here during the difficult times of this PhD.
      Scarlett

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