Restriction lift date: 2026-12-31
An exploration of the lived experience of bulimia nervosa, family-based treatment for anorexia nervosa, and the process of externalisation
Loading...
Files
Date
2023
Authors
Tennyson, Aisling
Journal Title
Journal ISSN
Volume Title
Publisher
University College Cork
Published Version
Abstract
Systematic Review
Objective: This is the first qualitative systematic review that focuses solely on the experience
of bulimia nervosa (BN). Although similarities between various eating disorders (EDs) are
well documented in the literature, the uniqueness of the BN experience has also been
highlighted, including the feelings of stigma towards the condition which makes help-seeking
more difficult.
Method: A systematic search of literature was conducted, and findings from 17 qualitative
studies were synthesised using meta-ethnography.
Results: Five conceptual themes emerged: shame of not reaching the thin ideal; the
diagnostic hierarchy with bulimia as anorexia’s “failed sister”; the conflict of bulimia as a
friend and a foe; the binge/purge cycle as a dysfunctional coping strategy; and living a double
life concealing bulimia. The impact on self-identity was an overarching conceptual theme,
highlighting the similarities and distinct differences between the BN experience and other
EDs.
Discussion: Findings are discussed in relation to theory, research and practice. This review
provides a clearer understanding of the lived experience of BN and highlights the need of
sensitivity from clinicians and primary care physicians who may be involved in the
assessment of ED diagnosis.
Major Research Project, Empirical Study
Family-Based Treatment (FBT) is recommended as the first line of intervention for
young people (YP) with anorexia nervosa (AN). It utilises principles of family therapy, such
as externalisation to help separate the YP from their anorexic thoughts and behaviours using
language and metaphor. Previous research (Lonergan et al., 2022) highlighted some potential
barriers of implementing FBT, so this study explores the experience of FBT with YP
themselves. Semi-structured interviews were carried out with adolescents attending FBT for
AN enquiring about their overall experience of FBT and externalisation. It was a qualitative
study, analysed using Interpretative Phenomenological Analysis (IPA). Four main group
experiential themes emerged: why am I here? the beginnings of a hard journey; beacons of
hope; and the reward of a new perspective. Externalisation was generally experienced as
providing hope and agency in recovery and reduced feelings of guilt and blame among
participants.
Practitioner Points
• AN recovery through FBT is a challenging but transformative journey. Clinician
support, psychoeducation about AN, family support, externalisation, and weight
restoration, were all useful tools to helping them get their life back through FBT.
• Recovery from weight restoration in the final stages of FBT brought about a new
perspective, a stark contrast to the denial of AN reported initially.
• Externalisation can provide hope and agency in eating disorder recovery and help
young people separate their eating disorder thoughts from their own but should be
delivered with personal consideration and sensitivity
Description
Controlled Access
Keywords
Qualitative research , Anorexia nervosa , Externalisation , Eating disorder , Family-based treatment , Bulimia nervosa , Meta-ethnography , Systematic review , Lived experience
Citation
Tennyson, A. 2023. An exploration of the lived experience of bulimia nervosa, family-based treatment for anorexia nervosa, and the process of externalisation. DClinPsych Thesis, University College Cork.