Seeing through the façade of Anorexia: A grounded theory of emotional change processes associated with recovery from Anorexia Nervosa

Journal article


Drinkwater, Danielle, Holttum, Sue, Lavender, Tony, Startup, Helen and Oldershaw, Anna 2022. Seeing through the façade of Anorexia: A grounded theory of emotional change processes associated with recovery from Anorexia Nervosa. Frontiers in Psychiatry. 13, p. 868586. https://doi.org/10.3389/fpsyt.2022.868586
AuthorsDrinkwater, Danielle, Holttum, Sue, Lavender, Tony, Startup, Helen and Oldershaw, Anna
AbstractObjectives: Difficulties in managing emotions have been implicated in the development and maintenance of anorexia nervosa (AN), and psychological treatment models seek to address this in putative targets of change. Yet the field of psychotherapy remains unclear and insufficiently evidenced about the process of change and how this is actually achieved, including in what steps and in what order within clinical treatment. This qualitative study sought to develop theory about the process of emotional change during recovery from anorexia. Methods: Semi-structured interviews were carried out with nine women currently engaged in psychological treatment for anorexia. Interviews included questions pertaining to participants’ experience of anorexia, emotions, and emotion management. A constructivist version of grounded theory was employed. Results: The analysis produced 10 major categories, comprising over 60 focused codes. Categories were clustered together into three super categories, reflecting 3 distinct but interrelated phases of participants’ journeys toward recovery. The phases were: (1) Coping in a world of uncertainty, (2) Seeing through the façade of anorexia, and (3) Recovery and growth. Whilst movement toward later positions often appeared to be contingent on earlier ones, the analysis suggests that this was not an entirely linear process and that participants moved between positions as they grappled with the process of change. Participants came to view behaviors associated with anorexia as emotion-management strategies that were not working and as a façade. As they moved toward recovery and growth, they became less confined by their need for safety, and to see emotions as meaningful and valuable. Becoming more connected to emotional experience and expression, coincided with positive shifts in their intra and interpersonal relationships. Conclusion: These findings support the recent shift toward emotion-focused models of anorexia. They also highlight an important focus in supporting individuals with AN to connect with, and be guided by, emotional experiences in their relationships with themselves and the world around them. This new grounded theory offers a putative process of change that could be utilized to guide intervention development.
KeywordsPsychiatry; Anorexia; Emotion; Recovery; Emotion regulation; Schema therapy; Emotion focused therapy
Year2022
JournalFrontiers in Psychiatry
Journal citation13, p. 868586
PublisherFrontiers
ISSN1664-0640
Digital Object Identifier (DOI)https://doi.org/10.3389/fpsyt.2022.868586
Official URLhttps://www.frontiersin.org/articles/10.3389/fpsyt.2022.868586/full
Publication dates
Online24 Jun 2022
Publication process dates
Accepted01 Jun 2022
Deposited11 Jul 2022
Publisher's version
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Output statusPublished
Licensehttp://creativecommons.org/licenses/by/4.0/
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25 years of Salomons, 9 years of psychology research
Lavender, T., Spencer, A. and Callanan, M. 1998. 25 years of Salomons, 9 years of psychology research. Psychology Research Journal. 8 (ii), pp. 3-5.
Clinical psychology training and the core placement issue: ways forward
Ashcroft, J., Callanan, M., Adams, M., Roth, A., Gray, I. and Lavender, T. 1998. Clinical psychology training and the core placement issue: ways forward. Clinical Psychology Forum. 112, pp. 50-52.
The role of clinical psychologists in community mental health teams
Blumenthal, S. and Lavender, T. 1997. The role of clinical psychologists in community mental health teams. Clinical Psychology & Psychotherapy. 4 (3), pp. 192-200.
Express yourself? Research in brief
Holttum, S. 1998. Express yourself? Research in brief. The Psychologist. 11 (6), pp. 296-296.
Is abstinence from alcohol dangerous? Research in brief
Holttum, S. 1998. Is abstinence from alcohol dangerous? Research in brief. The Psychologist. 11 (4), p. 186.
Qualitative research methods in psychiatric rehabilitation
Lavender, T. and Lake, N. 2000. Qualitative research methods in psychiatric rehabilitation. Psychiatric Rehabilitation Skills. 4 (2), pp. 321-339. https://doi.org/10.1080/10973430008408413
Putting aggression into context: an investigation into contextual factors influencing the rate of aggressive incidents in a psychiatric hospital
Lavender, T. and Shepherd, M. 1999. Putting aggression into context: an investigation into contextual factors influencing the rate of aggressive incidents in a psychiatric hospital. Journal of Mental Health. 8 (2), pp. 159-170. https://doi.org/10.1080/09638239917535
Schizophrenia
Lavender, T. 2000. Schizophrenia. in: Champion, L. and Power, M. (ed.) Adult Psychological Problems Hove, UK Psychology Press. pp. 201-224
Service practitioner and referrer perspectives of a primary care based mental health consultation service
Tulett, F., Jones, F. and Lavender, T. 2006. Service practitioner and referrer perspectives of a primary care based mental health consultation service. Clinical Psychology Forum. 166, pp. 19-23.
An investigation of the impact of training social workers and their managers
Duffy, T., Holttum, S. and Keegan, M. 1998. An investigation of the impact of training social workers and their managers. Alcoholism. 34 (1-2), pp. 93-104.
Personality style, psychological adaptation and expectations of trainee clinical psychologists
Brooks, J., Holttum, S. and Lavender, T. 2002. Personality style, psychological adaptation and expectations of trainee clinical psychologists. Clinical Psychology & Psychotherapy. 9 (4), pp. 253-270. https://doi.org/10.1002/cpp.318
Determinants of quality of life in black African women with HIV living in London
Onwumere, J., Holttum, S. and Hirst, F. 2002. Determinants of quality of life in black African women with HIV living in London. Psychology, Health and Medicine. 7 (1), pp. 61-74. https://doi.org/10.1080/13548500120101568
The relationship between acceptance and cognitive representations of pain in participants of a pain management programme
Rankin, H. and Holttum, S. 2003. The relationship between acceptance and cognitive representations of pain in participants of a pain management programme. Psychology, Health and Medicine. 8 (3), pp. 329-334. https://doi.org/10.1080/1354850031000135768
Factors influencing levels of research activity in clinical psychologists: a new model
Holttum, S. and Goble, L. 2006. Factors influencing levels of research activity in clinical psychologists: a new model. Clinical Psychology & Psychotherapy. 13 (5), pp. 339-351. https://doi.org/10.1002/cpp.501
Perceived improvements in service user involvement in two clinical psychology training courses
Holttum, S. and Hayward, M. 2010. Perceived improvements in service user involvement in two clinical psychology training courses. Psychology Learning & Teaching. 9 (1), pp. 16-24. https://doi.org/10.2304/plat.2010.9.1.16
Factors in outcome of cognitive-behavioural therapy for psychosis: users' and clinicians' views
McGowan, J., Lavender, T. and Garety, P. 2005. Factors in outcome of cognitive-behavioural therapy for psychosis: users' and clinicians' views. Psychology and Psychotherapy: Theory Research and Practice. 78 (4), pp. 513-529. https://doi.org/10.1348/147608305X52559
The physical healthcare experiences of women with mental health problems: status versus stigma
Birch, S., Lavender, T. and Cupitt, C. 2005. The physical healthcare experiences of women with mental health problems: status versus stigma. Journal of Mental Health. 14 (1), pp. 61-72. https://doi.org/10.1080/09638230500048032
WAIS III UK: an extension of the UK comparability study
Wycherley, R., Lavender, T., Holttum, S., Crawford, J. and Mockler, D. 2005. WAIS III UK: an extension of the UK comparability study. British Journal of Clinical Psychology. 44 (2), pp. 279-288. https://doi.org/10.1348/014466505X29440
Working with others
Lavender, T. and Allcock, S. 2006. Working with others. in: Hall, J. and Llewelyn, S. (ed.) What is Clinical Psychology? Oxford Oxford University Press. pp. 297-312
Deconstructing delusions: a qualitative study examining the relationship between religious beliefs and religious delusions
Drinnan, A. and Lavender, T. 2006. Deconstructing delusions: a qualitative study examining the relationship between religious beliefs and religious delusions. Mental Health, Religion and Culture. 9 (4), pp. 317-331. https://doi.org/10.1080/13694670500071711
Children's explanations of aggressive incidents at school within an attribution framework
Joscelyne, T. and Holttum, S. 2006. Children's explanations of aggressive incidents at school within an attribution framework. Child and Adolescent Mental Health. 11 (2), pp. 104-110. https://doi.org/10.1111/j.1475-3588.2006.00397.x
Psychosocial rehabilitation: intervention
Lake, N. and Lavender, T. 2007. Psychosocial rehabilitation: intervention. in: Lindsay, S. and Powell, G. (ed.) The Handbook of Clinical Adult Psychology London Routledge. pp. 564-583
Psychosocial rehabilitation: investigation
Lake, N. and Lavender, T. 2007. Psychosocial rehabilitation: investigation. in: Lindsay, S. and Powell, G. (ed.) The Handbook of Clinical Adult Psychology London Routledge. pp. 540-563
Training and staff retention: National issues and findings from the South Thames (Salomons) clinical psychology training programme
Lavender, T., Willis, R. and Burns, S. 2007. Training and staff retention: National issues and findings from the South Thames (Salomons) clinical psychology training programme. Clinical Psychology Forum. 180, pp. 38-45.
How do women experience myocardial infarction? A qualitative exploration of illness perceptions, adjustment and coping
White, J., Hunter, M. and Holttum, S. 2007. How do women experience myocardial infarction? A qualitative exploration of illness perceptions, adjustment and coping. Psychology, Health and Medicine. 12 (3), pp. 278-288. https://doi.org/10.1080/13548500600971288
An investigation into the relationship between attachment, gender and recovery from psychosis in a stable community-based sample
Mulligan, A. and Lavender, T. 2010. An investigation into the relationship between attachment, gender and recovery from psychosis in a stable community-based sample. Clinical Psychology & Psychotherapy. 17 (4), pp. 269-284. https://doi.org/10.1002/cpp.655
The Doncaster model: a new ways of working for applied psychologists perspective
Lavender, T. 2008. The Doncaster model: a new ways of working for applied psychologists perspective. Clincial Psychology Forum. 181, pp. 31-34.
Reflections on involving service users and carers in clinical psychology training
Holttum, S. 2008. Reflections on involving service users and carers in clinical psychology training. The Higher Education Academy Psychology Network Newsletter. 48, pp. 2-3.
Perceived changes associated with autogenic training for anxiety: a grounded theory study
Yurdakul, L., Holttum, S. and Bowden, A. 2009. Perceived changes associated with autogenic training for anxiety: a grounded theory study. Psychology and Psychotherapy: Theory Research and Practice. 82 (4), pp. 403-419. https://doi.org/10.1348/147608309X444749
Peer relationships in adolescents experiencing a first episode of psychosis
Mackrell, L. and Lavender, T. 2004. Peer relationships in adolescents experiencing a first episode of psychosis. Journal of Mental Health. 13 (5), pp. 467-479. https://doi.org/10.1080/09638230400006775
Developing services for people with dangerous and severe personality disorders
Lavender, T. 2002. Developing services for people with dangerous and severe personality disorders. Criminal Behaviour and Mental Health. 12 (2 Supp), pp. S46-S53. https://doi.org/PMID:12459810
Cognitive executive function in Down's syndrome
Rowe, J., Lavender, T. and Turk, V. 2006. Cognitive executive function in Down's syndrome. British Journal of Clinical Psychology. 45 (1), pp. 5-17. https://doi.org/10.1348/014466505X29594
Comparative clinical feasibility study of three tools for delivery of cognitive behavioural therapy for mild to moderate depression and anxiety, provided on a self-help basis
Pittaway, S., Cupitt, C., Palmer, D., Arowobusoye, N., Milne, R., Holttum, S., Pezet, R. and Patrik, H. 2009. Comparative clinical feasibility study of three tools for delivery of cognitive behavioural therapy for mild to moderate depression and anxiety, provided on a self-help basis. Mental Health in Family Medicine. 6 (3), pp. 145-154.
Violence and mental disorder: a critical aid to the assessment and management of risk
Blumenthal, S. and Lavender, T. 2001. Violence and mental disorder: a critical aid to the assessment and management of risk. London Jessica Kingsley.