Women who have recovered from eating disorders: Perspectives on etiology.

Abstract

Women who have recovered from eating disorders have a unique perspective on the nature and development of these disorders. Q methodology was used to investigate the etiology of eating disorders as understood by women who have recovered from them. The Q-sort deck included items generated from a review of theories concerning the development of eating disorders. Each card described a reason for developing an eating disorder. Participants (N = 79) ranked the 80 Q-sort items according to the reasons that were most and least important in the development of their eating disorders. Results demonstrated that women endorsed some theories as accurately reflecting their understanding and rejected others. Women understood fear of fat, needs for control, and dependence on the perceptions of others as central in the development of their eating disorders but disagreed on the importance of experiences such as sexual abuse, incest, or family violence. Principal components analysis identified five groups of women with distinct perspectives, including: Thinness as Success, Interpersonal Conflict and Control, Shame and Compensation, Trauma: Attempts at Mastery, and Sexual Conflicts and Unwanted Emotions. Relationships between the Q-sort person factors and a standard measure of eating disorders, the EDI-2, were found, thus establishing the validity of the Q-sort measure. Finally, to aid the interpretation of these perspectives, interviews were conducted with women who best represented each of these perspectives in order to obtain narrative accounts of women's understanding of the development of their eating disorders and recovery process. Diagnostic differences were also identified. Women with a history of anorexia nervosa were more likely to emphasize the importance of their eating disorders providing them with a sense of control, whereas women with a history of bulimia nervosa were more likely to describe judging themselves on the basis of others' perceptions. The Q sorts of anorexic and bulimic participants were then compared with those of a group of experienced clinicians. Both anorexic and bulimic participants were more likely than clinicians to emphasize the importance of appearance issues in the development of their eating disorders. Implications for theory and treatment of eating disorders were discussed.