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Embodying the self : women's experiences of disordered eating and identity Fitzpatrick, Kelley 2010

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Embodying the Self: Women’s Experiences of Disordered Eating and Identity  by Kelley Fitzpatrick B.S.W., The University of British Columbia, 2004 A THESIS SUBMITTED IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF  MASTER OF SOCIAL WORK in The Faculty of Graduate Studies  THE UNIVERSITY OF BRITISH COLUMBIA (Vancouver) May 2010 © Kelley Fitzpatrick, 2010  ABSTRACT Disordered eating is a widespread phenomenon which carries emotional, psychological, and physical repercussions. Women are especially vulnerable to developing patterns of disordered eating which can become a consuming aspect of a person’s life, thereby shaping aspects of identity. In exploring the relationship between identity and disordered eating, I have used a feminist lens to shed light on the contemporary social context and its role in perpetuating the belief that a woman’s identity is embodied in her physical body. Postmodern feminism, Marxist feminism and social construction feminism have been included to provide further depth to the analysis. I have adopted a phenomenological approach in carrying out a series of unstructured in-depth interviews with individual women in order to answer the following research question: What are women’s experiences with disordered eating and personal identity? The interviews have been analyzed to provide the reader with a structural and textural description of the women’s experiences which converge to describe the essence of this phenomenon. The research findings will then be discussed in terms of their implications for social work practice. It is my hope that these insights will be used by service providers to better understand the needs of women currently struggling with this issue. In this way, the gains which women have made in their personal lives can become a piece of this larger social and political issue.  TABLE OF CONTENTS Abstract  ii  Table of Contents  iii  Acknowledgments  iv  Introduction  1  Chapter 1: Conceptual Context  4  Chapter 2: Methodology  10  Chapter 3: Results  18  Chapter 4: Discussion  38  Conclusion  47  References  48  Appendices Appendix A  51  Appendix B  53  Appendix C  54  Appendix D  56  Appendix E  58  —  II  —  ACKNOWLEDGMENTS  To begin with, I would like to acknowledge the many contributions of the women who participated in this research study. Through sharing their stories so openly, the women have shed much light on the complexities of disordered eating and identity. Their interviews have lent new insight into both the understanding and treatment of disordered eating. I would like to thank each woman for her individual contribution to the project and for generously giving of her time.  I would also like to acknowledge the commiffee members for this research study which include; Dr. Paule McNicoll, Anne Merrett-Hiley and Dr. Margaret Wright. The time they have taken to help formulate the study, and the thought-provoking questions they have asked along the way, are greatly appreciated. A special thanks to Paule McNicoll for the time that she has spent giving much helpful direction.  Finally, I would like to acknowledge my family for all of the support that they have given to my education and career choice. Thank-you for always encouraging me to persevere and for sharing in my passion for working with women affected by disordered eating.  -  iv  -  INTRODUCTION I have chosen to explore the issue of disordered eating and identity as this is an area with which I have direct personal experience. Currently, I work as a therapist in the field of eating disorders and am very passionate about this area. In addition, my own experience of disordered eating has led me to want to work with others who are struggling. In the first chapter of this research study, I will situate myself in the research and discuss the importance of this research to the field of social work. it is necessary to situate myself within the research as the study has been informed by both feminist and phenomenological research methods. I will begin with a description of my own experiences with the phenomenon under study. Looking back, it saddens me to recognize the extent to which my childhood and adolescent memories revolve around food, weight and body image. I can recall several specific instances in which I was told, in no subtle way, that I shouldn’t eat a particular food because I may get fat or that I was becoming chubby and needed to “watch it”. At the age of 10, I decided for myself that I was too fat. It is difficult to recall now how and when I first started to engage in disordered eating behaviours. What I do recall is that much of my high school years were spent thinking about weight loss and eventually the behaviours associated with my attempts to lose weight, escalated. For a few years, I counted calories obsessively, exercised compulsively and purged on occasion. As I began to lose weight, I noticed that people responded to me differently and praised me often for my “success”. I began to fear that if I gained back the weight, I would somehow be a failure or worse yet, unlovable. I am now able to reflect on the fact that much of my own personal identity was entrenched in body image throughout these years. Over the years, I have been able to construct meaning out of my struggles and this experience has become an integral aspect of my sense of self.  -1-  Because of these experiences, I believe that I was able to empathize with the women I interviewed. As a feminist methodology was used, I positioned myself within the interview by sharing aspects of my experience with the women. It was my hope that this, along with other decisions described in the methodology section, would create a more balanced power dynamic between myself and the women who participated in the research. Over the past two years, I have worked as an eating disorder therapist with adult women and have seen several clients struggling with questions of identity. This process often presents a great deal of complexity and I have felt ill-equipped to help my clients negotiate this process. Because of this, I felt that it was important to speak to women who have recovered from an eating disorder in order to understand how they were able to negotiate this process for themselves. Exploring processes of identity development in connection with disordered eating has relevance to the field of social work. Many social workers are employed in positions where they act in a therapeutic capacity with women with disordered eating. This typically occurs through a combination of individual, group or family therapy. It has been my experience that in this therapeutic relationship, identity dilemmas inevitably arise in women’s journeys of recovery. In addition to demonstrating the prevalence of disordered eating, this research also supports the idea that identity is an important variable to address in the treatment of disordered eating. It is important that we understand these processes of identity and their significance to the women with whom we work. Additionally, it is imperative that the women who have recovered be given a voice in contributing to our understanding and treatment of disordered eating. This is in line with the social work values of empowerment and working collaboratively with our clients. In chapter one of this research study, I will begin by discussing the prevalence of disordered eating amongst women and girls in western countries. I will then review the literature which has explored  -2-  disordered eating in connection with processes of identity. Following this, I will discuss the theoretical framework which has informed my research study. This will involve a discussion of feminist perspectives including postmodernism, Marxism, and social constructionism. In chapter two of the study, I will outline my methodology. This will entail a rationale for the research methods used and will outline decisions that were made related to sampling and the recruitment of participants. In this chapter, I will also address ethical considerations that were made in carrying out this research project. Chapter two ends with a discussion pertaining to the process of data analysis. In chapter three, the results of the qualitative interviews will be presented. The chapter begins with a short description of how each participant situated her experience. Following this description, the reader will find both textural and structural descriptions of the women’s experiences. The voices of the women are widely represented here and many excerpts are provided of the women’s stories. Finally, the chapter ends with a composite description of the essence of the phenomenon. In chapter four, the results of the research study will be discussed. In this chapter, I will also explore how the women’s experiences compare or contrast to previous research. Additionally, I will highlight the many contributions that the women made to the research study. The chapter concludes by exploring implications for social work practice and areas for future research. Finally, in the conclusion section, the reader will find a summary of the research study with final thoughts.  -3-  CHAPTER 1: CONCEPTUAL CONTEXT Disordered eating and body image preoccupation are a widespread social issue. It has been estimated that 40-45% of adolescent and young women are trying to lose weight at any given time (Piran & Cormier, 2005). McVey and Davis (2002) found that in a sample of 400 Canadian girls in the seventh grade, 61 percent had dieted in an attempt to lose weight. Furthermore, many of these girls had attempted to control their weight in more fanatical ways such as purging and excessive exercise. Similarly, Jones, Bennett, Olmstead, Lawson and Rodin (2001) found that in another sample of Canadian high school girls, 27 percent exhibited disordered attitudes and behaviours related to body image and food. Additionally, disordered eating appears to be occurring across many cultures and regions of the world (Rich, 2006). It is important to note that disordered eating patterns are estimated to be two to five times more prevalent than clinically diagnosed eating disorders (Gucciardi, Celasun, Ahmad & Stewart, 2003). These demographics reveal a disturbing cultural context in which the lives of both girls and women are being significantly impacted by efforts to conform to a body image ideal. In looking at the issue of disordered eating, I would like to draw attention to the range of attitudes and behaviours which encompass the spectrum of disordered eating. To borrow from Lumley (2002, p.6), this spectrum of eating attitudes ranges from “body image acceptance” on the one hand, to clinically diagnosed eating disorders on the other, with “body image dissatisfaction”, “food/weight preoccupation” and “emotional eating” falling in the middle. From a postmodern perspective, adopting a spectrum view of disordered eating enables us to see the complexity of the issue as opposed to understanding it in dichotomous terms i.e.; normal vs. disordered. Secondly, a postmodern perspective of the spectrum of disordered eating allows us to see that individuals may move back and forth at various times along the spectrum (Lumley, 2002).  -4-  Just as disordered eating is not a static entity in women’s lives, neither is identity. As Mullaly (2002, p.146) points out, ‘The individual does not possess a single identity, but multiple identities that may shift and change over time and/or with changed contexts”. As a postmodern perspective is informing my research, it is important to view identity not as fixed, but rather as continuously evolving in conjunction to how one’s world is experienced (Hoskins, 2002). This emphasis on how one’s world is experienced lends itself to exploring the interplay between disordered eating and ‘The many complex and gender-specific ways in which our contemporary socio-economic, cultural and political contexts are deeply implicated in this field of distress” (Malson, 1999, p. 138). In exploring this broader context, we are able to reach beyond medicalized explanations of disordered eating which tend to pathologize women by situating their experience in problems related to character or a maladaptive need for perfection or control (Rich, 2006). In its focus on symptomology, medically based interpretations of disordered eating also limit our ability do unveil the broader influences at play in the development and maintenance of disordered eating. Furthermore, the use of medically based criteria to identify eating disorders serves to invalidate the experiences of many women. If woman’s experience does not reflect these precise criteria, her experience may not be recognized or treated. As mentioned previously, I have chosen to focus exclusively on women and their experiences of disordered eating as I believe that women are influenced by culture in ways which are different from their male counterparts. Specifically, I am referring to the patriarchal values underlying how women are valued for their appearance, most often embodied in body ideals. As Greenspan (1983 in Brown & Jasper, 1993 p. 361) has poignantly stated, ‘The important point is that woman in contemporaty patriarchal society is fundamentally identified with her body. Her body is her power (emphasis original). Men are their brains; women are their bodies”. Additionally, it is widely acknowledged that while issues of body image  -5-  disturbance and disordered eating do affect both men and boys, the prevalence amongst women continues to be much higher (Choate, 2005; Gucciardi et al., 2003). From a feminist perspective, it is interesting to look at how eating disorders can also be seen as a form of resistance against patriarchal values and ideals (Brown, Weber and Au, 2008, Dias, 2003, Wolf, 1991). Brown, (in Brown & Augusta-Scott, 2007) explains that disordered eating behaviours take socially constructed norms of body management to the extreme and consequently, make these struggles visible. Wolf (1991, p. 198-199) also illustrates the ways in which eating disorders are a form of resistance. She states, “anorexia is spreading because it works. Not only does it solve the dilemma of the young woman faced with the hunger cult, it also protects her from Street harassment, and sexual coercion; construction workers leave walking skeletons alone. Having no fat means having no breasts, thighs, hips or ass, which for once means not having asked for it”. The conceptualization of disordered eating as a form of resistance is in opposition to “gender stories [which] essentialize women as compliant victims of social pressure to be thin” (Brown & Augusta-Scott, 2007, p. x). Marxist feminism is useful in highlighting the ways in which patriarchy maintains women as a subordinate class via the body. One of the ways in which this takes place is through the emphasis on the body as being a “product” in the neoliberal economy. Through such emphasis on women’s bodies as a product, and the discourse of self-management that surrounds this, women are encouraged to pursue the perfection of their “product”, thereby taking their attention away the pursuit of educational and vocational goals. A Marxist feminist perspective of women’s subordination as a class has also been highlighted by several authors in the area of eating disorders [Bruch, 2001; Hoskins, 2002; Piran, 2001; Wolf, 1991].  -6-  In looking at the onset of eating disorders from a historical perspective, both Naomi Wolf (1991) and Catherine Steiner-Adair (2001, in Bruch, 2001) have commented on the paradox inherent in the fact that as feminism gained momentum and women began to make gains in the areas of employment and education, a body image ideal emerged which resembled a nearly vanishing woman and coincided with the onset of widespread disordered eating. Hoskins (2002, p.234) has further argued that these images have been created to “express vulnerability, male dominance, dependence, and the trivialization of women’s position in contemporary society”. Piran (2001, p. 172) also illustrates this point in highlighting how women continue to be oppressed even “in the context of multiple new social and vocational opportunities available for young women in western countries, the body stays a silent and oppressed domain”. In 1963, Betty Friedan argued in The Feminine Mystique that a woman’s identity was situated in her sexuality and understood only in relationship to others, i.e. as wives and mothers. Friedan argued that the key to a woman’s personal liberation lay in her ability to foster the development of her identity outside of these limitations. In both The Obsession (1981) and The Hungry Self, (1985) Chernin explores these questions of identity as they relate to experiences of disordered eating. In her earlier work, she highlights the extent to which women become consumed in their quest to pursue the thin ideal and how this impacts various aspects of the self. In her later work, Chernin posits that eating disorders arise as a response to conflicts of identity. Hoskins (2002) has echoed this notion in conceiving of eating disorders as the place wherein women are able to enact struggles related to identity. As noted, women often become consumed in their attempts to meet these body ideals, thereby diverting attention away from cultivating other parts of their identities (Choate, 2005) and coming to see their bodies as an “all consuming project” (Brumberg 1997 in Hoskins, 2002, p. 233). This notion is further entrenched by the belief that women are capable of making changes to their bodies and achieving these ideals if they work hard enough at it (Lumley, 2002). A postmodern framework is useful here in  -7-  demonstrating how the body in a postmodern world is “increasingly fed on fantasies of rearranging, transforming, and correcting, limitless improvement and change” (Bordo, 2003, p. xvi-xvii). Social construction feminism is also useful in exploring the ways in which gender shapes women’s experiences of how their bodies should look and the impact that such cultural constructions have on women (Lorber, 2005). Lastly, Marxist feminism is helpful in drawing attention to the ways in which women as consumers are exploited in their quest to meet these ideals through a market which heavily targets women’s efforts to diet, exercise, and lose weight. Several authors have highlighted that the experience of having an eating disorder can become an integral aspect of a person’s identity (Bulik & Kendler, 2000; Tan, Hope & Stewart, 2003). In a qualitative study of women’s journey of recovery from anorexia, Weaver, Wuest and Ciliska (2005) explore how eating disorders can become integral to a woman’s identity and the difficulty that is associated with developing an identity separate from the eating disorder. Levenkron (2001) has also drawn attention to how women come to define themselves by their eating disorder and perceive their eating disorder as something which gives them focus and makes them unique. I would argue that these ideas may also pertain to women struggling with disordered eating as again, I am conceiving of eating disorders as being part of the continuum of disordered eating. My research explores the interplay between disordered eating and identity and seeks to understand how the women themselves situate this relationship. Identity construction is a theme which does emerge in the literature on disordered eating. It does not however, appear to have been incorporated into many of the studies related to disordered eating. Hoskins (2002) points out that in the area of eating disorders, academics have highlighted the need to explore the connection between identity development and the current cultural context. This continues however, to remain an area which is largely unstudied. Previous literature which has explored the relationship between disordered eating and identity has situated a “lack of self-respecting identity” (Finelli,  -8-  2001, p.24) and other problems in identity development as the precipitating factor for the development of eating disorders (Bruch, 1978, Stein & Corte, 2007). I would argue again that the broader socio-cultural factors need to be explored in order to avoid the pathologization of women’s experiences. Up to this point, the studies that have been carried out on disordered eating have been primarily quantitative studies in which researchers have chosen the variables of importance. It is also important to note here that the majority of studies which have explored this relationship have looked at clinically diagnosed eating disorders, typically anorexia nervosa. Women who have experienced disordered eating in their own lives have not often been given a voice to identify the issues that are of relevance to them. Qualitative studies conducted by Lamoureux and Bottorf (2005) and Patching and Lawler (2009), have echoed the need for researchers to allow space for women to share their experiences and perspectives without the limitations of such dialogue being placed upon them. Until women are able to shed light on their own experiences, service providers will miss out on valuable insights into the needs and strengths of women with disordered eating.  -9-  CHAPTER 2: METHODOLOGY From a feminist perspective, objectivity does not exist in research and researchers are strongly encouraged to position themselves within the research and equalize power differentials in the research process (Saulnier, 1996). For this reason, along with the fact that subjective experience provides the focus of this study, I used a qualitative research design involving un-structured in-depth interviews with individual women. I chose a phenomenological approach to explore the essence and “meaning for several individuals of their lived experiences” (emphasis original Creswell, 2007, p. 57). In this case, the lived experiences were women’s journeys with disordered eating and identity formation. I had already conducted in-depth interviews with two women in a prior research study of the same nature and have incorporated these interviews into this research study. Four additional women were recruited, allowing for a total sample size of six women. The decision to recruit a relatively small sample was based on the fact that I used a purposeful sampling design which incorporated snowball sampling. As Patton (2002) points out, the focus of qualitative inquiry should be placed on the richness of the interviews as opposed to the generalizability and sample size. With respect to snowball sampling, I had some women referred to me by others working in the field of eating disorders. One of the research participants also contacted two other women that she knew of and who she thought would potentially be interested in the research study. Additionally, there were a few women who opened up about their experiences of disordered eating when I informed them of my research interests. These women expressed interest in the research study and I felt that they should be given an opportunity to have their stories heard. I believe that knowing these women on a personal level was also a strength in the research as I have rapport with them and feel this presented an advantage in the interview process. This could have also been a disadvantage in the sense that women may not have felt as comfortable sharing openly due to their concern of how this would affect our future interactions.  -10-  Although I am not in a position of authority to any of these women, there was still a potential ethical implication of approaching women who I know on a personal level as they may have felt social pressure to participate in the research. This was handled by having the principal investigator e-mail the women to let them know of the upcoming research and stating that if they would like further information, they may respond. I believe that e-mailing the women as opposed to approaching them face-to-face or by telephone conversation minimized the social pressure to participate. The email included a letter of introduction (see Appendix A) which stated that participation is optional and voluntary. In the recruitment of participants, I also e-mailed a recruitment notice (see Appendix B) to some of my colleagues, a few of whom had already expressed that they may know of someone who would be interested in participating. I had also intended to place a recruitment notice in the local newspapers and at local colleges and universities. This was not necessary as saturation was reached through snowball sampling. Participants for this research project included adult women who self-identified as having experienced disordered eating in the past and who had sought support (either formal or informal) for this. Selection criteria included the following: •  Self identify as a woman  •  Aged 19 or older  •  Self-identify as having experienced disordered eating in the past  •  Self-identify as having recovered from disordered eating  •  Self-identify as having sought support for disordered eating  Exclusionary criteria included the following: •  Anyone who was unable to give informed, voluntary consent  •  Men  -  11  -  As stated previously, I chose to interview only women as I believe that women and men experience the cultural context in different ways. I decided to only interview women age 19 or older in order for the women to be in a position to provide voluntary consent. I decided to include women who self-identify as having experienced disordered eating because I felt that it was important for the women to define this on their own terms and not through the medical system or researcher involved in the project. Additionally, I did not define “identity” for the participants in the study as again, from a feminist post-modernist perspective, ‘There is no stable, fixed, knowable, or essential self or identity” (Brown & Augusta-Scott, 2007, p.xv) and therefore one aspect of analysis was exploring how participants engaged in such discussion. With respect to the criterion of having recovered from disordered eating, created this criterion to attract women who were able to reflect on their recovery process and their lives following their experience with disordered eating. I also chose to only include women who had sought some form of support for disordered eating as I believe that this contributed to the ethical principle of “minimizing risk”. Because these women have been able to seek out the support necessary in the past, it was my hope that if the research study was emotionally distressing to them, they would be able to draw on the support systems available to them. It is important to note here that the term support may entail formal support such as the medical system and/or counselling services or informal support through family and/or friends. Again, the women self-identified seeking out support and this was not decided by the researcher. In carrying out this research project, I used an interview guide (see Appendix C) that consisted of areas for exploration across the interviews, and which also allowed for issues outside of the guide to be identified by participants (Patton, 2002). Additionally, as noted by Patton (2002) the interview guide allowed for spontaneous conversation to emerge. As I have used a feminist methodology, I felt it was important to incorporate a design which would give women control over the direction of the interview and how they  -  12  -  wished to answer the questions. As stated previously, the primary research question which I have sought to answer is the following: What are women’s experiences with disordered eating and personal identity? For participants who chose to partake in the study, there was an initial one-on-one in-depth interview of up to 90 minutes. A follow-up meeting or conversation was also offered to the participants. Two of the participants chose to participate in a follow-up interview and two of the other participants communicated with me about changes and/or clarification that were needed. The purpose of the second interview was to clarify information from the first interview and to allow further exploration of the issues most important to the participants. As highlighted by Maxwell (2005), prolonged engagement with the participants may serve to enhance the validity of the study by allowing for new ideas to be created and explored. From a feminist perspective, I felt it was important that the women participating in the interview were given the opportunity to choose both the setting and location of the interviews. This decision was based on my belief that this allows women more control over the interview; thus it is in line with the overarching goal of balancing power dynamics between the interviewer and participants. The majority of the participants decided to meet in a coffee shop of their choosing. Two decided to meet in their home. With respect to ethical considerations, I have ensured that participants were involved in the project through a process of informed consent. This was done by providing the potential participants with a letter of introduction (Appendix A) outlining the research purpose, the intended uses of the information and what they may expect from engaging in the interview. Women were also given an opportunity to ask questions prior to consenting to their involvement in the research (see Appendix D for a blank copy of the consent form).  -  13  -  With respect to the ethical principle to “do no harm”, the study deals with a sensitive topic and had the potential to be emotionally distressing to the participants. As I have formal training and experience in social work practice and currently work in the field of eating disorders, I felt that I was well equipped to handle any emotionally distressing events which may have come up for the participants. In order to minimize risk to the participants, I also “checked in” with the women as needed throughout the interviews to ensure that they were comfortable in continuing. Upon request I was also willing to help locate appropriate support (i.e. counselling services and support groups). With respect to confidentiality, women were given the option of remaining anonymous in the study or using their real names if they so desired. As pointed out in the Patton text (2002, p.411), some participants may feel it important to use their real names in “owning their own stories”. Again from a feminist perspective, I felt that it was important to allow women the decision over how they would like this to be treated. For the participants who chose to remain anonymous, a pseudonym has been used to reference them, Identifying information was also removed from all of the participant files. All conversations were audiotaped and transcribed with all identifying information removed. Participants were also given a copy of their transcript in order to clarify or remove information that they did not wish to be included. Additionally, files have been stored in a secure location (locked filing cabinet and password protected computer files) separate from any information which might personally identify the participants. Lastly, the ethical principle of voluntary participation was treated carefully from the initial recruitment of participants (as previously described) through to the completion of the research study. Voluntary participation was an on-going process. This meant that participants were advised that they could choose to end their involvement in the study at any time and could exercise choice over any questions which they did not want to answer.  -  14-  Throughout the interviews and in the process of analyzing the data, I clarified my understanding of the women’s responses with them and attempted to make this as much of a collaborative process as possible. As Patton (2002) points out, participants often appreciate researchers checking back to ensure accuracy as it demonstrates the value of their responses. The women also had the opportunity to read their transcriptions and will also have an opportunity to read the final research product upon completion. This was done to ensure that the women’s stories are being accurately represented and to minimize crosscultural misinterpretations and biases. Electronic copies of the participants’ transcripts have been copied onto a disc with all identifying information removed. This, along with the signed consent forms, will be stored in the School of Social Work archives for a period of five years. Audiotape recordings of the participants’ interviews have been de magnetized and electronic recordings have been deleted from the recording device. Any written notes were also destroyed following the writing of transcriptions. A tape recorder and/or electronic recording device were used for the interviews so that with the permission of the participants, I was free to make notes throughout the conversation. As Patton (2002) points out, note taking can be useful in enabling the researcher to be fully present throughout the interview while also allowing for attention to non-verbal gestures. I transcribed all of the interviews myself; verbatim, to ensure that the participants responses were recorded accurately as well as to enable me to be fully engaged in the conversation. Additionally, I discussed the findings of the research study with my supervisor. The decisions described above were made in the hopes that they would enhance the validity and credibility of the research study. As the first step of data analysis in a phenomenological study, Creswell (2007, p.59) suggests the use of “epoche (or bracketing), in which investigators set aside their experiences, as much as possible, to  -15-  take a fresh perspective toward the phenomenon under study”. This has been achieved by both situating myself in the research and continuing to reflect on my own experiences with the subject matter at hand. I did also feel however, that it was important from a feminist perspective to share aspects of my own experience of disordered eating with the women. This was done in an attempt to equalize the power differentials inherent in the research process. In this way, I was unable to set my own experiences aside when interviewing the women. FolTowing the process of bracketing described above, the transcription of the interviews was the second step of data analysis. I attempted to transcribe the recordings as quickly as possible following the interviews. I felt that this could help in the data analysis as I would still have the nuances of the interview fresh in my memory. The written notes that I made in the interview were also helpful in reminding me of the specific nuances of each interview. The written notes that I took were mainly related to things that stood out to me in the participants’ stories or non-verbal gestures that were remarkable. As I was transcribing the data, I made notes of the aspects of the interview that stood out to me. Once I had completed all of the transcriptions, I looked at each one individually to contextualize each woman’s experience. I sought to understand as much as possible about each woman’s individual experience. In doing this, I looked at how they started the interview, the language that was used throughout, the use of symbolism, and the variables that were brought up outside of the interview guide. I looked closely at the circumstances that the women described in relationship to the setting and context of their experience. Additionally, I looked at emotional displays and how the women used stories in describing their experience. Lastly, I looked at each interview through the lenses of postmodern, Marxist and social construction feminism to provide further depth to the analysis. I went over each woman’s transcript several times to pull out as much as I could that would help me to understand her individual experience. The findings derived from the contextualization of the data have been described in the structural description of  -16-  the results section. The structural description speaks to the essence of “how” women experienced the phenomenon at hand (Creswell, 2007). Following the contextualization of the data, I went through the transcripts to single out significant statements that related to the research question. These statements were all given equal value. Once I felt that all the significant statements had been pulled from the interviews, these were then grouped into themes. From there, I looked closely at the themes that had occurred across the women’s stories and five major themes had emerged. The data were organized into these five major themes and then in looking closely at each theme, subthemes were derived out of these. These themes and subthemes were then written into a textural description to describe exactly “what” the women had experienced in relation to the research question as is required in phenomenological studies (Creswell, 2007). This textural description is included in the results section.  -17-  CHAPTER 3: RESULTS Throughout the interviews, the majority of the participants began by providing a chronological account of their experience. In this recount, some of the women said directly what they thought contributed to the onset of disordered eating while other women alluded to it. Some of the women also spoke to the factors that were important in the maintenance of, and recovery from, disordered eating. To introduce the results derived from these interviews, I will start with a brief explanation of the way in which each participant situated her experience. Because it is paramount that each woman’s confidentiality be protected, I have given each participant the name of a different colour so that her unique circumstances will not be cross referenced with the various statements that have been provided in the rest of this section. In Silver’s account of the onset of disordered eating, she spoke to me about how her family had recently moved to a new town and for the first time, she felt accepted by her peers. She described wondering “what is it that they are liking?” and her fear of not being in control of this situation. She believes that this led to a desire to control her weight and she subsequently began to restrict her caloric intake and over-exercise. In this description, Silver also noted that her father struggled with alcoholism and that she was “always trying to put on a brave face” She did not elaborate in terms of how she felt this may have been connected to her experience of disordered eating. In my interview with Scarlet, she highlighted a complex relationship with her father with whom she lived as a young teenager. She also cited the onset of puberty as being important in the development of disordered eating as she recalled being “horrified” by the physical changes that were transpiring within her. Scarlet explained that the concurrence of these factors led to her wanting to “mediate the relationship between that uncontrollable living environment and those uncontrollable changes that are happening in yourself [referring here to herself]’ In this case, the way that Scarlet was able to mediate these factors was  -18-  through disordered eating. It was also interesting that Scarlet remarked on her belief that her body served as a vehicle to act out a “confused identity.” In the interview with Magenta, she shared that she had been very tall and overweight as a child. She felt that because of this, her family perceived her as a “monster” and responded by putting her on various diets at a young age. Throughout her story, Magenta situated the uncertainty that she felt about herself as being important in both the onset and maintenance of disordered eating. She remarked “I would just twist myself into what anybody wanted me to be. There was no sense of self at all” Magenta elaborated to say that her disordered eating served as a way of managing any fear that she was experiencing. In my interview with Teal, she explained that she struggled with low self-esteem and a lack of confidence from a young age. Teal remarked, “I felt I was not worth as much as other people....! just had this feeling that everybody else’s opinion is more important than mine”. She said that she did not know why she felt this way and remarked that she believed her family had done all the right things in trying to help her. Tealtold me that it was no longer important to her to understand the root causes of these feelings. In her interview, she reflected a great deal on the various tools that helped in her journey of recovery. In Fuchsia’s description of her experience, she recounted finding “comfort...approval and affection” in food from a very young age. She also felt that from a very young age, she was starting to internalize ideals of societal expectations for women. In the interview, Fuchsia goes on to describe some of the dynamics that she felt contributed to the maintenance of disordered eating. One of these that stood out to me was the extent to which food and body image were emphasized by others. Fuchsia alluded to feeling that she was often identified with her weight and this seems to have contributed to the maintenance of her experience with disordered eating.  -19-  When I met with Violet, she explained that she and her family were involved in various activities which focused heavily on appearance and body image. Wolet recalled that she was teased at times and felt a sense of pressure to look a certain way. When she started to lose weight, Violet noticed that she received positive feedback and believes that this contributed to the maintenance of disordered eating. In helping me to understand the origins this experience, Violet reflected on the uncertainty that she felt around where she fit in her family. She recalled her desire of wanting to stand out and feel special. In analyzing the data to compose a textural description, significant statements were singled out. From these statements, five major themes and several sub-themes were uncovered. In spending time with the data, it also became apparent to me that these five themes converged to create the description of the processes involved in the relationship between disordered eating and identity. In the interviews with the women, the first theme that emerged was “the fusion of disordered eating and identity”. The sub-themes that followed from this include “life being governed by disordered eating” and, “others relating to me as disordered eating”. The second theme that emerged in the data analysis was “distinguishing disordered eating from the self”. The sub-themes that emerged from this were the “recognition of the extent to which disordered eating consumed my life”, and “identifying and addressing the voice associated with disordered eating”. The third theme in this textural description was “discovering new aspects of the self” which seemed to have presented both exciting prospects and challenges to the women interviewed. One sub-theme emerged amongst the women here and that was of ‘The importance of taking risks”. The fourth theme to be uncovered was that of “diminished presence of disordered eating within myself”. Lastly, the theme of “conceptualization of the experience of disordered eating as a positive aspect of identity” emerged from the women’s stories. The sub-theme to arise from this larger theme was that of “making meaning of my experience”. It is important to note that while the themes described here are presented as processes of women’s experiences with disordered eating and identity, I am also aware of the fact that this was, and  -20-  continues to be, a fluid process in the women’s lives. It is not my intention to present this as the process that all women struggling with disordered eating would move through in the same way as I recognize the many unique variables and circumstances to each woman’s experience. 1) The fusion of disordered eating and identity In carrying out the data analysis, this theme became evident to me in the way that women situated disordered eating as an aspect of the self. In the interview with Renee, she recalled this experience and the feelings that arose from it. She stated, ‘1 think it was a sense of loss. Like I’ve lost who I am and that’s taken over” (Renee).  Similarly, Julie illustrated this point in the following way, “I actually felt... .that because the eating disorder had taken so much, I actually felt that I was my eating disorder. I couldn’t distinguish. I thought I was it and it was me.... That we were the same thing” (Julie).  Julie went on to share the difficulty that this fusion presented in recovery. She explained, “I felt like it was my identity. And it was really hard in the recovery because how can you recover from something that you are. Like, I had no clue how to do it” (Julie).  In helping me to understand how disordered eating becomes fused with the sense of self, the women described the ways in which their lives were governed by disordered eating. This is presented below as the first subtheme for the fusion of disordered eating and identity. Life being governed by disordered eating Many of the women shared about how their lives were consumed by disordered eating and quickly answered that it affected everything or took up every second. An excerpt from each of the women illustrating this point reads as follows:  -  21  -  Gosh, it affected eveiything. Absolutely eveiything.... Because everything really revolved around when I could binge next.. .it does feel like their whole life when you’re there, for sure” (Shelley). “it affected everything. Family life, friends.. ..social life. I had no social life. It was my personal choice. I would rather workout or binge, or whatever it was....pretty much everything was about the eating disorder... had no hobbies. Like all my hobbies were reading diet books. Learning about, kind of calories so I understood..., exercising and doing all the newest and latest exercise plans” (Julie) “I think every day of my life was a, ‘the big diet’s going to start tomorrow day” (Apr10 “whatever I’d be doing, I’d be feeling a self-consciousness. So I know that I didn’t get into sports because I felt like I was too fat to begin with. Which was not true... .and I felt too awkward. I felt like there’s no way I can belong... .1 was so preoccupied with trying to conceal the ugliness”. (Angeline) “I [still] had to make sure I had time for my eating disorder” (Sara) “Everything revolved around that. So it really holds you captive” (Renee)  Another important subtheme that arose from women’s experiences of the fusion between disordered eating and identity was how this was reinforced through interactions with others. This presented the following subtheme of: Others relating to me as disordered eating In my interview with April, she described this dynamic. She explained, “it always felt to me that the first thing people would notice about me would be my weight.... if someone spoke to  me and didn’t speak to me about weight loss, I was okay because hey, they’re not emphasizing that. It gave me a bit of a vacation, you know, I didn’t have to think about it, cause they weren’t bringing it up.” (April).  The interview with Renee also shed light on the ways in which the disordered eating identity can be reinforced by others. Renee recalled how her eating disorder started to become seen as her identity both at school and at home. She explained,  -22-  “I became that sick- that girl in 10th grade with an eating disorder... So that was my identity, cause that was me” (Renee) “They saw me as the sick person in the family.. .it was like I didn’t have a name anymore. You know, that was just me and that was the role I was to fulfill” (Renee).  Renee also offered a great deal of insight into how this serves to further entrench disordered eating and suggests way in which families and others can avoid this dynamic. Her thoughts around this will be further explored in the discussion section. 2) Distinguishing disordered eating from the self  The women who participated in the research also described a process of starting to distinguish themselves from disordered eating. They named two key aspects involved in this process. The first process to which the women spoke was the recognition of the extent to which disordered eating was consuming their lives. The second process entailed identifying and addressing the “voice” associated with disordered eating. It was interesting to discover in the process of data analysis that nearly all of the participants spoke of the recognition of this “voice” and how they learned to distinguish this from themselves. These two aspects will be presented as the subthemes related to distinguishing disordered eating from the self. Recognition of the extent to which disordered eating consumed my life  This process was described by the participants in the following ways, “I was just sick of being sick. Like I was sick of the whole eating disorder. And I thought I don’t want to do this anymore. I really realized that this is not a life. Before I didn’t give it any thought because all that mattered was how thin I was, what I looked like. But eventually I got, this is not a life. I’m not doing anything, really. All the other people are going out, going to the prom and all that, having fun. I actually never did that because I was busy with other things and I wasn’t living, I was just existing and at some point it just hit me, that’s what it was.” (Julie)  -  23  -  “I just thought, what a hassle this is... every time I eat something, I’m worried. Why? It takes up so much time and energy to always be thinking about it. I’m sick and tired of it... It was such a waste of time. When I think of all, when I think of those years, literally years.... of setting my schedule, controlling everything I did around what I was eating and food, and what a waste of time” (Sara).  Identifying and addressing the voice associated with disordered eating Examples of the ways in which participants described their awareness of the “voice” associated with disordered eating are described as follows: “in my recovery I had to learn that we are not same. So that the eating disorder has taken over but I’m still somewhere in there. Just very hidden somewhere, and I had to learn to separate those two... voices, they say. The eating disorder voice that was constantly telling me, “you’re ugly”, “don’t do this, do that”. And the real me that was still somewhere hidden. And I had to learn to... nourish the real me and allow it to grow inside the eating disorder” (Julie). “being able to remove myself from the situation and from that little voice inside your head and see it for what it is” (April).  Others also spoke of this process of identifying and challenging disordered eating thoughts. Renee described her recognition of “irrational thoughts” which in her case were indicative of disordered eating. In the interview with Sara, she also spoke of how.she learned to rationalize with disordered eating thoughts in recovery and gave an example of how she is able to continue this to maintain the gains that she has made in recovery. 3) Discovering new aspects of the self Out of this process of distinguishing themselves from disordered eating, it seemed that space opened up in the women’s lives to uncover new aspects of themselves. The women described some of the positive aspects of opening up themselves in the following ways,  -  24  -  “it was just exciting to learn who I was. And to really leave that behind. And you know, really focus on what was coming, and what was the future” (Shelley).  “[I was] delighted at discovering this aspect of my body and myself, ME, that I’ve never known before” (April) In explaining the process of discovering new aspects of their identities, the women also pointed out the difficulties that arose for many of them in the process. This challenge is described in my interview with Shelley below, “So you have to really be re-born again uh, completely. To yourself. And start from scratch, and say “this is me, completely naked”, now where do I go? How do I put this together and become who I’m really supposed to be and who I’m supposed to be is okay to be, right..And then I started the journey of you know, understanding who I was. Because I had no idea. I would just twist myself into what anybody wanted me to be. There was no sense of, of self at all”. (Shelley)  Julie also highlighted the challenges that she felt were presented to her, “I didn’t know anymore what I liked. I felt I just liked reading diet books and learning about exercise and doing exercise and all that” (Julie).  The importance of taking risks The importance of risk-taking was the main subtheme that arose from understanding women’s process of discovering new aspects of themselves. Several of the women commented on the challenge of giving up the safety and comfort that was derived through disordered eating and the need for them to take risks in order to move through this process. The following excerpts demonstrate the extent to which this can pose a challenge for women recovering from disordered eating. “For me, it was hard at first and I hear that a lot too. It’s scary like, what am I without this? You know, like, I’m so used to day in and day out, this is what I think about, this is what I do, like what am I going to do now? So for me, it was hard but the main thing was to find other things that I’m passionate about... that can override the eating disorder” (Renee).  -25-  “sometimes it feels like giving up is easier because at least you know your eating disorder. You know what you’re getting yourself into...even though it’s pain, you know the pain. And with recovery there’s a lot of new  pain happening and it’s scary. Because with the eating disorder you know what’s happening tomorrow. Because what’s happening tomorrow is what happened the last however many years. But with recovery, something new can happen- or does happen- every single day and that is scary” (Julie). “that was very hard to let go, because it’s frightening, stripping off- I could always say, well I’m not, I’m not doing anything at school because I have weight issues, you know, like, I’m not going out to social events because I have weight issues” (April)  The following statements further illustrate the importance of taking risks and how this benefitted the women in their process of identity development. In the statements below, the women spoke explicitly of their process of risk-taking. “I ended up taking these risks according to the original framework of, no you’re a failure, you know, why bother with any of it? I did end up taking these risks and things ended up feeling very different from how I thought that they would feel”. (Angeline) ‘Taking risks were very important for me. Because I would get stronger and stronger. So I could fall back on every risk that I’d taken, because it always worked out (Shelley).  Shelley went on to explain that in this risk-taking, she found that her experience of disordered eating no longer had the same amount of space in her life. She explained this dynamic in the following way: “gaining a sense of who I was... automatically the need [for disordered eating] just decreased. Because that empty, sort of feeling wasn’t there. Or the need to fill up that emptiness had decreased”. (Shelley).  4) Diminished presence of disordered eating within myself  The fourth theme that emerged in my interviews with the women was the gradual and fluid process by which they experienced a diminished presence of disordered eating within themselves. The majority of the women explained that for them, the presence of disordered eating had not completely vanished but rather  -26-  ‘Went to sleep” (Angeline) or ‘Went into remission” (April). This was further illustrated through the  statements below, ‘Thoughts about food and body image consume a lot of my life. But, they’re not the emphasis of my life anymore’ (April). “if I start feeling like I’m fat, which still happens, .self-conscious of you know, a few extra pounds.. I don’t .  see it as me going ‘oh my god, I need to go hide’ or ‘I need to get rid of this, I need to start a cocaine habit so that I starve’ or whatever. I just see it in the bigger context of my personal journey” (Angeline)  “it’s not something that I struggle with but I think that in times of stress, it’s something that you have to watch.  ...  like I’ll never engage in the behaviours again. It’s not, I’ll never go there but maybe once every  couple of years a thought will come to mind but I’m able to be aware and it passes (Renee)  It is important to note that the majority of the women felt that they while they continue to experience some thoughts which would be indicative of disordered eating, there was also an ability to re-frame this experience not as pathology but rather as something which can be empowering to them. Shelley states, “I’m very strong about being recovered and that that is completely possible. You know, does it come up now and again? Yes. But that doesn’t mean I’m not recovered. That means that I see it as a sign and I know what to do with it. Which means I’ve recovered” (Shelley).  She also explained that she now understands the presence of disordered eating as a unique ability that she has to see, “that something internally, spiritually is kind of off So please take a look. Or you’ll be going down a dark road.. .1 do truly feel that it’s a gift. So if my mind, and my body and my soul want to tell me to pay attention, I have a very specific way of getting that attention. And I don’t know if other people have that” (Shelley).  -27-  5) Conceptualization of the experience of disordered eating as a positive aspect of identity The final theme that emerged amongst the women’s stories was how they came to a place of conceptualizing their experiences of disordered eating as being a positive aspect of themselves. Out of these difficult experiences, the women were able to construct an identity in which the experience of disordered eating is not forgotten, but rather re-framed into a positive aspect of their being. Renee stated explicitly, “It shaped my identity before in a negative way but now it’s in a positive way” (Renee).  Shelley described this experience in the following way, “It was a bit of a blessing and a bit of a gift all together. At the end of it alL... It’s brought me tons of things. In  the end”. (Shelley)  In my conversation with April, she explained the process of conceptualizing her experience as a positive part of her identity, while at the same time balancing this with recognition of the challenges that she faced. She stated, “there’s stages and there’s a process of letting go and of not feeling too attached to... that identity. But of honouring it. There’s that balance. Being like yeah, this is a good experience, this was.. .you know, a tough experience. And of honouring my body too, because my body literally bears the scars of being vety overweight, you know? It is a physically lingering thing that has marked myself, that has marked my body.... I guess part of it will always be a part of me... .in my mind as well as my physical being” (April)  Making meaning of my experience In understanding how the women came to re-frame their experience as being a positive aspect of their identities, space was opened up for them to share how they have made meaning from their experiences. For the most part, the ways in which women have derived meaning from their experiences emerged  -28-  spontaneously in the interviews. In referring to her ability to now work with others who are struggling with disordered eating, Shelley stated, “[I] do really believe spiritually, that that job was given to me” (Shelley)  Other women shared the following inspirational thoughts, “that’s become not my identity, but in a way it has, like someone who has recovered and who’s living a good life now. And you know, is realistic about it but is also contributing to others andjust showing that there’s hope. Functioning in the world... So that’s kind of a positive thing from it, like I feel that’s my identity now. In a way I’m glad! went through all of that because it’s shaped what I want to do and who I am” (Renee). “before the eating disorder was something negative, it destroyed me- or it could have destroyed me- and, and now, I’ve turned it around into something, it’s a blessing almost, because now I can share my story to help others” (Julie).  In contextualizing the individual interviews, the use of stories and language were looked at closely to understand what the women were trying to convey both directly and indirectly. Additionally, the use of symbolism was highlighted in the process of data analysis. In composing a structural description, I also looked for what was brought up spontaneously by the women. I felt this was necessary in order to understand what the women themselves felt to be of importance in their stories. Opening up space for women to share these aspects of their story proved to be very enlightening in understanding the key factors of their recovery journey. Lastly, the interviews were also looked at through a feminist lens that was specific to post-modernism, Marxism and social constructionism. At this stage, it is also necessary to draw attention to the differences which exist amongst women who experience disordered eating. From a postmodern perspective, it is essential to explore the concept of difference within the context of multiple, subjective experiences, all of which have equal value (Saulnier, 1996). These variables have been important in highlighting how disordered eating is experienced differently  -29-  for every individual due to their unique position within society. I have attempted throughout the results and discussion section to acknowledge the unique circumstances of each woman’s experience. Through the process of both conducting and reading the interviews, it was very evident to me the extent to which the participants felt their lives were governed by disordered eating. Some of the women expressed this directly, while others conveyed their experience through the use of detailed stories in which they shared the lengths to which they went in order to maintain their eating disorder. An example of this was as follows, “I had two gym memberships so I would, instead of going to school, I would go to one gym and then to other gym. So I would either have a starvation day and workout like crazy or I would have a binge day, going from supermarket to supermarket buying food, bingeing, so that was what I did when I didn’t go to school” (Julie).  Like Julie, Sara also shared stories about the extent to which her life revolved around disordered eating and how time consuming it became for her. It was also interesting to note that she spoke of her experience of treatment through the use of stories. She recounted being hospitalized for disordered eating in a generalized psychiatric unit and told stories describing the other patients on the unit. This suggested to me, that she possibly situated her experience as being quite different from that of the other patients on the unit. Looking at how stories were used to convey memories related to food and body image also lent insight into the women’s experiences. For example, April shared the following memory,  ‘  remember we had sports day in... .preschool and we had tires out, and we had to go through the tires and  I remember being afraid that I would not fit through the tires” (April).  I thought that it was very telling that April recalled fear of her body not being acceptable from such a young age. It was also interesting to me that her memory of what would be likely be an enjoyable event for most children, is shaped by thoughts about her body.  -30-  The use of language was also evident in looking back through the interviews. I noticed that many of the participants spoke frequently of themselves in the second person or third person. At times, it also seems that they used language which pathologized their experience. In describing her experience, Sara said, ‘you’re so screwed up”while April referred to herself as ‘That poor girl, you know, who I felt nothing but sympathy for’ It was also interesting to note the participants’ use of language in describing their relationships with their bodies. Some alluded to feeling detached from their bodies through statements such as, “I don’t hate you anymore... I don’t resent you anymore” (Angeline referring here to her body).  Others commented on this directly. An example of this was as follows, “I always felt very separate from my body...and there was a big disconnect from my body, ilke it wasn’t mine.., it was somebody’s else’s (April).  In contextualizing the interview with April even further, it was also interesting to also look at her use of language around weight. She recalled, “asking people constantly, “do you think I’m fat?”, “do you think I’m fat?”, do you think I’m fat?”, like every person who would listen for two seconds, I’d ask, “do you think I’m fat?” and I wanted that... .reassurance that I was okay and I needed it constantly” (April).  In looking at this statement, we can see the extent to which April equated being “okay” with not being “fat”. Another statement that she made in the interview further illustrates this point, “God forbid, the worst thing for an overweight person to think about is to think about getting worse, getting even more overweight” (April).  The use of symbolism in the interviews also stood out to me as an interesting aspect of the research. In my interview with Shelley, she described her understanding of the symbolism of disordered eating in the following way,  -31-  “I see that very symbolically in food. You know, the stuffing? So now that I realize how strong it is and how quickly my emotions come up. To keep that down is work”. (Shelley)  In some of the other women’s interviews, the symbolism behind their use of the terms “nurturance” and “nourishment” was also evident. Julie spoke of the need to “nourish the real me” in her recovery from disordered eating while Angeline described her understand of nurturance in this way, 7when] access to nurturance isn’t being threatened, I think that feeling that on a really deep level is what gradually alleviated my compulsive need to overeat. And gradually alleviated my need to control my food’ (Angeline)  In describing her relationship with food, April situated nurturance early on in our interview and stated, “It wasn’t a nourishment thing from the age of 4.. .it became something completely different” (April).  In composing a structural description of the women’s experiences with disordered eating and identity formation, it was also necessary to highlight the variables that the women brought up spontaneously outside of the interview guide. This was helpful in understanding the variables that they situated as being of importance and which may have otherwise been missed. One of the variables that emerged spontaneously in all six of the participants interviews was that of anxiety. Examples of this were demonstrated in this way, “the anxiety was just brutal. I was just so anxious all the time. All the time. You know, so unsafe. Really unsafe in my world” (Shelley)  and in Angeline’s statement, “I’m [also] not going to alleviate any sense of anxiety by the perfect meal. You know? Or by not eating” (Angeline).  Several of the women also brought up addiction and suggested that they conceptualized their experience of disordered eating as being related to experiences of addiction. Noteworthy of mention is also  -32-  the fact that some of the women spoke to the fact that they felt disordered eating to be different from addiction in the sense that they needed to construct a new relationship with food as opposed to omiffing it from their lives. This was evidenced in the following statement by Renee, “I think it feels like any other addiction. I really do. But it’s harder because you have to deal with food on an  everyday basis” (Renee).  Similarly, April described this challenge in the following way, “anybody who’s addicted to a certain pattern or a certain substance, be it food, be it drugs, be it alcohol, they’re always going to live with that, they’re always going to be tempted during times of stress to turn to that. I think with food it’s especially difficult because it’s not like heroin in the sense that you stop it, you stop heroin, you don’t have heroin. We get a little bit of heroin everyday in that we get a little bit of food everyday. So there’s always the opportunity to get triggered again” (April).  Discussion of the supports accessed by the women was not included in the interview guide. In some of the interviews, I did ask the women about what was helpful to them in their recovery process. In the other interviews, the women brought this up spontaneously. What stood out to me was that the majority of the women spoke of internal processes and informal supports as having been of most benefit to them. It was interesting to me that both Shelley and Angeline spoke about being involved in individual therapy but noted that disordered eating was not the focus of their therapy. Shelley states, “looking back, it was really a very individual process for me. It’s [disordered eating] something that we never ever talked about in my sessions”. (Shelley)  Renee and Sara both brought up the importance of support groups and the benefit that they derived from this experience. This was evidenced in the following statements, “Eventually going to support groups was so helpful.... just listening to what the people had to say and hearing myself talk eventually, I found that so helpful. That combined with a lot of work on my own”. (Renee).  -33-  “I’m a firm believer in group therapy....even if you didn’t say anything, you’re in group and you didn’t feel alone. You didn’t feel like the things you were doing [which] are totally ridiculous” (Sara).  Similarly, Julie spoke of the importance of connecting with others who were trying to recover from disordered eating via on-line recovery forums. Two of the women also identified having received treatment in a hospital setting but commented on the inadequacy of this treatment in addressing their concerns. In describing her experience of recovery, Renee stated the following, “I can’t say it happened in the hospital (laughs). I mean you get physically stabilized in the hospital but I didn’t really feel that the issues were dealt with. It was just like, okay, you’re at a stable weight” (Renee)  In contextualizing the women’s interviews, the minimization of the women’s experiences became evident to me. It seemed that at times, the women expressed a minimization of their own experiences. The following statement from Sara is indicative of this, “Even when I was sick and dying, evetything was okay....! didn’t let myself get that deep into it, this was just what was happening and I kind of was going through the motions of it... this was just something I had to do” (Sara).  While April conveyed the extent to which her life was impacted by disordered eating, she also expressed the feeling that her experience would be minimized by others. She stated, “I didn’t think people would want to hear me talk, about.. .you know, my weight issues, or my body image or anything like that, no, I thought the counsellors only wanted to see me if! had something, you know, seriously wrong in my life” (April).  Lastly, the participants’ interviews were contextualized through the lenses of post-modern feminism, Marxist feminism and social construction feminism. From a post-modern feminist perspective, it stood out to me that the women’s stories reflected the extent to which disordered eating continued to shift and evolve throughout various points of their lives. This is in opposition to the perspective of disordered eating as being a constant and fixed entity in women’s lives. The following statement by April was very  -34-  telling of the post-modernist perspective of the body as being “increasingly fed on fantasies of rearranging, transforming, and correcting, limitless improvement and change (Bordo, 2003, p. xvi-xvii)”. She stated, “It’s still a very ingrained, habitual pattern to look at umm. .a beautiful woman and go, ‘I want to look exactly .  like her... I want to have her butt, I want to have her thighs, and her boobs would be nice too’ “(April)  Contextualizing the interviews through a Marxist feminist perspective shed light on how attempts to adhere to a body image ideal took attention away from the women’s ability to pursue educational and vocational goals. This was consistent with the contributions of Marxist feminism which seek to understand the ways in which women are in a subordinate position via the body. In my interview with Julie, she spoke of how disordered eating impacted her ability to engage in academic interests and referred to the experience of disordered eating as “my full-time job”. Sara spoke of not being able to work because of the extent of her disordered eating and how this created financial difficulty for her. Other participants spoke of how disordered eating limited their participation in academic endeavours, sometimes to the point of not being able to continue in school. It is interesting to note however, that in their recovery, many of the women went on to pursue vocational goals related to helping other women who are struggling with disordered eating. A social constructionist feminist perspective was especially useful in drawing attention to the ways in which the women situated their struggle with disordered eating and the influences that shaped its development. The notion of “perfectionism” emerged in the interviews and was illustrative to me of the dominant discourses which situate the development of disordered eating in women’s pathological need for control or perfectionism. Sara also spoke to me in her interview of what she viewed as the ‘ypical” characteristics of someone with disordered eating and the ways in which she saw herself as being both similar and different to this. She saw herself as fitting into the stereotype of someone with disordered eating in that she had “nothing to worry about” in terms of her weight at the time of onset. Conversely, she saw  -35-  herself as being different from the stereotype in the sense that she was not depressed. She elaborated to say that the physicians involved with her conveyed to her that they felt she was “unique” from other patients with disordered eating. Her thoughts about these “stereotypes” were reflective to me of the socially constructed discourses surrounding eating disorders. Some of the women also highlighted socially constructed notions of gender and femininity in their interviews. In the case of both April and Angeline, these descriptions emerged spontaneously. April described the following understanding of socially constructed expectations of women, “So a good woman is slim, elegant, wispish, waiflike, quiet... you know? Even it their personality isn’t (laughs) and somehow it seems inadequate if you don’t conform to the opinions of what a woman- a good woman is” (April).  April continued to say, ‘Too much of anything was bad... being too loud, too rough, too heavy, too... all these vety undesirable, unfeminine characteristics. ..it made me feel like it was undesirable” (April).  It was interesting to me that Angeline also described a similar understanding of the ways in which a woman’s body is understood to be reflective of aspects of the self. She stated, “So I couldn’t be delicate. Like I couldn’t, that’s dissonant, that’s, you know, the fat girls’ not delicate, she’s not self-contained, she’s got- what is it? She’s funny and she’s edgy, don’t mess with her. Kind of thing. She doesn’t do her hair that way because that’s sexy, that’s alluring, you know, she would be so silly. I felt like I would be ridiculed to go out there and present myself as a sexually attractive person because they’d go, ‘oh my god. Who the hell is she kidding?’ So instead, I went out there and I presented myself as... the intelligent, eccentric, rowdy, dangerous person.’ (Angeline).  April also spoke to the folklore that shaped her understanding of femininity. She recalled being subjected to the following fairy tale narrative as a child,  -36-  ‘The princess, the helpless, you know, maiden lost in the woods, with...no voice, no weight on her (laughs) and she.. .gets saved by a prince. That very much shaped my identity as, you know, what I wanted to be as a woman.” (ApriL  Creswell (2007) suggests that in phenomenological studies, a composite description should follow structural and textural descriptions and should combine the structural and textural elements identified. The aim of such is to provide the reader with an understanding of the essence of the phenomenon under study. The following paragraph will attempt to reflect the essence of women’s experiences of disordered eating and identity. The women interviewed for this research study described the complex relationship between their experience of disordered eating and sense of self. There was an element of disconnection that the women spoke of in describing their relationships with their bodies throughout their experience of disordered eating. In sharing their experiences, the women also shed light on the internalization of dominant discourses related to women’s bodies and femininity. The women spoke about how much of their life was consumed by disordered eating and how this led to a diminished ability to pursue academic and vocational goals. They reflected on how they came to see the ways in which disordered eating was impacting their lives and how this led to their ability to eventually externalize this experience. In perceiving disordered eating as something distinct from the self, the women described a process wherein new aspects of identity were uncovered. The anxiety that accompanied their experience of disordered eating and the risks that they had to take in moving through this process were highlighted in their stories. The participants situated internal processes and informal supports as being of the most benefit to them throughout this difficult journey. They spoke of how they often felt that conventional treatment was inadequate and that professionals were “not getting it’. Finally, the women spoke of the profound meaning that they have derived through their experience and how for many of them, this has led to a desire to help other women who are struggling with disordered eating.  -  37  -  CHAPTER 4: DISCUSSION In discussing the results derived from the research study, I will first acknowledge the limitations of the study. Following an acknowledgment of these limitations, I will explore the findings in relation to the research previously discussed. Thirdly, I will highlight the contributions brought forward by the women participating in the research. Fourthly, I will explore how the findings have implicated the use of narrative therapy as a potentially helpful tool in co-authoring alternative stories of identity and disordered eating with the women with whom we work. This section ends with a discussion of implications for social work practice and areas for future research. In feminist research, it is acknowledged that objectivity does not exist and therefore research cannot be without bias. Nonetheless, I will describe here the biases of which I am aware in order to account for these. To begin with, I am aware of the fact that both my personal and professional experiences with the subject matter have biased the research design and data analysis. In the interview process, I had a role to play in the types of questions that were asked and may have unintentionally lead the participants in a particular direction based on my own biases about the issue being discussed. In terms of the sampling design, participants were aware that the research pertained specifically to disordered eating and identity. Therefore they may have been interested in participating because they felt they could speak to this experience. For this reason, the women who were interviewed may not have been representative of the whole population under study. With respect to the data analysis, my own subjective experience would have also biased the variables and themes which were apparent to me. Much of the literature discussed in the conceptual context has highlighted identity as an important variable in the onset and maintenance of disordered eating. The lens through which this has been viewed varies greatly. Some of the research situates disordered eating as arising in response to conflicts of identity  -38-  (Chernin, 1985) or as a place wherein women are able to enact struggles related to identity (Hoskins, 2002). Additionally, other research suggests that women’s “lack of self-respecting identity” (Finelli, 2001, p. 24) is a precipitating factor for the development of disordered eating. The contributions by Chemin (1985) and Hoskins (2002) have explored the socio-cultural influences at play in struggles of identity. In doing so, they avoid further pathologizing women for their experiences. This research study has followed suit by using a feminist framework to understand the context of women’s experiences. This allows for the ability to expand our understanding beyond “a lack of self-respecting identity” which locates the problem as occurring within the woman. As previously discussed, research has also indicated that the experience of having an eating disorder can become an integral part of a person’s identity and that this creates difficulty in developing a separate identity (Bulik & Kendler, 2000; Tan et al., 2003; Weaver et al., 2005). The women interviewed for this research study certainly seem to have reflected the ways in which disordered eating became fused with their sense of self. They also spoke to the need to separate themselves from this experience and the difficulty associated in doing so. What struck me as being an important contribution of the women’s stories was the extent to which they unveiled strengths in themselves in this process and also came to eventually see this as a positive aspect of their identity. Some of the research reviewed has suggested that eating disorders provide individuals with a sense of uniqueness or being special (Levenkron, 2001). There were significant differences amongst the women that I interviewed with respect to how they situated this experience. Some of the women alluded to feeling a sense of uniqueness through their eating disorder. They spoke of not wanting to “blend in” and of how disordered eating made them feel strong at times. However, some of the other women did not seem to relate to what has been suggested in the research. Instead, these women commented on how they didn’t want to be seen or noticed and tried to avoid standing out. This was described as being “under the radar”.  -39-  The differences are important to highlight in demonstrating how the experience of disordered eating and identity is experienced uniquely for each woman. As stated, many of the women situated informal supports and internal processes as being integral to their recovery. This is consistent with the findings derived from a qualitative study by Lamoureux and Bottorff (2003) which explores identity processes in recovery from anorexia. When we focus solely on women who have received formal eating disorder treatment, we may miss out on many valuable contributions from women who have found their way through the journey of recovery without formalized supports. Additionally, it was noted in some of the women’s interviews that they felt professionals were “not getting it”. I believe that it has been very beneficial to open up this dialogue and allow women the opportunity to lend insight into this complex issue. From a feminist perspective, this is especially important in positioning women as the experts in their own lives. The women interviewed for the research study spoke of the importance of having others in their lives not relate to them as the disordered eating. They shared that this can further entrench an individual’s struggle with disordered eating by reinforcing the idea that the person is their disordered eating. Renee highlighted the importance of family members and friends focusing on other aspects of the individual’s identity in helping the individual move toward, and through, recovery. This is a helpful reminder to those working with family members of women struggling with disordered eating. It also serves as an important reminder to be mindful of the dialogue with which we are engaging our own clients. This will be further discussed when looking at the potential use of narrative therapy and implications for social work practice. As described in the data analysis, all of the participants lent insight into how they have made meaning from their experiences. Sharing their experiences of meaning-making with women struggling with disordered eating could be empowering to the participants. It would also be helpful for women who are  -40  -  struggling to see the potential for hope and meaning in their experience. This has implications for social work practice which will be discussed. In addition to sharing her experience of meaning making, one of the participants highlighted many tools that were helpful in her journey of recovery. She spoke of how she created a “coping catalogue” that she could refer to for alternative activities when she wanted to engage in disordered eating behaviours. She also shared about the importance of removing her scale and the labels out of her clothing in an effort to diminish the importance of these numbers. Allowing opportunities for women who have recovered from disordered eating to share these tools with other women who are struggling also has implications for social work practice which will be discussed. In reflecting on the data analysis, it became apparent to me that much of what the women described about their experiences with disordered eating and identity processes were consistent with the contributions of narrative therapy. The first theme to emerge in the data analysis was the “fusion of disordered eating and identity”. The women spoke of how they had difficulty separating themselves from disordered eating and how this was reinforced by those around them. This is consistent with a narrative perspective which draws attention to the totalizing of the individual as their eating disorder. This is described as occurring when individuals are “labelled as ‘anorexics’ or ‘bulimics’ and, in that linguistic process, fully adopt the identity of the eating disorder” (Weber, Davis and McPhie, 2006, p. 393). Weber et al. (2006) further demonstrate how this can result in the individual blaming themselves for their struggles. As noted previously in the data analysis, it appeared at times that the women who participated in the research engaged in pathologizing language when referring to themselves and their own experiences. The role of language will be explored further throughout this discussion. Narrative therapists propose that when women become aware of the impact of disordered eating in their lives, space begins to be created between them and the eating disorder (Epston, Morris and Maisel, 1995). In the data analysis, the “recognition of the extent to which disordered eating consumed my life” was -41-  presented as a subtheme in the women’s stories and seems to mirror the above process described in narrative therapy. Of course, externalization of the eating disorder is a key concept of narrative therapy (Brown et al, 2008) and this was also very much reflected in the women’s stories. The theme of “distinguishing disordered eating from the self” and subtheme of “identifying and addressing the voice associated with disordered eating” were presented by the women as the process through which they went in externalizing disordered eating from themselves. In narrative therapy it is suggested that individuals and therapists co-author new stories and identities (Brown & Augusta-Scott, 2007). The women’s re-authoring of their stories was reflected in how they started to discover new aspects of identity and also in how they re-conceptualized the experience of disordered eating as a positive aspect of identity. Lastly, in this process of deconstructing and reconstructing stories, narrative therapy suggests that individuals can make meaning of their struggles (Weber et al, 2006). This mirrors the final theme described by the women in coming to a place of discovering meaning and purpose out of this challenging experience. As noted previously, the women spoke of the difficulty associated with feeling that they were the eating disorder and how this was reinforced through interactions with others. I believe that socia’ workers can play an important role in helping women to re-author this experience. As suggested by narrative therapists, language is a necessary component of this process (Weber et. al, 2006). By avoiding the use of pathologizing and totalizing language with our clients, we can build this in to the therapeutic relationship. It has been my experience working as a therapist in the field of disordered eating, that clients often think that they should be talking about their eating disorder symptomology in both individual and group therapy sessions. This often surprises me but I am also aware of how this is likely reflective of dominant medical discourses which support an emphasis on weight and disordered eating behaviours. The focus on  -42-  symptomology in medical models of treatment likely contributes to the minimization of women’s experiences which was evidenced in the research findings. Alternatively, narrative therapists emphasize the importance of “shifting the focus of intervention away from weight preoccupation and eating behaviour” as this “leaves room to explore how these preoccupations distract women from the meaning of their struggles” (Brown et al, 2008, p.95). The research findings also support the use of narrative therapy in helping women struggling with disordered eating to understand the socially constructed discourses surrounding gender and selfmanagement that so often accompany disordered eating (Brown et al, 2008). As discussed in the results section, the women’s stories revealed the dominant discourses at play in the experience of disordered eating. Narrative therapy suggests that helping women to uncover these discourses can serve to externalize the problem by exploring the context and taking the emphasis off individual pathology (Padulo & Rees, 2006). As discussed in the data analysis, the women’s stories also highlighted the symbolism behind their experiences of disordered eating. It seemed that their ability to unveil symbolism was helpful in understanding the meaning behind these experiences and in moving away from a place of blaming themselves for their struggles. Padulo and Rees (2006) point out how the use of symbolism and metaphors can be beneficial in externalizing disordered eating in a narrative therapy approach. Also described in the structural description were the women’s experiences of being disconnected from their bodies. Padulo and Rees (2006, p. 68-69) have summarized the importance of looking at symbolism and the mind-body connection in narrative therapy: “it is relevant for women with disordered eating to participate actively in creating and illustrating a story because it allows resonance between the body and the mind that is often experienced as  -43-  disconnected... .when a link is provided between the mind and body through the writing of stories, the woman is given a forum for symbolic thought and communication to develop”. Throughout this discussion, I have demonstrated the ways in which the participants’ experiences reflect many of the processes proposed in narrative therapy. This was not something that I had expected to uncover when entering into the research or data analysis. It is interesting to me that the majority of women did not access formalized supports in their recovery from disordered eating and none spoke explicitly of narrative therapy. Somehow still, these women were able to deconstruct and reconstruct the meaning of their struggles and re-author their stories. As narrative therapy has been implicated in working with women to negotiate disordered eating and identity processes, I will suggest that this be an area of further research. Because of the limited sample size and the fact that the use of narrative therapy was not the initial focus of this research study, more research is needed into this area. A study by Weber et al. (2006) points to positive outcomes of narrative therapy in group work practice for women with disordered eating. An article by Padulo and Rees, (2006) looks at the use of narrative therapy in combination with motivational interviewing for women with disordered eating. Padulo and Rees (2006, p. 70) suggest the incorporation of motivational interviewing as it supports the view that “lasting change has to come from the decision of the woman, not from the therapist or other individuals in the woman’s life” and emphasizes how important it is when working with women with disordered eating “not to push, condemn, convince, or coerce”. Narrative therapy is also potentially empowering for women as they are situated as the experts of their experience and therapists work in a model of co-research to understand the woman’s experience (Weber et al., 2006). The application of narrative therapy with both individuals and groups, as well as in combination with motivational interviewing, could be interesting areas for further research.  -  44  -  A study by Epston et al. (1995) uses letters taken from a narrative therapy process with a client over a period of time and has the client evaluate the effectiveness of this approach. Future studies in which clients can evaluate the effectiveness of narrative therapy in negotiating disordered eating and identity processes are needed. This would be consistent with continuing to position women as the experts of their own lives. In line with positioning women as the experts of their own experiences, it is important to continue to incorporate the voices of women who have recovered from disordered eating into further research and models of practice. I would suggest that this could take the form of further unstructured or semi-structured studies which allow space for women to tell us what is important in understanding and treating disordered eating. In addition to future studies around the use of narrative therapy in the treatment of disordered eating, it wouTd also be helpful to understand more about the processes described by the women who participated in the research. For example, it would be helpful to look at the following questions: 1) How did the women start to uncover new aspects of themselves? 2) How were they able to re-frame their experience of disordered eating as positive? Additionally, as this research was carried out with women who identified as having recovered from disordered eating, and who did not necessarily receive treatment for this, it would be interesting to understand more about the processes of identity for women in medically based treatment programs for eating disorders. It has been my observation in working with in-patient units and residential programs that treatment itself can become the main focus of a person’s life. It would be interesting to understand more about how this shapes identity for the recipients of this treatment. Specifically, it would be interesting to look at how, if at all, eating disorder treatment may serve to further entrench the disordered eating identity that the research participants spoke of. The women who participated in the research have lent a great deal of insight into implications for social work practice. For example, the women spoke of how disordered eating is similar to other forms of  -45  -  addiction but highlighted how this can be even more challenging as they needed to construct a new relationship with food and their bodies. In this way, abstinence based models are not applicable. Additionally, many of the women shared that recovery for them has meant a diminished presence of disordered eating as opposed to a complete absence of it. These insights point to the use of a harm reduction model when working with women struggling with disordered eating. For example, harm reduction could mean assisting clients in developing their own definition of recovery and looking at improving quality of life. It has been my experience working with this population that clients often perceive themselves to be “failing” if they are continuing to experience some degree of disordered eating symptoms in their journey of recovery. Social workers can play an important role in helping clients to reframe notions of recovery and in continuing to reflect on and uncover strengths throughout the process. As has been demonstrated in this study, women’s strengths and internal resources need to be unveiled. It would be helpful for example, to allow opportunities for women who have recovered from disordered eating to speak at support groups for clients and/or caregivers to lend improved understanding to professionals and families and to lend hope to women who are currently struggling. This would also allow for women who have recovered to share some of the tools that were helpful to them in their recovery journey. The women who, participated in the research also highlighted how important informal supports and internal processes were for them in their recovery from disordered eating. They also spoke of how they felt professionals were note “getting it” at times. These insights have very important implications for social work in that we need to open up space in our interactions with clients for them to help us understand what it is that they believe professionals do not understand. Obviously, this is necessary in our direct work with clients but also in helping clients to communicate with other professionals and advocating on their behalf. Lastly, the women’s statements speak to the importance of engaging informal supports and caregivers in the treatment process as directed by the client.  -46  -  CONCLUSION This research study has sought to understand women’s experiences with disordered eating and identity formation. In doing so, I have used a feminist theoretical framework which has incorporated perspectives of postmodernism, Marxism, and social constructionism in providing depth to the understanding and analysis of this complex issue. Women were recruited to participate in a series of qualitative un-structured in-depth interviews. The interviews were analyzed using a phenomenological framework. Structural and textural descriptions of the women’s experiences have converged to create an understanding of the essence of this phenomenon. The women’s experiences have reflected many of the processes proposed in narrative therapy for working with women struggling with disordered eating. Recommendations have been made for further research into the use of narrative therapy in the field of eating disorders. Recommendations have also been made for further studies which would seek to understand more about the processes described by the women in the research study. Lastly, I have highlighted the need for more unstructured or semi-structured qualitative research studies which would allow for women’s voices to be heard in the understanding and treatment of disordered eating. Implications for social work practice have also been discussed and include the use of a harm reduction model and the importance of engaging informal supports. The research has also pointed to the value of providing opportunities for women who have recovered from disordered eating to share their stories with those affected by disordered eating. In this way, women who have recovered can improve our understanding of this complex issue and generate the hope of recovery for those who are struggling. In this research study, the women who participated were able to lend valuable insight and contributions to our understanding of disordered eating and processes of identity. Through sharing their stories, the gains which these women have made in their personal lives have been incorporated into our understanding of this broader social and political issue.  -  47  -  REFERENCES Bordo, S. (2003). Unbearable weight: feminism, western culture, and the body. Berkeley: University of California Press. Brown, C., & Jasper, K. (Eds.). (1993). Consuming passions: feminist approaches to weight preoccupation and eating disorders. Toronto: Second Story Press. Brown, C. & August-Scott, T. (Eds). (2007). Narrative therapy: making meaning, making lives. London: Sage Publications. Brown, C.G., Weber, S. & Ali, S. (2008). Women’s body talk: a feminist narrative approach. Journal of Systemic Therapies, 27(2), 92-104. Bruch, H. (1978). The golden cage: the enigma of anorexia nervosa .Cambridge: Harvard University Press. Bruch, H. (2001). The golden cage: the enigma of anorexia nervosa. Cambridge: Harvard University Press. Bulik, C.M. & Kendler, K.S. (2000). “I am what I (don’t) eat”: establishing an identity independent of an eating disorder. The American Journal of Psychiatly, 157(11), 1755-1760. Chernin, K. (1981). The obsession: reflections of the tyranny of slenderness. New York. Harper Collins. Chernin, K. (1985). The hungry self women, eating, and identity. New York. Times Books. Choate, L. H. (2005). Towards a theoretical model of women’s body image resilience. Journal of Counseling & Development, 25(83), 320-330 Creswell, J.W. (2007). Qualitative inquiry and research design. Thousand Oaks: Sage Publications. Dias, K. (2003). The ana sanctuary: women’s pro-anorexia narratives in cyberspace. Journal of International Women’s Studies, 4 (2), 31-45. Epston, D., Morris, F., & Maisel, R. (1995). A narrative approach to so-called anorexia/bulimia. Journal of Feminist Family Therapy, 7(1/2), 69-96. Finelli, L.A. (2001). Revisiting the identity issue in anorexia. Journal of Psychosocial Nursing & Mental Health Services, 39 (8), 23-29. Friedan, B. (1963). The feminine mystique. New York: Dell Publishing Co Inc. Gucciardi, E., Celasun, N., Ahmad, F. & Stewart, D.E. (2003). Women’s Health Surveillance Report. Ottawa: Canadian Institute for Health Information. Hoskins, M.L. (2002). Girls’ identity dilemmas: spaces defined by definitions of worth. Health Care for Women International, 23, 231-247.  -  48  -  Jones, J.M., Bennett, S., Olmstead, M.P., Lawson, M.L. & Rodin, G. (2001). Disordered eating attitudes and behaviours in teenaged girls: a school-based study. Canadian Medical Association Journal, 165 (5), 547-552 Lamoureux, M. M. H. & Bottorff, J.L. (2005). “Becoming the real me”: recovering from anorexia nervosa. Health Care for Women International, 26, 170-188. Levenkron, S. (2001). Anatomy of Anorexia. New York: W.W. Norton & Company Inc. Lorber, J. (2005). Gender Inequality. (3rd ed.) Los Angeles: Roxbury Publishing Co. Lumley, H. (2002). Making the connection: disordered eating in our communities. Visions: BC’s Mental Health Journal, 16, 6-7. Malson, H. (1999). Women under erasure: anorexic bodies in postmodern context. Journal of Community & Applied Social Psychology. 9, 137-153. Maxwell, J. A. (2005). Qualitative research design: An interactive approach (2nd ed.). Thousand Oaks: Sage Publications. McVey, G.L. & Davis, R. (2002) A program to promote positive body image: a 1-year follow-up evaluation. Journal of Early Adolescence, 22(1), 96-108. Mullaly, B. (2002). Challenging Oppression: A Critical Social Work Approach. Toronto: Oxford University Press Padulo, M.K. & Rees, A. (2006). Motivating women with disordered eating towards empowerment and change using narratives of archetypal metaphor. Women and Therapy, 29 (1/2), 63-81. Patching, J. & Lawler, J. (2009). Understanding women’s experiences of developing an eating disorder and recovering: a life-history approach. Nursing Inquiry, 16(1), 10-21. Patton, M.Q. (2002). Qualitative Research and Evaluation Methods. Thousand Oaks: Sage Publications. Piran, N. (2001). V. reinhabiting the body. Feminism and Psychology, 11(2), 172-176. Piran N. & Cormier, H.C. (2005). The social construction of women and disordered eating patterns. Journal of Counseling Psychology, 52 L4), 549-558. Rich, E. (2006). Anorexia dis(connection): managing anorexia as an illness and an identity. Sociology of Health & Illness, 28 (3), 284-305. Saulnier, C. (1996). Feminist Theories and Social Work. New York: Haworth Press Inc. 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, 58-69.  -  49  -  Tan, J.O.A., Hope, T., & Stewart, A. (2003). Anorexia nervosa and personal identity: The accounts of patients and their parents. International Journal of Law and Psychiatry, 26, 533-548. Weaver, K., Wuest, J. & Ciliska, D. (2005). Understanding women’s journey of recovery from anorexia nervosa. Qualitative Health Research, 15(2), 188-206. Weber, M., Davis, K., & McPhie, L. (2006). Narrative therapy, eating disorders and groups: enhancing outcomes in rural NSW. Australian Social Work, 59 (4), 391-405. Wolf, N. (1991). The Beauty Myth. New York: William Morrow and Company, Inc.  -  50  -  Appendix A THE  UNIVERSITY OF  BRITISH  Ii ir’I  COLUMBIA  School of Social Work 2080 West Mall Vancouver, B.C. Canada V6T 1Z2 Tel: (604) 822-2255 Fax: (604) 822-8656 www.socialwork.ubc.ca  ILiII 0  LU  LETTER OF INTRODUCTION  Title: Embodying the Self: Women’s Experiences of Disordered Eating and Identity Formation Principal Investigator: Paule McNicoll, Ph.D. School of Social Work, UBC Phone: (604) 822-2977 Co-Investigator:  Kelley Fitzpatrick, MSW Candidate School of Social Work, UBC Phone:  My name is Kelley Fitzpatrick and I am a Master’s of Social Work candidate studying at the University of British Columbia. As part of fulfilling my adademic requirements, I am embarking on a research project that will seek to understand the relationship between disordered eating and identity. I am looking to interview individual women who have recovered from disordered eating and who sought support (either formal or informal) in their recovery. In doing so, I hope to gain a rich understanding of how women understand their identity in relationship to the experience of disordered eating. This knowledge will be aimed at helping service providers to better understand the needs of women with disordered eating and coordinate effective programs aimed at helping women to recover from disordered eating.  -51-  Participation will entail meeting with myself for up to ninety minutes to discuss the above issues. With your permission, a second interview may take place to allow for further exploration of the issues which you feel are important. The interview(s) will be informal and will take place in a setting and location of your choice. A follow-up phone call may be required for further clarification. All conversations will be audiotaped and transcribed with all identifying information removed. Your participation in this study is voluntary and you will be free to withdraw from the project at anytime. You have the right to refuse to answer any questions and to withdraw information that you may not want used in this study. All your input will be confidential. If you have any further concerns or questions, please feel free to contact myself, Kelley Fitzpatrick at or Dr. Paule McNicoll at 604-822-2977. Thank you for your time, Sincerely,  Kelley Fitzpatrick, MSW Candidate  -  52  -  Appendix THE  B UNIVERSITY  BRITISH  OF  COLUMBIA  School of Social Work 2080 West Mall Vancouver, B.C. Canada V6T 1Z2 Tel: (604) 822-2255 Fax: (604) 822-8656 www.socia Iwo rk.ubc.ca  •1 \/  Have you experienced disordered eating in the past? Did you seek any support (formal or informal) during that time? If your answer is “Yes” I would like to speak with you about your experience Why?  I am seeking input from women who have recovered from disordered eating in order to better understand the impact of this experience on identity.  What is required? I would like to meet with you to discuss your experience. This one-to-one meeting will take place in a location and time of your choosing and will take approximately ninety minutes. With your agreement, a second follow-up interview of up to sixty minutes may take place. Why participate? We need to better understand the needs of women with disordered eating. Your input will help service providers coordinate effective programs aimed at helping women to recover from disordered eating. A gift certificate in the amount of $20 will be provided for your participation in the interview.  If you are interested in participating or would like to know more about this study, please contact:  Kelley Fitzpatrick, MSW Candidate University of British Columbia  -  53  -  Appendix C INTERVIEW GUIDE  Questions  1) How would you differentiate between normal eating and disordered eating? Possible follow-up questions:  What has normal eating looked like in your life? What has disordered eating looked like in your life? 2) What role do you think disordered eating has played in your life? Possible follow-up question:  What aspects of your life were impacted by disordered eating?  3) How has your identity been shaped by disordered eating? Possible follow-up questions: To what extent has this taken place? What aspects of your “self” were affected by your experience of disordered eating? What aspects of “who you are today” have resulted from your experience?  4) In thinking about your own experiences, how do you understand the relationship between disordered eating and identity? Possible follow-up questions:  -  54  -  What do you recall about your identity prior to the onset of disordered eating? What do you recall about your identity while you were struggling with disordered eating? How do these fit with your sense of identity now?  -55-  Appendix D THE  UNIVERSITY  OF  BRITISH  COLUMBIA  School of Social Work and Family Studies 2080 West Mall Vancouver, B.C. Canada V6T 1Z2 Tel: (604) 822-2255 Fax: (604) 822-8656 www.socialwork.ubc.ca  PARTICIPANT CONSENT FORM litle: Embodying the Self: Women’s Experiences of Disordered Eating and Identity Formation Principal Investigator: Paule McNicolI Ph.D. School of Social Work, UBC Phone: (604) 822-2977 Co-Investigator:  Kelley Fitzpatrick, MSW Candidate School of Social Work, UBC Phone:  We are seeking input from women who have experienced disordered eating and sought support in their recovery. We are trying to understand the relationship of this experience to identity. This knowledge will be aimed at helping service providers to better understand the needs of women with disordered eating and coordinate effective programs aimed at helping women to recover from disordered eating. The research is being conducted as part of the co-investigator’s graduate degree. If you should choose to participate in this study, an interview of approximately 90 minutes would take place with the co-investigator. The purpose of this interview would be to discuss your experiences with disordered eating and the relationship of this experience to your personal identity. With your permission, a second interview may take place to allow for further exploration of the issues which you feel are important. The interview(s) will be informal and will take place in a setting and location of your choice. A follow-up phone call may be required for further clarification. All conversations will be audiotaped and transcribed with all identifying information removed. You will be given a  -56-  copy of your transcript in order to clarify or remove information that you do not wish to be included. This study deals with a sensitive topic and could be emotionally distressing to some participants. I will attempt to “check in” with you throughout the interview to ensure that you are feeling comfortable. I will not have a therapeutic role in enacting the research but am willing to help locate appropriate resources for follow-up support. Your participation in this study is voluntary and you will be free to withdraw from the project at any time. You have the right to refuse to answer any question and to withdraw any information you do not wish to be included in this study. Moreover, unless you specify in writing, your input will remain confidential. This will be done by removing all identifying information from your files and using a pseudonym to reference you. Files will be stored in a secure location separate from any information which might personally identify you for a period of five years. If you have concerns regarding this study, please feel free to contact Dr. Paule McNicoII at (604) 822-2977. It you have concerns regarding your treatment of rights as a participants in this project, you may contact the Research Subject Information Line in the UBC Office of Research Services at (604) 822-8598 (or if long distance, e-mail to RSlL@ors.ubc.ca). Thank-you for considering your involvement in this project. If you agree to participate, your signature is required below. Sincerely,  Kelley Fitzpatrick, MSW Candidate  I hereby consent to participate in the study described above. I have received a copy of the consent form.  Name (please print)  Signature  Date  -57-  Appendix E  The University of British Columbia Office of Research Services  LJRC  Behavioural Research Ethics Board Suite 102, 6190 Agronomy Road,  Vancouver, B.C. V6T 1Z3  CERTIFICATE OF APPROVAL FULL BOARD -  PRINCIPAL INVESTIGATOR: Daule McNicoll  -  INSTITUTION I DEPARTMENT: UBC/Arts/Social Work  UBC BREB NUMBER: H09-01 601  NSTITUTION(S) WHERE RESEARCH WILL BE CARRIED OUT: -  Institution  Site  NI/A  N/A  )ther locations where the research will be conducted:  The study will be carried out in a location chosen by the participant, probably in their home.  CO-INVESTIGATOR(S): Kellev Fitzøatrick ISPONSORING AGENCIES: IN/A  PROJECT TITLE: Embodying the Self: Women’s Experiences of Disordered Eating and Identity Formation  IREB MEETING DATE: uiy 9, 2009  CERTIFICATE EXPIRY DATE: IJuly 9, 2010  DOCUMENTS INCLUDED IN THIS APPROVAL:  IDATE APPROVED: IJuly 20, 2009  Document Name  Version  Consent Forms: Consent Form advertisements: Recruitment Notice Questionnaire. fl..t.rnqaire Cover Letter. Tests: Interview Guide Letter of Initial Contact: Letter of lntroducon  I  Date  2  July 19, 2009  N/A  June 22, 2009  N/A  June 22, 2009  N/A  June 22, 2009  Ehe application for ethical review and the document(s) listed above have been reviewed and the Drocedures were found to be acceptable on ethical grounds for research involving human subjects. Approval is issued on behalf of the Behavioural Research Ethics Board and signed electronically by one of the following:  -58-  Dr. M. Judith Lynam, Chair Dr. Ken Craig, Chair Dr. Jim Rupert, Associate Chair Dr. Laurie Ford, Associate Chair Dr. Anita Ho, Associate Chair  -59-  

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