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Understanding women’s experiences of normalization of eating in recovery from anorexia nervosa Matic-Smyrnis, Kosovka Kosa


Research into recovery from anorexia nervosa has been limited to determining the typical course and long-term outcome of people diagnosed and treated for anorexia nervosa. No attention has been given to understanding the process of changing and normalizing eating behaviour during recovery. This study describes the process of eating normalization as experienced by 13 women who perceived themselves as having recovered from the disorder. Participants who worked with a dietitian also commented on the significance of the dietitian’s role in their recovery. This study used a qualitative research design to elucidate the themes underlying the process of eating normalization. Data were collected through semi-structured interviews and the Eating Attitude Test-26 questionnaire. Grounded theory methods were used in data analysis, generating a contextually grounded central theme of having the freedom to enjoy all foods. The central theme consisted of four phases: 1) Acknowledging the disorder (awareness of physical complications, decline in social activity, disliking the type of person one became, and finally becoming tired of the anorexic game); 2) Accepting support and deciding to change (being ready, deciding to change eating patterns, accepting weight gain, and engaging support); 3) Confronting old patterns and learning new ways (mentoring healthy eating, experimenting with new foods, and making incremental changes); and 4) Food becoming a non-issue (eating whatever/whenever one wants, reaching a balance, creating an identity without an eating disorder, and gaining freedom to enjoy food and life). Six participants who worked with a dietitian reported mixed feelings about the significance of the dietitian’s role in their recovery. Three women found nutrition intervention beneficial, while three were dissatisfied with their interactions with a dietitian. Three themes emerged from the data describing the role of the dietitian: education, support, and mentoring. Based on these findings, the study provides recommendations that dietitians who wish to work with individuals affected by anorexia nervosa must have a good understanding of counselling skills on the issues underlying an eating disorder, and be able to function as educators, nutrition therapists and mentors in assisting clients with normalizing their eating behaviour during the recovery process.

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