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