"Doctor-Prescribed and Mother-Encouraged": Interpersonal Interactions and Body Image Concerns in Higher-Weight Clients with Eating Disorders

Abstract

Restrictive Eating Disorders (EDs) have the highest mortality rate of any psychiatric illness. Among restrictive EDs, individuals can present across the weight spectrum, however those with low body weight have traditionally been the focus of ED research. Though a major issue in ED treatment, there has only been small amount of research done to understand the impact of problematic weight-biases and stigma on the treatment and recovery of this illness. This thesis is a qualitative thematic analysis of the ED illness narratives. It examines the impact of interpersonal interactions (between family members, peers, and medical providers) on participants’ experiences of body image concerns and disordered eating for higher weight women with restrictive EDs. This analysis describes participant-perceived impacts of interpersonal relationships on body image and their own ED narratives. Methods: Drawing from a larger ongoing longitudinal, observational, mixed-methods study of women and non-binary persons with atypical anorexia, this study utilized a purposive sub-sample (n=21) of semi-structured qualitative baseline interviews to describe participant perceived impacts of interpersonal relationships on body image and eating disorder illness narratives. Results: The analysis found several emerging themes relating to the impact of interpersonal interactions on body image and eating disorder illness narratives in the following categories: 1) Family Interactions, 2) Peer Interactions, 3) Medical Provider Interactions, and 4) Positive Interactions. Emerging themes included: 1) problematizing bodies, internalized fat phobia; 2) normalizing dieting, pathologizing body, disbelieving ED/missed ED symptoms/unacknowledged, encouraging ED behaviors; and 3) teasing, bullying, isolation, and norming of societal expectations. As one of the disciplines most frequently involved in treating eating disorders, these findings suggest that social workers need to address how they interact with higher weight clients—particularly clients with EDs, including being critical of traditional social work interventions, educating members of their interdisciplinary team about the importance of intersectional identities of ED patients, focusing on prevention efforts with families and peers (targeting body shame and dieting), and advocating against weight stigma toward a more weight inclusive models of treatment.