title: Hunger for meaning: interpretative phenomenological analysis of self-experienced turning points in eating disorders
Creators: name: Clark, Lili
Publisher: name: The University of Edinburgh
Year: 2025
Subjects: subject: eating disorders
subject: Eating disorders
subject: Identity
subject: Interpretative Phenomenological Analysis
subject: Qualitative Research
subject: meaning-making
subject: sense-making
subject: turning points

description: Eating Disorders (EDs) present as severe psychiatric syndromes with profound impacts on both physical and mental well-being, often posing significant challenges to treatment interventions. Historically, the conceptualization of EDs has predominantly relied on biomedical frameworks, overlooking the subjective experiences that underpin accurate clinical understanding. This oversight has ramifications, influencing both research priorities and the efficacy of intervention strategies. This qualitative thesis endeavours to explore the mechanisms of change inherent in the trajectory of EDs as they are subjectively experienced. This research supports established positions that EDs, characterized by their heterogeneity, fundamentally involve disturbances in the sense of self and identity. However, the specific features or aspects of self and identity that contribute to the vulnerability of developing an ED remain elusive. The initial study conducted was a mixed-methods systematic review employing a best-fit framework synthesis to elucidate the self-experience unique to EDs. Thirty studies meeting the inclusion criteria were critically reviewed, revealing a consistent theme: participants' robust desire to align their embodied experiences with personal needs and circumstances. It was concluded that more holistic theories of EDs are essential for advancing clinical knowledge and intervention efficacy, emphasizing multidimensional frameworks that highlight the phenomenological (i.e., meaning- making) aspects of embodiment. Study 2 employed a multi-perspectival interpretative phenomenological analysis (IPA) of focus group data from practitioners with and without lived experience of EDs. This analysis aimed to explore how changes in self-experience are perceived and conceptualized in clinical spaces, highlighting both shared understanding and areas of divergence. Four themes were developed: A ‘line in the sand’: Learning what isn’t known; ‘This is just something I have to do’: Believing what you’re doing is going to make things better; ‘What I have gained’: Drawing on personal experience; and Helping create ‘a life worth living’. Findings emphasised the importance of personalized and flexible interventions, while also revealing barriers in language and communication that hindered the understanding of lived experiences of EDs. Study 3 further explored the lived experience of turning points in EDs using in- depth semi-structured individual interviews and IPA. Participants, reflecting the challenges identified in Study 2, struggled to fully articulate their self-experience during their ED, despite a keen awareness thereof. Three themes were developed: Turning Points are ‘Understanding in a way which leads you to taking action’; Locked in an ED ‘feels more like a survival instinct’; and ‘Only I could do something but I wasn’t alone’ in Opening Up to Recovery. The findings underscored the significance of self-identified turning points as anchors for motivated action potential towards both positive (recovery) and negative (maintenance or relapse) outcomes. Collectively, the findings of these three studies highlight the importance of subjective experience in understanding complex disorders like EDs, particularly through the lens of narrative turning points. This approach holds promise for clarifying clinical ambiguity and improving treatment outcomes by tailoring interventions to individual needs and potentially predicting disorder trajectories. Moreover, the identification of turning points offers a novel perspective on conceptualizing and classifying EDs, enriching our understanding of psychopathological trajectories and evolving psychological frameworks.