A Retrospective Look at the Internal Help-Seeking Process in Young Women With Eating Disorders

Abstract

This qualitative study retrospectively explored the help-seeking process in women with eating disorders. Interviews were conducted with 14 college-age women suffering from anorexia nervosa, bulimia nervosa, or eating disorder NOS. Grounded theory was utilized to develop a preliminary model of the help-seeking process. Participants described a gradual shift from denial to increased awareness of self and the impact of the illness. This core process was transient in nature and influenced by interpersonal feedback, critical incidents, the women's general attitude toward help- seeking, and prior treatment experiences. Implications for clinicians include an increased focus on the transient awareness of self and the illness.

Resistance to treatment and change in anorexia nervosa: a clinical overview

“…Schoen and Coworkers [29] in a recent paper demonstrated a correlation between insight of illness and the seeking of professional treatments whilst other authors [31] supported indeed that duration of illness correlates with greater insight rather than with a more severe disorder.…”

“…In this regard, the data in literature are debated and do not clarify whether denial of illness is a psychosis-like symptom or rather a rigid and disadaptive defense mechanism helping patients to protect themselves by anxiety and depression [26,31] and to avoid treatments [89] or negative emotions [22,23]. It is likely that both these aspects are true; nevertheless, hypothesizing denial as a defense mechanism could be more in line with its time consistency [86], independently of fluctuations in ED symptomatology [28,29]. …”

“…At now, it is not possible to distinguish whether denial is already expressed at the onset of illness or it is enhanced with time and potentially by inappropriate treatments. However, it should be considered as a central issue to be addressed in treatments rather than a prognostic element [29]. …”

“…Several factors have been called into question as enhancing treatment resistance: 1) low self-esteem and 2) mood intolerance [65]; 3) perfectionism [65,78]; 4) body experiences [17,125]; 5) general psychopathology [39,56,64]; 6) personality [66-68,72,73,76,79]; 7) interpersonal relationships [65,75]; 8) cognitive inflexibility and 9) avoidance of experience and emotions [29,131,132]; 10) care givers’ expressed emotion [14,62,71,75]; 11) poor problem solving abilities [69];12) scarce social support [64,74]; and 13) reduced relational abilities [39,69,133] (for a review on widely used treatment models see: Hay and colleagues [134]). Evidence on a relationship between dropout, treatment response and both character and temperament [14,67,135] encourages to focus on considering in detail patients’ personality.…”

Treatment seeking for eating disorders: Results from a nationally representative study

“…Previous studies identified several significant predictors of treatment seeking among individuals with EDs (see Ali et al, , for a comprehensive review), including high‐ED symptom severity, medical complications, and body image concerns (Cachelin, Rebeck, Veisel, & Striegel‐Moore, ; Cachelin & Striegel‐Moore, ; Forrest et al, ; Hepworth & Paxton, ; Mond et al, ; Schoen et al, ). These findings are likely due to the fact that greater symptom severity, concomitant physical health problems, and body dissatisfaction increase an individual's psychological distress and social/occupational role impairment.…”