Battles over ‘unruly bodies’: Practitioners’ interpretations of eating disorders and the utility of psychiatric labelling

Abstract

Our article offers a critical appraisal of psychiatric medical constructions of eating disorders (EDs) by highlighting the complexity of professional discourses, power plays, claims and counterclaims in ongoing struggles over ‘unruly bodies.’ Inductive thematic analysis of data from five studies was undertaken, covering thirty semi‐structured interviews with UK health‐care professionals working in the ED field. Professionals engaged in various struggles over eating disorders, which were compounded by the labelling process itself. Although person‐centredness was valued, encounters with ED patients were frequently framed as outstandingly problematic in terms of treatment resistance, with clients’ unruliness spurred on by ED competitiveness on social media and in‐hospital rivalries. Paradoxically, the labelling of eating disorders created further expectations in terms of achieving specific weight levels and diagnostic labels, reportedly resulting in lay competition over who was sickest, which was mirrored by treatment priorities within an overstretched public health system. Narratives also highlighted interesting tensions between professionals rationalising their work with patients and acknowledging themselves as potentially vulnerable to societal pressures promoting EDs. Arguably, while lay narratives around EDs continue to be framed by authorities as unruly behaviours in deviant individuals, the gap between officially sanctioned and illicit ED discourses will only grow.

For Medicinal Purposes: Whose Advice Exerts Authority on Medical Marijuana?

“…To do so, we applied the "breadth-and-depth" method for secondary qualitative analysis from "Big Qual"-which is defined as the analysis of "large volumes of qualitative data" (Davidson et al 2019). Our approach allows us to contribute to the growing literature in the sociology of health that employs secondary qualitative analysis (Fixsen et al 2022;Ryan and Ziebland 2015). The "Big Qual" approach allows qualitative scholars to analyze larger data sets and thus is analogous to computational tools developed by methodologists that similarly allow qualitative researchers to analyze larger data sets (Deterding and Waters 2018).…”

“…These data were collected from 2013 to 2015 and for a different set of research questions. Our analysis is, therefore, an example of secondary qualitative analysis (Belot and Van Ingelgom 2017;Duchesne 2017;Hughes and Tarrant 2020) that seeks to contribute to the growing literature in the sociology of health that uses secondary qualitative analysis (Fixsen et al 2022;Ryan and Ziebland 2015). Participants were never explicitly asked about medical authority or doctors, only how they voted for a ballot measure that sought to legalize medical marijuana.…”

Delusions in Anorexia Nervosa

“…Such beliefs dominate patients' lives to a considerable degree (Tan et al, 2006) and are strongly associated with their self-identities (Gregertsen, Mandy, & Serpell, 2017). Indeed, the way in which those with AN identify with their values regarding thinness is a well-recognized contributing factor to treatment resistance (Fixsen, Ridge, Ponsford, Holder, & Saran, 2022;Vitousek et al, 1998). Finally, in terms of aetiology, value of thinness beliefs may bear more similarity to overvalued ideas, as there is a plausible link between such beliefs and personality traits, such as perfectionism (Fairburn, Cooper, & Shafran, 2003).…”