A small study explored how issues of identity can affect treatment.
Reprinted from Eating Disorders Review
January/February 2011 Volume 22, Number 1
©2011 Gürze Books
We all have a social identity, or that portion of our self-concept that comes from our membership in a social group. According to two British psychologists, a person’s social identity can change during the course of an eating disorder. Also, other studies have shown that identity issues can affect the development and maintenance of eating disorders.
In one study by Rich (2006), it was reported that females diagnosed with anorexia nervosa perceived their diagnosis to be a stigmatized identity and some participants attempted to build alternative, positive self representations of “anorexia identities’ by accessing pro-ana web sites. In Giles’ study of social identities on such web sites, it was found that participants created positive in-group eating disorder identities by defining their diagnosis in the face of criticism from others, and by viewing groups outside the eating disorders group as “wannabees” and “normals.” Identity issues have also been reported in the development and maintenance of eating disorders.
The British researchers, Drs. Julie Ison and Sarah Ken, recently reported the results of their study of 8 patients with eating disorders who were recruited from three specialist eating disorder services. All had a primary diagnosis of an eating disorder (Eur Eat Disords Rev 2010; 18:475). The 8 women ranged in age from 21 to 36 years; 4 had a diagnosis of bulimia nervosa, 2 were diagnosed with anorexia nervosa, and 2 had a diagnosis of eating disorder not otherwise specified (EDNOS). The duration of the eating disorders ranged from 2 to 22 years (median: 9 years).
The women participated in a semi-structured interview during which they were asked open-ended questions, such as their thoughts about having an eating disorder, and were also asked to explore their feelings and thoughts about their own diagnosis and other eating disorders. In addition, they were asked how they felt others viewed people with eating disorders.
Three underlying themes emerged; shifts in identity, out-of-group perceptions and influences, and eating disorders as an in-group. The participants associated both positive and negative aspects with eating disorders. They also noted that their perceptions had changed over time, so that negative aspects became more pronounced in comparison to positive aspects. As motivation to change their behavior increased, they began to note more negative aspects of the disorder.
The authors surmise that the presence of an eating disorder can have an impact upon accessing treatment and recovery. For example, if a person views the eating disorder positively and infers that others also associate positive characteristics to it, this could result in resistance to or ambivalence about seeking treatment. In contrast, having a negative social identity might persuade patients with anorexia nervosa, for example, to return to a normal healthy weight, and thus enhance their motivation to change.