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    Exploring the narratives of people with lived experiences of eating-related distress and their stories of recovery : a thesis presented in partial fulfilment of the requirements for the degree of Doctor of Clinical Psychology, Massey University, Auckland, Aotearoa, New Zealand
    (Massey University, 2023) Amarasekara, Natasha Amrini
    A significant portion of the eating disorder literature prioritises a clinical perspective informed by diagnostic classification and clinical markers of recovery. Yet, research into the perspectives of people’s lived experiences provides very different accounts of eating-related distress and personal recovery. The personal recovery model privileges lived experiences, where symptom remission is not necessary to recover/y, but instead “recovery in” as opposed to “recovery from” is better aligned. Broad qualitative analyses cite factors in alignment with the recovery model; however, these studies often abstract from the daily, lived recoveries. In this study, I examined the narratives of recovery among 15 adults with lived experiences of eating-related distress. Specifically, those who self-identified challenges related to food, weight, body shape, and/or exercise, and identified as doing better currently relative to one’s own past experiences. A day in the life questioning approach allowed for a micro-contextualised view of recovery, exploring what it means to be “in” or “enacting” recovery across daily practices. A narrative analysis was conducted which attuned to complex social, cultural, and relational contexts, grounded within a social constructivist epistemological approach. Narratives included: Re-Appraising Body, Image and Identity, Neutrality and Nourishment, Routine and Structure, and Media and #Recovery. Participants formed intentional daily practices in recovery, largely described as an active process requiring continued re-appraisal. Daily practices centered around energy, function, pleasure, accomplishment, comfort, control, self-development, visibility, and routine. Participants described alignment, resistance, and opposition to master narratives and sociocultural prescriptions on recovery, offering a counter narrative to the clinician and researcher recovery perspectives that have traditionally dominated the literature and guided service provision to date. Overall, these multi-layered narratives align with critical feminist perspectives and may importantly inform evidence-based practice from the “inside out”.
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    Conceptualizing eating disorder recovery research: Current perspectives and future research directions
    (BioMed Central Ltd, 2022-11-15) Hower H; LaMarre A; Bachner-Melman R; Harrop EN; McGilley B; Kenny TE
    Background How we research eating disorder (ED) recovery impacts what we know (perceive as fact) about it. Traditionally, research has focused more on the “what” of recovery (e.g., establishing criteria for recovery, reaching consensus definitions) than the “how” of recovery research (e.g., type of methodologies, triangulation of perspectives). In this paper we aim to provide an overview of the ED field’s current perspectives on recovery, discuss how our methodologies shape what is known about recovery, and suggest a broadening of our methodological “toolkits” in order to form a more complete picture of recovery. Body This paper examines commonly used methodologies in research, and explores how incorporating different perspectives can add to our understanding of the recovery process. To do this, we (1) provide an overview of commonly used methodologies (quantitative, qualitative), (2) consider their benefits and limitations, (3) explore newer approaches, including mixed-methods, creative methods (e.g., Photovoice, digital storytelling), and multi-methods (e.g., quantitative, qualitative, creative methods, psycho/physiological, behavioral, laboratory, online observations), and (4) suggest that broadening our methodological “toolkits” could spur more nuanced and specific insights about ED recoveries. We propose a potential future research model that would ideally have a multi-methods design, incorporate different perspectives (e.g., expanding recruitment of diverse participants, including supportive others, in study co-creation), and a longitudinal course (e.g., capturing cognitive and emotional recovery, which often comes after physical). In this way, we hope to move the field towards different, more comprehensive, perspectives on ED recovery. Conclusion Our current perspectives on studying ED recovery leave critical gaps in our knowledge about the process. The traditional research methodologies impact our conceptualization of recovery definitions, and in turn limit our understanding of the phenomenon. We suggest that we expand our range of methodologies, perspectives, and timeframes in research, in order to form a more complete picture of what is possible in recovery; the multiple aspects of an individual’s life that can improve, the greater number of people who can recover than previously believed, and the reaffirmation of hope that, even after decades, individuals can begin, and successfully continue, their ED recovery process.
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    Normalised eating in the treatment of eating disorders : a thesis presented in partial fulfillment of the requirements for the degree of Master of Science in Human Nutrition at Massey University, Manawatu campus, New Zealand
    (Massey University, 2014) Stiles, Garalynne
    Background: Normalising eating behaviour is one of the primary goals for recovery from eating disorders. There is a lack of consensus or working definition about what normalised eating is. Investigation of eating patterns in recovered eating disorder patients has been limited. The assumption appears to be that normalised eating will automatically follow weight restoration. Aim: To describe normalised eating as a treatment goal for eating disorders among women aged 18 to 60 years using a sample of “expert opinions”. Methods: Mixed methods design, including an online survey and in-depth interviews to expand on findings from the survey. Participants were recruited through online and print advertising. The online survey asked respondents to assess the “normality” of a range of eating practices and to give examples of eating in a “normal day”. Nutrient analysis was carried out using FoodWorks and SPSS was used for statistical tests. Content analysis was used for depth interviews and qualitative data from the online survey. Results & Conclusion: Sixty-seven online surveys were completed by six women who had recovered from an eating disorder, 20 eating disorder dietitians, 15 other eating disorder clinicians and 26 healthy control women. A range of eating patterns and practices were described as normalised (e.g. 2-7 eating episodes in a day; cutting muffins in 1-4 pieces). While normalised eating is more likely to involve a specific set of actions (e.g. 3 meals and 2-3 snacks), reasons for eating seem to underpin normalised eating more than specific actions (e.g. “if hungry after dinner will have a piece of fruit”). Eating for a variety of reasons gives rise to flexibility. Flexibility within the confines of a nutritionally adequate diet was the central theme of normalised eating which emerged from this study.
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    Identifying fundamental criteria for eating disorder recovery: a systematic review and qualitative meta-analysis.
    (2017) de Vos JA; LaMarre A; Radstaak M; Bijkerk CA; Bohlmeijer ET; Westerhof GJ
    BACKGROUND: Outcome studies for eating disorders regularly measure pathology change or remission as the only outcome. Researchers, patients and recovered individuals highlight the importance of using additional criteria for measuring eating disorder recovery. There is no clear consensus on which additional criteria are most fundamental. Studies focusing on the perspectives of recovered patients show criteria which are closely related to dimensions of positive functioning as conceptualized in the complete mental health model. The aim of this study was to identify fundamental criteria for eating disorder recovery according to recovered individuals. METHODS: A systematic review and a qualitative meta-analytic approach were used. Eighteen studies with recovered individuals and meeting various quality criteria were included. The result sections of the included papers were searched for themes that were stated as criteria for recovery or 'being recovered'. All themes were analyzed using a meta-summary technique. Themes were labeled into criteria for recovery and the frequency of the found criteria was examined. RESULTS: In addition to the remission of eating disorder pathology, dimensions of psychological well-being and self-adaptability/resilience were found to be fundamental criteria for eating disorder recovery. The most frequently mentioned criteria were: self-acceptance, positive relationships, personal growth, decrease in eating disorder behavior/cognitions, self-adaptability/resilience and autonomy. CONCLUSIONS: People who have recovered rate psychological well-being as a central criterion for ED recovery in addition to the remission of eating disorder symptoms. Supplementary criteria, besides symptom remission, are needed to measure recovery. We recommend including measurements of psychological well-being and self-adaptability/resilience in future research, such as outcome studies and in routine outcome measurement.