Anorexia nervosa - its nature and treatment : a phenomenological investigation : a dissertation presented in partial fulfilment of the requirements for the degree of Master of Philosophy in Education at Massey University
This study examined the psychosomatic syndrome of anorexia nervosa, its characteristics, etiology and effects. In addition the treatment of the disorder was considered from the perspective of the three psychotherapeutic approaches most commonly applied to it; psychodynamic, behavioural and family therapy. The historical emergence and identification of anorexia nervosa was briefly described and the emergence and development of the three treatment approaches were outlined. The diagnosis, characteristics, incidence and factors concerning outcome in the disorder were examined. Each treatment perspective was considered in turn by outlining its understandings of human functioning and approach to abnormal functioning in general. Its theoretical stance towards anorexia nervosa was elaborated and the treatment procedures based upon this described. Finally the outcome of treatment within each approach was considered. A case study method employing a phenomenological approach was used to explore the perceptions and experiences of seven subjects who were or who had been anorexic. In addition the perspective and experience of some of those closely associated with them at the time of their anorexia was also examined. Issues concerning the research method and the selection of the subjects were discussed and the nature of the contact with them and the manner in which the data was collected described. Data collected from the subjects, their associates, documentation provided by the subjects and observations were analysed into themes which emerged during the process of the data collection. These were grouped into four theme categories comprising: The Self-Physical, the Self-Psychological, the Self and Others and Intervention. The findings in each theme category are discussed in relation to existing literature. Major findings included an emphasis on issues concerning control and self concept in the disorder, a reluctance to develop sexual relationships and a continued concern about food, exercise and interpersonal relationships. Vocational choice indicated a preference for welfare-type work. Close family relationships were evident with some confusion apparent about female roles. Treatment experiences in the main tended to be perceived negatively in that they appeared largely controlling and insensitive. No one theoretical approach to the disorder could be identified as providing a completely comprehensive perspective with each having distinct advantages and disadvantages. Control and self-concept issues were identified as needing to be central to any consideration of anorexia nervosa treatment and it was reiterated that psychotherapeutic treatment needs as much as possible to recognize the unique nature of each case and not be too constrained by prescribed theoretical frameworks.