Sage Journals: Discover world-class research

Abstract

Despite the high percentage of adults living with anorexia nervosa (AN) over the life course, there is limited understanding of what it means to be living with AN in midlife when the majority of research has focused on adolescents and young adults. As such, clinical practice for individuals in midlife is informed by a severe and enduring AN (SE-AN) framework, which assumes that recovery is not necessarily feasible past young adulthood. This study used constructivist grounded theory methodology to understand the experiences of adults in midlife living with AN. In-depth analyses of 19 participant narratives in midlife show that individuals face barriers to seeking help or remaining in recovery; however, midlife can also act as a significant catalyst toward recovery. Subsequently, there is merit in revisiting the utility of the SE-AN framework in the context of life course theory and exploring resilience-informed approaches in supporting recovery from AN.

Keywords

anorexia nervosa midlife resilience life course theory constructivist grounded theory methodology qualitative Canada

Get full access to this article

View all access options for this article.

References

Alaggia

Donohue

(2018). Take these broken wings and learn to fly: Applying resilience concepts to practice with children and youth exposed to intimate partner violence. Smith College Studies in Social Work, 88(1), 20–38. https://doi.org/10.1080/00377317.2018.1404282

Ali

Farrer

Fassnacht

D. B.

Gulliver

Bauer

Griffiths

K. M.

(2017). Perceived barriers and facilitators towards help-seeking for eating disorders: A systematic review. International Journal of Eating Disorders, 50(1), 9–21. https://doi.org/10.1001/eat.22598

Anastas

J. W.

(2004). Quality in qualitative evaluation: Issues and possible answers. Research on Social Work Practice, 14(1), 57–65. https://doi.org/10.1177/1049731503257870

Arcelus

Mitchell

A. J.

Wales

Nielsen

(2011). Mortality rates in patients with anorexia nervosa and other eating disorders: A meta-analysis of 36 studies. Archives of General Psychiatry, 68(7), 724–731. https://doi.org/10.1001/archgenpsychiatry.2011.74

Baker

J. H.

Runfola

C. D.

(2016, March). Eating disorders in midlife women: A perimenopausal eating disorder? Maturitas, 85, 112–116. https://doi.org/10.1016/j.maturitas.2015.12.017

Bamford

Barras

Sly

Stiles-Shields

Touyz

Le Grange

. . . Lacey

(2015). Eating disorder symptoms and quality of life: Where should clinicians place their focus in severe and enduring anorexia nervosa? International Journal of Eating Disorders, 48(1), 133–138. https://doi.org/10.1002/eat.22327

Birmingham

C. L.

Hlynsky

J. A.

Goldner

E. M.

Gao

(2005). The mortality rate from anorexia nervosa. International Journal of Eating Disorders, 38(2), 143–146. https://doi.org/10.1002/eat.20164

Brandsma

(2007). Eating disorders across the lifespan. Journal of Women & Aging, 19(1-2), 155–172. https://doi.org/10.1300/J074v19n01_10

Brewerton

T. D.

(2007). Eating disorders, trauma, and comorbidity: Focus on PTSD. Eating Disorders: Journal of Treatment & Prevention, 15(4), 285–304. https://doi.org/10.1080/1064026070145311

10.

Broomfield

Stedal

Touyz

Rhodes

(2017). Labeling and defining severe and enduring anorexia nervosa: A systematic review and critical analysis. International Journal of Eating Disorders, 50(6), 611–623. https://doi.org/10.1002/eat.22715

11.

Calugi

El Ghoch

M. E.

Dalle Grave

(2017). Intensive enhanced cognitive behavioural therapy for severe and enduring anorexia nervosa: A longitudinal outcome study. Behaviour Research and Therapy, 89, 41–48. https://doi.org/10.1016/j.brat.2016.11.006

12.

Charmaz

(2000). Grounded theory: Objectivist and constructivist methods. In Denzin

N. K.

Lincoln

Y. S.

(Eds.), Handbook of qualitative research (2nd ed., pp. 509–535). Sage.

13.

Charmaz

(2014). Constructing grounded theory. Sage.

14.

Charmaz

(2015). Teaching theory construction with initial grounded theory tools: A reflection on lessons and learning. Qualitative Health Research, 25(12), 1610–1622. https://doi.org/10.1177/1049732315613982

15.

Cohn

Murray

S. B.

Walen

Wooldridge

(2016). Including the excluded: Males and gender minorities in eating disorder prevention. Eating Disorders: The Journal of Treatment & Prevention, 24(1), 114–120. https://doi.org/10.1080/10640266.2015.1118958

16.

Creswell

(1998). Qualitative Inquiry and research design: Choosing among five traditions. Sage.

17.

Dakanalis

Timko

C. A.

Favagossa

Riva

Zanetti

M. A.

Clerici

(2014). Why do only a minority of men report severe levels of eating disorder symptomatology, when so many report substantial body dissatisfaction? Examination of exacerbating factors. Eating Disorders: The Journal of Treatment & Prevention, 22(4), 292–305. https://doi.org/10.1080/10640266.214.898980

18.

Dawson

Rhodes

Touyz

(2014). “Doing the impossible”: The process of recovery from chronic anorexia nervosa. Qualitative Health Research, 24(4), 494–505. https://doi.org/10.1177/1049732314524029

19.

Eddy

K. T.

Dorer

D. J.

Franko

D. L.

Tahilani

Thompson-Brenner

Herzog

D. B.

(2008). Diagnostic crossover in anorexia nervosa and bulimia nervosa: Implications for DSM-V. American Journal of Psychiatry, 165(2), 245–250. https://doi.org/10.1176/appi.ajp.2007.0706951

20.

Eddy

K. T.

Tabri

Thomas

J. J.

Murray

H. B.

Keshaviah

Hastings

. . . Franko

D. L.

(2017). Recovery from anorexia nervosa and bulimia nervosa at 22-year follow-up. Journal of Clinical Psychiatry, 78(2), 184–189. https://doi.org/10.4088/JCP.15m10393

21.

Elder

G. H.

(1994). Time, human agency and social change: Perspectives on the life course. Social Psychology Quarterly, 57(1), 4–15. https://doi.org/10.2307/2786971

22.

Elder

G. H.

Pellerin

L. A.

(1998). Linking history and human lives. In Giele

J. Z.

Elder

G. H.

(Eds.), Methods of life course research: Qualitative and quantitative approaches (pp. 264–295). Sage.

23.

Elran-Barak

Fitzsimmons-Craft

Benyamini

Crow

Peterson

C. B.

Hill

. . . LeGrange

(2015). Anorexia nervosa, bulimia nervosa, and binge eating disorder in midlife and beyond. Journal of Nervous and Mental Disease, 203(8), 583–590. https://doi.org/10.1097/NMD/0000000000000333

24.

Erguner-Tekinalp

Gillespie

C. W.

(2010). Mental health practitioners’ professional opinion of etiology of eating disorders. International Journal of Mental Health, 39(3), 68–87. https://doi.org/10.2753/IMH0020-7411390305

25.

Fletcher

Sarkar

(2013). Psychological resilience: A review and critique of definitions, concepts, and theory. European Psychologist, 18(1), 12–23. https://doi.org/10.1027/1016-9040/a000124

26.

Gaudiani

J. L.

Brinton

J. T.

Sabel

A. L.

Rylander

Catanach

Mehler

P. S.

(2016). Medical outcomes for adults hospitalized with severe anorexia nervosa: An analysis by age group. International Journal of Eating Disorders, 49(4), 378–385. https://doi.org/10.1002/eat.22437

27.

Glaser

Strauss

(1967). The discovery of grounded theory: Strategies for qualitative research. Aldine.

28.

Gonzales

Chronister

K. M.

Linville

Knoble

N. B.

(2012). Experiencing parental violence: A qualitative examination of adult men’s resilience. Psychology of Violence, 2(1), 90–103. https://doi.org/10.1037/a0026372

29.

Hay

P. J.

Cho

(2013). A qualitative exploration of influences on the process of recovery from personal written accounts of people with anorexia nervosa. Women & Health, 53(7), 730–740. https://doi.org/10.1080/03630242.2013.821694

30.

Kask

Ramklint

Kolia

Panagiotakos

Ekbom

Ekselius

Papadopoulos

F. C.

(2017). Anorexia nervosa in males: Excess mortality and psychiatric comorbidity in 609 Swedish in-patients. Psychological Medicine, 47(8), 1489–1499. https://doi.org/10.1017/S0033291717000034

31.

Keel

P. K.

Brown

T. A.

(2010). Update on course and outcome in eating disorders. International Journal of Eating Disorders, 43(3), 195–204. https://doi.org/10.1102/eat.20810

32.

Keith

J. A.

Midlarsky

(2004). Anorexia nervosa in postmenopausal women: Clinical and empirical perspectives. Journal of Mental Health and Aging, 10(4), 287–299.

33.

Le Grange

Lock

(2005). The dearth of psychological treatment studies for anorexia nervosa. International Journal of Eating Disorders, 37(2), 79–91. https://doi.org/10.1002/eat.20085

34.

Maine

M. D.

Samuels

K. L.

Tantillo

(2015). Eating disorders in adult women: Biopsychosocial, developmental, and clinical considerations. Advances in Eating Disorders: Theory, Research and Practice, 3(2), 133–143. https://doi.org/10.1080/21662630.2014.999103

35.

Mangweth-Matzek

Hoek

H. W.

Rupp

C. I.

Kemmler

Pope

H. G.

Kinzl

(2013). The menopausal transition—A possible window of vulnerability for eating pathology. International Journal of Eating Disorders, 46(6), 609–616. https://doi.org/10.1002/eat.22157

36.

Mangweth-Matzek

Hoek

H. W.

Rupp

C. I.

Lackner-Seifert

Frey

Whitworth

A. B.

. . . Kinzl

(2014). Prevalence of eating disorders in middle-aged women. International Journal of Eating Disorders, 47(3), 320–324. https://doi.org/10.1002/eat.22232

37.

Mangweth-Matzek

Kummer

K. K.

Pope

H. G.

(2016). Eating disorder symptoms in middle-aged and older men. International Journal of Eating Disorders, 49(10), 953–957. https://doi.org/10.1002.eat.22550

38.

Marshall

Lengyel

Utioh

(2012). Body dissatisfaction among middle-aged and older women. Canadian Journal of Dietetic Practice and Research, 73(2), 241–247. https://doi.org/10.3148/73.2.2012.e241

39.

Mayer

K. U.

(2009). New directions in life course research. Annual Review of Sociology, 35(1), 413–433. https://doi.org/10.1146/annurev.soc.34.040507.134619

40.

Micali

Martini

M. G.

Thomas

J. J.

Eddy

K. T.

Kothari

Russell

. . . Treasure

(2017). Lifetime and 12-month prevalence of eating disorders amongst women in mid-life: A population-based study of diagnosis and risk factors. BMC Medicine, 15(1), 12–22. https://doi.org/10.1186/s12916-016-0766-4

41.

Midlarsky

Nitzburg

(2008). Eating disorders in middle-aged women. The Journal of General Psychology, 135(4), 393–407. https://doi.org/10.3200/GENP.135.4.393-408

42.

Miles

M. B.

Huberman

A. M.

(1994). Ethical issues in analysis. In Miles

M. B.

Huberman

A. M.

(Eds.), Qualitative data analysis: An expanded sourcebook (pp. 288–297). Sage.

43.

Monteleone

A. M.

Monteleone

Serino

Scognamiglio

Di Genio

Maj

(2015). Childhood trauma and cortisol awakening response in symptomatic patients with anorexia nervosa and bulimia nervosa. International Journal of Eating Disorders, 48(6), 615–621. https://doi.org/10.1002/eat.22375

44.

I. S. F.

Cheung

K. C. K.

Chou

K. L.

(2013). Correlates of eating disorders in middle ages and older adults: Evidence from 2007 British National Psychiatric Morbidity survey. Journal of Aging and Health, 25(7), 1106–1120. https://doi.org/10.1177/0898264313494798

45.

Peat

C. M.

Peyerl

N. L.

Muehlenkamp

J. J.

(2008). Body image and eating disorders in older adults: A review. The Journal of General Psychology, 135(4), 343–358. https://doi.org/10.3200/GENP.135.4.343-358

46.

Pike

K. M.

Dunne

P. E.

Addai

(2013). Expanding the boundaries: Reconfiguring the demographics of the “typical” eating disordered patient. Current Psychiatry Reports, 15(11), 411–418. https://doi.org/10.1007/s11920-013-0411-2

47.

Podfigurna-Stopa

Czyzyk

Katulski

Smolarczyk

Grymowicz

Maciejewska-Jeske

Meczekalski

(2015). Eating disorders in older women. Maturitas, 82, 146–152. https://doi.org/10.1016/j.maturitas.2015.06.036

48.

Rance

Clarke

Moller

(2017). The anorexia nervosa experience: Shame, solitude and salvation. Counselling & Psychotherapy Research, 17(2), 127–136. https://doi.org/10.1002/capr.12097

49.

Rikani

A. A.

Choudhry

A. M.

Ikram

Asghar

M. W.

Dilkash

. . . Mobassarah

N. J.

(2013). A critique of the literature on etiology of eating disorders. Annals of Neurosciences, 20(4), 157–161. https://doi.org/10.5214/ans.0972.7531.200409

50.

Rosling

A. M.

Sparén

Norring

von Knorring

A. L.

(2011). Mortality of eating disorders: A follow-up study of treatment in a specialist unit 1974-2000. International Journal of Eating Disorders, 44(4), 304–310. https://doi.org/10.1002/eat.20827

51.

Rutter

(2012). Resilience as a dynamic concept. Development and Psychopathology, 24(2), 335–344. https://doi.org/10.1017/S0954579412000028

52.

Schlegl

Quadflieg

Löwe

Cuntz

Voderholzer

(2014). Specialized inpatient treatment of adult anorexia nervosa: Effectiveness and clinical significance of changes. BMC Psychiatry, 14(1), 258–269. https://doi.org/10.1186/s12888-014-0258-z

53.

Scholtz

Hill

L. S.

Lacey

(2010). Eating disorders in older women: Does late onset anorexia nervosa exist? International Journal of Eating Disorders, 43(5), 393–397. https://doi.org/10.1002/eat.20704

54.

Sharan

Sundar

(2015). Eating disorders in women. Indian Journal of Psychiatry, 57(2), 286–295. https://doi.org/10.4103/0019-5545.161493

55.

Slevec

J. H.

Tiggemann

(2011). Predictors of body dissatisfaction and disordered eating in middle-aged women. Clinical Psychology Review, 31(4), 515–524. https://doi.org/10.1016/j.cpr.2010.12.002

56.

Southwick

S. M.

Bonanno

G. A.

Masten

A. S.

Panter-Brick

Yehuda

(2014). Resilience definitions, theory, and challenges: Interdisciplinary perspectives. European Journal of Psychotraumatology, 5(1), Article 25338. https://doi.org/10.3402/ejpt.v5.25338

57.

Stewart

M. C.

Schiavo

R. S.

Herzog

D. B.

Franko

D. L.

(2008). Stereotypes, prejudice and discrimination of women with anorexia nervosa. European Eating Disorders Review, 16(4), 311–318. https://doi.org/10.1002/erv.849

58.

Strober

(2004). Managing the chronic, treatment-resistant patient with anorexia nervosa. International Journal of Eating Disorders, 36(3), 245–255. https://doi.org/10.1002/eat.20054

59.

Touyz

Hay

(2015). Severe and Enduring Anorexia Nervosa [SE-AN]: In search of a new paradigm. Journal of Eating Disorders, 3(1), 26–29. https://doi.org/10.1186/s40337-015-0065-z

60.

Treasure

Cardi

Leppanen

Turton

(2015). New treatment approach for severe and enduring eating disorders. Physiology & Behavior, 152, 456–465.

61.

Treasure

Schmidt

Hugo

(2005). Mind the gap: Service transition and interface problems for patients with eating disorders. British Journal of Psychiatry, 187(5), 398–400. https://doi.org/10.1192/bjp.187.5.398

62.

Ungar

(2013). Resilience, trauma, context, and culture. Trauma, Violence, & Abuse, 14(3), 255–266. https://doi.org/10.1177/152483805

63.

Ungar

Ghazinour

Richter

(2013). Annual research review: What is resilience within the social ecology of human development? Journal of Child Psychology and Psychiatry, 54(4), 348–366. https://doi.org/10.1111/jcpp.12025

64.

van Manen

(1997). Researching lived experience (2nd ed.). The Althouse Press.

65.

Weaver

Wuest

Ciliska

(2005). Understanding women’s journey of recovering from anorexia nervosa. Qualitative Health Research, 15(2), 188–206. https://doi.org/10.1177/1049732304270819

66.

Wildes

J. E.

Forbush

K. T.

Hagan

K. E.

Marcus

Attia

Gianni

L. M.

(2017). Characterizing severe and enduring anorexia nervosa: An empirical approach. International Journal of Eating Disorders, 50(4), 389–397. https://doi.org/10.1002/eat.22651

67.

Wonderlich

Mitchell

J. E.

Crosby

R. D.

Cook Myers

Kadlec

LaHaise

. . . Schander

(2012). Minimizing and treating chronicity in the eating disorders: A clinical overview. International Journal of Eating Disorders, 45(4), 467–475. https://doi.org/10.1002/eat.20978

Supplementary Material

Please find the following supplemental material available below.

For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.

For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.

0.08 MB

0.00 MB