Eating Disorder Metaphors: a Qualitative Meta-Synthesis of WomenS Experiences
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Eating Disorder Metaphors: A Qualitative Meta-synthesis of Womens Experiences by Rachael Brooke Goren-Watts B.A., Brandeis University, 2001 MPH, University of Massachusetts, Amherst, 2007 M.S., Antioch University New England, 2010 DISSERTATION Submitted in partial fulfillment for the degree of Doctor of Psychology in the Department of Clinical Psychology At Antioch University New England, 2011 Keene, New Hampshire EATING DISORDER METAPHORS ii DISSERTATION COMMITTEE PAGE ǣ ǣ Ǧ ǯ ͻǡʹͲͳͳ Ǧ ȗǤ ǣ Ǥǡ ǣ Ǧǡ ǡ Ǥǡ ȀͻȀͳͳ ȗǯ Ǥ EATING DISORDER METAPHORS iii Acknowledgements This dissertation would not be possible without the support of a number of people. Thank you to Susan Hawes and Barbara Belcher-Timme for agreeing to serve as members on my dissertation committee. Dr. Hawes, I have appreciated your willingness to offer knowledge on qualitative research, and to allow our tangential conversations to occur as they often resulted in my ability to have creative ideas and deeper understandings. Dr. Belcher-Timme, thank you for your honesty, even when it was difficult to hear. Throughout our work in both case conference and dissertation, I have appreciated your compassionate directness, as it models and inspires an authentic way of being in the world and a reminder to be assertive in ones beliefs. Dr. Colborn Smith, thank you for stepping in during my advisers sabbatical, having a listening ear when I needed to talk, and maintaining a good enough holding environment for the completion of the memoir. A special thank you to Dr. Martha Straus, my adviser for the duration of my time at Antioch University and the chair of my dissertation committee. Marti, this is a moment where the written word feels too limiting and cliché. Your unconditional love and support kept me going throughout this program. Knowing that you got me made it feasible to continue plugging along and trust the process. I dont feel that I can thank you enough and hope that our relationship can continue beyond the walls of Antioch. To my Antioch community, professors, staff, and students, thank you for being my Monday Family for the past four years. It has been a source of support and an asset to have you there for the full range of emotional affect that is present in our community. I will miss seeing your friendly faces and hearing about your lives. I want to especially thank my fellow advisees: Jennifer McLean, Maura Cole, and Jamie Carroll for your input and lengthy EATING DISORDER METAPHORS iv discussions about our dissertations. Although, we all know that what I really want to thank you for is sharing funny You Tube videos, for without humor, life loses its luster. I want to thank my past and present supervisors: Claudia Ciano-Boyce, Eliza McArdle, Steven Klein, Sheri Katz, and Tammy Bringaze. Each of you helped to form my identity as a psychologist and I appreciate your willingness to take a chance on me as a practicum student. Dr. Ciano-Boyce, thank you for the reminders to trust myself as that has been one of the more important lessons of my training. To my parents favorite son, Josh, I want to apologize for not listening to you on the night that my dissertation data disappeared. You were right. Thank you to my parents for your support; you encouraged me to take the risk by attending this program and I am eternally grateful for the experience. Your pride in my abilities to see this through has been a source of strength. To Molly, I know that neither of us knew that my signing onto this doctoral program would mean that you would take the brunt of, well, fill-in-the-blank. Thank you for your patience, appreciation, homemade meals, patience, taking on more than your fair share, researching safe AWD vehicles, patience, putting up with processing the process, setting the alarm, and have I said patience?! I owe you one and I promise to make more eye contact with you now, rather than my laptop. To my extended family of relatives and friends, thank you for being willing to listen to things that dont pertain to you and validating my reality. As a wide-cast net of loving and compassionate individuals, you are all part of my intentional community where we lean on one another for support, reassurance, vitality, laughter, joy and sadness, and the deepest meanings of friendship. EATING DISORDER METAPHORS v Dedication This dissertation is dedicated to all the women who stayed to choose to fight. May you serve as a reminder that when we believe we cannot fail, anything is possible. EATING DISORDER METAPHORS vi Table of Contents Acknowledgements........................................................................................................................iii Dedication....................................................................................................................................... v Table of Contents........................................................................................................................... vi Abstract........................................................................................................................................... 1 Chapter 1......................................................................................................................................... 2 Chapter 2: Literature Review.......................................................................................................... 4 Scope of the Problem of Eating Disorders.................................................................................. 4 Eating Disorder Duration, Recovery, and Relapse ..................................................................... 6 Gender and Eating Disorders...................................................................................................... 8 Race, Ethnicity, Sexual Orientation, Age, and Eating Disorders ............................................... 9 Critique of Literature ................................................................................................................ 10 Chapter 3: Metaphors and Social Constructionist Thought.......................................................... 15 Social Constructionist Theory................................................................................................... 17 Application of Metaphor........................................................................................................... 18 Chapter 4: Theoretical Conceptualizations of Eating Disorders................................................... 23 Psychological Models ............................................................................................................... 23 Addictions Model/Twelve-Step................................................................................................ 28 Trauma and Comorbidity.......................................................................................................... 29 Biomedical Models ................................................................................................................... 32 Socio-Cultural/Feminist Models............................................................................................... 33 Chapter 5: Method ........................................................................................................................ 38 Hermeneutics ............................................................................................................................ 38 Qualitative Meta-synthesis........................................................................................................ 40 Procedures................................................................................................................................. 42 Chapter 6: Findings....................................................................................................................... 50 Context for the Eating Disorder: Perceived Precipitants of the Eating Disorder ..................... 50 The Experience of the Eating Disorder..................................................................................... 55 Reasons for Seeking Treatment and/or Starting Recovery....................................................... 84 EATING DISORDER METAPHORS vii Experience of Initial Stages of Recovery/Treatment................................................................ 88 Experience in Recovery .......................................................................................................... 113 Experiences of Being Recovered............................................................................................ 132 Chapter 7: Discussion and Conclusion ....................................................................................... 140 Meaning of ED Metaphors...................................................................................................... 140 Understanding Womens Metaphors with Theoretical Paradigms ......................................... 145 Implications for Treatment ..................................................................................................... 147 Implications for Future Research............................................................................................ 149 Concluding Thoughts.............................................................................................................. 152 References..................................................................................................................................