Not Quite this and not Quite that: Anorexia Nervosa, Counselling Psychology, and Hermeneutic Inquiry in a Tapestry of Ambiguity

  • Emily P Williams University of Calgary, Werklund School of Education
  • Shelly Russell-Mayhew University of Calgary, Werklund School of Education
  • Nancy J Moules University of Calgary, Faculty of Nursing
  • Gina Dimitropoulos University of Calgary, Faculty of Social Work
Keywords: ambiguity, anorexia nervosa, hermeneutic inquiry, counselling psychology

Abstract

As a group of researchers exploring how to best understand the complex topic of families discovering their loved one has anorexia nervosa (AN), we found that we had to weave ambiguity into our design. Embracing ambiguity allowed us to create a tapestry that acknowledges the ambiguity of AN, counselling psychology (and other helping professions), and hermeneutic inquiry. In fact, the “not quite this and not quite that” features of these three constructs emerged as the thread that holds the inquiry together. We review the topic of AN through a lens of ambiguity.  Further, we position both the field of counselling psychology and the research method of hermeneutic inquiry as compatible frameworks in the study of AN, in both practice and research. By acknowledging, and at times even embracing, ambiguity, we respect the complexity of the situation we are studying.  

References

Adlam, J. (2015). Refusal and coercion in the treatment of severe anorexia nervosa: The antigone paradigm. Psychodynamic Practice, 21, 19-35. http://dx.doi.org/10.1080/14753634.2014.989714

Aletheia. (n.d.). Online etymology dictionary. Retrieved from
http://www.etymonline.com/index.php?term=Alethea

Ambiguity. (n.d.). Merriam Webster's online dictionary. Retrieved from
https://www.merriam-webster.com/dictionary/ambiguity

Ambiguous. (n.d.). Online etymology dictionary. Retrieved from
http://www.etymonline.com/index.php?term=ambiguity

American Psychiatric Association [APA] (2010). Practice guideline for the treatment of patients with eating disorders (3rd ed.). Washington DC: Authors.

American Psychiatric Association [APA] (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: Authors.

Anorexia. (n.d.). Merriam Webster's online dictionary. Retrieved from
https://www.merriam-webster.com/dictionary/anorexia

Becker, A.E., Grinspoon, S.K., Kilbanski, A., & Herzog, D.B (1999). Eating disorders. North England Journal of Medicine, 340, 1092-1098. doi: 10.1056/NEJM199904083401407

Bedi, R.P., Haverkamp, B.E., Beatch, R., Cave, D.G., Domene, J.F., Harris, G.E., & Mikhail, A.M. (2011). Counselling psychology in a Canadian context: Definition and description. Canadian Psychology/Psychologie canadienne, 52, 128. doi: 10.1037/a0023186

Bedi, R.P., Sinacore, A., & Christiani, K.D. (2016). Counselling psychology in Canada. Counselling Psychology Quarterly, 29, 150-162, doi: 10.1080/09515070.2015.1128398

Berkman, N.D., Lohr, K.N., & Bulik, C.M. (2007). Outcomes of eating disorders: A systematic review of the literature. International Journal of Eating Disorders, 40, 293-309. doi: 10.1002/eat.203

Bezanson, L., Hopkins, S., & Neault, R.A. (2016). Career guidance and counselling in Canada: Still changing after all these years. Canadian Journal of Counselling and Psychotherapy (Online), 50, 219-239. Retrieved from http://search.proquest.com.ezproxy.lib.ucalgary.ca/docview/1810336129/fulltextPDF/E62712D97E2748EDPQ/1?accountid=9838

Botha, D. (2015). Anorexia nervosa: A fresh perspective. Theory & Psychology, 25, 328-345. doi: 10.1177/0959354314566490

Brown, C., & Jasper, K. (Eds.). (1993). Consuming passions: Feminist approaches to weight preoccupation and eating disorders. Toronto, ON, Canada: Second Story Press.

Bruch, H. (1965). The psychiatric differential diagnosis of anorexia nervosa. In J.E. Meyer & H. Feldman (Eds.)., Anorexia nervosa (pp. 70-87). Stuttgart: Thieme.

Canadian Psychological Association [CPA]. (n.d.). Family Psychology. Retrieved from http://www.cpa.ca/aboutcpa/cpasections/familypsychology/

Canadian Psychological Association [CPA]. (n.d.). Industrial/Organizational Psychology. Retrieved from
http://www.cpa.ca/aboutcpa/cpasections/industrialorganizationalpsychology

Caputo, J.D. (2015). Foreword: The wisdom of hermeneutics. In N.J. Moules, G. McCaffrey, J.C. Field, & C.M. Laing, Conducting hermeneutic research: From philosophy to practice (pp. ix- xiii). New York, NY: Peter Lang.

Carter, J.C., Mercer-Lynn, K.B., Norwood, S.J., Bewell-Weiss, C.V., Crosby, R.D., Woodside, D.B., & Olmsted, M.P. (2012). A prospective study of predictors of relapse in anorexia nervosa: Implications for relapse prevention. Psychiatry Research, 200, 518-523. https://doi.org/10.1016/j.psychres.2012.04.037

Cash, T.F. (2002). The situational inventory of body-image dysphoria: Psychometric evidence and development of a short form. International Journal of Eating Disorders, 32, 362-366. doi: 10.1002/eat.10100

Craigie, J., Hope, T., Tan, J., Stewart, A., & McMillan, J. (2013). Agency, ambivalence and authenticity: The many ways in which anorexia nervosa can affect autonomy. International Journal of Law in Context, 9, 20-36. doi:10.1017/S1744552312000456

Colton, A., & Pistrang, N. (2004). Adolescents' experiences of inpatient treatment for anorexia nervosa. European Eating Disorders Review, 12, 307-316. doi: 10.1002/erv.587

Cooper, M.J. (2005) Cognitive theory in anorexia nervosa and bulimia nervosa: Progress, development and future directions. Clinical Psychology Review, 25, 511-531. doi:10.1016/j.cpr.2005.01.003

Corrigan, P., & Rao, D. (2012). On the self-stigma of mental illness: Stages, disclosure and strategies for change. Canadian Journal of Psychiatry, 57, 459-464. Retrieved from http://search.proquest.com.ezproxy.lib.ucalgary.ca/docview/1037989332/fulltextPDF/4F0702B5305E49E5PQ/1?accountid=9838

Discovery. (n.d.). Merriam Webster's online dictionary. Retrieved from
https://www.merriam-webster.com/dictionary/discovery

Discover. (n.d.). Online etymology dictionary. Retrieved from
http://www.etymonline.com/index.php?term=discover

Domene, J.F., & Bedi, R.P. (2013). Counseling and psychotherapy in Canada: Diversity and growth. In R. Moodley, U.P. Gielen, & R. Wu (Eds.), Handbook of counseling and psychotherapy in an international context (pp. 106-116). New York, NY: Routledge.

Forney, K.R., Brown, T.A., Holland-Carter, L.A., Kennedy, G.A., & Keel, P.K. (2017). Defining "significant weight loss" in atypical anorexia nervosa. International Journal of Eating Disorders, 50, 952-962. doi: 10.1002/eat.22717

Franko, D.L., Keshaviah, A., Eddy, K.T., Krishna, M., Davis, M.C., Keel, P.K., & Herzog, D.B. (2013). A longitudinal investigation of mortality in anorexia nervosa and bulimia nervosa. American Journal of Psychiatry, 170, 917-925. https://doi.org/10.1176/appi.ajp.2013.12070868

Gadamer, H-G. (2013). Truth and method (Bloomsbury revelations; J. Weinsheimer & D. G. Marshall, Trans.). London, UK: Bloomsbury.

George, L., Thornton, C., Touyz, S.W., Waller, G., & Beumont, P.J.V. (2004). Motivational enhancement and schema-focused cognitive behavior therapy in the treatment of chronic eating disorders. Clinical Psychologist, 8, 81-85. doi: 10.1080/13284200412331304054

Gilbert, N., Arcelus, J., Cashmore, R., Thompson, B., Langham, C., & Meyer, C. (2012). Should I ask about eating? Patients' disclosure of eating disorder symptoms and help-seeking behaviour. European Eating Disorders Review, 20, 80-85. doi:10.1002/erv.1143

Gladding, S.T., & Alderson, K.G. (2012). Counselling: A comprehensive profession (Éd. can.). Toronto, ON, Canada: Pearson Canada.

Gray, E.K., Murray, H.B., & Eddy, K.T. (2015). Diagnosing anorexia nervosa. In L. Smolak & M.P. Levine (Eds.), The Wiley handbook of eating disorders (1st ed; pp. 93-104). West Sussex: John Wiley & Sons. doi: 10.1002/9781118574089.ch8

Grondin, J. (1994). Introduction to philosophical hermeneutics. New Haven, NY: Yale University Press.

Gull, W.W. (1997). V. - Anorexia nervosa (Apepsia Hysterica, Anorexia Hysterica). Obesity, 5, 498-502. (Reprinted from Transactions of the Clinical Society of London, pp. 22-28, by W. W. Gull, 1874.) doi: 10.1002/j.1550-8528.1997.tb00677.x

Habermas, T. (2015). History of anorexia nervosa. In L. Smolak & M.P. Levine's (Eds.), The Wiley handbook of eating disorders (pp. 11-24), West Sussex, UK: John Wiley & Sons.

Halmi, K.A. (2005). A complicated process: Diagnosing and treating anorexia nervosa and bulimia. Psychiatric Times, 22, 59-59. Retrieved from http://go.galegroup.com.ezproxy.lib.ucalgary.ca/ps/i.do?p=HRCA&u=ucalgary&id=GALE|A132920473&v=2.1&it=r&sid=summon&authCount=1#

Hoek, H.W. (2006). Incidence, prevalence and mortality of anorexia nervosa and other eating disorders. Current Opinion in Psychiatry, 19, 389-394.
doi: 10.1097/01.yco.0000228759.95237.78

Hubert Lacey, J., & Sly, R. (2015). Severe and enduring anorexia nervosa: Diagnosis, features, and radical new treatment approaches. In L. Smolak & M.P. Levine's (Eds.), The Wiley handbook of eating disorders (pp. 142-156), West Sussex, UK: John Wiley & Sons.

Kass, A.E., Kolko, R.P., & Wilfley, D.E. (2013). Psychological treatments for eating disorders. Current Opinion in Psychiatry, 26, 549-555. doi:10.1097/YCO.0b013e328365a30e

Kearney, R. (2010). Anatheism: Returning to god after god. New York, NY: Columbia University Press. doi: 10.7312/kear14788

Keel, P.K., Dorer, D. J., Eddy, K.T., Franko, D., Charatan, D.L., & Herzog, D.B. (2003). Predictors of mortality in eating disorders. Archives of General Psychiatry, 60, 179-183. doi: 10.1001/archpsyc.60.2.179

Keel, P.K., & Brown, T.A. (2010). Update on course and outcome in eating disorders. International Journal of Eating Disorders, 43, 195-204. doi: 10.1002/eat.20810

Khalsa, S.S., Portnoff, L.C., McCurdy-McKinnon, D., & Feusner, J.D. (2017). What happens after treatment? A systematic review of relapse, remission, and recovery in anorexia nervosa. Journal of Eating Disorders, 5, 20. https://doi.org/10.1186/s40337-017-0145-3

Lalande, V.M. (2004). Counselling psychology: A Canadian perspective. Counselling Psychology Quarterly, 17, 273-286. doi: http://dx.doi.org/10.1080/09515070412331317576

Laségue, D. (1997). On hysterical anorexia. Obesity, 5, 492-497. (Reprinted from Medical Times, pp. 265-266, by D. Laségue, 1873.) doi: 10.1002/j.1550-8528.1997.tb00676.x

Levine, M.P., & Smolak, L. (2006). The prevention of eating problems and eating disorders: Theory, research, and practice. Mahwah, NJ: Lawrence Erlbaum

Malson, H., & Burns, M. (Eds.). (2009). Critical feminist approaches to eating dis/orders. New York, NY: Routledge.

Marzola, E., Abbate-Daga, G., Gramaglia, C., Amianto, F., & Fassino, S. (2015). A qualitative investigation into anorexia nervosa: The inner perspective. Cogent Psychology, 2, 1032493. http://dx.doi.org/10.1080/23311908.2015.1032493

Moules, N.J. (2002). Hermeneutic inquiry: Paying heed to history and Hermes. An ancestral, substantive, and methodological tale. International Journal of Qualitative Methods, 1, 1-21. Retrieved from http://journals.sagepub.com/doi/full/10.1177/160940690200100301

Moules, N.J., McCaffrey, G., Field, J.C., & Laing, C.M. (2015). Conducting hermeneutic research: From philosophy to practice. New York, NY: Peter Lang.

Munley, P.H., Duncan, L.E., & McDonnel, K.A. (2004). Counseling psychology in the United Sates of America. Counselling Psychology Quarterly, 17, 247-271. doi: 10.1080/09515070412331317602

Neumark-Sztainer, D., Levine, M.P., Paxton, S.J., Smolak, L., Piran, N., & Wertheim, E.H. (2006). Prevention of body dissatisfaction and disordered eating: What next? Eating Disorders, 14, 265-285. doi: 10.1080/10640260600796184

Neumark-Sztainer, D. (2005). "I'm, like, SO fat!": Helping your teen make healthy choices about eating and exercise in a weight-obsessed world. New York, NY: Guilford.

Neumark-Sztainer, D., Story, M., Hannan, P.J., Perry, C.L., & Irving, L.M. (2002). Weight-related concerns and behaviors among overweight and non-overweight adolescents: Implications for preventing weight-related disorders. Archives of Pediatrics and Adolescent Medicine, 156, 171-178. doi: 10.1001/archpedi.156.2.171

Nordbø, R.H.S., Espeset, E.M.S., Gulliksen, K.S., Skårderud, F., & Holte, A. (2006). The meaning of self?starvation: A qualitative study of patients' perception of anorexia nervosa. The International Journal of Eating Disorders, 39, 556-564. doi: 10.1002/eat.20276

Nordbø, R.H., Espeset, E., Gulliksen, K.S., Skårderud, F., Geller, J., & Holte, A. (2012). Reluctance to recover in anorexia nervosa. European Eating Disorders Review, 20, 60-67. doi: 10.1002/erv.1097

Reid, M., Burr, J., Williams, S., & Hammersley, R. (2008). Eating disorders patients' views on their disorders and on an outpatient service: A qualitative study. Journal of Health Psychology, 13, 956-960. doi: 10.1177/1359105308095070

Robertson, S.E., & Borgen, W.A. (2016). Introduction to the special issue on the history of counselling in Canada. Canadian Journal of Counselling & Psychotherapy/Revue Canadienne de Counseling et de Psychothérapie, 50, 197- 206. Retrieved from
https://search-proquest-com.ezproxy.lib.ucalgary.ca/docview/1810336249?pq-origsite=summon&accountid=9838

Robinson, P.H., Kukucska, R., Guidetti, G., & Leavey, G. (2015). Severe and enduring anorexia nervosa (SEED?AN): A qualitative study of patients with 20+ years of anorexia nervosa. European Eating Disorders Review, 23, 318-326. doi: 10.1002/erv.2367

Russell-Mayhew, S. (2007). Preventing a continuum of disordered eating: Going beyond the individual. The Prevention Researcher, 14, 7-10. Retrieved from
http://www.onehealth.ca/r_alberta_nwt/video_conferences/E110404A-HOB.pdf

Ryan, C.J., & Callaghan, S. (2014). Treatment refusal in anorexia nervosa: The hardest of cases. Journal of Bioethical Inquiry, 11, 43-45. doi: 10.1007/s11673-013-9498-8

Parry-Jones, W.L.L. (1985). Archival exploration of anorexia nervosa. Journal of Psychiatric Research, 19, 95-100. doi: https://doi.org/10.1016/0022-3956(85)90004-4

Santonastaso, P., Camporese, A., Caregaro, L., & Favaro, A. (2008). Late onset anorexia nervosa treated with olanzapine: A case report. Psychological Topics, 17, 329-33. Retrieved from https://doaj.org/article/3c6564ab0cfe4060a2f5905e64e63fa9

Schwarz, D., Ponder, K.L., & Feller, E.R. (2009). Delayed diagnoses: Nonspecific findings and diagnostic challenges in eating disorders. Case Reports in Medicine, Article ID 841037
doi:10.1155/2009/841037

Selvini Palazzoli, M. (1974). Anorexia nervosa. London: Faber. (Original work published 1963).

Sinacore, A.L. (2015). Introduction. In A.L. Sinacore & F. Ginsberg (Eds.), Canadian counselling and counselling psychology in the 21st century (pp. 3-14). Montreal, QC, Canada: McGill-Queens University Press.

Steinhausen, H.C. (2002). The outcome of anorexia nervosa in the 20th century. American Journal of Psychiatry, 159, 1284-1293. Retrieved from http://www.saegre.org.ar/biblioteca/arbol_bibliografico/agosto2005/1284_anorexia_outcome.pdf

Steinhausen, H.C. (2008). Outcome of eating disorders. Child and Adolescent Psychiatric Clinics of North America, 18, 225-242. doi:10.1016/j.chc.2008.07.013

Sundgot?Borgen, J., & Torstveit, M.K. (2010). Aspects of disordered eating continuum in elite high?intensity sports. Scandinavian Journal of Medicine & Science in Sports, 20, 112-121. doi: 10.1111/j.1600-0838.2010.01190.x

Tantleff-Dunn, S., Barnes, R.D., & Larose, J.G. (2011). It's not just a "woman thing": The current state of normative discontent. Eating Disorders, 19, 392-402. doi:10.1080/10640266.2011.609088

Vandereycken, W., & Van Humbeeck, I. (2008). Denial and concealment of eating disorders: A retrospective survey. European Eating Disorders Review, 16, 109-114. doi: 10.1002/erv.857

von Ranson, K.M., Wallace, L.M., & Stevenson, A. (2012). Psychotherapies provided for eating disorders by community clinicians: Infrequent use of evidence-based treatment. Psychotherapy Research, 23, 333-343. doi:10.1080/10503307.2012.735377

Voriadaki, T., Simic, M., Espie, J., & Eisler, I. (2015). Intensive multi?family therapy for adolescent anorexia nervosa: Adolescents' and parents' day?to?day experiences. Journal of Family Therapy, 37, 5-23. doi: 10.1111/1467-6427.12067

Watson, H.J., & Bulik, C.M. (2013). Update on the treatment of anorexia nervosa: Review of clinical trials, practice guidelines and emerging interventions. Psychological Medicine, 43, 2477-2500. doi:10.1017/S0033291712002620

Williams, S., & Reid, M. (2010). Understanding the experience of ambivalence in anorexia nervosa: The maintainer's perspective. Psychology and Health, 25, 551-567. doi: 10.1080/08870440802617629

Williams, E.P., Russell-Mayhew S., & Ireland, A. (in press). Disclosing an eating disorder: A situational analysis of online accounts. The Qualitative Report.

Young, R. (2009). Counseling in the Canadian mosaic: A cultural perspective. In. L.H. Gerstain, P.P. Heppner, K.L. Norworthy, S. Aegisdottir, & S.A. Leung (Eds.), International handbook of cross-cultural counseling: Cultural assumptions and practices worldwide (pp. 359-367). Thousand Oaks, CA: Sage.

Young, R.A., & Nichol, J.J. (2007). Counselling psychology in Canada: Advancing psychology for all. Applied Psychology: An International Review, 56, 20-32. doi: 10.1111/j.1464-0597.2007.00273.x
Published
2018-01-22
Issue
Section
Articles