“You’re Just Looking at One Piece of the Puzzle… My Weight”: A Phenomenological Examination of Diagnostic Crossover in Eating Disorders

Hanna P. Christian

doi:10.29333/ajqr/14084

Hanna P. Christian ¹ ² ^*

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AM J QUALITATIVE RES, Volume 8, Issue 1, pp. 57-70

https://doi.org/10.29333/ajqr/14084

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Abstract

This paper examines the phenomenology of diagnostic crossover in eating disorders, the movement within or between feeding and eating disorder subtypes or diagnoses over time, in two young women who experienced multiple changes in eating disorder diagnosis over 5 years. Using interpretative phenomenological analysis, this study found that transitioning between different diagnostic labels, specifically between bulimia nervosa and anorexia nervosa binge/purge subtype, was experienced as disempowering, stigmatizing, and unhelpful. The findings in this study offer novel evidence that, from the perspective of individuals diagnosed with EDs, using BMI as an indicator of the presence, severity, or change of an ED may have adverse consequences for well-being and recovery and may lead to mischaracterization or misclassification of health status. The narratives discussed in this paper highlight the need for more person-centered practices in the context of diagnostic crossover. Including the perspectives of those with lived experience can help care providers working with individuals with eating disorders gain an in-depth understanding of the potential personal impact of diagnosis changing and inform discussions around developing person-focused diagnostic practices.

Keywords: feeding and eating disorders, bulimia nervosa, diagnostic labels, diagnostic crossover, illness narrative

References

Acle, A., Cook, B. J., Siegfried, N., & Beasley, T. (2021). Cultural considerations in the treatment of eating disorders among racial/ethnic minorities: A systematic review. Journal of Cross-Cultural Psychology, 52(5), 468–488. https://doi.org/10.1177/00220221211017664
Ali, K., Farrer, L., Fassnacht, D. B., Gulliver, A., Bauer, S., & 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/10.1002/eat.22598
American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed.). American Psychiatric Association.
ANAD | Free Eating Disorder Support Groups & Services. (2021, November 21). https://anad.org/
Baffsky, R. (2020). Eating disorders in Australia: A commentary on the need to address stigma. Journal of Eating Disorders, 8(1), Article 11. https://doi.org/10.1186/s40337-020-00287-3
Bordo, S. (1993). Unbearable weight: Feminism, Western culture, and the body. University of California Press.
Bray, B., Rodríguez-Martín, B. C., Wiss, D. A., Bray, C. E., & Zwickey, H. (2021). Overeaters anonymous: An overlooked intervention for binge eating disorder. International Journal of Environmental Research and Public Health, 18(14), Article 14. https://doi.org/10.3390/ijerph18147303
Breithaupt, L., Kahn, D. L., Slattery, M., Plessow, F., Mancuso, C., Izquierdo, A., Dreier, M. J., Becker, K., Franko, D. L., Thomas, J. J., Holsen, L., Lawson, E. A., Misra, M., & Eddy, K. T. (2022). Eighteen-month course and outcome of adolescent restrictive eating disorders: Persistence, crossover, and recovery. Journal of Clinical Child & Adolescent Psychology, 51(5), 715–725. https://doi.org/10.1080/15374416.2022.2034634
Brelet, L., Flaudias, V., Désert, M., Guillaume, S., Llorca, P.-M., & Boirie, Y. (2021). Stigmatization toward people with anorexia nervosa, bulimia nervosa, and binge eating disorder: A scoping review. Nutrients, 13(8), Article 2834. https://doi.org/10.3390/nu13082834
Burns, M. (2004). Eating like an ox: Femininity and dualistic constructions of bulimia and anorexia. Feminism & Psychology, 14(2), 269–295. https://doi.org/10.1177/0959353504042182
Castellini, G., Cassioli, E., Rossi, E., Mancini, M., Ricca, V., & Stanghellini, G. (2022). Bridging cognitive, phenomenological and psychodynamic approaches to eating disorders. Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity, 27(7), 2273–2289. https://doi.org/10.1007/s40519-022-01379-6
Connecting Food, Eating, Body and Mind. (2012). https://www.reddit.com/r/bulimia/
Counihan, C. M. (1992). Food rules in the United States: Individualism, control, and hierarchy. Anthropological Quarterly, 65(2), 55–66. https://doi.org/10.2307/3318134
Eating Disorders. (2008). https://www.reddit.com/r/EatingDisorders/
Eating Disorders, Uncensored. (2014). Reddit. https://www.reddit.com/r/eating_disorders/
Eiring, K., Wiig Hage, T., & Reas, D. L. (2021). Exploring the experience of being viewed as “not sick enough”: A qualitative study of women recovered from anorexia nervosa or atypical anorexia nervosa. Journal of Eating Disorders, 9(1), Article 142. https://doi.org/10.1186/s40337-021-00495-5
Eli, K. (2018). Distinct and untamed: Articulating bulimic identities. Culture, Medicine and Psychiatry, 42(1), 159–179. https://doi.org/10.1007/s11013-017-9545-8
Ellis, J. M., Essayli, J. H., Zickgraf, H. F., Rossi, J., Hlavka, R., Carels, R. A., & Whited, M. C. (2020). Comparing stigmatizing attitudes toward anorexia nervosa, binge-eating disorder, avoidant-restrictive food intake disorder, and subthreshold eating behaviors in college students. Eating Behaviors, 39, Article 101443. https://doi.org/10.1016/j.eatbeh.2020.101443
Fichter, M. M., Quadflieg, N., Crosby, R. D., & Koch, S. (2017). Long-term outcome of anorexia nervosa: Results from a large clinical longitudinal study. International Journal of Eating Disorders, 50(9), 1018–1030. https://doi.org/10.1002/eat.22736
Foran, A.-M., O’Donnell, A. T., & Muldoon, O. T. (2020). Stigma of eating disorders and recovery-related outcomes: A systematic review. European Eating Disorders Review, 28(4), 385–397. https://doi.org/10.1002/erv.2735
Frey, I. (2020). Anorexia’s failed little sisters: Reflections on researching bulimia as a former bulimic. Social Theory & Health, 18(2), 138–151. https://doi.org/10.1057/s41285-019-00100-5
Geller, J., Fernandes, A., Srikameswaran, S., Pullmer, R., & Marshall, S. (2021). The power of feeling seen: Perspectives of individuals with eating disorders on receiving validation. Journal of Eating Disorders, 9(1), Article 149. https://doi.org/10.1186/s40337-021-00500-x
Glazer, K. B., Sonneville, K. R., Micali, N., Swanson, S. A., Crosby, R., Horton, N. J., Eddy, K. T., & Field, A. E. (2019). The course of eating disorders involving bingeing and purging among adolescent girls: Prevalence, stability, and transitions. Journal of Adolescent Health, 64(2), 165–171. https://doi.org/10.1016/j.jadohealth.2018.09.023
Gotovac, S., LaMarre, A., & Lafreniere, K. (2020). Words with weight: The construction of obesity in eating disorders research. Health, 24(2), 113–131. https://doi.org/10.1177/1363459318785706
Hamilton, A., Mitchison, D., Basten, C., Byrne, S., Goldstein, M., Hay, P., Heruc, G., Thornton, C., & Touyz, S. (2022). Understanding treatment delay: Perceived barriers preventing treatment-seeking for eating disorders. Australian & New Zealand Journal of Psychiatry, 56(3), 248–259. https://doi.org/10.1177/00048674211020102
Johns, G., Taylor, B., John, A., & Tan, J. (2019). Current eating disorder healthcare services – the perspectives and experiences of individuals with eating disorders, their families and health professionals: Systematic review and thematic synthesis. BJPsych Open, 5(4), Article e59. https://doi.org/10.1192/bjo.2019.48
Kearns, E. (2020). Anorexia nervosa and bulimia nervosa as expressions of shame in a post-feminist [Master's thesis, University of South Florida]. https://digitalcommons.usf.edu/etd/8456
Kenny, T. E., & Lewis, S. P. (2023). More than an outcome: A person-centered, ecological framework for eating disorder recovery. Journal of Eating Disorders, 11(1), Article 45. https://doi.org/10.1186/s40337-023-00768-1
Levinson, C. A., Cusack, C., Brown, M. L., & Smith, A. R. (2022). A network approach can improve eating disorder conceptualization and treatment. Nature Reviews Psychology, 1(7), 419–430. https://doi.org/10.1038/s44159-022-00062-y
Linville, D., Brown, T., Sturm, K., & McDougal, T. (2012). Eating disorders and social support: Perspectives of recovered individuals. Eating Disorders, 20(3), 216–231. https://doi.org/10.1080/10640266.2012.668480
Lowe, M. R., Piers, A. D., & Benson, L. (2018). Weight suppression in eating disorders: A research and conceptual update. Current Psychiatry Reports, 20(10), Article 80. https://doi.org/10.1007/s11920-018-0955-2
Maietta, R., Mihas, P., Swartout, K., Petruzzelli, J., & Hamilton, A. (2021). Sort and sift, think and shift: Let the data be your guide an applied approach to working with, learning from, and privileging qualitative data. The Qualitative Report, 26(6), 2045–2060. https://doi.org/10.46743/2160-3715/2021.5013
Marks, R. J., De Foe, A., & Collett, J. (2020). The pursuit of wellness: Social media, body image and eating disorders. Children and Youth Services Review, 119, Article 105659. https://doi.org/10.1016/j.childyouth.2020.105659
Martin-Wagar, C. A., & Weigold, I. K. (2023). Internalized stigma as a transdiagnostic factor for women with eating disorders. Eating Disorders, 31(2), 173–190. https://doi.org/10.1080/10640266.2022.2095481
McEntee, M. L., Philip, S. R., & Phelan, S. M. (2023). Dismantling weight stigma in eating disorder treatment: Next steps for the field. Frontiers in Psychiatry, 14, Article 1157594. https://doi.org/10.3389/fpsyt.2023.1157594
Mensinger, J. L., Tylka, T. L., & Calamari, M. E. (2018). Mechanisms underlying weight status and healthcare avoidance in women: A study of weight stigma, body-related shame and guilt, and healthcare stress. Body Image, 25, 139–147. https://doi.org/10.1016/j.bodyim.2018.03.001
Mirabella, M., Muzi, L., Franco, A., Urgese, A., Rugo, M. A., Mazzeschi, C., Speranza, A. M., McWilliams, N., & Lingiardi, V. (2023). From symptoms to subjective and bodily experiences: The contribution of the Psychodynamic Diagnostic Manual (PDM-2) to diagnosis and treatment monitoring in eating disorders. Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity, 28(1), Article 35. https://doi.org/10.1007/s40519-023-01562-3
Mitrofan, O., Petkova, H., Janssens, A., Kelly, J., Edwards, E., Nicholls, D., McNicholas, F., Simic, M., Eisler, I., Ford, T., & Byford, S. (2019). Care experiences of young people with eating disorders and their parents: Qualitative study. BJPsych Open, 5(1), Article e6. https://doi.org/10.1192/bjo.2018.78
Mond, J. M., & Arrighi, A. (2012). Perceived acceptability of anorexia and bulimia in women with and without eating disorder symptoms. Australian Journal of Psychology, 64(2), 108–117. https://doi.org/10.1111/j.1742-9536.2011.00033.x
Monteleone, A. M., Pellegrino, F., Croatto, G., Carfagno, M., Hilbert, A., Treasure, J., Wade, T., Bulik, C. M., Zipfel, S., Hay, P., Schmidt, U., Castellini, G., Favaro, A., Fernandez-Aranda, F., Il Shin, J., Voderholzer, U., Ricca, V., Moretti, D., Busatta, D., … Solmi, M. (2022). Treatment of eating disorders: A systematic meta-review of meta-analyses and network meta-analyses. Neuroscience & Biobehavioral Reviews, 142, Article 104857. https://doi.org/10.1016/j.neubiorev.2022.104857
Mortimer, R. (2019). Pride before a fall: Shame, diagnostic crossover, and eating disorders. Journal of Bioethical Inquiry, 16(3), 365–374. https://doi.org/10.1007/s11673-019-09923-3
Ostermann, T., Vogel, H., Boehm, K., & Cramer, H. (2019). Effects of yoga on eating disorders: A systematic review. Complementary Therapies in Medicine, 46, 73–80. https://doi.org/10.1016/j.ctim.2019.07.021
Plessow, F., & Eddy, K. T. (2015). Diagnostic crossover. In T. Wade (Ed.), Encyclopedia of feeding and eating disorders (pp. 1–5). Springer Singapore. https://doi.org/10.1007/978-981-287-087-2_122-1
Rohrbach, P. J., Dingemans, A. E., Spinhoven, P., Van Ginkel, J. R., Fokkema, M., Wilderjans, T. F., Bauer, S., & Van Furth, E. F. (2022). Effectiveness of an online self-help program, expert-patient support, and their combination for eating disorders: Results from a randomized controlled trial. International Journal of Eating Disorders, 55(10), 1361–1373. https://doi.org/10.1002/eat.23785
Russell, G. (1979). Bulimia nervosa: An ominous variant of anorexia nervosa. Psychological Medicine, 9(3), 429–448. https://doi.org/10.1017/s0033291700031974
Salvia, M. G., Ritholz, M. D., Craigen, K. L. E., & Quatromoni, P. A. (2023). Women’s perceptions of weight stigma and experiences of weight-neutral treatment for binge eating disorder: A qualitative study. EClinicalMedicine, 56, Article 101811. https://doi.org/10.1016/j.eclinm.2022.101811
Samuels, K. L., Maine, M. M., & Tantillo, M. (2019). Disordered eating, eating disorders, and body image in midlife and older women. Current Psychiatry Reports, 21(8), Article 70. https://doi.org/10.1007/s11920-019-1057-5
Shatz, I. (2017). Fast, Free, and Targeted: Reddit as a source for recruiting participants online. Social Science Computer Review, 35(4), 537–549. https://doi.org/10.1177/0894439316650163
Silén, Y., Sipilä, P. N., Raevuori, A., Mustelin, L., Marttunen, M., Kaprio, J., & Keski-Rahkonen, A. (2021). Detection, treatment, and course of eating disorders in Finland: A population-based study of adolescent and young adult females and males. European Eating Disorders Review, 29(5), 720–732. https://doi.org/10.1002/erv.2838
Sims, R., Michaleff, Z. A., Glasziou, P., & Thomas, R. (2021). Consequences of a diagnostic label: A systematic scoping review and thematic framework. Frontiers in Public Health, 9, Article 725877. https://doi.org/10.3389/fpubh.2021.725877
Smith, J. A. (1996). Beyond the divide between cognition and discourse: Using interpretative phenomenological analysis in health psychology. Psychology & Health, 11(2), 261–271. https://doi.org/10.1080/08870449608400256
Smith, J. A., & Osborn, M. (2003). Interpretative phenomenological analysis. In J. A. Smith (Ed.), Qualitative psychology: A practical guide to research methods (pp. 51–80). SAGE Publications.
Smith, J. A., & Osborn, M. (2015). Interpretative phenomenological analysis as a useful methodology for research on the lived experience of pain. British Journal of Pain, 9(1), Article 41. https://doi.org/10.1177/2049463714541642
Smith, J., Flowers, P., & Larkin, M. (2009). Interpretative phenomenological analysis: Theory, method and research (2nd ed.). SAGE Publications.
Stanghellini, G., Daga, G. A., & Ricca, V. (2021). From the patients’ perspective: What it is like to suffer from eating disorders. Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity, 26(3), 751–755. https://doi.org/10.1007/s40519-020-00913-8
Turner, H., & Peveler, R. (2023). The eating disorders: Anorexia nervosa, bulimia nervosa, binge-eating disorders, and OSFED. In Essentials of human nutrition (pp. 379–389, 6th ed.). Oxford University Press.
van den Berg, E., Houtzager, L., de Vos, J., Daemen, I., Katsaragaki, G., Karyotaki, E., Cuijpers, P., & Dekker, J. (2019). Meta-analysis on the efficacy of psychological treatments for anorexia nervosa. European Eating Disorders Review: The Journal of the Eating Disorders Association, 27(4), 331–351. https://doi.org/10.1002/erv.2683
Waller, G. (1993). Why do we diagnose different types of eating disorder? Arguments for a change in research and clinical practice. European Eating Disorders Review, 1(2), 74–89. https://doi.org/10.1002/erv.2400010203
Walsh, B. T., Hagan, K. E., & Lockwood, C. (2023). A systematic review comparing atypical anorexia nervosa and anorexia nervosa. The International Journal of Eating Disorders, 56(4), 798–820. https://doi.org/10.1002/eat.23856
Whiskin, E. (2023). What’s in a name? The social meanings of eating disorder diagnoses: An autoethnography [Master's thesis, Victoria University of Wellington]. https://doi.org/10.26686/wgtn.23937390
Wilkop, M., Wade, T. D., Keegan, E., & Cohen-Woods, S. (2023). Impairments among DSM-5 eating disorders: A systematic review and multilevel meta-analysis. Clinical Psychology Review, 101, Article 102267. https://doi.org/10.1016/j.cpr.2023.102267
Zapcic, I., Fabbri, M., & Karandikar, S. (2023). Using Reddit as a source for recruiting participants for in-depth and phenomenological research. International Journal of Qualitative Methods, 22, Article 16094069231162674. https://doi.org/10.1177/16094069231162674

Citation

Christian, H. P. (2024). “You’re Just Looking at One Piece of the Puzzle… My Weight”: A Phenomenological Examination of Diagnostic Crossover in Eating Disorders. American Journal of Qualitative Research, 8(1), 57-70. https://doi.org/10.29333/ajqr/14084

Christian, H. P. (2024). “You’re Just Looking at One Piece of the Puzzle… My Weight”: A Phenomenological Examination of Diagnostic Crossover in Eating Disorders. American Journal of Qualitative Research, 8(1), pp. 57-70. https://doi.org/10.29333/ajqr/14084

Christian HP. “You’re Just Looking at One Piece of the Puzzle… My Weight”: A Phenomenological Examination of Diagnostic Crossover in Eating Disorders. AM J QUALITATIVE RES. 2024;8(1), 57-70. https://doi.org/10.29333/ajqr/14084

Christian, Hanna P.. "“You’re Just Looking at One Piece of the Puzzle… My Weight”: A Phenomenological Examination of Diagnostic Crossover in Eating Disorders". American Journal of Qualitative Research 2024 8 no. 1 (2024): 57-70. https://doi.org/10.29333/ajqr/14084

Christian, Hanna P. "“You’re Just Looking at One Piece of the Puzzle… My Weight”: A Phenomenological Examination of Diagnostic Crossover in Eating Disorders". American Journal of Qualitative Research, vol. 8, no. 1, 2024, pp. 57-70. https://doi.org/10.29333/ajqr/14084

Christian HP. “You’re Just Looking at One Piece of the Puzzle… My Weight”: A Phenomenological Examination of Diagnostic Crossover in Eating Disorders. AM J QUALITATIVE RES. 2024;8(1):57-70. https://doi.org/10.29333/ajqr/14084