Emotional Meanings Assigned to Eating Disorders: Narratives of Women with Anorexia and Bulimia Nervosa

Special Article - Eating Disorders

Ann Nutr Disord & Ther. 2017; 4(1): 1040.

Emotional Meanings Assigned to Eating Disorders: Narratives of Women with Anorexia and Bulimia Nervosa

Leonidas C¹ and dos Santos MA²*

¹Department of the Federal University of Triângulo Minera, University of So Paulo, Brazil

²Department of Psychology, University of So Paulo, Brazil

*Corresponding author: Manoel Antônio dos Santos, Department of Psychology, University of So Paulo, Faculty of Philosophy, Sciences and Letters of RibeiroPreto, Bandeirantes Avenue, Monte Alegre, So Paulo, Brazil

Received: January 30, 2017; Accepted: February 21, 2017; Published: February 23, 2017


This study aimed to investigate emotional meanings assigned to Eating Disorders (ED) through narratives of women affected with these psychopathological conditions. Participants were patients in a Brazilian service specialized in treatment of ED. A semi-structured interview was used for data collection. Recruitment continued until data saturation was reached. The verbatim transcription of interview data was analyzed through thematic content analysis, which was employed by two researchers. Results showed that, after the occurrence of ED, participants began to experience feelings of distress, anxiety and loneliness, which were related to lowered self-esteem and social isolation. Family dynamics was characterized as confrontational, but in contrast, was considered participants´ primary social support network. These data underlined that the emotional meanings attributed to ED need to be addressed and explored by health care professionals to gain a detailed understanding of patients’ illness experiences.

Keywords: Eating disorders; Narratives; Family


According to DSM-V [1], Eating Disorders (ED) can be characterized as psychopathological conditions that involve serious disturbances in eating behavior and affect mostly teenagers and young women. These disorders present a chronic and disabling progress, and can result in biological, psychological and social damages that cause increased morbidity and mortality. They affect a wide age range - usually between 13 and 21 years - and may have a fatal outcome if not treated, depending on the seriousness of the disease or the consequences of health problems. They are prevalent in women of all social levels, being the third most common mental disorder among women [2].

Anorexia Nervosa (AN) and Bulimia Nervosa (BN) are the two most prevalent types of ED. AN may be characterized as a refusal of the individual to maintain appropriate body weight to their age and height, an intense fear of gaining weight and a significant disturbance in the perception of shape or size of the body, resulting in cachexia [1]. Regarding the aspects of personality of AN patient, several authors cite inferiority, inadequacy and insecurity, perfectionism, obsessiveness, compulsiveness, negative emotions, withdrawal and avoidance behaviors [3,4]. Cooper, Deepak, Grocutt and Bailey suggest that the experience of “feeling fat”, intensely experienced by patients with ED, seems to be related to a combination of factors such as anxiety, internal and external bodily sensations, feelings rejection, social exclusion, and negative beliefs about themselves [5].

According to patients´ reports, the onset of ED is usually associated with the occurrence of a stressor event: critical comments about weight end of a love relationship, loss of a loved one, and other traumatic events. Then, the individual begins to live in relation to the diet, the concern about their weight and body shape, physical activities, calories´ tables and pathological fear of fat [4]. This kind of obsessive thinking leads to a very strict discipline in performing diets, which success leads to feelings of control [6].

In contrast, BN involves recurrent episodes of binge eating, feelings of loss of control over eating during the binge episodes, and recurrent inappropriate compensatory behaviors such as vomiting, use of laxatives, diuretics and metabolism stimulant medications, excessive physical exercises, among others [1]. The disorder is also associated with impulsive behaviors and comorbidities, such as histrionic personality disorder traits and borderline type [7,8], a floating self-esteem and maladaptive thoughts and emotions. It is common to find evidence of chaotic attitudes, not only regarding to eating habits, but also in other aspects of life such as studies, work and romantic relationships [8].

The typical exaggeration of patients with BN usually occurs in the form of private and solitary acts, and configures an attack to cooking, to education and to moral behaviors, subverting biological needs of the hunger and contesting what is ethically and aesthetically accepted, as well as rules, uses, learning’s and the social dimension of eating [8]. From brandished attacks, arise moral disapproval and shame experienced by individuals affected by these conditions.

Regarding to psychological functioning, women with BN have a number of maladaptive thoughts and emotions regarding their eating habits and their body weight. Moreover, they also have unstable self-esteem and believe that a well-designed body would solve their problems of personal insecurity. To accomplish the idealized body, these women perform excessive diets, purging rituals and strenuous exercise. Thus, the desire to lose weight seem to be associated with personal disorganization, in which regulation and control over eating can be considered as an attempt to organize and stabilize the chaotic mental state [8].

According Frosthlom [9], patients´ perception about their psychopathological condition is quite relevant and should be taken into account in medical decisions. Their own ideas and concepts about the disorder may provide subsidies for the expansion of biopsychosocial models, contributing to the reduction and/or prevention of the development of chronic diseases.

Listening to patients´ perceptions about the ED is needed in scientific research as well as in health assistance, since their narratives constitute the legitimate instrument of communication of emotional experiences [10]. Individual´s narrative is the professional´s most palpable tool to access patient´s difficulties and internal conflicts. The bond between individuals and their “anorexic voice” could explain their ambivalence to change [11]. Hoskins describes a narrative of one woman’s reconstitution of self while recovering from anorexia nervosa. Narratives are understood as expressions of the self and the living experience for the individual who narrates [10,12].

The present study aimed to investigate the emotional meanings assigned to ED through narratives of women affected with these psychopathological conditions, in order to understand the emotional experiences involved in living with AN or BN.


A qualitative approach was used once the study sought to establish the perspectives of those with ED. The collective case study [13] design was used, since the study involves, in general, the description of experiences of women who are part of a specific group, the ED.


This research included 12 women who were in treatment for ED at Assistance Group on Eating Disorders (GRATA), from Clinics´ Hospital, Faculty of Medicine of RibeiroPreto, and University of So Paulo, Brazil. As presented in Table 1, the average age of participants is 27, 7 years. Eight of them were diagnosed with purging type AN, and four of them with BN. Anthropometric data presented in Table 1 was obtained from hospital records. To prevent participants´ identification, names were replaced by fictitious ones.

Citation: Leonidas C and dos Santos MA. Emotional Meanings Assigned to Eating Disorders: Narratives of Women with Anorexia and Bulimia Nervosa. Ann Nutr Disord & Ther. 2017; 4(1): 1040. ISSN:2381-8891