Strategies of Self-Protection and Connection

This assignment delves into the complex relationship between trauma, body image, and self-preservation. It centers around an interview transcript from a participant named E, who shares her experiences with sexual assault, eating disorders, and the strategies she used to cope. Students are tasked with analyzing the transcript to identify themes related to self-protection, connection, and the influence of others on self-perception. Key concepts include the enduring impact of early experiences, strategies of disconnection and avoidance, and the search for a sense of self amidst distress.

Fight against anorexia from personalised perspectives:
A Phenomenological Analysis

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Acknowledgement
I would like to take this opportunity to express my profound gratitude and deep regard to my
Supervisor Dr.Jackie Gray for her exemplary guidance, valuable feedback and constant
encouragement throughout the duration of the project. Her valuable suggestions were of
immense help throughout my project work. Her perceptive criticism kept me working to make
this project in a much better way. Working under him/her was an extremely knowledgeable
experience for me. I would also like to give my sincere gratitude to all my peers who without
whom this research would be incomplete.

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Abstract
Eating disorders like anorexia nervosa have been linked with a persistent over concern with body
shape and physical appearance. Long-term suffering from anorexia nervosa leads to the
development of severe health conditions related to malnutrition. The aim of the present study
was to conduct an exploration of the perceptions and viewpoints of individuals who have
reported to have recovered from anorexia nervosa, or are recovering from the same condition. An
archival qualitative methodology was employed and the data analysis conducted with
interpretative phenomenological analysis. Videos posted by six women were selected from
YouTube in order to study factors influencing development of anorexia nervosa. Analysis leads
to the generation of four possible themes. The main themes include experience of fragile sense of
self, influence of others on self-perception, strategies to employ to manage the sense of self and
the enduring influence of early experience. All these themes will be cited as the reason behind
the development of anorexia nervosa. The findings of the study of this phenomenological
analysis will helpful in ascertaining the psychology of the individual suffering from anorexia
nervosa and their journey towards the subsequent recovery.

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Table of Contents
INTRODUCTION 5
AIMS AND RESEARCH QUESTION 8
METHODOLOGY 9
QUALITATIVE DESIGN 9
INTERPRETATIVE PHENOMENOLOGICAL ANALYSIS (IPA) 9
RESEARCH DESIGN 10
DATA 10
PARTICIPANT CHARACTERISTICS 10
ETHICAL CONSIDERATIONS 11
DATA ANALYSIS 11
ANALYSIS AND DISCUSSION 13
THEME 1- EXPERIENCING A FRAIL SENSE OF SELF 14
THEME 2- INFLUENCE OF OTHERS ON SELF-PERCEPTION 17
THEME 3: STRATEGIES EMPLOYED TO MANAGE THE SELF- SENSE 18
THEME 4: THE ENDURING INFLUENCE OF EARLY EXPERIENCES 20
CONCLUSION 22
REFLECTION 23
STUDY REFLECTIONS 23
METHODOLOGICAL CONSIDERATION AND STUDY LIMITATIONS 23

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REFERENCES 25
APPENDIX A: VIDEO TRANSCRIPT 30
VIDEO 1 30
VIDEO 2 34
VIDEO 3 44
VIDEO 4 50
VIDEO 5 59
VIDEO 6 63

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Introduction
Organisations throughout the globe are striving at present to reduce the stigma and
disgrace related to eating disorders. Eating disorders have been linked with a persistent over
concern with body shape and size as indicated by extreme behaviours such as strenuous exercise,
prolonged fasting and self-induced vomiting to reduce body fat and weight (Costa et al., 2016).
Scientists denote eating disorders as mental disorders that have an adverse impact on the mental
and physical health of the person (Costa et al., 2016).
The present Diagnostic and Statistical Manual of Mental Disorder classifies eating
disorders into three distinct categories: Anorexia Nervosa (AN), Bulimia Nervosa (BN), and
Eating Disorder Not Otherwise Specified (EDNOS). The DSM- IV –TR criteria for Anorexia
Nervosa highlights persons who are refusing to maintain a certain body weight above or at a
normal level as appropriate for the individual considering the age and height; for people who
have a strong fear of becoming fat or gaining weight; or have certain disturbed body image due
to body shape and weight; Amenorrhea for at least three consecutive menstrual cycles
(Mustelinet al., 2016). The Anorexia nervosa category has again been classified into two classes;
restricting-type and purging/binge eating type. For those suffering from the first form of anorexia
nervosa, the tendency is to achieve the weight loss through fasting, dieting and excessive
exercise. For others, there is a regular engagement in binge eating and/or purging wherein they
self-induce vomiting and misuse laxatives and diuretics (Eddy et al., 2017).
The health risks associated with anorexia nervosa (AN) had been well pointed out by
(Gianiniet al., 2017). Long-term anorexia leads to severe health conditions related to
malnutrition. Potential complications include concerns with bones and muscles, osteoporosis,

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heart conditions, kidney conditions, fertility problems and problems with functioning of the brain
and the nervous system. At least1.6 million individuals (approx) in the UK are estimated to
suffer from anorexia and other eating disorders. While an underestimation might be involved, it
is known that the needs of the community are frequently unmet (anorexiabulimiacare.org.uk,
2018). Anorexia mostly affects women and adolescent girls, and the average age of developing
the disease is 16 to 17 years. Figures for 2015 indicated that about 2.9 million people were living
with anorexia. Further, about 0.9%- 4.3% of women in western countries suffer from anorexia at
some point in their lifetime. While the condition has become more diagnosed at the present
century, the factors contributing to the same are still to be explored (Byrne et al., 2017).
A rich pool of literature exists on the involvement of self in eating disorders such as
anorexia. The self-concept has been denoted to be multifactorial, containing different empirical
selves; spiritual self, social self and body self. Literature has linked the concept of self in
anorexia to two fundamental theories; feminist theories, and cognitive and behavioural
perspectives. Feminist theory in regards to anorexia sits well within the psychoanalytic
conceptualisation of self. Theorists have put forward the argument that female psychosocial
development is guided by cultural ideals regarding perfect women (Young et al., 2018). These
theorists have repeatedly associated anorexia nervosa and other eating disorders with pressures
from the society that conflict with the ability to have a satisfying identity. The reliance on such
case is mainly the methods of coping with the absence of a distinct self, such as poor eating habit
(Holmes et al., 2017). Behavioural and cognitive perspectives relate the concepts of self-image,
self-schema and body dissatisfaction in anorexia (Pike & Olmsted, 2016). According to Junneet
al., (2016), self-schema is noted to be the cognitive generalisations regarding self due to
experiences. The essence of low self-esteem lies in negative self-image which is derived from

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interactions with the society and related experiences. Abuse, neglect, lack of praise and affection
are the contributory factors. Disturbed body image or body dissatisfaction relates to the
individual’s inclination towards being unhappy due to body weight (Junneet al., 2016). Body
image disturbances are probably the most common driving force behind anorexia nervosa and
the related conditions (Junneet al., 2016). O'Connell et al, (2017) have collected quantitative
evidence and have opined that individuals with anorexia nervosa (AN) may nurture beliefs in the
domain of food, body image and appearance that are often delusional nature.
While qualitative research regarding the experiences of anorexic patients has attempted to
explore views of the self, there lies a gap in exploring secondary aims. The existing studies
focused on the application of a discourse analysis (DA), the approach noted to have the focus on
the social construction of reality (Holmes et al., 2017). Such studies gave the suggestion that
additional understanding would be required in this domain through a different qualitative
research methodology. Interpretative Phenomenological Analysis (IPA) is a notable qualitative
approach aiming at exploring how participants make sense of their personal and social world
(Edward, 2017). The two approaches are distinct as the IPA aims at exploring the experience and
thinking of participants, contributing more significantly to the understanding of the underlying
principles of eating disorder and self.

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Aims and research question
The aim of the present study was to carry out an exploration of the perceptions and
viewpoints of individuals who have reported to have recovered from anorexia nervosa, or are
recovering from the same condition. The research was directed at gaining an in depth
understanding of the experiences of self of women who had suffered the eating disorder anorexia
nervosa through an Interpretative Phenomenological Analysis (IPA). Primarily, the objective was
to determine what the individuals felt about experiencing the condition, and what suggestions
they have for others in the society. The study was about how the reports of individuals
recovering from anorexia can affect the understanding of others in the society about the adverse
impact of the condition. The intension was therefore to find out how the individuals recovered
from their condition and what acted as the motivational factors. The attitudes and knowledge of
the individuals were to be understood through the study.
The research questions that were addressed in the research related to the areas of interest were as
follows
1. How do the individuals describe and view themselves at present?
2. Did the individuals experience considerable changes in their view of self-image with
different people in the society and diverse situations?
3. What were the views of the individuals regarding the contributory factors behind their
inclination to view themselves that way?
4. What were the opinion of the individuals regarding why they had a particular perception
about themselves and the related experience?

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Methodology
Qualitative design
This research employs a qualitative, archival design utilising YouTube videos containing
narratives relating to the experience of, and recovery from, anorexia nervosa. The value of
qualitative methods in eating disorder research has been previously highlighted by Taylor,
Bogdan and DeVault (2015), who have described the lack of adequate research in this area as the
main weakness in developing theory and clinical practice. According to Terrell et al. (2012)
quantitative research has provided great deal of progress but it has limitations as this research
approach utilises structured reporting methods and this produce fragmented picture. With this
information in mind, a qualitative research approach was chosen for this study as it will enable
the emergence of unanticipated findings (Taylor, Bogdan & DeVault, 2015).
Interpretative Phenomenological Analysis (IPA)
According to Larkin and Thompson (2012), IPA is the best suited process for qualitative
research. IPA is consistent with the aims of the research and is focussed on exploring experience
in its own terms rather than trying to reduce the research on predefined categories (Larkin &
Thompson, 2012). Moreover, IPA is phenomenological and social constructionist in both sense
and is generally concerned with the personal experience via involving interpretation and
consideration of the context (Larkin & Thompson, 2012). Joseph (2014), is of the opinion that
IPA has an idiographic approach that helps to keep synchronization with the aim of the study.
Lastly IPA is of great importance in the domain of health psychology study and hence selected
for this qualitative analysis (Joseph, 2014).

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Research Design
Data
A purposive sample of participants was employed in accordance with the IPA
requirements. Youtube videos were use for the recruitment of the sample and then analysed via
using IPA (Joseph, 2014). As an archival study, this research did not require participants.
However, pre-existing videos posted on YouTube by six women who were recovering/recovered
from anorexia nervosa. The inclusion criteria include female, age limit above than 18 years old
and suffering from anorexia nervosa. The exclusion criteria include eating disorders with obesity,
male participants, non-English speaking and age lower than 18 years. The decision to focus on
one gender was taken in order to maintain the homogeneity of the sample. Women were selected
because of their higher prevalence of eating disorders in comparison to men Gueguenet al.
(2012). Age above 18 years was selected because an adult sample will have advantage of longer
life stories from which self-narratives can be easily drawn Gueguenet al. (2012). Non-English
speaking was selected as exclusion criteria because qualitative research rely mostly on the flow
of the language which otherwise might have lost under the though point of translator.
Participant Characteristics
Participant Alias
(named changed)
Participant Age Eating disorder Recruitment
context
KB Video 1 Above 18 years Anorexia nervosa Youtube
SS Video 1 Above 18 years Anorexia nervosa Youtube
CS Video 1 Above 18 years Anorexia nervosa Youtube
CC Video 1 Above 18 years Anorexia nervosa Youtube
BB Video 1 Above 18 years Anorexia nervosa Youtube

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E Video 1 Above 18 years Anorexia nervosa Youtube
Ethical considerations
According to Ritchieet al. (2013) informed consent is a crucial factor under the ethical
consideration of qualitative research. A letter seeking the permission to include their video in this
study along with informed consent form was sent to each of the six selected owners of the videos
separately via the email Id retrieved from their YouTube portal. None of them reverted and after
waiting for two weeks, the researcher progressed with the research as per ethical approval. In
order to ensure that the selected participants did not feel obliged to take part, it was emphasised
in the mail that they were under no obligation to do so, and that whether or not they are willing
to provide their videos for the research, it would not affect their life or the treatment process for
eating disorder. Participants were also informed that they can withdraw their video at any time,
without giving any reason for doing so. Participants were notified about the confidentiality and
its limits. They were notified that although the quotes from their videos will be used in the
writing the thesis, all identifying information about them (like names and places) would be
removed from the transcripts.
Data analysis
Data analysis was done via IPA and each video was viewed and reviewed several times
for proper framing of the themes. Each and every recording was listened numerous times, in
order to erect the transcript. Each transcript was then re-read several times and the second margin
was used to note the emergent themes. Thus drawing on both the transcript along with the initial

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analyses. The emergent themes were listed chronologically and them mover of form a related
cluster of themes. Smith et al., (2009) detailed how super-ordinate themes can evolved via
abstraction subsumption, polarization, contextualization, numeration and function.

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Analysis and discussion
The aim of the present research was to gain insight into the experiences of self for
women who have recovered from anorexia nervosa or are recovering from this condition. The
analysis of the transcript (discussed in detail in appendix A) helped in the generation of the
themes. The four themes that emerged from the findings are as follows-
 Experiencing a frail sense of self
 Influence of others on self-perception
 Strategies employed to manage self sense
 The enduring influence of early experiences


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Figure 1: Thematic map of themes and key points
Source: Created by author
Blue: Main themes
Orange: subthemes
The following section discusses the themes in a detailed manner drawing in extant literature to
support the analysis.
Theme 1- Experiencing a frail sense of self
Participants have described that they were either self obsessed or suffered from low self-
esteem and this frail sense about self or uncertainty about the self image and dragged them

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towards the development of AN. The research indicates that the individual’s sense of self were
highly frail and fragile due to the negative experiences of feeling highly uncertain about
themselves. This is evident from the quotes of SS who stated that, “When I went to the job
interview and there was someone with similar skills as me but was slimmer I never got accepted.
I was completely unhappy with how I was”. KB opined that “I was always a very petite girl.
Then my stepfather died and everything changed. I began comfort eating to numb the pain. I
went from 48 kilograms to 60 kilograms in just weeks. I had never felt so disgusting in my life”.
According to Rosenberg (2015) individuals with feeling of uncertainty about themselves lead to
fragmented feelings of self. This fragmented and uncertainty experience might be the result of
using different coping strategies together with disconnecting from self-orientation (Rosenberg
(2015). Chances are also high that the individual’s fragile self-concepts are due to the toxic
childhood experiences. This is evident from the statement of SS who stated that “I got myself
into a bad relationship and in this bad relationship this person controlled me in many ways but
one of the ways was with food”. The statement of E further highlighted the reference towards the
toxic childhood experience like. “I was sexually assaulted at homecoming. I was traumatized. I
started losing weight”. Matheson et al. (2015) highlighted that having an extreme mental state is
daunting and this has lead to negative influence over the self perception and thereby generating
an adverse attitude over self.
Thus in the video of E it can be said that the early experiences of trauma had been
the negative experience. The experience trauma in the form of sexual assault had an adverse
impact on the perception of Emma towards her own look. In case of CC, she was highly
dissatisfied with her body image and wanted to come out of the condition. The unfeminine body
image was the prime reason why she engaged in restricting her food intake, leading to anorexia.

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She had stated, “I wanted a small petite body as I didn’t have nice curves.” This truly indicates
the extent to which CC was dissatisfied with her body image. The video of SS highlighted that
she experienced a lack of certainty regarding her life and was pessimistic about her life.
From the analysis of the above cases, it can be stated certain adverse influence
during the childhood or a negative image of self leads to the generation of fragile sense of self
leading to the development of eating disorder (McAdams et al., 2016). The knowledge gathered
from the videos can be noted to be congruent with theories emphasising on the fact that women
suffering from eating disorders such as anorexia have a considerable feeling of insecurity about
themselves. They, in addition, suffer from high level of social anxiety that aggravate the issue.
Like form the quotes of SS it is evident that she suffers from social anxiety, “When I went out
partying with my friends I always felt like the fat girl”. One can understand that the condition can
be managed when the focus is on body image and one presents the ‘false self’. Further to the
emphasis on body image leading to defencelessness to suffer from any eating disorder, there lies
the issue of feelings of deceitfulness and deceit that are highly distressing (Ambwaniet al., 2016).
As individuals become focused on pleasing other individuals instead of focusing on own self,
there is a direct inhibition of development of dependable sense of self and reasonable sense of
self. This indicates an association with the findings that individuals often attempt to develop a
good feeling of sense when others are pleased and this drains the actual strong sense of self. The
predominant negative views of self have also been discussed widely in literature. Empirical
studies have tried to identify the core schemas and beliefs of individuals suffering from eating
disorders (Cardiet al., 2016). Individual’s predisposition to have considerable negative feelings
was evident from the videos.

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Theme 2- Influence of others on self-perception
The approach to understand changes in self, due to influence of others had been
praiseworthy. The finding that other individuals from the social vicinity can have a deep impact
on the lives of individuals suffering from, or recovered from anorexia is distinct. In case of KB it
is noted that the friends of her had a deep impact on her life that drew her to become a victim of
anorexia nervosa. The fact that her friends did not support her being overweight was the main
contributory factor towards her condition. In case of CN we find that she developed the condition
as she wanted to have a better self-image as a result of physical appearance and body shape. For
example, she was found saying, “As a child, I didn’t have a care in the world but Being called
“chubby” effected me more than people thought”.
As opined byLucci and Patrikelis (2017) people can influence lives of others in relation
to body image and self-esteem in both positive and negative manner. This statement is aligned
with a huge pool of literature where it is mentioned that changes in self is common when
different people influence differently. The degree of influence, as witnessed from the accounts of
the videos, seems to be a part of the larger magnitude resulting in changes of self.
In terms of negative influence, it is clear that changes in self as a response to other’s opinion is a
result of negative interpretation carried out by the individuals. In such a case, the individuals do
not come up with an over comment or behaviour (Phillipouet al., 2015). The findings from the
video analysis fit into the cognitive model of poor and often negligible self-esteem. According to
Ambrosecchia et al. (2015) people who suffer from poor self esteem are more bound to have
negative influences from others of influence of others on self perception. This leads to the
emergence of core beliefs that are negative. Consequently, individuals find social anxiety linked
with eating disorder. For example, CC said, “I was generally happy child I was bubbly and

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outgoing!! I did suffer from anxiety from a young age”. She mentioned this anxiety coming from
not having a feminine body. This low self-esteem of not having a feminine body increases the
negative influence of others over self perceptions. Negative thoughts and assumptions are
activated that trigger inappropriate situations. Like casting extreme punishment over the body
like in this case is extreme dieting and exercising. However, the response of different people
would be different and the extent of eating disorder would vary (Ambrosecchiaet al., 2015).
Positive influence of individuals from the society is self-constructing and different from
negative influence at the core. It seems that one can accept her own self if there is a form of
motivation and powerful influence. Although research indicates that there is a positive influence
on how an individual perceives herself due to other’s viewpoint, the impact on eating disorder
might not be the same always. Compliments received from people who are near and dear always
encourage one to recover from eating disorder and start life afresh. The powerful and reinforcing
consequence of considerable commend for being thin and has been identified as notable driving
factor (Via et al., 2016).
Theme 3: Strategies employed to manage the self- sense
This theme highlights the general manner under which the participants were coping with
or trying to managing their perceptions about themselves. The theme coincides with the
relationship between anorexia and the sense of self that participants of the focused group (groups
recovering or recovered from AN) described experiencing. It also acts as an interpretation that
participants were disconnecting to safeguard their fragile sense of self and lastly that participants
extracted self-worth through pleasing other people, although this can be a drain over their own
sense of self.

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In video 4, CC the participant wanted to have a petite body as according to her she is
devoid of female curves. So in order to make herself feel feminine, she indulged in crash dieting
and extreme exercise which resulted into the development of eating disorder. According to the
reports published by Kaye et al. (2013), individuals suffering from anorexia nervosa tend to have
a childhood temperament along with sudden personality traits like anxiety, perfectionism and
anxiety. This is expressed in their neurobiological traits and making them susceptible towards the
development of anorexia nervosa. In case of KB, she undertook over-eating in order to fight with
her grief so this can be highlighted as a management strategy as opined by Kaye et al. (2013).
KB further opined that while gaining weight, “I would hear rumours that my own friends were
making fun of me behind my back” so in order to fight against this criticism she started dieting
and losing weight. Similarly in case of CS, in order become skinny like everyone surrounding
her, she started dieting. She said “exercising became an addiction. I became obsessed with the
image I seen. Food became less and less. Sipping meals became a talent or me”. In case of CC, it
is clearly admitted by CC herself that she used to suffer from anxiety about her body image and
perceptions of others so in order to cope up with the same she stated losing weight via extreme
dieting thus it can also be regarded as a management of sense of self in order fight against social
anxiety or fear of body shaming thus relating with the concept stated by Kaye et al. (2013). The
same concept goes with the video 5 of BB. BB was fit girl but in spite of that, she had an
obsession to staying thin and skinny. Kaye et al. (2013) further opined that restricted eating at
times act as a weapon for mood enhancer for example restricted eating reduced negative mood
arising via interaction between dopamine reward system and serotonin aversive. Thus in case of
CC, her lathery towards food might have developed at the initial level in order to fight against
her childhood anxiety disorders of negative self-image and later when she gradually grew up it

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became an habit and subsequently transformed into disease. In case of BB there are similar
instances like she said, “to become fit I started to excise more and eat healthier. I managed to
lose 4 kilos, 58 down to 54. I was excited with the results so decided to continue my healthy
ways”. In other it can be said that this feeling of self-satisfaction in order to manage her poor
body image lead to the development AN (Treasure & Schmidt, 2013). Treasure and Schmidt
(2013) further opined that ill state of mind leads to the development of weak central coherence.
Wide-range of impairments like attention bias, impaired signalling of interpretation and
sustained regulation of negative emotions lead to the development of anorexia. In case of CC she
is attention biased or it can be explained in a sense that she is extremely self-conscious. In the
video she was quotes saying “I wanted a small petite body as I didn’t have nice curves. I got
teased for having unfeminine body”. So in order to get attention via attracting mass through her
feminine curves, CC indulged in unhealthy dieting and exercise regime. The same thing goes
with BB as her sense of self consciousness increase when she was in grade 8 and got selected in
the state squad of trampoline. It can be explained in a different way too that though it is
highlighted that their journey towards achievement of perfect attractive body was not for
attention seeking but for personal accomplishment in order to make themselves better (Treasure
& Schmidt, 2013).
Theme 4: The enduring influence of early experiences
The fourth theme aims to capture three form of early experience that recurred among the
participants and which is appeared to cast a significant effect upon how they developed
themselves as adults. The enduring influence of early experiences is known to cast a significant
impact towards the development of anorexia. The study illustrated in video 3 of CS, showed that
she was extremely conscious about her entire physical appearance or how she looks especially

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when she was addressed as chubby. She said, “Being called “chubby” effected me more than
people thought” She felt extremely bad about her chubby look when highlighted by others. This
prolong disturbance of the self-esteem or self-image gradually lead to the development of
anorexia nervosa during the later stages of her life. It is also clear from the video and the quotes
of CS that these negative comments which she received from her peers or friendly during her
childhood in relation to her physical appearance made her feel bad and she is found saying the
“It stuck with me”. According to the reports published by Copeland et al. (2015), bullying is the
most common childhood experience with enduring psychosocial consequences. Copeland et al.
(2015) further reported that bullying in childhood both in relation to body shaming results in the
generation of eating disorder, anorexia in the later stages of life. According to the reports
published by Norris et al. (2014), restrictive food intake among the young adults is mostly
prevalent among the group of population who became the victims of body shaming or bullying
during their childhood. According to Norris et al. (2014), traumatic experience like bullying in
childhood lead to formation of encoding memories at the more general level in order to feel
protected from the painful activation of the specific memories. Norris et al. (2014) further opined
that bullying also comes in the form of body shaming like in case of SS she said, “I felt so
demotivated and so depresses and so lost. If I go to the gym I need to go to the gym for the next
million”. Abuse in childhood can further be highlighted as an enduring influence of early
experience as it is evident from E. E was sexually assaulted by one of her relative and after that
she stated hating or got scared about her own body image and hence stated dieting or reducing
weight to change her body image. So in order fight against such encoding memories, the victims
began to develop certain strategies like a constant fight to prove them wrong and this lead to the
development of the eating disorder like anorexia nervosa.

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Conclusion
Thus, overall the results were found in consistent with the existing theories highlighted in
literatures. Thus from the above discussion it can be concluded that the reason behind the
development of fatal disorder, anorexia is: constant effort one manage the sense of self, enduring
influence in the early childhood, influence of others on self-perception and experiencing a fragile
sense of self. It is also highlighted by the transcript obtained from the owner of the videos that
majority of them were either too obsessed about their self-image in front of others or had
something tragic experience in childhood like physical abuse. All these cumulate into the
development of a definite perception about the body image and thereby leading to undertaken
some severe measures in order to transform their body as their liking or as per the perception of
others. Review of the literature also helped to highlight that the possible metal health
complications which are associated with the process of development of anorexia nervosa is
obsessive compulsive disorder (OCD), stress and anxiety. Moreover, apart from the
psychological perspectives, the review of literature also helped to highlight that there are certain
physiological perspectives behind the development of depression and anxiety like the decrease in
the nutritional content and decrease in the BMI. This findings of the literature review is
consistent with the findings of the videos as the owners of suffers from anxiety and obsession
towards staying fit from their childhood. The research also highlighted that the development of
anorexia hampers the quality of life as the affected individuals suffer from fatigue, weakness
drowsiness and muscle wasting. This physiological symptom gradually stems together into fatal
consequences. Proper support from the family and self realization is the main way to recover
from this serious eating disorder.

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Reflection
Study Reflections
During the process of carrying out this research I was careful about any issues that may
rise through confusion about my research and clinical role, for me. It was a completely new
experience for me to perform research from videos rather than therapy interview. Having not
conducted any qualitative research before made the entire research process more engaging. I had
to put a lot of efforts to search for the videos in you tube in order to ensure that the videos was
based on the focus of the research questions and on the therapeutic approach. A further reflection
was that I wondered that if my assumptions based upon my gender, appearance and status as a
student manipulated my though point of selection of the videos or the participants for the
research. While watching the videos, it also became difficult for me to relate with their personal
experiences. I wondered how an urge of looking attractive or losing weight may develop a
complete hatred towards food even at the cost of health.
Methodological consideration and study limitations
The strength of the methodology is to employ an approach that enabled in-depth
exploration of the experience of the participants. Each video was carefully analysed which
helped to capture the experience of the participants while facilitating good level of interpretative
engagement within the text. Although I was new to the concept of qualitative analysis and IPA, I
endeavoured to ensure the quality of the research via conducting rigorous research in IPA and
seeking supervision from an experienced IPA researcher.
The size of the sample may seem to be the weakness of the study. However, as IPA only
demands small number participants only 6 participants were included in the study. This actually

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turned around to be the strength of the study allowing in dept analysis of the voices of each
participants. Moreover, it helped to gain ethical approval faster. However, in retrospect, at
present it is apparent that a much refined sampling pool would have made recruitment process
easier and would perhaps enabled an opportunity to recruit more homogenous sample. The
heterogeneity of diagnosis within the sample size of the study is defensible in terms of
transdiagnostic conceptualisations of eating disorders. The finding that there were numerous
consistent themes in between the accounts vouched for the idea of transdiagnostic process. It is
also recognised that the themes were generated o the basis of their narrative only not via
purposeful deflection towards a pre-determined theme.
In terms of the validity of findings, it should be considered that all the participants were
either recovered from eating disorder or recovering. It is acknowledged that this will help to have
had an effect on how the participants interpreted their experiences in the past and the associated
link between the perception of themselves and their eating disorder (anorexia). Another
important point behind validity of the findings is that due to the participants’ strategies of
disconnecting from their self-experience in the videos, it is likely that they were unable to
explain their thoughts about themselves and thus it not possible to completely access some
aspects of their experiences from the videos.

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References
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30
Appendix A: Video Transcript
Video 1
Name of the interviewee- K B (name changed)
Original Transcript Analysis Emerging Theme
1. My anorexia story
2. I was always a very petite girl
3. Then my stepfather died and
everything changed
Eating to manage
emotions (negative
emotions)
Negative experiences of
self: experiencing a
fragile sense of self4. I began comfort eating to numb the
pain
5. I went from 48 kilograms to 60
kilograms in just weeks
Awareness of other’s
reactions
6. I had never felt so disgusting in my
life
The influence of negative
judgment of others:
theinfluence of others on
self-perception
7. And people started to notice
8. I would hear rumors that my own
friends were making fun of me behind
my back
9. I was so embarrassed. So I started
limiting what I could eat
Behavioral change
(limiting eating)
10. and people started to notice Physical change
(weight loss)
11. I was praised by people at school and Awareness of other’s Feeling good about self

31
strangers when I when out. I felt so
good. So I kept on going.
reaction other’s
reaction (positive)
through positive
feedback: theinfluence of
others on self-perception12. “How did you do it?” they asked. So I
lied and told them I had gotten into
fitness.
13. Little did they know, right? Emotional
consequences of
weight change
(positive emotions-
feeling good)
14. I was lying to everyone that I loved
15. I started to become severely
underweight
Physical change
(weight loss)
16. My friends and family would cry
when they saw me. But I could not
stop. I felt so good for the first time in
years.
A tendency of self
harm to manage a
urge of fetching
compliments
The function of eating
disorder in improving the
sense of self: strategies
for managing sense of
self
17. I was hurting so much inside. It was
the only thing that I felt I could be
happy about in my life. I felt I could
at least be good at something; being
sick
18. I was then offered a modeling
contract. I felt beautiful but at the
same time, not beautiful enough
Mixed feeling of
about self
19. My bones started to show and people Behavioral change

32
were no longer impressed. They were
disturbed.
(limiting eating in
order to stay thin)
20. I would eat a few apples in the space
of four weeks
21. I was smiling on the outside by dying
on the inside.
Negative
consequences of
massive weight loss
The function of eating
disorder in deteriorating
the sense of self:
strategies for managing
sense of self
22. I weighed myself 8-10 times a day. If
I gained 0.1 grams I would fall apart
and not leave the house.
23. It was never good enough
24. My bones showing were my pride and
joy.
25. My face started to cave in
26. I was slowly dying
27. My organs were slowly failing
28. I was sitting on the bathroom floor
crying one day
The function of eating
disorder in deteriorating
the sense of self:
strategies for managing
sense of self
29. I couldn’t bear living this way. I was
ruining my relationship with my
boyfriend, I have lost most of my
friends and no one wanted to be
around me.
30. I had gone to my mother and got
admitted into the eating disorder
clinic.
Self realization

33
31. It was the most difficult experience
that changed my life for the better.
Strategies of connection
and protection of fragile
self: strategies for
managing sense of self
32. I started to enjoy food and life again. I
started building relationships again.
33. People actually started to like my
company for the first time in years.
34. It was a long and tough journey and I
still have weak moments but it does
not control my life any longer.
Stages of recovery
via initiating eating
Strategies of connection
and protection of fragile
self: strategies for
managing sense of self35. Life started to become worth living
again. There is always hope.

34
Video 2
Name of the interviewee- S S (name changed)
Original Transcript Analysis Emerging Theme
1. I am going to share a very
personal story of me
2. It’s about my journey in
fighting two of the most
biggest and upsetting battles
I’ve ever known
3. I am not talking about a
little bit of weight gain and
a little bit of weight loss at
various points in life
4
.
I have been obese and also I
have been on the other way
where I was severely
underweight and I had
anorexia for four years and
to be really honest both
ends of the spectrum were
equally dark and very
isolating
The function of eating
disorder in deteriorating the
sense of self: strategies for
managing sense of self
5. When I started to put in
weight it coincided when I
went off to university. I was

35
a UK 8 and remember it
vividly I was very sporty
6
.
Then I got myself into a bad
relationship and in this bad
relationship this person
controlled me in many ways
but one of the ways was
with food. Gradually over
time I went from a UK dress
size 8 to into a 16 then to an
18 and then at my absolute
biggest I was a size 20
Eating in order to fight
negative emotions
7. It is about how you feel in
your mind and at that time I
was not healthy I was
exhausted constantly. I felt
very depressed particularly
in terms of things like
clothes shopping
Emotional response due to
negative self realisation
The influence of negative
judgment of others:
theinfluence of others on
self-perception
8. I noticed a few things. First
of all I gone from like a
really fit well person to
someone who I’d get up in
the morning I could wake
up and by midday I needed
to have a nap. Other things
Emotional response due to
negative self realisation

36
were that I could not get
work when I look back sort
of had a gut feeling
9. When I went to the job
interview and there was
someone with similar skills
as me but was slimmer I
never got accepted. I was
completely unhappy with
how I was
Emotional response to
others' reactions
(embarrassment)
The influence of negative
judgment of others:
theinfluence of others on
self-perception
10 When I went out partying
with my friends I always
felt like the fat girl
11 Things started to change
when I got rid of this bad
relationship. I managed to
get a job.
12 It was one year after coming
out of the university I felt so
demotivated and so
depresses and so lost. If I go
to the gym I need to go to
the gym for the next million
years
Behavioural change
(joining excercise)
The influence of negative
judgment of others:
theinfluence of others on
self-perception
13 When I was at work I met

37
David who is now my
husband and he did not even
know I existed. I thought he
was stunning and if he was
married or had a girlfriend.
He was actually single and a
business professional
14 Before just going up to him
I felt I needed to feel good
about myself. I joined a
gym I had this motivation or
not build up the courage to
ask him out.
Physical changes (weight
loss)
Negative experiences of
self: experiencing a fragile
sense of self
15 When I went to the gym I
felt myself cool. Gym was
the place where I could go
after work. It became my
sanctuary. I was not
embarrassed.
Emotional consequences of
weight change (positive
emotions - feeling good)
16 My weight loss happened so
quickly I hadn’t changed
my diet by this point. Juts
doing the exercise I started
to lose pounds. Within the
first two months I went
from a size 20 to a size 16.
Physical changes (weight
loss)
The function of eating
disorder in improving the
sense of self: strategies for
managing sense of self

38
A further four months
passed and I was down to a
size 12. This for me was
just incredible.
17 I had not asked David out
and one of my friends
embarrassingly asked him
on my behalf. Now we are
married so actually it
worked out.
18 I ended up applying for new
jobs as I was in here for two
and half years and was done
with it.
19 I kept a diary and I used to
write it in every single day,
the calories I had eaten,
where I was allowing
myself to eat. If I went to
the gym and exercised then
I would let myself eat
Self awareness in order to
fetch good compliments
20 When I went to lunch with
anyone I felt anxiety to eat
in front of them. What if
they realized something
weird was going on. I could
Behavioral change
(limiting eating)
The function of eating
disorder in deteriorating the
sense of self: strategies for
managing sense of self

39
not hide the fact I was not
eating.
21 This picture David took we
went to Rhodes I was in my
early stages of my illness.
We would get up in the
morning and did not want to
lie down we went to the
beach and hikes and wanted
to walk off whatever
amount of calorie in took. I
felt the need to burn out my
calorie.
Emotional consequences of
weight change (positive
emotions - feeling good)
22 There is this mountain on
the side we need to walk in
there. I felt so weak I could
hardly walk down the side
of this mountain. I did not
want to say anything I was
very hungry
23 There would be days when
you would want to eat and
there is this switch flicked
in your head
Behavioral change
(limiting eating)
24 I used to hate the feeling, it
used to make me physically
Behavioral change Negative experiences of
self: experiencing a fragile

40
sick the feeling of being full (limiting eating) sense of self
25 I dropped down to about
eight stone at my lightest. I
looked so old I was only 25
26. I was looked way older
than my years. I just had
deep lines around my eyes
26 Eighteen months out of my
anorexia I was eating but I
was still about nine and half
stones
27 I think the turning point for
me was a couple of things.
The first thing that was it
kicked off with David and
then there was party
Support from family
members
The function of eating
disorder in improving the
sense of self: strategies for
managing sense of self
28 There were people who had
not been kindest to me
when I was big. They told
me I looked thin.
Support from family
members
29 I was never happy I was I
was always picking on
myself for things that were
not right
Positive emotions through
support
30 I was wearing this dress I

41
never have fitted it in with a
size six it was too big on me
31 A lot of people looked at
me. I could see people’s
faces and I was proud
Emotional consequences of
weight change (positive
emotions - feeling good)
32 Now that I have lost weight
you are jealous
33 The next day I went to
Facebook and there was this
girl I could not see her face.
I said oh my god who is that
girl
34 I remember seeing this
person. There were lines in
between the muscles and
around the collarbones and
thin legs
35 This person looked really
horrific
36 David looked at me and was
like it was you. I did not see
myself as that
Feeling good about self
through positive feedback:
theinfluence of others on
self-perception
37 If I’d seen my face in it I
probably wouldn’t have
Negative emotions
(embarrassment)

42
thought oh look she is really
thin. I would not have
criticized the photo
38 I was able to look at that
person objectively
39 I did not continue to cut
back my food and exercise
as much as possible
40 I told David it was the best
thing I did and I would
really recommend that if
you in that situation when
you can’t stop eating tell
someone good friend tell
your partner tell a doctor
tell however you are
comfortable with you are
not going to be judgmental
Strategies of connection and
protection of fragile self:
strategies for managing
sense of self
41 I changed jobs I did
everything I was doing
before. It is a different
mentality where I am today
Fight with self
42 I am a healthy UK size 10
for the first time. In years I
really feel comfortable I my
Positive emotions Strategies of connection and
protection of fragile self:
strategies for managing

43
own skin sense of self
43 I feel really good
44 There are days when there
is stress but I do not control
it by eating. I am better at
seeing and understanding it
45 I have become a stronger
person. I have become more
aware of myself

44
Video 3
Name of the interviewee: CS (Name changed)
Original transcript Analysis Emerging themes
1. As a child, I didn’t have
a care in the world
Sense of self is undermined
by perfectionism and self-
criticism: Experiencing
fragile sense of self
2. Being called “chubby”
effected me more than
people thought
Awareness of others'
reactions (negative)
3. Yah it was just a
childhood insult
Emotional response to
others' reactions
(embarrassment)
4. It stuck with me Behavioural change
(physical exercise)5. As I got older, I started
up exercising
The influences of
(perceived or actual)
negative judgements by
others: Influence of others
on self-perception
6. I became a sprinter
7. Competing and enjoying
it
Enjoying the physical
fitness and physical
changes (weight loss)8. I was quiet good
9. I finally found a hobby
10. I always giggled and
loved everyone
11. Nothing holding me
back

45
12. Then came Dieting Behavioural change
(limiting eating)13. The number of the scales
slowly started turning
into my life
14. Everyone was so skinny,
I wanted to be like them
Awareness of others'
reactions (positive)
15. It was always on my
mind
16. Exercising became an
addiction
Obsession towards self
image
17. I became obsessed with
the image I seen
18. Food became less and
less
Extreme restriction of food
19. Sipping meals became a
talent or me
20. The weight started
dropping
21. Although my energy
faded
22. Exercising increased and
food decreased
23. Although I looked
happy, happiness was
rear for me, I hated not
Decline in energy and a
grief about self
I constant effort to fetch
good comments: Influence
of others on self-

46
having energy perception
24. Keeping up with my
friends was a struggle
25. I was constantly
thinking about food.
Calories, running
26. I was always cold
27. My mum got worried
and pulled me out of
school
Making sense of the
Anorexia nervosa: A denial
towards the disease
development: Strategies
employed to manage the
sense of self
28. Doctors asking questions
and ticking boxes
29. I was diagnosed with an
eating disorder
30. I was eating less than
300 calories a day.
Practically starving
myself to death
31. I couldn’t care, I
couldn’t grab excess
skin anymore, that made
me happy and it was
hard to make me happy,
I was no malnourished
and sick
Emotional consequences of
weight change

47
32. I practically felt no
emotions at all
33. No matter what anyone
said, I couldn’t see any
problems
34. Constant was fighting
with my boyfriend and
family
Emotional impact on
relationships
35. I was sick, cold and
always sad
36. I didn’t have a life
37. I barley left my room
apart from a morning
run and then go back to
bed
Emotional consequences of
weight change
38. I wanted to change, but
emotionally couldn’t.
The thought of changes
terrified me
39. So I stayed at my
comfort zone
40. Constantly going against
my parents and lying
41. I was slow and very
weak. I could barely

48
walk
42. My birthday came and I
collapsed that night
while forced to eat food
that I have denied for
years
Anorexia and its outcome
and impact of wellbeing:
making sense of the AN
43. It was my home now.
Fortunately for me..the
nurses got lazy and I got
worse
44. I missed my home and
my friends, I cried every
night
45. I was discharged on a
dangerous weight.
Barely living after not
having much help from
doctors
46. After wondering while I
was so depressed asking
why am I still sick. I
realised, it was only me-
who could save myself
The support from family
towards recovery- battling
anorexia: Strategies
employed to manage the
sense of self
47. After months and
months, back and forth

49
and with the help of my
family, finally my
thoughts changed and
saved myself
48. My mum wasn’t crying
herself to sleep anymore.
49. It wasn’t a choir to eat
food. I enjoyed it. Eating
all day everyday while
slowly getting mu life
back
50. Following my idols,
helping me realise food
is to nourish your body,
not punish
51. I started to have energy.
All the Time. I actually
felt happy
Positive emotions along
with increase in calorie
intake
52. To this day, I still get
bad thoughts. But I
know what life I enjoy
more
53. I have learnt it’s not
your body image, you
are going to look back
Self realization

50
on. It is the memories,
the time spent with your
loved ones. The
adventures....I have
never been happier
54. I am not afraid of lunch
date and calories. I can
run again
55. Anorexia nervosa is a
disease and it almost
killed me and only you
can save yourself
Video 4
Name of the interviewee: CC (name changed)
Original
transcript
Analysis Emerging themes
1 I was generally
happy child I was
bubbly and
outgoing!! I did
suffer from anxiety
from a you age
though
An anxiety about self image

51
2 I was never a bid
eater but I did
enjoy a big range
of food and was
never scared of
gaining weight
3 In fact, I was
picked on for being
skinny. I had been
going to camhs
since I was 10 and
put on medication
to help my anxiety
I also take
medication for my
low moods.
4 I was very anxious
person but I was
still bubbly and
outgoing for most
of the time. I also
have had severe
OCD for around 5
years
Anxiety about other’s opinion
5 It wasn’t until I
was almost 18
An urge to look perfect In order to make more presentable
to others and to look attractive: