Putting the pieces together: The subjective experience of anorexia nervosa over the course of the disorder

Throughout the history of psychology there is evidence of fragmentation, at multiple levels. As a result of this fragmentation knowledge of mental illness exists in the form of separate fragments or pieces, and the understanding of the subjective experience of a mental illness as a whole is often lost in the pieces. Such fragmentation is a concern as it has a significant impact on those suffering from a mental illness, as they may not feel understood, or aspects of their experience of mental illness may be missed or overlooked. Thus potentially reducing the individual's ability and willingness to approach and engage in treatment, reducing the possible efficacy of treatment and increasing the risk of relapse. The experience of not feeling understood, difficulties engaging in treatment and relapse are particularly common for individuals with anorexia nervosa, a disorder which has markedly been prey to the fragmentation in psychology. These experiences are concerning when one considers that anorexia nervosa is a chronic disorder, associated with severe physical and psychological consequences, including death, due to physical complications or suicide. The impact of the disorder stems beyond the individual, with families and care-givers also experiencing high levels of distress. Due to the risk, severity and chronic nature of anorexia nervosa, it is important that understanding of the subjective experience of anorexia nervosa is increased to foster research, development and implementation of efficacious interventions. These concerns led to the research question guiding this research: what is the human subjective experience of anorexia nervosa over the course of the disorder? The purpose of a broad research question was to maximize the pieces of experience gathered, as well as establish the context of experiences, and thereby gathering a picture of the subjective experience of the disorder in its complexity.;As a vast array of, albeit fragmented, knowledge exists on anorexia nervosa over the course of the disorder, theories and hypotheses from the literature were used as points of triangulation. In order to capture the subjective experience of anorexia nervosa qualitative methodology was used, and 15 self defined recovered sufferers of anorexia nervosa were interviewed. During the interview, participants were asked to describe their experience of anorexia nervosa over the course of the disorder, as well as comment on the perceived relevance of theory and hypotheses (or pieces of knowledge) from four different orientations (biological, social-cognitive, family and existential) that exist in the field. Data analysis involved gathering pieces from theory and participant experience, organizing these pieces, and working up from the data to establish a picture of an individual's experience at the different stages of the disorder, and how this changes over time. As the research was exploring both what is the subjective experience, and how it changes over time, data analysis was guided by both phenomenological and grounded theory methodology. An adapted form of Heidegger's (1962) worlds of being was also used, to assist organization of pieces, based on where the experience was in relation to the individual. From this analysis a Threat, Distress, Alleviation Model, as well as phases of maintenance and recovery, were developed that meaningfully tie together pieces of experience, to capture the complex subjective experience of anorexia nervosa at different stages, and how an individual moves through the stages. The Threat, Distress, Alleviation Model, and accompanying phases increase the understanding of the subjective experience of anorexia nervosa, and have the capacity to assist research, development and implementation of efficacious treatment.;The development of the Threat, Distress, Alleviation Model, and accompanying phases, also acts as a small step towards resolving the issue of fragmentation, and recapturing the subjective experience of mental illness.