Michael Levine's Eating Disorders Prevention/Sociocultural Factors Newsletter
NO. 81: (i) Big(ger) Picture; (ii) Negative Embodiment; (iii) Athletes & ED Risk; (iv) Families & EDs; (v) Nature/Correlates of EDs, Part 2 (n = 2); and (vi) Pathways and Obstacles to Tx (n = 4)
Colleagues (N now = 1229 in 48 countries),
RESUMPTION of the Levine Eating Disorders Prevention/Sociocultural Factors Newsletter
From Saturday, October 19 through Friday, October 25, my wife and I and the still adorable little (but too big to fit under an airline seat if she stands up) dog drove the 3000+ miles (5000+ km) from Santa Barbara, California, to West Haven, Connecticut to be present for (I know, I know: often a contradiction of terms when applied to me) and celebrate the birth of our second grandchild and help out with care of the 2.5-year-old granddaughter. The trip went fairly well, all things considered, except for a couple of eerie glitches with our navigation system — such as the first evening, when we were exhausted after finishing packing and a very long drive to Flagstaff, Arizona, leading us confidently and clear-voiced to a cannabis store instead of our hotel (what can I say?).
Our daughter (and son-in-law) went to the hospital on the evening of Tuesday, October 30 (Eastern), for the induction procedure (it was a high risk pregnancy), and very early in the morning of Halloween our daughter gave birth to a healthy 8-pound, 10-ounce girl, Thippa (pronounced “tip-uh”) Irene Manvi—named after our son-in-law’s beloved grandfather and my wife’s mother. They all came returned home around 9:00 pm Eastern on Friday, November 1.
We will be staying at our daughter and son-in-law’s home until mid-December 2024, and I look forward to seeing in person the 6 members of this Group who live and work in New Haven or not too far away.
Please (a) continue to send me any and all announcements (e.g., conferences, awards, webinars, prevention resources, your recent publications); and (b) pass along the following to anyone who would like to join this free email list.
Project HEAL invites you to an
Informed Community Forum, a virtual event offering a unique approach to
Continuing Education (4 CE Credits) on Eating Disorder Care
Friday, November 15th, 10:00 am - 4:30 pm EST | 7:00 am - 1:30 pm PST | 2:00 pm - 8:30 pm UTC
Received 28 October (California time), 2024, via a “Earn 4 CEs at Project HEAL’s 2nd Annual InformED Community Forum” email from Project HEAL.
Project HEAL's Informed Community Forum [is] a virtual event offering a unique approach to continuing education on eating disorder care. Perfect for both generalists and seasoned professionals, you’ll gain 4 CE credits while engaging in insightful, real-world discussions.
Date: Friday, November 15th, 10:00 am - 4:30 pm EST | 7:00 am - 1:30 pm PST | 2:00 pm - 8:30 pm UTC
Why Attend?
Earn 4 CE Credits while exploring in-depth, candid conversations.
Hear from clinical leaders and lived-experience experts on today's most pressing topics in eating disorder care.
Featured Sessions:
Confronting the Culture of Stoicism: Men, Eating Disorders, and the Fight to Feel
The Weight of Expectations: Understanding GLP-1 Risks - Sponsored by Eating Recovery Center
Number Nonsense: Debunking Junk Science on BMI & BRI – Sponsored by The Emily Program
Athletes & the Pressure to Perform: Eating Disorders, Body Image, and Mental Health – Sponsored by Acadia Healthcare
REGISTER NOW to secure your spot and be part of the conversation that will enhance your practice and help you provide more informed care.
If you have any questions or would like to discuss sponsorship, please reach out to Kaylee Kron, Director of Development at Project HEAL, at Kaylee@theprojectheal.org.
REQUEST FOR RESEARCH PARTICIPATION BY AND/OR ASSISTANCE WITH RECRUITING
Professionals Who Work in an Eating Disorder Unit, as well as, Those with Lived Experience and Carers
from Drs. Rahul Khanna (Australia) and [our own] Andrea Phillipou (Australia)
for a study entitled
Avoidant/Restrictive Food Intake Disorder in Specialised Eating Disorder Services
Received via a 30 October 2024 email from Dr. Rahul Kahanna (Australia) on behalf of our own Andrea Phillipou (Australia). Dr. Kahanna writes that “I am a academic psychiatrist from Melbourne and part of a qualitative study exploring adaptations workers in specialist eating disorders units are making to improve outcomes for ARFID.”
Dr. Rahul Kahanna | Program Director (Clinical) | Transforming Trauma Victoria* | Director, Innovation & Medical Governance | Phoenix Australia
*Formerly Mental Health State-wide Trauma Service
ML NOTE 1: Drs. Kahanna and Phillipou and I would appreciate it if you would pass this request along to (a) any and all people who might be qualified and interested, and/or (b) those who mentor, supervise, and otherwise work with or know such people.
[The Social Media Announcement, with QR code, states]
Research Participants Sought [for a study entitled]
Avoidant/Restrictive Food Intake Disorder in Specialised Eating Disorder Services
Work in an eating disorders unit?
Help set the agenda for ARFID clinical practice & research
The aim: This qualitative exploratory study aims to understand contemporary practices, challenges and opportunities in the treatment of ARFID in Specialised Eating Disorders Services.
The ask: Participants will be asked to participate in a 30 min interview on Teams to share insights to progress the field.
We are seeking a broad mix of staff from any discipline (including in lived experience / carer roles) across age ranges and locations
This study has ethics approval through the University of Melbourne HREC (# 28615). Formal consent processes will occur at the time of interview, however the participant information can be accessed here to learn more about the study. The principal investigators can be reached on Hasini.paranawithana4@austin.org.au and rahul.khanna@unimelb.edu.au
Register to participate at: tinyurl.com/helparfid
Research Publication Categories in This Newsletter
(i) The Big(ger) Picture; (ii) Negative Embodiment; (iii) Athletes and ED Risk; (iv) Families and EDs; (v) Nature and Correlates of Eating Disorders, Part 2 (n = 2); and (vi) Pathways and Obstacles to Treatment (n = 4)
CONGRATULATIONS to our own
Dr. Cheri Levinson (USA), Ms. Claire Cusack (USA), Ms. Rowan Hunt (USA), and Drs. Hannah Fitterman-Harris (USA) and Christina Ralph-Nearman (USA) and colleague for publication of the Big(ger) Picture article in #1.
Drs. Sarah Murnen (USA; Kenyon professor - just sayin’ . . .) and Taryn Myers (USA; Kenyon alum - just sayin’ . . .) and colleagues for publication of the Negative Embodiment review/meta-analysis article in #2.
Nadia Micali (England/Switzerland/Denmark) and Ulrike Schmidt (England) and colleagues, including distinguished scientist-practitioner Dr. Ivan Eisler (England), for publication of the Families and Eating Disorders Review article in #4.
Drs. Jason Nagata (USA) and Kyle Ganson (Canada) and colleagues for publication of the Pathways and Obstacles to Treatment article in #7.
The Big(ger) Picture - The Future of the Eating Disorder Field: Inclusive, Aware of Systems, and Personalized
1. Levinson, C. A., Cusack, C., Hunt, R., Fitterman-Harris, H. F., & Ralph-Nearman, C., & Hooper, S. (2024). The future of the eating disorder field: Inclusive, aware of systems, and personalized. Behaviour Research and Therapy. Advance online publication. https://doi.org/10.1016/j.brat.2024.104648
Email address for correspondence: cheri.levinson@louisville.edu
ABSTRACT. Eating disorders are serious psychiatric illnesses associated with large amounts of suffering, high morbidity, and high mortality rates, signifying a clear need for rapid advancements in the underlying science. Relative to other fields of clinical psychological science, the eating disorder field is new. However, despite the fields’ late beginnings, there is growing science in several important areas.
The current paper discusses the current literature in three primary areas of importance: (a) diversity and inclusion, (b) systemic and social factors, and (c) treatment personalization. We discuss how these areas have huge potential to push both eating disorder and clinical psychological science in general forward, to improve our underlying understanding of psychological illness, and to enhance treatment access and effectiveness. We call for more research in these areas and end with our vision for the field for the next decade, including areas in need of significant future research.
Negative Embodiment
2. Kvaka, A., Murnen, S. K., Nolen, E., & Myers, T. A. (2024). Feminism, femininity, and negative embodiment: A contemporary meta-analytic test. Sex Roles. Advance online publication. https://doi.org/10.1007/s11199-024-01529-3
Full text available for download at: https://link.springer.com/article/10.1007/s11199-024-01529-3#citeas
ABSTRACT. Previous work has examined the relations between feminism, feminine gender roles, and body image concerns with inconclusive findings. The purpose of this study was to conduct an updated meta-analysis of the relation between feminist identity and negative embodiment, and to conduct new analyses to test how endorsement of femininity relates to negative embodiment. Through the technique of meta-analysis, we analyzed 80 studies (87 samples, N = 24,308) and 217 effect sizes to examine these associations. The predictor variables were measures of feminist identity and endorsement of femininity. The negative embodiment criterion variables were measures of body dissatisfaction, self-objectification, internalization of cultural body ideals, and disordered eating attitudes.
Feminist identity was found to be negatively associated with negative embodiment, but only modestly, with small but significant effect sizes across most variables. Endorsement of femininity was found to be positively associated with negative embodiment, with mostly significant effect sizes ranging from small to large. These findings underscore the importance of considering the roles of feminist identity and traditional gender ideology in the etiology and prevention of women’s experiences of negative embodiment.
Athletes and Eating Disorder Risk
3. Kenđel Jovanović, G. K., & Čulina, T. (2024). Prevalence of potential risk of eating disorders among young, unprofessional European athletes: Results of the ERASMUS+ project SCAED. Frontiers in Nutrition, 11, 1398464. https://doi.org/10.3389/fnut.2024.1398464
Full text available for download at: https://tinyurl.com/3d8bx538
ABSTRACT. Introduction: Adolescent athletes are at higher risk of developing eating disorders (ED) due to sports environment pressures and developmental characteristics. The ERASMUS+ project Sports Community against Eating Disorders (SCAED) aims to assess the prevalence of the potential risk of eating disorders among young, unprofessional European athletes and to provide them with easier access to professional support and knowledge.
Methods: The online survey included 462 unprofessional athletes from six European countries aged 12–25 (average age 18.49 ± 5.50) on their socio-demographics, sports and lifestyle habits, behaviors, concerns, and perceived pressure from coaches and teammates regarding body weight and shape. The eating disorder potential risk was assessed using the Eating Disorder Examination for Adolescents (EDE-A) and Eating Disorders Screen for Athletes (EDSA).
Results: Every seventh (14.9%, EDE-A) and fifth (19.9%, EDSA) of young, unprofessional European athletes were at possible risk for developing eating disorders. Overall potential risk (18.7% EDE-A, 26.6% EDSA), dietary restraint (12.9%), and concerns about eating (9.5%), shape (23.7%), and weight (19.6%) were significantly more prevalent among female athletes.
Younger athletes showed a slightly higher prevalence and avoidance of food. Athletes training in weight-sensitive sports exhibited more behaviors related to eating disorders. Females (p = 0.003), younger, and those athletes training in less weight-sensitive sports noted higher weight- and shape-related pressure from coaches. Dissatisfaction with their current weight was expressed by 44.6% of athletes, while 46.1% thought that they needed to lose weight to improve performance.
Conclusion: The observed prevalence of the potential risk of ED among young, unprofessional European athletes is concerning, particularly due to limited access to support. Efforts to reduce the prevalence should target female and younger athletes in weight-sensitive sports. The SCAED Erasmus+ project aims to decrease ED prevalence among young, unprofessional European athletes, their families, and coaches by supporting them through education and professional consultation.
Families and Eating Disorders
4. Martini, M. G., Yim, S. H., Eisler, I., Micali, N., & Schmidt, U. (2024). Bonding and parent-child quality of interaction in parents with eating disorder: A scoping review. European Eating Disorders Review. Advance online publication. https://doi.org/10.1002/erv.3144
Full text available for download at: https://onlinelibrary.wiley.com/doi/10.1002/erv.3144
ABSTRACT. Objective: To summarise existing evidence on bonding and parent-child quality of interaction in parents with eating disorder (ED). Methods: A scoping review was conducted. Seven databases (PsycInfo, Embase, Medline, Pubmed, OpenGrey, ProQuest and Google Scholar) were examined and studies exploring research into bonding and quality of interaction in parents with ED were included.
Results: Seventeen quantitative studies were included in the review. Reviewed literature suggests that parents with ED tend to be more intrusive, may exhibit more negative expressed emotions and may be involved in higher levels of mealtime conflicts during mealtimes. Additionally, they may be less sensitive and may offer less structured in non-feeding interactions. Children of parents with ED may have a more difficult temperament, may display greater internalisation and externalisation problems, may be less responsive to their parents and exhibit more behavioural difficulties.
Conclusion: Overall, we found that parents with ED are more likely to have difficulties during interactions with children, compared with controls, both in feeding and non-feeding contexts which might impact children's mental health. Proposals for future research are suggested to enhance our understanding of the intergenerational transmission of ED, holding the potential to pinpoint therapeutic and preventative targets for both parents with ED and their children.
Nature and Correlates of Eating Disorders, Part 2 of now at least 6
5. Dieffenbacher, A. L., Meule, A., & Voderholzer, U. (2024). Purging frequency and number of purging methods as indicators of severity in bulimia nervosa: Interactive effects with binge eating episodes. European Eating Disorders Review. Advance online publication. https://doi.org/10.1002/erv.3147
Full text available for download at: https://onlinelibrary.wiley.com/doi/full/10.1002/erv.3147
ABSTRACT. Objective: In the Diagnostic and Statistical Manual of Mental Disorders-5, severity of bulimia nervosa (BN) is defined by the frequency of purging behaviour. Previous research suggests the number of purging methods as an alternative rating. The current analysis investigated characteristics (sociodemographic and treatment-related variables, body mass index [BMI], eating disorder-specific and general psychopathology) of persons with BN as a function of purging frequency and number of purging methods in order to examine which approach might be better suited for indicating severity of BN. Method: Two-hundred and sixty-one persons (98.5% female; mean age 25.2 years, SD = 9.41; mean BMI 22.0 kg/m2, SD = 3.79) with BN completed self-report questionnaires on eating disorder-specific and general psychopathology at admission to inpatient (n = 214) or daypatient (n = 47) treatment.
Results: Higher severity based on either purging frequency or number of purging methods tended to relate to lower BMI and higher eating disorder-specific and general psychopathology. In addition, binge-eating frequency differentially related to eating disorder-specific and general psychopathology as a function of severity groups. Conclusions: This study partially supports the utility of both purging frequency and the number of purging methods as indicators of severity in persons with BN. However, focussing only on purging behaviours may be short-sighted as it appears necessary to consider the number of binge-eating episodes as well when evaluating severity of BN.
6. Robillard, C. L., Claes, L., Victor, S. E., Myin-Germeys, I., & Kiekens, G. (2024). Self-criticism is a real-time predictor of non-suicidal self-injury and disordered eating: An ecological momentary assessment study among treatment-seeking individuals. Journal of Affective Disorders. Advance online publication. https://doi.org/10.1016/j.jad.2024.10.121
Full text available for download at: https://tinyurl.com/ms2uffdv
ABSTRACT. Background: Although theory and research implicate self-criticism as a risk factor for non-suicidal self-injury (NSSI), the nature of this association in daily life remains unclear. This study used ecological momentary assessment (EMA) to address whether (1) trait and state self-criticism elevate the risk of NSSI, (2) state self-criticism predicts NSSI behavior in real-time via increased NSSI urge intensity, and (3) the risk pattern extends to disordered eating (DE; binge eating, purging, restrictive eating). Method: A total of 125 treatment-seeking individuals who self-injure (87.20 % female; Mage = 22.98, SD = 5.32) completed measures of trait self-criticism at intake, followed by six daily assessments for 28 days (15,098 assessments; median compliance = 78.6 %) measuring self-critical thoughts, NSSI, and DE. Multilevel vector autoregressive models were constructed within a dynamic structural equation modeling framework.
Results: Patients who reported higher mean state self-critical thoughts experienced more intense NSSI urges and an increased risk for NSSI behavior during treatment. Higher-than-usual self-critical thoughts predicted NSSI urge intensity and NSSI behavior within the following 2 h. NSSI urge intensity partially mediated the effect of self-critical thoughts on NSSI behavior. Trait self-criticism did not predict comorbid DE, but aggregated state self-critical thoughts were associated with binge and restrictive eating. The within-person risk pattern of self-criticism generally extended to DE, with full mediation via DE urges for purging and restrictive eating, but not binge eating. Conclusions: Self-criticism is a real-time predictor of NSSI and comorbid DE. These findings underscore the relevance of monitoring self-criticism outside the therapy room, as it may be an important treatment target.
Pathways and Obstacles to Treatment
7. Pang, N., Nagata, J. M., Testa, A., & Ganson, K. T. (2024). Mapping eating disorders in adolescents and young adults: An investigation of geographic distribution and access to care in Ontario, Canada. Journal of Eating Disorders, 12, 136. https://doi.org/10.1186/s40337-024-01098-6
Full text available for download at: https://tinyurl.com/3d6nxrch
ABSTRACT. Background: There is limited research on the spatial distribution of eating disorders and the proximity to available eating disorder services. Therefore, this study investigates the distribution of eating disorders among adolescents and young adults in Ontario, Canada, with a specific focus on geographic disparities and access to publicly-funded specialized eating disorder services
Methods: A community sample of 1,377 adolescents and young adults ages 16–30 across Ontario between November and December 2021 participated in this study and completed the Eating Disorder Examination Questionnaire. Utilizing Geographic Information System (GIS) technology, we mapped the geographic prevalence of eating disorders and examined proximity to specialized eating disorder services. Multiple linear and logistic regression analyses were utilized to determine the association between geographic region and eating disorder symptomatology. Additionally, t-tests were utilized to examine differences between time/distance to specialized services and clinical risk for eating disorders.
Results: Applying geospatial analysis techniques, we detected significant spatial clusters denoting higher eating disorder scores in rural areas and areas with fewer specialized services. Likewise, our findings report disparities between rural and urban areas, suggesting that rural regions exhibit elevated rates of eating disorders. There were no associations between distance/time to services and eating disorder symptomology. Conclusions: The discrepancies in eating disorder symptomology between urban/rural may stem from stigma and unique socio-cultural contexts in rural communities. The study underscores the need for targeted intervention, including telehealth, in addressing the eating disorder challenges faced by adolescents and young adults in rural regions.
Plain English summary: This study explores how common eating disorders are among adolescents and young adults in Ontario, Canada, with a specific focus on the geographic disparities of eating disorders. This study uses mapping technology to assess where eating disorders were more common and how close these areas were to specialized eating disorder treatment services. The findings showed that places with fewer services, especially rural areas, had higher rates of eating disorders. However, there wasn’t a clear link between how far people lived from these services and the severity of their eating disorders.
This may suggest that those in rural areas might struggle more with eating disorders due to greater stigma and different social and cultural factors compared to urban areas. This study emphasizes the need for targeted interventions, like telehealth, to address these disparities. This research is pivotal in guiding equitable healthcare solutions for eating disorders, particularly in underserved rural communities.
8. Crowther, E., Lewis, V., Minehan, M., & Joshua, P. R. (2024). Knocking on locked doors; a qualitative investigation of parents’ experiences of seeking help for children with eating disorders. Clinical Psychologist, 28(3), 297–307. https://doi.org/10.1080/13284207.2024.2404123
Full text available for download at: https://tinyurl.com/4k2wx469
ABSTRACT. Objective: The impact of eating disorders in adolescents extends to the whole family, particularly the parents. These parents are uniquely positioned as their children’s case manager, feeder, and advocator, often with little experience or training to guide them. This investigation aimed to develop an in-depth understanding of the experience of parents seeking help for children with eating disorders. Method: Semi-structured interviews were conducted with eight parents who had accessed treatment for their child’s eating disorder within the past 3 years through the Australian health system. Interpretative phenomenological analysis was used to understand their experience.
Results: Two main themes and six subthemes were identified: Parental Gauge on High (“trusting parental instincts”, “desperation for a compass and map” and “discarded expertise”), and Disappointment in the Healthcare System (“GP’s casual responses to serious cases”, “treatment lucky dip” and “the whirlwind of re-engagement”). Conclusions: The findings highlight the difficulties in identifying symptoms and seeking initial help as well as the ongoing toll on parents to navigate the health system and support their children. Findings of the study suggest a need for ongoing, inclusive, and holistic support to help parents navigate care for their children.
9. Castañeda, F., Cerda, J., Jara, R., Riestra, F., Urrejola, P., Vogel, M., Gumucio, M. E., Irribarra, V., Álvarez, J., Díaz, M. A., Kompatzki, P., & Costa, D. (2024). Exploration of barriers to treatment for patients with eating disorders in Chile. Journal of Eating Disorders, 12, 160. https://doi.org/10.1186/s40337-024-01104-x
Full text available for download at: https://tinyurl.com/mtkbfvt2
ABSTRACT. Background: Eating disorders (EDs) are associated with high morbidity and mortality, affecting predominantly young people and women. A delay in starting treatment is associated with chronic and more severe clinical courses; however, evidence on barriers and facilitators of access to care in Latin America is scarce. We aimed to identify barriers and facilitators of ED treatment in Chile from the perspective of patients, relatives, and health professionals. Methods: Qualitative approach through semi-structured interviews with patients, their relatives, and health professionals. Participants were recruited from two ED centers in Santiago, Chile (one public and one private). Analysis was mainly based on Grounded Theory, using MAXQDA software.
Results: 40 interviews were conducted (n = 22 patients, 10 relatives, and 8 health professionals). The mean age of patients was 21.8 years, while the mean duration of untreated ED was 91.4 months (median 70 months). Five categories emerged with intersections between them: patient (P), family and social environment (FSE), health professionals (HP), healthcare system (HCS), and social and cultural context (SCC). Relevant barriers appeared within these categories and their intersections, highlighting a lack of professional knowledge or expertise, cultural ignorance or misinformation regarding EDs, and patient’s ego-syntonic behaviors. The main facilitators were patients’ and relatives’ psychoeducation, recognition of symptoms by family members, and parents taking the initiative to seek treatment.
Conclusions: This study provides information regarding access to treatment for patients living with EDs in Chile. A practical public health approach should consider the multi-causality of delay in treatment and promoting early interventions. Plain English Summary: Eating disorders (EDs) may severely affect the daily functioning of people enduring them. A delay in starting treatment is associated with a disease that is more difficult to treat. To our knowledge, there are no published studies carried out in Latin America exploring factors influencing treatment initiation in EDs patients. This study aimed to identify facilitators of and barriers to treating patients with EDs in Chile. We interviewed patients (n = 22), their relatives (n = 10), and health professionals (n = 8) from a private and a public center in Santiago, Chile.
Our analysis showed that the main barriers to starting treatment were the lack of professional knowledge in ED, the monetary cost of illness, and cultural misinformation. Facilitators were related to the role of the family in recognizing and addressing the disease while being educated in EDs by professionals. This study helps to provide data about treatment access in developing countries. While facilitators and barriers were similar to others reported in the literature, the untreated ED’s duration was longer. It is essential to address these barriers to provide access to treatment more efficiently and prevent severe and enduring forms of disease.
10. Habibagahi, K., & Ferrari, M. (2024). Advocacy through storytelling: Challenging eating disorders and eating disorders stigma. Journal of Eating Disorders, 12, 145. https://doi.org/10.1186/s40337-024-01099-5
Full text available for download at: https://tinyurl.com/3cxddpmh
ABSTRACT. Background: Although eating disorders (EDs) are among the most stigmatised mental illnesses, a number of individuals break past this stigma and engage in ED advocacy by sharing their recovery stories. Little is known, however, about the role of such advocacy in their healing journeys. Methods: To bridge this gap, the authors examined the role of autobiographical oral storytelling in the ED recovery of adult advocates. Autobiographical oral history interviews were carried out with adult advocates (n = 16) recovering from EDs. The data were analysed using a mixture of actantial* and thematic analyses. Authors also used activity theory to categorise how storytelling was translated into concrete social actions. Results were then interpreted through frameworks of embodiment and the intersectionality of identity.
*ML NOTE 2: Initially, I thought this was a typographical error; shows you what I know (sigh) . . . . According to Hebért (2019; see http://www.revue-texto.net/Parutions/Livres-E/Hebert_AS/5.Actantial-Model.pdf for details), “The actantial model is a tool that can theoretically be used to analyze any real or thematized action, but particularly those depicted in literary texts or images. In the actantial model, an action may be broken down into six components, called actant. Actantial analysis consists of assigning eachelement of the action being described to one of the actantial classes.”
Results: Advocates chose to share their ED stories as a way to embody resilience and make meaning from their ED experiences. Beyond personal gains, the social benefits of sharing their stories included raising hope and openness to converse further with audiences, advocating for greater ED resources (e.g., ED literacy among school staff), and offering new training initiatives for healthcare professionals. The ties between storytelling and the unique aspects of one’s identity are also discussed.
Conclusions: Engaging in advocacy through storytelling can positively affect both the advocates and the audiences with whom they connect. Future studies, informed by feminist biopsychosocial frameworks, can examine storytelling as a therapeutic intervention. Such frameworks serve as alternatives to biomedical models of EDs and mental illnesses. They also emphasise the need for broader changes that destabilise oppressive body cultures and display how storytelling can help mobilise change.
Plain English summary: Eating disorders (EDs) have been identified as one of the most stigmatised mental illnesses, making it difficult for individuals to seek professional help or disclose their mental health situation. Nevertheless, a handful of individuals become advocates who combat this stigma by sharing their personal struggles and ongoing healing journeys. The researchers of this study used a narrative-based approach to analyse the experiences of such advocates while identifying the personal and social benefits of their storytelling advocacy.
The outcomes of this study suggested that advocates found these storytelling initiatives to be deeply meaningful because they were able to reflect on how far they have come while increasing hope among audiences that recovery is possible. The findings from this research support the ongoing need for novel interventions against ED stigma, including the potential to incorporate storytelling as a way to normalise conversations on EDs while enhancing the resilience of individuals undergoing recovery.