Women’s eating disorder origins as responses to childhood trauma and negative social self: a qualitative study exploring lived experience perspectives

Research has identified many risk factors, ranging from individual to sociocultural believed to contribute to the development of eating disorders. However, the majority of studies are quantitative and tend to focus on anorexia nervosa exclusively, while prioritizing the voices of experts over those with lived experience’s descriptions of causes. This is problematic because individuals with eating disorders have been found to hold different perceptions regarding the cause of their condition compared to individuals without an eating disorder. In this study, we address these gaps. We focus on the voices of individuals with lived experience rather than experts, take a qualitative approach to get richer, fuller accounts of individuals’ experiences than may be allowed by quantitative data alone, and investigate the onset of a spectra of eating disorders rather than limit focus to one particular type. The purpose of this qualitative study is to explore the perceived origins of eating disorders from the perspective of women with lived experience. We interviewed 21 women to elicit their eating disorder life story narratives. Women’s eating disorder life story narratives were analyzed using reflexive thematic analysis. Analysis identified two origin story themes: Eating Disorder as Response to Childhood Trauma (i.e., private threats to the self) and Eating Disorder as Response to Negative Social Self (i.e., public threats to the self). Taken together, these two origin story themes help situate women’s eating disorder beginnings in their private and public contexts. Study results are discussed as holding both academic and practical significance. Academically, this study advances eating disorder research in five ways. First, it extends research on eating disorder causes. Second, it advances the area’s feminist efforts. Third, it increases lived experience perspectives. Fourth, it accelerates the area’s reflexive turn. Fifth, it addresses diverse eating disorder experiences. Practically, study results hold utility for women with eating disorders and eating disorder professionals by better contextualizing women’s eating disorder beginnings and aiding in sense-making. Many risk factors contribute to the development of eating disorders, from individual characteristics to broader social pressures. Research in this area often prioritizes expert viewpoints and leans on quantitative methods. Here, we foreground lived experiences and shift the methodological approach. In this study, we listen to women who identify as having had an eating disorder and explore what they believe contributed to the development of their eating disorder qualitatively. Through analysis of interviews with 21 women, we found that the eating disorder originated as Responses to Private and Public Threats to the Self. The first theme, Eating Disorder as Response to Childhood Trauma, captures the ways participants traced the origins of their disorder to early life family trauma. In the second theme, Eating Disorder as Response to Negative Social Self, participants traced the beginnings of their eating disorder to public rather than private threats to the self, which we refer to as a negative social self. Taken together, these two themes help situate women’s eating disorder beginnings in their private and public contexts. Considering causes from the perspective of individuals with first-hand experience of the condition has become increasingly important in both research and clinical practice.