A missing dimension? Christian religion, spirituality and eating disorder healthcare: a qualitative study

Eating disorders are serious conditions that require more effective, individualised approaches to care. For some people, religious and spiritual factors can become intertwined with eating disorders, heightening struggle and/or supporting recovery. However, such factors are rarely considered in mainstream approaches to eating disorder care. Additionally, patient and healthcare provider attitudes and experiences concerning religion and spirituality in eating disorder care are not well understood, especially in contexts outside the USA. To explore the views and experiences of healthcare providers and people with eating disorder lived experience in Australia and New Zealand concerning the role of Christian religion and spirituality in eating disorder healthcare. Participants included (a) people with a Christian background and lived experience of an eating disorder/s (n = 21) and (b) eating disorder healthcare providers (n = 16; six participants belonged to both groups). Participants were recruited through media, professional organisations and personal contacts. They completed an initial survey, from which 31 participants were purposively selected for demographic diversity and participated in a semi-structured interview (mean duration 73 min). Transcripts were analysed using thematic analysis. Three themes resulted from analysis: (1) Relevance: ‘an elephant in the room’. For many, though not all, participants religion and spirituality were intertwined with personal identity, worldview, and eating disorder risk and recovery. Overlooking this could miss opportunities to personalise care and avoid miscommunication. (2) Reservations: ‘wearing gloves’. Barriers to considering religion and spirituality in eating disorder care existed at multiple levels. These included uncertainty about whether and how religion and spirituality could be discussed, and perceived professional and systemic barriers. (3) Responses: ‘working with’ faith. Nonetheless, some participants described experiences in which aspects of religion and spirituality were incorporated in eating disorder care. Approaches included exploring the patient’s religious and spiritual struggles and supports, and in some cases integrating Christian resources in care. Acknowledging and exploring individual religious and spiritual perspectives and experiences may enhance healthcare for some patients with eating disorders. A clinical framework is proposed to support healthcare providers to consider religion and spirituality, and in some cases incorporate Christian resources in eating disorder care. Eating disorders (EDs) are serious and complex conditions that require more effective approaches to care. One domain that is largely overlooked in most ED treatments is religion and spirituality (R/S). For some people, R/S may exacerbate their ED and/or be a resource for recovery. Emerging evidence suggests that many patients would like healthcare providers (HCPs) to enquire about their R/S beliefs, and that therapies incorporating these may be as effective as traditional therapies for a range of mental health conditions. We interviewed 31 people from Australia and New Zealand who had experienced an ED (21 people) and/or provided ED healthcare (16 people, six people belonged to both groups) to explore their views and experiences regarding R/S in ED care. We focused on Christian R/S in this study. Not all participants felt that R/S were relevant to their ED care. For others, R/S affected their identity, worldview and ED experience. Patients and HCPs were often cautious about raising religious and spiritual issues, and there were also perceived professional and system-level barriers. Nonetheless, participants described both helpful and unhelpful experiences of R/S being considered in ED care. A framework for considering R/S in ED care is suggested.