Externalizing your eating disorder: a qualitative interview study

Many patients with anorexia nervosa (AN) have the experience that their eating disorder is part of who they are. Therefore, in the treatment of AN, healthcare professionals try to make clear to patients that there is a distinction between who they are and their AN. Through labelling certain thoughts and behaviour as stemming from AN, healthcare professionals guide patients in recognizing what is AN and what is not. This process is called externalization. In this study, fourteen patients with AN were interviewed on their thoughts about the relation between their identity and their eating disorder, and their experiences of externalization of AN within treatment. What becomes clear in these interviews is that patients’ perceptions on the relation between AN and their identity varies greatly, from experiencing AN as part of who they are to AN as something completely alien to them. Externalization is sometimes experienced as helpful, yet at the same time patients felt as if all behaviour was labelled as part of AN, which made them feel as if they were wrongly accused of being dishonest or not taken seriously. For healthcare professionals it is important to know that these side effects may arise when externalizing AN in treatment.