Disordered eating in sport: narrative's turn

A growing body of evidence suggests that athletes are at increased risk of disordered eating and eating disorders. The principal explanation proffers that extreme pressure to lose weight for performance gains can encourage the development of pathological attitudes and behaviours with regards to food and weight. The current consensus is that elite female athletes participating in sports with a focus on leanness or aesthetics are at greatest risk. This existing knowledge has emerged from a literature base characterised by a narrow focus on prevalence rates and risk factor identification. As a consequence, there are few examples of studies that address disordered eating in sport interpretively and we know little about how athletes experience the illness. The overarching aim of this thesis therefore, was to interpretively explore athletes subjective accounts of their disordered eating experiences, adding new, alternative insights that compliment the existing literature. In Study 1 I adopted an interpretative phenomenological analysis as a means to give voice to four athletes who have experienced disordered eating. The aim of this study was to document athletes personal accounts and to interpret these accounts from a psychological perspective. In-depth, semi-structured interviews were conducted and verbatim transcripts were analysed according to the procedures of IPA. Three superordinate themes emerged from the data: the struggle to disclose, social support needs, and identity challenges. Athletes stories provided rich descriptions of their subjective disordered eating experiences. Their accounts give critical insight into the impact of eating disturbance on the lives of athletes. In Study 2 I drew on narrative theory to interpretively analyse the life-story of Holly, a female athlete who engages in severe self-starvation. The broad aim here was to build on the interpretive insights gleaned in Study 1 and provide a detailed, qualitative exemplar of an athlete s life with disordered eating. More specifically, this study sought to explore the narrative processes by which an athlete comes to understand disordered eating and the impact this holds for experience. More than 7 hours of life history data was gathered over a period of 8 months through unstructured interviews. Holly described a struggle to align her life experiences with a culturally specified achievement narrative that lauds normative success. When neither her academic nor sporting endeavours fulfilled the achievement narrative, Holly was thrust into emotional turmoil and began to conceive of self-starvation as a means to achieve. Holly s narrative is in many ways fractured and void of the coherence necessary to move on from her troubles. It is argued that narrative realignment and coherence might be encouraged through narrative therapy. For Study 3, I sought to add a further detailed exemplar to the disordered eating in sport research base. Again building on the initial insights of Study 1, extended life-history data provided scope to delve into the deep complexities and pertinent ambiguities that characterise lived experiences. In applying principles of narrative analysis to this data, the objective was to provide further details as to how a disordered eating athlete makes sense of illness and the implications of this meaning making for future experiences. To achieve this I explored the stories of Beth, a former elite athlete with experience of anorexia nervosa and, as she revealed, sexual abuse. Six unstructured life history interviews took place over a period of 12 months yielding more than 9 hours of interview data. Due to a lack of previous narrative opportunities, the story Beth told was in many ways embryonic. Throughout our conversations Beth constructed multiple, fragile and sometimes contrasting narrative coherences indicative of a fragmented and uncertain understanding of her life. Beth s atypical story helps create a more complete understanding of eating disorders in sport and serves as an additional narrative resource from which others might draw to story experience. With Study 4 I sought to address the lack of family involvement in disordered eating in sport research. Given it is widely accepted that families are important in the management and treatment of eating disorders, I explore the experiences of an elite athlete with an eating disorder as well as the experiences of her parents. The underlying aim here was to explore the impact of athlete disordered eating on participants, both individually and as a family. Family members attended interviews individually on 3 separate occasions over the course of a year. Analysis involved repeated readings of the transcripts, sensitising towards issues of narrative content and structure. Participants interpreted the eating disorder through specific narrative types which shaped their experiences and guided their actions. Difficulties arose when personal experiences strayed from the preferred narrative to live by and when family members held contrasting narrative preferences. Suggestions are forwarded as to how an appreciation of eating disorder illness narratives might inform treatment and support practices. In conclusion, this thesis has demonstrated that it is insufficient to study disordered eating through solely positivist means. It is only through consistent, focused, interpretive study that a fuller, more complete, understanding of the illness can be achieved. Specifically, we must begin to add experiential insights to the medical preoccupation with nosology and symptomatology. This thesis has taken a significant step towards adding such insights. When invited to recount their experiences, athletes provide rich, powerful, subjective accounts that enable us to see disordered eating in sport through a new lens. The way athletes make sense of illness is sometimes ambiguous and contradictory, often complex and transient and always consequential for future experiences. Essentially, the narratives used to describe disordered eating impact on how disordered eating is lived through. As such, future research must explore the potential of narrative therapy to ease future disordered eating experiences, while also continuing to add to the critical mass of interpretive studies available.