Schema modes in eating disorders: an interpretative phenomenological analysis
- Authors: Bowker, Chantal Ann
- Date: 2021-10-29
- Subjects: Eating disorders , Anorexia nervosa , Bulimia , Compulsive eating , Schema-focused cognitive therapy , Interpretative phenomenological analysis (IPA)
- Language: English
- Type: Doctoral theses , text
- Identifier: http://hdl.handle.net/10962/196072 , vital:45723 , DOI 10.21504/10962/196072
- Description: The DSM-5 prevalence rate of anorexia nervosa is 0.4%, bulimia nervosa is 1% to 1.5%, and binge eating disorder is 1.6% (American Psychiatric Association, 2013). Although treatment approaches for eating disorders have high drop-out rates and low rates of recovery, treatment modalities that address childhood factors contributing to the eating disorder, as well as the eating disorder behaviours, have better outcomes. Schema therapy is an integrative approach that has been used for the treatment of eating disorders for more than a decade. Central features in schema therapy include the identification of early maladaptive schemas arising from unmet needs and schema modes. Schema modes, composed of schemas and coping mechanisms, are active for an individual at a particular time in response to triggers in the environment (Brown et al., 2016). Identifying an individual’s modes is a crucial aspect that reflects the underlying structure of the individual’s creation of reality. A phenomenological understanding of the modes is essential for developing a case conceptualisation and treatment plan. Differences exist in the naming and description of modes in the current schema therapy literature, which suggests the need for a phenomenological investigation of these structures. This research study used a mostly qualitative approach, in the form of clinical interviews, substantiated by questionnaires, to examine schema modes. Case presentations using the schema therapy model are provided for five women with either anorexia nervosa, bulimia nervosa or binge eating disorder. Then, through a process of interpretative phenomenological analysis, specific modes are examined as to how they are experienced by the participants and influence their behaviour. The features of schema modes in these clinical cases are compared to the existing literature to extend the understanding of schema modes in eating disorders. The participants’ experiences revealed that they had schema modes in common, regardless of the eating disorder presentation, but that the features of the individual modes varied. Modes found in the current literature such as the Detached Self-Soother and Perfectionist Overcontroller coping mode, were found in all the participants. Four of the five participants had an Eating Disordered Overcontroller mode. Features consistent with the existing descriptions of the Perfectionist Overcontroller, Eating Disordered Overcontroller and Detached Self-Soother modes were noted, and new features were identified. The Perfectionist Overcontroller and Eating Disordered Overcontroller have been presented here as complex composite modes with sub-modes that work together in a coherent way in the service of the same project (Edwards, 2020b). Twenty-three features are identified in the parent modes. Blended parent modes, with multiple features active in a situation, were described. The blended parent modes expand on the existing literature on parent modes. The findings in this research support and extend the mode structure identified in the schema therapy theory, and highlight the idiosyncratic nature of the modes. , Thesis (PhD) -- Faculty of Humanities, Psychology, 2021
- Full Text:
- Authors: Bowker, Chantal Ann
- Date: 2021-10-29
- Subjects: Eating disorders , Anorexia nervosa , Bulimia , Compulsive eating , Schema-focused cognitive therapy , Interpretative phenomenological analysis (IPA)
- Language: English
- Type: Doctoral theses , text
- Identifier: http://hdl.handle.net/10962/196072 , vital:45723 , DOI 10.21504/10962/196072
- Description: The DSM-5 prevalence rate of anorexia nervosa is 0.4%, bulimia nervosa is 1% to 1.5%, and binge eating disorder is 1.6% (American Psychiatric Association, 2013). Although treatment approaches for eating disorders have high drop-out rates and low rates of recovery, treatment modalities that address childhood factors contributing to the eating disorder, as well as the eating disorder behaviours, have better outcomes. Schema therapy is an integrative approach that has been used for the treatment of eating disorders for more than a decade. Central features in schema therapy include the identification of early maladaptive schemas arising from unmet needs and schema modes. Schema modes, composed of schemas and coping mechanisms, are active for an individual at a particular time in response to triggers in the environment (Brown et al., 2016). Identifying an individual’s modes is a crucial aspect that reflects the underlying structure of the individual’s creation of reality. A phenomenological understanding of the modes is essential for developing a case conceptualisation and treatment plan. Differences exist in the naming and description of modes in the current schema therapy literature, which suggests the need for a phenomenological investigation of these structures. This research study used a mostly qualitative approach, in the form of clinical interviews, substantiated by questionnaires, to examine schema modes. Case presentations using the schema therapy model are provided for five women with either anorexia nervosa, bulimia nervosa or binge eating disorder. Then, through a process of interpretative phenomenological analysis, specific modes are examined as to how they are experienced by the participants and influence their behaviour. The features of schema modes in these clinical cases are compared to the existing literature to extend the understanding of schema modes in eating disorders. The participants’ experiences revealed that they had schema modes in common, regardless of the eating disorder presentation, but that the features of the individual modes varied. Modes found in the current literature such as the Detached Self-Soother and Perfectionist Overcontroller coping mode, were found in all the participants. Four of the five participants had an Eating Disordered Overcontroller mode. Features consistent with the existing descriptions of the Perfectionist Overcontroller, Eating Disordered Overcontroller and Detached Self-Soother modes were noted, and new features were identified. The Perfectionist Overcontroller and Eating Disordered Overcontroller have been presented here as complex composite modes with sub-modes that work together in a coherent way in the service of the same project (Edwards, 2020b). Twenty-three features are identified in the parent modes. Blended parent modes, with multiple features active in a situation, were described. The blended parent modes expand on the existing literature on parent modes. The findings in this research support and extend the mode structure identified in the schema therapy theory, and highlight the idiosyncratic nature of the modes. , Thesis (PhD) -- Faculty of Humanities, Psychology, 2021
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In My Flesh : Fabricating the Bulimic Body
- Authors: Hodgson, Ashley
- Date: 2021-04
- Subjects: Bulimia , Human body -- Social aspects , Human figure in art , Diseases in art , Art therapy
- Language: English
- Type: thesis , text , Masters , MFA
- Identifier: http://hdl.handle.net/10962/177317 , vital:42809
- Description: My MFA exhibition In My Flesh, explores my own personal experience of an eating disorder: bulimia nervosa, through the medium of sculpture and installation. Situated in the Fine Art Sculpture and Painting building on Rhodes University campus, this practical submission takes the form of a multi-sensory installation depicting the fleshy interior of a bulimic body. The sculptural works that make up the installation resemble enlarged bodily forms and cavities, namely the mouth; the oesophagus, the stomach; the intestines; and the flesh. These anatomical forms are made from fabric which has been melted, manipulated, and stained using food and other synthetic dyes. The arrangement of the sculptural components (parts of the body affected by bulimia) does not mirror the human body exactly, and their intentionally disordered placement creates a feeling of dis-ease and disturbance for the participant experiencing the installation. This mini-thesis, In My Flesh: Fabricating the Bulimic Body, unpacks the visual, tactile and audio elements of this practice as research submission as they relate to my interest in bodily boundaries, corporeal traces and material extensions. I look at these themes as they translate into installation, and discuss the way in which bulimia is experienced, theorised and represented. I position my work in relation to the concept of the abject as proposed by Julia Kristeva, and visually analyse artworks by Mona Hatoum, Heidi Bucher and Ernesto Neto who make use of immersive installation strategies that resonate with my own practice. This supporting document considers the three conceptual elements informing my installation: embodiment, space, and materiality. In the first chapter of this document: Embodying the Bulimic Body, I address bulimia as less open to visual interpretations than other eating disorders because of its secretive and hidden nature. I go on to frame the illness in relation to theories around bodily boundaries and abjection and argue that bulimia epitomises abjection. In Chapter Two: Architecture of the Bulimic Body I engage with the idea of architectural structures as having anatomic features. I interrogate how the body moves through space, leaving traces of itself behind. Chapter Three: Fabricating the Bulimic Body concentrates on the main medium used in In My Flesh: fabric. In my discussion of this material, I unpack its metaphoric and symbolic qualities, as well as its personal resonance with my own lived experience. , Thesis (MFA) -- Faculty of Humanities, Fine Art, 2021
- Full Text:
- Authors: Hodgson, Ashley
- Date: 2021-04
- Subjects: Bulimia , Human body -- Social aspects , Human figure in art , Diseases in art , Art therapy
- Language: English
- Type: thesis , text , Masters , MFA
- Identifier: http://hdl.handle.net/10962/177317 , vital:42809
- Description: My MFA exhibition In My Flesh, explores my own personal experience of an eating disorder: bulimia nervosa, through the medium of sculpture and installation. Situated in the Fine Art Sculpture and Painting building on Rhodes University campus, this practical submission takes the form of a multi-sensory installation depicting the fleshy interior of a bulimic body. The sculptural works that make up the installation resemble enlarged bodily forms and cavities, namely the mouth; the oesophagus, the stomach; the intestines; and the flesh. These anatomical forms are made from fabric which has been melted, manipulated, and stained using food and other synthetic dyes. The arrangement of the sculptural components (parts of the body affected by bulimia) does not mirror the human body exactly, and their intentionally disordered placement creates a feeling of dis-ease and disturbance for the participant experiencing the installation. This mini-thesis, In My Flesh: Fabricating the Bulimic Body, unpacks the visual, tactile and audio elements of this practice as research submission as they relate to my interest in bodily boundaries, corporeal traces and material extensions. I look at these themes as they translate into installation, and discuss the way in which bulimia is experienced, theorised and represented. I position my work in relation to the concept of the abject as proposed by Julia Kristeva, and visually analyse artworks by Mona Hatoum, Heidi Bucher and Ernesto Neto who make use of immersive installation strategies that resonate with my own practice. This supporting document considers the three conceptual elements informing my installation: embodiment, space, and materiality. In the first chapter of this document: Embodying the Bulimic Body, I address bulimia as less open to visual interpretations than other eating disorders because of its secretive and hidden nature. I go on to frame the illness in relation to theories around bodily boundaries and abjection and argue that bulimia epitomises abjection. In Chapter Two: Architecture of the Bulimic Body I engage with the idea of architectural structures as having anatomic features. I interrogate how the body moves through space, leaving traces of itself behind. Chapter Three: Fabricating the Bulimic Body concentrates on the main medium used in In My Flesh: fabric. In my discussion of this material, I unpack its metaphoric and symbolic qualities, as well as its personal resonance with my own lived experience. , Thesis (MFA) -- Faculty of Humanities, Fine Art, 2021
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