Les troubles alimentaires, le rétablissement et la pratique du travail social au Québec: Étude exploratoire

Abstract

Eating disorders are complex and biopsychosocial in nature. Some of these disorders are defined in the Diagnostic and Statistical Manual of Mental Disorders (DSM), a powerful document that has shaped the research and treatment of eating disorders, with a particular focus on anorexia and bulimia in clinical settings (Arnaiz, 2009; Black, 2003; Gremillion, 2002; Wilson, 2004). Conversely, social work research and theorizing on the topic of eating disorders is largely absent in the literature, despite the identification of social factors that cause, maintain and exacerbate eating disorders (American Psychiatric Association, 2018; Leblanc, Duncan, & O’Neill Gordon, 2014; Public Health Agency of Canada, 2002).

Currently, publicly funded eating disorder treatment in Canada is delivered through hospital programs whose resources are limited, resulting in an acute care model conceived for anorexia and bulimia (de Oliveira, Colton, Cheng, Olmsted, & Kurdyak, 2017; Leblanc et al., 2014). However, the research indicates that a large faction of the eating disorder population is excluded from the current treatment model (Hart, Granillo, Jorm, & Paxton, 2011; Hudson, Hiripi, Pope, & Kessler, 2007; Mitchison, Dawson, Hand, Mond, & Hay, 2016). As a result, many individuals are recovering in the community, outside formal eating disorder clinics and hospital units (Leblanc et al., 2014; Mitchison et al., 2016; Public Health Agency of Canada, 2002).

This exploratory study sheds light on the lived experiences of eating disorder recovery in a Quebec community setting, and the possible role of social workers in this process. Contrary to the acute care treatment model that is highly medicalized, recovery is a unique journey towards well-being that is defined by the person living with mental illness (Davidson, Tondora, Staeheli Lawless, & Rowe, 2009; Deegan, 1996; Provencher, 2002). As such, eating disorder recovery is not defined by an objective measure such as weight or frequency of symptoms, but by the individual’s quality of life. Recovery-oriented intervention models are person-centered, socially oriented, strengths based, and focused on quality of life (Davidson et al., 2009; Provencher, 2002); all of which are in harmony with social work’s core values and professional skill set (OTSTCFQ, 2012).

A feminist qualitative research approach was applied to this topic, as the goal of the study was to uncover subjugated knowledge (Hesse-Biber, 2014), with a particular focus on gender. Deductive theoretical sampling was used to recruit 12 adult participants through 3 Quebec community organizations specializing in eating disorders, in three major centers (Montreal, Sherbrooke, and Quebec). The resulting sample was diverse in age, type of eating disorder, ethnicity, and recovery trajectory.

In-depth interviews were conducted with the participants in a feminist approach, then analyzed using a combination of thematic analysis and grounded theory. The results uncovered a complex reality of eating disorder recovery in the Quebec community. Interestingly, participants definitions of recovery emphasized the unique and long-term nature of this process, that was not measured by the absence of eating disorder symptoms but by the ability to function in the various spheres of their lives (relationships, work, school, leisure, etc.). A variety of support systems were required in the recovery process, including: intuitive eating nutritional interventions, group work, and support from loved ones. Much of this support was found in the community, as evidenced by the fact that half of the sample completely bypassed the medical system in their recoveries.

Participants also identified several barriers to recovery that were related to how eating disorder services are conceived and delivered based on DSM criteria. The fact that few services for binge-eating disorder exist, despite having full diagnostic criteria (American Psychiatric Association, 2018) and being identified as the most prevalent eating disorder in North America (Hudson et al., 2007), is by far the most disturbing finding of this study. In addition, participants whose eating disorder manifested in overweight or obese bodies all experienced a generalized stigmatization of fat that impacted their recoveries negatively. Other barriers reported by participants were a lack of specialized eating disorder services, and first-line health and social service professionals’ unawareness of eating disorders.

Participants in this study agreed that social work could provide support to individuals recovering from an eating disorder, if better trained. Outside the acute phases of the disorders, social work would be well situated to provide support and education to loved ones, to work on issues of quality of life, and to assist individuals in finding eating disorder resources. If training in recovery-oriented practice and the social aspects of eating disorders were included in the core social work curriculum, social workers would be better equipped to provide eating disorder support in the community, where much of recovery takes place.