Being and doing anorexia nervosa: An exploration of diagnosis, identity-work, and performance of illness.

This research examines how individuals experience the diagnosis of anorexia. Specifically, it explores how individuals come to be diagnosed with anorexia and the meanings they attach to this process, how the diagnosis informs their self-understanding and identity, including in a treatment context, and how they manage and perform the diagnosis, both within and outside treatment. I used two qualitative methods; autoethnography and interviews. The former was a ‘moderate’ autoethnography. Drawing on memory, personal diaries, and clinical documents, I analysed my own experiences of being diagnosed with anorexia and undergoing four long-term inpatient admissions in an adult specialist eating disorder unit. I undertook the interviews, which were ‘in-depth’ and minimally structured, with 14 individuals. All but one had been formally diagnosed with anorexia and undergone treatment, and one was self-diagnosed. Analysing the data, I identify different routes to diagnosis, which involve varying interpretive processes and are associated with different subjective meanings of being diagnosed. Drawing on Brinkmann’s cultural psychology of diagnosis, I also address the ‘being’ and ‘doing’ of anorexia. In terms of ‘being’, I show how individuals learn a diagnostically-informed anorexic identity in treatment contexts. However, diagnostic understandings are not necessarily wholly accepted or internalised. Rather, they are reflectively and critically engaged with, such that individuals may reject aspects of the diagnosis and associated clinical understandings. I argue that clinically-based ‘anorexic scripts’ inform how individuals relate to and ‘do’ their diagnosis. In valuing being positioned as anorexic, individuals sometimes seek to ‘live up to’ these scripts, monitoring their own illness-performances against them. The findings shed light on ‘hidden’ consequences of being diagnosed and related clinical activity, and on how individuals experience their ‘symptoms’ and engage with treatment.