Sensing self: The process of recovering from bulimia nervosa

Phenomenological interviews with thirteen women who have recovered from bulimia nervosa were transcribed and analyzed to derive a data-grounded theory of how women recover from this disorder. The dissertation considers participants' experience of the most important changes in recovering; attributions of those changes; helpful phenomena in formally and naturally therapeutic contexts; shifts in readiness to change; persistent aspects of bulimia nervosa; and maintenance and consolidation of changes.; What emerges as the core experience of recovering is the process of coming to experience a sense of self, where the word sense is as important as the word self. When we use the phrase "a sense of self," we are apt to put the emphasis on the word self: "She has no sense of self" "She has a real sense of self." But if we place equal stress upon sense and self, the term takes on new resonance, new meaning. The noun suggests the verb: to sense oneself. And the verb suggests the question: How does a woman sense herself? It is this verb and this question to which participants in this study draw attention. It is this verb and this process of coming to sense oneself that this dissertation explores.; Sensing self is defined as focusing inward and referencing and attuning to self-experience. Sensing self is opposed to dissociation.; This dissertation identifies and illustrates eleven component processes of change that describe how participants came to sense self. It identifies and discusses the metaphor of "sensing when enough is enough." A felt sense of enough is one of six essential elements that converge to mark a behaviorally manifest shift in readiness to recover. Sensing when enough is enough is linked to a sense of agency.; This dissertation identifies and illustrates relational phenomena that foster self-sensing, including the use of voice, identification, imagery and imagination, education about the process of change, and coached practice in sensing self. It identifies and illustrates physical, psychic, and social aspects of self-experience, as well as continuing vulnerabilities, and describes how recovering continues beyond symptom remission. Implications for treatment, etiology, and prevention are discussed.