Uncertainty Certain with Eating Disorders

When something is ambiguous, it means there are multiple ways it can be understood, described, and interpreted. That something can take on different shapes, roles, and characteristics.  Ambiguity can make things difficult for those who prefer neat and tidy answers and make those who consider themselves to be black and white thinkers uncomfortable. When dealing with something ambiguous, it puts individuals in the position of either acknowledging and even embracing it or shutting down and turning away. Hence, ambiguity pulls different responses from people, which is fitting given the definition of the term. The reason I bring up the concept of ambiguity within a blog meant for the discussion of eating and weight related issues is to highlight that ambiguity is inherent within these areas. Ambiguity is the norm, which I believe frustrates many clinicians, torments families, and creates endless uncertainty for individuals experiencing these issues. Since I have come to understand the ambiguous nature of eating disorders (EDs; i.e., ambiguity of disclosure, symptoms, treatment outcomes, et cetera) as both a clinician and researcher, it has left me in a position wondering how I can best accept this ambiguity and even use it to my advantage. Since after all, the more I fight with ambiguity and attempt to solve it, the further I stray from my goals.

I will demonstrate the uncertainty certain within EDs, with two professional examples. First, as a clinician working with individuals and their families affected by EDs, I must navigate the ambiguity inherent within the experience. From the time someone presents for help to the point of discharge, there are infinite scenarios that clinicians could face. When considering assessment and diagnosis, the obscurities could be plenty. Now, add in an individual’s motivations for recovery and in some cases a dose of ambivalence towards the whole process and clinicians can be faced with amounts of complexity that are overwhelming even to them. I believe that there is a common misconception among individuals in treatment for EDs that clinicians have all of the answers, but of course this is not true. Clinicians are human, wanting to help as best we can.  Without possessing magic powers, successful ED clinicians must embrace the ambiguity and not be bulldozed by the wavering, anything-but-linear process.

Second, as a researcher, I want to find the best way to understand the complicated nature of EDs, while also realizing that I may never understand the experience in full. Eating disorders can be interpreted in so many ways. I cannot say that another researcher’s interpretation is wrong if it does not reflect my own understanding, rather, I recognize the experiences of individuals and families impacted by EDs to be full of heterogeneity and particulars. As a researcher, I also embrace what has led me to study this topic. I believe that researchers who are passionate about what they do are passionate for a reason. I must honor what led me here and harness it to make better interpretations of the topic that will best inform my practice and the field. The ability to do so requires a comfort with uncertainty. To note, just because I am writing this does not mean that embracing ambiguity comes naturally to me. We all must work on this ebb and flow that is ED research. I would imagine that if researchers with little tolerance for uncertainty or vagueness were to undertake research in this area, they would swiftly experience burn out.

Being in a position to learn more about the topic and be able to reflect on the data is an incredible opportunity. It has, and will, continue to allow me to stay curious and fully listen to what the other has to say. In my role as both a clinician and researcher, I am opening my understanding to be challenged, so that I may learn something new about EDs. I do so to avoid cramming my clients and research participants into a box that doesn’t capture their experience, nor help them reach their goals.

Bio: Emily P. Williams is a doctoral candidate at the University of Calgary, studying Counselling Psychology. She is interested in maladaptive behaviours individuals use to cope with emotion dysregulation, particularly disordered eating. Emily’s doctoral dissertation examines the experiences of parents who discover their child has anorexia nervosa. Her dissertation will be the first study exploring this topic. In the future, Emily looks forward to completing her studies, registering as a Psychologist, and practicing as a clinician.