“When treatments mimic the eating disorder, it gives patients this idea that recovery or freedom could look a little bit like the captivity that they’re used to.”: Exploring the meaning of surveillance in eating disorder treatment.

Scholars have conceptualized Anorexia nervosa as an internalization of the objectification that people experience in society. More specifically, people may take on the kind of body monitoring and criticism from society and others, and begin monitoring themselves, including tracking diet and body checking. Existing eating disorder treatment often relies on therapists, behavioral aids, and other staff members in treatment, watching and monitoring individuals behavior and eating and these treatment centers often teach new monitoring strategies like meal planning and recording of thoughts. This study explores how people who have attended inpatient and residential treatment for Anorexia nervosa make meaning of monitoring and surveillance in treatment. The researcher conducted interviews with individuals who have attended multiple inpatient and residential treatment centers, are in recovery, and are currently not in eating disorder treatment beyond outpatient care. Participants described how treatment reinforced narrow ideas about the eating disorder that regulated access to care and led to an increased focus on weight. Participants described how they learned new monitoring practices in treatment that led to new eating disorder behaviors. Participants understood surveillance and monitoring in treatment by staff and through monitoring structures as dehumanizing and taking away of their voice. Finally, participants learned compliance in treatment, not the skills that they wanted to learn to be in recovery. Overwhelmingly, participants spoke to the inadequate care they received in treatment centers, and the difficulty accessing eating disorder support more broadly. These results highlight the complexity of monitoring in treatment, and its potential for harm.