Figured World of Eating Disorders: Occupations of Illness

The importance of including occupational therapists as part of the multidisciplinary team in the management of eating disorders: a narrative review incorporating lived experience

The literature demonstrates the importance of utilizing a multidisciplinary approach in the treatment of eating disorders, however there is limited literature identifying the optimal team of professionals for providing comprehensive and effective care. It is widely accepted that the multidisciplinary treatment team should include a physician, a mental health professional, and a dietitian, but there is minimal literature explaining what other professionals should be involved in the medical assessment and management of eating disorders. Additional team members might include a psychiatrist, therapist, social worker, activity therapist, or occupational therapist. Occupational therapists are healthcare professionals who help their clients participate in the daily activities, referred to as occupations, that they have to do, want to do, and enjoy doing. Many factors (e.g., medical, psychological, cognitive, physical) can impact a person's ability to actively engage in their occupations. When a person has an eating disorder, it is likely that all four of the aforementioned factors will be affected, thus individuals undergoing treatment for an eating disorder benefit from the incorporation of occupational therapy in supporting their recovery journey. This narrative review strives to provide education on the role of the occupational therapist in treating eating disorders and the need for increased inclusion of this profession on the multidisciplinary team. Additionally, this narrative review offers insight into an individual's personal experience with occupational therapy (i.e., lived experience) during her battle for eating disorder recovery and the unique value that occupational therapy offered her as she learned to manage her eating disorder. Research suggests that occupational therapy should be included in multidisciplinary teams focused on managing eating disorders as it empowers individuals to return to activities that bring personal meaning and identity.

Eating disorders: When food "Eats" time

The presence of a physical or mental health issue, such as an eating disorder (ED), impacts daily activities, also known as occupations. For example, an overinvestment in body shape and weight undoubtedly can lead to an underinvestment in other, more meaningful occupations. To address ED-related perceptual disturbances, a detailed log of daily time use can pinpoint food-related occupational imbalances. This study aims to characterize the daily occupations associated with EDs. The first specific objective (SO.1) is to categorize and quantify the temporal organization of a typical day's occupations as self-reported by individuals with an ED. The second specific objective (SO.2) is to compare daily occupational time use among people with different ED types. This retrospective study based on time-use research principles was conducted by analyzing data from an anonymized secondary dataset (Loricorps's Databank). Data were collected between 2016 and 2020, from 106 participants, with descriptive analysis completed to determine the average daily time use for each occupation. A series of one-way analyses of variance (ANOVAs) were performed to compare perceived time use in each occupation for participants with different types of EDs. The outcomes show a marked underinvestment in leisure categories compared to the general population. In addition, personal care and productivity can represent the blind dysfunctional occupations (SO.1). Moreover, compared to those with binge eating disorder (BED), individuals with anorexia nervosa (AN) are significantly more invested in occupations that focus explicitly on perceptual disturbances, such as personal care (SO.2). The highlight of this study is the distinction between marked versus blind dysfunctional occupation, which offers specific avenues for clinical intervention.

Exploring occupation in recovery from bulimia nervosa: An interpretative phenomenological analysis

Introduction

Recovering from bulimia nervosa challenges a person to learn, revise, and do occupations that contribute to rather than detract from health. This study utilized Interpretative Phenomenological Analysis to (a) explore the recovery experiences of six adult women with histories of bulimia nervosa and (b) interpret how their accounts reflected the assumptions and characteristics of occupation.

Methods

Data were collected via audio-recorded, semi-structured interviews. Data analysis within and between cases identified six superordinate themes, which included interpretation in terms of criteria of occupation.

Findings

Superordinate themes reflect (1) occupation emerged in recovering from bulimia nervosa through committed action, not doing what fueled bulimia nervosa, adopting new ways of living, prioritizing self-care, connecting with others, and creating supportive environments and (2) recovery from bulimia nervosa can be construed as an occupation.

Conclusion

This study provides insight into nuances of recovery from bulimia nervosa. Results offer novel implications distinct to an occupational therapy lens, for example, consideration of self-care beyond eating and meal preparation; modification of the home, work, and social environment; and setting goals associated with not doing versus doing. Further, the interpretative finding of recovery as occupation holds implications for the evolving philosophical considerations within occupational science and therapy.

L’ergothérapeute : un professionnel de la santé? Vraiment? Dans quelle mesure?

Comme maints professionnels de la réadaptation, l’ergothérapeute est d’emblée considéré comme un professionnel de la santé. Or cette association entre l’ergothérapie et la santé peut être nuancée, voire contestée.

Toward the reconceptualization of the relationship between occupation and health and well-being

Background.

Foundational to the occupational therapy profession is the belief that engagement in occupation is health promoting; however, this belief fails to account for occupational engagement that may be risky or illness producing. Consensus regarding the nature of the relationship between occupation and health has yet to be achieved.

Purpose.

The purpose of this study is to provide a comprehensive description of how the relationship between occupation and health and well-being is discussed within the occupational therapy and occupational science literature.

Method.

The methodological framework outlined by Arksey and O’Malley served as the basis for this scoping review of the occupational therapy and occupational science literature.

Findings.

One hundred and twelve articles were identified as meeting the criteria for inclusion. The dominant discourse portrays the relationship between occupation and health as positive.

Implications.

The broader literature suggests that occupational engagement can have both positive and negative effects on health and well-being. As such, the reconceptualization of the relationship between occupation and health and well-being is warranted to enable occupational therapists to practise in a more client-centred manner.

A transactional perspective on occupation: a critical reflection

BACKGROUND

The emergence of a transactional perspective on occupation, informed primarily by John Dewey's work, has gained increasing popularity in occupational science and occupational therapy.

AIM

The aim of this paper is to offer a critical reflection on a transactional perspective on occupation and to advance the dialogue on a transactional perspective on occupation.

METHODS

A framework for critical reflection of theory was applied to a transactional perspective on occupation, exploring five domains of theory usefulness: clarity, simplicity, generality, accessibility, and importance.

FINDINGS

A transactional perspective on occupation presents with clear strengths including its ability to capture complex relationships, its generality, and its importance to occupational research. However, there is a need to address issues in clarity and accessibility by establishing consistent definitions of constructs, further developing the construct of occupation within the perspective, and applying methods well suited to understand its relational perspective.

CONCLUSIONS

A transactional perspective on occupation has more recently emerged as a promising perspective through which to understand occupation. It holds promise in understanding cultural conceptualizations of occupation and the relationship between occupations and the natural environment. Future work should address possible dissonance between its pragmatic underpinnings and harmful occupations, and develop contextual elements beyond the social.

"What Do You Think We Should Do?": Relationship and Reflexivity in Participant Observation

This article uses three concepts as a framework by which to examine how the interrelational elements of ethnographic approaches to qualitative inquiry reflect dimensions of therapeutic engagement. Participant observation, reflexivity, and context are all widely and routinely included within research methods; however, they are less frequently attended to directly in their experiential capacity through the lens of the researcher, clinician turned investigator. A unique study design will be profiled to reflect the complicated juxtaposition between methods, questions, sample population, time, space, and identity. Studying occupational therapy students traveling abroad for a short-term immersion experience, this narrative study called on a necessary and attentive awareness of locality as the researcher traveled with the group. Conducting ethnographic research where the researcher's therapeutic skills aided and constrained relationships resulted in rich, guarded, and relevant insights that parallel the therapeutic use of self in occupational therapy practice.