“It Was Something Outside of Me, Controlling Me”: Young People's Perspectives on the Role of Externalisation in Recovery From Anorexia Nervosa

Abstract

Objective

Externalisation is a therapeutic approach that separates the problem from the person, widely used in treating anorexia nervosa (AN) to help young people understand their illness and to collaborate with their families against the disorder. Whilst adult and clinician perspectives on externalisation are well documented, young people's experiences remain underexplored. This study addresses that gap, examining how young people experience AN in relation to their identity and the therapeutic use of externalisation.

Method

Ten older adolescents and young adults (aged: 15–21) who had received treatment for AN or atypical AN as an adolescent, participated in semi-structured interviews. Interviews were transcribed and recorded verbatim, then analysed using reflexive thematic analysis.

Results

Thematic analysis identified three key themes: “Identity fusion” “Empowerment through externalisation” and “Sustaining the battle.”

Conclusions

Findings suggest that although young people may initially resist externalisation, viewing it as a threat to their identity, the technique helps them and their families better understand the illness, reducing feelings of blame and guilt. Over time, externalisation enables young people to reclaim their identity and redefine themselves beyond AN. The study highlights implications for clinical practice and future research.