An Exploration of Relapse Experiences in Eating Disorders and the Relationship Between Caregiver PTSD Symptoms, Eating Disorder Factors, and Caregiving Skills

Heal-Cohen, Natasha (2025) An Exploration of Relapse Experiences in Eating Disorders and the Relationship Between Caregiver PTSD Symptoms, Eating Disorder Factors, and Caregiving Skills. Doctoral thesis, University of East Anglia.

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Abstract

Recovery outcomes for individuals with eating disorders (EDs) remain poor, and the impact on family members is significant. This thesis portfolio aims to address gaps in our understanding of the experiences of both individuals with EDs and their parental caregivers.

A systematic review and thematic synthesis were conducted to explore individuals’ experiences of relapse. Qualitative data from 16 studies were synthesized, generating five themes that describe relapse as enticing, unstoppable, protective, destructive, and instructive. The findings highlight the risks of insufficient professional and social support in the face of an enduring attachment to the ED and unresolved psychological vulnerabilities. Despite variation in individuals' mindsets upon relapse, concerningly, relapse was commonly interpreted in ways that fuelled self-criticism and diminished hope for recovery.

A subsequent quantitative empirical study examined post-traumatic stress disorder (PTSD) symptoms in 123 parental caregivers of children and young people (CYP) with ED symptoms via an online survey. Findings revealed over half (62.6%) reported probable PTSD in relation to their child’s ED. Demographic and ED-related factors together explained 21% of the variance in PTSD symptoms, with ED relapse contributing the largest independent association. Additionally, PTSD symptoms accounted for 34% of the variance in caregiver skills, with greater PTSD symptoms associated with less adaptive caregiving behaviours, such as self-care and insight and acceptance.

In the final discussion chapter, findings from both studies are critically evaluated and examined in relation to theory, evidence, and clinical practice. The chapter highlights the interdependencies between individuals with EDs, caregivers, and professionals, and considers the importance of relational, trauma-informed, tailored approaches that address and balance the psychological needs of both individuals with EDs and their caregivers.

Item Type:	Thesis (Doctoral)
Faculty \ School:	Faculty of Medicine and Health Sciences > Norwich Medical School
Depositing User:	Chris White
Date Deposited:	27 Oct 2025 15:28
Last Modified:	27 Oct 2025 15:28
URI:	https://ueaeprints.uea.ac.uk/id/eprint/100796
DOI:

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