Using artwork and Interpretative Phenomenological Analysis to explore the experience of coping with body dysmorphic disorder

Body dysmorphic disorder (body dysmorphia; BDD) is a mental health condition characterised by experiencing impairing preoccupations about aspects of one’s appearance. The psychological process of coping with BDD is a highly personal and varied experience that has not yet been explored in qualitative research. It can be extremely difficult to put into language the subtle and ambiguous phenomena that one experiences when attempting to convey what it is like to live with its symptoms. Our arts-based phenomenological design invited participants to provide both visual and narrative data. Participants created artwork to represent their experiences of coping with BDD on a bad day and on a more manageable day, then took part in a semi-structured follow-up interview. In this study, we used a multimodal hermeneutic-phenomenological approach combining Boden and Eatough’s (2014) Framework for the Analysis of Drawings, and Interpretative Phenomenological Analysis (Smith, 1996) to explore an individual’s experiences of coping with BDD

Visual representations of coping with body dysmorphic disorder: A multimodal hermeneutic phenomenological approach

Background: Body dysmorphic disorder (BDD) is a mental health condition characterised by distress associated with perceived defects in one’s physical appearance. Such defects are likely to be very slight or invisible to external observers, making it difficult for people with BDD to convey what they see. Methods: Participants created artwork representing how they cope with BDD, then completed a follow-up interview to discuss their artwork. Framework for the Analysis of Drawings was used together with Interpretative Phenomenological Analysis. Findings: Three overarching themes were generated from the analysis, centred around BDD’s fusion with one’s lifeworld, perceptual detachment, and fragmented selves. Conclusions: We suggest incorporating artwork creation in BDD research and clinical settings may elucidate understanding of “hidden” experiences. Clinicians may find it helpful to reflect on how the distinctive BDD “way of seeing” can infuse not just specific perceptions of the body, but also the person’s wider relationship to the world

A phenomenological exploration of self-identified origins and experiences of body dysmorphic disorder

Body dysmorphic disorder (BDD) is a debilitating mental health condition that presently affects ~2% of the general population. Individuals with BDD experience distressing preoccupations regarding one or more perceived defects in their physical appearance. These preoccupations and perceived distortions can have a profound impact on key areas of social functioning and psychological health. Individuals’ BDD origins have not been explored in significant depth and have been, often unhelpfully, conflated with social media usage and exposure to idealistic imagery of the body. Such generalisations fail to acknowledge the complexity of BDD development and onset, highlighting the importance of moving towards an understanding of people’s implicit theories regarding their own experience. It is therefore essential to gain insight into how individuals make sense of the experiences which they believe led to the development and onset of BDD. The aim of this exploratory study was to elicit and phenomenologically analyse the accounts of individuals with lived experience of BDD in order to examine their beliefs about its origins and understand how they navigate the world with a distorted sense of self. Participants provided written and verbal accounts regarding both their BDD onset and experiences of living with the disorder. Both components of the study were analysed using Interpretative Phenomenological Analysis. Four main themes were generated from the data: Exposure to bullying and external critique of appearance; Experiencing rejection, shame, and a sense of not being enough; Developing an awareness of the solidification of concerns, and Learning about and reflecting upon triggers. Participants attributed their BDD onset to adverse experiences such as childhood bullying, receiving appearance-focused criticism, rejection and being subjected to emotional and physical abuse. The findings from this study highlight the complexity of BDD development and onset in individuals, and the need for appropriate care and treatment for those affected by BDD

Adopting, implementing, and assimilating coproduced health and social care innovations involving structurally vulnerable populations: Findings from a longitudinal, multiple case study design in Canada, Scotland, and Sweden

Background: Innovations in coproduction are shaping public service reform in diverse contexts around the world. Although many innovations are local, others have expanded and evolved over time. We know very little, however, about the process of implementation and evolution of coproduction. The purpose of this study was to explore the adoption, implementation, and assimilation of three approaches to the coproduction of public services with structurally vulnerable groups.Methods: We conducted a four-year longitudinal multiple case study (2019-2023) of three coproduced public service innovations involving vulnerable populations: ESTHER in Jönköping region, Sweden involving people with multiple complex needs (Case 1); Making Recovery Real in Dundee, Scotland with people who have serious mental illness (Case 2); and Learning Centres in Manitoba, Canada (Case 3), also involving people with serious mental illness. Data sources included 14 interviews with strategic decision makers and a document analysis to understand the history and contextual factors relating to each case. Three frameworks informed the case study protocol, semi-structured interview guides, data extraction, deductive coding, and analysis: the Consolidated Framework for Implementation Research, the Diffusion of Innovation model, and Lozeau’s Compatibility Gaps to understand assimilation.Results: The adoption of coproduction involving structurally vulnerable populations was a notable evolution of existing improvement efforts in Cases 1 and 3, while impetus by an external change agency, existing collaborative efforts among community organisations, and the opportunity to inform a new municipal mental health policy sparked adoption in Case 2. In all cases, coproduced innovation centred around a central philosophy that valued lived experience on an equal basis with professional knowledge in coproduction processes. This philosophical orientation offered flexibility and adaptability to local contexts, thereby facilitating implementation when compared with more defined programming. According to the informants, efforts to avoid co-optation risks were successful, resulting in the assimilation of new mindsets and coproduction processes, with examples of how this had led to transformative change.Conclusions: In exploring innovations in coproduction with structurally vulnerable groups, our findings suggest several additional considerations when applying existing theoretical frameworks. These include the philosophical nature of the innovation, the need to study the evolution of the innovation itself as it emerges over time, greater attention to partnered processes as disruptors to existing power structures, and an emphasis on driving transformational change in organisational cultures

Adopting, implementing and assimilating coproduced health and social care innovations involving structurally vulnerable populations: findings from a longitudinal, multiple case study design in Canada, Scotland and Sweden

Background: Innovations in coproduction are shaping public service reform in diverse contexts around the world. Although many innovations are local, others have expanded and evolved over time. We know very little, however, about the process of implementation and evolution of coproduction. The purpose of this study was to explore the adoption, implementation and assimilation of three approaches to the coproduction of public services with structurally vulnerable groups. Methods: We conducted a 4 year longitudinal multiple case study (2019–2023) of three coproduced public service innovations involving vulnerable populations: ESTHER in Jönköping Region, Sweden involving people with multiple complex needs (Case 1); Making Recovery Real in Dundee, Scotland with people who have serious mental illness (Case 2); and Learning Centres in Manitoba, Canada (Case 3), also involving people with serious mental illness. Data sources included 14 interviews with strategic decision-makers and a document analysis to understand the history and contextual factors relating to each case. Three frameworks informed the case study protocol, semi-structured interview guides, data extraction, deductive coding and analysis: the Consolidated Framework for Implementation Research, the Diffusion of Innovation model and Lozeau’s Compatibility Gaps to understand assimilation. Results: The adoption of coproduction involving structurally vulnerable populations was a notable evolution of existing improvement efforts in Cases 1 and 3, while impetus by an external change agency, existing collaborative efforts among community organizations, and the opportunity to inform a new municipal mental health policy sparked adoption in Case 2. In all cases, coproduced innovation centred around a central philosophy that valued lived experience on an equal basis with professional knowledge in coproduction processes. This philosophical orientation offered flexibility and adaptability to local contexts, thereby facilitating implementation when compared with more defined programming. According to the informants, efforts to avoid co-optation risks were successful, resulting in the assimilation of new mindsets and coproduction processes, with examples of how this had led to transformative change. Conclusions: In exploring innovations in coproduction with structurally vulnerable groups, our findings suggest several additional considerations when applying existing theoretical frameworks. These include the philosophical nature of the innovation, the need to study the evolution of the innovation itself as it emerges over time, greater attention to partnered processes as disruptors to existing power structures and an emphasis on driving transformational change in organizational cultures

An exploration of the experience of living with Body Dysmorphic Disorder (BDD) using multimodal hermeneutic phenomenological approaches and Interpretative Phenomenological Analysis

Body Dysmorphic Disorder (Body Dysmorphia; BDD) is a debilitating mental health condition characterised by experiencing impairing preoccupations with one or more perceived defects in one’s physical appearance. BDD affects approximately 2% of the general population but has a suicidal ideation rate of 80%. BDD is under-researched, and the majority of research published on the disorder focuses on risk factors, comorbidities and interventions, meaning there is very little understanding of the personal and idiographic experiences of those living with it. This research took a qualitative, phenomenological approach to explore the disorder using Interpretative Phenomenological Analysis (IPA; Smith, 1996) and multimodal hermeneutic phenomenological approaches in order to offer participants an array of modes in which they could make sense of their experiences of BDD. In a hermeneutic-autoethnographic piece, I explored my own BDD experience regarding difficulties with experiencing childhood appearance-related bullying, race-related bullying, rejection, and psychological abuse. In a study exploring people’s self-identified origins of BDD, some of the key themes generated from participant data included experiencing a sense of entrapment with a distorted view of the world; being a prisoner in one’s own skin; having an exposed and vulnerable relational self; experiencing loss and ‘stolenness’. Additionally, I explored the psychological process of coping with BDD, through artwork and semi-structured interviews. Participants highlighted the fusion between BDD and their lifeworld; attempting to detach from their perceived selves; experiencing a fragmented self, and moving towards a reconciliation of the self and body. The research findings in this thesis demonstrate that using qualitative and creative methods can help to gain a deeper understanding of what it is like to live with BDD from the perspective of those who experience it. My research indicates that professionals should consider individuals’ perceived BDD origins in treatment, implement peer-to-peer support and explore the embodied experience of the disorder

Creative phenomenology within health and social care research: bridging the gap between experience and expression

Phenomenology focuses on how we experience and interact with phenomena in the world. Phenomenologically inspired methods have long been applied to the study of health and care as a human science. However, generating the kinds of rich, experience-near data that supports the phenomenological project requires careful and considerate methods which attend to the needs of the research population. Presenting and discussing examples of our empirical work, we demonstrate compatibility and complementarity between a phenomenological methodology and creative methods of data generation. Participant creations of written descriptions, art, photovoice and relational mapping are explored. Covering topics such as men’s experiences of migraine, coping with body dysmorphic disorder, living with ‘unseen’ health conditions and parenting young people with intellectual disabilities, we demonstrate how the quality of the data collected is improved through the integration of creative methods of data collection in qualitative psychological research. Through giving the platform and freedom for participants to express themselves beyond spoken words, we argue that these methods shift the power balance of the typical researcher-participant dynamic. Data created through creative methods has the potential to reach, and resonate with, wider audiences; moving ‘beyond’ traditional approaches to generating data becomes a means of enacting material change