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 A PHENOMENOLOGICAL STUDY OF SELF-LOVE

IN WOMEN’S EXPERIENCES HEALING FROM BULIMIA

Sheila Deyette Orbanic, Ph.D.

University o f Connecticut, 2001

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This research was a phenomenological study of self-love in women’s
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experiences healing from bulimia. Feminist research methodology, interpretive

phenomenology and existential-holistic nursing perspectives guided the inquiry.

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Eight women (mean age = 29.8 years) who reported that self-love is an aspect of

their experiences healing from bulimia participated individually in 2 audiotaped

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research dialogues. Data consisted o f the 16 transcribed dialogues, participants'

written summaries of self-love in healing, and participants’ selections of music,

artwork and prose. Van Manen’s method for thematic analysis, Drew’s method

for the development and use o f a researcher’s synthesis of intentionality, and

phenomenological writing as method were used to analyze data.

Three major themes were identified 1) The Happening-Realizing o f Self-

love in Healing; 2) Discovering Self-love through Transformative Life

Experiences; and 3) The Feeling-Being o f Self-love in Healing. Theme #1

involved two sub-themes: (a) realizing one’s holistic self, and (b) awakening to

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 Sheila Deyette Orbanic— University o f Connecticut, 2001

one’s spirit. Theme #2 involved 4 sub-themes: (a) journaling, (b) leaving home or

going away to college, (c) engaging in therapy, and (d) experiencing critical,

abusive, or nurturing relationships. The last major theme comprised 3 sub-themes:

(a) empowered freedom, (b) authenticity-strength, and (c) peace-harmony-joy.

Self-love was understood as a dynamic, holistic phenomenon of healing,

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authenticity and existential human being. Self-love in healing was an experience

of enduring self-acceptance, perseverance and fully, freely participating in being.

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Self-love in healing was described as a feeling and awareness that involved

meaningful and poignant self-realizations. These realizations were accompanied

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by visceral sensations and emotions that as a gestalt, created a peaceful,

empowering transcendent experience. Self-love may be considered a tangible

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conduit to the soul. Findings were congruent with existential holistic perspectives

of human being, healing, self-transcendence, expanding consciousness,

authenticity, and spirituality. Implications for nursing concern self-love as a

philosophy for holistic practice, particularly for self-awareness, personal knowing

and therapeutic use o f self. Further study and research will contribute to the

refinement of these basic ideas, and to the development o f a fully matured model

o f self-love as healing energy.

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 A PHENOMENOLOGICAL STUDY OF SELF-LOVE

IN WOMEN’S EXPERIENCES HEALING FROM BULIMIA

Sheila Deyette Orbanic, Ph.D.

A.D.N., Quinnipiac University, 1986

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B.A., Quinnipiac University, 1989

M.S., St. Joseph College, 1996

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A Dissertation

Submitted in Partial Fulfillment of the

Requirements for the Degree of

Doctor o f Philosophy

at the

University of Connecticut

2001

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 UMI Number: 3004850

Copyright 2001 by
Orbanic, Sheila Deyette

All rights reserved.

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___ ®
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UMI
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All rights reserved. This microform edition is protected against
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 Copyright by

Sheila Deyette Orbanic

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2001

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 APPROVAL PAGE

Doctor of Philosophy Dissertation

A PHENOMENOLOGICAL STUDY OF SELF-LOVE IN

WOMEN’S EXPERIENCES HEALING FROM BULIMIA

Presented by

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Sheila Deyette Orbanic, Ph.D.
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Major Advisor
Peggy Chinn

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Associate Advisor
:y Di
Nancy %
Drew

Associate Advisor
Carol Polifroni

University of Connecticut

2001

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 DEDICATION

To Leona Ruel Deyette with infinite gratitude, respect and admiration:

Though we have each lived, learned and loved in our own unique ways...

I feel that through this experience we have healed together. I love you. Mom.

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 ACKNOWLEDGMENTS

This page is perhaps the most difficult one to write. It marks the end of the

dissertation and my doctoral studies—a process and experience, which has shaped my

life by generating new purpose, meaning and the confidence to be who I am today, and

envision who I may become. In many respects, engaging in doctoral study served as a

methodological framework, which not only advanced my knowledge o f nursing, but it

also supported my evolving personhood. My professors were master craftswomen o f this

methodological framework... opening and encouraging mutual dialogue, posing thought-

provoking questions, pointing out both classic and contemporary literature, and lifting

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weary spirits with their patience, comforting touch, perseverance and wisdom.

During these four years I did not just leam about concepts such as holism,
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feminism, authenticity, the patterns of knowing and theories of human being and

becoming, in many respects I lived them—that is how I know their meaning. The
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dissertation and my doctoral studies as a whole provided a phenomenological context for

what was an unparalleled experience of expanding consciousness. 1 am both enlightened

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and humbled by this process, and I will be interminably grateful to the women— my

professors—who through their professional and personal example made this possible.

The women I speak o f with such sincere gratitude, admiration and respect are Drs.

Peggy Chinn, Carol Polifroni, Nancy Drew, Cheryl Beck and Henrietta Bemal. Thank

you for being the individuals you are—knowledgeable, visionary, compassionate,

empowered, dedicated, and committed to your students and to nursing. These special

thoughts go to the members of my advisory committee: Peggy, you have taught the

beauty, meaning and purpose of aesthetics in nursing, of peace and power, and what it

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 means to live with a feminist consciousness. You never dissuaded me from pursuing what

I was passionate about, and you never let me think that I could not complete the

dissertation within the relatively brief period of time I had given myself. I will always be

especially fond of this affirmation you voiced in class one spring day in 1998:“I trust that

I know what I need to know and I am who I need to be today. I trust in the process.” I

repeat that affirmation often and have shared it with other women in my life and practice.

Carol Polifroni, when I think o f you I am reminded of the accountability,

responsibility and fortitude nursing scholarship requires, and how truly important it is to

“question the assumptions” that we have built our practice and knowledge upon. Carol I

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also recall that very emotional and fretful semester when I questioned who I was,

including my priorities about doctoral education, my commitments to family, and my

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practice. You listened to me, hugged me, and gave me the time and the room to discover

a new balance in my life, and for that too, I am grateful.

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Nancy Drew, over the years you have shared in, walked alongside and guided me

through this most recent leg of my academic and personal journey since the 1990s when
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we first met at St. Joseph College. You were then, and you remain a strong, warm and

inspirational presence in my life. You introduced me to phenomenology as philosophy

and method, and to psychodrama as a personal and professional therapeutic tool useful

for facilitating self-awareness and healing. Thank you Nancy for your insight, guidance

and patience, particularly during data analysis! Thank you Nancy, for always

understanding and believing in me.

Now 1 shift the focus to my family...my accomplishments were not achieved

without the tireless efforts, patience, support and love of my family. I speak o f Shawn,

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 my beloved husband of 14 years; my cherished and loved parents, Ronald and Leona

Deyette; and my precious son, Zachary, who is now seven. Through these years, which

have been marked by considerable triumphs and tribulations, exhaustion, exhilaration and

tears, each one of you have been there when I needed you...and even when I did not

know that I needed you! All of you, Mom, Shawn, Dad and Zachary were there in so

many unique and meaningful ways— I thank and love you all.

In closing I would also like to acknowledge one other person who has been and

remains so very meaningful to me, and that person is you, Carol Daisy. You are my

friend and my teacher. You were there at all hours and on any given day...you smiled at

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me, laughed at me, frowned at me, listened to me, let me hug you when I needed to, and

teased me incessantly afterwards. I will always think o f you fondly...you too, made this
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journey possible, and I thank you.
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 TABLE OF CONTENTS

CHAPTER 1....................................................................................................................1

Focus and C ontex t of the I n q u i r y .................................................................................I

Aim of the Study and Research Q uestion...........................................................1

Inception and Motivation for the Study..............................................................2

Background and Significance.............................................................................. 4

Self-love: Origins of the Dominant Western View........................................4

Bulimia...............................................................................................................5

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Self-love in Healing and Bulimia Recovery...................................................8
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Conceptual Meaning of Key Term s...................................................................10

Method of Inquiry and Researcher Perspective................................................ 12

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Personal Assumptions.....................................................................................14

Significance and Relevance for Nursing........................................................... 15

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Summary and C onclusion.................................................................................. 15

CHAPTER I I .................................................................................................................17

L iterature R eview ................................................................................................17

Distinguishing Between Conflicting Connotations of Self-love.................... 17

Self-love Understood as Narcissism and Selfishness................................. 20

Self-love Understood in the Context of Existential Human Being, Healing

and Well-being.................................................................................................25

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 Distinguishing Self-love from Self-esteem, Positive Self-Regard

and Self-w orth.................................................................................................29

Research on Self-love.........................................................................................32

Self-love in Healing and Bulimia Recovery..................................................... 40

Research on Bulimia R ecovery......................................................................... 41

C onclusions......................................................................................................... 46

CHAPTER III............................................................................................................... 47

P hilosophical and E xperiential C ontext of the Study ............................ 47

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Origins of the Study............................................................................................ 48

Understanding How the Phenomenon Drove the Research Methodology....5 1

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Phenomenology...................................................................................................54
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Interpretive Phenomenology.......................................................................... 57

The Heideggerian View of Person as it Relates to Self-love in Healing ..63

A Lifeworld Paradigm for Nursing Research...................................................66

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Feminist Methodological Perspectives in R esearch........................................69

Sum m ary..............................................................................................................71

CHAPTER r v ..............................................................................................................73

M ethod of Inquiry ............................................................................................... 73

General Methodological Framework Applied to This Study......................... 73

Management of the Researcher’s Experience as Data in this Study 75

Procedures............................................................................................................78

Protection and Recruitment of Study Participants...................................... 78

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 Description of Participants............................................................................. 81

Data Collection................................................................................................ 82

Conducting the Research D ialogues............................................................. 85

Data Analysis...................................................................

Phase One Analysis......................................................................................... 93

Phase Two A nalysis........................................................................................ 97

Phase Three A nalysis.................................................................................... 106

Soundness and Integrity of the S tu d y..............................................................108

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Conclusion...........................................................................................................112

CHAPTER V ...............................................................................................................114
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F indings: U nderstanding S elf-Love in H ealing .........................................114
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The Study Participants.................................................................................. 114

Major Thematic Categories...............................................................................118

The Happening-Realizing of Self-Love in Healing................................... 119

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Discovering Self-Love in Healing through Transformative Life

Experiences..................................................................................................... 127

The Feeling-Being of Self-love in H ealing................................................ 155

Summary of Findings.........................................................................................167

CHAPTER V I .............................................................................................................169

Discussion: S elf-Love as H ealing E n er g y ...................................................169

Limitations of the Study.................................................................................... 171

Reflections on the Research Journey...............................................................173

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 Discussion of the Findings in Relation to the Literature...............................176

Research on Self-Love..................................................................................176

Self-love as Healing Energy in the Context of Nursing Literature.......... 179

The Findings Compared with Other Health Science and Humanities

Literature........................................................................................................ 187

Implications for N ursing................................................................................... 195

Nursing Practice............................................................................................. 195

Nursing Education..........................................................................................197

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Nursing Research...........................................................................................198

Implications of this Study for Women Healing from Bulimia......................199

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Participant’s Reflections on Their Experiences of the Study........................200

My Reflections on the Study............................................................................201

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Conclusions........................................................................................................202

Toward a Model o f Self-love as Healing Energy......................................204

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REFERENCES........................................................................................................... 206

APPENDIX A ............................................................................................................ 219

DSM-IV C r it e r ia for B u l im ia N e r v o s a (1994)............................................219

APPENDIX B ............................................................................................................ 220

U se of H u m a n S u b je c t s R e v ie w F o r m ............................................................ 220

APPENDIX C ............................................................................................................ 221

L etter o f In t r o d u c t io n t o C o l l e a g u e s ........................................................221

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 APPENDIX D ............................................................................................................ 223

D e s c r ip t io n of the S t u d y ............................................................................................... 223

APPENDIX E ............................................................................................................. 225

L etter to P o t e n t ia l P a r t ic ip a n t s ............................................................................. 225

APPENDIX F ............................................................................................................. 228

C o n s e n t T o P a r t ic ip a n t in S t u d y F o r m ................................................................. 228

APPENDIX G ............................................................................................................ 230

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P a r t ic ip a n t D a t a S h e e t .....................................................................................230
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APPENDIX H ............................................................................................................ 232
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T h e F e e l in g -B ein g of S elf- lo ve in H e a l in g ......................................................... 232

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 CHAPTER I

Focus and Context of the Inquiry

The focus of this dissertation was to understand women’s experiences of self-love

in healing from bulimia. Self-love was defined at the outset of the study as self­

acceptance, valuing self and an unconditional positive regard toward self. This chapter

includes the aim and motivation for the study, an introduction to the research

phenomenon, which is self-love in healing, and a summary of the literature concerning

women’s experiences of bulimia recovery. This chapter also includes conceptual

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definitions pertinent to the study. Consistent with both feminist and interpretive

phenomenological methodology, personal assumptions and perspectives about the

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research phenomenon are documented. The significance of this study for nursing is

outlined and the chapter concludes with a summary.

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Aim o f the Study and Research Question

The aim of this study was to explore and understand women’s experiences of self-
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love in healing from bulimia. The phenomenon of interest was self-love in healing as

experienced by women who report recovery from bulimia. The research question

addressed by the inquiry is “W hat are women’s experiences o f self-love in healing from

bulimia?” Eight women, who reported that self-love was an aspect of their experience

while recovering from bulimia, participated individually in two research dialogues, which

were conducted with a feminist consciousness and using an interpretive

phenomenological research paradigm. Participants had the option of using expressive

media, such as music, artwork, and prose, to convey their experiences o f the research

phenomenon. Van Manen’s (1990) and Drew’s (2001) interpretive methods for

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conducting phenomenological inquiry were combined to provide a framework to analyze

data. Data consisted o f transcribed audiotaped recordings, participants’ written

summaries of self-love in healing, and artwork, music and prose selected by participants.

Consistent with feminist research perspectives and Drew’s (2001) phenomenological

method, my pre-understandings and experiences of the research phenomenon were

considered data for analysis.

Inception and Motivation for the Study

This inquiry developed in response to a dilemma experienced by women trying to

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heal from bulimia, women with whom I have worked during eight years o f advanced

nursing practice as a psychotherapist and eating disorders specialist. The dilemma

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concerns the anguish and difficulty women experience when faced with the notion of

experiencing, knowing, or loving themselves. In practice, women living bulimia

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expressed how utterly disconnected they felt from themselves. Women experienced a

powerful opposition to the notion o f loving themselves despite their ardent desire for
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inner peace, happiness and recovery. Women described feeling perplexed and expressed

their bewilderment when they realized that they could not feel a love toward self. Many

women had trouble even considering the possibility of self-love despite their insistence

that they deeply loved other people, just not themselves. In order to help women help

themselves, I needed to further what I understood of self-love in healing, hence, the

inception o f this study.

Research focused on elucidating a recovering bulimic woman’s experience o f her

emotions, her inner being, spirituality or self-transcendence was not located. Through

professional practice and personal life experience, I came to believe that deeply personal

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and meaningful experiential phenomena fueled, supported and characterized women’s

healing journey. Autobiographical and self-help literature concerning eating disorders

recovery support this professional and personal observation; that healing from bulimia

takes place on multiple levels of human perception and experiential sensations. Healing

from bulimia encompasses the entire way a woman feels about, envisions, cares for and

identifies with her genuine, holistic self. Based on my experience as a psychotherapist

specializing in the treatment of women with eating disorders, I have observed the

following healing pattern concerning women’s recovery from eating disorders. As a

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recovering woman becomes more fully aware o f and in tune with her existential being,

she begins to value that sense of wholeness, well being and peace. As these perceptions,
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emotions and transformative experiences of self are realized and appreciated more fully,

the woman is motivated to live her life in ways that facilitate health, well being and
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recovery from bulimia. Self-love appears to be at least one significant aspect of women’s

transformative healing experiences but so little was understood about ontological self-
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love and more specifically women’s experiences of coming to know self-love in healing

from bulimia.

For example, where does healing energy come from? How is healing energy

replenished and from what source? These two questions both intrigued and concerned me

because women living bulimia, as I did for six years, perceive very little or no energy to

draw from. Based on my experiences in clinical practice, I posited that personal healing

energy might reside in the multi-dimensional and dynamic being of self-love. I believe

that for some women, healing from bulimia may lie less in the hands of science than it

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does in a woman’s capacity and willingness to love self sincerely, deeply, wholly,

responsibly and unconditionally.

The vast majority of research on bulimia recovery has focused on identifying

medical interventions and treatment modalities that reduce symptoms and change

thinking patterns. There has been very little scholarly attention given to research designed

to understand what subtle and remarkable phenomena transpire at the deepest levels of

women’s emotional psyche and existential being. I posit self-love as a phenomenon of

this magnitude, one that may reside at both the core and apex of healing and well being.

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Background and Significance

The background and significance of this study is presented in terms of the origins
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of the dominant Western view of self-love, the nature and prevalence of bulimia, the lack

of knowledge on self-love as a phenomenon of healing, and the absence o f research on

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women’s experiences of self or self-love in the process of healing from bulimia.

Self-love: Origins of the Dominant Western View

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In present day Western society self-love remains a controversial concept stirring

at the very least mixed emotions, and at worst strong reactions from individuals who

consider self-love synonymous with narcissism, self-centeredness and selfishness (Myss,

1997; Gilligan, S. 1997; Fromm, 1956; Magno, 2000). Two factors, which have

contributed to this prevailing or dominant view of self-love, are the perspectives of the

ancient Greeks and the development o f Judeo-Christian ideology, both o f which have

shaped traditional Western medicine and psychology. Plato (428-348 BCE) for example,

admonished self-love and considered that the majority o f the human race were innately

selfish (Magno, 2000). St. Augustine (354-430 CE) spoke of the virtues o f selfless love

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where all love that was noble and pure was that kind, which was felt toward another or

given to others. Selfless love and self-love were considered polar opposites— “a view that

dominates the hearts and minds o f men and women to his very day” (Magno, 2000, p. x).

Judeo-Christian ideology implies that to focus on ourselves as human beings is to lose

sight of God, and to love ourselves in effect diverts love from God, who is considered the

ultimate source of all that is good and loving. In Chapter II- Literature Review the Judeo-

Christian perspective is discussed further and evidenced that there are some

contemporary Christian authors whom dispute longstanding biblical views that self-love

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is synonymous with selfishness and an affront to God is also presented.

B u lim ia
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As many as 10% of females in the United States and an estimated 25% of college-

aged women (Harvard Mental Health Letter, 1997) live a relentlessly self-destructive,
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self-perpetuating illness called bulimia nervosa. Bulimia nervosa is characterized by

cyclical patterns of bingeing and purging inordinate quantities of food to lose or manage
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body weight. Purging most commonly involves self-induced vomiting, but it can also

include laxative, stimulant (ephedrine, caffeine, MaHuang Extract) and diuretic abuse, as

well as excessive exercising all in order to achieve weight loss or low weight

management. Lifetime prevalence o f bulimia nervosa among women ranges from 1.1% to

4.2% and the prevalence among children and adolescents is unknown (American Journal

of Psychiatry [AJP], 2000, p. 7). Bulimia affects 1-3% of middle and high school age

girls and 1-4% of college age women (Eating Disorders Awareness Prevention [EDAP],

2000). Ninety percent of bulimic individuals are female, the average duration o f illness is

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3 to 5 years (Costin, 1997), and prognoses for full recovery range from 40 to 50% (Keel

& Mitchell, 1997) over five to 15 years.

Bulimia nervosa is an eating disorder that shares characteristics common to

anorexia nervosa, binge eating disorder and obsessive compulsive disorder (Academy for

Eating Disorders [AED], 1998; AJP, 2000). Bulimia nervosa is most commonly

associated with eating large quantities of food and self-inducing vomiting to minimize

calorie absorption and subsequent weight gain. People suffering from bulimia may also

use laxatives, diuretics, enemas, excessive exercise, enemas or syrup o f ipecac to rid the

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body of calories and facilitate weight loss. There are also people who exhibit

“combinations of eating disorder symptoms that cannot be strictly categorized as either

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anorexia nervosa or bulimia nervosa” (AJP, 2000, p. 3). In addition to bingeing and

purging activities, people with bulimia nervosa often experience “depressive, anxious,
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and impulsive symptoms as well as sexual conflicts, disturbances with intimacy” (AJP,

2000, p. 3) and engage in self-mutilation (Levenkron, 2000). The American Psychiatric

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Association (AJP, 2000) describes bulimia nervosa as a “dissociated self-state, as

resulting from deficits in self-regulation and impulse control, and as representing

resentful, angry attacks on one’s own body out of masochistic/sadistic needs” (p. 7).

Recovery from bulimia presents a number of difficult challenges to both patients and

healthcare professionals. Traditional and current treatment modalities, therapeutic

approaches and treatment interventions are not sufficiently developed or understood to

produce consistent, strong, positive outcomes.

Bulimia nervosa is also a significant socio-cultural problem tied to the sex-class

oppression of women (Maine, 2000; Shillito, 1993). Eating disorders, including bulimia

R e p r o d u c e d with p e r m is s io n of t h e cop y rig h t o w n e r. F u r th e r r e p r o d u c tio n prohibited w ith o u t p e r m is s io n .

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nervosa are fueled in part by the popular media’s emphasis on youthful appearance,

aesthetic beauty, muscle-toned physiques, and with regard to women in particular,

unnaturally low body weight (Streigel-Moore, Silberstein & Roden, 1986). In the United

States a male dominated media floods contemporary society with images of extremely

thin, scantily-clad females striving to be noticed by physically fit, attractive men.

Impressionable youth, both male and female, are inundated with images of beautiful,

young, happy and thin people in magazines, music videos, film and other electronic

media. The degree to which an adolescent female believes that being fat is bad and that

W
being thin is good, the more at risk she will be to developing an eating disorder (Streigel-

Moore, Silberstein & Roden, 1986). It is notable that in order to preserve the desired
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muscular physique that is desirable for male modeling careers, men must eat healthy

balanced meals, exercise and get adequate rest. However, many female models must
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starve themselves to acquire and maintain the desired waif-like appearance. The

nutritional habits of female models sacrifice critically important nutrients, muscle mass,
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and bone density. Feminist perspectives on eating disorders (Fallon, Katzman & Wooley,

1994; Orbach, 1978; Steiner-Adair, 1986; Gilligan, 1982; Chemin, 1985) have begun to

explicate the complex relationships, which exist among women, disordered eating

patterns, female psychological development, family dynamics, and sociocultural factors.

Recovering from bulimia is a tenuous, prolonged process marked by frequent

relapses and often necessitating intensive outpatient, partial or inpatient hospitalization to

adequately address medical consequences and symptoms, and to treat co-morbid illness,

specifically mood disorders (Keel, Mitchell, Miller, Davis & Crow, 1999). While

psychotropic medications and various types of psychotherapeutic interventions have

R e p r o d u c e d with p e r m i s s io n of t h e co p y rig h t o w n er. F u r th e r r e p r o d u c tio n prohibited w ith o u t p e r m is s io n .