“It’s complicated”: Carer perspectives on causes of eating disorders in family members.

Objective: This qualitative study investigated perspectives on causes of eating disorders as experienced by those caring for affected individuals with an eating disorder in New Zealand. Method: Participants were nine carers of affected individuals, recruited from an online survey, who consented to semi-structured qualitative interviews. Inductive thematic analysis was undertaken to identify themes from the data. Results: : The overall theme informed by the data was ‘It’s complicated’, reflecting carer perspectives that eating disorder causes were complex and multifactorial. This theme was supported by sub-themes of; ‘it’s like Swiss cheese’; ‘it came out of the blue’ and ‘in hindsight maybe…’. Most participants indicated potential eating disorder causes had not been formally explored with treatment teams, although carers had reflected on possible causality across the treatment journey. Conclusion: All participants expressed uncertainty when reflecting on what factor(s) may have caused an eating disorder in their family member. Participants reflected that causes were likely a complex combination of environmental, social, psychological and biological influences. Future research would benefit from data analysis of dyads of carers and affected individuals who identify significant recovery from the eating disorder, in order to reflect back upon possible causes without the demands of treatment or continuing eating disorder symptomatology.