Table 3 Additional quotes on an externalizing approach

Positive experiences of an externalizing approach

Interviewer: “Did separating these two sides help you?”

Participant F: “It feels okay to be able to say ‘Oh, that was my eating disorder.’ Or ‘that was truly the healthy side of me.’ I now know how to distinguish the two.”

“I really need other people to help me. They have to point it [the AN] out to me, because I have lost all track of my thoughts.”—Participant L

Ambivalence towards an externalizing approach

Participant K: Within treatment, they actually place the eating disorder in a chair, they really try to show that it’s something separate. And then they will point at the chair and say “that’s the one that is speaking now,” so they do really try to externalize it

Interviewer: What’s that like for you?

Participant K: In the short run, difficult. But if I’m motivated, then it’s fine, because then I know ‘it’s not me that’s wrong’ … They try to communicate it as clearly as possible, but sometimes I do still feel criticized as a person.”

Experiences of being dismissed as a person

“Some people say ‘I am not mad at you, but at your eating disorder, and I think that how you behave because of your eating disorder is unacceptable,’ whereas with other people I just have the feeling that they get angry with me … Then it feels as if they are attacking me as a person. Then I’ll think ‘Oh, they really do hate me’ “—Participant A

Experiences of distrust and wrongful accusation

“In all kinds of things he [participant’s father] saw something that originated from the eating disorder, even though that was not always the case. It felt as if I was wrongly accused of something.”—Participant J

“At a certain point it was the case that everything I said that wasn’t to their [participant’s parents] liking, was attributed to the eating disorder, while there were indeed things that I, myself, genuinely wanted or did not want. … I remember sometimes thinking ‘But this is just unfair’.”—Participant M