Fig. 1

Diagram depicting how the acute experiences of depression and anxiety, problems with cognition and effects of the illness on the brain and body within AN are interlinked. These acute experiences directly contribute to the conflict between accommodating AN, in terms of daily life, and developing a non-AN identity, which may ameliorate some of the acute cognitive and affective difficulties. The development of a non-AN identity, in contrast to accommodating to AN, may lead to recovery and liberation (represented by the dashed green arrow). This in turn improves optimism for the future, which sustains recovery (represented by the bidirectional dashed amber arrow). On the other hand, accommodating to AN led to positive views of the future, albeit these perceptions were biased towards AN (represented by the non-dashed green arrow). People acutely unwell with AN were able to see recovery as liberation, leading to a positive future. However, the inability to perceive a future with AN obstructed thoughts of recovery (represented by the single-sided amber arrow), leading to feelings of stuckness and hopelessness. Double-sided arrows represent a bidirectional relationship whereas single-sided arrows represent a potentially causative pathway. Created with biorender.com