Interpersonal wounds and identity among people with anorexia nervosa: A qualitative content analysis of autobiographical memories elicited by disgust-related cues

Background: Research on autobiographical memory (AM) in anorexia nervosa (AN) has largely focused on quantitative aspects such as specificity, while qualitative investigations of thematic patterns remain limited. This study aimed to compare the content of cued AMs between individuals with AN and healthy controls (HCs) using a qualitative approach. Methods: Sixty-three adults (AN = 43; HC = 20) completed a computerised written version of the Autobiographical Memory Test, generating memories in response to six-self- or moral-disgust-related cue-words. A total of 189 AMs (AN = 129; HC = 60) were coded using a conventional qualitative content analysis. Results: Twelve codes were constructed from the data, two of which were excluded from theme development. Three overarching themes were identified: 1) relational wounds – the role of others, 2) relational vigilance, and 3) identity disturbance. AMs reflecting iatrogenic harm, body mistrust, betrayal, impact of interpersonal experiences, moral self-evaluation, shame, and feelings of wrongness or being different were unique to, or more frequent in, the AN group than HCs. Across themes, individuals with AN exhibited more intense, enduring, and unresolved relational and self-related difficulties, whereas HCs described similar experiences in a more situational, flexible, and adaptive manner. Conclusions: A qualitative exploration of the content of cued AMs from people with AN is a novel approach to understanding its phenomenology. In this study, interpersonal and self-related mistrust were prominent features of AMs in people with AN. Understanding these qualitative differences in AM content may inform interventions aimed at restoring relational trust and self-acceptance.