“Without this part, it’s hard to truly recover”: adults’ experiences of body compassion in eating disorder recovery—a reflexive thematic analysis

Abstract

Background

Eating disorder recovery can be complex, with high relapse rates despite various therapeutic approaches. Recent research suggests body compassion may play a protective role in recovery, but studies remain limited. This study aims to explore adults' experiences of body compassion in their eating disorder recovery journey.

Methods

Ten adults aged between 19 and 49, self-identified as recovered or ‘in recovery’ from anorexia nervosa, bulimia nervosa, and/or binge eating disorder, and who had received therapeutic support, participated in online semi-structured interviews. Following ethical approval, data were analysed using Reflexive Thematic Analysis (RTA).

Analysis

Participants described body compassion’s development as a dynamic process captured through five interrelated themes: Foundation, Confusion, Growth, Reconnection, and Resistance. Foundation highlights body compassion’s central role in sustaining recovery. Confusion reflects its initially elusive nature. Growth covers factors and practices supporting its development. Reconnection describes a new relationship with the body through caring actions. Resistance represents a shift toward challenging internalized ideals and societal pressures. These themes inform a tentative model outlining body compassion’s role and progression in recovery.

Conclusion

This research frames body compassion as a dynamic, reparative force supporting a more holistic, inclusive, and compassionate approach to eating disorder recovery. These findings highlight the need for person-centred treatment models viewing the body as a site of healing, not just symptom management. Clinicians should integrate clear definitions and targeted body compassion practices while addressing broader sociocultural influences, including social media.

Plain language summary

Recovering from an eating disorder is often challenging, with many people experiencing relapse even after treatment. This study explored how body compassion—treating one’s body with kindness and acceptance—can support recovery. Through interviews with ten adults recovered or recovering from anorexia, bulimia, or binge eating disorder, we found that body compassion developed gradually over time. Participants described a journey with five key stages: body compassion as a foundation for recovery; feeling initial confusion about what body compassion meant; experiencing growth through supportive practices, people and therapies; reconnecting with the body in a more caring way; and ultimately resisting harmful societal pressures about appearance. Therapies that focused on compassion and trauma-informed approaches were particularly helpful, along with support from others and alignment with personal values. As participants became more compassionate toward their bodies, they shifted from self-criticism to body acceptance and neutrality—neither loving nor hating their bodies. The study highlights the importance of including trauma-informed care in treatment and calls for a broader focus that addresses societal norms prioritising thinness and appearance-based validation, particularly in social media contexts. Overall, body compassion emerged as a powerful and transformative part of recovery, offering a more hopeful and inclusive path to healing.

Background

Eating disorder recovery

Eating disorders are mental health conditions characterised by serious disturbances in eating behaviours and preoccupation with food, weight, and shape [71]. The most common eating disorders are binge eating disorder (BED), anorexia nervosa (AN) and bulimia nervosa (BN) [3]. Living with an eating disorder can negatively affect several aspects of an individual’s quality of life, including daily functioning, health, relationships, and sense of self [74]. Individuals with eating disorders often experience a disrupted relationship with their bodies, characterized by a sense of disconnection, estrangement, or alienation, which can exacerbate shame and maintain disordered behaviours [44]. The course of recovery varies widely and for a significant number of people, eating disorders can be lifelong and are related to high rates of morbidity and mortality [66].

The literature on eating disorder recovery has traditionally centred on symptom reduction, often operationalised through clinician assessments and self-report measures focused on symptom remission [24]. While such clinical outcomes are important, they may not fully capture the lived experience of recovery [22]. Recent research has called for a more comprehensive understanding that incorporates subjective dimensions of recovery as articulated by those with lived experience [74]. Qualitative findings suggest that factors such as self-compassion, positive interpersonal relationships, hope, identity, and purpose are integral to recovery, highlighting that recovery is not solely defined by the absence of clinical symptoms. In line with this, Kenny [41] emphasised the need to move beyond rigid, categorical recovery models. Participants in their study critiqued the application of fixed criteria, such as body mass index (BMI), arguing that these fail to account for the complexity, individuality, and non-linear nature of recovery [42, 70]. Instead, recovery was described by participants as a dynamic and evolving process that includes not only symptom reduction but also enhanced coping, identity beyond the disorder, and greater self-acceptance [41]. Therefore, the question of whether one is ‘recovered’ should be considered within the context of personal meaning and individual experience [74].

Current evidence-base

Even though, several therapeutic approaches have shown promise, Cognitive Behavioural Therapy (CBT) currently has the strongest evidence-base for the treatment of eating disorders in adults (National Institute for Health and Care Excellence [NICE], [54]). However, its effectiveness can be limited, with high relapse rates observed across diagnostic groups [4]. A recent meta-analysis by Sala et al., [63] reported relapse rates of approximately 40–50% for AN and 30% for BN and BED over a 10-year follow-up period.

These findings emphasise the need for further research aimed at enhancing treatment efficacy and understanding what supports the recovery processes. One promising direction involves addressing the emotional mechanisms underpinning eating disorders.

Self-compassion and eating disorders

Compassion-Focused Therapy (CFT), developed by Gilbert [29], was designed to assist individuals in managing difficult emotional experiences, particularly those related to shame and self-criticism [71]. The targeting of self-compassion has been considered a promising treatment direction [53] as eating disorders are frequently conceptualised as maladaptive strategies for regulating negative affect, such as shame [32, 45]. Gilbert [29] defines self-compassion as “a sensitivity to suffering in self and others with a commitment to try to alleviate and prevent it” (p. 13).

An extensive body of literature supports the relevance of compassion in the context of eating disorders [32, 53]. Empirical findings consistently show that individuals with eating disorders tend to exhibit lower levels of self-compassion when compared to non-clinical populations [62]. CFT-based interventions have been associated with improvements in body image and reductions in body related shame [40, 71]. Furthermore, self-compassion has been linked to increased positive affect and improvements in various dimensions of positive body image [10]. A number of studies indicate that self-compassion can buffer against risk factors for eating and body image concerns [57], Brain et al., 2016), prevent the emergence of such risk factors [71], and reduce the severity of existing eating disorder and body image pathology [72]. In addition, group-based CFT interventions have shown evidence in producing favourable outcomes that support recovery from eating disorders, such as fostering compassion toward oneself and others, while simultaneously reducing negative emotional states [40].

Given the documented benefits of self-compassion in the treatment and recovery from eating disorders, there is increasing interest in examining the specific role that body compassion (i.e., compassion directed toward the body), as opposed to general self-compassion, may play in facilitating recovery [57]. Self-compassion can be cultivated within therapeutic contexts, particularly through Compassion-Focused Therapy (CFT [30]), which develops skills of self-kindness, emotional regulation, and acceptance. Body compassion may be seen as a specific extension of these processes to experiences of the body. Within Gilbert’s [30] three flows of compassion model—compassion for self, for others, and from others—body compassion most directly reflects the self-directed flow, offering a targeted approach to the shame and disconnection often experienced in eating disorders. As the body is frequently the primary site of distress and control in these conditions [60, 76], clarifying how body compassion operates within recovery remains an important but underdeveloped area of inquiry.

Body compassion and eating disorders

Current recovery models emphasize the importance of reconnecting with the body as a site of agency, meaning, and identity [60]. In this context, body compassion may be central to restoring embodied self-awareness and trust.

Further, body image (i.e., an individual’s perceptions, thoughts, and feelings about their body, encompassing evaluative, affective, and behavioural dimensions [17] plays a central role in the onset and maintenance of eating disorders with body dissatisfaction linked to greater illness severity and poorer recovery outcomes [51]. Promoting a positive body image is therefore an important aspect of recovery.

Compassion-based constructs, such as self- and body compassion, may support this process by fostering kindness toward the body, mindful awareness, and a sense of shared humanity, thereby buffering against body dissatisfaction and facilitating recovery.

In recent years, there has been growing scholarly interest in the emerging construct of body compassion [1]. Body compassion has only recently started to be explored and defined formally,thus, it can be often confused with concepts such as body image, self-care or body positivity [8]. However, this construct has been introduced as a conceptual bridge between self-compassion and body image [1]. Beadle et al. [8] have recently provided a comprehensive definition of body compassion, describing it as “compassion towards one’s own body,” comprising elements of kindness, common humanity, and mindful awareness. Furthermore, it includes sensitivity to bodily distress, suffering, and pain, along with the motivation and ability to alleviate such experiences “(p. 954).

The concept of body compassion first emerged as a thematic element in qualitative research across diverse populations, including individuals in yoga-based interventions [18], physically active paraplegic men [67], young women engaged in regular exercise [9] and postpartum women [75]. Some of these studies identified body compassion as a dynamic, evolving process closely associated with mindful awareness, cognitive restructuring, self-care practices, and the ability to process difficult emotions (e.g. [75]).

Although empirical research on body compassion within the context of eating disorders remains limited, preliminary quantitative findings suggest promising associations. Higher levels of body compassion have been linked to positive body image outcomes, such as increased body image flexibility (i.e., ability to openly experience thoughts or feelings about the body without acting on them or trying to change them; [2, 46]), as well as positive emotional states, including feelings of determination and inspiration [1]. Notably, Oliveira et al. [57] emphasized the adaptive qualities of body compassion, particularly its buffering effect on the relationship between shame and disturbances in body image and eating behaviours. Similarly, Barata-Santos et al. [7] found that body compassion moderated the impact of major life events on eating disorder symptoms, suggesting a protective role in psychological resilience. Importantly, Beadle et al. [8] demonstrated that body compassion, was found to be a unique predictor of eating pathology, whereas general self-compassion was not.

More recently, Burychka, Montilla and Rivera [14] have stressed the need for further research to delineate the role of body compassion in eating disorders. Oliveira et al. [57] also argued that understanding the protective functions of body compassion could significantly inform the development of intervention and prevention programs for eating disorders. Nevertheless, there remains a significant gap in the literature, as no qualitative studies to date have examined the lived experiences of adults around the role of body compassion in eating disorder recovery. Consequently, the patients' perspectives remain underrepresented in this field.

In summary, while self-compassion has demonstrated broad benefits across clinical populations, body compassion may offer a more targeted framework for addressing the unique bodily shame and disconnection experienced in eating disorders. This is particularly relevant given that the body is often the primary site of distress in these conditions [60]. However, theoretical clarity regarding how body compassion operates within recovery remains underdeveloped.

Aim and research question

Given the gaps in current research, this qualitative study aimed to explore adults’ experiences of the role of body compassion in the eating disorder recovery journey. Given the subjective, dynamic, and context-dependent nature of recovery and the limited understanding of how body compassion is lived and experienced, qualitative inquiry is well-suited to explore these nuanced processes [38].

The central research question guiding this inquiry is:

• What is the role of body compassion in eating disorder recovery?

To further investigate this overarching question, the following sub-questions were explored:

• How is body compassion conceptualized by individuals in recovery?

• What is the perceived importance of body compassion in recovery?

• When and how does body compassion develop during recovery?

• What factors facilitate the development of body compassion?

• How does body compassion manifest in practice?

Methods

Design

Given the aim of identifying broad patterns across a diverse participant group, a reflexive thematic analysis (RTA) was selected [11, 12]. RTA is an idiographic, interpretative approach that emphasises the researcher’s active role in theme construction, aligning with a social constructionist paradigm [16]. This method supported inductive analysis while enabling both semantic and latent themes to be developed. The analysis was conducted by the first author, who engaged reflexively throughout the process, recognising that their subjectivity and lived insights are an integral part of meaning making [12].

Recruitment

Purposive sampling was used to recruit participants online via United Kingdom (UK)based eating disorder charities, organisations, and social media platforms through a recruitment poster (see Appendix A). Eligible participants were UK residents aged 18 or above, of any gender, who had previously received a formal diagnosis of either anorexia nervosa (AN), bulimia nervosa (BN), and/or binge-eating disorder (BED). A transdiagnostic approach was adopted to capture shared psychological features across diagnoses, such as preoccupation with weight, shape, and their control, acknowledging diagnostic fluidity and supporting a more unified understanding of eating disorder psychopathology [25]. Inclusion criteria were that participants no longer met diagnostic thresholds, as indicated by a score of two or less on the SCOFF screening tool [52], see Appendix B) and self-identified as recovered or ‘in recovery’. A precise measure of recovery duration was not included because the concept of recovery can be highly individual and non-linear [43], allowing for a richer understanding of how body compassion develops across different recovery stages, which aligned with the flexibility and inclusivity of RTA [11]. Participants were also required to have engaged in prior psychological treatment, currently not meet diagnostic criteria or be undergoing treatment, to minimise the confounding effects of active psychopathology and reduce the ethical risks associated with involving acutely unwell individuals.

The sample size was informed by the depth of information needed to meaningfully explore the research question and aligned with the concept of information power [49], rather than aiming for data saturation. While additional recruitment efforts were made, the decision to conclude data collection after ten participants was based on the richness of the data and the development of coherent, nuanced themes that sufficiently addressed the study’s aims.

Participants

Ten participants, aged between 19 and 49, took part in the study. All identified as White British, with the majority identifying as female. All had a primary diagnosis of AN. However, four were later diagnosed with BN and one with BED. Duration of recovery ranged from three to twenty years. Participants had accessed ten different psychological treatments, and the treatment duration ranged from seven months to three years. Most self-identified as recovered, while four described themselves as currently ‘in recovery’. See participant demographic information below (Table 1).

Table 1.

Participant's Demographic Information

Participa nts (pseudonym)	Age	Gender	Ethnicity	ED (diagnosis)	ED length (years)	Treatments received	Overall treatment duration	Subjective recovery status
Sunflower	29	Female	White British	AN & BN	3	CBT-E & EMDR	1 year	Recovered
Ellie	24	Female	White British	AN	7	CBT-E & CFT	1 year	Recover ed
Max	26	Male	White British	AN	11	FT-AN, CBT-E CFT	7 month s	Recovered
Emma	32	Female	White British	AN	7	FTAN, CBT-E & ACT	3 years	Recovered
Lou	19	Female	White British	AN	5	Counselling, CFT & EMDR	1.5 years	Recovered
Sky	24	Female	White British	AN, BN	6	DBT & EMDR	1 year	Recovered
Matt	35	Male	White British	AN & BED	15	Support group	2 years	Inrecovery
Grace	49	Female	White British	AN & BN	20	CBT & Psychothe rapy	3 years	Inrecover y
Mary	20	Female	White British	AN & BN	5	CBT-E	1.5 years	Inrecovery
Anna	29	Female	White British	AN	10	FT-AN, MANTRA	2 years	Inrecovery

ED = Eating disorder, AN = Anorexia nervosa, BN = Bulimia nervosa, BED = Binge eating disorder, CBT-E = Enhanced cognitive behavioural therapy, FT-AN = Family therapy for anorexia nervosa, CFT = Compassion focused therapy, ACT = Acceptance and commitment therapy, EMDR = Eye movement desensitization and reprocessing therapy, DBT = Dialectical behavioural therapy (DBT), MANTRA = Maudsley model of anorexia nervosa treatment for adults

Data collection

A semi-structured interview schedule was developed (see Appendix C), informed by professional expertise, lived experience, key literature, and supervisory input. The interviews explored participants’ recovery journeys, with particular emphasis on their perceptions of body compassion: its’ development, trajectory, and relevance within the recovery process. In keeping with the principles of RTA, the interview schedule was used flexibly, allowing space for participants to guide the conversation and for new insights to emerge organically [11]. The interview schedule was also reviewed by an individual with lived experience of an eating disorder, who was recruited through a support organisation. They provided feedback on the clarity and sensitivity of the questions, which informed minor refinements to the final schedule. For participants who had difficulty conceptualising body compassion, the definition provided by Beadle et al. [8] was offered to support clarity and understanding. During interviews, participants were reminded of this definition where necessary to support consistent understanding.

Ethics

Ethical approval for this study was obtained from the University of Plymouth’s Research Ethics and Integrity Committee (Approval Number: 5017; see Appendix D). Prior to participation, all interviewees received detailed information about the study, including assurances of confidentiality, the informed consent process, and their rights to withdraw at any time or take breaks as needed. Given the potentially sensitive nature of the research topic, a distress protocol was developed to safeguard participant wellbeing. This included the option to pause or terminate interviews, offer immediate support, and conduct follow-up check-ins if necessary. After each interview, participants were debriefed and provided with information about relevant mental health resources. To ensure anonymity and comply with Data Protection Act [21], pseudonyms were used, all identifying information was removed from transcripts, and data were securely stored on the University’s OneDrive system.

Procedure

Eating disorder charities and organisations shared the study poster via their websites, newsletters, and social media. Interested individuals contacted the researcher by email and were invited to an initial online meeting to discuss the study, review the participant information sheet (see Appendix E), and ask questions. During this meeting, the SCOFF [52] was used to confirm the absence of current eating disorder symptoms. Participant rights were explained, and the consent form (see Appendix F) was signed electronically. A 48-h reflection period was provided before interviews were scheduled, with consent reconfirmed at the start of each interview. Interviews were conducted online via a secure platform (Microsoft Teams), lasting 60–90 min. With consent, interviews were audio-recorded and transcribed verbatim. After each session, participants were debriefed (see Appendix G), given mental health resources, and received a £20 voucher. They were also informed they may be contacted during analysis for theme clarification and could receive a summary of the final report.

Data analysis

Qualitative data were analysed using RTA following Braun and Clarke’s [11, 12] six-phase framework within an interpretivist paradigm. This approach acknowledges that the meanings participants attribute to their experiences are co-constructed and shaped by the researcher’s own experiences and knowledge [37]. Both inductive and deductive strategies informed the analysis [5]. While theoretical concepts guided the development of interview questions and shaped initial interpretative lenses, open coding was employed to prioritise participants’ perspectives over fitting responses to predefined theories. Data familiarisation involved repeatedly reading the transcripts, drawing on the first author’s role as both interviewer and transcriber, while noting initial observations such as recurring phrases, emotional tone, and emerging points of interest. Codes were generated at the level of meaningful units, and similar codes were clustered during the theme development phase. Themes and sub-themes were then reviewed, refined, and named to ensure coherence and analytic clarity. During analysis, descriptions reflecting the emotional and cognitive processes associated with body compassion (e.g., treating the body kindly in response to distress, recognising shared struggles, mindful awareness) were carefully differentiated from broader notions of body appreciation or self-care. Reflexive discussions were facilitated by reviewing transcript excerpts with research supervisors to enhance awareness of how different interpretative frameworks might influence theme construction. In addition, to enhance methodological rigour, the codes and themes generated during analysis were reviewed and verified by the second and third authors, ensuring that the coding was both consistent and reflective of the data, while remaining aligned with the social constructivist approach guiding the study. In addition, the lead author's positionality and prior knowledge were continuously reflected upon to promote transparency in the analysis process (see Researcher Reflexivity below). These ongoing reflective discussions and a clear audit trail aimed to uphold trustworthiness. Findings were presented by integrating analytic narrative with illustrative data extracts to address the research question. In line with RTA, themes were not treated as objectively verifiable but as interpretive constructs shaped through iterative reflection [13].

Researcher reflexivity

The first author’s (VA’s) research approach was shaped by an interpretivist and experiential stance, acknowledging that meaning is co-constructed and context-dependent [13]. While VA aimed to centre participants’ lived experiences, reflecting essentialist leanings at times, a constructionist orientation encouraged critical reflection on how sociocultural factors might have shaped their narratives. The analysis was primarily inductive, drawing on both semantic and latent meanings, with theoretical concepts informing rather than determining interpretation. As a white Greek trainee clinical psychologist with familial experience of eating disorders, it is acknowledged that VA’s personal history and cultural background inevitably shape how they engaged with the data. Growing up in a culture that places strong emphasis on specific beauty ideals, VA recognised that their experiences may not reflect those of the participants. While proximity to the topic can enable compassionate understanding, it also necessitates ongoing reflexivity to critically examine how assumptions may influence interpretation. To support this, VA engaged in regular supervision, kept a reflective journal, and took part in reflexive conversations.

Results

Themes and subthemes

Five overarching themes, each accompanied by corresponding subthemes numbered for clarity (e.g., 1a), were developed during the analysis (see Table 2 below).

Table 2.

Themes and subthemes

Themes	Subthemes
1. Foundation	(1a) “Without this part it’s hard to truly recover”
2. Confusion	(2a) “It’s hard to describe” (2b) “Trust the Process” (2c) “I don't know what comes first”
3. Growth	(2a) “Letting go” (2b) “Re-parenting the body” (2c) “I was surviving, but now I get to live”
	(2d) Receiving love and compassion
4. Re-connection	(3a) “Listen to the body” (3b) “Accept what you’ve been given” (3c) “I’m body neutral” (3d) Appreciate the body (3e) Compassionate noticing
5. Resistance	(5a) “You have to look this way to be accepted” (5b) “Rebelling”

Together, these five themes form the conceptual foundation for a tentative proposed model of body compassion’s development within the context of eating disorder recovery. The theoretical contributions and implications of this model will be explored in greater depth in the discussion section. For clarity and coherence, however, the themes are presented individually in the following section.

Moreover, before presenting the themes, it is important to acknowledge that some participants found it difficult to conceptualise body compassion. This may be due to the inherent complexity of the concept or variations in the therapeutic approaches they had experienced. To support understanding and consistency, participants who expressed uncertainty were offered a definition of body compassion, as outlined by Beadle et al. [8] and referenced in the introduction.

Theme 1. Foundation

A central theme for all participants was the emphasis on body compassion’s foundational role in the eating recovery process.

1a. “Without that part, it's very hard to truly recover”

Participants described body compassion as essential for achieving sustained recovery, emphasizing that without it, recovery might remain unattainable: “Becoming more compassionate towards my body is a big part of where I'm right now. So, I think without that part, it's very hard to truly recover… if you still hate and judge your body” (Max) and, “I needed to get there [body compassion] … to feel that I’ve fully recovered” (Emma).

Several participants reflected on the lack of support they received in this area during treatment. They expressed frustration that body-related issues were not adequately addressed by services, despite their efforts to communicate their significance: “I identified that I was never going to be able to fully recover until I was able to accept my body and be kind to it… I was constantly saying to them – “body image, body image, body image”—and it just wasn't happening, and I almost felt like it was being dismissed” (Anna).

However, others noted that difficulties with body compassion often persisted even after normalising eating behaviours, suggesting that this aspect of recovery may require targeted therapeutic attention: “I think body stuff are really hard. It feels so ingrained. Yes, I can eat properly, but am I ever going to feel better in my body? I think that is the bit that can often get stuck …. this was something missing during therapy” (Emma).

This theme captures participants’ perspectives on the foundational role of body compassion in achieving sustained recovery, while also highlighting their reflections on its frequent neglect within the therapeutic support they received.

Theme 2. Confusion

Another central theme was participants’ reflective accounts of their experiences navigating body compassion during recovery. Body compassion was seen as a confusing, inherently difficult to define or articulate concept. While viewed as vital to recovery, it was consistently described as an elusive, gradual process that was more evident in later stages of recovery.

2a. “It’s hard to describe”

Body compassion was perceived as a confusing concept that is hard to describe and articulate: “To be truthful, I don't really know how to describe it” (Mary). This may be a result of it being missing in the therapy they accessed: “It’s a bit confusing…I don’t really get it… I don’t remember learning about it in therapy” (Anna). In addition, some participants reflected that body compassion is often confused with other related concepts, such as self-care and body positivity, and that this conceptual ambiguity creates further confusion: “I’m not sure what it means…is it about self-care or loving your body?” (Mary).

However, those who had accessed compassion focused therapy (CFT) and who had a shorter illness duration, were able to describe it. They tended to do this in a visceral and behavioural way rather than a cognitive one: “Body compassion for me is giving your body what it wants in a way. Making sure you're resting it, you are eating what you want, and then it's also a sense of feeling good in your body so you're not sat there, like pointing out everything that you think is wrong with it” (Ellie).

In contrast, others focused on how it related to their changed relationship to their bodies: “Body compassion is living my life in a way that makes my body feel its best, regardless of what impact that might have on my appearance. It is about what does my body actually need to feel? What does my body need in this moment?” (Sunflower).

This subtheme reflects both a lack of conceptual clarity and the absence of body compassion as a formal focus in therapeutic settings, while also illustrating how certain therapeutic frameworks, such as CFT may facilitate its lived understanding.

2b. “Trust the process”

Participants talked about how developing body compassion is a process that takes time and is more noticeable at the end of the recovery: “For me body compassion took a long time…at least ten years. I have been struggling for a long time. I had to trust the process…I reached a point in the end where I thought that living life in an overweight body would be actually better than living life like this” (Anna).

It was further noted that this process is not linear and needs patience: “Be patient with yourself. I think becoming compassionate to your body is not going to be fixed overnight. It’s sort of gradual work in progress. It took at least six years or so…Sometimes you're going to feel like one step back or two steps back, one step forward. It's definitely not as easy as going from like A to B. It’s all about trusting time and at first, it'll feel really weird, but it gets easier" (Max).

This subtheme highlights body compassion as a dynamic, long-term process that required participants to trust in gradual progress which included setbacks.

2c. “I don't know what comes first”

The relationship between self-compassion and body compassion was discussed. Some viewed them as deeply interconnected and developing simultaneously whilst others considered body compassion to be an outcome of developing broader self-compassion:

For example, “I don't know what comes first. Personally, I think they’re the same. They very much come together for me. If I'm compassionate to my body, I’m also with myself and the opposite” (Max). In contrast: “I think if you can protect the mind and have compassion for yourself, your identity, your ego, so to speak, I think that matters greatly, because then you could look at whatever size you are and go, I'm OK with that. Body compassion I think is a byproduct of self-compassion" (Matt).

This subtheme highlights that while participants agreed on a connection between the two constructs, there was ambiguity regarding their sequencing and distinctiveness.

Theme 3. Growth

This theme captures participants' experiences on how body compassion grew and developed through therapeutic processes, including working through past trauma, learning to re-parent the body, receiving compassion from others, and reconnecting with core values.

3a. Letting go

Many participants described therapy as a key catalyst in growing body compassion. For some, this involved reprocessing trauma, particularly childhood experiences, through eye movement desensitisation and reprocessing therapy (EMDR), which helped them relinquish control over their bodies and internalised beliefs about worth and appearance: “It was only when I dealt my childhood trauma with EMDR, that I reached a point where I could then accept that I did not need to control my body anymore” (Sunflower). However, more than merely no longer needing to control their bodies, actively there was a sense of letting go: “I had internalized the view that there was something wrong with me and that I was unlovable because of my thighs… This need for control left and I was then able to just let go and be kinder to my body…EMDR saved me” (Sky).

Experiences with enhanced cognitive behavioural therapy (CBT-E) were mixed. Some found it helped shift rigid thinking: “I liked CBT-E…it made me think differently about my body” (Emma). In contrast, others found it overly focused on weight and food monitoring, which heightened preoccupations: “When I had [CBT-E], I didn’t like it. Have you tried like writing down your food? Have you tried regular eating? I've been struggling years…I have tried all these things, and they are not working. It was so damaging for me was being weighed every single session, it made me more obsessed with it [body]” (Sunflower).

Third-wave therapies, particularly compassion-focused therapy (CFT) and dialectical behaviour therapy (DBT), were described as particularly helpful in fostering self-kindness and emotional regulation. CFT was described as reducing body-directed self-criticism: “CFT helped… I’m not that critical and disgusted by it [body] anymore” (Ellie) whereas, through DBT, participants had become more attuned and compassionate towards their body's needs:

“DBT therapy helped me think differently and be more realistic. I remember thinking Why am I stressing out over this? Whatever… I clearly haven't eaten enough. I need to eat something”

(Sky).

The value of peer support was highlighted, particularly group settings that fostered a sense of belonging and shared understanding: “I joined a peer support group. Everybody had different stories, but we all hated our bodies…I felt that we can beat this together. I didn’t feel alone anymore” (Matt). Importantly, some participants emphasised the need for readiness to engage in therapeutic work: “I had to first be ready to work on my body” (Sky).

In summary, while participants reflected on therapy and recovery more broadly, their accounts consistently linked these experiences to body compassion. EMDR facilitated “letting go” of controlling and self-critical attitudes towards the body, CBT-E showed mixed effects in either supporting or undermining compassionate body relationships, and third-wave approaches (CFT, DBT) directly encouraged self-kindness and body attunement. Even peer support and readiness for change were framed in relation to reducing body hatred and cultivating more compassionate engagement with the body.

3b. Re-parenting the body

Participants frequently discussed how the process of nurturing and caring for themselves, providing the compassion and support they lacked in childhood, was central to their journey of growing body compassion. Many used the metaphor of being a ‘good parent’ to describe this process:

“When thinking about body compassion, I use the analogy of a good parent. I think everyone who makes recovery needs to become a good parent to themselves, partly because they never probably had good parents... Developing that kind inner monologue and knowing that this good parent is there and it's trusted, it gives you all the information, all the confidence. It’s present and is supporting you” (Matt)

CFT was described as facilitating participants’ development of self-compassion by fostering responsibility for re-parenting their bodies, acknowledging that this responsibility lies with them, not others:

“CFT helped me realise that I’m an adult now and I need to take care myself and treat my body the way a good parent would do. I shouldn't expect others to give me anything. So, it's my job to give it to myself…So, it's just little things like if I have an eating disorder thought and avoid cooking dinner, I’ll think, If that was your child would you allow that? No. So, treat yourself like you would treat someone that you actually care for’” (Lou)

This subtheme emphasizes the significance of re-parenting the body by re-learning how to offer compassion and nurturing, particularly through CFT practices. Participants described this process as taking responsibility for themselves in the way a good parent would, providing the support, care, and guidance they had previously missed.

3c. “I was surviving, but now I get to live”

Participants emphasized that a crucial aspect of developing body compassion was reconnecting with their personal values. This transformation allowed them to move from merely surviving to actively engaging in life. For many, rebuilding relationships and reconnecting with others, especially family and friends was key to this process: “I don’t focus on the numbers in the scales anymore…I have tons of friends, a lovely partner and a really great family” (Sky). This was very much an active process: “I think it was through living my life and re- engaging with life—seeing friends, having a boyfriend, repairing family relationships that a lot of the changes, both with my eating but also the way I view my body, happened. It's like … I was surviving, but now I actually get to live (Emma). Motherhood and creating new life was also a powerful motivator for self-compassion and caring for their bodies: “I really want to have a baby. I need to be kind to my body and take care of it enough to want to keep it [the baby] safe. That’s a really big motivator for me” (Anna).

Others found a sense of self through creative expression and enjoyment, which further shifted their focus away from their body: “Since I found myself … my voice again, I realized that I am a pretty cool person, that I'm really creative and colourful, and I have a pretty cool sense of style and I’m passionate about things like languages, travelling and just really having fun! There is much more to me than my weight” (Sky). The importance of surrounding themselves with people who share similar values was also emphasized: “I believe that if someone loves you for your body that's not love. You don't want to be around people that only value your body. This made me think what I really value and what people I want in my life” (Sunflower).

This subtheme refers to participants reconnecting with what is truly important to them, such as building and creating relationships, expressing creativity, and pursuing life goals, as being instrumental in their journey of developing body compassion. They began to realize that there are things more significant than their bodies, including relationships, personal passions, and future aspirations.

3d. Receiving love and compassion

Participants highlighted the significant role that receiving love and compassion from others played in developing body compassion. The support of family, friends, and therapists was seen as instrumental in fostering a more compassionate relationship with their bodies.

Several participants spoke about the transformative impact of having a compassionate, loving family: “My husband was a bit of a magician! I don't know how, but within six months I'd put on over 20 kilos and I wasn’t even thinking about it… He was the first person that saw me and not my illness and gave me some much love and compassion” (Grace).

Others reflected on the importance of having a compassionate friend: “When I had these thoughts that I’m fat and my head was spiralling, I would message my best friend, and we talked about it. She was always there for me, just listening and not judging” (Emma).

The significance of a compassionate therapeutic relationship was highlighted: “I felt seen by her [therapist] for the first time. She was caring, understanding and never judged me” (Sunflower). Indeed, the therapeutic relationship could be more important than the therapeutic model used: “I feel it doesn't really matter what therapy you do…but who is your therapist” (Matt).

However, the absence of compassion, particularly from mental health services, was also experienced which negatively impacted their sense of body compassion. While for some this was expressed as a lack of compassion, for others there was active shaming:

“I know that services are stretched… but it almost seems like they're very fast to kind of kick you out the door once your weight has restored. But what about how I feel about my body? I felt like they didn't ever push me to get me to the other side. They didn't encourage me and support me enough...I felt dismissed” (Anna)

“I truly believe that my eating disorder could have been nipped in the bud really quickly if I'd have really had the love and support from services. They were so shaming, like when I went back and I looked awful, they literally were sarcastic. Cause if you're not offered compassion...if you just end up with layers of shame, then how are you going to feel anything else but shame?” (Grace)

This subtheme emphasizes the importance of participants receiving love and compassion from loved ones and therapists in fostering body compassion. Some expressed frustration over not receiving adequate support from mental health services, leading to feelings of dismissal and shame, which hindered their recovery.

In summary, this theme illustrates how participants developed body compassion through therapeutic engagement, re-parenting practices, value-based reflection, and receiving compassion from others. This growth process, in turn, supported their ability to re-connect with their bodies and engage in intentional, body-compassionate actions.

Theme 4. Re-connection

Participants described the process of re-connecting with their bodies through deliberate, compassionate actions. This included listening to their body’s needs, developing body acceptance and neutrality, practicing body appreciation, and compassionate noticing skills.

4a. “Listen to the body”

Participants reflected on their ability to listen to their bodies’ needs with compassion and to act differently. This process involved developing attunement and tuning into their body’s signals, whether related to rest, nourishment, or enjoyment.

For some, this manifested through listening to the need for rest or nutrition:

“I try to listen to my body a bit more and I allow my body to relax and do what it needs to do and not overuse it. I’m consistently nourishing my body when it needs to be fed “(Max).

Others discussed indulging in enjoyment without guilt: “I remember going on holiday and just having that ability to listen to my body and eat ice-cream for the first time in years and not worry too much about it… I came to accept that I have needs and that's absolutely OK” (Anna).

Some of the participants also emphasised the shift in how they approached clothing choices: “I binned all these tight jeans… I wear things that suit me and that makes me feel so comfortable” (Lou).

More generally, body compassion enabled participants to respond kindly to their bodies, whether physically or emotionally: “It’s all about respecting the body’s needs. I now hardly give it a second thought. So, if it's telling me that I'm stressed, I'll try and do something to destress, or I try and get some rest. Or if I feel a need to like go for a walk, I'll go for a coffee and cake” (Lou).

This subtheme captures participants’ experiences of reconnecting with their bodies by listening to and responding to their needs with greater kindness, such as prioritizing rest, nourishing themselves, finding enjoyment, choosing comfortable clothing, and managing emotions.

4b. “Accept what you've been given”

Body acceptance was seen as a critical component of re-connecting with the body, highlighting a shift toward acknowledging and respecting the body as it is, without striving for change or idealisation. Participants described how they came to terms with the fact that the goals of their eating disorders were unrealistic and counterproductive, and how they began to accept their bodies as they were.

Body acceptance meant realizing that the body’s natural state couldn’t be forced into an unrealistic ideal: “I realized there's no point in trying to achieve the impossible and just accept what I've been given. Especially because everyone's body is different. There's nothing wrong with having those different qualities … It felt like a breakthrough moment” (Sky).

Focussing on how their body felt rather than how it looked was emphasised: “OK, my body might not look like necessarily what I would love it too, but it feels like how I would love it to. Like I'm so fit. I'm so strong. I'm so healthy. I feel fantastic! I still think I’m too big sometimes, but if I'm always going to think that I might as well just be happy and healthy whilst thinking that” (Sunflower). To this end, trusting their bodies to know what they needed was important, even when it was challenging: “I had to come to terms and eventually accept that my body is going to tell me what it needs, and I just need to trust it that it knows best. And if it needs to gain weight, it needs to gain weight. It was hard but freeing…” (Matt).

Acceptance of their eating disorder was also an important step toward accepting their body: “First accepting my disorder, then accepting that I needed to get better…and then it moved into accepting who I was as a person and eventually accepting my body” (Sky).

However, despite these insights, some participants still expressed uncertainty about achieving body acceptance: “I'd love to have that kind of body confidence one day, but I don’t know how to get there” (Lou). In contrast, others shared some hope:

“I hope there is a point where I'm happy with my body someday. But it's just hard because I don't remember how it actually feels as it's been that long... I wouldn't say my relationship with my body is as strong as someone that hadn't had an eating disorder... I’m still a bit more wary. So, it’s always in the back of my mind. I wonder if it's always going to be there? Or if I will just get strong enough to ignore it?” (Ellie)

Those earlier in their recovery journey or who had struggled with body image for a long time, still found body acceptance particularly challenging: “I think I'm always so self-critical…I’m always tearing my body apart since I was a child” (Mary) Societal narratives around recovery and body acceptance were particularly challenging: “I don’t really know if I’d be able to accept my body, be kind and fully recover. I’ve heard people say that you cannot fully recover from an eating disorder…that makes me quite pessimistic” (Anna).

One key experience was that, while participants can show compassion in various areas of their lives, they continued to struggle with accepting their bodies. This suggests that self-compassion may be compartmentalised, not as a uniform capacity applied across all aspects of life, but rather varying in degree across different domains: “If it's other things like academic, I kind of take it, OK. But not the body” (Anna).

Comparisons were a struggle. For some, this was comparing their current bodies to their past eating disorder identity and struggling with the idea of being healthy: “I tend to compare myself with my old self. I can't stand to look at myself in the mirror. I just don't. I struggle kind of accepting my healthy body and this new healthy identity” (Anna). However, this was also experienced when other people did the comparing: “I can't stand it when people see me and they're like, oh, you look so much better now, or you look healthy. That to me in my head is just they’re calling me fat” (Mary).

This subtheme highlights the importance of developing body acceptance to re-connect with the body. Most participants described a shift from striving for appearance-based goals promoted by their eating disorder to trusting their body’s innate wisdom and focusing on how it feels. While some expressed hope for body acceptance, many faced ongoing challenges rooted in early body dissatisfaction, self-comparisons, and negative societal messages.

4c. “I'm more neutral”

Participants who developed body acceptance reflected on having also developed neutral feelings towards their bodies, reporting a shift from body hate to neutrality. Body neutrality referred to participants adopting a non-judgemental stance toward their bodies, focusing less on appearance and more on lived experience and functionality:

“I hated my body back then, 100%. Now, I wouldn't say I love it, but I wouldn't say I hate it. I just. I'm just stable in it, more neutral” (Ellie).

A few participants even described a sense of detachment towards their bodies and a stronger connection with their emotional world: necessarily have a relationship where I am thinking about the particulars of my body…but now I have a stronger relationship with my mind” (Matt) Most participants expressed scepticism about the body positivity movement: “I don't really sort of buy the body positivity movement … it really sets people up to fail as society doesn’t promote that in any way” (Emma). Instead, body neutrality was emphasised: “Love and pride in my body is maybe a bit out of reach, but just kind of neutrality is possible” (Lou).

This subtheme refers to participants moving from a place of body hate to neutrality. A few reported not having a relationship with the body but connecting more with their minds.

They also shared that the body positivity movement might be a difficult and unrealistic goal.

4d. Body appreciation

Participants described re-connecting with their bodies by cultivating a deep sense of appreciation—not only for what their bodies can do, but for their resilience and enduring presence throughout recovery. Some spoke about appreciating and valuing their body’s abilities: “The parking ticket was running out, and the car park was a five-minute walk, and I ran, and I just remember I got to the car in time. I remember thinking how grateful I am. I could not have done that in the body I was in six months ago. I just remember thinking what bodies are really for? To be able to do stuff like that and to be liked?” (Sunflower).

For others there was a reflection on acknowledging past hardships and expressing gratitude for their body’s resilience:

“I’d like to apologise to my body because I feel like I did put it through an awful lot... how harsh and critical and disgusted I was by it. But I guess also thank it that it did keep showing up for me even when I wasn't showing up for it. It still serves me well. It’s fit, well and healthy...I've always been extremely lucky” (Emma)

This subtheme reflects participants’ capacity to reconnect with their bodies, appreciating both their functional abilities and their resilience, and expressing gratitude for their body’s persistence and support throughout recovery.

4e. Compassionate noticing

Developing the ability to notice and respond to negative thoughts with compassion was another key aspect of re-connection with the body:

“If I have the thought that I'm fat, I'm now very able to notice that and go, oh, that's interesting. I wonder what's going on there for me? I feel like I can be aware and know that it's not reality and know that I don't have to act on those thoughts. A bit more like oh, that's an interesting observation. I wonder what that's telling me, rather than restrict or punish my body” (Emma)

For some participants, CFT played a role in supporting this shift: “Using CFT and noticing the self-critic does help me quite a lot. So instead of beating myself up I'm like, oh, I'm just noticing…oh thanks mind for having my best interests at heart!” (Lou). Beyond merely recognising the self-critic, others talked about consciously acting against these thoughts: “I’ve managed to wear things that have pushed me out of my comfort zone and made that conscious decision to appreciate my body and say that I actually I do look nice in this” (Anna).

This subtheme referred to participants developing compassionate noticing skills that supported the re-connection with their bodies. They reflected on the importance of noticing thoughts, feelings, and perceptions, interacting with them in a compassionate way and acting by either ignoring it or consciously acting against them.

In summary, participants described re-connecting to their bodies and creating a new relationship with it through taking compassionate, intentional actions. These included attuning to bodily needs, fostering body acceptance, and shifting focus from appearance to functionality. While many moved from body hatred toward neutrality, often perceiving body positivity as unattainable, some continued to struggle with deeply ingrained body dissatisfaction dating back to childhood, as well as a sense of loss related to their eating disorder identity. However, most progressed toward appreciating their body’s resilience. Practices such as compassionate noticing helped challenge critical self-talk and cultivate a more respectful relationship to their bodies. Building on earlier therapeutic work (Theme 3), these shifts were central to restoring bodily reconnection (Theme 4). This renewed relationship empowered participants not only to overcome internal barriers but also to confront and resist external pressures and sociocultural ideals (see Theme 5 below).

Theme 5. Resistance

This theme captures participants’ reflections on the broader societal and cultural forces that impede the development of body compassion, particularly diet culture, social media, and dominant beauty ideals. Developing body-compassion appeared to help participants critique and resist harmful societal messages, by fostering kindness toward themselves and recognising their fallibility [55]. As a result, they viewed societal ideals critically, reduced internalised shame, and asserted autonomy over their bodies, drawing on the body compassion growth (Theme 3) and bodily re-connection (Theme 4) they developed.

5a. “You have to look this way to be accepted”

Many participants discussed how societal standards, especially those perpetuated by social media, promoted unattainable body ideals, leading to harmful self-comparisons and internalised stigma.

These influences were particularly salient for younger participants: “It’s hard to not compare yourself to other people on social media. For example, seeing all these models with perfect bodies and perfect lives on Instagram …It’s so fake and triggering” (Anna). Similarly,

Max noted: “Tik Tok is all about diet culture” (Max).

Participants expressed frustration with the implicit societal message that thinness equates to value and worth: For example, “Society is saying you have to look this specific way to be accepted” (Sky) and “If you are not thin, you don’t matter…” (Mary). The emotional toll of unsolicited comments on appearance was also emphasised:

“Why talking about bodies? What right do you have to tell me how to look and talk about my body?” (Emma). This the case even when these were apparently intended as positive:

“Body compliments are so dangerous” (Anna).

This subtheme refers to participants reflecting and sharing their frustration on societal barriers to body compassion, such as social media, thin idealisation and body complements.

5b. “Rebelling”

Building on body compassion growth (Theme 3) and bodily re-connection (Theme 4) participants described how developing awareness, and critical insight helped them resist harmful societal narratives.

For some, this began with personal reflection: “I realized there's no point in trying to achieve the impossible. Everyone's body is different … there's nothing wrong with having those different qualities” (Sky). For others, this reflection was triggered by reading: “I read an article and it kind of made me angry, realizing how society is always pushing different body types on people, and saying you have to look this way to be accepted. And then I realized there's no point in letting others control how I look and what I weigh … I felt like I was rebelling against it!” (Sunflower).

Others found empowerment through education about the human body’s natural functions and needs: “When you strip around all these society messages and thoughts and feelings about body size and all of that, the human body’s drive is to survive” (Sunflower). Therapy also facilitated this resistance: “Therapy helped me realize there's no point in letting others control how I look and what I weigh… I remember thinking who are you to tell me how I should look? I had to unfollow insta accounts” (Anna).

Developing body-compassion appeared to help participants critique and resist harmful societal messages. By fostering kindness toward themselves and recognising their fallibility [55], they could view societal ideals critically, reduce internalised shame, and assert autonomy over their bodies. Self-compassion thus provided a foundation from which to challenge external pressures without diminishing their critical awareness. In summary, many participants were able to first acknowledge and then challenge not only internal barriers (described in previous themes) but go a step further to resist external systemic obstacles to body compassion. They identified pervasive influences such as social media, diet culture, and societal glorification of thinness, as having fostered feelings of inadequacy and shame. Despite these pressures, they described pathways to resistance, including critical reflection, education, and therapeutic support which empowered them to reclaim autonomy over their bodies and reject the idea that their worth is determined by appearance.

These findings lay the groundwork for a deeper exploration of body compassion’s role in recovery, which is further examined in the discussion that follows.

Discussion

The aim of this study was to explore adults’ experiences of body compassion in eating disorder recovery, aiming to address a literature gap. The research question “What is the role of body compassion in eating disorder recovery?” was investigated through semi-structured interviews with ten UK-based adults self-identifying as recovered or ‘in recovery’ who had accessed various psychological treatments. Data were analysed using reflexive thematic analysis (RTA; [12]).

Five seminal themes were developed: (1) Foundation (2) Confusion (3) Growth (4) Reconnection and (5) Resistance. While presented separately for clarity, the authors suggest these themes collectively depict a dynamic journey of embodied healing. Initially, body compassion was described as a foundation to recovery (Theme 1), yet a confusing concept (Theme 2). Its growth through therapeutic engagement, re-parenting the body, and receiving compassion (Theme 3) disrupted shame-based patterns and fostered a shift from survival toward vitality. As a result, participants re-connected with their bodies via conscious practices such as interoceptive awareness, body acceptance, neutrality, appreciation and compassionate attention (Theme 4). Simultaneously, participants moved to a resistance phase where they managed to not only challenge internal barriers but also critically challenge external sociocultural beauty ideals (Theme 5).

Therefore, based on the participants experiences, the themes inform a tentative model that positions body compassion as the foundation for recovery, followed by the interconnected stages below: confusion, growth, reconnection, and resistance (see Fig. 1).

Fig. 1.

Tentative model of body compassion’s development in eating disorder recovery

This model expands on existing frameworks, aligning with elements of Herman’s [35] trauma recovery model outlining three key stages: safety, remembrance and reconnection. The first stage focuses on establishing physical and emotional stability and in the second stage processing occurs. The final stage involves rebuilding a meaningful life, restoring relationships and fostering empowerment. While presented sequentially, Herman [35] emphasizes that recovery is flexible and not always linear, with movement between stages based on individual's needs.

Similarly, participants in this study shared different experiences on how the stages of body compassion unfold. However, there was a consensus that body compassion forms a foundational element of recovery. Most participants who self-identified as recovered, typically those younger with shorter illness durations who had accessed compassion or trauma-focused therapies, described the development of body compassion as a linear staged process, moving through identifiable stages in sequence. In contrast, others described a less linear trajectory, moving between these stages in response to personal, relational, or contextual challenges. This variability also aligns with the transtheoretical model of change [61], which recognizes that individuals might move through stages at different paces and may revisit earlier phases.

Participants currently ‘in recovery’, particularly those with longstanding body image struggles, who accessed therapy later in life, reported greater difficulty with developing body compassion. They often found themselves between the confusion and growth stages with no clear movement. Notably, even those who struggled to cognitively understand body compassion described experiencing it as a felt, unspoken sense that nonetheless supported their recovery. These findings point to several critical directions for future investigation, which are elaborated in the subsequent section on future research. Prior to that, the following review situates the findings within the broader context of existing literature.

Foundation and confusion

Body compassion emerged as both essential and conceptually ambiguous in eating disorder recovery. This reflects existing literature noting the difficulty in integrating the complex constructs of “body” and “compassion” [15], particularly among individuals with eating disorders, that might struggle with alexithymia [69, 73]. Despite definitional challenges, participants consistently viewed body compassion as foundational to recovery, echoing evidence of its protective role and superior predictive value over general self-compassion [7, 8]. This may suggest that the benefits of body compassion can occur even without full cognitive understanding, operating more as an embodied, experiential process. However, they reported a lack of explicit focus on body compassion in current treatment models, echoing critiques that traditional approaches often emphasize symptom reduction over lived experience [22]. However, confusion emerged as a pivotal stage in the process of growth and reconnection, as it reflected participants’ initial struggle to understand and articulate body compassion. This stage provided a reflective space that enabled deeper engagement with bodily experiences, fostering gradual development of self-kindness, embodied awareness, and acceptance, ultimately supporting recovery.

Growth and reconnection

Participants described the development of body compassion as a gradual process requiring both internal work and external support. Trauma-informed therapies, particularly eye movement desensitization and reprocessing therapy (EMDR; Shapiro, [65]) helped some participants to process early relational trauma. A few described these experiences as supporting a renewed connection with their bodies, which aligns with research on EMDR’s promising role in reprocessing emotional wounds related to eating disorders [6, 33].

While some found enhanced cognitive behavioural therapy (CBT-E) limited in addressing emotional and systemic distress, third wave therapies were particularly helpful. For example, some participants compassion found that compassion therapy (CFT) supported body attunement and self-compassion [31] and dialectical behavioural therapy (DBT) supported more realistic thinking leading to acceptance [34]. In addition, participants reflected on the importance of taking value-based actions to achieve body compassion, which might align with research on the effectiveness of acceptance and commitment therapy (ACT) in eating disorders recovery [45, 58].

Importantly, the therapeutic relationship was often seen as more impactful than the treatment modality itself, reinforcing the centrality of therapeutic alliance [28]. Non-compassionate or dismissive clinical interactions were reported as harmful, compounding shame and disconnection aligning with research on eating disorder stigma within services [48, 56]. In contrast, receiving compassion from others, including family, peers and therapists, played a key role, aligning with Gilbert’s [30] three flows of compassion model. This suggests that receiving compassion from others might have helped participants to cultivate self-compassion. Hence, this internal growth supported participants to move to a phase of bodily reconnection.

Reconnection with the body involved intentional practices of attunement, acceptance, neutrality, appreciation, and compassionate noticing. These practices are supported by research on embodiment and emotional regulation [19] which highlights that developing awareness of bodily sensations and cultivating a non-judgmental, accepting stance toward the body can enhance emotional regulation, reduce stress, and foster a sense of integrated self [19]. Such embodied practices encourage individuals to perceive their bodies as sources of information and support, rather than objects of evaluation, aligning closely with the development of body compassion observed in this study. Body acceptance and neutrality were seen as more accessible alternatives to body positivity, which some viewed as unrealistic or exclusionary [59]. Body appreciation functioned as a protective factor, linked to emotional regulation, reduced social comparison, and lower thin-ideal internalization [47, 50]. This internal re-connection in turn led to an external ability to resist external societal narratives. These findings align with Woekel et al. (2013), who found that body-related reconnection in postpartum women involved mindful awareness, self-care, and processing difficult emotions. However, in the context of eating disorder recovery, participants additionally described a pivotal ‘confusion’ stage, the protective filter of positive body image, and the role of resistance against sociocultural pressures—elements less emphasized in prior studies. This highlights how body compassion can function both interpersonally and as a tool for negotiating external societal forces.

Resistance

Participants described a transformative shift from internal healing to external resistance, particularly against sociocultural forces embedded in diet culture and magnified through social media. Platforms such as TikTok and Instagram were frequently cited as spaces that promote thin ideals, facilitate constant body comparison, and reinforce appearance-based validation. These accounts align with a growing body of literature documenting social media’s harmful impact on body image and eating behaviours [20, 64]. This reflects the dual pathway model [68], which suggests that internalizing thin ideals drives body dissatisfaction through negative affect and dietary restraint. In this study, developing body compassion may buffer these effects by reducing self-criticism, fostering acceptance, and supporting more adaptive coping. As such, it could act by reducing the thin-ideal internalisation in the first place, although it could also impact the other components in the model to reduce the likelihood of eating pathology.

Despite these pervasive challenges, participants actively engaged in resistance strategies. Developing body compassion appeared to create a ‘protective filter’ through which participants experienced their bodies. This filter might have allowed them to critically assess and reject harmful societal or interpersonal messages, while selectively taking in affirming, supportive information. In this way, positive body image acted as a buffer against negative messaging, reinforcing resilience and supporting recovery. These strategies included self-education, therapeutic engagement, cultivating awareness of body functionality and establishing digital boundaries. These actions were often grounded in earlier work on body compassion and were instrumental in fostering a more connected and empowered relationship with the body. This phase of resistance resonates with critical consciousness theory [27], which describes the process by which individuals become aware of the systemic, social and political structures that dominate them and develop the agency to challenge and transform these forces. In this context, resistance was not merely reactive but emerged as a proactive, consciousness-driven step toward reclaiming autonomy over the body in the face of dominant cultural narratives.

Clinical implications

These findings highlight several key implications for clinical practice. First, participants’ difficulty in conceptualising body compassion highlights for a clear, inclusive, and service-user-friendly definition of body compassion to support its integration into treatment. Clinicians should normalise body compassion as central to recovery, moving beyond a symptom-reduction model. Recommendations include the use of validated body compassion measures, greater patient involvement in recovery frameworks and a re-evaluation of discharge criteria. Given the non-linear nature of body compassion’s development, stage-sensitive approaches such as motivational interviewing can support the development of body compassion by addressing individuals’ readiness for change, helping them explore ambivalence, and take value-based steps toward self-kindness and embodied awareness [36].

Integrating trauma recovery into eating disorder treatment may be beneficial. Participants’ accounts suggest that approaches such as EMDR could support individuals on the restrictive intake self-harm (RISH) pathway, where disordered eating may function as a form of trauma regulation [23]. Findings also highlight the potential value of therapies that explicitly target body compassion, for example through CFT-E [32], adapted CBT-E modules or principles drawn from ACT to support values-based recovery actions. Clinicians might further promote body reconnection through psychoeducation, experiential practices, or adopting body neutrality as an inclusive alternative to body positivity. These suggestions are tentative and based on participants’ reflections; further research is required to evaluate their effectiveness in broader clinical settings.

Compassion from others also emerged as critical, reinforcing the importance of trauma-informed and compassion-focused care. Early intervention, co-produced recovery initiatives and enhanced clinician training may be key. Researchers have found that social media amplifies body-based oppression in relation to racism, sexism, and classism [26, 39]. As such, a recovery model may also need to be sensitive to these intersecting inequalities. Clinicians should integrate media literacy into therapy and support individuals in curating healthier online environments. Beyond therapy, advocacy for safer digital spaces and inclusive policy is needed. Including diverse body representation and challenging dominant beauty ideals [39] is vital to building a more compassionate and equitable recovery journey.

Strengths and limitations

This study represents the first qualitative exploration into the role of body compassion in eating disorder recovery, addressing a significant gap in the literature. A major strength of this research lies in its rich, in-depth exploration of participants lived experiences, providing novel insights into a relatively underexplored construct. The use of RTA allowed for nuanced interpretation and prioritization of participants’ voices, aligning with the study’s interpretivist paradigm. Moreover, the inclusion of participants from diverse diagnostic backgrounds, treatments and recovery stages enabled the identification of cross-cutting patterns and enriched the data by capturing a range of perspectives. Conducting the study online enhanced accessibility by enabling participation from individuals across diverse geographic locations throughout the UK. This approach minimized barriers such as travel time, expenses and physical mobility constraints, facilitating a more diverse and representative sample that enriched the depth and breadth of the findings.

However, several limitations should be acknowledged. The use of a small and heterogeneous sample introduced complexity in theme development and posed a risk of overgeneralization. While subgroup analyses (e.g., by diagnosis or gender) were considered to understand how body compassion manifests differently across groups it was not conducted, to maintain analytic focus on overarching experiences of body compassion. The retrospective design also limits the ability to draw conclusions about the development of body compassion over time or across different stages of recovery. Although variation in recovery stages enriched the diversity of perspectives, it may have introduced inconsistencies in participants’ understanding or descriptions of body compassion, despite efforts to clarify its definition. Furthermore, the study’s exclusive focus on body compassion, deliberately excluding other recovery factors such as social support or broader systemic influences beyond social media, means that findings should be interpreted within the context of a multifactorial recovery process. Nonetheless, despite these limitations, the study offers valuable insights into body compassion’s role in eating disorder recovery and lays the groundwork for further.

investigations.

Future research

Future research should address key gaps to enhance understanding of body compassion in eating disorder recovery. Longitudinal studies are needed to track its development over time and examine whether higher baseline levels predict better outcomes over a longer period. Clarifying the relationship between body compassion and general self-compassion is also essential. Randomized controlled trials (RCTs) should evaluate whether integrating a body compassion module into existing treatments like CBT and CFT improves their efficacy. The potential of EMDR to support individuals with trauma-related eating disorders by fostering body compassion also warrants further study. Future research could also incorporate the use of innovative methods, such as analysing compassionate letter writing in therapy, to provide deeper insight into change processes.

Research should aim to examine the proposed model of body compassion development, assessing whether the process is linear, cyclical or how it varies across individuals. Additional or transitional stages, especially between growth and resistance, and the impact of sociocultural influences on progression should also be explored. Studies are needed to evaluate the clinical utility of this model, testing whether stage-specific interventions improve outcomes and whether body compassion mediates long-term change. Given the influence of digital culture, future research should examine how social media shapes body compassion and assess media literacy-based interventions. Finally, research should investigate how cultural background, identity, emotional regulation, and social connectedness might interact with body compassion to inform more inclusive and holistic treatments.

Conclusion

This study offers a novel contribution to the understanding of body compassion as a central, yet often overlooked, component in eating disorder recovery. Five interconnected themes, Foundation, Confusion, Growth, Re-connection, and Resistance, were developed, forming a tentative model of body compassion’s development during eating disorder recovery.

Participants described body compassion as essential to sustained recovery, despite its conceptual ambiguity and lack of emphasis in treatment. Therapeutic engagement, particularly trauma-informed and compassion-focused approaches played a crucial role in its growth. Reconnection with the body was achieved through conscious practices like attunement, acceptance and appreciation. Resistance involved challenging both internalised shame and external societal ideals, especially those perpetuated by digital culture.

These findings emphasize the need for person-centred treatment models that centre the body as a site of healing, not just symptom management. Clinicians are encouraged to integrate clear definitions and targeted practices related to body compassion and to engage with broader sociocultural factors, including media influences. Despite limitations such as sample heterogeneity and retrospective design, this study lays important groundwork for future research. Further studies should continue exploring the promising role of body compassion across diverse populations, in relation to broader recovery factors and aim to examine the proposed model further. Ultimately, this research positions body compassion as a dynamic and reparative force, one that invites a more holistic, inclusive, and compassionate approach to eating disorder recovery.

Recruitment poster

SCOFF screening tool [52]

Ethical approval

Interview schedule

• Demographics (e.g., age, ethnicity, ED diagnosis, duration, treatments accessed, subjective recovery status)
• Can you briefly tell me about your eating disorder recovery journey?
• How would you describe your current relationship with your body?
• Can you tell me about a time when you noticed any shift in how you treated or thought about your body?
• When you hear the term “body compassion,” what does it mean to you?
• How did you learn about body compassion?
• What or who has helped you to develop body compassion?
• What behaviors have you stopped doing since developing this relationship?
• Can you describe any experiences/memories where you felt compassion toward your body?
• How, if at all, has your experience of body compassion changed during your recovery?
• Is there anything else about your experience of body compassion or recovery you would like to share?

Participant information sheet

Plymouth University- Doctorate in Clinical Psychology.

Name of Researcher: Vasiliki Anagnostopoulou.

Researchers Supervisors: Dr Nicholas Troop and Dr Chantal Baillie.

Title of Research: The Role of Body Compassion in Eating Disorder Recovery.

Thank you for taking an interest in this study. Please take your time to decide whether or not you wish to take part. Before you decide, it is important that you understand the study’s aim and what your involvement will include. Please read the following information carefully and do not hesitate to ask us anything that is not clear or for any further information.

What is this study about?

This study’s aim is to explore the role of self-compassion towards the body (i.e., body compassion) in eating disorder recovery (whatever you define your own recovery). We are interested in hearing peoples lived experiences and views around body compassion’s perceived relevance, importance, and its trajectory during their own recovery journey. Hearing your experiences will better help us understand what can be helpful during recovery and thus might improve eating disorder treatment outcomes.

Who can take part?

To take part in this study you must be:

• Aged 18 + 

• Any gender.

• Have been previously received a diagnosis of an eating disorder, including anorexia, bulimia and/or binge-eating disorder.

• Have completed psychological treatment for the eating disorder.

• Are currently not having eating disorder symptoms.

• Able to complete an online interview in English.

Do I have to take part?

It is completely up to you whether you decide to take part in this study. If you do decide to take part, you will be given this Information Sheet to keep and you will be asked to sign a Consent Form. It is important that you can give your informed consent before taking part in this study and you will have the opportunity to ask any questions in relation to the research before you provide your consent. Agreeing to join the study does not mean that you have to complete it. You are free to withdraw at any stage without giving a reason and without any consequences.

What will happen if I choose to take part?

First, I will send you the information sheet to read. Then we will have an initial 15-min online meeting for you to ask any questions, confirm that you meet the inclusion criteria via asking you some brief questions and arrange the interview date. If you consent to proceed to the interview and met the inclusion criteria, you will be given a consent form to sign. Then, you will be invited to take part in a 60–90-min interview via an online video communication platform (e.g., Teams). In the end on the interview, you will be debriefed. Following the interview and during the data analysis, I may return to you via email or video call to ask follow-up questions or to check the integrity of the data (this is optional).

Participation is entirely voluntary. You have the right to stop taking part in the research at any time up to the point of data analysis, where the data will be coded and anonymised. Please let me know within 2 weeks of the interview whether you would like to remove your data. You can do that by emailing me with your participant alias (pseudonym). You also have a right not to answer specific questions or to ask for audio and video recording to stop. There is no consequence to deciding that you no longer wish to participate in the study.

Are there any benefits in taking part?

I hope that taking part in this study is an interesting experience for you. Some benefits could be:

• Having the opportunity to tell your story and talk about your experiences.

• Having your voice heard.

• Positively influence other people’s recovery.

• Sharing your knowledge and understanding around an under-researched area.

• Informing care and support within eating disorder services.

Remuneration

All participants that meet the inclusion criteria and complete the interview will be offered £20 One4all voucher covering a range of different shops. Participants that do not meet the criteria and do not procced to the interview will be given a leaflet with access to mental health resources.

What information about me will you be collecting?

First, we will ask you to share some demographic information (e.g., age, gender), some information about your recovery journey (e.g., previous diagnosis, length of the eating disorder and treatment accessed). We will also have to answer some brief questions to make sure you meet the inclusion criteria. Then we will procced to the main interview. The audio and video from the interview will be recorded and I will use it to transcribe our conversation into a Word format. You can switch the screen off during the interview if you prefer. Following this, the recording will be deleted, our conversation will be anonymised, and I will ask you to choose your preferred alias (pseudonym).

Will my information be kept safe?

Please be aware that all information you share will stay confidential, no identifiable information will be shared, and your data will be anonymous. Only the research team (myself and my supervisors) will have access to the raw data. All data and consent forms will be stored securely on a password-protected device (i.e., Plymouth University OneDrive). Recording and transcriptions will be transferred to the OneDrive immediately after the interview and all identifying information will be deleted from the data. The interview recording will be destroyed once it is transcribed. The transcribed interview in anonymised form will be destroyed 10 years after the interview. You will be able to withdraw your data until they are anonymised and coded 2 weeks after the interview.

Use of personal data and data protection rights

The University of Plymouth is bound by the UK 2018 Data Protection Act and the General Data Protection Regulation (GDPR), which require a lawful basis for all processing of personal data and an additional lawful basis for processing personal data containing special characteristics. You have a range of rights under data protection legislation. For more information visit:https://plymouth.ac.uk/students-and-family/governance/information-governance/your-information-rights or contact the University Data Protection Officer at: dpo@plymouth.ac.uk.

Confidentiality

All data will be stored in line with the Data Protection Act. All identifying information will be removed from the transcript and final report. Quotations may be used in the report, but these will be shared using a pseudonym to protect your identity. The only time confidentiality may be broken would be if there were concerns about your safety or the safety of someone else. I would inform you that this was something I needed to do.

Are there any risks?

Although I hope the interview will be a positive experience, some of the topics covered in the interview (e.g., talking about your experience recovering from eating disorders) may have the potential to cause distress. Remember that have the right to share as much or as little as you feel comfortable disclosing. I can send you the interview questions to read beforehand. You can also choose to pause or end the interview at any point. After the interview, we will be offered a debrief, a leaflet with mental health resources and a check-in (if needed). I will also be able to provide support and guidance on where additional help can be accessed if required.

What will happen to the results of the study?

The results will be written up in a report and presented as part of my Doctoral thesis. It is expected that this thesis will be completed by September 2025. The study may also be published in a peer reviewed academic journal. However, all data and results will be presented in anonymised form and there will be no way to identify individuals.

Who has reviewed the study?

The University of Plymouth Faculty of Research Ethics and Integrity Committee has reviewed and approved this study. Study ID:5017.

What should I do if I have concerns about this study?

In the first instance, you are encouraged to raise your concerns with myself. However, if you do not feel comfortable doing so, then you should contact my supervisors or the Faculty of Health Research Ethics and Integrity Committee via email: FOHEthics@plymouth.ac.uk.

What if I have more questions?

If you need any further information to help inform your decision to take part in this research project, you can contact me via email below: Vasiliki.anagnostopoulou@plymouth.ac.uk.

Thank you for taking the time to read this information sheet, I look forward to hearing from you in the near future.

Participant consent form

Plymouth University- Doctorate in Clinical Psychology.

Name of Researcher: Vicky Anagnostopoulou.

Researcher Supervisors: Dr Nicholas Troop and Dr Chantal Bailie.

Title of Research: The Role of Body Compassion in Eating Disorder Recovery.

Please tick to confirm you have understood the following statements:

Debrief Form

Plymouth university – doctorate in clinical psychology

Thank you so much for taking part in this study. In this debrief I will share additional information about the main aim of the study, what will happen after the interviews are completed and some mental health support services.

What was the aim of the study?

The study aims to gather adult’s experiences of the role that body-compassion plays in the recovery from eating disorders. There is some research showing the importance of self-compassion in treatment and recovery from eating disorders. However, little is known about the self- compassion directly towards our bodies (body compassion).

Therefore, through the interviews we were interested in exploring your own experiences of body compassion and its relevance (is it important?), role (how does it work?) and trajectory (timeline of when it appears in recovery?). We were interested in hearing about your unique recovery stories, both positive and/or difficult experiences, and making sense of what body compassion meant for you during your recovery.

We hope that through gathering these experiences, we will create some deeper understanding of how body compassion might be helpful in recovery, inform practitioners in the field, challenge the medical model of seeing recovery as symptom-focused, and positively influence eating disorder services.

What will happen to my interview (data)?

The interview will be typed up in word format and the transcript will be stored on a secure University of Plymouth OneDrive account. Only myself as a key researcher have access to it. Only the anonymised version of the transcript will be accessible by my supervisors in an anonymised form. The interview audio recording will be destroyed once it is transcribed, alongside any identifiable data.

The transcript will then be analysed along with every other participant’s transcript to generate themes. I might contact you via email to ask you if you would like to validate the themes and check their accuracy, but this is optional. The themes will then be mapped against other research on body compassion and eating disorders.

Anonymous quotes from your interview may be used in my final report, which will be shared with Plymouth University Clinical Psychology Doctoral Course and may be published in academic or professional journals. A short summary of the research will be available to participants on request.

You can let me know if you wish to no longer participate in the study and you can ask for your personal details and interview data to be deleted 2 weeks after the interview takes place. You do not need to give a reason why. After this point, your data will be anonymised, the analysis of the data will have started and your data will be integrated with all the other data, so I will no longer be able to remove your data. You can do this by contacting me via my email: vasiliki.anagnostopoulou@plymouth.ac.uk.

After the project is finished, all the information about you will be deleted. This means your name, email, phone number and the recording. We have to keep written copies of what was said in the interview for up to 10 years in case anyone wants to check the research. The written copy will not be linked to you, and you will not be identifiable.

Mental health support

As discussed in the Information Sheet please see below some support to access should you feel any distress following the interview. I would encourage you to use any well-being or self-care strategies that may be helpful for you.

• Samaritans: You can call 116 123 (free from any phone) or email jo@samaritans.org

• BEAT Eating Disorders Charity Website: https://www.beateatingdisorders.org.uk/

• SANE line: If you're experiencing a mental health problem or supporting someone else, you can call SANE line on 0300 304 7000 (4.30 pm–10.30 pm every day).

• Campaign Against Living Miserably (CALM): You can call the CALM on 0800 58 58 58 (5 pm–midnight every day) if you are struggling and need to talk. Or if you prefer not to speak on the phone, you could try the CALM webchat service.

• Shout: If you would prefer not to talk but want some mental health support, you could text SHOUT to 85,258. Shout offers a confidential 24/7 text service providing support if you are in crisis and need immediate help.

If you have questions, please do not hesitate to get into contact us:

Author contributions

Dr Vicky Anagnostopoulou is the primary author. She conceptualized the study, conducted the interviews and led the analysis and writing. Dr Nicholas Troop and Dr Chantal Bailie supervised the project, contributed to methodological design, provided critical revisions, and approved the final version of the manuscript. All authors read and approved the final manuscript.

Funding

Not applicable.

Data availability

The participants of this study did not give written consent for their data to be shared publicly, so due to the sensitive and qualitative nature of the research, supporting data is not available.

Declarations

Ethics approval and consent to participate

This study was approved by the Ethics Committee of Plymouth University (Ethics Code: 5017) on the 5th of August 2024. All participants provided written informed consent prior to enrolment in the study. This research was conducted ethically in accordance with the World Medical Association Declaration of Helsinki.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.