Q & A: The Unselfish Anorexic

Q: Some of my anorexia nervosa patients seem particularly “self-less.” They’ll take on major projects to help other people without really seeming to care what happens to themselves. Sometimes they seem to be pretty self-destructive, almost suicidal in their self-neglect. Is this behavior a suicide equivalent? (E.R., Atlanta, GA)

A: That’s an interesting observation. Many clinicians encounter patients with anorexia nervosa who appear to be extremely altruistic, passionate about “doing good” for others, and acting as people-pleasers, as if they are trying to make others think highly of them and not to become angry with them. Recently, some researchers have distinguished what they call “rejection of life,” or not caring too much about living, from “death preoccupation,” i.e., contemplating or being attracted to death, in some patients with anorexia nervosa and bulimia nervosa. The notion of “rejection of life” reflects the fact that these individuals are attuned to the needs of others and refrain from promoting their own needs or interests. In these researchers’ terms, this way of being in the world often reflects “…a struggle to exist, but to exist in the narrowest possible parameters.” This mode of existence may relate to the fact that many of these patients feel extraordinary guilt at anything that would seem to be promoting their own self-interests, as if they have no right to exist or to want anything for themselves (Int J Eat Disord 2002; 311: 43). It remains to be discovered just how pervasive this phenomenon is among women with eating disorders (or others for that matter) and what correlates with these findings.