Anorexia Nervosa: Uncovering Beliefs That Interfere with Treatment

According to Dr. Janet Treasure and her colleagues, valued beliefs may have even more powerful effects than social reinforcers, such as attention gained by refusing food and positive reactions to their thinness (Int J Eat Disord 25:177, 1999). The valued beliefs also make some patients ambivalent about the value of treatment. Examples of valued beliefs about anorexia nervosa include a feeling that anorexia makes the patient feel looked after and protected, or provides a sense of control, or makes her feel special.

The researchers asked 18 patients attending an eating disorders unit to write 2 letters to their anorexia nervosa, one addressing it as a friend and the second approaching it as an enemy. The letters were then classified as “pro-codes” showing the valued nature of anorexia nervosa, or “anti-codes,” which were negative statements about the disorder.

The positive and negative results

Almost all patients used a “guardian” theme for the pro-anorexia letters, and about half of all “pro-codes” described feelings of being safe and protected by the disorder. Other positive results included feelings of increased attractiveness, being in control, or being special or different from others. Examples of negative feelings when anorexia was viewed as an enemy included the belief that the disorder had taken over their lives and personalities.

Some applications for therapy

Examining the “anti-” themes in patients’ letters may have implications for therapy. For example, many patients expressed concern about their health and their feelings that they had been taken over by their illness. Such patients might benefit from materials about the health problems caused by anorexia nervosa—if they are presented in a nonjudgmental way. Dr. Treasure and colleagues note that this is an exploratory study, and that further information will come from in-depth interviews, focus groups, and self-report questionnaires.