Examining the Value AN Patients Place on their Illness

Unraveling some of the many paradoxes of the disorder.

Among the many paradoxes of treating anorexia nervosa (AN) is the high value patients place on maintaining the disorder in spite of its many physical, psychological, and social costs. Psychologists Eva C. Gregertsen, William Mandy, and Lucy Serpell of University College, London, recently offered suggestions for dealing with the egosyntonic nature of AN (Front Psychol. 2017; Vol 8, article 2273, published online). (Egosyntonic refers to aspects of one’s behavior or attitudes viewed as acceptable and consistent with one’s fundamental personality and beliefs.)

Unraveling the ‘benefits’ patients derive from AN

The authors sought to untangle the many complex threads of the benefits AN patients feel they receive via their illness. An interesting series of studies on this topic has accumulated and it is reviewed and summarized in this paper. Some of these benefits include an enhanced sense of security and control, mental strength and skill, and confidence. For others, AN provides a means of avoiding negative experiences and emotions through a myopic focus on the body, food, and weight. Patients reported feeling an inner sense of strength, mastery, and skill by keeping such a focus. For others, AN provided a way of promoting care and gaining attention. One more paradox is the popular view that AN is a disorder mainly centered about physical appearance and an ideal of beauty. Instead, the authors argue that the gap between the public perception of AN and the true experience of AN challenges the central role many cognitive theories ascribe to the importance of weight and shape in maintaining the disorder.

But, negative feelings as well

There is also another side to the paradox: patients’ negative feelings about AN. One of the authors, Dr. Lucy Serpell, has written extensively about the paradox of AN, and the negative side and the perceived burden of the illness. She notes that AN patients describe feeling “cheated” or tricked by the disorder because it “had made false or empty promises.” The ramifications of AN had caused the patients to lose friends, alienate family members, and to give up their social life and career opportunities. Some reported feeling numb and emotionally stifled from the constant battle with the illness.

Dr. Gregertsen and colleagues note that the growing understanding of perceived advantages of AN endorsed by patients underscores the importance of developing ways to counteract this barrier to recovery. Concentrating on changing behaviors without understanding the individual patient’s underlying motivations to maintain AN despite the costs, may leave him or her with a set of helpful but never used tools, according to the authors. In addition, emphasizing the negative sides of AN without exploring and dismantling the patient’s perceived benefits may be of limited use. “Focusing only on eating disorder behaviors as opposed to exploring the meaning of the behaviors may leave the patient feeling unheard,” write the authors. Instead, by giving the patient a chance to express the unique significance that AN holds for her or him helps build understanding and rapport between patient and therapist, and may improve treatment outcome.

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