Also Included In: Psychology / Psychiatry
Article Date: 27 Nov 2011 - 0:00 PST
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"It feels like there's two of you inside - like there's another half of you, which is my anorexia, and then there's the real K, the real me, the logic part of me, and it's a constant battle between the two." - 36 year old study participant with anorexia nervosa.
People with anorexia nervosa struggle with questions about their real, or "authentic," self - whether their illness is separate from or integral to them - and this conflict has implications for compulsory treatment, concludes a study in the Hastings Center Report. The researchers also conclude that exploring ideas of authenticity may help clinicians formulate therapeutic approaches and provides insights into whether compulsory treatment can be justified.
For the study, researchers in the U.K. interviewed 29 women who were being treated for anorexia nervosa at clinics throughout the south of England. The interviews asked questions about how the women view their condition, including their understanding of it, how they feel about compulsory treatment, and their thoughts about the impact of anorexia on decision-making. Although the researchers did not ask about authenticity or identity, almost all of the participants spoke in terms of an "authentic self," the researchers write, "and, for almost all, the relationship between anorexia nervosa and this authentic self was a significant issue."
Participants characterized this relationship in different ways. Many saw anorexia nervosa as separate from their real self. Some expressed the idea of a power struggle between their real and inauthentic self. Others said that other people could provide support to enable the authentic self to gain strength within the struggle.
The researchers interpret the patients' notion of their illness as separate from their authentic self as a sign of hope. "Conceptualizing the anorexic behavior as an inauthentic part of the self may well be a valuable strategy for many in helping to overcome it," the authors write.
The authors also say that, in their view, the distinction between an authentic and an inauthentic self is not necessarily the same as a lack of capacity for decision-making and cannot justify overriding a patient's refusal to consent to treatment, although they believe that their findings give grounds for not simply acquiescing to refusals of help. "Some authorities argue that compulsory treatment should never be used for anorexia nervosa," they write. "We believe, however, that we should take seriously the possibility that a person in the throes of anorexia nervosa may be experiencing substantial inner conflict, even though the person may not be expressing that feeling at the time."
The authors conclude that clinicians need to monitor patients' views over time and that if the inner conflict persists, it suggests a lack of capacity for decision-making and, therefore, a risk of significant harm. In this case, they say, "perhaps the evidence from these accounts is sufficient to override treatment refusal in the person's best interest." An unanswered question is whether patients who regard anorexia nervosa as an inauthentic part of the self are most likely to respond to treatment. "A question of empirical study is whether those who separate the anorexic self from a perceived authentic self are more successful at overcoming anorexia nervosa than those who do not," the researchers write.
Article adapted by Medical News Today from original press release. Click 'references' tab above for source.Visit our eating disorders section for the latest news on this subject. The authors are Tony Hope, professor of medical ethics at the Ethox Centre in the University of Oxford, a fellow of St. Cross College, and honorary consultant psychiatrist; Jacinta Tan, a child and adolescent psychiatrist and medical ethicist who is a senior research fellow at Swansea University; Anne Stewart, a consultant child and adolescent psychiatrist at the Oxford Health NHS Foundation Trust and honorary senior clinical lecturer in the Department of Psychiatry at Oxford University; and Ray Fitzpatrick, professor of public health and primary care at the University of Oxford.
The Hastings Center Please use one of the following formats to cite this article in your essay, paper or report:
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8 Dec. 2011.
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posted by Nate on 27 Nov 2011 at 5:14 pm
I am now dating a woman who has battled anorexia in her past. She still eats quite poorly as she only allows herself to eat those things she knows she likes. She has been so honest and forward with me about this that it makes me love her even more. I want to help and want to make sure I am being the absolute best man for her in her life. How do I do this best? I am in unchartered territory but want to be not just a support for her but someone she grows with. Any advice?
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posted by Lia on 28 Nov 2011 at 5:38 am
As someone who has struggled with annorexia and is now in a relationship while trying to recover, I can tell you that the one thing that helps the most is my boyfriend focusing on things OTHER than my body when he complimnets me. When he tries to soothe my body concerns by telling me I look awesome "just the way I am" I know he's trying to help, but I also still need to gain weight to be healthy and knowing he likes me as I am right now makes it even more difficult to change. When he talks about my personality or how he's proud of my academic accomplishments etc. it helps me to recognize that I am so much more than my body and this eating disorder.
As much as I hate it, I also like it when he pushes me to eat a bit more. There is a fine line between what is and isn't ok to say, but a little bit of encouragement helps me at least.
I also think that the fact that he listens without judging has helped me so much. He's one of the only people I feel like I can talk to about what is going on in my head without feeling crazy. He never pretends to understand what I am going through- how could he, but he is supportive and tells me that even though he can't imagine what it's like, he knows how difficult it must be for me.
Hope that helps a bit. She's lucky to have someone like you that cares enough to want to help and loves her despite her imperfections.
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posted by Joy on 28 Nov 2011 at 12:33 pm
I have a history of eating disorders and occasionally the old mental battle comes up during a meal when I am emotionally drained from the circumstances of life. In those cases, it helps to have someone with a positive attitude distracting me away from my thoughts with a story, interesting conversation, or something funny. If your girlfriend is ever having trouble eating, maybe it is because the mental struggle is paralyzing her and she needs to refocus her thoughts on something else and then the eating becomes more of a background activity and less of a terrifying decision.
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posted by Nicole on 5 Dec 2011 at 6:40 pm
I can't help thinking it would be better to integrate the two conflicting parts rather than have the person completely disassociate from something which, whilst they might consider inauthentic, is still a part of them.
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