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"Denial" in Anorexia: Wilful or Choiceless (or in between)

25/5/2012

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The “denial”  (note those “”) of the illness in anorexia is well described. It is one of the most frustrating aspects of the illness for carers and clinicians alike.  It contributes greatly to the expressed emotion (frustration, anger, criticism and patient blaming) that comes from clinicians and acts as a therapist driven therapy interfering behaviour.  Therapist will describe their feelings that somehow the patient is willfully lying to them, because the patient “must” be aware of their illness.  They are being that naughty anorexic patient who seems to seek out to disrupt therapy.

What if clinicians ask that question that we ask patients so often “Is there a different, more workable, way of thinking about this?”  As always, the answer is yes.

Until I began reading the blogs of Laura Collins, I had never heard of anosognisia.  This is apparently a common problem in several brain diseases which where the sufferer no insight or is unaware of the illness.  It occurs in neurological diseases such as Alzheimer’s disease, Huntington’s disease and after strokes.  It can also be a feature of schizophrenia and bipolar disorder.

Some FMRI pictures and more information can be found here.

Im not sure if it has ever been studied in anorexia nervosa.  Im not sure if it would be preexisting and exacerbated by starvation, or caused by starvation.  

It important though for us to hold information in a way that may help us see that anorexia nervosa is not a willful choice. Holding this stance is incredibly helpful for therapist (and hence their patients).


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    Author

    Chris Thornton is a Clinical Psychologist and the Clinical Director of The Redleaf Practice, a specialist outpatient clinic for the treatment of eating disorders.  He is interested in bringing elements of positive psychology, Cognitive Behavioural Therapy and Acceptance and Mindfulness approaches to the treatment of eating disorders.   

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