Anorexics attribute meaning to their symptoms

For many patients with the eating disorder anorexia nervosa, their self-starvation has real meaning and purpose in their lives. “Therefore, treatments of anorectic behavior which disregard the meaning that the patients attribute to the illness are likely to end in relapses,” lead investigator Dr. Ragnfrid H. Nordbo, of the Norwegian Institute of Public Health in Oslo, told Reuters Health.

Nordbo and colleagues conducted a qualitative study of the perceptions of 18 women with anorexia nervosa. The subjects, who were between 20 and 34 years old, underwent focused, in-depth interviews. The study findings are published in the November issue of the International Journal of Eating Disorders.

“Most anorectic patients regard their illness as meaningful,” Nordbo said.

Specifically, the team identified eight core “constructs” that play central functions in the maintenance of anorexia nervosa. They are: security, avoidance, mental strength, self-confidence, identity, care, communication, and death.

The security construct refers to anorexia as a way of providing structure, stability and organization, whereas the avoidance construct provides a way to evade negative and harmful emotions.

The constructs of mental strength (inner strength), self-confidence (feeling acknowledged and worthy of compliments) and identity (achieving new identity) are inter-related and may fuel the anorexic behavior.

Likewise, the care construct refers to anorexia as a way of eliciting care and attention from others. Evoking attention is a feature of the communication (communicating difficulties) construct as well.

The eighth construct—death, a wish to starve to death—is somewhat novel, the authors say, in that “systematic research has so far not described anorexia nervosa as an intended method of dying.”

The death construct “reemphasizes the severity of this type of eating disorder,” the authors note.

“Therapists who do not take these intentions into consideration are likely to elicit resistance and sooner or later fail in their treatment attempts,” Nordbo’s group writes. “We therefore emphasize the importance of encouraging patients to express their personal values and to explain how their eating disorder both fulfills and compromises their values.”

SOURCE: International Journal of Eating Disorders, November 2006.

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