Conceptualizing anorexic behavior as an inauthentic part of the self may well be a valuable strategy for many anorexia nervosa sufferers in helping to overcome it, say medicos.
Their investigation, appearing in the Hastings Center Report, notes that people with anorexia nervosa struggle with questions about their real, or "authentic," self - whether their illness is separate from or integral to them. This conflict, the researchers contend, has implications for treatment.
For the study, the researchers interviewed women who were being treated for anorexia nervosa at clinics throughout the south of England. Although the researchers did not ask about authenticity or identity, almost all of the participants spoke in terms of an "authentic self," the study notes, "and, for almost all, the relationship between anorexia nervosa and this authentic self was a significant issue."
The 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.
Researcher Tony Hope, from the University of Oxford, said the patients' notion of their illness as separate from their authentic self hints at possible treatment strategies. "Conceptualizing the anorexic behavior as an inauthentic part of the self may well be a valuable strategy for many in helping to overcome it."
Interestingly, the researchers believe that 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 conclude.
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Source: The Hastings Center