A new report concludes that people with anorexia nervosa struggle with questions about their real, or “authentic,” self.
Researchers believe an understanding of the conflict has implications for compulsory treatment. Clinicians believe an approach that explores ideas of authenticity may represent a new therapeutic avenue and could provide insights into whether compulsory treatment can be justified.
Researchers in the UK interviewed 29 women who were being treated for anorexia nervosa at clinics throughout the south of England. In the interview, women were asked about how they viewed 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.” Moreover, researchers report that, “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 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 discovery that patients view their illness as separate from their authentic self is viewed by researchers 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.”
To summarize, investigators believe clinicians need to monitor patients’ views over time. 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.
Source: The Hastings Center