In Anorexia Nervosa, Inner Conflicts Over The ‘Real’ Self Have Treatment Implications ?>

In Anorexia Nervosa, Inner Conflicts Over The ‘Real’ Self Have Treatment Implications

“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

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.

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