In sickness and in health

One of the most common features of anorexia is an inability to see that you are sick. I don't have a problem, no, no. You're the one with the problem. Worrying too much. Freaking out over nothing. Oh, I know. You're jealous. Right? Aren't you jealous?

Losing weight was NOT my problem. Was not a problem, in my mind. I set out to lose weight, and damn did I succeed. So how could this be a problem? I still have trouble seeing the huge fuss. I wasn't that sick. Was I?

(My mom is nodding her head yes. Yes, Carrie, you were. I can just see it.)

And yet. Yet I did understand several things. I was lonely and miserable. My hair was falling out. My skin was a pale yellowish-gray color. I was always cold. I had no energy.

But I was losing weight! I was losing weight, dammit.

This is known as "illness intrusiveness," a measure of how much you believe your illness (anorexia, depression, cancer, etc) is impacting your life. They can measure this via questionnaire, and a group at the University of Toronto indeed did just that. They compared illness intrusiveness in people with anorexia to intrusiveness in people with other psychiatric and medical conditions.

Lo and behold, they found that people with anorexia found their illness to be much more intrusive than other patients also hospitalized with other conditions. So even if they weren't able to say, "Gee, I think I'm losing too much weight. Better go have a sandwich!" there was a tacit understanding that the eating disordered behaviors were problematic.

I don't know if this was a universal feature of people in this study, and it likely wasn't. And therapy should not be hinged on this recognition. It often isn't enough to let individuals "choose" to recover. But it can help.

A group at the Maudsley Hospital in London is looking at a technique called motivational interviewing. My first thought was of Stewart Smalley on Saturday Night Live (you know, back when it was still funny), staring in the mirror with his little cardigan, saying, "I'm good enough, I'm smart enough, and doggone it, people like me."

Not quite.

Rather, this technique can help people make positive changes as they move forward with eating disorder recovery. When used properly, it can help provide perspective on what patients might be missing by continuing with the eating disorder--much like it might be used with substance abusers.

But trying to show a heroin addict what he's missing when he's high as a kite isn't going to do you any good. He needs to detox. For a person with an eating disorder, they need to be eating regularly, not engaging in other ED behaviors and at a healthy weight (that is, detoxed) before this really reaches its full potential. I see it being really useful in adults with eating disorders, people who might not otherwise be willing to embrace recovery or have someone to give them that shove forward. Something to keep you afloat in those waves of anxiety can be priceless.

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Anonymous said...

This ones sort of along the same lines. And of course anyone who's seen it up close would agree--AN is a soul sucking nightmare that will really mess up a person's life.

Int J Eat Disord. 2008 Apr 29 [Epub ahead of print] Links
A pilot case series using qualitative and quantitative methods: Biological, psychological and social outcome in severe and enduring eating disorder (anorexia nervosa).

Arkell J, Robinson P.
Department of Mental Health Sciences, Royal Free and University College Medical School, London, United Kingdom.
OBJECTIVE:: We explore the level of disability and quality of life in participants with severe and enduring eating disorder (anorexia nervosa). METHOD:: We use qualitative and quantitative methods to assess in detail eleven participants with a 10-year history of anorexia nervosa. Outcomes for quality of life are compared with those of a sample of primary care patients with moderate-severe depression. Outcomes for living skills are compared with a standardized community sample of patients with schizophrenia. RESULTS:: Despite scoring highly for communication skills and levels of responsibility, participants were as impaired as the sample of patients with schizophrenia for self-care and social contact. Participants were severely depressed and scores for quality of life mirrored those of the primary care population. Qualitative data illustrate intrapersonal and interpersonal avoidance leading to self-neglect and social isolation despite social skills. CONCLUSION:: Quality of life and living skills are as impaired as those of other severe and enduring mental illnesses. (c) 2008 by Wiley Periodicals, Inc. Int J Eat Disord 2008.

marcella said...

"Quality of life and living skills are as impaired as those of other severe and enduring mental illnesses" - and yet, certainly within Primary Care in the UK, eating disorders are not defined as mental illnesses. Grrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrr.

Anonymous said...

I'm curious. What are they defined as? I thought the abstract (haven't look at the full text) did a nice job highlighting the strengths of people who were AN--they scored high on communications skills and responsibility--yet they suffer so. It's horribly unfair.

Anonymous said...

I meant people who *had* AN, not people who *were* AN. Sorry. And, of course, it's very unfair to be saddled with schizophrenia too.

marcella said...

In the current Primary Care Quality and Outcomes Framework (the financial incentive scheme for British GPs) they aren't defined as anything. Of course it's true that specialist staff (whether they be psychiatrists, nurses or art therapists) who work with patients with EDs are almost always trained in general psychiatric work before they choose to specialise in this area which is funded by the psychiatric services. It is also true that most GPs would THINK that EDs are psychiatric illnesses and would diagnose and refer accordingly - BUT the computer toolkits and PCT data collection that is supposed to help them achieve quality care ignores the problem (along with substance abuse and personality disorders) totally. Thus you can have the rather strange situation of someone who has no record of a mental illness being sectioned under the mental health act - bizarre.

Tracey said...


Thanks for posting the MI info!

I actually think MI can be enormously beneficial to younger ED sufferes as well, not just adults. And for many therapists, MI training wouldn't hurt either.

-cheers said...

So true. The whole time I had anorexia I knew it was a problem, but I didn't know how to stop it.

carrie said...

Wow. Thanks for all of the feedback.

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I'm a science writer, a jewelry design artist, a bookworm, a complete geek, and mom to a wonderful kitty. I am also recovering from a decade-plus battle with anorexia nervosa. I believe that complete recovery is possible, and that the first step along that path is full nutrition.

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nour·ish: (v); to sustain with food or nutriment; supply with what is necessary for life, health, and growth; to cherish, foster, keep alive; to strengthen, build up, or promote


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