I am not convinced that all people with EDs exhibit anosognosia. Many people I know with bulimia nervosa or binge eating disorder are desperate for help with their eating behaviours and are very aware that their eating is out of control.

In terms of anorexia nervosa (AN).. Two people have recently commented on my blog stating that they made 'snap decisions' to recover from AN when they were at very low weights. I know of others with restricting AN who also decided to eat after a prolonged period of semi-starvation - because they were sick and tired of the illness. These observations suggest that some people with AN can operate freewill.

On a personal level, it was only during the first 12-18 months of AN, when I was a child, that I didn't recognise that I was ill. Through the remaining 26 years that I was actively anorexic I recognised that my behaviours were damaging my health but I couldn't get out of the illness on my own. I had such terrible anxiety and mood swings (mainly depression) when I tried to eat more that I felt suicidal. There was no way that I could have made a 'snap decision' to recover from AN. The process of recovery for me has been torture, and has entailed a lot more than just gaining weight. But for 26 years I didn't have anosognosia; just terrible fear.

I'm inclined to agree with ELT. I have met very few (if any) folk with eating disorders who would deny entirely that they have an illness. Some of the illest folk I know are entirely aware despite feeling terribly stuck and being unable to do all that is necessary to make changes towards some kind of recovery. It is one of my main frustrations with myself! One of the "symptoms" of anosognosia is the oft talked about "lack of insight". This too does not marry with my own experience, or, as far I'm aware, the experience of many.
I wonder if sometimes the term anosognosia gets a little mixed up with dissociation? I've thought this for a while now, as although I and many have insight into our illnesses, the detachment from, well, I guess "reality" really does hamper a continual movement forwrds towards "recovery". And yes, I agree with ELT in that I have spent many years trying to find my way out of the eating disorder only to be tripped up by terrible fear (which has lead to dissociation - which has tipped me off the precarious tightrope, or, just not let me climb up to the tightrope at all!)
Like anosognosia, this detachment ot dissociation is not chosen, but I believe it is part of the illness and perhaps part of my brains make-up.
I'd be interested what your thoughts on dissociation are Carrie, as I always give great weight to your views and value your opinions.
I suppose, also, I have a personal dislike of the use of anosognosia as someone who has been detained (in 1996) for a year via the Mental Health Act for my eating disorder. Somehow I find the term quite disempowering, as I did my detainment and subsequent "treatment" (and then my discharge in 1998 at which point I was no "better" than before, in fact weight-wise I was lower!). Although I was told frequently how great an insight I had into my own illness, it was obviously not enough to enable me (with all this "help" and support I was being given) to break free from the eating disorder. I just ended up feeling rather hopeless and, indeed rather helpless. Hmm, not sure but I may have strayed slightly from the topic at hand!
I'd be interested in any evidence, such as fMRI scans that showed the damage to the areas of the brain mentioned in the video from eating disordered patients that supports anosognosia. I'm more inclined to think it a direct result from the damage caused by malnutrition in those that do clearly appear anosognostic.
Of course these are just my own thoughts on this, I think it's important to discuss these things and be aware that anosognosia might be an issue for some folk. But also that it is not necessarily a true indicator or symptom of an eating disorder.
Hmm..interesting as usual Carrie, thanks!

Dear Carrie
I do enjoy reading your blog.
I looked into anosognosia a little while ago as i noticed that it was mainly the Feast boards that were talking about it in relation to eating disorders. The article they linked to wasn't an academic article by any means either.
I looked at a few journals and Walter Vandereycken's Denial of illness part 2 article touches on this. Also, from a neural perspective-as we learn from the "The Fault Is Not in Her Parents but in Her Insula—A NeurobiologicalHypothesis of Anorexia Nervosa" article which is freely available on the net- anosognosia affects Somatosensory cortex which affects Body evaluation.

I'm sure that there is more to it, but from a neural perspective there is answers.

It's probably something that can shift say from when you're younger denying that you have an eating disorder to denying the severity/effects of it in later years.

I think this applies to OCD too. I know that when I am in the middle of an obsession, I really do feel like it is real. The anxiety is high and even when people tell me it is my OCD talking, I don't believe them. It is not until that obsession goes away (or turns into another one) that I can see how illogical it was.

I get this, in a major way. I never knew I had an ed, despite being told by various md's and therapists that I did. I always just ignored them b/c it seemed it didn't apply, and that wasn't why I was there to see them anyway. The therapist I am currently seeing went-toe to-toe with me on it and demanded that I get treatment for it from an md and a dietitian if I was going to continue seeing her. We fought about it for months. There was nothing wrong with me- I just knew it. But she is the first professional I've ever really bonded with and trusted, so we kept fighting it out till she convinced me to receive some help. Even now, after getting a thorough medical evaluation and understanding that bloodwork results prove dehydration and EKG results prove irregularities in my heart, my brain still goes back to "there's nothing wrong with me" over and over- but at least now I am getting help- because I trust her. So I totally get this.

I did not lack awareness about my ED. I was painfully aware of it. My parents on the other hand....now there was some denial. As soon as I was on my own in college, I went into therapy.

Even in the grip of an obsession/obsessive behavior, it's possible to be aware of it and the damage it's creating. What's truly hard is breaking out of the behavior.

I didn't realize how sick I was becoming until I was in way over my head. Thank you for this blog.

That video was extremely sad, and it makes me question why I wasn't able to tell I was sick with anorexia for a long time. I literally did not believe I was ill. I thought everyone was exaggerating and that I was just *thin*.

I know this probably isn't a popular reaction, but I feel so sorry for the man in the video. He is so ill and he is unable to fathom that. I wonder what happened to him.

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