I wasn’t shocked to read this article, “Anorexia treatment: When less is more.” I sometimes feel that way myself. According to the article, “The results suggest that at least in fairly early stages of anorexia (this study excluded women with chronic severe symptoms or other psychiatric and medical disorders), anorexic patients should not be pushed too hard. The use of elaborate therapeutic techniques may backfire. Instead, they may do better with simple explanations, empathy, and support to help them help themselves. ” While I think that treatment is necessary, there are definitely a few drawbacks (in my eyes–these aren’t addressed in the brief).
- Attention – In a twisted way, treatment (whether it be nutrition, therapy, or dr. appts.) is reinforcing of the eating disorder. It’s validation that yes, you are sick. You get to talk about the disorder ad nauseum… which you probably want to do anyway, since you’re not eating and therefore definitely thinking about it. In nutrition, you can focus more on the food. With therapy, you get some relationship or attachment that you might not already have in your life. I’ll admit, as frustrating and annoying as treatment can be–there’s something desirable about having people fussing over you.
- Time – The more time you spend in treatment, the less time you’re spending in the “real world,” focusing on the other aspects of your life. Whether you’re inpatient or just going to a lot of appointments–you’re not in school, at work, with your family, etc. You miss “normal” activities and events because you’re busy talking about eating disorder stuff. Hmm… pass up an opportunity to be with others, surround yourself with normal eaters, feel validation in a different aspect of life… all for an hour of talking about black-and-white thinking, cognitive disortions, BDD, etc. ? That doesn’t sound helpful.
- Isolation – Having appointments, CBT worksheets, journalling assignments, etc. differentiates you from others around you. Often they don’t know what’s going on, and you’re spending more and more time doing treatment stuff. You need support… not to have appointments isolating you from friends and family even more.
- The “revolving door” – It’s true, people get stuck in the treatment cycle. Inpatient, outpatient, inpatient again… Treatment can quickly become someone’s life… when you’ve been away from the other stuff in your life for so long, it actually may be all you have going on. And when you make valuable relationships with treatment professionals or other individuals in groups… there’s some connection formed about being sick and being cared for / having meaningful relationships.
- Apathy – this is probably one of the biggest ones for me. I think there is some diminishing return on therapy. I definitely got more out of therapy years ago than I do now. Treatment and therapy has become normal, boring, dull, part of the routine…
- Defiance – Some people think anorexia is about control… having a professional take control of your treatment & eating disorder, therefore, is scary. I’ve refused to follow instructions in blatant defiance of my doctor or nutritionist before… sometimes doing things I wouldn’t have necessarily done if I didn’t know that someone would notice.
- Learning bad habits – I’ve definitely picked up some ED habits from examples my thearpist has given or other girls that i’ve met in treatment. I can’t say that I wouldn’t struggle with those behaviors without meeting those people… but maybe…
I’ll stop there, because I could go on for a long time (clearly). Don’t get me wrong, I think that anorexics (and others with EDs) need treatment… even if they’re clearly resisting, I think it’s irresponsible to not monitor them at all. My point with it all is that therapy isn’t this wonderful solution…
Later thought: I wonder what the results (1-year and 5-year follow-up) would be for this study.. and I wish they would include some kind of integrative or psychodynamic control in there, too…
Tags: anorexia, treatment, therapy, journal article
Grey Thinking 