Treating Anorexia as a Process of Reprogramming

Anorexia is one of the most intransigent psychiatric illnesses to treat, certainly much harder than any other eating disorder.

In this blog, I have written extensively about the eating disorder thought process of anorexia. People often experience it as screaming in their head, almost a person’s voice telling them what to do. The more they disobey these thoughts, the louder the screams get.

These are not psychotic symptoms which entail people hearing or seeing things that aren’t there. These voices are thoughts in one’s mind, disembodied thoughts that don’t fully seem like one’s own individual thoughts.

The person with anorexia often feels taken over by the thoughts to the point that their own thoughts and feelings are pushed aside and replaced by the eating disorder. One’s personality, wishes and feelings all become secondary to the demands of the eating disorder thoughts.

Successful therapy for severe anorexia can often feel like reprogramming: a process of unearthing the person’s true thoughts and feelings after years of being buried under the illness. The treatment involves creating a strong bond between the therapist and actual person to help the person to question the eating disorder thoughts and motives.

Once the person begins to question the thoughts, it leads to the possibility of considering others options. Is being so starved actually something that improves one’s life? Does it feel good to be sick and weak? Is being underweight a true accomplishment? Why is it worth forgoing everything else in life that matters? Isn’t it better to have real relationships than only a relationship with your eating disorder?

These questions are a start, but even when the person can see the contradictions, questioning the anorexia still feels like betraying these thoughts that have protected the person, kept her safe and made sure she felt ok. The step towards reframing this concept of betrayal as a process of moving forward in one’s life is equally critical.

It is almost as if recovery from anorexia is a reprogramming after being brainwashed by this illness. I can’t think of another Illness that coopts brain function yet still leaves the rest of one’s abilities intact.

The next post will address a secondary effect of anorexia. Namely, how does the concept of anorexia as brainwashing open the door to the cult of the brilliant clinician?

Secondary Diagnoses with Eating Disorders

Diagnoses in psychiatry are inherently confusing. There are categories with several criteria for each illness. If a patient fulfills enough of the symptoms, they receive the diagnosis. There are no definitive tests or diagnostic scans but only empirical data clinicians use to agree on definitions of illness.

This approach to mental illness was created to codify a language clinicians use to communicate with each other. However, it also leaves many people with a handful of diagnoses—a grab bag of symptoms which mean very little to patients when thrown together.

This experience is common for people with eating disorders. Most often, people with eating disorders develop a number of other symptoms secondary to the chronic eating symptoms such as depression, anxiety or OCD. The list of diagnoses following an eating disorder on a chart is often of little value. Normalizing eating almost always eliminates these issues as well. In other words, the eating disorder is usually the primary problem.

Some patients who have been ill for some time are excited or hopeful about the idea that another diagnosis may be the core issue. Their hope is that this new diagnosis opens the door for a clearer path to wellness.

Unfortunately, a new understanding by a clinician gives false hope. Some secondary diagnoses solidify over time and appear to be primary, but that only reflects the hardened nature of the eating disorder in a person’s life rather than the new realization which solves all their issues.

Bipolar disorder and Post-Traumatic stress disorder are the two most common illnesses which turn out to be primary and the eating disorder just a manifestation of those symptoms. Treating the primary issue in these cases can lead to a more swift recovery.

Panic disorder, Major depression and Obsessive Compulsive Disorder typically are secondary diagnoses. Focusing on these issues rarely leads to eating disorder recovery. OCD can sometimes appear to be the primary issue, but long-standing restriction typically leads to OCD symptoms that can be very strong but still secondary.

It is important to recognize and treat secondary diagnoses. No clinician should ignore these issues; however, treatment needs to stay focused primarily on eating disorder recovery. Prolonged periods of abnormal eating lead to symptoms that mimic other psychiatric illnesses, but eating disorder treatment needs to remain the number one issue.