Disordered Thinking in Anorexia: the Most Concerning Symptom

A complicated aspect of anorexia is the underlying belief early in the illness that one is not truly sick.

Disordered thinking is a psychiatric term that means one’s brain cannot follow facts logically and cannot process information correctly. In other illnesses, examples of disordered thinking are paranoid thoughts, an inability to make sense and delusions (a fixed false belief) about the world.

Some eating disorder symptoms begin to appear somewhat disordered but never represent overall disordered thinking, such as body image distortion or wildly overestimating the calories of food.

However, severe anorexia does have one thought process that appears disordered. In some of the worst cases of anorexia, people don’t believe they are truly sick. Sometimes people who are clearly underweight can’t see it. Others who are eating very little food in a day believe their body doesn’t need more. In the worst case scenario, people with significant medical problems from their illness cannot believe they are truly sick. These people may be shown irrefutable evidence of their illness and simply do not believe it.

The disordered thought process in anorexia is important for another reason. These cases are the most severe and have a likely chance of chronic illness and early death.

Tackling and challenging this thought process is imperative. In less severe cases, the standard treatment is nourishment and restoration of health because some issues with brain function reverse with food. In the most severe cases, food doesn’t change the underlying thoughts and may reinforce them because any weight gain only solidifies the disordered thoughts.

For these patients, it’s critical to have therapy focus on questioning these thoughts. The goals are to present the case for why the anorexia is severe over and over again. The disordered thoughts give the patient relief since they justify the need to restrict. Instead therapy needs to make the person question these thoughts each day. The risk of the disordered thoughts is that they become an undeniable truth. If that is too solidified, the chance of recovery goes down significantly.

It’s necessary for the person to know that this battle between disordered, untrue thoughts and the unpleasant reality needs to be the crux of treatment. Without a clear sense of the truth, all therapy will seem meaningless and the anorexia will take over completely.