Paradoxical Disease
Most people who get sick want to get better. When we contract a disease we usually go to the doctor to get medicine, right? Well, anorexia nervosa is one of the few diseases that the affected like having. This is what makes treating the disease so incredibly difficult. Image that you are a doctor. You know that the cure for your patient’s illness is a simple pill. If she would just take it, she would be cured. But she doesn’t want to take it! She wants to keep her illness.
In the same way, therapists know that food is an integral part of the recovery process for an anorexic. But their anorexic patients don’t want to get better. They won’t take the “pill”. This disease is particularly difficult to treat because, while the patients are dying before their very eyes, they want to keep their disease. It works for them. The psychological term for this is “ego-syntonic”. It means that the behaviors and effects of their anorexia make them feel good. While the feeling of hunger for a “normal” person is unpleasant, it feels good, even euphoric, for an anorexic. While lethargy and sluggishness is a drag for most people, these feelings are reward and reassurance for someone with anorexia. Most females are concerned when they are a-menstrual for several months. An anorexic likes this because it tells her that her starvation is working and she is still underweight.
Rather than feel calm and safe when satiated, anorexics feel extremely anxious and fearful; like crawling out of their skin. Hunger does not create a feeling of anxiety like it does for those who respond to our instinctual need to find food when hungry. Instead, it actually creates a feeling of calm and numbness. Not eating for an anorexic makes them feel victorious. The behaviors of this disease cause someone to feel competent, in control, even invincible. Who would want to give that up!?
This is why suggestions such as “just eat” or “why don’t you have a sandwich” don’t work for someone suffering from this disease. Recovery is not as quick as just popping a pill. It requires long and tedious work of meeting the underlying emotional needs until the behaviors are no longer needed. It also requires working with the afflicted to help them also see how their disease is not working for them. Until this realization breaks through the heavy denial, treatment will most probably be unsuccessful. Once someone realizes, at least on some level, that their disease is no longer accomplishing for them all that it originally did, change and recovery is much more possible.
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