More Than Denial: When Someone with an Eating Disorder Don’t Know They’re Ill

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The hardest thing to deal with eating disorders is recognizing that there indeed is a problem. In most instances, patients refuse to believe that they need help. In the eyes of family members and friends, it may seem like they’re just in denial. But the truth is, it’s a little more complicated than that. It would take a lot of patience and communication to bring them to the treatment they need.

The Case of Anosognosia

People with eating disorders often exhibit signs of a condition called anosognosia. This is a neurological syndrome characterized by brain damage, which results in a profound lack of awareness of a certain health problem. In this case, patients aren’t just in blatant denial of anorexia or bulimia. It’s more than defense mechanism kicking in to help cope with the prospect of such an illness. There’s really an anatomical defect that makes your loved one refuse to believe that they’re sick. You’re probably wondering why brain damage happens among eating disorder patients, in the first place. Well, doctors believe that it can be due to severe malnutrition. When the body doesn’t receive essential nutrients, it becomes difficult for the brain to process alarming information, like an eating disorder, that the person may not be able to reach a full understanding of their state. 

In anorexia and bulimia nervosa treatment centers, medical practitioners often identify anosognosia by taking note of what the patients say, as opposed to what they do. Someone with eating disorders who’s struggling with anosognosia will adamantly convince people around them that they don’t have a problem. Because in their perspective, there really is none. So you’ll find them saying, “there’s nothing wrong with me” or “everyone is just overly dramatic and paranoid.” But also you see them being so obsessed, sometimes to the point of getting so inconvenienced, when monitoring calories in their diet and exercising. In this state of unawareness, they will most likely turn down any suggestion for treatment, which of course, as you know, all the more worsens the health condition.

The Approach to ED-Anosognosia Patients

How then can you help your loved one suffering? Remember, an anorexic or bulimic person who has anosognosia isn’t aware of the problem. They’re not denying it. They really just don’t see it. Your goal then when you talk to them is to make them understand that there’s an issue to be addressed. Now, in bringing this up, be careful not to sound judgmental. Avoid comments on their appearance or weight changes. This will further feed their eating disorder thoughts. At the same time, they will argue that they don’t look thin or ‘anorexic enough’ precisely because eating disorder distorts body image. Focus instead on the habits you yourself have observed, as these are more ‘measurable’ and they can see the change in it. Instead of saying, “you’ve grown so stick-thin in the last weeks”, tell them, “I noticed that you haven’t been eating dinner with us.” This can be your springboard for communicating that they might want to consider getting help.

The Road to Recovery

Anorexic and weight obsessed young woman

It’s a real dilemma to help loved ones seek treatment for eating disorders. Especially when they don’t know that they have a problem. But don’t give up. Be patient in reaching out and enlightening them. Eventually, they will get there.