When Your Loved One Doesn’t Want to Get Better: Understanding Anosognosia in Anorexia Nervosa

Posted on April 11, 2024September 26, 2024 by Alison Pelz, LD, RD, CDE, LCSW

Anorexia nervosa is an eating disorder characterized by severe food restriction, an intense fear of weight gain, and body image disturbance. Anorexia nervosa affects many individuals of all genders, ages, and identities worldwide.

The consequences of anorexia nervosa can be devastating, both physically and psychologically. However, one of the most challenging aspects of this disorder, particularly for family members and caregivers (and even clinicians!), is the phenomenon known as anosognosia.

What is Anosognosia?

Anosognosia, stemming from the Greek words “nosos” (disease) and “gnosis” (knowledge), refers to a lack of awareness of one’s illness. Anosognosia often can feel and look like denial.

Denial is a defense mechanism and psychological response to avoid dealing with anxiety or other uncomfortable feelings. In contrast, anosognosia in mental health conditions is better described as a lack of awareness of their own condition.

Anosognosia can affect individuals struggling with bipolar, schizophrenia, eating disorders, and other psychological disorders.

In anorexia nervosa, individuals may minimize the severity of their condition. They may adamantly believe they are not sick, or that their behaviors are justified, making it incredibly difficult for them to recognize the need for treatment. It can feel like your loved one is being “difficult” and in teenagers it can be especially confusing because during adolescence it is normal for teens to be contrary or contradictory.

Anosognosia causes a person to be unable to achieve one or more of the following:

Accept that they have an illness or disorder.
See the signs and symptoms of their condition.
Connect their feelings and personal experiences back to that condition.
Understand and agree that the condition is serious and needs treatment.

One of the most dangerous aspects of anosognosia in anorexia nervosa is the individual struggling with insight when the condition becomes life-threatening.

This lack of awareness around a loved one’s illness can further complicate the treatment plan and, many times, prevent treatment from occurring altogether.

Parents frequently ask me if they should wait for their child to want to recover.

My answer is always no, because I know that anosognosia is most likely operating, and because the devastating effects eating disorders have.

Let’s face it – no teen really wants the devastating effects of an eating disorder. Contrary to popular belief, no one chooses to have an eating disorder.

How Anosognosia May be Affecting You

It’s already difficult enough to observe as a family member or loved one suffers from Anorexia nervosa, but anosognosia can make it incredibly distressing and frustrating. Despite your pleas, watching as your loved one deteriorates physically and emotionally, while they remain unaware of the severity of their condition, can evoke feelings of helplessness and despair.

To best help your loved one, you must recognize that anosognosia is not a choice but rather a symptom of the disorder.

It is deeply rooted in neurological and psychological mechanisms impairing the individual’s ability to perceive reality accurately. This is completely out of their control, and without professional help,they may be unable to leave behind their problematic and highly dangerous behaviors.

The Role of Brain Connection in Anosognosia

Research suggests that anosognosia in anorexia nervosa may have an anatomical basis.

Brain imaging studies indicate abnormalities in brain structure and function. According to a study published in the European Eating Disorder Review, up to 80% of individuals with anorexia exhibit some degree of anosognosia.

Malnutrition, a hallmark of anorexia, can lead to significant changes in brain chemistry and structure. This potentially contributes to the development of anosognosia. These neurological alterations can impair the individual’s ability to recognize their illness and hinder their motivation to seek help. This perpetuates the cycle of disordered eating behaviors.

The good news is with nutrition rehabilitation, anosognosia diminishes.

Navigating Treatment and Recovery

Supporting a loved one with anorexia nervosa requires patience, empathy, and a comprehensive understanding of the disorder. Here are some ways you can help your loved one on their journey to recovery:

Show Compassion and Understanding

When you are speaking to your loved one about their eating disorder, it’s important to approach the conversation with compassion. You want to validate their experiences and avoid judgments, criticism, and shaming.

Encourage Professional Help

Although it may be difficult for someone with an eating disorder to want to receive treatment, it is still important for you to encourage it. Most success is found in early intervention. When the illness is treated, early on, there are often better outcomes than for those struggling without help for years.

Educate Yourself

One of the best things you can do to support your loved one if they are struggling with anorexia and/or anosognosia is to educate yourself on the facts. This should include the common signs and symptoms, possible treatment options, and debunked myths. This information is powerful in helping you better advocate for your loved one and their well-being.

Foster Open Communication

Create a safe and supportive environment where your loved one feels comfortable discussing their thoughts and feelings. Encourage open communication and active listening, allowing them to express themselves without fear of judgment or criticism.

Practice Self-Care

Supporting a loved one with an eating disorder can be emotionally and physically draining. Take care of yourself and prioritize your own well-being, seeking support from friends, family, or mental health professionals if needed.

Be Aware of Triggers

One of the most important things to keep in mind is that even those deep into recovery can and will experience triggers. You can avoid adding to these by educating yourself on avoiding phrases and conversations, such as calorie counts or weight loss.

Expert Eating Disorder Treatment

If you think that a family member, child, or friend of yours is struggling with an eating disorder, it is important to consult a professional. With proper treatment, individuals can overcome their eating disorder and live a healthier life, both physically and mentally.

I am Alison Pelz, a psychotherapist and registered dietitian with over 16 years of experience. I specialize in treating eating disorders in Austin, TX.

If you or someone you care about is struggling with an eating disorder, don’t hesitate to reach out for help. To learn more about expert eating disorder treatment and schedule a consultation with me today. I am here to help you and your loved ones reclaim their lives and break through the chains of disordered eating.

Are you a clinician? Sign up for my mailing list and CE course!

Sources:

Impaired Awareness and Anosognosia in Mentally Ill: Study Summaries (Mental Illness Policy Org)
Anosognosia Condition and Anorexia (verywellmind.com)
European Eating Disorders Review | Eating Disorders Journal (Wiley Online Library)

4 Tips for Anyone Who Loves an Adult in Eating Disorder Recovery

Posted on November 10, 2021November 9, 2021 by Alison Pelz, LD, RD, CDE, LCSW

When you hear the words “eating disorder” what comes to mind? More often than not, eating disorders are associated with teenage girls. While it is true eating disorders often develop in adolescence, adults can have eating disorders, too.

It’s possible for eating disorders to initially develop later in life, not just during adolescence. It’s also possible that adults suffering from an eating disorder developed it during adolescence and never fully recovered. Life stressors (like a pandemic, for example!) later in life can also cause a relapse of eating disorders.

Eating disorders develop for a variety of reasons including genetics, temperament, gender, and dieting history to name a few.

It is less important why and how the eating disorder developed, and more important to focus on supporting your loved one in their eating disorder recovery.

If you love someone in eating disorder recovery, here are four ways to show your support:

1. Think about an eating disorder like a physical illness.

An eating disorder, like cancer, is not a choice. This is often misunderstood. If it was as simple as just choosing to eat more food, far fewer people would suffer with eating disorders.

If your loved one was going through treatment for cancer you may do some of the following: learn about their diagnosis, take them to treatment appointments, provide support, and check-in with them more frequently.

You can do the same with eating disorders. Eating disorders are dangerous and can cause long-term health effects and even death, and they should be taken seriously. See what you can do to understand that eating disorders (EDs) are a physical as well as mental illness.

2. Get educated on eating disorders.

Learning as much as you can about eating disorders is another way to support a loved one in recovery. Eating disorders on the surface appear to be about food. But, make no mistake, while food issues are part of the eating disorder, eating disorders are psychiatric illnesses that must be treated by experienced clinicians. Here are some resources to learn more about eating disorders:

The National Association of Eating Disorders
The Eating Disorder Sourcebook by Carolyn Costin
Eight Keys to Recovery from an Eating Disorder by Carolyn Costin and Gwen Schubert Grabb
Skills-based Learning for Caring for a Loved One with an Eating Disorder by Janet Treasure, Grainne Smith and Anna Crane

You can also ask your loved one if they would like for you to attend treatment appointments with them so you can get a better understanding of their treatment plan and goals.

There are also resources on social media sites like Instagram that offer helpful information about eating disorders, diet culture, and recovery. Make sure to check that the information you’re getting is coming from a reliable source – there are lots of folks out there who borrow language from body positive and anti-diet circles but who are still pushing intentional weight loss or food restriction. It can be really eye-opening to learn about the root causes of eating disorders, in addition to being a great way to support someone you love with an eating disorder.

3. Learn how to communicate with your loved one in a supportive way.

As with most things, supporting someone in eating disorder recovery requires communication. The best way to find out how to support them is to ask! Ask them directly what would make them feel supported or what they’re struggling with. Find out what they would find helpful or for ways you can provide support (or adjust your support if necessary).

It can be tricky to communicate about such emotionally charged topics. Statements such as these can feel supportive to your loved one.

“I know this is hard.”
“You can do hard things.”
“I am here if you would like to talk about it.”

There are a lot of ways to be supportive, but some statements aren’t helpful for folks in ED recovery. Unhelpful statements that you may be tempted to say (remember the ED is not only about the food)

“Just eat.”
“I don’t know why this is so hard…do what I do [insert advice about food, exercise].”

Remember, eating disorders are not just about the food. Everyone’s body is different, and most of us aren’t qualified to give out medical or nutritional advice anyway – we can leave that to the folks on the treatment team.

Another thing to keep in mind is that mealtime can be particularly stressful for those with eating disorders. Some meals and foods may be easier or harder for your loved one to eat. If you eat with your loved one at mealtime it may be helpful to focus on light conversations that have nothing to do with their eating disorder.

4. Be patient.

Eating disorder recovery is a marathon, not a sprint. Recovery is not linear, in fact, it can get quite messy. It requires lots of learning and unlearning, as well as patience and self-compassion.

Don’t give up, and keep checking in with your loved one. Get support for yourself if you need a space where you can process the emotions of supporting someone through recovery. It’s okay to recognize that supporting someone sometimes means asking for help yourself. The National Alliance for Eating Disorders has free support groups for loved ones.

If you are looking for more ways to support your loved one in eating disorder recovery, talking to a therapist may help. Please call for a free 15-minute phone consultation to learn how I work with clients with eating disorders and loved ones.

5 Surprising Ways to Support Your Loved One with an Eating Disorder

Posted on September 25, 2018August 30, 2018 by Alison Pelz, LD, RD, CDE, LCSW

Knowing what to do to help your loved one with an eating disorder can be confusing, worrisome and at times downright frustrating. But, you can’t just sit back and watch them suffer because you are concerned about their health and well-being.

You may feel like you don’t know what to say or do for fear of making their disorder worse. Or, you say well-intended words of encouragement only to result in a screaming match.

You are not alone.

You have probably heard the expression “Put on your oxygen mask before assisting others“, right? This rings true for caring for a loved one with an eating disorder. I am not suggesting that you don’t get treatment for your loved one with an eating disorder. But, taking care of yourself is a must.

This post is not going to tell you exactly what to say or do to make the eating disorder magically disappear. Instead, I’ll go over what you can do for yourself so you can be emotionally & physically available to support your loved one in their recovery.

Tips to support a loved one with their eating disorder:

Learn about eating disorders.

Oftentimes eating disorders are misunderstood, even by well-respected medical providers. Although eating disorders appear on the surface to be about food, they really aren’t. Eating disorders help the suffer manage stress, uncomfortable feelings and give a sense of control.

Learning about the particular type of eating disorder your loved one has, the medical and psychological factors associated with it most likely will leave you feeling less overwhelmed.

The Eating Disorder Sourcebook by Caroline Costin is a great starting point because it gives a comprehensive overview of eating disorders. Gurze Books is a publisher that exclusively publishes eating disorder books – they have books as well as workbooks. Lastly, the National Eating Disorder Association has a wealth of information on their website.

Encourage treatment.

Unfortunately, eating disorders don’t go away on there own. Often suffers initially don’t want to go to treatment because it can feel scary and overwhelming. Or perhaps they are in denial about having an eating disorder. Sufferers may try to recover from their eating disorder on their own, but it rarely works.

Adequate treatment is a must for full recovery. Treatment is important to reduce medical risks associated with eating disorders and even death (Anorexia Nervosa has the highest mortality rate of all psychiatric conditions).

To learn more about what treatment involves read Building a Treatment Team to Help Conquer your Eating Disorder and treatment options.

Practice Good self-care.

Self-care is more than just a mani-pedi or a massage. While those things may be part of your self-care routine, self-care means deliberate acts that you do to take care of your physical, mental and emotional health.

Examples of self-care could include: getting enough sleep, engaging in hobbies, spending time with friends, taking breaks, and setting limits at work and home.

Good self-care is needed by everyone but is particularly important to prevent burnout from caring for someone with an eating disorder. Furthermore, you are setting a good example by modeling good self-care for your loved one because self-care is a skill that is taught in eating disorder recovery.

Set boundaries.

In the literal sense of the word, boundary means a dividing line. Boundaries are often associated with dividing geographical space, for example, the boundary line between two countries.

In the world of psychology, boundaries mean the physical and emotional limits that separate your needs from others. Boundaries make us feel safe and teaches others how to treat us. Being honest about how you feel and asking for what you need (and don’t need) are signs of healthy boundaries. Setting firm boundaries can also help you manages stress, avoid burnout and improve personal relationships.

When someone struggles with setting firm boundaries it can leave the person feeling like a “doormat”, manipulated and used and erodes self-esteem.

I see all too often that caretakers take on too much, or feel they have to help control their loved one’s eating disorder behaviors. This is a lose-lose. This can make the caretaker feel exhausted and it doesn’t allow the person with the eating disorder to take full responsibility for their own recovery.

Just as with self-care, learning how to set boundaries is a key component in eating disorder recovery. So when you model firm boundaries you are helping your loved one!

Find support for yourself.

Having a loved one with an eating disorder can be challenging at times. Additionally, the course of treatment for an eating disorder can be lengthy. You probably have heard the phrase,”This is a marathon, not a sprint“. This certainly holds true for eating disorder recovery. According to the National Eating Disorder Association, recovery can take months and even years. Although there is no specific timeline for recovery my clinical experience informs that recovery takes at least a few years.

Finding support for yourself can help promote a healthy relationship with your loved one, reduce stress in the household or family and get unstuck from patterns of behavior that may be reinforcing the eating disorder.

Many parents, families, partners or spouses find it helpful to get professional support through support groups, group counseling or individual therapy.

Supporting a loved one with an eating disorder can be challenging, but can yield great rewards in your personal growth as well as your loved one.

I know I didn’t give you a cure-all to help your loved one recovery from their eating disorder. But, I hope a gave you tools to help manage your stress, worry and make you a more effective support person for your loved one.

Remember: taking care of yourself will help your loved one by leaps and bounds in their recovery!

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