Anorexia: a ‘new passion’ may help people recover

After a century of treating patients with anorexia nervosa, psychiatrists remain stymied as to how to loosen its grip. Forcefeeding may trigger suicide, and in many cases cognitive therapies are no match for patients’ burning drive to stay skeletally thin – even if it kills them.

Recently, however, a Canadian scholar challenged conventional ways of thinking about the illness with a theory involving archaic ideas about torturous passions and their power to take over mind, body and soul, The Globe and Mail reports.

Patients with anorexia are ruled by the heart, not the head, says Dr. Louis Charland, a University of Western Ontario philosophy professor. In a recent study published in the journal Philosophy, Psychiatry & Psychology, Charland and an international team of psychiatrists argued that anorexia sufferers are not just at the mercy of distorted thought patterns. Rather, they are in the throes of a destructive, all-consuming passion.

Charland, a member of Western’s Rotman Institute of Philosophy, says reclaiming the historic meaning of passion, whose root is Latin for suffering, and applying it to anorexia nervosa, will lead to more effective treatments. While controversial, the passions theory has been well received by psychiatrists and therapists, and is surprisingly in line with the latest neuroscience. Could it be a turning point in our understanding of this life-threatening disorder?

If anorexia is a passion, said Dr. Russell Marx, chief science officer for the U.S. National Eating Disorders Association (NEDA), “then it’s a crime of passion, because it’s the deadliest disorder in behavioural health.”

To that point, the mortality rate for anorexia is about five per cent – higher than that for schizophrenia, alcoholism or depression. Although anorexia is more common in young women and girls, it affects all ages, and an estimated 10 per cent of patients with eating disorders are male.

Only half of patients fully recover from anorexia. Of the other half, about 30 per cent will have partial recovery and 20 per cent will continue to suffer, or die.

Recent studies suggest the brains of anorexic patients may have overactive self-control centres, faulty reward circuitry and dulled responses in regions important for body awareness. At the same time, they show heightened activity in emotion-related neural networks in response to food.

The passions theory, which recognizes that patients have a deep emotional commitment to their disorder, may share common ground with alternative therapies, including body-oriented approaches.

Movement-based therapies help increase a patient’s “felt sense” of emotions, said Tannis Hugill, a Vancouver dance therapist who specializes in eating disorders. As patients begin to sense and express emotions physically, they learn to identify and tolerate a wider range of emotions, including joy, opening the door to “experiences other than fear and anxiety,” Hugill said.

For patients living at home, emotionally focused family therapy has emerged as one of the more successful treatments. In this approach, psychologists teach parents how to support a child’s eating at mealtimes, and how to closely attend to his or her emotional needs.

The emphasis on providing external support for eating has a parallel in the passions study, in which patients expressed relief when they handed over control of their eating to hospital staff. The originator of the theory, Ribot himself, suggested that order and routine may be helpful in overcoming a passion, the researchers wrote.

The traditional cure for a self-defeating passion, however, was to replace it with a healthier one – and hope it did not run amok in turn, Charland said.

This, too, is plausible in anorexia treatment, Marx said. He noted that recovered patients often become highly successful in medicine, business and law because of their single-minded focus, passion for detail and drive. Ultimately, “that is how people get better – they develop a new passion,” he said.

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