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

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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. (link to www.feast-ed.org)

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!

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4 tips to cope with weight gain in recovery from anorexia nervosa

4 Tips to Cope with Weight Gain in Recovery from Anorexia Nervosa

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Let’s face it – our society gives us strong messages from social media, print media, our schools, and the health care system that weight gain is bad.   Wherever we turn we are given the message that weight gain is a death sentence. (Which, by the way, is not true! If you want to learn more on this subject I highly recommend reading Health at Every Size).

Folks who are in recovery from an eating disorder have a double whammy to contend with.  One of the key features of anorexia nervosa (or really any eating disorder) is the fear of gaining weight. This fear plus societal pressure to look a certain way can make recovery from an eating disorder feel like an uphill battle.

Therefore, if you are in recovery from an eating disorder, it would make sense that you have an intense fear of gaining weight.  However, weight restoration is a must in recovery in order to maintain your physical and mental health.

Helping clients improve body image while restoring weight, nutrition, and health can be the hardest part of the recovery.  But it is possible with perseverance, patience, and hope.

I have gathered some wisdom from around the web from other treatment professionals and those in recovery to help you along with the process.

1. You are gaining weight that you shouldn’t have lost in the first place.

The weight gained in eating disorder recovery isn’t just regular weight gain–it’s weight restoration. You are healing through the weight gain – giving back what you shouldn’t have taken from your body in the first place.

Weight restoration can be complicated and difficult, and shouldn’t be a journey you embark on alone. To better understand the process, read this article on what weight restoration is, what it’s comprised of, and what you should expect when going through it.  It also includes a discussion of particulars you might not be familiar with, like refeeding syndrome (the complication of increasing food intake too quickly) and hypermetabolism (the increased rate of metabolic activity that often comes along with an eating disorder).

It also covers how difficult the process of weight restoration can be in recovery–and why it is critical to not only have a meal plan for weight restoration but a therapist to help throughout the journey.

Read the whole thing here: Working Through the Weight Restoration Phase of Anorexia Nervosa

2.  Accepting weight gain as part of recovery takes time (and lots of it!).

Accepting your body takes time.  In fact, it can be one of the slowest parts of recovery.  The author of this article provides several useful ways to cope with weight gain, including thanking your body!  It is a must read.

Some of the tips covered are:

  • remembering our bodies changes are never as visible as we fear
  • keeping perspective & remembering that the alternative is worse

Read the whole thing here:

5 Ways To Deal With Weight Gain When You Are In Recovery From An Eating Disorder

3.  Fear of weight gain usually reduces as your eating normalizes.

I have seen this in my clinical practice. As clients start to feel better physically because they are feeding themselves more regularly throughout the day, the fear of weight gain can lessen.

As weight gain also naturally redistributes after the initial gain, the prospect of weight gain becomes less overwhelming. Once your body has come out of life-saving mode, the weight you’ve gained back won’t just sit in one place. It will spread across your body, and will not be nearly as visible as someone in recovery might worry about when starting the process.

“Will I gain weight forever?”: What we know about weight trajectory during recovery from an eating disorder

Yes, Weight Gain Is Hard. Thankfully, We Have 8 Ways to Cope With Weight Gain For You

What this article shows us is that the odds of perpetual weight gain after the initial restoration, are actually pretty low. Your body will adjust back to a stable, healthy weight, and for the most part, stay stabilized.

4.  Weight restoration allows you to enjoy life more fully.

“Going to concerts has always been one of my favorite things to do. The atmosphere, the music — I can go on about it for hours. Ever since my eating disorder came to peak, I’d lost this love.”

Dietary restriction and malnutrition often occur pretty slowly, and sufferers from eating disorders may often not notice that their sense of joy and zest for life is blunted and dulled. Without proper nourishment, your body just isn’t able to sustain you through life as well.

With proper nutrition, you will begin to get feel more like your old self. Your body will have the nourishment it needs to keep healthy, to keep energy sustained, and you will be able to once again be an active participant in your life & hobbies.

How I’m Learning to Love Weight Gain in Eating Disorder Recovery

 

With your renewed energy, your emotions will feel full and vibrant again–allowing you to enjoy life in a way you may have not even realized you were missing out on. With weight gain comes this capacity to feel full and alert and restored.

Accepting weight gain in eating disorder recovery can be a long and difficult journey. It isn’t something that happens overnight. Work and support are necessary components to the journey. Keeping these four key things in mind can help you on your journey to recovery and weight restoration.

Please call for a free 15-minute phone consultation to learn how I work with clients with eating disorders.

4 tips to cope with weight gain in recovery from anorexia nervosa
4 tips to cope with weight gain in recovery from anorexia nervosa