The dangers of anosognosia

Perhaps the most confusing thing about anorexia is that the patient can function so well in other areas of life: school and work, for example. Patients who are floridly ill can remain quite lucid and intellectually engaged on topics outside food/body. This confuses loved ones, as we expect all abilities to thrive or fail in tandem. This even confuses many therapists, especially those unfamiliar with eating disorders. It is hard to believe that what we are seeing are symptoms and not free will.

Patients with anorexia are often "anosognosic" - they truly do not feel ill and they experience their own behaviors and thoughts as normal. This is not a choice or conscious denial - it is a brain condition. This anosognosia is dangerous on many levels, but frightening when it guides policies or public opinion.

I am reading with amazement the fashion columnist Liz Jones speaking with such insight and compassion for others but seemingly entirely unconscious of what seems to be a very serious mental illness driving her behaviors and thoughts. Reading her description of her "experiment" in eating normally - and then going back - I feel helpless and horrified. She has an illness - but what's OUR excuse? I want society to step up and get her help as we would if she was wandering in the street with a head wound. I want no one to be able to mistake what she is describing for a desire to be thin. I want her to be relieved of her post and brought to hospital.

And I don't want this person to be discussing or guiding fashion. It scares me to think of how many people guiding and guarding that industry are actually ill.

Fatten me up! What happened when former anorexic Liz Jones had to eat normally for three weeks

I weep when I realise how many other women starve themselves like me


  1. Did you see that terrible special on the BBC last year when they took two women and had them "try" eating disorders for two weeks, deliberately doing food restriction and overexercise, just to make a one hour show? This is the reciprocal of the case you're discussing, but it reminded me of it. Anorexics are not the only ones that see their behaviors as unproblematic sometimes, I think, society focuses on the surface and also is largely ignorant to how profoundly deep and distorted those thoughts can become.

    I think that EDs might actually be a little less dangerous if they were more debilitating. I got a perfect score on my SAT during a period when I was consuming about the same amount in an entire day as I have for breakfast these days. I should have been in a hospital, honestly. I think one of the absolute most insidious aspects of an ED is how it can hide behind a facade of accomplishments and "functionality" while still eroding internal life every day.

  2. I agree with you Cammy - starvation can even ENHANCE an individual's sense of well being and ability to function in the short term, but then so can heroin and alcohol. Sadly much of the professional world doesn't regard the use of these substances as a mental illness either - ho hum

  3. o.O I hope someone intervenes and she is able to enter some sort of treatment to get help. She thinks it's too late to get help, ED has terribly distorted her mind because it IS NOT too late. Sigh.

  4. I agree that anosognosia is probably one of the most dangerous aspects of this illness. I know for me it's still my biggest stumbling block--I still don't really believe that I ever had or have a problem despite what my family, friends, and doctors have to say about it. Like Cammy, I was performing at such an exceptionally high level that I couldn't (and still can't) make myself believe that not eating was really affecting me in any terrible way. If I was really that sick, I tell myself, wouldn't I have just fallen over and died?

    But with all that said, I'm not really sure that Liz Jones does not understand her behavior and actions to be disordered. I think, given what she said, that she appeared to understand that she had significant problems and was suffering from more than a mere desire to be thin. She might see her behavior as a cemented part of her personality, but I do think, given her compassion for the other sufferers, that she recognizes it as abnormal. But I also think that she does not (as would be expected given the nature of this disease) feel able or motivated to make any real change in her eating habits. To be honest, I was more horrified by the cavalier headlines that accompanied this article (i.e. Anorexic eats normally for three weeks! as though this is some kind of circus trick) and the fact that this article was actually published and promoted in such a fashion. I felt it was very irresponsible on the part of the publisher.

    I'm also a little concerned about the notion that this woman should unilaterally be "removed from her post" and taken to a hospital. I think there are very real issues of autonomy even for individuals whose cognitive functioning has been affected, and we should respect autonomy as much as possible while still trying to help the individual receive appropriate treatment. I understand that this may be nearly impossible for an adult who is suffering from an anosognosic illness and whose illness has compromised their autonomy significantly, but I do think that there are better options than forced treatment. I think we have not been creative enough in working for treatment that gives the affected individual as much autonomy as possible and control over their treatment while still providing the necessary support

    I do think however, that the fact that this woman's illness is treated as some combination of circus freak-show and mere personality does speak to how backward our society is when it comes to providing real support, information, understanding, and treatment for individuals suffering from mental illnesses.

    Sorry for this very long comment.

  5. An honest confession from someone that's made a profession out of anorexia. A love-hate relationship.

    Yet she remains lucid enough to give insight into her social, emotional and relationship struggles and how starvation has changed the neural pathways of her brain.

    Whilst she can enjoy the benefits of food for three weeks and feel the humanness and joy of living, there is underlying admission that this is really an experiment to see what it's like. The medical complications are not a deterrent to change course.

    The elusive high of Ahrimen has chained her to a life of social and emotional deprivation, with a warning for others not to follow the path of self destruction.

    The only point that resonates truth for me is the eating after 7p.m. As the old saying goes, "Eat like a King at breakfast; Dine like a Prince at lunch; Eat like a Pauper at dinner time".

    What a duality. We need improved diagnostic tools and uniform strategies to address this problem when it first emerges in early childhood. Time for the paradigm shift in identifying and treating eating disorders.

  6. In reference to the beginning of this entry, this is aggravating for me in a partially selfish way.

    When I was really sick, I felt fried. I couldn't think, concentrate, focus.. my grades suffered, I would show up to my 8 hour classes upwards of 4 hours late, and my interest in school was far past the point of present.

    It's frustrating to watch really sick patients who should be in the ER - let alone an EDU - working their asses off and studying full time to reach their degree. I couldn't do it. I don't know where the brain capacity comes from when your brain is completely starved. Scientifically, it doesn't make sense. I was lucky if I could hold an intelligent conversation.

    But I suppose, from a non-selfish point of view (and relating more to the actual point of your entry) it's dangerous as hell because these "lucky" sufferers who CAN think "coherently" are passing themselves off as healthy, focused people, even when talking about things that they are disorderly passionate about.

    If that makes sense..

  7. To be totally honest, I think the UK is crazier about food than the US. And the daily mail is a trashy gossip rag.

  8. Again you are a voice of reason in a mad world. I am just appalled at what passes for "normal" and "healthy" these days. It's so upsetting that many people are openly ill and nobody tries to help them.

  9. Wow. I thought I was the only one who felt similar to Emily Sam. I can't even concentrate or function well when I'm fully nourished (I have ADHD) unless I am taking my ADHD meds. How come I can't even read a stupid newspaper article when I'm well-nourished (if I'm not on my meds) yet some people who are at death's door still manage to hold down a good job or get 4.0 GPAs? My meds allow me to focus almost like a normal person but it still seems so unfair. They are starving. They're brains are FRIED to the max and they'll STILL manage to function well! I don't get it!

    At an intellectual level, I know that people like Liz Jones are very ill and unhappy. But on an emotional (and very childish) level, I am filled with a jealous RAGE.

  10. When people ask me what anosognosia is (the most frequent question, usually followed by "how do you pronounce it?" which I generally decline to answer because I dunno), I like to describe it as this: one of the symptoms of the illness is an inability to recognize that you're sick. It's part of eating disorders. Even when I was able to recognize I was sick, I never thought it was a big deal. Even during this last relapse, even though I'm quite active in the field and should really "know" better.

    I guess it's better illustrated by this thought: I was initially jealous of this woman, jealous that she "only" had to eat normal for three weeks and could then "go back" to starving. That is the nature of eating disorders.

    And yes, I was/currently am one of the high-functioning anorexics. My brain power did suffer, but I was acing physical chemistry at my lowest weight. The problem is that so many people are willing to overlook "trivial" matters like, you know, life threatening weight loss and simply not eating because if I were sick, I shouldn't be able to function AT ALL. I studied harder than ever when I was ill- the obsessive nature of the ED actually facilitated this. I looked back at my notes several months later, even at some of the lab reports and assignments I turned in, and I couldn't even remember doing them.

  11. I personally was a little upset by the article - not because she thinks her behaviors are normal - I actual don't think she thinks that... and even if she did... we've normalized eating disorders to a degree.
    what upset me was her attitude. She made it seem like it was too late for her... it's never too late. It may be harder to get better the longer you've been actively engaging in eating disorder behaviors, but it is never too late...

  12. Laura,

    I'm not sure how to get in touch with you....

    I'd like to quote from this post on my blog which is to help my friends and family understand AN as it works in our family. Are you happy for me to do that?


  13. Thank you all for the comments. I learn something from you all every day.

    Sharon, I'm a big fan of your blog. Quoting from each other's blogs is one of the cool things about blogging. I'm flattered - of course you can!

  14. Liz Jones irritates me and, what irritates me more, is that I actually read those articles she wrote. She's clearly ill and needs help and I'm sure she's getting some sort of help seeing as she's so open about her disorder.

    Sorry not a very useful comment, but I thought I might just say.

    Also anything in the Daily Mail probably isn't worth reading.

  15. Like Carrie, I too felt jealous that she only had to eat for three weeks. And although I was functioning at a fairly high level, I also have trouble remembering most of what I did and said when I was at my worst. I do remember looking back at things I had written and having no memory of ever writing them. I even found that I had clothes and other things I had purchased and that I had no memory of buying. It is very frightening and I think the most frightening part of it is that I still have a hard time convincing myself that this was a big deal.

  16. Good point, Woolen Typist!

    And Jessie, when you are fully well again I believe you will look back at what you write now with new eyes.


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