People with anorexia nervosa struggle with questions about their real, or "authentic," self – whether their illness is separate from or integral to them – and this conflict has implications for compulsory treatment, concludes a study in the Hastings Center Report. The researchers also conclude that exploring ideas of authenticity may help clinicians formulate therapeutic approaches and provides insights into whether compulsory treatment can be justified.
For the study, researchers in the U.K. interviewed 29 women who were being treated for anorexia nervosa at clinics throughout the south of England. The interviews asked questions about how the women view their condition, including their understanding of it, how they feel about compulsory treatment, and their thoughts about the impact of anorexia on decision-making. Although the researchers did not ask about authenticity or identity, almost all of the participants spoke in terms of an "authentic self," the researchers write, "and, for almost all, the relationship between anorexia nervosa and this authentic self was a significant issue."
Participants characterized this relationship in different ways. Many saw anorexia nervosa as separate from their real self. Some expressed the idea of a power struggle between their real and inauthentic self. Others said that other people could provide support to enable the authentic self to gain strength within the struggle.
The researchers interpret the patients' notion of their illness as separate from their authentic self as a sign of hope. "Conceptualizing the anorexic behavior as an inauthentic part of the self may well be a valuable strategy for many in helping to overcome it," the authors write.
The authors also say that, in their view, the distinction between an authentic and an inauthentic self is not necessarily the same as a lack of capacity for decision-making and cannot justify overriding a patient's refusal to consent to treatment, although they believe that their findings give grounds for not simply acquiescing to refusals of help. "Some authorities argue that compulsory treatment should never be used for anorexia nervosa," they write. "We believe, however, that we should take seriously the possibility that a person in the throes of anorexia nervosa may be experiencing substantial inner conflict, even though the person may not be expressing that feeling at the time."
The authors conclude that clinicians need to monitor patients' views over time and that if the inner conflict persists, it suggests a lack of capacity for decision-making and, therefore, a risk of significant harm. In this case, they say, "perhaps the evidence from these accounts is sufficient to override treatment refusal in the person's best interest." An unanswered question is whether patients who regard anorexia nervosa as an inauthentic part of the self are most likely to respond to treatment. "A question of empirical study is whether those who separate the anorexic self from a perceived authentic self are more successful at overcoming anorexia nervosa than those who do not," the researchers write.
The authors are Tony Hope, professor of medical ethics at the Ethox Centre in the University of Oxford, a fellow of St. Cross College, and honorary consultant psychiatrist; Jacinta Tan, a child and adolescent psychiatrist and medical ethicist who is a senior research fellow at Swansea University; Anne Stewart, a consultant child and adolescent psychiatrist at the Oxford Health NHS Foundation Trust and honorary senior clinical lecturer in the Department of Psychiatry at Oxford University; and Ray Fitzpatrick, professor of public health and primary care at the University of Oxford.
Michael Turton | EurekAlert!
Drone vs. truck deliveries: Which create less carbon pollution?
31.05.2017 | University of Washington
New study: How does Europe become a leading player for software and IT services?
03.04.2017 | Fraunhofer-Institut für System- und Innovationsforschung (ISI)
An international team of scientists has proposed a new multi-disciplinary approach in which an array of new technologies will allow us to map biodiversity and the risks that wildlife is facing at the scale of whole landscapes. The findings are published in Nature Ecology and Evolution. This international research is led by the Kunming Institute of Zoology from China, University of East Anglia, University of Leicester and the Leibniz Institute for Zoo and Wildlife Research.
Using a combination of satellite and ground data, the team proposes that it is now possible to map biodiversity with an accuracy that has not been previously...
Heatwaves in the Arctic, longer periods of vegetation in Europe, severe floods in West Africa – starting in 2021, scientists want to explore the emissions of the greenhouse gas methane with the German-French satellite MERLIN. This is made possible by a new robust laser system of the Fraunhofer Institute for Laser Technology ILT in Aachen, which achieves unprecedented measurement accuracy.
Methane is primarily the result of the decomposition of organic matter. The gas has a 25 times greater warming potential than carbon dioxide, but is not as...
Hydrogen is regarded as the energy source of the future: It is produced with solar power and can be used to generate heat and electricity in fuel cells. Empa researchers have now succeeded in decoding the movement of hydrogen ions in crystals – a key step towards more efficient energy conversion in the hydrogen industry of tomorrow.
As charge carriers, electrons and ions play the leading role in electrochemical energy storage devices and converters such as batteries and fuel cells. Proton...
Scientists from the Excellence Cluster Universe at the Ludwig-Maximilians-Universität Munich have establised "Cosmowebportal", a unique data centre for cosmological simulations located at the Leibniz Supercomputing Centre (LRZ) of the Bavarian Academy of Sciences. The complete results of a series of large hydrodynamical cosmological simulations are available, with data volumes typically exceeding several hundred terabytes. Scientists worldwide can interactively explore these complex simulations via a web interface and directly access the results.
With current telescopes, scientists can observe our Universe’s galaxies and galaxy clusters and their distribution along an invisible cosmic web. From the...
Temperature measurements possible even on the smallest scale / Molecular ruby for use in material sciences, biology, and medicine
Chemists at Johannes Gutenberg University Mainz (JGU) in cooperation with researchers of the German Federal Institute for Materials Research and Testing (BAM)...
19.06.2017 | Event News
13.06.2017 | Event News
13.06.2017 | Event News
27.06.2017 | Power and Electrical Engineering
27.06.2017 | Information Technology
27.06.2017 | Physics and Astronomy