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Treat anorexia as a 'passion' to provide more effective treatment

Photo: Treat anorexia as a 'passion': scholar
A visiting philosopher of psychiatry from Canada believes changing the discourse around anorexia and addiction is critical to prevention.

Addictions and eating disorders should be viewed as "passions" in order to provide more effective treatment, according to a visiting Canadian scholar.

Many psychologists and psychiatrists agree that there is great difficulty in treating people with eating disorders and addictions.

Evidence shows cognitive based-therapies aren't often very successful in managing a person with anorexia nervosa (AN), and people who work in the field are constantly asking how they can work differently in order to provide more effective therapies.

Professor Louis Charland is a philosopher and health care ethicist from Western University, Ontario.
He suggests changing the discourse around anorexia and addictions provides greater understanding and could be crucial in preventing "healthy passions" from becoming "unhealthy" ones.

While it sounds unconventional, Prof Charland believes this approach can be used to complement current treatments.

Calling something an eating disorder is not very informative but when you talk about a person's passion you are referring to a complex set of behaviours based around a fixed idea, he said.

"Passions can begin innocently enough, proving a person with meaningful activity and purpose, but when they become extreme they can suck a person into a powerful downward spiral where they've effectively lost control," he says.

You have to be able to catch an "unhealthy passion" early because if they go unchecked then a person will quickly reach that point of no return.

Unfortunately, the huge complication with this is that in our society we tend to want to view people as free agents and often don't interfere, he said.

Susan Sawyer, a professor in adolescent health at the Murdoch Childrens' Institute, believes there is some synergy between Prof Charland's views and the need for more rigorous thinking about how to help young people with AN turn their lives around.

"Because it can be the most devastating condition that effectively puts adolescent development on hold."

The timing of interventions, however, is critical and when someone is critically underweight there is no time to be "shilly-shallying" around, Prof Sawyer said.

AN usually starts in adolescence and impacts around one in every 100 people aged 12-18. Its mortality rate is among the highest of any psychiatric illness.

Family-based treatment has the strongest evidence for success of any interventions that have currently been tested on patients with AN.

"I would agree we have lots to learn and increasingly developmental neuroscience is likely, also, to be very helpful in the understanding of the ideology of eating disorders but not necessarily yet in terms of interventions."

That said, she says Prof Charland risks suggesting that therapists in the field don't understand where the patient is coming from, which is arguably somewhat harsh.

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