Anorexia Nervosa is characterised by the patient’s anosognosia, the inability of their brain to recognise that they are sick. Such lack of insight is evident from their initial presentation and can either be continual or intermittent during their illness. A significant number of patients fail to realise that they are sick until they have actually been restored to good health and gained an improved cognitive wellbeing to better understand their illness. Such denial of the anorexic adolescent should not delay or affect the treatment that is crucial to their survival. Therefore the Maudsley method of family based treatment incorporating their re-feeding and weight restoration can be undertaken without the patient’s consent or compliance.
The onus is on the parents to ensure that their anorexic child receives wholesome and balanced nutrition in order for them to achieve and maintain a healthy weight during the period of time that such close supervision is necessitated. However during the recovery phase when the physical health has been restored and their mental health has been ameliorated the adolescent does need to develop insight so as to be instrumental in their own recovery whereby they can start to achieve the much desired outcome of living an independent and healthy life. Such insight requires their acknowledgement and acceptance of their mental illness and the recognition that they cannot blame themselves or their parents for their condition.
It is essential for them to also acknowledge and accept that there could be a possibility of relapse should they not maintain a continuum of adequate nutrition. Such insight also includes the required mental health capacity to recognise how their continued nutrition is vital to their existence which can be affected by their own consequent disordered thoughts, behaviours and emotions. Additionally, they need to gain the required insight so they can be assured of maintaining their ideal body weight so as to prevent the likelihood of relapse now or in the future. Subsequently, the importance of highlighting the risks and vulnerabilities of anorexia nervosa to the patient and their parents starting from the initial session is paramount in ensuring the patient eventually starts to process the pertinent information. Although such benefit and subsequent progress cannot be gained by the adolescent for considerable time, they will eventually become strengthened in their journey to self recovery.
Finally, the parents greatly benefit from such conversations and eventually the adolescent after weight restoration and improved brain function is able to become significantly impacted by such knowledge which is further assistive to them in their own recovery. Furthermore, it is important to note that the development of insight is dependent on the patient’s own unique experience of having anorexia. Although the nutrition and weight restoration is imperative to their recovery, it must be recognised that the patient cannot be forced to acquire or gain an insight. It is essential for the patient to become an active participant in the process on their own accord as coercive pressure towards the patient with achieving insight would be tantamount to the efficacy of their recovery from anorexia.