Search This Blog

Saturday, 14 April 2012

Weight, Shape and NLP

I am presently engaged in a long and detailed email exchange with Extralong Tail, Giant Fossilised Armadillo and Marcella about Fairburn, transdiagnostic models and turning 18.

We have been bemoaning (again) various problems including  Non-fat phobic AN.

This is where someone presents with full blown anorexia nervosa but does not have the preoccupation with weight and shape, so beloved of Fairburn et al (and the DSM!).  The fear tends to centre around change itself, rather than the physical manifestation(s) of that change - a sort of OCD/anxiety.  Whilst researching the Transdiagnostic model and reading about Glenn Waller's eggs, I came across this from Fairburn, which contains this:

"There is a new way of rating the Dietary Restraint subscale items such that restraint for the purpose of gaining a sense of control in general is rated, as well as restraint intended to influence shape or weight"

This is where I do think that Fairburn needs a bit more Gestalt and to move away from HIS obsession with fat phobia.  Once outside his beloved weight and shape concerns, it is like someone puts a blindfold on him and he reverts to Hilde Bruche for an explanation and comes up with "it's all about control".

Now I happen to believe that the weight and shape concerns have two roles to play in AN.

The first is very tentatively connected, very tentatively but, in the eyes of the mass media is the major "cause" of an eating disorder.  That primary role is that someone may decide to go on a diet because they are unhappy with their weight or shape.  My understanding of eating disorders goes along the lines that weight loss is a (if not "the", but ELT or GFA will probably come up with some sciency alternatives) trigger that pulls the genetically loaded gun, that fires the bullet that is the AN.  Why people lose weight or, most importantly, don't gain enough weight (during/after a growth spurt, due to extreme physical training for a sport, due to an illness etc) is for a myriad of reasons and tend to be more to do with general disconnect and social anxiety than an overwhelming urge to get "Elle"'s body.

Ergo, weight and shape concerns may be an environmental factor (among many, many others) that contribute to an initial weight loss or lack of weight gain at an important developmental stage.

The second role of weight and shape is as a symptom of AN.  Many of us have heard weight and shape concerns, especially at the extreme depths (or end stages) of an eating disorder.  I do not disagree that many patients, plucking desperately at flaps of paper thin skin, may believe that they are "fat" and that eating a piece of chocolate would instantly turn them into the human equivalent of a pregnant hippo.  However, I have argued that this could be an expression of extreme anxiety and fear that is too complicated to be put into words.  This anxiety needs to be expressed in terms that society will understand and our society is obsessed with "fat".  I even got Carrie Arnold to half agree with me.

Ergo, in my opinion this weight and shape concern is expression of anxiety  and is not the disorder itself, merely a symptom of it.

Interestingly, I have recently been exploring the world of NLP therapy.  I like the idea of NLP for treatment of eating disorders because, unlike Fairburn's NICE approved, clinically tested CBT, it does this:

"NLP does not have the same model of "problem" and "solution" as clinical psychiatry. Instead its model is based upon helping clients to overcome their own self-perceived, or subjective, problems rather than those that others may feel they have"


Maybe Fairburn should stop insisting that everyone over 18 with an eating disorder has "weight and shape concerns" and maybe NICE should stop insisting that CBT is the only therapy.  Perhaps we should be helping those with eating disorder overcome their problems and not treating them for problems that we feel they should have.

2 comments:

  1. I wonder whether "this kind of dietary restraint" is seen more in younger and non-western patients because they haven't yet had as much experience in answering the same old same old questions?

    ReplyDelete
  2. I tried to comment from my account 'Extra Long Tail', but the comment wouldn't post...

    "Maybe Fairburn should stop insisting that everyone over 18 with an eating disorder has "weight and shape concerns" and maybe NICE should stop insisting that CBT is the only therapy. Perhaps we should be helping those with eating disorder overcome their problems and not treating them for problems that we feel they should have."

    Yes. I agree.

    It would be wonderful, for those who manage the costs of treatment and the allocation of funding, if AN could be explained by a simple model - e.g. 'brain has broken', or 'person has faulty thinking' - then expect them to recover with rapid re-feeding and a few sessions of CBT. Unfortunately it doesn't always work that way.

    People are individuals, with unique life experiences that have shaped the development of their brains and the functioning of their minds.

    A big bugbear of mine is that AN is described as a disorder of 'body image'. I do not dismiss the idea that many people with AN do have concerns about body image and body dysmorphia. But what is really disturbed in AN is sense of self. And sense of self relates to more than just physical appearance.

    ReplyDelete