Anorexia and anorexia symptoms

Perhaps one of the most troublesome symptoms of anorexia nervosa and other restrictive eating disorders—especially for family members and therapists—is the patient’s belief that he or she is not sick.

Not believing that a common consequence of a person’s illness is that he or she does not want to recover. In fact, patients’ lack of attention to this issue has long been a defining feature of anorexia nervosa.

As early as 1873, the French doctor Ernest-Charles Lasègue, who first described anorexia nervosa, wrote: “‘I will not suffer, and then I will get better.’ This It’s a monotonous formula.”

As reported by Walter Vandereycken, MD, clinical research reports that as many as 80% of patients with anorexia nervosa under investigation have “denial disease.” In certain groups of patients with anorexia nervosa, this percentage may be lower.

Denial of disease is common in patients with eating disorders. In fact, the lack of insight into the severity of the disease is a decisive feature of anorexia nervosa.

In a study by Konstantakopoulos and colleagues, a subgroup (24%) of patients with anorexia nervosa had severely impaired insight. They also found that patients with restrictive anorexia nervosa had worse overall insights than patients with anorexia nervosa (the binge eating subtype).

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The diagnostic criteria for anorexia nervosa include “interference with the way of experiencing weight or body type.” Patients may be extremely thin, but think they are overweight.

The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) states: “People with anorexia nervosa often either lack insight or deny the problem.”

In the early writings on anorexia nervosa, this lack of understanding of this problem is often referred to as denial, and was first described when psychodynamic theory dominated.

However, this condition has recently been renamed agnosia. This term was originally used by neurologists to describe a neurological syndrome in which people with brain injuries have a severe lack of awareness of specific defects.

Anosognosia or lack of consciousness has an anatomical basis and is caused by brain damage, most likely due to malnutrition.

Recently, the term has also begun to be applied to mental illnesses such as schizophrenia and bipolar disorder. Brain imaging studies seem to indicate a brain connection between agnosia and these diseases.

The National League of Mental Illness (NAMI) reports that agnosia affects 30% of people with schizophrenia and 20% of people with bipolar disorder, and it is believed to be the main reason why patients with these diseases often do not take medication.

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It makes sense to apply the term anorexia to anorexia nervosa, because we know that the brain is affected by malnutrition. In a 2006 paper, Dr. Vanderycken wrote: “In many cases of anorexia nervosa, the shocking indifference to weight loss looks similar to the agnosia described in neurological diseases.”

In 1997, Dr. Casper wrote, “The lack of attention to the potentially dangerous consequences of malnutrition does indicate that shocking information may not be processed or may not attract people’s attention.” Suffering from malnutrition or brain damage People may not be able to think clearly and use denial as an emotional defense mechanism.


Observing anorexia nervosa through the lens of anorexia can have a major impact. If a person with severe mental illness with life-threatening complications does not believe that he or she is sick, he or she is unlikely to receive treatment. This increases the potential risks of medical problems and long-term illnesses.

These people may not be able to perform insight-oriented treatment, which until recently was a common treatment for anorexia nervosa. This is one of the reasons why more intensive treatment (such as hospital care) is usually required. This is also the reason why family-based therapy (FBT) may be more successful: In FBT, parents assume the responsibility of restoring the nutritional health of the patient.

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When people with eating disorders refuse to believe that they are sick or seem not interested in recovery​​, they are not necessarily rebellious or resisting. They are more likely to have no insight.

Fortunately, if your loved one is a minor or a financially dependent young person, recovery does not require motivation. You can be firm and persistent in treating them.

Dr. Vandereycken wrote, “It’s not easy to communicate with someone who has an eating disorder but denies it.” He proposed three strategies for his relatives:

  1. Show support and care (otherwise you will appear indifferent);
  2. Express empathy and understanding; and
  3. to be honest.

In short, agnosia is a brain disease; this is different from denial. Fortunately, the brain regained nutrition and regained a healthy weight. Motivation and insight usually return in time so the individual can solve the rest of his recovery.

Further reading

A review of research on mental illness agnosia can be obtained through the Treatment Advocacy Center. Laura Collins wrote about anorexia nervosa.