Willpower is not the solution to eating disorders.

To assume that willpower can overcome an eating disorder is to fall into a trap.

Eating disorders are a serious social problem The conceptualization and recognition of eating disorders has grown exponentially in the last 10 years.

Today, anorexia nervosa (AN) and bulimia nervosa (BN) are not the only eating disorders permeating the psychiatric field, as there is increasing social awareness of other recently described disorders such as binge eating disorder (BED) or avoidant/restrictive food intake disorder (ARFID).

Estimating the prevalence of these disorders, both physical and emotional, is very difficult, especially because of the transient and unnoticed nature of many of the conditions. For example, the long-term prevalence of anorexia nervosa in adolescents is estimated to be 0.3 to 2.2% and the point prevalence 0.1 to 1.5%. As far as bulimia is concerned, the figures are similar: 0.1 to 2% of the young population.

As shocking as it sounds, as the British Medical Journal (the BMJ) points out, anorexia nervosa is the psychiatric pathology with the highest mortality rate in the world. It is the first cause of severe Weight loss in young women and also takes the podium in terms of admission rate to specialized centers. With this data, today we want to bring you an idea that should be more than clear: willpower is not the solution to eating disorders..

What are eating disorders?

Before entering into subjective terrain, it is necessary to establish a number of diagnostic basics.

An eating disorder is defined as a mental pathology dictated by dietary habits that negatively affect the physical and/or emotional health of the patient..

This includes anorexia, bulimia, binge eating disorder, picky eating disorder, pica, rumination syndrome and other conditions. It should be noted that obesity is not included in this set of clinical pictures.

We are not going to describe the symptomatology of each of the disorders, as it is not our intention to go through the spectrum of all eating disorders. However, as an example, we present to you the diagnostic criteria used by the Diagnostic and Statistical Manual of Mental Disorders (DMS-5) to identify anorexia nervosa. to identify anorexia nervosa:

• The patient restricts energy intake in relation to needs, leading to significantly low body weight according to age, sex, developmental course and physical health.
• Intense fear of gaining weight or becoming fat. The patient presents a persistent behavior that directly conflates with possible weight gain.
• Alteration in the way in which one perceives one's own weight or constitution. There is a lack of recognition of the seriousness of the underweight condition.

According to the ICD-10 (international classification of diseases) for a person to be considered anorexic, he/she must present a weight 15% lower than expected for his/her condition and age, have a Body Mass Index (BMI) lower than 17.5, voluntarily induce his/her own thinness, exhibit behaviors that evidence a distorted body image, or and suffer a series of characteristic endocrine disorders (in women, modification of the hypothalamic-pituitary-gonadal axis).

Can you carry anorexia alone?

The answer is categorical: no. We recover a fact that we have cited previously, but that should not be forgotten: anorexia is the deadly disease with the highest mortality rate in the world, above schizophrenia and bipolar disorder, considered more "serious" by the general population.. Without treatment, up to 20% of people with eating disorders end up dying, while this figure drops to 2-3% with the relevant medical and psychological approach.

In addition to these data (which already speak for themselves), the study Mortality Rates in Patients With Anorexia Nervosa and Other Eating Disorders stipulates that anorexia nervosa is a serious illness that should be taken into account. As a product of a meta-analysis comparing 36 different studies and various sources, it was found that only 46% of treated patients recover completely from the pathology, 33% reach a state of "normalcy" (with behavioral residuals of anorexia) and 20% remain chronically ill in the long term.

In addition, it is estimated that only 1 out of 10 people with eating disorders receive treatment and, of all of them, 80% end up in the clinical approach earlier than they should (they are sent home when it is not yet time). These data are not intended to discourage anyone, but to show how difficult it is to deal with this type of disorder. If it is already difficult to eliminate all traces of a disorder such as anorexia after internalization and medical and psychological intervention, imagine the difficulty of dealing with such a serious condition on one's own.

The real treatment of eating disorders

We have already stipulated that willpower is not the solution to eating disorders, as up to 2 out of 10 people who decide to carry them on their own end up dying. So what to do?

You may be surprised to learn this fact, but according to the scientific paper Anorexia nervosapublished in the BMJ in 2007, it is estimated that anorexia and other disorders require an average recovery time of 5 to 6 years after diagnosis, which entails regular monitoring and, in many cases, consecutive interventions. and, in many cases, consecutive interventions. Thirty percent of patients do not fully recover at any time.

In addition, drastic hospital interventions that deprive the patient of all freedom and autonomy have been largely discredited: this is only done when the patient's life is in danger. In the long term, family therapy in adolescents and cognitive-behavioral therapy in adults have shown good results, always with emphasis on the patient's freedom and autonomy.In the long term, family therapy in adolescents and cognitive-behavioral therapy in adults have shown good results, always emphasizing the normalization of ideal eating habits and promoting a change in the patient's distorted thoughts about image.

It is necessary to accept, but not to normalize

One of the major difficulties in the treatment of eating disorders is that many patients do not see their condition as a pathological condition, but as a lifestyle choice. Vomiting food is an obvious sign of an illness, but choosing selectively and obsessively at all times what to eat or "stop eating for a few days because I look fat" enters a gray area that, in many cases, is excused within normality.

The reality is that no obsessive behavior is normal. If you count every calorie of every food, if you stop eating as soon as you gain a kilo of weight, if you are ashamed of your physical appearance or if you notice that your life revolves around a conflictive relationship with food, you need help. Anorexia, bulimia and other disorders have a solution, but only if the patient is willing to recognize his or her problem and decides to put him or herself in the hands of a multidisciplinary team of professionals.