Is anorexia a form of psychosis?

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Is anorexia a form of psychosis?

Postby Obti » Wed Oct 11, 2017 9:45 pm

Is anorexia a psychotic disorder considering it's delusional aspect?
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Re: Is anorexia a form of psychosis?

Postby maven » Thu Oct 12, 2017 2:34 am

Obti wrote:Is anorexia a psychotic disorder considering it's delusional aspect?

No.
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Re: Is anorexia a form of psychosis?

Postby workingmama » Thu Oct 12, 2017 9:05 am

In addition to which no diagnostic criteria demands any delusional thinking. Many people with a restrictive eating disorder do not believe themselves to be overweight/large, but find themselves restricting intake due to a multitude of other causes (a need/attempt to gain a sense of control, self-punishment, and many other reasons).

Was there a reason/particular case behind your question?
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Re: Is anorexia a form of psychosis?

Postby Obti » Thu Oct 12, 2017 5:44 pm

I guess I should have been clearer, I mean anorexia with anosognosia. I'm asking due to confusion around someone I know with personal experience of an eating disorder who feels the delusional like quality of this i.e. the lack of awareness of health issues being underweight ect means it constitutes a psychotic disorder. I'm inclined to disagree as feel that a psychotic condition describes both delusional beliefs and source monitoring issues (typically seen as hallucinations and thought broadcasting or insertion) but would like to hear other people's perspectives.
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Re: Is anorexia a form of psychosis?

Postby lingua_franca » Thu Oct 12, 2017 10:14 pm

Lack of insight is not a problem unique to psychosis. People with depression can lack insight (for example, by assuming that their mood state is normal for everyone and they just need to suck it up). People with OCD can lack insight ("I'm just making sure my doors are locked, it's what everyone does!") It doesn't mean that they are experiencing psychosis. As with these cases, people with anorexia are usually able to give a very plausible and internally consistent rationale for how they are acting - "I am trying to be healthy, I'm avoiding saturated fats and sugars, just like the government advises. If a low-fat diet is good, a no-fat diet must be better. I'm NOT overexercising. Lots of people go to the gym every day. I need to go more often because my metabolism is slower than theirs," and so on.

People do not have to be experiencing hallucinations in order to have psychosis. It's enough to have delusions. But these delusions will be qualitatively different from the lack of awareness sometimes seen in eating disorders and other mental health conditions. They are usually much more fragmented and disjointed, for a start. In my last CAMHS ward I worked with a girl who was convinced I was planting microchips in her body, and her reasoning for this did not possess the same (admittedly distorted) internal logic as the lines of reasoning given above. I'd say that's the key difference.

(On a separate note, being at a very low body weight can sometimes trigger psychotic symptoms such as hallucinations, but this is a by-product of starvation, not that common, and so not a core part of anorexia.)
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Re: Is anorexia a form of psychosis?

Postby maven » Thu Oct 19, 2017 5:51 am

Obti wrote:I guess I should have been clearer, I mean anorexia with anosognosia. I'm asking due to confusion around someone I know with personal experience of an eating disorder who feels the delusional like quality of this i.e. the lack of awareness of health issues being underweight ect means it constitutes a psychotic disorder. I'm inclined to disagree as feel that a psychotic condition describes both delusional beliefs and source monitoring issues (typically seen as hallucinations and thought broadcasting or insertion) but would like to hear other people's perspectives.

Why all these labels? Mental health conditions aren't discreet boxes you can just pop people in with any great reliability. They all reflect complex mixtures of risk and resilience factors both in the individual and in their environment, coupled with difficult experiences that have led them to think, feel and behave in ways that impair their daily lives. Like anyone else with a mental health difficulty, people with a restrictive eating disorder need a formulation to help to understand how they have got there, what is maintaining it, and what might help them to break out of the patterns they are stuck in. It is much more worthwhile to explore the meaning of their symptoms to them, than it is to consider whether/which abstract diagnostic labels to stick on their box as if they have a random medical condition that is outside of their sphere of influence.
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