Patient Refusal of Care

Ambivalence & resistance to recovery are common

Some people might even deny the presence or severity of their eating disorder.

This is because for many people, eating disorders are functional and egosyntonic disorders.

This means that the eating disorder can form a large part of the person's self-image and often serves important functions in the person's life.

The eating disorder may help to manage personal, emotional, and psychological difficulties.

For example, an eating disorder may serve a person by:

  • Numbing painful emotions
  • Providing distraction from issues that feel overwhelming
  • Providing a sense of control and efficacy in their life
  • Informing a meaningful or special identity

Appreciating the egosyntonic and functional nature of an eating disorder can go a long way to understanding challenges in assisting someone recovering from an eating disorder.

Recovering from an ED is confronting and requires a huge amount of change

Not wanting to engage in treatment doesn't equate to someone not yearning love and a sense of worthwhileness.Husband of someone with a lived experience of Anorexia Nervosa

It makes sense that when challenged to 'give up' an eating disorder through treatment, extreme anxiety and fear will be provoked for the individual.

This can be addressed, in part, by developing a strong therapeutic alliance with the person, adopting a compassionate and non-judgemental approach, and externalising the eating disorder.

Tips to managing distress:

  • Reassure the individual that treatment is for their safety and wellbeing
  • Involve family, friends, and carers in treatment
  • Interpret unhelpful behaviours as a method of coping with distress
  • Externalise the eating disorder so that the individual does not feel blamed
  • Encourage the individual to express emotions in a healthy, appropriate manner
  • Teach strategies to cope with distress such as emotional tolerance and relaxation skills
  • Encourage the individual to experiment with different coping strategies until they find one that helps
  • Conduct regular risk assessments