Beyond Cognition and Affect: An Analysis of Anorexia Nervosa within the Framework of Addiction

Abstract

Anorexia Nervosa is widely recognized as having both cognitive and affective dimensions. Current accounts typically explain the perplexing behaviors associated with this eating disorder by emphasizing either its cognitive components—particularly false beliefs related to the denial of the patient’s actual conditions—or its affective components, such as the intense fear of gaining weight. I will argue that neither approach is sufficient to fully capture the complexity of Anorexia Nervosa. This paper explores a more comprehensive approach that goes beyond the cognition-affect dichotomy, aligning better with the DSM-5 criteria for Anorexia Nervosa. These criteria suggest that while both affective and cognitive components play significant roles, neither the cognitive element nor the affective element is necessary or sufficient to define the condition on its own. I propose that this can be achieved by drawing an analogy with addiction, where both conditions can be seen as stemming from and maintained by an all-consuming fixation that permeates individuals’ lives and profoundly influences their behaviors. In Anorexia Nervosa, this fixation manifests as a pervasive preoccupation with body size and weight. What distinguishes these behaviors is their internal self-endorsement, aligning with the well-documented ego-syntonic nature of Anorexia Nervosa: sufferers perceive these behaviors as consistent with their feelings, values, and ideals, making them resistant to change. Understanding Anorexia Nervosa within the framework of addiction, particularly by recognizing the pivotal role of ego-syntonic fixation, allows for a more comprehensive approach to the disorder that sheds light on its high resistance to treatment and the challenges faced in clinical interventions.