Facing Eating Disorder Delusions, Part I

Typically delusional thoughts are fixed beliefs about the world that someone is convinced are true but that are clearly false. More often than not, these beliefs are so prominent and so all consuming that they significantly disrupt the person's life and relationships. 

Sometimes the delusions can be circumscribed, for instance focused solely on one person or one event happening in the world. In these circumstances, the delusions only come to light when the specific target is discussed. 

Delusions in an eating disorder are both circumscribed and also internal. The fake beliefs about food and weight only pertain to that person and not others. In addition, the thoughts are shrouded in secrecy and rarely come to light. Unlike almost all other delusions, they only are revealed when questions probe enough to elicit the beliefs. 

Yet these delusions are so powerful that they affect most decisions every single day and profoundly limit how someone lives their life. 

Eating disorder delusions come in two similar patterns. First they can revolve around severe limitations of foods that one can eat or the amount one is allowed to eat. Breaking these laws around food actually feels like doing something absolutely horrific, something illegal that deserves punishment.

The delusions can also revolve around a belief that the person either has never been sick with an eating disorder or has never been very sick despite clear evidence that proves otherwise. Some people with clear organ damage or even at risk of dying still believe they are well. 

It's important to recognize that these are thoughts someone with an eating disorder absolutely believes are true. They are not just passing thoughts. This is often what makes understanding these illnesses so hard. 

Questioning delusions is very difficult. Directly confronting them typically fails immediately and brings any trust in a relationship into question. The way to challenge these fixed thoughts is to essentially build a case against them.

By amassing evidence that shows how these delusions are false, one can begin to bring to light the lack of data to prove these thoughts are true. Even with overwhelming evidence, it can continue to be hard to escape a delusion. It often takes months of questioning the thoughts to weaken them in time.

Gradually, the most important step is to help the person herself begin to question the delusions directly. I'll discuss that more in the next post.