Is Anorexia a Form of Monomania?
A relic of the 19th century, ‘monomania’ is a term that is seldom used these days. Yet monomania surrounds us. It describes those with “fixed ideas” that are very difficult to overcome.
We encounter different levels of monomania in everyday life. It’s evident in politicians with fixed ideas, whose unshakeable political views seem to bear no relationship to the general way of looking at life, and in fanatics driven by religious beliefs at odds with general understanding. It can even be observed among some sports and entertainment fans, whose concept of the team or entertainer are exaggerated beyond reality.
None of these people will budge in the slightest from the idea which consistently dominates their mind, thoughts and behaviour. Nor will they accept arguments that their idea could be false or based on a misconception of reality. In every other aspect of life, these people might function normally.
Monomania has also been linked to anorexia nervosa (anorexia), because of the fixed inflexible ideas held by those with this eating disorder about body shape and weight. Where it differs, is in the level to which it affects and endangers the life of the person with this particular fixed idea.
There is some debate about whether monomania involves delusion or obsession. In most cases, as with anorexia, the connection is primarily delusion – but elements of obsession also exist. The fixed idea at the root of the disorder is delusional. However, fears supporting the idea, and behaviours that are adopted can become obsessive to the point of compulsion.
Delusion involves a person getting fixated on an idea, which although logically constructed, does not necessarily follow the same logical reasoning shown in other areas. The fixed idea in anorexia is a distorted idea of the perfect body image, and involves the achievement of an often unattainable body shape and weight.
Delusions are non-negotiable. Those with anorexia will accept no arguments or proof from anyone who sees their idea as far removed from reality. They will rigorously deny they have a problem and resist treatment because of this, and because they see the results of their behaviour as positive in terms of their delusion.
Delusions are linked to dopamine and the positive reward centre of the brain. The delusion can sometimes develop into manic enthusiasm and interest in the fixed idea. It is not necessarily frightening, and may involve positive feelings, so people may act on it regardless of whether it could harm others or themselves.
Obsession is linked to the serotonin system and the fright or alarm response. Obsessions arise from unpleasant thoughts or ideas, which cause feelings of anxiety and fear. They are totally uncontrollable, even though the person involved usually realises that they are completely unrealistic.
Since obsessions do not evoke pleasant feelings, people are more likely to try to suppress them rather than act on them in ways that will harm others or themselves.
A third aspect of anorexia, after the delusionary body shape and weight goals, is the fear of becoming ‘fat,’ which would compromise the delusion. This fear is uncontrollable, becomes overvalued, and forms an obsession.
Suppression of the obsession may lead to increased anxiety and attempts to exert some sort of control with compulsive behaviour like food restriction, purging, over-exercising, or drawing up diet regimens as a ‘ritual’ to protect the sufferer.
Cognitive Behavioural Therapy (CBT)
Cognitive behavioural therapy is seen as one potential route to treating the monomania aspect of anorexia, because of its focus on thought patterns.
In recent years there has been a move towards treating anorexia and other eating disorders as a group based on what the various disorders have in common (weight and body shape overvaluation), rather than a diagnostic approach based on how they differ. An “enhanced” form of CBT called CBT-E, developed by UK Professor Christopher G. Fairburn in the 1980’s to treat Bulimia Nervosa, has been extended to all eating disorders, including anorexia.
CBT-E has two forms, one focusing on the eating disorder alone. The other form includes those factors that could interfere with the ability to change cognitive patterns. These can include difficulty managing negative emotions, low self-esteem, perfectionism, and difficulty interrelating with others.
All forms of CBT are based on the idea that cognitive thought patterns govern our behaviour. The aim of the therapy is to help identify negative thought patterns that result in unhealthy behaviour and replace those with thought patterns that result in healthy behaviour. In addition, CBT tries to instil skills to help people either resolve problems in their lives or learn to cope with them.
Although a fixed idea is hard to shake off, CBT provides an environment in which the person with anorexia can process and understand their monomania and their own cognitive patterns and achieve a positive outcome.