Controversial issues concerning the concept of palliative care of anorexic patients
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Arch Psych Psych 2010;12(4):49–59
Anorexia is a grave and often fatal illness. Death rates would undoubtedly be higher if anorexics were not force-fed once their weight became dangerously low. A very important feature distinguishing anorexia from other mental disorders is highly ambivalent attitude of sufferers to their own illness. On the one hand, anorexic individuals seem to accept their progressing malnutrition, which supports suggestions of researchers that egosyntonicity which refers to the patients' sense of the anorexia nervosa being a part of themselves or of their identity, is a fundamental aspect of this disorder. Thus denial and resistance towards treatment, which are frequent among anorexic patients represent their conscious attempts to preserve its egosyntonic symptomatology. On the other hand, a lot of researchers underline destructiveness of anorexia, namely it not only doesn't give happiness, but also restricts the anorexic person's life to one dimension: in this context she/he can't derive satisfaction from another resource than the more and more mechanic, obsessive self-starving, which finally leads to exhaustion and desire for death. Some researchers ask whether anorexic patients can actually make competent decisions about their quality of life. If so, then the decision to refuse therapy may be on a par with other decisions to refuse life-prolonging therapy made by sufferers of debilitating chronic, or acute onset terminal illness. The aim of the article is to answer a question if data concerning the quality of life among anorexic individuals justify a proposition of palliative care over these persons.