Redefining Anorexia Nervosa and Its Causes to Rethink Its Care

Abstract

Described by the physicians Charles Lasègue and William Gull in two independent papers published in 1873, the conceptual birth of the diagnosis of anorexia nervosa is now 150 years old. The etiological quest of the past decades has been unsuccessful while epistemologically the definition of anorexia has continued to vary. The aim of this article is therefore twofold: to open up new avenues of reflection (a) by proposing a “sociopsychobiological” redefinition of anorexia nervosa by integrating a teleological perspective and (b) by questioning its current management, in particular the possible iatrogenic nature of care. Thus, we define anorexia nervosa here as any behavior in an individual who, when confronted with an existential problem, finds a solution by engaging in a quest for lightness, which can gradually become uncontrollable and lead to death from malnutrition. It is therefore pathological intentionality—pathological because it is uncontrollable—that constitutes the core of anorexia nervosa as a disorder. In the hospital context, this pathological intentionality clashes with the intentionality of the carers. Concerning the cared-for, I highlight the iatrogenic risk of caring for patients suffering from chronic and severe anorexia nervosa. If the locus of pathology is the intention of the subject, then any context of medical care that reinforces the vehemence of that intention is likely to be iatrogenic. This potential iatrogenic effect is of a very particular nature since it intrinsically reinforces the pathology. This concept of collision of intentions can lead to the development of new epistemological thinking, an argument for highlighting the iatrogenic risk of medical care and a plea for care that generates less suffering for both carers and the cared-for.