Ethical re-evaluation of contemporary treatments for anorexia nervosa: Is an aspirational stance possible in practice?

Abstract

Anorexia nervosa is a complex disorder that occurs mainly among young women and evokes strong reactions in treating health professionals. While the reactions of psychologists are shaped by treatment guidelines, considerations of professional practice and theories of anorexia, ethical features of contemporary treatment have not been explicitly or critically examined. This paper examines representations of current best and evidence-based practice that are often motivated by a well-intentioned, but limited, risk-reduction perspective. An alternative approach, based on an aspirational ethical stance, is presented along with detailed arguments as to how optimal care for all individuals with the disorder can be achieved. The implications of this stance are specifically explored with regard to the heterogeneity of anorexia, in relation to the chronic course of the disorder and with regard to alternatives that could be described as palliative.

Acknowledgements

We would like to acknowledge the many insights shared by Ania Filek, which, together with accounts of anorectic individuals in the literature, were invaluable in developing the ideas of this paper. Thank you to Ellen Digre for challenging comments in the early stages of the paper. We also would like to thank the anonymous reviewers for their feedback and, last but not least, Professor Susan Paxton for her encouragement and helpful comments on the manuscript.