I have read all of the post here and most of the links. I still have some more reading to do but I still don't see valid evidence to support anorexia being a disease that makes you helpless. Its not just one person that I have met that has brought me to my opinion, its quite a few people. And you didn't hurt my feelings. I just thinks it funny how a lot of people are taking offense to my opinion.
Now this is a different set of issues, no one is helpless in most cases. But helpless to do what is the question.
That includes people with severe biological symptoms, there are a few diseases like narcolepsy where e there are very few choices people can make to alter the course of the disease.
Now this is a separate issue from disease in general, people can not usually control the symptoms of a disease, but they can modify their response to the symptoms.
In the case of mental health issues only mild symptoms will respond to solely behavioral strategies. So depending on the severity of the symptoms the range of responses the individual may have will vary. This is true of schizophrenia, anxiety, depression and I believe anorexia nervosa.
In the case of anorexia nervosa, if the symptoms are strong they will have little ability to distract themselves from the intrusive thoughts and body distortions. As stated before the best course then it going to be medication, CBT and lifestyle changes. But without symptom reduction, there is little that CBT alone is going to be able to do.
Now the issue of helplessness is a very complex one and it is multifaceted.
There is the histrionic behavior or dependant behavior that has a behavioral payoff for a wide variety on individuals, it is not limited to those with a mental illness by any means. There are those who will use their condition as an excuse to get other people to do things that they can do for themselves. It is a very common human behavior.
But helplessness is also a feeling associated with depression and that can be co-occurring with anorexia nervosa, feeling overwhelmed is a common reason people feel hopeless when they are depressed there are some cognitive behavioral skills that will help there, but again in the fact of strong symptoms they will be mostly ineffective.
So again there are some things people are helpless to control, such as symptoms of anxiety, intrusive thoughts and compulsions. The response to those symptoms will be mostly under the control of the individual (bounded by panic and compulsion at times). But the effectiveness of changing responses is going to vary depending on the severity of the symptoms.
If a person has mild AN, it might be that they can use 'retalking' or decoupling and substitution of behaviors to have an effect upon the outcome of their response to symptoms. Standard CBT will have some effect and most likely reduce overall symptomology.
But is they are having more severe symptoms, then less likely unless there is medication and a reduction of symptoms to go along with the CBT.
Then there are always the three bugaboos of mental health treatment: substance abuse, lifestyle and relationships. They always mess with CBT and medication. Substance abuse is a major contributor to all sorts of mental health issues, stimulants in particular can mess up anxiety and worsen symptoms. It is not uncommon to have to have a dual treatment in place to reduce substance abuse while using CBT and medication. Then there is lifestyle, many people (and rightly so) do not want to change their lifestyle, they do not want to give up the stress in their lives because of things like money. Then the wonderful relationships, if you have an enmeshed partner or family member who derives their self worth from your helplessness, they often don't want the system to change.
So again the issue comes down to helpless over what, people can control some things and not others. There are people who will manipulate a situation and milk it for all it is worth and there are also those who really can't do more than hold place against their symptoms, then there are the vast majority somewhere in between.
