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The article presents the author's elaboration over the hypothesis that anorexia nervosa (AN) is a passion. Topics discussed include discussion of the parallelism between passion and mood, the author's concept of AN as not being affected by emotion, feeling or mood is emphasized, and the theoretical concept of passion as playing a significant role in explaining the clinical course of AN. The significant issues of identity and authenticity are discussed in detail.

Contemporary diagnostic criteria for anorexia nervosa explicitly refer to affective states of fear and anxiety regarding weight gain, as well as a fixed and very strong attachment to the pursuit of thinness as an overarching personal goal. Yet current treatments for that condition often have a decidedly cognitive orientation and the exact nature of the contribution of affective states and processes to anorexia nervosa remains largely uncharted theoretically. Taking our inspiration from the history of psychiatry, we argue that conceptualizing anorexia nervosa as a passion is a promising way forward in both our understanding and treatment of that condition. Building on the theory of the passions elaborated by Théodule Ribot, the founder of scientific psychology in France, we argue that there is convincing empirical evidence in defense of the empirical hypothesis that anorexia nervosa is a passion in Ribot's specific, technical sense. We then explore the implications of this finding for current approaches to treatment, including cognitive-behavioral therapy, and clinical and ethical issues associated with treatment refusals. [ABSTRACT FROM AUTHOR]

The article focuses on the decision-making capacity (DMC) of patients who refuse from medical treatment. It states that the stableness of the values and decisions of persons must be observed for them to be considered as capable of making decisions. It adds that the autonomy of the person must be respected unless the decision is against the welfare of the patient or if the person who makes the decision is mentally ill, wherein overriding the decision is considered rational.

This paper explores the ethical and conceptual implications of the findings from an empirical study (reported elsewhere) of decision-making capacity in anorexia nervosa. In the study, ten female patients aged thirteen to twenty-one years with a diagnosis of anorexia nervosa, and eight sets of parents, took part in semistructured interviews. The purpose of the interviews was to identify aspects of thinking that might be relevant to the issue of competence to refuse treatment. All the patient-participants were also tested using the MacArthur Competence Assessment Tool—Treatment test of competence. This is a formalized, structured, interviewer-administered test of competence, which is a widely accepted clinical tool for determining capacity. The young women also completed five brief, self-administered questionnaires to assess their levels of psychopathology. The issues identified from the interviews are described under two headings: difficulties with thought processing and changes in values. The results suggest that competence to refuse treatment may be compromised in people with anorexia nervosa in ways that are not captured by traditional legal approaches. [ABSTRACT FROM AUTHOR]

This article presents a study regarding patients with anorexia nervosa. The results of the study shows that many patients with anorexia nervosa who refuse treatment do not necessarily lack capacity. It discusses that the concept of competence or capacity has both a descriptive and a prescriptive component.