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Anorexia nervosa has been described as an illness of psychological inflexibility, an inability to behave in flexible and creative ways in the presence of difficult thoughts, feelings, and bodily sensations (Merwin et al., 2010). In fact, it has been shown that individuals with anorexia nervosa have less psychological flexibility than their recovered counterparts who, in turn, have less psychological flexibility than healthy controls (Merwin 106 The Spiritual Metaframework et al., 2010). This accords with clinical experience, which shows that patients who have achieved full symptom remission retain problematic psychological dynamics. It has been suggested that mindfulness- and acceptance-based treatments may provide a useful way of addressing the psychological inflexibility characteristic of patients with anorexia nervosa (Merwin et al., 2010). This psychological inflexibility takes a particular shape in the relationship that patients with anorexia nervosa establish with their bodies. Indeed, the body is not subject to precise manipulation. With innumerable variables contributing to its state at any moment, it defies our omnipotent manipulation. Those who lack the capacity to tolerate this ongoing flux may resort to desperate attempts to force homeostasis, whether through fasting, excessive exercise, or other means of flattening their experience of bodily aliveness. Similarly, behavioral symptoms such as weight checking and calorie counting provide a refuge from bodily unpredictability and change (Merwin et al., 2010).
Similarly, psychological inflexibility leaves its mark on mental life. The symptoms of anorexia nervosa provide a sense of predictability, safety, and control by providing clear rules for behavior, bypassing emotional experiences, which are experienced as confusing and messy. These rules tell the patient what, when, and how much to eat. With attention captured by these rules, patients are less likely to attend to their internal emotional experience. Ultimately, significant weight loss and prolonged starvation profoundly flatten the patient's emotional life by numbing the body. Indeed, increased parasympathetic activation (Miller, Redlich, & Steiner, 2003), among other physiological changes, has been shown to reduce the intensity of affect (Craig, 2004). Similarly, hunger cues fade away as starvation continues (Wang, Hung, & Randall, 2006). Understanding Anorexia Nervosa in Males, Tom Wooldridge, 105-106