Anorexia Nervosa as a ‘Passion’—or an ‘Addiction’
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Anorexia nervosa, passion, addiction, agency, capacity
Since the first descriptions of the disorder there have been attempts to place anorexia nervosa (AN) within established psychiatric categories (e.g., see, Russell 1970; Vandereycken and van Deth 1997). These have included depression, obsessional neurosis, variants of ‘hysteria,’ and phobia. However, the constancy of association of the various clinical features and their consistency over time argue against AN being a pathoplastic feature occurring in the course of other disorders. In the Diagnostic and Statistical Manual of Mental Disorder-IV, the eating disorders stand on their own under the broad rubric of ‘disorders usually first diagnosed in infancy, childhood or adolescence.’
Charland, Hope, Stewart, and Tan (2013), in an original contribution, present a case that AN might be best construed as a passion. Their description of passion is based on that of Ribot (1907), who offered a tripartite characterization of the ‘affective life’: The relatively fleeting or unstable feelings and emotions, and by contrast, the passions—long-lasting (months or years), intense, and playing a significant role in motivating and organizing a person’s long-term behavior around an idée fixe with its associated values and beliefs. Ribot’s description is further developed by the authors who offer more detailed criteria for identifying a passion. They suggest that seeing the condition as a passion provides a promising way forward for our understanding and treatment of AN.
Definition of a Passion
Further investigation of the concept would depend on how well the passions can be defined. The differentiation of a passion from emotions involves criteria that are quantitative: Duration and intensity certainly, whereas how prominent the cognitive component needs to be to constitute an idée fixe is at this stage unclear. The boundaries between emotions and a passion may thus be blurred, making a research definition difficult. Ribot (1906, 483) placed the idée fixe as first in order of importance of his three criteria for a passion, and perhaps being more amenable to measurement may provide, in conjunction with the other criteria, a workable basis for definition. The importance of the cognitive element of a passion, which Shand (1907) has pointed out may demonstrate high intellectual sophistication (as, for example, in ‘aesthetic’ passions), raises the question of whether a passion is rightly to be considered as primarily a disorder of affectivity. However, it is clear that the emotions are at least an equal partner in its constitution. The seven modernizing criteria offered by Charland and [End Page 371] colleagues, like Ribot’s, would remain subject to the same problems of definition.
On the other hand, the introduction of a well-developed conceptual framework for the emotions in this area of descriptive phenomenology is welcome. As the authors point out, the history of the ways the ‘emotions,’ including the ‘passions’ have been construed has involved many shifts, often subtle and confounded by differences between languages. As a result, and added to the underlying difficulties in characterizing them, the emotions have found little place in psychiatric terminology. The passions, because of their relative stability, offer an opening for a better understanding of the emotions in mental disorders. Most of us will recognize the phenomenon in people who become abnormally single-minded pursuers of a valued end—power, money, physical prowess, or the ‘purest’ of religious, aesthetic, or political ideals. Ribot included among the passions drunkenness and a love of gambling, to which I soon return.
AN as a Passion—or Addiction
By setting some key features of AN against the seven defining criteria for a passion proposed by the authors, a good case is made that AN fits well. These criteria are a long-term, affective orientation; a fixed ideational focus; a motivating power; an organizing schema for affectivity; an integration with cognition and reason; a progressive cumulative course; and a relationship to morbidity and psychopathology.
However, seeing drunkenness and love of gambling listed among Ribot’s passions raises the question of the relationship between at least some passions and the addictions. The relationship between a passion and an addiction may be worth exploring. There seem to be parallels at a descriptive...
