Ambivalence toward treatment is a defining feature of anorexia nervosa (AN), yet the role of illness-related beliefs in maintaining the disorder remains underexplored. While current models of AN maintenance foreground cognitive-emotional traits, coping styles, and interpersonal dynamics, illness-related beliefs are often reduced to binary “pro” versus “anti” positions, overlooking the ways language itself conveys ambivalence. This paper proposes a transdisciplinary approach, drawing on psychosomatic medicine, psychology, psychiatry, literary studies, and rhetoric, to examine how ambiguity in patient narratives reflects and sustains ambivalence.
Close analysis of diverse genres–including memoirs, poetry, and social media posts–reveals nuanced articulations that defy conventional coding schemes. Ambiguity, far from obscuring meaning, provides insight into the simultaneity of attraction and repulsion patients experience toward both AN and its treatment. By treating narratives as constitutive rather than merely descriptive of belief, this approach expands the evidentiary base of AN research and offers clinicians new tools for recognizing and engaging ambivalence in practice.
Integrating narrative and literary methods with psychological frameworks can deepen understanding of illness-related beliefs and support more holistic approaches to treatment. From its first description in the 19th century onwards, ambivalence–the coexistence of contradictory feelings–towards treatment has been recognized as a defining feature of anorexia nervosa (AN) (Gull, 1888; Serpell et al., 1999; Colton and Pistrang, 2004; Reid et al., 2008; Williams and Reid, 2010; Phillipou et al., 2025). Knio and Sridhar (2025) note succinctly that “patients’ motivation for recovery can coexist with strong identification with what it means to live with an eating disorder, engendering a sense of pride towards their illness.” A main manifestation of ambivalence involves ego-syntonic elements or “pro-anorectic beliefs” related to the experience of disordered eating (Schmidt and Treasure, 2006).
Pro-anorectic beliefs entail positive beliefs about the value or function of the illness or particular symptoms; this means that patients experience at least parts of the disorder as helpful or even necessary rather than burdensome. An example for such a belief as given by Schmidt and Treasure (2006) is: “anorexia helps me to cope with my feelings.” Typical content of these pro-anorectic beliefs circles around control and assurance, self-worth and identity, emotion regulation and the social consequences of the disorder. Other scholars also highlight ambivalence around the concept of control (Reid et al., 2008; Williams and Reid, 2010), with participants reporting “the belief that AN provided a sense of control yet also, at the same time, was in control of them” (Williams and Reid, 2010).
Relatedly, some individuals consider their condition “as an accomplishment rather than an affliction” (Vitousek et al., 1998). In addition, pro-anorectic beliefs may involve emotional avoidance, a sense of safety, and desired responses from others (Schmidt and Treasure, 2006). All these can coexist with the patient’s recognition of being in a potentially life-threatening situation and in need of treatment.
To understand ambivalence, it is pertinent to learn more about AN from patients’ perspectives as to how they experience the disorder. Narratives should be regarded as an essential part of personalized medicine because people create and make sense of their identities through narratives (Frank, 2022). By narrative we mean the product of a communicative act “in which a chain of happenings is meaningfully structured and transmitted in a particular medium and from a particular point of view” (Hühn and Sommer, 2012).
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