Strong Fixations

We see a lot of hyperfixation in eating disorder work

How do Fixations Show Up?

  • People are fixated about the quality of food – is it clean, does it contain meat or dairy, is it good for me?
  • Fixated about the calories in food.
  • Fixated about aspects of the body, my stomach is marginally rounder, my thighs are too big.
  • Fixated about weight: I weight 3 lbs more than I should, I look fat, so I am fat.
  • Fixated about people “thinner than me” or, in the case of body builders, “stronger” than me or do more exercise than me.
  • Fixated about people, such as we have a patient fixated with the opinions of a medical mystic who claims to get his information from the spirit world (and maybe he does).
  • Fixated about what I ate today, was it too much, how can I deal with that tomorrow or punish myself.
  • Fixated about the opinions of other people, who must be destroyed if they have alternative points of view

How do we understand the fixated patient?

Fixations are beliefs that are strongly wired into the brain and they connect to the “alarm centres of the brain” – the amygdala. Obeying your fixations is one way to stop the alarm centres from firing off. So having a fixation and obeying its rules is one way of staying safe in someone who would otherwise be too anxious. The fixation is thus a way of being safe and woe betide us for trying to take it away.

So we understand fixations as belonging to someone with an underlying problem with anxiety.  But we need to ask ourselves, is this anxiety just part of the personality, or it is welling up from deeper irrational beliefs about the self.  For example, if I believe deep down that I am a disgusting or immoral individual, I might become very fixated on eating “clean” or “vegan” so that I don’t have to experience that unwelcome feeling of being “dirty inside.” 

Deep and negative beliefs are installed inside us at a very early age, often before we have words or even memories of them.  So normal psychotherapy often doesn’t root them out. People with low levels of anxiety might say oh I ate a burger today, it wasn’t what I would choose but, it’s no big deal for once. But the fixated individual would consider it a tragedy. Psychologists call this kind of anxiety reducing behaviours “schema avoidance”.

Hyperfixation is a self-fulfilling prophecy. The more you obey or run the fixations, the stronger they become and the more fearful we become of doing the opposite of the compelling voice in our heads. We see this for example in people who exercise excessively. They may KNOW that it is OK to take a day off, but it just doesn’t happen.

There was once a young anorexic girl fixated on her daily exercise, she fell of her bike, fractured her  pelvis and was taken to hospital in an ambulance. When she was left alone on the gurney, she slipped out, and although in terrible pain, she went for a run around the block. Unsurprisingly, she was put on a Mental Health Section.

Another of my clients was fixated on alternative therapy as a cure for her cancer, shunned chemotherapy and declared that “doctors don’t know what they are doing”. She died.

I see fixations all around me, in anti-vaxxers, in conspiracy theorists, with activism on social media.  Some individuals hyperfixate on a person such as a guru or a terrorist. One thing is common to all of them; they are impervious to rational argument or to persuasion.  They may be benign or dangerous to themselves and they can be a nuisance or dangerous to other people.

Fixation as a Symptom

Fixations are described also as monomanias and can be a symptom of

Autism Spectrum
Anxiety Disorders

Unhelpful strategies include giving evidence to the contrary – such as persuading the person that their guru is a scammer or that “fat can be associated with diabetes”.  Telling someone that they are wrong or trying to stop them from preaching their opinions does not help.

There was once a religious sect in the 18th century who believed that Armageddon was to happen on a particulate day and time. They gathered together to pray and wait for the Apocalypse that didn’t happen. Did they change their view? Not at all. One half believed that the Apocalypse had happened and they were already living in a world-like heaven. The other half decided that the Lord was so impressed with their prayers, that He had put it off for now.

Psychologists have tools for managing fixations. This includes Cognitive Therapy. Cognitive therapy instals doubt and also addressed the value of holding on to the belief – in what way is this belief USEFUL to you? Trauma Therapy such as Eye Movement Sensitisation and Reprocessing, EFT (Tapping) and techniques from NLP can be helpful.

Treatment usually satisfies family members or friends but the fixator is not usually enthusiastic about changing their mind. As one person said to me – “Why would I want to stop minding about Clean Eating if it meant I would start eating rubbish like you do”.

Fixators on a person are also unwilling to let go of their infatuation. What sets in here is “sunk cost thinking” – if this person is really a baddy, I will have to deal with all the regret about the time, the money and the emotional  investment I have wasted. Regret is an emotion that most of us want to avoid.

Our experience of treating fixations thus is that therapy is resisted. Removing the fixation does nothing to deal with the underlying anxiety that can surge to the fore.


This is a contentious opinion, but I increasingly wonder if fixations can be tweaked by the use of Psilocybin or other psychedelic drugs. Carefully managed, they introduce fixators to an alternative reality. Fixations are about guarding a very fragile sense of self and during a guided “trip”, this sense of self is surrendered so that an alternative self can be installed.

I do not think that this would be helpful for someone with schizophrenia, so a careful assessment has to be done.  There is also the question of motivation. A fixator would want to be certain about the outcome of taking a psychedelic drug and may convinced that something bad would happen to them.

The Social Context

Fixations take place in a social context. Family members often confront the fixator – ineffectively- or accuse the fixator or ruining their life. Many behave as if they are treading on broken glass – which is stressful;  or the fixator withdraws to avoid more confrontation and pressure. Carers  often feel emotionally blackmailed – “Accept me as I am or get lost”.   They say that they have no choice other than to collude with the fixator. We see this with all kinds of issues, including anorexia.

Fixations thus destroy family harmony and cause ripples of mental harm to close relatives and friends.  Family members can become isolated, neglected, and lonely as the fixator pursues their lifestyle. A person fixated on, say, golf,  can leave their family members alone at weekends and fail to attend to their basic day-to-day needs both practical and emotional. Fixators reinforce their fixations by  bonding with others who share their views, thus reinforcing their “rightness”.

Groups of people who share an ideology gain a sense of superiority, that is alluring to the fixator who often has a fragile sense of worth. You see, we have special access to the truth, we are not in ignorance like everyone else.

People who live with a fixator need urgent help and support, independently of what is happening to their loved one.  At the very least they can say to the fixator, we are for now going to get help for our own feelings about what is going on.

If you are a carer, please don’t frame this up as “we are going to get advice for how to show you the error of your ways” because this is not going to help.

What kind of help carers receive depends on a full analysis of the situation as the family sees it together with any other information we can glean about the problem. There is no one-size-fits-all solution to living with fixations.


If you have a loved one with a hyperfixation, we do have family therapists who can support you. Mental health problems are never easy and must be handled one step at a time.  If the issue is food, weight, food fads, or over-exercise, call 0845 838 2040 and see how we can help.