What’s Control Got To Do With It

For some time, the core psychopathology associated with anorexia nervosa (AN) and other eating disorders (ED) has been identified as “an overvaluation of body shape and weight and one’s ability to control them.” Despite this widespread belief, there exists a subset of the AN population who do NOT endorse shape and weight concerns but otherwise resemble AN (e.g restricted eating behaviors). This group has interested researchers and intrigued them to try and identify the core psychopathology associated with restrictive eating patterns and behaviors that exist without the presence of body image concerns or distortions. These individuals have been classified as ‘nonfat phobic’ or NFP-AN by Becker, Eddy & Perloe (2009).

The Importance of Control for Nonfat Phobic Individuals with Anorexia Nervosa

For these individuals, it has been hypothesized that restrictive eating is motivated by an over-evaluation of or a desire for self-control in general. This model conceptualizes a need for control as the universal maintaining factor of restrictive eating in AN, with shape/weight concerns merely superimposed (Fairburn, Shafran, & Cooper, 1999). It was hypothesized that this generalized need for control would apply across multiple domains of life, including eating, and reinforces behaviors consistent with a high level of dietary restriction (Fairburn, 2008).

Critics of this stance, such as neuropsychological researchers who have identified altered brain pathways in individuals with ED, would argue that ED is not an issue of control, rather of misfiring signals and behavioral patterns. Other positions and stances exist on this issue as researchers continue to debate what the true organizing principle of AN is, although this hypothesis had been found to be congruent with some patient narratives.

Patient Narrative: Jenni Schaefer

One such patient narrative was highlighted in a recent study published to the International Journal of Eating Disorders. Jenni Schaefer’s offers the following description of her ED as the only thing she could control in her life: “In a world where it’s not possible to be perfect at everything, Ed [her eating disorder] had promised that I could always be perfect at one thing. Even if everything else in my life slipped away or was imperfect, I could be the perfect weight according to Ed. I could control what I ate even if I could not control other things. With Ed gone, this sense of control was gone (Schaefer, 2009).”

To further investigate this hypothesized core principle of control in individuals with NFP-ED, researchers utilized the Eating Disorder Examination and added items to assess a desire for control. In a surprising turn of events, findings were not consistent with the hypothesis.

Instead, researchers found “those with NFP-ED reported lower levels of psychopathology overall, and need for control specifically, than those with FP- ED.” These findings provide further support for the need for future research examining the elusive core psychopathology of NFP-ED. Interestingly, within the sample of NFP-ED individuals, the group was relatively “less ill” and many had never experienced symptom intensity that would warrant residential treatment. In fact, individuals with NFP-ED in this sample had significantly fewer prior hospitalizations for their ED than those with FP-ED.

An area to be explored in the future may surround whether poor insight or lack of awareness of one’s emotions and behaviors could explain the lower levels of general and ED-specific psychopathology reported in our NFP-ED sample. This lack of self-awareness may be both harmful and advantageous for the individual. Regardless of the core principle driving one’s experience with eating disorder, help and support is available. Contact us at www.ColumbusPark.com

If you or a loved one is experiencing an eating disorder, please don’t hesitate to contact us here at Columbus Park. We can help!