Myth: Anorexia is all About Control

Anyone who’s cared for a loved one with anorexia nervosa, who has the condition or who has been trying to understand this condition will have come across the following idea.

Anorexia nervosa is all about control. It happens when someone feels that they can’t control anything else in their lives. Food is the only thing they can control, so they start to restrict what they eat.

It’s an intriguing and creative idea, but is there any truth in it? If you look at it objectively, does that statement even make sense? And, more importantly, is it going to help someone recover from anorexia?

Let’s think about the statement above for a minute. For food to be the only thing in your life that you are in control of, your life would have to be extremely limited. You wouldn’t have access to any choices in terms of friends, social activities, hobbies, the Internet, books, clothes, education or anything else. In fact, for this statement to be true, you would have to exist in a tiny room without light or access to entertainment or other people.

In our lives we all make a multitude choices many times a day. What to wear. How to style our hair. Who we speak to. What to say. How to say it. Where to go. How to get there. What to watch. Where to watch it. What to read. What to think.

We might not have a choice about all of these things. The younger we are, the fewer choices we’ll have. But we will always have some choice, and therefore some control, over something. This is true for almost everybody, with the possible exception of hostages or prisoners of war.

So why do many people perceive this statement to be true? Well, as I explored in a previous post, anorexia nervosa begins with a caloric deficit, when someone’s intake of calories is lower than their output. After a period of time of reduced calories and weight loss, a switch is flicked in the brain of someone with a predisposition for AN and the illness starts. It’s true then that the illness may be triggered by an attempt to control something: food intake or body shape. But many, many people try to control their bodies through one diet or another or through exercise and most don’t then develop anorexia nervosa.

Of course, to the outsider it could seem that someone with anorexia nervosa is extremely controlling, and it might be assumed that a desire to feel a sense of control is a personality trait. In the early days of my daughter’s illness, she would stand over me monitoring what I was cooking, trying to persuade me to use different ingredients, to have an input into every meal, to watch every component that went into the meal. She also began to monitor her body shape religiously, to ensure that there was no fat anywhere on her tiny frame. And she watched what others were eating, encouraging them to eat just a little bit more, trying to ensure that everyone else at the table consumed a greater amount than she did.

Before the onset of the illness, she had done none of those things. In fact, my daughter had been supremely relaxed about her body shape and food, as was everyone in our family. Ours was a home filled with the smell of baking, where the concept of bad foods did not exist and where we’d enjoy long lunches around the table, sharing the delicious fare on offer, chatting, laughing, tucking in heartily. All types of food were eaten: cheese, cakes, fruit, vegetables, curries, lasagnes, pies, cream, seafood, meat. Table manners were non-existent. Mealtimes provided an opportunity to relax, enjoy each other’s company and catch up on each other’s lives.

So what changed? Why did my daughter suddenly become a person with a pathological need to control everything and everyone, in particular the food she ate?

She developed anorexia.

This controlling behaviour only started once the illness had set in. So this begs the question: was it really my daughter who was in control, or was she compelled to act in this way by the illness? Was she controlling everything in her life, down to the last crumb of bread that she did or didn’t eat? Or was the illness making her behave in this way?

Anorexia nervosa is, in fact, the opposite of being in control. It is about being out of control in almost every aspect of your life. You become someone who has no choice in so many aspects of life that most of us take for granted, particularly those relating to food — what time to eat, what to eat, who to eat with — but also how you spend your time, where you go, how much you move your body, what activities you participate in, whether you even have any fun at all. Freedom is all but lost, and you become the hostage in your own life.

I don’t believe that promoting the idea that the illness is all about someone’s need to be in control is helpful for recovery. And I certainly think that spending hours in therapy exploring why a person felt they had to control their weight or body shape in the first place — without addressing the main problem: malnutrition — is a path to nowhere. That’s a bit like treating cirrhosis of the liver simply by talking about the reasons why somebody had their first drink. It will not help someone get better because what they need for their brain to stop acting as if it’s malnourished is for it to stop being malnourished. They need to eat.

To view a person with anorexia as someone with an obsessive need to be in control is to look at this illness the wrong way round. The person who has the anorexia nervosa quickly finds that almost every aspect of their lives is being controlled by the lodger that has made itself at home in their brain, the cuckoo in the nest. And they feel utterly powerless to act in any other way. This illness is subtle; it becomes almost impossible to distinguish between the eating disorder thoughts and those of the person with the illness. And so the controlling behaviour becomes entrenched. The eatings disorder thoughts become louder and more weight is lost. And as more weight is lost the eating disorder thoughts become louder still, until the person with anorexia has forgotten what it’s like to live any other way.

Until all free will is lost.

Or at least it can seem like that. Because even when someone is in a severe state of malnutrition, even when the anorexia has really made itself comfortable, it is still possible to go against those thoughts, however powerful, however strong they have become. It is possible to boot out anorexia nervosa from your brain and, to coin a phrase, take back control.

If you’re reading this and you have anorexia, please don’t feel that all is lost, that it’s hopeless and that you are powerless to ignore the anorexia voice in your head. Many, many people have completely recovered from this illness and you can too. It won’t be easy. And you are going to have to do the thing that scares you most: eat food, and lots of it until your malnourished body and brain are fully recovered. But it will be worth it to have your freedom back.

You can evict anorexia. You can take back control. You’ve got this.

For recovery resources that may help, please see here.