It's all about control

You know, they say eating disorders are about control. Well, they're half right.

Everyone wants to control the conversation about eating disorders, certainly.

One of the symptoms of active anorexia and bulimia and BED is a dysfunctional obsession with control.

Not surprisingly, the ED world is also pretty focused on control as well: we all have our turf to protect, our investment in our preferred approach, our regrets to justify, and our frustrations to appease. And like kindergartners, sometimes we don't play nicely with one another.

I guess that's natural for a topic about which there is so little scientific clarity and so much need. We are an anxious polity - sufferers, caregivers, clinicians, payers, scientists, and the curious public. For lack of real data we make do with trading accusations. Kind of like nervous dogs in confinement, we become 'fear biters.'

Why can't we all just get along? Well, because we disagree. Many of the treatments out there truly are damaging. Many of the theories out there contradict each other. Many families simply give up when they consult three clinicians and get three mutually exclusive opinions and treatment plans.

Disagreement can be productive, but only if there is conversation. I don't see much of that out there. I see individual researchers doing their own thing (the nature of research). I see clinicians who don't read the science that is out there. I see clinics developing their own methods in isolation. Insurance companies pay for treatments without good research and don't pay for effective ones. I see journalists quoting the furthest poles of disagreement without commentary. I see writers, like me, peddling points of view. And I see parents simply overwhelmed and confused and seeking a direction - any direction.

How on earth can parents and loved ones make sense of it all?

Here's my dream: I want to put all the coolest researchers, the most innovative clinic directors, the most thoughtful health journalists, a panel of insurance people, some savvy top legislators, and a committee of fierce patients and caregivers in a small room for a week or two. Not let them out until they put every theory and bit of knowledge on the table and thrash it out. I want them to come out of that room with a document which outlines the state of the art, science, and action for a new era in eating disorder treatment. An ED Dream Team...

Is that so much to ask? Come on - we'll do it around my dining room table. Kaye and Bulik and Nunn and Lask and O'Toole and Treasure and Sodersten and Wisniewski and Boswell and le Grange and Lock and Zucker and Herrin and Hodges and Vandereyken and the whole gang! We'll have neighbors drop off casseroles and order in from Dominoes. My mother-in-law will make kugel. Everyone can bring their sleeping bags and we'll burn everyone's copies of The Golden Cage and the DSM-IV in the fireplace for warmth. It'll be fun.

Or maybe that's too controlling?


  1. Do you know what, I think Arthur Crisp would have loved it - I think you might have hated his ideas but you would still have made him welcome. Not quite sure about any form of book burning and anyway with that kind of warm crowd we'd probably keep cosy enough. Can I bring my favourite psychiatrist along?

  2. I agree that control is a very important contributor to bulimia (don't know much about anorexia). But, it's not "control" so much that we should focus on to help sufferers. It's the FEAR underneath our need to control that is what we need to focus on. Bulimics don't trust themselves at all. So, if things change or become instable, bulimics get severe anxiety that their already precarious lives will spiral even more out of control. We need to teach bulimics to hear their hearts, to trust themselves, and that they are capable and creative enough to deal with anything that comes along.

    Here is a post I wrote about how learning to allow is incredibly powerful in recovery and in learning to live a happy and fulfilling life:

    Michelle Hope


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