Overcontrol, Loss of Control, and The Label Trap
When 46-year old Ella (not her real name) came to my office the first time, I was struck by how unnaturally thin she looked: her jeans were baggy in the front and back, and her collarbones stood out like wings from her open neckline. “I’m not anorexic,” she claimed, “I’ve had binge eating disorder for 30 years. I only look like this because I lost some ‘excess’ weight after a period of binge eating last year. I’m here because I feel myself wanting to binge, and I’m afraid of going back to where I was.” Delving into her history, I discovered that she vacillates between these periods of loss of control over her eating (as her brain desperately sends out “please eat” signals in an effort to reach a healthy set-point), and periods of anorexic behaviour, as she whittles the hated weight from her frame and regains control. During these periods she fasts for days, takes laxatives, and exercises daily.
The starving and purging behaviours were of primary concern to me, so I addressed them first. Ella needed to start refeeding herself, hopefully, in a manner that felt acceptable to her. This is very tricky, as when one has become used to eating nothing for long periods, or very small meals, anything “normal” seems like overeating and can then trigger a binge.
She gained 4 much-needed pounds in a couple of weeks and began to panic about losing control. She stated that she was incapable of eating in accordance with her hunger signals because she would just continue to overeat. I tried to offer her reassurance that by eating mindfully, she would not gain two pounds a week indefinitely; bodies just don’t work like that. I gave her literature that explained how she would eventually reach her set-point and her weight would stabilize. She argued that I and the authors were wrong, that she will definitely overeat past her set-point as demonstrated in years past. I found this statement puzzling: how could she know what her set-point is, if she has never allowed herself to reach and maintain it for any length of time?
From what I gathered from her history, Ella’s BMI has never, ever been above average. During binge-eating cycles she would refer to herself as “Fat Ella,” although friends and family members would tell her that she looked great. A healthy weight is perceived by her as grotesque, leading her to “hide from the world,” and work on regaining her anorexic-like control.
I was never able to pose my set-point question to Ella. She terminated our sessions, stating that by labelling her behaviours as anorexic in nature, I was being unhelpful and focusing on the wrong thing for her.
Binge eating disorder... anorexia... bulimia...body dysmorphia... does the label really matter? I see chronic overcontrol leading to loss of control, allowance of weight and shape to determine one’s self-worth, lack of acceptance of the body’s natural tendencies, and, perhaps most importantly, using food to deal with feelings, as core issues that link all these diagnoses.
Ella is searching for the holy grail of dieters: the ability to maintain a weight well below her natural set-point, without feeling intense pressure to overeat. I suppose if science ever comes up with a solution to this conundrum, I’ll be out of a job, and the world will be boring with its lack of physical diversity. Until then, however, I will continue to work with my overcontrolling clients on paying mindful attention to, and eating in accordance with their real hunger and satiety cues, and acceptance of their bodies as genetics and nature intend them to be.
I sincerely hope that Ella takes a leap of faith and gets the help she needs. One thing is certain regarding her future, as ACT founder Steven Hayes wrote: “If you always do what you’ve always done, you will always get what you always got.”
With love,
Ellen
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Keep Your Worries To Yourself
Dear Ellen:
I am very worried about my daughter. She is 21-years old, has struggled with an eating disorder for the past 5 years, and now she wants to move out on her own. She has maintained her weight for the past 8 months and seems to be following her meal plan, but I don’t know if she will continue to make progress on her own. I think she should wait a little longer, but she argues with me that she can take care of herself. What is your advice?
Worried Mother in Vancouver
Dear WM:
I think “worried mother” is a redundancy. No doubt your daughter knows that you are concerned for her well-being, but does she also know that you have confidence in her ability to create a life for herself that works well for her? When a parent expresses so much worry and concern, it’s hard for the young adult to feel secure about her capability to negotiate the complicated world in which we live. There has to be some room for exploration and error as we all try to figure things out as we go along. “I know you can do it” goes a lot further than “I told you so.”
There’s an old, corny saying about how a parent’s job is to give their child roots to stay grounded and wings to fly. Your job description does not include expressing your constant worry over your daughter’s decisions. I’m not saying that you shouldn’t worry – you’re probably going to do so for the rest of your life, but you can learn to be more subtle about it, don’t you think?
Work out a plan with your daughter for moving out that includes regular appointments with her treatment team: psychologist, dietician, physician, etc., and frequent visits with the family. Embrace her independence, but let her know she always has a home to return to – guilt and shame-free. You both can do it, I’m sure.
With Love,
Ellen
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These Worked For Me
I’d like to wish everyone a “Happy New Year,” but since reading The Happiness Trap, I’m trying hard to take notice of and reduce my own and others’ expectations to be unremittingly happy, and to instead practice acceptance and values-based living. Still, wishing everyone a “Functional New Year” doesn’t sound quite right.
I feel restored from my long holiday and ready to get back to work.
What I’d like to offer here for my first blog post of 2012, are three important insights that helped me recover from anorexia and bulimia. I hope that reading these inspires insights of your own that will set you on the path of recovery:
- My thoughts about me come from me/my mind. I may have heard them from a different source and internalized them (e.g., “you’re such a difficult child!”), but as an adult, it’s my prerogative and responsibility to tell myself the story about myself that is helpful for me to hear.
- My true friends like me for who I am, with all my neuroses, quirks, and imperfections, not for my weight, appearance, or my achievements.
- I like, and I mean really like, rich, dense, creamy, chocolately, carb-y food, so I need to find a way to integrate it into my life guilt-free. For me, this means learning portion control and valuing consistent exercise to keep me strong and fit.
I came to each of these realizations through hard work: opening up in therapy, writing in my journal, listening to my hunger cues and honouring them, and most importantly, making a daily commitment to living, really living, without my eating disorder calling the shots. This also meant allowing myself to look foolish when I tried new things like skiing, dancing, or tennis, and making the effort, Herculean at times, to reach out to others, instead of food, for comfort and support.
We’re off to a good start. Let’s make 2012 a year of growth, change, and optimal functionality.
With Love,
Ellen
Questions? Comments? Email ellen@ drdomm.com
A Re-Gift For You
Season’s Greetings from Pemberton, BC, where I am spending the holidays with my boys, big and small, dogs, and skis. For all this and more, I am truly grateful.
For my last post of 2011, I offer a re-gift of the work of Jean Kilbourne, to whom I attribute, in part, my recovery. In 1979, Jean presented her first film on the portrayal of women in advertising, “Killing Us Softly.” Here is the third update of this very, very important piece of work:
http://www.youtube.com/watch?v=1ujySz-_NFQ
I’m sending the link for part one; there is a second part as well – don’t miss it!
Parents, watch this with your children, especially your daughters, and talk to them about how they feel about what they see all around them, and how they feel about themselves. No one is immune from the effects of advertising.
Thank you, Readers, for your emails and stories that have inspired the blog posts of 2011. You inspire me!
Wishing you a positively memorable holiday season, and hoping that you treat yourselves with the compassion and kindness you most definitely deserve.
With Love,
Ellen
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