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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