I just watched yet another documentary on anorexia where they posited that a main motivator for girls and young women becoming anorexic is seeking control. Under this theory, which I literally have been reading and hearing for decades, these women are seeking to control something, something, in their lives. So they control their food. They control their diets. they control their calories, they control their exercise. They control their food habits, and their food quirks, and their food rituals, and often through those food idiosyncracies they control everyone around them. In some cases they binge and they feel out of control so they purge to get back into control.

But what if that paradigm is completely wrong?

And what if that’s why anorexics so seldom get better and stay better?

Sure, lots of girls (and women) who go into treatment (end even those who don’t, but have eating disorders nonetheless) have type-A personalities. They like control. They like to excel and they want to succeed. Maybe they are perfectionists.

But I have never- and I mean never- I mean bar none, no exceptions, not a one, not a single bingle itty bitty one- met/known/or heard of any girl or woman who began an eating disorder because her life needed more control.

Every one- with no exception- started because of a weight issue. Whether real or perceived, whether objectively true or medically completely unnecessary, each and every one felt she needed to do something about the size or shape of her body. And at some point that became (through whatever process was unique to that individual) an eating disorder.

If we could rewind that life back to age 10, 11, 12, 14, 15, and wave the magic wand that would make her feel okay enough, good enough, acceptable enough, beautiful enough, curvy enough (but heaven forbid, not too much), there would never be an eating disorder. If we could create perfect bodies (hear me carefully- I’m not saying “If we could create a society that accepted all body types as equally lovely and wonderful…” That isn’t this post, although there is certainly a place for that, okay?)- but if we could creat perfect bodies, and in each school and each city and each clique that definition would be slightly different- eating disorders would vanish.

Certainly at some point a control aspect does come into play with eating disorders. But to focus on control as the vortex of the storm is like saying control is the central issue in alcoholism because an alcoholic controls what they drink, when they drink, how much they drink, how much they put away for later, who they prefer to drink with, how much ice they prefer, what cup they prefer to drink out of, if they prefer to smoke afer or with a drink, what brand(s) they like, if they have rules about drinking and driving, if they have a favorite bar, etc etc etc.

A thing I have always found ironic about eating disorder treatment is how- especially given the idea that the disease is supposedly about control- that the treatment is about wresting every drop of control away from the patient. From therapists who believe that these women are sick because they need a sense of control, in-patient treatment(granted, lives can be at stake…) on every level every minute of the day seems designed to reinforce the idea that the woman no longer is capable of controlling any aspect of her life at all. She must eat what they say, under a time limit they impose, on a schedule they set, according to a daily routine they decide on, etc etc etc. And gain the amount of weight they determine to be healthy.

Sometimes you can see at the end of a documentary, a “success” story. A woman who is clearly medicated, who seems super blissed out, who is past a normal weight and is now pleasantly plump. You know that she is in heavy therapy, probably working hard to be okay with that, but if her therapist wasn’t on speed dial or she wasn’t heavily medicated it’s likely she is or would be suicidal. Because a woman doesn’t go from so anxious about her body that she gets an eating disorder to overweight without some serious angst. Then there are the woman who appear to be a healthy weight (the majority) but who are interviewed and you hear over and over are still fighting their ED. And always one or two die.

I wonder why it is so hard for the therapeutic community to let go of the idea that eating disorders are about control. What would it mean for them to admit that what they have been doing for so many years just isn’t working (the statistics are there already, so it’s not like it’s a secret), and try something new? I can’t think of any other illness where the medical community takes one glaring symptom and makes that the central focus. Can you imagine a cancer patient only being treated for pain? Or a heart patient only being treated for fluid retention? Or a gambling addict having the main focus of his therapy being getting counseled on how not to overdraft his checking account?

It hasn’t bothered me in the past, but for some reason tonight it just sent me into overload. Maybe it’s because I have yet another child in this age group, or maybe it’s because I am just bothered by continued misunderstanding. Maybe I have just seen one too many girls falling into the abyss, and I truly hope that finally someone will wake up and get this all correct.