In Charge? BE In Charge Of Eating Disorder Behaviors

July 26, 2010 Laura Collins

"It's all about control."

Not really. In fact, eating disorders are better described as being controlled: by thoughts and compulsions that lose all relationship to reality. Eating disorders take control of the person and the family. But how does one take control away from the anorexia or bulimia or binge eating and get normal life back? First: figure out who is in charge.

tugofwarTeamwork works

Teamwork is a key component of eating disorder recovery. Not only is it important for the patient to have people on his or her side against the illness, it is important that no one be pulling in the opposite direction.

I've learned that working as a team isn't as easy as it sounds. It requires everyone involved to have the same underlying ideas about what the illness is, who the patient is, what the support system is like, what the treatment should be, and exactly what roles everyone will play. I wish I believed that could happen naturally or by accident, but the truth is that it rarely does. It takes work, and it is hard.

I believe parents have to consider themselves and make sure they are an equal member of the team. Eating disorder treatment that concentrates on the patient in isolation is unlikely to be enough. But fair warning: not all eating treatment providers are used to doing this, and not all believe in it! Modern treatment of eating disorders needs to consider the whole picture to be successful, and if the family isn't involved in a positive way, they can do the opposite.

"When in charge, be in charge" is an excellent phrase but not always understood. It means that if you, as a parent, are responsible for food, medicines, monitoring, going to appointments, then you have to do so in a confident and assertive way. It has to be direct and it has to be supported by everyone else on the team. When we cede authority or responsibility to others, we need to do so willingly and with confidence as well - trying to control at a distance or without authority is painful and even counterproductive.

Having an eating disorder is frightening and confusing. Patients do better when the messages and boundaries are clear and consistent. It is so important that each member of the team - including parents - know exactly who is responsible for what and how information is shared.

For example, who is in charge of shopping, weighing, reporting on behaviors? And if new symptoms or compliance issues come up, who is responsible for communicating that to other members of the team?

The most important is knowing who is in charge of the team, however. Is it the doctor, the therapist, the parents, or the patient? Does the person who is in charge know they are, and are they taking care of everything, including communication with the others? I see so many cases where the therapist is considered in charge but isn't communicating with others on the team, including the parents. Many times, I see when the parent is in charge, but is too frightened to do what they need to do. Or times when the parents are in charge but disagree with each other.

In many cases, the person in charge is "ED" and that is rarely a good idea.

(next post I'll talk about when we're NOT in charge)

APA Reference
Collins, L. (2010, July 26). In Charge? BE In Charge Of Eating Disorder Behaviors, HealthyPlace. Retrieved on 2024, July 15 from

Author: Laura Collins

Kristine Baldo
July, 27 2010 at 4:46 pm

Great post, Laura. I agree about all the things parents need to do to be in charge. I look forward to your next entry.
Regarding the "It's all about control" issue, after years of thinking about and studying EDs, it seems to me that all ED sufferers are pathologically attached to a FEELING that they are in control of something as they engage in their ED behaviors: for anorexia, it's control of body weight with restriction; for bulimics, control of their false hunger when bingeing and then control of body weight when they purge; for over-exercisers, control of body weight and shape; for binge eaters, control of their false hunger.
Ultimately, they feel that, by using their ED behaviors, they are able to prevent experiencing some very scary emotions and thoughts that they'd like to keep under their awareness. The enslavement to their concept of "control" to us seems completely irrational, since they are controlling themselves to death or chronic ill-health and debilitation.
Sufferers must give up all of these feelings of control over their food, body weight/shape and exercise to someone else (or to a Higher Power as they do in Overeaters Anonymous and Anorexics & Bulimics Anonymous) in order to have a chance at recovery. As long as sufferers hang firmly on to their extreme ideas, they will be held tightly in the grip of their ED.

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