So many stereotypes exist about eating disorders, it can be hard to know which are actually rooted in truth. Many stereotypes are patently false: for instance, contrary to popular belief, eating disorders do not only affect young, white women, and they are absolutely not a vanity issue or a choice. But when people say eating disorders are really all about control…are they right?

Equip Peer Mentor Jamie Drago says that while a combination of factors influenced her eating disorder, control certainly played a role. “I felt like there were a lot of decisions in my life that were being made for me that I didn’t get a say in, or identities placed onto me by others that I wanted to be different,” she says. “I felt like I couldn’t get a grasp on not only the emotions related to that lack of autonomy and control, but also what felt like character flaws related to a lack of control or even ‘self discipline.’” To cope with those feelings, Drago leaned into her illness. “Eating disorder behaviors felt like something that could be mine, and no one could make those decisions for me,” she says.

While no two eating disorders are the same, many people do describe a similar relationship to control, and how the eating disorder gave them some semblance of autonomy or independence that they weren’t able to find in other areas of life. Read on to find out more about the role of control in eating disorders, how to find control outside of the illness, and strategies for making peace with the uncontrollable aspects of life.

What the research says about eating disorders and control

In a 2023 paper published in the Journal of Eating Disorders, researchers argued that while control can play a role in some eating disorder experiences, it’s not beneficial to overemphasize this factor to the exclusion of others. According to Equip psychotherapist Hannah Bishop, LPC, this study illustrates how exclusively focusing on the concept of control can actually further stigmatize and pathologize patients with eating disorders.

“It’s my understanding from the research that personality style subtypes may be a more useful way to think about eating disorders, in comparison to believing that, for example, anorexia is an overcontrolled eating disorder and bulimia or binge eating disorder is an undercontrolled eating disorder,” Bishop says. “In my own experience, I believe both ideas to be true: eating disorders can be a maladaptive way of developing a false sense of control and there is much more to the predisposition and ongoing cycle of an eating disorder than control.”

Rather than associating “control” with specific eating disorder diagnoses (and disassociating it from others), Bishop says it’s important to view personality traits as important factors that influence a person’s desire for control. “Personality factors such as perfectionism and harm avoidance can contribute to a person’s search for control. Perfectionism can include a hyper-focus on achievements—school, work, sports—and there can be a level of control and discipline necessary to achieve at a higher rate. Additionally, when an individual experiences harm avoidance they are more likely to want to control their environment so they won’t experience negative emotions or discomfort in new situations.”

Drago believes that in a sense, any eating disorder can include some desire for control. “Whether that be control of how others in society perceive or treat the person, control over ‘health’ or illness, emotions, or circumstances,” she says. “That desire for control just might show up through different presentations. Eating disorder behaviors are always serving some sort of function to meet a need, or the person likely wouldn’t be doing it..”

Why eating disorders can create a false sense of control

According to Bishop, eating disorders can provide a false sense of control by allowing people to focus on various behaviors like weighing or measuring food, following rigid schedules, calorie counting, monitoring the number on the scale, and more. “Those with eating disorders may use these controlling types of behavior to avoid the fluidity of emotions, the influence of trauma symptoms, or any other sort of triggers that may bring about some sort of emotional dysregulation,” she says.

Those with an eating disorder often have a distorted sense of hope, explains Bishop. That hope is rooted in the notion that by utilizing their disordered behaviors, they will find a sense of relief from uncomfortable feelings without actually having to face the sources of that discomfort. In this way, disordered behaviors create a false sense of control in order to feed this false sense of hope. “The reason why it is labeled a ‘false’ sense of control is because it is not the individual who is in control at this point—it’s the eating disorder,” Bishop says. “This idea can be really tough to navigate, especially when malnourished, because the eating disorder is such an all-encompassing illness that touches every part of someone's life and so it can be difficult to separate the individual from their eating disorder mindset.”

Drago agrees, noting that the illusion of control that eating disorders provide can often be very convincing. “For example, in my experience, I felt that my eating disorder would be a productive way to improve my situation or control my emotions and circumstances, when in reality, it actually ended up getting in the way of me being able to have the brain space to focus on actually addressing the difficulties I was experiencing,” she says. “When using eating disorder behaviors, it sometimes can feel like that is an active choice the person is making in the moment, but really, it eventually becomes an automatic unhelpful behavior that feels extremely difficult to resist or change—which is evidence that it actually is not that person's authentic self that is in full control over their actions anymore.”

The risks of using an eating disorder to feel in control

While the behaviors associated with eating disorders may temporarily offer someone a sense of control, that false feeling can lead to significant physical, psychological, and emotional consequences. And in the most severe cases, the drive for control can be fatal. “An eating disorder can hijack the brain into thinking that the individual is in control and as a result, the individual could lose their health and life if they continue the behaviors,” Bishop says. “The behaviors that often perpetuate the eating disorder and feelings of ‘control’ are used to feel short-term relief or as a maladaptive coping tool.”

The varied risks of using an eating disorder to feel in control can lead to a long list of negative consequences, according to Drago “From damage to physical health, to increased isolation and strained social relationships, impacts on overall mental health, as well as the fact that the person just is not addressing the root of what is making them feel the need to search for control,” she says. “When we don’t address the root causes, they will always remain underneath the behaviors on the surface.”

Without proper evidence-based treatment, Bishop says the eating disorder behaviors may continue to shield a person from feeling the discomfort of emotional ups and downs—but this shield doesn’t offer long-term protection against uncomfortable or negative feelings; instead, it impedes the ability to move past them (while also doing deep damage to a person’s mental and physical health and quality of life). “The emotions do not go away unless appropriately coped with and processed,” Bishop says. “While disordered behaviors may provide a short-term relief, the emotions that need to be coped with do not go away and can eventually become even more severe, leading to an even more intense spiral of behaviors and avoidance.”

How to find control outside of the eating disorder

As a clinician and someone with lived experience recovering from an eating disorder, Bishop says that any feeling of protection the eating disorder provides is inherently deceptive. “I can first handedly tell someone that life does not stop, even if the eating disorder tricks us into thinking we have some sort of safe bubble with its companionship,” she says. “The path of life with its ups and downs is a gift, and although parts of it can feel overwhelming and difficult, we are resilient individuals and can handle so much more than we believe we can.”

To begin reclaiming life outside of the eating disorder, Drago says it’s important to identify what may be provoking the sense of being out of control in the first place and finding healthy activities that offer reprieve from that feeling. This can be a complex and difficult process, which is why support from a multidisciplinary team is so critical to recovery.

“For me, doing things like cleaning and organizing my room or house can help me feel like I have taken action to decrease what feels like chaos,” she says. “Writing things down can sometimes help get all of those ‘out of control’ things onto paper to then try to see what action steps need to be taken that might help.”

Additionally, Drago says a longer-term practice may involve distinguishing the things in life that are actually controllable and those that aren’t, and learning to make peace with the parts of life beyond our jurisdiction. In the mental health field, this process is often referred to as “radical acceptance,” or accepting what is beyond our control and embracing the reality of our current circumstances. “We can understand and recognize that not being able to control outside factors can be very frustrating, anxiety provoking, etc.,” she says. “But anchor back into the control we have over how we react to these feelings.”

With all this in mind, Bishop feels it’s important for people to know that while control may play a significant role in the evolution of eating disorders, there are often many other factors at play as well. “By focusing solely on control when treating patients, we could be ignoring other areas of their life that may be responsible for the illness,” she says. “Eating disorders are stigmatized, and the notion that someone may choose to utilize the eating disorder as a sense of control should continue to be dismantled. We know eating disorders are complex illnesses and there are various factors leading someone to be more susceptible to having one, including genetics, societal norms, life events, and other environmental factors.”

Bishop encourages anyone struggling with an eating disorder to reach out for help and allow a professional or team of experts to provide the necessary support and guidance. “I would remind anyone struggling that nobody is perfect and we all have the ability to learn new skills to engage in life in a healthier way,” she says. “Recovery is messy and life can be as well. The sooner we can practice radical acceptance of the things we cannot control, the sooner we can move through the peaks and valleys of healing.”