Overcontrol is common with eating disorders
29 April 2021
Individuals with anorexia often have a high level of self-control, which can lead to exaggerated compulsions and rigidity and difficulty in opening up about emotions and in creating close relationships. Treatments targeting this can help patients with mild to moderate anorexia. This is the finding of a new dissertation by Martina Isaksson.
Anorexia has a higher mortality than any other psychiatric illness, and research has had difficulty in contributing to effective treatment methods. The percentage of patients who recover after treatment is relatively low, about 30 per cent, and the risk of relapse is high. In addition, between 30 and 70 per cent of all patients end treatment before completed.
In her research, Martina Isaksson has tested two instruments for measuring different aspects of control: the Ego Resilience Scale (ER) and Ego Undercontrol Scale (EUC). Both instruments demonstrated good results when they were tested on two non-clinical groups of 483 and 197 individuals, respectively.
“A measurement instrument is crucial for being able to find and examine the problem and contributing to a deeper understanding. They are also central in researching the phenomenon,” says Martina Isaksson.
Overcontrol with anorexia
In second study, Isaksson examined the occurrence of overcontrol among patients with eating disorders, with a special focus on different types of anorexia. The results showed that overcontrol was more prominent in anorexia than in bulimia.
“This was actually expected, but we saw that this was also true even when using the new diagnostic criteria that are a bit more inclusive. It also seems to be true for the atypical anorexia group that are not below weight. Compared with the control group, there were major differences at the group level, but if you look at the individual level, there are naturally individuals with anorexia that are also undercontrolling. That’s why it is important to measure this.”
Repress thoughts and feelings
Overcontrol means repressing thoughts, feelings and behaviour with the aim of achieving long-term goals. For example, instead of eating the biscuit, they say they will eat it on Friday.
“This is often viewed positively by society, but it can go overboard. Hiding that I do not feel well, that I need help, so that no one can come close to me.”
In a third study, Isaksson looked at the effect of an outpatient treatment of moderately severe anorexia and overcontrol, which looked at 13 patients over 40 weeks. The eight individuals who completed the treatment were all improving or healthy after the treatment, had achieved a healthy weight and estimated their eating disorder symptoms like the normal population (in Sweden).
“We had a study design where we followed a few individuals very closely, each week. This allowed us to see that the change occurred when we had the intervention. Prior to this, their weight was unchanged and after a while it went up, so overall the results were positive. But the treatment needs to be evaluated more.”
Provided as outpatient care
The treatment is not specifically focused on anorexia but rather on different types of psychological illness where self-control can be exaggerated, such as hard-to-treat anxiety or depression. In the study, the treatment was given to individuals with anorexia as outpatient care, with individual therapy, skills training and SMS contact as needed. The study also asked how the patients experienced the treatment.
“Many liked the combination of both individual therapy and skills training. They learned to open up about themselves, share their experiences instead of keeping everything locked inside. Some felt that it might be difficult to also focus on this if you had a severe eating disorder, particularly in outpatient care. So, it is possible that some individuals need additional support.”
Isaksson hopes that in the future they can develop more individualised treatments for eating disorders, but that will require more research both on measurement instruments and on treatments.
“Anorexia is difficult to treat and to study. At the same time, it is possible to become healthy and most do recover eventually, but it can be a ten-year process. We need to find better or more ways of helping these individuals.”