Monday, September 13, 2010

Anorexia and loss of control - Part 4

Some anorexics report a sense of being out of control. They may say things like:

“I had to gain some control back from my body while I could.”

In Transactional Analysis terms this is quite clear to explain.

Weak A & P

The diagram shows a person with weak Adult and Parent ego states. This leaves the Child ego state on its own and it will feel a sense of anxiety. It may also feel a loss of control because the Child ego state does not have the ability to regulate itself.

In the usual functioning personality it is the Parent and Adult ego states that regulate the Child. It is the Adult and Parent who tell it what time to go to bed, what foods to eat and not eat, when to be polite, courteous and so forth.

Even if the Child ego state protests against the restrictions it will also like them because it gives a sense of stability and a sense of control in its life. What would happen if you said to a six year old girl, “You can eat what you like and go to bed whenever you like?” It is quite likely the child would live on lollies, soft drink and pizza and go to bed at any hour of the night or day. The Free Child ego state runs rampant. Whilst that may feel good for a little while sooner or later the youngster is going to have a sense of loss of control because it is out of control.

Woman & fruit

With the anorexic for some reason the same situation is being played out in adolescence and adulthood. For some reason a strong Adult and Parent did not develop. Or at least for some reason they are not currently functioning in a robust way.

This is quite easy to diagnose and a treatment plan is quite clear. There is a need for Adult ego state strengthening such as described here.

One also would want to develop the Parent ego state. This can be done by the client introjecting the therapist into their Parent ego state. Alternatively the person can practice imitating others who function well in their Parent ego state. This will build up the strength of the Parent ego state tapes. This is described in much more detail here.

As the Adult and Parent ego states develop the individual will report more of a sense of safety inside and thus the sense of internal control increases.

To observe how the three ego states or parts of the personality are relating one can set up a simple 2 chair exercise. In one chair sits the Child ego state or the small child in the client. In the other chair sits the big person which is a combination of the Parent and Adult ego states.

Ego states 2 chair

The person then sits in each of the chairs and speaks from that part of self reporting what they think and feel and dialogues to the other chair. Those who sense a lack of control when asked to speak from the P/A will present as ineffectual, lack a potency or be at a loss to say much at all. Then when in the C chair the person will report a lack of trust or faith in the P/A to look after them or deal with life's problems as they present.

This is quite an easy and simple technique to do and can be used reasonably often to assess what is happening between the different parts of the personality and to do self parenting exercises to build the Parent and Adult. Once the person has done it once or twice they can easily slip into the parts of the personality and perform the exercise.

Girl vomit
Loss of control?



  1. These posts about anorexia are very compelling. Why do some of people suffering the condition pull through and yet others cannot seem to get out of it. Sixty Minutes had story about a particular girl with anorexia (last sunday). You may have watched it. I was wondering just how successful her therapy was and were her parents enabling her behaviour a bit. It was very sad for everyone.

    "I had to gain some control back from my body while I could" You would not think a body could have so much control would you? It certainly feels like it at the time. To this day I am constantly assessing what I eat and what impact it will have on my body. (how much exercise I must do to work of a slice of bread). BMI, BMR - energy in, energy out. Hard to relax but at least I am healthy.

  2. Hello Linda,

    Whilst it is always hazardous to generalize in the field of psychology, those who die via anorexia or go close probably have made the suicide decision. The Don't exist injunction as it is called in Transactional Analysis.

    Those who do not probably have not made such an early decision in childhood.

    Good for you for being healthy.


  3. Oh! That poor girl - happy hour huh?

  4. No Roses, she doesn't look all that happy does she


  5. So Anorexics have the ability to exerise control through their diet.

    Better that psychologically than having no control over something?

  6. I think I can feel another post coming on kahless about control of the body. Thank you for being inspiring!

    Food refusal in the high chair can be one of the first ways a child can take control of its body. The child can be saying to mother, "I am in control of what goes into my body, not you!"

    The key is how does mother respond to such a statement by the young child?


  7. I like saying something that is inspiring!