Feeling a loss of control over eating behaviors is an important symptom that can help distinguish between eating disorder diagnoses. This specific symptom can be incredibly troubling, as the concept of control and either having it or not having it has moral implications in our culture.
Many who experience loss-of-control experience increased feelings of shame for those that think of their loss of control as a personal failing. Control also plays a large role in the development of disordered eating beliefs and behaviors.
Beginning with the DSM-III being published, loss-of-control (LOC) became a primary symptom of Binge Eating Disorder (BED) that distinguishes an overeating episode as “bingeing.” The LOC piece of eating disorder behaviors and development is important to consider, as it can have concerning consequences.
One study asserted that “regardless of the amount of food consumed, the sense of LOC during eating episodes predicts significant distress, impairment, and clinical outcome, including the development of eating disorders .”
The Challenges of Identifying and Defining LOC
Even with the potential risks involved in experiencing LOC when eating and the significant role they play in eating disorder diagnosis, there is no definitive way to measure what exactly a feeling of LOC is. The lack of guidelines on this front leads to concerns that BED is being misdiagnosed.
As “BED excludes the compensatory behaviors seen in BN (Bulimia Nervosa) that may more obviously signal an eating disorder, and it does not require the presence of any other maladaptive eating behaviors besides regular LOC eating in order to be diagnosed, clarifying the definition of LOC is particularly important for the prevention of BED underdiagnosis .”
There is also a concern that BED will be overdiagnosed as distressed eating behaviors such as “grazing, chaotic or disorganized eating, stress-related or emotional eating, eating much more rapidly than normal, and mindless eating” could be conflated with LOC .”
The same study cited above sought to explore how the lack of an objective definition for LOC impacted BED diagnoses as well as how one could possibly be established.
Results indicated that “experienced clinicians are best at recognizing BED when binge-eating episodes are characterized by both LOC and an objectively large amount of food .”
Considering the results and the importance of the role of LOC in determining a BED diagnosis, study creators emphasized the need to establish a standard clinical description of what is considered a LOC.
Study results found three descriptions of LOC that were most closely associated with accurate BED diagnosis:
1.) “It’s hard for me to stop eating when I eat like that,”
2.) “I feel like I can’t stop or limit the amount of food or the type of food I’m eating,”
3.)“I don’t really try to control my eating anymore. Eating like that is pretty much inevitable .”
Determining a definitive clinical guideline for identifying what a feeling of LOC is can help increase accurate diagnoses of BED and lead to a greater understanding of binge eating behaviors.
Resources: Berber, L. A. Et al. (2020). Patient descriptions of loss of control and eating episode size interact to influence expert diagnosis of ICD-11 binge-eating disorder. Journal of Eating Disorders, 8:71.
About the Author:
Margot Rittenhouse, MS, PLPC, NCC is a therapist who is passionate about providing mental health support to all in need and has worked with clients with substance abuse issues, eating disorders, domestic violence victims, and offenders, and severely mentally ill youth.
As a freelance writer for Eating Disorder Hope and Addiction Hope and a mentor with MentorConnect, Margot is a passionate eating disorder advocate, committed to de-stigmatizing these illnesses while showing support for those struggling through mentoring, writing, and volunteering. Margot has a Master’s of Science in Clinical Mental Health Counseling from Johns Hopkins University.
The opinions and views of our guest contributors are shared to provide a broad perspective on eating disorders. These are not necessarily the views of Eating Disorder Hope, but an effort to offer a discussion of various issues by different concerned individuals.
We at Eating Disorder Hope understand that eating disorders result from a combination of environmental and genetic factors. If you or a loved one are suffering from an eating disorder, please know that there is hope for you, and seek immediate professional help.
Published December 23, 2020, on EatingDisorderHope.com
Reviewed & Approved on December 23, 2020, by Jacquelyn Ekern MS, LPC