Overcontrol in anorexia nervosa : assessment, occurrence, and treatment

Abstract: Excessive overcontrol – characterized by high risk aversion, compulsiveness, emotion inhibition, and social deficits – has been suggested to be a core mechanism for developing and maintaining anorexia nervosa. However, such factors are rarely targeted as key elements in treatment of the disorder. The overall aim of this thesis was to evaluate the occurrence of over- and undercontrolled personality styles in patients with eating disorders, and to evaluate the treatment effects and patient experiences of Radically open dialectical behavior therapy (RO DBT) for outpatients with anorexia. In a cross-sectional study (Study I) with two non-clinical samples (n = 483 and n = 197), psychometric evaluations showed that a new shortened version of the Ego Undercontrol Scale (EUC-13), measuring over- and undercontrol, and the Ego Resilience Scale (ER) measuring adaptive control, seemed promising for assessing the constructs. In a cross-sectional study (Study II) assessing the occurrence of overcontrol in a clinical and non-clinical population, findings showed that overcontrol was more common in restricting anorexia (n = 34) and atypical anorexia (n = 29), than in bulimia (n = 76), borderline personality disorder (n = 108), and a non-clinical sample (n = 444). Anorexia with binge eating and purging (n = 31) showed similar, but somewhat lower, levels of overcontrol compared with atypical and restricting anorexia. However, differences from the other eating disorder groups were not significant. In a single-case experimental design study with 13 patients (Study III), the effect of RO DBT – a treatment developed for disorders related to excessive overcontrol – was evaluated for outpatients with mild to moderate anorexia. Findings were that all completers (62%) were in remission after treatment, and that the treatment clinically and reliably reduced eating disorder psychopathology and clinical impairment, and increased quality of life. In a qualitative interview study (Study IV), 11 participants from Study III reported that they appreciated the comprehensive approach, where both the eating disorder and the overcontrol were addressed, and that sharing with others was important. Findings indicated that the EUC-13 and the ER seemed promising for assessing overcontrol, undercontrol, and resilience. The occurence of overcontrol in different types of AN raised questions regarding if treatment of AN would be more effective if these difficulties were addressed. Lastly, preliminary evidence showed that outpatient RO DBT could be effective for patients with mild to moderate AN and overcontrol, and that the treatment was well received by the patients.