Control (over food/body)

In this context, “control” means that the child carefully regulates exactly what they eat, how much they weigh, and what their body looks like. They count calories, eat only at set times, cut their portions into small pieces, exercise a lot, or set strict rules about which foods are allowed. In anorexia nervosa, this control is particularly prominent.

From the outside, this often appears to be iron discipline. Internally, however, something else is happening. The child experiences controlling their body and fasting as something positive, while eating normally triggers anxiety. Even a small, balanced meal can trigger the fear of gaining weight. This fear accompanies many people with the condition throughout the day; their thoughts constantly revolve around food, weight, and body shape.

During puberty, many things change at once: the body, emotions, and the demands of school and friendships. If a child experiences this as overwhelming and confusing, eating becomes the one area they can control on their own. This provides a sense of stability.

Specialized websites describe typical personality traits that play a role here: perfectionism, a tendency to conform, a predisposition toward compulsive behavior, and low self-esteem. Weight and appearance then come to exert an exaggerated influence on how much the child values themselves. Every gram lost confirms: “I’m accomplishing something; I’m in control of myself.” Success on the scale temporarily replaces the child’s lack of self-esteem. This is precisely what makes it so hard to give up control—to the child, it feels like protection, not an illness.

The causes can rarely be pinpointed individually. Biological predisposition, personality, beauty ideals, and triggering events such as loss, separation, or teasing about appearance all intertwine.

At home, the battle often shifts to the dinner table. Parents want their child to eat, while the child defends their own rules. If the child’s usual sense of control is threatened during a shared meal, it can trigger intense fear, anger, and aggression. What begins as concern ends in arguments, tears, and slamming doors.

This is exhausting for parents. Many fall into a fear of losing control themselves and then try to monitor every bite. This usually makes the situation worse, because both sides are fighting over the same issue. Parents’ own anxiety about their child’s weight can also increase the pressure. Important to know: The disorder takes a toll on the entire family, and this is not the result of poor parenting. Family conflicts are considered a general risk factor, not the sole cause.

The goal is to gradually give the child back responsibility for their meals without turning every meal into a battle. Here are a few concrete approaches:

• Structure instead of negotiation: Set mealtimes and meals that aren’t up for discussion at the table. The rules are established in advance, which takes the pressure off the moment.
• Don’t talk about calories and grams: Conversations about numbers fuel a desire for control. It’s better to talk about the day, feelings, and stressors.
• De-escalate: When a conflict arises, stay calm and defuse the situation instead of forcing the child to eat. Techniques for this can be found under “Avoiding Meal Escalation.”
• Relinquish control in small steps: depending on age and stage of the illness, with support from the treatment team. At first, parents take on a lot of responsibility; later, the child regains it.

For children and adolescents, involving the family is an integral part of treatment. A well-known approach is family-based therapy (the Maudsley Approach). Psychotherapy is primarily recommended as treatment for the eating disorder itself, often supplemented by restoring a healthy weight.

Warning signs include rapid weight loss, increasingly strict eating rules, withdrawing from shared meals, excessive exercise, and constant preoccupation with body shape and weight. The sooner families seek support, the better the outlook. The first places to turn to are pediatricians’ offices, psychotherapy practices, and specialized counseling centers for eating disorders. Free telephone counseling is available through the hotline of the BIÖG Eating Disorders Portal.

Rückenwind “Eltern” provides coaching to support you along the way. Janike is a social worker and parent coach currently training to become a child and adolescent psychotherapist; she does not make diagnoses. Whether an eating disorder is present and how it is treated can only be determined by a child and adolescent psychiatry (KJP) specialist or a medical or psychotherapeutic professional.