Are eating disorders “all about control?” The elusive psychopathology of nonfat phobic presentations

Objective There are a subset of individuals with eating disorders (EDs) who do not overevaluate body shape/weight (i.e., nonfat phobic ED; NFP‐ED). According to the transdiagnostic cognitive–behavioral conceptualization of EDs, a need for control, in general, is hypothesized as the core psychopathology of NFP‐EDs, with shape‐ and weight‐related motivations for ED behavior merely superimposed in FP‐ED presentations. This study tested the need for control as motivation for restriction in NFP‐ED, using items aimed at assessing control from the Eating Disorder Examination (EDE) Restraint scale. Method Females ages 13–27 years consecutively admitted to residential treatment completed the EDE, Eating Disorder Inventory‐3 Drive for Thinness subscale (EDI‐DFT), and other self‐report measures of psychopathology. We included patients with DSM‐5 EDs, but excluded patients with avoidant/restrictive food intake disorder. Twenty participants had NFP‐ED (≤14 on EDI‐DFT) and 124 had fatphobic ED (FP‐ED; >14 on EDI‐DFT). Results NFP‐ED scored significantly lower than FP‐ED on EDE Restraint scale shape/weight [χ 2 (1) = 10.73–35.62, p 's < .01] and on control items [χ 2 (1) = 10.72–20.62, p 's < .01], in addition to scoring lower on measures of general psychopathology and impairment. Discussion Findings suggest those with NFP‐ED report lower psychopathology overall and the new EDE Restraint scale control items do not capture additional motivation for restriction beyond that captured in the original Restraint scale shape/weight items. Future research should examine whether this latter finding is due to a minimizing response style in NFP‐ED, an incomplete capture of desire for control by the EDE assessment method, or indeed reflects that need for control does not motivate restriction in NFP‐EDs.