The Fallacy of Willpower in Eating Disorders

Clinicians regular conflate eating disorder recovery and willpower. For people with anorexia, they say that willpower is the essential ingredient to be able to follow a meal plan. For bulimia, therapists describe willpower as the main way to avoid binges. For binge eating disorder or compulsive overeating, willpower is the only way to stop eating.

All research into treatment shows that this therapeutic approach is ineffective, yet the theory is pervasive in the clinical community, to the detriment of all those seeking help.

The focus on willpower as a part of eating disorder recovery, despite its clear ineffectiveness, is due to three issues.

First, therapists struggle to manage the helplessness and powerlessness they often feel when treating people with eating disorders. Therapy may include insightful sessions, a clear understanding of the cause of the eating disorder and a definite plan moving forward. Even still, the person may make no or marginal progress. Without any clear culprit, the therapist can easily blame willpower—the patient—for the failure to move forward, absolve themselves of responsibility and avoid more frustration.

Second, the concept of willpower camouflages a therapist’s lack of knowledge or experience treating people with eating disorders. Willpower reflects an aspect of therapy called motivational interviewing first adapted for people with substance abuse issues. Although there is some benefit utilizing this treatment approach for eating disorders, the therapy does not take into account the greatest difference between the two: food. However, it’s a convenient way to explain why someone is not progressing in treatment and instead blame the patient for her illness. It behooves patient and therapist to get a second opinion or try a different course when a clinician is unclear how to proceed rather than attribute a stall in progress to a largely irrelevant treatment modality.

Third, the therapist is unwittingly reinforcing the eating disorder mindset when focusing on willpower. Since this approach is wholly ineffective, it only makes the patients feel more inadequate and more helpless. Rather than trying to find a new way the circumvent the illness, the therapist expresses frustration in the most facile way: leading the patient back to the helpless state of the illness.

When a patient encounters a team focusing on willpower as a core part of treatment, the patient ought to both confront the team about this approach and, more importantly, seek new help. Using willpower as a fulcrum to leverage recovery inevitably fails and only reinforces the illness. Better treatment exists elsewhere.