Families and Eating Disorders: It's Not What You Think

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One of the more dangerous and damaging myths about eating disorders is that parents (especially mothers) are to blame for the illness’s development.  This view is dangerous because it can lead parents to blame and disempower themselves when their energies can be better used to advocate for and help their child to recover.  Many treatment professionals still believe that parents are part of the cause and consequently exclude them from the treatment process.

 

Historically, professionals have sometimes blamed inexplicable psychiatric disorders on poor mothering.  The “schizophrenogenic mother” was believed to cause schizophrenia and “refrigerator mothers” were blamed for autism.  We have since learned that schizophrenia and autism are largely caused by genetic factors.  The same holds true for eating disorders.  Although it is now widely appreciated that eating disorders are caused by complex factors, parental blame for eating disorders stubbornly persists. 

Parental blame for eating disorders has a long history and dates back to the early 1900s when Sir William Gull, who is credited with coining the term anorexia nervosa, wrote that parents were “generally the worst attendants.”  In the 1960s, Salvador Minuchin developed the psychosomatic family model, which placed the blame for anorexia on dysfunctional family processes characterized by rigidity and enmeshment.

However, research has not supported this theory.  It is worth noting that Minuchin was observing families after their child became sick and thus the relationship appeared dysfunctional from what the illness did to the family. Parents do not cause eating disorders any more than they cause obsessive compulsive disorder (OCD) or any other disorder.

 We now understand that eating disorders develop in a wide range of family contexts and that there is no specific family structure or pattern of family functioning that causes eating disorders.

Evidence supports that eating disorders do run in families, but heredity—not nurture—is largely to blame.  Recent research has demonstrated that families can actually be extremely helpful in the treatment of eating disorders and should not be routinely excluded.  Cynthia Bulik, Ph.D., FAED, in her “Eating Disorders Myths Busted” talk for the National Institute for Mental Health stated, “What we know in eating disorders is that families are often our best allies in treatment.  They don't cause the disorders.  They are our allies in recovery.  It's our job to help give them the blueprint about what they need to do to become allies in recovery.”

In 2009, the Academy for Eating Disorders issued a Position Paper on the Role of the Family in Eating Disorders:  “It is our position that families should be involved routinely in the treatment of most young people with an eating disorder.

 Exactly how such involvement should be structured, and how it will be most helpful will vary from family to family.”

Research on one particular model of treatment, Family Based Treatment (FBT) for adolescent anorexia, has highlighted that families can play a central role in the treatment of young people with eating disorders.  In FBT the therapist empowers and mobilizes the family to help their child recover.  In FBT parents are part of the treatment team.  They attend sessions with their child and are tasked with providing meals that are appropriate for the individual in recovery.  They use structure and whatever leverage they have to inch the client back to appropriate behaviors and a healthy weight.

In the past, parents were typically relegated to a secondary role.  They were often encouraged not to get involved in a battle for control with their “individuating child” by trying to dictate what the child should eat.  However, this is no longer considered best practice.  Even for adolescents and young adults who are not in formal FBT, parents can provide support, help with meals, and should be included in treatment decisions unless there is a specific reason they should be sidelined.  Parents can also play a critical role in the early identification and recognition of a problem.  Perhaps the major contraindications for full FBT would be abusive parents.  However, in general research on FBT has shown that many types of families can be involved in recovery in a positive way.

Just as families can help individuals recover from an eating disorder, families can also get entrenched and perpetuate an eating disorder once it has started.  Research in the United Kingdom by Janet Treasure, OBE PhD FRCP FRCPsych, has focused on parenting styles and how families may become overwhelmed and stuck by the onus of caregiving for an individual with an eating disorder.  Her research points to the importance of treatment professionals also providing education and support to families so they can be effective in helping their loved one recover.

If you are a parent or family member of a person with an eating disorder, don’t get stuck in fear or blame:  mobilizeFamilies Empowered and Supporting the Treatment of Eating Disorders (F.E.A.S.T) provides a number of resources for family members and parents of those with eating disorders.  

Reference:

Bulik, C., Academy for Eating Disorders, Families Empowered and Supporting Treatment of Eating Disorders, National Association of Anorexia Nervosa and Associated Disorders, National Eating Disorders Association, The International Association of Eating Disorders Professionals Foundation, . . . Trans Folx Fighting Eating Disorders. (2015). Nine Truths about Eating Disorders [Brochure].  

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