Surefire ways to piss me off

Like I've said before, keeping up on the latest writings about eating disorders is both the apogee and perigee of my work here at ED Bites. Reading other blogs like The Science of EDs is definitely a high point, the apogee. The perigee? Stuff like this article, title "Surefire Ways to Give Your Kids an Eating Disorder."

*headdesk*

The suggestions, according to the blog's author Michelle Lewis, are things like:

  • Be critical and abusive
  • Expect perfection
  • Nurture your own eating disorder
  • Be emotionally distant
  • Use food as a reward or punishment
In contrast, here's what the scientific literature says about "surefire" ways to give your kid an ED:





That's right--nothing. The research literature indicates no definite cause of eating disorders. The links in both biology and environment serve to increase or decrease risk. This is true even for other diseases like cancer. A 10-pack-a-day habit certainly dramatically increases your risk for developing lung cancer (as does baking in a tanning bed and skin cancer), but it's not "surefire." Lots of smokers don't get cancer, and plenty of people who do everything right DO get cancer. 

In her defense, Lewis later said that she meant things that would promote body dissatisfaction and disordered eating, not eating disorders. It's something that never fails to piss me off and get me spluttering, this conflation of body dissatisfaction and eating disorders. Most people I know are dissatisfied with their bodies. As long as it doesn't really interfere with your quality of life, I don't consider it pathological. It would be great if people looked in the mirror and were reasonably satisfied with what they saw, but cringing at your reflection does NOT an eating disorder make.

The other thing that irritates me about this post is how it assumes that parents play a major role in determining whether a person will develop an eating disorder. If a child has an eating disorder, the feeling is that, ipso facto, they had bad parents. Family therapy, for me, resembled nothing more than a witch hunt. It was a harmful waste of time, health, and money.

Truth: every parent is flawed.
Truth: some people with EDs have bad parents.
Truth: some people with EDs have good parents.
Truth: an ED tells you nothing about the quality of the sufferers parents.

It's nonsense, utter nonsense, to assume that a parent can single-handedly cause their child's eating disorder. Dr. Julie O'Toole of the Kartini Clinic has remarked that she has treated children whose parents DID try to give them anorexia. Their parents were suffering from Munchausen's by proxy. When the children were hospitalized, they resumed eating normally (well, as normally as one would expect for a starving child). They didn't have eating disorders. And their parents were actively trying to give their child anorexia.

Part of me cringes to see information like this still published (and shared on Facebook and Twitter, mind you, by MEDA, a national eating disorders association) in this day and age. But I'd rather see it published and brought into the light, rather than have it fester below the surface. Have it be the mindset that everyone has but no one is willing to admit to.

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73 comments:

Danielle said...

I hate that some people try to blame EDs on parents. My parents were none of those things listed. Parents will already be blaming themselves as it is, they do not need people further adding to this. My best friend's mum has an eating disorder, and my friend has not developed one.

I agree that certain behaviours can probably contribute, parents calling their children fat, for example, parents that are very negative. But that could cause all kinds of different behavioural problems like violence, crime, not just eating disorders.

Really is frustrating. I don't want my mum thinking in any way that she caused me to develop anorexia.

Danielle said...

Wow, same name and my sentiments exactly, Danielle :)

Anonymous said...

I find that some people want to find a "cause" or something to deal with it, like that's a magic button they can push to fix it. It can help to know what triggers/encourages, but even knowing the cause doesn't fix everything. It's a long process. I was in a group counselling session back when my bulimia was active (I've been in recovery for a very long time now) and I remember her pressing me about issues in my life until she forced me to admit that I was touched inappropriately at a young age by an older cousin. She was so self-satisfied that she had found the "cause" of my bulimia as bulimia=sexual abuse. Um, that incident BARELY impacts me and looking back now I know it was a myriad of factors, primarily how my father had nearly died of a heartattack recently (at the time, he survives to this day). Although, that only amplified my symptoms, not caused them. I still don't know everything that caused me to develop bulimia and yet I've been doing well for close to a decade with only one 4 month relapse in the middle of that.

Parents feel enough guilt and trauma without laying the blame directly on them unnecessarily.

hm said...

I think it's important to read the whole article. The list you provided sent me reeling with feelings of failure and guilt.

I have an ed. Sometimes it makes me emotionally distant. Sometimes the ed voices in my head make me edgy, irritable, and critical with my kids. I struggle with these things. But I try my ***** off to compensate for these things- to relate, to connect, to give positive affirmation. And sometimes I do give them treats for a fun reward.

The article is not totally on target with its assumptions, but it also isn't as trite as the above list! They said "be critical and abusive" not just be critical- "withhold emotionally" not just be distant- "nurture your own ed" not just HAVE an ed- and "use food for rewards and punishments" not just use food for rewards. All of these things are significantly different than how I originally took them! And I am very, very relieved that they are.

I might struggle with criticizing sometimes, but I am not abusive. I might be emotionally distant sometimes, but I never purposely withhold- I am always trying to reach out. I have an ed but I am sure as hell not trying to nurture it- I'm trying to overcome it. And I would never, EVER withhold food from my children in order to punish them.

I'm not trying to pick a fight, but I do think you should be careful to not misrepresent- when I read the list you posted, I felt devastated and flushed with guilt- I assumed that there was a societal view that people like me, with my struggles, are absolute failures as parents. It really hurt. If I had not read the whole article, I would have still felt like that. Your list probably describes many of your readers. But the list in the article most likely does not.

Regardless, they definitely mistitled this article. It is a good article addressing how to treat or not treat children, and how our behaviors and choices can impact them and contribute to their attachment status and self-esteem. Perhaps it should have been titled "Surefire ways to lower your kids' self-esteem" or something of the like. And the first paragraph rewritten.

But, honestly, Carrie, I love you, but your list hurt me more initially than reading that article did- be careful when you reword!

Anonymous said...

Hi Carrie,

Have you got links to those comments by Julie O'Toole, re. Munchausens, etc? I'd be really interested in reading them, having unfortunately had one such parent, which equally unfortunately resulted in a "real" ED (not the "fake" kind Julie referred to). But really really interested in research into what I always thought was a very obscure set of circumstances!

Thanks for your help :-)

Anonymous said...

Anonymous: does your Munchausens parent also have ED? Any other ED in the family? The Munchausens parent may not have caused the ED, but created a perfect storm of biology + environment ...? Just a thought ...

howdidIgethere said...

Truth: some people with EDs have bad parents.
Truth: some people with EDs have bad parents.

Did you mean:
Truth: some people with EDs have bad parents.
Truth: some people with EDs don't have bad parents.

??

Tetyana said...

^ Or some people WITHOUT EDs have bad parents? Anyway, we all get it, so it is cool.

I agree with everything you wrote, except I'm not sure the article itself is as bad as you (and others) have portrayed it to be. What I mean is that the points you make are valid, but I'm not sure the article is making those points per se. I agree that the title is ridiculously bad. Perhaps I'm not so angry about it because I'm not a parent and one of my parent's behaviours definitely drove a lot of my symptoms early on (but not later on). Some things that parent can say still send me into an eating disordered mess. I don't blame them for the eating disorder, they had nothing to do with the fact that I find restricting and bingeing/purging numbing. Failed experiments or negative results in grad school, and important exams overwhelmed me to the point of resorting to symptoms.

Some of the things Lewis lists are bad and parents really shouldn't do them, but there's no link, as far as I'm aware, of any of those behaviours and eating disorders. Bad parenting is bad parenting, but eating disorders are much, much more complex than just to be caused by bad parenting!! But certainly bad parenting can easily make things worse once someone already has an eating disorder or is starting to develop it. I have no doubt about that. But, good parenting can, of course, make it better.

I agree with this, it annoys me too, a lot:
"It's something that never fails to piss me off and get me spluttering, this conflation of body dissatisfaction and eating disorders. Most people I know are dissatisfied with their bodies. As long as it doesn't really interfere with your quality of life, I don't consider it pathological. It would be great if people looked in the mirror and were reasonably satisfied with what they saw, but cringing at your reflection does NOT an eating disorder make."

Varsha said...

"Truth: an ED tells you nothing about the quality of the sufferers parents"

I agree 100% with that statement. We cannot make any assumptions about the parents of a person with an ED.

I'm sorry you didn't find family therapy helpful. I found family therapy helpful because we focused on the future and building upon our family strengths to facilitate my recovery.

I don't think family therapy would have been helpful if my family or any member of my family was treated as "dysfunctional."
(As the person with the eating disorder, it didn't seem like blaming and shaming took place during our sessions.)

Carrie Arnold said...

hm,

I changed the list to make it more reflective of what the article actually said. I apologize for hurting you- that was NOT my intent. You're a great mom and I know you do everything in your power to make sure your kids are healthy and happy.

Tetyana,

I think the author does make really good points. I should perhaps have made that clearer. It's the link with EDs that I have the big problem with.

hm said...

Carrie, did I mention that I love you? Oh, yes, I think I did. And this would be why. :)

Thank you for hearing me and for caring and responding. You rock!

Anonymous said...

I agree! I have one parent with a healthy view on food and body image and one who is completly distorted battling her own ED. They were divorced when i was a young age. I do not balme either of them at all exspecailly not my mom she did the best she could and my dad did all he could to prevent this and give me a healthy view on food. ITs what i make of it now to change and be in complete recovery. So mant therapist i have seen in the past just want to blame blame blame..... but really how much does that help me.... i take responsibilty of it and changing my life. Whats the point of dwelling in the past, i can not change it.... but i can change my present and future and i choose to live in recovery!

Danielle said...

I'm doing a Psychology degree and had my eating behaviour and disorders module this morning, the compulsory exam question we do is 'Unhealthy early parental bonding is associated with eating disorder symptoms. Discuss.'
We are to focus our research on papers that have used the 'Parental Bonding Instrument'. Not yet looked into it but should be intriguing...

Anonymous said...

I'm not saying that i agree with all of that article-but even here on the King's college website they state more or less the same thing? I don't think the author was saying that all parents will behave like this, just that these things in some may contribute to the development of an eating disorder. I don't know, it seems to all be down to genetics these days to some people.
..............
Research has shown that someone is more likely to develop an eating disorder if they have been brought up in an environment where food and eating, weight or body shape have assumed a disproportionate significance, or if they have been ridiculed because of their size or weight. Someone is more likely to develop an eating disorder if they have been brought up in an over-protective or over-controlling environment, where independence has not been encouraged and where they have not been encouraged to think for themselves. Other risk factors include a difficulty expressing feelings and emotions; family disharmony and troubled interpersonal relationships; a history of sexual and/or physical abuse; unrealistic family expectations for achievement; and a tendency to comply with other people's demands.
http://www.kcl.ac.uk/iop/depts/pm/research/eatingdisorders/alreadyknow.aspx

Carrie Arnold said...

I love Janet Treasure, but I don't like the way the website is worded.

My problem isn't with including environment. NOTHING is purely genetic. The problem is what aspects of the environment contribute to EDs and how. And I don't know that we have good enough answers to nail down something like overprotective and over-controlling parents. The only way to answer that question is to follow a group of kids from birth onwards and track these things as well as incidence of EDs. Which will never happen because EDs are rare enough that you will need a huge sample and have to follow them over several decades, which is expensive as hell.

Do you know if the site has references to these studies? I'd love to see them.

Anonymous said...

Dear Ed Bites, another mom of an anorexic in recovery coming on here to tell you thank you. Thank you for sticking your proverbial neck out there in bloggsphere in support of parents. Naturally there is some parrying back and forth, each response trying to out cerebrally psych the other. I hope you can use your ninja skills and deflect all that, and just know that I am deeply and compassionately appreciative ~ mindfully yours ~ Amoma

Tetyana said...

"I think the author does make really good points. I should perhaps have made that clearer. It's the link with EDs that I have the big problem with."

Basically. I think there are probably some links, but it is incredibly difficult to untangle additive genetic traits, shared, and non-shared environmental factors (for the reasons you mention, rarity, the need for a longitudinal study, $$$$$).

Anonymous said...

As a grown woman/parent that has struggled with an ED as a teenager, then recovered, married, had 4 children and relapsed, I am so past the blame. It's a strange thing that we always have to have a reason why some people have certain diseases or traits. Sure, I had a horrible relationship with my mother, I think she hated me for being so sick, yet, when she sent me away from her, to get proper care I got even sicker. I have heard so many different theories on this from so many different psychiatrists, truth is there is no difinitive answer. Do I pray everyday that my kids wont follow in my footsteps, you bet I do. I try my best on a daily basis to promote health, good body image, happiness to your true self and not others, like all parents do. Are we to blame if something goes wrong? I don't believe so.
Sure I've been told secretly a part of me wanted to piss off my mom with my ED, but I can tell you I didnt feel like that. At my darkest point, the alien inside, my ED, was making ALL my choices and I had no cares, just a skeleton along for the ride. MOst of the time, not even coherent.
In the end, I have decided that I, and only I, am responsible for my choices. There are people ALOT worse off than I that didnt succumb to an eating disorder. I did. Sure I see the perfect storm traits but what truly triggers it, I think we may never know. So, I have decided that I am what needs to be fixed, not to look elsewhere but inside, and that is usually the hardest thing to do. Like I tell my kids everyday, "the right things are quite often the hardest things."
Blame will not bring recovery, it is damn hard work that has to be done by the individual suffering and some very patient medical/support staff.

Anonymous said...

Anon with the King's link.
Carrie, i don't know what research they used to write that. I know though that Ruth Striegel Moore has done a bit of research into risk factors and eating disorders.

Reading though over the comments and the original article and comments left, i can clearly see the issue that people have with the article. It is very tabloid in style and designed to cause a stir. Of course as well as you wrote, there is no surefire way to give your child an eating disorder.
The basic content though is pretty much the same as that King's link.

I don't know things are very up in the air with research at the moment. I myself though could relate to some of those risk factors. With it being up in the air it's a bit confusing to me. Although i don't think this myself, I could understand if in some cases that some people might think that genetics too easily lets abusive people of.

Of course the majority parents of those with ed's are good parents and are doing their level best and i agree that looking for blame is not really helpful.

Perhaps in some people things like withholding emotionality is not conducive to good mental health and perhaps this type of awareness should be at least raised under mental health awareness in general. If potential risk factors are glossed over, i do think of the potential impact of that also.
That said though, such tabloid style reporting like Michelle's is not really helpful.

Anonymous said...

Here are a couple of those studies.
I cannot admit though to having read any yet.
The first one though at least references some of Treasure's older work.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2669537/pdf/ukmss-4504.pdf

http://digilib.bc.edu/reserves/py549/roma/py54923.pdf

Anonymous said...

Hi Carrie,

i read this article today. i knew of it a couple days ago and chose to ignore it.

i wrote a reply to Ms. Lewis from the perspective of someone living and battling with Anorexia Nervosa as an adult (onset age 14). When it WAS NOT published and two others were i copied it and sent it to a friend because a surefire way to piss ME off is to be censored. i'll email it to you if you want to read it. It was far from inflammatory but something in it wasn't well received from this woman who treats EDs. She states "A good therapist helps you to feel understood, respected and hopeful." i don't feel the least bit respected.

If you read carefully through the now 36 comments every one that argues for her account also says we should account for biology. My comment pointed out that this said it all to *me* and that therapists should err with the evidence to not cause any MORE harm. The fact is many are lazy, believe what suits their own thinking or training and make a conscious choice to not stretch their thinking beyond that.

If therapists who claim to treat EDs (her cover page clearly shows her focus to be on weight LOSS) don't want to do the homework to stay current on facts then they will continue to have clients who come in week after month after year on end, not well. They will also keep the mortality rate exactly nose on to where it is by ignoring evidence based treatment because it doesn't curry to their particular training. Insurance companies and therapists like this have one thing in common and it's not the client's well-being.

The article is dangerous enough. Hopefully people will read about the author and gain some insight for themselves.

Becky said...

I can't really say too much because my blood pressure is still returning to a normal level after reading Ms. Lewis's entire article. I firmly believe that if you can't say something nice, don't say anything at all. I'm trying REALLY hard to stay nice.

Thank you Carrie for countering this perspective with science and thoughtfulness. It is unfathomable to me that in 2013 there are STILL therapists who find it useful and productive to point fingers at parenting and think that will help those who are trying to recover from biologically based brain illnesses. Why? What good does that do?

If her outdated theories are correct, why don't all the children in families with parents who do these awful things develop eating disorders?

I hear folks in the field say that we are past the point where people are blaming parents...hardly. We're light years away. We need more research so we can stop this nonsense. Obviously I will have job security in helping parents to learn to stop blaming themselves with so many undereducated therapists out there doing damage to families.

Thank you Carrie. I was as nice as I could be.
Becky Henry
Hope Network, LLC

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I'm a science writer, a jewelry design artist, a bookworm, a complete geek, and mom to a wonderful kitty. I am also recovering from a decade-plus battle with anorexia nervosa. I believe that complete recovery is possible, and that the first step along that path is full nutrition.

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