Stop the blame game

Last month, I wrote about the death of anti-anorexia activist Isabelle Caro. This morning, I learned that her mother Marie had committed suicide over the death of her child. Grief, guilt, and despair are painful, if normal, responses to loss.  I'm not faulting her mother for these seemingly intolerable feelings.  What I am wondering is how our habit of subtly blaming the parents for their child's eating disorder contributed to Marie's death.

In basically all of the news stories on Isabelle's death, there were comments about her mother, who was portrayed as a sort of Cruella de Ville of anorexigenic mothers.  An AOL story today said that:

Isabelle often spoke about her mother's phobia about Isabelle growing up and gaining weight, as well as her mother's depression. She had a lonely, difficult childhood as a result and had been anorexic since the age of 13. She wrote a 2008 memoir titled "The Little Girl Who Didn't Want to Get Fat."
This story also noted that Marie was especially devastated after a particularly critical article was posted about her in the wake of Isabelle's death.

Was Marie a perfect mother? Nope.
Did she cause her daughter's eating disorder? Nope.

A susceptibility to anorexia was part of Marie's genetic legacy that she bequeathed to Isabelle. Did she comment on her daughter's weight and size? I don't know. Even if she did, that couldn't cause Isabelle's anorexia.

Writes Dr. Julie O'Toole of the Kartini Clinic in a comment on her blog:
Even the most neurotic, dysfunctional, abusive parenting will not cause AN, much less what you have described above. AN is a brain disorder. Such parenting might, however, cause severe disordered eating, a neurotic obsession with appearance, or misplaced values.
In my years of practice I have had two mothers who actively tried to give their daughters anorexia nervosa. Why? Because they were mentally ill themselves. It is called Munchausen-by-proxy, and of course it didn't work. You can't give someone anorexia nervosa, even if you want to, and certainly not inadvertently.
It is likely that Marie was never told she could help her daughter recover, imperfections and all.  She clearly loved her daughter.  And if Marie herself had a subclinical eating disorder (I have no evidence that she did), it could have contributed to her alleged fears of Isabelle's gaining weight.

I remember discussing contributing factors with my mom in therapy.  At first, I believed that all of the unhelpful things she did were a direct cause of my eating disorder.  Anorexia was a rebellion!  A way of getting back!  A way of control!  Now I realize that these unhelpful things were a) inadvertent (how was she to know that getting good grades could be a bad omen?) and b) totally unrelated to my eating disorder.

Marie's death shows that the blame game is deadly--not just for sufferers, but also for loved ones.

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Cathy (UK) said...

The whole Isabelle Caro story is tragic - in so many ways, and that includes the sensationalist media reporting. RIP both Isabelle and Marie.

I personally think that the whole 'blame game' around EDs is pointless. It doesn't help a person to recover. Some people with EDs have idyllic childhoods, while others have terrible childhoods. I was watching a media review of the film 'Black Swan' yesterday evening, which apparently goes some way to attributing EDs on ballet (not that I have any interest in watching it). Anyone can restrict food, purge, take laxatives (whatever) to sustain a low weight... (i.e. disordered eating). But disordered eating is not the same as a clinical ED which controls the person rather than vice versa. IMO, the 'acid test' is whether the pattern of behaviour is easily broken.

The conscious thoughts that drove my AN DID focus on control. However, what I was controlling was my own overwhelming anxiety that has existed throughout my life. I was not deliberately 'doing anorexic behaviours' to exert my own independence or to get back at others. Anorexic behaviours numb anxiety, and that's why they 'worked' for me.

Cathy (UK) said...


...attributing EDs to (not on) ballet

Katie said...

I absolutely agree with you that blame doesn't help. There are some situations when anger at other people for causing you pain is a healthy thing, but like you, I don't think that parents or bullies or abusers can literally CAUSE eating disorders, because there has to be an underlying predisposition.

Having said that, I am unsure why there/how is such a big distinction between eating disorders and disordered eating, and where the line would be drawn. When I was a teenager I probably would have fallen more into the DE than ED category - I cycled between restricting and bingeing/compensating, but the behaviours were in fact easily broken, usually when I turned to self harming or was distracted by my life going well (!). It wasn't until I got to my early 20s that I became very severely anorexic. According to current thinking, since I must have had the predisposition to become anorexic later on, how can I account for the fact that undereating as a teenager did not trigger the full syndrome then? Personally, especially given the research you posted a few months ago about AN, BN and EDNOS having similar mortality rates, I am inclined to take all eating disorders and disordered eating very, very seriously. After all, isn't suicide one of the leading causes of death? And disordered eating causes quite enough pain to drive someone to suicide.

I'm not criticising anyone, I just genuinely don't understand why the distinction between ED/DE is made. What if eating disorders/DE exist more on a continuum than being separate disease processes? It would account better for the fact that some people jump between EDs...

HikerRD said...

Talking about placing blame, there was an article in a French newspaper yesterday stating that Isabelle's father was suing the hospital where isabelle stayed, for negligence resulting in her death.

HikerRD said...

And in response to Katie, at EDz conferences, DE and ED are in fact presented as a continuum, as opposed to two separate and distinct conditions.

hm said...

Isabelle's mom didn't give her AN, and she couldn't have healed her of it either. The girl needed serious intervention and treatment- probably forced on her. Instead she got money-hungry photographers and agents that used her AN like a publicity stunt. Tragedy of human errors there- people really missing opportunities to give a person truth who desperately needed it. No one person's fault. But something we can all learn from- if you see someone suffering from a deadly disorder, be proactive rather than passive.

Anonymous said...

just plain sad. thank you, for your honest.

cheryl said...

It just shows how much an ED affects everyone in your life.. I never play the blame game..How does it help?What I do know that my ED has affected my husband and boys immensely. I used to think my disease was just about me, I was in control and I could manage my anxiety..oh how much more indepth the illness is and how it trickles down into everyone's lives you touch. thanks for the post. Very inmportant info.

Cathy (UK) said...

Katie and HikerRD (above) raised interesting issues relating to the transdiagnostic model of EDs (put forward by Fairburn et al. in the UK). I agree that many people switch back and forth between ED subtypes but not everyone does. But neither do I think that anyone with any mental illness fits neatly into a DSM box.

I was always restricting AN. I have never had the urge to binge or purge in my life, and as a small child I had quite severe eating difficulties and emetophobia (the latter still remains). For me, eating has always been associated with anxiety, and I don't especially enjoy food. I view it as medicine.

In terms of the genetic pre-disposition to EDs: I don't view this pre-disposition as being some sort of inherent 'timebomb' that is triggered by food restriction. I am more inclined to support the hypothesis that the role of genetics in EDs is in the development of personality, and that it is certain personality characteristics (especially anxious-obsessive) and cognitive style that account for the link to biological pre-disposition. That hypothesis fits well with my family, none of whom has ever had an ED. However, I share many mood and personality characteristics with the rest of my close family. We are all anxious, we've all had depression, we are all obsessive etc.

For me, AN was very much an expression of my inherent characteristics and also my OCD, which had been there for many years pre-AN, and still remains post-AN. Weight gain assisted my recovery from AN, but did nothing to alter my cognitive style, including my rampant OCD.

hm said...

Cathy (UK)- (or anyone else who has a thought on this!) I'm rather nervous b/c my dietitian says repeatedly that I need to put on more weight b/c I'm still obsessing/controlling/blah blah blah. I don't see how gaining weight will alleviate these things, and am worried she's going to blow me up like a balloon in an effort to make these traits go away. Depression, anxiety, OCD, ADHD all run rampant in my family, although I am the only one with an ED. I GET putting on weight to make my heart safe, extend longevity, etc- and I acknowledge I'm not up to par in those areas. But once I am, putting on weight for the sake of becoming not so obsessive??? Do you think that's reasonable? Or even possible? I am a nervous wreck. Any thoughts from anyone on this would be greatly appreciated.

Cathy (UK) said...

@hm - I understand what you are saying. Everyone told me (for many years) that weight gain to a healthy level would reduce my obsessionality. I didn't believe them because of my lifelong obsessionality, OCD etc. However, there came a point, 6 years ago, after a history of AN spanning over two decades, that my physical health was extremely poor; in fact I became bedridden for a while. I knew that weight gain would reverse many of these physical health problems - and it did, except for my osteoporosis and immune suppression, which were 'too far gone'. I now find eating much easier and have no worries about my weight, calories or eating 'pure stodge', but I am still as anxious and obsessional as I have always been.

However, I do know that some people find that weight gain reverses all or most of their psychological difficulties. I think it depends upon what you were like (temperament and personality) before the ED. People who had no difficulties pre-AN seem to find that weight gain is the answer to all of their problems. Therefore, to achieve a healthy weight is well worth the effort and there's certainly nothing to lose by doing so!

Emily said...

Over the past decade I have blamed my ED on my dad for being abusive, my mom for not doing anything about my dad, my dance teachers who liked me thin, my peers who liked me thin, the thin-obsessed society that I live in, and myself for allowing myself do fall so deeply in this never-ending pit of self-hate. I don't know what caused my ED, but it makes me too overwhelmed to even think about it. Maybe, when I get the financial stuff figured out and get into treatment, someone will help me with all of that.


Anonymous said...

Let's be brutally honest -
the blame game is a way to push help away and avoid what needs to be done. In anything in life.
You can talk and wring your hands and flail about all day. Useless. What is needed for recovery from an eating disorder is adequate, regular nutrition for the restoration of truly healthful weight and full health. This includes brain health, as it is part of the body.
When the brain is re-nourished the facts are bound to be clearer.


Carrie Arnold said...


Your RD is right. It's really hard to explain what happens when you get to a healthy weight and then stay there. It's not like being at a healthy weight made the AN go away. It didn't. But it almost seemed to take the claws out of the hold that AN had on me. I could be a bit more rational about my treatment and what I needed to do in order to stay healthy.

Anonymous said...

I have spent over 1,000 hours during the past four years studying the scientific literature on the causes of anorexia nervosa. There is literally no reliable evidence presented anywhere in that literature that would convince any objective and reasonable person that parenting style or family interpersonal dynamics are a contributing cause. Nevertheless, that hypthesis continues to be advanced in reputable journals by well-known researchers. Whenever I see such a contention, I ask the author for evidence. So far, not one researcher has been able to provide it. I have concluded, therefore, that the idea that parents contribute to causing anorexia is an unsubstantiated hypothesis and that anyone who claims to be an expert and contends that it has been proven is guilty of scientific misconduct. In my opinion, those researchers should be investigated by journal editors, their professional peers, and the institutions that sponsor their research. If they cannot back up their assertion with convincing evidence, they should be stripped of their academic positions and prohibited from receiving public research funding in the future. Their fate should be the same as Andrew Wakefield's, who misled the public by claiming that there exists a causal link between childhood vaccines and autism, when there isn't.

T said...

I wonder if there are several roles the genetics plays in this--personality being one and the idea of a "timebomb" being the other?

I certainly see both in my life. I had all the hallmark personality traits that many others with AN report ie. perfectionism, high anxiety black and white thinking, etc.

I also know that for me, letting myself get hungry (ie skipping even one meal) sets of a chain reaction. I can have been doing very well for weeks or months but one skipped meal and I am trapped in obbsesive thoughts about weight and restricting. The longer I go without restricting, the more these thoughts build.

And I also agree about the "blame game." We need to stop blaming parents for a disease--I am a childhood cancer survivor and my parents were never blamed for that, even though it also the result of a genetic predisposition, triggered by some event.

I also think that ED treatment needs to stop blaming the patient. I know more girls than I can count who blame themselves and alot of conventional treatment only reemphasizes this. I go to a wonderful treatment center but nowhere do they mention the genetics behind EDs and I find that learning about this helps a lot of girls immesurably. They are able to accept they have a disease, stop wasting time blaming themselves and get focused on actually getting better.

hm said...

Cathy (UK)- Thanks for your thoughts. There was no "pre" for me- I've had the same thoughts, obsessions, and behaviors for as long as I can remember. Sounds like you can relate. But it is good to hear that, at least with regards to your weight and calories, your anxiety has relaxed. Perhaps I can hope for the same.

Carrie Arnold- Thanks for being direct, as always. I need to see my RD as rational and myself as not in the weight area. Period. It's hard, and I'm not very trusting.

I wonder when it will be time for ME to make decisions about my weight and my recovery. I'm so tired and frustrated at everyone else making these choices for me. It's exhausting, and makes me feel small and defensive.

Carrie Arnold said...


You are an amazing, wonderful woman. The ED is nothing compared to you. One day, you will be able to take control of your health. I hope it is soon!

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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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