HerArticle

As the daughter of a chronic bulimic (my mother is now 70 years old), I feel comfortable saying that my grandmother had everything to do with my mother developing an eating disorder. She was domineering, hurtful and created an environment hostile to expression of feelings. (I should mention that I adored my grandmother but I saw how she interacted with my mother). As a result, my mother turned to food and developed a life-long problem that remains unresolved. I am on the side of holding parents responsible if they are contributors to a child developing an eating disorder. Growing up the daughter of a bulimic mother profoundly affected me and my ability to experience feelings without using food to mediate those feelings. Joanna's article resonated for me and my experience.

There are all kinds of families in the world. No one deserves to live in a domineering, hurtful or hostile environment. However, not everyone that lives in this kind of environment develops an eating disorder. A very small percentage of the entire population, for instance, develops anorexia. If simply living in a difficult environment caused an eating disorder, then the numbers would be greater than they are.

Likewise, there are many out there that come from perfectly fine families with life stressors that are not outside the normal range. Yet they go on to develop an eating problem.

Unless you have the genetics for it in the first place, an eating disorder is highly unlikely to develop. Research has shown that, for anorexics, they are very unlikely to come from homes that are abusive. They come from all kinds of home and all kinds of backgrounds.

The most common trigger for entrance into an eating disorder in the genetically susceptible?
Going on a diet. Losing weight is often initially met with positive comments from others. For the predisposed, it can have a calming effect and set into motion a cascade of biochemically based brain changes.

In my opinion, blaming and searching for causes is destructive. It does not allow the family to focus together in an attempt to fight the illness. It delves into possible causes that can distract from the real and urgent need for complete, full nutrition. It can potentially legitimize distorted thinking on the part of ill loved ones if the therapist talks only with the person suffering an ED and does not hear the family's perspective. Once a person is refed, then is the time to address anxieties, developmental issues, etc. if needed.

Family-Based therapy (aka the Maudsley Method) is research based and has the highest evidence for effectiveness in adolescents. It puts parents in charge. It does not counsel young sufferers until their brain is rehealed enough to make use of it. It does not blame families. It sees families as the best resource.

Who would you go to if your child was ill?

anne

Dear Daughter of 70 year old mother with chronic bulimia,

Thank you for writing. Over twenty years ago a woman in her mid twenties
asked me if she could find a 12-step program for adult children of parents who had eating disorders, bulimia in particular.

My heart broke at the magnitude of her question. The answer, of course, was "No." At that time in our society her existence was unknown or unacknowledged or both. All people with eating disorders were considered to be female, white and in their very early teens.

An adult child of a bulimic woman, if recognized, would destroy that illusion. The bulimic woman would have to be at least of child bearing age plus the age of her adult child. That would put the bulimic person in the neighborhood of forty. This was inconceivable at the time, except for the people who were living with the illness.

I still receive mail from women in their 50's and 60's who share for the first time that they continue to suffer from an eating disorder.

The Maudsley Method philosophy has a straightline focus on the adolescent living at home and who is severely deprived nutritionally.

The full range of eating disorder healing experiences encompass every aspect of a person's life and is quite profound for the individual and for the people in his or her life if they can remain in relationship. Working with adults who have eating disorders is very different from working with children.

And working with adult children of mothers (or fathers) with a history of eating disorders is still, in my opinion, a neglected area in mental health.

The good news is that the principles in Al-Anon (the 12-step program) for the most part, apply to adult children of a person with an eating disorder. And today, many mental health clinicians, unfortunately, have rich experience in working with adults whose parents suffer or have ever suffered from addiction. Here too, overlap exists, so
the adult child of a bulimic person can be understood and get effective help.

A core principle in the healing work revolves around boundaries, i.e. recognizing boundaries, dismantling unhealthy boundaries, constructing and honoring healthy boundaries.

Thank you again, for writing. I'm glad you found my article and were moved to share a bit of your story. Please feel free to write again.

warm regards,

Joanna

I'd just like to say that I think this is a very powerful and interesting thread. Thanks to all of the participants.

Family-based therapy (Maudsley) is also used with adolescents suffering from bulimia, not just anorexia nervosa. And, while there is still much to learn about how best to treat chronic eating disorders of long duration in older patients, it is likely that many of those eating disorders started in adolescence or young adulthood. How wonderful it would have been if those behaviors could have been interrupted at an early stage of the illness, instead of becoming chronic. All evidence points to early intervention as leading to better outcomes.

While research on the Maudsley method has been studied in adolescents, I know of people who have successfully used it with older adult children. While perhaps not the norm at this time, it is not impossible.

For bulimia in older patients, the evidenced-based treatment of choice is Cognitive Behavioral therapy and antidepressant medications. I am personally less familiar with this as this was not my family's issue. However, I have done a great deal of reading and research on ED's in general.

Bob, I appreciate your willingness to maintain an open mind an acknowledge that people with ED's come from all sorts of backgrounds. What I found so upsetting in Joanna's column was the 'this is the way it is' for eating disordered patients, as though they were all lumped into one.

Please recall the schizophrenogenic mother of schizophrenia or the refrigerator mothers of autism. No one believes that anymore. Why do eating disorders, a mental illness, deserve the special distinction of being blamed on parenting, on the media or on society?

Dr. Thomas Insel says, and I quote "...Anorexia nervosa, among the most serious of mental disorders, can be deadly for young women who get caught up in a malignant cycle of weight loss and compulsive behaviors. The mortality rate for those with anorexia nervosa is estimated at 5% per decade. Research tells us that anorexia nervosa is a brain disease with severe metabolic effects on the entire body. While the symptoms are behavioral, this illness has a biological core, with genetic components, changes in brain activity, and neural pathways currently under study. Most women with anorexia nervosa recover, usually following intensive psychological and medical care."

He also states:

"How badly we have done by parents by separating individuals from families,
and blaming families for the problem...
We need to ask for a day of atonement for past care,
and we need to bring families into the picture."
Dr. Thomas Insel Director of the US National Institute of Mental Health 2007

There are obviously differing views in the ED treatment world. This is a big part of the problem for families...and ultimately sufferers.