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To the Daughter of the 70 year old bulimic mother and difficult personality grandmother,

I do feel for you. Please believe that. I also have lived with family members with eating disorders. I also had a strong willed and opinionated grandmother who, as much as I loved and admired her in certain respects, I also found her difficult (and hard for my mother as well). I can relate to much in your post.

I obviously don't know your relatives and am not in a position to make judgments. But let me re-frame this a bit if I might.

Often times I think it can appear that a family may be trying to control a child (an adult one even) or overly involved with a child. It could be easy to assume "boundary violations"(e.g., over-control, over-involvement, over-protection, high expression of emotions or maybe even difficulty expressing one's feelings) caused an individual to develop an eating disorder. But, when a child suffers from an eating disorder, I would suggest that the opposite could also be true. It's the old chicken and egg dilemma. Which came first? Could it be that your loved one develop symptoms of an eating disorder which then brought out strong reactions from her family? Especially long ago at a time when these illnesses were poorly understood and barely treated?

Perhaps your Grandmother's reaction was born out of frustration and anger at her inability to help her daughter or stop the behavior--especially if she viewed the behavior as a 'choice' rather than an illness. Perhaps her own hurt, worry, confusion and anger bubbled over at times. Eating disorders are difficult for everyone, all around. There was (and often still is) shame and guilt associated with eating disorders for both sufferers and families.

I can't know the dynamics in your family. However, it may be that there is more than one angle, one way of looking at it.

anne

I just found this on the Maudsley Parents web site. Although preliminary, this is an encouraging step, so I am passing it on. I am sure there will be more to come.

My daughter is 20 and has anorexia nervosa. So far, counseling hasn't helped. She was too sick and depressed to stay at college so we brought her home. We'd like to try family-based treatment and she says she doesn't want to go to a treatment center. Is she too old for this to work?

Angela Celio Doyle, PhD responds:

There is no clear first-line treatment for adults with anorexia at this point in time. However, there is initial support for the Maudsley approach with college-aged individuals. The National Institute of Mental Health highlights three important components in treatment of adults:

1. weight restoration
2. treating the psychological issues related to the eating disorder
3. reducing or eliminating the behaviors or thoughts that lead to disordered eating, along with relapse prevention

The Maudsley approach for young adults fits these criteria and is based on the premise that parents continue to play a major role in their child’s life even when their child is a young adult; this role might involve emotional support and guidance or it could be financial (i.e., parents pay for college). This situation provides an opportunity for parents to help their child recover, although careful attention needs to be paid to their healthy psychosocial development as an increasingly independent young adults.

In a recent case series at The University of Chicago, a small number of young adults were provided the Maudsley approach with some modifications based on their age. The results were positive, overall, with the majority of the patients recovering and returning to school at short-term follow-up. Additionally, the patients and their families reported positive feelings towards the treatment approach. A paper describing the results of this case series is in the process of being reviewed for publication by the International Journal of Eating Disorders. Because this form of the Maudsley approach is still being developed and refined, your best bet would be to seek out treatment with a trained and experienced Maudsley therapist who would be willing to adapt the treatment to an older individual. Additional research using randomized controlled trials will need to be done to determine whether this approach is the best treatment for young adults, however.

anne

As a former anorexia sufferer, I am appalled by this article.

My daughter also suffers from anorexia, which started at the same age as mine did.

True experts tell us that genetics and personality traits are two of the major factors that cause ED.

"Boundary issues"?

I can tell you that I myself never experienced any of the things that you talk about - boundary issues, nor abuse nor sexual molestation.

My parents were very loving, as I was a loving parent to my daughter.

This article does more harm than good to sufferers and their families/loved ones.

This does not surprise, however, since I have encountered many 'misguided' therapists over the years.

I hope the professionals take this author to task on this one.

Dear Joanna,

The issue of boundaries has certainly struck a nerve! As I said, all that you wrote makes a lot of sense to me and speaks to my experience. I think that parents can be loving AND violate boundaries with their children. In my grandmother's case with my mother, the intrusion on my mother's sense of self was pretty blatant, my mother's boundary issues with me were more subtle and fell on the side of neglect. In both cases, my mother and I suffer, to varying degrees, from an unstable sense of self and feelings of low self worth. I've worked hard in therapy for years and have made progress. My mother, who never sought treatment for her bulima, often seems like an adolescent to me, stuck in the past with her mom. That's not to say she isn't kind, generous and loving, but her disease, which I see as a mental health issue, has compromised her sense of self, self-efficacy, self-esteem and discovery and fulfillment of her dreams and hugely impacted the quality of her relationship with her daughters.

Now that I am raising my own daughter, I've decided the buck stops with me. I'm interested in the prevention side of things, not treatment so much. My concern is helping mothers with bulimia understand that they can, and likely will, negatively impact their own child's development and increase the risk for passing on an eating disorder. I've lived this and talked to other women in similar situations. So, with my daughter, I see her as her own being and my job is to guide her and help her become the person she is meant to be. I work hard to keep my issues to myself, something I wish my mother had done with me, although I do think she tried.

Maybe some day there will be an organization for children of parents with eating disorders like there is for children of alcoholics. There do seem to be many similarities.

It is very striking to me that the mothers who have commented on this article are so offended and rejecting of the whole boundary issue. Perhaps it hits too close to home or perhaps the nature of anorexia is so frightening that something so intangible as boundary issues seems inconsequential and offensive. Parents need to be held accountable but it doesn't mean they are bad people. Families are ocmplicated and relationship patterns get passed down through generations uncommented on and unacknowledged. My sincere hope is that through my work in therapy and by writing about my experiences that I can stop those patterns from poisoning my daughter's life.

Thanks,
Carol

PS A book that was recommended to me as helpful for children of parents with an ED is called "Children of the Self-Absorbed: A Grown Up's Guide to Getting Over Narcissistic Parents" by Nina Brown. I found it helpful.

Joanna-

Obviously this is a very thought and emotion provoking post! As a psychologist who has also worked with eating disorders (and trauma) for over 20 years I found myself nodding as I read along. What I think may be confusing is that not all boundary violations are intentional. Parents are often doing their best, acting with good intentions, perhaps struggling with their own unaddressed childhood issues. The result can be getting out of sync, disconnected and/or overprotective in a way that is harmful. Thank you for illustrating some of the ways this can play out!

I also think the research about anxiety disorders predating the development of eating disorder behaviors can be confusing. What this may overlook is that anxiety often is a reaction to the types of emotional experiences you describe.

Thank you for this thought provoking topic and conversation!

Kathleen Young, Psy.D.
www.drkathleenyoung.com