Number One Reason for Developing an Eating Disorder

An interesting question to ask would be, "do children who are refed in a hospital or other setting have the same 'cure' rate as those refed by parents at home with the Maudsley method?" If they are, then this would support the hypothesis that eating disorders are caused by a brain diseased triggered by malnourishment. I do not know the specific statistics, but I do know that refeding alone does not 'cure' most people with ED, although it is one of many important components for healing. Perhaps the Maudsley method of refeeding indirectly reteaches parents and child something about boundaries and/or some of the many other inter-relational skills that perhaps contribute to the development and maintainence of EDs.

The questions about ED etiology and treatment suggested by all who have posed are intriguing. As with addiction, depression and other multi-factorial mental/brain illnesses we may never have an evidence-based "best" treatment. Different approaches work for different people. But the more we know, the better able we will be to identify the cause(s) of a particular individuals ED and offer the most appropriate treatment. This discussion has certainly encouraged me to keep reading, researching, and an open-mind when it comes to treating patients and continuing with my own recovery process.

Richelle

Let’s take a hard look at your hypothesis for this article:
“I have concluded that there is one outstanding theme that runs through every person with an eating disorder whom I have encountered….people with eating disorders have experienced, on a sustained basis, relentless boundary invasion on every level.”

Allow me to draw your attention to some very interesting developments in the realm of legal psychology. ‘Research on memory fallibility is now front and center, in the context of police investigations and jury verdicts. …Although juries and decision-makers place great reliance on eyewitness identification, they are often unaware of the danger of false memories.’

“Several studies have been conducted on human memory and on subjects’ propensity to remember erroneously events and details that did not occur. Elizabeth Loftus performed experiments in the mid-seventies demonstrating the effect of a third party’s introducing false facts into memory.” This study clearly demonstrated…”The introduction of false cues altered participants’ memories.” …”Courts, lawyers and police officers are now aware of the ability of third parties to introduce false memories to witnesses.”

“So what is an "original memory?"6 The process of interpretation occurs at the very formation of memory—thus introducing distortion from the beginning.”… “Every act of telling and retelling is tailored to a particular listener; …The act of telling a story adds another layer of distortion, which in turn affects the underlying memory of the event. This is why a fish story, which grows with each retelling, can eventually lead the teller to believe it.”

“Experiments conducted by Barbara Tversky and Elizabeth Marsh corroborate the vulnerability of human memory to bias.” Their research showed that “Memory is affected by retelling, and we rarely tell a story in a neutral fashion. By tailoring our stories to our listeners, our bias distorts the very formation of memory—even without the introduction of misinformation by a third party."
I’ve quoted liberally from this article: http://agora.stanford.edu/sjls/Issue%20One/fisher&tversky.htm

Your hypothesis is built on anecdotal experience, patients telling you what you expect to hear. The longer you base your practice on the assumption that “boundary invasion” is the key to understanding eating disorders, the greater the likelihood you’ll miss all evidence to the contrary. Of all people, I would expect you to understand how easily a therapist can influence a patient’s perceptions of their own past.

When we believe every problem is a nail, we never learn how to use anything but a hammer.

May I ask why your article constantly refers to the afflicted person as a "she" or a "her"? Is there a reason why you are being gender specific? Do males afflicted by these terrible diseases mean too little to even acknowledge? You do realise that as an "expert" with this style of writing you are contributing to a large proportion of silent males who are afraid to voice their problems?

Amy, there is no data to support the point of view put forth by Joanna.

Perhaps something from the 19th century but certainly nothing from THIS century.

I have read through these posts and may be missing something but I am still waiting to see the data that backs up the premise/title of this article. I find it unfortunate that an article like this would be thrown out there without the appropriate data to back it.
-Amy

I am an ED sufferer myself, and am currently 28, having an EDs on and off (mostly on) for the past decade or so. I went to several psychotherapists, and may have even read this article when it was first published. I spent years looking for what might have "caused" my eating disorder. My mom and I were enmeshed. She was too dependent on me. Or maybe my dad wasn't involved enough. My brother had learning disabilities- did I feel the pressure to be everything to my family?

Maybe. Maybe not.

It was only when I started seeing a therapist who had me stop looking for the cause and start normalizing my eating that I began to make any progress. What I learned about family pathology was this: every family has it. If you spend enough time in therapy, sifting through enough memories and interpreting and re-interpreting enough scenarios, you will find boundary violations, you will find enmeshment, you will find that "emotions weren't always expressed freely." I've never met anyone who could emote freely, and most of them never had EDs. Now that I'm in recovery (not without lots of slips and bumps), I find that my family is probably less pathological than many. My parents could NOT have caused my eating disorder. Period. Full stop.

When you say "causation," there has to be a long line of epidemiological research to verify this fact. When we say cigarette smoking can cause cancer, we know the cellular mechanisms by which this happens--the components of the cigarettes that bind to the DNA and cause mutations, and which mutated genes can go on and spur unrestricted cell growth. Ta-da! Cancer. We don't know that with EDs. We do know that about 75% of your risk is GENETIC. We do know that dieting and/or malnutrition likely TRIGGER the eating disorder. Genes and environment, culture and chemistry, all combine in eating disorders and in every other illness out there. You can't separate nature and nurture. So to say that "boundary violations" cause eating disorders is a gross overstatement and not in line with the latest research. No, we don't know precisely what causes eating disorders but we do know that it's a hell of a lot more biology and a lot less parents/culture/something nebulous called "boundaries." EVERYONE has had boundary violations. EVERYONE has seen skinny models. Yet only a few develop eating disorders.

Carrie
www.edbites.com

Our 18 year old daughter has been fully recovered from her triggered eating disorder predisposition for over a year. She was very ill for several months and close to death at one point. We knew we couldn't have 'caused' the ed (diagnosis EDNOS)....we nor she fit any of the 'traditional' profiles for eds....but we were the dutiful parents of a child w/an ed, so we tried hard to find/figure out what was wrong with our family/us as parents ($$$) that could have caused our incredibly healthy, wonderful, happy daughter to make such a devastating 'choice'. FINALLY, we learned about the Maudsley Method and read current research.

We successfully re-fed our daughter at home in a very short period of time, and she has remained healthy since. She understands that she has a biological (genetic) predisposition to triggering an ed if she should become malnourished, and she takes full responsibility (as is age appropriate) for keeping herself fully nourished.

In hindsight, it is easy to see/understand how our daughter became inadvertantly malnourished during a late teen growth spurt which accompanied a typically busy teen schedule and an extended period of physical exertion through normal extracurricular activities. Once malnourished (which, by the way, isn't necessarily accompanied w/immediate weight loss), with the (unknown) predisposition for an ed, she crashed. A beautiful life went spinning out of control.

I want to encourage any parents reading this 'discussion' that your child can fully recover from an eating disorder with full nutrition, supervision (to ensure what goes in, stays in), rest and adequate time (and perhaps counseling) for the brain to heal. Full recovery isn't only possible, it is highly probable with your immediate nutritional intervention.

I remember wondering if my husband and I would have to be responsible for feeding our daughter forever. No. With full nutrition and stabilized healthy body weight, the brain heals. With that healing and cognitive maturity (which isn't fully realized until the mid 20s), our loved ones are not only able to take responsibility for their self care, they want to.

That was our familiy's experience with an ed, and I have learned that our experience is not unusual.

Moms and dads, it's not your 'fault'; our genes are our genes. Read, research, pray.....and nourish. Lose the guilt and get back to the table with your child asap.

I appreciate this 'discussion' and the opportunity to offer hope to parents/caregivers of triggered ed children/loved ones. Thank you.

A few years back, an article appeared in The Boston Globe.

Title: The ancestry of anorexia: Blame Biology, Not Parenting

http://www.boston.com/yourlife/health/mental/articles/2003/12/30/the_ancestry_of_anorexia/

A "must read" for all ED specialists, parents/loved ones and sufferers.

I’ve been thinking about this ‘boundary’ issue. Between parent and child (or teen), the term ‘boundaries’ has a somewhat different connotation than it would between a therapist/patient.

Ideally, a parent needs to set, teach and model appropriate boundaries for their children in all areas of life--behavioral, verbal, physical, social, etc.

When a child ‘crosses a boundary’, the parent corrects the child in order to keep them safe, to teach them how to take care of themselves and how to negotiate and get along in life. Boundary ‘limits’ are set by parents dependent on the child’s age and developmental stage.

If you’ve a child, teen or even young adult that happens to show signs of a mental illness (an ED in the instance we’ve been talking about), what happens to boundaries? Do you perhaps violate a child’s boundaries by reading their diary if you fear they are self-harming, suicidal or abusing a substance? How do you handle issues around eating? Do you insist (lovingly) upon proper eating and full nutrition no matter what you see/hear from the child? Or, do you view it a ‘choice’ the child must make to eat—when, what, how much and even IF? In the case of a mentally healthy young person, there is room for flexibility, but even then parents typically give ‘controlled choices’ (boundaries/limits) within which children may make decisions. You may chose what you’d like to wear to school, but the ‘boundary’ is that it must be appropriate to the weather and appropriate to the school’s dress code. You may serve yourself what you’d like at dinner, but you must join the family for meals and must choose from among a variety of food groups. When a child/adolescent/teen becomes ill with an eating disorder, they regress both emotionally and physically. If depressed (and this is common) making even small decisions becomes very difficult and anxiety provoking.

At times (and this is a term I’ve heard somewhere, but maybe not in relation to parent/child relationships), you—as a responsible, loving parent--must cross boundaries. This is really different than an egregious violation such as verbal, physical or sexual abuse. Crossing boundaries is not necessarily a bad thing; in fact, in certain instances I would argue that it is absolutely crucial to the health and well being of an ill family member. If that member is incapable of setting their own boundaries and, as a result, is not taking care of themselves properly, is incapable of making decisions in their own best interest, and is held hostage by an illness (not eating, making themselves sick by purging, etc.), then crossing a boundary is the loving, right and ethical thing to do until that person is once again well enough to take on the job for themselves.

I don’t condone reading someone else’s diary. A confession here: I have done it once, at a time when my child began to withdraw socially from friends and family, when she began actively self-harming and starving and when she began making suicidal statements. Normally, this is not something I would ever do. I haven’t done it since (and there is no need, as she is doing much better). At the time, I was desperate for a better understanding of her mind. In reality, however, reading a few pages in her diary did not tell much more than I already knew with my own (disbelieving) eyes. The fact that she left her diary open, all over the house, seemed to me a not too subtle call for help in it’s own way. Did I feel good about it? No. Would I do it ever again? I can’t answer that. Each situation is so unique and presents it’s own ethical dilemma.

The closest I can come is to say that, inside me, I feel the difference between violating someone on a ‘sustained basis on every level’ and the real and urgent need to ‘cross boundaries’ for reasons of safety and health. Parents and family members need to be supported in doing this, and to do it both well and ethically. They also need to relinquish this just as soon as it is safe to do so.

anne