My last blog about the latest encouraging study of the Maudsley method as a treatment for anorexia brought forth a volley of comments. Some of those who wrote asked for more information about the risk factors that may contribute to eating disorders.
The first thing to keep in mind is that eating disorders do not have a single "cause." Biology most definitely contributes. Researchers have found that genetics likely account for more than half of an individual's vulnerability, but genetics alone don't "cause" these disorders. Genes can be turned on, and they can be turned off, and the switch involves environment and experience. Environmental factors can include family and societal values, exposure to fashion magazines and billboards for supersized food, and attitudes of friends. Experiential risk factors can range from an extreme diet or schoolyard bullying or teasing, to a death or divorce in the family, emotional abuse, or other acute emotional distress.
In the course of researching and writing my last book, "Gaining," I found the following metaphor the most useful way to describe how all these factors interact to produce eating disorders: Genes shape the gun, environment loads it, and stress pulls the trigger.
Dr. Kathleen Franko, a psychiatrist with the Cleveland Clinic, has written a succinct overview of eating disorders with references to recent research.
The following excerpts suggest just how complex these syndromes really are:
Biologic Factors First-degree female relatives and monozygotic twin offspring of patients with anorexia nervosa have higher rates of anorexia nervosa and bulimia nervosa. Children of patients with anorexia nervosa have a lifetime risk for anorexia nervosa that is tenfold that of the general population (5%). Families of patients with bulimia nervosa have higher rates of substance abuse, particularly alcoholism, affective disorders, and obesity.
Psychosocial Factors High levels of hostility, chaos, and isolation and low levels of nurturance and empathy are reported in families of children presenting with eating disorders.1-3 Anorexia has been postulated as a reaction to demands on adolescents to behave more independently or to respond to societal pressures to be slender. Anorexia nervosa patients are usually high achievers, and two thirds live at home with parents. Many consider their bodies to be under the control of their parents. Family dynamics alone, however, do not cause anorexia nervosa. Self-starvation may be an effort to gain validation as a unique person. Patients with bulimia nervosa have been described as having difficulties with impulse regulation.
Just as there is no single "cause," there is unfortunately no single treatment that will "cure" every person who suffers from an eating disorder. The Maudsley method, or family-based therapy, can work if the family is willing and able to participate directly in the child's treatment -- but it is generally recommended as a treatment for anorexia, not necessarily other eating disorders. Some individuals benefit from medication. Others require in-patient treatment programs. Still others begin to heal only when they "click" with the right individual therapist. That's why it's so important to seek out experienced specialists in eating disorders treatment.
To find a treatment professional who can help you understand your illness and your best options, go to http://www.aedweb.org/source/EDProfessional/
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Eating disorders do not develop without malnutrition.
Food is the medicine and full recovery is possible.
In your article, you quote from a website written by Kathleen Franko that says high levels of hostility, chaos, and isolation and low levels of nurturance and empathy are reported in families of children presenting with eating disorders. Unfortunately, this might give your readers the impression that these descriptions tend to be common in families of people with eating disorders, or that these characteristics are known to play a role in the genesis of eating disorders. Actually, neither conclusion is supported by the evidence. One large study, for example, failed to find any data to support the hypothesis that eating disordered patients have had a childhood characterized by any particular pattern of parental relationship. International Journal of Eating Disorders, Vol 7, pp. 101-106 (1988) Another study, involving a national birth cohort, found no role for parenting as a risk factor for the development of anorexia nervosa. J Am Acad Child Adolesc Psychiatry 2009 Aug: 48(8): 791-9 Kathleen Franko cited three sources for her statement about families. However, I would urge your readers who are interested in this topic to actually read the full text of the articles cited by Ms. Franko. Not one actually provides support for the hypothesis.
I couldn't agree with you more about the OCD. For us it was an OCD with numbers. As more and more people are coming to believe that Bulimia is an entirely seperate brain disease, I subscribe to the theory that purging (whether PAN or BN) is a form of extreme anxiety. This may explain why many sufferers cross over between the two diseases.
I know that you have - like me - have personal experience of having lived an eating disorder.
What do you think was the CAUSE of your eating disorder?
Parents and children need to hear this message and not feel guilty.
I am sure Dr Franko is a good person. However, I am worried that some of her material is very outdated and has been refuted by Dr Thomas Insel of NEDA as long ago as 2007. It is a fast changing world and maybe there hasn't been time to update the website with the latest research. This includes the understanding that when families seek treatment for their ill children, it is a time of high stress and chaos, as finding help is very difficult. Parents of cancer sufferers have been observed having much the same reaction, but they are not blamed for their child's illness.
The view shared by many Eating Disorder experts is that, whilst environmental problems may trigger a desire to loose weight, anorexia (in particular) is triggered by weight loss, sometimes by as little as 7lbs. www.feast-ed.org
I totally relate to CatMiller's comment. When I was in the midst of my bulimia, I blamed my parents for everything. But playing the victim didn't help me get better. It kept me stuck. Eleven years ago, I found recovery in a Twelve Step program (you can read more about it on my blog about marriage and mental illness: http://bit.ly/cZVVyr), which completely changed my life for the better.
If you're standing on a bridge that's burning, figuring out why it's in flames isn't important. What's important is getting yourself to safety. What's important is jumping off that bridge.
For years, I blamed my parents for everything that was wrong with me.
As a recovered person and sage individual, I realize that my anorexia and other issues had more to do with ME and my personality/makeup than anything my parents 'did' to me.
In retrospect, I had two wonderfully imperfect parents who stood by me any time I was in need throughout my life. My dad died two years ago and I am sorry that I did not have the opportunity to express to him how much I appreciated all he did for me throughout my life. Fortunately, I did have the opportunity to do so with my mom. Research is coming out that eating disorders are biological brain malfunctions and have much to do with genetic and personality makeup.
As a child, my family life was utter chaos, and I was always expected to be the 'perfect child' despite it all. To this day, I can be quite the perfectionist. My parents back then didn't want to think their child was anything but perfect, because to admit anything else would mean they weren't perfect parents (they were actually quite awful).
I just hope that parents who read this blog can see that regardless of what brought their child to the eating disorder, they need help NOW, and will get them what they need. It would have been a whole lot easier for me if my parents had done that 20 years ago.