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Dr. David Herzog

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Breaking the Silence

Posted: 04/13/2012 4:17 pm

"They could pull themselves together if they wanted to."

"She acts this way only to get attention."

"I wish he would stop this foolishness and grow up!"

"She should just go out and eat a cheeseburger."

These public attitudes about anorexia nervosa -- although unwarranted -- are all too common. Some people view this eating disorder not as the serious illness it is, but rather as a choice that patients can turn on and off at will. Often individuals with anorexia are seen as selfish, vain, weak or mostly to blame for their disorder; one of the consequences of this stigma is that many sufferers are reluctant to seek treatment. Those with anorexia who binge and purge are typically ashamed of these behaviors, and go to great lengths to keep them secret.

The stigma surrounding anorexia nervosa impacts not only those who have the disorder, but also their families. Parents may ask themselves questions such as, "Am I to blame for my child's eating disorder?" "Does my daughter's anorexia nervosa speak of problems within our family?" "What does my teenager's eating disorder say about me as a parent?" Families don't blame themselves when a child develops cancer or diabetes. Yet when a young person is diagnosed with anorexia, parents often experience shame and -- quite understandably -- do not know how to cope with it; their shame breeds silence, which perpetuates public stigma.

One way to reduce the stigma associated with anorexia nervosa is to provide an environment that allows for open discussion of eating disorders, and the Harris Center's annual Public Forum is designed for this very purpose. Our forums focus on body image and the media, offering our community opportunities for dialogue with international leaders in industries that impact self-image. Past forum speakers include Natalie Portman, Anna Wintour, Michael Kors, Diane von Furstenberg, and Geri Halliwell. Our past three forums have drawn audiences averaging 750 people -- parents, students, educators, and members of the press.

The Harris Center's 15th Annual Public Forum, "Health is Beauty: Defining Ourselves," took place on April 2, 2012 at Harvard University Memorial Church. We had a wonderful lineup of speakers. Arianna Huffington spoke first and then conducted interviews with Vogue Italia editor-in-chief Franca Sozzani and international supermodel Doutzen Kroes. It is very challenging for high-profile figures to talk publicly about their own experiences with eating disorders. Yet that is exactly what Arianna Huffington did. Her candor and courage set a tone that made other parents less inhibited about sharing their own stories.

In describing what had led her to participate in the Forum, Arianna acknowledged that her two daughters, now at Yale University -- one a sophomore, the other a senior -- both struggled with eating disorders. "When Isabella was 11 year old, I noticed that she had different ways of eating" -- she was avoiding carbohydrates. "I missed the first signs [of the disorder], but on her 12th birthday Isabella refused to eat [a piece of] her birthday cake." That's when Arianna knew it was time to get help. Arianna's words "missed the first signs" raised a valuable point. Eating disorders are notoriously difficult to recognize, especially in the early stages, and yet many parents -- including those who did detect the symptoms and did seek help -- tend to chastise themselves for not doing so sooner.

The image of Isabella refusing her birthday cake captured the fear and powerlessness that many parents encounter upon spotting signs of an eating disorder in their child. Arianna went on to highlight other painful moments in her journey with Isabella -- memories with which many parents in the audience identified. For example, Arianna recalled how the doctor who diagnosed her daughter's eating disorder explained that Isabella would need hospitalization if she could not reach a medically safe weight within the next two months. Arianna described her daughter's "long red hair" thinning as a result of under-nutrition. A number of Arianna's other memories of Isabella's eating disorder come to life in her book, On Becoming Fearless... in Love, Work, and Life.

I participated in the panel discussion by providing clinical information about eating disorders. It is a challenge to convince individuals with anorexia to accept help; many are brought to treatment, denying that they have an eating problem. In order to build an alliance with these patients, I look for a topic with which they can relate; for example, eating the same foods at the same time every day and thinking about food and their bodies almost all the time. Giving patients information about bone loss and about the risk of fractures can also help motivate them to engage in treatment.

As part of the panel discussion, I emphasized that parents are not the cause of their child's eating disorder. There are many factors that contribute to the development of anorexia nervosa. There are precipitants such as stress and loss, and there are core risk factors such as perfectionism, obsessionality, anxiety and mood disorders, and genetic predisposition. It is important that parents seek support through our networking systems. It will not be easy to reduce the stigma associated with anorexia nervosa, but doing so will help improve the lives of countless individuals and their families.

For more by Dr. David Herzog, click here.

For more on eating disorders, click here.

If you're struggling with an eating disorder, call the National Eating Disorders helpline at 1-800-931-2237.