This week, I received three calls from well-intentioned parents who had just found out that their daughters were in the serious grips of an eating disorder. One 12-year-old was downing 50 laxatives a day; another, a 15-year-old dancer, had lost over 10 lbs in a few months -- she was now 5' 7" and 105 lbs; a 13-year-old had been secretly bingeing and vomiting for at least six months.
Every mother told me a different version of the same story. "I didn't realize it was as bad as it was. I didn't want to be too controlling ... I didn't want to make the problem worse ... I didn't want to ruin our relationship." In each case, the parents thought they were making the right decision, based on their understanding of their child. All of them had been thinking alot about their kids. They weren't just ignoring things. They were trying to parent as they knew best.
So it is important to hear what I am about to say, without blame, without criticism, but more as a call to arms -- a cultural alarm. Parents, pay attention: We are in the midst of a crisis.
When it comes to food and weight, we need active parenting now. We have to be pro-active in the same way we are with drugs and alcohol.
Here are some thoughts as to what we can do:
One last word: It is very important to know that all the parents I mentioned were well-intentioned and trying to make the situation better, not worse. So when I tell parents to pay attention and list things they can do to help their child become healthier, the next thing that happens is that parents can skid into self blame and worry that they haven't done it right. This is not about blame -- it is about expanding awareness. Parents can't know what to do if they've never been taught how.
As a recent reader (librainstars) wrote after my last blog about fighting with your kids, "The hardest thing for me is thinking I am at fault".
Ironically, if you haven't felt that as a parent, likely you haven't really been in it as a parent -- it comes with the territory. But as we all know, self-blame leads to paralysis -- not growth. So when blame enters the picture, catch your breath and use the moment to just be curious. Put into words why you have made the decisions you have. There may be a clear reason why you have proceeded in the way you have, so explaining your rationale, your decision-making process -- even if it was faulty -- is great role modeling for your teenager. The work is to continue to think of ways you could have been more effective and keep a resolve to try to respond next time in a way that you will get the best of your kids -- and in which they will get the best of you.
In this culture of severely distorted eating and body image, getting the best of one's kids is going to mean trying over and again to listen, to pay attention and to talk. This is hard work. As the reader ended her response to me, so I will end my response to you: "Raising children should come with a book. I am glad, though, that it does come with love".
David Katz, M.D.: How Kids Can Keep You Fit
Vivian Diller, Ph.D.: The Beauty Paradox: When Feminism and Vanity Collide
Brian Gresko: What Writing Teaches Us About Parenting
The void that is trying to be filled in any of these types of conditions is similar. It can never be reached and ultimately without help a person may end up dead or institutionalized. Though the fear of this reality may not be known to the person nor even if so be anywhere near enough to stop it is only through the connection that progress may begin. Therefore a healthy fear of the type of behavior associated with binge eating and the results may be of some benefit.
Truly a person may only start to recover once they have reached a bottom. Unfortunately that bottom may be reached over and over again once someone slips out of recovery.
Those that stay recovered are only those that work on the principals of recovery each and every day.
Addiction, addicts to food, drugs, alcohol, etc. I believe is generated through a biological effect on the brain that never goes away. It can only be put aside through therapy and recovery programs realizing that life in general is an environmental trigger. As thousands of varying types of thoughts filter through the brain we need to learn which ones to ignore and how.
People don't choose anorexia, so making children "scared" of it, as suggested by Judith, wouldn't be helpful.
The good news is that early intervention and treatment has shown success. American Academy of Pediatrics, Identification and Management of Eating Disorders in Children and Adolescents, http://pediatrics,aappublications.org/cgi/content/full/126/6/1240 The treatment with the strongest evidence involves parents taking the leading role in interrupting eating disordered behaviors. http://www.sciencedaily.com/releases/2010/10/101004162823.htm See review funded by the National Institute of Mental Health. http://www.ncbi.nlm.nih.gov/pubmed/18444053 Treatments based on talk therapy and interpersonal relationships, on the other hand, were found to be much less effective. Therefore, Judith's advice, while fine as far as it goes, is not sufficient to either prevent or treat these illnesses.
But isn't an eating disorder a mental illness? A brain disorder that takes even the most benign messages and amplifies them beyond rationality?
I wonder if the guilt that parents feel when hearing these messages may come from their gut feeling, one I think is correct, that an eating disorder is SO MUCH more serious and so much more about a problem with the brain than any messages from outside could create or stop. By way of analogy, a family that keeps a clean house - even an immaculate house - don't cause an obsessive compulsive disorder in a child. The OCD is a genuine organic problem that seizes upon societal and personal values, but isn't caused by them. OCDs, by the same token, are not treated by explaining that germs are not that serious and that cleanliness is not as important as they believe it to be.
Does that make sense?
But any 'well-intentioned' parent is going to have a hard time finding an ED specialist who uses evidence-based treatment. Instead, they will get the message that EDs are caused by 'controlling mothers' (among other unproven theories). This started back in the 1970s with Hilde Bruch's "The Golden Cage" and has persisted in spite of evidence to the contrary.
I'm glad to see Dr. Brisman promote the role of parents in actively interfering with EDs. Unfortunately, this is NOT the norm.
EDs are serious biological brain disorders that are triggered by malnutrition, not a reaction to poor parenting. I'm not sure they can be prevented. I was as clued up as any parent about anorexia--and yet my daughter developed anorexia after participating in World Vision's 30-hour famine. We were told to 'back off' and not be so controlling...until she ended up in the hospital. Luckily we found facts and support at www.FEAST-ED.org and the parent support forum, www.aroundthedinnertable.org. Two years later, she is fully recovered and leading a healthy, happy life.
Serve a variety of healthy foods, but don't teach children that there are bad foods.
Don't make negative comments about other peoples weight or appearance while your children are listening.
Teach children to value diversity of all types.
www.feast-ed.org and www.aroundthedinnertable.org.
In all my searching for information and support to help my daughter, who suffers from anorexia, these websites have provided the best support, information and knowledge available.
There are also videos available at http://www.youtube.com/user/CandMedPRODUCTIONS#p/u
on using and explaining, evidence based treatments for eating disorders. The site also has links there to other videos by top resources and researchers in the field.