The medicalization of eating disorders -- that is, the push to find the genes that trigger them -- has offered solace to many sufferers. It's got to be easier to consider anorexia and bulimia more like, say, an autoimmune illness linked to an inherited vulnerability than than a reflection of family trauma or your own insecurities.
Unfortunately, at this point, the hunt for the illusive eating-disorder gene is just that. Illusive. Perhaps one day, doctors will be able to tailor treatments to fix genes that prompt self-destructive behavior. For now, without any quick fix, the best solution may in some ways hark back to something a bit old-fashioned: looking at the home environment and exploring your and your child's emotional issues around food, control and power.
This is one of the messages in Judy Scheel's informative and compassionate new book, When Food is Family. She is, in some ways, turning the clock back to the days when we used to psychoanalyze those who suffered from anorexia or bulimia. But there's a modern twist: cognitive behavior therapy.
And while most experts are already using cognitive behavior therapy -- practical steps to help patients develop healthier methods of coping -- many shun the psychoanalytic part. Scheel believes that the best way to get to the root of the problem is to explore past and current family issues, the things that may have prompted the disordered eating in the first place. Then she couples the self-exploration with strategies to move forward.
"The nurture and the environmental piece play a huge role," Scheel said. "We haven't found the gene and while people are hungry to find it, I that raises a lot of flags that we are looking to medicalize something. We have to get back to what we did in the 70s and 80s, looking at eating disorders as a psychological disorder. They don't fall from the sky. The nurture piece and the environmental piece play a huge role."
As difficult as it is, Scheel, who has been treating children with eating disorders for 25 years, says parents need to explore the family dynamics or the damaging messages they may be feeding their children. She worries that the excitement about the genetic basis for illness has pushed the pendulum so far away from the crucial environmental factors. We no longer examine what is going on at home, she says, partly because no one wants to blame a parent. And yet, part of the reason for a child's self-destructive behavior may have to do with parenting. Sometimes we do have to confront our own child-rearing foibles to help our children overcome their own issues. (And sometimes their issues are our issues as well.)
When Food is Family contains anecdotes about parents who are so controlling that children feel the need to restrict food as a way to assert their own independence, about families that are so emotionally starved that children fill an emotional void with food. None of these analyses are brand new, but the coping techniques she outlines offer a framework for families who may be coping with a child who is starving or purging or both.
As Dr. Katherine Zerbe, a professor of psychiatry at the Oregon Psychoanalytic Center, commented in the preface of the book, Dr. Scheel offers therapeutic exercises that can provide hope to both the parents and the patient. The downside is that the process takes a lot of painful soul-searching and a brutally honest appraisal of the emotional underpinnings within the family. But the upside -- an enormous upside -- is that families who are willing to go through the process not only help their children recover but find new and deeper ties among themselves. As anyone who has dealt with these disorders knows, there is no quick fix.
One of her main thrusts is finding an emotional voice, rather than an emotional behavior. She even provides a vocabulary list to help teens and their parents express themselves more clearly. There are categories, such as "happy," that includes words such as "overjoyed," "high-spirited" and "hilarious." The category "afraid" includes "mistrustful," "wary," "uncomfortable."
And while this may sound silly, simply telling people to communicate may not be the best medicine. Providing them with words is truly helping the dialogue. She believes that for some teens unable to express themselves verbally, they prove their point by withholding food.
Also, she examines the mothers who may have their own issues around food. Like it or not, our children learn by modeling our behavior. Girls with eating disorders are highly likely to have mothers who fear food, too. Genetics? Maybe. Or perhaps your daughter has picked up your message that being a few pounds overweight is dreadful. If you skip meals or hide your food, you are sending a message that it's normal behavior. As difficult as it may be, mothers with eating disorders may have to confront their own issues if they truly want to help their children develop healthy attitudes about body image.
"I think we have gotten too far away from the psychological approach. Parents today want a sound bite, a solution that will take no more than, say, four months," said Dr. Sheele. She believes that those who suffer can reach a full recovery in terms of symptoms, but may have a lifelong struggle in terms of an inner voice driving them back to self-destructive behaviors. The key, as she writes, is not about a cure but learning to recognize your own or your child's vulnerabilities and act on them before they spiral into dangerous habits all over again.
Follow Randi Hutter Epstein, MD, MPH on Twitter: www.twitter.com/randihepstein