Food Is a Family Issue

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

Comments

[psychminor]

01:29 AM on 03/13/2012

While both sides are arguing, the victims of these diseases are still suffering. They need to be identified and helped.

[anonymousmd]

08:42 AM on 03/12/2012

They are placed on an equal playing field with their clinicians, and treated with the dignity and respect they deserve. I don't want to blame parents, not because I am afraid of offending them, but BECAUSE THERE IS NOW EVIDENCE THAT THIS IS NOT AN ACCURATE STANCE IN THE MAJORITY OF CASES, and because there is zero evidence that blaming them helps their children, even in the few cases when their behavior needs to change to help their children.

I realize that it is threatening to the field to think that parents can know as much about their children as seasoned clinicians, and that the sacred cows many have built their careers on are being questioned. However, FBT is proving its efficacy, over and over - it would behoove Dr. Scheel, if she truly wants to help families, to get formal training in this modality before judging it less effective than her own. She may be surprised by the results. However, regardless, my real issue is not actually with Dr. Scheel's book - that's for a different day - but with the stance taken here by Dr. Epstein that Dr. Scheel's approach reflects necessary work for families that is just hard and honest, while other approaches parents adopt somehow are easier. While I am sure Dr. Scheel motivates parents to do hard work, so do other approaches, and to imply otherwise is silly and reductionistic, and does not elevate Dr. Scheel's work but instead makes it challenging to take seriously.

[anonymousmd]

08:41 AM on 03/12/2012

As an MD who specializes in these illnesses, I am dismayed by the review Dr. Epstein has posted. It implies that adopting another approach or disagreeing with Dr. Scheel's approach is taking an "easier" way out. In fact, she even quotes Dr. Scheel as stating that parents want a "sound bite". She also states that people "don't want to blame parents" so they don't examine what is going on at home. These comments reflect an alarming ignorance of the current state of the art in eating disorders treatment. The reality is that there is not an evidence base behind the approach outlined by Dr. Scheel. That doesn't mean it has no merit, but it does mean it is anecdotal, based on her experience as a clinician in the field, and should be put in that context. Parents who elect to use evidence-based treatments, such as family-based treatment (FBT), to combat eating disorders in their children are not at all taking an easy way out; in fact, they are willingly putting themselves on the front lines of fighting these illnesses, which is an exhausting, emotionally challenging process, that requires - mandates, even - serious self-reflection on the part of caregivers throughout the process. The family IS examined in this process - but they are examined as agents of change, and when there are things they need to adjust in their behavior, this is reflected to them without blame or shame. (continued)

[Neverloseheart]

01:19 AM on 03/16/2012

As a mom who has been through both types of treatments, for me, FBT was actually more difficult and tiring BUT it was not as scary because I was given good advice and back up and support. While my daughter was receiving a psychotherapeutic approach, I was terrified as I could see that she was not improving, she was becoming more ill, but at the same time, I was rendered helpless, and considered to be part of the problem.

I wonder if anyone who hasn't been in this situation can see how this might make a parent anxious and lead the psychologist to think that the parents are the problem, whereas it's actually the psychologist!!! Like a movie where a person wakes up in a mental hospital and can't convince anyone that they are normal!

In FBT and I was treated as a responsible adult who would be in charge of the feeding. It made all the difference in the world! How do I feel now? I feel very competent as a parent. I was never forced to reflect on any parenting mistakes I might have made. I did learn how to take care of my daughter while she was sick, it wasn't intuitive at all to have to get a teenager to eat. I did have to learn HOW to stay calm in the midst of her storms. But that's over now and our relationship is very good and remarkably like it was before she got sick.

[knowledge seeker]

01:50 AM on 03/12/2012

As a psychotherapist specializing in eating disorders I find parents eager to know their role in their child's ED curious about these maladaptive coping strategies. What Dr. Scheel maps out in her book for families is not damning or finger pointing. EDs are not the flu; they don't just appear out of nowhere. They emerge in psycho-social environments where the emotional learning and primary familial relationships, where self esteem starts, are relevant to the appearance of an ED. We cannot predict what family will harbor an ED. But, as we see with all maladaptive coping strategies, something, for that child is missing. Possibly this is something a parent couldn't have predicted. A tendency toward perfection and obsession may not be something the parent could have been equipped to deal with. Thus it is so important to develop an emotional language where difficult feelings, depression, OCD, or anxiety can be managed effectively in the framework of the family’s relationships with each other. Effective communication and safety with your child suffering with an ED, and who may be predisposed to anxiety, is essential for healing an ED long term. If you read the book you will see this is what Dr. Scheel is describing. For many of the folks voicing simplified, reductionist comments about Dr. Sheel's knowledgeable compassionate approach and who also admit to not even reading the book, I plead with them to stop the aggressive polarizing comments that make me think the posts are from advertising agents for Maudsley.

[Charlotte Bevan]

03:42 AM on 03/12/2012

"It is a capital mistake to theorize before one has data. Insensibly one begins to twist facts to suit theories, instead of theories to suit facts." - Sherlock Holmes

[Erica Husain]

06:26 AM on 03/12/2012

Knowledge seeker, psychotherapist without name, I don't need to have read the book to see how the comments section here is shaping up. Your piece above is the most reductionist I have read so far. You have reduced the comments of anyone who takes issue with the content of the book to which this article refers with a single sneer when you make reference to "advertising agents for Maudsley".

There are many knowledgeable and compassionate people here who have commented, who have studied much of what has been written or promulgated or researched in this field, who have lived with an eating disorder at close quarter and who have used compassion and knowledge in so doing, who have read the book even, and you have attempted to disparage them with umbrella terms like "reductionist", "simplified", "agressive", "polarizing" - I would take that beam out of your eye first before committing poison virtual pen to virtual paper again from behind that cloak of anonymity that your choice of moniker gives you.

This is a comments section and surely others are entitled to an opinion; I personally find your attempts to besmirch these others from your chosen vantage point of professional specialisation in the field, for whatever that is worth, unworthy of this debate and your professionalism. I would bear in mind that they may have good cause by now to be mistrustful of many who profess to be specialists in this particular field; I only wish that we could expect more.

[Holly Marciniak]

05:55 PM on 03/11/2012

(continued from 2 previous posts)

One more point I’d like to address: Most sufferers deep in the grips of an ed are UNABLE to be independent and healthy simultaneously, and parents willing to be in charge of their food for a time is their only hope- that does NOT mean the parents are “controlling”- it means that they care. Encouraging “independence” in a person acting irrationally is a dangerous thing indeed. Parents need to be empowered in their child’s treatment. Telling parents that their child is trying to assert his/her independence through food restriction- will do the opposite of empowerment.

I see in comments below that the author you have quoted has a more rounded approach to eds than what your article implies. I would ask that you reconsider the tone of your article, and give thought to the numerous kind, loving parents who are dedicating endless hours and energy to the scientifically based idea that food is medicine, and that, first and foremost, their child needs to become physically strong and healthy again.

There is no point spending years in psychoanalysis of the home environment and dynamics while the child is starving to death. A dead child is not an enlightened child. And a bereaved parent is not an enlightened parent.

Eds kill. Food first- focus on giving parents the power to help feed their child. Self-exploration of the sufferer should happen later.

[Holly Marciniak]

05:53 PM on 03/11/2012

(continued from previous post)

3."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." coupled with this book quote: ' "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," ' These quotes imply that the REAL work happens only when parents do things in the manner YOU suggest, and that parents who choose a scientific approach instead are looking for a quick fix- that they have less concern for their children- and less desire to get in the trenches and get down and dirty and do whatever it takes to help their child heal. But stories I have read of parents who saw their child’s ed as a disease and took it on toe-to-toe as such sound more like war heroes than like lazy, half-concerned people looking for a quick fix. They put their own lives on hold and they take the ed on with determined ferocity- giving up their social lives, their vacation time, whatever it takes- to help make their child physically healthy again.

[Holly Marciniak]

05:52 PM on 03/11/2012

I do not believe harm was intended in this article, but the offensive wording has great potential for offense and damage.

1. "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." This implies that people who take a scientific approach to their own or their child’s ed are looking for the “easy” path- that they are lazy/wanting a quick fix. This implication is unjust and unwarranted.

2. "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." This implies that families are to blame for eds in children, which will contribute to parent disempowerment- parents scared of being accused of “causing” their child’s ed may become too frightened to step forward and ask for help for their child. In addition, there has been extensive research proving that family dynamics are NOT to blame for eds, and that parents taking charge of their child’s illness (i.e. Maudsley) is by far the most successful treatment approach.

[KristineM]

06:27 PM on 03/10/2012

As the parent of a child with an ED, I consider the FIRST order of business in treatment to be a return to physical health. Failure to turn around the destructive symptoms of restriction can cause stunting, life-long physical damage and death. My priorities are (1) finding effective treatment which turns around the physical destruction ASAP, (2) giving me the tools I need to support my child’s recovery effectively during all the time when she is not at an appointment, and (3) when the crisis of dangerous physical damage has been averted and she is physically healthier, addressing how she can progress into being able to manage her own eating, sustained over time, and eventually becoming fully emotionally, psychologically and physically healthy.

Randomized clinical trials show that the best results over time for anorexia are demonstrated by Family-Based Treatment: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3038846/?tool=pmcentrez. I have not been able to find any RCTs demonstrating the efficacy of Ms. Scheel’s therapy for treatment of EDs.

There is no proof that parental behavior causes or contributes to manifestation of EDs or any other major psychiatric disorder. In the past, professionals blamed mothers for autism and schizophrenia and were proven wrong. Most people with EDs have siblings who don’t. Most people who have had the types of situations mentioned in the article never manifest EDs. I recommend http://www.feast-ed.org/, Families Empowered and Supporting Treatment of EDs, for info about EDs and treatments.

[Neverloseheart]

03:27 PM on 03/09/2012

My daughter received about 9 months of the type of care that is beatified by this author. She was in the hospital 7 times and she thought she was bad and her family was bad because we parents are divorced. We switched to a more evidence based type of care, we were empowered to help her and she has not been hospitalized since then. She went right back to school and is living the normal life of a teenager and maintaining her weight for the past three years. I see that her anxiety set point is higher than other people and she is learning to deal with this through a combination of family based treatment, DBT therapy and medications. Upon scientific review, these types of treatments have a much better rate of recovery than what is proposed by this author. It certainly has not been easy at all but it has been successful and I'm so grateful that science is finding treatments for my daughter's disease. And it has kept our family together.

[KKelschASC]

12:13 PM on 03/09/2012

Last year I did a film about ED, "Someday Melissa" by Judy Arvin. Melissa died as a result of her Eating Disorder. Judy picked up her broken heart and made the film. I learned a lot through the lens. I learned even more after I read Dr. Scheel book, which to me seems to be well researched and balanced. I think it is unfair to personally rip apart a noted therapist and her book without reading a word of it. It takes enough courage to render an opinion based on a carefully researched belief system that will stir some controversy. Dialogue is one thing. Bitter misdirected anger is another. Parents are not blamed. To ask her if she has ever seen a child suffer is unconscionable. I might suggest you actually READ THE BOOK. I have made many films about addiction and have wonderfully joined the world of long term recovery. I have heard the program that gave me my life back attacked and vilified in almost the same language today. The Nature vs. Nuture debate goes on and on. I think it's a combination. I know that their has always been a shift from one platform to the other in my case depending on the stance of the addiction specialist.
I suggest you spend some time after a deep breath and go to the library. Get the book for free. BUT READ THE BOOK.

[Charlotte Bevan]

01:25 PM on 03/09/2012

Whilst I admire your passion (and your film) and am a great supporter of "Someday Melissa", I do feel I need to ask you a question. Have you read "Eating with your anorexic" by Laura Collins, "Brave Girl Eating" by Harriet Brown, James Lock's work, Daniel Le Grange's work, Walter Kaye's work, Janet Treasure's work, Bryan Lask's work, Frampton's work, Nunn's work, Julie O'Toole's blog, Carrie Arnold's blog, about the Ravello project? - the list can go on, if you would like. I don't want to be rude or confrontational and am merely enquiring.

[KKelschASC]

05:35 PM on 03/09/2012

I'm familar with some of the work.. I'm a Director of Photography not a therapist. I do think that the biological component is with merit. I also think that the behavorial dynamic has validity. There are many paths to a destination. I think many should be explored. This has set me thinking about a new doc. I admire your broad span of knowledge. I was thrust into this world inadvertantly. As for my own addictive nature, I'm at a point where I don't care what started it, I only want to continue my recovery into its 3rd decade.

[Colleen49]

03:29 AM on 03/10/2012

KKeisch, I did read Judy Scheel's book. You are right about one thing: it is her OPINION. It is not supported by any evidence.

Her bibliography contains five (5) references. Four of them are irrelevant to the book (exercise addiction, TV and body dissatisfaction, etc). Four of them are over 12 years old. Honestly, I would expect the average high school term paper to be better researched.

It's impossible to say that parents are not blamed with chapters like, oh, let me just randomly open the book: "Accepting your part in the problem," "Eating disorders develop when there is no room for negative emotions," "Criticism: Moving beyond judgment and blame," "Responsibility: Owning your mistakes"...need I go on?

Her book is deeply offensive to me as a parent. There's a lot of good advice for being a good parent. The problem is that the author assumes that you have not been a good parent (that's called BLAME); the proof of that is that your child is ill. It's Cuckoo's Nest!

I'm sad about girls like Melissa, and I am determined to help parents find good help before their own children die. This book will not help. Try "Help Your Teenager Beat an Eating Disorder" if you want a book that actually helps. Check out www.maudsleyparents.org and www.feast-ed.org. There you will find information that actually is evidence-based and well-researched--which will help sufferers recover and truly support parents without blame.

[KKelschASC]

04:16 PM on 03/10/2012

Like I said before, I'm a Cameraman not a therapist. Are you a therapist? I've been reading her blog on Psychology Today and have seen many references to the research in her responses. It's insulting to me as a reader to equate her authorship with that of a high school student. The book is not a stuffy academic tome, but seems to be written as accessible to a family. I may not be a health field specialist, but I think I'm fairly intelligent with my terminal degree from NYU School of the Arts. As I have come to read and understand, Dr. Scheel is, as she says, supplying one cog in the wheel of eating disorder causes. (see my comment about many paths to a destination.) Dr. Scheel makes no bones about saying that the research using the Maudsley Method is valid and she does support the biological basis. Dr. Zerbe, a noted psychiatrist, wrote the Foreword which addresses the theory behind Dr. Scheel's book. It seems to me, that parents do have a role at times. Dr. Scheel addresses this as one component. This just seems like common sense.
Early in my recovery, I read a book called "Rational Recovery". It had much "research" behind it. The Big Book, on the other hand, has been attacked since 1934 for it's lack of scientific bonafides. I can only say that had I followed the advice of the former rather than the latter, I would be incapable of response today.

[Judy Scheel]

10:43 AM on 03/09/2012

NIMH adapted a Biopsychosocial Approach to include an understanding of eating disorders. Dr. Insel, Director, “There are so many avenues to developing an eating disorder. There is no one single cause but rather a complex interaction between the biological issues, such as genetics and metabolism, etc., psychological issues, such as control, coping skills, personality factors, family issues, and social issues, such as a culture that promotes thinness and media that transmits this message.” Causes of eating disorders are complex and are unique to the individual and must all (biology, relational, environment) be given consideration. Yes, EDs are illnesses, but the behavior often serves as a statement for what is unable to express verbally and emotionally. Recovery is integration of mind and body and finding ways to live life authentically, experientially, relationally and with self care - without the need to engage in self-destructive and self-defeating acts. Read the extraordinary work of respected clinicians in the field, K Zerbe, MD, M Maine, Ph.D, D Bunnell, Ph.D, D Siegel, MD, C Bulik, MD. The book is about healing relationships. Treatment involves different approaches and what is best for the patient. CBT, DBT, FBT are effective. The relationship that develops between therapist and patient and therapist and family promotes healing - based on authenticity, communication, mutual respect and clinical competency. Professionals may disagree, but true professionals respect the work and ideas of others. Please read my book and the reviews of my book by legitimate professional sources. J Scheel

[Charlotte Bevan]

02:13 PM on 03/09/2012

Judy

Can you clear something up for me, please?
"Recovery is integration of mind and body and finding ways to live life authentically, experientially, relationally and with self care - without the need to engage in self-destructive and self-defeating acts."

Are you implying that the self-destructive and self-defeating acts are a concious decision on behalf of the sufferer?
When you describe recovery as "rational", are you implying that an eating disorder is an irrational act? If so, precisely in which sense are you using the word irrational? Are you talking about the difference between what is in a person's interests and what they perceive to be in their interest? Flawed reasoning? Unconciously made decisions? Something else?

I find it interesting that you appear to view eating disorders as a question of choice (whether concious or unconcious). If this is not so, please could you clear this up for me?

[Judy Scheel]

10:29 AM on 03/09/2012

I agree with many of the comments. However, there needs to be some context and clarification. There is no one size fits all for EDs & etiology is complex & unique to the sufferer - how it developed or the best approach for treatment. My book deals with helping families heal and patients recover. There is NO shame or blame. It finds ways in simple language, exercises and reflections to help families understand emotional and relational underpinnings that may have contributed. Not all families will find themselves in my book. We must consider all the possible contributing factors that include biological (especially predisposition to depression and anxiety), genetic pursuits, environmental, cultural and relational. I address all these factors and explore the relational and attachment issues that may be present before the eating disorder developed or have emerged once the disorder has taken hold. The book teaches families how to speak an emotional language and understand the metaphoric use of the ED. It helps families learn to communicate and share in the responsibility of familial healing, it helps the person with the ED take responsibility for her well being. The subtitle of the book is "a loving approach to heal eating disorders. Professionals need to be aware and committed to understanding all that is before us; this includes biological, genetic, environmental and relational issues to EDs. As we teach our patients about not having all or nothing thinking, we as professionals must have the same responsibility. No one is disagreeing with

[Harriet Brown]

11:27 AM on 03/09/2012

I would consider the label "emotionally starving family" to be chock full of shame and blame. Just saying.

[Charlotte Bevan]

01:16 PM on 03/09/2012

Judy

I haven't read the book. I have read the review and I am assuming the reviewer has read the book. The impression you give in the paragraph above is NOT the impression the reviewer gives. I have also studied your work and I do understand that your heart is in the right place and that you have great empathy with eating disorder sufferers - hey, no one's in this field for money!

However, I do feel that this book does emphasise too much the stereotypical view of the family - monstrous mothers who diet and call their over anxious children fat, with a distant father looming menacingly in the background. I am afraid I have little time for psychoanalyists - they were the people who invented "packing" as a cure for autism - sigh - and do so want the world to move on to understand that we parents of children with eating disorders are not the dementors many perceive us to be.

Perhaps whatever you meant to say came out wrong? Because the paragraph above sounds nothing like the review. Perhaps it would have been kinder to sufferers and parents alike to include the biological, genetic and the evidence based stuff so people could have a clearer understanding of what an eating disorder actually is composed of?

Have you read David Wood's introduction to "Eating Disorders and the Brain" by Lask, Nunn and Frampton? Perhaps you would like to include that in your next print run?

[Judy Scheel]

05:22 PM on 03/09/2012

Thank you for your most thoughtful and honest reflection. This is why I needed to respond quickly to the article. The context and whole picture is vital; without it, I appear, to use an eating disorder phrase, "all or nothing in my thinking." My book does include a basis in understanding eating disorders from a full perspective (including biological - that is, nature) and offers a view of how relationships are affected and affect eating disorders. Yes, sometimes there are parents who are extremely anxious about their children's, particularly their daughters', weight and whose own eating is disordered, but the majority of the relational issues that are written in my book are not this and where there is one illustration of this in my book it is understood, explained and addressed in a compassionate manner. The reality is that there are some parents who are obsessed with weight and food and who do project this fear on to their children. Of course I know the work of Lask....I treat eating disorders. Nature stacks the deck, but nurture and the environment can contribute to playing the hand. An integrated view is just that. Once again, thank you. Your comments are refreshing and deeply appreciated.

[E70]

08:23 AM on 03/09/2012

There are many valid and accurate points in this article about Dr. Scheel's book. However, to emphasize what Tom Blaschko said, Dr. Scheel gives hands-on, practical ways for parents to serve as team members in the recovery process. Her book is not alienating to parents - rather she sees them as necessary and critical elements for positive change. Please read the book. To say she is "blaming controlling parents" or "marginalizing those with eating disorders" is a complete misrepresentation of her work.

Additionally, she does not say that there is no evidence or validity to the possibility of genetic determinants in the development of eating disorders. Rather, as people wanting to help those afflicted with this horrific disorder, we need to realistically view this disorder as a multi-faceted disease, caused by many factors. Along those lines, she stresses we need to not overemphasize the medicalization of eating disorders and misunderstand the complexities if the illness.

[Charlotte Bevan]

01:27 PM on 03/09/2012

E70

Just to turn things on their head. If you ignore the medical aspects of the illness, in order to "understand" it better, patients die. Just sayin....

[Gaby58]

06:04 AM on 03/13/2012

...many of us arduously spent months re-feeding and nurturing our ED child back to health. Funny thing, my daughters have grown up in a loving, healthy, nurturing environment; no attachment issues - they are loved unconditionally and know it. Now one daughter falls ill with AN - her life was hanging on a thread for several weeks - did not have anyone to help me through - figured it out - went where the science led me - She lived - twice she nearly died - I fed her 6 x daily, without fail, through rages, hostility and violence - with calm and determination I kept going.... She is healthy, well and in solid recovery only 8 months after diagnosis....Thank goodness I did not rely on psychotherapy to heal her brain or this dreadful discourse hanging over the field of ED treatment...This book is alienating and dangerous ...

[LuluNZ]

07:04 PM on 03/08/2012

Please please please research your articles before you publish them. This book and article are spreading all the wrong messages and further marginalising those with eating disorders.

Eating disorders are not caused by dysfunctional families, control issues or mothers with their own food issues. We're quite happy to accept that the stress of caring for a child with cancer might make parents appear dysfunctional so why can we accept that parents caring with a disease that is more lethal than some forms of childhood cancer might also be stressed and not operating at their best.

Science has shown that psychoanalytically based methods do not help those with eating disorders (or in fact most other conditions). Treatments based on these methods cure around one third of people, taking on average seven years and with up to 20% of patients dying in the process. What does work is the Maudsley method for anorexia nervosa, and bulimia in adolescents and young adults and CBT (often combined with medication) for older patients with bulimia or binge eating disorder. 70-90% of people fully recover by these methods taking on average one year. Feast-ed.org is a great source for further information.

To the editors: eating disorders are poorly understood by both the public and many treatment providers. Please show some social responsibility by researching what you publish and not further spreading information that hurts those in desperate need of help.

[Sesquip]

06:42 PM on 03/08/2012

Goodness, I didn't think anyone took the outdated, opinions-not-backed-by-evidence nonsense in Schael's book seriously! How does this stand against clear and definite research, for example, that people who suffer from eating disorders have trouble focusing on positive facial expressions & spend longer than average focusing on negative aspects?