Monday 19 December 2016

Does anyone out there still believe that parents cause eating disorders?

If so, I would like to direct them to this superb article by Julie O'Toole, MD - Founder and Chief Medical Officer, Kartini Clinic for Children and Families, which sets out the rock-solid scientific evidence for eating disorders being brain disorders and that "parents are part of the therapeutic solution, not the source of the problem". For Dr O'Toole, the "take-home message that biology sends us is that not only do parents not cause eating disorders, schizophrenia, autism, and other brain disorders, they couldn’t cause them if they wanted to".

Yet I suspect there may still be clinicians who point the finger at parents: poor parenting, over-protection and so on. Dr O'Toole includes links to some truly dreadful outdated citations which blame parents. Conclusions range from "Maladaptive paternal behavior may play a particularly important role in the development of eating disorders in offspring" to "this study lends evidence to the clinical contention that high-concern parenting in infancy is associated with the later development of anorexia nervosa. This may derive, in part, from aspects of unresolved grief" and "these results support the growing literature on the interrelationship between disordered family relationships and eating disorders."

A number of years ago Becky Henry, US-based author of “Just Tell Her To Stop: Family Stories of Eating Disorders” told me of an occasion when, at a high-profile conference on the neuroscience of eating disorders, "a psychotherapist who had been working in the field for many years leaned over to me and said: 'There may be some truth in what these two are saying but if it weren’t for pathological parents, we wouldn’t have eating disorders.'"

On top of this I often hear parents blaming themselves for 'causing' the eating disorder. "Where did we go wrong?" and so on.

I strongly suggest that anyone who still wonders if parents are to blame for eating disorders reads Dr O'Toole's article from start to finish.

She says: "As a pediatrician I saw every kind of family: highly functional, highly dysfunctional, and everything in between. And guess what? Once we began to observe parents of patients with anorexia nervosa, we saw every kind of family, not one kind, as had been taught for years. It turns out, the Emperor had no clothes: there was no “anorexogenic family”. This clinical observation, not yet supported by published studies (in fact, flying directly in the face of the commonly cited literature) was essential in establishing a treatment paradigm which involved parents in re-feeding their own child."

Parents are "a crucial element of the solution", not part of the problem, which is one of the reasons why modern evidence-based treatments like FBT operate "on the principle that parents need to be in charge of and involved in re-feeding their child".

PS: Interestingly, from what I can see, none of the above outdated citations talks about boys with anorexia, just girls / daughters. A further clue to why this kind of thinking is so outdated?

Read Dr O'Toole's article here.

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