What parents need to know about the causes of eating disorders

Last updated on November 6th, 2023

There are many outdated theories about what causes eating disorders. Hereā€™s what you need to know so that you can focus on what matters. If your mum thinks you gave your child an eating disorder, show her this.

This is the whole of Chapter 5 of my book. A longer, earlier version is here, if you want a lot of detail.


This chapter will be brief because you only really need to know three things:

  • Despite a lot of research, the causes of eating disorders are still unknown (so anyone telling you your child got ill because ā€“ fill in the blank ā€“ doesnā€™t know what theyā€™re talking about.
  • Researchers have looked into whether parents or their parenting style might cause an eating disorder, and the answer is a very clear ā€˜Noā€™.
  • Now concentrate on treatment

If youā€™re interested on what is and isnā€™t known about causation, see my page here. For now, think of eating disorders as biopsychosocial: an interaction of genes, biological /physiological factors, personality, life events and environment.

Itā€™s human to want to make sense of the terrible things that happen to us, and I know you will be looking for a cause, starting with ā€˜what you did wrongā€™. Donā€™t imagine for one moment that family therapy for eating disorders is interested in ā€˜fixingā€™ parents. ā€˜Therapyā€™, here, means ā€˜treatmentā€™, and ā€˜familyā€™ really means ā€˜based within the familyā€™. Modern therapists know you couldnā€™t possibly have caused the eating disorder. They want you to stop ruminating about what you did or didnā€™t do in the past, and instead, attend to the all-important ā€˜nowā€™. They give you a central role in treatment because your bond of love and your dedication make you the best person for the job.

Did everything start with bullying in school? Was it the ā€˜healthyā€™ eating lecture in class? Or that time a doctor, incredibly, told your child to lose weight? None of these could possibly be a single cause, since not everyone who is bullied, or exposed to restrictive eating messages, goes on to develop an eating disorder. But itā€™s often clear how an event provided a trigger to a particular individual, perhaps tipping them over a threshold. When your child is a lot better, you can revisit these ideas to support relapse prevention. You canā€™t forever shield youngsters from triggers, so you will use unfortunate incidents to help your child to practise self-care skills and become more resilient.

Of course you will attend to bullying and not send your child back into a snake pit. But in terms of treating the eating disorder for the months to come, theories on causation make little or no difference.

ā€œI treat patients with leukemia. I donā€™t need to know how they got it to treat them.ā€ [i]

There will be people around you who think your child somehow chose to have an eating disorder, or that theyā€™re vain or narcissistic or overly influenced by peers or by the media. People may also nod wisely and say, ā€˜Itā€™s all about control, of courseā€™ or ā€˜She didnā€™t want to grow upā€™ or ā€˜Itā€™s a way for him to cope with difficult emotionsā€™. This is all simplistic pop-psychology (for more on the "It's all about control" chestnut, see anorexiamyths.com/am-blog/anorexia-is-all-about-control) and an insult to the sophisticated research going on.

ā€œI wish our therapist had told us what took us so long to find out: ā€˜This isn't anyone's fault and your child isn't doing this deliberately.ā€™ā€

If you want to shut people up fast, tell them that the illness is genetic, or more accurately, ā€˜biopsychosocialā€™. If youā€™re in a more patient mood, you might like the suggestions I make in Chapter 11.

We now know that the same genes operate to increase the risk for anorexia (we will have to wait for genome studies on other eating disorders) and several other psychiatric conditions: OCD, depression, schizophrenia and anxiety. This makes sense to all the parents whose child with anorexia also suffered from anxiety or OCD before the illness struck. Other links coming from genome studies include: attainment of academic degrees, the drive to exercise or move, some metabolic traits, and the tendency to low body-fat. [ii]  Please understand that genes will not, on their own, cause an eating disorder: epigenetics (an interplay of genes and environment) is behind most ā€˜geneticā€™ illnesses. [iii]

Iā€™ll talk a little more about triggers and risk factors, as far as they are relevant to how youā€™re going to help your child.

Weight loss is a major risk factor. It can trigger the illness, prolong it, or be part of what sends your child back into relapse. Conversely, the illness is presently treated and kept at bay (and there are even epigenetic changes) by taking care of nutrition, weight and psychological wellbeing.

Stress comes into the mix. With all the upheavals and uncertainty of the Covid pandemic, there was an estimated three to four-fold rise in eating disorders.  [iv]

Consider also the inherited personality traits associated with anorexia: our children are often very smart, conscientious, high achieving, determined, sensitive and kind. Such traits are just lovely, but as they interact with each other and with environmental influences they can become a burden. Our children are often found to suffer from perfectionism, poor self-esteem, difficulty in set-shifting (the ability to adapt, change course, be flexible), black-and-white thinking, and a vulnerability to depression or anxiety. With this bookā€™s attention to compassion, your child will learn the art of using their personality traits to their advantage.

Be aware that most studies look at people while theyā€™re suffering from anorexia, not before, so they are not able to distinguish cause and effect. While anxiety, OCD or perfectionism often pre-date an eating disorder, plenty of parents only see these mindsets emerge while their child is malnourished. My daughter developed mental rigidity and various irrational fears while the anorexia was strong. As she recovered, she became her old emotionally intelligent self again.

Although Iā€™ve mentioned possible risk factors that might help you make sense of whatā€™s happening with your child, please understand there is no simple mechanism of causation. A number of risk factors have to collectively tip someone above some threshold. You could think of it as many streams all feeding into a river. The research goes on.

Your child didnā€™t choose to have an eating disorder

I want to emphasise that this eating disorder is in no way your childā€™s fault. At no time does he choose any of his obnoxious, distressing or dangerous behaviours or beliefs. He is a puppet on a string. He lost his freedom the day the eating disorder took hold.

You need to get this at a very deep level, because if youā€™re anything like what I was, blame will leak out in your words or in your body language in times of stress, right when your child most needs your support. This will hold back progress.

Even though my daughter knew that skipping meals and secrecy were likely to re-trigger the illness, and even though she was terrified of ever being ill again, at age 15 she secretly cut down on school lunches. I could blame her for that. But it is such illogical behaviour that I can only think that forces outwith her control drove her to it.

The more we let go of judgements and accept that our kids are the way they are, the more we can bring about change. Concentrate on living and breathing non-judgement and acceptance towards your child, and make that the culture in your household.

When people in recovery blame their parents

Some adults blame their parents for the illness, remembering conflict and terrible things said. Most likely, the chaos at home was a combination of a tough illness with insufficient support for all. Unless there was child abuse, the evidence is that parents donā€™t cause eating disorders. Yes, some of us have said stupid things about food or weight, but then life, and in particular, our society, supplies triggers aplenty.

Parents with an eating disorder

Have you suffered from an eating disorder yourself? Do you presently suffer from one but manage to keep it under control? You may be scared that therapists will blame you for your childā€™s eating disorder, or that they will consider you incapable of contributing to your childā€™s treatment.

First, understand that because of genetics, itā€™s very common for both child and parent to be affected by an eating disorder.

It is perfectly appropriate that you should care for your child just the same as any parent. What matters is what you do now, not what you did in the past. The trials that validated Family-Based Treatment did not exclude parents with eating disorders.

If you can get rid of any notion of shame around your own eating disorder, it will be easier for you to have unconditional acceptance of your child.

From what Iā€™ve picked up through the grapevine, parents who suffer from an eating disorder are pretty good at keeping it under control while all their efforts go into supporting their child. Still, if youā€™re struggling, do seek help. If I were king, the clinics that treat our kids would also be set up to treat parents.

The only time a therapist should be interested in your eating disorder is if it drives you to collude with your childā€™s illness. Sure, weā€™ve all been taken in by our childā€™s pleading and bargaining ā€“ but Iā€™m talking about parents who actively get in the way of treatment. I have met a teenager whose mother supplied her with laxatives and helped her bin food. Clearly someone else had to take on the childā€™s treatment ā€“ in her case, it was her older sister.

Why? Why us? How to let go

If you are losing precious energy asking ā€˜Why?ā€™ or ā€˜Why us?ā€™ please know thatā€™s normal. Pause, put a gentle hand on your cheek, and send yourself messages of kindness. You are suffering. It really hurts when you think you could have done something different. You so want the best for your child. May you find clarity and courage.

Self-compassion will transform the pain better than reading heaps of research. It will move you towards deep acceptance of what is, summarised by this mantra:

ā€œShit happens.ā€

The Serenity Prayer

The Serenity Prayer may be more to your taste:

ā€˜Grant me the serenity to accept the things I cannot change, courage to change the things I can, and wisdom to know the differenceā€™[v]

If youā€™re finding this hard to apply, see Chapter 15 for tools that help with acceptance and letting go. These may liberate you of the torment of guilt and free up a lot of bandwidth.

Your child needs food urgently and you need all your energy for the challenging task ahead. Redirect your focus to the call for action. Whatā€™s going on with your child? What are her issues and her needs right now? How can you feed her? Every day youā€™re going to get better at it. Thatā€™s what matters.


Next:

* Go to Chapter 6: Practical steps to help your child beat the eating disorder *

* Go to Table of contents *


Endnotes

 [i]  From a doctor at an eating disorder conference http://internationaleatingdisorderadvocacy.blogspot.com/2015/05/international-conference-on-eating.html

 [ii]  Watson, H.J., Yilmaz, Z., Thornton, L.M. et al. Genome-wide association study identifies eight risk loci and implicates metabo-psychiatric origins for anorexia nervosa. Nat Genet 51, 1207ā€“1214 (2019) doi:10.1038/s41588-019-0439-2 Follow Cynthia M Bulik for the latest, e.g her 2019 talk on youtu.be/KduYI304iro

 [iii]  Excellent short podcast on epigenetics of eating disorders: Howard Steigler on edcatalogue.com/episode-164-dr-howard-steiger-epigenetics-eating-disorders

 [iv]  bbc.co.uk/news/uk-50969174 and eating disorder organisations across the world

[v] The serenity prayer and verses similar to it, are available on Wikipedia: http://en.wikipedia.org/wiki/Serenity_Prayer

3 Replies to “What parents need to know about the causes of eating disorders”

  1. Thanks for the informaiton on the cause. I want to bring in friends and family, but even in my first discussions/support seeking with only two friends, the cause was discussed and questions were asked. Both were directed at me (the mother) and my own behaivours around body image and food.
    This is currently preventing me form reaching out, telling others, involving friends and family or asking for support. It helps me begin to formaulate my future response when confronted with stupid, questions, remarks and assumptions.
    Thankyou.

    1. Hi Emma, this can indeed be tricky, or even extremely painful when it's someone we were close to. Sometimes we discover that people we thought loved us are attached to some theory about what caused our child's eating disorder, and sometimes we realise we've been judged harshly all along. Some parents say they discover who their true friends are. Some take refuge in groups of parents in a similar situation. Personally I enjoyed having a great therapist/counsellor, and I also have valued the discipline of directing my thoughts, so as not to poison my mind with unnecessary gumpf, so as to make space for more life-affirming stuff.

  2. Easy to read, loads of info, but not leaving me mind boggled. I like your 'voice' is that the writers term? Feels like we're in a conversation.

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