Last updated on October 6th, 2020
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 – fill in the blank – doesn’t know what they’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 ‘No’.
- Now concentrate on treatment
If you’re interested on what is and isn’t known about causation, see my page here
It’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 ‘what you did wrong’. Don’t imagine for one moment that family therapy for eating disorders is interested in ‘fixing’ parents. ‘Therapy’, here, means ‘treatment’, and ‘family’ really means ‘based within the family’. Modern therapists know you couldn’t possibly have caused the eating disorder. They want you to stop ruminating about what you did or didn’t do in the past, and instead, attend to the all-important ‘now’. 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 ‘healthy’ 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. Some could have provided a trigger – they might well be one element of a whole, poorly understood, complex mechanism. When your child is a lot better, you can revisit these ideas to support relapse prevention. You can’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, theories on what might have caused the illness make no difference.
“I treat patients with leukemia. I don’t need to know how they got it to treat them.”
There will be people around you who think your child somehow chose to have an eating disorder, or that they’re vain or narcissistic or overly influenced by peers or by the media. People may also nod wisely and say, ‘It’s all about control, of course’ or ‘She didn’t want to grow up’ or ‘It’s a way for him to cope with difficult emotions’. This is all simplistic pop-psychology, and an insult to the sophisticated research going on.
“I wish our therapist had told us what took us so long to find out: ‘This isn't anyone's fault and your child isn't doing this deliberately.’”
If you want to shut people up fast, tell them that the illness is genetic. That’s an over-simplification, but good enough for outsiders. (If you’re in a more patient mood, you might like the suggestions I make in Chapter 11). Indeed genome studies are revealing ‘strong genetic correlations with various metabolic features’. That’s for anorexia (I’m afraid there’s a lot more research on anorexia than on the other eating disorders). Note that genes will not, on their own, cause an eating disorder: most illnesses come from an interplay of genes and environment.
I’ll talk a little more about triggers and risk factors, as far as they are relevant to how you’re going to help your child.
Weight loss and major stressors seem to be risk factors. These 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 by taking care of nutrition, weight and psychological wellbeing.
There are also 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 book’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 they’re suffering from anorexia, not before, so they are not able to distinguish cause and effect. While many parents note that their child suffered from anxiety or perfectionism since they were toddlers, plenty don’t. My daughter displayed mental rigidity only while the anorexia was strong. As she recovered, she became her old emotionally intelligent self again.
Although I’ve mentioned possible risk factors that might help you make sense of what’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 didn’t choose to have an eating disorder
I want to emphasise that this eating disorder is in no way your child’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 you’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
You may have come across people who had, or still have, an eating disorder, and who very much lay the blame at their parents’ feet. They remember that family life was utter hell. Is it possible they had loving parents before the eating disorder hit them and the family home then turned into a war zone? Could it be, tragically, that the parents would have continued to be supportive if only they’d had better advice and access to modern treatment?
Whichever way the parents had behaved before the illness began, the eating disorder would probably have manifested itself eventually. 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 child’s eating disorder, or that they will consider you incapable of contributing to your child’s treatment.
First, understand that because of genetics, it’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. When James Lock and his team conducted trials to validate Family-Based Treatment, they 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 I’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 you’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 child’s illness. Sure, we’ve all been taken in by our child’s pleading and bargaining – but I’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 child’s treatment – in her case, it was her older sister.
Why? Why us? How to let go
If you are losing precious energy asking ‘Why?’ or ‘Why us?’ please know that’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:
The Serenity Prayer
The Serenity Prayer may be more to your taste:
‘Grant me the serenity to accept the things I cannot change, courage to change the things I can, and wisdom to know the difference’
If you’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. What’s going on with your child? What are her issues and her needs right now? How can you feed her? Every day you’re going to get better at it. That’s what matters.
 From a doctor at an eating disorder conference http://internationaleatingdisorderadvocacy.blogspot.com/2015/05/international-conference-on-eating.html
 The first study was: Duncan, L., Yilmaz, Z., Gaspar, H., Walters, R., Goldstein, J., Anttila, V., Bulik-Sullivan, B., Ripke, S., Eating Disorders Working Group of the Psychiatric Genomics Consortium, Thornton, L., Hinney, A., Daly, M., Sullivan, PF., Zeggini, E., Breen, G., Bulik, CM., 'Significant locus and metabolic genetic correlations Revealed in genome-wide association study of anorexia nervosa' in Am J Psychiatry (Sep 2017), 174(9):850-858, ncbi.nlm.nih.gov/pubmed/28494655 Follow Cynthia M Bulik for the latest, e.g her 2019 talk on youtu.be/KduYI304iro