Did I cause my child’s Anorexia?
Parents always ask if families cause eating disorders (EDs), did they cause the problem? I wish! That’s what I tell parents when they ask what they did to make their child develop Anorexia Nervosa, Bulimia Nervosa, or Binge Eating Disorder.
If worried parents caused EDs, the cure would be a simple matter of training them to behave differently. But families do not cause eating disorders. The best explanation for the origin of EDs is this.
Genetics load the gun and environment pulls the trigger.
What this means is eating that disorders develop when the person has a genetic vulnerability that gets triggered by their environment.
The Case of Amy
For instance, consider the hypothetical case of Amy. Let’s say Amy was born to a family in which she has an aunt with Anorexia, a 1st cousin with Bulimia, and her sister has Binge Eating Disorder. This tells us Amy likely has DNA that makes her susceptible to developing one of those disorders. But that doesn’t mean she will. If Amy does not have experiences that push her to over-focus on weight, food, or exercise, she very well may happily dance her way through life without ED struggles.
On the other hand, if Amy grows up in a setting where weight is emphasized and she is rewarded for dieting or losing weight, or punished for not dieting or gaining weight, there is a good chance she will develop an eating disorder. The family DNA she was born with has loaded the gun. Her environment pulls the trigger and the disorder may emerge. Notice I said, “may emerge.”
How do we know about the genes-environment connection?
Everything we know about genetic influences and etiology (causes) of eating disorders is based on probability studies. We have research that shows differing percentages of people who have the disorder come from this or that type of family, or have these or those traits. We are not able to examine an individual patient with an eating disorder and say for certain that the ED was caused by this or that.
What do we know about the causes of eating disorders?
On the genetic side of the equation we know that:
- There is a strong tendency for eating disorders to run in families. Estimates of heritability (how well genes account for individual differences in traits) are very high for Anorexia and Bulimia, and somewhat lower but still appreciable for Binge Eating Disorder. This does not mean that If your parent has an eating disorder you will also have one. It means that you have the genetic setup that puts you more at risk than someone with no close relatives with these disorders.
- Eating disorders tend to occur in families where Obsessive Compulsive Disorder (OCD) is also present. We do not completely understand the connection but we do know that it is common to see OCD co-occur with EDs. In families where both of these disorders show up, they sometimes afflict different individuals and sometimes both occur within the same individual.
- Certain personality traits that are to some extent genetically based are also frequently found in people with eating disorders. Those traits most commonly linked to development of EDs are perfectionism, impulsivity, and negative emotionality. (Negative emotionality is the tendency to react to things with negative emotions—the equivalent of having a glass half-empty outlook.)
On the environment side of the equation we know:
- Growing up in a family that focuses on weight control or athletic prowess can give children the message that what they look like or how strong or skilled they are is important to how much they are valued or loved.
- Participation in activities that place a premium on weight, strength, or appearance are also high-risk for EDs. Sports such as wrestling where participants must “make weight,” as well as those that emphasize size and shape such as gymnastics can trigger EDs in vulnerable participants.
- The fact we live in a culture that embraces bizarre standards of beauty (see Eating Disorders are Tough!) places the genetically vulnerable individual directly in the cross-hairs of the gun.
What can parents and families do?
Although families are part of what makes someone vulnerable to developing an eating disorder, families do not cause eating disorders. While we cannot change our DNA, there are steps we can take to minimize the risk of our children getting sick, and to promote healing if they do develop an ED.
- Show your children you love and admire them because they are lovable. They do not have to master a particular skill nor look a certain way for them to make your heart happy.
- Invest more time admiring their interest in activities and subjects than their accomplishments. Applaud their efforts whether or not they succeed.
- Do not criticize their bodies—not even “constructive criticism” which I have spent infinite therapy time helping patients overcome. You may think you are helping. You are not.
- If you are going to admire their appearance, make it about the fact that they look like themselves, or seem especially bright-eyed today. And most important, admire everything else about your children 1,000 times more often than you admire their appearance.
- If you do not like your own body, please keep that to yourself or share it with your therapist! As I explain in my book, “No matter how lovingly you describe your child’s body, hearing mom or dad put down their own bodies sends the message that body size and shape are important and can be ‘wrong.’ Further, as your child develops into a man or woman, he or she begins to look more like mom or dad. If mom or dad is ‘ugly’ in any way, the only logical conclusion your child can draw is that he or she too is ‘ugly.’”
- Ban “good food/bad food” from your vocabulary. Looking at food from this good/bad framework sets people up for trying to avoid foods they love and consequently making those foods tempting. (The forbidden apple is always the one most difficult to resist.)
- Teach your children that food is a lovely thing that keeps our bodies healthy and is a pleasure to eat and share.
Clearly, this list is incomplete. There are an infinite number of things that go into the good-parenting recipe. However, if you reflect on these suggestions, stir in a healthy helping of love, and apply lavishly, you will have a recipe for an ED-resistant child. More information and help can be found at these websites: Academy of Eating Disorders, National Eating Disorders Association, Association of Anorexia and Associated Disorders.