by Erin Parks, Ph.D.
As a clinician and researcher who specializes in Eating Disorders, I often contemplate how to increase awareness of Eating Disorders and what, in particular, is least understood about the condition and those who suffer from it. This thought was predominantly on my mind as the National Eating Disorder Awareness Week (February 26th to March 2nd, 2018) just wrapped up. A few weeks prior, I had an epiphany in an unlikely interaction that led me to the answer.
I was interviewing an applicant for a clinical position to our center, who, besides having impressive credentials, was kind, funny and thoughtful. In the course of the interview, I told her about our own center and its research focus on neuroimaging and genetics to look at the neurobiological underpinnings of eating disorders. I also mentioned that our center takes an agnostic approach to conceptualizing Eating Disorders, consistent with Family Based/Maudsley therapy, which is based in the belief that that parents do not cause eating disorders. The applicant smiled, met my gaze, raised her eyebrows, and leaned in as though we were about to share a secret, and said:
“I understand why you tell the parents that, but surely you don’t really believe that.”
I truly do believe that parents do NOT cause Eating Disorders. I share that belief with our directors, our researchers, our clinicians, our office managers, our dietitians, our cooks, and every last member of our staff. We know that Eating Disorders, like other complex medical and mental health illnesses such as cancer, epilepsy, schizophrenia, and autism, are caused primarily by neurobiological and genetic factors. It is easy for us to refrain from blaming the parents as THE cause of Eating Disorders because we spend our days working with caring and concerned parents who are doing their best to raise happy and healthy children. These parents are shocked that their child has become so ill, because similar tothe interviewing clinician, they too had previously believed that poor parenting caused Eating Disorders.
I wish I could say that was the first time in an interview that someone had asked me if I secretly blamed the parents, but there are many intelligent and caring people—clinicians, teachers, neighbors, friends—who believe the common myth that faulty parenting causes eating disorders. This myth of parental causation has existed for many illnesses and most mental health disorders. For decades, parents, and in particular mothers, were traditionally cited as the primary cause of mental illness in their offspring. In the 1940s, the “schizophrenogenic mother,” a mother who was simultaneously rejecting and overprotective, was a popular theory of the etiology of schizophrenia. With greater awareness of mental illness and its genetic underpinnings, the idea that parents cause schizophrenia—or ADHD, autism, depression–has generally (and thankfully) fallen out of favor. Yet, the myth of parental roles in the causation of Eating Disorders continues to prevail. To understand why that is, one must consider the characteristics of Eating Disorders:
Eating disorders have the highest mortality of any mental illness—rates that many studies suggest may be comparable to common pediatric cancers. And yet, when we hear of a child getting diagnosed with cancer, friends and neighbors spend very little time wondering what caused the cancer and instead energy is focused on treating the cancer and supporting the family. The same is not true when a child is diagnosed with an eating disorder.
When I asked a focus group of caring, intelligent parents what thoughts came into their minds when hearing of a 13-year-old being hospitalized for an eating disorder, they confided that they wondered about the parents: did they diet in front of their children; did they pressure them to succeed; did they convey certain messages about body image? There is this cultural sense that there is a right way and a wrong way to raise a child, and doing it incorrectly can cause problems—including eating disorders. So what is the right way?
There is a prolific stream of conflicting parenting articles offering the latest opinion/theory/research on how to approach feeding your family.
Here are just a few examples:
- Don’t feed your kids sugar: they’ll become addicted vs. Feed your kids sugar: depriving them will make them binge later
- Make your kids try new foods: if not, they’ll never develop a healthy palate vs. Don’t worry if your kids are picky eaters: they will have disordered eating if you make food a battle
- Don’t bribe your kids with food: food shouldn’t be a reward vs. You can bribe your kids with food if it helps them eat their vegetables
- Hide vegetables in your kids’ foods vs. Don’t lie to your kids about what’s in their food
- Let your kids eat as much or as little as they want: follow their lead so they become intuitive eaters vs. Your kids should be on a schedule, including meals: structure is good for kids.
- Gluten is bad vs. All food is good
- Kids have to eat meat vs.No, kids should eat meat
- Dieting is bad: teach kids to love their bodies at all shapes vs.Model healthy eating: we have an obesity epidemic
- If you put your kid on a diet they will develop an eating disorder vs. If you don’t put your kid on a diet they will become obese and get diabetes
The conflicting advice continues when the parenting articles discuss achievement. Parents should teach their children art and music and sports and STEM skills and foreign languages. Parents enroll their children in way too many activities. Parents should let their children choose their activities. Tiger Moms vs Free Range Kids. Kumon vs Montesorri. It’s your fault if your children get hurt—you should have been watching them. Don’t be a helicopter parent and let your children play unsupervised. Challenge your kids, they need frustration and failure—they need grit. Don’t push your kids—they’ll develop eating disorders.
Parenting is an unyielding stream of decisions, creating infinite iterations of parenting.
Our clinic has worked with hundreds of families and while their home cultures slightly differ, most are just typical families, trying to find moderation amid the sea of conflicting internet advice when it comes to feeding and raising their kids. No matter what food and parenting choices they made for their families, somewhere there is an expert saying that they made the wrong choice and that is why their child has disordered eating.
A confession: I have two toddlers and I consume the endless stream of conflicting parenting articles that fill my Facebook feed and the Huffington Post. Sometimes I WANT parents to be the cause of language delays and college dropouts and cancer and bullying and ADHD and eating disorders. Then I could just parent “correctly” and guarantee that nothing bad will ever happen to the two children I love most in this world. But the reality is that there are pros and cons to all decisions and there are complex causes to complex issues. The reality is that parents everywhere are trying their very best, doing a very good job, and are parenting in ways that may look very similar to how each of us parent—and their children are struggling with difficult and scary things—including eating disorders.
Many articles during Eating Disorders Awareness Week spoke of hypothesized causes of eating disorders, e.g., food culture, focus on achievement, the media, and so forth, and while it can be important to think about the negative consequences of some aspects of our culture, this search for a singular cause can feed into the culture of blaming the parents. The majority of parents will diet, the majority of women will feel bad about their bodies, the majority of teens will feel pressure to succeed, and the majority of images of women in the media will be distorted and unhealthy—and yet the majority of children will NOT develop eating disorders.
I sincerely hope we can turn the conversation to the successful evidence-based treatments that now exist for eating disorders and how we can improve upon them so that treatments are effective, accessible, and affordable for everyone. I hope that we can discuss how parents know their children best and can be the most wonderful treatment allies in helping their children fully recover from an eating disorder. If I draw awareness to just one thing about Eating Disorders, may it be this: parents are NOT the cause of their children’s Eating Disorders and they do not deserve to be blamed.
Part of the Maudsley or FBT approach is to involve the family in treatment. There is strong evidence that children, teenagers, and even young adults heal faster and relapse is prevented, when parents are involved. Parents are critically important, and often provide valuable perspectives on their child to treatment providers. And while parents may not have caused the eating disorder, they may need new skills to fight the eating disorder. When well informed, they can implement important behavioral and emotional components that will support their child’s recovery. Perhaps one of the most important lessons in coming together as a family to support their child’s eating disorder treatment and recovery is to experience what a resource their family is, as they develop new skills, express their caring for each other, and share the insights they are learning in response to this challenge. Not only may their child recover from the Eating Disorder, but all family members may grow, thrive, and develop new strengths in unexpected ways.
Dr. Erin Parks is a clinical psychologist and the Director of Outreach and Admissions for the UCSD Eating Disorder Center for Treatment & Research. Dr. Parks’ current focus is on how to best educate clinicians, parents, and the community about the neurobiological basis of eating disorders and the evidence-based treatments that are now available.
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