There used to be a time when the relationship a child had to their parent(s) was blamed by the clinical community as causing the child’s eating disorder (ED). As a result, children were often removed from the home and placed in a treatment facility to develop insight into this relationship. Times have changed.
This is an exciting time in ED treatment where more widely held beliefs in the clinical community are that parents are not to blame and children are also not to blame for causing an ED. But, although it might come as a relief that you are not at fault for your child’s mental illness, as a parent you will and must play an important role in your child’s treatment and possibility for recovery. So, check any remaining guilt you have at the door, roll up your sleeves, and be ready for the challenges ahead.
Now that we’ve clarified that it’s not your fault, you might be asking yourself, what does cause ED?
While there’s not one specific answer to this question, possible explanations include:
• ED has been found to be a highly heritable disorder and up to 50-80% of those that develop it have biologic genetic vulnerabilities.
° Reading this made sense to me. I remember my oldest brother developing an ED.
• Increasingly the symptoms of an ED are now understood to be the consequence of being malnourished and in a constant starvation state.
° The Minnesota Semi Starvation Experiment in the 1940’s documented how a group of formerly healthy young men exhibited similar symptoms to ED after undergoing caloric restriction. Some of the symptoms included social withdrawal, strange ritualized eating, irritability, paranoia, and hoarding of food.
° How well I recognized some of these same symptoms in my own child at her most ill: wiping down the food on her plate, eating food in a particular order, and checking her body for fat.
• Brain scans reveal that there are many neurological changes associated with eating dysregulation and starvation (Dr. James Lock). In addition, it is now understood that brain function and chemistry are altered by even small deficiencies in diet especially during adolescence.Studies have shown that the two main areas of impairment in executive function include weak central coherence and difficulty set shifting.
1. Weak central coherence is the tendency to have a cognitive processing style that focuses on details rather than the big picture.
2. Difficulty set shifting is the inability to think flexibly to manage ambiguity, tendency toward perseveration, and perfectionism.
° Perseveration, perfectionism, and the inability to think flexibly where all traits I saw in my child.
• ED often occurs in people with other mental conditions or in those with a family history of anxiety, depression, and OCD.
º Again, for me, this was further evidence of the heritability factor, as I had suffered from anxiety and so did my mother.
As you can see, the causes of ED are complex, but so are the triggers. Leading researchers acknowledge that they have no idea what activates an ED (Dr. Julie O’Toole MD of Kartini Medical Clinic). Possible triggers could include a loss of weight from sports, a diet, or a combination of environmental and biological stress.
Increasingly children are becoming highly athletic and playing multiple sports at younger and younger ages. Often, participation in sports focuses on aesthetics and requires a low BMI to advance. (wrestling and gymnastics are two examples) In addition, demanding sports schedules can make it difficult for parents to find time to put together balanced meals for their child.
° This made eminent sense to me. My daughter participated on two soccer teams and it was a challenge to come up with snacks and meals on the go. Her weight plummeted during an intense soccer season.
Dieting, which is a pervasive behavior in modern western society, has been labeled a gateway to ED. Most people can risk a temporary period of restriction, which is usually not effective in weight reduction long-term, without consequence. However, others with a predisposition toward the disorder may respond to a period of nutritional restriction or instability with a plummet of self-perpetuating thoughts and behaviors which could lead to an ED. However, it is trivializing and belittling to those deeply ill with an ED to blame drive for thinness or a diet for causing their mental illness. ED is not caused out of vanity, but exists in a society that places emphasis on existent triggers.
- The Role of Environment and Biological Stress
Some environmental influences can increase the chances of a person developing an ED, but probably only if that person has the biological predisposition Also; society receives a lot of attention and blame for causing ED. There is a lot of debate about this, however, there is little data to support the belief that the media cause people to develop an ED, but there is also no conclusive data to dispute this.
For more information on how to help your child battle and overcome their eating disorder, check out the following resources: Give Food A Chance by Dr. Julie O’Toole, Help Your Teenager Beat An Eating Disorder by James Lock, MD, PHD, Daniel Le Grange PHD and F.E.A.S.T. Families Empowering and Supporting Treatment.