You Don’t REALLY Believe That?

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By: Erin Parks, PhD

Having appreciated the humor that comedians have poked at“awareness” campaigns, I wanted to be very intentional about what, exactly, I wanted to make people aware of during Eating Disorder Awareness Week (#EDAW). And then the answer hit me in the face.  I was interviewing a clinician—she was kind, funny, had an excellent resume—and I was telling her about the culture and theoretical orientation of our center.  I told her that our research uses neuroimaging and genetics to look at the neurobiological underpinnings of eating disorders and that our three clinics take an agnostic approach, consistent with Family Based/Maudsley therapy, in that we truly believe that parents do not cause eating disorders and they are not to be blamed.  The applicant smiled, met my gaze, raised her eyebrows, and leaned in as though we were about to share a secret…

“I understand why you tell the parents that, but surely you don’t really believe that.”

really 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 believe, that like cancer and epilepsy and schizophrenia and autism, there are neurobiological and genetic causes to eating disorders.  But it is easy for US to believe this—we spend our days working with wonderful parents. These parents remind us of ourselves; they’ve been trying their very best to raise happy and caring children. These parents are shocked that their child has become so ill, because similar to the 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 parents cause eating disorders.  This myth of parental causation has existed for many illnesses and most mental health disorders: schizophrenia, ADHD, autism, depression.  But it feels particularly pervasive for eating disorders—why is that?

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 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, what messages did they give 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.

Don’t feed your kids sugar: they’ll become addicted.  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 pallet.  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. You can bribe your kids with food if it helps them eat their vegetables.  Hide vegetables in your kids’ foods. 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.  Your kids should be on a schedule, including meals: structure is good for kids. Gluten is bad.  All food is good.  Kids have to eat meat.  No kids should eat meat.  Dieting is bad: teach kids to love their bodies at all shapes.  Model healthy eating: we have an obesity epidemic.  If you put your kid on a diet they will develop an eating disorder.  If you don’t put your kid on a diet they will become obese and get diabetes.  Confused yet?

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 that is not our reality.  In reality 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 this week will talk about hypothesized causes of eating disorders—food culture, focus on achievement, the media—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 get eating disorders.

I 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 they are effective, accessible, and affordable for everyone.  I hope 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.  I hope everyone can now believe that parents are truly, really, not to blame.

This post originally appeared on ucsdeatingdisorders.tumblr.com


About the Author: Dr. Erin Parks is a clinical psychologist and the Director of Outreach and Admissions for the UC San Diego Eating Disorders Center for Treatment & Research . She is passionate about educating clinicians, parents, and the community about the neurobiological basis of eating disorders and the evidence-based treatments that are now available. Dr. Parks wants to help society view mental illness as brain illness–narrowing the funding and resource gap between physical and mental disorders.

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