--Adolescent program parent
By Dr. Mark Warren
Often times while in treatment clients wonder how and why their eating disorder developed. The common question “What caused my eating disorder?” is very complicated because it pulls from so many ideas, understandings, conceptions, and misconceptions about the importance of causation, the implication of causation, and the definition of what causation means. Before we deal with the notion of causation itself, it is crucial to point out there is no evidence that knowing causation leads to cure, and no current evidence that knowing cause provides an avenue to change the treatment that we do. Having said that, virtually all clients and families want to know why they have an eating disorder. We believe, and research has indicated, that there are biological factors that predispose an individual to the illness and environmental factors then influence the manifestation of the disorder. This mirrors most psychological illnesses. When you have a treatment that is purely biological for an illness it moves someone towards recovery, but usually they do not feel better until they have re-established the quality of life they had before the illness. This often means a re-establishment of social contacts, work, school, and the ability to experience personal growth, change, pleasure and happiness. So we are careful not to say that the lack of these things are the causes of the illness, even though attaining them may be a core part of the recovery process. The experience of cure does not need to flow directly from the notion of causation. We know that nourishment and cessation of behaviors is a prerequisite to getting better, and we also know that after stabilization of symptoms there is still much work to do. Our current understanding is that the work left to do is not due to underlying things that caused the illness, but rather issues that may persist after refeeding, issues of body image, negative self talk and shame, and the ability to experience oneself as whole and healthy.
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Contributions by Sarah Emerman
By, Dr. Mark Warren
The book Eating Disorders and the Brain edited by Drs Lask and Frampton continues to be an extraordinarily important book to understanding the etiology of eating disorders. Given our current knowledge, we often say that eating disorders are biologically based. Yet, this is somewhat of a two-dimensional statement as eating disorders are experienced as complex and multi factorial. A large number of factors seem to be interacting when someone presents with an eating disorder. These include genes, early attachment, personality issues, cultural issues, cultural norms, peer relationships, sensitivity, and on and on. Current biological work is beginning to show us is that many of these factors may in fact be related to one and other. The complex development of the eating disorder can be understood as the product of a specific genetic profile that develops in a specific individual under specific circumstances. Rigidity, perfectionism, skillfulness, and skill deficits, that are often seen in individuals with the illness are often mislabeled as “causes” when they are in fact part and parcel of the same developmental picture that may ultimately result in an eating disorder. With continued research of the brain, we are closer to understanding this complexity in terms of a specific biology that causes multiple expressions and can ultimately understood and treated through development and improvement of structures within the brain.
Take a look at this interview with Dr. Julie O'Toole, founder of the Kartini Clinic, on the evidence supporting that eating disorders are biologically based illnesses. Dr. O' Toole does a fantastic job of explaining the biology behind the development of eating disorders and common misconceptions regarding the influence of other external variables:
Parents and Media Not to Blame for Anorexia, Doctor Says
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Do families cause eating disorders?
Really, we don’t need to write a post longer than that one word. In fact, there is no evidence that families cause eating disorders, and there has never been any evidence that families cause eating disorders. There has been a significant amount of unfounded and unjustified suspicion over the years about families and causation, which is not unique to eating disorders. Families have been speculated to be the cause of every psychiatric disorder from schizophrenia to bipolar disorder to autism for as long as these disorders have existed.
On the other hand, families can cure eating disorders. We recently discussed this fact in reference to the new data on family based therapy. Some people might ask: “If families can cure eating disorders, doesn’t this imply that they were part of the problem at some point in the past?” Again, the answer to this is no. The fact that families have a role in the treatment and in fact are the most powerful catalysts in helping their children does not in any way imply that they had anything to do with causation. It would be no more true to link these two things than it would be to say that doctors who prescribe chemotherapy cause cancer.
So no, families do not cause eating disorders. But they can cure them. For more information on the effectiveness of Family Based Therapy, please visit the following links:
New Research on the Maudsley Method for the Treatment of Anorexia
This is an article from the Swedish medical data bank on family education and development of Eating Disorders. It is one the first epidemiological studies of this sort. The information may not be complete, but it is an interesting addition to the literature. Check it out below:
Note also that very few patients got any treatment at all. Hopefully we can change that.
There are a great number of therapists and programs that treat eating disorders. Since there is no national qualification to be an expert, it is crucial that the patient and family know if therapy is working as soon as possible.
When you first meet a therapist or talk to a program, find out why they think they know how to treat eating disorders. If they say they’ve had training, ask where and when their training was obtained. If they say they have treated other patients, ask how many and if the therapist has tracked their progress. Training and experience are crucial. Expert care for eating disorders is almost always needed to see improvements.
It is important to remember that all effective eating disorder therapies involve changes in behavior. If treatment for your eating disorder is working, your eating disorder behaviors should be lessening. The behaviors that should be decreasing may include:
People may be surprised to learn that talking about your family and the cause of your eating disorder are not effective ways to reduce behaviors. These are things to discuss after your behaviors have ceased. Because nobody really knows what causes an eating disorder, therapies that look for causes before symptoms are under control are likely to be ineffective. If you are being told that you have to know why you have an eating disorder before it will get better you probably are not getting effective therapy.
Next week: The importance of getting treatment early on.
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