Judy Scheel, Ph.D., LCSW
The search for genetic causes of anorexia and bulimia is a serious and necessary endeavor. Some success has been achieved. But even if a definitive genetic cause is found, it is agreed that there are many components necessary to account for the development of an eating disorder. (see below. ) And if indeed we find the gene what then? Genes may then be linked to “the” root cause, but gene therapy cannot tend to the psychological needs and familial breakdown and issues that have occurred for them along the way. So the question is, “If we find the gene, what do we do then?” Families will still have a child with an eating disorder. They will be looking for ways to help the child and we need to provide therapy techniques that are effective in leading to a successful eating dynamic.
Research into genetic causes has found some compelling results. Twin studies estimate that 50–83% of the variance in AN, BN, and binge eating disorder (BED; a form of EDNOS) are accounted for by genetic factors. These studies have included conditions meeting threshold and sub-threshold criteria for AN, BN, EDNOS (specifically BED and sub-threshold presentations of AN and BN).4–10 Molecular genetic studies have begun to identify chromosomal regions and genes that may contribute to the genetic diathesis (see below Academy for Eating Disorders position paper.)
In addition to genetic causes, the biological roots of anxiety and depression have been researched and are evident in many patients with eating disorders, both before the onset of the eating disorder and often throughout the course of the illness.
Evidence is pointing to other factors in causation and effective treatment approaches. We know that patients with eating disorders have many issues regarding trust, self-worth and self-esteem. Relationships tend to be rife with issues of emotional safety and trust, insecure connections to others, detached or over-involved relationships, and actual or perceived abandonment and rejection. These are what we in the field consider, Attachment Issues.
The overwhelming message from the research literature is of abnormal attachment patterns in eating-disordered populations – more specifically, insecure attachment is common. (see below Ward & Gowers – Handbook of Eating Disorders – Second Ed 2003.)
What is Attachment Theory?
Attachment Theory succinctly states the quality of the early attachment relationship to a parent/primary caregiver is crucial in determining personality, values, and psychological health, including the development of self-worth and self-esteem. Securely attached children use their caregiver as the foundation and “base” to explore their world, and as a result and over time develop a high trust in themselves and others. The parent facilitates this by carefully and respectfully tending to the needs of the child; the child feels safe with the parent. Over time, the safety that the child felt in relationship with the parent is then integrated into the person; self-worth and self-esteem take hold and continues to develop and ripen in the individual throughout life. Strong self-worth ad self-esteem enables the individual to pursue others who emulate these qualities.
Eating disorder sufferers typically utilize their disorder to find security, comfort and emotional stability. Food is used as the relationship of choice often because relationships with people feel less secure and predictable. Food is something that is always available and will bring temporary emotional comfort while simultaneously is a way to express psychological distress.
All of this is useful in understanding the etiology of eating disorders, but the etiological findings don’t answer the vital question parents ask, “What do I do now?” The eating disorder, regardless of the cause, now exists. Eating disorders affect families; families affect eating disorders; there needs to be a way to break the feedback situation that makes the eating disorder worse. Parents need instruction in the best way to handle the situation their family is in.
What has been found is that therapy based in Attachment Theory has been effective in treating eating disorders. I have found all of this to be true in my 25 years of practice. Parents working with their children can improve their attachment with them and reduce the severity of eating disorders.
About the book:
When Food is Family: A loving approach to heal eating disorders is a hands-on working guide for families and individuals with eating disorders. The book demonstrates, through examples and exercises, how to heal, repair and build attachments among family members. The book acknowledges the biological and physiological components of eating disorders. Of course, they are part of the mix. As we know, the causes of eating disorders are complex and multi-causational. There is no one size fits all understanding of cause for all patients and no one size fits all approach to treatment. What we do know is that relationships are affected for all involved. What I am offering in the book is something families can do to help the person with an eating disorder get better starting where they are now. When Food is Family provides an understanding of how food becomes the metaphoric voice, how relationships are impacted and how to change familial patterns of communication and establish trust and empathy so long term recovery can have a greater opportunity to take hold. (Scheel, J. Idyll Arbor, Inc. 2011. Release date October. Available August 2011.)
1. Position paper on eating disorders by NIMH. The NIMH has adopted and adapted a Biopsychosocial Approach to include an understanding of eating disorders. Thomas Insel, MD, Director NIMH, stated, “There are so many avenues to developing an eating disorder. There is no one single cause but rather a complex interaction between the biological issues, such as genetics and metabolism, etc., psychological issues, such as control, coping skills, personality factors, family issues, and social issues, such as a culture that promotes thinness and media that transmits this message.” (For further info go to http://nimh.nih.gov/health/piblications/eating-disorders)
2. Klump, K et al. Academy for eating disorders position paper: eating disorders are serious mental illnesses. International journal of eating disorders. 2009. 42:2 97-103 (Go to www.aedweb.org)
3. Ward, A et al. Attachment research in eating disorders. British journal of medical psych. March 2000. Vol 73. 35-51.
See also Ward A. Attachment and childhood development. Handbook of Eating disorders. 2nd ed. Treasure, Schmidt and Furth. 2003.
See Also Alantar, Z. Eating disorders in the context of attachment theory. 2008. Anatolian Jrnl of psychiatry. 97-104.
Cedar Associates in the Community
Susan Schrott was an invited guest speaker at the Blue Door Gallery in Yonkers, NY for their Women InEmpowerment Series on July 23rd, 2011. She spoke about eating disorders and eating disorder prevention.