Twitter / Remuda Ranch

“Families are very much a part of the puzzle of eating disorders. There are [many] reasons why a person has an eating disorder.”

I am going to quote my first therapist on this one.

Parents, "how does this make you feel?"


  1. As a 'non-tweeter', I have yet to get the point. Is the tweet like a haiku? Is it supposed to be clever, or thought-provoking, or just short? What is the point in being succinct if you are so ambiguous that your statement has no meaning? Are Remuda advertising their services with this? (and, if so, to who?)

    How does this make me feel? Like laughing, or perhaps crying - I'm not sure which.

  2. [Disclaimer: I'm not a parent of someone with an ED. As for now, I'm the "person" in my family with the ED. My daughter is almost three, and I hope that she doesn't inherit this from me.]

    At first reading, this sounds so blaming and negative. It makes me cringe and hope my parents never see things like this, even though I know they have.

    But what about this take on it:

    If we grant that there are many reasons a person has an eating disorder, and if we grant that families are a very much a part of the puzzle of eating disorders, then doesn't it make sense that families would be part of the "puzzle" of recovery and healing from an eating disorder?

    My family played and still does play such a crucial role in my continued remission. There were many reasons why I have an eating disorder, and my family helped me find some of those causes and actively helps me confront issues I face (such as feeling like I'm unworthy of being heard).

  3. As a parent, I would not trust the health and well-being of my kid to any treatment center that subscribed to this point of view. For more than thirty years, the hypothesis that parents and families cause eating disorders has been around. Entire careers have been based on trying to find out how. But the research has come up dry. It's now time to move on and make progress. I'm afraid the person who made this statement about families being part of the puzzle is stuck in old ways of thinking.

  4. The statements leave me feeling confused. I would want further clarification. What exactly do they mean by "part of the puzzle"? Do they mean causes, support for treatment, genetic heritability?

    My H and I provided the genes for our daughter with an ED, so to the extent that ED is genetically inherited, then we would accept responsibility for that. (There have been no other EDs in either of our families that we know about.) As far as our parenting behavior, my H and I are confident that we are loving, supportive parents who provided everything a child needs for positive development. We have another child with no mental illness. And we have supported our D through years of EDs, mandating treatment when she was a minor, and supporting treatment for her now that she is an independent adult.

    What is their list of "[many] reasons why a person has an eating disorder"?

  5. As someone with an e.d, I could not be more in agreement with Remuda's statement (and Remuda and I certainly do not always agree).

    Do I think that families are part of the puzzle? Absolutely. Does my treatment team also acknowledge that fact? Yes. Does this mean that I or my treatment team blames my parents? Absolutely not!!

    Simply, it means that we all acknowledge that family dynamic and environment (to which *I* contribute as much as my parents and my sibling) can play a part in the development of the eating disorder. And acknowledging that is not about placing blame, nor is it about saying that the family or parents are a root cause. It is merely pointing out that we need to consider family dynamics, communication styles, etc., ALONG WITH other factors like neurobiology, genetics, societal ideologies, life experiences, etc., etc.

    What about thinking about this the other way around. How might it make an eating disordered person feel to assert that the family does is not very much a part of the puzzle? To me, personally, it is incredibly guilt-inducing, isolating, and frankly, it feels unjust. Eating disorders do not develop in a vacuum.

  6. forgive me, my caps aren't working for some unknown reason.

    if you substituted the words...heart disease, diabetes, autism, depression, etc...in your last two paragraphs, instead of ed's, i think you could make an argument for the environment (family included) as in some ways contributing to or maintaining these other illnesses also. but, in none of these illnesses that i know of are parents routinely separated from their ill adolescents for weeks on end during inpatient hospitalizations or excluded from therapy sessions to the point that they primarily act as chauffeurs and often know little about what is going on. Nor, with these illnesses are they routinely questioned about the possibilities of sexual abuse, etc. nor, upon admission are patients told they are going to be 'helped' to figure out why they 'chose' these illnesses (eg, as in stopping eating with an ed).

    do you see the difference? the shame, guilt and anguish visited upon families, most often without good evidence? there is a different standard for eating disorders than for other illnesses.

  7. Oh yes, I absolutely see the difference. However, I would hesitate to equate the treatment that you mentioned, which, while it unfortunately does occur, is a skewed model of "individual" based treatment with "individual" treatments writ large. And I put "individual" in quotes, because any responsible, informed e.d. treatment program includes the family (or other support members if appropriate), even if their model seems individualized.

    The kind of treatment that you described is absolutely shame-inducing, alienating, and irresponsible. I couldn't agree more. But there are many, many treatment facilities that provide individualized care without falling into the traps that you mentioned.

    For example, the vast majority individualized programs that I know of encourage family involvement through family therapy, support groups, and programs geared specifically to help support and give recovery tools to the loved ones of people with eating disorders. A responsible "individualized" treatment program works to draw in the family, does not blame them, AND also allows the person with an eating disorder a safe space that is her/his own, something that many people with eating disorders do not feel they have in their general life.

    As far as residential treatment programs go, they generally encourage family involvement oftentimes. However, there are bigger forces at work here too. Frankly, there are not that many residential treatment facilities for people with eating disorders, so this means that people sometimes have to be away from family. I think this is an issue of lack of care facilities, however, and not an issue of the treatment facility specifically which, generally speaking, would like to have family members more involved. It's also a matter of insurance/cost. Getting insurance to cover the cost of one person in a treatment facility is oftentimes impossible, but then add to that the cost of taking off work, traveling if need be, lodging, etc., and it's just out of reach for many. But, again, I would not look at the treatment center as the problem, but rather, our country's health care system, work benefits, etc.

  8. If Remuda has figured out what causes anorexia nervosa, why doesn't it publish the answer so the rest of us will know?

  9. Laura,

    I'm so glad you posted about this. I saw a "retweet" of this (I don't "follow" Remuda so I didn't see the original) and it's one of those things that is factually correct but insinuates so much, most of it negative.

    My current therapist looks at my family as a whole and tries to figure out where we do well and where we need help to do better in fighting my ED. Are some of my parents' quirks part of the puzzle? In a sense- anxiety isn't particularly noteworthy because we all have it. We're all perfectionistic and more than a bit compulsive, each in our own fun little way.

    The problem is that Remuda and every other treatment center out there says that they are family-friendly and that they don't blame the parent. No, they just help the parents heap the blame on themselves. Or ask the parents to do some good soul-searching and self-flagellation and beg their children for forgiveness for giving them an eating disorder. That's not to say that environment and family are irrelevant to how an ED develops, but Remuda tends to treat parents as a piece of the puzzle that needs to be fixed and/or removed.

    But I guess maybe Remuda (and other treatment centers) needs to stop looking at family and culture and so on and asking why. What treatment centers need to do is ask how families and friends and society can best support someone moving towards recovery. Thom Rutledge perhaps says it best: "Learn from the past, then get the hell out of there."

  10. I was the retweet; I confess! ;-) And, I was actually hesitant to follow Remuda on Twitter because there are some things about their treatment program that definitely worry me.

    Remuda is far from perfect, and they certainly don't have anorexia "figured out." (Though I don't think they were claiming that in that tweet, since they still referred to e.d.'s as a "puzzle.") Anyway, I'm going to step off Remuda b/c this is bigger than them.

    I don't think it's fair to make a statement regarding "every other treatment center," because, well, none of us have been to every treatment center. Yes, there are treatment centers that claim not to blame the parent and then either do blame parents or cause them to blame themselves. It's not productive, it's not helpful, and it does happen. AND their are treatment centers that treat both the individual and strongly encourage family/parental involvement without placing blame. They may be few and far between, but I am hopeful the model is catching on.

    And, for some people, taking the time to work out past events/dynamics/experiences that may have encouraged the development of an e.d. can be helpful. Each person is different. Should we linger on that and pay attention only to the past? Of course not. I agree that we can examine it, deal with it, learn from it, and MOVE ON. Absolutely.

    Yet, if we are not open to looking at how family dynamics (and, as I mentioned before, this is not about blame or about looking at a only certain members of the family; it is about dynamics which include the person w/ the e.d.) may have been a piece of the e.d. puzzle, we risk dragging those past dynamics into the present/future.

    I did not think the Remuda treat was placing blame. I think that it was - rightfully, in this case - encouraging acknowledgment of the roles that everyone in the family plays. If we look for parent blaming, we can find it, perhaps in Remuda's tweet (or in their treatment, unfortunately). If we look for people who claim the FBT model was harmful to their relationships w/ parents, we can find that too. I actually started following this blog b/c those were the experiences I had heard, and I wanted to hear something else because I think it can be unproductive to take any extreme (whether that is extreme individualized treatment or extreme family-based treatment) and generalize that. There are many treatment centers and families out their engaged in healing, balanced, blame-free treatment that meets eating disordered individuals' different needs. And I think that, for some (if not many), one of those needs is being able to talk openly and honestly, without blame or shame, about the family environment and dynamics. I read Remuda's tweet as trying to encourage that.

  11. Oh! And like someone above said, acknowledging family dynamics as they may have been present as one of may pieces of the e.d. puzzle also allows treatment centers to move on from the past and acknowledge the importance of the family as a positive and supportive agent of recovery.

  12. I'm on my phone, so forgive me if I'm not quite as thorough as usual.

    I'll admit my bias from the start: I don't trust Remuda at all, and I'm skeptical of almost every other treatment center out there. The way I've seen most treatment centers look at families has been in a negative-blaming way. When they say "piece of the puzzle," it usually implies "part of the cause."

    Perhaps the clincher is that evidence-based treatment facilities (U Chicago, Stanford outpatient, UCSD, Kartini) don't really look at families as a piece of the puzzle. They look at families as resources--imperfect resources, perhaps, but resources nonetheless.

  13. Here is an explanation from Remuda on how they feel about familes and eating disorders. I am so thankful that I did not send my 11 yr od daugther thousands of miles a way and pay for her to have her brain washed on this garbage.



  14. I think Remuda and other residential programs have a conflict of interest that makes it difficult for them to be objective about families. The more they stir up conflict in the family, the more families will decide they cannot treat the eating disorder in the home and will send their kids to a treatment center. That, of course, brings in more money for the treatment center. Google Remuda and you'll find it is owned by a private equity investment firm that is in business to make as much money as possible. Remuda hires many family therapists whose employment depends on families being willing to subject themselves to the "you families are a major cause of your kid's illness (but we don't blame you)" school of thought. It is obvious to anyone following the health care debate in the US that the medical treatment industries are rife with conflicts of interest that distort treatment decisions. Remuda and other residential centers are no different.
    I'm not saying residential centers should never be
    used. But I am saying parents need to be aware of the conflict of interest and should be very cautious.

  15. I agree that Remuda is problematic in a lot of ways. I'm skeptical of . . . well, a lot. I don't want to go off on them here though, b/c this isn't really "about" Remuda.

    Carrie, I agree with your statement that a lot of treatment facilities (and a lot of independent e.d. treatment "specialists") are problematic. I think that it really speaks to the complexity of this illness and the treatment of it. And I'll admit my bias; coming into this, I had heard one good outcome from FBT and a slew of negative ones. So that made me skeptical.

    I don't say that to cause an argument, but rather to point out that there are ALWAYS negative tales to tell. And, there are many facilities and families doing amazing work with/for eating disordered people. Let's face it, some people don't recover from eating disorders. For some people, it takes multiple rounds and kinds of treatment. And often research funds go to finding a biological cause rather than really looking at treatment modalities and out comes (the research is there, but it's not as much as many of us would like). I think there will always be negative treatment experiences, but this is perhaps especially noticeable given the complexity of these illnesses and the fact that we are still learning how to treat the - and there is no "one size fits all" treatment method.

    I guess my point is that it is possible to look at the family - Remuda's methods aside - without placing blame, and I think that can be valuable for many people with e.d.'s and their families.


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