Parents do cause oranges!

My dear friend Malia made an excellent point recently (she makes so many of these, routinely) when she looked at the staggering kerfuffle over at Poppink's blog (also being played out on the AED forum, the ATDT forum, the Somethingfishy forum, in this blog's comments, and in my inbox...). Malia said we're talking apples and they're talking oranges.

At least its all about the food.

She's right. This comment on my blog kind of articulates it: "While there are parents out there that do care. That are in no way responsible for their children's eating disorder... there are parents that were a large contributing factor to their child's development of one.My parents were certainly the largest contributing factor to mine. The reason I like your blog is because it has shown to me that some parents do care about their children enough to want them to get help for their eating disorders... My mother used to call me a fat ass day after day, among other actions and words.When she found out I was abusing diet pills, diuretics, and laxatives... she didn't get me help - she asked me if they worked and started taking laxatives herself."

If you think of an eating disorder as dieting, feeling bad about yourself and your body, and struggling to find yourself in life - and to many people that does define an eating disorder - then sure, parents can cause an eating disorder. Parents can abuse, neglect, hurt kids and leave children wounded, emotionally disabled, permanently victimized. Parents can commit "relentless boundary invasion at every level" and do horrible damage. Parents can push or allow a child to diet, binge, self-harm, purge. And without a doubt, parents can transmit negative body image and self-doubt and insecurity. But is that an eating disorder?

When I speak of eating disorder I'm talking about a mental illness. I'm talking about a brain condition where the behaviors of restriction, bingeing, purging, body image distortion, obsessional thinking about food, and social isolation are SYMPTOMS. I'm talking about a phenomenon that happens to people with a genetic predisposition and only under certain circumstances. This brain disorder doesn't discriminate - it strikes happy healthy families and wretched dysfunctional families. Anorexia and bulimia and their variants may look, in early stages, like dieting and compensating and our culture's (stupid) obsession with looks, but I'm talking about a very different fruit here.

The problem is that they look similar at one end of the spectrum, and an eating disorder starts out looking like something we recognize. And - this is the important intersection - dieting TRIGGERS the mental illness we're talking about by setting off something in the brain that the person afflicted isn't consciously aware of. Dieting (or losing weight accidentally or failing to fuel growth or activity) triggers eating disordered thinking in the brain for a certain percent of us.

I'm talking about a mental illness that malignantly takes over a person's life and personality and tries to kill them. I'm talking about something that isn't a choice, and the person can't be talked out of or reached rationally. This apple is poisoned and requires outside intervention to be revived from.

Mistaking apples for oranges here is serious stuff - recoveries are stalled as we lose time trying to make orange juice with apples and wondering why our apple pie is so citrusy.

Thank you, Malia, and thank you Kat, for helping me sort the produce here. Neither of you should be held responsible for the tortured orchard of analogy here. And Kat, I am so sorry your mother was so ineffective and hurtful. I fear she may have an eating disorder herself and that is no position to raise children. With a time machine we could go back and heal her so she could have better nurtured you!


  1. All I can say is that I hope I did some good on Something Fishy while I was there.
    Blocking someone on an "assumption" revealed a narrow minded approach to dealing with a serious disease. It also undermines my ability to discriminate and speak freely about this. I HAVE been silenced, it seems, and I will no longer tolerate this type of CONTROL. How ironic is that?
    Sadly,I think "some" see your approach as the narrow one which means they are not truly listening.I've always heard and seen that you understand and recognize that there can be much work when treating an ED. Behaviors can be worked on, parents and loved ones educated. Nourishment is only stabilizing the building.
    There is still too much treatment that BLAMES everyone else and wants the sufferer to spill their story while still starving and continuing life threatening behaviors.(for years no less) I feel this is wrong on every level, beginning with medical ethics. "Do No Harm" needs to be remembered.
    I have a great deal of respect and understanding of what you say Laura.
    I also have a hunch that there are spiritual lessons for our own growth during this life time. Does this mean I want to sit around and chew on all the wrongs that others have done to me...well perhaps sometimes. Then I wake up and realize it's not where I want to be as it holds me down. There are all sorts of parents out there beginning with loving. There are also neglectful, loopy, certifiable, some who are fact our society is oppressive and controlling.The way to deal with this is to empower. Blame takes away my power. This causes harm. How simple is this...that bad medicine does harm.
    Your path is compassionate. I know this. So do those who get what it is you hope to see happen.

  2. edit my post as you wish! I had to delete a whole bunch myself. LOL

  3. If eating diorders know no boundaries then a cross cultural study would find it any population. Right?

    We don't see it in starving African populations or third world countries where affluence is not a reality.

    My take is that it's an "egocentric" disorder. Western societies are hung up developing individual ego identity. In third world countries where adequate food is barely enough, communities operate more from a group ego consciousness.

    Maybe its the difference between Californian Oranges and Cassava

  4. Thanks for explaining it this way. I've always known that supposedly EDs were "illnesses" and "not choices." But I never could quite figure out how that is true for me. I always figured that nothing traumatic happened to me before the ED so how could it be a mental illness. I mean, all in all, I had a good child hood. Yet I've technically had an ED for about 7 years now (this 7th year is way better than the first 4...). I always thought that I just went on a little mission to "get healthy" 7 years ago and got a little obsessive about it. But since there was no big trauma, it must somehow be my choice that I just can't/couldn't stop making. I've never heard it explained that the dieting TRIGGERS something in the brain. That makes a lot of sense in my case. Thanks!

  5. Laura, I really like the poisoned apples/oranges analogy. Thanks to Malia and you. In our family, my sister and I are the oranges, and my D is the apple.

    Kat, thanks for your very personal, heartfelt story about your mother's negative behaviors and your subsequent ED. I am so sorry for your suffering.

    My own daughter has EDs and various co-morbid mental health issues. With all the discussion of this "boundaries" issue, I have been doing some thinking about my adolescence. Back in the 60's my sister and I were both in the "overweight" category of today's BMI calculators. Neither of us expressed any unhappiness with our body sizes, but my Mom sent us to YMCA programs for weight loss that included diets and exercise. When our weight losses didn't stay off, she gave us her "diet pills", which were actually amphetamines. I remember the buzz from these pills and losing weight effortlessly. I also remember my suicidal gesture in junior year of high school, but I never did manifest an eating disorder. I thank my lucky stars that I didn't have the genetic predisposition for one.

    My own D was always around the 50th percentile for her age, and I never said one negative thing about her body. I appreciated the strength and coordination she exhibited in her sport, encouraged her non-sports activities, and we ate delicious family meals, with a large variety of foods and snacks, with no hint of concern about body size from my husband and I. But, on her own, my D decided to lose a few pounds and soon was lost in the grip of anorexia at age 11. So my D never had that relentless boundary invasion, but did have that predisposition.


  6. Laura, you have done and continue to do so very much for the field of sufferers and parents/carers and have undoubtedly helped save lives through transforming thoughts and blame. Please keep sharing your thoughts and truths –in doing so, you prevent the suffering of so many.
    Though, I’m concerned that separating eating disorders into apples or oranges undoes some of your tireless and progressive efforts of enlightening so many to “parents are not to blame for eating disorders.” I rather see what we’ve all been discussing since Poppink’s comments arose, as a ‘gray’ area/shade of “yellow” in a pool of oranges and apples. Like water in a pool mixes from the shallow end to the deep end, I think apples and oranges in this comparison, also are fluid. And if we try to separate the shallow end water from the deep end water, we’ll forever be struggling to separate the water, when what’s really important is to accept the fact that water is a fluid substance (unless of course we use chemistry to change it’s actual form). ~ Of course most of your readers are aware and agree that the formerly written-in-stone camps of “parents do cause eating disorders” and “parents absolutely do not cause eating disorders” is a divisive two-camp mentality and did/continues to do such a disservice to all involved. I can say with confidence that your intent here is not to separate, but rather to further understanding and to awaken others to a newer/improved way of viewing the variable causes of eating disorders. But I'm not sure everyone will 'hear' what you were trying to convey in your entry here's some added support:
    I hear and comprehend on the visceral level what you are saying about, “A parent cannot cause a mental illness!”, and also hear you acknowledging that a parent can influence the symptoms that lead to the mental illness. So, I agree with you. But I think there's also this to consider: The universal understanding is that Eating Disorders are a definitive mental illness, a brain disorder, including disorders of the thoughts/behaviors, and of body physiology. These are not separate, but co-occurring, at varying levels throughout the duration of the disorder/disease. If we begin to separate symptoms/cause from what constitutes the disease, into the classification you described as “brain condition” vs “eating disorders”, we open a door to the past of mis-educating, under-preventing, and mal-treating those affected by eating disorders, including parents. (eg.: we cannot dissociate the dangerous consequence of environmental factors such as dieting, because not all eating disorders are caused by dieting.)
    And while I know you, Laura, and know that’s not what you seek to do, I felt like this some might not understand your knowledgeable and wise intent behind saying, the “poisoned apple needs intervention to be revived”. I know that you are aware that re-feeding alone does not make the poison disappear and does not make parents like Kat’s transform their thinking. The revival of the apple is one necessary, uncompromising, and vibrant component of creating a recovered physiological brain –AND psychological brain, which, of course, is connected to the body. Brain chemistry and brain cognition are not separable when it comes to complete recovery; you cannot have one without the other. So, I think we must keep in mind (when serving sufferers, carers, insurers, providers, etc.) the question: can you have one without the other when talking about causes?
    I think we need not to completely separate oranges and apples when discussing eating disorders. I think we need to raise the bar for all involved, especially the parents, sufferers, researchers, and the clinicians affected by eating disorders, and take a Broccoflower approach: discuss eating disorders causes as “Orapples”.

  7. First:
    I think that the point that's missing is that the no boundaries issue is what's drawing the predisposed mental illness to the surface.

    Second: I was reading the comments and as for why we don't hear about reported cases of eating disorders in third world countries... it's because as put, they are starving, so not eating would not be a change. I'm not sure if that makes sense... but not eating as a way of coping, a way of dealing, would not have the same effect if you were not able to consume much food anyway.

  8. Such a rich set of comments.

    One by one:
    Mary, did they throw you off Something Fishy, too? I'm sorry. There's a real problem over there!

    Carolin, my guess is that populations that have recently or chronically known famine would have culled the ED genes out. But I also note that EDs are seen in all cultures and areas of the world. If you go into the literature there really isn't anywhere they don't exist. But it does seem the moral element does play into this - self-starvation is different from that imposed from the outside.

    Now is now: I'm so sorry no one has offered that idea to you during treatment. I would really like to see that as a basic element to what patients and their families learn at diagnosis.

    Kristine, isn't it interesting how when we reframe these issues we see the past in a new way?

    Kathleen, I think we CAN say that parents never cause eating disorders, and we must. Do parents sometimes suck? Yes. Do they sometimes force their children to do unhealthy things, yes. But it is a really important and not extreme viewpoint that you can't make someone have an eating disorder any more than you can make them have diabetes.

    I'm sure there is some cross pollination on this issue, but I've got to stand by the analogy for this purpose: because it matters in treatment. Parents need to know from the get-go that guilt and blaming must be left at the door. And at the same time, society has to deal with it's orange issues NOW and FULLY and not just in the case of eating disorders.

    And Kat: here's how I look at the boundary thing. That sense that one's boundaries have been invaded is a symptom of this mental illness, just like sadness is a symptom of depression. I have seen no evidence whatsover that patients actually experience any more boundary invasion that anyone else.

    Phew. Sorry for the long comment!!

  9. Let's just say the winds have changed and leave it at that.

  10. At first I regarded the EmpowHer article as simply a smashing example of antiquated, outdated thinking on EDs. I'd read it before, and kind of rolled my eyes, and ignored the kerfluffle for a few days. I knew it was there but never investigated.

    But NOW I'm realizing this: it gets at the heart of what is wrong with some of the thinking on eating disorders. At the root of the chasm between Poppink's thinking and the more modern research-oriented thinking that you (and others like you) do is really about what cuases eating disorders? And not only that, but what IS an eating disorder? These are NOT rhetorical questions and they NEED study, they need research, they need answers.

    Although I write frequently on the importance of genetics and biology in my blog and on my random soapboxes (my mom has probably earned an advanced degree in genetics through my ranting), I would never discount the importance of environment. Bad parenting is important, and bad parenting SUCKS and can cause HEAPS of damage in a child's life. Good parenting can make a huge difference in a vulnerable child's life. But I truly do not think that a person can develop an eating disorder without the neurochemical background even with the most horrific of experiences. Trauma does change the brain- look at PTSD. But some people are far more vulnerable than others. It's the same with eating disorders.

    I really wish that every treatment provider out there would read this post, and if I didn't get nods in agreement, I think it would be a pretty quick way to screen out those who weren't up to date on the latest thinking on EDs. (Stephanie, you are nodding, aren't you? :) )

  11. It's funny. My dreams were influenced by this post last night. I dreamed my family sat at a round table eating a regular meal. I sat alone eating a small ORANGE. My dad gave me kudos for eating healthy. I became very angry at him and threw the rest of the orange on the ground. I refused to eat anymore.

    I'm not sure if I agree with dividing things into apples and oranges.

    I'm not sure what the benefits would be.

    I never qualified as being Anorexic. I quickly lost enough weight to be underweight. I OBSESSED with food and weight. I compulsively exercised. But I didn't do enough damage. Does that mean I didn't have an eating disorder? Does that mean I'm an orange instead of an apple?

    We can sit there and say I didn't have an eating disorder. But I feel that's wrong. My eating disorder might not have been as extreme and dangerous as other people's. But I think I definitely had a problem. I definitely think my eating was DISORDERED.

    I think it would be better to recognize 2 things.

    A) There are varying degrees of eating disorder severity. Some people have cases that are so severe, they will end up killing themselves if not prompt attention given. Other people have eating disorders which are just as emotionally destructive, but they're not in immediate severe physical danger.

    B) The cause of eating disorders is both genetic and environmental.

    I know there are parents out there who want to believe it's all genetic. And I understand the benefits of that. No one wants to believe we caused our child's problem. And I do think blame and guilt can get in the way of treatment. I think it beneficial for parents to get the message. "Hey, this is not your fault at all. But we do have great ideas on how you can fix things for your child."

    That's a great empowering message for parents.

    I'm just not convinced it's 100% true.

    I do think ED is a disease like any other. But I also think MOST diseases have both genetic and environmental factors.

    For example, there's skin cancer. Some people have skin that makes them more susceptible. There's a genetic component to skin cancer. But environment also plays a huge part.

    Let's say a parent has a child with fair skin and freckles. They let the kid play outside all day with no sunscreen and hat. The child grows up and has skin cancer. Should we say to the parents "Hey, it wasn't your fault. The child had the skin cancer gene."

    No. I don't think so.

    With what we know today, it's irresponsible to allow ANY child to spend that much time outside without protection. These parents did a BAD thing. I think they are to blame. If they had been good parents and put sunscreen on their child, the child probably would not have gotten cancer.

    I think if we start looking at diseases purely in a genetic way, we stop taking responsibility.

    If we think of diseases as purely environmental, than we take TOO much responsibility and we pass around too much blame.

    I think it needs to be a combination.

    I think we need to realize that certain people have genes that make them vulnerable to eating disorders. But if they're protected and nurtured the eating disorder won't happen, or it will be quickly nipped in the bud.

    The problem of course is that EDs are easily triggered. And it's NOT always the parents who do the triggering. But sometimes it is. Sometimes parents say and do things that are very wrong. It's not just that they shouldn't be saying these things to people with the ED gene...they shouldn't be saying them to ANYONE.

  12. (continued)

    My guess is this is what happened. There are these wonderful loving caring understanding parents out there. Their teenagers get an eating disorder. These parents are blamed and they shouldn't be.

    These parents get their children prompt treatment. They don't see their ED children as attractive. They're not proud of their ED children for looking like models. They know their child is sick. They want to save their child's life.

    These parents did nothing to harm their child. But they do everything in their power to save their child.

    I think their one mistake is believing other parents out there are just like them. It's sadly not true. Some parents are very shallow. They'll be happy to see their child getting thinner and thinner. They'll be proud. They'll encourage it.

    I think the children of both types of parents have the same disorder. They both have the bad ED gene. They both had something that triggered the gene into action. For some children, it is the parents who did the most triggering. For other children it is something else.

    Maybe instead of dividing people into apples and oranges, we can recognize that there are different types of apples. They're all still apples, but each type is a little bit different.

  13. Dina,
    You said exactly what I was thinking but you're much more eloquent than I am.

    For some children the ED is triggered by dieting but for some of us, it is our lousy parents who trigger it. There is plenty of evidence that STRESS can cause changes in the brain. And believe me, being abused is very stressful. My experiences did not just affect me in a wishy-washy "emotional" way. I am convinced that being abused also f-ed up my brain chemistry.

    For those of us who really did have bad parents, it is very invalidating to hear other parents say that it is purely genetics. We want to have our experiences acknowledged too.

    This was my favorite quote,

    "I think if we start looking at diseases purely in a genetic way, we stop taking responsibility.

    If we think of diseases as purely environmental, than we take TOO much responsibility and we pass around too much blame.

    I think it needs to be a combination."

  14. Please, please hear me: I am not saying that bad parenting is okay. I'm not saying parents don't need to change or that some have not done damage. In fact, my whole message for six years has been the same: that parents DO need to step up. We need to react to the illness properly and do whatever it takes to help our children.

    You can have an eating disorder AND HAVE TERRIBLE, DAMAGING PARENTS. It does not invalidate one's experience of having bad parents to say that the issues are separate and BOTH important. People who have been abused or trespassed on need help, sympathy, treatment. No parents should ever be insulting their children or criticizing their appearance, ever.

    But we need to be good parents FOR ITS OWN SAKE and not because of an eating disorder. Why should we have to have an eating disorder to get attention to these issues? Why would we only care about our society's body-hating if it causes eating disorders?

    Parents need to be treated with the benefit of the doubt and not assumed to be pathological on the basis of having an eating disordered child. The legacy of blaming parents isn't a problem because it hurts parents but because it hurts PATIENTS and families.

  15. Laura,

    I agree. Parents DO need to be treated with the benefit of the doubt...DEFINITELY. I just read some of your post about schizophrenia. I get what you're saying.

    I also agree with what you say also about society. We shouldn't need an eating disorder to get attention for these issues.

    I just don't like dividing problems into apples and oranges. Maybe simply because I don't know which fruit bowl to put myself in.

    My parents were never horribly abusive. They're good people. At worst I'd label them as shallow and ignorant.

    My eating disorder started innocently. I went on a diet. I've been on diets before, but for some reason this one turned into an eating disorder.

    My parents didn't do anything at that time to cause the eating disorder. Once it was in place though, they definitely did things to encourage it to continue. I can't say this encouragement is what made it continue though. Who knows....

    As a child and teenager, I received a LOT of invalidation from my parents. I've read that this can cause eating disorders. So then I CAN blame my parents perhaps.

    Or maybe not. Maybe my eating disorder gene made me a difficult child to deal with. Perhaps my parent's frequent invalidation was in response to what they found to be a very challenging child.

    I think maybe it should be about giving the parents the benefit of the doubt. But recognizing that the ED gene needs to be triggered somehow. And sometimes it's the parents who either do the triggering or encourage the ED to continue.

    I don't believe there is an orange ED. Parents can be awful to a child, but if the child is not predisposed to the ED, they won't develop ED symptoms.

    I think all of us ED people are I said before. We all have that horrible seed within us. It's just we all have different things that make the seed grow.

  16. Dina, when I hear what you are saying I think "AND" instead of "SO."

    Your parents invalidated you and encouraged your dieting AND you had an eating disorder. This sounds and means something different than if you use SO.

    Your parents should not have treated you in this way, and it must have made it cruelly difficult to recover under those circumstances. I wish I could go back and talk with your parents and explain what an eating disorder really is, and how they could help you.

  17. I'm really glad freed foundation replied so eloquently- I don't think I can say it better.

    Are you familiar with the serotonin receptor studies? Having a certaib mutation increases your risk of depression et al *if* combined with a neglected childhood. Other neglected children will not get depressed- other mutations result in depression almost entirely independent of the environment.

    It doesn't mean both conditions aren't, ultimately, brain disorders.

    It may mean that different treatments are needed. I had enjoyed reading your blog because it provided a refreshing perspective and addressed the physiological aspect of eating disorder mentality. For me, recognizing this (i think like an anorexic when I am starving myself, starving changes my thoughts, eating helps me think like *me* again) has been tremendously helpful in making the anorexia increasingly ego-dystonic. Along with (non-blaming, I'm 25 & haven't lived at home for >8 years, this isn't about my parents) psychotherapy, fixing my intake (even when I 'dont want to') has helped me make great strides.

    I think you're doing a disservice to separate this into two distinct disorders. All anorexics need nutritional rehab to restore normal brain chemistry. it is a biologically based disease in all cases. Some patients need a different kind of therapy to address problems from childhood. Others, and I put myself in this category, need therapy because their ed stunted their emotional growth & created so many more problems. And of course, this is a spectrum.

    I'm a cancer researcher, and would never want to delve into this murky world of research professionally for a number of reasons. But think of a patient with lung cancer- sure, most lung cancer patients were smokers. Some lung cancer patients never smoked, and obviously don't need smoking cessation interventions. All patients with lung cancer all ill, and all need chemo. They aren't such different diseases.

  18. Actually, I'm not saying there are two disorders. I'm saying eating disorders are a mental illness - a brain disorder.

    I'm saying people who are on unhealthy diets and dislike or hate their bodies don't necessarily have an eating disorder.

    Does that clarify?

    Treatment for the former should not be treated as if it is the latter.

  19. I agree with FREED and Dina.

    I agree it is a mental health illness. To say it is a pure brain/genetic disorder and does not have any other triggers than dieting seems extremely narrow to me.

    I agree that some disordered eating is in no way an eating disorder. There are plenty of people out there who diet, obsess a little about being thinner etc. This is not the same as the all-encompassing annihilating anguish of a true ED.

    My understanding of genetics is that switches turn genes on and off. There are very few situations where the gene is just there and causes a complaint without any contributary factors.

    Stress and trauma can and does change brain chemistry in the same way that non trauma triggers can do. This happens in other conditions such as depression.

    Ask yourself this question: why is it that some people with severe ED's are very easily and effectively treated with therapy?

    I can speak from personal experience. After suffering from an ED for 27 odd years I received psychodynamic counsilling. Without once addresing the behavioural aspect of my ED it went away as a result of correcting the disordered thinking I had and re learning emotional awareness skills. I delat with pain and trauma from my childhood and that lifted the mindset immeasureably.

    I do realise that I would not have been well enough to do this if I had been severly undernourished at the time but I did not get rid of the ED (in my head) until I fully dealt with the underlying issues.

    I would like to say that I in no way think that parents cause an ED. I in no way believe that parents should be blamed or judged. They need to be treated with the same supportive care that the ED sufferer should receive. However, saying that a proper ED is only caused by genetics and dieting is wrong in my experience and in the experiences of others that I know.

    I would also like to say that people develop a variety of mental health issues: depression, ED's, OCD, anxiety, self harm etc. Why does one person develop one and not the other? I beleive environment is key. It could be peer pressure, personality type,cultural pressures, cirumstance, trauma. In my opinion it does not matter. A mental health problem is a mental health problem.
    Trauma may cause some to develop an ED and others to develop depression. The only relevant issue is that all get help.

    We should be thinking less about who is and IS NOT to blame and more about helping those who suffer.


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