"often with positive attributes"

My search for a published, authoritative, unified theory of eating disorder causation, perpetuation, and resolution has ended:

The American Journal of Psychiatry Childhood personality and temperament traits, which tend to be relatively mild, appear to contribute to a vulnerability to development of an eating disorder . Such traits may become intensified during adolescence as a consequence of the effects of multiple factors, such as puberty and gonadal steroids, development, stress, and cultural influences. For anorexia nervosa, there is a dysphoria-reducing character to dietary restraint. In contrast, for bulimia nervosa, overeating is thought to relieve negative mood states. But chronic pathological eating leads to neurobiological changes that increase denial, rigidity, depression, anxiety, and other core traits, so that patients often enter a vicious circle. This results in a out-of-control downward spiral whereby a significant proportion of patients develop a chronic illness or die. Fortunately, a substantial portion of those with anorexia nervosa and bulimia nervosa recover by their early to mid-20s, although mild to moderate degrees of temperament and personality traits persist, often with positive attributes."

All else, as a great philospher said, "is commentary." The above paragraph is all we need to know, really, to re-orient ourselves and steel ourselves to the task and be OPTIMISTIC. Well, some of us also need it translated into English, but that's what good clinicians and advocacy organizations are for.

This elegant diagram paints the picture:

I don't know if they give a Nobel for this sort of thing, but from where I'm sitting I think we should start a new prize called the "Kaye Award" and give it to Dr. Walter Kaye first.


  1. Hear, hear! Fantastic! My D was "anxious, perfectionistic, obsessive, etc." as a child, and her ED started at age 11 with the progression noted by Dr. Kaye. I'll vote for him to be the first recipient of the Kaye Award.

  2. Dang, I so hate to nitpick my very fave ED homeboy...but...

    "Childhood personality and temperament traits, which tend to be relatively mild, appear to contribute to a vulnerability to development of an eating disorder . Such traits may become intensified during adolescence as a consequence of the effects of multiple factors, such as puberty and gonadal steroids, development, stress, and cultural influences."

    I take issue with this statement. How I love Dr. Kaye and all the work he has done! But whenever I read this kind of thing, I think: there is still that taint of Old School thinking in this.

    My anorexic daughter was NOT anxious, perfectionistic or OCD at any time in her childhood. She was a well-adjusted, emotionally-flexible girl and continued as such during puberty. DIETING led to the denial, rigidity, depression, anxiety, etc he describes later. And how! But it was NOT present before, and now that she is recovered, she no longer exhibits those traits (okay, we are still working on the rigidity, but it's improving).

    I hate this labelling because it prevented me from seeing what was in front of my very eyes. I was aware of EDs (they run in my family) and did my best to prevent them. But having this so-called 'anorexic personality profile' in my mind blinded me to seeing it in my daughter. In fact, I was watching the OTHER daughter--who is indeed anxious and perfectionistic and fits this profile--but does not have an eating disorder.

    I think this profile does a disservice to sufferers and to parents who might dismiss the idea that their child has an ED because these traits don't apply.

    EDs are genetic and can occur in non-anxious, non-perfectionistic people too.

    I see Dr. Kaye prefacing his reports with this statement quite often. I wonder if he is throwing the Old School people a bone. Is it a way to get professionals with a more personality-driven approach on board with him? Would they read the report if it were fully biological in nature?

    I wish he didn't have to reinforce this stereotype. It got in the way of our treating our daughter.

  3. My daughter was anxious, but only beginning around age 10-11, not previous to that. And I would not have described her as either OCD or perfectionistic.

    She was slower to do things in general...slower reader, slower completing homework, etc. This is supposedly due to a processing weakness. So, maybe it could appear as tho she is perfectionistic since she is very bright, but in fact she may find it harder to do things quickly.

    She also went on a diet...which I did not know about at the time as she kept it quiet.

  4. I like Dr. Kaye's research but I couldn't quite take all this info from him with a thumbs up.

    As far as positive attributes afterwards I do agree here. My d had approx. $300 to her name and she does make about $100 a month.

    She took her $300 and decided to give it to the poor for the Operation Shoe Box for kids at Christmas around the world. I'd say that is a positive attribute for a girl her age.

  5. My daughter does a lot of similar 'giving of herself'. The problem with it is that she practically gave herself away and wouldn't allow herself anything in the process. All part of that ultra-guilty feeling. She is working on finding a balance where it feels good to give to others AND to herself.

    Maybe it's part of that 'emotional anorexia' that's been talked about over on ATDT.

  6. Colleen,

    My daughter would not have been diagnosed or perceived as anxious or obsessional before her illness. She was quite upbeat and loving life - if more goal oriented than many peers. I believe ED was the trapdoor that almost opted her out of the anxiety problem I now recognize was there at a low level before and puberty was bringing on with a bang.

    The good news, it seems to me, is that if someone DIDN'T have much of these traits before malnourishment that they won't have to learn to live with them later. That's GOOD.

    I would not want us to stop looking for these traits in advance just because not all patients present this way.There are lots of illnesses with atypical presentations. The key is that failure to gain weight, body dysmorphia, new and dysfunctional avoidance of food should be taken seriously regardless of previous anxiety, right?

  7. I fear that if there is a stereotypical profile of an anorexic out there, then there's a good chance AN won't be considered as a diagnosis in someone who doesn't exhibit those traits--and treatment can be delayed. AN gets ruled out by professionals often enough, but especially when there are these profile expectations...and meanwhile, the kid gets sicker.

    How many boys have suffered from a lack of dx or delayed treatment because they don't fit the profile? How about minorities?

    I have a friend who was sure her son had AN 15 years ago. She's a doctor, so she had access to more information at that time than most of us, and she was pretty darn sure of herself. Unfortunately, her husband was equally sure that their son couldn't be AN since it 'only' affected girls...and her husband's a doctor too. They struggled with this for months, and meanwhile their son got sicker.

    I think it's the same thing no matter what stereotype you place on a disease--gender, personality traits, family dynamics, sexual trauma, whatever. It can be very hard to overcome expectations.

    And of course I am happy if my daughter returns to her previously un-anxious self!

    And I do feel like I'm nitpicking here. The important thing is to focus on the science and biology of this horrible disease--and God bless Dr. Kaye for his work! And you too, Laura, for all that you do, definitely.

  8. Anne,

    Although my d gives of her money to the poor in other countries, she doesn't neglect giving to herself. She spends her money at Aeropostle store, buys new purses and shoes for herself.

    So, although she likes to share with others, she never leaves herself out and likes to receive gifts from others.

    She does seem to want to protect the kids at school who everyone else picks on or isolates from the group. I think she has a very tender heart and despite ED, she has come out shining!


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