By: Judy Scheel, Ph.D., LCSW

A recent article in the Journal News (March 18, 2007) “Study tests Anorexia therapies,” reported that the National Institute of Mental Health (NIMH) is funding a significant study to compare two treatment methods both involving family therapy.  This article was actually sent to me by two people, one that I am currently treating and one that I had treated in the past.  Both of these individuals had significant family issues prior to the development of their eating disorder – one individual sought treatment when she was an adult and was seen individually. The focus of her treatment was on improving the quality of her relationship with her mother and on understanding and the resolving the relational issues that led to her eating disorder and how those issues kept her from getting close to people presently in her life.  The other individual was a teenager and the family was consulted on a regular basis in an effort to repair and strengthen the family’s relationship and on helping them understand that the eating disorder was the voice of their child’s pain and distress.  Ultimately, the goal in family therapy was to help this patient find her voice through words and emotion versus the behavioral voice expressed via her eating disorder and in helping the entire family learn a new language of empathy, communication, tolerance of emotion, trust and mutual respect and helping them determine appropriate family roles and boundaries.

The significance of the family in the development and recovery process in eating disorders is emblematic at CEDAR.  Yes, there are biological forces at play, and the research has been and currently is being funded in this area, but little has been funded to examine what role family members have in the causation of eating disorders.   In fact, the major study funded by the NIMH does not address the family’s role in causation, but rather focuses on a theoretical approach that helps parents come up with a plan to help their child eat normally and on what is making it difficult for the child to eat.   This is at least a start in the exploration of the family and family relationships. There are some eating disorder treatment models that dance around or ignore the impact of the family as causal.  Many of us in the treatment field believe this does the family and sufferer an injustice.  There is beauty in acceptance and sharing of responsibility; it is what is necessary for change to occur.   When family members are able to acknowledge the mistakes they made and are open to making changes facilitates recovery for the sufferer and healing for the family as well.  Most members of the family including the member, who has the eating disorder, bear responsibility for the cause of the eating disorder and the family’s unrest.   Blaming is not the point or the intent of family therapy; it is about taking responsibility which includes listening, learning new ways of communicating, learning how to empathize and confronting painful issues.  Family therapy is also about forgiveness and healing.

Those of us in the eating disorder community who practice within a relational model are excited that this research is getting some necessary funding.  Addressing relationships issues in the treatment of eating disorders is the sine e qua non of recovery in conjunction with a sound behavioral approach to reduce and eliminate symptoms. 

The trend in research has been toward finding biological causes, genes and other non-psychological or environmental reasons why eating disorders develop.  We at CEDAR believe and continue to believe that eating disorders are multi-causal including:  psychological, familial, biological, sociological and cultural.  A common phrase among many seasoned eating disorder therapists is, “In the development of an eating disorder, biology may load the gun, but the environment (psychological issues, familial issues, cultural and social messages regarding weight and body image) pulls the trigger.  Or, we are all born with a particular nature and how the individual’s nature is nurtured by all internal and external forces are contributors to the development of an eating disorder.

What took so long you may ask for the funding to be put into studying families and eating disorders? 

On the one hand, it is way more difficult to try and ‘quantify’ for research purposes, ‘qualitative’ issues in people and relationships.  It is easier, for instance, to ask, “On a scale of 1-10, how would you rate your level of perfectionism?”  Or, “How many times do you weigh yourself on a weekly basis?, than to quantify for statistical purposes, “How would you describe your relationship with your parents?”

Another major issue is that those organizations that receive the most funding in eating disorder research i.e. hospitals and university teaching hospitals are often interested in biological and ‘hard’ science and so look toward finding variables that are able to be analyzed and tend to minimize the more clinically theoretical models like psychoanalytic theory and relational theories like Object Relations and Attachment Theory.  Also, major institutions are generally large and financially well endowed with resources and staff.    Therefore, they tend to be in a position to have staff that can write the grants to seek the funding.

The bottom line is that the term ‘family’ is finally being given some consideration in eating disorder research and perhaps finally getting the funding necessary to proceed. Hopefully, this will lead to examination of the other branches of causation on the family tree.