Shame, Blame and Eating Disorders

scheel3The concepts of shame and blame have emerged lately in relation to people with eating disorders and those who care for them, i.e. parents.

We have long been dealing with helping patients with eating disorders not feel ashamed of their disorders, the secrets around their symptoms, or for that matter, to not feel ashamed of who they are, their needs, feelings (especially negative ones) desires, or their bodies.

What has been stirring lately in the eating disorder blogging world has been the notion that some in our field are seeking to blame parents for their child’s eating disorder. I have never met an eating disorder professional for whom this is true. Eating disorder etiology is extremely complex; its origin is as unique as is the sufferer. Many forces, internal and external (nature and nurture and environment) can, and often do, contribute in an intricate combination.

What I have seen in my many years of practice is that oftentimes, family members need to confront their attitudes and behaviors toward their loved one who has an eating disorder. Sometimes these attitudes have predated the eating disorder and have made a contribution to their loved one’s negative self perception. Sometimes attitudes and behaviors emerge in response to the overwhelming despair and hopelessness that accompanies watching a loved one starving herself. Sometimes family dynamics over a long period of time (job stress, marital discord, substance abuse by a parent) have had an influential and lasting effect on a child at risk of developing an eating disorder.

In any event, parents—me being one myself—often say and do things they wish they had not or are unaware that they may be doing presently. Or, perhaps they project attitudes and beliefs on to their child that are not helpful or serve to reinforce the eating disorder behavior (i.e. a parent who is overly concerned about their own or child’s weight and body.) Asking parents to accept responsibility is not an attempt to shame. We know the parents care because they are there trying to help their child. But taking responsibility is in fact the starting point for real healing for the sufferer.

When families enter treatment, they are often at a loss for how they can help or what they may be saying, doing or responding that is not, or has not been, helpful to their ill loved one. Parental involvement is vital for successful treatment. We teach them how to care for each other in new ways, helping everyone in the family, including the person with the eating disorder, understand what each other may be doing or saying that is not useful, productive, or is perhaps damaging, and then making changes as appropriate.

I have learned in the 20 plus years of treating eating disorders that where there has been familial disconnection, repair is possible and restorative—yes, this means the acceptance of responsibility for how or what a parent, in particular, may have contributed to their child getting side lined or begin to doubt their own truth and experience. We are way more reliable as parents when we listen to our children and are honest about our role in their lives, both positive and negative.

Accepting responsibility for our part in the family dynamic that has contributed to negative thinking or, for eating disorder sufferers, self-defeating or self-destructive behavior is not assigning blame in any way. In fact, it is the opposite. Parents who accept responsibility for helping their child should feel gratified with their success in helping the child to recover. All successful eating disorder programs ask parents to change what they do. Exactly what changes are asked depend on the current condition of the child. I’ll talk more about that in a later blog.

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