First, let me say that I don't think we will ever be able to know exactly why an eating disorder develops in one person and not another. However, I do think it always helps to be curious about one's family -- whether there is an eating disorder crisis or not.
Curiosity and understanding allow for change and opportunities for each person to feel heard, connected and able to grow, both individually and in relation to others. It also allows for the possibility of moving on from one's family and taking hold of one's own life, even if other family members remain unchanged. (I always say this with the caveat that this kind of change cannot happen until someone is medically stable -- we can't expect this of someone who is starving).
With these thoughts as a base, here's the research study I would like someone to do. Ideally, researchers would find 1,000 families to be tracked over time and measured on standard psychological variables having to do with communication, boundaries, anger management, substance abuse, eating behaviors and other issues that have been associated with anorexia, bulimia and binge eating disorders. I want these families to be tracked before, during and after the adolescence of any kids in the family. And then I want to measure for the development of eating disorders.
Early studies indicated that substance abuse, lack of disciplinary boundaries, parental over-involvement and parental neglect all led to eating disorders of one sort of another. Minuchin's early research is an example of this. But these studies were flawed. They didn't have controls and were done by researchers who were trying to prove their own points. The research was biased at best. At worst, it basically said that parents were to blame for eating disorders.
I have seen thousands of parents over these last almost (gulp) 30 years. There is not one family that looks like another -- I have seen an extraordinary array of pathology. But I've also seen an extraordinary array of health and resilience. I believe that if we looked at families in which the children do not have an eating disorder, we will still see an array of issues regarding communication, emotions and interpersonal issues -- many of the same issues that plague families in which a disorder exists. As gratifying as relationships and family can be, they are complicated. Parse through any relationship or family and there will always be things to fix.
No question; some family situations are more challenging than others. And in those families when there is turmoil, abuse or neglect, the symptom of choice in our culture is often disordered eating. Many people, if they have been hurt, damaged or abused by their family, feel like there isn't anywhere to turn. I believe that these people will sometimes turn to an outside substance or destructive activity (drinking, drugging, food, starvation, cutting, etc.) to dull and contain the unbearable pain. In our culture, focusing on one's body and weight is a way for any kid to manage his or her feelings. This means that the potential for developing an eating disorder will be set in place.
However for some kids, there is a genetic link to obsessive thinking, shyness and perfectionism (see the work of Dr. Michael Strober). For those kids, the galloping emotional and social complications associated with hitting adolescence may be all it takes to jumpstart a severe problem with anorexia or another eating disorder. For these kids, it is unclear what in the family may -- or may not -- have contributed to the heartbreaking disorder that can destroy a teen's life as well as that of his or her family.
Our work is not to jump to conclusions, but to allow for ongoing questions about what can help with eating disorder prevention and recovery. We know a lot more than we did 30 years ago, but we still face more questions than answers. Let us not forget that it is only in the unknown that discovery takes place.