Did I cause my child's eating disorder?

I try to imagine how different my family's experience would have been from the beginning if I had found this:

Did I cause my child's eating disorder?

Instead of this:

 I hope, soon, the former will be the norm, and the latter will fade away.


  1. The positive thing about YOU getting all this ummmm "information" is that you did something about it and made the world slightly safer for the rest of us. Thank you.

  2. Love that statement by Mark Warren on the Cleveland Center for Eating Disorders website! That is music to my ears. And I was very happy to see the links to FEAST, Maudsley Parents and the new research on FBT.

  3. These slides hurt my eyes. And I know some of these screen shots aren't that old...I came across them when my beautiful daughter was sick too.

    I think one of the best gifts I ever gave my daughter was the confidence I had in my and my husband's parenting. I KNEW that we were not just 'adequate' but EXCELLENT parents. And that we were NOT the cause. That confidence led me to science and evidence-based treatments...not the absolute BS listed on your slides.

    Still...it hurts.

    Thank you, Laura, for the work you do to help professionals change their attitudes.

  4. I'm sorry to say I found all of those screen-shots recently. I actually had to throw a bunch out because there were so many.

    I did hear protests from some who saw those slides, from clinicians who say they don't blame parents but they do believe "family factors contribute" and/or maintain eating disorders.

  5. Rothman, "Causation and Causal Inference in Epidemiology," American Journal of Public Health, Vol 95 (2005)
    ("Philosophers agree that causal propositions cannot be proved, and find flaws or practical limitations in all philosphies of causal inference.") I would tell any clincian who claims "family factors contribute" to read this article and then reflect on whether her claim is based on objectivity or instead on stories or fantasies that she is living in her own mind.

  6. The only way to know whether "family factors" contributed to, or caused, an eating disorder is to do an experiment. One would need to go back in time, have the sufferer re-live her entire life again, exactly as before, except without the "family factors" thought to be responsible. If she still developed an eating disorder, then you would know that the family factors did not cause or contribute, it must have been other things that did. If she did not develop an eating disorder, then you would know that the family factors did cause or contribute. But since there is no way we know of to go back in time, we can only speculate what the result would have been in the experiment. Consequently, determining whether family factors caused or contributed to the development of an eating disorder is inherently speculative. That being the case, any clinician who claims to know what caused or contributed to the disorder is demonstrating a proclivity to make decisions on the basis of speculation and is someone who is lacking a basic awareness of the limitations in her ability to know how historical events would have turned out differently in different circumstances. In other words, she would be someone who is susceptible to believing in magic and the supernatural. I would not trust an ill person to the care of such a treatment provider. Instead, I would look for providers who base decisions on evidence and logic.

  7. An informal poll for all here:

    Which is easiest to deal with?

    a) Parents DO cause eating disorders?

    b) Parents don't cause eating disorders but can contribute by x, y and z

    c) Parents don't cause eating disorders (said with a wink)

    I ask this out of curiosity because I think we got c and now think I prefer b

  8. Oh, I take A! So much better to simply put it on the table to discuss. B is wiggly and difficult to quantify so it gives the same alienating, crippling position to the parents as A but without a clear opportunity to discuss it. And C is just creepy.

  9. While I firmly believe we did not cause our daughter's eating disorder, I am so frustrated that I didn't recognize the seriousness of it earlier . . . and also that I didn't choose FBT earlier; I only discovered it at the point - like you - when "traditional" therapy wasn't working. It is my hope that pediatricians, dietitians, and therapists will become knowledgeable and utilize treatment that truly works.

    Thanks for your blog and especially all of your work on the F.E.A.S.T. site.

  10. Speaking from someone that's had an eating disorder for years and only recently went through treatment... I think that my family (amongst other things) WAS a catalyst if not more. I also think it wouldn't have gotten nearly as severe (thus probably would not have been such a huge factor for so long - to the point where I got kicked out of the military) had my parents admitted I had one (they denied it even when I called them and told them everything, because it had gotten to the point where I thought I was going to wind up killing myself). They chose to not be helpful and to deny the situation. They still do.

    They don't believe I need to see a therapist or a dietitian and think I'm wasting money.

    That's affected me. I hate to say it, but it has.

    I think for SOME (not all) parents are a HUGE factor. Parents telling you you're worthless and don't deserve dinner - that plays a huge role. It was destined for me to develop some sort of coping skill... I chose the maladaptive coping skill that an eating disorder can be.

  11. Kat,

    Perhaps it would help if we separate - I do - cause from have an effect. Of COURSE parents affect their children. Of COURSE poor parenting and cruelty affect mental illness. Having an eating disorder in a family that is unsupportive, cruel, or even just clueless is a huge problem and surely worsens prognosis.

    I separate this from cause because most eating disorders don't happen under those circumstances. Eating disorders happen in all kinds of families and there doesn't need to BE any common factor except that the person has a genetic predisposition and for any reason suffers too little food for their needs. It can be a random comment or a massive assault. Separating cause from perpetuating or complicating factors is important so we can help BOTH the illness and for those who need it: any abuse or unhealthy environment. Both when needed, but not an assumption of both when not. Does that make sense?


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