November 22, 2011

Attachment to theories

I'm hearing dismay and concern from a number of families about the attachment theories around eating disorders. I share that concern. Vulnerable parents who encounter those theories will find them plausible, as of course attachment is an important part of human development and integral to the parent role. We all care deeply about our relationships with our loved ones and the idea of failing at that task feeds directly into good parents' fears. When a serious mental illness puts a spotlight on possible parent pathology this is a leap that risks harm. When those attachment issues can be anything from the otherwise benign to complete family disruption then the attachment concept is stretched beyond credibility.

An eating disorder diagnosis tells us nothing, really, about the person's family or history, except that they are now ill and in urgent need of family support and clinical care based on current science, not unfounded theories.

Unfortunately, mental illness can cause attachment issues that seem to be environmental when they are really temporary symptoms. These symptoms are very easy to interpret as attachment related: social disconnection, disconnect with the body, rejection of family assistance, a conviction that there is meaning behind these thoughts and behaviors, and especially a disconnect with those who know them best: because the illness isolates and distorts reality.

I'm not sure whether my comments on a recent article at Psychology Today will be published, as the atmosphere has grown heated as families express their distress, but here is what I said:

I spend a lot of time with experts and researchers in the field of eating disorders. The experts are quite clear in saying that we really don't know what causes eating disorders. We do have a better grasp on what does NOT, as despite earnest efforts to substantiate older theories no real evidence has ever been validated. 
It is SO important that we take care in publishing theories on the cause of eating disorders. There is a tragic history of unsupported theories gaining currency and causing great harm. Attachment theories around autism and schizophrenia come to mind here, as these completely false ideas hurt those patients terribly by disabling their parents from action and support. 
Attachment is an important aspect of life for all human beings. Its role in causing mental illness is less clear. What we do know is that when a patient's parents are told that attachment problems are at the root of causing or maintaining this terribly dangerous illness that the family is at enormous risk of responding poorly. Imagine if a family facing caregiving with childhood cancer were told the same? 
The burden of proof on these theories is a heavy responsibility. As well-meaning as it may be, the risk of harm is enormous. 
Laura Collins
Executive Director
F.E.A.S.T. (Families Empowered and Supporting Treatment of Eating Disorders)

4 comments:

  1. This is the story I should have told everyone during the recovery panel at the symposium, but it wasn't until we were studying attachment theory at college last week (I did a lot of gritting my teeth) that I remembered this.

    I was diagnosed with an attachment disorder by the first psychiatrist I saw, when I was 16. This was mid-2001 and we'd had a family computer for about six months, so of course I went straight home and searched for a description. What I found was a lot of discussion about abused, fostered and bereaved children, and a prognosis which terrified me (without treatment, attachment disorders were thought to lead to psychopathy). I didn't think my childhood had been that bad - I mean, money was tight and I was the eldest of five so my parents were very busy and stressed out, but I knew they loved me. But the list of symptoms fit me perfectly, as far as I could tell. Anxiety, depression, self harm, disordered eating, attention seeking and manipulative behaviour, an inability to form and keep friendships, social withdrawal and so on. So naturally, as a sixteen year old, I started to look for ways in which my parents had damaged me.

    I can come up with a better theory now. I was an anxious child by temperament, not due to abuse. I reached and reacted badly to puberty - all those crazy hormones don't mix well with a person who has difficulty coping with change. I was also bullied, which messed up my previously good self esteem. I became extremely withdrawn - suicidally depressed but unable to tell anyone. I stopped eating properly because I had lost my appetite through stress and then discovered that it made me feel better. I also started cutting myself when I accidentally nicked myself shaving my legs, and found that it had some bizarre tranquillizing effect on me.

    I can see how that could be framed as an attachment disorder, but it wasn't. A combination of things caused me to display many of the apparent symptoms, but none of that related to my early childhood or my parents, who were worried sick and baffled by their silent, moody, self destructive child. Knowing what one looks like, I know I was a securely attached child before puberty. I have secure attachments now too. What I was actually suffering from was an inability to cope with my inborn personality traits, the bullying and the chemical cocktail of being a teenager.

    But that diagnosis destroyed my relationship with my mum. We barely spoke except for occasional screaming matches until, like I said at the symposium, I was raped - and then we had something to blame besides each other for the way I was. And after that first psychiatrist misdiagnosed me with an attachment disorder rather than the reactive depression, anxiety and eating disorder that I really had, my mum refused to meet any of the other healthcare professionals involved in my treatment. She believed they would all blame her.

    So there you go - professionals who only see what they are looking for really can destroy families. I know you hear that all the time from parents, but as a former patient now well enough to see things clearly I can back that up too. Luckily I get on much better with mum now, but that diagnosis nearly made me homeless. It nearly killed me. If they had just involved mum when I was first seen, asked her questions about how I had been as a child and when things had started going wrong they might have got things right first time, and I could have avoided years of illness.

    I wrote you an essay, sorry!

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  2. I blogged about this last weekend (http://extralongtail.wordpress.com/2011/11/20/parents-and-anorexia-nervosa/). I have never been diagnosed with an attachment disorder or a personality disorder, but like Katie, above, I was a very anxious child, I didn't deal well with puberty and had a long history of OCD that pre-dated my anorexia by a number of years.

    I don't dispute attachment theory in itself. There is a large body of literature linking poor attachment to personality disorders. I am not an expert, so I cannot stick out my neck and state that there is no link between attachment and the risk of eating disorders. But I can speak from a personal perspective - which is that I have awesome parents, who were always there for me. My mother gave up her career to be with my brother and I when we were children, was very 'hands-on' and very caring.

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  3. Interesting read and 100% true, the burden of the diagnosis is...well what it is. I do not entirely understand the concept of attachment theory, however I did like what you write about things being a symptom of the bigger issue. It pays large dividends when the core issues are brought to the table for the lives of the patient, and sometimes the families provided they are all ready for the answer.

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  4. Excellent post, Laura! And, Katie, thanks for your "essay". I wouldn't have wanted it one word shorter. Your perspective is very valuable. Thanks also to extralongtail for her thoughts.

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