January 28, 2015

Epigenetics: old parent blaming in new shape?

stretch! stretch!
I note with interest, reminded by a lovely snarker in comments on my last post, the new interest in epigenetics and eating disorders. It's coming up all over the place.

I'm fascinated by epigenetics and the promise that it will yield insights into the underpinnings of eating disorders and human health in general. This is some of the most exciting stuff in medicine right now.

I'm amused by those who were not all that interested in genetics before but have leapfrogged over the well-known 53-83% heritability factor for eating disorders and jumped headfirst into epigenetics in a sort of "see! see! you parents DO cause eating disorders" late embrace of science.

Most people who are interested in the promise of epigenetics are genuinely interested in the role of environment and predisposition. Even the role of parenting. I am.

Some, however, are just unable -- even in denial, maybe? -- to accept that eating disorders are really not a sign of society's ills and parental perfidy. Do some parents suck? Yes. Do some parents of eating disorder patients suck? Duh. But are the symptoms of eating disorders a reflection of a person's  parenting? Not that we know of. So why do we keep going back to THAT aspect of environment, I wonder?

Epigenetics is not the Usual Suspect that you are looking for. There is still no reason to think that an eating disorder diagnosis says ANYTHING about the parents or the sufferer's life. It's just a diagnosis. It's a real brain disorder that ravages lives and families but can be successfully treated by those with genuine and complex interest in the science.

Here's the litmus test. If you didn't believe in genetics and EDs before, you think parents are probably contributing to the causation of most eating disorders, you think eating disorder sufferers are telling us something about society and families, then you may just not be as interested in epigenetics as you think.

25 comments:

  1. Science magazine published a summary of epigenetics research, entitled
    "The Seductive Allure of Behavioral Epigenetics: Could chemical changes to DNA underlie some of society's more vexing problems? Or is this hot new field getting ahead of itself?" (Google the title of the paper if you want to read the full text) The bottom line, according to the article, is that "there's very little evidence in humans that epigenetics connects early life experience to behavioral or health problems later in life" (p 24), that "epigenetics represents only one class of potential mechanisms for altering gene activity" (page 27), that "lots of [researchers] have spent lots of time and money" researching a possible link between epigenetics and human behavioral and health conditions and have come up "empty-handed" and are therefore now "a little grumpy about this." (page 27) Specifically, nobody has shown a link between epigenetics and anorexia nervosa.

    ReplyDelete
  2. Your insistence on framing the etiology of eating disorders as black-and-white, environment OR genetics, is really...weird.
    I can't honestly think of anyone in the field who believe that eating disorders AREN'T created by a combination of BOTH environmental AND genetic factors....
    Well, except you.
    I mean, sure, you give lip service to the fact that parents can influence their kids (when we're talking about how helpful parents can be). But the lengths you will go to.... not just to share your own perspective, but to SILENCE any dissenting point of view.... You demand that everyone agree with you, or you attempt to take away their forum for speaking their own truth. That smacks of narcissism, a desperate need to always be in control, and a complete lack of respect for alternative experiences. What's most ironic is that when an eating-disordered person DOES say their parents had a negative influence on them (let's be clear that this does NOT happen with every eating disordered person, but when it does....), it is PRECISELY this type of black vs. white "my way or the highway", agree-with-me-or-I'll-throw-a-fit, you-can't-talk-unless-you-agree-with-me, don't-say-something-I-like-or-I'll-steal-the-safe-space-you-created-for-yourself-and-others, that children mention.

    NO WONDER WHY you can't tolerate hearing about it.

    ReplyDelete
  3. Lemme guess....
    Your daughter has already mentioned to you multiple times that you're not open to feedback, and that if things aren't going your way, you shut people out and flip your lid?
    ...because that's already OBVIOUS to anyone else who spends 5 minutes talking with you.
    Your daughter is 100% right....

    ReplyDelete
  4. I don't believe in silencing other points of view. (I approve your posts here, for example) Silencing people doesn't serve my purpose, which is the conversation. Most people DON'T agree with me so if that caused me to fall into a narcissistic faint I'd spend all my time on the floor.

    It isn't black and white to say that parents don't cause eating disorders. It's stating the reality of what the research says. That isn't an issue that needs balance or nuance or gradation.

    Environment, however, is different than just parenting. As I say. All the time. Including in this post.

    You can insist that environment means parenting but you'd have to find some evidence of it to share. It's one of the most studied aspects of eating disorders and it hasn't been found, but do try. We'll wait.

    Meanwhile, I am glad the field has moved on to stop blaming parents and started supporting them in pursuing good evidence based care.

    ReplyDelete
  5. Didn't you just take over someone else's group, kicking them out, because they didn't adhere to your belief system? Not only is that a huge display of inappropriate boundaries, but it's indicative of your my-way-or-the-highway approach. Conflict resolution is not your strength. You simply shut people out or demand that they stay silent in order to maintain any affiliation with you. That's not healthy.

    "Environment, however, is different than just parenting"
    PS- environment INCLUDES parenting. Are you trying to claim that it doesn't?

    ReplyDelete
    Replies
    1. 1. No, I didn't. I believe I know what you are talking about but I'm not involved or part of it at all. You have me mistaken for someone else.

      2. Environment does include parenting. But that part of environment has been studied endlessly with no evidence that we can cause, prevent, deter, cause, or promote eating disorders. Time to find a new horse to flog and let parents do their job of loving and supporting their kids.

      Delete
    2. Anonymous, you really do seem to credit Laura with a lot of power - and time! One thing that has changed in the decades since Laura started her work is that there are a lot more parent advocates about. In the beginning, people like Laura were pretty much on their own with a few timid friends like me riding along on their coat tails. Now there are many parent groups, many individuals, many facebook groups and twitter feeds. Sadly, occasionally parent activists, like any group of people under a lot of pressure, have disagreements and are unkind to each other. As I don't know any of the people in the case I believe you are talking about personally I cannot comment on the rights or wrongs of it but yes, it is sad, and no, it has nothing to do with Laura. She's a very powerful lady, but even she isn't the root of EVERYTHING in the ED world.

      Delete
    3. I do truly believe that parents have a seriously important place in the ED advocacy world- and in supporting people with EDs to recover!
      However, Laura seems to be FAR more black-and-white in terms of her thinking than other parent-of-ED advocates I've met....which is actually unfortunate.
      Her extreme stance does more to discredit the cause than it does to support it....because it so closely mirrors the stereotypes of the controlling, authoritarian, agree-with-me-OR-ELSE style that is so often the focus of ED-parent stereotypes.

      Delete
  6. Wait-- so you're saying that there's nothing parents can do to influence whether or not their children have eating disorders, as you're simultaneously promoting family-based treatment as the cure?
    Which is it?
    Can the family help? Or are they helpless?
    Sorry, can't have it both ways.

    ReplyDelete
    Replies
    1. You know what my answer to that is. But for those watching, my answer is as always that parents don't CAUSE eating disorders or other mental illness. But how we respond is CRITICAL.

      Responding with guilt and self-doubt are not good. Responding with evidence-based care, calm, courage, and a lot of hard work IS.

      We don't cause allergies or diabetes or other illnesses, either, but it sure matters how we respond.

      Delete
  7. Holy cow, Laura! And I thought I get beat up in cyberspace! I love the way the author of those unkind and aggressive comments listed above posts as "anonymous". Where is the courage of conviction that you so bravely display? If people will not "sign" their comments, how seriously can one take them?

    But onto epigenetics: in my view, the reason people suddenly love epigenetics is because they do not understand it in the least. They think it is some vague "environment" (aka psychological) effect that will disprove the fact that this is a highly heritable neurobiological brain disorder, one that parents not only do not cause, but couldn't cause if they wanted to. And epigenetics is not some squishy thing, it has to do with changes on the cloud or skin of molecules that sits on atop the actually DNA double helix, turning genes off and on. It relates to biological events such as dietary changes, exposure to viruses, temperature, etc. not to global entities such as "parenting". Of course "parenting" can be broken down into biological effects, just as "war time" or "dieting" can--but the message is, there's no escape from understanding biology and biochemistry if you want to understand eating disorders.

    ReplyDelete
    Replies
    1. Agreed, Julie, on all points.

      Science literacy is part of the problem. Too often, people learn as much as they want to know, as long as it suits their worldview. Pointing that out is considered rude, and it leads to a sense of being condescended to among those who actually don't really understand. But the fact is we are not all operating at the same level of intellectual grasp of the issues. I am actually not as science literate as I wish I was, and try hard not to speak above my scientific pay grade. I choose my sources carefully, and attempt to think critically. I admit when I don't know, and remain open to being wrong. I like being wrong, actually, as it leads to growth.

      Delete
  8. Thank you Dr O'Toole. I too am not as scientifically literate as I would like to be and was having a hard time articulating my vague feeling that surely what is being talked about in epigenetics in terms of "environment" must be more than something as broad as "parenting" (does anyone know when "parent" became a verb?), and that the effects of environment on genes must surely be more complex and subtle than a simple "cause and effect, bad parent causes biologically based illness"

    ReplyDelete
  9. Dear Anonymous, Please don't waste your energy on Laura or Feast. Or any of their "friends." I'm trying to make sure that something-fishy stays on the internet. I think we need to rally around supporting valid reseach and sites like something-fishy. I think our energy is best spent that way. Laura's view points, etc are really toxic. I suggest to anyone to read the book "toxic parenting." People like Laura never change.

    ReplyDelete
    Replies
    1. Awww. How sweet.

      You had me at "valid research."

      Delete
    2. Other Anonymous-
      Thanks for the message!
      Unfortunately, I know you're right... In the same way that I know my own narcissist/BPD mother will never change. Because they're never wrong. And they are always the victims. And everyone is out to get them. And sure, their kids have problems and stuff, but why would we focus on THAT when we could focus how they're giftins themselves?

      Delete
    3. Dear Anonymous,

      I am sorry that your mother was ill and mistreated you. You deserved better.

      Delete
  10. http://www.traumacenter.org/products/pdf_files/Compulsion_to_Repeat.pdf

    Valid research from a highly regarded leader in the field. But of couse, you (and every one else) already knows how you will respond. You are very predictable.

    ReplyDelete
    Replies
    1. Sigh. It speaks for itself. Those who find that piece compelling and "valid research from a highly regarded leader in the field" do. Those who don't, don't. I don't. Predictably enough.

      Delete
    2. Hey, I read the link above (traumacenter.org) There are only two references to eating disorders in that paper, footnotes 143a and 126. However, footnote 143a cites to "unpublished data" from 1988 and therefore isn't "valid research" because in order for research to be considered valid the data must be published so that readers can see the proof, if there is any. Footnote 126 is a paper published in 1981 about "self-mutilation," not eating disorders. The paper describes 20 teenagers who suffered from self-mutilation and a personal history of trauma, but not one of the 20 kids was suffering from anorexia nervosa, so it's hard to see how that paper offers evidence of a link between parents and anorexia nervosa.

      Delete
  11. more from "Anonymous"

    http://www.amazon.com/The-Body-Keeps-Score-Healing/dp/0670785938

    More real, valid research-and even recent/current-imagine that!

    ReplyDelete
  12. Ha! Ha! you beat me to the punch...lol

    ReplyDelete
  13. sorry, deleted the above because I thought it was a duplicate. Posted it for you.

    ReplyDelete
  14. From: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3246041/pdf/nihms337414.pdf

    "A number of studies have revealed that epigenetic mechanisms may contribute to eating
    disorders including anorexia nervosa. Atrial natriuretic peptide (ANP), one of the volume
    and appetite regulating hormones, has an important role in anorexia nervosa. Elevated
    plasma levels of ANP have been reported in women suffering from anorexia nervosa
    (Ohashi et al., 1988). In contrast, reduced mRNA expression of the ANP locus has been
    reported in female anorexia nervosa patients along with a significant increase in ANP
    promoter region methylation in a subset of anorexia- and bulimia-nervosa patients exhibiting
    purging behavior (Frieling et al., 2008). Explanations have been proposed to account for the
    contrasting patterns associated with anorexia nervosa provided by the protein data (detection
    of increased ANP levels in plasma) and the mRNA data (reduced ANP gene expression),
    including ANP activation of nitric oxide, which increases the activity of some DNA
    methyltransferases through inflammatory processes (Hmadcha et al., 1999), which are
    Toyokawa et al. Page 7
    Soc Sci Med. Author manuscript; available in PMC 2013 January 1.
    NIH-PA Author Manuscript NIH-PA Author Manuscript NIH-PA Author Manuscriptknown to contribute to anorexia (Gautron & Laye, 2009), and a decrease in enzymes that
    degrade ANP among patients with eating disorders (Frieling et al., 2008; van West et al.,
    2000). Although these explanations require further verification, the combined protein,
    mRNA and methylation level data do indicate that dysregulation of ANP is associated with
    anorexia nervosa, and suggest that hypermethylation of the ANP gene promoter may provide
    a mechanism that contributes to the development of this disorder. More generally, anorexia
    nervosa also provides a possible example of how epigenetic processes may mediate the
    effect of the image of ideal body and cultural background on dietary behavior"

    ReplyDelete