PREVENTING A VICIOUS CYCLE OF ANOREXIA

NEW YORK TIMES COLUMN: FAMILIES TODAY:
PREVENTING A VICIOUS CYCLE OF ANOREXIA
By: T. Berry Brazelton, M.D., and Joshua Sparrow, M.D.

Q. I dealt with anorexia nervosa for 10 years. Though I am now healthy, I still consider myself a recovering anorexic. I’m terrified there may be some truth to the idea that eating disorders can be inherited. My mother has also struggled with her weight. How can I protect my 14-month-old daughter from this legacy?

A. Perhaps you can think of yourself not as a recovering anorexic but as a person recovering from anorexia.

Anorexia nervosa can seem to take over your life. By reaffirming your identity, you may help your daughter discover and assert her own.

Young adolescents with anorexia often seem to have a fragile sense of who they are. They may focus on attending to everyone’s needs except their own.

In the movie “Black Swan,” Natalie Portman’s character, Nina, is scripted to follow this pattern – she lives her tortured life as a dancer to fulfill her mother’s unrealized dreams. Sometimes people with anorexia discover that as children they felt pressured to sacrifice the development of their own identities for a parent’s sake. Their parents didn’t mean to pressure them. But sensitive children may pick up on parental needs and problems, misunderstand them and hold themselves responsible.

Awareness of a parent’s fragility can turn into self-deprivation, self-punishment and self-hatred: “I don’t deserve to eat or to enjoy eating. I am fat and greedy and need to stop eating so that everyone else can have what they need – everyone but me.”

If this pattern has passed down from one generation to the next, psychotherapy can help. A new mother recovering from anorexia can learn to free herself from her own past and leave room for her baby to become her own person.

Psychotherapy can help stop a vicious cycle when parents worry that their problems may affect their young children. Parents may unwittingly urge their children to appear happy – thus reassuring themselves they have done no harm. This pressure can keep children from experiencing all their own emotions, including sadness and anger. As a result, the pattern continues.

Under the weight of pressures from one generation, the next one fails to develop fully. Nobody is at fault. But the pattern is hard to see and hard to stop – without help. Studies have shown that anorexia nervosa may be inherited. However, despite the increased likelihood, many children whose parents have struggled with this disease will not inherit it.

A hallmark of anorexia is loss of pleasure in eating. Studies have focused on how mothers with a history of anorexia feed their babies. These mothers seem to be more anxious and to take less pleasure in the feeding process than other mothers.

Psychotherapy can help them to relax and to attend to their babies’ cues about feeding and to enjoy these interactions.

Pleasure is a powerful motivator and an important part of the feeding experience throughout life. By the end of the first year, parents can help their babies start taking pleasure in feeding themselves. The babies will soon want to take over. At that point, avoiding struggles over food can help prevent bigger struggles later.

Responses to questions are not intended to constitute or to take the place of medical or psychiatric evaluation, diagnosis or treatment. If you have a question about your child’s health or well-being, consult your child’s health-care provider.

Dr. Brazelton heads the Brazelton Touchpoints Project, which promotes and supports community initiatives that are collaborative, strength-based, prevention-focused sources of support for families raising children in our increasingly stressful world. Dr. Sparrow, a child psychiatrist, is Director of Strategy, Planning and Program Development at the Brazelton Touchpoints Center. Learn more about the Center at www.touchpoints.org.

Reprinted with permission from the authors.