Last month, Time Magazine ran an article about the dangers of over-involved, over-protective parenting (otherwise known as “helicopter parenting” because these parents tend to hover over their children). The article is well-researched, well-written, and very interesting. As a therapist who frequently encounters this phenomenon in the parents of my adolescent and young adult patients, and as a product of this type of parenting myself, I have a few thoughts and observations on the issue.
I agree wholeheartedly with the author that today’s parents are far too over-involved and over-protective, and this is particularly true amongst middle- to upper-class families with well-educated parents. According to psychologist Eric Ericson, the primary developmental task of middle adulthood (ages 30-50) is seeking satisfaction through productivity in career, family, and civic interests. This is precisely the age at which adults are parenting young children and adolescents, and for helicopter parents, their striving for productivity is channeled into their children. Parents’ intentions are good, but the outcome can be problematic. You see, the middle adulthood psychosocial task of productivity stands in diametric opposition to the adolescent developmental task of identity formation. Children need to play, explore, relax, and interact with their surroundings in creative, imaginative ways. Adolescents need to loaf, “hang out,” date, experience “teen angst,” spend quality time with family and friends, develop their social skills, make their own choices (within reason), make mistakes, and learn from them.
Ideally, a healthy person will emerge from adolescence with a solid self-identity, resilience, confidence, good problem-solving skills, and the ability to tolerate discomfort and failure. Having worked in several college counseling centers, I can attest that many kids arrive at college without these skills and attributes. Their lives have been geared entirely towards achievement in academics, arts, and athletics, often not for the love of science or music or soccer, but because their parents pushed them and/or because they believed it would improve their chances of gaining admission to a prestigious college. Quite often, they don’t know how to structure their time, study properly, deal with disappointment, or make decisions independently. Sadly, many of them do not know who they are or what they enjoy.
Helicopter parenting has the potential to be quite harmful to children by increasing their stress and anxiety and preventing them from developing self-confidence, resourcefulness, problem-solving skills, distress tolerance skills, emotion regulation skills, and creativity. Children and adolescents are over-scheduled, over-worked, and pushed to succeed, often at the expense of their emotional health. There is not enough unstructured time for kids to play, explore, or create. There is little room for adolescent identity formation in between AP classes, Princeton Review SAT prep courses, college applications, three varsity sports, band practice, clubs, and mandatory community service hours.
These issues notwithstanding, one problem I have seen far too often in my profession is the tendency for therapists to blame helicopter parents for causing their child’s eating disorder. It is easy to look at over-involved parents and an adolescent’s misguided search for control and identity through self-starvation and conclude that the former caused the latter. But the belief that over-involved, controlling, or enmeshed parents cause children to develop anorexia nervosa (AN) or bulimia nervosa (BN) lacks solid scientific evidence. What’s worse, this belief has the potential to undermine treatment, disempower parents, confuse children, perpetuate deadly symptoms, erode physical and mental health, destroy families, and turn an acute illness into a chronic and disabling one.
There is a correlation between over-involved, over-protective parenting and the development of AN, but correlation does not necessarily indicate causation. If variable A (helicopter parenting) and variable B (child’s development of AN) are correlated, there are several possible explanations for the relationship between these two variables:
1.) A causes B
2.) B causes A
3.) Variable C causes both A and B
4.) Variables D, E, F, G, H, I, J, K, L, M, and N work together in complex ways to influence the development of both A and B.
Let’s examine each possible explanation.
1.) Explanation 1: Helicopter parenting causes children to develop AN. There is no reliable scientific evidence to support this explanation. Ironically, this explanation is touted far more frequently than the others, even by clinicians who specialize in treating eating disorders.
2.) Explanation 2: A child’s AN causes parents to become over-involved or over-protective. There is some evidence to support this explanation. If parents were not anxious, cautious, protective, or hovering before their child developed AN, you’d better believe they will be once their child becomes ill. This phenomenon is not unique to AN. Parents of children with any illness or medical condition naturally worry about their child and do whatever they can to protect her.
3.) Explanation 3: A third variable causes both helicopter parenting and AN in children. There is a wealth of evidence to support the genetic transmission of AN as well as related personality traits. The personality traits that predispose people to developing AN – anxiety, obsessiveness, perfectionism, and harm-avoidance – are largely genetic. In an adolescent female, these traits are likely to manifest as an eating disorder. In a middle-aged, middle-class, intelligent, well-educated parent, these traits are likely to manifest as over-involvement, over-protection, and over-investment in their child.
4.) Explanation 4: A complex interaction of other variables work together to produce both helicopter parenting and AN in children. This is the most thorough, and probably the most accurate explanation. As stated in explanation #3, genetics plays a major role in the development of AN. A wealth of environmental variables are also believed to influence the development of parenting style as well as AN (e.g., level of education, income, culture, peer group, family background, exposure to stressful life events).
I love working with adolescent children of helicopter parents. I require parents to be fully informed and actively involved in their child’s treatment, and helicopter parents slide seamlessly into this role. They are excellent candidates for Maudsley Family-Based Treatment because their anxiety level is high enough to propel them towards action, they thoroughly educate themselves on their child’s condition, they seek out the best treatment and resources, they are vigilant and persistent, they maintain a very high level of involvement and supervision, and they are tremendously invested in their child’s recovery. Misguided, ill-informed, old-school therapists argue that these characteristics caused the child’s AN, and they advise parents to “back off” and allow the child to make her own choices about food and weight and treatment. This approach rarely leads to lasting recovery.
While helicopter parenting certainly has the potential to cause harm, it can also be used to the child’s advantage in recovery if channeled properly. Helicopter parents tend to be wildly successful in Maudsley Phase I (re-feeding / weight restoration), and largely successful in Phase II (helping the adolescent eat properly on her own). Some of these parents are eager to step back in Phase III as their child deals with psychological and social issues and develops a healthy adolescent identity. Other parents struggle to let go when the time comes. With proper guidance from a good therapist, however, most helicopter parents can learn to manage their own anxiety enough to allow their children to blossom and develop as healthy, independent young adults. This does not come naturally for them, but never underestimate the power of the helicopter parent. If the therapist who helped save their beloved child from a life threatening illness coaches them to step back and let go, they’ll do it.
I really enjoyed reading this, particularly your delineation of correlation versus causation concerning helicopter parenting and AN. It is so often assumed that correlation equals causation in those who have not taken statistics – or forgot – or are so freaked out by their child’s illness that they lose all capacity to think rationally, when really there are the four possible explanations for a correlation that you explained.
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What is the evidence that “there is a correlation between over-involved, over-protective parenting and the development of AN”?
Is the evidence objective, or is it the subjective interpretation of clinicians and researchers who have been taught to expect those characteristics and are, therefore, inclined to interpret their observations of parents in a way that confirms their expectation? And how are parental involvement and protectiveness objectively and accurately quantified?
CB,
Thank you for your response. You pose excellent questions, and I am more than happy to clarify my points and begin a dialogue on this issue.
First, I want to reiterate that there is no reliable scientific evidence that any particular type of parenting causes EDs. I personally believe that parents do not cause EDs, and couldn’t cause them even if they tried. My aims in writing this post were manifold: 1.) To identify the problems associated with helicopter parenting, 2.) To explain the differences between correlation and causation, 3.) To emphasize that parenting style does not cause EDs, 4.) To explain how and why parenting style and EDs may be correlated, even though the former does not cause the latter, and 5.) To point out that helicopter parenting can actually be beneficial in family-based treatment if channeled properly.
There is some evidence from crossectional studies that overprotective and/or over-involved parenting is correlated with AN, which does NOT imply that parenting causes AN. I am aware of two studies which demonstrate that these two variables are correlated. Notably, neither study demonstrated causality:
Horesh et al (1996). Abnormal Psychosocial Situations and Eating Disorders in Adolescence. Journal of the American Academy of Child and Adolescent Psychiatry.
Shoebridge & Gowers (2000). Parental High Concern and Adolescent Onset Anorexia Nervosa: A Case-Control Study to Investigate Direction of Causality. British Journal of Psychiatry.
The Horesh et al study used semi-structured interviews, so the researchers’ questions were standardized to a degree but also allowed for some flexibility in response. Thus, it is quite possible that the researchers’ observations were tainted by their preconceived notions.
The Shoebridge & Gowers study used obstetric records and mothers’ self-reports. It is likely that the mothers’ self-reports were biased in some way. Perhaps they had read somewhere that EDs were associated with overprotectiveness, which resulted in a biased response pattern on the part of the mothers. The obstetric reports are likely to have been more objective, but even so, OB-GYNs, like all human beings, are biased.
The major problem with both of these studies is, of course, the reliance on human interpretation of any kind, whether that is from clinicians, researchers, parents, or children. This is a problem in research – no human being is completely unbiased. Unfortunately, it is very difficult to objectively quantify characteristics like parental involvement or overprotectiveness, and measurement of these traits generally involves some sort of subjectivity on the part of the parent, the clinician, or even the researcher who is completing a standardized questionnaire.
Dr. Janet Treasure of the Maudsley Hospital has done some excellent research on the neurobiological and genetic factors that cause EDs. She has also published books and given lectures on helping the entire family cope with the child’s ED. Her contention is that many families, quite understandably, respond to a child’s ED with increased anxiety, which in turn is manifested in increased involvement and overprotection. This is often the case in families where a child has any serious illness; it is not unique to EDs. Dr. Treasure also asserts that certain styles of interacting amongst family members may serve to reinforce or perpetuate an ED, and that families can and should receive guidance as to how they can work together to overcome unhelpful reactions in order to help their loved one recover.
In sum, the science very clearly indicates that parenting style does not cause EDs. There is some evidence supporting a correlation between helicopter parenting and EDs, although this research is admittedly flawed. Clearly, more rigorous scientific research is needed on this topic.
The Horesh study involved interviews with 20 young women who had suffered from anorexia for, on average 1.7 years, and who were hospitalized for AN in a facility in Israel. Given the duration of illness, and the fact that most anorexia patients who are hospitalized are placed inpatient by their parents against their will, one would expect them to describe their parents as overprotective and overcontrolling. Even so, the paper reports that the correlations with parental overprotection and parental pressures was only “modest” compared to a control group from the general population. Moreover, the manner in which the investigators chose to categorize parental conduct as overprotective or overcontrolling is subject to question. For example, a few of the anorexia patients complained that their parents had provided them “premature exposure to the world of adults.” Overprotection? This example seems to me to place doubt over all the findings. Other factors that reduce the value of the findings in the Horesh paper, in my opinion, are the extremely small sample size (only 20 patients), the authors’ acknowledgment that the ill patients’ answers to questions about their parents were “subjective” in nature, the fact that the results of the study have not, to my knowledge, been replicated by others, and the obvious bias of the authors against parents, as evidenced by their distorted discussion of the previous research literature.
The Shoebridge paper analyzed the obstetric medical records of 40 mothers of children who later developed anorexia nervosa to try to find evidence to support their hypothesis that overprotective parenting preceded the development of anorexia. Here’s an example of their approach: It turns out that ten of the 40 mothers of kids who later developed anorexia had suffered a previous “severe obstetric loss,” i.e. perinatal or infant death, before the birth of the child who developed anorexia. Those mothers, according to the records, therefore, worried more about miscarriage during the later pregnancy. The authors conclude that this heightened anxiety likely made them overprotective parents later. But there’s no evidence that it actually did. The authors also determined from the records that the mothers of kids who later developed anorexia took their kids to the pediatrician more often than the control mothers did. This is offered as evidence of “overprotection.” What? An explanation just as plausible is that the kids who later developed anorexia actually had more medical problems when they were young than the kids in the control group did. Or that the mothers in the anorexia group were not “overprotective,” but instead the mothers in the control group were “undeprotective” by not taking their kids to the doctor often enough.
Sarah, I agree with you that there is no reliable scientific evidence that “overprotective” or “overcontrolling” behavior by parents cause anorexia nervosa. I go a step further, however. I feel that there is not even reliable evidence of a correlation between the two. In other words, there’s no reliable evidence either that overprotectiveness/overcontrol cause anorexia or that anorexia causes overprotectiveness/overcontrol. The issue matters, in my opinion. As long as clinicians (of which you are not one) are prejudiced and perceive (consciously or unconsciously) that parents of kids with anorexia fit these stereotypes, they will continue to justify their “old school” model of treatment that tries to “remedy” these conditions. That model doesn’t work, it never has, and it is actually insulting to parents because it treats them as stereotypes and caricatures, not as real human beings. And all too often it translates into the advice that parents should not to try to refeed their starving kids, a prescription that is truly unhelpful and dangerous.
CB,
Wow! What a thoughtful analysis of these articles! You are absolutely correct – the methodology in both of these studies is quite flawed, which seriously limits our ability to draw definitive conclusions. The definitions of overinvolved and overprotective in these studies are vague and, frankly, pretty stupid. And after further consideration, and a more thorough reading of the studies I cited, which I know I should have done BEFORE I cited them 🙂 it seems as though there really isn’t any solid evidence demonstrating correlation between helicopter parenting and AN.
Your comment about the Shoebridge study echoes my clinical experience:
“The authors also determined from the records that the mothers of kids who later developed anorexia took their kids to the pediatrician more often than the control mothers did. This is offered as evidence of “overprotection.” What? An explanation just as plausible is that the kids who later developed anorexia actually had more medical problems when they were young than the kids in the control group did. Or that the mothers in the anorexia group were not “overprotective,” but instead the mothers in the control group were “undeprotective” by not taking their kids to the doctor often enough.”
I have observed that parents become more involved and protective of their child when the child develops an ED, cancer, diabetes, asthma, or any other serious illness. Some clinicians may call this “overprotection” or “overinvolvement;” I call it good parenting. Most parents would become anxious and protective of their child and much more involved in her life if she had a mental illness or physical illness.
My observations, which I have derived from my own clinical experience, are obviously biased since my practice naturally attracts a certain “type” of family. I require parents to be fully informed and actively involved their kids’ treatment, so the parents of my adolescent ED patients are, as a rule, extremely involved in their children’s treatment and extremely protective of them. The “underinvolved” or “underprotective” parents probably wouldn’t send their kids to me in the first place. I suspect that many ED professionals have similar experiences with parents, which may explain the presumption that parental involvement and overprotection are correlated with EDs. The less involved, less protective parents don’t bring their children in for ED treatment, so we presume they don’t exist.
The kids I treat almost always have very involved, well-informed, concerned parents who want effective, evidence-based treatment for their children, many of whom travel very long distances or make financial sacrifices to get it. While this may be called “helicopter parenting” by some, I see it as evidence of dedication, love, an excellent prognosis, and I make a point of telling families this at the beginning of treatment. What I find most ironic is that old-school ED professionals perform “parentectomies” or advise parents to back off, which is the PRECISE OPPOSITE of their natural parental instincts to become more involved and more protective when a child is ill. It is also the precise opposite of what empirical research shows us benefits kids the most – active family involvement in treatment and meal support at home.
As I implied by the title of this blog post, I believe that parents who are extremely involved and extremely protective have a lot to offer. I’ve observed that these parents are very valuable members of their child’s treatment team because they are so dedicated to their child’s recovery and so willing to do whatever it takes to help their children. It’s the less-involved, less-protective parents that concern me more. In the end, I guess the nature of the relationship between helicopter parenting and EDs (if such a relationship even exists) is not really important to me, since I don’t base my treatment on this theory. I base my treatment on what has been proven to work. “Show me the science” is a good motto. It’s a shame that so many clinicians base their treatment on the unproven theory that parenting style is related EDs. In my opinion,the most important things are providing evidence-based treatment to all patients and families, and harnessing each family’s unique strengths to help the patient recover.
Thank you for this excellent article. As parents of a very ill 14 yo with AN we have given up our lives to help her recover…as we would if she had cancer or any other life-threatening illness. Some family and friends judge this as giving her unnecessary attention and making a fuss over nothing! Up until the day she was admitted to hospital we were considered wonderful parents with a beautiful, happy, well-adjusted daughter….in the blink of an eye and a diagnosis (that we totally agreed with) we became ‘over-controlling’ and the cause of her illness. We definitely fit the profile you describe. We have searched the world for information and treatment and have found a place that provides ‘Maudsley’ treatment, although it is a long way from home (800kms!).
No words can describe the agony of seeing her spirit so crushed. But this evidence-based treatment has given us some hope. Reading articles such as this helps us to keep going knowing we are doing the most loving thing any parent can do for their child…