My Rebuttal to “Surefire Ways”

An essay written by a clinical social worker titled “Surefire Ways to Give Your Kid an Eating Disorder” has received a lot of attention in the blogosphere over the past week, including brilliant rebuttals by Laura Collins and Carrie Arnold. I wrote a reply to this essay on Ms. Lewis’ blog, but unfortunately she did not post it. I am not sure why my reply wasn’t posted, but I did notice that there are no posted replies from clinicians who strongly disagreed with the essay. Therefore, I have chosen to post my reply on my own blog. If you have attempted, unsuccessfully, to post a reply on Ms. Lewis’ blog, please feel free to post here. As a general policy, I post all replies except spam.

As a psychologist specializing in the treatment of eating disorders in children and adolescents, I was profoundly disappointed to read this essay. I have grown accustomed to hearing myths about eating disorders from lay people and from the media, but I hold professionals to a higher standard. Professionals who write articles for public consumption have an obligation to be accurate, up-to-date, and straightforward.

Ms. Lewis’s essay confuses the common problems of body dissatisfaction, perfectionism, and poor self-esteem with the psychiatric illnesses called eating disorders. Without question, parents have a major influence on their child’s self-esteem and body image, for better or for worse. Parents influence their children’s development in a variety of ways, and bad parenting can cause tremendous pain to impressionable children. However, there is no reliable evidence to indicate that parents cause eating disorders. The Academy for Eating Disorders recent position paper on The Role of the Family in Eating Disorders concluded that “There appears to be no consistent structure or pattern of functioning in families with a member who suffers from an eating disorder; rather, eating disorders evolve in a multiplicity of family contexts.”

For decades, psychologists and psychiatrists theorized that cold, withholding parents caused their children to develop autism, that erratic parenting caused schizophrenia, and that overbearing or perfectionistic parenting caused eating disorders. More recently, these theories have been disproven. While the precise causes of these illnesses are unknown, we do know that these are highly heritable, biologically-based brain disorders that are definitively not caused by any particular type of parenting.

A parent who is a “neat freak” – who uses hand sanitizer before every meal and requires his child to clean his room thoroughly twice a week – cannot give his child OCD. A child cannot acquire a parent’s mental illness by imitating his behavior.

By stating that encouraging perfectionism, withholding emotionally, and using food for rewards and punishments are “surefire ways to give your kid an eating disorder,” Ms. Lewis reveals her ignorance about her own area of expertise. She conflates body dissatisfaction with eating disorders and thereby inadvertently trivializes the most deadly of all psychiatric illnesses.

I respectfully urge Ms. Lewis to educate herself on the most recent scientific knowledge about eating disorders and to revise her essay to reflect this knowledge.

4 Replies to “My Rebuttal to “Surefire Ways””

  1. It means so much when peers approach peers on this. There is a tendency to think that if parents are speaking up on the topic we’re just defensive and in denial and don’t know what we’re talking about.

    I believe what you’ve said here has the authority and authenticity to speak to anyone with the intellect and professionalism to hear it. I am sure all parties care about patients and want the best for them — but with such a serious issue we can’t afford to be silent.

  2. Thank you Dr. Ravin!
    You remain a champion for parents and individuals dealing with eating disorders. As a parent of a daughter with RAN, I appreciate and value your comments because they reflect the most up-to-date scientific knowledge about eating disorders. Thank you for taking on this “professional” is hard enough for a parent to deal with relatives, neighbors and friends who do not understand the etiolgy of eating disorders…but it is inexcusable for these so-called “professionals” to continue to treat eating disorder patients with their antiquated ideas. I am a Physical Therapist. Approximately fifteen years ago, my State Board of Physical Therapy (Florida) deemed it neccessary for all PT’s to have up-to-date continuing education credits in Domestic Violence and Medical Errors because these were areas where Physical Therapists could be “first responders”. I think it is time for ALL state boards that license mental health professionals to require mandatory yearly continuing education credits in the new information about eating disorders! It would be unethical and professionally inexcuseable for me as a physical therapist to continue to treat my patients as if it were 1991 (the year I received my Master’s Degree of Physical Therapy).. if there is evidence-based research in a specific treatment modality, why should it be any different for medical physicians, nurses, or mental health professionals??

  3. I note that Micelle Lewis does not include anorexia nervosa in her clincial practice. I think this is a good idea. I’m afraid she would be in over her head if she attempted to help treat AN.

    There is an aspect of her blog post that is actually quite humorous if you think about it. She writes that if parents are “critical and abusive,” then food for their child will become “a comfort and never failing friend.” For people with anorexia nervosa, food is a discomfort and, in a sense, an enemy. Does this mean that we could treat AN by criticizing and abusing sufferers so that they will turn to food as a comfort and a friend? (Obviously not, but posing the issue that way shows how absurd her blog post really is.)

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