A new book on eating disorder treatment entitled When Food is Family will be published later this year. The book is written by a therapist with over 25 years of experience treating eating disorders who is also the founder and director of an eating disorder clinic.
The premise of When Food is Family is that early childhood relationships play a significant role in the development of an eating disorder. The book is based on attachment theory, which posits that “emotional support, understanding, empathy, and acceptance during a child’s development are the foundation of self-esteem and self-worth throughout life.” The author asserts that children develop eating disorders in part because they do not receive the emotional support and nurturing they need from their families, so they develop a “relationship with food” as a substitute for the intimate familial relationships they crave.
According to the online synopsis, When Food is Family “provides family members a step-by-step approach to understanding what attachment means, why connection to each other is important, how relationship breakdowns can lead to an eating disorder, how food becomes the relationship of choice, and how to go about repairing these relationships so that food (and the eating disorder) is replaced by healthy relationships within the family.”
My primary concern with this book is that it seems to set our field back about 20 years. There is no reliable scientific evidence to support the theory that disrupted attachments or dysfunctional family relationships lead to eating disorders. Nor is there any reliable evidence that treatment approaches predicated on these attachment theories help patients achieve recovery.
I absolutely agree that “emotional support, understanding, empathy, and acceptance during a child’s development are the foundation of self-esteem and self-worth throughout life.” Of course childhood environment is important in the development of self-esteem and emotional well-being. Of course “relationship breakdowns” within a family cause emotional suffering for everyone. Disrupted attachments are bad. Healthy attachments are good. But I am not aware of any evidence that disrupted attachments can lead to eating disorders.
The fact that some eating disorder patients come from dysfunctional families does not indicate that said family dysfunction caused their eating disorder. Correlation does not equal causation. Despite decades of research and millions of dollars spent on cross-sectional and longitudinal studies, researchers have not been able to identify anything that parents do, or don’t do, to cause eating disorders in their children.
The theories espoused by this book are not only unfounded and incongruent with our modern scientific understanding of eating disorders, but also potentially harmful to young patients and their families who are seeking treatment for these life-threatening illnesses.
When parents have a child with a poorly-understood, stigmatized, confusing, life-threatening illness such as anorexia nervosa or bulimia nervosa, they do not need to be told by an expert that family dysfunction is at the root of her illness. The family unit is not well-served when parents are told by an expert that they have failed to bond properly with their children, and this failure to bond has resulted in their child developing a serious illness. Parents with an anorexic or bulimic child do not need to be taught skills to develop healthy attachments with their children. They need well-informed professional support which empowers them to take aggressive action to help restore their child to health.