How to cope with childhood anorexia – don’t blame yourself
I hardly dare write this, in case I tempt fate, but one of the things I most dread is one of my children developing an eating disorder.
It must be purgatory. You spend so long in those early years coaxing them to swallow carrot purée, baking wholesome flapjacks and fretting about their protein intake. And then one day you have to watch, powerless, as they starve themselves.
Mothers of pre-teen children, I've noticed, have a range of charms for warding off the demon anorexia. We try not to say that any food is 'good' or 'bad', and then tie ourselves in knots attempting to explain why a fifth chocolate biscuit before supper is not a great idea.
We tut at images of impossibly chiselled physiques ('But they are superheroes, Mum,' my son not unreasonably points out). When my daughter shows signs of perfectionism I make the poor girl chant, 'There's no such thing as perfect.'
Like many of the wishful things we do as parents, this is probably spitting in the wind. The current scientific literature on eating disorders – I've been in the library, reading a lot of it – indicates that they are not caused by parents.
Anorexia and bulimia are extremely complex conditions, and it can be hard to unravel cause and effect. But study after study has shown that biological causes are more significant than anything a parent does or doesn't do.
We haven't quite caught up with the science on this one. Our culture is still stuck in the 'blame mother' discourse of 1970s psychoanalysis. The Golden Cage was an influential book on anorexia from 1978 by Hilde Bruch.
In Dr Bruch's view, the mothers of anorexic girls and boys were too cold, or else too warm. They smothered their children with treats, or they ignored them and went off to work. Whatever mothers did, it was wrong.
'Sadly many parents blame themselves,' for their child's anorexia or bulimia says Mary George of Beat, the leading British charity for eating disorders (whose website offers valuable help and advice: b-eat.co.uk).
But parents 'should not assume guilt'. The more we learn, says George, 'it becomes clear that parental influence on its own would not be responsible for a child developing an eating disorder'.
Research has uncovered biological causes for anorexia. Sufferers tend to have certain underlying genetic traits: perfectionism, an obsessive desire for order.
More significantly, a groundbreaking Swedish paper from 2007 suggested that the physical process of starving yourself could of itself trigger the symptoms of anorexia in the brain. When healthy male volunteers were asked to eat less food over a six-month period they started to think like anorexics. 'Anyone' can become anorexic 'by eating too little food for too long'.
This is not to say every parent is blameless. Severe cases of bulimia have been linked with disturbed and violent households. But mothers do not 'cause' eating disorders in the trivial ways we often assume.
Dieting mothers have anorexic daughters was a headline two years ago, based on a survey in Sugar magazine. But two pieces of serious research – from 1986 and 2005 – reached the opposite conclusion: mothers of anorexics were slightly less concerned with weight and dieting than a control group.
The good news is: families enduring this hellish illness should not heap blame on themselves. The bad news is: there is no magic charm we can invoke to protect our young against it.