Understanding Eating Disorders

Earlier this year I read a fantastic memoir about one mother's journey, trying to understand anorexia. Brave Girl Eating gives readers a glimpse inside the struggle to beat an eating disorder. I hope you'll gain new perspective after reading my interview with author and Psychology Today blogger Harriet Brown.

Harriet is an eclectic and curiosity-driven writer whose work appears in the New York Times Magazine, O, Health, Glamour, Vogue, and many other publications, on subjects ranging from fat acceptance to forgiveness. A frequent contributor to the Tuesday New York Times science section, she specializes in writing about issues that affect the lives of women and children.

Welcome Harriet Brown author of Brave Girl Eating to Field Guide to Families.

Lynne: Thank you for agreeing to share your story. It's a personal one, yet you've incorporated the latest research on eating disorders, namely anorexia into the book. Can you give us an overview? Do you call it a memoir?

Harriet: I do call it a memoir. In bookstores, I find it in all different places. Self-help. Inspirational. To me it is a memoir. I shared my story because I wanted to speak to other families. They want information. I was trying to convey the emotional reality of going through this with a child. It's overwhelming. You're in this strange place. And doctors aren't necessarily trained in this. Sometimes they're just parroting old news. I wanted other parents to know their feelings are common and shared. You're not alone. There's a way through it.

My daughter wasn't refusing to eat, she was terrified. My job was to stand with her. This disease is perplexing because the cognitive distortions are namely around food. It isn't rational to fight eating. And it can be tricky to figure this out because everything else remains relatively distortion free. It seems the simplest thing to say, "Why don't you just eat?" But it isn't that easy.

Lynne: I often counsel parents related to all manner of cognitive-behavioral issues, telling them that if a child could, she would. There's always some part of nature, or biology, as well as skills, that prohibit that. Can you talk about the connection between one's biology, or predisposition for eating disorders, and triggers?

Harriet: I hadn't given much thought to it before she became sick. I remember thinking there was a big element of choice involved. We live in a triggering society. Something astounding like 90% of girls diet. Combine that with personality traits that set a child up and other triggers and it's really a perfect storm situation. Overachiever, good girl mentality, perfectionistic tendencies, underlying anxiety issues-a family history of eating disorders-it all comes together. I believe in time, we'll see anorexia as an anxiety disorder. Recovery is a painstaking process. Some studies reveal that for a small number there's a spontaneously recover in the twenties. Perhaps because hormones play a mediating role, it's seen mostly in girls. There are still lots of questions about brain development and the role that plays in why young adolescents through young adults are diagnosed, and we rarely see onset in middle age.

Lynne: I was humbled by your decision to embrace professional help while not relinquishing your daughter's care to others. Namely adopting family-based treatment and not sending your child away to an inpatient setting. Was that a hard or relatively easy decision for you?

Harriet: It wasn't that hard. There were moments early on when I didn't know what to do. I was terrified. I was frantically trying to educate myself. I understand those who want someone to fix it. It's a human thing; you want someone to help you. You're utterly terrified. I can understand that parents might turn away. Especially when the medical establishment tells you inpatient treatment is the right thing to do. But I'm stubborn. It's my nature to persevere.

By the time my daughter wanted to go away, I knew it was her disease talking. One of the hardest things was distinguishing when it was her speaking to us or the disease. Her entire affect changed, her voice changed, what she said changed. Over time it made it easier to externalize the disease. It has gotten harder as she gets older. Harder to know what is her independence speaking. But no matter, it's hard as a parent to see your child in pain.

Lynne: Parental sacrifice isn't something anyone wants to embrace it seems, yet it's part and parcel of raising physically, emotionally, and spiritually healthy children. How did you feel about the personal and professional sacrifices you made to be your daughter's primary care giver, even when it was clear, your expertise in 'treating' her issues was evolving?

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Harriet: It was the way I had to do it. She was sick and I'm her mother. The supportive parental role is complicated and has a lot to do with the developmental time when the disease strikes. It's so much harder if the onset is late teens to college age. We're five, six years into this now, and we're still figuring this out.

Lynne: Talk a bit about the notion that once families have struggled with a high stakes emotional issues for a period of time, and then arrive in any kind of counseling, the dynamics played out no longer represent the families' baseline coping skills, but instead demonstrate their collective stress response.

Harriet: Absolutely one hundred percent true. Our daughter wasn't sick long before we landed at our first counselor. I know I came off harping, carping. I was terrified. We've actually always had a very lovely relationship, quite loving. But the higher the stakes the more true it is, that you don't demonstrate the way things were. As a parent goes on high alert, of course you may look dysfunctional. I was aware I was being judged. And of course, self-consciousness makes it worse. I'm sure there are things parents do that are part of the problem. But to only focus on that makes it about blame.

Lynne: I loved your author note, telling readers why you thought it important to get your family's permission/input before writing this story. I was especially struck by your honest disclosure about the nature of memory.

Harriet: I'd read memoirs where I was annoyed with the lack of perspective. I wanted to role model respect. Every writer has to figure out where the lines are. Where is it okay to give your perspective? Where is it important not to? I can only tell my piece of the story.

Lynne: What benefits have come from telling your story?

Harriet: It's been incredibly helpful for me. I'll be working to process this for the rest of my life. But more than that, I know that it helps other families.One of my goals is to let families know that they're not alone. They will get through it. And I really wanted physicians and therapists to be aware of the research. There are options. If we treated eating disorders more effectively in the beginning, at onset, girls may not be sick as long or die from it.We know how to cure it.I want to see us do a better job.

Lynne: Tell us, how your daughter is doing now?

Harriet: She's at the tail end of the relapse I describe at the end of the book. She's back to school at this point. It's a discovery process for all of us. And it will continue to be.

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From Brave Girl Eating:

Brave Girl Eating is the story of how my older daughter, Kitty, became anorexic and nearly died, and how my husband, my younger daughter, and I helped her recover. This is not a story about family dysfunction, sexual abuse, or a poor little rich girl dying for attention. It's not a cautionary tale about skinny fashion models and the media. It's a story about an ordinary teenage girl who fell down the rabbit hole of anorexia-by accident, as it always happens-and about her slow, painful, infinitely courageous climb back up to health and hope, moment by moment, ounce by ounce, one spoonful at a time.

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Lynne Griffin teaches family studies at the graduate level and she's the author of the parenting guide Negotiation Generation, and the novels about family Sea Escape and Life Without Summer. You can find her online here and at www.LynneGriffin.com, and you can follow her on www.Twitter.com/Lynne_Griffin and at www.Facebook.com/LynneGriffin.