“My name is Emily, I am 45 years old and I am scared of gaining weight. 20 years ago, I was diagnosed with Anorexia Nervosa (see fact box). It means that I was highly underweight and constantly thinking about how many calories I ate (or better said, I could avoid). I spent hours just looking at my body and seeing if I gained weight somewhere. For years, it was a struggle for me to eat in front of people because I was afraid of the comments. “Emily, you should eat more” or “Next time we go to McDonald’s so we get some calories in you”. I hated it. Today I am still skinny but my weight has normalized. Things changed with the birth of my two daughters, who are now 9 and 12 years old. However, I am still not happy with the way I look and I dislike when I have to eat high caloric food. Recently I read in an article that daughters of anorexic mothers often also develop an eating disorder (Zerwas et al., 2012). They argued that mothers act as role models for their daughter’s body image and that they teach them preoccupation with weight and shape. I became curious. Is it true, that mothers act as role models when it comes to daughter’s perception of their own body? Is it really, like mother, like daughter?”

Many psychologists have found that daughters of mothers with anorexia are often also diagnosed with an eating disorder later in life (Hall & Brown, 1983; Zerwas et al., 2012). When trying to explain this phenomenon, researcher’s standpoints divide into two separate corners. One group assumes that mothers act as role models for their daughters, while the other group of scientists assumes this relationship to be interactive; where mothers either facilitate or protect daughters from concerns about weight and shape.

S.M. Schmitt
DSM-V Classification
Source: S.M. Schmitt

Mothers as Role Models

One line of research focuses on mothers as a role models for their daughters when it comes to evaluating one’s body. Psychologists assume that when mothers are happy with their own body and eat normally without overthinking it, they in turn teach their daughter to love and accept their own body. This should

also hold when they don’t look like the photo shopped models in beauty magazines (Mchiza, Goedecke, & Lambert, 2011). The same is true for mothers with a negative body image. Children of mothers with lifelong eating disorders show feeding problems as early as 6 months after birth. When the same children are 4 years old they use chocolate or other candy to sooth their emotions (de Barse et al., 2015). Further, when daughters were 8 years old they try to eat healthier than their peers and are more aware of avoiding unhealthy snacks (Ammanity et al., 2014). This early implemented and abnormal eating pattern continues into the daughter’s teenage years (Allen, 2014).

Some researchers (Sadeh-Sharvit et al., 2015) wanted to know how daughters abnormal relationship with food develops. They interviewed a large group of anorectic mothers with babies and toddlers about their feeding behavior. Due to their own troubled relationship with food they experience a huge dilemma when feeding their children. Mothers constantly check their child’s weight, observe if they gained “too much” weight and have a desire for their child to be skinny. They also highly control the child’s food intake. They do so by giving their child less time to drink their bottle or they delay the onset of solid food to the child’s diet. Finally, mothers prevent their child from exploring food in their environment, which is an important process for the child to develop a healthy relationship with food. In sum, we form the foundation of our eating habits during childhood (see Tipp 3). These habits are primarily shaped by our mothers who control when, where, what and how much we eat. Children of mothers with eating disorders learn that food intake has to be limited, that being skinny is important and that their mother is happier when they eat less (Sadeh-Sharvit et al., 2015).

It seems that there is good evidence for the modeling behavior hypothesis. However, many studies show contrary results (Ogden & Steward, 2000) and the fact that not every daughter of an anorexic mother develops an eating disorder shows that there must be more to it.

The mother daughter interaction

The other direction of research assumes mothers to either facilitate or protect their daughters from weight and shape concerns. Psychologists consider an interactive relationship of the influence of mothers in the daughter’s development of eating disorders where many variables can influence this process. The Psychologist Dr. Ogten (1999) has found maternal autonomy, the perception to have control over your daughter’s actions and activities, to play an important role. Mothers who believe that they cannot control their daughter’s behavior often raise daughters who restrict their diet. When mothers also believe that their daughter have no control over her actions, then daughters show even worse dietary restrictions and are less satisfied with their body. This relationship was even stronger for mother daughter pairs that are highly dependent on each other (see Tipp 4). One example of this is, when daughters think it is very important that they live up to their mother’s expectations. These results not only show that the mother daughter relationship is more complex when it comes to weight concerns in daughters but also that a lack of independence is a risk factor for eating pathology in young women.

Another mechanism that can cause and maintain an eating disorder is a lack of boundaries between daughters and parents. Psychologist have found (Rowa, Kerig, & Geller, 2001) that anorectic daughters often complain that they have to act as the parent in the relationship (see Tipp 2). Further, they feel highly controlled by their parents compared to healthy same aged teenage girls. One example is when parents go through the daughter’s personal stuff even when asked not to do so (see Tipp 1). And finally, mothers often transfer their issues with their spouse onto the child. When there is an argument with their partner, they in turn also get angry at their daughters. Thus, when daughters feel like they can’t be the “child” in the relationship and when boundaries between parents and daughters become blurry it puts the child at risk to develop eating disorders.

The relationship is more complex

So, which one is true? Do mothers act as role models and induce a good or bad body image into their daughters OR is this process more complex? Both Theories show valid arguments. However, when we compare the two theory’s directly we find the influence of mothers on their daughters weight and food concerns to be more complex than simply modeling the mothers body dissatisfaction (Ogden & Steward, 2000). Rather, the mother daughter relationship is interactive in which it either protects or facilitates weight and shape concerns of the daughter. Many factors such as autonomy, self-esteem and a sense of one’s own identity influences the daughter’s relationship to food intake and evaluation of their body (Rowa, Kerig, & Geller, 2001; Ogten, 1999). Still, science has yet to determine other influential factors. Taking all this information into account we learn that Emily does not need to worry about her daughter simply copying her behavior. Yet she should be aware of not transmitting her own body concerns onto her daughter. She should not restrict and control her daughters eating too much, nor should she give her daughters the feeling that their mothers love depends on how much she weighs.

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4 tipps to prevent your daughter from developing an eating disorder

  • Know your boundaries. Women who developed anorexia nervosa often report a lack of boundaries with their mothers (Rowa, Kerig, & Geller, 2001). Do you really need to know everything your daughter thinks and feels? Puberty is tough enough on its own. I am sure you can imagine that you don’t need the additional pressure of your mother constantly gazing over you. Be the support that your daughter needs. That means, provide her with a stable foundation and be present when she needs you. However, allow her enough freedom to make her own decisions and to develop her own identity.
  • Be a parent, not a friend. Even though your teenage daughter now dresses like a grown up and uses as much make up (or probably more than the average adult), she is still your child. Therefore, try not to rely on your daughter for emotional support. Rather call up a girlfriend when you’re angry about work or have issues with your spouse (Rowa, Kerig, & Geller, 2001).  
  • Family dinners. It is important to teach children healthy eating patterns. Having regular times for family dinners will not only make sure that your daughter eats regular and healthy proportions. She will also learn to associate food with pleasant, social experiences. Even when your families schedule is crazy, make sure that everyone makes the daily family dinner a priority (Safeh-Sharvit et al., 2015).
  • Empower her. Research shows that young women who form their own identity and are self-confident are less likely to develop an eating disorder (Ogten et al., 1999). Being a mother myself I understand that it’s hard to see how quickly your daughter grows up. However, it’s the circle of life to let her leave the nest when the appropriate time has come. All you can do is give her the best foundation for life. Teach her that she can achieve anything she wants, when she is willing to work hard for it.

References

Allen, K. L., Gibson, L. Y., McLean, N. J., Davis, E. A., & Byrne, S. M. (2014). Maternal and family factors and child eating pathology: risk and protective relationships. Journal of eating disorders, 2(1), 11.

de Barse, L. M., Tharner, A., Micali, N., Jaddoe, V. V., Hofman, A., Verhulst, F. C., . . . Jansen, P. W. (2015). Does maternal history of eating disorders predict mothers' feeding practices and preschoolers' emotional eating? Appetite, 85, 1-7.

Diagnostic, D. (2013). statistical manual of mental health disorders: DSM-5. 5: Washington, DC: American Psychiatric Publishing.

About the Author

S.M. Schmitt

S.M. Schmitt is a Research Master student in Cognitive and Clinical Neuroscience specializing in psychopathology at the University of Maastricht, the Netherlands. 

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Do anorexic mothers teach their daughters to develop an eating disorder?