Re:Eating disorders

All of the comments here seem to be very useful and accurate. I would like to add an emphasis upon aspects that are of importance (some mentioned here more or less). As you and others have pointed out, the social context is extremely important (this is not a chemical imbalance or gene!!). So the treatment problem becomes 'how can I discern the developmental skills and experiences that are in need of being learned or used differently in these people within this family?' And, in addition, can I get a clue from observing the 'function' of the symptom in this family.

A few therapists/theorists, esp., will attempt to generalize each type of eating disorder and tell you that if the person is anorexia then, say, "the mother is telling the child that everything from the father is "poison'." (Sadly, a well known therapist in Germany has said this, I believe.) The entire approach of generalizing should be left out of treatment in a unique case (my opinion - not representing Zeig, Erickson, the Foundation or BOL!). At best it ~may~ help orient the therapist to a line of investigation that should be ruled out (to the degree one respects the work of the generalizing theorist - Freud, etc.) I'm glad to see that it is being left out of this discussion thread.

My take on treatment as taught by Erickson is that we examine each case for its uniqueness.
In that light, be sure to consider what the rewards might be for the occurrence and response to the symptom and its treatment for the family. (For instance, in one teenage eating disorder case I saw illustrated beyond doubt that, for that family, the ONLY time anyone touch anyone else was when the daughter got hospitalized). Hence, helping them all become able to touch, be calmer with nurturing, accept such care from each other, etc., was crucial to the developmental advance of each person and the family. (The parents were not at all intimate or affectionate or supportive or often sexual -- this was the last child in the home. And this daughter did not fell at all comfortable about dating given what she had failed to learn to that point about these issues).

Summing up: don't get too theoretical about it...just discover if there is any function for the eating disorder in the family or with the person....if so, help build experiences and understandings to meet those 'reinforcers' in a more adaptive manner. Then expand to helping folks further replace or refine those to be socially appropriate. And finally, don't just look at the symptom's function either, the crucial experiences and transactions each need in this stage of development are most likely weak or absent: (supporting, disengaging, visualizing, crying, dancing, chatting, resting, career planning, dating, facing someone's death, etc., etc., ... consider all such simple and needed things being demanded by this unique family and each individual). Therein you will most likely find the need -- helping them acquire it will result in the 'cure'.

One last word, the visceral reinforcers, muscular habits, time-use habits, and withdrawal habits, etc., of the symptom -- these may, in some cases, have to receive additional direct intervention to help more easily forget/disrupt them in some cases.

I hope these additional comments help add to the great answers in this threat which address the original question.

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