By Rachel Millner, PSY.D, CEDS-S, CBTP
To Parents of Kids with Eating Disorders (especially those who don’t fit the stereotype):
I am sorry that the eating disorder field has not been there for you in the ways we should be. As a field we have let you, and your children, down. We have reinforced the stereotype that only thin, white, wealthy, straight, cis girls get eating disorders and have put a great deal of research into anorexia while mostly ignoring other eating disorders. We have sent the message that parents are intentionally harming their kids and forget that parents exist in the same culture that we all do. We have harmed you and we have harmed your kids. It is time for us to do better.
As parents, we are seeking to do what’s best for our kids. We fall short often, but when we know better, we do better. This is also true in the eating disorder field. The vast majority of us in the eating disorder field came into this line of work wanting to help people whether through direct clinical work, research, or teaching. We fall short often, but when we know better, we need to do better. There is an opportunity here for us all to do better.
I think the eating disorder field and the parent community are in a parallel process in how we are needing to evolve and change in order to do better for our communities and help more kids with eating disorders. As a parent community, you need us in the eating disorder field to be doing this work. Those of us in the eating disorder field need you, as parents, to be doing this work. We need to push each other forward. Moving forward is scary, but staying stuck in our old convictions and beliefs doesn’t help anyone.
There are many ways we need to evolve and it is impossible for any one list to be exhaustive, but here are some suggestions of things we need to do both as a field and within the parent community to create change:
- We need to stop centering thin, white, cis girls with anorexia. This does not mean that the experience of people who fit this description isn’t important, but what it does mean is that every time this is the only image that is seen of someone with an eating disorder, anyone who doesn’t fit this description moves a step further away from getting help. We know that the quicker someone gets diagnosed, the better their prognosis. When we stop centering only one story and one stereotype, we help everyone else get diagnosed and treated quicker.
- We need to start recognizing eating disorders as a social justice issue. I know there are a lot of varying opinions and beliefs about what contributes to the development of eating disorders, but you don’t need to believe that culture causes eating disorders to recognize them as a social justice issue. The fact is that we live in a white supremacist culture that tells us some lives are more valuable than others. We live in a culture that tells us some bodies are more valuable than others. We live in a culture that tells us some voices should be heard over others. We live in a culture in which some people are given access over others. If we want to help those suffering with eating disorders (and prevent some eating disorders from starting) we need to acknowledge that living in this culture has an impact and be working to change it.
- We need to address fat phobia and weight stigma. As a field, we need to stop having any relationship with the “obesity” field. Body size is not an eating disorder or a problem to be solved. Period. We need to stop being afraid of our clients getting, or staying, fat. We need to stop setting goal weights too low. We need to stop giving one treatment plan to someone in a smaller body and another to someone in a larger body. As providers, we need to be willing to stop dieting and address our own internalized fat phobia. As parents, we need to stop commenting on our kids’ bodies or suggesting that they need to be changed. We need to stop our own dieting. We need to stop healthcare providers from telling our kids they need to lose weight. We need to take a firm stance on this. There should not be a single treatment center, provider, researcher, or professor that doesn’t practice from Health at Every Size(R) and we need to be helping the parent community to do the same.
- We need to recognize the role of trauma in eating disorders. I know this is a controversial one. I am not suggesting that everyone with an eating disorder has a trauma history, but I am suggesting that we need to make sure we are assessing for a history of trauma and providing trauma informed care-whether there is a history of trauma or not. We need to recognize that having a marginalized identity in this culture is trauma and name it as such. We need to remember that treatment that is fat phobic is trauma. We need to remember that if someone tells us something was traumatic for them- it was. It’s not up for debate.
As I said, this list is not exhaustive, but it is a place to start from. We have a common goal of helping those with eating disorders recover and preventing more people from developing eating disorders. We push forward together for the benefit of those who are most marginalized and most harmed.
Thank you! I am also interested in the links with autism and trauma through autism. I shall look forward to hearing more.
Thank you for this. Our child does not fit the stereotype. For starters, he’s male. Diagnosed at age 19. Now he’s age 23 and appears to be well on his way to recovery. Also, our son is black and we are white. Trauma did play a big role in his eating disorder. As he puts it “At first, restricting my food intake was a way to cope with the trauma, to control the trauma and shut down my feelings. But then ED took over, and I was in ED’s control.” He was often the only guy in residential, and always the only man of color. I believe his providers set a weight goal that was too low for him. Maybe that was on purpose so he would not freak out as he began to recover. He is now past the top of the weight goal they set for him. To look at him, you would say he could be much larger and no one would say he’s too large. I’m glad he’s still gaining weight and moving towards “state restoration” instead of “weight restoration”. I appreciate every person who works in the field of eating disorders and all that you do to help EVERYONE get well. Thank you for reminding providers to be aware of all people who suffer from eating disorders.
Thank you Rachel for this open and honest observation of the current ED assessment and treatment environment.
I believe it is critical that services and clinicians are open to carer input and are flexible in a tailored approach, BUT within a recognised framework of consistency and openness in sharing of management to carers.
There often are too many smokescreens and inconsistencies in which parents and carers are not kept informed – which further enables the illness..This needs to change.
We live in a white supremacist world???? Is your PERSONAL OPINION statement supposed to help white people in particular, struggling with mental illness and self worth feel better? I came on here to look for help for a loved one. As you look at my white child as “privileged” I can only assume any help you may have for her is marred. This is heartbreaking. The very people you are supposed to be helping and protecting will be hurt by this dangerous viewpoint.
I am replying as the blogs editor for F.E.A.S.T. First of all, I hope that you found the help that you were looking for on the FEAST website. If you need information or resources about something specific, please let me know. First and foremost, F.E.A.S.T is here to help parents and caregivers of people affected by eating disorders.
At F.E.A.S.T., we try to present a variety of content on our blogs. Diversity is important to us. That being said, we would never post anything that we feel can harm families or that is written by people with viewpoints that we consider dangerous. We believe that there is value in respectful dialogue and the exchange of ideas between people with different opinions and perspectives. That is how we grow and learn as a parent community.
Switching hats for a moment and speaking as another parent, I can relate to what you are saying because I also got a jolt when I read those words. I understand your reaction. I want to just share that I have come to understand through listening to some of these “non mainstream” viewpoints that having an inclusive perspective does not hinder or mar a treatment provider’s ability to help any patient, I think it enriches their ability to help ALL patients.
Thank you very much for this article. I especially appreciate your acknowledgement that there are many causes of eating disorders and therefore no one treatment is going to be effective for all.