Eating Disorders Do Not Discriminate. Neither Should Feminism. Or Recovery.
Despite the myth that eating disorders only affect straight, white, thin, adolescent girls, women and men of all sizes, skin colors, and sexual orientations develop eating disorders. I remember one African-American client (details changes for confidentiality) I saw who was struggling with an eating disorder. She was a bright young woman who struggled with severe bulimia that could not get her family to support her in her recovery because “that’s a white girl’s disease.”
Here are just a few statistics:
African-American girls aged 11-14 consistently scored higher than white girls of the same age on all Eating Disorder Inventory (EDI) scales measuring features commonly associated with eating disorders except for body dissatisfaction and drive for thinness (Striegel-Moore et al, 2000).[i]
A study conducted by Robinson et al, found that among the leanest 25% of 6th and 7th grade girls, Hispanics and Asians reported significantly more body dissatisfaction than did white girls. [ii]
Chamorro & Flores-Ortiz (2000) found that second-generation Mexican-American women-those born in the US to foreign-born parents-were the most acculturated and had the highest disordered eating patterns.[iii]
Acculturation can be defined as the shifting of values from host culture from culture of origin (Kemp & Thomas). This can be one of many intersecting factors in the development of an eating disorder. One woman I worked with in an eating disorder treatment center was a first generation bilingual immigrant. Because her mother didn’t speak English, she had to spend her therapy time translating for her mother. This repeated the dynamic of being “the hero” for the family, and kept the burden of parenting
her mother on her, not allowing her to get the care and attention she needed to heal from her eating disorder. Although the mental health team I worked with attempted to find a translator to lift this burden from the client, we were unsuccessful. Another “miss” in treatment and recovery for eating disorders is the shortage of bilingual therapists and therapists not trained in cultural competence.
Eating Disorders have complex etiology and don’t occur in a vacuum. There is a cultural context in which they occur. I often explore with clients what was going on in their own life, in their family, and in a larger cultural context during the time they developed an eating disorder. There is a reason that eating disorders DO affect many adolescent girls: this is the time during which they are developing into a woman! When we look at how the rite of passage of becoming a woman is held culturally (OR NOT), this make sense. Mary Pipher, PhD in her 2005 book Reviving Ophelia explores the phenomena of how girls entering womanhood begin to collapse inwardly against themselves in a culture that doesn’t support their rite of passage into womanhood:
Why had these lovely and promising human beings fallen prey to depression, eating disorders, suicide attempts, and crushingly low self-esteem? Crashing and burning in a “developmental Bermuda Triangle,” they were coming of age in a media-saturated culture preoccupied with unrealistic ideals of beauty and images of dehumanized sex, a culture rife with addictions and sexually transmitted diseases. They were losing their resiliency and optimism in a “girl-poisoning” culture that propagated values at odds with those necessary to survive.
Similarly, when other rites of passage (pregnancy and postpartum, midlife, coming out as bisexual, lesbian or gay) are not welcomed, there is a cultural compost heap fertile for eating disorders to develop. Eating Disorders do NOT only affect straight women and the research is beginning to reflect that (All research stats from the National Eating Disorders Website, NEDA.org):
- Beginning as early as 12, gay, lesbian and bisexual teens may be at higher risk of binge-eating and purging than heterosexual peers.
- In one study, gay and bisexual boys reported being significantly more likely to have fasted, vomited or taken laxatives or diet pills to control their weight in the last 30 days. Gay males were 7 times more likely to report bingeing and 12 times more likely to report purging than heterosexual males.
- Elevated rates of binge-eating and purging by vomiting or laxative abuse was found for both males and females who identified as gay, lesbian, bisexual or “mostly heterosexual” in comparison to their heterosexual peers.
- Gay men are thought to only represent 5% of the total male population but among men who have eating disorders, 42% identify as gay.
At the intersections of misogyny, racism, homophobia, and classism are implications for where we can become curious and fierce about advocating for women – and men, and transgender people – in their recovery and their rights. Feminist theory has a history of, among other intersectional misses, not addressing the experience of women of color. Intersectionality addresses how, when more than one aspect of discrimination intersects, something else altogether emerges that is missed.
“Intersectionality simply means that there are lots of different parts to our womanhood,” Brittney Cooper, an assistant professor of women’s and gender studies and Africana studies at Rutgers University, explained. “And those parts — race, gender, sexuality, and religion, and ability — are not incidental or auxiliary. They matter politically.”[iv]
Many people, including myself, believe that this intersectionality is the next wave of feminism– and recovery.
[i] National eating Disorders Association (NEDA) website
I stole the Opposite Land game from the most time-honored parenting resource of all: another mom. Here’s how it works: When you are going somewhere or doing something that requires a certain kind of behavior, visit opposite land first. So for example, before we go to the regular grocery store, we go to the opposite land one. In opposite land grocery stores, all the kids ride on the carts flinging their legs and feet into the aisles, toppling cans and boxes off the shelves. They race around banging into people, don’t say excuse me, and throw eggs out of the carton. They fill the cart up with cookies, chocolate, rainbow sprinkle doughnuts and NO GREEN VEGETABLES. Never. Not Ever.
This technique works if you really get into it and are silly, authentic, and loving. Then your kid knows your intention is to connect and stay connected with them. Kids are right brained and have not yet left the land of implicit knowledge, of being deeply connected with their bodies and felt-sense of another person. So if you’re not authentic and silly with opposite land, they will see right through you and know you are just trying to get them to behave in the grocery store (which, of course, you are, but in a child friendly and respecting-ly, playful way).
A Random Confession related to Opposite Land and Never Eating Tomatoes:
My child is a picky eater. Even though I am a HUGE advocate for the intuitive eating, there-are-no-bad-foods, philosophy, I still relapse into encouraging, bordering on nagging, my child to eat vegetables. As you can imagine, sometimes I “win” a particular battle, but I never (Never, Not Ever 🙂 ) win the war. My little one is all over implicit knowing on that. I know you are trying to get me to do what you want, but I am not going to leave what I know to be true in my body and my preferences. So I keep returning to presenting the food, being playful with it, model-ing eating vegetables, but not forcing them.
I recently was given a book in another great chain of motherhood wisdom (also known as passing-along-stuff-please-help-me-clear-a-little-space-in-my-house). It is fabulous. In it, Lola, the younger sister of Charlie, states that she won’t eat carrots (they are for rabbits), peas (too small and green), and:
“I absolutely will never Not Ever eat a tomato.”
Her older brother, well versed in opposite land and creative, playful parenting, assures Lola that they are not eating carrots, potatoes, peas, or fish sticks. They are eating “orange twiglets from Jupiter, cloud fluff, green drops from Greenland, ocean nibbles from the supermarket under the sea…” You get the idea.
As you can imagine, by the end of the book, Lola is experimenting with trying all kinds of new foods, including the dreaded Never Not Ever (re-named moon-squirters) tomatoes.
How does this apply to You?
(Parents, Non-parents, and people recovering from Eating Disorders, Depression, Anxiety or General Self-Hatred)
Opposite Land looks different for adults. It includes such blasphemous ideas as:
“You ARE good enough.”
“All foods are possible to eat without guilt, including chocolate cake.”
“Recovery from an Eating Disorder (Depression, Anxiety, General Self-Hatred) is possible.”
“Mistakes are allowed.”
“You can be loved the way you are.”
“There is nothing wrong with you.”
“What happened in your family of origin was not your fault.”
“It is okay to feel angry, sad, ashamed, or insecure.”
“You are not bad.”
I get it- these may seem to live in a fantasy world if you are accustomed to believing the opposite. They may seem even more preposterous than eating cloud fluff or orange twig-lets from Jupiter. But considering the possibility can be the beginning of believing it. Having a trusted loved one (spouse, therapist, supportive peer) help you in this process can be the most healing. You may even, like Lola, decide that you can sometimes, Not Always but Not Never, have the experience of being Good Enough. And that can be even more phenomenal than eating a moon-squirter.
Special thanks to Lauren Child and Candlewick Press for permission to reprint the beautiful images from:
I WILL NEVER NOT EVER EAT A TOMATO. Copyright © 2000 by Lauren Child. Reproduced by permission of the publisher, Candlewick Press, Somerville, MA.
The short answer? “It’s complicated.”
The longer answer: Genetics and temperament both play a strong role in the possibility of Depression or an Eating Disorder developing, but do not determine it.
The hopeful answer: Even if your child develops an Eating Disorder or Depression, it is possible to recover.
In this post, I will look at some of the risk factors that can lead to an Eating Disorder or Depression.
Eating Disorders: Are they inherited?
Eating Disorders develop as a combination of genetic vulnerability combined with temperamental traits and a facilitating environment. Some (but not all) risk factors named in Carolyn Costin and Gwen Schubert Grabb’s book 8 Keys to recovery from an Eating Disorder (W.W. Norton, 2012) that can contribute to developing an eating disorder include:
- being overweight or dieting as a child
- having a mother who diets or has an eating disorder
- early menstruation
- being bullied or teased
- engaging in sports or activities with a focus on appearance or weight (for example ballet, cheerleading, ice skating, wrestling, gymnastics, modeling)
- a history of childhood abuse
In a 2000 study in the American Journal of Psychiatry, results showed that anorexia nervosa has a heritability of 58%, but the authors were unable to rule out the contribution of environment. However, they did conclude that genetic factors influence anorexia and contribute to comorbidity of anorexia and depression.
Along with genetic links being discovered with both anorexia and binge eating, certain temperamental traits tend to foster the birth of an Eating Disorder. Ovidio Bermudez, in presenting at Eating Disorder Recovery Services conference* this past year discussed the following temperament traits as those at risk of developing an Eating Disorder:
- Anxiety, Depression, or OCD
- Low stress tolerance
- Low distress tolerance
- Sensitivity to real or perceived injury
So in other words, if you have a sensitive child who struggles with tolerating “distressing” feelings such as sadness, anger, or shame and you (or a family member) struggle with Depression, Anxiety or OCD, the ground is fertile for the seed of an Eating Disorder to sprout.
What about Depression?
At least 10% of people in the U.S. will experience Major Depressive Disorder at some point in their lives. According to statistics, two times as many women as men experience major depression. (There is a lot to be said there in terms of mis-diagnosis of symptoms, gender bias, and who reaches out for support to mental health professionals, that can affect these statistics, but that is for another blog.)
According to two Stanford doctors writing about genetics and brain function, genetics play a strong role in causing Major Depression (Levinson, Douglas F. M.D. and Nichols, Walter E. M.D., Professor in the School of Medicine Department of Psychiatry and Behavioral Sciences, Stanford, 2015). They write:
- The heritability (or percentage of the cause due to genes) is probably 40-50%, and might be higher for severe depression.
- The situation is a little different if the parent or sibling has had depression more than once (“recurrent depression”), and if the depression started relatively early in life… the siblings and children of people with this form of depression probably develop it at a rate that is 4 or 5 times greater than the average person.
What else contributes to Depression? And what about Postpartum Depression?
Stressful life events (trauma, loss of a loved one, moving/loss of support, having a baby) can lead to depression in and of themselves. When combined with a genetic risk, there is a stronger possibility of developing depression. And having one (or more) episode of depression increases the risk of having future episodes. (Kendler, Thornton, and Gardner, 2001)
While many women experience some mild mood change or “the blues” during or after the birth of a child, 1 in 7 women (and some recent research says 1 in 5) experience more significant symptoms of depression or anxiety. 1 in 10 Dads become depressed during the first year. (Postpartum Support International)
Risk factors for Postpartum Depression
Some women are more likely than others to develop Postpartum depression. The following factors put you at an increased risk:
- Previous history of depression
- History of severe PMS or premenstrual dysphoric disorder
- Medical complications for you or your baby
- Lack of support from family or friends
- A family history of depression or another mental illness
- Anxiety or negative feelings about the pregnancy
- Problems with a previous pregnancy or birth
- Marriage, Relationship, or money problems
- Stressful life events
- Substance abuse
How does Postpartum Depression impact children?
Postpartum Depression and other Perinatal Disorders (Anxiety, OCD, Psychosis) can affect children in the following ways:
- Behavioral Problems
- Delays in Cognitive Development
- Emotional Problems and/or Depression
According to Zero To Three, a research-based resource for federal and state policymakers and advocates on the unique developmental needs of infants and toddlers, untreated Depression can have detrimental effects on children’s functioning and future outcomes (2009).
The mental health of parents can affect young children… infants of clinically depressed mothers often withdraw from caregivers, which ultimately affects their language skills, as well as their physical and cognitive development. Older children of depressed mothers show poor self-control, aggression, poor peer relationships, and difficulty in school.
Unlike adults, babies and toddlers have a fairly limited repertoire of responses to stress and trauma. Mental health disorders in infants and toddlers might be reflected in physical symptoms (poor weight gain, slow growth, and constipation), overall delayed development, inconsolable crying, sleep problems, or aggressive or impulsive behavior and paralyzing fears. Early attachment disorders predict subsequent aggressive behavior. Some early mental health disorders have lasting effects and may appear to be precursors of mental health problems in later life, including withdrawal, sleeplessness, or lack of appetite due to depression, anxiety, and traumatic stress reactions.
So, if you have had or are currently suffering with and through (because it is possible to recover and get through it) an Eating Disorder or Depression, your child does have risk. But that does not mean they are doomed. It means, even more important than ever, that you get treatment and recovery yourself! When I attended Postpartum Support International’s training on Perinatal Mood Disorders, the message that they gave was: There is Hope and You are not alone. It is possible to recover and in recovering yourself, you help build a more protected base from which your child can thrive and grow.
Wade, Tracey D, Ph.D., Cynthia M. Bulik, Ph.D., Michael Neale, Ph.D., and Kenneth S. Kendler, M.D., “Genetic and Environmental Risk Factors Anorexia Nervosa and Major Depression: Shared Risk Factors,” Am J Psychiatry 2000; 157:469–471.
Eating Disorder Recovery Services The mission of EDRS (Eating Disorder Recovery Support), Inc. is to promote recovery and wellness for those impacted by eating disorders by providing support, information, and education to individuals, families, professionals, and the community at large regarding eating disorders and recovery resources. EDRS.net
Ovidio Bermudez, MD Dr. Bermudez has lectured nationally and internationally on eating pathology across the lifespan, obesity and other topics related to pediatric and adult healthcare, and has been repeatedly recognized for his dedication and advocacy in the field of eating disorders. eatingrecoverycenter.com
“Major Depression and Genetics” Douglas F. Levinson, M.D. and Walter E. Nichols, M.D., Professor in the School of Medicine
Department of Psychiatry and Behavioral Sciences (2015) Depression and Genetics
Zero To Three The Zero To Three policy Center is a nonpartisan, research-based resource for federal and state policymakers and advocates on the unique developmental needs of infants and toddlers. zerotothree.org
Link to Depression during and after Pregnancy Fact Sheet
Link to study on teaching sleep with infants to prevent Postpartum Depression:
Link to study on effects of Lexipro on treatment of Postpartum Depression:
Have you ever eaten “comfort foods” to calm yourself down? What about having a little ice-cream when feeling sad or depressed? Or does the thought of eating chocolate cake after a meal totally stress you out with anxious thoughts about your body? According to the latest research into neuroscience, there is a reason for it…
To read the full article, click here:
Who develops eating disorders and what you can do as a recovering Mom or Mom attempting to prevent your child having to recover
What causes eating disorders?
There is a common phrase among eating disorder clinicians that says “Genetics loads the gun and environment pulls the trigger.” Meaning, there are personality and brain state trait vulnerabilities that are risk factors for certain persons who, when faced with an environmental stressor (adolescence, leaving home/school, relationship break up or divorce, sexual trauma, loss of a loved one, pregnancy and postpartum, etc), then develop an eating disorder.
What traits make a person susceptible to an eating disorder?
As any parent knows, kids come out of the womb with their own unique temperament. It isn’t good or bad and it isn’t controllable. It simply is. Some kids are “slow to warm up,” some kids are “active.” It is apparent almost from infancy. The research literature on eating disorders has identified certain temperament traits that people with eating disorders often have including: negative emotionality/low self-esteem, perfectionism, inhibition, picky eating, obsessive compulsive, anxiety/fearfulness, mood lability, impulsivity.  Even though these traits may sound awful, actually, these traits can be great assets when channeled in the right direction. I myself struggled with low self-esteem, picky eating, shyness, perfectionism, and anxiety all through my childhood. As a recovered adult, I have learned to channel perfectionism into conscientiousness, shyness into being of service, negative emotionality into passion for recovery and empathy for suffering, and picky eating into acceptance of my preferences, anxiety into a creative and professional drive to grow as a person and clinician. I often work with clients on shifting their “character defects” into “character assets.” Falling in love (with appropriate professional boundaries of course) with my clients has helped me see this more clearly: people who have or are struggling with eating disorders are some of the most sensitive, empathic, creative, highly achieving, loyal, and dependable people I have met. They are also extremely hard on themselves. That is where being witnessed and encouraged by an external source of compassion can be especially helpful in recovery, until it can be grown it internally.
Twin studies of Anorexia and Bulimia suggest that there is a 50-80% genetic contribution to these disorders. Wow! 50-80%!  We did NOT learn that in my graduate school training or Psychologist licensure materials. That is similar to the genetic risk factors associated with Schizophrenia and Bipolar Disorder, for which all clinicians are trained to be on the lookout. How many people suffering with eating disorders as well as their parents would feel relieved of it being at least partially “not their fault” and on the lookout for prevention in knowing there was a genetic risk?
What can we DO about it?
1. Awareness of your own and your child’s temperament
Awareness is the first key. There is a 12-step slogan that is helpful to keep in mind here, called “Awareness, Acceptance, Action.” In other words, first, become aware of your own and/or your child’s temperament. If you or your child are of the more “slow to warm up” temperament, notice this and accept it without judgment. As one article describes:
Temperament is not something your child (or you) chooses, nor is it something that you created. There is not a “right” or “wrong” or “better” or “worse” temperament…some children are naturally more comfortable in new situations and jump right in, whereas others are more cautious and need time and support from caring adults to feel safe in unfamiliar situations…Some children seem to come out of the womb waving hello. Others are more hesitant around people they don’t know, beginning even as young babies. As they grow, these children often prefer to play with just one or two close friends, instead of a large group. Children who are slow to warm up often need time and support from trusted caregivers to feel comfortable interacting in new places or with new people.  This is fabulous article on “slow to warm up” temperament: http://www.zerotothree.org/child-development/challenging-behavior/cautious-slow-to-warm-up.html
2. Acceptance and Action of temperament fits
Once you have noticed with awareness and acceptance both your own and your child’s temperament, practice compassionate acceptance and action to accommodate both of these. For example, if you are more slow-to-warm-up but your child is active, go to places where you feel comfortable and your child can be themselves! This might be a playground or other space that the child can be safely active in and you can be an observer. Staying in the house with your active toddler climbing all over the furniture and throwing things is going to set you both up for frustration. If one or both of you are sensitive to sounds and tastes, incorporate that awareness into your planning, your home environment, your communication with caregivers and teachers. My toddler loves smooth textures. He will pretty much eat anything if it is smooth. If he finds a bump, leaf, or seed in it, he will not eat it. Instead of fighting this continually (which I tried!), I give him lots of smooth, blended food and little taste options of other textures to which he can say “no thank you” and leave on his plate until he “warms up” to try them. His school has optional “performances” for all the children. They can do somersaults, be a fire truck, dance, pretend to be a kitty cat, etc in front of all the teachers and parents every week. For an active child, this is a dream come true. These children leap into performing their first day. For a slow-to-warm-up child it is a nightmarish terror. My child has yet to “perform.” I have had to learn to contain my own anxiety and flashbacks of childhood violin recitals. If and when my child is ready, he will perform. Or not.
Here is a helpful article on Goodness of Fit between parents and children: http://centerforparentingeducation.org/library-of-articles/child-development/unique-child-equation/temperament/understanding-goodness-of-fit/
3. Be a mindful eater yourself and let your child maintain their own mindful eating
Recovering women (and men) need to re-learn to trust our bodies, our hungers, listen and trust our satiety levels. We need to re-learn how to “eat normally” and intuitively. Normal eating includes eating food that you like, giving some thought to food selection that includes nutrition without restricting, and sometimes eating for reasons that include emotional needs or convenience. I tell my clients recovering from eating disorders if food was devoid of emotional eating, we would all be eating pellets at mealtime This is not brave new world. We are never going to eat for ONLY physical reasons and that is ok! Food is pleasurable, food includes memories, food includes preferences, family and cultural experiences. I have always liked chocolate since I was a little girl. I have never liked mushrooms. This was true for me as a toddler and it is true for me as a middle-aged woman. This has remained true all through my eating disorder and 15 years of recovery. I need to respect that. I also need to be aware that sometimes I need to eat lunch early due to my child’s or my work schedule or have a snack in the afternoon in order to have a later dinner with my family. My recovery is flexible and mindful to these facets of eating.
Ellen Satter, a Nutritionist and Family therapist and authority on feeding and eating, who has written many books and articles with practical wisdom, offers the following description of normal eating:
Normal eating is overeating at times, feeling stuffed and uncomfortable. And it can be undereating at times and wishing you had more. Normal eating is trusting your body to make up for your mistakes in eating. Normal eating takes up some of your time and attention, but keeps its place as only one important area of your life.
In short, normal eating is flexible. It varies in response to your hunger, your schedule, your proximity to food and your feelings. 4
Children are natural intuitive eaters. Ellyn Satter offers the following “division of responsibility” suggestion for facilitating maintaining a sense of intuitive eating for children as they grow. “The parent is responsible for what, when, where. The child is responsible for how much and whether. Fundamental to parents’ jobs is trusting children to decide how much and whether to eat... Fundamental to parents’ jobs is trusting children to decide how much and whether to eat. If parents do their jobs with feeding, children do their jobs with eating.”
For a full version of the Division of Responsibility, go to
In summary, when we take away the shame and blame of eating disorders, prevention and recovery from them becomes a wide open place of exploration. It stops being about Who caused this or Why am I so messed up and turns into an interesting journey of appreciation and discovery.
Cassin, S. and von Ranson, K. (2005) Personality and eating disorders: a decade in review. Clin. Pyschol. Rev. 25, 895-916.
Wagner, A. et al. (2006) Personality traits after recovery from eating disorders: do subtypes differ? International Journal of Eating Disorders 39, 276-284.
Rachell, L. and Lilenfeld, L. (2011) Personality and temperament. In Behavioral Neurobiology of Eating Disorders (Current Topics in Behavioral Neurosciences, Vol. 6) pp3-16, Springer
 Bulik, CM et al. (2006) Prevalence, heritability and prospective risk factors for anorexia nervosa. Arch. General Psychiatry 63, 305-312.
 Zerotothree website Authors: Rebecca Parlakian and Claire Lerner, LCSW, ZERO TO THREE, Contributors: Patricia Blackwell, PhD Psychologist, Private Practice ZERO TO THREE Graduate Fellow