Dr. Dawn-Elise Snipes PhD, LPC, CRC, NCCClinical Director, AllCEUs.com

Understanding the benefits of or meanings behind symptoms can assist us in helping patients identify alternate solutions

Anorexics perceive their families as stable, not conflictual, cohesive and with no lack of nurturance.

Anorexic families ◦ show more rigidity in the family organizations ◦ have less clear interpersonal boundaries◦ tend to avoid open discussions of disagreements between

parents and children Anorexic families may be characterized as consensus

sensitive

Bulimic patients view their families as conflicted, badly organized, noncohesive and lacking and nurturance and caring

The bulimic family ◦ is more distance-sensitive implying stronger

interpersonal boundaries◦ less avoidance of disagreement◦ less stable family organization

Bulimics patients are seen as angrily submissive to rather hostile and neglectful parents

The most commonly observed feature in the families of eating-disordered patients is the lack of adequate joint parental authority

Parents have problems finding a balance between rational and flexible control on their child, and age-appropriate autonomy they give to the child

For bulimic patients child-rearing practices were characterized by a lack of care by both parents but especially by their mothers.

There is little research on the impact of an eating disorder on marriage.

What does exist indicates there’s◦ Collusion◦ Lack of intimacy◦ Communication deficiencies◦ Conflict avoidance◦ Hidden power struggles

Some mothers ◦ Find self-affirmation in relationships with their children,

so they tenaciously hold onto them◦ These children feel responsible for their mother’s

happiness and concurrently drawn to establish independence.

Most mothers will acknowledge that they miss the connection and long for the affirmation received from their infants.

As daughters grow they long for the comfort safety and a sense of being known and ministered to that was inherent in the original mother-daughter bond

Grandparents and grandchildren get along notoriously well because they both have the same common enemy, the parents.

How are the parents the “enemy” to both children and grandparents?

By noting the example set by their mothers and grandmothers women can see how they remain connected to their own mothers throughout adulthood.

What if this connection is unhealthy?

The common denominator underlying many cases of anorexia and bulimia is the amount of maternal over or under involvement that influences the child’s ability to establish personal boundaries, and regulate her own body

As daughters grow, both parties must withstand the loss and growth in the separation.

What losses are we talking about and how can they be coped with?

Accepting that one aspect of an eating disorder involves unresolved snags in the Separation-individuation process helps us to help the client start looking for solutions

Where does Dad fit into this separation-individuation crisis?

Eating disorders represent the developmental snags that temporarily but not irreversibly forced the individual off-track.

To become a woman herself the girl must establish herself as different from her mother.

How can she do this and how might this be thwarted by an overinvolved parent? What about an under-involved?

The mother experiences her little girl from the very beginning as “like me.”

As the child individuates the relationship may become strained if the child is forced into a path of “like me.”

Think of those you have known whose parents have tried to force them into a path of “like me.” How did they react? What was the effect on the parents?

Available fathers and father substitutes support the little girl’s femininity by their male presence and affirmation of her desirability and acceptance of her differentness

How is this accomplished? What does UPR by a father communicate to a child?

If Mother’s self-esteem is tied up in their children needing them, they may subtly give the daughter messages “you can grow but only if you do for me”

In what ways might a mother communicate this to her child?How might parents subconsciously sabotage their children’s

development?

A sensitive mother: ◦ Recognizes that her children are individuals with their own talents,

potentials, and problems.◦ Will naturally want to hold onto their love but will encourage the

development and individuation◦ Will enjoy her child’s growth and accomplishments.

A challenged mother◦ May react with loneliness bitterness or depression if she’s not happy

with herself as a woman.◦ May become over or under-involved in her child’s life◦ May experience reductions in her self esteem if she perceives her

daughter does not want to be “like me”◦ May experience fears of abandonment if the child is perceived to

need her less

Overinvolved mothers may be:◦ Attempting to reestablish a primary tie with her daughter as a

way to allay their anxiety and depression on growing older.

In what ways might a mother do this?What messages are communicated in an ED family about aging,

appearance and love?

◦ Searching for the affirmation found in a gratifying relationships. This expectation sets up an impossible situation for both

mother and daughter because neither can meet all the adult needs of the other.

The mother may castigate the daughter for her lack of attentiveness as daughter launches a diatribe against burdensome never satisfied mother.

How can this scenario be dealt with in therapy. What needs is each trying to fulfill?

Underinvolved mothers may be ◦ Attempting to reestablish themselves as youthful and desirable

to allay their anxiety and depression on growing older.

In what ways might a mother do this?What messages are communicated in an ED family about aging,

appearance and love?

◦ Searching for the affirmation found in a gratifying relationships. The mother may castigate the daughter for her neediness as

daughter launches a diatribe against a mother who does not care what she does.

How can this scenario be dealt with in therapy. What needs is each trying to fulfill?

The child resists against a womanly body ◦ To protect from experiencing herself as exactly like her mother

Why would she not want to be like Mom?

◦ Inhibiting her ability to be her own person◦ Preventing unacceptable traits that mother has (fat thighs, big

hips etc.)

Meanwhile she sets up situations so caretakers must become attuned to her physical needs

What purpose does this serve? What other ways could she accomplish this?

Both maternal over and under involvement can result in impairments in the child’s ability to self regulate.

For the restricter, self starvation may be an adaptive effort to defend against self-regulatory deficits resulting from maternal overinvolvement.

In contrast the bulimic, chaotic eating behavior may reflect a desperate attempt to compensate for an empty experience resulting from maternal under involvement.

The fundamental difference between the restricting and bulimic mode could be thought of as the bulimic patients search for something to take in compared to the anorexic patients attempt to keep something out.

In what ways might this be too simplistic?

What other meanings might restriction, bingeing, purging, desire to be “skeletal” or “double digits” have besides rejection of the

parents relational style or desire to stay a child?

In bulimia, patients:◦ Yearn for more maternal emotional involvement and nurturance

than they received. ◦ Felt lonely and found that mothers unavailable psychologically,

if not physically◦ Frantically search for a protective, available, ready response

from her mother if a mother is repeatedly unavailable or unable to meet the

needs of a child that child will anxiously cling to the mother in the absence of the mother alternative figures are sought.

What might these alternatives be and how do they fill the need for protection, soothing and comfort?

Without a firm foundation the child becomes insecure anxious and looks for ways to self-soothe

Food not only represents the mother by its feeding function but it also has the power to soothe.

Eating thus becomes a reasonably consistent and available source of nurturance

Bulimics long for the kind of relationship that their friends seem to have with their mothers.

Often, rather than risk being disappointed in other relationships, they cope with their loneliness by avoiding people in acting as if they don’t care.

Freud’s principal of Multi-determinism asserts that a given behavior rarely has only one cause or meaning.

It is not just biology, parenting, or society. In treatment patients find that they can rework memories

and feelings about their mothers to better understand why and how she did what she did and attempt to form a more forgiving if not loving memory

A benign maternal presence can be cultivated by working on the relationship with one’s mother in individual or family therapy. One may also search for suitable mother substitute for clients such as mentors or teachers

◦ If the patient desires to have “the mother she never had,” how can you help her with this in therapy?

Within the family relationships the father can be thought of as a benevolent disruption of the mother child symbiosis.

Dad is not a threat to the mother-daughter relationships as would be an outsider

Dad has less investment in molding the daughter to be like him, allowing her more independence, room for autonomy and self exploration

How can it go awry?

For girl’s healthy development, fathers must convey from their earliest interactions with her that she is beautiful and loved for who she is◦ The eating-disordered patient’s, father is perceived as

being absent from home either emotionally or physically. ◦ Even if the father was physically present his daughter

might find herself having to enter his world rather than having him reach out to actively enter hers.

What message does this send?

As a different and separate person, the father helps to wean the child from the primary unity and dependency on the mother.

The daughter turns him for confirmation of herself and to enhance her needed sense of separateness from her mother.

When her father is unable to help his daughter move out of the maternal orbit the daughter may turn to food as a substitute.

The very act of refusing or purging food cuts off a symbolic umbilical cord to the provider of food (the mother) and as such is an autonomous statement they don’t need you.

In more healthy functioning households the adults nurture each other so that there will be sufficient emotional resources available to nourish the families dependent children.

The parent without a partner may find their resources are sufficiently taxed and may even turn to the children themselves for solace and sustenance

What might be the effects on the child who has to be friend, comforter and child simultaneously?

Friends, parents and therapists of persons with eating disorders frequently find themselves experiencing an odd mixture of emotions that they cannot readily explain (bored, frustrated, or helpless).

When reading the forums (http://www.something-fishy.org/online/options.php), what conflicting feelings do you see/hear and how do you feel?

Through projective identification we are experiencing the same feelings as that of the patient.◦ This is an invaluable experience of empathy ◦ Helps us understand what is really within the heart of eating

disordered clients◦ Helps us help them identify their emotions and apply their

menu of feelings◦ Helps us model ways to appropriately cope with those feelings

How to the presence or absence of our fathers affect us?

How do we find ourselves assimilating his ideals and values often in ways that are not readily apparent?

How to the presence or absence of our mothers affect us?

How do we find ourselves assimilating her ideals and values often in ways that are not readily apparent?

Can one parent successfully fulfill the roles of both mother and father?