I have been asked many times “Did you ever find out what caused Joe’s anorexia”. The straightforward answer is no. However we have a few ideas about what could have been contributing factors:
- He went through a very early puberty. It is no coincidence that many cases of anorexia start in puberty, both in boys and girls. With girls the reason seems more obvious as they look in the mirror and see a more rounded shape developing. Boys tend to be more happy with their developing more muscular physique, but if a boy has a very early puberty, he might not appreciate the changes that are happening to his body and making him different from his peers. In addition the raging hormones can trigger irrational behaviour in either sex.
- Joe was and having recovered from his illness, is still, a very talented sportsman. This is his explanation. “ I thought I would be an even better sportsman if I lost a little weight. I felt really good when I lost weight and to start with all my friends commented on how good I looked. The trouble was it got out of control and I found I couldn’t stop losing weight. I just got scared of eating in case I put weight back on”. There are numerous cases of sportsmen restricting their diet for their sport and developing an eating disorder. Consider jockeys, gymnasts, light weight boxers, long distance runners, cyclists and ballet dancers who can all justify restricting their diet to ensure they maintain an “optimum” weight for their sport.
- Joe is the eldest child of a complex family. He has one sibling, three half siblings and three stepsiblings. It is likely that he felt he was always the last in the pecking order of all these younger children. For years he may have been craving more of our attention without us realising. He always seemed such a happy boy with a healthy appetite, and who loved his sport. When I read “ The Best Little Girl in the World “ by Steven Levenkron it made me realise how an outwardly happy and well balanced child could actually be feeling very lonely and left out by the demands of other children within the family.
- Research has shown that pre term babies are more likely to suffer from behavioural difficulties including eating disorders. Joe was born six weeks prematurely so this could have been a contributory factor.
There could have been many other triggers of Joe’s anorexia, but he didn’t bring them to our attention. Of course we agonised about such things as our family structure, was he being overstretched at school, was he being bullied etc? It is important to note that anorexia can appear in any family setting and in any social situation. We are a large complex family, but many small nuclear families, who appear to have no problems, have been affected by a visit from anorexia. Children from all walks of life are vulnerable. Some typical triggers might include:
- An overweight child being teased or bullied at school. Comments might be made in jest and in a friendly manner, but then taken to heart.
- A highly academic child might be bullied by less able children and see food as a way to control his life.
- A less academic child might see weight loss as the only thing he can achieve positive results with.
- A child whose parents are constantly dieting might follow suit.
- A child who has seen an overweight parent or relative suffer a heart attack might seek to prevent this happening to him by cutting back on food.
- Abuse within the family often leads to an eating disorder.
- A death in the family can create a feeling of helplessness and loss of control. A child might find comfort in having control over food.
- An overprotective or over dominant mother has often been blamed in the past for her child’s eating disorder.
- A passive or absent father has also been often cited as a reason for a child developing eating problems.
- Social pressures might cause a child to start dieting and exercising. Within our culture young men who have a slim and athletic build are portrayed as being popular, attractive, healthy and successful in life. A young boy with puppy fat might feel he has to take drastic measures to achieve this image as soon as possible.
As well as the above-mentioned social triggers, eating disorders can also be triggered by chemical or biological factors. Chemical imbalances in the brain can lead to all sorts of behavioural disorders. It is also increasingly believed that there may be a genetic link, and certainly eating disorders seem to run in families.
The bottom line is that every case is different. No one type of person gets an eating disorder, and no two people with an eating disorder are exactly alike. The common features seem to be that people who develop eating disorders suffer from a very low self esteem, and many find it difficult to express their true feelings or explain what is making them unhappy.
Of course we will never really know exactly what triggered Joe’s illness, and like most parents of anorexic children we went through many months of agonising over what we could have done better to prevent our son almost starving himself to death. Joe’s key worker made me feel much better when she made two points in our first meeting:
- It is much more important to look forward, not back. What caused Joe’s illness may well be totally irrelevant to his recovery and his future. Of course if we discovered, during the course of his therapy, that there was something in his life that was making him unhappy then we could endeavour to change it. In many cases of anorexia the initial triggers remain a complete mystery.
- All families are dysfunctional in some way. However simple or complex your family set up, there are always disagreements and periods where some members are less happy than others are. Of course we should examine our family set up, and try to change if necessary, but we shouldn’t assume that there must be something terribly wrong with our family simply because our son had developed anorexia. Family therapy (more of this later) is a very good forum for examining the family set up and discussing if any changes might be beneficial.