Most parents who have fought in the trenches of an eating disorder with their child recognize this scenario: Your otherwise kind and conscientious child has disappeared, and in her or his place you find an angry, cruel, and sometimes manipulative doppelganger with the emotional intelligence of a pail of gravel.
It's easy to get sidetracked from your resolve to be the empathic, yet firm parent who sticks to the task of getting your child to follow a meal plan. Emotional outbursts, sullen food refusal, slammed doors and hurled insults have a way of eroding a caretaker's composure, and pretty soon, you're ready to give in to the eating disorder just for a day or two of peace at home.
Parents and caretakers, take heart. An interesting area of research known as "theory of mind" posits that your child's brain really does change as his or her weight dips below the starvation level. Theory of mind researchers are studying the eating disordered person's ability to read facial expressions to intuit mental states, sometimes solely by looking at the eyes of the person they are with. They're finding that this ability falls victim to starvation, just as does the body's ability to maintain strong bones, keep warm, or grow lustrous, healthy-looking hair. A starving person has difficulty attributing emotions, beliefs, and desires to themselves and to others. Without this ability, it can be hard to function smoothly in the social world.
Judith Banker, Executive Director, Center for Eating Disorders in Ann Arbor, Michigan and past president of the Academy for Eating Disorders, explains that theory of mind research began in the field of child development and took root in the study of people with autism, who have difficulty recognizing and reading facial expressions. In the 1980s and even more so in the ‘90s and after, theory of mind studies have gained traction in the field of eating disorders as researchers have searched for overlaps in cognitive function among sufferers of autism and eating disorders.
Researchers, notably Ulrike Schmidt and Janet Treasure at Kings College in London and Nancy Zucker at Duke University, noted similarities between autism and anorexia nervosa. Hormonal changes, Banker notes, may also play a role in the diminished ability to parse facial expressions.
One test the researchers used showed both people with anorexia and recovered patients film clips of social interactions between people. Test subjects had to scrutinize facial expressions, body language, conversation and context to read complicated emotions such as desire, embarrassment and hostility. When a teen with anorexia looks into her worried, and frustrated parents' eyes, can she recognize the emotions written on their faces, and compare it to feelings she has experienced herself? Researchers noted clear deficits in this area among anorexics. The test was able to distinguish those currently suffering from anorexia and those who had recovered. So the good news is that this weakness in processing emotion seems to get better with recovery.
Ulrike Schmidt and colleagues are now readying a paper for the International Journal of Eating Disorders that looks at theory of mind in relation to bulimia. In her tests, Schmidt and her colleagues examine study subjects and the ability to attribute mental states to others and ourselves, which they call "mentalizing." Interestingly, when a group of patients with bulimia were given this test, they were better able to recognize negative emotion than the control group. Schmidt and colleagues have detected enough of a "distinct socio-cognitive profile" among bulimic patients (translation: they do read and process emotions differently) to merit further research.
The fact that patients with anorexia who have recovered seem to regain their ability to recognize and attribute emotions to others, Banker notes, indicates that this phenomenon could well be a temporary lapse into autism-like cognitive behavior. "When someone's in a state of starvation that kind of empathic, or higher-relational function shuts down," she notes, news she hopes will "reduce the personal hurt" that comes with the territory of helping a loved one battle anorexia.
"It is difficult to watch parents weep about some of the things their children say," Banker adds. "They'll say, ‘I don't know what happened to her.' Many seriously ill patients who previously had good relationships with parents can behave in extremely rude and cruel ways. They'll say, ‘I don't know why I'm doing these things even though it hurts my parents.' When they get better, they recognize the impact of their behavior and will cry and apologize for the way they treated their family."
It can be encouraging for parents to realize that these changes are temporary, "that the empathic process has shut down," adds Banker. "The harsh behavior is difficult but it is nothing for parents to take personally. It also puts the burden more on parents and on therapists to fill in the spaces for patients when they're in that state. They need to try to be stable and empathic, to look into the child's eyes, to recognize that they're not there. This can make it easier to not be so reactive, to overlook potentially hurtful behaviors, continue supporting them in eating and not get sidetracked by the slings and arrows."
Marcia Herrin and Nancy Matsumoto are co-authors of The Parent's Guide to Eating Disorders. Marcia is the author of Nutrition Counseling in the Treatment of Eating Disorders
Copyrighted by Marcia Herrin and Nancy Matsumoto