The Merits and Demerits of Making Parenting a Cause of Eating Disorders : A Qualitative Analysis of a Case of Anorexia Nervosa through a Patient's Narrative

Abstract

Background: The etiological model of eating disorders which asserts that inappropriate parenting results in the development of an eating disorder, which this study calls "the familial model," has already received much criticism. Although many Japanese medical professionals usually attempt to explain that the familial model is wrong because of its low scientific probability, the model still has a strong impact on patients with eating disorders and their families in Japan. To explain why many patients employ the familial model to understand their eating disorders in spite of the criticism, this study uses for its theoretical framework not a natural science method but an approach based on the narratives of the illness. Subjects and Method: This study conducted a qualitative interview with an anorexic patient. The interviews were conducted 14 times over a period of 27 months. Since this subject had internalized the familial model, this study analyzed how this internalization had occurred and how the patient interpreted the etiology of her anorexia nervosa. Result: The subject internalized the familial model through medical consultations, professional books about eating disorders, and her parents' attitudes, which drastically changed after her diagnosis. The subject continued to suffer severe anorexia as she faced difficult problems in her life. Indeed, the anorexic condition helped her to escape from these problems. The subject explained that she became anorexic because of inappropriate parenting from her parents who, for instance, expected too much from and exercised excessive control over their children ; therefore, she was only able to explain her psychological pain by starving herself. However, she started to recover from her anorexia after she succeeded in making social relationships outside her family. Conclusion: This study finds that the familial model is able to restore psychological coherence to the past and present of a patient disturbed by the development of an eating disorder. The study also shows how patients' guilt feelings about developing, having, and failing to recover from an eating disorder are alleviated by blaming their parents. Therefore, this study finds that through the internalization of the familial model the patient sees some gain from her illness. However, this gain at the same time results in inhibiting the recovery of their social skills, since through blaming their parents as a cause, they are allowed to escape into an eating disorder rather than confronting the real problems that they failed to handle in the process of developing their disorder.