Studying, as I do, in a department of family relations, I have become interested in family relationships and parenting. Accordingly, I have begun to take note of interesting studies that link family dynamics and parenting with eating disorders, including studies that look at the sibling relationship (as I wrote about here), family-based treatment, and motherhood/fatherhood in the context of eating disorders.
The literature appears to have shifted, lately, from a focus on “eating-disorder generating” families toward an acknowledgement of the complex family dynamics that can play into the development and treatment of eating disorders. A move away from mother- or family-blaming discourses is essential, I would argue, to gaining a better understanding of the lived experience of eating disorders for individuals and families alike.
Accordingly, I was pleased to stumble across an article by Tuval-Mashiach et al. (2013) that used a qualitative approach to explore the experiences of mothers with eating disorders. The authors suggest that their study helps to fill a gap in the literature surrounding how mothers experience the intersections between their motherhood roles, their eating disorder, and their familial relationships.
Acknowledging the mixed findings surrounding mothers’ perspectives on their children’s well-being in relationship to their eating disorders, they sought to understand the two-way relationship between mothering and eating disorders (i.e., how the “mother” role impacts the disorder and how the disorder impacts motherhood).
The experience of motherhood, much like the experience of eating disorders, is obviously not homogenous. So, before making claims about the “motherhood role,” it is important to take participant characteristics into account. This particular study took place in Israel, where authors recruited a sample of 13 mothers from an inpatient eating disorder unit housed at a hospital. This group of mothers:
- Had been coping with an eating disorder for an average of 15 years
- Ranged in age from 23-48
- Had children ranging in age from 7 months to 24 years
- Had between 1 and 7 children (average 2.5)
- 12 were married, and one divorced
- 3 were diagnosed with BN
- 4 were diagnosed with AN-R
- 6 were diagnosed with EDNOS
I was a bit concerned about the heterogeneity in the sample; in focus group studies, we generally aim for a relatively homogenous sample to increase the chance that participants will be able to discuss shared experiences. I would suspect that the experiences of a mother of a 7-month-old would differ drastically from those of a mother of a 24-year-old. The researchers did attend to the complexity of these mothers’ experiences, however, by modifying the focus group method and holding more sessions than would be used in a typical focus group study.
Focus Group Procedures and Analysis
Two of the authors (a psychiatrist and dietician) led 2 focus groups, one with 6 participants and one with 7. Each group met for 10 sessions; two mothers stopped attending after 2 sessions. Focus groups were centered around specific topics in the area of the motherhood-ED relationship, and were largely participant-driven (i.e., the content reflected the interests and experiences of the mothers).
The researchers took a narrative approach to data analysis, following Lieblich, Tuval-Mashiach & Zilber’s (1998) textual analysis model. Their analytic framework was based in prior understandings of the ways in which eating disorders may complicate the mother-child relationship, while remaining open to emerging information not captured in prior literature.
Two main themes surfaced through analysis, and were underscored by several subthemes, which I will briefly describe below.
1. Mothering practices and roles
The mothers in this sample identified a number of challenges linked to being mothers with eating disorders, including:
a. Discussing the illness with the child
Mothers articulated the difficulty of shielding their children from their eating disordered behaviours and the discomfort they felt in knowing their children were aware of their behaviours. The child’s age factored into some mothers’ openness in discussing their behaviours; mothers were more likely to be open with older children, as one might expect.
I know he knows everything, but we don’t talk about it. When I’m in the bathroom (to vomit), he knows he can’t talk or bother me. I know he knows everything, but he wouldn’t say a thing.
b. Child as caregiver
The mothers also identified a role reversal, in some cases, between parent and child. This was something that the mothers associated with a great deal of discomfort, and many made attempts to decrease the degree to which their children were involved. For example, some mothers described certain areas of their family lives as “conflict-free spheres,” (e.g., assisting children with homework, etc.) where their eating disorder did not impede their mothering roles.
c. Concerns about providing bad modeling
Children’s awareness of and involvement in their mothers’ disordered behaviours provoked strong, negative feelings among the mothers in this sample. Mothers were concerned that their behaviours could have a negative impact on their children through providing poor examples of healthy eating behaviours. Many hoped that their children would not look up to them, but also felt uncomfortable when their children would point out their disappointment in their behaviours, seeing this as a compromise to mothering authority.
I feel guilt about my current situation. I want to be a model for my daughter and I’m such a negative model, this is not a good model for a child her age. I don’t know what she thinks of my eating disorder deep inside her, of the other women here in the department. Would she like to reach this place too? I’m afraid, because a few days ago, she didn’t want to take a picture together with me because she’s more fat than I am, bigger than me.
d. Strategies developed to manage challenges of mothering
In order to combat some of the more negative aspects of their experiences, mothers developed a number of compensatory mechanisms to support their children. For example, participants used their experiences to inform their daughters in particular about the complexity of the human experience (i.e., that no one is perfect).
The best thing would be if we could let our children know that we are not perfect, and that they can choose what to take from us, and take the good things.
2. Motherhood as a defining aspect of a woman’s identity
Motherhood is described as an essential element of these women’s experiences, coloured by the experience of an eating disorder in both positive and negative ways.
a. Motherhood as a normalizing experience
Motherhood helped some of these women to feel more “normal” in the context of the family-oriented country in which they live (Gooldin (2002) comments on normalcy in the context of family-orientation). Though mothers’ experiences of parenting while simultaneously coping with an eating disorder are described as fraught with difficulty, these mothers articulated positive aspects of their experiences through their familial relationships as well.
b. The child as a motivation to recover
In the face of the difficult experience of coping with an eating disorder, mothers articulated a desire to recover that centered around wanting to be a good role model for the child or minimize the child’s suffering.
I’m tired of thinking and talking only about myself. If I didn’t have a family, with people who love me, it would have been much easier to be sick. But because there are others, and they suffer, it makes it much more difficult to give up.
c. Deficient motherhood
While motherhood helped some women to feel motivation to recover and to feel more “normal,” some mothers also felt as though their eating disorders made them inadequate mothers. Interestingly, this was often linked to their experiences of being mothered, earlier in their lives, and how they attempted to not follow their mothers’ examples.
All my life I’ve been trying to be different from my mother. It’s obsessive and it is exhausting. What can I do? If she gave me bad tools for life, than [sic] that’s what I have. If I feel stressed, immediately what comes to my mind is that I’m like my mother. How can it be? I tried so hard to do it differently.
The authors suggest that together, these themes point to the complex ways in which mothers negotiate different aspects of their identity, including the roles of mother and of individual suffering from an eating disorder. This knowledge may have clinical implications, such as the need to attend to the experiences of mothers with eating disorders. For example, specialized group or individual therapy might help mothers to develop or enhance strategies for coping with the guilt they may feel in relation to their children’s awareness of their behaviours.
While I think we need to be cautious in interpreting these results due to the relatively small sample size and the heterogeneity of the group, this study helps to shed light on the complexity of the motherhood experience in the eating disorder context. Particularly interesting to me is the way in which these mothers saw motherhood as both a helpful and stressful experience, in light of their eating disorder.
As the quotes illustrate, these mothers are acutely aware of the potential impacts that their behaviours might have on their children. In some cases, this awareness might contribute to an increased commitment to recovery. I also think it is important to continue to avoid blaming mothers for any potential impacts on their children’s well-being; no matter how much these women might want recovery, recovery can be extraordinarily difficult to attain.
Tuval-Mashiach R, Ram A, Shapiro T, Shenhav S, & Gur E (2013). Negotiating maternal identity: mothers with eating disorders discuss their coping. Eating Disorders, 21 (1), 37-52 PMID: 23241089