Longing and fear behind anorexia and bulimia In the past 10 years, there has been a quiet epidemic of eating disorders, including anorexia and bulimia, among teenage females in China. This may seem to be a problem caused by the pursuit of slimness, but when we face such children and their parents in the clinic, we always see various family stories of love and hate, and the desire and fear of the children who hide behind anorexia and bulimia. Every time, I can’t help but wonder: when parents try to pass on their love and expectations to their children, do they realize how this is misaligned with the needs and desires of their children? When they try to hide or swallow their own disappointment and resentment, how does the sensitive child explain and take up the responsibility? Part I: The Case The 18-year-old Xiaowen sat in the clinic and talked and laughed; she seemed calm and relaxed, open to our conversation most of the time, quick-witted, and sharp-tongued without losing her politeness and moderation – this was a girl who was easy to like. Yet one of the biggest problems such a girl brings to the clinic is the fear of disappointing and putting people off. The question she asked me the most was ‘Are you angry?’ ‘Do you think I suck?’ ‘Did I disappoint you?’ I turned to her mom and asked, ‘Does Little Wen act like this when he communicates with you?’ This question was like breaking the mom’s bitter water jar, ‘No, it’s not like that! If I frown, move my mouth, or even look at her, she will catch me and ask me questions. I don’t know where to put my hands and feet in front of her, and I am simply afraid to see her! Xiaowen has suffered from eating disorders for five years, first anorexia, then bulimia, once had severe malnutrition, amenorrhea, now although the weight is basically normal, menstruation has resumed, but has continued to eat a lot of vomit-inducing bulimic behavior. This ‘quirk’ directly brought her a year off from school, changed schools once, and her academic performance dropped significantly; in order not to let others know about her problems, she tried to stay away from her classmates and neighbors, and often went out by day and night, while at home she had shifted from the underground to the ground, eating, vomiting, and throwing tantrums with impunity. All of this distresses the family, but they can’t seem to find a way to get her to stop – every time she stays in the hospital the problem goes away and when she comes back home the old illnesses come back, is there some kind of magic in her house? Xiaowen’s mother looks young, stylish and energetic at first glance, and together with Xiaowen is easily seen as two sisters, while her father’s dress and demeanor are plain and even ‘rustic’ and ‘old-fashioned’. Parents in the hometown business, the economy is quite generous, but in the eyes of Xiaowen, mom has always wanted to do is ‘people on the people’, I do also very hard. The father’s contentment with the status quo annoys the mother so much that there is a constant war between the two, but the father refuses to change and ignores the pressure the mother throws at him, jokingly calling the mother ‘obsessive-compulsive’ and claiming that she always expects everything to be perfect. Dad avoids the war by spending most of his time out drinking and playing cards with his friends, leaving Mom alone in the house going crazy, with Little Man watching, of course. Mom’s attitude towards Dad didn’t work, but it did work for Little Wen, who tried to be what Mom expected him to be, and at a young age had a very ‘young adult’ demeanor, showing strong organizational and leadership skills at school, and taking care of Mom’s feelings at home in a somewhat manly manner. But the good times didn’t last long, after entering puberty, his mother’s dissatisfaction with Xiaowen’s body shape and public ridicule triggered Xiaowen’s protracted weight loss battle. When this weight loss battle switched from the extreme of over-control (moderation of food intake) to the extreme of total loss of control (induced vomiting after eating a large amount of food), Xiao Wen’s dream of obtaining a perfect image through self-control was shattered. However, Xiaowen’s illness did continue to tighten the bond between her mother and her, and focused the battle between her mother and father on herself. Part II: Clinical Diagnosis Xiaowen’s doubts about her self-image stem from her demand for self-image perfection, which in turn stems from her mother. Mom’s demands are not directed at Xiaowen alone. Of all her demands, accusations and complaints, how many are directed at herself, her husband, her relatives and friends, or her fate? Obviously Xiaowen didn’t make a distinction; she took it all in stride, eager to defuse her mother’s anger through her own efforts, to fulfill her expectations, and to get the love and security she needed. In a family with relatively sound relationships, there is at least one other avenue for a child to get all of this that he or she needs, and that is from Dad. And, when mom imposes her own expectations and demands on the family, dad can also model for the child how to make distinctions and deal with the kind of anger and blame that follows. Unfortunately, the pattern of Little Wen’s family relationships shows that Dad’s response to Mom is to run away, and while Dad can run away, how can the young Little Wen run away? And without Dad as an ally, how could she possibly cope with Mom’s powerful offense? Imagine with a mom who may fire at any time, waiting for a hit-and-run dad to come home, the only way for Xiaowen at this point is to ally herself with her mom, to think what her mom thinks, to feel what her mom feels, and not only to be a good child, but also to try to fill the empty role in the family – dad – to care for and protect her mom. Growing up in this way, Xiao Wen appears mature, sensitive and considerate on the one hand, but on the other hand, she has also inherited her mom’s harshness, both to herself and to others, which is what we see in the clinic – always worrying about not being good, and always believing that other people will be judgmental and harsh on her. In her subconscious mind, people who care for her can be just as demanding and disappointing as her mother. This makes her long for love but afraid to get close to others, making her life particularly tiring. Binge eating and vomiting sometimes help her to numb herself, and at other times, she is venting her anger at this sense of confinement. Part III: Parenting Advice: Understanding Yourself and Distinguishing Between Your Own Needs and Your Child’s Needs Wen’s mother drove her father away by using her own anger, which came from her desire to live a perfect life, her inability to manipulate her husband and her destiny, and the hopelessness and helplessness that it brought to her. Little Man’s dad is accepting of life; what he doesn’t accept is Little Man’s mom’s controlling nature. Unfortunately, instead of trying to make Little Man understand and accept this, he hides away alone. Xiao Wen accepts the baggage passed on to her by her mom, including the expectation of a perfect life, and tries to achieve a perfect self-image by being overly controlling, failing in the same way that makes her angry and hopeless. From Little Man, we see how a mom’s attitudes and emotions about life are passed on to her children. If you are a mom, you can do this just as easily; the negative and unhealthy can be passed on, as can the positive and healthy. So, to be a good mom, first review your own attitudes and emotions in life, and understand your expectations and feelings about life. That way, when you then go to ask for your loved ones and children and get frustrated you can ask yourself – is that your need or theirs? For example, asking a two year old to keep your living room spotless is clearly your need, not his/her, so if he/she refuses to cooperate, there is no need for justification or punishment, and if he/she does cooperate, then he/she deserves a thank you and a hug. As for your feelings of course they deserve to be honored, just like any of your other needs and expectations. But that’s your own reality, and as an adult you can learn and fight for many ways to deal with your feelings, such as discussing and confiding in someone you trust, and communicating and sharing them with loved ones. In any case, it is the responsibility of a good mom to distinguish between your own needs and those of your children, to draw the line, and to avoid letting your children carry the burden of your unmet needs and negative feelings. Ultimately, accepting the presence of imperfections and unpleasantness in your life can help you truly let go of them without fear of passing them on to the next generation to carry on. Don’t Push the Father A similar family pattern can be seen in so many children with eating disorders: the mother and daughter are tightly connected, and the father’s role in the family seems vague and irrelevant. However, we know that the role of the father is crucial in the development of both boys and girls. For a boy, his father is the one he learns to imitate, how to be a man, how to get along with women, and how to take responsibility for the family and society. For a girl, her father is the first man in her life, from whom she can not only experience the sense of security and intimacy brought by her father, but will also form the first impression of the opposite sex and the first-hand experience of contact with the opposite sex. Therefore, want to let the child grow up healthy, smart mom will not ignore the father’s position, more will not drive him away. Men are naturally more self-centered, first-time fathers tend to conflict between their own needs and the needs of their children, what they need at this time is encouragement and respect, mothers should pay attention to the child’s upbringing in the issue of more exchanges with the father to respect their views, emphasizing the fathers in the child’s growth in the contribution of the fathers. The fact that fathers are busy at work and rarely at home does not mean that their role in the family is absent. The image of fathers in the minds of children is more derived from their mothers. Even if the father is absent, mothers can still create the role of the father by saying, ‘If Daddy was here, he would say.’ ‘Count Daddy in, let’s vote.’ Even many divorced women are still successful in retaining the role of father for their children by never listing their husband’s sins or expressing resentment toward him in front of their children, naturally accepting their father’s visits to their children, and communicating with their children about the positive aspects of them as fathers. Remember, there is always a place in the home for the children’s father. Be the eyes of your child Another important thing you need to remember is – children are good at feeling, but not good at explaining. If you take your anger out on your husband, he will probably come right back and say, ‘Where did that come from, don’t come at me! But it’s not the same with a child. If you lash out at him, the child will agonize that he must have made a mistake. Moreover, children have strong feelings, and in a family where the marriage is at a standstill, even if the parents take care to avoid expressing them in front of the child, the child will still sense the crisis, and the bad thing is that he will interpret it as his own fault! So, your awareness and feedback is like the child’s eye, the ‘eye’ by which they understand the world, and if you close your eyes and don’t differentiate where your ground feelings are coming from, don’t perceive the purpose of your behavioral reactions, and don’t tell your child what you really think, he will just interpret everything that is not good as his own fault. So there are some words that are important to say, including ‘I’m sorry, it was my fault for snapping at you.’ ‘I’m crying, not because I’m sad, because I’m touched.’ ‘I’m not angry because of you….’ Being a parent is an opportunity to re-understand and accept yourself, an opportunity to re-understand and accept life, to complete a baptism and transcendence in life, may every parent enjoy this process.