LETTERS: Anorexia is not just genetic

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THE article "Infant anorexia" (Review, 8 October) raised some difficult and important issues with regard to eating disorders in pre- adolescent children. However, the article does notconvey the complexity of the difficulties that lead to eating disorders.

We find that it is not simply events in the family nor the attitudes of parents that constitute problems for the child, nor that the child with an eating disorder is simply "obstinate". It is much more the case that emotional difficulties experienced by children or adolescents fail to be dealt with in an emotional interaction with others and become, so to speak, embedded in the body. When this happens parent and child become caught in ways of relating where neither is able to express to the other the real emotional difficulties.

We have gathered plentiful evidence that individual and family therapy can help to translate "states of body" back into "states of mind" whose meaning can be understood. Communication between parents and children can be re-established in a fruitful way. Change becomes possible and it often occurs not only in terms of the disappearance of symptoms but considerable improvement in the texture of the parent/child relationship.

It is not helpful to think of eating disorders as purely genetic.

Gianna Williams Stephen Briggs

Tavistock Clinic

London NW3