Dr. Kathryn Zerbe, professor of psychiatry at Oregon Health and Science University and a longtime expert on eating disorders, recently took readers' questions on anorexia, bulimia, binge eating and related problems. Here, she responds to questions on the role of in-laws and other family members in promoting disordered eating.

    An Over-Controlling Mother-in-Law?

    Q.

    Dear Dr. Zerbe,

    When my husband and I were between homes, we stayed with his parents for two months. His mother became extremely controlling of our eating habits （mine in particular.）

    I was not allowed to help myself to anything in the fridge or kitchen except bread and sometimes yogurt. We had to sneak out to the grocery store and "hide" our food in the refrigerator （way in the back） and eat when she was not there.

    Eating normally was not allowed in the house. It was only when her husband came home that she began preparing dinner and then everything appeared normal. （By then I completely starving.）

    I found myself losing weight at an astonishing rate and dropped down to 105 lbs after about six weeks of this. When I found myself hiding food in the closet of the room we were staying in I realized how unheathy this was and moved out.

    Is there a name or term for someone who tries to control the eating habits of others in this way, or might this behavior simply be an eating disorder that is imposed upon others?

    Thank you,

    CH

    A

    Dr. Zerbe responds: There is no particular term for a person who tries so hard to control the habits of another, but it is fairly common to see someone who has an eating issue of their own impose it on others. Sometimes this is very direct, as your own case illustrates. At other times, the attempt to have impact is more subtle, and the person being targeted simply feels bad, or ashamed or guilty, when eating in front of the family member or friend. Psychologists refer to this phenomenon as projection.

    There are plenty of instances of women, for example, who go to lunch with an old friend and come home feeling miserable about themselves when nothing overtly derogatory or controlling has been said about food or body image. The person becomes somewhat preoccupied with her own diet, body image or weight for a while, only to learn later that the friend had an eating problem or struggle with body image. That person was, indeed, having negative thoughts and feeling about their own, and possibly their friend's, weight or body image, and the sensitive, empathic friend picked up on it. This is sometimes called in mental health circles "the contagion effect" because it's so much like catching a virus from another person.

    Fathers, Kids and Self-Image

    Q.

    When I was 16, my dad began to make snide comments about my weight. I had put on about ten pounds since my early teens but I stayed a healthy weight, ate right and played sports.

    He'd say, "are you sure you want to eat that?" if I ever reached for a cookie. He told me I'd never be as athletic as some of my friends, and he said he wouldn't have to say these things if I weren't "so fat."

    I'm 19 now and have since learned not to stand for this. My dad has gotten better but still says things along these lines. A strong support system and self-image kept me from considering an eating disorder.

    But I worry for other women whose fathers and husbands are the same or worse. How can we teach others, who may have the best of intentions, to encourage us to eat healthy and stay active instead of hurting and demeaning us?

    Anonymous

    A

    Dr. Zerbe responds: You raise many important issues in your post, including the role of fathers and other significant male figures in the positive or negative development of sense of self in young men and women.

    So often in the past psychiatry tended to "blame the mother," but we now understand that so many factors - genetic, biologic, the role of father and siblings, and environmental - all play their part. That is what needs to be addressed in treatment, and this stance of blaming anyone is not helpful when trying to overcome a mental health concern.

    If you want to read more about the role of fathers and father figures in the development of eating problems, I suggest my colleague Margot Maine's accessible book, "Father Hunger: Fathers, Daughters and Food."

    In my book "Integrated Treatment of Eating Disorders: Beyond the Body Betrayed," I have a list of "do and don't" tips for family members and concerned loved ones that encourage staying active and coping with eating issues. One critical step is to not place so much emphasis on weight or appearance and instead to have more useful dialogues at home about healthy eating and exercise. It's also important to avoid using terms like "going on a diet" or derogatory statements of any kind.

    It is certainly O.K. for you to continue to develop your assertiveness skills by saying, "Dad, that statement hurts my feelings" or "That remark is not helpful." If he does not seem to listen or "get it," tell yourself （as hard as this is to do） that that is his issue and you are only responsible for your own attitudes.

    Set a no-tolerance policy at home for teasing about weight or body, and increase awareness of the impact of mass media. Make discussing weight at mealtime a taboo subject and keep emphasizing that you are working hard to develop sources of self worth that do not depend on appearance.

    Finally, I will quote the father of one of my students who advised her, when she was going off to start college, to remember that "No!" is a complete sentence. That "no" can be applied to many situations in life, but in this case you could say, "No. Stop talking about this stuff." In other words, keep the communication lines open but maintain appropriate interpersonal and generational boundaries.

    俄勒岡醫(yī)科大學(xué)心理治療專(zhuān)業(yè)教授、營(yíng)養(yǎng)飲食專(zhuān)家卡斯琳·澤比（Dr. Kathryn Zerbe）最近解答了許多讀者來(lái)函中關(guān)于厭食、挑食、暴飲暴食等問(wèn)題。以下是她對(duì)家庭關(guān)系引起個(gè)人飲食失調(diào)問(wèn)題的解答。

    是不是婆婆管得太多？

    澤比醫(yī)生：

    我和丈夫結(jié)婚后，在婆婆家住了兩個(gè)月。老人家對(duì)我們（特別是對(duì)我）的飲食習(xí)慣管得很?chē)?yán)。

    除了面包和雞蛋，婆婆不允許我吃廚房、冰箱里的東西。我們夫妻不得不溜進(jìn)雜貨鋪，把好吃的東西"藏"在店鋪后面的冰箱里，然后，趁婆婆不在的時(shí)候，就悄悄吃。

    她家從來(lái)不按點(diǎn)吃飯。每天都要等到公公回家以后，婆婆才開(kāi)始準(zhǔn)備炒菜、煮飯，但那時(shí)我已經(jīng)餓過(guò)了。

    我發(fā)現(xiàn)自己瘦了好多。一個(gè)半月之后，體重只有105磅。我意識(shí)到老往臥室柜子里藏吃的不利于健康，于是，我搬出了婆婆家。

    請(qǐng)問(wèn)像這樣改變別人習(xí)慣的人是不是什么心理障礙？這會(huì)不會(huì)也是受他人影響而形成的飲食失調(diào)？

    謝謝

    CH

    澤比醫(yī)生答復(fù)：總想去改變別人飲食習(xí)慣的人也不算什么特殊的疾病，不過(guò)一個(gè)人不規(guī)律的飲食習(xí)慣很容易影響家人，就像你說(shuō)的那樣，它對(duì)別人直接造成影響；這種影響有時(shí)很微妙，會(huì)讓我們?cè)诩胰伺笥衙媲俺詵|西的時(shí)候，感到很狼狽、尷尬。心理學(xué)家們把這個(gè)現(xiàn)象稱(chēng)為投射。

    很多女性都會(huì)這樣。比如，有位婦女和老朋友出外飽享了一頓午餐，回家以后卻郁郁不樂(lè)，可家里誰(shuí)都沒(méi)有指責(zé)她怎么吃得多、長(zhǎng)得胖。一段時(shí)間里，她會(huì)對(duì)自己的體形、體重、飲食習(xí)慣等等問(wèn)題過(guò)分關(guān)注，她知道，這個(gè)朋友飲食失調(diào)，一直為肥胖問(wèn)題而苦惱。她覺(jué)得自己又胖又丑、不健康，也許又覺(jué)得朋友很難看，別人肯定在笑話(huà)她倆。這種消極情緒會(huì)像病毒一樣相互傳染，因此，心理學(xué)界有時(shí)把它稱(chēng)作"傳染效應(yīng)".

    親子、身材

    十六歲的時(shí)候，爸爸就開(kāi)始拐彎抹角、有一句沒(méi)一句的打擊我胖。從十歲到十六歲，我體重增加了10鎊，但我體重仍屬于健康范圍，而且飲食正常、經(jīng)常運(yùn)動(dòng)。

    每次我的手剛剛要摸到餅干，他立馬就來(lái)一句："又想吃了？"他說(shuō)我并沒(méi)有朋友們的體育運(yùn)動(dòng)細(xì)胞，如果我不是"大胖子",他就不會(huì)說(shuō)我了。

    今年，我十九歲，開(kāi)始慢慢不能容忍他的打擊。爸爸那些諷刺的話(huà)倒也越來(lái)越少，可時(shí)不時(shí)的還是會(huì)蹦出一句兩句。我的體格健康強(qiáng)壯，別人不會(huì)覺(jué)得我飲食習(xí)慣有問(wèn)題。

    可是，每看到被父親或丈夫嘲笑的女子，我都會(huì)為她們擔(dān)心。怎么才能讓別人鼓勵(lì)我們健康、積極地對(duì)待肥胖問(wèn)題，而并不是我們?nèi)螒{他們嘲笑、打擊？

    佚名

    澤比醫(yī)生的答復(fù)：你在故事里提出了一些很重要的問(wèn)題，其中一點(diǎn)你提到了，父親及其他男性家庭成員在少男少女成長(zhǎng)過(guò)程中，應(yīng)該是什么樣的角色。

    過(guò)去遇到這種情況，心理治療師們就會(huì)開(kāi)始指責(zé)長(zhǎng)輩的不是，不過(guò)現(xiàn)在大家更明白了，其實(shí)這種行為與遺傳、身體狀況、父親和兄弟的角色，甚至環(huán)境等等因素都脫離不了關(guān)系，是所有因素共同作用的結(jié)果。在治療過(guò)程中，我們需要明確這點(diǎn)。采用罵人的方式去減輕心理焦慮，是絲毫無(wú)益的。

    如果你想多了解父親在孩子建立良好生活習(xí)慣方面，應(yīng)該給予哪些幫助的話(huà)，我建議你可以看看我同事馬國(guó)特·梅恩（Margot Maine）寫(xiě)的《爸爸餓了：親子與美食》（Father Hunger: Fathers, Daughters and Food）這本書(shū)。

    我在《飲食失調(diào)的治療方法：從心理上來(lái)看》（Integrated Treatment of Eating Disorders: Beyond the Body Betrayed）這本書(shū)里，列出許多給患者及家屬的建議，鼓勵(lì)患者積極對(duì)待和解決飲食失調(diào)的煩惱。關(guān)鍵的一點(diǎn)，不要把體重和美貌看得過(guò)于重要，多與家人聊聊健康和運(yùn)動(dòng)的話(huà)題。盡量避免用"越吃越胖"之類(lèi)話(huà)取笑和打擊別人。

    你當(dāng)然可以果斷地對(duì)爸爸說(shuō)："爸爸，我不喜歡你說(shuō)的這些話(huà)。"或者直接告訴他："說(shuō)這些沒(méi)有用。"如果他跟本不予理睬，那你就要努力接受：爸爸說(shuō)什么是爸爸的事，我要堅(jiān)持自己正確的立場(chǎng)。

    不容忍家庭成員之間相互嘲笑體重問(wèn)題，提高對(duì)廣告效應(yīng)的認(rèn)識(shí)。吃飯時(shí)間別老談減肥之類(lèi)的話(huà)題，把更多精力放在提升內(nèi)在素質(zhì)上，而別老盯著身材不放。

    最后，我想引用下一個(gè)學(xué)生家長(zhǎng)的話(huà)。我學(xué)生離開(kāi)家準(zhǔn)備開(kāi)始大學(xué)生活，她爸爸告訴她--記住會(huì)說(shuō)"不"."不"字可以化解生活中很多矛盾，那你也可以對(duì)爸爸說(shuō)："不要再說(shuō)了。"一句話(huà)，我們既需要敞開(kāi)心扉交流，也要把握好人際、代際關(guān)系之間的分寸。