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.

俄勒冈医科大学心理治疗专业教授、营养饮食专家卡斯琳·泽比（Dr. Kathryn Zerbe）最近解答了许多读者来函中关于厌食、挑食、暴饮暴食等问题。以下是她对家庭关系引起个人饮食失调问题的解答。

是不是婆婆管得太多？

泽比医生：

我和丈夫结婚后，在婆婆家住了两个月。老人家对我们（特别是对我）的饮食习惯管得很严。

除了面包和鸡蛋，婆婆不允许我吃厨房、冰箱里的东西。我们夫妻不得不溜进杂货铺，把好吃的东西"藏"在店铺后面的冰箱里，然后，趁婆婆不在的时候，就悄悄吃。

她家从来不按点吃饭。每天都要等到公公回家以后，婆婆才开始准备炒菜、煮饭，但那时我已经饿过了。

我发现自己瘦了好多。一个半月之后，体重只有105磅。我意识到老往卧室柜子里藏吃的不利于健康，于是，我搬出了婆婆家。

请问像这样改变别人习惯的人是不是什么心理障碍？这会不会也是受他人影响而形成的饮食失调？

谢谢

CH

泽比医生答复：总想去改变别人饮食习惯的人也不算什么特殊的疾病，不过一个人不规律的饮食习惯很容易影响家人，就像你说的那样，它对别人直接造成影响；这种影响有时很微妙，会让我们在家人朋友面前吃东西的时候，感到很狼狈、尴尬。心理学家们把这个现象称为投射。

很多女性都会这样。比如，有位妇女和老朋友出外饱享了一顿午餐，回家以后却郁郁不乐，可家里谁都没有指责她怎么吃得多、长得胖。一段时间里，她会对自己的体形、体重、饮食习惯等等问题过分关注，她知道，这个朋友饮食失调，一直为肥胖问题而苦恼。她觉得自己又胖又丑、不健康，也许又觉得朋友很难看，别人肯定在笑话她俩。这种消极情绪会像病毒一样相互传染，因此，心理学界有时把它称作"传染效应".

亲子、身材

十六岁的时候，爸爸就开始拐弯抹角、有一句没一句的打击我胖。从十岁到十六岁，我体重增加了10镑，但我体重仍属于健康范围，而且饮食正常、经常运动。

每次我的手刚刚要摸到饼干，他立马就来一句："又想吃了？"他说我并没有朋友们的体育运动细胞，如果我不是"大胖子",他就不会说我了。

今年，我十九岁，开始慢慢不能容忍他的打击。爸爸那些讽刺的话倒也越来越少，可时不时的还是会蹦出一句两句。我的体格健康强壮，别人不会觉得我饮食习惯有问题。

可是，每看到被父亲或丈夫嘲笑的女子，我都会为她们担心。怎么才能让别人鼓励我们健康、积极地对待肥胖问题，而并不是我们任凭他们嘲笑、打击？

佚名

泽比医生的答复：你在故事里提出了一些很重要的问题，其中一点你提到了，父亲及其他男性家庭成员在少男少女成长过程中，应该是什么样的角色。

过去遇到这种情况，心理治疗师们就会开始指责长辈的不是，不过现在大家更明白了，其实这种行为与遗传、身体状况、父亲和兄弟的角色，甚至环境等等因素都脱离不了关系，是所有因素共同作用的结果。在治疗过程中，我们需要明确这点。采用骂人的方式去减轻心理焦虑，是丝毫无益的。

如果你想多了解父亲在孩子建立良好生活习惯方面，应该给予哪些帮助的话，我建议你可以看看我同事马国特·梅恩（Margot Maine）写的《爸爸饿了：亲子与美食》（Father Hunger: Fathers, Daughters and Food）这本书。

我在《饮食失调的治疗方法：从心理上来看》（Integrated Treatment of Eating Disorders: Beyond the Body Betrayed）这本书里，列出许多给患者及家属的建议，鼓励患者积极对待和解决饮食失调的烦恼。关键的一点，不要把体重和美貌看得过于重要，多与家人聊聊健康和运动的话题。尽量避免用"越吃越胖"之类话取笑和打击别人。

你当然可以果断地对爸爸说："爸爸，我不喜欢你说的这些话。"或者直接告诉他："说这些没有用。"如果他跟本不予理睬，那你就要努力接受：爸爸说什么是爸爸的事，我要坚持自己正确的立场。

不容忍家庭成员之间相互嘲笑体重问题，提高对广告效应的认识。吃饭时间别老谈减肥之类的话题，把更多精力放在提升内在素质上，而别老盯着身材不放。

最后，我想引用下一个学生家长的话。我学生离开家准备开始大学生活，她爸爸告诉她--记住会说"不"."不"字可以化解生活中很多矛盾，那你也可以对爸爸说："不要再说了。"一句话，我们既需要敞开心扉交流，也要把握好人际、代际关系之间的分寸。