From Matthew Tiemeyer,
Your Guide to Eating Disorders.
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About.com Health's Disease and Condition content is reviewed by Steven Gans, MD

Some believe that the family of a person with an eating disorder is always to blame. Families do have profound impact on their children, but there are many possible roots of eating disorder behaviors--whether anorexia, bulimia, or some other eating disorder. Keeping this in mind, a discussion on how families can set the stage for eating disorders is in order.

In general, families have no conscious desire to foster eating disorders. When a family's dynamics do create a setup in which a child develops disordered eating, the family is usually unaware of it. This makes it difficult to address without outside help. The eating problem may be kept secret, and when it isn't, the shock at the child's eating patterns can focus attention only on the eating and away from family issues.

Family Types Common Among Those With Eating Disorders

There are several family types that can make eating disorder development more likely. Newsome and Schettler provide an excellent breakdown of these types:

• The Perfect Family: Of course, "perfect" is a strong word; there is no such thing. But families in this category like to remain as close to perfect as they can. Anything out of line with this vision becomes taboo. This family will not openly control a child, but there will be enough nonverbal cues to teach her that doing something unexpected is not okay. The goal becomes to find ways to get relief from perfection or to attain perfection.
• The Overprotective Family: Children in this family rarely experience conflict. Parents act (often out of love) to make sure that the child's experience is mostly trouble-free. And that becomes the problem. Children instinctively know that they are not learning what is necessary to function on their own, and take action to mark their independence.
• The Chaotic Family: In a chaotic environment, change is the only constant. Parents and siblings consistently do the unexpected, making it impossible to know how to behave or how to get needs met. In this case, a child may seek a way to create something that is predictable.
• The Enmeshed Family: Like the Perfect Family, an enmeshed family is very focused on itself. In an enmeshed family, a child has a difficult time forming a life that is separate from the lives of other family members. In order to separate, a child may take unusual measures.
• The Disengaged Family: Children need intimacy and support from parents. When relationships in a family are superficial, a child naturally will seek ways to create more intimacy, and that begins with more contact. Anything that gets a parent's attention provides hope to the child.

Other Family Dynamics Contributing to Eating Disorders

• The Struggling Marriage: Marital problems will obviously be uncomfortable for a child. Children are quite good at figuring out ways to make parents unite. An eating disorder does this, because it gives both parents a common goal--helping the child beat the eating disorder. But the child will be resistant to treatment in this case, because she may fear that getting better will allow the parents to drift apart.
• Sexual Abuse: If sexual abuse is present in the family, an eating disorder can be a creative way to express the pain surrounding it. For example, bulimia's binge/purge cycle can be a reflection of a daughter's desire for a father coupled with her loathing of him for sexually abusing her.
• Child Treated as Adult: Sometimes a parent will rely on the child for emotional support, a role better served by the spouse. The child may use an eating disorder to stay physically small (an eating disorder can delay growth to full height) and reinforce that she is not an adult and should not have to function that way.

Problems Working With Families of Those With Eating Disorders

Parents of a child with an eating disorder have often poured much emotion and effort into changing the child's behavior by the time she comes to treatment. In fact, treatment may be delayed because of parents' fears that they will be blamed for the eating disorder (even when something else may be more responsible for it). Families must be treated with compassion and understanding to make progress possible.

When a therapist or other professional does suggest that there may be problems in the family, parents can become angry or withdrawn. This can confirm the child's fears and strengthen the eating disorder, because the family dynamics that have helped paved the way for it have strengthened as well. For example, a Disengaged family may become even more distant, and a Chaotic family may experience a new crisis.

Treatment for Families

Treatment centers and individual eating disorder therapists often include a family component in the normal course of treatment. This will often begin after the child is physically stabilized. It is common to work to uncover roles, communication styles, and areas of control or neglect.

A treatment option for families of those with anorexia that has generated a lot of excitement is the Maudsley method. The key feature of the plan is that no one gets blamed--the whole family teams up to fight the anorexia.

A Final Note

It is very tempting to look at the family of someone with an eating disorder and come to a quick conclusion about how the disorder came to be. Resist the temptation. It can take a very long time to fully understand all the dynamics and how they contribute--or don't contribute.

Back to What Causes Eating Disorders

Sources

Newsome, Carolyn, and Jim Schettler. 2004. "Family dynamics in eating disorders: An introduction." The Remuda Review 3(2004): 13-19.

Spannuth, Whitney A. 2006. "Family structure in eating disorders." Accessed 10 January 2006.