Some believe, erroneously, that the family dynamics of a person with an eating disorder are always to blame for it. 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. Plus, the roots of an eating disorder are always multiply determined by several biological and psychological factors.
Just as it's possible for an eating disorder to feed on family behaviors, it's also possible that an eating disorder's development comes before family tension. An eating disorder is stressful for all involved, and family issues can appear after the fact.
I know of no family that wishes to foster an eating disorder. When a family's dynamics do provide a backdrop for disordered eating, the family is unaware of it. This makes it hard to address without outside help.
Keeping these caveats firmly in mind, a discussion on how families of those with eating disorders often learn to function is in order.
Family Types Common Among Those With Eating Disorders
As stated, eating disorders seem to arise because of many factors. Eating disorder clinicians only see things after disorders have arrived. Knowing this, what do these professionals see in families?
Newsome and Schettler suggest a number of trends based solely on their clinical experience. Keep in mind that these family "types" can emerge after eating disorders arrive, and even when they don't, some children in these kinds of families will not struggle with eating:
- The Perfect Family: Of course, "perfect" is a strong word; there is no such thing. But families in this mold 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 of the child becomes to find ways to get relief from perfection or to attain perfection.
- The Overprotective Family: Children in this family rarely see conflict. Parents act (often out of love) to make sure that the child's experience is 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 may 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 are hard for children, and children are quite good at finding ways to unite parents. An eating disorder can do it. It gives both parents a common goal--helping the child beat the eating disorder. But the child may be resistant to treatment, fearing that getting better will allow the parents to drift apart.
- 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.
- 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 reflect a young woman's desire for healthy relationship with men coupled with her fear of them due to sexual abuse.
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 far more responsible for it). Families must be treated with compassion to make progress possible.
When a therapist or other professional suggests that there are problems in the family, parents can become angry or withdrawn. This can confirm the child's fears and strengthen the eating disorder if the family dynamics that have existed alongside 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 family components in the typical 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
Again, 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 C and Schettler J. Family dynamics in eating disorders: An introduction. The Remuda Review 3 (2004): 13-19.
Spannuth WA. 2006. "Family structure in eating disorders." Accessed 10 January 2006.
