Anorexia and family dynamics: the chicken or the egg?

Much of my first several years in therapy for my eating disorder was spent looking at how my family was messed up. The assumption from every professional that I talked to was twofold: first, that my family was, in fact, messed up and two, that the messed-up-ness preceded the eating disorder.

My family has issues. What family doesn't? But those issues tend to be amplified when you have a child with a life-threatening illness that few can understand and even fewer can treat.

A recent study in the International Journal of Eating Disorders compared family functioning and maternal distress amongst those with anorexia, those with Type I diabetes, and healthy controls. Why diabetes?

"Specifically, both AN and IDDM (Insulin-Dependent Diabetes Mellitus) represent chronic illnesses involving self-care activities that are crucial to the physical health and psychological well-being of the adolescent. Both conditions involve complex changes in lifestyle in the form of changes in the amount and time of food consumption and exercise, and complicated medical regimens. If left untreated, both problems can have serious physical sequelae, placing an extraordinary burden on the adolescent and family members."

The purpose of the study, the authors say, was to challenge the assumption that family dysfunction not only causes AN, but also predates the onset of illness.

"The inclination to see family dysfunction at the root of AN has made it possible to neglect an alternative hypothesis, the possibility that AN may cause family distress. Research suggests that caring for someone with an eating disorder carries a significant burden, taking a toll on the health and well-being of the caregivers."

Although the authors did find some differences between the two groups (diabetes and AN), they also found quite a bit of similarity.

"When compared with mothers of daughters with IDDM, families of girls with AN experienced greater family conflict, reduced parental alliance, and increased feelings of depression. However, once the emotional impact of the illness on the mothers was statistically controlled, group differences were no longer significant."

Part of this may be attributed to the culture of blame that surrounds eating disorders, the authors hypothesize, as well as the fact that many of the people with AN in the study had been recently diagnosed or had relapsed; those with diabetes were simply receiving ongoing care.

But the last sentence of the study really says it all: "With a change in our understanding of the distress found within families of AN, our view of these families can be transformed from being part of the problem to being part of the solution."

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Jessi said...

hmmm yes i like the last sentence. It makes perfect sesnse, sad that it isn't always viewed this way by our medical community!

Susie said...

"A recent study in the International Journal of Eating Disorders compared family functioning and maternal distress amongst those with anorexia, those with Type I diabetes, and healthy controls."

We must top the scales then! I have anorexia, my step dad is type 1 diabetic......and my poor mothers distress.....through the roof.

cbtish said...

The "average family" with 2.4 children is an old joke, but it doesn't stop being a joke just because the averaging is not numeric.

It is a fundamental error to assume that research studies averaging out data from many individual cases can then be applied to those cases individually. It results in a "one size fits all" approach that may in fact fit no one. Alas, this kind of sloppy thinking is all too common amongst researchers, and not only anorexia researchers.

Cammy said...

Wow, that is a cool idea for a study, fascinating!

Carrie Arnold said...


I'm not sure what your comment has to do with the study. All it shows is that chronic illness can, in and of itself, cause the family dysfunction that is often seen in people with anorexia (ie, it doesn't have to predate the illness).

Most of the latest research-based methods are NOT one size fits all. FBT encourages families to find the approach that best fits their situation while still ensuring that the child eats. It's hard to get more tailored than that. In an IP setting, you have less choice: the rules are the rules.

I don't think the researchers assumed anything about "typical" families, OR that the families of people with AN are somehow atypical.

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Harriet said...

Another reason for comparing AN with Type 1 diabetes is that the original comparisons made by Salvador Minuchin in his book Psychosomatic Families was between families dealing with AN and diabetes. So in a way it's coming back to some of the original "research" that "established" how dysfunctional "psychosomatic" families are.

Carrie Arnold said...


I didn't know that. Very interesting.

cbtish said...

I'm sorry if I misunderstood.

Nothing in the abstract, or in the parts you quoted, acknowledges the need for a tailored approach. I am glad that some research studies do involve tailored approaches, but this particular study does not seem to be one of them.

Carrie Arnold said...


I don't think this study looked at any approach- just at any potential family dysfunction.

Most therapies are individualized, ultimately. And even if they are manualized, that's not always bad. You need a consistent starting point. Chemo is consistent, why shouldn't therapy be? There's always going to be a need to adjust slightly, and good therapists will do that.

Blogking said...

My friend died of anorexia 3 months ago. She was healthy as a horse, had an amazing life, up until about a year and a half ago when she started feeling bad about her body and weight....she died at 88 pounds and I miss her every single day. I pray that this never happens to you or your loved ones. Celebrate life as much as possible!

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I'm a science writer, a jewelry design artist, a bookworm, a complete geek, and mom to a wonderful kitty. I am also recovering from a decade-plus battle with anorexia nervosa. I believe that complete recovery is possible, and that the first step along that path is full nutrition.

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nour·ish: (v); to sustain with food or nutriment; supply with what is necessary for life, health, and growth; to cherish, foster, keep alive; to strengthen, build up, or promote


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