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What Role Does the Family Play in Development, Maintenance and Treatment of Adolescent with an Eating Disorder

| April 15, 2012 | 2 Comments

The purpose of this essay is to clarify the role family plays in the developments, maintenance and treatment of eating disorders, focusing on anorexia nervosa and bulimia nervosa. It argues that family systems can be restructured, so that supportive families can be utilised as a part of the treatment process in order to facilitate patient recovery. 

Families Empowered and Supporting Treatment of Eating Disorders (FEAST) describe Anorexia Nervosa (AN) and Bulimia Nervosa (BM) as serious, potentially fatal brain disorder; the former being categorised by a compulsion for self-starvation, excessive exercise and severe weight loss and the latter being categorised by frequent binge eating, followed by compensatory behaviours such as self-induced vomiting.

Since the late 19th century, there have been accounts of detrimental roles of the family in the onset and maintenance of Eating Disorders (Silverman, 1997). Michel and Willard (2003a) suggested that there is vast research pointing towards the role of close family members as ‘negative influencers’, leading many families finding themselves excluded from the treatment process. This, however, was all set to change with the advent of a new stem of research started by Minchuin et al in 1978, reframing the role of the family and advocating a particular form of family therapy.

Research tends to focus on a causal relationship between the family and eating disorders. Jacobi et al (2004) suggested that developmentally informed research on this topic is too sparse to support claims of a causal relationship. Horesh et al (1997) found that inappropriate parental pressures distinguished patients with eating disorders from psychiatric and normal controls; Shoebridge et al (2000) found that early life over-protective parenting was more common behaviour in mothers of patients of AN than with controls and that lack of parental care distinguished AN and BN groups from controls. It has also been suggested that eating disorders can be developed from critical comments from family members about weight and body shape (Graber et al, 1994). Furthermore, family, twin and molecular genetic studies such as that of Striegel-Moore (2007) have provided increasing evidence for an argument that there may be a genetic predisposition towards disorders like AN and BN. Based on this, it may be the case that eating disorders emerge from a possible combination of genetic, family and sociocultural factors.

It has been argued, that although eating disorders may develop with the family structure, that there may also be a great potential for the same family structure to be restructured for the purpose of facilitating treatment and recovery. Eisner et al (2007) found that family involvement may be advantageous in reducing psychological and medical morbidity, particularly with younger patients suffering short term. Halmi et al (2005) found that drop-out rates, where parents were utilised, were much lower (15%) in comparison to adult studies (50%). Lock and Le Grange (2005) suggested that using the family as part of the treatment team can enhance the efficacy of the treatment where family involvement is supportive and active. Family involvement should be avoided, however, where the family is critical and unsupportive (Le Grange, 1992).

In conclusion, it would appear that the family structure, although often a factor in the development and maintenance of eating disorders, maybe restructured in order to implement family members in order to enhance and facilitate treatment by including them in supportive family environments or removing them from treatment in critical families.

 

References.

  • Eisler, I., Dare, C., Russell, G. F. M., Szmukler, G. I., Le Grange, D., Dodge, E. (1997). Family and individual therapy in anorexia nervosa: a five-year follow-up. Arch. Gen. Psychiatry 54: 1025-1030.
  • Graber, J.A., Brooks-Gunn, J., Paikoff, R.L., & Warren, M.P. (1994) Prediction of eating problems: An 8-year study of adolescent girls. Dev Psychol 30, pp. 823-834
  • Halmi, C. A., Agras, W. S., Crow, S. J., Mitchell, J. Wilson, G.T., Bryson, S. (2005). Predictors of treatment acceptance and completion in anorexia nervosa: Implications for future study designs. Arch. Gen. Psychiatry 62: 776-781.
  • Horesh, N., Apter, A., Ishai, J., Danziger, Y., Miculincer, M., Stein, D., et al. (1996) Abnormal psychosocial situations and eating disorders in adolescence. J Am Acad Child Adolesc Psychiatry 35, pp. 921-927.
    • Jacobi, C., Hayward, C., De Zwaan, M. Krawner, H. C., Agras, S. (2004). Coming to terms with risk factors for eating disorders: Application of risk terminology and suggestions for a general taxonomy. Psychol. Bull., 130: 19-65.
    • Le Grange, D., Eisler, I., Dare, C., & Hodes, M. (1992) Family criticism and self-starvation: a study of expressed emotion. J Fam Ther, 14, pp. 177-192.
    • Kadzin, A. E., Kraemer, H.C., Kessler, R.C., Kupfer, D.J., Offord, D. R. (1997). Contributions of risk-factor research to developmental psycho-pathology. Clinical Psychology Review 17: 375-406.
    • Michel, D.M. & Willard, S.G. (2003a) Family treatment of eating disorders. Clinical Focus, 10 (6), pp. 59-61.
    • Minuchin, S., Rosman, B., Baker, L. (1978). Psychosomatic Families: Anorexia Nervosa in Context. Cambridge: Harvard University Press.
      • Shoebridge, P. & Gowers S.G. (2000) Parental high concern and adolescent-onset anorexia nervosa: A case-control study to investigate direction of causality. Br J Psychiatry 176, pp. 132-137.
      • Striegel-Moore, R.H. & Bulik, C.M. (2007) Risk factors for eating disorders. Am Psychol 62, pp. 181-198.
      • Siverman, J. (1997). Charcot’s comments on the therapeutic role of isolation in the treatment of anorexia nervosa. International Journal of Eating Disorders. 21: 295-298.

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