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Causes of Eating Disorders - Family Influences

Bridget Engel, Psy.D., Natalie Staats Reiss, Ph.D., and Mark Dombeck, Ph.D.

There is more to eating disorders than inherited genetics, personality and coping deficits. These factors interact in a complex way with various family/environmental issues to play an important role in creating and maintaining eating disorders.

Much of the research on eating disorders has focused on the development of healthy emotional boundaries in families. Researchers have found that, in some cases, families are over-involved and enmeshed with an individual who has an eating disorder. "Enmeshed" is a psychological term describing a symbiotic and overly-intimate relationship in which the emotional and psychological boundaries between two people are so obscure or unclear that it is difficult for them to function as separate individuals with their own identities. Enmeshment generally develops slowly and typically does not erupt into conflict until the child becomes an adolescent, wanting to assert their independence and develop an identity outside of the family.

Teenagers in an enmeshed relationship may feel so powerless to develop a separate identity from an over-involved parent that they try to exert independence and autonomy by controlling what happens to their bodies. Take for example, an adolescent girl who wants to join her high school cheerleading squad, which would require her to be away from home after school for daily practices. This separation may be emotionally threatening to an over-involved parent, who compensates by sharing the cheerleading identity with her daughter via attendance at daily practices, games and any related social gatherings. The daughter is unable to develop an identity separate from her mother, so she tries to exert control the only way she knows how, by controlling her food intake. This type of behavior can slowly develop into an eating disorder.

Research also indicates that families of individuals with eating disorders tend to be overprotective, perfectionistic, rigid, and focused on success. They have high, sometimes unreasonable expectations for achievement and may place exaggerated attention on external rewards. Many children from these kinds of families try to achieve the appearance of success by being thin and attractive, even if they do not feel successful. If children perceive that they are failing to live up to family expectations, they may turn to something that seems more easily controlled and at which they may be more successful, such as food restriction or weight loss.

Pathology within the family may also contribute to eating disorders. Some individuals with eating disorders live in or came from families that exhibited dysfunctional or negative behaviors, such as alcohol and drug use. Marital discord, domestic violence and divorce are also not uncommon family issues for those suffering with an eating disorder. In addition, some people turn to an eating disorder after they've experienced a family trauma such as sexual or physical abuse, or neglect. Individuals who have experienced significant trauma may also develop Post Traumatic Stress Disorder, a debilitating condition that follows a frightening and often life-threatening event causing severe anxiety, flashbacks, and unwanted, repeated frightening memories or thoughts of the event.