Bridget Engel, Psy.D., edited by Kathryn Patricelli, MA
There is more to eating disorders than inherited genetics, personality and missing coping skills. These factors interact in a complex way with various family and environmental issues. Together they 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 that describes an interdependent and overly-intimate relationship. In this relationship, emotional and psychological boundaries between two people are so unclear that it is difficult for them to function as separate people with their own identities. This generally develops slowly over time. It typically does not cause conflict until the child becomes a teenager, wanting to be independent and to develop an identity outside of the family.
Teenagers in this type of relationship may feel powerless to develop a separate identity from an over-involved parent. They may try to get independence and freedom by controlling what happens to their bodies. Take for example, an adolescent girl who wants to join her high school cheerleading squad. This would require her to be away from home after school for daily practices. This separation may be emotionally threatening to an over-involved parent. The parent then tries to share the cheerleading identity with her daughter by attending daily practices, games and any related social gatherings. The daughter is unable to develop an identity separate from her mother. She tries to get control the only way she knows how, which is to control how much food she eats. This type of behavior can slowly develop into an eating disorder.
Research also indicates that families of people with eating disorders tend to be overprotective, perfectionistic, rigid, and focused on success. They have high and sometimes unreasonable, expectations for achievement. They may place too much 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 think 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. This often is food restriction or weight loss.
Issues within the family may also contribute to eating disorders. Some people with eating disorders live in or came from families that showed troubling or negative behaviors, such as alcohol and drug use. Marital fighting, 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 (PTSD), a crippling condition that follows a frightening and often life-threatening event. PTSD causes severe anxiety, flashbacks, and unwanted, repeated frightening memories or thoughts of the event.