Disturbed families or families disturbed: a reconsideration

Abstract

Background The relationship between anorexia nervosa (AN) and family disturbance has been a subject of debate since its first description. What began as a clear view of the pathologically disturbed family causing AN has become ever more complex over the decades. Objective The aim of this review is to explore the literature to examine the changes and evolution of clinical opinion around family dysfunction and AN over the last 20 years. Methods A narrative review of heterogeneous studies in peer-reviewed publications sourced from the major databases, including PubMed and ScienceDirect, to illuminate the topic of family distress and AN by highlighting the conflicting and complementary ways it has been studied. Results This review has highlighted the complexity of the relationship between anorectic sufferers and their families. It has explored the literature about parental burden, emotions and cognitive mechanisms together with parental attitudes about weight and shape. It is clear that there is no consistent psycho-social pathology in families which has been shown to be causative. However, over the last twenty years, research has highlighted the distress and family dysfunction caused by having to look after an anoretic child with poor mentalisation skills, insecure attachment and emotion dysregulation. Conclusion The area has become clearer over the last 20 years; research suggests a bi-directional relationship between AN and family dysfunction, with difficult dynamics becoming entrenched within the family. This is best addressed, the consensus suggests, by specialist family therapy and carer skills interventions. Longitudinal research is needed to definitively answer the question with rigorous scientific certainty. EMB rating Level V. Level of evidence Level I: Evidence obtained from: at least one properly designed randomized controlled trials; systematic reviews and meta-analyses; experimental studies. Level II: Evidence obtained from well-designed controlled trials without randomization. Level III: Evidence obtained from well-designed cohort or case-control analytic studies. Level IV: Evidence obtained from with multiple time series analysis such as case studies. Dramatic results in uncontrolled trials might also be regarded as this type of evidence. Level V: Opinions of respected authorities, based on descriptive studies, narrative reviews, clinical experience, or reports of expert committees.

Mother blaming and anorexia: How ideological state apparatuses have informed my perception of my mother's role in the formation of my eating disorder

“…I might, however, characterize the relationship I had with my mother as controlling. When we were apart, I felt acting independently was difficult, and did not fully trust her when I was a child; this corresponds with certain descriptions of mother-daughter relationships in the literature (Giles et al, 2021). In caretaking terms, it could be argued my mother exercised more active control than my father did over my eating habits; even now, she sometimes asks me about my EBs.…”

“…Mother-daughter relationships, in turn, are portrayed ambivalently . In general, mothers of daughters with anorexia are shown to be controlling and overinvolved in their daughters’ lives, while also acting emotionally distant and cold (Giles et al, 2021). Furthermore, it has been found that they express a higher volume of negative emotions toward their daughters compared to mothers whose daughters do not have EDs (Rienecke & Richmond, 2017).…”

“…Furthermore, it has been found that they express a higher volume of negative emotions toward their daughters compared to mothers whose daughters do not have EDs (Rienecke & Richmond, 2017). At the same time, women with anorexia trust their mothers less than women without an ED and express elevated feelings of anger and resentment toward them (Giles et al, 2021).…”

Promising effect of multi-family therapy on BMI, eating disorders and perceived family functioning in adolescent anorexia nervosa: an uncontrolled longitudinal study

“…Understanding the (complex) risk factors for AN is an essential condition for the development of reliable therapies (Glashouwer et al, 2020). Although clinical scientists now agree that family dynamics are not a cause of eating disorders per se, research suggests a bidirectional relationship between AN and family dysfunction (Giles et al, 2021). In other words, family functioning seems to play a role in the maintenance of AN, and AN itself contributes to the perseverance of poor family functioning, with troublesome dynamics taking hold within the family (Eisler, 2005).…”

Psychosocial and financial impacts for carers of those with eating disorders in New Zealand

“…There are additional reasons for documenting, understanding and addressing the impact on AN carers. While the relationship between family disturbance and AN is still far from clear [ 32 ], there is some consensus that vicious cycles can develop such that secondary strained family relationship dynamics may evolve over time. For example, overly anxious caregivers may find themselves taking more control of mealtimes, thereby leading to battles for control and escalated tensions because of this.…”