Protective factors against disordered eating in family systems: a systematic review of research

Abstract

ObjectiveThis systematic review aims to identify and evaluate the literature investigating protective factors and eating disorders (EDs), to establish what is known about factors in family systems that could be considered protective against the development of ED/disordered eating.MethodsA systematic review of the literature was conducted on five databases, using search terms related to ED/disordered eating and protective factors. Studies were systematically screened and included if they made reference to a protective factor within the family system and explored associations with a quantitative measure of ED/disordered eating behaviours. All included studies were evaluated for study quality.ResultsTwenty-five studies met criteria for inclusion. Ten papers made use of longitudinal or prospective designs appropriate to identify factors potentially protecting against the development of disordered eating difficulties, while a further 15 papers report cross-sectional associations between family factors and disordered eating outcomes. Studies looked at aspects of family relationships and family practices around food or eating. There was a particular research focus on the potential protective role of regular family meals.Conclusions and ImplicationsMany of the potential protective factors identified, such as family support and connectedness, may be non-specific to eating difficulties, promoting general adaptive development and a range of positive development outcomes. Factors in the family environment around food, eating and weight, such as frequent family meals and avoiding comments about weight, may be more specific to ED and disordered eating. Issues with the methodologies used severely impact on the ability to draw conclusions about whether factors are ‘protective’.

The Role of Family Relationships in Eating Disorders in Adolescents: A Narrative Review

“…This early empirical evidence is very interesting because they provide a complex picture of family relationships in eating disorders that are difficult to delineate univocally. Indeed, although the reported worse family functioning is a crucial element in families with eating disorders, compared to control families, there is no empirical evidence of a specific dysfunctional pattern for families with eating disorders, even more so when referring to the different diagnostic categories of eating disorders [25]. Even in the most recent studies, results concerning the evaluation of family functioning among the different diagnostic categories of eating disorders are divergent.…”

“…Family studies thus oriented have shown that, rather than the individual characteristics or behavioral variables, the dynamic interaction between all the members of the family and the role that each plays in relation to the others can explain the adaptive or problematic development of the members [37]. More in particular, whereas the first theories and clinical research focused on emotional aspects and on the parents expressed affection towards their children, the most recent studies have been interested in the forces among family members that support or affect the offspring's psychological development [25,[37][38][39][40]. Through the notion of the boundary, which indicates the invisible set of expectations that determines the behavior of each member within the family system [41], the theory of family systems identifies the three known profiles related to family interactions (cohesion, disengagement, and entanglement).…”

“…Visani and colleagues [88] have investigated the differences in family styles among families with anorexic and bulimic eating disorders, highlighting the heterogeneity in development pathways; the authors have reported that families with anorexia nervosa show problematic scales of FACES IV but also discrete protective factors, unlike families with bulimia nervosa, characterized by low levels of protective factors of cohesion and flexibility and a high level in disorganization and disengagement. In general, compared to families with children without eating disorders, families with patients with eating disorders report worse family functioning, although it is still unclear whether there are specific differences in relation to the different diagnostic typologies [25]. For example, studies on the evaluation of the representations of family functioning by adolescent females with eating disorders, using semi-clinical tools (such as interviews), have confirmed that bulimic subjects tend to describe their families as highly conflictual, while anorexic patients report their families as cohesive and well organized, but with little tolerance to conflict [24].…”

“…In this regard, whether it is clear that eating disorders among adolescents seem to be linked to individual vulnerability, on the other hand, family influence should be recognized as an important element associated with the onset and maintenance of the pathology [20][21][22]. In particular, some relational aspects, such as family functioning and the characteristics and quality of relationships between family members, have gained increasing interest among clinicians and researchers [23][24][25][26][27].…”

Dieting, body weight concerns and health: trends and associations in Swedish schoolchildren

“…Family meals, which might be a marker and facilitator of parental support and connectedness, is suggested to be a protective factor against eating disorders [32]. Previous studies have also demonstrated that eating with the family is associated with healthier diets, psychological wellbeing and decreased risk of obesity and unhealthy behaviours [33,34].…”