Theoretical and empirical models around caring for someone with an eating disorder: The reorganization of family life and inter-personal maintenance factors

Abstract

Background: Previous theoretical models regarding family functioning have proposed that dysfunctional family interactions may play a causal role in the development of eating disorders. Such models, while historically important, have been unhelpful in blaming families and are poorly supported by empirical evidence. Aims: The aim of this paper was to expand and develop models around familial patterns which may be more clinically valuable. Method: Recent empirical and theoretical evidence around family's experiences of caring for someone with an eating disorder were explored. Results: Recent literature supports the view that families may become ''reorganized'' around the illness. The following processes are discussed: (i) The central role of the symptoms in family life, (ii) The narrowing of time focus on the here-and-now, (iii) The restriction of the available patterns of family interaction processes, (iv) The amplification of aspects of family functioning, (v) The diminishing ability to meet family life-cycle needs, and (vi) The loss of a sense of agency (helplessness). Conclusions: Families may become stuck in unhelpful interactions and lose sight of their own strengths and resources. Professionals should address unhelpful processes within the family, using a collaborative approach. Declaration of interest: J. Whitney has been funded by RIED through the charitable organization, Psychiatry Research Trust.

Caring for a sibling with anorexia nervosa: A qualitative study

“…Siblings further indicated that the eating disorder interfered with eating together at family meals and this resulted in a lack of normalcy in their family. Other review papers on eating disorders have similarly pointed to the ways in which eating disorders interrupt and disrupt family meals (Whitney & Eisler, 2005). On the other hand, siblings recounted building a strong bond with their affected sibling as a result of them living with AN.…”

“…The significant disability associated with AN necessitates that the majority of affected individuals rely on caregivers, typically close family members, for emotional, instrumental and financial support. Although the lifethreatening nature of AN may compel family members to organize their life around supporting and accommodating their loved ones to ensure their survival (Eisler, 1995;Whitney & Eisler, 2005), the impact on the family has only recently garnered the attention of researchers and clinicians. The limited body of literature regarding caregivers of individuals with eating disorders suggests that they experience significant distress as a result of their caregiving role (CotteeLane, Pistrang, & Bryant-Waugh, 2004;Haigh & Treasure, 2003;Huke & Slade, 2006;Perkins, Winn, Murray, Murphy, & Schmidt, 2004;Santonastaso, Saccon, & Favaro, 1997;Treasure, Murphy, Szmukler, Todd, Gavan, & Joyce, 2001;Whitney, Murray, Gavan, Todd, Whitaker, & Treasure, 2005) and that it may be exacerbated by stigma, blame and shame (Highet, Thompson, & King, 2005;.…”

Collaborative care between professionals and non‐professionals in the management of eating disorders: a description of workshops focussed on interpersonal maintaining factors

“…In our previous research, we have found that some carers are somewhat sceptical and reluctant to be involved in family work (Whitney & Eisler, 2005). The workshop format serves to defuse some of the guilt and stigma attached to having someone with an eating disorder in the family.…”

“…The schedule of the workshop follows that recommended for adult learning with plenty of time for reflection and observation. We encourage the use of writing in between the sessions to foster self-reflection as used in our earlier work (Whitney & Eisler, 2005).…”

“…The aim of the workshops is to address carer's needs and also to interrupt some of the maintaining mechanisms defined both in our theoretical model and our research into the experiences of family members. In the initial phase of this work developed over 10 years ago, we explored the use of this approach for carers of people with the treatment resistant form of anorexia nervosa, that is inpatients in our specialist unit (Whitney & Eisler, 2005). The content has since been modified on the basis of the qualitative and quantitative feedback from both patients and their carers involved in that study and used in the context of carers of a wider patient group.…”