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Weight loss: families’ contribution to eating disorders WEIGHT LOSS: FAMILIES’ CONTRIBUTION TO EATING DISORDERS
Do families with an eating-disordered member have more physical and psychiatric disease? Studies produce different - and conflicting - answers. There does appear to be a higher incidence of weight problems, especially among families with a bulimic child. And the rate of depression is higher, again particularly among bulimics, than in the population as a whole.
What about personality? Is there a "typical" eating disorder family? Are there certain traits that would lead a bystander to say, "If the Joneses aren't careful, they're going to turn their daughter into an anorexic one day"?
No, although a lot of studies claim to identify such traits. One researcher, Dr. Joel Yager of UCLA Medical School, took a close look at these studies. He found they contained more different "family portraits" than you'd find on the walls of a photographer's waiting room.
One such study declared that an anorexic family was characterized by a fussy, nervous mother and a father who alternated between being quick-tempered and laid-back. No, said another, an anorexic's mother is robust and nagging, her father passive. Wrong, said a third; fathers are domineering and aggressive. Close, another chimed in; fathers are domineering but ïîï aggressive. Or sometimes domineering or sometimes not. Depending on your source, mothers are either attached or ambivalent toward their daughters; they are too strict or too lenient. Fathers are lenient, kind, and affectionate. No, they are cool, antagonistic, and hostile.
Remember the blind men and the elephant?
As Dr. Yager concluded, "If common personality patterns are to be found in these families, they will have to be at more subtle levels."
Does this mean that therapists must start from scratch every time a family walks into their office? Is there any pattern among eating-disordered families that provides some basis for therapy?
Yes - sort of. Recent research has found a number of different patterns among anorexic families, but certain anorexic families do fit to some extent the "model" of functioning I'll describe in a minute. While these traits are by no means universal, they may provide a good place to begin working with an anorexic family.
Perhaps the most important trait is the lack of joint parental authority. The parents disagree about basic issues in child rearing. As a result, the child gets mixed signals; she doesn't know what's expected of her.
Another common theme is that the mother tends to be the center of the family. Fathers tend to be absent because of work, death, or divorce. The children understandably develop closer relationships with the mothers.
The stereotype of an anorexic family is that the members all think and act as one unit—they are, to use the technical term, highly cohesive. Conversely, bulimic families are often thought to be highly disorganized. The reality is much more complex. Some anorexic families are so chaotic they can't plan a trip to the mall without arguing, while some bulimic families stick together like Velcro. Interestingly, as the patient gets older and is ready to leave home, some families grow more cohesive. It's as if they realize that the illness has served as a stabilizing force, and they are reluctant to face the changes that will befall once the patient leaves.
Families can sometimes delude themselves that the eating disorder is the only problem they must confront. One father said, "If only Gwen weren't starving herself, we'd be the all-American family." Such families are sometimes in for a rude shock: When the eating disorder abates, they must confront the presence of other issues in their lives.
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WEIGHT LOSS
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