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Anorexia and family dynamics: the chicken or the egg?

Posted Feb 19 2009 3:48pm
Much of my first several years in therapy for my eating disorder was spent looking at how my family was messed up. The assumption from every professional that I talked to was twofold: first, that my family was, in fact, messed up and two, that the messed-up-ness preceded the eating disorder.

My family has issues. What family doesn't? But those issues tend to be amplified when you have a child with a life-threatening illness that few can understand and even fewer can treat.

A recent study in the International Journal of Eating Disorders compared family functioning and maternal distress amongst those with anorexia, those with Type I diabetes, and healthy controls. Why diabetes?

"Specifically, both AN and IDDM (Insulin-Dependent Diabetes Mellitus) represent chronic illnesses involving self-care activities that are crucial to the physical health and psychological well-being of the adolescent. Both conditions involve complex changes in lifestyle in the form of changes in the amount and time of food consumption and exercise, and complicated medical regimens. If left untreated, both problems can have serious physical sequelae, placing an extraordinary burden on the adolescent and family members."

The purpose of the study, the authors say, was to challenge the assumption that family dysfunction not only causes AN, but also predates the onset of illness.

"The inclination to see family dysfunction at the root of AN has made it possible to neglect an alternative hypothesis, the possibility that AN may cause family distress. Research suggests that caring for someone with an eating disorder carries a significant burden, taking a toll on the health and well-being of the caregivers."

Although the authors did find some differences between the two groups (diabetes and AN), they also found quite a bit of similarity.

"When compared with mothers of daughters with IDDM, families of girls with AN experienced greater family conflict, reduced parental alliance, and increased feelings of depression. However, once the emotional impact of the illness on the mothers was statistically controlled, group differences were no longer significant."

Part of this may be attributed to the culture of blame that surrounds eating disorders, the authors hypothesize, as well as the fact that many of the people with AN in the study had been recently diagnosed or had relapsed; those with diabetes were simply receiving ongoing care.

But the last sentence of the study really says it all: "With a change in our understanding of the distress found within families of AN, our view of these families can be transformed from being part of the problem to being part of the solution."
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