Anorexia Impacts The Whole Family

How Does Anorexia Nervosa Affect the Family?

Anorexia nervosa (AN) can have profound and far-reaching effects on the entire family dynamic. The constant preoccupation with food, weight, and body image inherent in anorexia often creates tension and strain within family relationships. Family members may experience heightened stress, emotional stress, and a sense of helplessness as they grapple with the challenges of supporting a loved one with anorexia. [1] 

Parents and siblings of people with anorexia experience significant psychological and physical distress as their caregiver roles lead to:[2]

• Emotional difficulties
• Exhaustion
• Guilt
• Frustration
• Fear
• Increased internalizing behaviors, such as social withdrawal

However, a professional diagnosis of anorexia can lead to quality treatment, increased family solidarity and unity, enhanced personal growth for each member of the family, improved empathy, and increased knowledge of eating disorders like anorexia.[2]

If you are concerned about your child, sibling, or other family member’s disordered eating, contact a healthcare professional who specializes in eating disorders. They can conduct initial assessments and refer you to appropriate treatment options. If your family member is in immediate danger due to severe weight loss or malnutrition, you should seek emergency medical attention. The medical team at a hospital can help stabilize your loved one and provide them with immediate care like nutritional therapy, IV fluids, and 24-hour monitoring.

Anorexia as a Family Illness

One of the most emotionally devastating illnesses that impacts the entire family is when one of its members suffers from anorexia. Why is this true?

For one, anorexia nervosa most often emerges in young people, beginning anywhere from ages 14 through the twenties. In no way does this preclude older people from becoming anorectic. The realization that an adolescent child is afflicted with this disease arouses powerful reactions that can destroy the entire family unit. Family members watch with horror while their young and beautiful child who is only at the start of her life, slowly but surely starves herself to death.

Siblings can become resentful at what they perceive to be their sister or brother’s deliberate insistence on losing weight because they believe they are fat. Reasoning, begging, and outright displays of anger fall on deaf ears as the self-starvation continues unabated.

Parents often engage in self and mutual blame. They experience enormous guilt as each examines all they did wrong to cause their child to have this disorder. In fact, all family relationships become strained and conflicted as everyone walks around feeling angry.

Everyone blames the one who is suffering from this sickness. If you could put an ear to the wall of a family struggling with this you might hear such things as: “Why aren’t you eating your food,” with the retort of, “I am eating, I’m full and busting.” This is followed by everyone arguing, “No, you aren’t eating, look at your plate, stop this, you’re doing this on purpose, don’t you care about us, if you love us, you’ll stop doing this, you look like a skeleton.” The retort is, “I’m too fat, stop minding my business, this food has too much grease, I want to eat healthy, this is awful food.” The fighting continues to no avail.

The fun of the family having dinner together and talking about school, work, and the news, telling jokes, and laughing transforms into silence, strain, and hopelessness.

Beneath all the anger, blaming and resentment is the sinking fear that this loved one might die. Actually, this foreboding fills the day, whether at work or elsewhere.

In reality, no one is to blame when an eating disorder strikes a family. The causes of this type of disorder are complex. They range from genetic predisposition to advertising, peer pressure, the need and wish to be perfect, and much more. All these factors and more are part of the process that leads to an Eating Disorder (ED). Gain valuable insights into your eating habits with our Eating Disorder Self-Assessment tool.

Understanding Anorexia: A Medical Synopsis

Anorexia nervosa is a serious medical and psychiatric characterized by an intense fear of gaining weight, leading to severe restrictions in food intake and often resulting in self-induced starvation. It involves a complex interplay of psychological and physical factors.[3]

Psychologically, individuals with anorexia often experience:[3]

• Distorted body image
• Perfectionism
• Relentless pursuit of thinness, driven by deep-seated fears of inadequacy

This mental health condition profoundly affects cognition, emotion, and behavior, contributing to a persistent and harmful preoccupation with food, weight, and body shape.

Physically, anorexia can lead to a range of severe health consequences. Malnutrition, electrolyte imbalances, and hormonal disruptions are common, affecting the cardiovascular, gastrointestinal, and endocrine systems.[3]

The restrictive eating patterns associated with anorexia can result in emaciation, fatigue, and poor immune function. Left untreated, anorexia nervosa can have life-threatening implications. It is imperative to approach the treatment of anorexia comprehensively, addressing both the psychological and physical aspects, with interventions such as psychotherapy, nutritional counseling, and medical monitoring to promote recovery.[3]

Detecting Anorexia: Signs and Symptoms

If you are worried about a child, sibling, or other relative, you’ll want to know the signs and symptoms of anorexia so you can help them get treatment. Detecting signs of anorexia involves recognizing changes in emotional, physical, and psychological health. Some observable signs of anorexia include:[3],[4]

• Significant weight loss
• Preoccupation with food, dieting, and body image
• Distorted body image or perception of body size
• Excessive interest in nutrition labels or constant discussions about food
• Avoidance of specific foods or food groups
• Skipping meals or eating very small amounts
• Severe fatigue or lethargy
• Brittle nails
• A fine layer of hair all over their body known as lanugo
• Dizziness
• Irritability
• Mood changes
• Social withdrawal
• Secrecy around eating and food
• Excessive or compulsive exercise
• Denying or downplaying the severity of weight loss

Recognizing these signs is essential for early intervention and effective treatment of anorexia. If you are concerned, seek advice from healthcare professionals, such as doctors, psychologists, or eating disorder specialists.

Family Therapy: A Cornerstone of Support

Family therapy plays a crucial role in the comprehensive treatment of eating disorders, recognizing that these conditions often extend beyond individual dynamics to involve family systems.[5],[6]

The primary goals of family therapy or family-based treatment (FBT) in eating disorder treatment include:[6]

• improving communication
• Fostering understanding
• Addressing relational patterns that may contribute to or be affected by the eating disorder
• Enhance the overall family environment
• Provide support and education to family members
• Empower family members to contribute positively to the individual’s recovery journey

Typically, family therapy involves joint sessions with the person affected by the eating disorder and their family members. Therapists work to create a safe space for open communication, helping family members understand the impact of their interactions on the individual’s struggles and vice versa.

By addressing dysfunctional family dynamics, setting realistic expectations, and building a supportive network, family therapy aims to create a conducive environment for sustained recovery. 

Additionally, family therapy may incorporate psychoeducation about eating disorders, communication skills training, and strategies for reinforcing healthy behaviors within the family unit.[7]

All of this is the reason why treatment includes family therapy along with intense treatment by a team that includes psychiatrists for medication, nutritionists to form an eating plan with the patient, and a psychotherapist to help the patient learn to cope with life realistically. Family therapy has multiple purposes. First, it helps relieve the guilt, blame, and anger that pervades the family unit. It also helps members discuss how to help their loved one without being controlling and intrusive.

There is hope for recovery for the anorectic patient and the family. Towards this end, I want to recommend a wonderful book for those with an eating disorder as well as friends, family, and anyone who wants to learn about this:

Life Without Ed
How One Woman Declared Independence from Her Eating Disorder and How You Can Too
by Jenni Schaefer with Thom Rutledge, McGraw Hill Books, 2004

Your comments and questions are encouraged.

Allan N. Schwartz, PhD

Sources

1. Gilbert, A. A., Shaw, S. M., & Notar, M. K. (2000). The impact of eating disorders on family relationships. Eating disorders, 8(4), 331–345. https://doi.org/10.1080/10640260008251240
2. Avila-Zavala. (2021). Anorexia Nervosa and the Family: A Look at Well-Siblings, Parents, and Family Dynamics through a Family Systems Perspective. Modern Psychological Studies, 26(4). 
3. National Institute of Mental Health. (2023). Eating Disorders.
4. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596
5. Erriu, M., Cimino, S., & Cerniglia, L. (2020). The Role of Family Relationships in Eating Disorders in Adolescents: A Narrative Review. Behavioral sciences (Basel, Switzerland), 10(4), 71. https://doi.org/10.3390/bs10040071
6. le Grange, D., & Eisler, I. (2009). Family interventions in adolescent anorexia nervosa. Child and adolescent psychiatric clinics of North America, 18(1), 159–173. https://doi.org/10.1016/j.chc.2008.07.004
7. Lock, J., & Le Grange, D. (2001). Can family-based treatment of anorexia nervosa be manualized?. The Journal of psychotherapy practice and research, 10(4), 253–261.