Eating Disorders And Family Boundaries

In August of 2006, Dr. Dombeck wrote an excellent essay about “Boundaries and the Dysfunctional Family.” If you have not yet read this essay I highly recommend it especially as the present blog refers back to the issue of boundaries.

One of the observations I have made during the many years I have been seeing clients with eating disorders is that they often come from families with serious boundary problems. Salvador Minuchin referred to this boundary issue as enmeshment.

Quick answer element: Defining Enmeshment in Family Dynamics

Enmeshment refers to an unhealthy level of emotional closeness and dependence between individuals—family members in this case. This dependence can blur boundaries and inhibit personal autonomy and independence. It goes well beyond a healthy amount of intimacy. Enmeshment involves an excessive merging of identities, leading to a lack of individual identities, which can cause negative effects on well-being and mental health. This can be especially harmful for children in an enmeshed family because they will be unable to form their own opinions and thoughts separate from the parent(s).[1],[2],[3]>>

Introduction to Enmeshment

Enmeshment describes a family dynamic characterized by an excessive and unhealthy level of emotional closeness that results in a lack of boundaries, the fusion of identities, feelings, and thoughts, and preventing individual autonomy. This pattern can emerge in many types of relationships, such as friendships, romantic partnerships, and families, although this article will primarily focus on family dynamics.

Psychologically, enmeshment has several consequences, including:[1]

• Increased anxiety
• Depression
• Decreased mental well-being
• Emotional instability
• Lack of self-differentiation and individuation
• Inability to pursue one’s own goals
• Substance misuse
• Eating disorders like anorexia nervosa and bulimia nervosa

Enmeshed families often use manipulation and emotional abuse to form these excessively close relationships, demanding loyalty from family members and using excessive praise or superficial love to keep them close.[1]

In this article, we provide information on enmeshed family dynamics, particularly in the context of eating disorders, as well as provide treatment and recovery options to heal these family issues.

Recognizing Signs of Enmeshment

It can be difficult to tell if you are in an enmeshed family while you are inside of it. Here are some signs of enmeshment:[5]

• Inability to balance time apart and time together
• Separation may cause profound stress, fear, frustration, and anxiety
• Inability to handle change or challenges
• Issues supporting each other
• Unwilling or unable to celebrate differences among family members
• Lack of personal boundaries
• Overly dependent on each other
• Parents’ lives center around their children without other interests
• There is a high level of pleasing others or keeping the peace 
• Members may feel responsible for other members’ happiness
• Members may be shamed if they want independence
• Enmeshed parents may treat their children as friends, relying on them for emotional support
• Members may have trouble functioning alone
• Members may not have a strong sense of self

Real World Examples 

Having some real-world examples of enmeshed families can help you recognize if you are in one. Here are some examples:

• A parent relies on their child for support through a divorce
• A parent discloses personal and inappropriate sexual information to their child
• A family member gets offended and angry when a family member moves away
• A parent calls their daughter’s ex-boyfriend to ask why he broke up with her
• A family member can’t make a simple life decision without consulting other family members
• A member has no idea what their interests or passions are
• A parent controls what their child can or cannot pursue

Boundaries are Essential

As Dr. Dombeck points out, boundaries are barriers and, for human beings these barriers exist as ideas that allow us to distinguish self from non self. Therefore, these boundaries are not actually visible but exist as psychological constructs.

In families, there are important boundaries that are generational in nature. In other words, there are boundaries between children and parents. If a family is functioning in ways that are healthy then the boundaries between parents are children are flexible, Flexibility means that there is the right amount of authority in the hands of parents to allow for the guidance, socialization and education of the children. At the same time flexibility permits parents to allow children the experience of age appropriate autonomy so that they can grow in self confidence as they learn to function outside of the home.

A dysfunctional family is either: one in which the children are granted too much autonomy for their age and are, in reality, neglected, or: one in which parents and children become enmeshed so that boundary lines are violated.

Case studies in the field of eating disorders as well as my own observations show that eating disordered patients tend to come from families that are extremely enmeshed with the result that the sense of autonomy, individuality, and independence has not been established by adolescence and young adulthood, especially for females. It is for this reason that the treatment of young women with eating disorders includes family therapy in order to address the problem of enmeshment.

Clinical Examples of Enmeshment

These are fictionalized examples of the types of boundary problems I have observed:

Case 1

A young woman wants very much to please her parents. Both mother and father are accountants. Therefore, instead of taking the premedical course of study that she wanted during her college years, she studied accounting, went to graduate school and became a certified accountant earning an excellent living at a large business firm. However, she suffered from a mixed type of anorexia-bulimia but insisted there was nothing wrong with her. She hated her career but would not admit to any anger at either of her parents. Her parents purchased her a condominium, selected the furnishings and artwork for her and came to visit each weekend, stocking her refrigerator with food of their choosing. They never knew how little of the food she actually ate.

Case 2

During her childhood a young woman’s parents purchased a large television set for the family and placed it in her room. In order to watch television, the entire family had to go to her room. When she was very young this strange arrangement did not seem to bother her. However, when she became pubescent and started to rebel she was upset by family member walking into her room to watch their programs. These family members included her parents, brother and sister.

To make matters even worse, her sister’s clothes were stored in her closet necessitating the need for the sister to further intrude into her privacy.

There was never any explanation for these strange arrangements. What is significant is the fact that this patient became bulimic during the early part of her adolescence. Her sister and brother each developed their own types of psychological disorders.

Case 3

The last example is of a young woman who suffered from a case of anorexia that was serious enough for her to be hospitalized. Her extremely self centered parents were unforgiving of her for the hospitalization. They were convinced that she was being ungrateful to them for having raised her. In family meetings the father, who did not want to be there, was outraged by the inconvenience and cost this was putting him through. Her mother felt abandoned by her daughter’s hospitalization. It had always been the job of the daughter to care for her mother. Caring for this mother included listening to her mother’s complaints about her father’s poor sexual prowess. It never occurred to the mother that this was totally inappropriate information for her daughter to hear about. In fact, the mother discussed all the details of her unhappy marriage telling her daughter things that the mother should have been discussing with other adults.

Details Common to the Three Young Women

In all three cases these patients had no sense of self. Specifically, this means that none of them had any idea of what career choices they wanted for themselves, what taste in music they preferred or what political issues were important to them.

Each one of the three felt totally responsible for the well being of their parents and would do nothing that they believed could cause hurt or disappointment. They would not express anger at either of their parents and all insisted that their parents did the best they could.

In each case the young women had parents, particularly mothers, who made decisions for them. These mothers never recognized the fact that their daughters were now adults and needed to make their own decisions. Interestingly, each one of these patients denied that there was anything wrong with their mother making these decisions.

All three had great difficulty making decisions regardless of whether they wee dealing with major or minor issues. For example, selecting a movie to go to was a daunting task. Most often they would tell whomever they were with that “anything would be fine.”

In each of the cases the patients came to realize that restricting food was the only way they had of exerting some measure of control over their lives. However, this came only after a lot of hard therapeutic work.

Finally, in all three cases no one in the respective families noticed how thin their daughters were and all three families expressed surprise at learning about the eating disorder. It was only in case 3 that the parents expressed resentment at the diagnosis and at their daughter.

Eating Disorders: A Specific Concern 

Enmeshment can play a significant role in the development and perpetuation of eating disorders like anorexia, bulimia, and binge eating disorder.

In enmeshed relationships, where boundaries and blurred and self-differentiation is compromised, there can be an increased risk of unhealthy coping mechanisms, including disordered eating behaviors.

Research has shown that enmeshed family dynamics can contribute to the development of eating disorders. This is because family members may use disordered eating patterns like caloric restriction, binging, or purging to maintain control or self-autonomy.[6] These behaviors can progress and develop into a full-blown eating disorder. 

Additional Factors Behind Eating Disorders

There are additional factors behind eating disorders in addition to enmeshed family dynamics. Among these are:

1. The emphasis on physical beauty being defined as being thin in all of the media that influence young adolescents.
2. Traditional role expectation that girls prepare themselves to be mothers who nurture others at the expense of themselves.
3. Despite all of the social changes that have occurred the emphasis continues to be on girls being passive and exerting their influence through sexual beauty and through being aggressive and assertive.
4. It is not simply that, for girls, the emphasis is on physical beauty being defined as being thin but on physical beauty as a vitally important trait if she wants to feel accepted.

In the United States, eating disorders begin to exert themselves among girls from as early as nine and ten years old. For many young women anorexia or bulimia is full blown by the time they are in Middle School. Surveys show that most college women have experimented with purging at least once.

What are your thoughts about Eating Disorders and Family Boundaries?

Sources

1. Hann-Morrison D. Maternal enmeshment: The chosen child. SAGE Open. 2012;2(4):2158244012470115. doi:10.1177/2158244012470115.
2. Kivisto, K. L., Welsh, D. P., Darling, N., & Culpepper, C. L. (2015). Family enmeshment, adolescent emotional dysregulation, and the moderating role of gender. Journal of Family Psychology, 29(4), 604–613. https://doi.org/10.1037/fam0000118
3. Sauer, R. J. (1982). Family enmeshment. Family Therapy, 9(3), 299–304.
4. Coe, J. L., Davies, P. T., & Sturge-Apple, M. L. (2018). Family cohesion and enmeshment moderate associations between maternal relationship instability and children’s externalizing problems. Journal of family psychology : JFP : journal of the Division of Family Psychology of the American Psychological Association (Division 43), 32(3), 289–298. https://doi.org/10.1037/fam0000346
5. Matejevic M, Todorovic J, Jovanovic D. Patterns of family functioning and dimensions of parenting style. Procedia – Social and Behavioral Sciences. 2014;141:431-437. doi:10.1016/j.sbspro.2014.05.075.
6. Cerniglia, L., Cimino, S., Tafà, M., Marzilli, E., Ballarotto, G., & Bracaglia, F. (2017). Family profiles in eating disorders: family functioning and psychopathology. Psychology research and behavior management, 10, 305–312. https://doi.org/10.2147/PRBM.S145463