While genetic and biological factors seem to play a role, they do not explain why one monozygotic twin can develop anorexia without the other doing the same. As it is not 100% inherited, it is evident that there are cognitive and/or social elements at play. Furthermore, biological explanations fail to explain why eating disorders are more prevalent in Western cultures than in others; they give reasons that they continue to be a problem for women in the Western world, but not why they are especially a problem for women in the Western world, nor why they are on the rise.

Family systems theory describes the role of the family unit in the development of eating disorders, though does not state that the family system actually causes the disorder. Instead it is considered as the important context in which the problem develops and the disorder is also considered as affecting that family system in return. The critical aspects of the family systems model are that: families are homoeostatic and strive for an equilibrium, and that symptoms of a disorder can be used as a method to restore or maintain such a balance; and that symptoms of disorders can be used as a last-resort form of communication. For eating disorders, the typical family is believed to be highly conflict avoidant and lacking in ‘warmth’ or displays of emotion, often with an underlying dissatisfaction within the parental dyad. It is also common for Mothers to be highly/overly attentive to their children’s needs (which recalls the psychodynamic concept of the ‘too good parent’) and with higher than normal expectations for their success. Anorexic families also often exhibit ‘enmeshment’ – or excessive ‘togetherness’ – and intrusion on each others’ feelings and thoughts with less respect for ‘boundaries’. Another typical characteristic of the anorexic family are high ‘rigidity’ – the desire for a stable status quo. Empirical studies have supported these ideas. The family systems model then describes an eating disorder as being used by the child to communicate distress and/or re-establish a balance within the family.

By its own admittance, family systems theory does not explain in full the actual cause of the disorders but rather the context surrounding them and how such problems are sustained. A family systems approach also does not on the surface of it explain why eating disorders are predominantly a problem for Western women or why incidence has increased over the last few decades. It may be a result of the fact that different demographics serve different roles within families and that different cultures have different family systems (so that Western women experience a family role unique to them) but if so then the exact mechanism of this needs to be addressed. Additionally it fails to explain why under such circumstances a patient develops anorexia as opposed to depression or another disorder. It also fails to explain cases of anorexia in slightly older patients who may be living away from home.

Mack LeMouse

Copyrighted material; do not reprint without permission.

 

View all articles by Mack LeMouse