Family Dynamic and Eating Disorders

July 28, 2019
Eating disorders are quite prevalent in the young female population. Studies tend to focus mainly on the person afflicted with these conditions, however, there are few where their relatives were taken into consideration. The purpose of this article is to introduce the Expressed Emotion (EE) model in relatives of people with eating disorders. Also, the influence of family dynamic over the development of this psychopathological disorder.

Eating disorders are disturbances or alterations of behavior linked to food and, therefore, to its ingestion. These are maintained in the long term and entail a deterioration in the physical health of a person. In addition, there’s deterioration of their psychological, social, and family dynamic.

These disorders are studied a lot due to their prevalence among the female population. More specifically, due to their incidence among teenagers. Estimates reveal that up to 4% of teenagers and young female adults are currently afflicted by in the Western world. However, there are very few studies on the family dynamic of people with eating disorders.

This is an unavoidable and pressing challenge, given the enormous percentage of teenagers who are at risk of developing an eating disorder. It’s a social problem that can be directly connected to the family dynamic as it has many consequences in their overall well-being. It’s also highly relevant because family members have a huge influence during the course of this disorder.

What Leads to Eating Disorders

A distressed woman sitting on the floor.

Numerous studies seek to find not only the triggering factors of eating disorders but also their pervading ones. Models such as the multifactorial Vohs, Bardone, Joiner, Abramson, and Heatherton (1999) came up with showed the role of perfectionism in the development symptoms of anorexia nervosa.

In more recent studies, such as the one conducted by the National Autonomous University of Mexico in 2010, this perfectionism is defined as an extreme concern for being wrong or making mistakes. Also, as indecisiveness.

They highlight things such as body dissatisfaction and negative self-esteem, along with beginning a strict diet and weight gain. There are also other risk factors such as family conflicts and critical matters related to weight and body shape when developing an eating disorder.

Regarding the pervading factors of this condition, the most common ones are dietary restrictions, purgative behaviors, and a much reduced social environment. It’s in this latter one where the attitudes of their immediate family reflect.

Family Dynamic and Eating Disorders: What’s the Role of Expressed Emotion

Expressed Emotion (EE) is the emotional communication style within the family and is also one of the pervading factors of eating behavior disorders. EE is a model that began to take shape in the 50s at the Institute of Psychiatry, Psychology, and Neuroscience in London. In a first study, researchers observed that most of the relapses of people with schizophrenia happened to those who were released to their old family dynamic.

As a result, they subsequently conducted investigations to explain the elements of the family nucleus. They believed it had something to do with the relapses of those who returned to their homes. In fact, Brown, Birley, and Wing found three characteristics that are definitely related to the development and pervading nature of the condition:

  • Hostility
  • Emotional overinvolvement
  • Criticism

Other authors, such as Muela and Godoy, also include warmth and positive comments. In relatives of people with eating disorders, the EE model presents characteristics that are similar to those found in previous schizophrenia research.

“Women who love themselves are threatening; but men who love real women, more so.”

-Naomi Wolf-

Components of Expressed Emotion

  • Criticism. Negative evaluation by a family member regarding the behavior of a person with an eating disorder. (The content not only denotes criticism but also the manner in which they said it).
  • Hostility. Rejection from a family member. It’s not just criticism about something they person with an eating disorder did, but a general attack to them as individuals.
  • Emotional over-involvement. Intense emotional response by family members in an attempt to control the behavior of a person with an eating disorder. On the one hand, the emotional response may range from constant sobs and crying due to the situation. On the other hand, there’s the self-sacrifice required by the condition. Then, there’s also overprotection.
  • Warmth. Adequate emotional response from family members characterized by empathy, affection, and interest.
  • Positive comments. Verbal comments of affection to the person with an eating disorder.

All these components seem to play an essential role in the course of the condition of a person with an eating disorder. For example, when there are high levels of critical comments, hostility, and emotional overinvolvement, then the family context of the troubled person becomes coercive. Much more guarded and less flexible.

Longitudinal studies in the field show there are differences between eating disorders cases that lasted less, compared to the cases that became chronic. Researchers observed that only 6% of the relatives of those people who recovered quickly showed high levels of Expressed Emotion.

Numerous authors also studied the relationship of EE in relatives and the development of the eating disorder. As opposed to only studying its pervading nature once they had it. The results showed that between 55-60% of the relatives of people with eating disorders had a high EE.

The Relevance of the Family Dynamic in the Development of Eating Disorders

A woman taking a bite.

Given what was just mentioned above, it’s necessary to include psychoeducation as part of the treatment. Also, if necessary, require the family intervention of the person with an eating disorder in their psychological treatment.

A good emotional family adjustment, where all members can manage their emotions and have an outlet for their emotions at the right times, is vital for the improvement of people with eating disorders.

Furthermore, the involvement of family members is crucial. Especially when most of those affected by eating disorder conditions are young. Nobody expects family members to know just what to do and how to handle it. This is why they should be a part of the entire treatment. After all, they’re a huge part of the cure.

Thus, it’s important to not blame family members. To learn to stop labeling the person with an eating disorder. Also, to learn to reinforce alternative behaviors and improvements of the person with an eating disorder. Or to just take a deep breath and remain patient in the face of a condition that could last a long time.

  • Franco, K., Mancilla, J., Vázquez, R., Álvarez, G. y López, X. (2011). El papel del perfeccionismo en la insatisfacción corporal, la influencia sociocultural del modelo de delgadez y los síntomas de trastorno del comportamiento alimentario. Universitas Psychologica, 10(3), 829-840.
  • Adrados, V. (2014). Emoción expresada familiar en los trastornos de la conducta alimentaria. Tesis doctoral. Universidad de Chile, Chile.
  • March, J. (2014). El papel del perfeccionismo en la insatisfacción corporal, la influencia sociocultural del modelo de delgadez y los síntomas de trastorno del comportamiento alimentario. Tesis doctoral. Universidad Autónoma de Barcelona, España.
  • Moraleda, S., González, N., Casado, J., Carmona, J., Gómez, R., Aguilera, M. y Orueta, R. (2001). Aten Primaria, 28(7), 463-467.