Thanks to Melinda Hutchings I read a blog by the director of the Eating Disorder Resource Centre, Dr. Judith Brisman. Her blog discusses the possible role of family functioning in the development of eating disorders. You can read her blog here.
She begins to allude to the concept of an "anorexicogenic family" where features of the family, particularly "enmeshment" and "overcontrol" were thought to be related to the development of an eating disorder. As Dr. Brisman points out, the studies that described this were methodologically flawed and therefore inconclusive at best, and damaging to families at worst. The concept seems similar to the "schizophrenogenic" family pattern that used to be thought to "cause" schizophrenia. That is of course until we discovered that schizophrenia is a biological illness. Dr. Brisman points to some studies indicating a biological basis to anorexia, but I will talk about those in a later post.
Dr. Brisman is correct when she asserts that ALL families, not just those with children with eating disorders, present with a combination of psychopathology, and strength and resiliency. However, lets take those 1000 families that she wants to see in a research trial and then lets give their child a potentially chronic and life threatening disease. We could choose an illness like leukaemia. These families, I would boldly predict would demonstrate features like closeness and pulling together ("enmeshment") and maybe also try to control their distress in front of their child ("emotional overcontrol") and be worried about their child's activities and behaviour ("behavioural overcontrol"). I dare say these parents would demonstrate emotions and behaviour in line with an adjustment disorder, worry and anxiety ("psychopathology").
If we also treated these families as if they somehow caused the leukaemia (even if we didn't quite know how) and isolated them from the process of treatment, I suspect the parents behaviour may appear to be even more "pathological".
My point is that we as clinicians (and as society) have a negative bias when it comes to mental health and we look for pathology where we would not in a medical condition.
Now, eating disorders are not quite like leukaemia are they. Patients with leukaemia do not want their illness as someone with anorexia may appear to. They will not fight against parents to help them. They will not act to undermine treatment. Thus, the parents of a child with an eating disorder are also faced with the egosyntonicity of the illness. This feature of the eating disorders increases the difficulties parents face. The frustration of wanting to help someone who actively resists help can be overwhelming for clinicians, let alone parents. I suspect this part of the battle increases what we may see as "pathology" in the family.
So, Dr. Brisman's study not only needs to take 1000 families, but also needs to take into account the effects of having a child with a life threatening illness, the stigma of mental health, difficult access to treatment, and a child who resists treatment. Given these conditions I would love to study the family that does not react in a way that could be considered as 'pathological'. I strongly suspect that the family features that are seen to cause eating disorders are caused by a natural reaction to the trauma of having a child with an eating disorder. The research backs this hypothesis up.
Families are an important resource for treatment, particularly in children and adolescents. The outcome of patients treated with Maudsley Family Based Therapy is a testament to this. We are currently looking at ways to increase support for parents whose children are suffering from the eating disorders to decrease there feelings of guilt and blame, and to increase their effectiveness into helping their children overcome these insidious diseases.
If you would like to comment on this feel free to do so on our Facebook page.
She begins to allude to the concept of an "anorexicogenic family" where features of the family, particularly "enmeshment" and "overcontrol" were thought to be related to the development of an eating disorder. As Dr. Brisman points out, the studies that described this were methodologically flawed and therefore inconclusive at best, and damaging to families at worst. The concept seems similar to the "schizophrenogenic" family pattern that used to be thought to "cause" schizophrenia. That is of course until we discovered that schizophrenia is a biological illness. Dr. Brisman points to some studies indicating a biological basis to anorexia, but I will talk about those in a later post.
Dr. Brisman is correct when she asserts that ALL families, not just those with children with eating disorders, present with a combination of psychopathology, and strength and resiliency. However, lets take those 1000 families that she wants to see in a research trial and then lets give their child a potentially chronic and life threatening disease. We could choose an illness like leukaemia. These families, I would boldly predict would demonstrate features like closeness and pulling together ("enmeshment") and maybe also try to control their distress in front of their child ("emotional overcontrol") and be worried about their child's activities and behaviour ("behavioural overcontrol"). I dare say these parents would demonstrate emotions and behaviour in line with an adjustment disorder, worry and anxiety ("psychopathology").
If we also treated these families as if they somehow caused the leukaemia (even if we didn't quite know how) and isolated them from the process of treatment, I suspect the parents behaviour may appear to be even more "pathological".
My point is that we as clinicians (and as society) have a negative bias when it comes to mental health and we look for pathology where we would not in a medical condition.
Now, eating disorders are not quite like leukaemia are they. Patients with leukaemia do not want their illness as someone with anorexia may appear to. They will not fight against parents to help them. They will not act to undermine treatment. Thus, the parents of a child with an eating disorder are also faced with the egosyntonicity of the illness. This feature of the eating disorders increases the difficulties parents face. The frustration of wanting to help someone who actively resists help can be overwhelming for clinicians, let alone parents. I suspect this part of the battle increases what we may see as "pathology" in the family.
So, Dr. Brisman's study not only needs to take 1000 families, but also needs to take into account the effects of having a child with a life threatening illness, the stigma of mental health, difficult access to treatment, and a child who resists treatment. Given these conditions I would love to study the family that does not react in a way that could be considered as 'pathological'. I strongly suspect that the family features that are seen to cause eating disorders are caused by a natural reaction to the trauma of having a child with an eating disorder. The research backs this hypothesis up.
Families are an important resource for treatment, particularly in children and adolescents. The outcome of patients treated with Maudsley Family Based Therapy is a testament to this. We are currently looking at ways to increase support for parents whose children are suffering from the eating disorders to decrease there feelings of guilt and blame, and to increase their effectiveness into helping their children overcome these insidious diseases.
If you would like to comment on this feel free to do so on our Facebook page.
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