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 web log 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.
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:
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 art work 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.
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.
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.
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?
Experiences from living with an anorexic - - Sep 30th 2009
While many anorexics/ bulemics come from dysfunctional families, I think people should be aware that, just as often, families become dysfunctional because one member develops an eating disorder. Living with someone who is anorexic has taught me many things-chiefly, that my loved one not only lies about what and how much she eats, but, intentionally or unintentionally, she does not tell the truth about family relationships. My family has, like most families, faced some difficult times. However, throughout it all, we were blessed to have a mother who was always there for us and who also encouraged us to seek out educational opportunites and pursue our dreams. Since my sister ( in her 20's), became anorexic, my mom can do no right. If she asks my sister how work went, she is "interfering" and my sister claims she "acts like I can't do anything right." If she walks in the kitchen while my sister is there, my sister mutters under her breath and stomps off down the hall. My sister, of her own free will, lives with my mom (and is thus supported by her) but she tells other people that she can't live her own life because she has to support my mom. All I am saying is, as a counselor, be careful not to judge other people's families as dysfunctional too quickly, because sometimes the only reason they are dysfunctional is BECAUSE of the eating disorder.
Marriage suffered because of my enmeshed family - - Aug 12th 2008
Chills ran down my spine as I read this article. I and my sister had and still mildly have eating disorders and although I have a wonderful loving husband and two great kids, my parents ridiculous need for my attention and my mother's complete lack of boundaries put my husband and I in marriage counseling. Only then did I realize what both my parents had done to me. My mother was a classic example of Case number one and two. She complained (and still does) about my father and completely crosses the line on what is appropriate in all instances of my life. She has invited herself on many outings where she is not wanted and insisted on being the room when I delivered my babies. Even though I clearly stated that I did not want her there. Then, she shares private events of my labor and delivery with anyone and everyone. There is no sense of boundaries and no respect for a difference of opinion. Everytime we get together there is a huge focus on food and what everyone is eating and how thin this person is compared to that person. However, because both my parents never admit to mistakes, everything they do is because they love me, if I express anger over the way in which every meal and event is handled, I am immature, rude and disrespectful. As you can see, my husband and I are still dealing with this. But I have made great strides is getting them out of my life. We plan to move far away at the earliest possible moment. I am concerned for my children that having grandparents like this will cause them to have the same problems I have.
- anon - Jul 31st 2007
When I read case 3, I got the chills. Case 3 was talking about me so many years ago. One day, I got down to 90 lbs., I passed out in the bathroom. Instead of being concerned, my biological makers (i don't call them parents - they were too horrible and cruel to deserve that name) had to call the doctor. They were mad at me because I couldn't find a good balance. "You always go to extremes!", my mother screamed. I had tried to make a connection with them and let them know that I wasn't doing ok. They only shot me down. Either I was unappreciative because they were doing so much for me and were such loving parents. Sometimes my mother simply told me, "Oh teenage years are horrible time. It passes."
In retrospect, many years later, I have to admit that my parents did very little for me or my sisters. They certainly never showed us love or were genuinly loving. They only talked about it. Unfortunately, back then as a teenager I had very little or no social support. My biological makers did everything in their power to isolate me from the world and squelch any attempt on my part to have a social life or friends. Today I am on my way to become an adult survivor of the hell of a dysfunctional environment that I once lived in. I am going back to college to become a therapist. Becoming a therapist is a way of giving my life a new meaning. It is very important to realize that are many of those young women out there. Unfortunately, just like me back then, these young women never experienced genuine social support and fear humiliation and shame. It is extremely important that our society recognizes this and reaches out to children and young adults in those situations. It's in all of our best interest to strive to make this a better and kinder world.