.. ers no longer sustain her. She is unable to acknowledge her sexual desires and may regard her developing woman’s body as an alien invasion. Her fear of adult femininity may also be a fear of becoming like her mother. According to this theory, fasting restores a sense of order to her life by allowing her to exert control over herself and others.
She is proud of her ability to lose weight, and self-imposed rules about food are a substitute for genuine independence. Some students of anorexia believe that these girls starve themselves to suppress or control feelings of emotional emptiness. They struggle for perfection to prove that they need not depend on others to tell them who they are and what they are worth. According to some psychodynamic theories, a young woman has come to this desperate pass because her parents have never responded adequately to her initiatives or recognized her individuality. Now that she is an adolescent, they are implicitly making conflicting demands: show your capacity for adult independence, but do not separate yourself from the family. According to this theory, the anorectic girl has trouble distinguishing her own wants from those of other people, and she fears abandonment if she takes any action on her own. Denying her needs is the only way she knows how to show that she will not permit anyone else to control her.
She will not allow outside influences, including food, to invade her. Since women with anorexia are usually living with their parents when the symptoms develop, psychotherapists have often found it helpful to work with the whole family. The resulting discoveries and speculations are an important source of family systems theory, in which the family is conceived as a social unit with internal structures and processes that have a life of their own. Psychiatric disorders are regarded as defenses that compensate for disturbances and preserve family stability in a way analogous to the preservation of individual stability by neurotic symptoms in psychodynamic theory. Family systems theorists speak of family rules, roles, rituals, and myths; they analyze the distribution of power within a family and the workings of subsystems of various combinations of parents and children.
According to the theory, families with inflexible self-regulating mechanisms often produce psychopathology in one member, the person with obvious psychiatric symptoms, who is sometimes called the identified patient. A daughter who refuses to eat may be seen as trying to keep the family together by providing an object of common concern for parents who would otherwise be drifting apart. Or she may be trying to restore the balance of the family by siding with one parent in a conflict with the other. Families with anorectic daughters are often said to be smothering or enmeshed. The responsibilities of each person and the boundaries between them are indistinct.
Everyone in the household is said to be over-responsive to and overprotective of everyone else. Conventional social roles are maintained, but individual needs are not met, feelings are not honestly acknowledged, and conflicts are not openly resolved. When the daughter reaches puberty, her parents are reluctant to make necessary changes in the family rules and roles. In this view, anorexia is a symptom of a rigid family system’s need and inability to adapt to a new stage of development (Macmillian). Theories about the influence of parents raise similar questions of cause and effect.
The mother and father of a child who is starving herself are under great strain, and the family is bound to be in “turmoil.” In any case, an unhappy woman with an eating disorder will naturally be dissatisfied with her family. A parent who tries to intervene may be regarded as intrusive, one who tries to avoid conflict as uninvolved. Researchers have found that anorectic women are likely to describe their fathers as distant or their mothers as over controlling, but their brothers and sisters do not necessarily agree. These and other psychological and biological explanations can be reliably tested only by difficult, expensive long-term studies in which girls who develop eating disorders are compared with others before as well as after the symptoms appear (“Anorexia”). “Having a child in crisis with an eating disorder impacts on the entire family as well as the child.
The support mechanisms that parents may have come to depend on at work or in their leisure may no longer be helpful, thus causing disruption to these patterns and to family relationships. The purpose of this study was to investigate the challenges that parents face and changes that occur, particularly in relationships, when a child is diagnosed with an eating disorder and how parents cope with these changes. The findings indicated that there is a significant impact on relationships associated with age of child, personal leisure and level of confusion in the family. The findings also showed contrasts in the way families cope with having a child in crisis, either very negatively or very positively. The qualitative anecdotes describe the tremendous strains and changes in patterns within families particularly during the initial period of diagnosis.
The parents provide recommendations for researchers, practitioners and service providers that will be helpful to other families” (Gilbert). Cultural comparisons and historical studies confirm evidence from our own society that eating habits and preoccupations with similar effects may have different causes in different circumstances. For example, a woman is temperamentally predisposed to depression or anxiety, or suffers from family troubles or a neurochemical imbalance. The value her culture places on slenderness encourages her to diet. The weight loss causes physical and emotional changes that make it still more difficult to eat normally. The resulting hunger may lead to eating binges followed by vomiting and purging with laxatives. These episodes cause anxiety and depression that lead to further bingeing and further dieting. Treatment of anorexia can be frustrating, and recovery is usually prolonged and difficult.
Even women whose most serious symptoms are relieved often relapse or suffer from various residual effects and chronic troubles. In long-term studies covering periods from 4 to 30 years, 50% to 70% are found to be no longer clinically anorectic: they are menstruating and maintaining a weight in the normal range. About 25% show some menstrual irregularities, and their weight is sometimes low. The outcome is poor for another 25%; they are not menstruating and their weight is far below normal. Whether they recover or not, many of these women are still preoccupied with weight and dieting. Women with personality disorders and those who have symptoms for a long time before seeking treatment are least likely to recover. Evidence on the effectiveness of treatment is limited. Many women with anorexia or bulimia are never treated, and in long-term studies many drop out possibly those who are doing worst.
Researchers are calling for further cross-cultural research and more studies in which women are interviewed for the first time before developing symptoms. More information about self-help groups is needed. Researchers must examine more closely the relationship between eating problems and other psychiatric disorders, including addictions and compulsive behavior, partly so that treatments can be modified for different combinations of symptoms. An especially important goal of research is finding ways to prevent eating disorders or recognize and treat them at an early stage (Anorexia). Bibliography Bibliographic Citation Anorexia Nervosa. Grolier Multimedia Encyclopedia. 1995ed.
CD-ROM. Redmond: Grolier, 1995. “Anorexia Nervosa.” Clinical References System. 1998 Online. Internet. Available http://bewell.com Bower, Bruce.
“Women With Anorexic Face Ongoing Problems.” Science News 18 July. 1998: 3. Cavendish, Marshall. “Anorexia Nervosa.” Family Health. 1986: Vol. 1.
Gilbert, Adrienne A. “The Impact of Eating Disorders on Family Relationships.” Eating Disorders. University of Waterloo, Ontario. 1998: 1-22. Larson, David E., MD.
“Anorexia Nervosa.” Mayo Clinic Family Health Book. 1996 ed. 2. Macmillian, John. “Anorexia Nervosa.” Nutrition and Fitness.