Families of Patients
with Eating Disorders
Early family theories and studies of eating disorders overemphasized mother–child interactions, reflecting the myth that “parenting means mothering.” Later, the “absent father” gradually came into the picture. Then, the importance of the whole family was stressed by the systems theory approach. The interaction between the parental subsystem and the children was usually analyzed in terms of communication, problem solving, boundary setting, and so on. More recently researchers have started to focus on the specific educational role of parents. Siblings of patients with eating disorders, however, may still be considered a “forgotten” group, and interest in married patients—their choice of partners, their marital interactions, and their offspring—is still marginal. Most of these topics are reviewed in this chapter. Other chapters address the related topics of family–genetic studies of eating disorders (Chapter 42), risk factors for eating disorders, including intrafamilial traumatic experiences (Chapter 44) and the impact of maternal psychopathology on childrearing (Chapter 39).
It has been suggested by some clinicians that patients with anorexia nervosa are more often than expected only children, while others have claimed the opposite. Systematic comparative studies of large clinical samples, however, have failed to reveal any significant relation between family size and the presence of an eating disorder. Similarly, it has been suggested that anorexic patients are more often firstborns or lastborns rather than middle children, but again, in controlled studies, no significant differences in birth order have been observed. Furthermore, follow-up studies of patients with anorexia nervosa have shown that neither sibship position nor family size has prognostic significance. This finding does not exclude the possibility, however, that in some cases, a child’s occupation of a “special” position within the family may be linked to the development of an eating disorder.