AED Group Clarifies the Role of Family in Eating Disorders

A position paper refutes the idea that family factors cause eating disorders.

The etiology of anorexia nervosa (AN) and bulimia nervosa (BN) is complex, and treatment poses unique challenges for clinicians. One continuing challenge is an old misconception that will not die, namely that certain types of interactions among family members play a specific role in the etiology or maintenance of an eating disorder.

The Academy for Eating Disorders recently published a position paper specifically refuting the idea that family factors are either the exclusive or even the primary mechanism that underlies risk for a family member developing an eating disorder (Int J Eat Disord 2010; 43:1). A group led by Daniel le Grange, PhD noted that it is disturbing to see recent examples of public misinformation about the role of the family and eating disorders. For example, a high-profile model recently blamed parents and families for the occurrence of eating disorders after media attention given to the deaths of several runway models from complications of AN.

Dr. le Grange and colleagues pointed out that research continues to focus on the role the family may have in causing or contributing to an eating disorder, despite treatment programs like the Maudsley program, which have shown the family as a potential helpful resource in therapy. According to the researchers, the strength of the findings, positive and negative, is called into question by absence of psychiatric controls to determine specificity of the prospective associations identified, lack of power to test for the prediction of full-blown cases of eating disorders, and reliance on risk factor assessments of questionable reliability and validity.

In another area, genetic studies, there is increasing evidence that heritable influences underlie susceptibility to both AN and BN. This type of “family influence,” however, is of a much different type, according to the authors, and the nature of the transmissible risk is still unknown.

Evidence that family involvement is helpful

The good news concerning the family and eating disorders is that a small number of studies have shown that family involvement appears to be useful in reducing both psychological and medical morbidity, especially for younger patients with short-term eating disorders. This type of treatment seems to be well accepted by parents and patients alike. Only a few studies have assessed the helpfulness of family therapy for BN. Overall, the results of these studies suggest that family-based treatment method may be promising for some teens with BN, but also that further study is needed before any conclusions can be drawn.

The authors suggest that although no evidence supports the concept of “anorexigenic” parents, or parents who cause AN, in some cases involvement of the family may be contraindicated, for example, when parents have severe psychopathology. Clinicians should carefully assess parents’ competencies, motivation, and any history of adverse or traumatizing events. The Study Group concluded that families should be involved routinely in the treatment of most young people with an eating disorder, and that the specific structure and extent of their involvement should be determined on a case-by-case basis.