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Anorexia nervosa is a serious eating disorder that mostly effects women and usually begins in adolescence. There is a greater risk of death from anorexia nervosa (from either suicide or the physical implications of the illness) than there is from other mental illnesses, and it is very difficult to treat. Therefore, anorexia nervosa family implications are great.
The development and maintenance of anorexia nervosa has been closely linked with family functioning. It is also a highly genetic illness; first degree relatives of young women with anorexia nervosa are 10 times more likely to have the disorder themselves. This same link has also recently been identified with men. Key features of eating disorders such as body dissatisfaction and the desire to be thin have been found to be heritable, as are several personality traits often found in those with anorexia nervosa. These traints include perfectionism, high emotionality and traditionalism.
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Anorexia Nervosa and Family Personality Traits
While these personality traits may be transmitted genetically from a parent to a child, the presence of multiple people in a family with these personality traits may make for an intense family environment. Perfectionism is a multifaceted personality trait. It can be oriented toward the self (setting high standards for oneself), others (setting high standards for others) or society (attempting to live up to the standards set out by society). A person may develop anorexia nervosa because of their own self-oriented or society-oriented perfectionism, or because of a family member's imposed, others-oriented perfectionism. A family with a high concentration of this trait may also find it more distressing when a member is diagnosed with anorexia nervosa, as being considered ill would be unacceptable to their high standards. High emotionality may also contribute to both the development of anorexia nervosa and to the conflict caused by the presence of the disorder.
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Anorexia Nervosa and the Child-Parent Relationship
Many psychodynamic theorists propose that the core cause of anorexia nervosa is a disturbed parent-child relationship. They believe the development of the disorder to be a form of rebellion in a child raised to feel ineffectual. The development and maintenance of the disorder is an attempt to gain competence and respect from their parents. Following this, psychodynamic theorists believe that the anorexia nervosa implications for the family will be an environment high in conflict. The parents are likely to feel upset and frustrated that their child can no longer be so easily controlled. Indeed patients with anorexia nervosa often report high levels of conflict and low levels of support in their families. However, these same family characteristics have been found in families where a member is suffering from another psychopathology. This suggests an environment characterized by high conflict and other negative emotions are a consequence of living with a person with a mental illness.
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Minuchin's Family Characteristics of those with Anorexia Nervosa
An influential theorist on the topic of anorexia nervosa and the family, Salvador Minuchin, argues that the child's symptoms are a substitute for other conflicts in the family. That is to say, an unhealthy family life is already in operation before the development of anorexia nervosa. Understandably, further conflict is caused by the presence of anorexia nervosa; enabling the patient to maintain the disorder. Minuchin observed several characteristics in families with eating disorders. These characteristics may be either a cause or effect of the disorder. The first characteristic is enmeshment in which families have an extreme form of over-involvement in each other's lives. The second characteristic is over-protectiveness. The third characteristic is rigidity in which the family tries to maintain the status quo and avoid dealing with unpleasant events. The fourth characteristic is lack of conflict resolution.
In conclusion, research in to the relationship between the family and anorexia nervosa suggests that family conflict and negative emotions within a family can be both a cause and effect of anorexia nervosa. It is likely that a family environment that was suffering in the first place would be made worse by the onset of the disorder. However, family therapy is still the most widely used treatment for anorexia nervosa and family functioning has been found to improve after it.
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Kring, A.M., Davison, G.C., Neale, J.M. & Johnson, S.L. (2007) Abnormal Psychology. USA: John Wiley & Sons.
Minuchin, S, Rosman, B. & Baker, L. (1978) Psychosomatic Families, Anorexia Nervosa in Context. Harvard University Press: Cambridge, Mass.