What role does the family play in the eating disorder?
In many cases the client’s family has had or is still having a significant impact on the thinking that leads to the behaviors associated with Anorexia, Bulimia, binge eating and emotional eating. In the vast majority of cases the family members are completely unaware of the impact that they are having on the individual with an eating disorder. Often they are not even aware of the disorder, or if they are aware of it, they are unaware of its seriousness. Unfortunately, once they become aware, their efforts to help can have the opposite effect and may even exacerbate the problem. The dynamic of the overprotective mother and the hyper-critical father, while it does occur, is by no means the only dynamic in the development of an eating disorder. Peer pressure, sociocultural influences and situational factors such as personal loss or emotional trauma may be contributing factors as well. In the past 20 years there has been an increase in the number of women developing Anorexia in their late twenties or early thirties, suggesting that factors other than those associated with the family of origin are contributing factors.
Is the family to blame?
Most family members just want to help their loved ones. Individuals suffering from a serious eating disorder are exquisitely sensitive, perceiving criticism or ridicule where none was intended. Once the disorder is manifest, the harder the family member tries to help, the worse things become. To make matters worse, the things that do work are counter-intuitive whereas the things you do instinctively, such as insisting that your loved one eat, will usually result in more determined efforts to restrict. Likewise, insisting that he/she stop vomiting or exercising will reinforce his/her sense of failure, especially if he/she has not learned what triggers the behavior and what he/she can do to alter his/her response to those triggers. In all likelihood, he/she has probably been aware of the need to stop purging for quite a while before you learned of the disorder but has been unable to do so on his/her own.
We feel that she is just trying to manipulate us. Is that part of the disorder?
In general, the disorder does not begin as a way of manipulating family members.
On the whole, individuals with an eating disorder do not consciously decide to torture their families with their symptoms. However, Anorexia, can be a cry for help. If the family is dysfunctional and it is impacting the individual with the disorder, he/she may continue to decline until the dysfunctional dynamics improve. This can seem quite manipulative. That does not mean that he/she is conscious of this underlying dynamic. On the other hand, the individual with Anorexia generally does come to understand how frightening his/her refusal to eat is to his/her loved ones, and further that he/she can leverage that fear to get his/her way. However this is usually a later development in the course of the disorder and often occurs after treatment has begun as a form of resistance.
Because many individuals with the disorder have a number of unmet dependency needs, it is often necessary for them to be in a more protected environment than that which would be normal for individuals their age. For example, many individuals with Anorexia cannot tolerate engaging in food preparation for themselves, and need to have a “feeder” or an individual that purchases and prepares their food. An apparent contradiction, is the Anorexic that is obsessive about cooking. However, he/she is rarely, if ever cooking for herself and usually cannot eat food that he/she has prepared for others. In summary some individuals suffering from Anorexia can only eat food that they have prepared themselves while others can only eat food prepared for them. Most prefer to eat their food in private.
Bulimia, which is less apparent because individuals suffering from it are usually normal weight or slightly overweight, is less likely to make family members feel as if they are being held hostage. Whereas individuals with Anorexia may want people to see how thin they are, individuals with Bulimia do not want anyone to know about their binging or purging and will go to great lengths to keep it hidden. The sense of manipulation comes into play here when the individual with Bulimia overspends, steals food and lies about his/her activities to protect his/her binging and purging activities. Feeling like a hostage comes into play during recovery when the individual requires supervision 24-7 and family members must rearrange their schedules and lives to provide coverage.
The individual suffering from Bulimarexia (the combination of the two disorders) can be any combination of the two above in terms of holding family members hostage. His/Hers is the hardest disorder to treat because remission of the symptoms of Anorexia may result in increased symptoms of Bulimia and vice versa.