Eating Disorders 243- Many women show poor self-esteem, engage in dieting, and value
thinness. Many women also show dysfunctional cognitions. A small
minority develop an eating disorder. Cognitive behavioral theories can
explain why eating disorders are mainly a female problem. They can also
explain why they are a problem for the West, and why the prevalence
has increased over recent years. They cannot explain why so few indi-
viduals develop eating disorders.
A family systems model of eating disorders
A family systems approach to eating disorders considers the family as a
complex social system. It does not see the family as the cause of an eating
disorder; rather, it emphasizes the family as the context within which the
eating disorder is embedded (Eisler, 1995). Causality is seen as a circular
rather than linear process, as the eating disorder not only develops within
the context of a particular set of family relationships but also becomes part of
these relationships (Eisler, 1993). Family systems theory has been informed
by two main schools of thought, the “strategic approach” which draws on
the work of Erikson (1964, 1975), and the “structural approach,” which is
based on the work of Minuchin (e.g., Minuchin, Rosman, and Baker, 1978).
Although these two schools of thought emphasize different aspects of the
family system and recommend different approaches to family therapy, they
have the following four central tenets in common.
Symptoms as communicative acts
According to systems theory, symptoms arise out of disturbances within
relationships (either a couple or a family) and are regarded as communicative
acts between members of the system. Specifically, the symptoms are con-
sidered statements that something is wrong and are attempts to change any
existing difficulty. Haley (1973) stated that a symptom appears when a
person “is in an impossible situation and is trying to break out of it” (p. 44).
The symptom replaces verbal language within the system.
The homeostatic family
The second basic tenet is that of homeostasis and the importance of
equilibrium within the family system. The symptoms expressed by members
of this system are regarded as mechanisms to maintain this balance. The
problem is not, therefore, the symptom per se, but the difficulties that have
arisen within the family system, generating a need for the symptom to reestab-
lish balance.