The Psychology of Eating: From Healthy to Disordered Behavior

264 Treating Eating Disorders

behavior change will also promote a shift in cognitions. It has been shown
to be particularly effective for bulimia, but to date there is no substantive
evidence supporting its use with anorexia.

Family Therapy

A family systems analysis of eating disorders emphasizes four central com-
ponents: symptoms as communicative acts, the homeostatic family, the role
of boundaries, and conflict avoidance. Family therapy addresses these
factors by emphasizing the symptoms and the family dynamics. It does this
using both individual and family sessions depending upon the age of the
patient, and is mainly used for anorexic rather than bulimic patients.

The symptoms

During the early stages of family therapy the therapist will emphasize the
dangers of food restriction and weight loss, insist that problems such as
continued starvation, bingeing, and vomiting are self-perpetuating, and assert
that such symptoms must eventually be eliminated (Dare and Eisler, 1995).
In addition, for younger patients much family therapy involves asking the
parents to oppose the abnormal eating patterns, to take control of the
patient’s calorie intake and bulimic symptoms, and to develop a feeding
regimen that “compels the patient to eat more than her disorder would
dictate” (Dare and Eisler, 1995, p. 345). This can be facilitated by describing
how nurses bring about a change in eating behavior when patients are in
hospital, and by emphasizing the problems which would arise if the patient
were admitted into hospital. This approach can at times make the parents feel
that they are being blamed for their child’s problem, but it is argued that it
can succeed in bringing about change “by a mixture of intensely focused
sympathy, specific knowledge of the eating disorders and a powerful, sus-
tained insistence that somehow, something must change” (Dare and Eisler,
1995, p. 346). These interventions address the problem of the symptoms and
have been described as the problem-solving componentof family therapy.

Family dynamics

Family therapy also addresses family dynamics. At times, relationships within
the families of anorexics can be enmeshed and overinvolved. For older patients