244 Eating Disorders
Boundaries
A family systems approach also emphasizes the importance of boundaries
between individuals within the family which are described in terms of pro-
ximity and distance. These boundaries denote “who participates and how”
in the family, and delineate each member’s “turf.” They also indicate coali-
tions within the family in terms of close associations between individual
parents and children.
Conflict avoidance
The final tenet of a systems approach is the role of conflict avoidance.
It is argued that some families avoid conflict, and that symptoms may
arise within such families as a means to distract from any ongoing con-
flict and to facilitate conflict avoidance as the family’s way of function-
ing. Research has addressed the issue of conflict within the context of
“expressed emotion,” which has been mainly used within the literature on
psychosis. It has been argued that low levels of critical comments within
the family may be a reflection of lowered expressed emotion (e.g., Dare
et al., 1994).
These four components of family systems theory have been applied to
eating disorders. For example, Selvini Palazzoli described how the anorexic
family is often extremely close, with blurred intergenerational boundaries
(e.g., Selvini Palazzoli, 1974). She also described how the family avoids conflict
and has a need for a compliant perfect child. Within this framework, the
symptoms of anorexia are regarded as expressions of the conflict within
the family and an attempt to resolve the family’s problems. Minuchin
also applied family systems theory to eating disorders. He described the
“psychosomatic family” and suggested that anorexia nervosa is a prime
example of such a system (Minuchin, Rosman, and Baker, 1978). Minuchin’s
model of eating disorders has three factors:
- The child is physiologically vulnerable (although this is unspecified).
- The family has four essential characteristics: enmeshment (an extreme
form of overinvolvement and intimacy), overprotectiveness (an extreme
level of concern), rigidity (a determination to maintain the status quo),
and a lack of conflict resolution (families avoid conflict or are in a
permanent state of chronic conflict). - The anorexic child plays an important role in conflict avoidance, which
reinforces the child’s symptoms.