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WEIGHT LOSS: CHARACTERISTICS DESCRIBING INTERACTIONS OF FAMILIES WITH AN ANOREXIC MEMBER
Dr. Salvador Minuchin and his co-workers list five characteristics that describe the interactions of families with an anorexic member. These characteristics are:
• Enmeshment
• Over-protectiveness
• Rigidity
• Lack of conflict resolution
• Involvement of the sick child in unresolved parental conflict.
Enmeshment: One patient described her family as a “monster with six heads but only two feet -we each have an opinion, but we can’t get anywhere until we all agree on the direction.” She was describing enmeshment, the restricting web that binds family members to each other. Members are overly attuned to each other, and seldom offer any overt criticism. They infer one another’s feelings or opinions, and act accordingly. This gets to be such a habit that members expect others to know what they are thinking.
There may be little privacy, physical or emotional, in an enmeshed family. Such closeness blurs the normal family boundaries. Often, in a family therapy session, a conversation with one member is interrupted by another: “What she means is . . .” or, “No, let me tell you what really happened.” Such interruptions can reveal the enmeshment of family members with each other.
Over-protectiveness: By over-protectiveness, we mean an attempt to save someone from pain or suffering that prevents the person from developing a normal sense of autonomy. Over-protectiveness arises when members of a family feel highly vulnerable to the terrors of the outside world.
Let me give you an example. One anorexic patient, fourteen-year-old Neva, told her mother she was afraid no one would ask her to dance at an upcoming school party. The next day her mother called the other parents, begging them to “be sure and tell your son to ask Neva to dance. It’ll make her so happy” When Neva found out all of her dances at the party were setups, she felt worse than if she hadn’t danced at all.
Rigidity: Rigidity means that the family can’t adapt to new circumstances. Parents continue to treat their teenagers by the same rules as when they were much younger. In a rigid family, a child’s natural independence threatens to disrupt the balance. Sometimes rigidity shows up as an attitude about the roles each person must play. “My father says I shouldn’t get a job,” one seventeen-year-old girl told me. “He says my mother never worked, his mother never worked. I told him things change. He said, ‘Not in this family they don’t.’”
Lack of conflict resolution: Sometimes families bury their problems rather than confront them and resolve them. In an eating-disordered family, this is one of the most ingrained characteristics and one of the hardest to change. Through therapy, the family learns that an emotional disagreement is a normal part of living, not something that has to be avoided. On the contrary, it should be confronted and resolved. Therapy gives family members a safe forum in which they can express their disagreements – and not just those related to food. Then, under the guidance of the therapist, they learn and practice ways of resolving them.
Involvement of the child in parental conflict: In some families, a child allies herself with one parent against the other. Such alliances are unhealthy. They undermine the parents’ ability to exert authority jointly. They create factions that sap the family’s ability to function. Therapy helps the family recognize these patterns.
Some recent work has extended these observations to make them more useful to a family with a bulimic member. Dr. Richard Schwartz, a psychologist at the University of Illinois, has found that in addition to the characteristics identified by Minuchin, there are several other features typical of bulimic families: family isolation, excessive consciousness of physical appearance, and “special” meanings placed on food and eating. He has also outlined a number of possible ways that a bulimic’s symptoms function within a family. These include an excuse for not performing well enough, a passive form of rebellion, a way of getting nurturing attention, and a way to protect the parents’ marriage.
Although each family is different, here are some helpful “do’s and don’ts” for parents in bulimic families.
Do:
• Allow family members to decide what they eat
• Hold the patient responsible for the effects of her behaviors – for example, she should replace food after a binge or clean the bathroom after a purge
• Hold the patient responsible for her chores; however, it’s okay to substitute other household chores for kitchen chores
Don’t:
• Excessively monitor behavior
• Comment on her weight or appearance
• Fight at meals
• “Mind-read” – it’s better to ask
*103/35/5*
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