A Family Systems Approach to Eating Disorder Treatment

Eating disorders can affect the whole family, causing a great deal of stress and pain. Taking a family systems approach to treatment can be empowering for everyone affected. Eating disorders are serious psychiatric illnesses with high morbidity and mortality rates. Early intervention and a supportive, healthy family environment are key to recovery.

What is a Family Systems Approach?

Developed by Dr. Murray Bowen, the theory behind a family systems approach asserts that unrest and tension within the family unit can make emotional connections stressful and fraught with difficulty. There is the potential for the emotional connections within this unit to create a cohesive environment for its members if the correct conditions are fostered [1].

Creating such an environment that thrives and supports its members requires work and reflection so that families can establish healthy boundaries, create more positive relationships, adapt negative patterns of communication, and improve the functioning of both individuals and the whole family unit.

A family systems approach is based on the belief that we are all made up of several different components which are not in a rigid, permanent state but are malleable and in flux. The core concepts of family systems therapy consider the family members both as individuals and the system as a whole. It encourages individuals to understand their relationship with the different parts of their mind as well as others’ to create a fuller picture of their life. Exploring the multiple components of yourself in order to rebalance your internal system and achieve harmony and connection within the family unit can be a triggering, challenging experience and is best led by a family systems psychotherapist.

The family is a unit, and the emotional connections fostered by thoughts, feelings, and actions create an interdependent environment. This interconnectedness is essential in helping the family become cohesive and supportive of its members. If there is unrest and tension, emotional connections can become more stressful.

Eating Disorder Treatment 

Eating disorders, particularly anorexia nervosa, have the highest mortality rate of all psychiatric illnesses, affecting young girls more than any other group. The causes of eating disorders can vary, from cultural or societal expectations and trauma to genetic causes [2]. With the rise in social media, many attribute unrealistic beauty standards, glamorized through filters and photoshop, as the main causal factor of high rates of eating disorder diagnosis within this group. However, cases of eating disorders have pre-dated film and printed media, discrediting theories that popular culture is solely to blame. Recent neurological research widened medical apprehension of the biological risk factors for eating disorders, but effective interventions to mirror this shift in understanding are yet to be seen. 

While there are many effective eating disorder treatments available, many fail to recognize and address the multifaceted environmental, developmental, and psychological factors that have contributed to the development of an eating disorder [2]. A family systems approach helps those struggling with eating disorders to navigate the complexity of their inner and outer worlds.

The Family System Theory

Family systems theory focuses on interactions, behaviors, and relationships among a person’s internal family system, family members, the family as a whole, and other systems. The theory holds that when one person within the family develops a mental health disorder, it will influence the entire system [3].

The Family Systems Model was developed in the 1950s and is rooted in eight interconnected concepts:

Triangles – This refers to a relationship among three people. A triangle acts as a foundation for other emotional systems and is the smallest group number in which behavior can be observed and family systems therapy can be used.

Differentiation of the self – This refers to an individual’s ability to maintain a sense of identity, individuality, and ability to function on their own as opposed to a member of a group.

Nuclear family emotional process – This is based on Bowen’s theory that the nuclear family generally experiences difficulties or issues in four main areas: intimate partner conflict, problematic behaviors or concerns in one partner, emotional distance, and impaired functionality in children.

Family projection process – There can be a transference of issues from parent to child. This process often results in unstable emotions that cause high levels of anxiety or other challenging emotions.

Multigenerational Transmission – Bowen said that individuals predictably seek out partners with levels of differentiation of self that mirror their own. This subsequently affects the level of differentiation that is passed onto their children.

Emotional Distance – This is the process of one or more individuals distancing themselves from another family member in order to ease tensions. There is the potential for this to have the opposite effect and actually increase tensions and stress within the family unit. 

Sibling Position – Research shows that people who grow up in the same sibling position – such as the eldest child – have common characteristics.

Societal Emotional Process – The basis of societal emotional process explains how the emotional system governs behavior in whole societies. It describes how cultural forces are important in shaping how a society functions. However, they cannot explain the ebb and flow in how well societies adapt to the challenges they face [3].

Family Systems and Eating Disorders 

Several studies have documented the perceived differences in family functioning between young people with eating disorders. A family systems approach to eating disorder treatment focuses on finding the source of the problem rather than the individual’s fractured sense of self [2]. 

There can often be disagreement among family members concerning the perceived family functioning. In particular, some studies have found significant differences between the views of patients with eating disorders and those of the parents. Due to the fact family systems theory views the family as an integrated system, disagreement from a family member will cause disagreement within oneself. Within the context of eating disorder treatment, this means that improvement in a person with an eating disorder could be unraveled by the opinions and behavior patterns of other family members. 

Family systems theory fundamentally states that changes to the individual patient cannot be made without the cooperation and adaptation of the system as a whole. It is only by involving the suprasystem that the individual and family are a part of that the individual can heal.

The family unit can either hinder or help a person’s growth and healing. They can either add to the dysfunction within a young person’s mental health or facilitate balance and support. As Bowen claimed, that which is created in a relationship can be fixed in a relationship. 

If you or a loved one is struggling with an eating disorder, please contact Heather R. Hayes & Associates – call 800-335-0316 or email info@heatherhayes.com today.


[1] Watson, W. H. (2012). Family Systems. Encyclopedia of Human Behavior, 184–193. https://doi.org/10.1016/b978-0-12-375000-6.00169-5 

[2] Gray, Molly E. (2014) Conceptualization of anorexia nervosa : a theoretical synthesis of self-psychology and family systems perspectives. Masters Thesis, Smith College, Northampton, MA. https://scholarworks.smith.edu/theses/797 

[3] Learn about Bowen theory. The Bowen Center for the Study of the Family. (n.d.). Retrieved October 20, 2022, from https://www.thebowencenter.org/core-concepts-diagrams

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