Familial Factors

The modes of communications, ways to express emotions and education standards of a family may affect the development of children. According to Johnson et al. (2002) [13], understanding patients’ family background is essential for treatment because, for most of the times, they are inter-related. Another explanation are that eating disorders are a psychological problem about control and power struggle. This explanation can apply to many types of family relationship. The followings are some of the common problematic family relationships.


Authoritarian Parenting Style

Children who grow up under an authoritarian parenting style may feel that they lack autonomy. Many living arrangements are decided and arranged by their parents, especially their eating habits [14]. As a result, many of their things are manipulated by others and that they are unable to exert control over them. When they entered puberty and become rebellious, they have stronger and stronger desire to get back the autonomy and try to struggle for their own identity in their everyday lives. To establish their own identity, they need to first identify one thing that is easy to control in order to prove that they have the ability to control over their lives. However, when they soon recognize that everything around them is already under tight restraints, they then choose weight control, a seemingly easier and personal way, as a first step to demonstrate their autonomy towards their parents and themselves. Refusal to eat is very often a behavior to express their strong discontent over their parents’ control [15]. Gradually, eating disorders become a strong weapon for the children in power struggle between them and their parents within the family. By using eating disorders as their weapon, the children regain control over everything around them, and even their parents.


Over-protective Parenting Style

Nowadays, in Hong Kong, people generally have strong desire for high living standards. Many couples tend to choose to have one child only and as a result of this, they devote all the resources to their only child. The overly concerned parents would try to give the best of all things and take good care of every single detail in their child's daily lives. However, from the children’s personal growth, overprotective parenting style may make their children not able to handle things independently, they could either turn rebellious and egoistic or that they might rely on their parents too much. After a certain period of time, they may not want to grow up and would rather live under the protection of their parents [16]. Some patients would choose to use "eating problems" to obtain eternal care from their parents, trying to regress to the baby stage again so that they could be cared by their parents again.


Power Struggle within the Family

Besides, some children may use eating as a mean of grasping the attention from the significant others. According to Ma et al. (2002) [17], the ultimate goal of their behavior is to get back love and care from their parents. However, there are some special cases that children use eating disorders as a mean to restore their parents' marital relationship. Because of their eating problems, parents need to put away their personal conflicts with one another and align to confront their children’s problem. Sometimes, it can be the case of attention seeking among the siblings. Children are always afraid of losing mother’s love and care when there is a new member in the family. When they are sick, they may draw attention from the significant others which is what they are longing for. This may explain why eating disorders may sustain many years if the family do not recognize this vicious cycle.

In conclusion, although family relationship can be the cause of the illness, what we know is many patients do respect and love their parents very much. They often would not want to see their parents fighting one another or that they would like to bear the entire burden (to resolve problems within their family) all by themselves. This explains why they choose using their own body in a wrong way (refusal to eat or binge eating) to ventilate their emotions so as to avoid the outbreak of family conflicts and to restore the integrity of the family [18].


[13] Johnson, J., Cohen, P., Kasen, S., & Brook, J. (2002). Childhood adversities associated with risk for eating disorders or weight problems during adolescence or early adulthood.American Journal of Psychiatry, 159, 394-400.

[14]Agras, S., Hammer, L., & McNicholas, F. (1999). A prospective study of the influence of eating-disordered mothers on their children. International Journal of Eating Disorders, 25, 253-262.

[15]Chan, Z. C. Y., & Ma, J. L. C. (2002). Family themes of food refusal: Disciplining the body and punishing the family. Health Care for Women International, 23, 49-58.

[16]Minuchin, S., Rosman, B. L., & Baker, L. (1978). Psychosomatic families: Anorexia nervosa in context. New York: Harvard University Press.

[17]Ma, J. L.C., Chow, M. Y. M., Lee, S., & Lai, K. (2002). Family meaning of self-starvation: Themes discerned in family treatment in Hong Kong. Journal of Family Therapy, 24, 57-71.