Family Counselling and Eating Disorders

Contributor: Brad Kennington, LMFT, LPC is a therapist in private practice and Randall Lopez is currently a graduate student in the Master of Arts Counseling Program at St. Edward’s University, both are in Austin, Texas.

kampenwand-49899_640An eating disorder impacts far more than just the individual struggling with food and body image issues. Its toxic tentacles can reach into every relationship the eating disorder patient is involved in. And the closer the relationship, it seems the greater the impact.

As a marriage and family therapist, I have treated numerous families where a son or daughter is recovering from these debilitating disorders. Moms and Dads and brothers and sisters are on the front lines with the one struggling to recover from anorexia or bulimia.

They are also vital members of the treatment team whose support is crucial in helping someone fully recover from their eating disorder. And one thing I reiterate to all of the families I work with is that no one is to blame for the disorder but everyone can assist in the recovery.

Parents Might Feel Like They’ve “Failed”

Many of the parents who I work with initially express guilt about not being a good enough Mom or Dad and that they somehow “caused” their child’s or teenager’s eating disorder. There are many myths associated with eating disorders (e.g. only females develop eating issues, eating disorders are just about food, etc) and saying that parents are to blame is another myth that needs to be dispelled.

Research continues to show that there is a genetic component to eating disorders. In some ways it is analogous to asthma, which also has a genetic link.

But like asthma which can be triggered by one’s environment (e.g., being around smoke or a lot of dust), certain elements in one’s environment can trigger eating disorder behaviors (e.g., comments from peers, the thin ideal for women or muscular ideal for men espoused by the media and our larger culture, etc.).

Do parents “cause” asthma? No. Can parents help ease an asthma attack or help create an environment that makes asthma less likely? Yes. And I believe the same holds true for eating disorders.

The Role of Family Dynamics in Eating Disorders

baby-164897_640I think much of the debate about the role family dynamics play in the development of and recovery from an eating disorder is really a difference in perspective. One view is that an eating disorder in a family is a “system-generated problem.”

In other words, the eating disorder is the result of the relationship between genetics and the pre-existing family structure. The competing view is that the eating disorder is part of a “problem-generated system.” This means that the family structure is in response to the eating disorder and its related behaviors.

In my opinion, it is a moot point to discuss which came first, either certain family dynamics or the eating disorder, because at the end of the day, what is left is a family that has structured itself around a very powerful and parasitic problem.

This is how relationship systems respond—they structure themselves around the symptom much like our bodies do around a tumor. No one is to blame. It is just what systems do.

Restructuring Relationships Through Family Therapy

Family therapy involves restructuring relationships to create a “new” family system whose dynamics promote healing and recovery and removes the eating disorder from its central position within the family. I believe family therapy is most effective when the eating disordered behaviors have been disrupted and there has been weight restoration.

The attention can then begin to shift from the struggle over food and weight to the emotional needs of each family member.

It is important to acknowledge and validate the effects the eating disorder has caused everyone.

Eating disorders are a mental health issue that touches everyone in the family, not just the eating disordered patient, and everyone’s voice needs to be heard. Parents and siblings are often left feeling angry, confused, scared, resentful and alienated. Relationships are strained. The family system’s coping mechanisms are stretched.

Others can develop symptoms (e.g., marital conflict, substance abuse, school problems, etc) as family members struggle to manage in the midst of the intense chaos. Drop a large rock in a small puddle and watch the effects. An eating disorder is kind of like.

Hope for the Family to Recover Together

couple-498484_640But there is hope. The chaotic waters can be quelled. And what calms the chaos? Relationships. Studies show that adolescents who report lower levels of intimacy and connection and higher levels of conflict with their parents had an increase in weight concerns and eating disorder behaviors.

Moving parents and teenagers into a relationship that is more open, accepting and that leaves room for the no-longer child and not-yet adult to safely explore their identity separate from the eating disorder can be powerful medicine.

It is also important for family members to identify and take responsibility for any behaviors and attitudes that may have exacerbated the eating disorder. This is not about blame. Instead, it is about taking the power back from the eating disorder.

Maybe too much attention has been placed on appearance or comments have been made about weight, which only serve to feed the eating disorder. If we can identify our part in a problem, then we can play an active part in healing that problem.

Externalizing the Issues

In my work with eating disordered families, I also like to externalize the problem. Externalizing the eating disorder can de-pathologize the one struggling with the disorder while encouraging all of the family members to connect and collaborate with each other as they support everyone in the recovery process.

When someone has an eating disorder, the entire family struggles and suffers. Each one is wounded in some way and all need to have their voices heard and validated.

A recovered family system is not only rid of the eating disorder, but one where each member feels they belong and feels safe to exercise their own voice, a voice that may have been silenced for too long by the eating disorder.

Community Discussion – Share your thoughts here!

What is your experience with family therapy, relationships and eating disorder recovery?


  1. Gilbert, Kyle S., Harper, James M., Larson, Jeffry H., Berrett, Michael E., & Hardman, Randy K. (2009). Implicit family process rules in eating-disordered and non-eating disordered families. Journal of Marital and Family Therapy,35(2), 159-174.
  2. Highet, Nicole, Thompson, Marie, & King, Ross M. (2005). The experience of living with a person with an eating disorder: the impact on the carers. Eating Disorders: The Journal of Treatment & Prevention, 13(4), 327-344.
  3. Lam, Chun Bun, & McHale, Susan M. (2012). Developmental patterns and family predictors of adolescent weight concerns: a replication and extension. International Journal of Eating Disorders, (45)4, 524-530.
  4. Thomas, Sarah A., Hoste, Renee Rienecke, & Le Grange, Daniel (2012). Observed connection and individuation: relation to symptom in families of adolescents with bulimia nervosa. International Journal of Eating Disorders 45(7), 891-899.

About the Author:

Brad Kennington, LMFT, LPC is a therapist in private practice in Austin, Texas. Brad specializes in the treatment of eating disorders, relationships, anxiety and sexual orientation issues. He is also an associate faculty and clinical supervisor at the Austin Family Institute.

You can learn more about his work by visiting