– Parent Club Summary

On March 18, attendees had the opportunity to listen to a presentation by Dr. Mária Sonnevend at Murmo’s Parent Club. The presentation focused on various eating disorders and how they are embedded within the family structure. After introducing herself, the expert began with two quick questions to determine whether participants were personally affected or simply interested, and which eating disorder they wanted to hear about most. The second question received a wide variety of answers; most people were interested in Avoidant/Restrictive Food Intake Disorder (ARFID) and selective eating, but several also mentioned anorexia nervosa. Participants were able to continuously ask questions regarding these topics in the chat section, which psychologist Eszter Forgács aimed to answer briefly.

Eating Disorders in General

First, the presentation covered eating disorders comprehensively, focusing on their common characteristics. These include the fact that they typically develop at specific ages; they can cause physical complications; they all place a heavy burden on the family; they impact other areas of life; they often involve psychiatric comorbidities; and consequently, they require interdisciplinary treatment.

Other family members are particularly affected by a child’s eating disorder because the ritual of shared family meals is disrupted. Not eating is often a form of resistance against the parents (or at least, that is how the parent may perceive it). Because of this, tension is constant, anxiety—even due to physical complications—becomes permanent, and the family’s life becomes narrowed down.

The speaker presented the development of eating disorders from the perspective of both individual development and the family, but emphasized that there is no single cause and no party to blame.

  • In individual development: Personality traits are decisive, such as the individual’s capacity to tolerate ambivalence and anxiety, their emotional regulation, and their understanding of others’ emotions.

  • From a biological standpoint: Genetic factors can certainly be predisposing elements. Inherited temperament traits, sensitivity to interoceptive and sensory stimuli, and brain neurotransmitter levels all matter, among other things.

  • Other factors: There are certain risk factors like elite sports or perfectionism; triggering factors like teasing (such as body shaming) or an episode of choking; maintaining factors like social media or positive feedback following weight loss; and protective factors like friends and family.

Regarding the role of the family, Mária highlighted that the symptoms of an eating disorder always play a specific role in the family’s daily life, becoming a sort of organizing and regulating force. The symptom indicates a need for change in family functioning; often, it is “needed” for change to occur. It is crucial to emphasize that the family is primarily a resource, not the problem.

Different Forms of Eating Disorders

Next, the presentation covered various forms of eating disorders, starting with ARFID (Avoidant/Restrictive Food Intake Disorder), which begins in childhood. This includes selective eating and phobic-type eating disorders. In ARFID, there is no body image distortion; the child simply lacks interest in eating and does not want to eat on their own. The spectrum of accepted foods is narrowed down, they reject anything other than their preferred choices, and they experience stress if forced to eat.

  • Selective eating is a form of heightened pickiness where the individual is willing to consume fewer than 12 types of food. This most frequently begins during the introduction of solid foods. A biological hypersensitivity or a sensory processing disorder may lie in the background (stimuli above their threshold feel similar to pain). Other causes can include autism spectrum disorder, or a disturbance stemming from specific feeding circumstances and parent-child interactions (e.g., an anxious mother who fears the child will choke). In therapy, experimenting with sensory elements and textures with the involvement of the parent can help, as can rewarding eating.

  • Phobic-type eating disorder occurs when intense anxiety or fear prevents eating. Here, anxiety is the primary cause, rather than a pathological relationship with food itself. Such anxiety might manifest as an irrational fear of swallowing or vomiting. In therapy, rewarding eating, psychoeducation, and anxiety reduction are effective strategies here as well.

Moving on, the presentation shifted to the classic eating disorders that typically appear in adolescence: anorexia nervosa and bulimia nervosa. The speaker briefly discussed at-risk states and the illness itself.

Anorexia is often called the disease of paradoxes, as it is contradictory in several ways. The patient has an appetite but does not eat; they feel good when they are physically unwell; everyone else can see they are in a serious condition except for them.

Anorexic individuals are generally characterized by a disturbance in recognizing and experiencing their emotions, a general lack of interoceptive awareness, a desire to please, perfectionism, and a low tolerance for anxiety. Understanding the illness can be aided by recognizing that the individuals need the disease for some reason; it provides them with a sense of identity, control, predictability, and independence.

The Role of the Family System in Eating Disorders (Anorexia Nervosa, Bulimia)

It was stated that the family does not cause the illness. Instead, it creates a relational system in which the symptom carries meaning and purpose, usually serving a regulating and stabilizing function. Through this function, the symptom can “solidify,” and vice versa: it contributes to the stability and immutability of the family system. A crisis matrix often exists within the family system, and the symptom may maintain a pathological balance, protect other family members from developing, or lead to the neglect of siblings.

Risk factors at the family level can include:

  • Enmeshment: The intense over-involvement of family members in each other’s lives.

  • Rigidity: Sticking to habitual relational patterns and a difficulty with change.

  • Overprotection and conflict avoidance.

Characteristically, boundaries between subsystems within the family are weak, the child feels a heavy sense of responsibility for their family, and there is heightened anxiety regarding each other’s well-being. The family can easily become overwhelmed, making the changes of adolescence a particularly major crisis for such a system.

The question of emotional closeness versus distance is also interesting. Often, closeness, loyalty, and protection are valued more within the family than autonomy and self-actualization. Consequently, instead of developing autonomy, multiple areas remain under parental supervision and control; an eating disorder is frequently a rebellion against parental care.

This is why family therapy is a particularly effective method in treating anorexia nervosa. In therapy, instead of the dysfunctional patterns with which family members regulate each other’s behavior, workable, alternative solutions must be uncovered and reinforced. The focus must be shifted from the symptoms to the relational patterns. It is easier for the patient to change if the context around them changes as well.

At the end of the presentation, bulimia, multi-impulsive bulimia, and binge eating disorder were briefly mentioned, though not covered in detail. The concept of intuitive eating was also discussed. This is a currently popular approach to eating which suggests that by listening to our body’s signals, we should eat when we are hungry and stop when we are full, thereby reaching our ideal body weight. This is an appealing perspective for many and can even be helpful for individuals recovering from eating disorders.

Summary of the presentation by Dr. Mária Sonnevend, child psychiatrist and psychotherapist.