The role of the family
In the history of child and adolescent psychiatry, family factors have often been proposed as having an aetiological role in the development of a range of disorders. Unless we believe that genetic or constitutional factors are responsible for all mental health problems, a role for experiential factors has to be accommodated. In thinking about adolescence, it is hard to deny the role of family variables in inﬂuencing development. A multitude of parental factors, such as parental conﬂict, separation and divorce, or parental illness including mental illness will play a part in how developing young persons view themselves and their role in the world. Parental attitudes (alongside those of other adults, such as schoolteachers and peers) will in addition shape a range of moral, ethical and other values. Issues with particular pertinence to the development of eating disorders might include parental attitudes to weight, shape, eating, exercise and perfectionism as well as any history of eating disorder in parents themselves or their own families. The presence or absence of siblings will also have a signiﬁcant eﬀect on how young persons view themselves and their future. Elder siblings may act as ‘trailblazers’ for later siblings to follow. An older sibling may be fat, thin, successful or not, impulsive, out of control, promiscuous, controlled, perfectionist, competitive, bullying or otherwise. She may be the apple of her parents’ eye or nearly destroy them with concern. The younger sibling may then aim to live up to the elder’s achievements, concede that she never can, or determine never to cause the anguish perpetrated by the older brother or sister. Siblings can also suﬀer illnesses or disabilities, and this can result in the other children taking mature, responsible roles in their care, or resenting them and inhibiting their desire to bring friends home or their ability to make life choices, such as going to university, in order to support their parents. Many of these factors are non-speciﬁc, occur to a greater or lesser extent in all families, and are part of the rich, developmental experience that all children make sense of on the path to adulthood. Those relating to weight and shape or issues of control may hold
particular meaning to those who are vulnerable to the development of eating disorders.