If a young person develops an eating disorder, it’s not the fault of the family. Eating disorders develop as a complex result of social, biological, and emotional factors, including personality traits and cultural norms.
However, the family stress caused by anorexia can sometimes cause parents to be critical towards their children. This can both sustain symptoms of anorexia and act as a barrier to long-term recovery.
The good news is that family dynamics can change. With adequate support, parents can develop a deeper understanding of anorexia and develop skills to replace critical comments with warmth and positive statements of care.
This blog explores the impact of critical parents on young people with anorexia nervosa. It also outlines some support available for families to build supportive home environments that nurture recovery.
How Can Criticism from Parents Maintain Anorexia Nervosa?
While some parents are critical of their children before they develop an eating disorder, parental criticism often begins or intensifies with the onset of anorexia. Emotional reactions to a child’s illness, such as worry, fear, guilt, or frustration, sometimes put strain on family relationships. In some cases, parents cope with their emotions through criticism and hostility towards their children.
Parents are usually committed to their child’s recovery, health, and well-being. However, without effective support, families can develop unhelpful dynamics that help maintain a young person’s eating disorder.
When parents are critical of a young person and their eating behaviours, it increases their social withdrawal and isolation within the family. Without positive relationships to bring out different aspects of their self-value, strengths, and interests, they can become increasingly preoccupied with body shape and eating. Criticism can also lower their self-esteem, encouraging them to place most of their self-value on their body shape and weight.
Research shows that maternal criticism (including critical comments and expressions of dissatisfaction from mother to child) is related to the severity of their child’s disorder.
Critical Parents and Eating Disorder Recovery
Families are usually a young person’s closest support system. They tend to play a key role in recovery from any mental illness, offering emotional support and reinforcing positive behaviours. Given the importance of interpersonal relationships in maintaining anorexia, families may have an especially significant impact on a young person’s recovery.
One way that researchers use to assess the emotional well-being of a family is through their “expressed emotion”. Expressed emotion has two main dimensions: criticism expressed by parents towards their children and the emotional over-involvement of parents. Studies show that young people whose parents are more critical and overinvolved are more likely to drop out of treatment. They also tend to have worse treatment outcomes.
For example, studies have found that:
- Maternal criticism was related to treatment outcomes at both the end of treatment and the five-year follow-up
- Maternal criticism explained 34% of the differences in treatment outcomes at the end of treatment
Importantly, even low levels of parental criticism can have a significant impact on a young person’s recovery from anorexia. Young people with anorexia nervosa tend to be particularly sensitive to reward and punishment. This may partly explain why they find criticism so stressful.
What Causes Parental Criticism in Families Living with Anorexia?
It’s still not clear why some parents in families with anorexia become critical towards their children, while others remain warm and non-judgemental. One study found that mothers who were more critical had higher levels of anxiety than others. They were also more likely to be critical when their child had a more severe eating disorder.
For some mothers, a lack of understanding about anorexia, combined with anxiety about their health, might lead to critical comments towards their children. They may also be critical when they feel unable to cope with the stress of the illness and its impact on daily life.
In some cases, this may lead to a vicious cycle, where critical comments cause social withdrawal, making a young person’s symptoms worse. This, in turn, may make mothers more anxious and even more critical.
Parental Criticism Other Mental Health Disorders
Parental criticism doesn’t only impact recovery from anorexia nervosa. It’s also linked to recovery from many other physical and mental health conditions, including schizophrenia, depression, anxiety disorders, ADHD, diabetes, and epilepsy. Parental criticism (and emotional over-involvement) are linked to treatment drop-out, the long-term course of the illness, and treatment outcome.
The impact of parental criticism and emotional overinvolvement on people with schizophrenia has been researched extensively in the past decades. However, studies now suggest that these behaviours are even more important in the eating disorder recovery process.
From Criticism to Warmth: Treatment and Support
Even low levels of parental criticism can affect a young person’s health and recovery. This means that addressing criticism during the treatment process is really important. There is a widespread consensus that, where possible, families should be fully involved in a young person’s recovery program through family therapy, collaborative treatment planning, and integrated treatments.
Psychoeducation
In many cases, parents become critical of their children because they don’t understand what they’re experiencing. Parents may not understand why their child cannot ‘just eat’ nor recognise the deep psychological distress and complex processes that lead to disordered eating behaviours. These misunderstandings can lead to frustration, rejection, and criticism towards a young person.
Psychoeducation sessions teach families about the causes, course, and treatment of anorexia nervosa. They explain the different factors that maintain the disorder and underpin symptoms like restrictive eating, purging, or excessive exercise. This helps parents take a different perspective on their young person’s illness, rooted in empathy and support.
Family Skills-Learning
Family skills learning is an essential type of family therapy. In these sessions, families develop skills to improve family dynamics and better support a young person’s recovery.
For example, parents may learn how to manage their emotional responses and challenge feelings that may trigger critical comments or hostility. They may develop techniques that replace criticism with positive behaviours such as appreciation and warmth. Family therapy can also involve training in motivational interviewing, where parents learn how to encourage and validate young people’s will to recover and improve their self-worth.
Addressing Anxiety
Research shows that more anxious mothers also tend to be more critical of their children. This means that supporting mothers to manage and reduce anxiety is important not only for their own well-being but also for their children’s recovery. Mothers who are less anxious may be more empathetic and supportive of their children and communicate with greater warmth and less criticism.
There are many effective treatment approaches proven to improve anxiety. These include cognitive-behavioural therapy, somatic (mind-body) therapies, and interpersonal therapy.
The Wave Clinic: Specialist Recovery Programs for Young People
The Wave Clinic offers specialist mental health support for young people living with eating disorders and other mental health conditions. We provide top-tier clinical care from our residential and outpatient treatment spaces in Kuala Lumpur, designed and delivered by a team of experts worldwide. Our programs are family-centred and trauma-focused, recognising the way that past experiences and social contexts interplay to cause and sustain symptoms.
If you’re interested in finding out more about our programs, get in touch today. We’re here to support you.
