Through the Lens #6, Eating Disorders

Winter 2009 – Spring 2010
Roberta Gilbert


Dear Roberta,
I am interested in what the Bowen approach would be to eating disorders -- anorexia, in particular.
I would appreciate your comments or any literature you might recommend…
Thanks so much, P M


Dear P M,
In general, Bowen theory-guided therapy does not approach different symptoms differently. It assumes that most symptoms are ushered in by an overload of immaturity and anxiety. This overload, in the case of children, can circuit around the family system, intensifying as it does so.

While traditional medicine refers to various illnesses, diseases, or conditions, Bowen theory thinks of all these as symptoms. Symptoms of what? Symptoms of family emotional process gone awry. When people become ill, then, they are showing an overload of immaturity/anxiety. Anxiety, in the form of an over focus on the child is one of the patterns in which immaturity gets transmitted. Under better circumstances, the anxiety load is most commonly managed and modulated within the family system of relationships, so that people do not get sick. But sometimes the relationship system is overwhelmed with immaturity and anxiety, or unable to deal with the processing of them in a useful way. In that case, someone becomes sick, or shows symptoms of some kind.

How are symptoms such as anorexia selected? No one knows how or why a family or a person selects all the different symptoms available to it. But in general it is thought that most if not all of them are brought on by an overload of anxiety carried for too long a time. Sometimes, in a young person with anorexia I have noticed that the women in a family for several generations have seemed to be over concerned with thinness. Though this is not always the case, I think I have seen thinness as an issue in anorexic families a little more often than not.

What does Bowen family systems theory see in the case of a child who becomes ill or symptomatic? In the case of anxiety landing in a child, leading to symptoms like an eating disorder, we often see that parents have been anxiously over focus on a child for a protracted period. Because anxiety is transmissible from one person to another, by way of the parental anxious over focus, anxiety that is in the system ultimately ends up with the child carrying it. After the symptom develops, the parents become even more anxious and more focused on the child. In this way a vicious cycle ensues in which both anxiety/immaturity and symptoms intensify.

Where does this anxiety come from? Anxiety can originate from many sources. The commonest source described by family theory when a child becomes sick, is that parents have unresolved anxiety between them that they don’t know how to deal with, refuse to process, or are afraid of touching. The anxiety actually originates in their relationship. It is usually only intensified by one of the four relationship “patterns” that people put into place to try to fix things, and that Bowen described: conflict, distance, over/under functioning or triangles. This anxiety goes, not underground in them as individuals, as traditional theory often states, but it does go underground in the family emotional system. In the case of a sick child, it takes the form of focus on a child. It is “underground” because neither parent usually has any idea that the anxiety originated with them. They think that the problem is all about the child. They only come to understand the complexities of anxiety in the family relationship system as they learn to “think systems.” In addition to the family system itself, anxiety can originate in outside problems or stressors such as a job loss or economic stressors, upping the family anxiety level.

How should a problem in a child such as anorexia be addressed? This is something that needs to be taken up in therapy. I don't see how a support group, a therapy group, reading a book or simply going to a class, while they all might be helpful to a degree, would end up offering the kind of assistance that would be most useful. Traditional therapy is sometimes useful. But we have seen some amazing results with families taking the time and trouble to learn a new way of thinking, looking through a different lens, the lens of family systems theory. With a Bowen theory oriented therapist, they will be able to get a slightly bigger picture of what is going on, in terms of the family relationship system. The therapy relationship may feel “supportive,” but it is even more useful than that. A family systems oriented therapist will be able to show how Bowen theory applies to their situation. Over time, they can take new ideas home and use them continuously in all their relationships. By being in contact with a less anxious other person, (the therapist), their emotionality will calm down. As that happens, the thinking brain can begin to work. That is when solutions start to occur.
As families put their new ideas into practice, the symptoms drop away.
In your email, you also asked about resources. Of course, I would recommend the book I wrote for parents, Connecting With Our Children. This book looks at several different symptoms and shows how, when parents address their sources of anxiety and their own immature patterns productively, using family systems theory, the children's' anxiety load lessens and ultimately symptoms disappear. Their therapist will no doubt have a reading list of other useful books. Some others that I can recommend are (below).^{ii, iii, iv}

This of course, is because when we parents start to deal effectively with our own anxiety, there is less anxiety in the system to circulate around the system and land in our kids. This will usually, if not always, necessitate the help and guidance of a coach who has been “thinking systems” longer than we have ourselves.

It is also important to note that while a book might be useful in opening the door on a different way of thinking, it would not be adequate to address a serious condition like an eating disorder. There may be a need for a pediatrician or general physician--an emotionally calm one, to monitor the child--and also a family systems coach for themselves. I have watched this type of team approach be especially useful for families with an eating disorder child. For example, with one family with such a challenge—an eating disorder as well as suicidality in a child and a very distant marriage in the parents, the parents were able, in working with an especially calm and reassuring pediatrician, as well as a Bowen theory consultant, to see the disorder in the child resolve. (This took place after hospitalizations with traditional therapy had failed to produce any positive results.) The parents worked on their marriage distance so that eventually their relationship was satisfying and stable. The child grew up to have a successful career.

How did this happen? By working on their marriage relationship they automatically had less focus available for the child. They became better connected with their extended family systems. This effort also absorbed some of the over-focus. Then their better functioning marriage relationship meant that there was simply less anxiety floating around with which their family system had to deal. Under these circumstances the girl was able to function with more maturity and without symptoms.

Sometimes the excessive focus on children seems to arise out of a pattern found in the generations of the family. As people begin to look at their generations, seeing how other generations dealt with their immaturity and anxiety, they can see that child focus is simply a way of life for their family. This was a fact for the family just cited. Seeing that, they can work to process anxiety/immaturity in different and better ways.

If you have a question or comment you would like addressed in this column, please email Dr. Gilbert at rgilbert09@gmail.com.