Understanding Eating Disorders Through a Family Systems Lens

When one person in a family struggle with an eating disorder, it often impacts the entire system. Families may feel overwhelmed, confused, or even blame themselves—but the truth is, these challenges don't exist in a vacuum. One of the most powerful tools I use in my work with adults, teens, and families is family systems theory, which offers a compassionate and relational way to understand and treat eating disorders.

What Is Family Systems Theory?

Developed by Dr. Murray Bowen in the 1970s, family systems theory suggests that we are not isolated individuals but deeply connected to our family systems. Our behaviors—especially those that become symptoms—are shaped by patterns of communication, emotional closeness, stress, and coping that exist within the family unit. When tension builds in the system, emotional connections can become strained or even feel unsafe.

These patterns aren’t created overnight. Often, they span generations, passed down through beliefs, roles, and emotional responses. The good news? Just as patterns are learned, they can also be shifted. This is the core of family systems work: healing not just the individual, but the relationships and environments that shape them.

Why This Matters in Eating Disorder Treatment

Eating disorders like anorexia, bulimia, and binge eating disorder are rarely just about food. They often serve as ways to cope with deeper emotional pain, unmet needs, or family dynamics. Understanding the role of the family system in maintaining or healing from an eating disorder is essential.

Let’s break down Bowen’s eight core concepts and how they show up in eating disorder treatment:

1. Triangles

Eating disorder behaviors (like restricting, bingeing, or purging) can act like a "third party" in the family. Instead of addressing conflict or distress directly, the focus shifts to the behavior, helping the family avoid deeper emotional conversations.

2. Differentiation of Self

When family members are emotionally fused—meaning they struggle to separate their feelings from others’—it can be hard for a young person to develop their own identity. Recovery requires autonomy, but fear or anxiety about the client’s health can get in the way of that.

3. Nuclear Family Emotional Process

Sometimes, families organize their routines around the eating disorder. Mealtimes become battle zones, or everyone walks on eggshells. This can create a rigid, stressful home environment that unintentionally keeps the disorder in place.

4. Family Projection Process

Caregivers unconsciously pass down their own fears, anxieties, or unresolved issues to their children (may or may not be related to body image), children absorb these projections and can manifest in emotional difficulties or clinical symptoms (i.e. eating disorder).

5. Multigenerational Transmission Process

Emotional patterns, values, and coping mechanisms are passed down from one generation to the next. The eating disorder reflects not just current family dynamics, but inherited patterns of relating to self, body, and emotional needs across generations.

6. Emotional Cutoff/Distance

In families where emotions aren’t talked about openly, teens may use their eating disorder as a way to express or control their feelings. It becomes a substitute for emotional connection and communication.

7. Sibling Position

Siblings who aren’t struggling may feel overlooked or resentful. Sometimes, they develop symptoms of their own to reestablish a sense of connection or importance in the family dynamic.

8. Societal Emotional Process

Our culture glorifies thinness, control, and productivity. These societal pressures amplify individual vulnerability—especially in teens. Recovery isn’t just about the family; it’s also about unlearning harmful cultural messages.

Healing the Whole System

In therapy, I work with families to identify these patterns and make meaningful, sustainable changes. Rather than blame or shame, we focus on curiosity, compassion, and connection. Eating disorder recovery is not just about stopping the behaviors—it’s about creating a healthier environment where your teen feels safe, supported, and seen.

If you or your family is navigating the challenges of disordered eating, know that you’re not alone. Systemic family therapy can help your family grow together—not just cope but heal.