An integrative review of the literature on how eating disorders among adolescents affect the family as a system – complex structures and relational processes
| DOI | https://doi.org/10.1108/MHRJ-09-2015-0027 |
| Pages | 213-230 |
| Published date | 12 September 2016 |
| Date | 12 September 2016 |
| Author | Rakel Eklund,Martin Salzmann-Erikson |
| Subject Matter | Health & social care,Mental health |
An integrative review of the literature on
how eating disorders among adolescents
affect the family as a system –complex
structures and relational processes
Rakel Eklund and Martin Salzmann-Erikson
Rakel Eklund is based at the
Department of Health Care
Sciences, Ersta Sköndal
University College, Stockholm,
Sweden.
Martin Salzmann-Erikson is
based at the Department of
Health and Caring Sciences,
Faculty of Health and
Occupational Studies,
University of Gävle, Gävle,
Sweden.
Abstract
Purpose –The purpose of this literature review is to describe how eating disorders among adolescents
affect family relationships and the family’s daily living conditions and to describe the family’s experienced
need for professional support.
Design/methodology/approach –An integrative literature review based on the method of Whittemore and
Knafl. In all, 15 articles with both qualitative and quantitative approaches were reviewed.
Findings –The results are presented in two main themes: a disharmonic family and the need for input from
healthcare professionals. The results are discussed using Callista Roy’s adaptation model and the adaptive
modes: group identity mode, role function and interdependence.
Originality/value –This review paper will be of interest to clinical nurses and other professionals who
encounter families to clarify how the relationships and roles change within the family. To the authors
knowledge, no integrative review has paid attention to how the relational aspects of the family members, their
social roles and role constructions within the family affect daily living.
Keywords Family, Adolescents, Eating disorders, Integrative review, Psychiatric nursing,
Roy’s adaptation model
Paper type Literature review
Introduction
Eating disorders are psychiatric disabilities that most often have an onset in adolescence and
affect individuals’eating habits, which results in an excessive preoccupation with body
appearance (Hoek, 2006; Treasure et al., 2010). Steinhausen (2002) found in a review of 119
studies about anorexia nervosa in the twentieth century that the mortality rate was 5 percent and
full recovery was only achieved by about 47 percent of the patients. However, when an
adolescent is affected, it is not only the individual who is affected; the illness also affects the
whole family and their daily lives. This phenomenon was explored by Bowen (1978) in a
publication in which he developed the family system theory. Bowen emphasized the therapeutic
value of seeing the family as a system in which the individual family members’actions also
influence the family as a system and vice versa. Since Bowen’s conceptualization of the family
system, this view has impacted family therapy and has been legitimized in psycho-educative
therapy (see, e.g. Goldenberg and Goldenberg, 2002; Minuchin, 1974; Espie and Eisler, 2015).
This current study adheres to this view of a family as a system. Therefore, we make use of the
Received 9 September 2015
Revised 21 April 2016
8 June 2016
Accepted 9 June 2016
DOI 10.1108/MHRJ-09-2015-0027 VOL. 21 NO. 3 2016, pp. 213-230, © Emerald Group Publishing Limited, ISSN 1361-9322
j
MENTALHEALTH REVIEW JOURNAL
j
PAG E 21 3
nurse theorist Sister Callista Roy (2009) to further discuss family nursing and Roy’s adaptation
model to explain how work with families can have implications for clinical family nursing. However,
the purpose of this review is to focus on the phenomena regarding how the family relationships
are affected when an adolescent suffers from an eating disorder. We stress that these
phenomena are paramount in understanding the daily living conditions for these families, which is
highly useful for mental health nurses who support these affected families.
Background
Eating disorders affect an individual on a deeper level that extends beyond effects on the body
and bodily appearance; they also affect the identity of the ill person. Patching and Lawler (2009)
argue that eating disorders cannot be separated from their social and cultural contexts. They
stress that eating disorders are symptoms of other underlying issues and are not themselves
diseases. Hence, they hold that nurses should pay more attention to preventive interventions
rather than treatment and recovery. Due to the inseparability of socio-cultural aspects, it is not
possible to isolate the individual who is affected by an eating disorder from the rest of his or her
family. Jenkins and Ogden (2012) studied how to change an identity when an individual has been
affected by an eating disorder. In the recovery process, treatment includes psychological efforts
addressing identity and self-image.
It is well known that fa mily involvement is cru cial in treatment pr ograms for younger p atients
who are diagnosed with eating disorders and for their families (Fairburn and Harrison, 2003;
Treasure et al., 2010). Family-b ased treatment should be the f irst recommended treatme nt for a
family with an adolescent suffering from an eating disorder. This is because the family-based
treatment has a longerlasting effect than individual therapy (Couturier et al.,2013;Downsand
Blow, 2013; Smith and Cook-Cottone, 2011). A family is a system with individuals that in certain
ways influence eac h other. Every indiv idual has different r oles in the family and o ther roles in
systems outside the f amily. The family its elf is a cohesive unit in re lation to its surroun dings
(Wright and Leahey, 2012). Some previous studies have also demonstrated that living in a
family with an adolescent who has an eating disorder affects the relationships in the family and
changes everyday life routines, and relationships outside the family becomes affected
(Cottee-Lane et al., 2004; Johansson and Andershed, 2012; Whiting, 2014). Previous research
shows that the family can be a support system for the affected adolescent but also posit that
the parents and siblings need help and support from healthcare professionals (Dimitropoulos
et al., 2009; Spettigue et al., 2015).
Family-focussed nursing is grounded in the ontology of system theories. Thereby, the nursing is
based on the assumption that people are influenced by other people and that every situation can
be viewed from several different perspectives. When a family member in the system is suddenly
affected by changed conditions of life, for example, mental illness, this means that the system
changes and all the previous roles in the family change as well (Benzein et al., 2010; Mikkelsen
and Frederiksen, 2010). Family-focussed care assumes a salutary perspective, affirming and
strengthening the famil y’s resources. Moreover, f amily members may have unrea listic
expectations of each other because of a lack of understanding and communication difficulties.
Therefore, a primary task in family-focussed nursing is to help the family by establishing good
communication lines. Aspects of good communication have been given focus in previous
literature in order to achieve increased participation, cooperation and a sense of influence
among family members (Benzein et al., 2004; Mikkelsen and Frederiksen, 2010; Wright and
Leahey, 2012).
Despite the vast research focussing upon treatment programs, to our knowledge, no literature
review has paid attention to how the relational aspects of the family members, their social roles
and role construct ions within the famil y affect daily livin g. Hence, from a menta l health nursing
perspective we argue that it is important to gain depth in insight about how everyday living and
living conditions change for these fa milies and how roles a lter because of the i llness of the
adolescent. Furthermore, this paper also explore the need for support and care experienced by
the family. The healt h of the family as a system cannot be m inimized, as we stress that the f amily
as a system is importa nt for the individua l patient’s recovery process. Hence, this literature
PAGE214
j
MENTALHEALTH REVIEW JOURNAL
j
VOL. 21 NO. 3 2016
To continue reading
Request your trial