Wednesday 20/12/2023

PHOTO: Samuel Rios

Text: Anna Nagygyörgy, Viktória Farkas y Alejandra Misiolek

Throughout the day, we face different situations where we have a script in mind about how we should behave and what we can expect from others. While a small talk about the weekend during a morning coffee at the office would be considered normal, it would feel awkward to continue the topic of someone´s romantic life that you started after two shots at the Christmas party. Having these algorithms of social life guides us and makes these, often confusing social interactions a bit more predictable. But what happens if someone crosses this line? In this blog post, we go around the topic of boundaries, with special attention to its relation to eating disorders.

Tangible evidence of impact

In a study (1) from 2021, scientists examined for the first time how the brain reacts to the violation of complex social expectations. Using fMRI, they registered the neuronal activation change in the brain during boundary-crossing situations. The difference was detected when they presented the same situation in a work work-related context and a romantic relational context. In the condition “a work colleague gets angry with you for not noticing that they have changed their hairstyle”, the so-called fronto-insular region was activated, and this area contributed to the rapid detection of crossing boundaries. This change was not registered in the condition when our partner was angry with us for the same reason. It seems that this region plays a crucial role in mapping both consciously and unconsciously the appropriateness of social interaction, and the results serve as a piece of evidence that these violating events have a direct effect on a neural level.

Family boundaries of patients with eating disorders

Apart from work and romantic relations, an especially important environment where boundaries can be crossed is in the family, which may have decisive long-term consequences and is found to have a significant role in the formation of mental disorders. For a long time, eating disorders have been associated with boundary problems at home, and several studies have appeared in the field. What are the different problematic patterns in the child-parent relationship that can exist alone or concurrently, and the links studies found with eating disorders (2)?

Parentification is a form of role reversal, it means that children assume the role of the parents. They have caregiving responsibilities, are attuned to the needs of the parent, and provide emotional support, beyond their level of development. Studies show that childhood parentification is linked with psychopathology in adulthood.

In case of a divorce, for example, the older sibling can take care of the younger one as the mother might be depressed and inaccessible. If you are familiar with the series Stranger Things, the case of Jonathan Byers describes this phenomenon well.

Adultification is another type of role reversal, and it means that the parent relates with the child as a peer or a friend. They turn to the child for support and companionship, and a possible sign might be when mother and daughter go out together.

Enmeshment refers to the child’s extreme closeness to the parents, and this overinvolvement in the other’s life blocks the development of autonomy. It is found to be linked with both anorexia and bulimia, and anorexic patients report conflictual, emotional, and functional dependence, primarily with their mothers.
Psychological control or intrusiveness can also hinder healthy identity formation, similar to enmeshment. It is related to both anorexia and bulimia, and these female patients tend to describe their fathers as controlling.
Spousification means that the parents treat their children as their partners. It has two forms, hostile and seductive type. The hostile spousification refers to thinking about the child as a spouse but in a critical way, who is good for nothing.

In contrast, the seductive type means treating the child as a soulmate, as an intimate partner, and it blurs the sexual boundary between parent and child. Though it doesn’t necessarily involve physical relation with the parent, in an extreme form it means sexual abuse that can cause severe and various forms of dysregulation in the child. Among sexual abuse victims, higher body dissatisfaction, more bulimic symptoms and more frequent binge-purge episodes were identified.

Overprotectiveness happens when the parent underestimates the child’s capacity to overcome difficulties and handle stressors. Its extreme form is infantilization when parents encourage childish, dependent behavior and deny the maturity of their child. Overprotection is linked with general eating disorder symptoms and also with anorexia, and bulimia.

Towards a healthier family dynamics

The psychosomatic family model by Minuchin (3) was a turning point in the understanding of the development of disordered eating. In his research, anorexic families were found to have diffuse boundaries, to be overprotective and rigid, leaving little privacy for the child.

In contrast, he described the ideal family system (4) where the boundaries between parents and children are clear and well-defined, but remain flexible enough to adapt to changes. His concept supports a hierarchical structure where parents are the leaders who offer the necessary help and guidance to the children, whose influence is gradually decreased following the child’s needs.

Based on the results, the aim of family therapies could be to set strong but flexible boundaries and facilitate open communication of emotions and respect for others. Fathers should avoid infantilization and instead, promote the independence of their daughters, by their age. Mothers need to see the negative consequences of enmeshment and excessive control and instead support their daughters to form their own identities (2).

Sources:

A. R. Bland, R. Zahn, R. Elliott, J. R. Taylor & J. Hill (2021) Patrolling the boundaries of social domains: Neural activations to violations of expectations for romantic and work relationships, Social Neuroscience, 16:5, 513-521, DOI: 10.1080/17470919.2021.1953134
Tanja Ketisch, Rebecca Jones, Hamid Mirsalimi, Robin Casey & Tara Milton (2014) Boundary Disturbances and Eating Disorder Symptoms, The American Journal of Family Therapy, 42:5, 438-451, DOI: 10.1080/01926187.2014.912103
Minuchin, S., Rosman, B. L., & Baker, L. (1978). Psychosomatic families: Anorexia nervosa in context. Cambridge, MA: Harvard University Press.
Minuchin, S. (1974). Families and family therapy. Cambridge, MA: Harvard University Press.