Adolescence is a time of change. Young people experience rapid biological, emotional, and social development that affects the way they understand themselves and interact with the world.
Within the family system, adolescents gradually gain independence from their parents. They move from a relationship characterised by parental authority to one with a more equal dynamic. However, when an adolescent becomes unwell, they often require extra care and support, and this process may take a different shape.
It’s normal – and healthy – for parents to be involved in a young person’s recovery from illness. Research suggests that parental support is linked to better treatment outcomes and compliance with treatment. But when parents become too emotionally involved – or express their emotions through certain behaviours – it may become counterproductive.
This blog explores how emotional over-involvement from parents may affect young people’s recovery from anorexia nervosa and other mental health disorders.
What Is Emotional Over-Involvement?
Over the past decades, researchers have noticed the critical impact that family dynamics have on a person’s recovery from both mental and physical illness. They developed a concept called expressed emotion that tries to capture the emotional atmosphere of a family environment. Expressed emotion is built around two main pillars: parental criticism and emotional over-involvement.
Studies show that expressed emotion in families is a robust predictor of treatment outcomes for a range of mental health disorders, including schizophrenia, eating disorders, and depression.
Emotional over-involvement is a complex concept to measure. It includes things like exaggerated emotional responses, self-sacrificing, over-protectiveness, or overly-devoted behaviour. However, these traits are also related to the cultural context of a family. In some cultures, it’s normal for family members to be more involved in one another’s lives. In these cases, the threshold for what is considered ‘over-involvement’ may be higher.
Why Might Emotional Over-involvement Be Unhelpful?
Family environments depend on relationships based on support and respect. Part of this involves respecting one another’s age-appropriate independence and need to build their own identity.
Research suggests that overparenting – excessive involvement of parents in their children’s lives – is associated with a critical family environment and worse parent-child communication. It can also affect young people’s confidence in their abilities to achieve their goals and aims.
These consequences may be important to eating disorder recovery. Worse parent-child communication may harm parents’ abilities to offer emotional support and reinforce positive behaviours. Critical family environments can create stress that worsens eating disorder symptoms and leads to withdrawal or isolation. A lack of self-confidence may prevent young people from believing they can recover and committing to that goal.
Should Emotional Over-Involvement Among Adolescents with Anorexia Nervosa Be Considered Differently?
That said, some experts have suggested that among adolescents, it is not overparenting itself that is problematic but the intensity of overparenting. They think that at lower levels, ‘overparenting’ may even be beneficial.
This might be particularly true in the context of illnesses like anorexia. Adolescents with eating disorders may need input and support from parents, even if they find it intrusive.
Most research that links emotional over-involvement to poorer treatment outcomes involves adults rather than adolescents. However, scientists have now started to look into the impact of emotional over-involvement, specifically among adolescents, including those with eating disorders.
A recent review found that while parental criticism and warmth could often be linked to the severity of eating disorder symptoms, improvement in symptoms, treatment outcome, and treatment drop-out, the association with emotional over-involvement was weaker. Out of 11 studies, only 5 showed a link between emotional over-involvement and either diagnosis, symptomatology, or treatment outcome. One study found that emotional over-involvement from mothers actually improved eating disorder symptoms.
The authors suggest that these mixed results may, in part, be explained by the conceptualisation and measurement of emotional over-involvement. Emotional over-involvement is usually measured along several dimensions, such as over-protectiveness or strong displays of emotion. It’s possible that some of the traits are helpful for recovery from anorexia while others are not, leading to unclear results.
Emotional Over-Involvement and Family Involvement in Treatment
It’s important for families to be involved in a young person’s treatment process, from childhood to adolescence to young adulthood. Families can be a crucial source of emotional support, reinforcing positive behaviours that promote recovery.
As young people get older, they have more and more say over their healthcare. When parents are very emotionally involved, it may discourage adolescents or young adults from including their parents in their recovery program. One study found that the minority of adolescents who chose not to involve their parents in bulimia nervosa treatment had high levels of expressed emotion in the family, including emotional over-involvement.
This means that in the long term, emotional over-involvement may prevent young people from receiving appropriate and valuable parental support.
Emotional Over-Involvement and Parents’ and Carers’ Mental Health
In a family system, the wellness of every family member is important. Parents’ and carers’ mental health is valuable in itself: they should be able to continue to fulfil their own needs despite a child’s illness. Parents’ and carers’ well-being also affects their relationships with other family members, including their ability to care for a young person.
When parents are emotionally over-involved in a child’s illness, they may experience a greater sense of burden and poorer mental health. Emotional over-involvement can be thought of as a stress response to a child’s illness. Family members who are very involved in a young person’s illness may benefit from support in setting appropriate boundaries and practising self-care.
The Wave Clinic: Family-Centred Mental Health Support for Young People
The Wave Clinic offers specialist mental health support for young people with eating disorders and other mental health conditions. Our residential and outpatient programs offer a diverse selection of treatment modalities delivered with exceptional expertise. Directed and delivered by a team of professionals, our treatment space is a Global Centre of Excellence for the treatment of eating disorders.
At the Wave, we understand the importance of family in eating disorder recovery. Eating disorders are, to a large extent, maintained by interpersonal relationships, and these close family relationships also play a key role in overcoming them.
Our family-centred programs involve family members from the start of treatment in a process of collaborative planning. We invite families to our centre for a week of family therapy, supporting families to build supportive home environments that reinforce positive change. Throughout the duration of our treatment programs, we develop personal, lasting relationships with parents and offer ongoing support in the years ahead.
If you’re interested in finding out more about our programs, get in touch today. At The Wave, we make a difference.
