Free from Family, Imprisoned by Anorexia: Comparative Analysis of Immigrant Narratives and Eating Di


Self-Starvation: Systemic and Familial Perspectives

There are numerous rationales cited in literature for refusal of food intake amongst women spanning from religious theories to psychoanalytic, feminist and cultural perspectives (Palmer, 2008). However, the treatment for eating disorders has been strengthened by the work of family therapists including Minuchin (1978), Selvini-Palazzoli (1978), Maudsley (Dare et al., 1995; Rhodes, Gosbee, Madden, & Brown, 2005), who focused on understanding the familial and relational contexts surrounding eating disorder symptoms, as well as utilizing curious and respectful avenues to learn about and to work within the individual’s presenting culture and worldview. Unlike intrapsychic perspectives, family systems theorists emphasize circularity of relationships, and assert that specific events do not directly cause the eating disorder to occur; moreover, problems are viewed as created and reinforced by cycles of actions and reactions between people who are interconnected parts of the larger whole (Becvar & Becvar, 1996). Therefore, pathology of eating disorder symptoms, such as self-starvation, does not reside in the mind of the individual, but in the interactions between members of the relational system.

Family impacts on eating disorders: review of theories

Systemic frameworks suggest that the family member suffering with an eating disorder may not be the only family member suffering (Costin, 1999; Levitt, 2001), and that the sufferer may be coping with current issues related to her environment. It is important to note family behavior and symptoms of anorexia nervosa (Schmidt, Humfress, & Treasure, 1997). Several studies have found that anorexics showed more family problems. This information is reflected in recent findings investigating patient’s perspectives of causes of anorexia nervosa, for which ‘dysfunctional family’ environments were a commonly cited factor. For example, increased conflict and disorganization (Schmidt, Humfress, & Treasure, 1997), high paternal over-protectiveness (Calam, Waller, Slade, & Newton, 1990), and increased conflict (Shisslak, McKeon, & Crago, 1990), have all been cited as family pathologies of eating disordered individuals. These eating disordered families have been shown to display lower adaptability and cohesion (Waller, Slade, & Calam, 1990), lower maternal and paternal care (Palmer, Oppenheimer, & Marshall, 1988), as well as less cohesion, expressiveness, emotional support (Shisslak et al., 1990), and orientation towards recreational activities (Schmidt, Humfress, & Treasure, 1997). These family dynamics were thought to be relevant rationales for food refusal amongst anorexic participants in the study.

Family therapists in Western societies have also identified several components of the family context that may contribute to the development of anorexia, including patterns of family interaction (Minuchin et al., 1978), family beliefs (Stierlin & Weber, 1989; White, 1983), family culture (Selvini Palazzoli, 1974) and family sexual abuse or incest (Luepnitz, 1988). Selvini Palazzoli and the Milan team focused particularly on tending to circular processes between the families’ contribution to the disorder, and the behavior of the individual that perpetuates that role (Boscolo, Cecchin, Hoffman, & Penn, 1987; Selvini Palazzoli, Boscolo, Cecchin, & Prata, 1980). The Maudsley model placed emphasis on how individual, family, and sociocultural influences interact to maintain the disorder (Dare & Eisler, 1997). Specifically, Minuchin and colleagues (1978) hypothesized about a specific family context and structural characteristics in families within which eating disorders such as anorexia develop, such as enmeshment, overprotection, conflict-avoidance, rigidity, and involvement of the child in parental conflict. In Psychosomatic Families (1978) Baker, Rossman, and Minuchin observed that anorexic families all possessed similar characteristics, which consisted of interactional patterns that prohibited members, particularly the anorexic, from developing a stable sense of individuality or autonomy. For example, some researchers have suggested that eating disordered individuals may experience parental pressure that is inappropriate for their age, gender, or abilities (Horesh et al., 1996).

Other researchers have suggested that eating disordered individuals may also be more likely to receive low parental contact, and criticism from their families about weight, shape, and eating behaviors (Fairburn, Welch, Doll, Davies, & O’Connor, 1997). Furthermore, belief systems within anorexic families are thought to be rigid with high regard for loyalty to the family and specific role prescriptions for the anorectic family member (Palazzoli, 1978; White 1983). For example, families with an anorexic child may place emphasis on achievement, success, appearance and weight (Bruch, 1973; Hall & Brown, 1983). In regard to the egosyntonic nature of the state of emaciation, Russell (1995) acknowledges a variety of contributing psychosocial factors and asserts, “the patient avoids food and induces weight loss by virtue of a range of psychosocial conflicts whose resolution she perceives to be within her reach through the achievement of thinness and/or the avoidance of fatness” (p. 10). Banks (1992) says that extreme emaciation in one such patient was “a means of attracting attention from her peers and family” (p. 875).

Selvini-Palazzoli and Viaro (1988) and Selvini-Palazzoli, Cirillo, Selvini, and Sorrentino (1989) proposed a six-stage model for anorectic family process that emphasized the enmeshed quality of the eating disordered family as the primary clinical issue. The stages include a covert game in which members of the family disguise their feelings, goals, and intentions where first the parents reach an impasse demanding that the other change. Second, the future anorectic becomes involved in the relationship and may be totally devoted to her mother and confidant. Third, the daughter turns to her father after her mother turns attention away from her and usually onto another sibling. The future anorectic and father share contempt for the mother. Fourth, the daughter differentiates by changing her food intake. The mother’s attempts to control the daughter’s food intake reinforce the problem. Fifth, the daughter becomes disappointed by the father’s choice to not openly side with her against his wife. Finally, the daughter realizes that anorexia gives her power, and other family members become aware of ways they can influence one another vis-à-vis the daughter’s illness.

Family disturbances in roles, communication, regulation of emotion and inappropriate boundaries are also thought to hinder developmental tasks of the anorexic that may include separating from the family and creating an individual identity (Humphry & Ricciardelli, 2004). Two family patterns have been identified in families of anorexia classified as ‘centripetal’ or ‘centrifugal’ processes. Centripetal processes were dominated by themes of excessive cohesion, reduced emotionally expressiveness, and lack of permissiveness. Centrifugal families were characterized by lacking cohesion and attachment with high conflict before the onset of the anorectic symptoms (Schmidt, Humfress, & Treasure, 1997). Several issues can also increase the likelihood of eating disorder development such as coercive parental control (Haworth-Hoeppner, 2000), including a view of their fathers, but not their mothers, as overprotective (Calam, Waller, Slade, & Newton, 1990; Pole, Waller, Stewart, & Parkin-Feigenbaum, 1988); separation-individuation between mothers and daughters (Zerbe, 1995); and a distant father-daughter relationship (Zerbe, 1995). For example, a study by Hodges, Cochrane, and Brewerton (1998) revealed that anorexic subjects in the study perceived their family environment as being less cohesive and supportive than normal population subjects. Furukawa (1994) confirmed the family factor of excessive parental control for Japanese students in cultural exchange programs. Finally, Robinson and Anderson (1985) recognized family loss of a primary parent as a potential factor in a review of clinically documented cases of anorexia in African Americans.

Undoubtedly, it is impossible to grasp a comprehensive picture of the eating disordered individual without considering the relational context of that individual and precipitating factors contributing to the development of symptomatology of food refusal. Minuchin, whose views are widely quoted, stated that certain transactional patterns seem to be characteristic of all anorexic families, including over-protectiveness, conflict avoidance, rigidity and enmeshment (Minuchin, Rosman, & Baker, 1978). Stierlin and Weber (1989) reported the clinical impression that mothers would “on the one hand, anxiously hover over the anorexic daughter, enlist her as a source of concerns…and, on the other hand, treat her as an adult (i.e., parentified) confidante and ally in coalition directed against father” (p. 28). Additionally, eating disordered families were found to demonstrate less openness to discussing disagreements between parents and children than control families. Waller, Calam, and Slade (1989) asserted that anorectic women perceived their families as more rigid than the controls.

A considerable amount of research has also focused on family-of-origin history prior to the onset of eating disorders, leading to a variety of theories (Treasure, Schmidt, & van Furth, 2003). Interestingly, issues pertaining to boundaries, sexuality, perfectionism, or impulse control can extend back several generations (Costin, 1999; Pelch, 1999). As an example, Bowen (1992) discussed anorexia in the context of “family projection process” (p. 13), viewing anorexia as “a projection of fear of weight originating in the anorexic’s same-sex parent” (Young, 1998, p. 64). Research studies also indicate a higher incidence of eating disorders in families of sufferers (Strober & Humphrey, 1987).

Culture Change and the Family

Cross-cultural theorists have proposed that the experience of belonging to two different social worlds can result in a clash of culture, relating to the increase in eating disorders, and can have a greater impact if women have a more traditional family background (Humphry & Ricciardelli, 2004; Lake et al., 2000). For instance, high levels of conflict with parents over social choices such as going out, contact with the opposite sex, arranged marriage, and dress norms has been associated with greater eating disorder pathology among Asian females (Humphry & Ricciardelli, 2004; Furnham & Husain, 1999; Shuriquie, 1999). In Kam and Lee’s (1998) study describing a case of a 16-year old anorexic female from Hong Kong who denied fear of fatness as an issue, they discussed her goal of not wanting “to ‘give in’ to her family, especially her mother, who forced her to eat even when she was not in the mood to” (p. 229). Furthermore, internal conflicts, sense of disconnectedness, poor self-perceptions, lack of autonomy and sense of control over one’s life have all been posed as a means by which culture clash may lead to eating pathology (Humphry & Ricciardelli, 2004; Shuriquie, 1999). Additionally, a variety of content analyses of family therapy sessions with five Chinese anorexic patients identified several themes of self-starvation in contemporary Hong Kong families that related to self-sacrifice for family well-being, filial piety over individuation, bridging of parental conflict, expression of love or control, and camouflage of family conflicts (Ma, Chow, Lee, & Lai, 2000).

The culture and tradition of the family is thought to be of importance in how women experience the new culture and whether or not they develop eating disorder pathology as a way to cope. For example, Lake et al. (2000) found that Hong Kong born women who identified more with their traditional culture scored higher EAT-26 scores than those who were more acculturated to Western society. Parental overprotection has also been proposed as an important factor in the experience of culture clash. Furhnam and Husain (1999) discovered that high levels of conflict with parents over such issues as choice of friends were associated with greater eating pathology among Asian females in their study. In Bulik’s (1987) case study of eating disorders in immigrants, she learned that “emphasis on exercise, diet, and slenderness, was a means to acceptance in American society” (p. 138), and the women “began to evaluate their self-worth on the basis of their body and the ability to control their appetites” (p. 138). At the same time, these women expressed guilt over wanting to separate from their families, such that “family structures that emerged subsequent to immigration were not unlike the enmeshed and overprotective families described by Minuchin (1970) and Minuchin, Baker, Rosman, Leibman, Milman, and Todd (1975) in which personal autonomy of the child is subjugated to family loyalty” (Bulik, p. 138).

Food itself has also been thought to take on special familial significance to immigrants, and can be a symbol fraught with guilt since “abundance of food can serve as a reminder of the fortune of the immigrant relative to the deprivation faced by those left behind” (Bulik, p. 139). Bulik (1987) asserted that both women in her study, “responded to guilty feelings with extreme deprivation” and “the smallest indulgence led to disproportionate guilt and increasingly strict dieting” (p. 139). Coupled with this were experiences of depression and isolation following immigration and changes in social status, which made the identity associated with abstinence and dieting attractive.

Qualitative inquiry: Exploring drive to “self-starvation” amongst ethnic immigrants

Clearly there were numerous rationales for food refusal discovered in the theoretical data gathered for this research, which were extensive and not limited to family and systemically based theories. However, our research process indicated a lack of understanding and theories about drives to self-starvation from the real experts themselves, which are those individuals who suffer with an eating disorder. Particularly, there were significant gaps of information available regarding the experiences of ethnic immigrant women, which was troubling given the increased incidence of both immigration and eating disorders. Researchers have more recently begun to recognize such etiology amongst ethnic groups, and are learning that women from non-western origins including Latin and African cultures, and from such places as China, Japan, India, and Pakistan suffer from eating disorders (Abdollahi & Mann, 2001; Nakamura, Yamamoto, Yamazaki, Kawashima, Muto, Someya, Sakurai, & Nozoe, 2000).

Projections indicate that by the year 2025 racial and ethnic groups will comprise approximately 40% of all Americans (Bureau of the Census, 2001). At the same time, the prevalence of eating disorders amongst women is increasing and bold efforts are underway to improve health care services for a growing and culturally diverse population.

As many as 10 million females are battling anorexia or bulimia, and 25 million more people are struggling with binge eating disorder in the U.S. (National Eating Disorders Association, 2007). Eating disorders are considered to be complex conditions with the highest mortality rate of all mental illness (Eating Disorders Coalition, 2006).

Qualitative Research Methodology

This discovery-oriented research was designed in an effort to learn from the participants themselves, and evoke rich descriptions of the subjects’ experiences, which may surprise or challenge the researcher and previously held bias. Such information is intended to increase attention to helping mental health clinicians enhance multicultural competencies (Sue, Arredondo, & McDavis, 1992) so that services they provide are responsive to the cultural concerns of various ethnic groups (United States Public Health Service Office of the Surgeon General, 2001). The American Psychological Association recommends such methods of learning from individuals, and clinicians are encouraged to “articulate respect and inclusiveness for the national heritage of all groups, recognition of cultural contexts as defining forces for the individuals’ and groups’ lived experiences, and the role of external forces such as historical, economic, and socio-political events” (American Psychological Association, 2002, p. 15), to understand how individuals with eating disorders “function in the larger contexts of their families and society” (Murray, 2003, p. 279). Therefore, I utilized an exploratory qualitative research study to investigate the meaning of “self-starvation” amongst eating disordered immigrant women, since it would be useful in helping clinicians develop systematic and differentiated knowledge about the psychological meanings attributed to the eating disordered behavior in ethnic women. Such methods of qualitative inquiry required several procedures, which are part of grounded theory analysis. Grounded theory emphasizes systematic generation of theory from data (Charmaz, 2000), and stresses “emergent, constructivist elements” and “flexible, heuristic strategies rather than as formulaic procedures” (Charmaz, 2000, p. 510). Additionally, the methods included “development, refinement, and interrelation of concepts” (Charmaz, 2000, p. 510) through several strategies including—“(a) simultaneous collection and analysis of data, (b) a two-step data coding process, (c) comparative methods, (d) memo writing aimed at the construction of conceptual analyses, (e) sampling to refine the researcher’s emerging theoretical ideas, and (f) integration of the theoretical framework” (Charmaz, 2000, p. 510).

Research Discoveries: Immigrant Women and Family Influence

The impact of the family system appeared to be a strong component in counteracting or diminishing the participants’ desires to restrict food intake while residing in their countries. While several family therapists have noted that enmeshed family contexts characterized by overprotection and rigidity can influence the development of anorexia (Minuchin, 1978; Selvini-Palazzoli &Viaro, 1988), the exact opposite was noted in this research with immigrant women while they resided in their countries of origin.

Past Life in My Country—Protected from Anorexia

This category emerged in the research and related to the participants’ expression of their experience of themselves and their culture while living and interacting in their country of origin. Many of the women in the study appeared to have a relatively distant relationship to life in their native culture and only briefly discussed glimpses of times past as it related to their present lives and relationships in the U.S. In fact, in many cases, participants noted that their tight-knit family structure overpowered their own ability to deny food prior to moving to the U.S. Such as Vicki, an immigrant from Russia, whose food restriction began just two months following immigration noted, “my mom kept control over my food consumption in Russia” (3, 1, 1). Interestingly, the impacts of the participants’ families on their lives and experiences appeared to cross ethnic and cultural variations presented in the research. Specifically, the research data indicated that in most cases the structure of the participants’ families was self-corrective in nature due to the strength of their family structure as Amy who moved to the U.S. six years ago and currently lives with her sister noted, “You know you are with your family a lot of the time, um. You’re scrutinized, you’re under a microscope, so you kind of are apprehensive to do anything that would create question or bring on attention to yourself and there wasn’t as much a focus on the body within the family as there is in America” (4, 18, 3). The “tight-knit” (4, 11, 2) family culture as Amy and other participants noted appeared to aid in counteracting or diminishing their restriction of food intake. This was supported when some participants also described the family as a factor prohibiting them from acting out on desires to restrict food intake while living in their country. Vicki, whose food restriction began just two months following immigration said:

Vicki: I had an idea that I need to get skinnier back when I lived in Russia, since I was 15 maybe, 16, but I wasn’t that strong and um…when I was 18 I really wanted to get skinnier um…but my mom cooked food for me, and so she would keep control over that...and I decided my desire wasn’t that strong that I would just comprise food for going out, so I ate food. (3, 1, 1)

Eugenia, an immigrant from Russia who said she only speaks to “American friends” about the anorexia because she is “too embarrassed”, recalled the desire to be anorexic while residing in Russia.

Eugenia: Even though I wanted to do something like this earlier in life (restrict food), I knew I couldn’t get away with it. I couldn’t do it with my family around. But, being in college I was able to because I was a little bit more freer, and I just felt more comfortable doing it.” (1, 10, 2)

Participants such as Claire, who left the U.K. in order to attend college in the U.S., noted that she would be less susceptible to illness due to restrictive food behaviors if she were living in her country, “[I don’t think this food restriction would have gone awry if I was living in my country] because there were people who would have called me out on it well before I would have gotten to that point. (9, 28, 3)

Several participants also discussed how food restriction behaviors were unlikely to occur in their native countries due to the impact of the family involvement there. Therefore, family involvement appeared to be an important factor in protecting individuals in the study from developing anorexia prior to their immigration.

Future research may therefore seek to explore the specific qualities of tight-knit families in foreign countries which may serve as a protection instead of in the development of anorexia, as suggested by Minuchin (1978) and Selvini-Palazzoli and Viaro (1988), and/or explore how the structure of the family may interact with the larger cultural contexts in order to perturb the influence of thin media messages.

Transition to U.S—Free and Unprotected

This category also emerged in the research and described the participants’ personal experiences with transitional and adjustment experiences following their move to the U.S. The word “transition” in this research specifically relates to the “process of changing from one state or condition to another” (Pearsall, 1999). All participants interviewed in the study discussed and shared this experience of transition and culture change since they once lived in their native country and then immigrated to the U.S. It is important to note that the participants in the study moved to the U.S. at different times in their life, which may have had an impact on their specific experiences of transition. For example, if subjects immigrated to the U.S. at an early age, they may have not experienced stresses related to language barriers that participants arriving later in life frequently mentioned. Nevertheless, all subjects despite when they moved to the U.S. contrasted life in their culture of origin to their present life, and discussed their adjustment processes that were a difficult and necessary part of their transition to the new world.

Freedom from Roots

Immigrants in this study did not express factors associated with greater eating disorder pathology amongst some ethnic women. For instance, they did not discuss feeling guilty for having access to an “abundance of food” (Bulik, 1987, p. 139) compared to their relatives left behind. They also did not typically discuss conflicts with their family of origin regarding going out, contact with the opposite sex, and dress norms (Furnham & Husain, 1999; Humphry & Ricciardelli, 2004; Shuriquie, 1999). Interestingly, participants expressed that having freedom from their roots and culture enabled them to restrict food intake. In some cases, subjects discussed having the desire to restrict food prior to moving to the U.S., but not acting out on this desire while living in their country. They often cited their family participation as protecting them from pursuing food restriction. This information was different from what Minuchin and colleagues (1978) hypothesized that enmeshment and overprotection are characteristic of anorexic families. One rationale for this difference may have been the unique experiences and cultural differences in perceptions of immigrant women themselves who frequently reported separating from their culture of origin and integrating into the new culture. Additionally, it appeared that increased autonomy or freedom from one’s roots and culture, not “lack of autonomy” as noted by Humphry and Ricciardelli (2004) and Shurique (1999) encouraged eating disorder pathology amongst the interview participants. For instance, Claire, an immigrant from the U.K, said her food restriction began just one year following immigration. She stated, “Having freedom enabled me. With no one keeping you accountable for anything you are doing, you can do whatever you want, and no one would hold me accountable. So, I did whatever I wanted” (9, 29, 3). Vicki, whose food restriction began just two months following her move from Russia, also noted how lack of parental control influenced her food restriction following immigration, “I decided it’s time for me and I can do it, and I don’t have my mom’s strain [about my food consumption] that I have back in Russia…So, that’s how I started” (3, 3, 1). Amy, from Iran, and Eugenia, from Russia, whose anorexia flourished following their move to the U.S, described their experiences with freedom:

Amy: That sick, that mentality that I had that was just brewing [in Iran]…like what was brewing there for those years was able to then come out. I could carry out the thoughts,” (4, 12, 2). So, I was able to carry out the thoughts that I had into action once I got to America, because I had that freedom and it was more acceptable and it was easier. (4, 19, 3)…It’s easier to restrict when you are on your own than when you are around family. (4, 12, 2).

Eugenia emphasized wanting to restrict food earlier on while she lived in Russia, but resisted acting upon her desire:

Eugenia: Even though I wanted to do something like this earlier in life (restrict food), I knew I couldn’t get away with it. I couldn’t do it with my family around. But, being in college I was able to because I was a little bit more freer, and I just felt more comfortable doing it. (1, 10, 2)

Life With Anorexia—Negative Reinforcers: Feeling Like an Outsider

While participants in the study did report experiencing an increased connection and assimilation to others in the U.S. following attaining thinness, they also reported the experience of feeling like an outsider on many levels. Some subjects discussed being an outsider to their family of origin as a result of their new lifestyle. Sophie, who immigrated from Columbia, described feeling “more like an immigrant to them [my family] than to myself” (8, 25, 3). She said, “I am an outsider them [my family]” (8, 37, 4). Several participants, such as Sonia who is Guynese, noted feeling like an outsider for looking too thin. “Every time I go back home everybody always says, “My goodness she’s so thin, she looks terrible, she looks ugly”…(10, 26, 3).

It has been noted in previous research that more acculturated women may be more likely to have eating disorders (Chamorro & Flores-Ortiz, 2000; Gowen, Hayward, Killen, Robinson, & Taylor, 1999). However, outsider experiences to one’s family and culture of origin are less cited in the literature, and the impacts on immigrant women are worth further research exploration.

Several researchers have identified factors relevant to experiences of culture clash, including internal conflicts, sense of disconnectedness, poor self-perceptions, lack of autonomy and sense of control over one’s life which have all been posed as a means by which culture clash may lead to eating pathology (Humphry & Ricciardelli, 2004; Shuriquie, 1999). In this study, some participants did not feel their small size was acceptable by their families and cultures of origin. Nancy from China described how her thinness and food restriction behaviors are perceived those in her culture:

Nancy: My parents yell at me [for restricting food] and I know some of my friends…every time I go back to visit they are the same, like their parents are not happy and they complain. Even we go shopping to buy clothes, and the older generation sales people they ask, and they say “do you starve yourself?” “you are skinny”. And there is all kinds of comments that people make. (2, 19, 2)

In other cases, participants discussed how their food restriction was in direct conflict with how their cultures view food. For instance, Sonia noted that some people in Guyana cannot afford to buy food:

Sonia: In Guyana if you are thin, if you are skinny, it’s probably because you can’t afford to buy meat. You have no choice, but to buy vegetables. I think the typical person in Guyana thinks that behavior [restricting food] is very strange and will turn their nose up to someone who is very conscientious of what they eat. (10, 13, 1)…

Some participants also described being a disappointment in complying with familial expectations, such as arranged marriage or having a family, which was not possible due to their condition. Amy from Iran described being a disappointment to the family since her anorexia would not allow her to comply with familial expectations, such as arranged marriage:

Amy: I am struggling with not wanting that right now, and not wanting to be disappointing either to the family because that’s a big thing. It’s a major struggle for me too because in the culture that I’ve raised in you always try to please the family. Everything is about keeping the family name and living up to the family standards and expectations and values. And so…when you are the only one who is not moving ahead and maturing the same way as everyone else, you feel like you are disappointing. It almost like makes you want to go back into that eating disorder like mind, because it’s like “I’m already screwed. I am not doing what they want, so I might as well continue doing what I am doing, and try to at least master that”. (4, 30, 5)

In many cases, participants perceived their new appearance of thinness as a breaking away from their culture of origin. Such as Eugenia from Russia:

Eugenia: Even though I wanted to do something like this earlier in life (restrict food), I knew I couldn’t get away with it. I couldn’t do it with my family around. But, being in college I was able to because I was a little bit more freer, and I just felt more comfortable doing it.” (1, 10, 2)

Further exploring the nature of outsider awareness and the impact on drive to self-starvation may be relevant to future research with anorexic immigrant women. Specifically, it may be useful to investigate the impacts of outsider awareness with one’s culture of origin on the individual’s level of desire to maintain anorexia. Additionally, researchers can also explore the differences in norms regarding food, exercise, beauty, and family orientation between specific cultures versus that in the U.S. to determine levels of culture clash that may exist between them. Such knowledge may reveal how differences in cultures in anorexic immigrant women may impact outsider awareness, and encourage self-starvation behaviors.

Discussion

This article compared and contrasted known family theories on the development of eating disorders with research exploring the drive for food restriction in ethnic immigrant women to the U.S. The information revealed a complex set of experiences regarding family influence reported by immigrant women interviewed, and the impact of family involvement on the development of their eating disorder symptoms. Grounded theory research with 10 ethnic immigrant women from a variety of countries revealed that overprotectiveness and tight knight families seemed to discourage them from acting out on self-starvation behaviors while residing in their countries of origin. Additionally, they discussed how being apart from their family of origin influence impacted the development of their eating disorder symptoms while residing in the U.S. Such information about the influence of family in the experience of these women provides a counterargument against well-known and accepted family theories regarding the development of eating disorder etiology, such as that proposed by Salvador Minuchin. Although the study reached saturation of information available through the interview data, researchers and clinicians are encouraged to be aware of the “counter-culture” story and to conduct further inquiries into learning more about this emerging narrative.


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