As someone who talks about parentification (a lot), I’ve come to recognize that the connection between eating disorders and parent-child role reversal may not be explicitly clear. There is a winding road among different psychopathologies that may develop as a result of parentification, and eating-disordered behavior is but one of many potential stops on that path. For example, children who experience parentification may become adults who experience depression, anxiety, and alcohol use disorder. Despite this, researchers have found that the impact of parentification on eating disorders, personality disorders, and anxiety disorders is greater than on mood disorders and alcohol use disorder (Hooper and colleagues, 2011). Can we better understand such a complex interplay?

The Importance of Early Attachment Relationships

To grow up with a sense that the world is a safe place, children need to develop healthy attachment relationships with their caregivers. We can understand attachment as the process of bonding with your caregiver as an infant and young child. If you grow up with nurturing, responsive caregivers, your attachment style tends to develop securely and healthily. However, if you grow up with caregivers who are emotionally unavailable, distant, anxious, or absent, your attachment style tends to develop in a more insecure way, causing relational problems later in adulthood.

The Impact of Disruptions in the Attachment Relationship

Parentification acts as a form of attachment disruption. For example, parents who place unrealistic pressure on children to perform adult tasks, either emotionally or logistically, are often unavailable or inconsistent. They look to their children to fill their own emotional needs; this is pressure on a child with little power to do so. Additionally, when children cannot rely on a parent for support, they feel completely on their own. This builds an overwhelming sense of responsibility and makes it difficult for them to ask for help later in life. When help is inconsistent or non-existent, the child often stops looking for it.

There is evidence that suggests attachment disruptions, particularly those that influence the development of insecure attachment, play a part in eating disorders and related mental health distress (Attili and colleagues, 2018). Researchers have also found that the link between attachment and eating disorders is mediated by other factors including emotional dysregulation, depressive symptoms, body dissatisfaction, and perfectionism (Cortés-García and colleagues, 2019).

Potential Overlap Between Eating Disorders and Parentification

Many people, including professionals, have little knowledge of treating eating disorders (Johns and colleagues, 2019). Myths abound, and incorrect assumptions can prevent an accurate understanding of eating disorders from emerging. The “9 Truths About Eating Disorders” (Bulik, 2015) cuts through popular assumptions and provides a useful guide to help us understand eating disorders. Here are a few of the truths about eating disorders from Bulik’s list, along with my analysis of how parentification, if present, could connect.

1) Many people with eating disorders look healthy yet may be extremely ill.

Parentified children are often fearful about taking up space, adding to a parent’s burden, or failing at just about everything. Compulsive exercise, restricted food or fluid intake, or obsessiveness over body image may emerge as means of coping with an environment in which there is little children can control or feel safe in.

2) An eating disorder diagnosis is a health crisis that disrupts personal and family functioning.

Eating disorders may emerge as an attempt to maintain stability in unstable inner and outer environments. Because people may ‘look’ healthy on the surface and may go to great lengths to conceal their eating struggles or disorder, it can be easy to overlook the severity until families notice more glaring symptoms—if ever. Parentified children typically try to stay under the radar and are very good at masking their pain in front of family and friends—as a means of survival.

3) Genes and environment play important roles in the development of eating disorders.

Though the role of nature versus nurture has been painted as a debate, we can understand mental distress as a mix of both the genetic blueprint that we’re born with and what we experience in our environments growing up. Certain genetic and environmental conditions exist that make it more likely that parentification will occur, including the mental health issues of one or both parents, parental substance use, single parenthood, the death of one parent, and how parents themselves deal with stress.

Noticing and being aware of the overlap between parentification and eating disorders can help clinicians be mindful that if one condition is present, it’s good practice to take a closer look and see if the other could benefit from care and attention as well.