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Adolescence is a time of great change, when youngsters morph from children into teenagers, then further transition into young adulthood. In the process of maturing from childhood to adulthood, adolescents utilize the psychosocial dynamics of their families, cultures and peers to forge an identity based on their concept of themselves as individuals. Dysfunctional family dynamics and extreme cultural values such as excessive thinness can combine with genetic predisposition and psychosocial factors to create a foundation for eating disorders like anorexia, bulimia and binge-eating disorder, which are potentially life-threatening but treatable.

Self-Concept vs. Self-Esteem

Self-concept is what you think about yourself. It is an image of who you believe you are. Self-esteem is the value that you place upon who you think you are. Self-esteem attaches the value of “good” (high value) or “bad” (low value) to the self-concept. 

Psychologists believe that self-esteem is greatly affected by the health or dysfunction of family dynamics and cultural values. Low self-esteem combined with a dysfunctional self-concept augmented by dysfunctional family dynamics creates a risk factor for poor body image and eating disorders. 

An example of an eating-disorder-related self-concept and low self-esteem is, “I am fat and ugly.” It matters not to the anorexic teens that, in reality, they are not overweight. What matters is that they “feel” or believe that they are.

Family Dynamic and Adolescence

In adolescence, both self-concept and self-esteem values are heavily influenced by family, cultural, and peer values and dynamics, which in turn determine the boundaries for the process of individuation. In his article, “Adolescence and Self-Esteem,” published in Psychology TodayCarl E. Pickhardt, PhD, notes how self-esteem affects relationships. Families with low esteem tend to treat each other badly. The reverse is true of families with high esteem. 
Dr. Pickhardt also notes that there are normal variations in self-esteem that occur during adolescence. He posits that self-esteem normally suffers a blow upon entry into adolescence, when familiar childhood relationships and values change, and again upon departure from adolescence and entry into the adult world. 

Family Dynamics and Anorexia

In “Perceptions of Family Functioning and Self-concept in Adolescent Anorexia Nervosa,” My Trinh Ha, et al., found that an anorexic child’s perception of “how the family works and functions has the largest influence on evaluations of the self as compared to parental perceptions.” 

Perhaps the normal dips in self-esteem that occur during adolescence become negatively warped when family relationships are dysfunctional. When children are treated badly, it increases the likelihood that they will react by considering the maltreatment as normal, which is a highly un-healthy mental state especially at such an impressionable age. This can set the stage for self-abuse as a reaction to stress. 

Awareness of children's perception of their role within the family and how the family functions can help therapists involved in family therapy create ways to address family dysfunction and create the knowledge and motivation necessary for positive change, especially during eating disorder recovery.