# Family functioning and eating disorders in Chinese populations: a systematic review and meta-synthesis

## TL;DR

This study explores how family dynamics in Chinese populations may contribute to eating disorders, identifying cultural-specific factors like filial piety and communication patterns.

## Contribution

The study provides a systematic review and meta-synthesis of family functioning in Chinese populations with eating disorders, highlighting culturally specific themes.

## Key findings

- Six key family themes were identified, including family values, communication patterns, and parental control.
- Cultural factors like filial piety and gender preferences were found to influence eating disorder development in Chinese families.
- Quantitative findings only partially supported qualitative insights, suggesting a need for further research.

## Abstract

Familial factors play crucial roles in the development of eating disorders and related psychopathology. However, the generalizability of findings from Western studies on familial influences to Chinese populations remains questionable. This review systematically examines the relationship between family functioning, conceptualized within the family process model, and the development of eating disorders in Chinese patients.

Empirical studies were systematically reviewed on the basis of family process theory. The quantitative data were integrated and synthesized with qualitative data using a convergent integrated approach. A thematic analysis was conducted using NVivo 12. This review adhered to the Preferred Reporting Items for Systematic reviews and Meta-Analyses 2020 Checklist and was registered with PROSPERO.

Fifty studies (13 quantitative and 37 qualitative or case studies) highlighted six themes: (1) family values; (2) family tasks: individuality; (3) family communication: conflict avoidance and affective involvement; (4) parental roles; (5) parental control; and (6) specific behaviours (e.g., unhealthy feeding practices and negative family body talk). These factors may play a role in the development of eating disorders and provide insight into the dynamics within Chinese families.

Filial piety and gender preferences characterize cultural contexts in patients’, families’, and professionals’ narratives. While individuality and eating-related behaviours appear in both Chinese and Western contexts, notable differences exist. Avoidant family communication, emotional disengagement, parental control, and strong academic focus were identified, but parental roles and divisions showed no consistent patterns. Quantitative findings only partially support the qualitative descriptions.

The online version contains supplementary material available at 10.1186/s40337-025-01453-1.

This review explored how family relationships and dynamics might contribute to eating disorders specifically within Chinese populations. Because most existing research on family influences comes from other cultural contexts, the researchers focused on understanding the unique aspects relevant to Chinese families. They systematically analysed 50 existing studies involving Chinese patients, using a model that examines how families interact and function.

The analysis identified several key family themes linked to eating disorders in this group. These include the strong influence of cultural values like respect for parents (filial piety) and gender preferences, different individuality within the family, parental roles and divisions, communication patterns that avoid conflict, low emotional connection, high levels of parental control, an intense focus on academic achievement, and specific behaviours like unhealthy feeding practices or negative talk about body image at home. However, the evidence from in-depth interview studies was only partially matched by findings from statistical studies, indicating a need for further research to solidify understanding of these specific family dynamics and their role in eating disorders among Chinese individuals.

The online version contains supplementary material available at 10.1186/s40337-025-01453-1.