Overinvolvement of parents with their children can create serious difficulties for all family members. The most extreme example of such overinvolvement is termed enmeshment; this is a situation in which the ego boundaries among individuals are so poorly defined that they cannot separate or individuate from one another without experiencing tremendous anxiety, anger, or other forms of emotional distress. The preconditions for overinvolvement include intergenerational patterns of overinvolvement, insufficient separation and individuation of parents from their own parents, parental disharmony, situational or developmental crises, perhaps temperamental predisposition, and other related factors. The primary characteristic of these families is the extreme emotional closeness that exists between parents and children. Although this may be a normative aspect of parenting during infancy, as the child begins to separate from the parents, they usually respond by “pulling back” emotionally and allowing the child to become a separate individual. If parents feel threatened by the child’s move toward autonomy, they may undermine this process by focusing all their attention on the child, conveying to him or her the message that it is not all right to be a separate individual.
In some cases, the parents may continue to perform functions long past the age when the child is capable of self-care, such as feeding or dressing. In other situations, the child may withdraw from facing normal developmental tasks (e.g., going to school, sleeping over at friends’ homes) and may exhibit overt signs of separation anxiety. As with other forms of dysfunction, this ranges from minimal to severe.
Children whose parents are overinvolved also do not experience and learn normal family roles. Anxiety about normal developmental tasks and preoccupation with their parents’ emotional well-being leads some children to avoid developing friendships or to resist going to school. In the most severe cases, children can present with anxiety disorders, depression, and somatization disorders.
The physician’s approach to overinvolved or enmeshed families is outlined in the section on overprotective families. The most important function the physician can perform is to challenge firmly the parents to invest their emotional energy in areas other than their children. Emphasizing that the children need to separate from them to become healthy, independent, and self-reliant adults can help parents to relax their grip and to allow their children some emotional freedom. If discussion of these issues fails to result in change, the family should be referred for psychotherapy.