Definition/Introduction

Family dynamics refer to the patterns of interactions among relatives, their roles and relationships, and the various factors that shape their interactions. Because family members rely on each other for emotional, physical, and economic support, they are one of the primary sources of relationship security or stress. Secure and supportive family relationships provide love, advice, and care, whereas stressful family relationships are burdened with arguments, constant critical feedback, and onerous demands.[1]

Interpersonal interactions among family members have lasting impacts and influence the development and well-being of an individual via psychosocial, behavioral, and physiological pathways.[2] Thus, family dynamics and the quality of family relationships can positively or negatively impact health.

Several factors can influence family dynamics. Some researchers have identified individuation, mutuality, flexibility, stability, clear communication, and role reciprocity as the primary factors contributing to healthy family dynamics. In particular, mutuality, a shared feeling of cohesion and warmth, has been identified as the most vital contributing factor. In contrast, factors contributing to unhealthy family dynamics include enmeshment, isolation, rigidity, disorganization, unclear communication, and role conflict.[3]

The definition of family itself has morphed over the years. In previous generations, families stayed close to each other, and multiple generations helped raise the children. It is now more common for families to be spread across the country and grandparents to have less involvement in their grandchildren's lives. Without family close by, some develop a core group of local families, which they consider their family. This family structure can change as people move locations, so a person's family can be fluid. Another aspect of family that has changed over the years is the acknowledgment and acceptance of nontraditional families and the increase of blended families. 

Issues of Concern

Extensive research has demonstrated the importance of family dynamics to health, illness, and recovery outcomes; however, there is little scholarly consensus on the exact definition of family and family dynamics. For example, several studies of patients receiving treatment for mental illness have defined family strictly as the patient's parents.[4][5] Other studies investigating the role of family dynamics in recovery processes consider the patient's current living situation, including the spouse and children. Some studies define family loosely, including parents, siblings, extended family members, and children, while others do not.

The lack of clarity on who should qualify as a family member makes it challenging to analyze the role of family dynamics in health outcomes. As a result, it is often too difficult to develop positive interventions. To introduce more consistency in future studies, some researchers have called for establishing a more precise definition and classifying a scheme for identifying the members of a family unit.

One classification scheme proposes seven clearly defined family types: proton, electron, nuclear, atom, molecular, joint, and quasi-family.[6] Although this classification may have potential, it is not commonly used in current literature. Also, while clearly defined, the classification can be difficult to interpret. Other proposed solutions have challenged the notion of defining families in strict terms. Their proponents believe that study participants and patients should be allowed to define their families independently.[7] An alternative solution is to de-emphasize the centrality of family relationships in health and disease and broadly study social relationships instead.[8]

Clinical Significance

Family dynamics play a significant role in health outcomes and merit attention in clinical settings. Unhealthy family dynamics can cause children to experience trauma and stress as they grow up. This type of exposure, famously known as adverse childhood experiences (ACEs), is linked to an increased risk of developing physical and mental health problems. Specifically, ACEs increase an individual’s risk of developing heart, lung, or liver disease, depression, anxiety, and more.[9] Some common examples of ACEs include emotional, sexual, or physical abuse, parental divorce, criminal behavior or mental illness, or substance abuse in the family unit. Unhealthy family dynamics also correlate with an increased risk of substance use and addiction among adolescents.[10] Role conflict (emotional conflict arising from one person fulfilling multiple roles, and the duties of those roles conflict with each other) between parents and adolescents is a contributing factor to low-income family dynamics and is associated with adolescent aggression, whereas mutuality (cohesion and warmth) is shown to be a protective factor against aggressive behavior.[11]

A literature review of the effect of family dynamics on sleep health and cardiovascular health demonstrated negative family dynamics correlate with poor sleep outcomes, increased heart rate, and increased blood pressure, which leads to an increased risk of developing hypertension. The same study also found evidence that mutuality among family members is associated with better sleep outcomes in children.[1] Other studies demonstrate that unhealthy family dynamics caused by poor-quality interactions between parents and children are associated with an increased risk of childhood obesity. In contrast, positive interactions are a protective factor against childhood obesity.[12]  

Family dynamics are also important determinants of health and wellness for elderly patients. For example, healthy family dynamics that facilitate supportive interactions among family members increase the likelihood that older patients will elect to receive hip and knee replacement surgeries.[13] As a result of these joint replacement surgeries, patients experience less pain and regain the function of their diseased joints.   

Several pathways can help explain how family dynamics affect health. For example, stressful relationships among family members are associated with impaired immune function and increased allostatic load. In contrast, supportive relationships correlate with lower allostatic load. Behavioral pathways have also been implicated. Stressful relationships may lead to poor coping mechanisms that harm an individual’s health. In contrast, those in supportive relationships have family members who encourage them to behave healthier and assist them in medication compliance if applicable.[2][7]

How family dynamics influence health is not limited to the ones listed here. The long list of short- and long-term health outcomes associated with unhealthy family dynamics and the positive associations between healthy family dynamics and well-being illustrate the clinical significance of family dynamics. As such, providers must assess patients’ family dynamics through social history taking and other means before they develop a plan of action. To help patients develop and maintain healthy family dynamics, clinicians can suggest intervention programs like family sculpting and family therapy.

Nursing, Allied Health, and Interprofessional Team Interventions

Effectively assessing and addressing a patient’s family dynamic and its role in health and disease requires an interprofessional team of health professionals, including nurses, physicians, social workers, and therapists. Nurses are uniquely positioned to observe interaction patterns, assess family relationships, and attend to family concerns in the clinical setting since they frequently contact family members.[14] Physicians can use family sculpting techniques to help patients and their families develop and maintain healthy family dynamics. Therapists can intervene through family therapy, psychotherapy, and interpersonal therapy sessions to address interpersonal problems and strengthen family bonds. Social workers play a vital role by performing home visits to monitor and guide families to engage in healthy patterns that lead to supportive relationships. 

Collaboration among the interprofessional team advances family-centered care practices and provides patients and families with the necessary resources to develop and maintain healthy family dynamics. Numerous studies demonstrate family dynamics and the quality of family relationships have significant implications for the health of individuals.[15][16][17][18] This underlines the importance of assessing family dynamics and addressing unhealthy relationship patterns in clinical settings to promote the health and well-being of patients.[2][7]