Family interactions in bulimia nervosa. II: Complex intrafamily comparisons and clinical significance

Family experience with eating disorders scale: a systematic way to engage the family in treatment

PURPOSE

The purpose of this study was to measure congruence in perceptions of family dynamics in eating-disordered adolescents and their parents.

DESIGN AND METHODS

A pilot sample of 35 matched parent-child dyads completed either the Parent Version or the newly modified Client Version of the Family Experience with Eating Disorders Scale (FEEDS).

FINDINGS

Differences between parent and child perceptions on subscale totals were not demonstrated, but statistically significant differences on select items were shown.

PRACTICE IMPLICATIONS

The FEEDS offers a systematic way to explore differences and commonalities in perception among family members and to engage the family in treatment.

Relationships between family conflict, perceived maternal verbal messages, and daughters' disturbed eating symptomatology

The objective was to investigate relationships between family conflict and the perceived communication of negative messages regarding weight and shape from mothers to daughters, and daughters' disordered eating symptomatology. A correlational study was conducted in which a questionnaire was completed by 315 women aged between 14 and 28 years. The sample comprised both secondary school students (n=196) and university students (n=119). Disordered eating symptomatology was operationalised as drive for thinness, body dissatisfaction, and bulimic symptoms. Family conflict and the perceived frequency of negative messages regarding weight and shape communicated from mothers were also reported by participants. With current BMI treated as a covariate, support was provided for the proposition that frequency of negative messages is a more important contributor to disordered eating symptomatology than family conflict for both secondary school students and university students. However, for secondary students there was no relationship between family conflict and drive for thinness. Recommendations for future research are provided, including the possibility of considering the perception of both positive and negative weight-related messages, and the relative importance of such messages when conveyed by people other than the maternal figure, such as fathers, siblings and peers.

[Subjective family image in anorexia nervosa and bulimia nervosa in adolescence: a controlled study]

OBJECTIVES

The family environments of patients with eating disorders have been studied extensively in recent decades. The "Subjective Family Image Test" is an instrument developed especially to measure differential perceptions by family members. Assessments of subjective family image in families of adolescents by means of this test have been carried out in only a few samples.

METHODS

We aimed first to investigate subjective perceptions by adolescents of their family relations in a larger clinical sample of female adolescents (n = 118) suffering from anorexia nervosa of either subtype or from bulimia nervosa and to compare these perceptions with those of healthy controls (n = 96). Second we investigated intra-familial differences in perception.

RESULTS

The main findings were that bulimia nervosa patients perceived lower individual autonomy and lower emotional connectedness than all other groups, the adolescents with bulimia perceived significantly lower autonomy and emotional connectedness within the family than their fathers, and the restrictive anorexia nervosa patients perceived higher connectedness than their fathers. The relevance of these findings for understanding family dynamics are discussed.

Investigation of quality of the parental relationship as a risk factor for subclinical bulimia nervosa

OBJECTIVE

Previous literature suggests a link between the quality of the parental relationship and disordered eating in offspring. We investigated the relationship between offspring pyschopathology and the parental relationship using a population-based twin registry that contained 766 complete twin pairs.

METHOD

We used reports of twin lifetime psychopathology from the twins and quality of parental relationship and parental lifetime psychopathology from both parents.

RESULTS

Poorer quality of the marital relationship predicted the presence of subclinical bulimia nervosa (SBN) using both mother's (odds ratio [OR] = 0.83, 95% confidence interval [CI]: 0.71-0.97) and father's (OR = 0.78, 95% CI: 0.62-0.97) reports. It also predicted the presence of generalized anxiety disorder (GAD) and alcohol dependence. SBN was still strongly predicted by the marital relationship when parental psychopathology was included as a covariate.

DISCUSSION

These results are supportive of the notion that a conflictual and distant marital relationship can, at least partially, act as an environmental risk factor for SBN.

Twin studies of eating disorders: a review

OBJECTIVE

Twin methodology has been used to delineate etiological factors in many medical disorders and behavioral traits including eating disorders. Although twin studies are powerful tools, their methodology can be arcane and their implications easily misinterpreted.

METHOD

The goals of this study are to (a) review the theoretical rationale for twin studies; (b) provide a framework for their interpretation and evaluation; (c) review extant twin studies on eating disorders; and (d) explore the implications for understanding etiological issues in eating disorders.

DISCUSSION

On the basis of this review, it is not possible to draw firm conclusions regarding the precise contribution of genetic and environmental factors to anorexia nervosa. Twin studies confirm that bulimia nervosa is familial and reveal significant contributions of additive genetic effects and of unique environmental factors in liability to bulimia nervosa. The magnitude of the contribution of shared environment is less clear, but in the studies with the greatest statistical power, it appears to be less prominent than additive genetic factors.

Family functioning in anxiety and eating disorders--a comparative study

This study examines ratings of family functioning in families of origin and current (marital) families by patients with anxiety disorders (ADs) and compares them with known population means and with similar ratings by patients with eating disorders. Subjects were drawn from the Anxiety Disorders and Eating Disorders clinics of The Toronto Hospital, each group consisting of a consecutive sample. Family functioning was assessed using the general and self-rating scales of the Family Assessment Measure (FAM). Patients with ADs rated their families of origin less favorably than established population norms (general and self-rating scales, P < .001). Ratings by patients with ADs did not differ from comparable ratings by patients with eating disorders. AD patients' less favorable ratings of family of origin suggest a perception of significant family dysfunction. However, the similarity in ratings between AD and bulimia nervosa (BN) subjects suggests that this is unlikely to be specific to having an AD.

Family interactions in bulimia nervosa. I: Study design, comparisons to established population norms, and changes over the course of an intensive day hospital treatment program

This paper presents the results of a study examining self-reported family functioning by patients with bulimia nervosa (BN) and their parents before and after treatment for the eating symptoms of BN. Ratings of family functioning improved significantly over the course of treatment. There was no evidence of excessive denial or social desirability in the families.