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

Behavioral Alterations in Mice Carrying Homozygous HDAC4 A778T Missense Mutation Associated With Eating Disorder

Eating disorders (EDs) are serious mental illnesses thought to arise from the complex gene-environment interactions. DNA methylation patterns in histone deacetylase 4 (HDAC4) locus have been associated with EDs and we have previously identified a missense mutation in the HDAC4 gene (HDAC4^A786T) that increases the risk of developing an ED. In order to evaluate the biological consequences of this variant and establish a useful mouse model of EDs, here we performed behavioral characterization of mice homozygous for Hdac4^A778T (corresponding to human HDAC4^A786T) that were further backcrossed onto C57BL/6 background. When fed high-fat diet, male, but not female, homozygous mice showed a trend toward decreased weight gain compared to their wild-type littermates. Behaviorally, male, but not female, homozygous mice spent less time in eating and exhibited reduced motivation to work for palatable food and light phase-specific decrease in locomotor activity. Additionally, homozygous Hdac4^A778T female, but not male, mice display social subordination when subjected to a tube dominance test. Collectively, these results reveal a complex sex- and circadian-dependent role of ED-associated Hdac4^A778T mutation in affecting mouse behaviors. Homozygous Hdac4^A778T mice could therefore be a useful animal model to gain insight into the neurobiological basis of EDs.

[Comprehensive scores for the subjective family image test, SFIT : A social relations model analysis of 461 patients with eating disorders]

BACKGROUND

Given three person families the Subjective Family Image Test assesses the six dyadic relations on a valence and potency dimensions. Besides the total sum score (developmental conditions in the family) other aggregate scores are unsettled.

METHODS

Data of 461 patients with eating disorders was reanalysed in order to clarify which aggregate scores are comprehensive. Structural equation analysis followed the family social relations model.

RESULTS

Eight further latent variables with sufficient variance in the lay psychology of the patients were identified: at the valence dimension the three reciprocal dyads and the parents as two dispositional sources, at the potency dimension a dispositional source for each family member with complementarity for the parents (e. g. the dominant father to whom all others submit themselves vs. the submissive father who is dominated by the others). Because of the found complementarity a potency total score is inadmissible. For the same reason, the potency dimension is interpreted as dominance according to the Interpersonal Circumplex. The differences between parental and child roles in the lay psychology of the patients can be explained by attribution theory.

CONCLUSIONS

Future analyses of the subjective family image test will be guided by the 9 variables found. They allow interpreting the lay family psychology of patients with eating disorders in the terminology of the Interpersonal Circumplex. Beyond, the empirically found typology in combination with anamnestic data and observed family interaction allow to focus problematic areas of family relationships in family oriented interventions.

The role of food in family relationships amongst adolescents with bulimia nervosa: A qualitative study using photo-elicitation

Bulimia nervosa (BN) is a serious psychiatric disorder, with potentially dangerous complications. Family relationships play an important role in the way the condition develops or is perpetuated. The present study aims to better grasp the role of food in family interactions amongst teenagers with BN. Eleven interviews were carried out with five teenagers with BN aged from 16 to 18 and their parents, using photo-elicitation to carry out the qualitative investigation. A photograph of the table after a family meal, produced by the subject, was used as the basis for discussion. Interpretative Phenomenological Analysis was used to process the data. Our results were organised along two axes. The first describes the relationship between parent and child (the sharing of disarray about food between parent and child, food and the issue of children becoming autonomous from parents, food as a catalyser of conflict amongst other stressors). The second showcases relationships in the family as a group (the dining table as a likeness of family functioning, food at a crossroads between sharing and solitude). Our study showed that the dynamics in these families present differences from those of teenagers with anorexia nervosa, which must be taken into account. It confirmed the necessity of a systemic approach in addition to individual therapy (centred on the managing of emotions), and the benefits of creating occasions of family interaction which do not involve food to re-establish communication in the family relationships (including those with siblings).

Exploring Types of Family Environments in Youth with Eating Disorders

While many studies have explored the relationship between different eating disorder diagnoses and the familial social environment, current evidence does not support associations between distinct family interaction patterns (e.g. high enmeshment) and particular diagnoses (e.g. anorexia nervosa). The current study seeks to move beyond the current literature to explore whether empirically derived subtypes of family environment are associated with clinical features within a transdiagnostic sample of youth seeking treatment for eating disorders (n = 123). Latent class modelling of the Family Environment Scale identified three classes (i.e. different Family Environment Scale profiles): (1) Control-Oriented; (2) System Maintenance-Oriented; and (3) Conflict-Oriented. Data are presented to characterize the classes (e.g. age, gender, rates of different eating disorders, severity of eating disorder pathology and rates of comorbid disorders). These preliminary results suggest that family interaction types may help personalize treatment for eating disorders and encourage future research to guide such efforts. Copyright © 2017 John Wiley & Sons, Ltd and Eating Disorders Association.

A constituição da relação mãe-filha e o desenvolvimento dos transtornos alimentares

O presente estudo buscou compreender, por meio de abordagem qualitativa, como mães de adolescentes com transtornos alimentares vivenciaram o processo de cuidar de suas filhas desde a gestação até os dois anos de idade, procurando investigar se essas vivências relacionadas à maternidade guardam relação com o aparecimento futuro do transtorno. Foram entrevistadas seis mães de pacientes com anorexia nervosa, que estavam em seguimento ambulatorial em um serviço especializado. Os relatos maternos foram examinados pela análise de conteúdo. Os resultados evidenciaram dificuldades de sustentação (holding) por parte das mães, que acarretaram intenso sofrimento e sentimento de impotência diante das necessidades básicas das filhas. As crianças foram descritas como vorazes e insatisfeitas, sugerindo que teriam vivenciado dificuldades em assimilar o cuidado oferecido por suas mães em seus primeiros anos de vida. Desse modo, os resultados corroboram a importância de investigar as experiências infantis precoces para a compreensão da etiologia dos transtornos alimentares.

Perception of transgenerational family relationships: comparison of eating-disordered patients and their parents

Background

Disturbances in various elements of transgenerational family functioning patterns are not uncommon in studies of eating disorders.

We examined the relationship between patients’ perception of autonomy and intimacy in their families of origin and that of their parents in their own families of origin.

Material/Methods

The sample consisted of 112 girls who had a diagnosis of an eating disoder and their parents; 54 of the girls were diagnosed with anorexia nervosa restrictive subtype, 22 as anorexia nervosa binge/purge subtype, and 36 were diagnosed with bulimia nervosa. We had 2 control groups: 1 group consisted of 36 girls diagnosed with a depressive episode, dysthymia, or adjustment disorder with depressed mood and the other group was 85 female students from schools in Cracow, Poland and their parents. We used the the Family of Origin Scale to assess perception of family relationships. Statistical analysis was performed with the Statistical Package for the Social Sciences (SPSS 20.0.PL; Chicago, IL, USA).

Results

There was a significant association between daughters’ and fathers’ perceptions of autonomy in their families of origin in all groups. There was no significant association between daughters’ and mothers’ perceptions in all groups. The strongest correlation was between the non-clinical sample of girls and their fathers and for the bulimic group.

Conclusions

We did not detect any link indicating the specificity of transgenerational transmission of autonomy and intimacy in eating disorders. The results point to the importance of the father figure in studies of family systems, including the context of family transmission.

Perception of Autonomy and Connectedness Prior to the Onset of Anorexia Nervosa and Bulimia Nervosa

Objective: This study examines retrospective correlates of nonshared family environment prior to onset of disease, by means of multiple familial informants, among anorexia and bulimia nervosa patients. Methods: A total of 332 participants was included (anorexia nervosa, restrictive type (AN-R): n = 41 plus families); bulimic patients (anorexia nervosa, binge-purging type; bulimia nervosa: n = 59 plus families). The EATAET Lifetime Diagnostic Interview was used to establish the diagnosis; the Subjective Family Image Test was used to derive emotional connectedness (EC) and individual autonomy (IA). Results: Bulimic and AN-R patients perceived significantly lower EC prior to onset of disease compared to their healthy sisters. Bulimic patients perceived significantly lower EC prior to onset of disease compared to AN-R patients and compared to their mothers and fathers. A low family sum – sister pairs sum comparison – of EC had a significant influence on the risk of developing bulimia nervosa. Contrary to expectations, AN-R patients did not perceive significantly lower levels of IA compared to their sisters, prior to onset of disease. Findings of low IA in currently ill AN-R patients may represent a disease consequence, not a risk factor. Conclusions: Developmental child psychiatrists should direct their attention to disturbances of EC, which may be present prior to the onset of the disease.