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Rienecke RD, Trotter X, Jenkins PE. A systematic review of eating disorders and family functioning. Clin Psychol Rev 2024; 112:102462. [PMID: 38941693 DOI: 10.1016/j.cpr.2024.102462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 06/19/2024] [Accepted: 06/19/2024] [Indexed: 06/30/2024]
Abstract
The purpose of the current review was to address four questions: 1) Are there differences in family functioning or family environment among patients with different eating disorder (ED) diagnoses? 2) Are there differences in the perception of family functioning or family environment among different family members? 3) Is family functioning or family environment related to ED symptomatology? 4) Does family functioning or family environment change as a result of ED treatment? and 4a) If so, does this impact ED treatment outcome? Although most studies found no differences among ED diagnostic groups, those that did generally found worse family functioning among those with binge/purge symptoms than among those with the restricting subtype of anorexia nervosa. Differences in perceptions of family functioning among family members were found, with patients generally reporting worse functioning than their parents. Worse family functioning was generally found to be related to worse ED symptoms. The variety of treatment approaches and different assessments of outcome made it somewhat unclear whether family functioning consistently improves with ED treatment. More research is needed on family functioning and EDs, particularly in understudied groups such as males, and those with ED diagnoses other than anorexia nervosa or bulimia nervosa.
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Affiliation(s)
- Renee D Rienecke
- Eating Recovery Center/Pathlight Mood & Anxiety Center, USA; Department of Psychiatry and Behavioral Sciences, Northwestern University, Chicago, IL, USA.
| | - Xanthe Trotter
- School of Psychology and Clinical Language Sciences, University of Reading, Reading RG6 6ES, United Kingdom
| | - Paul E Jenkins
- School of Psychology and Clinical Language Sciences, University of Reading, Reading RG6 6ES, United Kingdom
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Haben Geschwister einen unterschiedlichen Einfluss auf die selbsteingeschätzte Familienfunktionalität bei Patientinnen mit Anorexia und Bulimia nervosa? Prax Kinderpsychol Kinderpsychiatr 2022; 71:528-542. [DOI: 10.13109/prkk.2022.71.6.528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Lukas L, Buhl C, Schulte-Körne G, Sfärlea A. Family, friends, and feelings: the role of relationships to parents and peers and alexithymia in adolescents with anorexia nervosa. J Eat Disord 2022; 10:143. [PMID: 36175986 PMCID: PMC9520900 DOI: 10.1186/s40337-022-00661-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 09/02/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Anorexia nervosa (AN) is associated with impairments in socio-emotional functioning, including difficulties in interpersonal relationships as well as alexithymia (difficulties identifying and describing one's emotions). Although the onset of the disorder is mostly in adolescence, a developmental period in which interpersonal relationships to parents as well as peers undergo major changes, only few studies have investigated the quality of interpersonal relationships in adolescent AN patients. Furthermore, the mechanisms linking poor relationship quality to eating disorder psychopathology are not yet clarified, albeit some research suggests that alexithymia might play a pivotal role. The aims of the present study were investigating the quality of interpersonal relationships to parents and peers in adolescents with AN compared to healthy adolescents as well as exploring the mediating role of alexithymia in the association between relationship quality and eating disorder symptoms. METHODS Self-report questionnaires were used to assess relationship quality (Inventory of Parent and Peer Attachment) and alexithymia (Toronto Alexithymia Scale) in 12-18 year old female adolescents with AN (n = 35) in comparison to healthy adolescents (n = 40). RESULTS Adolescents with AN reported lower relationship quality to both of their parents and to peers compared to healthy controls. Relationship quality scores were negatively correlated to alexithymia as well as eating disorder symptoms. Alexithymia fully meditated the association between eating disorder symptoms and relationship quality to parents and partially mediated the association between eating disorder symptoms and relationship quality to peers. CONCLUSION The results indicate difficulties in interpersonal relationships among adolescents with AN and emphasize the role of peer relationships for adolescents' eating disorder psychopathology. Alexithymia seems to play an important role in explaining the link between quality of relationships and eating disorder psychopathology. Results suggest that treatment should not only focus on family relationships but also address relationships to peers as well as adolescents' competence in identifying and dealing with their emotions.
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Affiliation(s)
- Linda Lukas
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital, LMU Munich, Nussbaumstr. 5, 80336, Munich, Germany
| | - Christina Buhl
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital, LMU Munich, Nussbaumstr. 5, 80336, Munich, Germany
| | - Gerd Schulte-Körne
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital, LMU Munich, Nussbaumstr. 5, 80336, Munich, Germany
| | - Anca Sfärlea
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital, LMU Munich, Nussbaumstr. 5, 80336, Munich, Germany.
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Bachner-Melman R, Lev-Ari L, Zohar AH, Linketsky M. The Eating Disorders Recovery Questionnaire: psychometric properties and validity. Eat Weight Disord 2021; 26:2633-2643. [PMID: 33582972 DOI: 10.1007/s40519-021-01139-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Accepted: 01/29/2021] [Indexed: 01/07/2023] Open
Abstract
PURPOSE There is no standardized measurement of recovery from an eating disorder (ED). We examined the psychometric properties and construct validity of the "Eating Disorders Recovery Questionnaire" (EDRQ), which defines recovery beyond symptoms to include self-acceptance, social emotional and physical health. METHODS Twenty-eight recovery-related items were administered to 978 people (9.5% men) aged 18-76. 172 participants had a current ED diagnosis (AN, BN or BED), 104 had a past ED diagnosis (AN, BN, BED or > one diagnosis), 105 had another past or present ED, and 579 had no lifetime ED. Participants also completed the Eating Disorders Examination Questionnaire, Dresden Body Image Questionnaire-35, Positive and Negative Affect Schedule-Short Form, Patient Health Questionnaire-9, Satisfaction with Life Scale and Positive Eating Scale. RESULTS Exploratory and confirmatory factor analyses yielded four factors (CFI = 0.93, RMSEA = 0.07): lack of symptomatic behavior, acceptance of self and body, social and emotional connection, and physical health. Group comparisons showed that currently ill women scored lower on EDRQ and positive indices and higher on negative indices than controls and previously ill women. Previously ill women scored similarly to controls on ED symptomatology, positive body experiences, depression, and positive and negative affect but had lower BMI, life satisfaction and positive eating. The EDRQ-EDEQ correlation was r = 0.67, indicating both overlap and distinct variance. CONCLUSION The EDRQ is a valid, reliable measure of ED recovery, defined more broadly than symptom remission. We recommend its incorporation into a standardized operationalization of recovery and its use by consumers, carers and service providers to monitor ED recovery status. LEVEL OF EVIDENCE Level III, case-control analytic study.
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Affiliation(s)
- Rachel Bachner-Melman
- Ruppin Academic Center (Clinical Psychology Graduate Program), Emek Hefer, Israel. .,Hebrew University of Jerusalem (School of Social Work), Jerusalem, Israel.
| | - Lilac Lev-Ari
- Ruppin Academic Center (Clinical Psychology Graduate Program), Emek Hefer, Israel.,The Lior Tsfaty Center for Suicide and Mental Pain Studies, Ruppin Academic Center, Emek Hefer, Israel
| | - Ada H Zohar
- Ruppin Academic Center (Clinical Psychology Graduate Program), Emek Hefer, Israel.,The Lior Tsfaty Center for Suicide and Mental Pain Studies, Ruppin Academic Center, Emek Hefer, Israel
| | - Michal Linketsky
- Ruppin Academic Center (Clinical Psychology Graduate Program), Emek Hefer, Israel
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Bachner-Melman R, Lev-Ari L, Zohar AH, Lev SL. Can Recovery From an Eating Disorder Be Measured? Toward a Standardized Questionnaire. Front Psychol 2018; 9:2456. [PMID: 30618916 PMCID: PMC6297874 DOI: 10.3389/fpsyg.2018.02456] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Accepted: 11/20/2018] [Indexed: 01/12/2023] Open
Abstract
Background: There is a clear need for a standardized definition of recovery from eating disorders (EDs) and for self-report instruments to assess where individuals with an ED are situated at a given point of time along their process of illness and recovery. It has been acknowledged that psychological and cognitive symptoms are important to recovery in addition to physical and behavioral indices. This study proposes a 28-item multidimensional questionnaire encompassing the main features of recovery from ED, derived from the endorsement of different criteria by people with a lifetime ED diagnosis, family members and ED clinicians. Methods: Participants were 213 volunteers over the age of 18 (118 people with a lifetime ED diagnosis, 58 healthy family members of people with EDs and 37 ED clinicians), who completed the ED-15 and indicated online how important they thought each of 56 criteria were for recovery from an ED. Results: Four factors were identified in an exploratory factor analysis: Lack of Symptomatic Behavior (LSB), Acceptance of Self and Body (ASB), Social and Emotional Connection (SEC), and Physical Health (PH). Confirmatory factor analysis using the seven highest loading items from each subscale confirmed the structure validity of a shortened version of this questionnaire, the Eating Disorders Recovery Endorsement Questionnaire (EDREQ), which had excellent goodness-of-fit indices. Despite a few between-group differences, there was general agreement that LSB was most salient to recovery, followed by ASB, SEC, and PH in that order. Conclusion: Despite the absence of a standardized definition of recovery from ED, there is a general consensus about its components. The EDREQ is a psychometrically sound questionnaire containing items that people with an ED history, their family members and therapists all define as important components of recovery. The inclusion of emotional and psychosocial aspects of recovery in addition to symptomatic and medical aspects is important to expand treatment goals and the concept of recovery from EDs beyond symptom relief and the absence of disease markers. As a clinical tool, the EDREQ stands to assist in setting and refining therapeutic goals throughout therapy, and in establishing standardized, comparable norms for recovery levels in research.
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Affiliation(s)
- Rachel Bachner-Melman
- Clinical Psychology Graduate Program, Ruppin Academic Center, Hadera, Israel
- The Paul Baerwald School of Social Work and Social Welfare, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Lilac Lev-Ari
- Clinical Psychology Graduate Program, Ruppin Academic Center, Hadera, Israel
| | - Ada H. Zohar
- Clinical Psychology Graduate Program, Ruppin Academic Center, Hadera, Israel
| | - Shay Lee Lev
- Clinical Psychology Graduate Program, Ruppin Academic Center, Hadera, Israel
- Student Counselling Service, University of Haifa, Haifa, Israel
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Head ML, Bruchmann K. The effects of health frame and target relevance in appearance social comparisons. JOURNAL OF APPLIED SOCIAL PSYCHOLOGY 2018. [DOI: 10.1111/jasp.12562] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Maggie L. Head
- Department of Psychology; Santa Clara University; Santa Clara California
| | - Kathryn Bruchmann
- Department of Psychology; Santa Clara University; Santa Clara California
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Bachner-Melman R, Zontag-Oren E, Zohar AH, Sher H. Lives on the Line: The Online Lives of Girls and Women With and Without a Lifetime Eating Disorder Diagnosis. Front Psychol 2018; 9:2128. [PMID: 30443238 PMCID: PMC6221959 DOI: 10.3389/fpsyg.2018.02128] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Accepted: 10/15/2018] [Indexed: 12/15/2022] Open
Abstract
This study aimed to compare the scope, internet use patterns, and degree of online need satisfaction of girls and women with and without a lifetime eating disorder (ED) diagnosis. Participants were 122 females aged 12-30, 53 with a lifetime ED diagnosis recruited via a hospital-based treatment program, and 69 age-matched controls recruited via normative social media sites. Participants completed questionnaires assessing disordered eating, body image, positive and negative affect, general distress, and life satisfaction, and completed an online survey about the scope of their internet use, the frequency of watching and posting pictures and videos, online friendships and social comparison, fulfillment of needs online, and mood after internet use. All questionnaire scores differed significantly between groups in the expected directions. Whereas overall, ED and control groups spent similar amounts of time online (6.21, SD = 5.13), they spent this time differently. ED participants reported devoting 56.7% of their online time to eating, weight and body image, versus 29.1% for controls, and spent significantly more time than controls on forums and blogs (t = -5.3, p < 0.0001, Cohen's d = 0.87). They also engaged more often in social comparison (t = 3.6, p < 0.005, Cohen's d = 0.65), had a higher online-offline friend ratio (t = 3.7, p < 0.0001, Cohen's d = 0.65), and more online friends with ED (t = 5.4, p < 0.0001, Cohen's d = 0.89). In comparison to controls, ED participants reported that their use of forums and blogs gave them more eating- and weight-related advice, and a greater sense of belonging, social support, and safety resulting from anonymity, with effect sizes of 0.63-0.96. However, they also reported more negative affect after posting online. Most online behaviors and patterns correlated positively with measures of symptomatology and negatively with measures of psychological health, in both groups. Internet use was rarely addressed in therapy. Professionals, families and friends should help people with disordered eating and EDs to broaden the scope of their internet use. They should invest less in food- and weight-related forums/blogs, expand their "real life" social lives and develop their interpersonal skills, so that their legitimate needs can be satisfied face-to-face, rather than virtually. Clinicians should address the online lives of their ED clients in therapy.
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Affiliation(s)
| | - Einat Zontag-Oren
- Clinical Psychology Graduate Program, Ruppin Academic Center, Emek Hefer, Israel
| | - Ada H. Zohar
- Clinical Psychology Graduate Program, Ruppin Academic Center, Emek Hefer, Israel
| | - Helene Sher
- Eating Disorder Unit, Child and Adolescent Psychiatry, Soroka University Medical Center, Beersheba, Israel
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Treasure J, Cardi V. Anorexia Nervosa, Theory and Treatment: Where Are We 35 Years on from Hilde Bruch's Foundation Lecture? EUROPEAN EATING DISORDERS REVIEW 2017; 25:139-147. [PMID: 28402069 DOI: 10.1002/erv.2511] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Revised: 02/13/2017] [Accepted: 02/14/2017] [Indexed: 12/13/2022]
Abstract
Hilde Bruch's foundation lecture in 1982 is a milestone from which to survey current theory and treatment for anorexia nervosa. Bruch described problems in body perception, emotion processing and interpersonal relationships as core theoretical aspects of the illness and built her theory of psychopathology on these aspects, as well as on animal studies on attachment. She also noted that many psychological problems result as consequence of starvation. In the first part of this paper, we parse Bruch's clinical descriptions into elements of psychopathology (disturbances in body perception, attachment, emotion expression, perception and regulation, social comparison, interpersonal, and family and therapeutic relationships), in order to assemble and update the theoretical evidence for a model of the illness. In the second part, we describe and extend her description of three core targets of treatment: family relationships, patient's inner confusion and nutritional restoration. Copyright © 2017 John Wiley & Sons, Ltd and Eating Disorders Association.
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Affiliation(s)
- Janet Treasure
- Department of Psychological Medicine, King's College London, Institute of Psychiatry, Psychology and Neuroscience, UK
| | - Valentina Cardi
- Department of Psychological Medicine, King's College London, Institute of Psychiatry, Psychology and Neuroscience, UK
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