Objective: To develop an instrument that can be used to assess the needs of carers of people with an eating disorder and to perform a pilot test of this measure. Method: A focus group was held with 12 carers of people with anorexia nervosa (AN). A self-report questionnaire, the Carers' Needs Assessment Measure (CaNAM), was developed from discussions of the focus group. A pilot test of the CaNAM was carried out with a sample of 28 carers of people with AN. Keywords: eating disorders; anorexia nervosa; carer; caregiving; needs INTRODUCTIONCarers of people with severe mental illnesses have specific needs, in terms of their own physical and mental health. In the United Kingdom there is a requirement within legislation to assess and, where possible, address these needs (Carers' Act, 1995 Health, 1999) where Standard 6: Caring for Carers states that 'All individuals who are involved in providing regular and substantial care for a person on the Care Programme Approach (CPA) should (1) have their caring, physical and mental health needs assessed at least once a year and (2) be given their own written care plan, which should be implemented in discussion with them'.A number of studies have investigated the experience of caring for someone with a mental illness, but the majority of these have concentrated on schizophrenia (e.g. Budd, Oles, & Hughes, 1998; Tucker, Barker, & Gregoire, 1998; Winefield & Harvey, 1993) and Alzheimer's disease (e.g. Donaldson, Tarrier, & Burns, 1998;Harwood et al., 1998); little attention has been paid to what it is like to care for someone with an eating disorder. However, the few studies that have investigated the experience of caring for someone with an eating disorder have found that it is comparable to caring for someone with schizophrenia. For example, a small Italian study found that the burden of care that carers of people with an eating disorder experience was similar to that of carers of people with schizophrenia (Santonastaso, Saccon, & Favaro, 1997). Furthermore, we replicated this finding (Treasure et al., 2001), using the Experience of Caregiving Inventory (Szmukler et al., 1996), a generic measure developed from focus groups with carers of people with schizophrenia. We also found that carers of people with an eating disorder had higher levels of distress than those who cared for people with psychosis. It is likely that this distress is a consequence of unmet needs.To date, no research has been undertaken to determine what the needs of carers of people with anorexia nervosa (AN) are and how they can be assessed and measured. Anorexia nervosa tends to start during adolescence, meaning that the family are often the main caregivers. Furthermore, caring for someone with AN is likely to be very demanding and stressful, given that AN has an average duration of 6 years (Strober, Freeman, & Morrell, 1997), the highest mortality of all psychiatric illnesses (Eckert, Halmi, Marchi, Grove, & Crosby, 1995;Harris & Barraclough, 1998;Herzog et al., 1993;Sullivan, 1995) and high levels of co-mo...

Adjusting to the impact of a family member experiencing an ED is problematic, as suggested by the relationship between shorter illness duration and greater negative appraisals of caregiving. Interventions to help reduce dependency and alleviate stigma may help to decrease carers' distress.

The high activity Val158 (H) allele of the dopamine-metabolizing enzyme catechol-O-methyltransferase (COMT) was associated with anorexia nervosa (AN) in a recent family trio-based study of patients from Israel. In an attempt to replicate this finding, we performed a combined family trio and case-control study in an European population from seven centers in six different countries (Austria, Germany, Great Britain, Italy [Milan], Italy [Florence], Slovenia, and Spain), together contributing a total of 372 family trios, 684 controls and 266 cases. TDT analyses of high (H) and low (L) alleles in family trios showed that H allele and L allele were each transmitted 101 times (chi(2) = 0, ns). Allele-wise case-control analysis using separate samples simply combined from the centers was also not significant, with the frequencies of the H allele 50% in cases and same in controls. Stratified analysis of data from all centers gave an odds ratio of 0.98 (Cornfield 95% confidence limits 0.78-1.24). Analysis by genotype was likewise not significant (overall chi(2) = 0.42). Because we were not able to support the primary hypothesis that Val158Met is a risk factor for AN, we did not perform secondary analysis of minimum body mass index (mBMI), age at onset or illness subtype (restricting or binge purging anorexia). Overall we found no support for the hypothesis that the Val158 allele of COMT gene is associated with AN in our combined European sample.

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