Perceptions of family relationships in adolescents with anorexia nervosa and their unaffected sisters

Abstract

The family relationships of patients with anorexia nervosa (AN) have been extensively studied over recent years. However, using case-control designs with unrelated controls is subject to various cultural and familial biases. Studying subjective differential perceptions of family relationships in sister-pairs discordant for the disorder may overcome some of these limitations. The aim of the present study was therefore, to investigate subjective perceptions of family environments in a clinically ill sample of female adolescent patients with acute AN and in their healthy sisters using the Subjective Family Image Test. We found significantly lower perceived individual autonomy and higher perceived cohesion in patients compared with their sisters but no difference in perceived emotional connectedness. Lower perceived individual autonomy of the ill children resulted mainly from their relationships with mothers but also in part from their relationships with fathers. This observed pattern might contribute to the maintenance of the disorder and should be addressed in individual and family interventions.

Childhood Body-Focused Behaviors and Social Behaviors as Risk Factors of Eating Disorders

“…Findings of childhood social behaviors in eating-disordered patients confirm the literature: insecure attachment, defensive behavior, and low individual autonomy [1, 2, 3, 4, 5, 6, 7, 8, 9, 54, 55, 58]. …”

“…This climate is best illustrated by the measures ‘nudity as a familial taboo’ and ‘sexuality not discussed in the family’, both of which were reported by the majority of eating-disordered patients. Although the literature describes dysfunctions, motherly overprotection, and conflict avoidance in families with eating disorder [1, 2, 3, 4, 5, 6, 7, 11, 18, 53, 54, 55], there are almost no studies looking at specific body-focused behaviors within the family.…”

Caring for a sibling with anorexia nervosa: A qualitative study

“…In contrast to the perception of non-affected siblings, affected siblings perceived themselves as less autonomous within their family and their family as more cohesive (Karwautz et al, 2003). Individuals with eating disorders (ED) perceive their non-affected sibling as more popular, with a greater number of close friendships (Karwautz et al, 2001;Murphy et al, 2000) and to have dated more than the non-affected sibling (Murphy et al, 2000).…”

The patient's view on quality of life and eating disorders

“…Although AN patients perceived their social support to be adequate, BN patients were dissatisfied. In a study of Karwautz et al 22 on the perception of family relationships, AN patients perceived lower individual autonomy and higher perceived cohesion in their family relationships compared to their sisters, but no difference in perceived emotional connectedness. Furthermore in a study on coping strategies and recovery Bloks et al 23 show that recovery in ED patients is associated with seeking social support.…”