Skip to main content
Log in

Family relations and eating disorders. The effectiveness of an integrated approach in the treatment of anorexia and bulimia in teenagers: Results of a case-control systemic research

  • Original Research Paper
  • Published:
Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity Aims and scope Submit manuscript

Abstract

This article presents the results of a broader clinical research into the effectiveness of integrated treatments in teenage eating disorders, carried out at the Complex Operative Unit of Psychotherapy (Unità Operativa Complessa or U.O.C.) of the Department of Psychiatric Sciences and Psychological Medicine in collaboration with the Department of Neuropsychiatric Science for Child Development (Dipartimento di Scienze Neuropsichiatriche dell’Età Evolutiva), both at the “La Sapienza” University of Rome. The hypothesis of this research project is that in diagnosticable situations such as anorexia or bulimia, an integrated and multidisciplinary treatment, which combines medical-nutritional interventions and family psychotherapy, allows better results than a single kind of treatment, which is the usual medical- nutritional intervention supported by psychiatric counselling. Twenty-eight cases (16 of bulimia and 12 of anorexia) were selected and then subdivided, with a randomized distribution, into two (experimental and control) homogeneous groups of 14 patients. The grouping variables were the diagnosis, the disorder’s seriousness and duration, BMI, gender, age, family composition and social status. The variables which have been examined in this article are the clinical parameters, which were valuated in accordance with the DSM IV-TR criteria, and relational parameters which were explored through the use of the W.F.T. Test (Wiltwyck Family Tasks). These parameters were tested at beginning as well as at the end of the therapies, in both the experimental group and the control group. Statistical analysis has shown that the experimental group, which was followed with the integrated treatment, experienced a significant improvement of the parameters as related to dysfunctional family interaction modalities, and that this improvement was correlated to the positive evolution of the clinical parameters. This improvement was not present or not of the same degree in the control group. The results, moreover, demonstrate the effectiveness of an integrated systemic treatment based on a complex approach compared to a reductionist approach.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Gordon RA. Anorexia and Bulimia: The Anatomy of a Social Epidemic. New York, Blackwell, 1990.

    Google Scholar 

  2. Dalla Ragione L. La casa delle bambine che non mangiano. Identità e nuovi disturbi del comportamento alimentare. Roma, Il Pensiero Scientifico Editore, 2005.

    Google Scholar 

  3. Hoek HW, van Hoeken D. Review of the prevalence and incidence of eating disorders. Int J Eat Disord 2003; 34: 383–96.

    Article  PubMed  Google Scholar 

  4. American Psychiatric Association DSM-IV-TR. Manuale diagnostico e statistico dei disturbi mentali. Text Revision. Milano, Masson, 2001.

    Google Scholar 

  5. Lucas AR, Beard CM, O’Fallon WM, et al. 50-year trends in the incidence of anorexia nervosa in Rochester, Minn.: a population-based study. Am J Psychiatry 1991; 148: 917–22.

    PubMed  CAS  Google Scholar 

  6. Kohn M, Golden NH. Eating disorders in children and adolescents: epidemiology, diagnosis and treatment. Paediatric Drugs 2001; 3: 91–9.

    Article  PubMed  CAS  Google Scholar 

  7. Jeammet P. Le devenir de l’anorexie mentale: une étude prospective de 129 patients evalués au moins 4 ans après leur prèmiere admission. Psychiatrie de l’enfant 1991; 34: 381–442.

    PubMed  CAS  Google Scholar 

  8. Jeammet P. Anorexie Boulimie. Les paradoxes de l’adolescence. Paris, Hachette Littératures, 2005.

    Google Scholar 

  9. Speranza AM. Aspetti diagnostici e caratteristiche psicopatologiche nei disturbi alimentari: un contributo di ricerca. In: Recalcati M (Ed) Il corpo ostaggio. Teoria e clinica dell’anoressia-bulimia. Roma, Ed. Borla, 1998.

    Google Scholar 

  10. Willi J, Giacometti G, Limacher B. Update on the epidemiology of anorexia nervosa in a defined region of Switzerland. Am J Psychiatry 1990; 147: 1514–7.

    PubMed  CAS  Google Scholar 

  11. Hall A, Hay P. Eating disorder patient referrals from a population region 1977–1986. Psychol Med 1991; 21: 697–701.

    Article  PubMed  CAS  Google Scholar 

  12. Hoek HW, Bartelds AIM, et al. lmpact of urbanization on detection rates of eating disorders. Am J Psychiatry 1995; 152: 1272–8.

    PubMed  CAS  Google Scholar 

  13. Turnbull S, Ward A, Treasure J, et al. The demand for eating disorder care: An epidemiological study using the General Practice Research Database. Br J Psychiatry 1996; 169: 705–12.

    Article  PubMed  CAS  Google Scholar 

  14. Fairburn CG, Harrison PJ. Eating Disorders. Lancet 2003; 361: 407–16.

    Article  PubMed  Google Scholar 

  15. Cuzzolaro M. Epidemiology of eating disorders. Some remarks of long term trends in incidence and prevalence in western countries. Adv Biosci 1995; 90: 105.

    Google Scholar 

  16. Cuzzolaro M. Anoressie e bulimie. Bologna, Ed. Il Mulino, 2004.

    Google Scholar 

  17. Harris EC, Barraclough B. Excess mortality of mental disorder. Br J Psychiatry 1998; 173: 11–53.

    Article  PubMed  CAS  Google Scholar 

  18. Birmingham CL, Su J, Hlynsky JA, et al. The mortality rate from anorexia nervosa. Int J Eat Disord 2005; 38: 143–6.

    Article  PubMed  Google Scholar 

  19. Onnis L. L’anoressia mentale nell’ottica della complessità: aspetti socio-culturali, psicodinamici, familiari. Attualità in Psicologia 1994; 9: 17–9.

    Google Scholar 

  20. Selvini Palazzoli M, Cirillo S, Selvini M, et al. Ragazze anoressiche e bulimiche. Milano, Ed. Raffaello Cortina, 1998.

    Google Scholar 

  21. Onnis L, Belcastro M, Benedetti P, et al. Research project on the treatment of anorexia and bulimia: An integrative, multidimensional approach. Eat Weight Disord 1997; 2: 164–8.

    Article  PubMed  CAS  Google Scholar 

  22. Onnis L, et al. Il Tempo Sospeso — Anoressia e Bulimia tra Individuo, Famiglia e Società. Milano, Ed. Franco Angeli, 2004.

    Google Scholar 

  23. Onnis L, Barbara E, Bernardini M, et al. La terapia sistemica integrata dell’anoressia e bulimia. Un’esperienza in un Servizio Universitario. Psicobiettivo 2005; 3: 85–7.

    Google Scholar 

  24. Jackson D. The study of the family. Family Process 1965; 4: 1–20.

    Article  Google Scholar 

  25. Minuchin S, Rosman B, Baker C. Psychosomatic Families. Cambridge, MA, Harvard University Press, 1978.

    Google Scholar 

  26. Stierlin H, Weber G. Unlocking the family door: a systemic approach to the understanding and treatment of anorexia nervosa. New York, Brunner/Mazel, 1989.

    Google Scholar 

  27. Selvini Palazzoli M. Anoressia-bulimia: un’epidemia sociale. Lo schiacciante numero di ruoli nella donna contemporanea. Terapia Familiare 1997; 53: 47–51.

    Google Scholar 

  28. Minuchin S, Montalvo B, Guerney B, et al. Families of the Slums. New York, Ed. Basic Books, 1967.

    Google Scholar 

  29. Minuchin S. Families and Family Therapy. Cambridge, MA, Harvard University Press, 1976.

    Google Scholar 

  30. Hodes M, Eisler I, Dare C. Family therapy for anorexia nervosa in adolescence: a review. J Res Soc Med 1991; 84: 359–62.

    CAS  Google Scholar 

  31. Le Grange D, Eisler I, Dare C, et al. Evaluation of family treatments in adolescent anorexia nervosa: A pilot study. Int J Eat Disord 1992; 12: 347–57.

    Article  Google Scholar 

  32. Russell GF, Szmulker G, Dare C, et al. An evaluation of family therapy in anorexia nervosa and bulimia nervosa. Arch Gen Psychiatry 1987; 44: 1047–56

    Article  PubMed  CAS  Google Scholar 

  33. Eisler I, Dare C, Russell GFM, et al. Family and individual therapy in anorexia nervosa. A 5-year follow-up. Arch Gen Psychiatry 1997; 54: 1025–30.

    Article  PubMed  CAS  Google Scholar 

  34. Eisler I, Dare C, Hodes M, et al. Family therapy for adolescent anorexia nervosa: The results of a controlled comparison of two family interventions. J Child Psychol Psychiatry 2000; 41: 727–36.

    Article  PubMed  CAS  Google Scholar 

  35. Arthur L, Robin D, Siegel PT, et al. Family versus individual therapy for anorexia: Impact on family conflict. Int J Eat Disor 1994; 17: 313–22.

    Google Scholar 

  36. Crisp AH, Norton K, Gowers S, et al. A controlled study of the effect of family and individual therapy in anorexia nervosa — a five-year follow-up. Arch Gen Psychiatry 2002; 54: 1025–30.

    Google Scholar 

  37. Lock J, Le Grange D, Forsberg S, et al. Is family therapy useful for treating children with anorexia nervosa? Results of a case series. J Am Acad Child Adolesc Psychiatry 2006; 11: 1323–8.

    Article  Google Scholar 

  38. Le Grange D, Lock J, Dymek M. Family-based therapy for adolescents with bulimia nervosa. Am J Psychother 2003; 2: 237–51.

    Google Scholar 

  39. Le Grange D, Crosby RD, Rathouz PJ, et al. A randomized controlled comparison of family-based treatment and supportive psychotherapy for adolescent bulimia nervosa. Arch Gen Psychiatry 2007; 64: 1049–56.

    Article  PubMed  Google Scholar 

  40. Perkins S, Schmidt U, Eisler I, et al. Why do adolescents with bulimia nervosa choose not to involve their parents in treatment? Eur Child Adolesc Psychiatry 2005; 14: 376–85.

    Article  PubMed  Google Scholar 

  41. Doyen C, Le Heuzey MF, Cook S, et al. Anorexie mentale de l’enfant et de l’adolescente: nouvelles approches thérapeutiques. Archives de Pédiatrie 1999; 6: 121–23.

    Article  Google Scholar 

  42. Cook-Darzens S, Doyen C, Mouren-Siméoni MC. A joint family consultation approach to the initial treatment of early-onset anorexia nervosa in a French pediatric hospital. J Fam Psychother 2001; 12: 55–77.

    Article  Google Scholar 

  43. Cook-Darzens S. Thérapie familiale de l’adolescent anorexique. Paris, Ed. Dunod, 2002.

    Google Scholar 

  44. Eisler I. The empirical and theoretical base of family therapy and multiple family day therapy for adolescent anorexia nervosa. J Fam Ther 2005; 27: 104–31.

    Article  Google Scholar 

  45. Scholz M, Rix M, Scholz K, et al. Multiple family therapy for anorexia nervosa: concepts, experiences and results. J Fam Ther 2005; 27: 132–41.

    Article  Google Scholar 

  46. Geist R, Heineman M, Stephens D, et al. Comparison of family therapy and family group psychoeducation in adolescents with anorexia nervosa. Can J Psychiatry 2000; 45: 173–8.

    PubMed  CAS  Google Scholar 

  47. Lock J, Agras WS, Bryson S, et al. A comparison of short-and long-term family therapy for adolescent anorexia nervosa. J Am Acad Child Adolesc Psychiatry 2005; 7: 632–9.

    Article  Google Scholar 

  48. Lock J, Couturier J, Agras WS. Comparison of longterm outcomes in adolescents with anorexia nervosa treated with family therapy. J Am Acad Child Adolesc Psychiatry 2006; 45: 666–72.

    Article  PubMed  Google Scholar 

  49. Onnis L. Psychosomatic Medicine: toward a new epistemology. Fam Syst Med 1993; 11: 137–48.

    Article  Google Scholar 

  50. Onnis L, Mulè AM, Vietri A. Anoressia e bulimia: nuovi indirizzi nell’ottica sistemica. Psicobiettivo 2001; 3: 31–46.

    Google Scholar 

  51. Selvini Palazzoli M, Cirillo S, Selvini M, et al. I giochi psicotici nella famiglia. Milano, Ed. Raffaello Cortina, 1988.

    Google Scholar 

  52. Onnis L, Di Gennaro A, Cespa G, et al. Le sculture del ‘presente’ e del ‘futuro’: un modello di lavoro terapeutico nelle situazioni psicosomatiche. Ecologia della mente 1990; 10: 21–46.

    Google Scholar 

  53. Onnis L, Di Gennaro A, Cespa G, et al. Sculpting Present and Future: a Systemic Intervention Model applied to Psychosomatic Families. Fam Process 1994; 33: 341–55.

    Article  PubMed  CAS  Google Scholar 

  54. Garner DM, Garfinkel PE. The eating attitudes test: an index of the symptoms of anorexia nervosa. Psychol Med 1979; 2: 273–9.

    Article  Google Scholar 

  55. Garner DM, Olmstead M, Polivy J. Development and validation of a multidimensional eating disorder inventory for anorexia nervosa and bulimia. Int J Eat Disord 1983; 2: 15–34.

    Article  Google Scholar 

  56. Derogatis LR. Manual of the SCL-90-R. Baltimore Clinical Psychometric Research, 1983.

    Google Scholar 

  57. Cuzzolaro M, Vetrone G, Marano GF, et al. BUT: una nuova scala per la valutazione del disagio relativo all’immagine del corpo. Psichiatria dell’Infanzia e dell’Adolescenza 1999; 66: 417–28.

    Google Scholar 

  58. Machover K. Drawing of the Human Figure: A Method of Personality Investigation. In: Anderson HH, Anderson GL (Eds) An Introduction to Projective Techniques and Other Devices for Understanding the Dynamics of Human Behavior. Englewood Cliffs, NJ, Prentice-Hall, 1951.

    Google Scholar 

  59. Corman L. The Double in the “Draw a Family” Test. L’Evolution Psychiatrique 1967; 1: 117–47.

    Google Scholar 

  60. Onnis L, Tortolani D, Di Gennaro A, et al. Il bambino con disturbi psicosomatici. La famiglia, la domanda, il servizio. Quaderni del CNR n. 19. Roma, Ed. NIS, 1985.

    Google Scholar 

  61. Onnis L, Tortolani D, Cancrini L. Systemic research on chronicity factors in infantile asthma. Fam Process 1986; 25: 107–22.

    Article  PubMed  CAS  Google Scholar 

  62. Onnis L, Tortolani D, Di Gennaro A, et al. Il bambino asmatico, la famiglia, l’intervento medico: revisione del concetto d’intrattabilità della malattia in una prospettiva sistemica. Ecologia della Mente 1986; 1: 15–36.

    Google Scholar 

  63. Onnis L, Di Gennaro A, Cespa G, et al. Prevention of chronicity in psychosomatic illness: a systemic research study into the treatment of childhood asthma. Fam Syst Health 2001; 19: 237–50.

    Article  Google Scholar 

  64. Szapocznik J, Rio AT, Hervis OE, et al. Assessing change in family functioning as a result of treatment: The Structural Family Systems Rating Scale (SFSR). J Marital Fam Ther 1991; 17: 295–310.

    Article  Google Scholar 

  65. Kopelowicz A, López SR, Zarate R, et al. Expressed emotion and family interactions in Mexican Americans with schizophrenia. J Nerv Mental Dis 2006; 194: 330–4.

    Article  Google Scholar 

  66. Szapocznik J, Mitrani VB, Lewis JE, et al. The role of family functioning in the stress process of dementia caregivers: a structural family framework. Gerontologist 2006; 46; 97–105.

    Article  PubMed Central  PubMed  Google Scholar 

  67. Mostwin D. Life Space Approach to the Study and Treatment of a Family. Washington DC, The Catholic University of America Press, 1980.

    Google Scholar 

  68. Onnis L, Barbara E, Di Giacomo S, et al. Dinamiche relazionali in famiglie con pazienti anoressiche e bulimiche adolescenti: risultati di una ricerca clinica. Ecologia della mente 2009; 2: 169–86.

    Google Scholar 

  69. Onnis L. Family and individual in adolescent mental anorexia. An experience of a “suspended time”. Human Systems 2011 (in press).

    Google Scholar 

  70. Onnis L, Cafagna D, Cherubini R, et al. Il disturbo dell’immagine corporea nell’anoressia e bulimia: risultati di una ricerca. Psicobiettivo 2006; 26: 135–50.

    Google Scholar 

  71. Onnis L, Bernardini M, Cafagna D, et al. Identità di genere e processi di identificazione nell’anoressia e bulimia dell’adolescenza. Dati dei tests proiettivi, utilizzati nel quadro di una ricerca sistemica. Infanzia e Adolescenza 2008; 2: 77–86.

    Google Scholar 

  72. Onnis L, Bernardini M, D’Onofrio C, et al. L’organizzazione dei legami familiari nell’anoressia e bulimia. Efficacia di un trattamento integrato. Psicobiettivo 2010; 30: 137–57.

    Google Scholar 

  73. Onnis L, Barbara E, Bernardini M, et al. L’approccio integrato in anoressia e bulimia: risultati preliminari di una ricerca sistemica. Medicina Psicosomatica 2010; 55: 13–25.

    Google Scholar 

  74. Bateson G. Mind and Nature: A Necessary Unity. New York, Dutton, 1979.

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to L. Onnis.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Onnis, L., Barbara, E., Bernardini, M. et al. Family relations and eating disorders. The effectiveness of an integrated approach in the treatment of anorexia and bulimia in teenagers: Results of a case-control systemic research. Eat Weight Disord 17, e36–e48 (2012). https://doi.org/10.1007/BF03325326

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF03325326

Key words

Navigation