Abstract
Background
Although the use of family therapy for adolescents with anorexia nervosa is well established, there has been limited research into the efficacy of family therapy in adolescents with bulimia nervosa (BN). No previous research has investigated why individuals with BN do or do not involve their parents in treatment. This is an exploratory study aimed at determining whether there are any differences between these individuals in terms of eating disorder symptomatology, psychopathology, familial risk factors, patients’ perception of parental expressed emotion (EE) and family functioning.
Methods
Participants were 85 adolescents with BN or Eating Disorder Not Otherwise Specified, recruited to a randomised controlled evaluation of the cost-effectiveness of cognitive-behavioural guided self-care vs. family therapy. Participants were interviewed regarding the history of their eating disorder and completed self-report measures.
Results
Patients who did not involve their parents in treatment were significantly older, had more chronic eating disorder symptoms, exhibited more co-morbid and impulsive behaviours and rated their mothers higher in EE. However, they did not have more severe eating disorder symptomatology.
Conclusions
These preliminary findings, although in need of replication with a larger sample and limited by the attrition rate in some of the self-report measures, indicate that patients who did not involve their parents in treatment may perceive their mothers as having a more blaming and negative attitude towards the patient’s illness. Public awareness about BN needs to be raised, focusing on reducing the stigma and negative views attached to this illness.
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References
Beavers WR, Hampson RB (1990) Successful families: Assessment and intervention. New York: WW, Norton
Brewerton TD, Lydiard B, Herzog DB, Brotman AW, O’Neil PM, Ballenger JC (1995) Comorbidity of Axis I psychiatric disorders in bulimia nervosa. J Clin Psychiatry 56:77–79
Brooks A, LeCouteur A, Hepworth J (1998) Accounts of experiences of bulimia: A discourse analytic study. Int J Eating Disord 24:193–205
Brown GW, Rutter M (1966) The measurement of family activities and relationships: a methodological study. Hum Relations 19:241–263
Bulik CM (1995) Anxiety disorders and eating disorders: A review of their relationship. N Z J Psychol 24:51–62
Butzlaff RL, Hooley JM (1998) Expressed emotion and psychiatric relapse. Arch Gen Psychiatry 55:547–552
Cole JD, Kazarian SS (1988) The Level of Expressed Emotion scale: a new measure of expressed emotion. J Clin Psychol 44(3):392–397
Cooper Z, Cooper PJ, Fairburn CG (1989) The validity of the eating disorder examination and its subscales. Br J Psychiatry 154:807–812
Crisp AH, Gelder MG, Rix S, Meltzer HI, Rowlands OJ (2000) Stigmatisation of people with mental illness. Br J Psychiatry 177:4–7
Dodge E, Hodes M, Eisler I, Dare C (1995) Family therapy for bulimia nervosa in adolescents: An exploratory study. J Fam Ther 17:59–77
Dolan BM, Lieberman S, Evans C, Lacey LH (1990) Family features associated with normal body weight bulimia. Int J Eating Disord 9:639–647
Eisler I, Le Grange D, Asen E (2003) Family Interventions. In: Treasure J, Schmidt U, van Furth E (eds) Handbook of Eating Disorders. 2nd Edition. John Wiley and Sons, pp 291–310
Fairburn CG, Welch SL, Doll HA, Davies BA, O’Connor ME (1997) Risk factors for bulimia nervosa. A communitybased case-control study. Arch Gen Psychiatry 54(6):509–517
Fairburn CG, Doll HA, Welch SL, Hay PJ, Davies BA, O’Connor ME (1998) Risk factors for binge eating disorder: a community-based case-control study. Arch Gen Psychiatry 55:425–432
Fairburn CG, Stice E, Cooper Z, Doll HA, Norman PA, O’Connor ME (2003) Understanding persistence in bulimia nervosa: a 5-year naturalistic study. J Consult Clin Psychol 71(1):103–109
Gardner SB, Winter PD, Gardner MJ (1991) Confidence Interval Analysis. Microcomputer Manual and Disc. Version 1.1. Br Med J
Guy W (1976) ECDEU assessment manual for psychopharmocology. Rockville, MD: US Department of Health, Education and Welfare, pp 516–520
Hedlund S, Fichter MM, Quadflieg N, Brandl C (2003) Expressed emotion, family environment, and parental bonding in bulimia nervosa: A 6-year investigation. Eat Weight Disord 8(1):26–35
Humphrey LL (1986a) Structural analysis of parent-child relationships in eating disorders. J Abn Psychol 95:395–402
Keller MB, Lavori PW, Friedman B, Nielsen E, Endicott J, McDonald-Scott P, Andreasen NC (1987) The Longitudinal Interval Follow-up Evaluation. A Comprehensive Method for Assessment Outcome in Prospective Longitudinal Studies. Arch Gen Psychiatry 44:540–548
Kuipers L, Moore E (1995) Expressed emotion and staff-client relationships. Implications for community care of the severe mentally ill. Int J Ment Health 24(3):13–26
Lacey JH (1993) Self-damaging and addictive behaviour in bulimia nervosa: A catchment area study. Br J Psychiatry 163:190–194
Le Grange D, Lock J, Dymek M (2003) Family-based therapy for adolescents with bulimia nervosa. Am J Psychother 57(2):237–251
Lock J (2002) Treating adolescents with eating disorders in the family context. Empirical and theoretical considerations. Child Adolesc Psychiatr Clin North America 11:331–342
McNamara K, Loveman C (1990) Differences in family functioning among bulimics, repeated dieters and non-dieters. J Clin Psychol 46:518–523
Moos RH, Moos BS (1981) Family Environment Scale Manual 2nd edition, Palo Alto, CA: Consulting Psychologists Press Inc
Moreno JK, Selby MJ, Aved K, Besse C (2000) Differences in family dynamics among anorexic, bulimic, obese and normal women. J Psychother Independent Pract 1(1):75–87
National Collaborating Centre for Mental Health (2004) Eating Disorders. Core Interventions in the treatment and management of anorexia nervosa, bulimia nervosa and related eating disorders. Br Psychol Soc R Coll Psychiatrists
Pole R, Waller DA, Stewart SM, Parkin-Feigenbaum L (1988) Parental caring vs. overprotection in bulimia. Int J Eat Disord 7:601–606
Schmidt U, Tiller J, Hodes M, Treasure J (1993) Risk Factors For The Development of Early Onset Bulimia Nervosa. In: Steinhausen, HC (ed) Eating Disorders and Adolescence. Anorexia and Bulimia Nervosa. Walter de Gruyter and Co. Berlin
Schmidt U, Humfress H, Treasure J (1997) Childhood experiences of care and abuse in eating disorders: Clinical and research implications. Eur Rev Eat Disord 5:184–207
Schwartz RC, Barrett MJ, Saba G (1985) Family therapy for bulimia. In: Garner DM, Garfinkel PE (eds) Handbook of psychotherapy for anorexia nervosa and bulimia New York: Guildford Press, pp 280–307
Stuart GW, Laraia MT, Ballenger JC, Lydiara RB (1990) Early family experiences of women with bulimia and depression. Arch Psychiatr Nurs 4:43–52
Szmukler GI, Eisler I, Russell GFM, Dare C (1985) Anorexia nervosa, parental “expressed emotion” and dropping out of treatment. Br J Psychiatry 147:265–271
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Perkins, S., Schmidt, U., Eisler, I. et al. Why do adolescents with bulimia nervosa choose not to involve their parents in treatment?. Europ.Child & Adolescent Psych 14, 376–385 (2005). https://doi.org/10.1007/s00787-005-0485-4
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DOI: https://doi.org/10.1007/s00787-005-0485-4