Family functioning in adolescent anorexia nervosa: A comparison of family members’ perceptions

  • F. Emanuelli
  • R. Ostuzzi
  • M. Cuzzolaro
  • F. Baggio
  • B. Lask
  • G. Waller
Original Research Paper


Abnormal patterns of family functioning have often been reported in anorexia nervosa. Moreover, members of families with an adult with eating disorders have different family functioning perspectives. This study investigated whether differences in family members’ perspectives, similar to the ones found in families of adults with eating disorders, can be found in families of adolescents with anorexia nervosa. Perceived family functioning, measured with the Family Assessment Device, was compared between 49 control and 34 clinical families, and across family members. Differences were found between the two groups on a number of aspects of family functioning, with the clinical families showing most disturbances. There was a general agreement across family members in their perceptions of family functioning, with one notable exception. Clinical daughters disagreed with both their parents about the family level of communication, whereas control daughters disagreed only with their fathers. Disagreements between clinical adolescents and their mothers about the family communication style appear to be important in anorexia nervosa in this age group, although it is not possible to reach conclusions about the direction of causality. These findings support the use of family-oriented therapies that aim to identify and work with difficulties in communication within the family.


Perceptions of family functioning anorexia nervosa family therapy 


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  1. 1.
    Kog E., Vandereyecken W.: The facts: a review of research data on eating disorders families. In: Kog E., Vanderlinden J. (Eds.), The family approach to eating disorders: assessment and treatment of anorexia and bulimia. New York, PMA, 1988, pp. 25–46.Google Scholar
  2. 2.
    Waller G., Calam R., Slade P.: Eating disorders and family interaction. Br. J. Clin. Psychol., 28, 285–286, 1989.PubMedCrossRefGoogle Scholar
  3. 3.
    Bruch H.: Eating disorders. Obesity, anorexia nervosa and the person within. London, Routledge & Kegan Paul, 1974.Google Scholar
  4. 4.
    Minuchin S., Rosman B.L., Baker L: Psycho-somatic families: anorexia nervosa in context. Cambridge, MA, Harvard University Press, 1978.Google Scholar
  5. 5.
    Selvini Palazzoli M.: Self-starvation. London, Chaucer, 1974.Google Scholar
  6. 6.
    Strober M.: Family factors in adolescent eating disorders. In: Cooper P.J., Stein A. (Eds.), Feeding problems and eating disorders in children and adolescents. Chur, Harwood Academic Publishers, 1992, pp. 139–146.Google Scholar
  7. 7.
    Russell J.D., Kopec-Schrader E., Rey J.M., Beumont P.J.V.: The Parental Bonding Instrument in adolescent patients with anorexia nervosa. Acta Psychiatr. Scand., 86, 236–239, 1992.PubMedCrossRefGoogle Scholar
  8. 8.
    Strober M.: The significance of bulimia in juvenile anorexia nervosa: an exploration of possible etiological factors. Int. J. Eat. Disord., 1, 28–34, 1981.CrossRefGoogle Scholar
  9. 9.
    Epstein N.B., Baldwin L.M., Bishop D.S.: The McMaster Family Assessment Device. J. Marital Fam. Therapy, 9, 171–180, 1983.CrossRefGoogle Scholar
  10. 10.
    Waller G., Slade P., Calam R.: Who knows best? Family interaction and eating disorders. Br. J. Psychiatry, 156, 546–550, 1990.PubMedCrossRefGoogle Scholar
  11. 11.
    Friedmann M.S., McDermut W.H., Solomon D.A., Ryan C.E., Keitner G.I., Miller I.W.: Family functioning and mental illness: a comparison of psychiatric and nonclinical families. Fam. Process, 36, 357–367, 1997.PubMedCrossRefGoogle Scholar
  12. 12.
    North C., Gowers S., Byram V.: Family functioning in adolescent anorexia nervosa. Br. J. Psychiatry, 167, 673–678, 1995.PubMedCrossRefGoogle Scholar
  13. 13.
    Waller G., Calam R., Slade P.: Family interaction and eating disorders: do family members agree? Br. Rev. Bulimia and Anorexia, 3, 33–44, 1988.Google Scholar
  14. 14.
    Dare C., LeGrange D., Eisler I., Rutherford J.: Redefining the psychosomatic family: family process of 26 eating disorder families. Int. J. Eat. Dis., 16, 211–226, 1994.CrossRefGoogle Scholar
  15. 15.
    Akister J., Stevenson-Hinde J.: Identifying families at risk: exploring the potential of the McMaster Family Assessment Device. J. Fam. Therapy, 13, 411–421, 1991.CrossRefGoogle Scholar
  16. 16.
    Eisler I., Dare C., Russell G., Szmukler G., le Grange D., Dodge E.: Family and individual therapy in anorexia nervosa: a five year follow-up. Arch. Gen. Psychiatry, 54, 1025–1030, 1997.PubMedCrossRefGoogle Scholar
  17. 17.
    Russell G., Szmukler G., Dare C., Eisler I.: An evaluation of family therapy in anorexia nervosa and bulimia nervosa. Arch. Gen. Psychiatry, 44, 1047–1056, 1987.PubMedCrossRefGoogle Scholar
  18. 18.
    Bryant-Waugh R., Lask B.: Annotation: eating disorders in children. J. Ch. Psychology Psychiatry, 36, 191–202, 1995.CrossRefGoogle Scholar
  19. 19.
    Nicholls D., Chater R., Lask B.: Children into DSM don’t go: A comparison of classification systems for eating disorders in childhood and early adolescence. Int. J. Eat. Disord., 28, 317–324, 2000.PubMedCrossRefGoogle Scholar
  20. 20.
    Roncone R., Rossi L., Muiere E., Impallomeni M., Matteucci M., Giacomelli R., Tonietti G., Casacchia M.: The Italian version of the Family Assessment Device. Soc. Psychiatry Psychiatric. Epidem., 33, 451–461, 1998.CrossRefGoogle Scholar
  21. 21.
    Epstein N.B., Bishop D.S., Baldwin L.M.: McMaster model of family functioning: a view of the normal family. In: Walsh F. (Ed.), Normal family processes. New York, Guilford Press, 1981, pp. 115–141.Google Scholar
  22. 22.
    Miller I.W., Epstein N.B., Bishop D.S., Keitner G.I.: The McMaster Family Assessment Device: reliability and validity. J. Marital Fam. Therapy, 11, 345–356, 1985.CrossRefGoogle Scholar
  23. 23.
    Stevenson-Hinde J., Akister J.: The McMaster model of family functioning: observer and parental ratings in a nonclinical sample. Fam. Process, 34, 337–347, 1995.PubMedCrossRefGoogle Scholar
  24. 24.
    Kabacoff R.I., Miller I.W., Bishop D.S., Epstein N.B., Keitner G.I.: A psychometric study of the McMaster Family Assessment Device in psychiatric, medical, and nonclinical samples. J. Fam. Psychol., 3, 431–439, 1990.CrossRefGoogle Scholar
  25. 25.
    Wallin U., Røijen S., Hansson K.: Too close or too separate: family function in families with an anorexia nervosa patients in two Nordic countries. J. Fam. Ther., 18, 4, 1996.CrossRefGoogle Scholar
  26. 26.
    Christie D., Watkins B., Lask B.: Assessment. In: Lask B., Bryant-Waugh R. (Eds.), Anorexia nervosa and related eating disorders in childhood and adolescence (2nd ed.). Hove, UK, Psychology Press Ltd., 2000, pp. 105–126.Google Scholar
  27. 27.
    Emanuelli F., Meyer C., Dennis L., Snell R., Waller G.: Perceived family function, core beliefs and eating pathology. Eating Disorders Research Society Annual Meeting — Poster session, Charleston, South Carolina, November 20th–November 23rd 2002.Google Scholar
  28. 28.
    Brunton J., Lacey H., Waller G.: Eating pathology in young adults: a pilot study of the impact of parental personality. Eating Disorders Research Society Annual Meeting — Poster session, Charleston, South Carolina, November 20th–November 23rd 2002.Google Scholar
  29. 29.
    Antonovsky A.: Unravelling the mystery of health. London, Jossey-Bass Inc. Pub., 1987.Google Scholar
  30. 30.
    Røijen S.: Eating disorders and family therapy: why, how and when? Eat. Weight Disord., 5, 16–23, 2000.PubMedGoogle Scholar
  31. 31.
    Vandereycken W.: Families of patients with eating disorders. In: Fairburn C.G., Brownell K.D. (Eds), Eating disorders and obesity, 2nd ed. London, The Guilford Press, 2002, pp. 215–220.Google Scholar

Copyright information

© Editrice Kurtis 2004

Authors and Affiliations

  • F. Emanuelli
    • 1
  • R. Ostuzzi
    • 2
  • M. Cuzzolaro
    • 3
  • F. Baggio
    • 4
  • B. Lask
    • 1
  • G. Waller
    • 1
  1. 1.Department of Mental HealthSt. George’s Hospital Medical SchoolLondonUK
  2. 2.Casa di Cura Villa MargheritaArcugnano (VI)Italy
  3. 3.Dipartimento di Scienze Neurologiche e Psichiatriche dell’ Età EvolutivaUniversità di Roma La SapienzaRomaItaly
  4. 4.DidascoVeronaItaly

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