The Relationship Between Family Mealtime Interactions and Eating Disorder in Childhood and Adolescence: A Systematic Review

During childhood and adolescence, family meal frequency has been found to have an inverse relationship with disordered eating behaviour. Also, family interactional patterns differ in families where there is a child with and without an eating disorder. This paper examines the relationship between family mealtime interactions during childhood and adolescence and eating disorder behaviour through a systematic review of the literature. The method was an asystematic electronic search of PsycInfo, Medline and Web of Knowledge undertaken in April 2012. Ten studies demonstrated a significant relationship between family mealtime interactions and disordered eating behaviour. Families where there is a child with an eating disorder display less positive interactions during mealtimes. While the findings can be linked to family based treatment for anorexia nervosa there is a need for prospective research in this area.     

What every nurse needs to know about nocturnal sleep-related eating disorder

This article provides information about a bizarre pattern of eating while asleep called nocturnal sleep-related eating disorder. People with this disorder, which has begun to be studied only recently, demonstrate features of both a sleep disorder and an eating disorder. Many clients are reluctant to initiate discussions regarding this condition because of feelings of powerlessness and shame. Other clients do not discuss their symptoms because nurses and other clinicians fail to gather accurate assessment data due to lack of knowledge within the professional community regarding the disorder. This review includes the historical background, definition of terms, and clinical manifestations of nocturnal sleep-related eating. In addition, emphasis on assessment and clinical management are included. Safety issues, the need to educate health care providers, and the role of the nurse in advocating for appropriate diagnosis, treatment, and referral are addressed.     

Two Case Studies on Family Work with Eating Disorders and Body Image Issues

This article highlights the need for clinicians who work with eating disorders and body image problems to address the deeper family issues underlying these symptoms. The authors propose an eclectic approach including family systems, structural and experiential family therapy theory as a guide. The paper begins with an overview of family therapy theories currently used in the treatment of eating disorders, and goes into greater detail about the three theories highlighted in the eclectic model proposed. The authors present two cases with actual case dialogue, demonstrating how they used this composite model. This article has both theoretical and practical implications for clinicians working in the field.     

Narrative Therapy,Eating Disorders and Groups: Enhancing Outcomes in Rural NSW

Abstract

The present paper reports on a study conducted with seven women who identified themselves as experiencing depression as well as an eating disorder and who live in a rural region of northern New South Wales. Self-referred, the women participated in a weekly group for 10 weeks, with a mixture of topics, conducted within a narrative therapy framework. A comparison of pre- and post-group tests demonstrated a reduction in depression scores and eating disorder risk. All women reported a change in daily practices, together with less self-criticism. These findings were supported by a post-group evaluation survey that revealed that externalisation of, and disengagement from, the eating disorder strongly assisted the women to make changes in their daily practices. Although preliminary and short term, the outcomes of the present study indicate that group work conducted within a narrative therapy framework may result in positive changes for women entangled with depression and an eating disorder.     

Laxative abuse: a hazardous habit for weight control

Laxative abuse is an increasingly popular weight-loss method on college campuses, particularly for individuals with eating disorders. It is a dangerous habit, which many mistakenly believe will prevent caloric absorption and weight gain. Serious medical problems that may occur with laxative abuse include electrolyte and fluid imbalance, structural and functional colonic changes, and allergic reactions. Because patients are often secretive about abusing laxatives, laxative abuse should be considered if there is suspicion about the use of potentially destructive weight-control methods or about an eating disorder. A complete history and physical exam are essential parts of an assessment that should also include questions about diet, eating and exercise habits, and body image. Laboratory tests may provide additional supportive data. Treatment includes education, discontinuation of laxatives, medical follow-up as necessary, and psychotherapy. A college campus is an ideal forum for education, referral, and prevention programs.     

Treating bulimia: A combined therapy approach

Bulimia is an increasingly common eating disorder which is separate and distinct from anorexia nervosa. The disorder is characterized by ingestion of large volumes of food, usually followed by self-induced vomiting or laxative abuse. Although sometimes seen as a symptom accompanying obesity or anorexia nervosa, bulimia is often associated with a normal weight and nutritional state. This paper includes a case study which describes 3 years of treatment and illustrates the personality characteristics common to bulimic patients, demonstrating a marked contrast with the classic anorexia nervosa patient. A combined treatment approach is illustrated which (1) emphasizes individual therapy as the means by which long-term changes in personality can be attained and sustained; (2) uses group therapy to provide peer support and behavioral intervention; and (3) utilizes imipramine to decrease panic and alleviate anxiety and depression.     

Implicit Family Process Rules in Eating-Disordered and Non-Eating-Disordered Families

Family environment has been shown to be one of the factors related to the presence of eating disorders among young-adult females. Clinical experience and theories about eating disorders postulate that implicit family rules are an intricate part of family process that may have a great effect on the creation and maintenance of such problems. This study compared implicit family process rules (specifically rules pertaining to kindness; expressiveness and connection; constraining thoughts, feelings, and self; inappropriate caretaking; and monitoring) in families with a young-adult female diagnosed with an eating disorder—either anorexia nervosa, bulimia nervosa, or eating disorder not otherwise specified—and families with a young-adult female without an eating disorder diagnosis. One hundred two families (51 eating disordered and 51 comparison) participated in the study. Mothers, fathers, young-adult female children, and siblings completed the Family Implicit Rules Profile ( Harper, Stoll, & Larson, 2007 ). Results indicated that eating-disordered families are governed by a greater proportion of constraining family rules than are non-eating-disordered families. Additionally, eating-disordered youth reported a lower proportion of facilitative family rules and a higher proportion of constraining family rules than did parents and siblings. Theoretical, research, and clinical implications are discussed.     

‘Somebody Else's Roadmap’: Lived Experience of Maudsley and Family‐based Therapy for Adolescent Anorexia Nervosa

The Maudsley and more recent family‐based therapy manualised approaches are positioned by some as the gold standard, evidence‐based therapy for adolescent anorexia nervosa (AN). However, a significant proportion of adolescents and their families either discontinue this therapy and/or find that it simply does not work for them. These adolescents and families are under‐represented in the literature on therapeutic interventions for adolescent AN. This paper begins to address this gap with an in‐depth qualitative case study that explores the lived experience of Maudsley family therapy (MFT)/family‐based therapy (FBT) for one female adolescent (age 14 years) and her family over the period of 3 years (ages 11–14). Although initially handing over the responsibility for her eating was comforting and reinstated a sense of control in the family system, these experiences were not maintained. When she did not progress past the first phase of FBT, she and her family experienced the approach as blaming. She felt silenced and family alliances were weakened. This paper analyses how the family members negotiated and preserved their identities within this disabling context.     

THE CLINICAL AND THEORETICAL IMPACT OF A CONTROLLED TRIAL OF FAMILY THERAPY IN ANOREXIA NERVOSA

The paper discusses the practical and theoretical implications of the results of a controlled treatment trial. Family therapy was compared with individual, supportive psychotherapy for the management of severe eating disorder. Family therapy was markedly more effective in achieving improvement in one of four subgroups of patients: (a): those with early onset, short duration; (b) early onset, duration more than 3 years; (c) late onset, after the age of 18 years; (d) those with bulimia nervosa. The therapies used are described, as are the changes in clinical practice arising from the study. Theoretical considerations concerning notions of family structure, the family life-cycle and symptomatic and family change are also discussed.     

Addressing Emotional Communication in Family Relationships in the Treatment of Young People with Anorexia: A Case Study

Family‐based treatment (FBT) is an evidence‐based approach to anorexia nervosa in young people. Because it is not always successful, attention has been given to how families experience the treatment. A number of therapists have proposed possible additions to, or improvements in, the model. In successful cases relational containment may be achieved in the first phase of treatment. The treatment is often successful, but when initial goals, such as weight recovery, are not achieved, continuing to use the techniques described in the manual may become unhelpful. Sometimes therapists may need to address issues such as emotion coaching that are not specifically addressed in the FBT model. We describe a case in which the therapist addressed the family's emotional style in the first stage of treatment. This focus enabled progress to be achieved despite the adolescent's continuing difficulty in eating without parental support, and her escalating symptoms of anxiety and obsessional compulsive disorder (OCD). Therapy helped the adolescent and family understand that anorexic and OCD symptoms can be understood as a way of distracting from and managing distress. When this connection was made in therapy, the parents could help their daughter to manage distress in more adaptive ways. Parents may need help with their own difficulties in processing distress. In this case the parents needed the opportunity to resolve feelings of grief about a miscarriage in order to do so. We propose that therapy should address family difficulties with managing distress from an early stage.     

Therapeutic Process as a Means to Navigate Impasse? Reflections on a Complex Case of Crosscultural Adolescent Family Therapy

This article explores the process of family therapy with a Turkish‐speaking single‐parent family with four children in which suicidal behaviour and family violence have become the norm. The following example describes a pivotal experience early within my career as a family therapist. The universality of first, being a beginner family therapist, and second, receiving a referral of a daunting, difficult case has led me to share my experience here. Central to this article is the focus on therapeutic process as a means to navigate beyond impasse. It is my hope that those who read this article will consider taking the risk to prioritise the therapeutic relationship, even when anxiety about ‘doing something’ to fix the problems is high.     

Women and Weight: A Treatment Programme for Both Normal and Overweight Women Preoccupied by Eating and Related Issues

In this paper a guide to group therapy for women with chronic concerns about overweight, body image and eating behaviour is described. The first level of therapy constitutes a ten-week course designed to help women break obsessional preoccupation with eating, weight and body image. A dilemma is posed so that women see themselves struggling paradoxically for social conformity for thinness on the one hand and to provide nurture and food on the other. The contributions of social environment, early learning and family tradition, present family structure and inappropriate treatment modalities are examined. The second level of treatment is designed for severely obese women who have succeeded in breaking the obsessional concern with eating behaviour. This level focuses on family of origin restraints as well as on current family and particularly marital restraints to weight loss. The preliminary outcome studies have been encouraging but long-term results are not yet available.     

Are we there yet? Faculty Members’ Beliefs and Teaching Practices Related to the Ethical Treatment of Lesbian,Gay, and Bisexual Clients

The purpose of this study was to explore (a) faculty members' beliefs about the ethics of reparative therapy and referring lesbian, gay, and bisexual (LGB) clients, (b) course content related to reparative therapy and referral of LGB clients, and (c) positions taken by programs associated with reparative therapy and referral of LGB clients. A total of 117 faculty members from accredited family therapy programs completed an online survey for this study. While the vast majority of faculty members reported that reparative therapy is unethical, there was less agreement related to the ethics of referring LGB clients, which may highlight the need for clearer ethical guidelines to regulate this potentially harmful practice. Implications for clinical training and future research are discussed.     

Reciprocal Influence of Couple Dynamics and Eating Disorders

Little research has focused on the ways that eating disorder processes and adult couple dynamics influence one another. The purpose of this study was to investigate the reciprocal influence of couple dynamics and eating disorder illness and recovery processes. We conducted 51 interviews with 17 couples where one member identified as currently suffering or having recovered from an eating disorder. Using grounded theory analytical methods, findings include the systemic interplay of the eating disorder and relationship, both partners' perspectives on the eating disorder and its role in the relationship, the noneating disorder partner's impact on the eating disorder, and coping strategies for recovery as a couple. Clinical implications for supporting couples experiencing eating disorder illness and recovery are discussed.     

The Concurrence of Eating Disorders with Histories of Child Abuse Among Adolescents

This study examined the relationship between eating disorders and reported history of physical or sexual abuse among male and female adolescents. A survey administered to high school students in a rural midwestern slate school system contained questions on eating behaviors, weight, lifestyle habits, parental substance abuse, and history of physical abuse, extrafamilial sex abuse and incest. Results showed that eating disorders were correlated with all three types of abuse. There were differences in prevalence of eating and weight problems and of child abuse according to gender and race. Presence of an eating disorder correlated with presence of other addictive behaviors, family history of substance abuse, and with low selfesteem, hopelessness and anxiety.     

Cultural Factors in Collegiate Eating Disorder Pathology: When Family Culture Clashes With Individual Culture

Objective: The authors evaluated the validity of familial enmeshment (extreme proximity in family relationships) as a risk factor for eating disorders across cultural value orientations. They tested the hypothesis that although familial enmeshment may be a risk factor for eating disorder pathology for (1) participants of non-Asian descent or (2) culturally independent participants, enmeshment will not be a risk factor for (1) participants of Asian descent or (2) culturally interdependent participants. Participants: 255 undergraduate women participated. Methods: Participants completed questionnaires on cultural value orientations, enmeshment, and eating disorder pathology. Results: As hypothesized, enmeshment was related to eating disorder pathology in non-Asian American and culturally independent participants, but not in Asian American and culturally interdependent participants. Conclusions: Depending on cultural values, enmeshment may or may not be a risk factor for eating disorders. This study highlights the importance of examining risk factors in the appropriate cultural framework when considering college student mental health.     

“Is This How I'll Be for the Rest of My Life?”

Abstract

Obsessive-compulsive disorder (OCD) is an anxiety disorder affecting 2% to 3% of populations throughout the world. This paper provides an overview of symptoms (obsessional thoughts and compulsive behaviours) and current treatment options (medication and cognitive-behaviour therapy). A case study involving data obtained from an OCD sufferer and her mother is presented. Analysis of the data within the context of past literature highlights the economic and emotional costs of OCD which include years of psychiatric treatment, therapy, and medication, loss of productivity due to long-term unemployment, and individual and family stress. A framework for mental health social work practice assumes three key foci: (1) the family system as a whole; (2) individual family members; (3) a broader perspective that takes into account the need for adequate resources, community education and further research.     

Childhood behavioral and emotional disorders

We reviewed the literature on family treatment for childhood behavioral and emotional disorders and found an increase in the number of studies since 1995; however there was significant variation by disorder and therapy model. There is substantially more research on externalizing disorders (i.e., conduct disorder, attention deficit hyperactivity disorder, oppositional defiant disorder) then internalizing disorders, depression and anxiety disorders. The data support the conclusion that family-based interventions produce results comparable to individually oriented interventions, and in some cases family-based interventions are superior to individual treatments. To date, cognitive behavioral family therapy and parent management have been the two models studied, almost exclusively. Implications for family therapy and future research are considered.