FAMILY INFLUENCES - emphasis on appearance?

traditional viewpoint (e.g. mother-daughter relationship)

current viewpoint (e.g. multifactorial and interactive)

family/genetic transmissionstransactional family patterns (Marcus &

Wiener, 1989)

appearance-related research

Traditional Viewpoints

Traditional #1 - anorexia as symptom e.g. any patient who lost 25 lbs was

anorexic did not think weight loss & fear of

obesity shared a common etiology AN seen as symptomatic of a variety

of underlying pathologies

Traditional Viewpoints

Traditional #2 - anorexia as single syndrome e.g. Bruch - denial of thinness,

struggle for control, separation-individuation

e.g. Crisp - weight and fat phobia, return to prepubescence

these statements are incompatible

Traditional Viewpoints

Traditional #3 - AN as multiple syndrome e.g. Janet - hysterical & obsessive

anorexics e.g. Garner, Molodofsky & Garfinkel -

distinguished between purging & nonpurging anorexics

need some commonality?

Current Viewpoint - Multifactorial

biological factors e.g. heritable aspects of mood, temperament,

impulse regulation, appetite

social pressures e.g. pursuit of thinness, overachievement

psychological vulnerabilities e.g. personality, self-disturbances

Family Contributions

Minuchin et al. (1978):enmeshmentoverprotectivenessrigidityconflict avoidancepoor conflict resolution

Restrictor/Bulimic Differencesrestrictor: overprotective,

overcontrolling, boundary problems, conflict avoidance, emotional restriction ‘nurturant enmeshment’

bulimic: higher levels of conflict, greater use of threats and physical coercion, violence between parents, neglectful family interaction styles

Transactional Family Patterns in Eating Disorders (Marcus & Wiener, 1989)

6 psychosocial transactional patternsanorexia as a behavioural pattern

anorexic deals with daily psychosocial events

both unusual and typical behaviours arise from same socialization patterns

atypical eating behaviour is acquired & maintained the same way as typical behaviour

structural-contextual model (not causal)

Transactional Family Patterns in Eating Disorders (Marcus & Wiener, 1989)

unit of analysis is the “transaction” event event incorporates what members do

themes are important what participant says & does during

transaction both verbal & nonverbal

improvisational script predictable pattern within family transactions limits or precludes change in content of

subsequent transactions

(1) Negativistic

theme of family script is “you should…you must…you have to” and “I won’t…you can’t make me”

food refusal is a way of acting against limitsnon-eating is done overtly

issues is control, not food distaste for the food

more likely to become bingers & purgers in parents’ absence

(2) Attention centering pattern

unless the child needs attention, the parents are often preoccupied with other concerns

limited eating elicits responses of concern & often exasperation

made to feel guilty about not eatingdifficulty with the food, not about

control or anger e.g. “It makes me sick”

(3) Distracting pattern

child’s behaviour distracts the parents from their marital difficulties

maintain family cohesion arguments seen as dangerous, as one parent

might leave the family

child typically is silent & does little other than not eat

child’s health is often negatively correlated with the degree of marital accord

(4) Childlike pattern

weight loss serves to maintain a dependent, conforming & nonsexual child

food refusal has helpless, immature quality e.g. “peas are yucky”

food quantity is predominant feature

focus on being the “good little girl”

(5) Attractive pattern

family theme is importance of “looks” and attractiveness for both the parents and the children

mother-daughter interaction focuses on diet tips, exercise, clothes

father places value on being a “good looking” woman

appearance is the issue food is not bad, as long as no weight gain occurs bingeing and purging may be common

(6) Self-punishing (aka “holy anorexia”)

seen as asocial, obsessive, withdrawn, loner, “strange”

rightness or wrongness of behaviour in generalapproval isn’t given to anything that isn’t

perfect food is not importantpleasure and fun are “sinful” family members are at the low end of the

weight scale, may not notice anorectic appearance

Familial Transmission

well-controlled studies have shown clear familial aggregation for AN and less consistently for BN

suggests that EDs may be familially transmitted syndromes

e.g. family study conducted found that the relative risks for AN were 11.3 and 12.3 in female relatives of AN and BN probands

the relative risks for bulimia were 4.2 and 4.4 for female relatives of AN and BN probands

Nature versus Nurture - Probable explanations

evidence of higher concordance among monozygotic than dizygotic twins

genetic? Confound as former have greater shared environment than the latter

“family trait” concept: effect of heritable temperamental traits that heighten susceptibility

e.g. anxiety or depression proneness

Familial eating concerns & traits - transgenerational effects

lack of attitudinal abnormalities in parents of ED patients

research demonstrates various personality & psychopathological traits to be familial in nature

ECS, DET, OCT (Steiger et al., 1996) parents’ affective instability & narcissism

with daughters’ eating & appearance

“Beauty” research in ED populations

objective vs subjective ratings of attractiveness

subjective attractiveness inversely related to weight & diet concerns

attractiveness (objective) positively related to weight preoccupation after controlling for body size and neurotic perfectionism

Recursive structural equation model(Davis et al., 2000)

N

SOP

FA

BMI

NPQ

WP