[Family environment in eating disorders: a study of the familiar factors influencing the onset and course of eating disorders].

OBJECTIVE: This study investigated the association of family environment and symptomatic characteristics in eating disorders.

METHOD: The subjects studied were 180 eating disorder patients who sought treatment at Tokai University Hospital and whose diagnoses were made using the SCID (Structured Clinical Interview for DSM-III-R) modified for DSM-IV. The subjects consisted of 52 Anorexia Nervosa Restricting Type (AN/R), 40 Anorexia Nervosa Binge-Eating/Purging Type (AN/BP), 57 Bulimia Nervosa Purging Type (BN/P), 17 Bulimia Nervosa Nonpurging Type (BN/NP) and 14 Binge-Eating Disorder (BED). All subjects were given the Family Adaptability & Cohesion Evaluation Scales III (FACES-III). Seventy eight female college students were administered the FACES-III, as normal controls.

RESULTS: On the cohesion (CO) dimensions of FACES-III, most AN/R perceived their families as significantly enmeshed (high CO), whereas most BN and BED perceived their families as disengaged (low CO). The families of AN/BP rated lower CO than AN/R, and higher CO than BN. On the adaptability dimension of FACES-III, most AN/BP and BED perceived their families as rigid, and most BN/P perceived their families either rigid or chaotic.

DISCUSSION: 1) The family environment of eating disorder patients exist, on a continuum of cohesion, from AN/R (enmeshed), through AN/BP (intermediate cohesion) and BN (disengaged), to BED (most disengaged). It's suggested that there might be an association of enmeshed family environment and severity of restrict-eating. In addition, the disengaged family environment might have an association with the onset of binge-eating. 2) It's also suggested that the two extremes on the adaptability dimension, rigid and chaotic, were the characteristic features of the family environment, which might precipitate and maintain binge-eating and purging symptoms. 3) The two hypotheses were proposed with regard to the familiar contribution on the outcome of AN/R. (a) AN/R, whose family environment are enmeshed, would not develop bulimic symptoms in the future. (b) AN/R, whose family environment are disengaged, particularly with rigid or chaotic atmosphere, have high risks of developing bulimia later. 4) The author discussed that dividing AN/BP into the two categories: binge subtype and non-binge subtype, should be recommended in the future diagnostic classification of the eating disorders, on the basis of analyzing both groups' family environments. 5) Comparing the family environment of the Japanese BED and the western BED suggested that the Japanese BED might be more severe in psychopathology. The author discussed the comorbidity of BED and the Borderline Personality Disorder, as well as the social influence on the clinical features of BED.