Perception of autonomy and connectedness prior to the onset of anorexia nervosa and bulimia nervosa.

Zeitschrift fur Kinder- und Jugendpsychiatrie und Psychotherapie

PubMedID: 22161943

Huemer J, Haidvogl M, Mattejat F, Wagner G, Nobis G, Fernandez-Aranda F, Collier DA, Treasure JL, Karwautz AF. Perception of autonomy and connectedness prior to the onset of anorexia nervosa and bulimia nervosa. Z Kinder Jugendpsychiatr Psychother. 2012;40(1):61-8.
OBJECTIVE
This study examines retrospective correlates of nonshared family environment prior to onset of disease, by means of multiple familial informants, among anorexia and bulimia nervosa patients.

METHODS
A total of 332 participants was included (anorexia nervosa, restrictive type (AN-R): n = 41 plus families); bulimic patients (anorexia nervosa, binge-purging type; bulimia nervosa: n = 59 plus families). The EATAET Lifetime Diagnostic Interview was used to establish the diagnosis; the Subjective Family Image Test was used to derive emotional connectedness (EC) and individual autonomy (IA).

RESULTS
Bulimic and AN-R patients perceived significantly lower EC prior to onset of disease compared to their healthy sisters. Bulimic patients perceived significantly lower EC prior to onset of disease compared to AN-R patients and compared to their mothers and fathers. A low family sum - sister pairs sum comparison - of EC had a significant influence on the risk of developing bulimia nervosa. Contrary to expectations, AN-R patients did not perceive significantly lower levels of IA compared to their sisters, prior to onset of disease. Findings of low IA in currently ill AN-R patients may represent a disease consequence, not a risk factor.

CONCLUSIONS
Developmental child psychiatrists should direct their attention to disturbances of EC, which may be present prior to the onset of the disease.