Article

The Assessment of the Family of People with Eating Disorders

Psychological Medicine Department, King's College London, Institute of Psychiatry, London, UK.
European Eating Disorders Review (Impact Factor: 1.38). 07/2008; 16(4):247-55. DOI: 10.1002/erv.859
Source: PubMed

ABSTRACT The National Institute for Clinical Excellence (NICE) guidelines for eating disorders recommend that carers should be provided with information and support and that their needs should be considered if relevant. The aim of this paper is to describe how to structure an assessment of carers needs so that the family factors that can contribute to the maintenance of eating disorder symptoms are examined. We describe in detail the pattern of interpersonal reactions that can result when a family member has an eating disorder. Shared traits such as anxiety, compulsivity and abnormal eating behaviours contribute to some of the misperceptions, misunderstandings and confusion about the meaning of the eating disorder for family members. Unhelpful attributions can fuel a variety of emotional reactions (criticism, hostility, overprotection, guilt and shame). Gradually these forces cause family members to accommodate to the illness or be drawn in to enable some of the core symptoms.

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    • "Moreover, moderate correlations were found with specific elements hypothesised to contribute to illness maintenance included in other measures associated with caregiving such as the Experience of Caregiving Inventory (Szmukler et al., 1996), the Hospital Anxiety and Depression Scale (Zigmond & Snaith, 1983) and the Levels of Expressed Emotion (LEE) (Cole & Kazarian, 1988). The original four-factor structure of the EDSIS has been used in carer intervention outcome studies (Goddard, MacDonald, Sepulveda, et al., 2011; Grover, Naumann, et al., 2011; Grover, Williams, et al., 2011; Hoyle, Slater, Williams, Schmidt, & Wade, 2013; Pepin & King, 2013; Sepulveda, Lopez, Todd, Whitaker, & Treasure, 2008) as has the original five-factor structure of the AESED (Goddard, MacDonald, Sepulveda, et al., 2011). However, a six-factor structure for the EDSIS has since been proposed within an Australian sample of carers of someone with "
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    ABSTRACT: Objective: Caring for someone diagnosed with an eating disorder (ED) is associated with a high level of burden and psychological distress which can inadvertently contribute to the maintenance of the illness. The Eating Disorders Symptom Impact Scale (EDSIS) and Accommodation and Enabling Scale for Eating Disorders (AESED) are self-report scales to assess elements of caregiving theorised to contribute to the maintenance of an ED. Further validation and confirmation of the factor structures for these scales are necessary for rigorous evaluation of complex interventions which target these modifiable elements of caregiving. Method: EDSIS and AESED data from 268 carers of people with anorexia nervosa (AN), recruited from consecutive admissions to 15 UK inpatient or day patient hospital units, were subjected to confirmatory factor analysis to test model fit by applying the existing factor structures: (a) four-factor structure for the EDSIS and (b) five-factor structure for the AESED. Results: Confirmatory factor analytic results support the existing four-factor and five-factor structures for the EDSIS and the AESED, respectively. Discussion: The present findings provide further validation of the EDSIS and the AESED as tools to assess modifiable elements of caregiving for someone with an ED.
    03/2014; 2(1):322-334. DOI:10.1080/21642850.2014.894889
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    • "Family relationships in Anorexia Nervosa (AN) are considered as one of the key elements implicated in the evolution of this disorder [1] [2] [3] and Family-Based Treatment is the most widely practiced treatment in adolescents with AN [4] [5]. "
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    ABSTRACT: Expressed Emotion has been called a "black box", since little is known about contributing factors. The aim of this study was to examine which parental and which patient/illness-related characteristics contribute to maternal and paternal Expressed Emotion levels. Sixty adolescent girls with Anorexia Nervosa (AN) and their parents completed instruments that evaluate characteristics of the adolescent's illness and patient/parental psychological characteristics (depression; anxiety; obsession-compulsion; social anxiety and alexithymia). The following illness-related characteristics were recorded: age at AN onset, duration of illness, AN subtype (restrictive AN-R vs. purging type AN-B), current Body Mass Index (BMI) (in kg/m(2)), minimum lifetime BMI and number of previous hospitalizations, the Global Outcome Assessment Scale total score. Levels of Expressed Emotion were assessed for the two parents using the Five-Minute Speech Sample. Less than 30% of the parents in our sample expressed high levels of Critical EE and Emotional Over-Involvement. Our main findings indicate that maternal Criticism (Critical EE levels, Critical Comments, Dissatisfaction) and the sub-dimensions of maternal Emotional Over-Involvement (EOI EE) (Statement of loving Attitudes and Excessive Details about the past) were related both to the severity of the daughters' clinical state and to maternal psychological functioning. Only paternal levels of anxiety explained paternal Dissatisfaction, EOI EE and Statement of loving Attitudes. Parental psychological functioning and the severity of the daughters' clinical state have an impact on the family relationships. These elements should be targeted by individual treatment for parents where necessary, and by psycho-educational sessions about Anorexia Nervosa for parents generally.
    Comprehensive psychiatry 10/2013; 55. DOI:10.1016/j.comppsych.2013.10.002 · 2.26 Impact Factor
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    • "Eventually, the patterns of family interaction can become restricted so that the family feels helpless to change the situation and becomes fearful of doing anything outside the usual routine (Eisler, 2005). In other words, as a consequence of trying to cope with their adolescent's illness, the family may get stuck in patterns of interaction that help to maintain the eating disorder (Schmidt and Treasure, 2006; Treasure et al., 2008). Family-based therapy consists of three phases: (i) parents re-feed their adolescent and prevent unhealthy behaviour such as purging, (ii) control of eating is slowly handed back to the adolescent, and (iii) "
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    ABSTRACT: Adolescent eating disorder symptoms, depression and anxiety, the impact of their symptoms on their parents, and parental self-efficacy were assessed before beginning family-based day hospital treatment, and at 3 and 6 months post-assessment. Parents' self-efficacy increased during the first 3 months of treatment, and their knowledge and confidence in their effectiveness against the eating disorder continued to increase between 3 and 6 months post-assessment. Adolescent eating disorder symptoms, depression and anxiety, and the impact of the symptoms on their parents decreased between 3 and 6 months post-assessment. The results suggest that family-based treatment can be adapted to day hospital programmes for adolescents. The results also provide preliminary support for a treatment duration of at least 6 months.
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