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: 2.46). 07/2008; 16(4):247-55. DOI: 10.1002/erv.859
Source: PubMed


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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Available from: Ana R Sepulveda,
    • "Research consistently shows that families perceive the ED behaviours as challenging, leading them to experience intense emotional reactions including anxiety, guilt and burden (Coomber & King, 2013a; Kyriacou, Treasure & Schmidt, 2008a; Kyriacou, Treasure & Schmidt, 2008b; Zabala, MacDonald & Treasure, 2009). Furthermore, it has been postulated that familial responses to AN may inadvertently maintain illness behaviours (Treasure et al., 2008). However, no research has been conducted to gauge the affected individual's perceptions of how their families respond to their illness behaviours, which leaves a crucial gap in our understanding of how families can either support or undermine their loved ones in their struggle with AN. "
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    ABSTRACT: The current study explores how affected individuals understand their family's perceptions of anorexia nervosa (AN). Perceptions of individuals with AN regarding their family's understanding of the illness may influence their ability to accept family support. Thematic analysis was used on qualitative data of 19 individuals with AN undergoing inpatient treatment. Participants perceived that families: (a) considered AN a problem with food rather than a mental illness; and (b) viewed treatment as time limited, and complete recovery as achievable. Family-based interventions are needed to facilitate understanding about AN, as well as the behavioral and psychological adjustments required during treatment and recovery.
    Eating disorders 10/2015; DOI:10.1080/10640266.2015.1090870 · 1.48 Impact Factor
    • "Initially, the elements of ECHO were delivered in the form of workshops that were found to reduce carer distress (Sepulveda, Lopez, Todd, Whitaker, & Treasure, 2008) and expressed emotion (Sepulveda et al., 2010). These also produced positive effects for the patients themselves (Goddard, Macdonald, & Treasure, 2010). "
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    ABSTRACT: Experienced Carers Helping Others (ECHO) is an intervention for carers of people with eating disorders. This paper describes the theoretical background and protocol of a pilot multicentre randomised controlled trial that will explore the use of two variants of ECHO for improving outcomes for adolescents with anorexia nervosa (AN) referred for outpatient care. Adolescent patients and their carers (typically parents and close others in a supportive role) will be recruited from 38 eating disorder outpatient services across the UK. Carers will be randomly allocated to receive ‘ECHOc’ guided self-help (in addition to treatment as usual), ‘ECHO’ self-help only (in addition to treatment as usual) or treatment as usual only. Primary outcomes are a summary measure of the Short Evaluation of Eating Disorders at 6- and 12-month follow-ups. Secondary outcomes are general psychiatric morbidity of AN patients and carer, carers' coping and behaviour, and change in healthcare use and costs at 6- and 12-month follow-ups. Therapist effects will be examined, and process evaluation of ECHOc will be completed. The findings from this pilot trial will be used in preparation for executing a definitive trial to determine the impact of the preferred variant of ECHO to improve treatment outcomes for AN. Copyright © 2014 John Wiley & Sons, Ltd and Eating Disorders Association.
    European Eating Disorders Review 07/2014; 22(4). DOI:10.1002/erv.2298 · 2.46 Impact Factor
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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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