Psychiatric symptomatology and perception of family functioning in an eating disorder day program

Abstract

The role of the family in the development of eating disorders has been a predominant research focus. However, no other known studies of patients in an eating disorder (ED) day treatment program (DTP) have explored the relationship between self-reported family system functioning, self-reported comorbid psychopathology and current comorbid psychological symptom status. Objective. This study examines patients at presentation to an ED DTP, their self-reported perception of family functioning and the relationship with characteristics of their own comorbid psychopathology characteristics. The hypothesis states that the patients in an ED DTP for anorexia nervosa (AN), bulimia nervosa (BN) and Eating Disorder Not Otherwise Specified (EDNOS) whose Family Adaptability and Cohesion Evaluation Scale-II (FACES-II) scores are indicative of family dysfunction (extreme family type) will score higher at admission on the self-report measures: Symptom Checklist-90-R (SCL-90-R); Eating Disorder Inventory-2 (EDI-2); Beck Depression Inventory (BDI) and The Twenty-Item Toronto Alexithymia Scale (TAS-20) than patients whose FACES-II scores indicate a more functional family interaction. Method. Medical records of fifty-one day treatment female patients, ranging in age from 12 to 26 years, were examined by ED diagnosis and family type (using the FACES-II), and for significant differences on four self-report measures: SCL-90, EDI-2, BDI and TAS-20. Results. Using MANOVA analyses, significant differences on the self-report instruments for the entire sample and for the AN and BN patients were obtained when studying patients within different family types as defined by FACES-II. Results supported the initial hypothesis, revealing that for the entire sample significant differences existed between family type on the SCL-90 (Wilks' Lambda (12, 38) = .469, F = 3.58, p = .0013). Subsequent ANOVAs showed that significant differences were limited to the depression [F (1, 49) = 5.23, p = .027] and positive symptom dimensions [F (1, 49) = 4.12, p = .048]. An additional analysis utilizing the MANOVA supported the hypothesis that examined the overall sample and the differences between family type on the variables: EDI-2 (subscales---Ineffectiveness, Perfectionism, Interpersonal Distrust, Interoceptive Awareness), BDI and TAS-20. The MANOVA supported the hypothesis that significant differences existed between family types on all of the dependent variables combined (Wilks' Lambda (6, 23) = .599, F = 2.57, p = .0472). Subsequent ANOVAs indicated that Interoceptive Awareness significantly differed between family types [F (1, 28) = 4.61, p = .041] and the BDI significantly differed between family types [F (1, 28) = 5.51, p = .026]. Secondary hypotheses examining the patient sample by ED diagnosis also displayed significant differences that are consistent with the primary findings reported above for the overall sample when ED diagnosis was not taken into consideration. Discussion. These findings support the conviction that it is essential to evaluate various areas of functioning when treating individuals with eating disorders, from family functioning to eating pathology to personality characteristics. In sum, these data specific to DTP patients support previous findings for both inpatient and outpatient ED family studies. Overall, as family functioning is perceived to be more dysfunctional, the level of self-reported eating pathology and current comorbid psychological symptoms is also more severe.