FAMILY INFLUENCES - emphasis on appearance?

1. FAMILY INFLUENCES - emphasis on appearance? • traditional viewpoint (e.g. mother-daughter relationship) • current viewpoint (e.g. multifactorial and interactive) • family/genetic transmissions • transactional family patterns (Marcus & Wiener, 1989) • appearance-related research

2. Traditional Viewpoints • Traditional #1 - anorexia as symptom • e.g. any patient who lost 25 lbs was anorexic • did not think weight loss & fear of obesity shared a common etiology • AN seen as symptomatic of a variety of underlying pathologies

3. Traditional Viewpoints • Traditional #2 - anorexia as single syndrome • e.g. Bruch - denial of thinness, struggle for control, separation-individuation • e.g. Crisp - weight and fat phobia, return to prepubescence • these statements are incompatible

4. Traditional Viewpoints • Traditional #3 - AN as multiple syndrome • e.g. Janet - hysterical & obsessive anorexics • e.g. Garner, Molodofsky & Garfinkel - distinguished between purging & nonpurging anorexics • need some commonality?

5. Current Viewpoint - Multifactorial • biological factors • e.g. heritable aspects of mood, temperament, impulse regulation, appetite • social pressures • e.g. pursuit of thinness, overachievement • psychological vulnerabilities • e.g. personality, self-disturbances

6. Family Contributions Minuchin et al. (1978): • enmeshment • overprotectiveness • rigidity • conflict avoidance • poor conflict resolution

7. Restrictor/Bulimic Differences • restrictor: overprotective, overcontrolling, boundary problems, conflict avoidance, emotional restriction • ‘nurturant enmeshment’ • bulimic: higher levels of conflict, greater use of threats and physical coercion, violence between parents, neglectful family interaction styles

8. Transactional Family Patterns in Eating Disorders (Marcus & Wiener, 1989) • 6 psychosocial transactional patterns • anorexia as a behavioural pattern • anorexic deals with daily psychosocial events • both unusual and typical behaviours arise from same socialization patterns • atypical eating behaviour is acquired & maintained the same way as typical behaviour • structural-contextual model (not causal)

9. Transactional Family Patterns in Eating Disorders (Marcus & Wiener, 1989) • unit of analysis is the “transaction” event • event incorporates what members do • themes are important • what participant says & does during transaction • both verbal & nonverbal • improvisational script • predictable pattern within family transactions • limits or precludes change in content of subsequent transactions

10. (1) Negativistic • theme of family script is “you should…you must…you have to” and “I won’t…you can’t make me” • food refusal is a way of acting against limits • non-eating is done overtly • issues is control, not food • distaste for the food • more likely to become bingers & purgers in parents’ absence

11. (2) Attention centering pattern • unless the child needs attention, the parents are often preoccupied with other concerns • limited eating elicits responses of concern & often exasperation • made to feel guilty about not eating • difficulty with the food, not about control or anger • e.g. “It makes me sick”

12. (3) Distracting pattern • child’s behaviour distracts the parents from their marital difficulties • maintain family cohesion • arguments seen as dangerous, as one parent might leave the family • child typically is silent & does little other than not eat • child’s health is often negatively correlated with the degree of marital accord

13. (4) Childlike pattern • weight loss serves to maintain a dependent, conforming & nonsexual child • food refusal has helpless, immature quality • e.g. “peas are yucky” • food quantity is predominant feature • focus on being the “good little girl”

14. (5) Attractive pattern • family theme is importance of “looks” and attractiveness for both the parents and the children • mother-daughter interaction focuses on diet tips, exercise, clothes • father places value on being a “good looking” woman • appearance is the issue • food is not bad, as long as no weight gain occurs • bingeing and purging may be common

15. (6) Self-punishing (aka “holy anorexia”) • seen as asocial, obsessive, withdrawn, loner, “strange” • rightness or wrongness of behaviour in general • approval isn’t given to anything that isn’t perfect • food is not important • pleasure and fun are “sinful” • family members are at the low end of the weight scale, may not notice anorectic appearance

16. Familial Transmission • well-controlled studies have shown clear familial aggregation for AN and less consistently for BN • suggests that EDs may be familially transmitted syndromes • e.g. family study conducted found that the relative risks for AN were 11.3 and 12.3 in female relatives of AN and BN probands • the relative risks for bulimia were 4.2 and 4.4 for female relatives of AN and BN probands

17. Nature versus Nurture - Probable explanations • evidence of higher concordance among monozygotic than dizygotic twins • genetic? Confound as former have greater shared environment than the latter • “family trait” concept: effect of heritable temperamental traits that heighten susceptibility • e.g. anxiety or depression proneness

18. Familial eating concerns & traits - transgenerational effects • lack of attitudinal abnormalities in parents of ED patients • research demonstrates various personality & psychopathological traits to be familial in nature • ECS, DET, OCT (Steiger et al., 1996) • parents’ affective instability & narcissism with daughters’ eating & appearance

19. “Beauty” research in ED populations • objective vs subjective ratings of attractiveness • subjective attractiveness inversely related to weight & diet concerns • attractiveness (objective) positively related to weight preoccupation after controlling for body size and neurotic perfectionism

20. Recursive structural equation model(Davis et al., 2000) N SOP FA BMI NPQ WP