西方家庭影响进食障碍的研究述评

家庭是进食障碍发展过程中一个重要的影响因素。已有众多西方学者采用各种方法对进食障碍和家庭之间的关系进行了研究。从时间发展脉络来看, Minuchin等学者首先对此进行了经典临床研究; 随后有众多量化研究出现, 对此可以依据不同的测量水平、研究变量和被试视角进行梳理; 近些年, 有学者采用质化研究方法重新对此进行探讨。进食障碍家庭研究的发展趋势表现出：重视本土化研究、对家庭做多水平的探讨、兼顾家庭结构和家庭变化过程。     

Healing the Wounds of the Mahantdori

The magnitude of the Mahantdori, or Cambodian holocaust, must be understood by therapists who are trying to help the survivors deal with the illness and injuries that are a product of this destruction. This paper presents an overview of the events that have come to be known as the Mahantdori and a model for treating the multiple levels of trauma with which the Cambodian family must deal. The Contextual Model of Family Therapy, as described by Ivan Borzormenyi-Nagy, is used as the structure for helping to rebuild trust within the family while at the same time treating the injuries of the individual family members. The changing role of Cambodian women and their need to form new support groups because of their devastating loss of family are described.     

Psychotherapie, Globalisierung, Hartz?IV

The mental effects of globalization, the economic crisis and unemployment must not be underestimated. In general they have to be looked upon as a complex system of structural traumatization which is causing severe psychological mental disorders, such as depression. Not only that, a psychotherapist has to pay particular attention to this. More than in physical illnesses the psychotherapist has to be solidly united with the patient, which might also result in political action.     

A family study of outpatients with borderline personality disorder and no history of mood disorder

While several studies have examined psychiatric disorders in the relatives of individuals with borderline personality disorder, many of these studies have not employed a family study methodology and suffer from other methodological shortcomings. Thus, the conclusions from family data addressing the validity of borderline personality disorder, its relation to other conditions, and its distinction from mood disorders, continue to be debated. The present investigation employed a family study design with direct interviews with relatives, structured diagnostic interviews with both probands and relatives, and blind assessment of relatives. Rates of psychiatric disorders were examined in 563 relatives of outpatients with mood disorders (n = 119), 54 relatives of outpatients with borderline personality disorder and no history of mood disorder (n = 11), and 229 relatives of never psychiatrically ill controls (n = 45). Results indicate increased rates of mood disorders and personality disorders in the relatives of borderline probands compared with never psychiatrically ill controls. Familial aggregation of psychiatric disorders was generally similar for borderline personality and the mood disorder comparison group. The results suggest there may be common etiological factors between borderline personality disorder and mood disorders.     

Das Wichtigste im Leben – aber nicht in der Psychotherapie?!

Mental health can be substantially impaired by a low partner-relationship quality and nearly all mental disorders are associated with distress. Additionally, couple’s interaction has an impact on parental behavior. Special attention must be paid to family violence. Based on this background, the reciprocity model and the theory of marital stability are described. Detailed suggestions are given for the assessment, treatment planning and couple-oriented as well as parent-orientated interventions. The suggestions are exemplified with a case vignette. Some legal and ethical standards as well as psychotherapeutic conditions may limit the application of these interventions.     

Community Participation Needs of Families With Children With Behavioral Disorders: A Systems of Care Approach

The purpose of the current study was to convey findings regarding the community participation needs of families who have children with behavioral disorders. The changing focus of community-based service provision to the systems of care approach for children with mental health needs requires family input to identify and better address their needs. This study identified characteristics of community participation in families of children with mental health needs through a survey, using mixed methods design and purposeful sampling. Evolved themes supported challenges for policymakers to make changes in professional, school, and community supports. Occupational therapists have a strong skill set to offer these families and must work collaboratively with family organizations, provide support for successful engagement in desired social activities, and build adaptive behaviors in children with mental health needs.     

Family Factors in the Development and Management of Anxiety Disorders

Family variables are thought to play a key role in a wide variety of psychopathology according to many theories. Yet, specific models of the development of anxiety disorders place little emphasis on general family factors despite clear evidence that anxiety runs in families. The current review examines evidence for the involvement of a number of family-related variables in the development of anxiety disorders as well as the importance of families in their management. Evidence across most areas is shown to be weak and inconsistent, with the one exception being an extensive literature on the role of parenting in the development of anxiety. There is also currently little evidence that family factors have a strong role to play in the treatment of anxiety, aside from research demonstrating the value of parents and partners as non-critical supports in therapy. The promises and hints in the literature, combined with the currently inconsistent methods, suggest that considerably more research is needed to determine whether specific family factors may yet be shown to play a key role in the development and management of anxiety disorders.     

Psychological treatment of eating disorders

Significant progress has been achieved in the development and evaluation of evidence-based psychological treatments for eating disorders over the past 25 years. Cognitive behavioral therapy is currently the treatment of choice for bulimia nervosa and binge-eating disorder, and existing evidence supports the use of a specific form of family therapy for adolescents with anorexia nervosa. Important challenges remain. Even the most effective interventions for bulimia nervosa and binge-eating disorder fail to help a substantial number of patients. A priority must be the extension and adaptation of these treatments to a broader range of eating disorders (eating disorder not otherwise specified), to adolescents, who have been largely overlooked in clinical research, and to chronic, treatment-resistant cases of anorexia nervosa. The article highlights current conceptual and clinical innovations designed to improve on existing therapeutic efficacy. The problems of increasing the dissemination of evidence-based treatments that are unavailable in most clinical service settings are discussed.     

Practising family therapy in India: how many people are there in a marital subsystem?

Systemic therapy would appear to be a viable form of treatment for people who exist in cultures that contain complex, extended family systems, such as those found in India. The practice of family therapy in India has evolved from Western concepts. These concepts appear to offer Indian therapists relevant and practical ways of working with families. However, some of these concepts need modifying before they can be used in an Indian context. Indian families may have very different worldviews and ideas of 'self' compared to families in the West, leading to different family organization. The situation can be further complicated by the cultural norms of therapists themselves. Therapists in India are often highly educated, come from upper-middle-class families and have been exposed to different cultures. They increasingly share many of the values of their counterparts in the West. At the same time, they retain aspects of their own cultural heritage, which is also the dominant culture for a large number of the families with whom they work. Thus, not only must Indian family therapists seek to work in culturally appropriate ways; they must also tolerate their own internalized conflicts regarding differing cultural norms. With the use of clinical data, this paper describes some of the personal and professional problems experienced by an Indian family therapist working with Western constructs of family organization.     

Ferenczi’s Revolutionary Therapeutic Approach*

Many of the revolutionary principles introduced by Ferenczi in his clinical practice have now been widely accepted especially in the field of trauma and trauma therapy. Examples of these innovative views include his emphasis on empathy as opposed to technical neutrality and his stress on the real conditions of child caring and family environmental deficits and on the consequences of interpersonal violence and abuse that lead to “identification with the aggressor” by the victim thereby resulting in the internalization of both aggressiveness and guilt (the split guilt of the abuser). The resulting “fragmentation” of the personality, which is now considered dissociation (instead of Freud’s “repression”), is at the root of several severe disorders, characterized by distortion of reality, loss of touch with one’s body and loss of trust in the other. Therefore “abreaction is not enough”. A new, positive relational experience must be re-inscribed at the level of implicit memory.     

Female Adolescents with Eating Disorders,Parental Psychopathological Risk and Family Functioning

Epidemiological studies on adolescents with eating disorders demonstrate a high prevalence of disordered eating behaviors, with a higher prevalence of eating disorders among girls. Several studies have recently demonstrated an association between female adolescents’ eating disorders, parental psychopathological risk, and an impaired family functioning with poor quality of the relationships among family members. On the basis of these premises, we conducted a cross-sectional study initially recruiting 243 families of female adolescents affected by anorexia nervosa (Group A), bulimia nervosa (Group B), and binge eating disorder (Group C) (average age 14–17) to assess their psychological profile (SCL90-R), specific representations of their family functioning (FACES-IV), and the possible effect of adolescents’ psychological profiles and parents’ psychopathological risk on family functioning. Our results indicate that adolescents and parents in Groups A, B, and C show an unequivocal psychopathological profile; in particular, adolescents with anorexia present the most severe psychopathological risk. Further, our results show that adolescents and their parents differ in their perception of their family functioning. More specifically, adolescents with anorexia perceive their family as highly disengaged, poorly interwoven, and rigid, in addition cohesion and communication qualities are perceived as low. Interestingly, parental psychopathological risk predicts adolescents’ specific perception of their family functioning. These findings may guide clinical interventions as they suggest that distinct maternal psychopathological symptoms can be associated with a variety of clinical configurations in their offspring, whereas paternal psychopathological risk may be present in adolescents suffering from all forms of eating disorders.     

Stress for families today

Rapid changes in family life have created enormous challenges and pressures on developing families - divorce, two working parents, disappearance of the extended family, unclear cultural values for our children's future, poorly defined support systems for stressed families, inadequate substitute care when both parents work-all contribute to an anxious atmosphere for young families. Parents who must return to work „too early”︁ (and we have no established standards yet for what this means to either child or adult development) seem to grieve about the loss of the relationship with the developing child. They may even set up defenses against making a strong and painful attachment. They may not become involved in the child's development in a way that will foster their own development as nurturing adults. The grieving and the necessary defenses against it are predictable and must be mitigated in order to foster nurturing adults within the family. Children must be provided with caring, intensely involved adults in order to assure their optimal future development. We must provide them and their parents with adequate substitute care. This paper suggests adjustments at the industrial level that must be made to foster parental involvement and to assure positive outcomes for future generations.     

Genetics in eating disorders: state of the science

Eating disorders have been viewed as psychiatric illnesses that are strongly influenced by societal pressures towards thinness and attractiveness. Although the environmental context of these disorders must not be neglected, recent research in the area of genetic epidemiology suggests a substantial influence of genetic factors on liability to eating disorders. This review presents a synthesis of current knowledge about genetic factors implicated in the etiology of eating disorders.     

Existe-t-il une typologie familiale dans les pathologies addictives ? Revue critique de la littérature sur les familles d’adolescents présentant des troubles alimentaires ou des conduites de dépendance aux substances

Among factors favoring the addictive behaviors, some specific family processes are often identified in eating disorders and dependences with psychoactive substances. Different models of systemic orientation described the familial disturbances involved in the addictive pathologies emphasizing either the emotional interaction and the processes of differentiation family, either the structure and the level of family cohesion. This article proposes a critical review of the systemic literature on the familial disturbances involved in the families of adolescents with eating disorders or with a substance-dependence. The systemic models (Bowen, Minuchin) are reference values in the understanding of family processes and therapy with families. The observations of these family processes have been confronted to empirical researches integrating different epistemological levels and different methods. The empirical results are heterogenous concerning the different forms of family functioning associated with these addictive pathologies. The empirical studies support the hypothesis of a family dysfunctioning in the different addictive behaviors and demonstrate the relationship between the severity of familial disorders and the severity of the addictive disorders. However, the family configuration described by the typological models is rarely found complete or with a similar intensity between the families. The studies support the hypothesis of an emotional distance in the family interactions and a lack of parental care which could correspond to factors of chronicity or vulnerability. Comparing the family characteristics of these two types of addictive behaviors, the literature supports the existence of (1) some specific family characteristics according to the type of addictive behavior (in particular the conflict avoidance which appears specifically in anorexic families) (2) some similar family patterns of interactions between the members of addictive families in particular the representation of a low family cohesion, an intergenerational enmeschment and a high level of control. These family patterns suggest rather to a dimensional approach of the family characterized by different protective or risk factors. We suggest that these family patterns could constitute, according to their importance (intensity and frequence), a family risk factor of development or aggravation of the addictive behaviors.     

Predisposition factors in anorexia nervosa.

Since its first recognition, a number of researchers have endeavored to link anorexia nervosa to underlying pathology. For example, in the past, attempts were made to associate anorexia with such psychiatric disturbances as schizophrenia, anxiety disorders, and obsessive-compulsive and antisocial personality disorders. Most recent efforts have focused on the possible link between anorexia nervosa and affective disorders. This article reviews the literature concerned with investigating psychiatric disturbances and genetic variables hypothesized as predisposing factors in the etiology of anorexia nervosa. Particular emphasis is given to research which discusses the association between anorexia nervosa and depression. Psychopharmacological evidence and family genetics studies are reviewed. Suggestions for future research are also made.     

Family involvement and empowerment in mental health service provision for children with emotional and behavioral disorders

Involvement of families is a critical component in effective systems of care for children with disabilities and their families. We investigated the sociodemographic correlates of family involvement in mental health services for children who have emotional and behavioral disorders. Further, we investigated the relationship between family involvement and family empowerment. The Family Involvement Scale-Family Version was used to measure involvement of families in the provision of mental services for their children and the Family Empowerment Scale was used to measure pempowerment in families with children who have emotional and behavioral disorders. In additions, demographic data concerming family composition, race, education, incone, membership in a parent support group, and the mental health status of the children were also collected. The results showed that mothers, as well as respondents with less formal education, reported greater involvement in services for their children than fathers and those who were more educated. Further, the knowledge subscale of empowerment was significantly correlated with all, subscales of family involvement and personal empowerment was significantly correlated with the treatment subscale of family involvement.     

The Efficacy of Systemic Therapy for Childhood and Adolescent Externalizing Disorders: A Systematic Review of 47 RCT

Systemic (family) therapy is a widely used psychotherapy approach. However, most systematic efficacy reviews have focused solely on “family‐based treatment” rather than on the theoretic orientation “systemic therapy.” We systematically review trials on the efficacy of systemic therapy for the treatment of childhood and adolescent externalizing disorders. All randomized (or matched) controlled trials (RCT) evaluating systemic/systems‐oriented therapy in various forms (family, individual, group, multi‐family group therapy) with child or adolescent index patients (0–17 years) suffering from mental disorders were identified by data base searches and cross‐references. Inclusion criteria were as follows: index patient diagnosed with a DSM‐ or ICD‐listed mental disorder, and trial published in any language up to the end of 2011. The RCTs were analyzed for their research methodology, interventions applied, and results (postintervention; follow‐up). A total of 47 trials from the United States, Europe, and China, published in English, German, and Mandarin, were identified. A total of 42 of them showed systemic therapy to be efficacious for the treatment of attention deficit hyperactivity disorders, conduct disorders, and substance use disorders. Results were stable across follow‐up periods of up to 14 years. There is a sound evidence base for the efficacy of systemic therapy for children and adolescents (and their families) diagnosed with externalizing disorders.     

Exploring experience of family relations by patients with anorexia nervosa and bulimia nervosa using a projective family test

Elements of family dynamics have been shown to be related to onset, course, as well as prognosis of anorexia nervosa and bulimia nervosa. The goal was to explore the experience of family relations in a group of patients with eating disorders using a projective family test. The Patient group (anorexia=21, bulimia=16), as well as a healthy Control group, were given a projective family test, the Eating Disorder Inventory-2, as well as Karolinska Scales of Personality. The Patient group expressed more discord within the family picture than the Control group, such as cold and loveless relationships and not feeling validated. The group of patients reporting the most family discord did not show more eating disorder pathology or general psychopathology. They did, however, have higher scores on the Eating Disorder Inventory-2 subscale Maturity Fears, as well as higher values on the Karolinska Scales of Personality subscale Socialization. These results are interpreted within the background of methodological challenges in this area of research.     

Psychoeducation and expressed emotion by parents of children with learning disorders

The present study assessed use of a psychoeducation group program on expressed emotion, family functioning, and child behavior by parents of children with learning disorders. 81 parents of children with learning disorders were randomly assigned to a psychoeducation group program (n=46) or to a regular treatment group (n=35). A semistructured interview for parental expressed emotion, self-reports of family functioning, and child behavior were utilized at baseline and after an 8-session psychoeducation group program. Parents who attended the program differed significantly from parents in the regular treatment group on measures of criticism, warmth, and positive remarks, and overall expressed emotion, but not on measures of perceived family functioning and child behavior. Findings indicate a psychoeducation group program could be effective in helping parents to establish a more positive emotional climate in their relationships with their children who have learning disorders.