Operant reinforcement with structural family therapy in treating anorexia nervosa

Abstract

This paper integrates clinical data gathered through psychotherapy with dual-career couples and research findings from social psychology and sociology. The paper's main focus is the clinical understanding and therapeutic interventions most appropriate for these couples' marital and individual difficulties. The paper briefly describes characteristics of the dual-career lifestyle and personalities. The analysis provides case examples illustrating external and internal sources of stress generated by a lack of time or the need for an effective system for handling housework and childcare.     

Possible differences in family patterns in anorexia nervosa and bulimia nervosa

This paper examines the interactions in three families, one where the daughter had anorexia nervosa and two where the daughters had bulimia nervosa, and proposes some differences in the families’ patterns of enmeshment. It is hypothesized that these may be linked to differences in the development of the mother—child relationship. Implications for the choice of therapeutic strategies are discussed.     

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.     

Mother-blaming in family therapy: An empirical investigation

Abstract

This study tested two hypotheses derived from the feminist critique of family therapy in a sample of AAMFT members. The stimulus was a brief vignette of an initial therapy session with a family presenting a teen-aged child as the identified patient. It was hypothesized that family therapists would rate the mothers in the vignette as more dysfunctional than fathers. It was also hypothesized that mothers would be asked to bear more of the burden of change in treatment plans written by subjects. Neither hypothesis was supported. However, respondents did rate the concerned parent, regardless of sex, as more dysfunctional. Since this is a role often occupied by women, this finding may indicate some gender bias.     

The psychopathology of anorexia nervosa: A factor analytic investigation

To examine the psychopathology of anorexia nervosa, behavioral assessment measures sampling a wide range of relevant constructs were collected on 150 women diagnosed as having anorexia nervosa. The data were subjected to an exploratory factor analysis using maximum-likelihood estimation and oblique rotation. Five factors were extracted, which were titled Fasting and Restrictive Eating, Depression, Anxiety, and Negative Self-image, Bulimic Behaviors, Fear of Fatness/Body Image Disturbance, and Impulsive Behavior/Post-Traumatic Response. Discriminate function analysis suggested that, other than the bulimic behaviors factor, the Impulsive Behavior/Post-Traumatic Response factor best discriminated between bulimic and restrictor subtypes of anorexics. These data suggest that the underlying dimensions of anorexia nervosa are very similar to those of bulimia nervosa. The findings also have implications for the multidimensional assessment and treatment of anorexia nervosa as well as conceptual models of the disorder.     

The phi coefficient and chi square as indices of item validity

Two new methods of item analysis are described. One involves the computation of the coefficient (correlation of a fourfold point distribution) and the other involves chi square. The only data required are the proportions of passing individuals in the upper and lower criterion groups, for the determination of , and in addition,N, for the determination of chi square. Abacs are presented for graphic solution of the two indices of validity, and tests of significance are provided.     

神经性厌食症的家庭治疗--西方关于神经性厌食症心理治疗的新进展

弗洛伊德关于家庭和心理性别发展的论述给神经性厌食症的理解、分析与治疗带来了新的关注焦点,在其之后的学者将他的思想进一步继承和发展,创造出了以家庭为关注对象的且在当代得到广泛应用的系统家庭疗法,并将该疗法应用到了神经性厌食症的诊断与治疗中,取得了开创性的成果.     

The Peter Pan Syndrome: Inpatient treatment of adolescent anorexia nervosa

Specific strategies designed for intervening in family, hospital, community, and school systems are discussed as crucial components in the treatment of adolescent anorexia nervosa. It is suggested that all these systems inadvertently collude in the “Peter Pan Syndrome”: maintaining the adolescent-identified patient in a latency age role in order to protect mother from depression and the family in its entirety from an “empty nest” developmental crisis. When strategic and structural alterations occurred within the above mentioned systems while the child was hospitalized and after discharge, the anorectic symptom was alleviated.     

The Peter Pan Syndrome: Inpatient treatment of adolescent anorexia nervosa

Specific strategies designed for intervening in family, hospital, community, and school systems are discussed as crucial components in the treatment of adolescent anorexia nervosa. It is suggested that all these systems inadvertently collude in the “Peter Pan Syndrome”: maintaining the adolescent-identified patient in a latency age role in order to protect mother from depression and the family in its entirety from an “empty nest” developmental crisis. When strategic and structural alterations occurred within the above mentioned systems while the child was hospitalized and after discharge, the anorectic symptom was alleviated.     

Moderators and mediators of remission in family-based treatment and adolescent focused therapy for anorexia nervosa

Few of the limited randomized controlled trails (RCTs) for adolescent anorexia nervosa (AN) have explored the effects of moderators and mediators on outcome. This study aimed to identify treatment moderators and mediators of remission at end of treatment (EOT) and 6- and 12-month follow-up (FU) for adolescents with AN (N = 121) who participated in a multi-center RCT of family-based treatment (FBT) and individual adolescent focused therapy (AFT). Mixed effects modeling were utilized and included all available outcome data at all time points. Remission was defined as ≥ 95% IBW plus within 1 SD of the Eating Disorder Examination (EDE) norms. Eating related obsessionality (Yale-Brown-Cornell Eating Disorder Total Scale) and eating disorder specific psychopathology (EDE-Global) emerged as moderators at EOT. Subjects with higher baseline scores on these measures benefited more from FBT than AFT. AN type emerged as a moderator at FU with binge-eating/purging type responding less well than restricting type. No mediators of treatment outcome were identified. Prior hospitalization, older age and duration of illness were identified as non-specific predictors of outcome. Taken together, these results indicate that patients with more severe eating related psychopathology have better outcomes in a behaviorally targeted family treatment (FBT) than an individually focused approach (AFT).     

Cross-cultural issues in the treatment of intractable anorexia nervosa

This paper presents a case of intractable anorexia nervosa in a child burdened beyond her capabilities by unresolved conflicts in a parent. The dynamics will be assessed in the context of open systems theory of family function to suggest that the mother's conflicts, fixated at the time she left her native country, and her attempts to adapt to a new one, combined with other family members' failure to understand or appreciate the mother's cultural roots, interrupted the patient's normal maturation/development. The paper also presents a successful course of treatment of the binational anorexic girl, using a comprehensive inpatient program, emphasizing intensive family therapy with an open systems theory framework.The earlier version of this paper was presented at the Sixth World Congress of the International College of Psychosomatic Medicine, Montreal, Canada, September, 1981. Helpful comments by Regina Casper, M.D., helpful discussion by Kenneth Calestro, M.A., and support and encouragement by Katharine N. Dixon, M.D. are greatly appreciated.     

Anorexia nervosa: the treatment of a male case with combined behavioural and family therapy

The successful treatment of a case of anorexia nervosa in a 14-year-old boy is described in this paper. The treatment comprised an initial month-long hospital-based behavioural weight gain programme. Concurrently a family evaluation was conducted. Family therapy, involving the parents only, was conducted over a subsequent four month period. The management of a relapse four months after the termination of treatment is described and information obtained at 9 and 16 month follow up is presented.     

Milan systemic family therapy: a review of ten empirical investigations

Ten empirical investigations of Milan Family Therapy (MFT) are reviewed in this paper. The studies include both single and comparative group outcome trials; investigations of therapeutic process; clinical audit and consumer satisfaction surveys. Substantive findings and methodological issues are discussed in the light of family therapy and individual psychotherapy research generally. Findings indicate that MFT may lead to symptomatic change in two-thirds to three-quarters of cases and to systemic change in half the treated cases. Engagement of fathers may be important for positive outcome. Technical aspects of MFT, such as the use of screens and teams, may lead to client dissatisfaction in some cases. MFT-based consultation may be effective in resolving therapeutic impasses. Coupled with short-term residential placement, MFT may reduce the risk and complexity of cases as rated by referring social workers.     

A study of temperament and personality in anorexia and bulimia nervosa

Although temperament and personality traits could influence the development and course of eating disorders, only a few studies examined the similarities and differences in personality between anorexia and bulimia nervosa. We compared 72 patients with DSM-IV eating disorders and 30 healthy controls. Dimensions of personality and personality disorders were evaluated with the Eysenck's EPQ, Cloninger's TCI, and the SCID-II questionnaires. The rates of impulsivity and clinical features were evaluated using specific rating scales. A comorbid personality disorder was found in 61.8% of patients with eating disorder. Avoidant personality disorder appeared was relatively common in anorexia nervosa restricting type; borderline personality disorder was most frequent in bulimia nervosa and the binge eating-purging type of anorexia nervosa. From a dimensional perspective, anorexic patients presented high scores in the dimension of persistence. Higher harm avoidance and impulsivity was found in bulimic patients. The overall eating disorders group presented high scores in neuroticism and low scores in self-directedness. Eating disorder patients have heterogeneous features of temperament and personality traits. Cluster C personality disorders seem more common in anorexia nervosa restricting type and impulsive personality features are associated with bulimic symptoms. Impulsivity seems to be a key aspect of temperament of bulimic patients, whereas anorexic symptoms are linked to persistent temperament traits.     

Alcoholism and the family in peru: The impact of an alcoholic on teenagers' perceptions of the family

Abstract

We studied Peruvian high school students' perceptions of their family environment when a member of their household had a significant problem with alcohol using specialized forms of both the Family Environment Scale (FES) and the Michigan Alcohol Screening Test (SMAST). Of our sample of 218 high school students in Lima, Peru, 91.7% lived in a household in which a member had a significant problem with alcohol as defined by the family form of the SMAST. Also, when the alcoholic individual was a member of the nuclear family, the high school students perceived their families as less cohesive, less well organized, and with a lesser ability to express themselves. These family perceptions are similar to those found in American high school students who live with an alcoholic family member. Possible epidemiologic and family implications of these findings are discussed.