MONTREAL – Treatment for anorexia nervosa might one day use videotapes of family meals to personalize therapy for patients, according to a pilot study.
Family mealtimes play a central role in anorexia nervosa, not only because of their focus on eating, but also because of their focus on family interaction, said investigator Richard L. Levine, M.D., who presented his study as a poster at an international conference sponsored by the Academy for Eating Disorders.
“In terms of the etiology of eating disorders, family interactions matter,” said Dr. Levine, director of the eating disorders program at the Milton S. Hershey Medical Center, in Hershey, Pa.
“We recognize there is a biological predisposition to eating disorders in terms of genetics and the imbalance of neurotransmitters, and there are also certain cultural pressures from the food and fashion industries. But family interactions also exert influence on patients and their eating habits,” he said in an interview.
For example, quantitative research shows that interactions in families of anorexic patients are often characterized by parental overprotection, enmeshment, rigidity, and poor conflict resolution, he said. In addition, maternal anxiety and “high concern parenting” in early and middle childhood correlate with anorexia nervosa.
The investigators sought to determine whether qualitative findings could confirm some of those themes.
The study included three female patients, ranging in age from 17 to 19 years, who each videotaped five family meals and between three and five monologues, or “video diaries.”
The patients also completed three psychological measures, which included the Family Environment Scale, the Minnesota Multiphasic Personality Inventory-Adolescent, and the Eating Disorder Inventory-2.
The themes that emerged from the videos and the psychological assessments identified families that were paternally dominant and highly critical–consistent with the quantitative research, said Elizabeth Hoffman, Ph.D., another investigator and manager at the same eating disorders program. “Fathers dominated the conversation at the meals, there was a lot of criticism of others outside of the family, and there was a lot of sibling competition and focus on achievement,” Dr. Hoffman told this newspaper.
Family therapy has traditionally attempted to address many of those issues, but it is usually on family interactions that occur in an artificial environment, she explained.
“Videotapes illuminate family patterns that we don't usually see in the regular family therapy environment, which could help us target therapy more appropriately,” she said.
In contrast to the families of anorexic patients, families of patients with bulimia nervosa are in many ways the mirror opposite, Dr. Levine said.
Those families of bulimia patients tend to be less structured, with fewer guidelines and less parenting in general, he said. There is more chaos in the family and often more chaos in the patients,” he said.
A separate poster presented at the meeting confirmed this general trend.
In a survey of 124 college undergraduates, Daniel J. Munoz and his colleagues at the University at Albany, State University of New York, analyzed family mealtime frequency and family stability and how they related to the symptomatology of bulimia.
They found that greater frequency of family mealtimes and higher levels of family stability, as measured by the SAFE test (Stability of Activities in a Family Environment), predicted a decreased likelihood of bulimia as measured by the Eating Disorders Inventory-2 and the Bulimia Test-Revised.
“Examining the regularity of family activities–including mealtimes–may provide an additional pathway toward assessment, intervention, and prevention of bulimia,” they wrote.