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Originalarbeiten/Original articles

Perception of Autonomy and Connectedness Prior to the Onset of Anorexia Nervosa and Bulimia Nervosa

A Retrospective Study in Sister Pairs Discordant for an Eating Disorder

Published Online:December 13, 2011https://doi.org/10.1024/1422-4917/a000150

Abstract

Objective: This study examines retrospective correlates of nonshared family environment prior to onset of disease, by means of multiple familial informants, among anorexia and bulimia nervosa patients. Methods: A total of 332 participants was included (anorexia nervosa, restrictive type (AN-R): n = 41 plus families); bulimic patients (anorexia nervosa, binge-purging type; bulimia nervosa: n = 59 plus families). The EATAET Lifetime Diagnostic Interview was used to establish the diagnosis; the Subjective Family Image Test was used to derive emotional connectedness (EC) and individual autonomy (IA). Results: Bulimic and AN-R patients perceived significantly lower EC prior to onset of disease compared to their healthy sisters. Bulimic patients perceived significantly lower EC prior to onset of disease compared to AN-R patients and compared to their mothers and fathers. A low family sum – sister pairs sum comparison – of EC had a significant influence on the risk of developing bulimia nervosa. Contrary to expectations, AN-R patients did not perceive significantly lower levels of IA compared to their sisters, prior to onset of disease. Findings of low IA in currently ill AN-R patients may represent a disease consequence, not a risk factor. Conclusions: Developmental child psychiatrists should direct their attention to disturbances of EC, which may be present prior to the onset of the disease.


Die Wahrnehmung von Autonomie und Verbundenheit vor Ausbruch von Anorexia nervosa und Bulimia nervosa – eine retrospektive Studie bei diskordanten Schwesternpaaren

Fragestellung: Das Ziel vorliegender Studie war es, bei Patientinnen mit Anorexia und Bulimia nervosa retrospektive Korrelate nicht-geteilter Familienbeziehung vor Ausbruch der Erkrankung mittels multipler Informanten zu erfassen. Patienten/Methodik: 332 Personen (Anorexia nervosa, restriktiver Typ (AN-R): n = 41 und deren Familien); Bulimische Patientinnen (Anorexia nervosa, binge-purging Typ; Bulimia nervosa: n = 59 und deren Familien). Zur Diagnose wurde das “EATAET Lifetime Diagnostic Interview,” zur Erhebung von Autonomie und Verbundenheit das “Subjektive Familienbild” verwendet. Ergebnisse: Bulimische und AN-R Patientinnen nahmen vor der Erkrankung, verglichen mit ihren gesunden Schwestern, signifikant weniger emotionale Verbundenheit innerhalb ihrer Familien wahr. Bulimische Patientinnen nahmen vor Beginn der Essstörung signifikant weniger emotionale Verbundenheit wahr als AN-R Patientinnen und erlebten signifikant niedrigere emotionale Verbundenheit im Vergleich zu ihren Eltern. Eine niedrige Familiensumme der emotionalen Verbundenheit hatte einen signifikanten Einfluss auf die Entstehung von Bulimia nervosa. Entgegen der Erwartung nahmen AN-R Patientinnen nicht signifikant weniger Autonomie vor Beginn der Essstörung verglichen mit ihren gesunden Schwestern wahr. Die bei aktuell an Magersucht Erkrankten festgestellte niedrige Autonomie dürfte daher eine Folge der Erkrankung sein und keinen Risikofaktor für diese darstellen. Schlussfolgerungen: Die entwicklungsbezogene Kinder- und Jugendpsychiatrie sollte bei Essstörungen besondere Aufmerksamkeit auf Störungen der emotionalen Verbundenheit lenken, die schon vor Ausbruch der Erkrankung vorhanden sind.

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