Perceptions of family styles by adolescents with eating disorders and their parents.

PURPOSE: The traditional view has been that there is a great deal of rigidity and enmeshment in the families of adolescents with eating disorders, with poor communication and satisfaction among family members. We used the Family Adaptability and Cohesion Evaluation Scales IV (FACES-IV) to study whether this traditional view remains true or whether family styles among those with eating disorders have changed over time to include a wider range of families.

METHODS: Forty-four patients (aged 14-18 years; mean, 15.4 years; 38 females and 6 males) being treated for an eating disorder in a Division of Adolescent Medicine completed the FACES-IV questionnaire, along with the Beck Depression Inventory (BDI). Patients were diagnosed with anorexia nervosa (38.6%), eating disorders not otherwise specified (59.5%), and bulimia nervosa (2.3%) according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. They had a mean BMI of 19.6 at the time of questionnaire completion, which was an average of 175 days from first visit. Parents (38 mothers and 6 fathers) completed the FACES-IV and the BDI at the same visit without conferring with their children.

RESULTS: A great majority of patients and parents reported their families as being connected/very connected (93% of patients and 98% of parents) and flexible/very flexible (80% and 93%), with low/very low enmeshment (89% and 89%), moderate/low/very low rigidity (77% and 95%), low/very low chaos (84% and 86%), and moderate/high/very high communication (85% and 50%). Despite these scores, all well within the normal range for families with teenagers, 70% of patients and 64% of parents reported low/very low satisfaction with their families, well below the normal range. Depression scores were moderate/severe for 44% of patients and 14% of parents. Analysis of variance and t-tests showed no differences between FACES-IV scores and age, gender, ethnicity, diagnosis, and time from first visit for patients, whereas patients and parents who were more depressed were each more likely (p<0.05) to report greater dissatisfaction with their families.

CONCLUSION: A great majority of patients with eating disorders and their parents reported their family styles to be in the healthy range. However, many patients and parents, especially those with depression, expressed dissatisfaction with their families. These data demonstrate that older concepts of the families of adolescents with eating disorders need to be reconsidered.