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Anorexia Nervosa: Lessons from a Follow-up Study

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Helm Stierlin
Helm Stierlin
Helm Stierlin
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Gunthard Weber
Gunthard Weber
Gunthard Weber
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Abstract

Presents data from 81 families with a member who was treated for anorexia nervosa between 1978 and 1987 and followed up in 1984 and 1987. Topics discussed include the triggering situations for disease onset, patients' symptoms, family therapies, and follow-up. Results of the follow-ups are discussed in terms of (1) patients' eating behaviors, weight, and menstruation; (2) their relationships with peers; (3) individuation from family of origin and development of family relationships; and (4) symptoms and complaints of other family members. Four cases involving female patients (aged 11–28 yrs) illustrate the range of clinical experience, as well as the methodological problems in assessment. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
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Anorexia Nervosa: Lessons from
a Follow-up Study
Helm Stierlin, MD,Ph.D., and Gunthard
Weber,
MD
In 1984 and 1987 we carried out follow-up studies on most of the anorexia
families we had been treating. The first time we included
31,
the second time 62
families. The findings from the first study have already been published (11).
With each study we had different aims in mind and employed different
methods. Before we focus on these, we would like to comment briefly on the
value and limits of outcome studies in general.
These studies provide information on the natural course of an illness or
disturbance and on the efficacy of therapeutic measures. Therefore, it should
not surprise us that there now exist over 50 studies, worldwide, which examine
the course of anorexia nervosa after various types of therapy. Recently Hsu (5)
gave a critical overview of such studies. When compared with other outcome
studies in the psychotherapeutic domain, studies of anorectics promise relatively
clear-cut results. They can measure not only "soft" psychosocial factors but also
"hard" data such as weight gain, menstruation, and observable changes in eating
behaviors. However, even here, a number of methodological problems remain
that have been insufficiently addressed by existing studies. For example, Hsu (5)
mentions several serious methodological failings of outcome studies in anorexia
nervosa. He mentions in particular:
• lack of clinical data and inadequate diagnostic criteria;
• lack of adequate description of treatment;
• inadequate followup (e.g., short duration of follow-up, a high failure-to-
trace rate, indirect methods of evaluation, poorly defined outcome criteria,
failure to employ multiple outcome measures).
We may add to this list another failing: The health of the other family
members and the development of the whole family are not given enough
attention. Our experience as family therapists has taught us that frequently
Helm Stierlin, MD, Ph.D., is the medical director of the Department of Family Therapy, University of
Heidelberg Medical School, Heidelberg, West Germany. Gunthard Weber, MD, is a psychiatrist and
family therapist in private practice in Wiesloch, near Heidelberg, West Germany.
This article was written in collaboration with Arnold Retzer.
This article has been adapted with permission from a chapter in Unlocking the Family Door, by Helm
Stierlin, MD, Ph.D., and Gunthard Weber, MD. New York: Brunner/Mazel, 1989, pp. 179-230.
120 Family Systems Medicine, Vol. 7, No. 2,1989 © FSM, Inc.
This document is copyrighted by the American Psychological Association or one of its allied publishers.
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
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Evidence for the Effectiveness of Family Therapy for Anorexia NervosaIs There a Link between Particular Type of Family Functioning and Anorexia Nervosa?A Theory for Clinical PracticeA Model of TreatmentConclusion NoteReferences
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Family Assessment: Centripetal and Centrifugal Family Systems
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  • Jan 1981
  • AM J FAM THER
A consideration of interactional style is useful to both researchers and clinicians interested in family assessment. This paper offers data and process evaluation scales designed to determine family interactional style, conceptualized as a continuum ranging from centripetal (CP) to centrifugal (CF), and containing at the midpoint a mixed area in which facets of both the CP and the CF styles are found.
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Investigation of ‘weight pathology’ of 58 mothers of anorexia nervosa patients and 204 mothers of schoolgirls
Article
  • Mar 1986
Synopsis ‘Weight pathology’ – defined by Kalucy et al. (1977) as ‘deviations in weight, shape, eating behaviour and activity’ – has been hypothesized to be unduly common in families with anorexia nervosa. It was investigated in this study by means of questionnaires evaluating both weight history and attitudes towards weight-related matters in 58 mothers of anorexia nervosa patients and 204 mothers of schoolgirls of similar age and socioeconomic status (SES). No support was found for the hypothesis. A family history of aberrant weight and mother's current weight and past weight histories showed no significant differences between the groups. 142 other mothers of schoolchildren and 446 attenders at Weight Watchers also completed the questionnaire on attitudes towards weight-related matters. Mothers of patients showed a lower concern on all scales than did all other groups. The findings are discussed in relation to earlier controlled studies of family factors in anorexia nervosa.
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Psychotherapy and growth: A family systems perspective
  • Jan 1977
  • W R Beavers
Beavers, W. R. Psychotherapy and growth: A family systems perspective. New York: Brunner/Mazel, 1977.
Handbook of eating disorders. Part 1: Anorexia and bulimia nervosa
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Hsu, L. K. G. Outcome and treatment effects. In P. J. V. Beumont, G. D. Burrows, & R. C. Casper (Eds.), Handbook of eating disorders. Part 1: Anorexia and bulimia nervosa. New York: Elsevier, 1987.
A family approach to anorexia nervosa: Study, treatment and outcome
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Rosman, B. L., Minuchin, S., Baker, L., & Liebman, R. A family approach to anorexia nervosa: Study, treatment and outcome. In R. A. Vigersky (Ed.), Anorexia nervosa. New York: Raven, 1977.
Why long intervals between sessions? The therapeutic control of the family-therapist suprasystem
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  • M Selvini Palazzoli
Selvini Palazzoli, M. Why long intervals between sessions? The therapeutic control of the family-therapist suprasystem. In M. Andolphi & I. Zwerling (Eds.), Dimensions of family therapy. New York: Guilford, 1980.