Predicting Bulimic Episodes Based on Family Conflicts

Reprinted from Eating Disorders Review
January/February 2004 Volume 15, Number 1
©2004 Gürze Books

Stressful family interactions can predict bulimic symptoms among teenage girls, according to the results of a recent study (Int J Eat Disord 2003; 34:450).

Although many theories have been proposed to explain how family interactions influence bulimic behaviors, these theories have not been tested empirically. Similarly, studies have not yet determined whether individual variations in bulimic patterns can be explained by individual perceptions of family interaction, particularly levels of family conflict and emotional expression.

Several studies have shown a connection between daily stressors and binge eating among adult bulimics. For example, Shaye (1989) showed that some adults with bulimia who are forced to break their diet early in the day consume more sweets than do individuals who are allowed to maintain their diets throughout the day. This pattern was reported only in individuals who were stressed. In addition, adults with bulimia nervosa recalled that they experienced one or more hassles in the 60 minutes before binge eating but that they did not encounter hassles before a regular snack or meal (J Consult Clin Psychology 1987; 55:534).

Study used multiple daily questionnaires

Dr. Deborah M. Okon and associates at Pacific Graduate School of Psychology, Palo Alto, CA, and the University of New Mexico, Albuquerque, tested the stressor theory in 20 girls with clinically diagnosed bulimia.

Twice each morning, afternoon, and evening for one week, the girls participating in the study completed a set of questionnaires about their current activity, affect, and bulimic behaviors whenever they were contacted via pager. Then twice daily, at midday and late evening, they completed a second set of questionnaires that included the current activity items as well as questions about the frequency and extent of daily hassles. Patients reported that they spent less than 2 minutes filling out each form.

To study bulimic behavior, a modified version of the 9-item Binge Scale measured the frequency and duration of binges and purges as well as feelings such as depression, and feeling out of control, before the binge and after the binge. Six times daily participants reported all binge/purge behaviors that occurred since the last time they were paged.

Family hassles and bulimic symptoms

As the researchers had predicted, the girls’ perception of their family environment helped explain individual differences in bulimic symptoms by clarifying the relationship between family hassles and bulimic symptoms. For the teens who perceived their family as having a high level of conflict, 40% of the variability in bulimic episodes that occurred between 6 pm and midnight was explained by family hassles experienced between 2 pm and 10 pm. Similarly, 42% of the variability in symptoms was explained for participants who perceived their family as low in emotional expressiveness.

The authors feel that their study provides support for family systems theorists who argue that a child’s symptoms must be considered in the context of their family system. According to the authors, the study results also suggest the need for more research focusing on adolescents with diagnosable eating disorders, and indirectly supports therapies that decrease the bulimic symptoms among teens by changing the family’s interactions.

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