From the Guidelines
When evaluating patients with eating disorders, it is crucial to gather a comprehensive family history, including information about eating disorders, other psychiatric illnesses, and medical conditions such as obesity, inflammatory bowel disease, and diabetes mellitus, as recommended by the American Psychiatric Association 1. This information is vital because family history can provide insight into potential genetic and environmental factors that may contribute to the development and maintenance of eating disorders.
- Key aspects of family history to explore include:
- Presence of eating disorders, such as anorexia nervosa, bulimia nervosa, or binge eating disorder, in first-degree relatives
- History of other psychiatric illnesses, including mood disorders, anxiety disorders, obsessive-compulsive disorder, and personality disorders
- Medical conditions that may be relevant to eating disorders, such as obesity, inflammatory bowel disease, and diabetes mellitus
- Family members' relationships with food, body image concerns, dieting behaviors, and weight-related comments or teasing
- Understanding family dynamics, including communication patterns, conflict resolution styles, and attitudes toward achievement and perfectionism, can also help contextualize the development and maintenance of eating disorders, as noted in the American Psychiatric Association practice guideline for the treatment of patients with eating disorders 1.
- By gathering this comprehensive family history, clinicians can better diagnose and treat eating disorders, and identify patients who may benefit from more intensive monitoring due to genetic vulnerability, in line with the recommendations of the American Psychiatric Association 1.
From the Research
Family History in Eating Disorder Patients
When evaluating patients with eating disorders, several aspects of family history are important to consider:
- A history of major affective disorder in first-degree relatives, as it has been found to be significantly more prevalent in the families of bulimic probands 2
- The presence of eating disorders in first-degree relatives, although the difference in prevalence may not be significant 2
- A history of alcoholism in first-degree relatives, as it may exert a negative influence on eating disorder behaviors and is associated with increased psychopathology in eating behavior, substance use, and personality vulnerability domains 3
- The pattern of interpersonal reactions within the family, including shared traits such as anxiety, compulsivity, and abnormal eating behaviors, which can contribute to the maintenance of eating disorder symptoms 4
- The family's emotional reactions, such as criticism, hostility, overprotection, guilt, and shame, which can fuel unhelpful attributions and enable core symptoms of the eating disorder 4
Assessment of Family History
A comprehensive assessment of the family's needs and dynamics is crucial in understanding the factors that contribute to the maintenance of eating disorder symptoms. This includes:
- Examining the family factors that can contribute to the maintenance of eating disorder symptoms 4
- Considering the needs of carers and providing them with information and support, as recommended by the National Institute for Clinical Excellence (NICE) guidelines for eating disorders 4
- Evaluating the impact of the eating disorder on the family and the family's impact on the eating disorder 5
Implications for Treatment
Understanding the family history and dynamics is essential in developing effective treatment plans for patients with eating disorders. This includes:
- Involving families in the treatment process, as recommended by the American Psychiatric Association 6
- Providing patient-centered treatment options, including referrals when indicated 6
- Addressing the complex interplay among biological predisposition, environmental and sociocultural factors, neurobiological influences, and psychological factors that contribute to the development and maintenance of eating disorders 6