European Child & Adolescent Psychiatry 5:18-24 (1996) © Steinkopff Verlag 1996 C. Wewetzer W. Deimel B. Herpertz-Dahlmann E Mattejat H. Remschmidt Follow-up investigation of family relations in patients with anorexia nervosa Received: 29 September 1994 Accepted: 13 February 1995 Dr. Chr. Wewetzer (~) • W. Deimel B. Herpertz-Dahlmann • E Mattejat H. Remschmidt Clinic for Child and Adolescent Psychiatry of the Philipps-University Marburg 35032 Marburg, FRG Abstract In a group of 22 formerly anorectic inpatients (follow-up 3.8 years after treatment) and in a con- trol group of 24 paralleled young women, the subjective perception of the family structure was assessed using the "Subjective Family Image (SFI)', in order to investigate the question whether the family struc- ture of former anorectics differs from the controls and whether in- dividual development of the former inpatients is associated with the ex- perienced family structure. Em- pirical results are in favor of the following two hypotheses: 1) Com- pared to the control group, former- ly anorectic inpatients experience family relationships as more corn- plicated and less satisfying. The quality of family relationships in the patient group is reduced, even at the time of follow-up. 2) In- dividual outcome (individual course of the illness) and quality of family relationships at time of follow-up are associated. Patients with a good outcome experience family relation- ships as more positive than patients with a poor outcome. The accor- dance of these findings to other empirical results and their implica- tions for clinical practice are discussed. Key words Anorexia nervosa - follow-up - family relations Introduction Clinical studies that deal with the pathogenetic links in the development of anorexia nervosa are numerous. Several authors (2, 27, 36, 44) have early underlined the importance of familial interaction disturbances as a pathogenetic determinant. Minuchin et al. (27) emphas- ized enmeshed relationships between family members, as well as overprotective parental attitude. Additionally, they described rigid role structures, conflict denial and tenden- cies to harmonize. Their concepts could at least be par- tially supported by empirical studies, which showed that in families of anorectics problems of parent-child-en- meshment and boundary regulation are frequent (9, 22-24). On a balance, the empirical evidence concerning the family environment of eating disordered patients shows that there are substantial differences compared to normal families. But the questions whether these dys- functions are specific for eating disordered patients' families and whether there is a subtype specificity (restric- tive anorectics vs. bulimics) have not yet been decided and need further exploration (8, 13-18, 20, 21, 30, 38-41, 43). Furthermore, the causal relationship needs clarifica- tion: It is still quite unclear whether the described family dysfunctions are to be regarded as etiological factors or whether the dysfunction characteristics are consequences of the eating disorder (7, 19). Whereas in studies with a pathogenetic orientation, family features have been analyzed quite frequently, in follow-up examinations, the familial aspect is less taken into account. As a rule, familial characteristics have been assessed by interviews in a global and unspecific manner. In the cases in which familial dysfunctions were stated,