Perception of Family Functioning and Depressive Symptomatology in Individuals With Anorexia Nervosa or Bulimia Nervosa Victor Fornari, Katarzyna Wlodarczyk-Bisaga, Michael Matthews, David Sandberg, Francine S. Mandel, and Jack L. Katz This study investigated the relationship between the perception of family functioning and depressive symp- tomatology in individuals with eating disorders (EDs). Subjects were evaluated by diagnostic clinical inter- view using DSM-III-R criteria for EDs, the Schedule for Affective Disorders and Schizophrenia-Lifetime Ver- sion (SADS-L), and two self-report measures, the Beck Depression Inventory (BDI) and the Family Assess- ment Device (FAD). A significant association was found between self-reported depressive symptomatol- ogy and perceived poor family functioning. Subjects with bulimia nervosa (BN) reported a significantly more dysfunctional family background than subjects with anorexia nervosa (AN). In our sample, the pres- ence of self-reported depressive symptomatology was a more powerful predictive variable for perceived family dysfunction than the diagnosis of affective disorder. Also, the diagnosis of BN was a more consis- tent predictor of dysfunctional family interaction than the diagnosis of affective disorder. Depressive symp- toms and EDs seem to play different roles in the way in which they contribute to dysfunctional family pat- terns. Copyright© 1999by W.B. Saunders Company I NTEREST IN THE ROLE of family factors in the development and maintenance of eating disorders (EDs) dates back to the 1873 description of anorexia nervosa (AN) by Lasegue. 1 More systematic approaches to the investigation of fam- ily factors in the etiology of EDs were initiated by Minuchin et al, 2 and by Selvini-Palazzoli and the Milan school of family therapy? Several studies identified prevailing styles of functioning in fami- lies with eating-disordered individuals and indi- cated that interactions in these families differ from those in families without eating-disordered mem- bers. 4,5 Family interactions of subjects with anorec- tic and bulimic symptoms have been found to be dichotomous in that subjects with AN describe their families as cohesive and organized with a lower tolerance of conflict,6,7 as opposed to subjects with bulimia nervosa (BN), who report their families to be significantly more conflicted and less cohe- sive. 8,9 However, it has also been suggested that families of AN subjects are heterogenous, 1° and that, for example, there is no single dominant family pattern characteristic of AN. H Differences described in the patterns of family functioning are also possibly related to methodological limitations. From the Departments of Psychiatry and Biostatisties, North Shore University Hospital, Manhasset; and Division of Child and Adolescent Psychiatry, Children's Hospital of Buffalo, Buffalo, NY Address reprint requests to Victor Fornari, MD, Division of Child and Adolescent Psychiatry, North Shore University Hospi- tal, 400 Community Dr, Manhasset, NY 11030. Copyright © 1999 by W.B. Saunders Company 0010-440X/99/4006-0005510. 00/0 For example, there are theoretical differences in the conceptualizations of family interactions, a2 and findings are elicited by a wide variety of assess- ment measures (self-report and observational mea- sures). 13 In recent years, there has also evolved a consider- able interest in the comorbidity of ED and other psychiatric conditions. Halmi et al. TM and Fornari et al.15 found that subjects with AN and BN have high rates of both depressive and anxiety disorders. Similarly, high rates of personality disorder (PD) have been reported in ED subjects. 16,17 While the family interactions of individuals with ED and the possible comorbidity of ED with other conditions have generated considerable research interest, there has been little research concerning the relationship between the functioning of these families and the presence of other symptomatic behaviors. Steiger et al.18 found no association between the ED severity and the reported family functioning, but found a significant relationship between the sever- ity of the PD and the degree of dysfunctional family interactions. Waller 19 found that in ED subjects also diagnosed with borderline personality disorder (BPD), specific features of pathologic family interactions were associated with particular symptoms of BPD. Thienemann and Steiner2° re- ported that dysfunctional family interactions of ED subjects were correlated with both the self-reported level of depression and the clinical diagnosis of major depressive disorder (MDD). Moreover, Miller et al.21 found that families of patients with MDD show severely impaired functioning, even more so than families of subjects with alcoholism, schizo- 434 Comprehensive Psychiatry, Vol. 40, No. 6 (November/December), 1999: pp 434-441