[Do Siblings have a Different Influence on Self-Assessed Family Functioning in Patients with Anorexia and Bulimia Nervosa?] / Haben Geschwister einen unterschiedlichen Einfluss auf die selbsteingeschätzte Familienfunktionalität bei Patientinnen mit Anorexia und Bulimia nervosa?

The impact of family factors, particularly the sibling status, on the development and course of eating disorders has been rarely investigated.Therefore, the aimof the present study was to assess a putative association between sibling status and self-rated family dysfunctionality in a large sample of study participants with bulimia nervosa and anorexia nervosa. A total cohort of n = 568 outpatients aged twelve years and older, of whomhalf had the diagnosis of anorexia (n = 288, 50.7 %), was assessed for self-rated family dysfunctionality using the well-validated German General Family Questionnaire (FB-A), while the symptom level (Global Severity Index) was determined using the SCL-90-Rsymptomchecklist. Patientswith anorexiaweremore frequently only children compared to the bulimia group who had generallymore siblings (22.6%vs. 14.4%, p = 0.012). In patients with bulimia nervosa, bivariate analyses revealed a significant positive association between the presence of siblings and the degree of family dysfunctionality (only child: 33.6 ± 17.6, sibling child: 39.3 ± 15.5, p = 0.043). Linear regressionmodels adjusted for age, body-mass index, parents living in separation, and the Global Severity Index (GSI) confirmed a significant association between higher family dysfunctionality as a dependent variable and sibling status (beta = 0.163, 95%confidence interval [CI] = 1.431; 12.774, p = 0.014).No such relationship was found in the anorexia group (p = 0.418).The differential associations between sibling status and self-rated family dysfunctionality found for the two eating-disorder entities may indicate differences in the pathogenesis of anorexia and bulimia nervosa.

[Family Functioning, Interpersonal Problems and Symptom Severity in Anorexia and Bulimia Nervosa - Comparison of Female Patients and Highschool Students]. / Familienbeziehungen, interpersonelle Probleme und Symptomausprägung bei Anorexia und Bulimia nervosa ­ Patientinnen und Schülerinnen im Vergleich.

Interrelations between dysfunctional family interaction and interpersonal problems and eating behaviors as well as psychic impairment are investigated by comparing a non-clinical sample of N = 97 female highschool students to N = 115 patients with anorexia nervosa (AN) and N = 101 patients with bulimia nervosa (BN) of a specialised outpatient unit. 19,7 % of the highschool students showed clinically significant eating behaviors. 32,3 % of the highschoolstudents, 35,5 % of the patients with AN and 48,1 % of the patients with BN had committed non-suicidal self-injurious behaviour at least once. All diagnostic instruments applied were able to differentiate the patients with BN from the patients with AN and the highschool students. Patients with BN showed more impairment by their eating disorder, more psychic symptoms, more dysfunctional family relations and more interpersonal problems than patients with AN and controls. Dysfunctional family interaction, interpersonal problems, and their interaction predicted general psychological strain, eating problems and the relative desired weight in a synergetic way. Self-injurious behavior was best predicted by psychic strain, depending on dysfunctional family and interpersonal relations and their interaction. Patients with AN tend to present themselves and their interpersonal relations in a positive way. Future studies using more specific measurements should re-examine the prevalences of self-injurious behaviours in non-clinical adolescent samples, which is to be focussed more intensely in adolescents as well as eating disorders should.

Parent-child age gaps in patients with anorexia and bulimia nervosa and their associations with family dysfunction.

BACKGROUND: Family factors are linked to the development of anorexia nervosa (AN) and bulimia nervosa (BN). However, due to a lack of direct comparison, it is still unknown whether the two entities of eating disorders differ with respect to the age gaps between parents and their affected children. METHODS: In a cohort of 568 patients from the FamFINED study (FAMily Factors INvolved in Eating Disorders) diagnosed with eating disorders, we assessed the relationships between the parent-child age differences and family dysfunction, as determined by means of the General Family Questionnaire ("Allgemeiner Familienbogen" [FBA]). RESULTS: Data showed that the age difference between the mother and the affected child was significantly higher in AN compared to BN patients (29.3 ± 5.3 vs. 28.3 ± 5.1 years, p = 0.017). Logistic regression confirmed that, also in adjusted models, the mother-child age difference significantly differed between the diagnoses of the two eating disorders (exp (B) = 0.918, 95% confidence interval 0.87-0.97, p = 0.004). However, the paternal age difference did not reach a statistical significance in the comparison between the two groups (p = 0.071). CONCLUSIONS: The two entities of eating disorders differed significantly with respect to the age difference between the mother and the affected subject. The maternal age difference was higher in anorectic than in bulimic patients from the same study population. Further research is required to identify the psychophysiological mechanisms underlying these age-dependent effects.

[Evidence for Psychodynamic Therapy for Children and Adolescents]. / Evidenz für psychoanalytisch begründete Verfahren für Kinder und Jugendliche.

In Germany, cognitive-behavioral therapy, psychodynamic therapy, and systemic therapy are scientifically and legally approved as suitable procedures for treating mental disorders. While all methods have provided empirical evidence of their effectiveness in adults according to defined criteria of the "Scientific Advisory Board for Psychotherapy" (in German: "Wissenschaftlicher Beirat Psychotherapie"), i. e., the official board which decides upon the formal scientific approval of psychotherapeutic approaches in Germany, an evaluation is lacking for the psychodynamic methods in children and adolescents. Against this background, we evaluated the available empirical data for psychodynamic therapy in children and adolescents based on the methods paper of the "Scientific Advisory Board for Psychotherapy" (2019; version 2.9). Published reviews served as the basis for identifying relevant studies, supplemented by a systematic literature search. We identified 91 potentially relevant studies but could not consider the majority of these due to formal exclusion criteria (mainly not disorder-specific, no control group). Up to 26 of the remaining studies provide evidence of efficacy as defined by the "Scientific Advisory Board for Psychotherapy". These cover 10 of the 18 areas of application as defined by the "Scientific Advisory Board for Psychotherapy". According to our evaluation, the reviewed studies provide empirical evidence for the three most relevant areas of application (i. e., affective disorders; anxiety disorders and obsessive-compulsive disorders; hyperkinetic disorders and conduct disorders). Thus, the available evidence supports the suitability of psychodynamic therapy as a method for the treatment of children and adolescents.

[The Sense of Family - Developmental Lines and Problems]. / Das Familiengefühl ­ Entwicklungslinien und Probleme.

The Sense of Family - Developmental Lines and Problems In spite of multiple criticism and diversification of family types family remains a "destination of yearning". Family stays always in contradiction to the culture of the surrounding society. The sense of family describes the sense of one's own family as a whole. It is composed of the experiences in dyads, triads, tetrades and polyades as well as the emotional atmosphere and the life style of the family as a whole. To the construction of the family as a whole as an internal object, the inner self-image of the family and corresponding the sense of family contribute the "missions" the family passes on to the children, the dynamics of loyalty, the multigenerational network, family narratives and family myths as mediators of the collective memory as well as the active shaping of relationships by the activity of the child itself. The change of family structures by "verticalisation", new communication technologies, and the "anthropo-technologies" of reproduction are still to be explored in respect to their possible consequences for the sense of family.

[Comprehensive scores for the subjective family image test, SFIT : A social relations model analysis of 461 patients with eating disorders]. / Welche Variablen lässt das Subjektive Familienbild zu? : Eine Social Relations Model Analyse für 461 Patientinnen mit Essstörung.

BACKGROUND: Given three person families the Subjective Family Image Test assesses the six dyadic relations on a valence and potency dimensions. Besides the total sum score (developmental conditions in the family) other aggregate scores are unsettled. METHODS: Data of 461 patients with eating disorders was reanalysed in order to clarify which aggregate scores are comprehensive. Structural equation analysis followed the family social relations model. RESULTS: Eight further latent variables with sufficient variance in the lay psychology of the patients were identified: at the valence dimension the three reciprocal dyads and the parents as two dispositional sources, at the potency dimension a dispositional source for each family member with complementarity for the parents (e. g. the dominant father to whom all others submit themselves vs. the submissive father who is dominated by the others). Because of the found complementarity a potency total score is inadmissible. For the same reason, the potency dimension is interpreted as dominance according to the Interpersonal Circumplex. The differences between parental and child roles in the lay psychology of the patients can be explained by attribution theory. CONCLUSIONS: Future analyses of the subjective family image test will be guided by the 9 variables found. They allow interpreting the lay family psychology of patients with eating disorders in the terminology of the Interpersonal Circumplex. Beyond, the empirically found typology in combination with anamnestic data and observed family interaction allow to focus problematic areas of family relationships in family oriented interventions.

Cognitive-Behavioral and Psychodynamic Therapy in Adolescents with Social Anxiety Disorder: A Multicenter Randomized Controlled Trial.

BACKGROUND: Although social anxiety disorder (SAD) has an early onset and is frequently found in adolescence, evidence for psychotherapeutic treatments of SAD in adolescents is rather scarce. Within the Social Phobia Psychotherapy Research Network (SOPHO-NET), we examined the efficacy of cognitive-behavioral (CBT) and psychodynamic therapy (PDT) compared to a waiting list (WL) in these patients. METHODS: In a multicenter randomized controlled superiority trial, 107 patients, aged 14-20 years, were randomized to CBT (n = 34), PDT (n = 34), or WL (n = 39). Assessments were made at baseline, at the end of treatment, and 6 and 12 months after termination. The Liebowitz Social Anxiety Scale for Children and Adolescents (LSAS-CA) applied by raters masked to the treatment condition was used as the primary outcome. As secondary outcomes, rates of response and remission and the Social Phobia Anxiety Inventory (SPAI) were used. RESULTS: Both treatments were superior to WL in the LSAS-CA (CBT: p = 0.0112, d = 0.61, 95% CI 0.14-1.08; PDT: p = 0.0261, d = 0.53, 95% CI 0.06-1.00). At the end of treatment, response rates were 66, 54, and 20% for CBT, PDT, and WL. The corresponding remission rates were 47, 34, and 6%, respectively. CBT and PDT were significantly superior to WL regarding remission (CBT: p = 0.0009, h = 1.0; PDT: p = 0.0135, h = 0.74), response (CBT: p = 0.0004, h = 0.97; PDT: p = 0.0056, h = 0.72), and the SPAI (CBT: p = 0.0021, d = 0.75, 95% CI 0.27-1.22; PDT: p = 0.0060, d = 0.66, 95% CI 0.19-1.13). Treatment effects were stable at 6- and 12-month follow-ups. CONCLUSIONS: These results are comparable to the large SOPHO-NET trial in adults (n = 495). Early treatments for social anxiety are needed in order to prevent chronic manifestation of SAD.

Cognitive-Behavioral and Psychodynamic Therapy in Female Adolescents With Bulimia Nervosa: A Randomized Controlled Trial.

OBJECTIVE: The authors compared cognitive-behavioral therapy (CBT) and psychodynamic therapy (PDT) for the treatment of bulimia nervosa (BN) in female adolescents. METHOD: In this randomized controlled trial, 81 female adolescents with BN or partial BN according to the DSM-IV received a mean of 36.6 sessions of manualized disorder-oriented PDT or CBT. Trained psychologists blinded to treatment condition administered the outcome measures at baseline, during treatment, at the end of treatment, and 12 months after treatment. The primary outcome was the rate of remission, defined as a lack of DSM-IV diagnosis for BN or partial BN at the end of therapy. Several secondary outcome measures were evaluated. RESULTS: The remission rates for CBT and PDT were 33.3% and 31.0%, respectively, with no significant differences between them (odds ratio [OR] = 0.90, 95% CI = 0.35-2.28, p = .82). The within-group effect sizes were h = 1.22 for CBT and h = 1.18 for PDT. Significant improvements in all secondary outcome measures were found for both CBT (d = 0.51-0.82) and PDT (d = 0.24-1.10). The improvements remained stable at the 12-month follow-up in both groups. There were small between-group effect sizes for binge eating (d = 0.23) and purging (d = 0.26) in favor of CBT and for eating concern (d = -0.35) in favor of PDT. CONCLUSION: CBT and PDT were effective in promoting recovery from BN in female adolescents. The rates of remission for both therapies were similar to those in other studies evaluating CBT. This trial identified differences with small effects in binge eating, purging, and eating concern. Clinical trial registration information-Treating Bulimia Nervosa in Female Adolescents With Either Cognitive-Behavioral Therapy (CBT) or Psychodynamic Therapy (PDT). http://isrctn.com/; ISRCTN14806095.

Terapia psicodinámica familiar de la anorexia nerviosa / Psychodynamic family therapy for anorexia nervosa / Teràpiafamiliar psicodinàmicade l’anorèxianerviosa

La anorexia nerviosa es un grave trastorno psicosomático, aunque muchas veces está íntimamente enlazado con las relaciones familiares. En algunos casos, también se produce en un contexto multifactorial, diferenciando cuatro niveles de desarrollo de la patología: el nivel biológico (neurofisiológico), el social, el familiar y el individual (psíquico). La dinámica familiar de la patología suele tener un elevado impacto en la relación terapéutica y en la dinámica de transferencia y contratransferencia. A continuación, se presentan la experiencia clínica y algunos resultados de estudios efectuados en las dinámicas familiares de la anorexia, así como también los pasos de su tratamiento. También se hablará sobre la indicación de las sesiones de terapia familiar y su ajuste al caso concreto. A través de las barricadas: entre profesores y estudiantes adolescentes

Anorexia nervosa is a severe psychosomatic disorder, but one that is often deeply interwoven with family interactions. In some cases it also appears in a multigenerational context. Four levels of development of the illness must be differentiated: the biological (neurophysiological), social, family and the individual (psychic) levels. The family dynamics involved with this illness often have a high degree of impact on the therapeutic relationship and the dynamic of transference and countertransference. Clinical experiences and some research results on the family dynamics of anorexia are presented, as well as the steps for treatment. Questions of indications for family therapy sessions and their setting will also be discussed

L’anorèxia nerviosa és un greu trastorn psicosomàtic, tot i que moltes vegades està íntimament enllaçat amb les relacions familiars. En alguns casos també es produeix en un context multifactorial, i es diferencien quatre nivells de desenvolupament de la malaltia: el nivell biològic (neurofisiològic), el social, el familiar i l’individual (psíquic). La dinàmica familiar de la malaltia sovint té un elevat impacte en la relació terapèutica i en la dinàmica de transferència i contratransferència. Seguidament es presenten l’experiència clínica i alguns resultats d’estudis efectuats en les dinàmiques familiars de l’anorèxia, així com també els passos del tractament. També es parlarà sobre la indicació de les sessions de teràpia familiar i de l’ajustament al cas concret

[Psychodynamik focal therapy of bulimia nervosa for female adolescents and young adults]. / Psychoanalytisch-orientierte Fokaltherapie der Bulimia nervosa bei weiblichen Jugendlichen und jungen Erwachsenen. Ein Manual.

A manual for a disorder oriented psychodynamic treatment of bulimia nevosa and atypical bulimia nervosa of female adolescents and young adults is presented. This manual is applied in a therapy project, which started in 2007. The work on conflicts and structural dysfunctions is meant to lead to the removal or alleviation of the symptoms and an improvement of eating behavior and body image. The bulimic symptoms are contextualized and focussed according to the conflicts and ego-structural deficits of the patients. Typical patterns of interpersonal relationships, transference, conflict, defence and structural problems as well as therapeutic steps are described. The typical psychosocial situation of female adolescence and young adult age is taken into account. Special emphasis is laid on the limitedness of the therapy to 60 sessions and the active structuring of the final phase of he therapy by the therapist.

[Interrater-reliability of the OPD-CA, the axes conflict and structure]. / Interrater-reliabilität der OPD-KJ-Achsen Konflikt und Struktur.

The reliability of the meanwhile widely used Operationalized Psychodynamic Diagnostics in childhood and adolescence (OPD-CA) is only rarely examined. By means of audiovisual recordings of OPD-CA-interviews with 39 adolescents in the context of a randomized-controlled psychotherapy study for the treatment female adolescents with bulimia nervosa and atypical bulimia nervosa the reliability of the axis conflict and the axis structure were examined. This was carried out by the calculation of Intraklassen-correlations of three raters. The rater agreements ranged from good to excellent, except for impulse control in the axis structure, where the results were satisfactory. The relevance of the results for clinical practice is discussed.

[Intergenerational transmission of trauma--empirical research and family dynamics approach]. / Die mehrgenerationale Weitergabe von Traumatisierungen--empirische und familiendynamische Perspektiven.

A tendency to pass on traumatic experiences from one generation to the next can be observed in family systems. This continuity manifests itself very differently, e. g. in posttraumatic stress disorders, anxiety disorders, mood disorders, aggressive behavior, social withdrawal or health risk behaviors in the second or third generation. Besides physiological mechanisms (e. g. levels of cortisol) psychosocial "mediators" as attachment security, emotional regulation and availability, parenting style as well as family dynamic processes like family secrets, communication deviances and resulting disturbances of mentalization, disturbances of interpersonal boundaries, conflicts of loyalty and delegation are of relevance. A case example and considerations of resilience processes are given as well.

[Family dynamics and family therapy of obsessive-compulsive disorder]. / Familiendynamik und Familientherapie bei Zwangsstörungen.

Obsessive-compulsive disorders and behaviours characterising an anancastic personality disorder have a direct interpersonal impact. Conflicts of subjects with OCD are often focussed on control and submission, order and cleanliness, a technical-signal processing cognitive style and insecure self-object-boundaries. In the patients families obsessive compulsive disorders and behviours, restrictions in the development of autonomy and a controlling parenting style are often to be found. Unsecure attachment is discussed as one possible contribution to the development of OCD. Relatives are often involved in obsessive-compulsive symptoms. The psychosocial burden on them is often considerable. The inclusion of the family into the treatment of children and adolescents improves treatment results.

[Family relationships and family therapy of eating disorders]. / Familienbeziehungen und Familientherapie bei Essstörungen.

A multitude of empirical studies clearly demonstrates that the origin and course of eating disorders is closely linked to family factors. The influence is exerted in a direct way by conveying attitudes towards food, eating, weight, shape and appearance within the family and in a more indirect way by the family relationships. Families of bulimics differ from those of anorexics by a higher degree of conflict, impulsivity, expressiveness and by lower affective resonance and cohesion. Family therapy has proven to be effective in the treatment of eating disorders. A sketch of a family therapy describes the conflict oriented approach which includes behavioral elements in oder to stabilize the eating behavior and the weight.

[Contemporary family systems--developments, problems, and possibilities]. / Familiensysteme heute--twicklungen, Probleme und Möglichkeiten.

Contemporary forms of family life and their development are described. The thesis of the pluralism of family types as a historical new phenomenon is critically reviewed, with special consideration of the relationship between family life and working world. An increasing move away from the "fordistic model" of family life took place during the last two decades towards the "multilocal multigenerational family". This development is, among others, due to the increased life expectancy and the change in the population structure. Simultaneous to this the boundaries between family and working world become more permeable. If the stability of employments decreases and the mobility of employees increases in a large scale, is discussed controversely. For an increasing number of families it becomes more and more difficult to make flexibility at work compatible with security for the children or to cope with the consequences of unemployment.