The relationships between clinical features of eating disorders and measures of individual and family functioning.

The performances of 114 eating disordered females on measures of individual and family functioning were examined via t-tests, analyses of variance, and chi squares analyses. Subjects met DSM-III-R criteria for anorexia nervosa, anorexia nervosa with bulimia nervosa, bulimia nervosa, or eating disorder not otherwise specified. Measures included selected scales of the MMPI, Rotter's Internal-External Locus of Control Scale, the Bem Sex Role Inventory, the Eating Disorder Questionnaire, the Moos Family Environment Scale, and the Berren-Shisslak Family Dynamics Survey. First, performances on the measures were compared to normative samples and across diagnostic groups. As expected, the subjects differed from normative samples on many dependent measures, but the diagnostic groups differed little among themselves. Next, an examination of 45 clinical features suggested that subjects were not as symptomatically distinct as diagnosis might imply. Finally, diagnosis was set aside to examine the relationships of specific clinical features to the measures of individual and family functioning. These features included age, weight history, food binges, vomiting, laxative and diuretic use, food restriction, menstrual history, exercise, drug and alcohol abuse, symptom severity, inpatient treatment history, and additional diagnosis. Surprisingly, a history of anorectic weight was not related to any of the measures, but amenorrhea emerged as a clinical feature of some import, not just among the anorectic subjects but among subjects generally. Other findings suggested that patients who binge have difficulty with separation, that binges may be a metaphor for unsatisfied cravings for nurturance, and that vomiting and exercise may enhance a sense of separateness while laxative use may represent the private expulsion of anger. The need for family involvement in treatment was highlighted by many relationships between the clinical features and indices of family dysfunction