Autonomy disturbances in subtypes of anorexia nervosa.

Abstract

This study examines the hypothesis, derived from several theories, that disturbances in the development of autonomy are a central psychological feature in anorexia nervosa. Several measures relevant to autonomy, including the General Causality Orientations Scale (Deci & Ryan, 1985b), Structural Analysis of Social Behavior (Benjamin, 1977), Mutuality of Autonomy Scale (Urist, 1977), and Family Environment Scale (Moos, 1974) were administered to 19 restrictive anorexics, 14 bulimic anorexics, and 17 normal control subjects. All three groups were matched for age, sex, race, education, and marital status; the anorexic groups were matched for current percentage of ideal body weight, duration of illness, and treatment history. We hypothesized that both restrictive and bulimic anorexics would evidence greater problems with autonomy than would controls and, further, that the three groups would show differential patterns of response on these measures. Results largely confirmed these hypotheses. The restrictors experienced a greater sense of impersonal causality than did either the butimic anorexics or the controls. Compared with the control group, both restrictive and bulimic anorexic groups exhibited poorer self-concept, more pathological object relations, and more disturbed family interactions. We concluded that problems with autonomy-related issues are prominent in anorexia nervosa and that different subtypes may be associated with distinct forms of autonomy disturbance. Anorexia nervosa is a psychosomatic disorder characterized by extreme weight loss, disturbed body image, and intense fear of becoming fat (American Psychiatric Association, 1980). Among the psychological features most often associated with this syndrome is a deviation in the development of autonomy (Garfinkel & Garner, 1982). Deficits in autonomy and initiative figure heavily in diverse etiological theories, including individual psychodynamic (Bruch, 1973, 1982), object-relational (Goodsitt, 1977; Masterson, 1977; Sours, 1980), and familysystems (Minuchin, Rosman, & Baker, 1978; Selvini-Palazzoli, 197 l) perspectives. Although autonomy disturbances appear to be a common theme in the clinical literature, empirical confirmation is largely absent (Hsu, 1983). Thus in this study we sought to explore the nature of autonomy deficits in patients with anorexia nervosa. To accomplish this goal, we had to ascertain the specific autonomy disturbances postulated to underlie anorexia nervosa. Bruch (1973, 1982) defined the anorexic's difficulties with autonomy as a struggle for control, for a sense of identity, competence, and effectiveness ( 1973, p. 251). A triad of major psychological manifestations result from these autonomy difficul