Family-Based Therapy for Adolescents With Anorexia Nervosa

Abstract

Dr Ishida raises a valuable question: Do eating disorders arise from a culture of affluence? After all, one can hardly picture a child from a family struggling to put food on the table denying herself food. However, the stereotype that patients with eating disorders are indulged and need only to gain more appreciation for their good fortune is neither helpful in a treatment sense nor well supported. Specifically, although data suggest that a majority of patients with anorexia nervosa come from an affluent background, the prevalence of this disease in patients from lower socioeconomic classes has increased substantially.1Garfinkel PE Garner DM Anorexia Nervosa: A Multidimensional Perspective. Brunner/Mazel, New York, NY1982Google Scholar, 2McClelland L Crisp A Anorexia nervosa and social class.Int J Eat Disord. 2001; 29: 150-156Crossref PubMed Scopus (66) Google Scholar In addition, findings suggest that women with bulimia do not differ from those without an eating disorder with regard to social class.3Dolan BM Evans C Lacey JH Family composition and social class in bulimia: a catchment area study of a clinical and a comparison group.J Nerv Ment Dis. 1989; 177: 267-272Crossref PubMed Scopus (12) Google Scholar Although one might suggest that the middle-class value system has become more widespread in society, it is difficult to make causal inferences regarding the influences of such a value system on the origins of this disease. Certainly, as Dr Ishida mentions, pressures to achieve and values regarding attractiveness have been suggested.4Striegel-Moore RH Silberstein LR Rodin J Toward an understanding of risk factors for bulimia.Am Psychol. 1986; 41: 246-263Crossref PubMed Scopus (889) Google Scholar Although an affluent culture may value thinness, only a minority of individuals take such values to a pathologic extreme.5Polivy J Herman CP Causes of eating disorders.Annu Rev Psychol. 2002; 53: 187-213Crossref PubMed Scopus (728) Google Scholar Clearly, while such a value system may provide the backdrop for an eating disorder, research suggests that the origins are multifaceted.3Dolan BM Evans C Lacey JH Family composition and social class in bulimia: a catchment area study of a clinical and a comparison group.J Nerv Ment Dis. 1989; 177: 267-272Crossref PubMed Scopus (12) Google Scholar, 5Polivy J Herman CP Causes of eating disorders.Annu Rev Psychol. 2002; 53: 187-213Crossref PubMed Scopus (728) Google Scholar To date, no research has been conducted to determine if community service interventions would be efficacious for the treatment of eating disorders. However, our clinical observations have been that many of these patients are already intensely involved in community service activities as a prerequisite for college admissions. Family-Based Therapy for Adolescents With Anorexia NervosaMayo Clinic ProceedingsVol. 80Issue 3PreviewTo the Editor: I read the article by Sim et al1 on family-based therapy for adolescents with anorexia nervosa with much interest. Anorexia nervosa and bulimia are diseases of affluence. Symptoms arising from intrapersonal and interpersonal struggles with family and school relate to too much emphasis on overachieving and growing up too fast in an affluent society in which overabundance and overindulgence are the norm. Full-Text PDF