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Familial contributions to the etiology and course of anorexia nervosa and bulimia.

In this article, we summarize the current knowledge of familial influences in anorexia nervosa and bulimia. Three lines of evidence are reviewed: descriptions of family interaction, familial correlates of the course and phenomenology of symptoms, and studies of familial transmission. We conclude that although certain familial patterns are associated with eating disorders, there is no single mechanism or pathway of influence. Rather, it seems likely that certain personality factors, which may be genetically determined, predispose the individual to greater sensitivity and vulnerability to powerful familial and social experiences that impinge adversely on self-esteem and self-efficacy. Although the role played by familial factors in the etiology of eating disorders currently excites a great deal of theoretical interest, empirical data are fragmentary, and most ideas about the nature and extent of this role are highly speculative (Kog & Vandereycken, 1985; Yager & Strober, 1985). In this article, we review evidence on the familial factors that have been linked to the development and course of anorexia nervosa and bulimia. We do not imply that these factors are the most influential determinants of vulnerability to the eating disorders; rather, we believe that a detailed account of the potential advances and the methodological problems that hamper ongoing efforts in this area is timely.