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Redefining the psychosomatic family: family process of 26 eating disorder families.

This paper reports part of the data from a comparative trial of two forms of family intervention for the management of eating disorders in adolescents. Measures of family process at the beginning of treatment included Expressed Emotion (EE) and the Family Adaptability and Cohesion Evaluation Scales (FACES). EE in the families of both anorexic and bulimic patients were, on the whole, at low levels. The low levels of parental Critical Comments might be taken to represent the conflict avoiding character of the families of psychosomatic patients. However, the families showed low levels of Emotional Overinvolvement, which contradicts the clinical descriptions. The FACES scores revealed patterns that were superficially contradictory to the accepted clinical descriptions in that the patients appeared to have perceived their families as not close and as highly structured. The parents experienced their family structure as more similar to the clinical descriptions, scoring their families as more flexible and cohesive than do the patients. The FACES ideals for family organization scored by patients and parents more nearly equate with the clinical descriptions of enmeshment and lack of boundary structure. The relationship between the research findings and the clinical evaluation will be discussed.