Une Faute Sans Nom

Lasthénie de Ferjol, heroine of the tale Une Histoire sans Nom written by Barbey d'Aurevilly, a young lady leading herself to death by self provoked hemorraghes, appears to be a paradigm of family problematic passed from one generation on to the next one through actings. We study here the link between self bleeding and severe anorexia nervosa, which is described in several case reports, noticing that both of these two symptoms are quite specific from the women. We can understand through this tale how a mother tangled up in a great driving violence and the destructivness coming with the fight against melancolic collapse can pass this violence on to her daughter in an underword way. Then the young girl repeats a story which is not hers, trying to get out of this destiny with actings: we see here how an unhealthy behaviour can be salutary, because of the differenciation it carries out. After all, Lasthénie de Ferjol syndrom seems to be very close to anorexia nervosa, the blood of provoked hemorraghes refering to the undernutrition provoked amenorrheae. The central problematic of these teenage girls' deseases would be the stakes and the risks of reaching womanhood, that is to say the acception of the passive position, which refers to the infans- mother relationship.     

The body as hostage of the self. Phenomenological aspects of anorexia nervosa

There are several basic structures upon which anorexia nervosa could develop: hostility between mother and daughter, feministic protest, abandonnism, the ascetic structure, the reluctance against the being-thrown-on-the-world, asw. The phenomenological analysis reveals, through these different structures, a common distress. The patient feels the others, and also, the existence, as a violence. Yet, she feels help ass in her fight against this violence. So she takes her own body as hostage in order to delay her entry in the existence.     

Assumptions and Beliefs in Adolescents With Anorexia Nervosa and Their Mothers

A pilot study examined the specific cognitive content of female adolescents with anorexia nervosa. The relationship between daughter and mother concerns, and concerns in mothers, also were investigated. All participants completed a measure of assumptions and negative self-beliefs related to eating disorders. Adolescents with anorexia nervosa scored more highly on all subscales of the measure than nonclinical adolescent controls. There were significant daughter mother relationships on two subscales in the clinical, but not the nonclinical, group. However, the two groups of mothers did not differ on any subscale. Possible explanations for the findings, and implications for treatment and research, are briefly considered.     

Lasthénie de Ferjol syndrome. Apropos of a case]

After a brief review of literature, the authors report a case of the "Lasthénie de Ferjol" syndrome. From clinical observations, they establish theoretical landmarks and underline the necessity for searching the meaning.     

A clinical and phenomenological study of 185 Spanish adolescents with anorexia nervosa

The objectives of the present study were the following: to determine the socio-familial, academic and interpersonal characteristics specific to anorexia nervosa (AN); to study comorbidity in patients with anorexia and morbidity in their parents; and to ascertain whether patients with anorexia nervosa in Spain are similar to those in other countries. The research team revised the clinical records of 185 Spanish adolescents with AN (aged 11–18 years). The results were compared with those obtained from a group of 185 psychiatric patients without AN matched by sex, age, time of consultation and centre. No significant differences were found with regard to broken home, birth order or parent-patient conflict. The parents of patients with anorexia have a higher standard of education and develop more affective disorders. When compared with other patients, the individuals with anorexia nervosa perform much better academically but are more socially withdrawn. Males with anorexia nervosa perform worse academically than females and have more anxiety diagnoses. Patients with anorexia have a high comorbidity for affective and obsessive-compulsive disorders. Sufferers from anorexia nervosa in Spain are clinically analogous to patients with anorexia in other countries. The two characteristics specific to these patients are a high standard of academic performance and an intense degree of social withdrawal, although there are certain factors common to other pathologies relating to adolescence.

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Zusammenfassung Die Ziele der vorliegenden Studie bestanden darin, die sozio-familiären, bildungsmäßigen und interpersonellen Charakteristika zu bestimmen, die für Patienten mit Anorexia nervosa spezifisch sind. Außerdem wurde die Komorbidität der Patienten ebenso wie die Morbidität der Eltern untersucht. Es sollte geklärt werden, ob die spanischen Patienten mit Anorexia nervosa mit Patienten aus anderen Ländern vergleichbar sind. Die Forschungsgruppe untersuchte die Krankengeschichte von 185 spanischen Jugendlichen mit AN im Alter von 11 bis 18 Jahren. Die Ergebnisse wurden mit einer psychiatrischen Kontrollgruppe verglichen, die im Hinblick auf Geschlecht, Alter, Vorstellungszeitpunkt und -Zentrum parallelisiert war. Es fanden sich keine signifikanten Unterschiede im Hinblick auf den Anteil zerrütteter Familien, Geburtsrang oder Konflikte zwischen Eltern und den Patienten. Die Eltern von Patienten mit Anorexia hatten eine höherwertige Ausbildung; sie zeigten häufiger affektive Störungen. Im Vergleich zu anderen Patienten schneiden die Anorexia nervosa-Patienten in bezug auf Schulerfolge besser ab, sie sind jedoch in sozialer Hinsicht zurückgezogener. Männliche Jugendliche mit Anorexia nervosa wiesen schlechtere Schulleistungen auf als die weiblichen und litten häufiger unter Angststörungen. Patienten mit Anorexia nervosa weisen eine hohe Komorbidität mit affektiven Störungen und Zwangsstörungen auf. Insgesamt ähnelt die Symptomatik der Patienten aus Spanien der anderer Länder. Die beiden Charakteristika, die für diese Patienten spezifisch sind, sind der hohe schulische Leistungsstandard und der ausgeprägte soziale Rückzug, obwohl es bestimmte Faktoren gibt, die sich auch bei anderen psychiatrischen Störungen im Jugendalter häufiger finden.

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Résumé Les objectifs de cette étude étaient: de déterminer le caractéristiques socio-familiales, scolaires et interpersonnelles spécifiques à l'anorexie mentale; d'étudier la comorbidité des patients anorexiques et la morbidité de leurs parents; et de vérifier si les patients anorexiques espagnols ressemblent à ceux des autres pays. L'équipe de recherche a réexaminé les histoires cliniques de 185 adolescents espagnols anorexiques (âgées de 11 à 18 ans). Les résultats obtenus ont été comparés avec ceux d'une groupe des 185 patients psychiatriques sans anorexie mentale appariés selon le sexe, l'âge, da durée de la consultation et le service. Aucune différence significatives n'ont été trouvées concernant les ruptures familiales, l'ordre de naissance ou les conflits entre parents et patients. Les parents des patients anorexiques ont un niveau d'éducation plus élevé et développent plus souvent des troubles affectifs. Par rapport aux autres patients, les patients anorexiques ont des performances scolaires plus élevées mais sont plus inhibés socialement. Les gar¢ons avec une anorexie mental ont un moindre niveau scolaire que les filles et ont plus souvent un diagnostic d'anxiété. Les patients anorexiques ont une comorbidité plus importante concernant les troubles affectifs et obsessionnels compulsifs. Les patients anorexiques espagnols ressemblent cliniquement à ceux des autres pays. Les deux caractéristiques propres à ces patients sont un niveau élevé de performance scolaire et un degré intense d'inhibition sociale bien qu'ils présentent également certains facteurs communs aux autres pathologies de l'adolescence.

     

L’accouchement : un événement psychique

The psychic process of maternity is a widely recognized and studied mechanism, and its diachronic aspect has been the most frequently described. The present study focusses on the moment of expulsion, and we have attempted to determine the reactions that take place at a psychic level both in the mother and child during the process of childbirth. Expulsion, an act that marks the separation between two bodies has its psychic aspect, denoted by what Freud referred to as “a sense of hatred”, in which what was until then contained within undergoes a movement towards its being expelled, and is then finally expelled outside, an experience which inaugurates the first within-without distinction. Pierra Aulagnier’s conceptualization of the life of the psyche provides a means of representing the mother’s rediscovery during childbirth of suppressed psychic material associated with her own infantile history, that of her own birth, a rediscovery which is only made possible by the process of regression that is characteristic of maternity. The maternal psyche thus serves as a mould for the infant, who will utilize this pictogram of birth transmitted by his mother to come to terms with and represent the process of upheaval that he is experiencing. In Freudian terms, as expulsion gives rise to the psychic experience during this movement of a “a sense of hatred”, we thus postulate that a transgenerational transfer of this birth pictogram may take place - or in other words, a “pictogram of a sense of hatred” — and that this representation provides childbirth with an additional psychic dimension.     

Background factors in anorexia nervosa

Fifty-one adolescents with anorexia nervosa and 51 sex-, age- and school-matched comparison cases were psychiatrically and physically examined. Twenty-four of the anorexia cases constituted the total population of anorexia nervosa cases born in 1970. The cases were examined at a mean age of 16 years. The mothers were interviewed in detail concerning hereditary and other family factors, child's early physical and temperamental development, and the family's overall social situation. Medical records pertaining to the pre-, peri- and neonatal periods were analysed blind to diagnosis. Thirty-five of the anorexia cases (69%) had a reasonably plausible background factor which could have contributed to the development of the eating disorder. Similar background factors were encountered in 2 (4%) of the comparison cases. The findings are discussed as they pertain to anorexia nervosa etiology.

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Zusammenfassung Es wurden 51 Jugendliche mit Anorexia nervosa und 51 Vergleichsfälle, die nach Geschlecht, Alter und Schultyp parallelisiert waren, psychiatrisch und körperlich untersucht. Vierundzwanzig der Anorexiefälle bildeten die Gesamtpopulation der 1970 geborenen Fälle von Anorexia nervosa. Die Fälle wurden mit einem durchschnittlichen Alter von 16 Jahren untersucht. Die Mütter wurden hinsichtlich Heredität und anderer Familienfaktoren, der frühen körperlichen Entwicklung und Temperamentsentwicklung des Kindes und der allgemeinen sozialen Situation der Familie befragt. Medizinische Krankengeschichten wurden hinsichtlich der prä-, peri- und neonatalen Periode ohne Kenntnis der Diagnose analysiert. Fünfunddreißig der Anorexiefälle (69%) hatten einen genügend plausiblen Hintergrundsfaktor, der zur Entwicklung der Eßstörung beigetragen haben könnte. Vergleichbare Hintergrundfaktoren wurden bei zwei (4%) der Vergleichsfälle gefunden. Die Befunde werden hinsichtlich der Beziehung zur Ätiologie der Anorexia nervosa diskutiert.

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Résumé Cinquante et un adolescents présentent une anorexie mentale et 51 cas témoin appariés suivant le sexe, l'âge et le niveau scolaire subirent un examen psychiatrique et somatique. Vingt quatre des cas de l'échantillon total d'anorexie sont nés en 1970. La moyenne d'âge lors de l'examen était de 16 ans. Il y eut un entretien détaillé avec les mères concernant l'hérédité et d'autres facteurs familiaux, le développement précoce du corps et du tempérament de lénfant et lénsemble de la situation sociale de la famille. Les données médicales des périodes pré, péri et néo-natales furent analysées en aveugle du diagnostic. Trente cinq des cas d'anorexie (69%) présentaient des facteurs d'antécédents ayant pu d'une façon raisonnablement plausible contribuer au développement du trouble alimentaire. Ces facteurs semblables furent retrouvés chez deux des cas témoins (4%). Ces faits sont discutés en tant que jouant un rôle dans l'étiologie de lánorexie mentale.

     

Assumptions and beliefs in adolescents with anorexia nervosa and their mothers

A pilot study examined the specific cognitive content of female adolescents with anorexia nervosa. The relationship between daughter and mother concerns, and concerns in mothers, also were investigated. All participants completed a measure of assumptions and negative self-beliefs related to eating disorders. Adolescents with anorexia nervosa scored more highly on all subscales of the measure than nonclinical adolescent controls. There were significant daughter- mother relationships on two subscales in the clinical, but not the nonclinical, group. However, the two groups of mothers did not differ on any subscale. Possible explanations for the findings, and implications for treatment and research, are briefly considered.     

Le féminin et le maternel dans l’anorexie mentale, une passivité créatrice : ceci n’est pas une femme

In this study, anorexia nervosa has been examined from an etiopathogenic and psychoanalytical viewpoint. The sociocultural environment and transgenerational context have been analyzed as contributing factors in the dysfunction of early parent-child relations and the subsequent effect of this on the development of the child, particularly during adolescence. We have hypothesized that the “failure’’ on the part of the mother to express her feminine and maternal nature, and the absence of attention paid to her child’s own body are major contributing factors. This absence of expression of the maternal instinct does not favor a positive perception and integration into the child’s personality of the feminine aspect of its nature, and thus contributes to the development of a sado-masochistic attitude that is focused on the infantile stage. The most frequently encountered condition in the mothers of anorexic patients appears to be the resurgence during maternity and in the initial mother-infant exchanges of a syndrome that can be defined in terms of a mind-body split which is responsible for the child’s failure to construct a psychic and somatic self. The structuring of the self in the child, in particular the impulsive and identificatory aspects of its personality are negatively affected by the absence of a feminine role model, as when the self is separated from the carnal origin of the emotions this can cause a marked inability to constitute a body image. We therefore consider that in these pathologies, the underlying cause is an absence of focus on the somatic self, which has an effect on the initial construction of a body image. We hypothesize that a “body to body’’ transmission (in the form of body engrams) of a maternal psychopathology occurs, and that as the child is confronted with the unstructured development and lack of management of its mother’s feminine and maternal nature, it does not have a physical or psychic reference. Therefore the bodily sensations become linked to the development of a morbid autosensuality and autoeroticism, as they have not been physically or mentally stimulated in a positive manner by the object, that is to say by the mother.     

Le sacrifice fait à Dieu de Séraphine de Senlis

Séraphine Louis, called “Séraphine de Senlis”, is a french painter whose work itself was known to the public at the beginning of the 20th century, further to an exhibition at Senlis, a small town of the department of Oise where she lived up to 1932. Her creative work, remarkable for the multiplicity of its themes and the exceptional richness of its colours, worthy of the most beautiful medieval inspiration, still to-day produces a real attraction. This warranted no less than a film in 2008 as well as an exhibition at the Maillol museum in Paris in 2009. Concerning our interest, this rests mainly on the clinical reading of the case and that from the strict indications given in the psychiatric reports of Clermont and also according to the evidence given by relatives and especially that of Anne-Marie Uhde — sister of the collector Wilhem Uhde, which accounts for her reputation — and set down by the art historian, Alain Virccondelet in his thesis dedicated to the artist. We shall then show clearly, beyond the esthetical representation to which the film of Martin Provost pays tribute what we choose to qualify as the “logical run”, which questions the rule and the function of creation for Séraphine de Senlis. Within this perspective, our concern will especially be to show how the public success and recognition of the artist and her work have not been beneficial to her.     

Le cas Lola Voss de Ludwig Binswanger : modalités du distancement chez une schizophrène

We consider Binswanger's case Lola Voss—published in his major book Schizofrenie, which was summed up by Alfred Storch in L’Evolution Psychiatrique in 1958—from the point of view that Heidegger names keeping at a distance in Being and Time. Keeping at a distance, related to being with the others, means that in schizophrenia, Dasein is no longer able to let things be and is more and more captivated by a single project-of-world. Lola’s compulsion of reading fate by means of playing with letters and phonemes, and her phobia of clothes express the failing of temporal continuity and the pre-eminence of spatiality through the appearing of taboos. In Lola’s case, world phenomena (changes in spatiality and temporality), language phenomena (playing with letters) and body phenomena (clothes as expression of self) express this keeping at a distance, this extinguishing desire, this impossibility to love that fills up all her thoughts.     

Lautréamont : structure autistique ou clivage du moi-corps ?

The works of the Count de Lautréamont, the Songs of Maldoror and Poésies I and II, is located with that of Mallarmé like the avant-garde, which at the end of the XIXth century, revolutionized the poetic language. In their book, The distinction of the autism, Robert and Rosine Lefort present this work like concerning an autistic structure, defining it as based on three points: destructiveness, the expulsion of the Other and double in reality. Interested by this assumption and intrigued by the strangeness of the Songs of Maldoror, after a thorough study of many research which related to the works and the life of Isidore Ducasse, said Count de Lautréamont, the author proposes the idea of bringing together the universe of the autistic structure and the one issued of the action of ego splitting, more precisely body ego splitting in an archaic moment. In the Songs of Maldoror, the recurring resurgence of death, crime and of the dead mother, “who loves most and betrays you soon or last”, constitutes the pivot of such a proposal which establishes a link between the lacanian theory of the autistic structure and the freudian theory onewith splitting mechanism. Lastly, the writing, from its “abstract materiality” is presented like the centration on the sensation as possible substitution to a total or partial autistic positionning.     

Untreated anorexia nervosa. A case study of the medical consequences

This case demonstrates the devastating physical sequelae of 30 years of untreated anorexia nervosa. A full array of these consequences occur in this one patient and include the following: malnutrition and hypoproteinemia, electrolyte disturbances, cortical atrophy with hydrocephalus ex vacuo, tricuspid and mitral valvular dysfunction, anemia, impaired lower gastrointestinal motility, delayed gastric emptying, disturbances in the hypothalamic pituitary target organ axes, severe osteoporosis, marked edema, and extreme muscle wasting. Other possible physical sequelae of her anorexia nervosa are discussed. Psychiatrists, as well as other physicians, should be vigilant in diagnosing this illness and treating it as early as possible. This particular patient was in the medical system for numerous admissions and workups over three decades before the correct diagnosis of anorexia nervosa was made.     

Psilocybin in the treatment of anorexia nervosa: The English transition of a French 1959 case study

Psilocybin is a psychotropic molecule that is a partial agonist of serotonin 2A receptors and is the main psychoactive compound in hallucinogenic mushrooms. After the observation in 1953 in Mexico of ritual practices involving ingestion of such mushrooms, psilocybin was chemically characterized and synthesized in 1958 thanks to the collaboration between the Muséum national d’Histoire naturelle in France and the Sandoz pharmaceutical laboratories in Switzerland. The interest of this substance in psychiatric therapy was then evaluated for the first time at the Sainte-Anne Hospital in Paris, by the team of Professor Jean Delay. Among the patients who received this substance was a 35-year-old woman who was hospitalized for compulsive manifestations emblematic of anorexia nervosa and who experienced an immediate and lasting improvement. The original 1959 article (published in the Annales de la Société Médico-Psychologique) gives details of the patient's family background, biography and clinical examination. It then outlines the observations after two injections of psilocybin four days apart, in particular the autobiographical verbal statements that allowed the patient to understand the psychogenesis of her illness. After a long hiatus, psilocybin is once again the subject of medical research, with clinical trials now underway assessing psilocybin in the treatment of anorexia nervosa (NCT04505189; NCT04052568; NCT04661514) and this 1959 case study, is the first known demonstration of the safety and efficacy of psilocybin treatment of anorexia nervosa. This case study thus provides an interesting insight into possible therapeutic mechanisms and is of great interest to the field moving forward.     

Les stratégies d'attachement, leur transmission et le fonctionnement familial d'adolescentes anorexiques mentales

Bowlby's attachment theory emphasizes the importance of early child-environment interactions in order to develop “internal working models”, secure or insecure, which will influence future relationships with caregivers, peers and other members of the environment. Many factors are involved in the development of eating disorders, and for some authors anorexia nervosa may also be considered as a form of psychological regulation. It is surmised that this type of regulation facilitates coping with occurrences of separation during the “separation-individuation” stage of the adolescent period in a specific group of adolescents who are vulnerable to separation or transition events. During puberty, it has been observed that this vulnerable group displays a specific pattern of attachment or modification of prior internal models of attachment. Following Mary Ainsworth's paradigm, many studies have therefore suggested that subjects with eating disorders show “insecure” attachment, and more precisely “avoidant” attachment in anorexia nervosa. Recent studies on family functioning in anorexia nervosa have also suggested specific types of family interactions, enmeshed and rigid, and some authors such as Stevenson-Hinde hypothesized a link between family functioning and attachment strategies. We decided to study a population of young anorexic girls in terms of their quality of attachment and family interactions, and hypothesized that attachment types in subjects with anorexia nervosa would be associated with maternal type of attachment and specific family functioning. This paper describes a study conducted on a cohort of 29 subjects from the Outpatient Eating Disorder Unit of Robert Debré Hospital in Paris. Ten female adolescents with a mean age of 14 years and a DSM-IV diagnosis of restrictive anorexia nervosa, their ten mothers and nine fathers agreed to participate in the study. The main objective was to examine links between attachment strategies in outpatients with anorexia nervosa, their mode of transmission and family functioning. Two self-questionnaires were administered: Ca-mir and FACES III. Results suggested that patients and families perceived themselves as having secure attachment and that attachment transmission stemmed from the paternal rather than the maternal side. Our results do not confirm those from previous studies on attachment and anorexia nervosa. Young anorectic patients from our cohort perceived themselves as secure whereas in the literature attachment is described as insecure. Several reasons may explain this result. Our cohort of patients had a mean age of 14 years; previous studies were performed on older adolescents or young adults and it is possible that attachment strategies change over time, especially during adolescence when the subject is faced with the separation-individuation stage. At the beginning of puberty, young subjects may display a secure attachment which may be modified towards the end of puberty. Bowlby has suggested that attachment may be sensitive to psychotherapy; our subjects were involved in outpatient treatment or family therapy that may also have influenced their attachment strategies. Mothers from our group described insecure attachment but surprisingly it is the fathers' attachment type which is supposed to be transmitted to daughters. Perhaps these insecure women have chosen specific companions to protect themselves and their children? In opposition to Stevenson-Hinde's hypothesis, we did not find a correlation between attachment strategies and family functioning. Nevertheless, our results have to be interpreted with caution because of methodological biases. Our cohort is small, we have no control group and the “gold instrument” for evaluating attachment is the Adult Attachment Interview that is not validated as a French instrument. In conclusion, results from this study do not confirm the existence of relationships between insecure attachment and anorexia nervosa, or attachment type and family functioning, in young subjects. Future controlled studies are needed in order to explore attachment and psychopathology in children and adolescents, links between attachment, family functioning and internal temperamental dimensions.     

Hemiplegic migraine type 2 caused by a novel variant within the P-type ATPase motif in ATP1A2 concomitant with a CACNA1A variant

BackgroundFamilial hemiplegic migraine (FHM) is an inherited autosomal dominant disorder characterized by migraine with reversible hemiplegia. FHM1 is caused by variants in CACNA1A, encoding a P/Q type neuronal voltage-gated calcium channel α subunit, which is also associated with episodic ataxia type 2 (EA2). FHM2 is associated with ATP1A2, which codes for an Na⁺/K⁺-ATPase isoform 2 subunit.Case presentationWe identified an FHM2 family, the mother and her daughter, with a novel variant in ATP1A2, p.Gly377Asp, located in a well-conserved P-type ATPase motif. Additionally, the mother harbored deletion in the CACNA1A, associated with EA2, but her daughter did not. The mother presented migraine with typical aura without motor deficit, whereas her daughter had migraine accompanied by recurrent motor deficit and altered consciousness. The additional CACNA1A deletion in the mother might serve as a modifier.ConclusionOur report emphasizes the importance of genetic analysis to diagnose neurological ion channel/transporter diseases.     

A 16-year follow-up of a case of severe anorexia nervosa

A 16-year follow-up of a case of extreme anorexia nervosa treated exclusively by operant conditioning techniques is presented. The present status of the patient is reviewed with respect to her eating habits, weight, physical and social activity and her general adaptation to life.     

Étude du lien parental dans l’enfance chez les enfants et adolescents avec anorexie mentale

IntroductionAnorexia nervosa constitutes a severe and complex eating disorder occurring principally in adolescence. It is one of the most deadly psychiatric disorders. Considering the multifactorial nature of anorexia nervosa, the important place of the family and the growing interest in the theory of attachment in eating disorders, parental bonding is questioned in anorexia nervosa. The main study goal is to analyze parental bonding in a population of children and adolescents with anorexia nervosa. The secondary objective is to study differences according to the age group.MethodWe realized an observational pilot study in Bordeaux over a period from June 2015 to April 2017. Twenty five young girls with anorexia nervosa, aged 10 to 17 years, hospitalized in the department of child and adolescent psychiatry and department of eating disorders have been included and divided into two groups: peripubertal for children under 14 and pubertal for children aged 14 to 17 years. We met them individually to complete a series of questionnaires including the Parental Bonding Instrument (for assessing attachment), the Mini International Neuropsychiatry Interview for Children and Adolescent (for detecting the presence of comorbidity) and a structured questionnaire for collecting general information on anorexia nervosa.ResultsResults revealed high parental care, high maternal and paternal overprotection with predominantly “optimal” parenting style followed by “affectionate constraint” style. Significant differences were observed in anorexia nervosa patients with maternal (P = 0.011) and paternal (P = 0.085) overprotection in pubes compared to peripubertal. In correlation analysis, there was a positive correlation between maternal protection and age of diagnosis and a negative correlation between parental care and duration of illness. Furthermore, the maternal overprotection tended to be correlated significantly and positively with the age of the diagnosis and the paternal overprotection with the body mass index.ConclusionOur study shows a rating by the parents of warm and understanding parents, an over-protective mother and a father encouraging autonomy. There is maternal and paternal overprotection in pubertal anorexia nervosa compared with peripubertals. Our results suggest the importance of analyzing parenting style in addition to Parental Bonding Instruments results and of supporting the importance of the development of family therapy in the anorexia nervosa.     

Questions&Ansers

Question: What evidence is there that genetic factors might predispose individuals to anorexia nervosa?

It is now well established that all major psychological illnesses run in families. While the causes of these conditions are multiply determined, genetic factors appear to play a highly important role in determining the familial susceptibility patterns seen in conditions such as manic depression, unipolar depression, panic disorder, substance abuse, generalized anxiety, and schizophrenia. Likewise, several studies have shown that anorexia nervosa also exhibits such a tendency to cluster in families. For instance, in a study we published in 1990 the International Journal of Eating Disorders, we identified anorexia nervosa in 4% of female relatives of patients with anorexia nervosa, whereas not a single case was detected in relatives of patients with other forms of psychiatric illness; the lifetime risk of developing anorexia nervosa in the general female population has been estimated at 0.3 to 0.7%. Similarly, twin-centered studies of anorexia nervosa, although still few in number and not without limitations, have suggested that identical twins are more likely to share the illness than are nonidentical twins, a finding consistent with the influence of genetic factors.