title: Perception of autonomy and connectedness prior to the onset of anorexia nervosa and bulimia nervosa.
abstract: OBJECTIVE
  This study examines retrospective correlates of nonshared family environment prior to onset of disease, by means of multiple familial informants, among anorexia and bulimia nervosa patients.
  
  
  METHODS
  A total of 332 participants was included (anorexia nervosa, restrictive type (AN-R): n = 41 plus families); bulimic patients (anorexia nervosa, binge-purging type; bulimia nervosa: n = 59 plus families). The EATAET Lifetime Diagnostic Interview was used to establish the diagnosis; the Subjective Family Image Test was used to derive emotional connectedness (EC) and individual autonomy (IA).
  
  
  RESULTS
  Bulimic and AN-R patients perceived significantly lower EC prior to onset of disease compared to their healthy sisters. Bulimic patients perceived significantly lower EC prior to onset of disease compared to AN-R patients and compared to their mothers and fathers. A low family sum - sister pairs sum comparison - of EC had a significant influence on the risk of developing bulimia nervosa. Contrary to expectations, AN-R patients did not perceive significantly lower levels of IA compared to their sisters, prior to onset of disease. Findings of low IA in currently ill AN-R patients may represent a disease consequence, not a risk factor.
  
  
  CONCLUSIONS
  Developmental child psychiatrists should direct their attention to disturbances of EC, which may be present prior to the onset of the disease.
authors.affiliation: Department of Child and Adolescent Psychiatry, Medical University of Vienna, Austria.
authors.forename: Julia
authors.initials: J
authors.lastname: Huemer
authors.forename: Maria
authors.initials: M
authors.lastname: Haidvogl
authors.forename: Fritz
authors.initials: F
authors.lastname: Mattejat
authors.forename: Gudrun
authors.initials: G
authors.lastname: Wagner
authors.forename: Gerald
authors.initials: G
authors.lastname: Nobis
authors.forename: Fernando
authors.initials: F
authors.lastname: Fernandez-Aranda
authors.forename: David A
authors.initials: DA
authors.lastname: Collier
authors.forename: Janet L
authors.initials: JL
authors.lastname: Treasure
authors.forename: Andreas F K
authors.initials: AF
authors.lastname: Karwautz
mesh_terms: D000293:Adolescent; D000328:Adult; D000856:Anorexia Nervosa / Q000175:diagnosis / Q000523:psychology*; D052018:Bulimia Nervosa / Q000175:diagnosis / Q000523:psychology*; D005195:Family Relations; D005260:Female; D006801:Humans; D007389:Internal-External Control; D007406:Interview, Psychological; D007600:Judgment; D008875:Middle Aged; D009769:Object Attachment; D016487:Parenting / Q000523:psychology; D026684:Personal Autonomy; D012189:Retrospective Studies; D012307:Risk Factors; D035781:Siblings; D055815:Young Adult