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.

This study examined perceived environment among families with a depressed, depressed and anxious, anxious, or normal child from the 4th to 7th grades. Fifty-one such children were classified according to criteria from the K-SADS and a set of self-ratings of depression and anxiety. Results showed that children in all three diagnostic groups, and to a lesser extent their mothers, experienced their families as more distressed on a host of dimensions relative to controls. In addition, significant differences were found between families with a depressed and anxious child and those with an anxious child. Discriminant function analyses revealed that 68.63% of the youngsters could be classified correctly into depressed and anxious groups on the basis of their family ratings alone.

Parallel scales of children's self-control were developed for teachers and children. Teachers rated children on 15 self-control items using a 5-point frequency scale. Children responded to a yes/no format for each of their 11 self-control items. Both scales were factored based on responses of 763 fourth and fifth graders from 36 classes. The teachers' scale consisted of two factors replicated across halved subsamples: (a) Behavioral/Interpersonal and (b) Cognitive/Personal Self-Control. The children's scale had four orthogonal factors: (a) Personal Self-Control, (b) Interpersonal Self-Control, (c) Self-Evaluation, and (d) Consequential Thinking. Full-scale and factor scores had high reliability. The validity of each scale was supported, although the two were only weakly related to each other. Selfcontrol ratings by teachers and children related to naturalistic observations and to teacher ratings of frustration tolerance and acting-out/aggressive problems. Teachers' (but not children's) ratings of self-control related to IQ and achievement. Girls were rated as better self-controlled than boys by both groups. There were no grade-level differences. The discussion considers uses of the scales in large-scale social-systems studies.Research and intervention efforts in children's self-control have been directed primarily at remediating deficits, that is, improving performance through training in component and related skills. Findings show that young children can be taught to set goals effectively (Spates & Kanfer, 1977), to plan (Patterson & Mischel, 1976), to self-monitor (Piersel & Kratochwill, 1979), to self-evaluate (Barling, 1980), and to self-impose consequences (Humphrey, Karoly, & Kirschenbaum, 1978). Moreover, children trained in these skills have shown improvements, at least in the short run, in such intractable problems as aggressiveness (Camp, Blom,

This study tested the psychodynamic formulation that binge eating in bulimia reflects familial and intrapsychic deficits in nurturance, empathy, and to some extent, affective regulation. The study compared parental relationships and introjects among young women (N = 80) with bulimia, bulimia-anorexia, anorexia, and normal controls using Benjamin's Structural Analysis of Social Behavior model and rating scales. As expected, the results revealed that the two bulimic subgroups experienced deficits in parental nurturance and empathy, relative to normal young women. However, only the deficits in perceived nurturance were specific to bulimia, that is, were also more severe than in classical anorexia. In addition, both bulimics and anorexics viewed their parents as more blaming, rejecting, and neglectful toward them relative to normal controls, and they treated themselves with the same hostility and deprivation. These findings were interpreted as partially supportive of the psychoanalytic hypothesis of binge eating in bulimia.

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