Dehaqani, Mohammad Ali Besharat; (1997) An investigation of the relationship between personality-family factors and response to treatment in young adult anorexic and bulimic patients. Doctoral thesis (Ph.D), UCL (University College London).

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Abstract

This thesis reports on a study of family-, personality-, and treatment-related factors in eating disorders. The primary aim of the investigation is to examine the relationship between personality-family factors and eating disorders, and their prognostic value in relation to engagement-outcome in different types of psychological treatment. A study was undertaken evaluating 78 consecutive outpatient referrals to the Maudsley Hospital Eating Disorder Clinic for eating disorders. The patients were all at or over the age of 18 years. An extensive evaluation for both pre- and post-treatment phases was made of the patients and their families, in which three types of outpatient psychological treatment (family therapy, individual focal psychoanalytic psychotherapy and cognitive analytic therapy) for young adults suffering from eating disorders were compared with a fourth control treatment, supportive therapy. This thesis is divided into two parts. Forwarded by presenting the "introduction and outline of the thesis", the first part comprises a review of the literature, which includes research on "expressed emotion", "personality disorders", "self-disclosure", and "self- and other-blame". The design and methodology of the study are presented in this part of the thesis, as well. The second part presents the results and discussion of the study in five sections, family expressed emotion, personality disorders, patient's response style to therapist and therapy, self- and other- blaming attitudes, and prognostic factors, respectively. First, it is shown that a critical attitude of the relatives is associated with specific interactional behaviours of the relatives, patients, and the whole family. Therefore, a better understanding of both the nature of EE constructs and the family EE patterns can be gained when it is evaluated within the family relationships. Second, it is shown that both AN and BN patients who require outpatient treatment seem to equally display a personality pathology necessitating special attention in the treatment setting. Characterological differences between anorexic and bulimic patients are important aspects of the present investigation. Third, evidence is provided for reliability (and to a lesser degree for validity) of a new measure of assessing patient's response style to therapist and therapy, the Patient Response Style Scale (PRSS). Fourth, evidence is also provided for reliability (and also to a lesser degree for validity) of a new measure of assessing self- and other-blaming attitudes, the Self- and Other-Blame Scale (SOBS). A high level of feeling self-blame among eating disorder patients and their relatives is shown. The association of other-blaming attitudes with personality disorders and poor psychological well-being is confirmed. Fifth, It has become apparent that EE is sensitive to changes in the patient, and can predict the outcome of treatment. Personality disorders are found to be associated with poor response to treatment in eating disorders. The importance of prognostic values of the PRSS and SOBS variables are confirmed. The clinical and theoretical implications of the study, as well as limitations of the study, are discussed in this part of the thesis. The thesis is closed with presenting the concluding statements drawn from the results of the study.

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