Weighing In on Eating Disorder Issues:
Into the Great Wide Open: Family Risk and the Prevention of Eating Disorders (part 2)
Michael P. Levine, Ph.D., FAED. In last month’s column, I communicated my surprise that, despite evidence demonstrating genetic risk factors for eating disorders and the value of including families in the treatment of child/adolescent eating disorders (EDs), there are no published studies of prevention of disordered eating (DE) and EDs in high-risk (HR) families. Here is one way to redress that deficit. The first goal would be an open (uncontrolled) prevention trial. Integrating this with the later stages of a research-oriented outpatient ED treatment program would facilitate recruitment of participants. Families are considered HR if (1) biological mother or father has an ED; and/or (2) child or adolescent has an ED and is living at home with at least one biological sibling who does not. Ideally, the innovative program would be developed collaboratively by stakeholders, including at least one each of the following: ED prevention specialist, family-based clinician, parent with an ED, sibling of a child/adolescent with an ED, and a researcher with experience designing, implementing, and evaluating programs for youth at HR for mood disorder. The latter is essential because published prevention research in that area is large enough to have generated several meta-analyses. While the stakeholders’ input is crucial, it is usually important in the early stages of innovative program development to cast the net widely. Thus, it is likely that the ED prevention program for HR families would include interactive family and individual activities addressing three interrelated components: (1) specific, robust risk factors for EDs (e.g., body dissatisfaction, internalization of the thin ideal); (2) general risk factors for psychopathology, including conditions comorbid with EDs (e.g., negative affect, maladaptive perfectionism, negative urgency); and (3) enhanced family functioning that support the person who is recovering from an eating disorder and increase the probability that the family will provide protective factors for those at risk.