Marital status and eating disorders: An analysis of its relevance
Introduction
Eating disorders (ED) in general and anorexia (AN) and bulimia nervosa (BN) in particular are complex disorders, in which problems are linked on a behavioral, cognitive and emotional level [1], [2]. Several factors are implicated in the development and maintenance of those pathologies. Furthermore, as in other psychiatric disorders [3], [4], [5], some studies have demonstrated the relevance of interpersonal relationships as maintaining factor in EDs [6].
This topic has been considered in the ED literature from different theoretical frameworks: from psychoanalytical [7] and systemic approach [8], [9], [10], [11] to behavioral-cognitive point of view [12], [13], [14].
The relationship between marital functioning and psychiatric disorders has been examined in several recent studies in general terms [15], [16] and referred to specific pathologies such as affective disorders [17], anxiety disorders [18], obsessive-compulsive disorders [19] and addictive behaviors [20], [21]. Even some authors suggested the high relevance of marital stability on the long-term recovery in general mental health disorders [22]. Nevertheless, this topic has surely received insufficient attention in the ED literature, as other authors suggested [23], [24], mainly due to the fact that adult married women or those in long-term relationships were underrepresented in the ED clinical samples used [25], [26].
The few studies where this topic was specifically examined evidenced that married patients with an ED may exhibit longer duration of the illness and were older [27] and even presented higher severity of the disorder [11]. Nevertheless, when the variable age was controlled, married ED patients did not present higher severity of the disorder [24], whereas it did when a general non-ED population was considered [23]. Furthermore, those married ED patients were commonly those who presented major dissatisfaction with their interpersonal relationships and higher deficits in conflict resolution skills [28] even when compared with controls [29].
Besides the methodological problems involved in this type of research, as mentioned above, few studies have been done about the impact of marital relationships in ED. In those studies, where this topic has been specifically assessed, important methodological limitations were present: lack of control of variables that may have an influence (i.e., age of the patients) or introduction of biases when selecting the samples (i.e., considering only married vs. unmarried patients, not giving enough importance to other subcategories).
In view of this criticism, the present study had the following objectives: (1) to check the hypothesis that married ED patients have more severe eating psychopathology even after controlling the variable age, (2) to assess the effect of the different subgroups of the category “marital status” on the severity of the disorder and (3) to ascertain whether there are differences with regard to this category between AN and BN patients.
Section snippets
Sample
ED patients (n=332, 198 BN and 134 AN) consecutively admitted to our unit between January 1998 and October 2000 participated in the study. All patients fulfilled the criteria for those pathologies according to DSM-IV [30] and all were female: 67.2% (n=223) of the sample were of purging type (12.7% AN vs. 54.5% BN), 14.1% (n=46) were unemployed, 34.9% (n=116) employed and 41.3% (n=154) were students. Furthermore, 74.6% (n=244) lived with their parents and 87% (n=289) were single. No divorced
Description of the sample
As shown in Table 1, on comparing both diagnostic groups (AN vs. BN), there were no significant differences in any of the main general features. Nevertheless, as expected, due to their differential psychopathological aspects, the following features were significantly different between the two diagnostic groups: body weight, body mass index, weekly frequency of bingeing and vomiting. Furthermore, there were significant differences on the motivational stage between groups. The BN patients
Acknowledgements
Financial support was received from the European Union (Framework-V Multicentre Research Grant, QLK1-1999-916) and Fondo de Investigación Sanitario (FIS) (00/258) of Spain. We also thank Mrs. Frances Connan and Francis McCabe for their valuable comments.
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