SUMMARY OF THE RESULTS

This thesis has explored four issues: (1) family expressed emotion, (2) personality disorders, (3) patients response style to therapist and therapy, and (4) self- and other-blaming feelings in a sample o f families with an eating disorder patient. Chapter 4 presented the results of the study into

five sections. The results will be briefly summarized here.

In section A, the distribution of family expressed emotion was reported , with rating based on the Standardized Clinical Family Interview (SCFI), both at intake and at the termination o f treatment. At intake, the levels of critical comments, hostility, emotional over-involvement, and positive remarks were rated low. The mean number of critical comments for the fathers was 1.29 and for the mothers 1.60. Mothers of bulimic patients scored higher on critical comments and emotional over-involvement than did mothers of anorexic patients. Levels of critical comments in single­ parent families was significantly higher than those of two-parent families.

The mean number o f critical comments and emotional over-involvement had significantly decreased over the treatment period for both fathers and mothers, whereas the mean number o f parents’ warmth had significantly increased. Nearly half of the high EE families, 45.50%, at intake had become low EE in the course of treatment. In three families in which patients had made poor progress at the end o f treatment period, family EE levels had changed from low to high. The AN patients showed significantly more improvement during the course of therapy than did BN patients.

Section B presented the distribution of personality disorders based on the Personality Assessment Schedule (PAS). Overall, 39.7% o f the patients had no personality disturbances and 46.9% of the patients met the PAS criteria for at least one personality disorder. The BN patients tended to fulfill the criteria more than the AN patients. The most common diagnoses were “anxious” and “histrionic” personality disorder in the AN and BN group, respectively. The association between family EE scales and personality disorders was detected. Mothers of the patients with personality

disorder tended to show more critical comments to the patients than did mothers o f the patients without personality disorder. Over the treatment period the family EE levels o f patients without personality disorder had reduced, whereas the family EE levels of the patients with personality disorder had remained the same.

Section C reported the distribution o f the patient’s response style to therapist and therapy as measured by the Patients Response Style Scale (PRSS). This is a new measure developed specifically for the purpose of this study. It was shown to have good interrater reliability and a robust predictor of outcome. Bulimics tended to reveal more mixed disclosing style which implies more discrepancy between the levels of verbal and non-verbal measures in this group o f patients than anorexics. Anorexics also demonstrated a greater significant correlation between verbal and nonverbal aspects of their response style to therapist and therapy than did bulimics.

Patients without personality disorder tended to show more Self-Disclosure (SD) and Emotional Engagement (EEn) than did patients with personality disorder.

Section D presented the distribution of self- and other-blame feelings among families with an eating disorder patient based on the Self- and Other-Blame Scale (SOBS) ratings. This is a new measure developed specifically for the purpose o f this study. It was shown to have good interrater reliability and a robust predictor of outcome.

Mothers blamed themselves for the patient’s eating problems significantly more than did fathers. Patients expressed significantly more other-blaming attitudes towards their parents than did parents to the patients. Famihes of bulimic patients tended to express more self- and other- blaming attitudes than families of anorexic patients. Bulimics were more likely to blame their parents specifically the mothers, whereas anorexics tended to blame themselves rather than their

parents. Families of the patients with personality disorder blamed themselves more than did families o f the patients without personality disorder. Eating disorder patients with additional PD also blamed themselves, as well as their parents more than did those without PD. Patients who blamed themselves tended to express higher levels of SD/EEn whereas patients who blamed their parents (particularly mothers) tended to reveal lower levels of SD/EEn.

The investigation o f the association between the SOBS and family EE scales revealed that family (both mothers and fathers) other-blaming feelings were positively and significantly correlated with family critical comments and family hostility, and negatively correlated with family warmth. High EE families showed significantly more self-blame and also other-blaming attitudes than did low EE families.

Section E reported the prognostic factors. It was shown that patients’ progress in treatment at the termination o f treatment, as assessed by the general outcome scores o f the Morgan-Russell scales, could be predicted by 1) the mothers’ critical comments at intake: Higher critical comments at intake was correlated with poorer outcome at the end o f treatment period; 2) the patients’ PD: Patients without personality disorder showed significantly more improvement in treatment at the termination than did the patients with personality disorder; 3) the PRSS: Examination of the predictive power of the PRSS revealed that patients who showed higher levels o f SD/EEn to the therapist and therapy did significantly better in psychotherapy than those who showed lower levels of SD/EEn. The PRSS was also shown to be a particularly powerful predictor of outcome in focal psychoanalytic therapy and to a lesser degree predicted outcome in family therapy and cognitive analytic therapy; 4) the SOBS: Concerning prognostic value o f the SOBS, poor outcome in therapy was related to both the mothers’ SB and the patients blaming mothers.

Finally, multivariate analyses revealed that the patients’ SD ratings, as well as the mothers’ SB scores, could be considered as the most important predictive factors in the present study.