Epidemiology, Etiology, and Course of Eating Disorders

In the second half of the 19th century, William Gull, Ernest-Charles Lasègue, and Pierre Janet described anorexia and, due to a lack of therapy options, advised removing patients from their social environment for a certain period of time. This approach was called “parentectomy,” and the family was attributed responsibility for the development of the eating disorder (Fichter 2008). In later works, mothers were described as dominant, intrusive, and ambivalent, while fathers were described as passive and not very assertive (Vandereycken et al. 1988). In the 1970s, a family therapy movement emerged that understood the family as a holistic system and, based on systemic theoretical considerations, assumed specific family interaction patterns and conflicts as the genesis of eating disorders in adolescents (“systemic family therapy,” cf. Minuchin et al. 1975 and Selvini-Palazoli 1978). The eating disorder of the so-called “index patients” was seen as an indicator of a dysfunctional family and at the same time as a desperate attempt to maintain the status quo. Specific patterns (especially in anorexic families) were described and interpreted as the basis of the pathology.