Familial contributions to the etiology and course of anorexia nervosa and bulimia.

In this article, we summarize the current knowledge of familial influences in anorexia nervosa and bulimia. Three lines of evidence are reviewed: descriptions of family interaction, familial correlates of the course and phenomenology of symptoms, and studies of familial transmission. We conclude that although certain familial patterns are associated with eating disorders, there is no single mechanism or pathway of influence. Rather, it seems likely that certain personality factors, which may be genetically determined, predispose the individual to greater sensitivity and vulnerability to powerful familial and social experiences that impinge adversely on self-esteem and self-efficacy.