This study describes symptoms and family interactional patterns of 10 anorexia nervosa patients studied on an acute inpatient psychiatric service in which family and group treatment are emphasized and standardized multidimensional behavioral rating scales are routinely collected. All of the patients were female and conformed to the following criteria: a weight loss amounting to greater than 25 per cent of ideal weight, bizarre food avoidances and fads, and no evidence of psychosis. Two distinct phases of hopsitalization emerged. In the initial phase of 6 weeks, weight increased rapidly and behavioral symptoms decreased during the first 4 weeks, while from the 4th to 6th weeks, weight gain decreased and ratings on four symptoms (depressed mood, compulsivity, histrionic behavior and verbal hostility) increased, approaching admission levels. During this phase, patients skillfully managed to occupy any discussion with the topic of food to the exclusion of any emotional content. Parents mirrored the characteristics of the individual patients, in that they suppressed positive feelings and demonstrated an abundance of intellectualism, rational disputation and rigidity. The second phase of hospitalization occurred from the 7th week on. The four symptoms diminished and a steady weight gain persisted for the remainder of the hospitalization. Increase in symptoms with accompanying weight fluctuations seemed to occur at times of stress, for example, as discharge approached. During the second phase of hospitalization, once weight was no longer a critical problem, more dynamic family issues emerged in the interactions and verbalizations of patients and family. These related to 1) dependency, 2) separation and 3) a pattern of changing alliances within the family. The theoretical implications of these findings are dicussed. Follow-up data obtained 1 to 5 years after hospitalization are presented. © Williams & Wilkins 1969. All Rights Reserved.
