Differing Perceptions of Family Functioning Among Adolescents with Eating Disorders and Their Family Members in a Hungarian Sample

Authors

DOI:

https://doi.org/10.5708/EJMH.21.2026.0058

Keywords:

Hungarian clinical sample, Family Assessment Device, anorexia nervosa, family functioning, family discrepancies

Abstract

Introduction: Family functioning is closely linked to adolescent anorexia nervosa, yet family members often differ in how they perceive family relationships and processes.

Aim: To examine differences in perceived family functioning among adolescents with anorexia nervosa and their family members, and to explore associations with well-being and perceived stress.

Methods: The sample included 72 Hungarian families entering family therapy (N = 243), comprising adolescents with anorexia nervosa, mothers, fathers, and siblings. Family functioning was assessed with the McMaster Family Assessment Device (FAD), well-being with the WHO Well-Being Index (WBI-5), and perceived stress with the Perceived Stress Scale (PSS-4). Linear mixed models with random family intercepts were used to account for clustering within families.

Results: Significant family-level clustering was found for overall family functioning and all FAD subscales. Patients reported poorer family functioning than mothers, fathers, and siblings, particularly in Communication, Behaviour Control, and General Functioning. Poorer perceived family functioning was associated with lower well-being and higher perceived stress. Family role remained a significant predictor of both outcomes.

Conclusions: Family members of adolescents with anorexia nervosa differ systematically in their perceptions of family functioning, with patients reporting the greatest difficulties. These findings support the value of multi-informant assessment and suggest that discrepancies in family perceptions may

References

Bowen, M. (1978). Family therapy in clinical practice. Jason Aronson.

Chesney, E., Goodwin, G. M., & Fazel, S. (2014). Risks of all-cause and suicide mortality in mental disorders: A meta-review. World Psychiatry, 13(2), 153–160.
https://doi.org/10.1002/wps.20128

Dancyger, I., Fornari, V., Scionti, L., Wisotsky, W., & Sunday, S. (2005). Do daughters with eating disorders agree with their parents’ perception of family functioning? Comprehensive Psychiatry, 46(2), 135–139.
https://doi.org/10.1016/j.comppsych.2004.07.024

De Los Reyes, A., Augenstein, T. M., Wang, M., Thomas, S. A., Drabick, D. A. G., Burgers, D. E., & Rabinowitz, J. (2015). The validity of the multi-informant approach to assessing child and adolescent mental health. Psychological Bulletin, 141(4), 858–900.
https://doi.org/10.1037/a0038498

De Los Reyes, A., & Epkins, C. C. (2023). Introduction to the special issue: A dozen years of demonstrating that informant discrepancies are more than measurement error: Toward guidelines for integrating data from multi-informant assessments of youth mental health. Journal of Clinical Child & Adolescent Psychology, 52(1), 1–18.
https://doi.org/10.1080/15374416.2022.2158843

De Los Reyes, A., & Kazdin, A. E. (2005). Informant discrepancies in the assessment of childhood psychopathology: A critical review, theoretical framework, and recommendations for further study. Psychological Bulletin, 131(4), 483–509.
https://doi.org/10.1037/0033-2909.131.4.483

De Los Reyes, A., & Ohannessian, C. M. (2016). Introduction to the special issue: Discrepancies in adolescent–parent perceptions of the family and adolescent adjustment. Journal of Youth and Adolescence, 45, 1957–1972.
https://doi.org/10.1007/s10964-016-0533-z

De Los Reyes, A., Thomas, S. A., Goodman, K. L., & Kundey, S. M. A. (2013). Principles underlying the use of multiple informants’ reports. Annual Review of Clinical Psychology, 9, 123–149.
https://doi.org/10.1146/annurev-clinpsy-050212-185617

Drjenovszky, Z., & Sztáray Kézdy, É. (2023). The distribution of unpaid domestic work in Hungarian stay-at-home father—working-mother families. Social Sciences, 12(3), Article 116.
https://doi.org/10.3390/socsci12030116

Eisler, I. (2005). The empirical and theoretical base of family therapy and multiple family day therapy for adolescent anorexia nervosa. Journal of Family Therapy, 27(2), 104–131.
https://doi.org/10.1111/j.1467-6427.2005.00303.x

Emanuelli, F., Ostuzzi, R., Cuzzolaro, M., Baggio, F., Lask, B., & Waller, G. (2004). Family functioning in adolescent anorexia nervosa: A comparison of family members’ perceptions. Eating and Weight Disorders-Studies on Anorexia, Bulimia and Obesity, 9, 1–6.
https://doi.org/10.1007/BF03325038

Epstein, N. B., Baldwin, L. M., & Bishop, D. S. (1983). The McMaster Family Assessment Device. Journal of Marital and Family Therapy, 9(2), 171–180.
https://doi.org/10.1111/j.1752-0606.1983.tb01497.x

Gowers, S. G., & North, C. (1999). Difficulties in family functioning and adolescent anorexia nervosa. British Journal of Psychiatry, 174(1), 63–66.
https://doi.org/10.1192/bjp.174.1.63

Holtom-Viesel, A., & Allan, S. (2014). A systematic review of the literature on family functioning across all eating disorder diagnoses in comparison to control families. Clinical Psychology Review, 34(1), 29–43.
https://doi.org/10.1016/j.cpr.2013.10.005

Horesh, N., Sommerfeld, E., Wolf, M., Zubery, E., & Zalsman, G. (2015). Father–daughter relationship and the severity of eating disorders. European Psychiatry, 30(1), 114–120.
https://doi.org/10.1016/j.eurpsy.2014.04.004

Jenkins, P. E., Hoste, R. R., Meyer, C., & Blissett, J. M. (2011). Eating disorders and quality of life: A review of the literature. Clinical Psychology Review, 31(1), 113–121.
https://doi.org/10.1016/j.cpr.2010.08.003

Le Grange, D., Lock, J., Loeb, K., & Nicholls, D. (2010). Academy for eating disorders position paper: The role of the family in eating disorders. International Journal of Eating Disorders, 43(1), 1–5.
https://doi.org/10.1002/eat.20751

Lock, J., & La Via, M. C. (2015). Practice parameter for the assessment and treatment of children and adolescents with eating disorders. Journal of the American Academy of Child & Adolescent Psychiatry, 54(5), 412–425.
https://doi.org/10.1016/j.jaac.2015.01.018

Lock, J., & Le Grange, D. (2015). Treatment manual for anorexia nervosa: A family-based approach (2nd ed.). The Guilford Press.

Lukas, L., Buhl, C., Schulte-Körne, G., & Sfärlea, A. (2022). Family, friends, and feelings: The role of relationships to parents and peers and alexithymia in adolescents with anorexia nervosa. Journal of Eating Disorders, 10, Article 143.
https://doi.org/10.1186/s40337-022-00661-3

Mensi, M. M., Criscuolo, M., Vai, E., Rogantini, C., Orlandi, M., Ballante, E., Zanna, V., Mazzoni, S., Balottin, U., & Borgatti, R. (2022). Perceived and observed family functioning in adolescents affected by restrictive eating disorders. Family Relations, 71(2), 724–736.
https://doi.org/10.1111/fare.12611

Miller, I. W., Epstein, N. B., Bishop, D. S., & Keitner, G. I. (1985). The McMaster Family Assessment Device: Reliability and validity. Journal of Marital and Family Therapy, 11(4), 345–356.
https://doi.org/10.1111/j.1752-0606.1985.tb00028.x

Minuchin, S., Rosman, B. L., & Baker, L. (1978). Psychosomatic families: Anorexia nervosa in context. Harvard University Press.

National Institute for Health and Care Excellence. (2017). Eating disorders: Recognition and treatment (NICE Guideline NG69).
https://www.nice.org.uk/guidance/ng69

Ohannessian, C. M., Lerner, R. M., Lerner, J. V., & von Eye, A. (2000). Adolescent-parent discrepancies in perceptions of family functioning and early adolescent self-competence. International Journal of Behavioural Development, 24(3), 362–372.
https://doi.org/10.1080/01650250050118358

Pászthy, B., Ábrahám, I., & Törzsök-Sonnevend, M. (2020). Az Emberi Erőforrások Minisztériuma egészségügyi szakmai irányelve a gyermek- és serdülőkori evészavarok ellátásáról. [Clinical practice guideline of the Ministry of Human Capacities on the management of eating disorders in children and adolescents]. Egészségügyi Közlöny, 70(7), 1174–1212.

Rienecke, R. D., & Le Grange, D. (2022). The five tenets of family-based treatment for adolescent eating disorders. Journal of Eating Disorders, 10, Article 60.
https://doi.org/10.1186/s40337-022-00585-y

Rienecke, R. D., Trotter, X., & Jenkins, P. E. (2024). A systematic review of eating disorders and family functioning. Clinical Psychology Review, 112, Article 102462.
https://doi.org/10.1016/j.cpr.2024.102462

Stauder, A., & Konkolÿ Thege, B. (2006). Az Észlelt Stressz Kérdőív (PSS) magyar verziójának jellemzői [Characteristics of the Hungarian version of the Perceived Stress Scale (PSS)]. Mentálhigiéné és Pszichoszomatika, 7(3), 203–216.
https://doi.org/10.1556/mental.7.2006.3.4

Sulyok, R. S., & Miklósi, M. (2026). Az információforrások közötti diszkrepancia jelentősége a pszichológiai kivizsgálás során [The significance of informant discrepancies in psychological evaluation]. Neuropsychopharmacologia Hungarica, 28(1), 30–36.

Susánszky, É., Konkolÿ Thege, B., Stauder, A., & Kopp, M. (2006). A WHO Jól-lét Kérdőív rövidített (WBI-5) magyar változatának validálása a Hungarostudy 2002 országos lakossági egészségfelmérés alapján [Validation of the Hungarian Version of the WHO Well-Being Index (WBI-5) using data from the Hungarostudy 2002 National Health Survey]. Mentálhigiéné és Pszichoszomatika, 7(3), 247–255.
https://doi.org/10.1556/mental.7.2006.3.8

Szumska, I., Túry, F., Csoboth, C. T., Réthelyi, J., Purebl, G., & Hajnal, Á. (2005). The prevalence of eating disorders and weight‐control methods among young women: A Hungarian representative study. European Eating Disorders Review, 13(4), 278–284.
https://doi.org/10.1002/erv.633

Túry, F., Babusa, B., & Varga, M. (2010). History of eating disorders in Hungary. Psychiatria Danubina, 42(1), 73–84.

Túry, F., Szabó, P., Dukay-Szabó, S., Szumska, I., Simon, D., & Rathner, G. (2021). Eating disorder characteristics among Hungarian medical students: Changes between 1989 and 2011. Journal of Behavioural Addictions, 9(4), 1079–1087.
https://doi.org/10.1556/2006.2020.00078

Udo, T., & Grilo, C. M. (2019). Psychiatric and medical correlates of DSM‐5 eating disorders in a nationally representative sample of adults in the United States. International Journal of Eating Disorders, 52(1), 42–50.
https://doi.org/10.1002/eat.23004

Waller, C., Slade, P., & Calam, R. (1990). Who knows best? Family interaction and eating disorders. British Journal of Psychiatry, 156(4), 546–550.
https://doi.org/10.1192/bjp.156.4.546

Downloads

Published 2026-07-01

How to Cite

Gyenis-Kátay, N., Soltész-Várhelyi, K., Hamilton, B., Balázs, J., Vakaliosz, A., Rottmayer, D., Dorn, K., & Török, S. (2026). Differing Perceptions of Family Functioning Among Adolescents with Eating Disorders and Their Family Members in a Hungarian Sample. European Journal of Mental Health, e0058, 1-18. https://doi.org/10.5708/EJMH.21.2026.0058