{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T07:17:42Z","timestamp":1788419862605,"version":"build-2803163510"},"reference-count":30,"publisher":"Springer Science and Business Media LLC","issue":"3","license":[{"start":{"date-parts":[[2025,11,26]],"date-time":"2025-11-26T00:00:00Z","timestamp":1764115200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/deed.de"},{"start":{"date-parts":[[2025,11,26]],"date-time":"2025-11-26T00:00:00Z","timestamp":1764115200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/deed.de"}],"funder":[{"DOI":"10.13039\/501100003385","name":"Georg-August-Universit\u00e4t G\u00f6ttingen","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100003385","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Neuropsychiatr"],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:title>Summary<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Psychological constructs of individual autonomy (IA) and emotional connectedness (EC) differ between patients with anorexia nervosa (AN) and bulimia nervosa (BN); however, it is unclear whether objective family factors modulate these associations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      In a\u00a0cohort of 445 participants from the FamFINED study (FAMily Factors INvolved in Eating Disorders) with eating disorders (EDs) diagnosed as AN (\n                      <jats:italic>n<\/jats:italic>\n                      \u202f=\u2009232) or BN (\n                      <jats:italic>n<\/jats:italic>\n                      \u202f=\u2009213), we assessed objective psychosocial family factors as well as the IA and EC constructs using the self-rated Subjective Family Image Test (SFIT) questionnaire.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      While the two ED entities did not differ with respect to IA in univariate analysis (\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u20090.355), patients diagnosed with AN had higher perceived EC than participants with BN, as assessed by a\u00a0lower score for the difference between the actual and desired family image (16.0\u202f\u00b1\u200915.8 vs. 21.6\u202f\u00b1\u200917.6,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&lt;\u20090.001). In a\u00a0regression model adjusted for age, body-mass index, living in parental home, and parental separation, we found that the EC score used as the dependent variable differed significantly between the two ED entities (exp\u03b2\u202f=\u20094.8, 95% confidence interval\u202f=\u20090.54\u20139.11,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u20090.028). In contrast, no association was observed between IA and ED diagnoses using the same set of confounders (\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u20090.717).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The higher perceived EC in AN patients compared to those diagnosed with BN indicates more intense feelings of family solidarity, regardless of objective family factors.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s40211-025-00558-y","type":"journal-article","created":{"date-parts":[[2025,11,26]],"date-time":"2025-11-26T15:18:50Z","timestamp":1764170330000},"page":"113-119","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Patients with anorexia nervosa perceive higher emotional connectedness to their parents than bulimia nervosa patients independent of objective family factors","Patientinnen mit Anorexia nervosa empfinden eine st\u00e4rkere emotionale Bindung zu ihren Eltern als Patienten mit Bulimia nervosa, unabh\u00e4ngig von objektiven famili\u00e4ren Faktoren"],"prefix":"10.1007","volume":"40","author":[{"given":"Elias","family":"Fischer","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Noah","family":"Lensch","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"G\u00fcnter","family":"Reich","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3509-1400","authenticated-orcid":false,"given":"Thomas","family":"Meyer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,11,26]]},"reference":[{"issue":"2","key":"558_CR1","doi-asserted-by":"publisher","first-page":"317","DOI":"10.1017\/S0033291701003129","volume":"31","author":"A Karwautz","year":"2001","unstructured":"Karwautz\u00a0A, Rabe-Hesketh\u00a0S, Hu\u00a0X, Zhao\u00a0J, Sham\u00a0P, Collier\u00a0DA, Treasure\u00a0JL. Individual-specific risk factors for anorexia nervosa: a\u00a0pilot study using a\u00a0discordant sister-pair design. Psychol Med. 2001;31(2):317\u201329.","journal-title":"Psychol Med"},{"issue":"1","key":"558_CR2","first-page":"46","volume":"91","author":"BC Harrington","year":"2015","unstructured":"Harrington\u00a0BC, Jimerson\u00a0M, Haxton\u00a0C, Jimerson\u00a0DC. Initial evaluation, diagnosis, and treatment of anorexia nervosa and bulimia nervosa. Am Fam Physician. 2015;91(1):46\u201352.","journal-title":"Am Fam Physician"},{"issue":"9","key":"558_CR3","doi-asserted-by":"publisher","first-page":"1619","DOI":"10.1002\/eat.23572","volume":"54","author":"PT Vo","year":"2021","unstructured":"Vo\u00a0PT, Fowler\u00a0N, Rolan\u00a0EP, Culbert\u00a0KM, Racine\u00a0SE, Burt\u00a0SA, Klump\u00a0KL. The effects of puberty on associations between mood\/personality factors and disordered eating symptoms in girls. Int J Eat Disord. 2021;54(9):1619\u201331.","journal-title":"Int J Eat Disord"},{"issue":"2","key":"558_CR4","doi-asserted-by":"publisher","first-page":"415","DOI":"10.2307\/1129730","volume":"56","author":"HD Grotevant","year":"1985","unstructured":"Grotevant\u00a0HD, Cooper\u00a0CR. Patterns of interaction in family relationships and the development of identity exploration in adolescence. Child Dev. 1985;56(2):415\u201328.","journal-title":"Child Dev"},{"key":"558_CR5","volume-title":"Das subjektive Familienbild","author":"F Mattejat","year":"1993","unstructured":"Mattejat F, Scholz\u00a0M. Das subjektive Familienbild (SFB). G\u00f6ttingen, Bern, Toronto, Seattle: Hogrefe. 1994.\u00a0"},{"issue":"3","key":"558_CR6","doi-asserted-by":"publisher","first-page":"141","DOI":"10.1007\/s40211-018-0298-6","volume":"33","author":"M Strack","year":"2019","unstructured":"Strack\u00a0M, Flesch\u00a0R, Reich\u00a0G. Welche Variablen l\u00e4sst das Subjektive Familienbild zu? Eine Social Relations Model Analyse f\u00fcr 461 Patientinnen mit Essst\u00f6rung (Comprehensive scores for the Subjective Family Image Test, SFIT: A\u00a0social relations model analysis of 461 patients with eating disorders).\u00a0Neuropsychiatr. 2019;33(3):141\u201350.\u00a0","journal-title":"Neuropsychiatr"},{"issue":"1","key":"558_CR7","doi-asserted-by":"publisher","first-page":"61","DOI":"10.1024\/1422-4917\/a000150","volume":"40","author":"J Huemer","year":"2012","unstructured":"Huemer\u00a0J, Haidvogl\u00a0M, Mattejat\u00a0F, Wagner\u00a0G, Nobis\u00a0G, Fernandez-Aranda\u00a0F, Collier\u00a0DA, Treasure\u00a0JL, Karwautz\u00a0AF. Perception of autonomy and connectedness prior to the onset of anorexia nervosa and bulimia nervosa. Z\u00a0Kinder Jugendpsychiatr Psychother. 2012;40(1):61\u20138.","journal-title":"Z Kinder Jugendpsychiatr Psychother"},{"issue":"4","key":"558_CR8","doi-asserted-by":"publisher","first-page":"251","DOI":"10.1024\/1422-4917.30.4.251","volume":"30","author":"A Karwautz","year":"2002","unstructured":"Karwautz\u00a0A, Haidvogl\u00a0M, Wagner\u00a0G, Nobis\u00a0G, W\u00f6ber-Bing\u00f6l\u00a0C, Friedrich\u00a0MH. Subjektives Familienbild bei Anorexia nervosa und Bulimia nervosa im Jugendalter: eine kontrollierte Studie (Subjective family image in anorexia nervosa and bulimia nervosa in adolescence: a\u00a0controlled study).\u00a0Kinder Jugendpsychiatr Psychother. 2002;30(4):251\u20139.\u00a0","journal-title":"Z Kinder Jugendpsychiatr Psychother"},{"issue":"3","key":"558_CR9","doi-asserted-by":"publisher","first-page":"128","DOI":"10.1007\/s00787-003-0319-1","volume":"12","author":"A Karwautz","year":"2003","unstructured":"Karwautz\u00a0A, Nobis\u00a0G, Haidvogl\u00a0M, Wagner\u00a0G, Hafferl-Gattermayer\u00a0A, W\u00f6ber-Bing\u00f6l\u00a0C, Friedrich\u00a0MH. Perceptions of family relationships in adolescents with anorexia nervosa and their unaffected sisters. Eur Child Adolesc Psychiatry. 2003;12(3):128\u201335.","journal-title":"Eur Child Adolesc Psychiatry"},{"issue":"6","key":"558_CR10","doi-asserted-by":"publisher","first-page":"528","DOI":"10.13109\/prkk.2022.71.6.528","volume":"71","author":"I Loewens","year":"2022","unstructured":"Loewens\u00a0I, Reich\u00a0G, Meyer\u00a0T. Do siblings have a\u00a0different influence on self-assessed family functioning in patients with anorexia and bulimia nervosa? (Haben Geschwister einen unterschiedlichen Einfluss auf die selbsteingesch\u00e4tzte Familienfunktionalit\u00e4t bei Patientinnen mit Anorexia und Bulimia nervosa?). Prax Kinderpsychol Kinderpsychiatr. 2022;71(6):528\u201342.\u00a0","journal-title":"Prax Kinderpsychol Kinderpsychiatr"},{"issue":"1","key":"558_CR11","doi-asserted-by":"publisher","first-page":"32","DOI":"10.1007\/s40211-022-00433-0","volume":"38","author":"EJ Michel","year":"2024","unstructured":"Michel\u00a0EJ, Reich\u00a0G, Meyer\u00a0T. Parent-child age gaps in patients with anorexia and bulimia nervosa and their associations with family dysfunction. Neuropsychiatr. 2024;38(1):32\u20138.","journal-title":"Neuropsychiatr"},{"issue":"6","key":"558_CR12","doi-asserted-by":"publisher","first-page":"362","DOI":"10.1097\/YCO.0000000000000818","volume":"35","author":"Y Sil\u00e9n","year":"2022","unstructured":"Sil\u00e9n\u00a0Y, Keski-Rahkonen\u00a0A. Worldwide prevalence of DSM\u20115 eating disorders among young people. Curr Opin Psychiatry. 2022;35(6):362\u201371.","journal-title":"Curr Opin Psychiatry"},{"key":"558_CR13","volume-title":"Symptom-Checkliste-90-R-standard","author":"H Franke","year":"2002","unstructured":"Franke GH. Symptom-Checkliste-90-R-standard. 2nd\u00a0ed. G\u00f6ttingen: Hogrefe; 2002.","edition":"2"},{"issue":"6","key":"558_CR14","doi-asserted-by":"publisher","first-page":"434","DOI":"10.1016\/S0010-440X(99)90087-1","volume":"40","author":"V Fornari","year":"1999","unstructured":"Fornari\u00a0V, Wlodarczyk-Bisaga\u00a0K, Matthews\u00a0M, Sandberg\u00a0D, Mandel\u00a0FS, Katz\u00a0JL. Perception of family functioning and depressive symptomatology in individuals with anorexia nervosa or bulimia nervosa. Compr Psychiatry. 1999;40(6):434\u201341.","journal-title":"Compr Psychiatry"},{"key":"558_CR15","volume-title":"Family relationships of patients with bulimia nervosa: a\u00a0comparison study with patients with anorexia nervosa and a\u00a0non-ED control group","author":"G Reich","year":"2003","unstructured":"Reich\u00a0G. Familienbeziehungen von Patientinnen mit Bulimia nervosa: Eine Vergleichsstudie zu Patientinnen mit Anorexia nervosa und einer nicht-essgest\u00f6rten Kontrollgruppe (Family relationships of patients with bulimia nervosa: a\u00a0comparison study with patients with anorexia nervosa and a\u00a0non-ED control group). Heidelberg, Kr\u00f6ning, Asanger Verlag; 2003.\u00a0"},{"issue":"1","key":"558_CR16","first-page":"50","volume":"39","author":"A Boetticher","year":"2014","unstructured":"von Boetticher\u00a0A, Strack\u00a0M, Reich\u00a0G. Autonomie und Verbundenheit in famili\u00e4ren Triaden von T\u00f6chtern mit Essst\u00f6rungen. Familiendynamik. 2014;39(1):50\u20139.","journal-title":"Familiendynamik"},{"key":"558_CR17","volume-title":"Exploring the role of connectedness in anorexia nervosa: a\u00a0scoping review","author":"L Hengstermann","year":"2024","unstructured":"Hengstermann\u00a0L. Exploring the role of connectedness in anorexia nervosa: a\u00a0scoping review. Student Thesis: University of Twente; 2024."},{"issue":"1","key":"558_CR18","doi-asserted-by":"publisher","first-page":"231","DOI":"10.2466\/pr0.103.1.231-242","volume":"103","author":"EB F\u00e4ldt Ciccolo","year":"2008","unstructured":"F\u00e4ldt Ciccolo\u00a0EB. Exploring experience of family relations by patients with anorexia nervosa and bulimia nervosa using a\u00a0projective family test. Psychol Rep. 2008;103(1):231\u201342.","journal-title":"Psychol Rep"},{"issue":"3","key":"558_CR19","doi-asserted-by":"publisher","first-page":"338","DOI":"10.1002\/eat.1093","volume":"30","author":"RC Casper","year":"2001","unstructured":"Casper\u00a0RC, Troiani\u00a0M. Family functioning in anorexia nervosa differs by subtype. Int J Eat Disord. 2001;30(3):338\u201342.","journal-title":"Int J Eat Disord"},{"key":"558_CR20","doi-asserted-by":"publisher","first-page":"543","DOI":"10.13109\/prkk.2022.71.6.543","volume":"71","author":"AK Wohlfahrt","year":"2022","unstructured":"Wohlfahrt\u00a0AK, Strack\u00a0M, Reich\u00a0G. Family functioning, interpersonal problems and symptom severity in anorexia and bulimia nervosa \u2013 comparison of female patients and highschool students (Familienbeziehungen, interpersonelle Probleme und Symptomauspr\u00e4gung bei Anorexia und Bulimia nervosa \u2013 Patientinnen und Sch\u00fclerinnen im Vergleich). Prax Kinderpsychol Kinderpsychiatrie. 2022;71:543\u201363.\u00a0","journal-title":"Prax Kinderpsychol Kinderpsychiatrie"},{"issue":"2","key":"558_CR21","doi-asserted-by":"publisher","first-page":"150","DOI":"10.1002\/erv.2574","volume":"26","author":"TA Brown","year":"2018","unstructured":"Brown\u00a0TA, Avery\u00a0JC, Jones\u00a0MD, Anderson\u00a0LK, Wierenga\u00a0CE, Kaye\u00a0WH. The impact of alexithymia on emotion dysregulation in anorexia nervosa and bulimia nervosa over time. Eur Eat Disord Rev. 2018;26(2):150\u20135.","journal-title":"Eur Eat Disord Rev"},{"key":"558_CR22","doi-asserted-by":"publisher","first-page":"47","DOI":"10.1016\/B978-0-12-822290-4.00004-9","volume":"183","author":"J Hogeveen","year":"2021","unstructured":"Hogeveen\u00a0J, Grafman\u00a0J. Alexithymia. Handb Clin Neurol. 2021;183:47\u201362.","journal-title":"Handb Clin Neurol"},{"issue":"4","key":"558_CR23","doi-asserted-by":"publisher","first-page":"237","DOI":"10.1002\/cpp.625","volume":"16","author":"JR Fox","year":"2009","unstructured":"Fox\u00a0JR. Eating disorders and emotions. Clin Psychol Psychother. 2009;16(4):237\u20139.","journal-title":"Clin Psychol Psychother"},{"key":"558_CR24","doi-asserted-by":"crossref","unstructured":"Valdanha-Ornelas \u00c9D, Squires C, Barbieri V, dos Santos MA. Family relationships in bulimia nervosa. Psicol Estudo. 2021;26.","DOI":"10.4025\/psicolestud.v26i0.47361"},{"key":"558_CR25","doi-asserted-by":"publisher","first-page":"492","DOI":"10.1007\/s43076-023-00287-7","volume":"33","author":"M da Matta Sim\u00f5es","year":"2025","unstructured":"da Matta Sim\u00f5es\u00a0M, Gil\u00a0M, dos Santos\u00a0MA. The relationship between fathers and children with anorexia and bulimia nervosa: a\u00a0systematic review and meta-synthesis of qualitative studies. Trends Psychol. 2025;33:492\u2013517.","journal-title":"Trends Psychol"},{"key":"558_CR26","doi-asserted-by":"publisher","first-page":"891","DOI":"10.1002\/eat.22029","volume":"45","author":"SA Thomas","year":"2012","unstructured":"Thomas\u00a0SA, Hoste\u00a0RR, Le Grange\u00a0D. Observed connection and individuation: relation to symptoms in families of adolescents with bulimia nervosa. Int J Eat Disord. 2012;45:891\u20139.","journal-title":"Int J Eat Disord"},{"issue":"3","key":"558_CR27","doi-asserted-by":"publisher","first-page":"479","DOI":"10.1111\/1469-7610.00464","volume":"40","author":"DM Fergusson","year":"1999","unstructured":"Fergusson\u00a0DM, Woodward\u00a0LJ. Maternal age and educational and psychosocial outcomes in early adulthood. J\u00a0Child Psychol Psychiatry. 1999;40(3):479\u201389.","journal-title":"J Child Psychol Psychiatry"},{"issue":"4","key":"558_CR28","doi-asserted-by":"publisher","first-page":"525","DOI":"10.1590\/S1679-45082015AO3366","volume":"13","author":"MC Lofrano-Prado","year":"2015","unstructured":"Lofrano-Prado\u00a0MC, Prado\u00a0WL, Barros\u00a0MV, Ten\u00f3rio\u00a0TR, Souza\u00a0SL. Obstetric complications and mother\u2019s age at delivery are predictors of eating disorder symptoms among Health Science college students. Einstein. 2015;13(4):525\u20139.","journal-title":"Einstein"},{"issue":"12","key":"558_CR29","doi-asserted-by":"publisher","first-page":"5244","DOI":"10.1038\/s41380-022-01753-x","volume":"27","author":"SH Wang","year":"2022","unstructured":"Wang\u00a0SH, Wu\u00a0CS, Hsu\u00a0LY, Lin\u00a0MC, Chen\u00a0PC, Thompson\u00a0WK, Fan\u00a0CC. Paternal age and 13 psychiatric disorders in the offspring: a\u00a0population-based cohort study of 7\u00a0million children in Taiwan. Mol Psychiatry. 2022;27(12):5244\u201354.","journal-title":"Mol Psychiatry"},{"key":"558_CR30","doi-asserted-by":"crossref","unstructured":"Schmauch L, Michel EJ, Reich G, Meyer T. Psychopathological symptom severity and parent-child age differences in patients with eating disorders (Intensit\u00e4t psychopathologischer Symptome  und Eltern-Kind-Altersunterschiede bei Patientinnen mit Essst\u00f6rung). Neuropsychiatr. 2025 (in press).","DOI":"10.1007\/s40211-025-00528-4"}],"container-title":["neuropsychiatrie"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s40211-025-00558-y.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s40211-025-00558-y","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s40211-025-00558-y.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T06:52:06Z","timestamp":1788418326000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s40211-025-00558-y"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,11,26]]},"references-count":30,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2026,9]]}},"alternative-id":["558"],"URL":"https:\/\/doi.org\/10.1007\/s40211-025-00558-y","relation":{},"ISSN":["0948-6259","2194-1327"],"issn-type":[{"value":"0948-6259","type":"print"},{"value":"2194-1327","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,11,26]]},"assertion":[{"value":"4 August 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"30 October 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"26 November 2025","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"E.\u00a0Fischer, N.\u00a0Lensch, G.\u00a0Reich and T.\u00a0Meyer declare that they have no competing interests.","order":1,"name":"Ethics","label":"Conflict of interest","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Ethical approval (#32\/1\/17) for the study was obtained from the Institutional Review Board of the University of G\u00f6ttingen Medical Center, and the trial was registered in the ClinicalTrials.gov register (#NCT05339165).","order":2,"name":"Ethics","label":"Ethical standards","group":{"name":"EthicsHeading","label":"Declarations"}}]}}