This study investigates the outcome of anorexia nervosa in adolescents in relation to precipitating life events and changes in family functioning over time.

Thirty-five adolescents with anorexia nervosa and their mothers were administered measures of life events and family functioning at initial assessment and 1 and 2 year follow-up, when outcome was also assessed.

Fifty-five per cent of patients had a good outcome. Patients from initially well-functioning families or those with precipitating life events improved more in the first year, than those with dysfunctional families or without events. Subjects perceived a deterioration in family functioning at 1 year follow-up but an improvement at 2 years. Mothers reported no changes.

Approximately half of a series of early onset cases of anorexia nervosa can be expected to recover by 2 years. Healthy family functioning and presence of a precipitating life event predict good short-term outcome. The relationships between subjects' perceptions of family functioning and their recovery from anorexia nervosa is discussed.

Difficulties in family functioning have been noted since early descriptions of anorexia nervosa and may be of importance aetiologically. Previous studies have a number of methodological problems.

Thirty-five anorexic adolescents were age/sex matched with psychiatric and community controls. A diagnostic interview and a questionnaire, the Family Assessment Device (FAD) were administered to control subjects and their mothers. Anorexic families only received the McMaster Structured Interview of Family Functioning.

Multivariate analyses of FAD scores showed pathological ratings for psychiatric control but not anorexic families, compared with community controls. By contrast objective ratings revealed marked dysfunction in anorexic families (greater in the purging subgroup).

Family functioning in anorexic families is normal by self-report but not by an objective measure. Anorexic families in the purging subgroup appear most dysfunctional.