The inter-generational transmission of eating disorders

Associations between parental engagement in disordered eating behaviors and use of specific food parenting practices within a racially, ethnically, and socioeconomically diverse sample

Parents influence their children's eating behaviors through their use of food parenting practices, or goal-directed behaviors that guide both what and how they feed their child. Prior research suggests that parents who engage in disordered eating behaviors are more likely to use coercive food parenting practices, which are known to be associated with the development of maladaptive eating behaviors in young people. The present study sought to extend our current understanding by examining the association between parental engagement in disordered eating behaviors and use of a broader range of food parenting practices in a socioeconomically and racially diverse, population-based sample (n = 1306 parents/child dyads). Parents self-reported their disordered eating behaviors, as well as use of coercive and structure-based food parenting practices. A series of separate linear regression models, adjusting for parent and child sociodemographic and anthropometric characteristics, revealed that parents engaging in restrictive disordered eating behaviors and binge eating reported significantly higher levels of coercive food parenting practices, including pressure-to-eat, restriction, threats and bribes, and using food to control negative emotions. Parental engagement in restrictive disordered eating behaviors was also associated with significantly higher use of food rules and limits. Overall, parental engagement in compensatory disordered eating behaviors was significantly associated with higher levels of restrictive and emotional feeding practices, as well as with lower levels of monitoring. Given prior research supporting a relationship between exposure to coercive control food parenting practices and the development of maladaptive eating behaviors in young people, results from the current study provide support for the role that food parenting practices might play in the intergenerational transmission of disordered eating behaviors.

Mental health symptoms are related to mothers' use of controlling and responsive child feeding practices: A replication and extension study

Parents have an important role in feeding their children. Parents' child feeding practices can be influenced by numerous factors. The presence of mental health symptoms can be associated with more controlling, less sensitive parent-child feeding interactions. However, it is not known whether mental health symptoms are related to parents' use of responsive, more autonomy supportive feeding practices which are important for promoting children's healthy eating habits. This study therefore aimed to examine the relationships between mental health symptoms and the use of controlling and responsive child feeding practices. A community sample of 415 UK mothers with a child age 2-4 years took part. They completed self-report measures of their levels of anxiety, depression and disordered eating behaviours as well as a comprehensive measure of their child feeding practices. The presence of mental health symptoms was significantly associated with greater self-reported use of controlling feeding practices, such as more restriction for weight control and using food as a reward. Maternal symptoms of anxiety and depression were related to lower use of modelling and monitoring but to giving children more control around food. Mothers' restrained and external eating behaviours were associated with greater use of several responsive feeding practices, including encouraging balance and variety, involvement, and teaching about nutrition. Together, these findings highlight the broad impact that mental health symptoms can have on mothers' controlling and responsive child feeding interactions. Interventions to support families to promote healthy child eating habits need to be aware of the role of even fairly mild, non-clinical levels of mental health symptoms on maternal sensitivity and involvement in feeding their children.

Maternal feeding practices and children's eating behaviours: A comparison of mothers with healthy weight versus overweight/obesity

This study aimed to explore differences between mothers with healthy weight versus overweight/obesity in a wide range of their reported child feeding practices and their reports of their children's eating behaviours. Mothers (N = 437) with a 2-6-year-old child participated. They comprised two groups, based on their BMI: healthy weight (BMI of 18.0-24.9, inclusive) or overweight/obese (BMI of 25.0 or more). All mothers provided demographic information and completed self-report measures of their child feeding practices and their child's eating behaviour. In comparison to mothers with healthy weight, mothers with overweight/obesity reported giving their child more control around eating (p < 0.001), but encouraged less balance and variety around food (p = 0.029). They also had a less healthy home food environment (p = 0.021) and demonstrated less modelling of healthy eating in front of their children (p < 0.001). There were no significant differences in mothers' use of controlling feeding practices, such as pressure to eat or restriction, based on their own weight status. Mothers with overweight/obesity reported their children to have a greater desire for drinks (p = 0.003), be more responsive to satiety (p = 0.007), and be slower eaters (p = 0.034). Mothers with overweight/obesity appear to engage in generally less healthy feeding practices with their children than mothers with healthy weight, and mothers with overweight/obesity perceive their children as more avoidant about food but not drinks. Such findings are likely to inform future intervention developments and help health workers and clinicians to better support mothers with overweight/obesity with implementing healthful feeding practices and promoting healthy eating habits in their children.

Parent questionnaires measuring feeding disorders in preschool children: a systematic review

AIM

Preschool feeding disorders are common and debilitating and are associated with a range of developmental and medical issues. Parent report allows assessment of feeding in a naturalistic environment over time, with advantages over time-limited, clinic-based observations. However, little is understood about the limitations and advantages of current parent-report measures. We aimed to systematically review the psychometrics and clinometrics of parent-administered feeding questionnaires.

METHOD

Five search engines were used to identify questionnaires that met inclusion criteria, i.e. being norm-or criterion-referenced, child focused, appropriate for preschool children, and measured two or more feeding domains (e.g. dysphagia/oral motor delay, food refusal).

RESULTS

In total 3535 abstracts were identified and 215 full-text articles were evaluated. Five questionnaires met the criteria. The Behavioral Pediatrics Feeding Assessment Scale (BPFAS) was the most reliable questionnaire identified, with good test-retest reliability and internal consistency. More predictive and concurrent validity data was available for the BPFAS, the Mealtime Behavior Questionnaire, and the Montreal Children's Hospital Feeding Scale than for other measures.

INTERPRETATION

Further research is needed on the psychometric properties of feeding questionnaires used in research and clinical practice. To date, the BPFAS has the most comprehensive reliability and validity data of any parent-administered feeding questionnaire for preschool children.

Unintentional role models: links between maternal eating psychopathology and the modelling of eating behaviours

This study explored the relationships between maternal modelling of eating behaviours with reported symptoms of maternal eating psychopathology, anxiety and depression. Mothers (N = 264) with a child aged 1.5 to 8 years completed three self-report measures designed to assess modelling of eating behaviours, eating psychopathology and levels of anxiety and depression. The study found that higher levels of maternal eating psychopathology were positively associated with eating behaviours that were unintentionally modelled by mothers but that maternal eating psychopathology was not associated with more overt/intentional forms of parental modelling. In addition, higher levels of maternal depression were associated with lower levels of both unintentional and intentional forms of maternal modelling, whereas maternal anxiety was not found to correlate with modelling behaviours. This study highlights the possible detrimental influences of maternal mental health in relation to mothers providing their child with a positive parental role model around eating and feeding.

Predictors of paternal and maternal controlling feeding practices with 2- to 5-year-old children

OBJECTIVE

This study aimed to identify predictors of controlling feeding practices in both mothers and fathers of young children.

DESIGN

Cross-sectional, questionnaire design.

SETTING

Nursery schools within the United Kingdom recruited participants.

PARTICIPANTS

Ninety-six mothers and fathers comprising 48 mother-father pairs of male and female children aged 2 to 5 years.

MAIN OUTCOME MEASURES

Parents' child feeding practices, eating psychopathology, general mental health symptomology, and their children's eating behaviors and temperament.

ANALYSIS

Preliminary correlations; stepwise regressions.

RESULTS

Maternal controlling feeding was predicted by children's eating behaviors (emotional over- and undereating), child temperament (sociability), and maternal general mental health symptoms. Paternal reports of children's eating behaviors (slow eating and emotional undereating) were the only significant predictors of fathers' controlling feeding practices.

CONCLUSIONS AND IMPLICATIONS

Mothers' and fathers' feeding practices seem to be better linked to child characteristics than to the presence of eating psychopathology symptoms. Children's emotional eating predicted all 3 controlling feeding practices in mothers and warrants further study to elucidate the causal nature of this relationship.

A clinical study of the intergenerational transmission of eating disorders from mothers to daughters

Clinicians and researchers have long recognized the existence of eating disorders in very young children, including infants whose mothers have eating disorders. This paper combines reviews of the literature relevant to the study of eating disorders from the perspectives of both research and psychoanalytic theory in order to explore the psychodynamics of the intergenerational transmission of eating-disordered pathology from mother to child. A developmental pathway as well as several mechanisms that illuminate the pathogenesis of the intergenerational transmission of eating disorders are proposed and described. Clinical-observational data from a therapeutic play nursery for mothers with eating disorders and their children are presented, and this material is examined in relation to the proposed psychodynamic pathways of transmission.

Emphasizing interpersonal factors: an extension of the Witkiewitz and Marlatt relapse model

AIM

Recently, Witkiewitz & Marlatt reformulated the Marlatt & Gordon relapse model to account for current research findings. The present paper aims to extend this model further to incorporate social variables more fully.

METHODS

The social-factors and alcohol-relapse literatures were reviewed within the framework of the reformulated relapse model.

RESULTS

The literature review found that the number of social network members, investment of the individual in the social network, levels of general and alcohol-specific support available within the social network and specific behaviors of network members all predict drinking outcomes. However, little is known about the mechanisms by which these social variables influence outcomes. The authors postulate that social variables influence outcomes by affecting intra-individual factors central to the reformulated relapse prevention model, including processes (e.g. self-efficacy, outcome expectancies, craving, motivation, negative affective states) and behaviors (e.g. coping and substance use). The authors suggest specific hypotheses and discuss methods that can be used to study the impact of social factors on the intra-individual phenomena that contribute to relapse.

CONCLUSION

The proposed extension of the relapse model provides testable hypotheses that may guide future alcohol-relapse research.

Maternal cognitions, psychopathologic symptoms, and infant temperament as predictors of early infant feeding problems: a longitudinal study

OBJECTIVE

The current study examined the contribution of prenatal and postnatal maternal core beliefs, self-esteem, psychopathologic symptoms, and postnatal infant temperament to the prediction of infant feeding difficulties.

METHOD

Ninety-nine women completed questionnaires assessing their core beliefs, psychopathology, and self-esteem during pregnancy and at 6 months postpartum. At 6 months, mothers also rated their infant's temperament and feeding, and were ob-served feeding their infants.

RESULTS

Maternal reports of child feeding difficulties were predicted by higher levels of emotional deprivation and entitlement core beliefs and lower levels of self-sacrifice and enmeshment core beliefs during pregnancy. Postnatal social isolation core beliefs, lower maternal self-esteem, and more difficult infant temperament added significantly to the variance explained by prenatal factors. Maternal core beliefs, self-esteem, psychopathology, and infant temperament failed to significantly predict independent observations of child food refusal.

CONCLUSION

Maternal cognitions are implicated in the development of maternal reports of feeding difficulty.

Breast-feeding, maternal feeding practices and mealtime negativity at one year

This paper explores whether breast-feeding, mediated by lower maternal use of controlling strategies, predicts more positive mealtime interactions between mothers and their 1 year old infants. Eighty-seven women completed questionnaires regarding breast-feeding, assessing their control over child feeding and mealtime negativity at 1 year of infant age. Seventy-four of these women were also observed feeding their infants solid food at 1 year. Mediation analyses demonstrated that the experience of breast-feeding, mediated by lower reported maternal control over child feeding, predicted maternal reports of less negative mealtime interactions. The experience of breast-feeding also predicted observations of less conflict at mealtimes, mediated by observations of maternal sensitivity during feeding interactions. The implications of these findings are discussed.

Maternal core beliefs and children's feeding problems

BACKGROUND

Although maternal mental health problems have been implicated in the exacerbation of childhood feeding difficulties, little research has assessed the contribution of broader maternal cognitions to these problems. The current study examined gender differences in the relationships between mothers' core beliefs and children's feeding problems.

METHODS

One hundred and three mothers of girls and 93 mothers of boys (age range, 7-64 months) completed the Young Schema Questionnaire and the Child Feeding Assessment Questionnaire.

RESULTS

While controlling for child age, a clear link between maternal core beliefs and perceived feeding difficulties emerged for mothers of girls. In particular, abandonment, failure to achieve, dependence and incompetence, enmeshment and defectiveness, and shame beliefs were associated with increased reports of feeding problems in girls. In contrast, emotional deprivation and subjugation beliefs were associated with maternal reports of food fussiness and food refusal in boys.

CONCLUSIONS

There appears to be a clear role for maternal core beliefs in the reporting of feeding difficulties in children, and the specificity of these links differs depending on the gender of the child. Further research is required to establish the direction of causality and the specificity of these relationships.

Is Bowen theory valid? A review of basic research

In the last 15 years, a substantial number of studies have tested the theoretical validity of Bowen family systems theory. A review of this basic research provided empirical support for the relationship between differentiation and chronic anxiety, marital satisfaction, and psychological distress. Bowen's assumption that couples with the same level of differentiation marry was not supported. His specific theories of sibling position and triangulation also received little empirical support. Research on multigenerational transmission has generally ignored Bowen's theoretical perspective, and more research needs to test Bowen's claim that his theory is universal. In addition, researchers still need to examine the effect of differentiation on child functioning, physical health problems, and adaptability.

The relationship between parental eating problems and children's feeding behavior: a selective review of the literature

This review describes the research evidence linking parental eating problems with processes that affect children's food selection and rejection, including child feeding difficulties, and child dieting practices and attitudes. First, studies that assess the relationship between parental eating disorder and child feeding are reviewed. Secondly, research that examines the relationship between parent and child dieting behavior and attitudes is reviewed. Finally, the eating characteristics of parents whose children have feeding difficulties are discussed. There is no consensus in the literature about the relationships between parent and child feeding and eating disturbance, and mechanisms for the intergenerational transmission of these behaviors have yet to be established.

Eating attitudes across age and gender groups: a Canadian study

OBJECTIVE

The purpose was to examine the eating attitudes across gender and age groups.

METHOD

The study included 343 individuals over 18 years of age (range: 18 to 94 years; mean 48 +/- 22), who were divided into 3 age categories: 18 to 34 years, 35 to 64 years and 65 years and above with a distribution of 35% (119), 37% (128) and 28% (97) respectively. The participants completed a background questionnaire and the Eating Attitudes Test (EAT-26).

RESULTS

A total of 30 participants (8.7%) scored above the cut-off point on the EAT-26 which is indicative of potential eating disturbances. Only statistically significant gender differences were observed in the total EAT-26 scores. Factor analysis revealed three subscales of EAT-26, food preoccupation, image preoccupation, and external focus or social pressure, with acceptable level of reliability and these were used for age and gender comparison. Age and gender differences were observed in the food and image preoccupation subscales only.

DISCUSSION

Although EAT-26 is widely used in clinical and non-clinical population, age and gender comparisons have not been made in a population-based sample. Use of the subscales of eating attitudes should help health professionals better identify those at risk for eating disturbances and provide the opportunity for intervention.

Critical issues in the care of pregnant women with eating disorders and the impact on their children

Pregnancy and eating disorders is a subject that has received relatively little attention in the literature. Nevertheless, serious complications have been found in both the mother and the baby during both pregnancy and post partum period. This article alerts practitioners to the physical and psychological risks that imperil pregnant women with histories of recent eating disorders, describes the experiences of three women with eating disorders during pregnancy whose children developed eating difficulties, and suggests some guidelines for the screening and care of women with eating disorders and their babies.