Effects of parental relations and upbringing in troubled adolescent eating behaviors

Disordered eating among college students: The effects of parental attachment and the mediating role of emotion dysregulation

ObjectivesThe current study explored the relationship between parental attachment and disordered eating among college students. This study also explored the potential mediating role of factors associated with emotion regulation. Participants: One hundred sixty-seven undergraduates (M = 18.93 years, SD = 1.02) participated in the current study. Methods: Participants completed an anonymous questionnaire reporting their perceptions of their parental attachment relationships, emotional reactivity, difficulty regulating emotions, and disordered eating. Results: Analyses using structural equation modeling indicated that difficulty regulating emotions mediated the relationship between maternal attachment and disordered eating, but not between paternal attachment and disordered eating. Emotional reactivity did not emerge as a significant mediator. Conclusions: These findings suggest that maternal attachment relationships may be associated with difficulty regulating emotions in adulthood, which may in turn impact disordered eating attitudes and behaviors.

Negative messages from parents and sisters and Latina college students' body image shame

Using the sociocultural model and risk and resilience theory, we examined the moderating role of Latinas' family relationship quality on the associations between negative eating and weight messages from fathers, mothers, and sisters, and Latinas' body image shame. Utilizing Amazon Mechanical Turk, we recruited a sample of 195 Latina young adults (M_age = 23.24, range = 18 -25; SD = 1.95; 67.4 % Mexican-origin) who reported retrospectively on negative appearance-related messages from each family member (i.e., fathers, mothers, and sisters), positive (e.g., parental warmth and sibling intimacy) and negative (i.e., parental psychological control and sibling negativity) relationship quality with parents and sisters, and current body image shame. Hierarchical linear regression analyses revealed that negative eating and weight messages from fathers, mothers, and sisters and sibling negativity were positively and significantly associated with Latinas' body image shame. Further, we found that under conditions of high paternal psychological control but not low, the associations between fathers' messages and Latinas' body image shame were strengthened. For mothers, under conditions of low maternal psychological control but not high, the associations between mothers' messages and Latinas' body image shame were strengthened. Our findings reveal that family members' negative comments are harmful for Latinas' body image.

Appearance Esteem Trajectory According to Three Different Sources of Support Among Adolescents Over a School Year

Although social support has been linked to body satisfaction, there has been little research on the effect of differential sources of support on the trajectory of appearance esteem over time. To address this gap, this study explored changes in adolescents' appearance esteem to perceived social support over one year. Data were collected from 339 Canadian adolescents (54.57% females) in Grade 7 (M_age = 12.05) and Grade 10 (M_age = 15.14). Multilevel growth modeling revealed that perceived social support from fathers was not associated with appearance esteem, whereas mothers' support had the strongest effect on appearance esteem, consistently over time. Friends' support was also related to an increase in the appearance esteem trajectory, but only for older students. Overall, this prospective study provides a better understanding of the unique contribution of three different sources of social support during adolescence for preventing negative appearance esteem, beyond the effects of other related variables.

SYMBIOTIC ILLUSION AND FEMALE IDENTITY CONSTRUCTION IN EATING DISORDERS: A PSYCHOANALYTICAL PSYCHOSOMATICS’ PERSPECTIVE

Abstract: This study aims primarily to reflect on the role of symbiotic illusion in the construction of female identity in women with eating disorders (ED), using premises from psychoanalytic psychosomatics. Considering ED as psychopathologies related to the affective economy, Oedipal relations play crucial role in the process of identity constitution. Mother-daughter relationships in ED are shaped in the molds of symbiotic illusion, with weak father figures. We presented a case study to briefly illustrate the theoretical framework. The omissive posture of a father to interdict the symbiotic relation leads daughters to find themselves unable to libidinally invest in other objects.

Effect of intrapersonal emotional competences on the relationship between attachment insecurity and severity of eating disorder symptoms in patients with restrictive anorexia

OBJECTIVE

Attachment insecurity and emotional competences (EC) form a key part of conceptual models of anorexia nervosa (AN). We explored the relationship between attachment dimensions and EC on the severity of eating disorders in patients diagnosed with restrictive AN.

METHOD

Sixty-three female patients with restrictive AN and 63 healthy participants completed self-report measures (eating symptoms, EC, attachment, depression, and anxiety).

RESULT

Patients with restrictive AN used fewer adaptive and more maladaptive regulation strategies and showed low levels of intrapersonal EC. The partial least squares path modeling analysis showed that high levels of attachment anxiety or avoidance lead to a decrease in intrapersonal EC, which in turn contributes to greater severity of eating symptoms in anorexic patients.

CONCLUSIONS

Lower intrapersonal EC played an important mediating role in the effects of attachment insecurity on the severity of eating disorders. The joint use of therapeutic programs that target both EC and attachment processes constitutes a promising approach.

Exploring the reciprocal relationships between adolescents' perceptions of parental and peer attachment and disordered eating: A multiwave cross-lagged panel analysis

OBJECTIVE

This prospective study explored bidirectional associations between attachment quality towards mother, father, and peers and disordered eating among a large population-based sample of boys and girls in the transition from preadolescence to adolescence. Specifically, we examined whether insecure attachment relationships emerged as a risk factor for or as an outcome of disordered eating.

METHOD

A population-based sample of 904 adolescent girls and boys was assessed four times, at baseline (T1; M_age  = 10.8 years) and at 2-, 4-, and 6-year follow-up (T2, T3, and T4). Prospective data were analyzed using cross-lagged panel models for each attachment figure (i.e., mother, father, peers) in a multigroup design to compare genders.

RESULTS

Better attachment to the mother led to less pronounced disturbed eating in girls across the entire age range and in boys across two time periods. In girls, more pronounced disordered eating at T3 predicted worse attachment to the mother at T4 and better attachment to the father at T1 predicted less disturbed eating at T2. In boys, disordered eating at T1 predicted better attachment to the father at T2. Concerning peer attachment, better attachment at T1 predicted disordered eating at T2, in boys only. No other significant cross-lagged effects emerged.

DISCUSSION

These findings highlight the differential and gender-specific contribution of attachment figures to the development of disordered eating in adolescence. Programs aimed at improving communication and trust in the relationship with parents might be promising in the prevention of disordered eating and the subsequent deterioration of parent-child attachment relationships.

Mediators linking insecure attachment to eating symptoms: A systematic review and meta-analysis

In the last two decades, the number of studies focused on the mediators connecting insecure attachment with Eating Disorders (EDs), at both clinical and sub-clinical level, has considerably increased. However, there has not been a systematic synthesis of this literature to date. To fill this gap, the current meta-analytic review aimed at identifying and quantifying the extent to which mediators contribute to the explanation of this relationship. The present study was registered with PROSPERO (CRD42017076807). A comprehensive search process in seven different electronic databases retrieved 24 studies that examined how insecure attachment leads to ED symptoms through mediation analysis. Standardized regression coefficients of the indirect and total paths of 21 mediation models were pooled. Studies were coded and ranked for quality. We found evidence to show that maladaptive emotion regulation and depressive symptoms had the highest effect size for mediation (mediation ratio [P_M] = 0.71). Further, body dissatisfaction, neuroticism, perfectionism, mindfulness and social comparison had significant, but moderate to low mediating effects (P_M = 0.21–0.58). The methodological quality of these studies was mostly low to moderate and potential areas for development were highlighted. Our findings support the direct targeting of these psychological constructs in prevention programs and treatment of EDs. Future investigations addressing the time sequence between the variables will provide valuable clues to untangle the prospective contribution of each variable on the development and maintenance of eating pathology.

Relação Pai-Filha e Transtornos Alimentares: Revisando a Produção Científica

Resumo Investigou-se a produção científica dedicada ao estudo da relação entre pai e filha com transtornos alimentares. Foi realizada uma revisão integrativa nas bases PsycINFO, CINAHL, PubMed e LILACS, no período de janeiro de 2000 a junho de 2014. Foram selecionados 27 artigos, a maioria proveniente de países europeus e constituída de estudos quantitativos. A vinculação pouco segura com a figura paterna e o relacionamento emocionalmente distante entre pai e filha foram aspectos recorrentes nas publicações selecionadas. Os estudos apontaram a importância de se investigar e assegurar a participação do pai no tratamento. Porém, nenhum dos artigos revisados investigou o envolvimento paterno no contexto da assistência. Destaca-se a necessidade de investir em estudos qualitativos e no contexto brasileiro.

Family therapy approaches for anorexia nervosa

BACKGROUND

Anorexia nervosa (AN) is characterised by a failure to maintain a normal body weight due to a paucity of nutrition, an intense fear of gaining weight or behaviour that prevents the individual from gaining weight, or both. The long-term prognosis is often poor, with severe developmental, medical and psychosocial complications, high rates of relapse and mortality. 'Family therapy approaches' indicate a range of approaches, derived from different theories, that involve the family in treatment. We have included therapies developed on the basis of dominant family systems theories, approaches that are based on or broadly similar to the family-based therapy derived from the Maudsley model, approaches that incorporate a focus on cognitive restructuring, as well as approaches that involve the family without articulation of a theoretical approach.This is an update of a Cochrane Review first published in 2010.

OBJECTIVES

To evaluate the efficacy of family therapy approaches compared with standard treatment and other treatments for AN.

SEARCH METHODS

We searched the Cochrane Common Mental Disorders Controlled Trials Register (CCMDCTR) and PsycINFO (OVID) (all years to April 2016). We ran additional searches directly on Cochrane Central Register for Controlled Trials (CENTRAL), MEDLINE, Ovid Embase, and PsycINFO (to 2008 and 2016 to 2018). We searched the World Health Organization (WHO) trials portal (ICTRP) and ClinicalTrials.gov, together with four theses databases (all years to 2018). We checked the reference lists of all included studies and relevant systematic reviews. We have included in the analyses only studies from searches conducted to April 2016.

SELECTION CRITERIA

Randomised controlled trials (RCTs) of family therapy approaches compared to any other intervention or other types of family therapy approaches were eligible for inclusion. We included participants of any age or gender with a primary clinical diagnosis of anorexia nervosa.

DATA COLLECTION AND ANALYSIS

Four review authors selected the studies, assessed quality and extracted data. We used a random-effects meta-analysis. We used the risk ratio (with a 95% confidence interval) to summarise dichotomous outcomes and both the standardised mean difference and the mean difference to summarise continuous measures.

MAIN RESULTS

We included 25 trials in this version of the review (13 from the original 2010 review and 12 newly-included studies). Sixteen trials were of adolescents, eight trials of adults (seven of these in young adults aged up to 26 years) and one trial included three age groups: one adolescent, one young adult and one adult. Most investigated family-based therapy or variants. Reporting of trial conduct was generally inadequate, so that in a large number of studies we rated the risk of bias as unclear for many of the domains. Selective reporting bias was particularly problematic, with 68% of studies rated at high risk of bias in this area, followed by incomplete outcome data, with 44% of studies rated at high risk of bias in this area. For the main outcome measure of remission there was some low-quality evidence (from only two studies, 81 participants) suggesting that family therapy approaches might offer some advantage over treatment as usual on rates of remission, post intervention (risk ratio (RR) 3.50, 95% confidence interval (CI) 1.49 to 8.23; I2 = 0%). However, at follow-up, low-quality evidence from only one study suggested this effect was not maintained. There was very low-quality evidence from only one trial, which means it is difficult to determine whether family therapy approaches offer any advantage over educational interventions for remission (RR 9.00, 95% CI 0.53 to 153.79; 1 study, N = 30). Similarly, there was very low-quality evidence from only five trials for remission post-intervention, again meaning that it is difficult to determine whether there is any advantage of family therapy approaches over psychological interventions (RR 1.22, 95% CI 0.89 to 1.67; participants = 252; studies = 5; I2 = 37%) and at long-term follow-up (RR 1.08, 95% CI 0.91 to 1.28; participants = 200; studies = 4 with 1 of these contributing 3 pairwise comparisons for different age groups; I2 = 0%). There was no indication that the age group had any impact on the overall treatment effect; however, it should be noted that there were very few trials undertaken in adults, with the age range of adult studies included in this analysis from 20 to 27. There was some evidence of a small effect favouring family based therapy compared with other psychological interventions in terms of weight gain post-intervention (standardised mean difference (SMD) 0.32, 95% CI 0.01 to 0.63; participants = 210; studies = 4 with 1 of these contributing 3 pairwise comparisons for different age groups; I2 = 11%) . Overall, there was insufficient evidence to determine whether there were any differences between groups across all comparisons for most of the secondary outcomes (weight, eating disorder psychopathology, dropouts, relapse, or family functioning measures), either at post-intervention or at follow-up.

AUTHORS' CONCLUSIONS

There is a limited amount of low-quality evidence to suggest that family therapy approaches may be effective compared to treatment as usual in the short term. This finding is based on two trials that included only a small number of participants, and both had issues about potential bias. There is insufficient evidence to determine whether there is an advantage of family therapy approaches in people of any age compared to educational interventions (one study, very low quality) or psychological therapies (five studies, very low quality). Most studies contributing to this finding were undertaken in adolescents and youth. There are clear potential impacts on how family therapy approaches might be delivered to different age groups and further work is required to understand what the resulting effects on treatment efficacy might be. There is insufficient evidence to determine whether one type of family therapy approach is more effective than another. The field would benefit from further large, well-conducted trials.

Eating disorders in men

Eating disorders are traditionally thought of as a problem specific to women, but evidence suggests the disorders also occur in men. Identifying the problem and referring patients for treatment can be difficult. Understanding the nuances of these disorders and realizing the incidence in men is important, as it is often overlooked as a differential diagnosis.

Associations between parent-child relationship quality and obesogenic risk in adolescence: a systematic review of recent literature

Adolescence is a period of significant cognitive, social and physiological change, presenting unique risk factors for weight gain. Childhood obesity research has traditionally focused on the influence of parent-level factors on children's eating and weight status. Increasingly, emphasis is turning towards the reciprocal nature of the parent-child relationship and its influence on health behaviour. A systematic literature review was conducted to investigate the relationship between parent-child relationship quality (defined as the felt emotional bond between parent and child) and obesogenic risk (weight status, eating attitudes and behaviours, level of physical activity and sedentary behaviour) in adolescence; 26 papers were included in the review. The results neither support nor challenge an association between parent-child relationship quality and weight, with study design flaws and limited measurement of the parent-child relationship precluding robust conclusions. The review does however suggests that several aspects of the parent-child relationship are important in understanding eating attitudes and behaviours, including the felt emotional bond between the parent and child, the child's perception of how much the parent cares for them and the mother's sensitivity towards the child. The need for further longitudinal research into the association between parent-child relationship quality and obesity risk across this developmental period is discussed.

Parental attachment insecurity predicts child and adult high-caloric food consumption

Eating habits are established early and are difficult to change once formed. This study investigated the role of caregiver-child attachment quality and its associations with high-caloric food consumption in a sample of middle socio-economic status children and adults, respectively. Survey data were collected from an online questionnaire administered separately to 213 (143 girls) children and 216 parents (adult sample; 180 women). Two studies showed that an insecure parental attachment, whether actual (Study 1; children) or recalled (Study 2; adults), significantly and positively predicted high-caloric food consumption in both samples. The present findings highlight the importance of parental attachment and its association with unhealthy eating patterns in children and adults.

Attachment and mentalization and their association with child and adolescent eating pathology: A systematic review

OBJECTIVE

Insecure attachment and mentalizing difficulties have been associated with eating pathology in adulthood. However, it is unclear whether eating pathology is associated with attachment or mentalization in children. The aim of this study is to systematically review the literature in this emerging field.

METHOD

Electronic databases were used to search for articles.

RESULTS

Twenty-two studies were identified. In the 15 studies investigating attachment, an association with eating pathology was found in all studies. Mentalizing difficulties and eating pathology were found to be correlated in the seven studies which examined their association.

DISCUSSION

In keeping with the adult literature, cross-sectional studies of children and adolescents consistently report associations with eating pathology. There is some evidence from prospective studies that insecure attachment may be a risk factor for the development of eating pathology in adolescence. The literature on mentalization and eating pathology suggests that adolescents with anorexia nervosa may have difficulties in recognizing emotions. Further research using clinical samples and well-validated measures of attachment and mentalization are required to shed further light on this area.

Eating disorders in adolescence: attachment issues from a developmental perspective

In the present article we review findings from an emerging body of research on attachment issues in adolescents with eating disorders from a developmental perspective. Articles for inclusion in this review were identified from PsychINFO (1966-2013), Sciencedirect (1970-2013), Psychindex (1980-2013), and Pubmed (1980-2013). First, we will outline the crucial developmental changes in the attachment system and discuss how they might be related to the early onset of the disease. Then we will report on the major results from attachment studies using self-report and narrative instruments in that age group. Studies with a developmental approach on attachment will be analyzed in more detail. The high incidence of the unresolved attachment pattern in eating disorder samples is striking, especially for patients with anorexia nervosa. Interestingly, this predominance of the unresolved category was also found in their mothers. To date, these transgenerational aspects are still poorly understood and therefore represent an exciting research frontier. Future studies that include larger adolescent samples and provide a more detailed description including symptom severity and comorbidity would contribute to a better understanding of this complex and painful condition.

Steering teens safe: a randomized trial of a parent-based intervention to improve safe teen driving

BACKGROUND

Crashes are the leading cause of death for teens, and parent-based interventions are a promising approach. We assess the effectiveness of Steering Teens Safe, a parent-focused program to increase safe teen driving.

METHODS

Steering Teens Safe aimed to improve parental communication with teens about safe driving using motivational interviewing techniques in conjunction with 19 safe driving lessons. A randomized controlled trial involved 145 parent-teen dyads (70 intervention and 75 control). Intervention parents received a 45-minute session to learn the program with four follow-up phone sessions, a DVD, and a workbook. Control parents received a standard brochure about safe driving. Scores were developed to measure teen-reported quantity and quality of parental communication about safe driving. The main outcome measure was a previously validated Risky Driving Score reported by teens. Because the Score was highly skewed, a generalized linear model based on a gamma distribution was used for analysis.

RESULTS

Intervention teens ranked their parent's success in talking about driving safety higher than control teens (p = 0.035) and reported that their parents talked about more topics (non-significant difference). The Risky Driving Score was 21% lower in intervention compared to control teens (85% CI = 0.60, 1.00). Interaction between communication quantity and the intervention was examined. Intervention teens who reported more successful communication had a 42% lower Risky Driving Score (95% CI = 0.37, 0.94) than control parents with less successful communication.

CONCLUSIONS

This program had a positive although not strong effect, and it may hold the most promise in partnership with other programs, such as Driver's Education or Graduated Driver's License policies.

TRIAL REGISTRATION

ClinicalTrials.gov NCT01014923. Registered Nov. 16, 2009.