Perceptions of nonshared childhood environment in bulimia nervosa

Mediation effect of recent loss events on weight gain in obese people who experienced childhood parental death or separation

Adverse events during childhood, including loss of a parent, are related to a higher risk of adult obesity. We investigated whether childhood parental loss is related to adult rapid weight gain through exposition to a later loss event. We assessed the mediation effect of recent loss and non-loss events on the association between childhood loss and rapid weight gain in 138 individuals seeking bariatric surgery. Our results showed that recent loss events mediate the effect of childhood parental loss on rapid weight gain (0.790; p < .001), suggesting the need for specific programs to prevent and treat obesity in individuals with multiple losses.

Inpatients with severe anorexia nervosa and their siblings: non-shared experiences and family functioning

OBJECTIVES

The aims of this study were the following: to identify perceptions of patients with anorexia nervosa (AN) and their siblings regarding differential experiences within and external to the family including sibling interactions, parental treatment, relationships with peers and events that are unique to each sibling; (2) to compare how patients and their siblings perceive eating disorder symptoms, parental affection/control, social support and stigma; and (3) to test associations with family functioning for patients with AN and their siblings.

METHOD

A total of 26 patients paired with their siblings were recruited from an Eating Disorder Program and administered standardized instruments measuring different experiences within and external to the family, the impact of eating disorder behaviours, stigma, social support and family functioning.

RESULTS

Patients rated high on the differential experience of jealousy in contrast to their siblings. Patients scored higher than their siblings on eating symptoms, whereas siblings scored higher on social support. The impact of AN on the family, stigma towards the individual and family, and social support accounted for 37% of the variance in family functioning from the sibling perspective after controlling for age and gender. Of these variables, impact of AN on the family made the largest contribution.

DISCUSSION

Family-based and sibling-based interventions that aim to reduce the effects of the illness on the sibling relationship and the family are recommended.

The relationship between childhood parental loss and metabolic syndrome in obese subjects

The increasing global trend of obesity is a fundamental contributor to the growing prevalence of metabolic syndrome, a cluster of medical abnormalities including impaired glucose and lipid metabolism, obesity and hypertension. Results from animal and human investigations have shown that early life stress can result in weight gain and metabolic changes. Our aim is to investigate whether a particular type of an early adverse event, i.e. parental loss during childhood, is associated with the development of metabolic syndrome in severely obese subjects. One hundred thirty-five consecutive obese patients who were seeking bariatric surgery were assessed for metabolic syndrome according to the Adult Treatment Panel (ATP) III criteria. Information regarding the experience of parental separation or bereavement before the age of 17 was collected with the use of a semi-structured interview. In our population, 31.1% of the subjects met the criteria for metabolic syndrome. No significant differences in demographic factors, health habits or psychiatric diagnosis were found between patients with and without coexisting metabolic syndrome. After adjusting for age and gender, multivariate logistic regression analysis revealed that both childhood loss of a parent and a body mass index (BMI) value greater than 50 were significant predictors of metabolic syndrome. This study provides preliminary evidence linking childhood parental loss to risk factors for the development of metabolic syndrome.

Perceived non‐shared environment, personality traits, family factors and developmental experiences in bulimia nervosa

OBJECTIVE

The role of perceived non-shared environmental influences and personality traits in the risk of developing bulimia nervosa (BN) was compared in 40 women with BN and their non-eating disordered sisters.

METHODS

The two sisters were compared for (a) eating pathology, (b) perceived non-shared environmental factors (differential family relationships, developmental teasing, traumatic experiences), (c) personality traits (impulsivity, affective instability, narcissism), and (d) psychopathology (anxiety, depression).

RESULTS

Specific perceived non-shared risk factors (e.g. perceptions of teasing), nonspecific non-shared risk factors (e.g. insecure paternal attachment) and personality traits (e.g. narcissism) distinguished women with BN from sisters. In the final logistic regression, insecure paternal attachment predicted the risk for BN, while trends were apparent for narcissism and developmental teasing after controlling for psychopathology.

CONCLUSIONS

Our correlational cross-sectional design does not allow for investigation of direction of effects. However, it is an important first step in identifying possible perceived non-shared environmental influences and personality traits that may constitute vulnerability factors predisposing individuals to the development of BN. Findings are discussed in the light of existing models of risk factors for the etiology of BN.

A comparison of early family life events amongst monozygotic twin women with lifetime anorexia nervosa, bulimia nervosa, or major depression

OBJECTIVES

To investigate the differential profile of early family life events associated with lifetime anorexia nervosa (AN), bulimia nervosa (BN), and major depression (MD).

METHOD

Only data from the monozygotic twins (n = 622) were examined from a community sample of female twins who had participated in three waves of data collection. Eating disorder and MD diagnoses were ascertained from the Eating Disorder Examination at Wave 3 and interview at Wave 2 respectively. Early family events were ascertained from self-report measures at Waves 1 and 3. Two case control designs were used, including a comparison of women: (1) who had lifetime AN, BN, MD, and controls, and (2) twin pairs discordant for either AN, BN, or MD (where the unaffected cotwin formed the control group).

RESULTS

Across the two types of designs, compared to controls, both AN and BN were associated with more comments from the family about weight and shape when growing up. AN was uniquely associated with higher levels of paternal protection while BN was associated with higher levels of parental expectations.

CONCLUSION

While some overlap among early life events was indicated, especially related to parental conflict and criticism, there was evidence to support some degree of nonoverlap among life events associated with AN, BN, and MD.

Father-daughter relationship and eating psychopathology: the mediating role of core beliefs

OBJECTIVE

The study aimed to establish the relationships between recalled paternal rearing behaviours, core beliefs and eating symptomatology and to test whether core beliefs play a mediating role between the father-daughter relationship and eating psychopathology.

DESIGN

Associations between eating psychopathology, core beliefs and recalled parental rearing behaviours were examined in women with and without eating disorders. Regression analyses were used to test whether core beliefs played a mediating role in the relationship between paternal rearing behaviours and eating psychopathology.

METHOD

Sixty-six eating-disordered women and fifty female controls completed three self-report questionnaires measuring parental rearing behaviours, core beliefs and eating psychopathology.

RESULTS

In eating-disordered women, paternal rejection and overprotection were found to predict aspects of eating psychopathology via the mediating role of abandonment, defectiveness/shame and vulnerability to harm core beliefs.

DISCUSSION

Core beliefs relating to feelings of abandonment and inherent defectiveness appear to be important in the relationship between unhealthy father-daughter relationships and eating disorder symptoms.

Parental bonding and bulimic psychopathology: the mediating role of mistrust/abuse beliefs

OBJECTIVE

To determine whether the previously reported relationship between parental bonding and bulimic psychopathology is mediated by the development of unhealthy core beliefs.

METHOD

One hundred and two nonclinical women completed the Parental Bonding Instrument, the short form of the Young Schema Questionnaire, and the Bulimic Investigatory Test, Edinburgh.

RESULTS

Mistrust/abuse beliefs were found to be a partial mediator in the relationship between paternal overprotection and the severity of bulimic attitudes.

CONCLUSIONS

The findings suggest that the development of mistrust/abuse beliefs is important in determining the effect that paternal overprotection has on bulimic attitudes.

Family therapy for identical twins with anorexia nervosa

The rarity of identical twins with anorexia nervosa (AN) makes formulating an effective treatment approach for this subset of individuals quite difficult Clinicians may be applying treatment strategies that have been designed for individuals with an eating disorder. However, these approaches might have to be modified for the treatment of identical twins. The few available case studies have not discussed the challenges a clinician faces when treating identical twins with AN. In this report we describe the presentation of the case of adolescent monozygotic twins who were simultaneously concordant for AN. We discuss their unique presentation and our approach to their treatment.

Parent-daughter discrepancies in perception of family function in bulimia nervosa

Eating disorders have traditionally been associated with disturbed family function. Most empirical data regarding this issue, however, were gathered from eating disorders patients. Attitudes, function, and inter-personal relationships were examined within 16 families with a member suffering from bulimia nervosa (BN) and compared to 16 matched healthy families. Perception of family function was significantly more derogatory in bulimic subjects than in their parents, while in control subjects and parents, perception was largely congruent. Subjects suffering from BN perceived their families as less cohesive, adaptable, and supportive than did healthy subjects. No such difference in perception of family function was observed between parents of respective groups. This preliminary study shows that parent-daughter discrepancy in perception of family function may prove more characteristic of eating disorder families than any particular deficit. Future research should aim to replicate these findings, incorporate them into treatment paradigms, and employ them to monitor treatment outcome.

Eating disorders: relations with inconsistent discipline, anxiety, and drinking among college women

Since as many as 20% of all college women report symptoms of eating disorders, the present study examined the relationship between self-reported eating disorder symptoms. anxiety, drinking, and retrospective reports of inconsistent parenting during childhood. 101 college women, 85% Euro-Americans of mean age 19 yr., completed an anonymous survey including questions from the Eating Disorder Index-1, the Retrospective Family Unpredictability Scale, the Trait Anxiety Scale, and measures of drinking in the previous month. Eating disorder symptoms correlated with self-reported drinking quantity, anxiety, and retrospective ratings of inconsistent discipline. This appears to be the first time eating disorder symptoms have been associated with inconsistent discipline. Implications for etiology and treatment of eating disorders are discussed.

Does environment matter? A review of nonshared environment and eating disorders

OBJECTIVE

Nonshared environmental influences are experiences that are unique to siblings reared in the same family. We review studies highlighting the importance of nonshared factors for the development of eating disorders and suggest areas for future research.

METHODS

Findings from behavioral genetic studies of eating disorders as well as methodological issues are reviewed.

RESULTS

Twin studies suggest that approximately 17%-46% of the variance in both anorexia nervosa (AN) and bulimia nervosa (BN) can be accounted for by nonshared environmental factors. Studies directly examining these influences are scarce, although initial data indicate that differential paternal relationships, body weight teasing, peer group experiences, and life events may account for the development of eating pathology in one sibling versus another.

DISCUSSION

Additional research is needed to identify specific nonshared environmental influences on eating disorders such as differential parental and sibling treatment, disparate peer group characteristics, and differential experience of life events such as physical and sexual abuse.

Relationship of temperament and perceptions of nonshared environment in bulimia nervosa

OBJECTIVE

Examine the relationship between temperament variables and perceptions of nonshared environment as they relate to bulimia nervosa.

METHOD

Fifty-seven adult women completed the Tridimensional Personality Questionnaire and the Sibling Inventory of Differential Experience. These measures provided assessments of frequently studied temperament traits as well as nonshared environmental factors believed to be associated with psychopathology and temperament.

RESULTS

Bulimic subjects showed higher levels of harm avoidance than did control subjects. Also, bulimic subjects perceived their fathers as less affectionate and more controlling than control subjects. Among bulimics, high levels of harm avoidance were associated with high levels of maternal affection and low levels of maternal control. Similarly, among bulimics, high levels of novelty seeking were more likely to be associated with decreased paternal control than was true for control subjects.

DISCUSSION

These findings highlight the possible relationship between particular temperamental variables and associated family responses in bulimia nervosa.

Nonshared environment: a theoretical, methodological, and quantitative review

When genetic similarity is controlled, siblings often appear no more alike than individuals selected at random from the population. Since R. Plomin and D. Daniels' seminal 1987 review, it has become widely accepted that the source of this dissimilarity is a variance component called nonshared environment. The authors review the conceptual foundations of nonshared environment, with emphasis on distinctions between components of environmental variance and causal properties of environmental events and between the effective and objective aspects of the environment. A statistical model of shared and nonshared environmental variables is developed. A quantitative review shows that measured nonshared environmental variables do not account for a substantial portion of the nonshared variability posited by biometric studies of behavior. Other explanations of the preponderance of nonshared environmental variability are suggested.

Perception of parental acceptance in women with binge eating disorder

The authors contribute to the validating literature for binge eating disorder (BED) by examining perceptions of parents and satisfaction with life among obese women with and without BED. Participants were female patients, recruited through a private medical clinic, who were assigned to groups on the basis of body mass index (BMI) and scores on the Questionnaire on Eating and Weight Patterns (QEWP; R. L. Spitzer et al., 1992). Groups consisted of (a) obese women with BED (n = 32), (b) obese women who had no eating disorders (n = 51), and (c) nonobese women with no eating disorders (n = 30). All participants completed the Parental Acceptance/Rejection Questionnaire (PARQ; R. P. Rohner, 1986), the Satisfaction with Life Scale (SWLS; J. Fischer & K. Corcoran, 1994), and the Beck Depression Inventory (BDI; A. T. Beck & R. A. Steer, 1987). Obese women with BED perceived their fathers as more rejecting than did women in the other groups. Moreover, obese women with BED perceived their fathers as significantly more rejecting than their mothers. The BED group indicated lower satisfaction with life and higher levels of depression than the groups without eating disorders. These findings further validate the diagnostic category of BED. Obese women with BED appear to be a distinct subgroup of the obese population. The results indicate a need for further assessment of the father-daughter relationship in connection to BED and other eating disorders.

The relationship between eating disorders and personality in physically active women

The aim of the study was to examine the relationship between personality factors, self-reported eating disorders, type of physical activity, level of sport competition and hours spent on physical activity each week among physically active non-athletes and athletes. A total of 591 high school women participated in the study. The mean age was 19 during the data collection. Scores were obtained on the Karolinska Scales of Personality (KSP) and a questionnaire concerning eating disorders (1) and physical activity. All diagnoses were based upon the DSM-IV criteria for anorexia nervosa (AN), bulimia nervosa (BN) and eating disorder not otherwise specified (EDNOS). The prevalence of AN was 1.5%, BN 2.0%, AN+BN 0.3% and EDNOS 12.9%. The prevalence of eating disorders (ED) was highest among physically active non-athletes who were members of fitness clubs (odds ratio (OR)= 1.86, 95% CI: 1.08-2.79). However, there was no relationship between the prevalence of eating disorders and the level of sport competition or time spent on physical activity. The results showed that women with eating disorders scored higher in anxiety, hostility and detachment, and lower in socialisation than the women without eating disorders. The results indicated that individuals with certain personality characteristics had a higher risk for being classified with ED, but it does not seem to be related to whether they are physically active or not. The findings in this study may support the hypothesis that participating in physical activity can have some positive psychological effects, but this does not necessarily apply to patients with AN and BN. ED may have a biological/genetic explanation according to Eysenck's personality theory.