Eating disorders, parent-child conflicts, and family therapy in Shenzhen, China

New media facilitate adolescents' body dissatisfaction and eating disorders in Mainland China

New media play a significant role in adolescents' body dissatisfaction and eating disorders in Mainland China, through shaping social standards, peers, and family dynamics. How to mitigate their adverse effects on adolescents, reduce body dissatisfaction, and prevent eating disorders is a significant social issue that demands serious consideration.

The Roles of Family and School Members in Influencing Children's Eating Behaviours in China: A Narrative Review

This review explores the influences of family and school members on children in China, in order to promote healthy eating behaviours among children and prevent childhood malnutrition in the Global South. Family members and school members are defined as parents, guardians (such as grandparents and other relatives), siblings, peers, and teachers. A search of four databases returned 94 articles, 18 of which met the eligibility criteria. Most of the included studies were from mainland China; a few were from Hong Kong and Taiwan. More quantitative than qualitative studies were found, among which, cross-sectional studies were dominant. The 18 papers included in the study explored the influences of family members and school members on the eating behaviours of children, based on seven themes: (1) social–demographic characteristics, (2) food intake of parents, (3) nutritional knowledge and health awareness of family or school members, (4) parents’ perceptions of their children’s body weight, (5) feeding strategies of family members, (6) family relationships, and (7) intergenerational differences of caregivers. In the current analysis, parental education levels, mother’s occupation, health awareness of parents and teachers, and positive feeding styles, such as encouraging healthy eating and controlling overeating, were positively correlated with the healthy eating behaviours of children. Meanwhile, healthy eating behaviours of children were negatively associated with caregivers’ lack of nutritional knowledge, misperception of weight, instrumental and/or emotional feeding, and working on nonstandard shifts. More related research using cross-disciplinary approaches is needed and there should be more discussions about how teachers, siblings, and peers affect the dietary behaviours of children.

Evaluation of the Effectiveness of an Empathy Training on Empathy Skills, Life Satisfaction, and Relationship Quality for Chinese Adolescents and Their Mothers: A Mixed Methods Study

Using a pre- and post-test design, this study examined the changes in empathy skills, life satisfaction, and relationship quality among mainland Chinese adolescents (ages 13–15 years) and their mothers ( N = 108 dyads) following an empathy training intervention. Participants completed a 20-day empathy training, including two in-person group training sessions and daily journals on assigned topics. Participants’ mother-child relationship quality, mother-child conflict, life satisfaction, and empathy skills were measured three times, and selected participants were interviewed to explore their experience of the training. The research procedure followed protocols that were approved by an Institutional Review Board. ANOVAs were used to examine quantitative data and inductive analysis was used for qualitative data. The findings suggest that after the training, both adolescents and mothers reported significant benefits in mother-child relationship quality and life satisfaction. However, participants’ empathy skills (i.e., perspective taking and empathic concern skills) did not change. Possible mechanisms of the observed changes included the empathy skills (e.g., perspective taking skills) learned through the training and the reciprocal nature of positive changes within the mother-child dyad. The current study suggests that empathy training may benefit adolescents and their mothers, both within the relationship and in their general life satisfaction.

[Female patients with eating disorders and their parents experience in China: A qualitative study]

INTRODUCTION

Recent tendencies show a stabilization in Western countries of the incidence of anorexia nervosa but an increase in Asian countries where it used to be lower. The emergence of these diseases in non-Western countries suggests a culture change syndrome on an individual or societal scale. The great number of changes having occurred in China in the past decades would favor the occurrence of eating disorders. A variability of symptoms of eating disorders can be observed depending on the cultural background which also influences the treatment. There are few studies that exist within an Asian context, and they mostly focus on the care.

OBJECTIVES

In this study, we intend to explore the experience of Chinese female patients hospitalized for an eating disorder and the experience of their parents: their relationship with the symptoms, with their health and their understanding of the disease, in order to identify the impact of the Chinese cultural context upon the disorder.

METHOD

It is an observational, phenomenological and qualitative study. A purposive sampling was formed from a clinical population group of young teenagers and women, coming from various areas of China and hospitalized in the specialized Psychosomatic Department of Shanghai Mental Health Center, in August and December 2017. The degree of urbanization, the regions and ages categories were wide-ranging, allowing us to maximize the richness of the data assessing the disease and care representations. Two semi-structured interviews were realized with the participants, then with one or both parents. The interviews were realized with an evaluative interview guide by the same researcher together with a Chinese psychology student in order to clarify the translation and the interpretation of the cultural elements expressed by the participants. The analysis was based on the Interpretative Phenomenological Analysis. Two researchers read the interview transcripts several times, identified themes then connections between the themes to build a set of meta-themes depicting the narratives. Every meta-theme was linked with its corresponding themes which necessitated during the analysis constant back and forth between the analytical data and the source material.

RESULTS

Thirteen female patients and 11 parents took part in the study. The patients were between 12 and 31 years of age. They showed a wide range of eating disorders: restrictive anorexia, anorexia nervosa, or bulimia nervosa. Their Body Mass Index at the time of the interview ranged from 11 to 22. Three meta-themes emerged from the analysis: concerns about thinness and health are real catalysts for seeking care, the opposition between parental beliefs about factors of good health and eating symptoms in young girls, and changes in parenting and traditional educational methods induced by eating symptoms. These different themes highlight the fear of thinness and good health being powerful therapeutic levers in China, the intergenerational agreements and disagreements on the factors of good health with the parental experience of consideration around the eating disorder of their daughter, and an impact of traditional educational modalities on the family relational aspects that change with the disorder.

DISCUSSION

Exploring the experience of young Chinese girls or women suffering from eating disorders highlights the complex interactions between the cultural and clinical context of eating disorders. Weight loss is experienced with great difficulty by the young women of our study, who report somatic symptoms and worry about their thinness. Our results show the central position occupied by maintaining oneself in good health in China, for parents and teenagers alike. This allows a quick reliance on healthcare. The intergenerational differences in China are increased by the rapid changes occurring within Chinese society which can cause conflicts and particularly violent struggles. Its younger generations are becoming more and more globalized. These results provide further evidence that eating disorders are culture change syndromes. The therapeutic impact of our results is twofold. On the individual level, there are therapeutic cultural levers linked with Chinese culture, and they have to be sought in all cultures. The therapeutic education of Chinese patients must be centered on the somatic consequences of the disease in order to increase the adherence to the care. On the familial level, the therapeutic approaches centered on intergenerational conflicts must be developed.

CONCLUSION

The rapid sociocultural changes in China are causing important intergenerational differences, notably between traditional educational modalities and the need for independence of young people who require specific familial therapy. The cultural elements must be taken into account in order to understand eating disorders and to develop relevant therapeutic approaches.

Family Psychic Transmission and Anorexia Nervosa

Abstract Studies show that family relationships can act as mediating agents in triggering and maintaining the symptoms of anorexia nervosa (AN), especially the mother-daughter relationship configuration, which contains unconscious elements transmitted inter-generationally. This study aimed to understand the role of intergenerational psychic transmission in the articulation of anorexic symptoms in a young woman in treatment. Three generations of women of the same family were interviewed: maternal grandmother, mother and daughter, all diagnosed with AN. Some psychic contents that could not be elaborated were identified in the reports and these were, subsequently, converted into legacies transmitted to later generations. Feelings of inhibition and shame regarding sexuality and the female body, transmitted from grandmother to mother and from mother to granddaughter, seem to have blocked the emotional development in all generations. Incorporating these findings into treatment may facilitate the processing of the transmitted unconscious contents, contributing to the reorganization of the family's psychodynamic functioning.

A constituição da relação mãe-filha e o desenvolvimento dos transtornos alimentares

O presente estudo buscou compreender, por meio de abordagem qualitativa, como mães de adolescentes com transtornos alimentares vivenciaram o processo de cuidar de suas filhas desde a gestação até os dois anos de idade, procurando investigar se essas vivências relacionadas à maternidade guardam relação com o aparecimento futuro do transtorno. Foram entrevistadas seis mães de pacientes com anorexia nervosa, que estavam em seguimento ambulatorial em um serviço especializado. Os relatos maternos foram examinados pela análise de conteúdo. Os resultados evidenciaram dificuldades de sustentação (holding) por parte das mães, que acarretaram intenso sofrimento e sentimento de impotência diante das necessidades básicas das filhas. As crianças foram descritas como vorazes e insatisfeitas, sugerindo que teriam vivenciado dificuldades em assimilar o cuidado oferecido por suas mães em seus primeiros anos de vida. Desse modo, os resultados corroboram a importância de investigar as experiências infantis precoces para a compreensão da etiologia dos transtornos alimentares.

Psicodinâmica dos transtornos alimentares: indicadores do Teste das Pirâmides Coloridas de Pfister

É amplamente reconhecida a influência de fatores emocionais na gênese e manutenção dos transtornos alimentares (TAs). Este estudo teve como objetivo analisar o funcionamento lógico e afetivo de pessoas com diagnóstico de TAs. Participaram do estudo 27 pacientes (23 mulheres, média de idade de 17,5 anos, a maioria com bulimia nervosa). O instrumento utilizado foi o Teste das Pirâmides Coloridas de Pfister. Os dados foram cotados segundo recomendações da literatura. Os resultados evidenciaram que os aspectos racionais apresentam um padrão de boa capacidade de organização. Quanto aos aspectos emocionais, observou-se uma desregulação dos mecanismos de controle eficiente dos afetos e impulsos. Por não suportarem os estados de ansiedade decorrentes do descontrole dos afetos, os participantes denegam seus impulsos, gerando uma estabilidade emocional precária que dificulta a elaboração dos conflitos. Evidenciou-se o comprometimento psíquico no grupo investigado e, por conseguinte, a necessidade de oferecer acompanhamento psicológico conjugado com reabilitação nutricional.

Avaliação psicológica de pacientes com anorexia e bulimia nervosas: indicadores do Método de Rorschach

Este estudo teve por objetivo avaliar o funcionamento lógico, afetivo e a adaptação social de pacientes com Anorexia Nervosa (AN) e Bulimia Nervosa (BN). A amostra foi composta por 27 participantes. Para coleta dos dados foi utilizado o Método de Rorschach. Os dados foram codificado e interpretados segundo as normas da Escola Francesa. Os resultados indicaram que os participantes apresentam capacidade produtiva e desejo de estabelecerem relacionamentos afetivos. Todavia, são facilmente invadidos por uma carga de afetos que não conseguem modular, o que os predispõe ao isolamento social, que gera acúmulo de inquietações e ansiedades introjetadas. A incapacidade de elaborar a tensão interna resultante os leva a escoar a ansiedade pela via somática. Evidenciou-se o comprometimento das funções psíquicas dos pacientes com AN e BN, o que indica a necessidade de acompanhamento psicoterapêutico integrado à assistência da equipe multiprofissional.

The factor structure of the Chinese family assessment instrument adapted for parent report

This article reports on a confirmatory factor analytic study of an adapted version of an instrument designed to assess family functioning of Chinese families. The Chinese Family Assessment Instrument, originally designed for completion by adolescents, was adapted for completion by parents. A sample of 700 parent dyads of elementary school children (382 girls and 318 boys) completed the adapted questionnaire. Initial factor analyses showed that the existing five-factor structure used for adolescents' responses was not a good fit for these data. Instead, a four-factor solution emerged where the factors were positive family functioning, negative family functioning, tolerance for family members, and parental understanding. This structure was the same for both mothers and fathers. Further studies of the Chinese Family Assessment Instrument parent adaptation are required to test the factor structure that emerged. Following such studies, validation studies will be required.

Educational and support intervention to help families assist in the recovery of relatives with eating disorders

The aim of this study was to develop and test an educational and support nursing intervention in Iceland to help families assist with the recovery of relatives with eating disorders. Studies indicate that if families receive adequate help in the recovery process of a relative with an eating disorder, the prognosis is better. The study is a pre-post design. The intervention was based on the Calgary Family Intervention Model. An educational and support intervention, which lasted for 3 weeks, was provided for 21 family members of individuals with eating disorders. The patients had been diagnosed with anorexia nervosa, bulimia nervosa or an eating disorder not otherwise specified. Participants were divided into three groups. The main findings revealed a significant improvement according to the scales used for measuring understanding in the level of expressed emotion questionnaire and for measuring eating behaviour, concern with weight and food, and denial of the problem in the anorectic behaviour observation scale. The participants' responses to the research questions about their satisfaction with the educational and support intervention were positive. The study indicates that an educational and support intervention can prove beneficial for families and patients with eating disorders.

Body dissatisfaction, engagement in body change behaviors and sociocultural influences on body image among Chinese adolescents

Body dissatisfaction and body image disorders are becoming increasingly prevalent in developing non-Western countries such as China, but there is a lack of research examining the sociocultural factors that in other contexts have been associated with these problems. The current study investigated body dissatisfaction, engagement in body change behaviors, and sociocultural pressures on body image, and the relationships between these variables among 517 adolescent males (N=219) and females (N=298) in China. Females reported greater body dissatisfaction than males, and males reported using strategies to increase their muscle bulk more often than females. Males reported pressure from a variety of sociocultural sources to increase their muscles or weight, while females reported pressure from the media to lose weight. For males body dissatisfaction was predicted by pressure from peers to increase their muscle bulk, while for females pressure to lose weight from peers, adult relatives, and the media was likely to increase body dissatisfaction. Pressure from the media and adult relatives was also predictive of body change behaviors in both males and females. The findings are discussed in relation to previous research in both Western and non-Western contexts.