Toward a Biological, Psychological and Familial Approach of Eating Disorders at Onset: Case-Control ANOBAS Study

Relationship between parental perfectionism and child's disordered eating: mediating role of parental distress and validation of the arabic version of the eating disorders examination questionnaire-short-parent version (EDE-QS-P)

BACKGROUND

Eating disorders are an emerging global health crisis, with significant implications for both physical and psychological well-being. Disordered eating behaviors in childhood can serve as precursors to more severe eating disorders if left untreated. Previous literature evidences a strong association between perfectionism, as well as parental control and eating disorders, highlighting perfectionism as a significant factor in the development and maintenance of ED symptoms. Early intervention during this critical developmental period is essential to address these risks, prevent the progression to clinical eating disorders, and support healthier long-term outcomes for children. This study aimed to assess the mediating role of parental psychological distress in the association between perfectionism in parents and disordered eating in children. As a secondary objective, the study intended to validate the Arabic version of the Eating Disorders Examination Questionnaire-Short Parent Version (EDE-QS-P).

METHODS

A diverse sample of Lebanese parents of children aged 6-11 years (N = 502; mean age of 36.24 ± 8.29 years, 74.5% of mothers) were recruited from schools, community centers, and healthcare facilities into this cross-sectional study. One parent per child completed all the questionnaires, which assessed disordered eating in children, parental perfectionism, and psychological distress. The instruments used included the Eating Disorder Examination Questionnaire-Short Parent Version (EDE-QS-P) for disordered eating, the Big Three Perfectionism Scale - Short Form (BTPS-SF) for parental perfectionism, and the Depression, Anxiety, and Stress Scale-8 Items (DASS-8) for parental psychological distress. The SPSS software v.25 was used for statistical analysis. To examine the factor structure of the EDE-QS-P, we conducted a Confirmatory Factor Analysis (CFA) using SPSS AMOS v.28 software. The mediation analysis was conducted using PROCESS MACRO v.3.4 model 4.

RESULTS

The Arabic EDE-QS-P showed a unidimensional factor structure, strong internal consistency reliability and high convergent validity. Higher child's disordered eating scores were reported by fathers compared to mothers (8.32 ± 9.12 vs. 5.62 ± 7.69, t (500) = 3.01, p = 0.003). Parental distress mediated the association between parental perfectionism and child's disordered eating (indirect effect: Beta = 0.14; Boot SE = 0.02; Boot CI 0.11; 0.18). More parental perfectionism was significantly associated with more parental distress, and higher parental distress was significantly associated with more child's disordered eating. Higher parental perfectionism was significantly and directly associated with more child's disordered eating.

CONCLUSION

This study successfully validated the Arabic version of the EDE-QS-P in Lebanon, confirming its validity and reliability for assessing parental-reported disordered eating in children in Arab contexts. Elevated parental perfectionism correlates with increased child disordered eating, mediated by parental distress. This suggests that healthcare providers should be alert to signs of perfectionism and psychological distress in parents and provide appropriate interventions, such as cognitive-behavioral therapy or stress management techniques, to alleviate these issues and lower the risk of eating disorders in children.

An update on the underlying risk factors of eating disorders onset during adolescence: a systematic review

Introduction

Eating disorders (EDs) are serious psychological problems that affect not only the individual, but also their entire environment. The prevalence rates of EDs are higher among the adolescent population. A better understanding of ED risk factors is essential to design effective prevention and intervention programs that focus beyond the areas of weight and appearance.

Methods

The main objective of this systematic review was to identify the risk factors of EDs and provide a comprehensive approach, analyzing the interplay between individuals, their inner circle, and the society characteristics. The Web of Science, Scopus, CENTRAL and PsycInfo databases were searched.

Results

The initial search produced 8,178 references. After removing duplicates and performing the selection process by three independent reviewers, 42 articles were included in the systematic review according to the pre-specified inclusion criteria. The results suggest the relevance of society and the inner circle on the development of EDs.

Discussion

The internalization of the thin ideal, promoted by the current society, and living in an unsupportive, unaffectionate, non-cohesive environment were associated with the onset of EDs symptomatology. Other associated variables with this ED indicator were poor-quality relationships and feeling judged about appearance. These aspects seem to be essential for the development of individual characteristics like self-esteem or adaptative coping during adolescence. This systematic review has shown the complex etiology of EDs and the relevance of the interplay between the different areas involved. Furthermore, this information could be relevant to improve the design of innovative and more effective prevention and intervention programs.

Systematic review registration

PROSPERO, identifier CRD42022320881.

Perfectionism and eating disorders in children and adolescents: A systematic review and meta-analysis

There is a consistent link between perfectionism and eating disorders, however no meta-analysis to date has synthesized this literature in children and adolescents. We hypothesized that there would be significant, small pooled correlations between perfectionism dimensions and eating disorder symptoms in children and adolescents. Published, peer-reviewed articles with standardised measures of perfectionism and eating disorder symptoms were included. Articles were excluded if the age range was over 18 years. Overall, 39 studies were included (N = 13,954 participants, M age = 13.7 years). Total perfectionism (r = 0.25), perfectionistic strivings (r = 0.21), and perfectionistic concerns (r = 0.31) had significant positive associations with eating disorder symptoms. Most studies were rated as fair or good quality. Limitations included high heterogeneity, insufficient studies to investigate age as a moderator, the inclusion of only English articles, and predominately cross-sectional studies which precluded causal inference. Higher perfectionism was associated with greater eating disorder symptoms in children and adolescents. Future research should focus on longitudinal studies of eating disorder symptoms in children and adolescents.

Perfectionism in Children and Adolescents with Eating-Related Symptoms: A Systematic Review and a Meta-Analysis of Effect Estimates

Background: Over 40 years of research implicates perfectionism in eating disorders in childhood and adolescence. However, the nature of this relationship remains understudied. To address this gap, we performed a systematic review and a meta-analysis to quantify the magnitude of the associations between perfectionism (i.e., unidimensional perfectionism, perfectionistic strivings, and perfectionistic concerns) and eating-related symptoms during childhood and adolescence. Methods: The literature search was conducted using five electronic databases in accordance with PRISMA guidelines: MEDLINE, Embase, CINAHL Complete, APA PsycINFO, and EMB Reviews. A total of 904 studies were identified; a total of 126 were included in the systematic review, and 65 in the meta-analysis (N = 29,268). Sensitivity analyses were also carried out to detect potential differences in age and clinical status. Results: All the associations we investigated were both significant and positive. Small effect sizes were found between eating global scores and unidimensional perfectionism, perfectionistic strivings, and perfectionistic concerns (res = 0.19, res = 0.21, res = 0.12, respectively) and remained significant in each age group in both clinical and community samples. Perfectionistic concerns were moderately associated with all eating measures, especially in community samples and samples with a mean age under 14. Conclusions: Psychological interventions specially designed to target perfectionistic concerns in the early stages of development may help prevent the onset or reduce the intensity of eating-related symptoms during childhood and adolescence.

Mechanisms by which adverse childhood experiences, other traumas and PTSD influence the health and well-being of individuals with eating disorders throughout the life span

BACKGROUND

Multiple published sources from around the world have confirmed an association between an array of adverse childhood experiences (ACEs) and other traumatic events with eating disorders (EDs) and related adverse outcomes, including higher morbidity and mortality.

METHODS

In keeping with this Special Issue's goals, this narrative review focuses on the ACEs pyramid and its purported mechanisms through which child maltreatment and other forms of violence toward human beings influence the health and well-being of individuals who develop EDs throughout the life span. Relevant literature on posttraumatic stress disorder (PTSD) is highlighted when applicable.

RESULTS

At every level of the pyramid, it is shown that EDs interact with each of these proclaimed escalating mechanisms in a bidirectional manner that contributes to the predisposition, precipitation and perpetuation of EDs and related medical and psychiatric comorbidities, which then predispose to early death. The levels and their interactions that are discussed include the contribution of generational embodiment (genetics) and historical trauma (epigenetics), social conditions and local context, the ACEs and other traumas themselves, the resultant disrupted neurodevelopment, subsequent social, emotional and cognitive impairment, the adoption of health risk behaviors, and the development of disease, disability and social problems, all resulting in premature mortality by means of fatal complications and/or suicide.

CONCLUSIONS

The implications of these cascading, evolving, and intertwined perspectives have important implications for the assessment and treatment of EDs using trauma-informed care and trauma-focused integrated treatment approaches. This overview offers multiple opportunities at every level for the palliation and prevention of EDs and other associated trauma-related conditions, including PTSD.

Prevention of eating disorders: 2021 in review

This review of 19 prevention-related publications in Eating Disorders during 2021 is framed by four models: (1) Mental Health Intervention Spectrum: health promotion → types of prevention → case identification/referral → treatment; (2) the prevention cycle: rationale and theory, shaped by critical reviews → clarifying risk and protective factors → program innovation and feasibility studies → efficacy and effectiveness research → program dissemination; (3) links between disordered eating (DE) and eating disorders (EDs); and (4) Kraemer and Jacobi's criteria for variable, causal risk factors (RFs). Twelve articles demonstrated the strengths and limitations of cross-sectional investigations of RFs for DE and EDs: five explored the role of trauma in activating genetic and psychological RFs (e.g., anxiety and experiential avoidance), while five suggest other variables meriting further evaluation: ergogenic supplement use, "feeling fat," internalized weight bias, food insecurity, and compulsive exercising. One article presents a pilot program that reduced risk factors in a high-risk group: professional ballerinas. Implications of the absence of efficacy, effectiveness, dissemination, and advocacy studies, along with the need to develop tailored programs for various high-risk groups, are discussed.