Parenting styles, maladaptive coping styles, and disturbed eating attitudes and behaviors: a multiple mediation analysis in patients with feeding and eating disorders

Role of parental educational level as psychosocial factor in a sample of inpatients with anorexia nervosa and bulimia nervosa

Introduction

Evidence on parental educational level (PEL) as a risk factor for Eating Disorders (EDs) is mixed, and no study has assessed its role in relation to the compliance and outcomes of treatments in EDs. Further, no study differentiated from the educational level of mothers and fathers, nor considered the possible mediation of perfectionism in fostering EDs.

Methods

A clinical sample of 242 first-ever admitted inpatients with EDs provided information on PEL and completed the following questionnaires: the Eating Disorder Examination Questionnaire (EDE-Q) and the Frost Multidimensional Perfectionism Scale (F-MPS). Clinicians also provided information on the Hamilton Rating Scale for Anxiety (HAM-A) and the Hamilton Rating Scale for Depression (HAM-D) for each participant.

Results

Individuals with high PEL (whether mothers, fathers, or both parents) showed significantly higher scores on depressive symptoms and lower on parental criticism, were younger, had an earlier age of onset, had fewer years of illness, more were students and employed, and fewer had offspring. Individuals with fathers or both parents with high educational levels suffered more from Anorexia Nervosa rather than Bulimia Nervosa, had a longer length of stay during the current hospitalization, had less dietary restraint, and had higher personal standards. Individuals with mothers with high educational levels showed a lower rate of previous substance or alcohol addiction. Personal standards partially mediated the relationship between higher PEL and lower dietary restraint.

Discussion

PEL emerged to be a twofold psychosocial risk factor, being associated with higher depressive symptoms and a longer length of stay, but also with a shorter duration of illness and better scholar and working involvement. Higher PEL was related to higher personal standards but not to global perfectionism. Patterns of eating psychopathology emerged based on the high PEL of mothers or fathers.

Effect of Adverse Childhood Experiences, Parenting Styles, and Family Accommodation on Patients Diagnosed with Obsessive-Compulsive Disorder

Background

Obsessive-compulsive disorder (OCD) is a mental illness that has multiple biological, psychological, and sociological factors. The aim of this study was to investigate childhood traumatic experiences, parenting style, and family adaptive behaviors in patients with OCD, to explore the psychosocial factors that affect its occurrence, and to analyze the correlation between these psychosocial factors and OCD symptoms to better understand its etiology.

Methods

We recruited 109 patients diagnosed with OCD (patient group) and 144 healthy controls (control group) into this study. The Obsessive-Compulsive Inventory-Revised (OCI-R), Childhood Trauma Questionnaire-Short Form (CTQ-SF), Egna Minnen Betraffande Uppfostran (EMBU), and Family Accommodation Scale-Patient Version (FAS-PV) questionnaires were administered to all participants.

Results

Patient OCI-R scores for checking, hoarding, obsessing, ordering, washing, neutralizing, and total OCI-R scores were significantly higher when compared with the control group (all P < .05). Patient CTQ scores for emotional abuse, physical abuse, sexual abuse, emotional neglect, physical neglect, and total CTQ scores were significantly higher when compared with the control group (all P < .05). Patients' EMBU scores for F1, F2, F3, F5, F6, M1, M2, M3, M4, M5, and total EMBU scores were significantly higher when compared with the control group (all P < .05). There was no significant difference in the F4 scores between the 2 groups (P = .622). Patient FAS-PV scores for the direct participation and facilitation of OCD symptoms, avoidance of OCD triggers, taking on patient responsibilities, modification of personal responsibilities, and total FAS-PV scores were significantly higher when compared with the control group (all P < .05). The total OCI-R score showed a significant positive correlation with emotional abuse, physical abuse, sexual abuse, physical neglect, and total CTQ score (r = 0.564; r = 0.518; r = 0.542; r = 0.586; r = 0.603, all P < .05). The total OCI-R score showed a significant positive correlation with the scores for F1, F2, F3, F5, F6, M1, M2, M3, M4, M5, and the total EMBU score (r = 0.504; r = 0.531; r = 0.611; r = 0.466; r = 0.519; r = 0.665; r = 0.351; r = 0.597; r = 0.667; r = 0.484; r = 0.586; r = 0.662, all P < .05). The total OCI-R score showed a significant positive correlation with scores for direct participation and facilitation, avoidance of OCD triggers, taking on patient responsibilities, modification of personal responsibilities, and total FAS-PV score (r = 0.571; r = 0.624; r = 0.670; r = 0.592; r = 0.684, all P < .05).

Conclusion

Our findings highlight the importance of adverse childhood experiences, parenting styles, and family accommodation on OCD patients. Importantly, these adverse experiences are closely related to the severity of symptoms in these patients. We suggest that psychological, and not only physiological, changes play a crucial role in the occurrence and development of OCD. This study confirmed that family and childhood experiences play an important role in the occurrence of OCD, and family education in childhood greatly affects the occurrence of OCD. Therefore, it can be inferred that good family psychological education in childhood has a positive effect on reducing the risk of OCD. If family psychological education can be included in community medical services, this will help to mitigate the development of mental health situations.