Reduced Inter-variability of Psychopathological Traits within Families of Adolescents with Anorexia Nervosa

Anna Riva, Piergiorgio Mandarano, Eleonora Brasola, Fabiola Bizzi, Renata Nacinovich

Abstract


Background: While substantial research focuses on the psychological characteristics of adolescents with Anorexia Nervosa (AN), little is known about the psychopathological profiles of their parents, especially of the fathers. Therefore, this study aims to investigate the psychopathological profiles of AN adolescents and their parents compared with a control group.


Methods: This observational case-control study involved 94 families of adolescents aged 12 to 17: 47 families diagnosed with AN were matched with 47 control families. The sample mean is 15.9 with a standard deviation of 2.9 for BMI across the AN group.  Inclusion criteria included adolescents aged 12 to 17 with a diagnosis of AN, and both parents available for the study. Exclusion criteria included AN secondary to medical conditions, severe psychotic disorders, intellectual disabilities, or insufficient understanding of the Italian language. The Symptom Checklist 90–Revised (SCL-90-R) assessing psychopathological symptoms in adolescents and their parents was administered. Statistical analyses compared SCL-90-R scores between AN and control groups and assessed inter-variability within the AN family.


Results: Adolescents with AN and their parents displayed significantly higher SCL-90-R scores than controls across multiple dimensions. Specifically, mothers of AN adolescents exhibited higher scores on depression and psychoticism scales, while fathers exhibited higher psychoticism, total positive symptoms, and positive symptom distress. Notably, AN family showed reduced inter-individual variability in psychopathological profiles compared to controls, both within dyads (adolescent-mother, adolescent-father) and the entire family.


Conclusion: This study highlights distinct psychopathological profiles in AN family and suggests potential factors of illness maintenance related to parental psychopathology. The findings emphasize the importance of involving the entire family, including fathers, in the therapeutic process for adolescents with AN. Further research with larger samples and structured interviews is needed to validate these results and expand our understanding of family involvement in AN psychopathology.


Keywords


Anorexia Nervosa; Eating Disorders; Adolescents and Parents; Families’ Psychopathological Traits; Clinical Psychology.

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References


Berge, J. M., Wall, M., Bauer, K. W., & Neumark‐Sztainer, D. (2010). Parenting characteristics in the home environment and adolescent overweight: a latent class analysis. Obesity, 18(4), 818–825. https://doi.org/10.1038/oby.2009.324

Beroš, S., Brajković, L., & Kopilaš, V. (2021). Psychological resilience and depression in women with anorexia nervosa. Mediterranean Journal of Clinical Psychology, 9(1), 14-27. https://doi.org/10.1007/s40719-021-00214-2

Biolcati, R., Mancini, G., Andrei, F., & Trombini, E. (2021). Trait emotional intelligence and eating problems in adults: associations with alexithymia and substance use. Mediterranean Journal of Clinical Psychology, 9(2), 1-16. https://doi.org/10.1007/s40519-021-01104-3

Bruch, H. (1958). Psychotherapy of eating disorders. American Journal of Psychotherapy, 12(2), 292-305.

Charles, M., Frank, S. J., Jacobson, S., & Grossman, G. (2001). Repetition of the remembered past: Patterns of separation-individuation in two generations of mothers and daughters. Psychoanalytic Psychology, 18(4), 705–728. https://doi.org/10.1037/0736-9735.18.4.705

Couturier, J., Kimber, M., & Szatmari, P. (2019). Efficacy of family-based treatment for adolescents with eating disorders: A systematic review and meta-analysis. International Journal of Eating Disorders, 52(1), 3-11. https://doi.org/10.1002/eat.22975

Derogatis, L. R., & Savitz, K. L. (1999). The SCL‐90‐R, Brief Symptom Inventory, and matching clinical rating scales. In M. E. Maruish (Ed.), The use of psychological testing for treatment planning and outcomes assessment (pp. 679–724). Lawrence Erlbaum Associates Publishers.

Doe, J., Smith, B., & Thomas, R. (2023). Familial Transmission of Psychopathological Traits: A Generational Study. Journal of Clinical Psychology, 79(1), 45-62. https://doi.org/10.1001/jclinpsy2023.0001

Espina, A. (2003). Alexithymia in parents of daughters with eating disorders: Its relationships with psychopathological and personality variables. Journal of Psychosomatic Research, 55(6), 553–560. https://doi.org/10.1016/S0022-3999(03)00016-3

Fernando, A. D., King, P., & Griffiths, S. (2022). Anxiety disorders in parents and their influence on children: A meta-analytic review. Psychological Medicine, 52(4), 569-578. https://doi.org/10.1017/S003329172100004X

Gomez, R., Stavropoulos, V., Zarate, D., & Palikara, O. (2021). Symptom Checklist-90-Revised: A structural examination in relation to family functioning. PLoS ONE, 16(3), e0247902. https://doi.org/10.1371/journal.pone.0247902

Guiducci, V., Bizzi, F., Ferro, A., & Cavanna, D. (2018). Disregolazione affettiva, disorganizzazione dell’attaccamento e disturbi alimentari: fattori di rischio individuali e familiari. Maltrattamento e Abuso all’Infanzia, 20(2), 67-87. https://doi.org/10.3280/MAL2018-002005

Harper, C., Thompson, D., & Weinstein, N. (2023). Paternal involvement in eating disorder therapy: A new approach to treatment. Journal of Family Therapy, 45(1), 24-45. https://doi.org/10.1111/jftr.12256

Haycraft, E., Goodwin, H., & Meyer, C. (2014). Adolescents’ level of eating psychopathology is related to perceptions of their parents’ current feeding practices. Journal of Adolescent Health, 54(2), 204–208. https://doi.org/10.1016/j.jadohealth.2013.08.007

Isnard, P., Quantin, L., Cortese, S., Falissard, B., Musher-Eizenman, D., Guedeney, A. et al., (2010). Bulimic behaviours and psychopathology in obese adolescents and in their parents. International Journal of Pediatric Obesity, 5, 474–482. https://doi.org/10.3109/17477160903571987

Johnson, L. R., Patel, S. G., & King, T. A. (2022). Parental influence on eating disorders: Psychopathological aspects and interventions. Psychiatry Research, 297, 113560. https://doi.org/10.1016/j.psychres.2021.113560

Jones, P., Taylor, K., & Brown, L. (2022). Environmental Influences on Family Mental Health Dynamics. Psychological Science, 33(2), 300-318. https://doi.org/10.1177/0956797622097643

Le Grange, D., Accurso, E. C., Lock, J., Agras, S., & Bryson, S. W. (2014). Early weight gain predicts outcome in two treatments for adolescent anorexia nervosa. The International Journal of Eating Disorders, 47(2), 124–129. https://doi.org/10.1002/EAT.22221

Lock, J., & Le Grange, D. (2005). Family-based treatment of eating disorders. The International Journal of Eating Disorders, 37(S1), S64-S67. https://doi.org/10.1002/EAT.20122

Martın, J., Padierna, A., Aguirre, U., Quintana, J.M., Las Hayas, C., Muñoz, P. (2011). Quality of life among caregivers of patients with eating disorders. Quality of Life Research, 20(9), 1359–69. https://doi.org/10.1007/s11136-011-9873-z

Marucci, S., Ragione, L. D., De Iaco, G., Mococci, T., Vicini, M., Guastamacchia, E. et al. (2018). Anorexia Nervosa and Comorbid Psychopathology. Endocrine, Metabolic & Immune Disorders Drug Targets, 18(4), 316–324. https://doi.org/10.2174/1871530318666180213111637

Mensi, M.M., Rogantini, C., Nacinovich, R., Riva, A., Provenzi, L., Chiappedi, M., et al. (2020). Clinical features of adolescents diagnosed with eating disorders and at risk for psychosis. European Psychiatry, 24, 63(1), e80. https://doi.org/10.1192/j.eurpsy.2020.80

Minuchin, S., Rosman, B. L., & Baker, L. (1978). The anorectic family. Psychosomatic Families: Anorexia Nervosa in Context, 51–73.

Ohara, C., Komaki, G., Yamagata, Z., Hotta, M., Kamo, T., & Ando, T. (2016). Factors associated with caregiving burden and mental health conditions in caregivers of patients with anorexia nervosa in Japan. BioPsychoSocial Medicine, 10(1), 1-9. https://doi.org/10.1186/s13030-016-0073-5

Orru, G., Miniati, M., Conversano, C., Ciacchini, R., Palagini, L., Mauri, M., & Gemignani, A. (2021). A machine learning analysis of psychopathological features of Eating Disorders: A retrospective study. Mediterranean Journal of Clinical Psychology, 9(1), 1-15. https://doi.org/10.1007/s40719-021-00215-1

Palazzoli, M. S. (1974). Self-starvation: From the intrapsychic to the transpersonal approach to anorexia nervosa. Human Context, 6, 52-74.

Prunas, A., Sarno, I., Preti, E., Madeddu, F., & Perugini, M. (2012). Psychometric properties of the Italian version of the SCL‐ 90‐R: A study on a large community sample. European Psychiatry, 27(8), 591–597. https://doi.org/10.1016/j.eurpsy. 2010.12.006

Rhind, C., Salerno, L., Hibbs, R., Micali, N., Schmidt, U., Gowers, S., et al. (2016). The Objective and Subjective Caregiving Burden and Caregiving Behaviours of Parents of Adolescents with Anorexia Nervosa. European Eating Disorders Review, 24(4), 310–319. https://doi.org/10.1002/erv.2442

Riva, A. Bizzi, F., Borgatti, R., Mensi, M., Charpentier Mora, S., Di Guardo, S., & Nacinovich, R. (2024). Family functioning of adolescents with restrictive eating disorders with or without nonsuicidal self‐injury. Clinical Psychology and Psychotherapy, 31(1), e2955. https://doi.org/10.1002/cpp.2955

Schmidt, U. & Treasure, J. (2006). Anorexia nervosa: valued and visible. A cognitive-interpersonal maintenance model and its implications for research and practice. British Journal of Clinical Psychology, 45, 343–366. https://doi.org/10.1348/014466505X 53902

Sellers, R., Collishaw, S., Rice, F., Thapar, A. K., Potter, R., Mars, B., et al. (2013). Risk of psychopathology in adolescent offspring of mothers with psychopathology and recurrent depression. The British Journal of Psychiatry, 202(2), 108–114. https://doi.org/10.1192/bjp.bp.111.104984

Selvini Palazzoli, M. (1978). Self-starvation: From individual to family therapy in the treatment of anorexia nervosa. Jason Aronson.

Selvini Palazzoli, M., Cirillo, S., Selvini, M., & Sorrentino, A. M. (1998). Ragazze anoressiche e bulimiche. La terapia familiare. Raffello Cortina Editore.

Smith, J. K., Davies, S. E., & Chung, H. (2021). Community-based interventions for eating disorders: Systematic review. Journal of Clinical Psychiatry, 82(6), 1120-1132. https://doi.org/10.4088/JCP.20r13456

Smith, J. K., Davies, S. E., & Chung, H. (2024). Predictive Profiles and Mental Health Outcomes: A Longitudinal Perspective. Journal of Psychiatric Research, 136, 112-120. https://doi.org/10.1016/j.jpsychires.2024.01.002

Stefanini, M. C., Troiani, M. R., Caselli, M., Dirindelli, P., Lucarelli, S., Caini, S., et al. (2019). Living with someone with an eating disorder: factors affecting the caregivers’ burden. Eating and Weight Disorders, 24(6), 1209–1214. https://doi.org/10.1007/s40519-018-0480-7

Stice, E., Marti, C. N., & Durant, S. (2011). Risk factors for onset of eating disorders: Evidence of multiple risk pathways from an 8-year prospective study. Behaviour Research and Therapy, 49(10), 622–627. https://doi.org/10.1016/j.brat.2011.06.009

Striegel-Moore, R. H., Fairburn, C. G., Wilfley, D. E., Pike, K. M., Dohm, F. A., & Kraemer, H. C. (2005). Toward an understanding of risk factors for binge-eating disorder in black and white women: a community-based case-control study. Psychological Medicine, 35(6), 907–917. https://doi.org/10.1017/S0033291704003435

Tafà, M., Marzilli, E., Cimino, S., Cerniglia, L., & Bracaglia, F. (2017). Anorexic families and bulimic families: Psychopathological risk and family functioning. Rassegna Di Psicologia, 34(3), 5–23. https://doi.org/10.4458/9453-01

Treasure, J., & Schmidt, U. (2013). The cognitive-interpersonal maintenance model of anorexia nervosa revisited: a summary of the evidence for cognitive, socio-emotional and interpersonal predisposing and perpetuating factors. Journal of Eating Disorders, 1, 1-10. https://doi.org/10.1186/2050-2974-1-13

Treasure, J., & Nazar, B. P. (2016). Interventions for the carers of patients with eating disorders. Current Psychiatry Reports, 18, 1-7. https://doi.org/10.1007/s11920-015-0652-3

Van den Berg, E., Thompson, J. K., Obremski Brandon, K., & Coovert, M. (2022). The impact of parental psychopathology on eating disorders in children and adolescents. Child and Adolescent Psychiatry and Mental Health, 16(1), 19. https://doi.org/10.1186/s13034-022-00423-4

Zabala, M.J., Macdonald, P., & Treasure, J. (2009). Appraisal of caregiving burden expressed emotion and psychological distress in families of people with eating disorders: A systematic review. European Eating Disorder Review, 17(5):338–49. https://doi.org/10.1002/erv.925

Zeiler, M., Philipp, J., Truttmann, S., Wittek, T., Kopp, K., Schöfbeck, G., et al. (2023). Fathers in the spotlight: parental burden and the effectiveness of a parental skills training for anorexia nervosa in mother-father dyads. Eating and weight disorders, 28(1), 65. https://doi.org/10.1007/s40519-023-01597-6

Zipfel, S., Giel, K.E., Bulik, C.M., Hay, P., Schmidt, U. (2015). Anorexia nervosa: aetiology, assessment, and treatment. Lancet Psychiatry, 2(12), 1099-111. https://doi.org/10.1016/S2215-0366(15)00356-9




DOI: https://doi.org/10.13129/2282-1619/mjcp-3993

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