Parenting styles of female patients with anorexia nervosa and bulimia nervosa: a comparative study_West China Medical Journal

Authors：

MA Jing ¹ , LI Xiao ^1,2 , LIU Xiaowei ^1,3 , ZHENG Linli ¹ , WANG Meiou ¹ ,  ZHANG Lan ¹

1. Centre for Mental Health, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;
2. Department of Acute Psychiatry, the Fourth People’s Hospital of Chengdu, Chengdu, Sichuan 610036, P. R. China;
3. Department of Geriatric Psychiatry, the Fourth People’s Hospital of Chengdu, Chengdu, Sichuan 610036, P. R. China;

Corresponding author：

ZHANG Lan, Email: huaxizhanglan@126.com

Keywords：

Eating disorders; anorexia nervosa; bulimia nervosa; parenting styles

DOI：

10.7507/1002-0179.202111128

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Objective To explore the characteristics of parenting styles of female patients with anorexia nervosa (AN) and bulimia nervosa (BN), to and provide a reference for the clinical treatment of eating disorders. Methods Patients with AN and BN between November 2019 and May 2020 in the Centre for Mental Health, West China Hospital, Sichuan University were retrospectively included. Female teachers and students from Sichuan University were used as normal controls. The general conditions of the subjects in the three groups were collected, and the parenting styles and behaviors of the subjects in the three groups were evaluated using Egna Minnen av Barndoms Uppfostran (Parenting Style Evaluation Scale). Results Finally, 30 subjects were included in the AN group, 44 subjects were included in the BN group, and 33 subjects were included in the healthy control group. There was no significant difference in the course of disease between the AN group and the BN group (P>0.05). There were no significant differences in age, place of residence, education level, parental divorce, parental education level and parental occupation among the three groups (P>0.05). The body mass index of the AN group was lower than that of the BN group and the healthy control group (P<0.05). The parenting style evaluation scale scores showed that in terms of father scores, there was no significant difference in the excessive interference dimension scores among the three groups (P>0.05). The score of preference dimension in AN group (14.60±4.45 vs. 10.18±5.98 vs. 10.36±5.90) was higher than that in BN group and healthy control group, the score of emotional warmth and understanding dimension in BN group (50.55±11.81 vs. 55.33±9.12 vs. 57.03±6.13) was lower than that in the AN group and the healthy control group, and the scores of rejection and denial dimension (7.91±3.65 vs. 10.10±3.85 vs. 10.16±3.83) and overprotection dimension (11.76±2.82 vs. 14.10±3.16 vs. 13.25±2.97) in healthy control group were lower than those of AN group and BN group (P<0.05). In terms of mother scores, the scores of preference dimension (14.40±4.64 vs. 10.59±5.92 vs. 10.94±5.34) in AN group was higher than that in the BN group and the healthy control group, and the scores of emotional warmth and understanding dimension (58.06±7.05 vs. 51.40±11.79 vs. 52.91±11.57) in healthy control group was higher than that in AN group and BN group (P<0.05). Conclusion Compared with healthy controls, the parenting styles of female patients with eating disorders show more negative emotions such as rejection and denial. The parenting styles of female BN patients show more negative emotions than female AN patients. These all suggest that the parenting style, attitude and behavior may be the influencing factors of female AN and BN.

Citation： MA Jing, LI Xiao, LIU Xiaowei, ZHENG Linli, WANG Meiou, ZHANG Lan. Parenting styles of female patients with anorexia nervosa and bulimia nervosa: a comparative study. West China Medical Journal, 2022, 37(3): 402-407. doi: 10.7507/1002-0179.202111128 Copy

1.	Treasure J, Duarte TA, Schmidt U. Eating disorders. Lancet, 2020, 395(10227): 899-911.
2.	Shah M, Sachdeva M, Johnston H. Eating disorders in the age of COVID-19. Psychiatry Res, 2020, 290: 113122.
3.	Mensi MM, Rogantini C, Nacinovich R, et al. Clinical features of adolescents diagnosed with eating disorders and at risk for psychosis. Eur Psychiatry, 2020, 63(1): e80.
4.	Sepúlveda AR, Moreno-Encinas A, Martínez-Huertas JA, et al. Toward a biological, psychological and familial approach of eating disorders at onset: case-control ANOBAS study. Front Psychol, 2021, 12: 714414.
5.	Culbert KM, Racine SE, Klump KL. Research review: what we have learned about the causes of eating disorders - a synthesis of sociocultural, psychological, and biological research. J Child Psychol Psychiatry, 2015, 56(11): 1141-1164.
6.	Izydorczyk B, Sitnik-Warchulska K, Wajda Z, et al. Bonding with parents, body image, and sociocultural attitudes toward appearance as predictors of eating disorders among young girls. Front Psychiatry, 2021, 12: 590542.
7.	Cerniglia L, Cimino S, Tafà M, et al. Family profiles in eating disorders: family functioning and psychopathology. Psychol Res Behav Manag, 2017, 10: 305-312.
8.	Meule A, Richard A, Schnepper R, et al. Emotion regulation and emotional eating in anorexia nervosa and bulimia nervosa. Eat Disord, 2019, 25: 1-17.
9.	Fisher M, Bushlow M. Perceptions of family styles by adolescents with eating disorders and their parents. Int J Adolesc Med Health, 2015, 27(4): 443-449.
10.	Berge JM, Wall M, Larson N, et al. The unique and additive associations of family functioning and parenting practices with disordered eating behaviors in diverse adolescents. J Behav Med, 2014, 37(2): 205-217.
11.	Sweeting H, Walker L, MacLean A, et al. Prevalence of eating disorders in males: a review of rates reported in academic research and UK mass media. Int J Mens Health, 2015, 14(2): 10.
12.	Kjelsås E, Bjørnstrøm C, Götestam KG. Prevalence of eating disorders in female and male adolescents (14-15 years). Eat Behav, 2004, 5(1): 13-25.
13.	Button E, Aldridge S, Palmer R. Males assessed by a specialized adult eating disorders service: patterns over time and comparisons with females. Int J Eat Disord, 2008, 41(8): 758-761.
14.	Li Z, Wang L, Guan H, et al. Burden of eating disorders in China, 1990-2019: an updated systematic analysis of the global burden of disease study 2019. Front Psychiatry, 2021, 12: 632418.
15.	American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed. Washington District of Columbia: American Psychiatric Pub, 2013.
16.	Perris C, Jacobsson L, Lindström H, et al. Development of a new inventory assessing memories of parental rearing behaviour. Acta Psychiatr Scand, 1980, 61(4): 265-274.
17.	岳冬梅, 李鸣杲, 金魁和, 等. 父母教养方式: EMBU 的初步修订及其在神经症患者的应用. 中国心理卫生杂志, 1993(3): 97-101, 143.
18.	Amianto F, Daga GA, Bertorello A, et al. Exploring personality clusters among parents of ED subjects. Relationship with parents’ psychopathology, attachment, and family dynamics. Compr Psychiatry, 2013, 54(7): 797-811.
19.	Bora E, Köse S. Meta-analysis of theory of mind in anorexia nervosa and bulimia nervosa: a specific İmpairment of cognitive perspective taking in anorexia nervosa?. Int J Eat Disord, 2016, 49(8): 739-740.
20.	Brewer R, Cook R, Cardi V, et al. Emotion recognition deficits in eating disorders are explained by co-occurring alexithymia. R Soc Open Sci, 2015, 2(1): 140382.
21.	Brewer R, Cook R, Cardi V, et al. Alexithymia explains increased empathic personal distress in individuals with and without eating disorders. Q J Exp Psychol (Hove), 2019, 72(7): 1827-1836.
22.	Iannaccone M, D’Olimpio F, Cella S, et al. Self-esteem, body shame and eating disorder risk in obese and normal weight adolescents: a mediation model. Eat Behav, 2016, 21: 80-83.
23.	Farstad SM, McGeown L, von Ranson KM. Eating disorders and personality, 2004-2016: a systematic review and meta-analysis. Clin Psychol Rev, 2016, 46: 91-105.
24.	Herraiz-Serrrano C, Rodríguez-Cano T, Beato-Fernández L, et al. Parental rearing and eating psychopathology. Actas Esp Psiquiatr, 2015, 43(3): 91-98.
25.	Dufresne L, Bussières EL, Bédard A, et al. Personality traits in adolescents with eating disorder: a meta-analytic review. Int J Eat Disord, 2020, 53(2): 157-173.
26.	Boucher K, Côté M, Gagnon-Girouard MP, et al. Eating pathology among patients with anorexia nervosa and bulimia nervosa: the role of narcissism and self-esteem. J Nerv Ment Dis, 2018, 206(10): 776-782.
27.	Hagan WS, Mericle S, Hunt BJ, et al. Qualitative patient experiences from the self-blame and perspective-taking intervention for eating disorders. J Eat Disord, 2021, 9(1): 127.
28.	Mensi MM, Orlandi M, Rogantini C, et al. Assessing family functioning before and after an integrated multidisciplinary family treatment for adolescents with restrictive eating disorders. Front Psychiatry, 2021, 12: 653047.
29.	Castro J, Toro J, Cruz M. Quality of rearing practices as predictor of short-term outcome in adolescent anorexia nervosa. Psychol Med, 2000, 30(1): 61-67.
30.	Abreu CN, Cangelli Filho R. Anorexia nervosa and bulimia nervosa-a psychotherapeutic cognitive-constructivist approach. Int Rev Psychiatry, 2017, 29(3): 248-253.
31.	Miller AE, Racine SE, Klonsky ED. Symptoms of anorexia nervosa and bulimia nervosa have differential relationships to borderline personality disorder symptoms. Eat Disord, 2019, 15: 1-14.
32.	Agras WS, Lock J, Brandt H, et al. Comparison of 2 family therapies for adolescent anorexia nervosa: a randomized parallel trial. JAMA Psychiatry, 2014, 71(11): 1279-1286.
33.	Bentz M, Pedersen SH, Moslet U. An evaluation of family-based treatment for restrictive-type eating disorders, delivered as standard care in a public mental health service. J Eat Disord, 2021, 9(1): 141.

1. Treasure J, Duarte TA, Schmidt U. Eating disorders. Lancet, 2020, 395(10227): 899-911.
2. Shah M, Sachdeva M, Johnston H. Eating disorders in the age of COVID-19. Psychiatry Res, 2020, 290: 113122.
3. Mensi MM, Rogantini C, Nacinovich R, et al. Clinical features of adolescents diagnosed with eating disorders and at risk for psychosis. Eur Psychiatry, 2020, 63(1): e80.
4. Sepúlveda AR, Moreno-Encinas A, Martínez-Huertas JA, et al. Toward a biological, psychological and familial approach of eating disorders at onset: case-control ANOBAS study. Front Psychol, 2021, 12: 714414.
5. Culbert KM, Racine SE, Klump KL. Research review: what we have learned about the causes of eating disorders - a synthesis of sociocultural, psychological, and biological research. J Child Psychol Psychiatry, 2015, 56(11): 1141-1164.
6. Izydorczyk B, Sitnik-Warchulska K, Wajda Z, et al. Bonding with parents, body image, and sociocultural attitudes toward appearance as predictors of eating disorders among young girls. Front Psychiatry, 2021, 12: 590542.
7. Cerniglia L, Cimino S, Tafà M, et al. Family profiles in eating disorders: family functioning and psychopathology. Psychol Res Behav Manag, 2017, 10: 305-312.
8. Meule A, Richard A, Schnepper R, et al. Emotion regulation and emotional eating in anorexia nervosa and bulimia nervosa. Eat Disord, 2019, 25: 1-17.
9. Fisher M, Bushlow M. Perceptions of family styles by adolescents with eating disorders and their parents. Int J Adolesc Med Health, 2015, 27(4): 443-449.
10. Berge JM, Wall M, Larson N, et al. The unique and additive associations of family functioning and parenting practices with disordered eating behaviors in diverse adolescents. J Behav Med, 2014, 37(2): 205-217.
11. Sweeting H, Walker L, MacLean A, et al. Prevalence of eating disorders in males: a review of rates reported in academic research and UK mass media. Int J Mens Health, 2015, 14(2): 10.
12. Kjelsås E, Bjørnstrøm C, Götestam KG. Prevalence of eating disorders in female and male adolescents (14-15 years). Eat Behav, 2004, 5(1): 13-25.
13. Button E, Aldridge S, Palmer R. Males assessed by a specialized adult eating disorders service: patterns over time and comparisons with females. Int J Eat Disord, 2008, 41(8): 758-761.
14. Li Z, Wang L, Guan H, et al. Burden of eating disorders in China, 1990-2019: an updated systematic analysis of the global burden of disease study 2019. Front Psychiatry, 2021, 12: 632418.
15. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed. Washington District of Columbia: American Psychiatric Pub, 2013.
16. Perris C, Jacobsson L, Lindström H, et al. Development of a new inventory assessing memories of parental rearing behaviour. Acta Psychiatr Scand, 1980, 61(4): 265-274.
17. 岳冬梅, 李鸣杲, 金魁和, 等. 父母教养方式: EMBU 的初步修订及其在神经症患者的应用. 中国心理卫生杂志, 1993(3): 97-101, 143.
18. Amianto F, Daga GA, Bertorello A, et al. Exploring personality clusters among parents of ED subjects. Relationship with parents’ psychopathology, attachment, and family dynamics. Compr Psychiatry, 2013, 54(7): 797-811.
19. Bora E, Köse S. Meta-analysis of theory of mind in anorexia nervosa and bulimia nervosa: a specific İmpairment of cognitive perspective taking in anorexia nervosa?. Int J Eat Disord, 2016, 49(8): 739-740.
20. Brewer R, Cook R, Cardi V, et al. Emotion recognition deficits in eating disorders are explained by co-occurring alexithymia. R Soc Open Sci, 2015, 2(1): 140382.
21. Brewer R, Cook R, Cardi V, et al. Alexithymia explains increased empathic personal distress in individuals with and without eating disorders. Q J Exp Psychol (Hove), 2019, 72(7): 1827-1836.
22. Iannaccone M, D’Olimpio F, Cella S, et al. Self-esteem, body shame and eating disorder risk in obese and normal weight adolescents: a mediation model. Eat Behav, 2016, 21: 80-83.
23. Farstad SM, McGeown L, von Ranson KM. Eating disorders and personality, 2004-2016: a systematic review and meta-analysis. Clin Psychol Rev, 2016, 46: 91-105.
24. Herraiz-Serrrano C, Rodríguez-Cano T, Beato-Fernández L, et al. Parental rearing and eating psychopathology. Actas Esp Psiquiatr, 2015, 43(3): 91-98.
25. Dufresne L, Bussières EL, Bédard A, et al. Personality traits in adolescents with eating disorder: a meta-analytic review. Int J Eat Disord, 2020, 53(2): 157-173.
26. Boucher K, Côté M, Gagnon-Girouard MP, et al. Eating pathology among patients with anorexia nervosa and bulimia nervosa: the role of narcissism and self-esteem. J Nerv Ment Dis, 2018, 206(10): 776-782.
27. Hagan WS, Mericle S, Hunt BJ, et al. Qualitative patient experiences from the self-blame and perspective-taking intervention for eating disorders. J Eat Disord, 2021, 9(1): 127.
28. Mensi MM, Orlandi M, Rogantini C, et al. Assessing family functioning before and after an integrated multidisciplinary family treatment for adolescents with restrictive eating disorders. Front Psychiatry, 2021, 12: 653047.
29. Castro J, Toro J, Cruz M. Quality of rearing practices as predictor of short-term outcome in adolescent anorexia nervosa. Psychol Med, 2000, 30(1): 61-67.
30. Abreu CN, Cangelli Filho R. Anorexia nervosa and bulimia nervosa-a psychotherapeutic cognitive-constructivist approach. Int Rev Psychiatry, 2017, 29(3): 248-253.
31. Miller AE, Racine SE, Klonsky ED. Symptoms of anorexia nervosa and bulimia nervosa have differential relationships to borderline personality disorder symptoms. Eat Disord, 2019, 15: 1-14.
32. Agras WS, Lock J, Brandt H, et al. Comparison of 2 family therapies for adolescent anorexia nervosa: a randomized parallel trial. JAMA Psychiatry, 2014, 71(11): 1279-1286.
33. Bentz M, Pedersen SH, Moslet U. An evaluation of family-based treatment for restrictive-type eating disorders, delivered as standard care in a public mental health service. J Eat Disord, 2021, 9(1): 141.

West China Medical Journal

Parenting styles of female patients with anorexia nervosa and bulimia nervosa: a comparative study

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