Background: A large theoretical body of knowledge exists emphasizing the importance of parental mentalizing in the context of anorexia-nervosa (AN). However, the empirical support to these assumptions is still scarce. The aim of the present study was to examine whether parents of patients with AN are characterized by a lower mentalizing ability, and whether it is associated with impaired mentalizing, AN symptomatology and eating disorder (ED) related psychological traits in the daughters.
Methods: Thirty-two family triads (fathers, mothers, and daughters) of female adolescent and young adult inpatients with AN were compared with thirty-three non-clinical family triads (N = 195). The mentalizing ability of all the participants was assessed using semi-structured interviews and coded using the Reflective Functioning Scale (RFS). Self-report questionnaires were administered to the daughters to evaluate ED symptomatology and ED related psychological traits (e.g., low self-esteem, interpersonal insecurity, emotional dysregulation).
Results: Decreased reflective functioning (RF) levels were found among mothers and fathers of patients with AN compared to their control peers. Examining the entire sample, clinical and non-clinical groups together, showed that both paternal and maternal RF were associated with the daughters' RF and each were found to have a significant and distinct contribution to the daughters' RF. Significant associations were found between lower levels of maternal and paternal RF and increased ED symptoms and ED related psychological traits. The use of a mediation model suggested a serial relationship in which low maternal and paternal RF contributes to the daughters' low RF, which in turn is associated with higher levels of psychological maladjustment, and ultimately contributes to the increased severity of ED symptoms.
Conclusions: The present results provide strong empirical support for theoretical models that suggest that deficits in parental mentalizing may represent important correlates of the presence and severity of ED symptoms in AN. Furthermore, the results highlight the relevance of fathers' mentalizing ability in the context of AN. Finally, clinical and research implications are discussed.
Keywords: Anorexia nervosa; Eating disorders; Mentalizing; Parental reflective functioning; Reflective functioning.
The goal of the study was to examine the relationship between deficits in parents' ability to reflect on their own and others' emotional experience and the severity of their daughter's eating disorder and psychological maladjustment. A clinical group of young female inpatients diagnosed with anorexia-nervosa and both their biological parents was compared to a control group of young females without eating disorder and their parents. Personal interviews assessed the participants' reflective ability and self-report questionnaires assessed the daughters' eating disorder severity and psychological difficulties. The results show that patients with anorexia nervosa and their parents are less able to reflect on their emotional experiences compared to the control group. The parents' reflective ability was found to be related to their daughter's reflective ability. For both fathers and mothers, the less able the parent is to reflect on his or her emotional experiences the higher the severity of the daughter's eating disorder symptoms and psychological maladjustment are. The results imply that deficits in the parents' ability to process their own and others' emotional experiences are related to the severity of eating disorders symptoms and psychological maladjustment among daughters.. The study results highlight the importance of assessing reflective abilities of fathers.
© 2023. The Author(s).