Background: People with eating disorders experience interpersonal difficulties, but little research explores relational attitudes in this population. We examined sense of relational entitlement towards parents, pathological concern, and psychological distress in adolescent girls with and without anorexia nervosa (AN) or atypical anorexia nervosa (AAN).
Methods: Questionnaires assessing sense of entitlement towards parents, pathological concern, and symptoms of depression and anxiety were completed by 85 girls with and 100 girls without AN/AAN (mean age 15.06 ± 1.41). The AN/AAN group also completed a measure of ED pathology.
Results: Eating pathology, pathological concern and symptoms of depression and anxiety were positively associated with both restricted and inflated sense of entitlement towards parents. AN/AAN participants scored significantly higher than controls on restricted and inflated sense of entitlement, pathological concern and symptoms of depression and anxiety. Restricted sense of entitlement and pathological concern partially mediation the association between AN/AAN and symptoms of depression and fully mediated the association between AN/AAN and anxiety. Within the AN/AAN group, pathological concern and symptoms of depression explained a large proportion of the variance in ED pathology.
Conclusions: Adolescent AN/AAN takes a heavy toll on emotional and social health, perhaps in part because crucial aspects of relational mutuality fail to develop. Teens with AN/AAN tend to over-focus on their parents' needs at the expense of their own needs. They also have impaired capacity to realistically appraise expectations from their parents, tending to feel over- and/or under-entitled to need fulfillment. These relational attitudes are associated with symptoms of depression and anxiety and should be addressed in therapy.
Keywords: Anorexia nervosa; Atypical anorexia nervosa; Pathological concern; Relational attitudes; Sense of relational entitlement.
In healthy relationships people trust another person to fulfill some but not all their needs. It is maladaptive to expect the fulfillment of all needs (inflated entitlement) or of no needs (restricted entitlement). Restricted entitlement generally masks frustration and an unconscious wish for need fulfillment, so that restricted and inflated entitlement can co-occur. We examined to what degree 85 adolescent girls with a restricting ED and 100 without an ED felt entitled to need fulfillment by their parents, and to what extent they sacrificed their own needs for their parents’. Girls with an ED reported higher levels of both restricted and inflated entitlement from their parents than the other girls, and reported placing their parents’ needs before their own more often. The more restricted and/or inflated their entitlement was, the more they tended to place their parents’ needs before their own, to have severe ED symptoms and to feel depressed and anxious. Teens with EDs may over-focus on their parents’ needs at the expense of their own and feel they deserve to have all or none of their needs fulfilled by their parents. These relational attitudes are associated with symptoms of depression and anxiety and should be addressed in therapy.
© 2023. BioMed Central Ltd., part of Springer Nature.