Empirical study on parental eating disorders and child development

Abstract

International literature has studied the role of parental eating disorder (ED) on children development, highlighting that it constitutes a relevant risk factor for the onset of offspring’s emotional-behavioural problems. Limited attention has been given to parental Binge Eating Disorder (BED) and its impact on offspring’s psychopathology. Thus, further investigations of this clinical manifestation as possible predictor of offspring’s psychopathology are needed. The present study aimed to assess the maladaptive outcomes in children of parents with psychopathological risk and psychiatric diagnoses. Specifically, we intended to verify whether offspring of parents who were both diagnosed with BED showed higher affective and behavioural problems, compared with their peers with only one parent diagnosed with BED. We conducted a longitudinal study (T1 18 months old children; T2 36 months old children) on a sample of 100 Italian couple of parents and children (Ntotal = 300), divided into three groups based on the presence of BED diagnosis. Group A, diagnosis in both parents; Group B, diagnosis only in the mothers; Group C, diagnosis only in the fathers. The presence of BED in one or both parents was associated with the emotional and behavioural development in offspring. Particularly, the diagnosis of BED in both parents had a direct effect on infants’ affective problems. The offspring of parents diagnosed with BED were more likely to manifest emotional and behavioural difficulties and psychiatric symptoms within the first three years of life.

Keywords: Binge eating disorderPsychopathologyChild development

1.Introduction

In early childhood, the affective and behavioural manifestations of children are particularly

sensitive to parental influence. Several studies have investigated the association between child

development and parental psychiatric diagnosis, focusing on the role of individual and

psychopathological variables related to deleterious consequences for psychological and physical

offspring’s well-being (Cimino, Cerniglia, & Paciello, 2015; Dietz, Jennings, Kelley, & Marshal, 2009;

Herba, Glover, Ramchandani, & Rondon, 2016).

Regarding to eating disorder (ED), theory and research suggest that this kind of diagnosis in

parents may acts as a significant risk factor in influencing children’s mental health. Indeed, as highlighted

by some authors (Cimino, Cerniglia, Paciello, & Sinesi, 2013; Micali, Stahl, Treasure, & Simonof,

2014a), ED is a complex phenomenon in which it is possible to track down a variety of individual and

especially relational components that can prejudice offspring’s development from childhood to

adolescence. Consequently, the impact of mother’s and father’s eating psychopathology on their infants

could be not only related to the transmission of specific eating symptoms, but involves various issues that

should be considered (Cimino et al, 2013; Micali et al., 2014a; Stein et al., 2006).

In the conceptualization of the course of the psychological development during childhood, we

agree with Developmental Psychopathology theoretical framework (Cicchetti & Rogosh, 1996; Rutter,

2013) that, in term of multifinality criterion, emphasizes how a single risk factor, including parental ED,

could forecast an entire spectrum of psychopathological problems in offspring. Moreover, in order to

explain the complexity of child development, we are also in agreement with the Transactional approach,

stressing the role of parent-infant relationship to onset and maintenance of problems in offspring

(Minuchin, Baker, & Rosman, 1978; Sameroff & Mackenzie, 2003).

2.Problem Statement

Nowadays eating disorders (EDs) are one of the most important public health problems in the

world (Smink, van Hoeken, Oldehinkel, & Hoek, 2014; Swason, Crow, Le Grange, Swendsen, &

Merikangas, 2011). The empirical literature in this area has especially examined the link between parental

EDs and children’s mental health (Taborelli et al., 2015; Watkins, Cooper, & Lask, 2012). A great deal of

research has found that parental EDs during childhood have an impact on infant’s psychopathology

(Ammaniti, Lucarelli, Cimino, D'Olimpio, & Chatoor, 2012; Cerniglia, Cimino, & Ballarotto, 2014).

Specifically, this type of psychiatric diagnosis in mothers and fathers results to be associated with

characteristic psychopathological profiles in their children, in terms of internalizing problems (e.g.,

withdrawal, depression) and externalizing problems (e.g., aggressive behaviour) (de Bars et al., 2015;

Micali et al., 2014a; Micali, De Stavola, Plobidis, Simonoff, & Treasure, 2014b). Investigations have also

identified with increasing accuracy various patterns linked to negative child outcomes. Micali et al.

(2014b), for instance, in a longitudinal study on parents and children, highlighted that maternal EDs

predict offspring’s psychiatric problems, in particular emotional disorders. Moreover, Easter et al. (2014),

examining longitudinal patterns of growth trajectories in children of women with eating disorders (EDs),

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showed that the growth of children of mothers with ED may be an important risk factor for the

development of an ED and other psychopathological problems in offspring.

Thus, research should strongly continue to explore the negative form of psychological functioning

that erode childhood development and family relational balance, focusing both internalizing and

externalizing behavioural difficulties (Cimino et al., 2016a).

However, to date research has mainly focused on parental eating disorders as anorexia nervosa and

bulimia nervosa, whereas much less studies have investigated the specific diagnosis of binge eating

disorder (BED) in mothers and fathers (Ammaniti et al., 2012; Blissett & Haycraft, 2011; Cimino et al.,

2016b; Fassino, Amianto, & Abbate-Daga, 2009). Indeed, the majority of works have paid much attention

to the negative influence of parental eating disorders on child outcomes, while, to our knowledge,

relatively little attention has been given to an analysis of the binge eating disorders (BEDs) in mothers,

fathers or both, and on its impact on infant’s psychopathology.

3.Research Questions

Binge Eating Disorder (BED), actually included in DSM-5 (American Psychiatric Association

2013) constitutes an empirically validated typology of eating disorder (Mitchell et al. 2010). As it is

known, it consists of binge behaviours in absence of compensatory-elimination conducts, with a particular

and relevant sense of loss control. Being a psychiatric disease in which the component of impulsivity is

very high, the emotional and behavioural functioning of parents affected by can be seriously

compromised, with important negative consequences for the relationship with offspring overtime.

The few studies that analysed the relationship between parental BED and psychopathological

problems in offspring have highlighted that children of parents diagnosed with BED reported high level

of psychopathological symptoms, compared to children of parents without BED (Roth, Munsch, Meyer,

Isler, & Schneider, 2008). These negative consequences have been documented in some other research:

Reba-Harreleson et al. (2010), for instance, have showed an association between maternal BED and

depressive and anxious symptoms in their children.

Moreover, the specific influence of paternal BED diagnosis on their children is still unclear.

In addiction, there is actually growing interest in understanding the effective weight of the fathers’

psychopathological profiles on offspring’s’ psychological well-being. Cimino et al. (2016b) have recently

found that children of one or both parents with BED psychopathology are more likely to exhibit

emotional and behavioural problems, compared to healthy controls. Overall, according to the authors,

having both parents with BED involves greater risk of developing internalizing and externalizing

problems for offspring (Cimino et al., 2016b).

Therefore, for all the above reasons, and to address the literature limitation, we strongly believe

that a systematic investigation of the specific impact of the parental BED on offspring’s mental health is

necessary to offer an integrative view of child development in a risky environment.

Furthermore, in order to have a more complete understanding of relational dynamics, it would be

relevant to better highlight the contribution of each parental figure, especially the paternal one, on

maladaptive outcomes in their children.

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4.Purpose of the Study

The general purpose of the present study was to fill the gap in the literature, by investigating the

link between parental BED and offspring psychological functioning. More specifically, the present

research aimed to analyse the possible effects of clinical manifestation of parental BED on children

psychopathology.

In line with the current international literature, we hypothesized that diagnosis of BED in parents

would have a direct negative influence on emotional and behavioural functioning in offspring. In other

words, we expected that the psychiatric disease in parents (BED) would be a predictor of children

psychopathology.

Our main objective was to estimate the risk for psychopathology in children of parents with BED

overtime (T1 and T2), verifying whether offspring of parents who were both diagnosed with BED exhibit

more psychological problems than children with only one parent with BED or none.

5.Research Methods

5.1. Subjects and procedure

We conducted a longitudinal study on psychopathological outcomes in offspring of parents

diagnosed with BED, assessing parents and their children at two time-points (T1 children 18 months; T2

children 36 months old).

The research subjects were 100 Italian couple of parents (aged between 25-45 years) and their

children (Ntotal = 300), recruited from an Italian program for prevention of maladaptive outcomes in offspring of parents with psychiatric diagnoses. Ninety-eight percent of participants were Caucasian.

Furthermore, all subjects came from families with middle or high socioeconomic status. All the

participants, voluntary and anonymous, had complete data on all study variables. None of those who

accepted dropped the task.

Prior permission was obtained from the Ethical Committee of the Medicine and Psychology

Faculty at Sapienza, University of Rome, in accordance with the Declaration of Helsinki.

The sample was divided into three groups, based on the presence of BED diagnosis. Group 1, N=

25 couples and their children (children’s average mean 18.99; s.d. 2.43), diagnosis in both parents; Group

2, N= 25 couples and their children (children’s average mean 19.63; s.d. 1.40), diagnosis only in the

mothers; Group 3, N= 25 couples and their children (children’s average mean 19.96; s.d. 2.38), diagnosis

only in the fathers. The children’s gender was balanced between males and females in each group.

This sample was paired to a healthy control group, recruited in Italian primary schools (Group C,

composed by parents without psychiatric diagnosis and their children), that had comparable socio-

demographic characteristics.

5.2. Measures

During T1 and T2 the parents were independently administered a questionnaire on their children’s

behaviour. Children’s psychopathology was measured using the following instrument.

20

Child Behavior Checklist (CBCL 1 ½–5)

The Child Behavior Checklist (CBCL 1 ½–5; Achenbach & Rescorla, 2001; Italian version by

Frigerio & Montirosso, 2002) is a report form scale comprising 99 items that assesses the child emotional

and behavioural functioning in different areas of daily functioning (age range: 18–36 months). It

measures three symptomatic scales: Internalizing, Externalizing, and Neither Internalizing Nor

Externalizing. The Internalizing scale includes the syndromes: Emotionally Reactive, Anxious/Depressed,

Withdrawn, Somatic Complaints; the Externalizing scale includes: Attention Problems and Aggressive

Behavior; the Neither Internalizing Nor Externalizing scale identifies the syndromes of Sleep Problems

and Other Problems. The instrument shows a good internal consistency (Cronbach’s α, 0.65 to 0.96).

5.3. Statistical analysis

To assess the presence of psychopathological problems in offspring of parents with BED we

carried out multivariate analyses of variance (MANOVA) on the data in the CBCL DSM-oriented scales

in all four groups at T1 and at T2 (considering the effects of age and gender). The variable group

consisted in the between-subjects factor (GC vs. G1 vs. G2 vs. G3).

Afterwards, the data were analysed to check the presence/absence of BED diagnosis in one or both

parents. To examine the associations between the BED diagnosis in parents and child psychopathology at

T1 and T2, the Pearson’s product-moment correlation coefficient was used.

Starting from the observed correlations, Structural Equation Modeling (SEM) was employed to

investigate the supposed model.

All data were performed with IBM SPSS software (version 23.0) and LISREL 8.80 (Jӧreskog &

Sӧrbom, 2006).

6.Findings

6.1. Offspring’s psychopathological profiles

To verify whether children of parents who diagnosed with BED showed maladaptive emotional-

behavioral functioning a MANOVA was conducted on four Groups on CBCL DSM-oriented scales.

Analyses showed a Group effect (λ= .229; F= 25.450, p =.000), with significant differences in the scores

of the children in T1 to T2.

At T1, a statistically significant effect on all the CBCL DSM-oriented scales administered was

found: affective problems (F3,200 = 60.50, p =.000), anxiety problems (F3,200 = 86.22, p =.000), pervasive developmental problems (F3,200 = 38.07, p =.000), and oppositional defiant problems (F3,200 = 45.88, p =.000). The results of the Bonferroni post-hoc test revealed significant differences in each of the DSM-

oriented scales at T1 and T2.

6.2. Direct effects of parental BED diagnosis on offspring’s’ psychopathological problems

In order to evaluate the associations between the presence of BED diagnosis and child

psychopathology, the Pearson’s product-moment correlation coefficient was applied to the CBCL DSM-

21

oriented scales at T1 and T2 and to the presence of BED diagnosis in the parents (mother vs. father vs.

both).

Both parental diagnosis of BED and the CBCL DSM-oriented scales at T1 were correlated with

the CBCL DSM-oriented scales at T2 (p <.01; 2-tailed).

Starting from these correlations, the path analysis model was performed in order to investigate

direct effects of parental diagnosis on child psychopathology at T2.

The examination of paths showed that the presence of BED in one or both parents was associated

with the emotional and behavioral development in offspring. Particularly, at T1, the diagnosis of BED in

both parents had a direct effect on infants’ affective problems (T2) (β =.56, p<.05). Maternal BED

showed a direct impact on children’s affective problems (β =.45, p<.05) and pervasive development

problems (β =.65, p<.05), whereas paternal BED had no direct effect on offspring’s’ problems.

It can therefore be seen an effective risk for psychopathology in children of parents with BED

overtime (T1 and T2).

7.Conclusion

The current study aimed to explore the maladaptive outcomes in children of parents with

psychiatric diagnosis, focusing on the specific impact of parental Binge Eating Disorder (BED) on

offspring’s psychopathology. To our knowledge, no research was carried out on this issue yet.

Overall, our findings showed that the presence of BED in one or both parents was associated with

the emotional and behavioral development in offspring. Particularly, the diagnosis of BED in both parents

had a direct effect on infants’ affective problems. In addition, while maternal BED had a direct influence

on children’s affective and pervasive development problems, paternal BED had no direct impact on

psychopathological problems in their children. However, it should be considered that the assessment of

the possible mediating variables was not used in the present study. For this reason a firm conclusion about

the specific effects of the maternal and paternal disease on offspring well-being cannot be made. Thus,

there should be further focus on the specific role of mothers and fathers in promoting or hindering the

healthy psychological development of children. We aim to investigate this aspect in future studies.

Our current study provided important information and suggestions for future research questions

and public health prevention. Indeed, the results are of considerable importance in relation to child mental

health, since, consistent with a suggestion provided by Cimino et al. (2013), the emotional and

behavioural difficulties showed by children in their first years of life would tend to increase overtime

(Cimino et al., 2013; Cimino et al., 2015). Thus, given that the children of parents diagnosed with BED

were more prone to manifest emotional and behavioural difficulties and psychiatric symptoms, it should

be paid particular attention in mental health prevention programs and effective interventions on all family

member.

In final conclusion, a productive focus for future studies would be the investigation of the

mechanisms by which the parental psychiatric diagnoses in strong impulsive component (such as BED)

impair psychological well-being in offspring. In this aim, given the few still studies present in the

literature on the role of fathers in promoting or otherwise modulating the onset of problems in children,

22

more attention should be addressed to the fathers’ psychopathological profiles with BED. In this regard

there is evidence that the involvement of fathers can reduce the impact of important issues such as, for

example, a maternal depression. In addition, recent studies are increasingly showing how a father

involved and present promotes the overall balance of the family (Cimino et al., 2013; Cimino et al.,

2015).

Some shortcomings of this work should be indicated.

A first limitation of our study could be attributed to the use of report form instrument to assess the

psychopathological problems in offspring (described by parents). Second, we did not assessed the family

functioning in general. Nevertheless, despite the aforementioned limitations, a longitudinal study was

carried out to investigate the offspring psychopathological outcomes, focusing on direct influence of

eating psychopathology in parents with BED. The present study adds to our knowledge about parental

BED and our findings can be used to improve the future research.

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Publisher

Future Academy

First Online

18.12.2019

Doi

10.15405/epsbs.2017.01.02.3

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