Empirical study on parental eating disorders and child development
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
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).
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),
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.
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.
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
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
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.
5.1. 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-
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.
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 &
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-
oriented scales at T1 and T2 and to the presence of BED diagnosis in the parents (mother vs. father vs.
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).
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
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,
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.,
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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