Abstract
Together with socio-cultural components, the family environment and early parent–child interactions play a role in the development of eating disorders. The aim of this study was to explore the nature of early parent–daughter relationships in a sample of 49 female inpatients with an eating disorder. To acquire a detailed image description of the childhood experiences of the patient, we used diagnostic imagery, a schema therapy-derived experiential technique. This procedure allows exploring specific contents within the childhood memory (i.e., emotions and unmet core needs), bypassing rational control, commonly active during direct verbal questioning. Additionally, patients completed self-report measures to assess for eating disorder severity, general psychopathology, and individual and parental schemas pervasiveness. Finally, we explored possible differences in the diagnostic imagery content and self-report measures in two subgroups of patients with anorexia nervosa and bulimia nervosa. The results showed that the most frequently reported unmet needs within the childhood memories of patients were those of safety/protection, care/nurturance, and emotional expression, referred specifically to the maternal figure. Overall, mothers were described as more abandoning, but at the same time particularly enmeshed in the relationship with their daughters. Conversely, patients perceived their fathers as more emotionally inhibited and neglecting. Imagery-based techniques might represent a powerful tool to explore the nature of early life experiences in eating disorders, allowing a more detailed case conceptualization and addressing intervention on early-life vulnerability aspects in disorder treatment.
Highlights
The nature of the association between parenting difficulties and eating disorder psychopathology is unclear, and the findings of the studies are still inconclusive
Literature exploring the connection between eating disorders and early parent–child relations includes studies based on the attachment theory and the parental bonding construct (Ward et al, 2000; Zachrisson and Skårderud, 2010)
According to the above premises, the aims of this study were: (i) to explore the content of negative childhood episodes in a sample of inpatients with eating disorders, through diagnostic imagery exercises; (ii) to investigate whether specific unmet core needs reported in the memory were associated with the individual and parental schemas of patients, as assessed through schema therapy-related self-report measures; and (iii) to explore the differences between anorexia nervosa and bulimia nervosa in individual and parental maladaptive schemas and the content of the childhood memories
Summary
The nature of the association between parenting difficulties and eating disorder psychopathology is unclear, and the findings of the studies are still inconclusive. The results were often conflicting due to the studied population (clinical or non-clinical groups), the eating disorder diagnostic subtype (Balottin et al, 2017), the treatment setting (i.e., hospitalization or outpatients treatment), and the severity of the disorder, which might be indicative of eventual comorbidities or specific personality features (Meneguzzo et al, 2021). Early exposure to traumatic events might have an impact on the neurobiological development of the brain, on the long-lasting neuroendocrine modifications that might account for a major risk of developing a future eating disorder (for a review, see Marciello et al, 2020)
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