Parent–child eating disorder perceptions investigated

Perth eating disorder specialists have uncovered a wide disparity in the reporting of eating disorder symptoms between parents and their children.

The study, recently published in the International Journal of Eating Disorders, utilised data from the HOPE (Helping to Outline Paediatric Eating Disorders) Project, a registry consisting of participants assessed at the Princess Margaret Hospital for Children Eating Disorders Program (PMH EDP) between 1996 and April 2013.

Dr Hunna Watson, Senior Research Psychologist at PMH EDP, was interested in exploring parent-youth agreement in the reporting of eating disorder behaviours and cognitions.

Parents and youth were interviewed separately by experienced clinicians using the Eating Disorder Examination (EDE), to obtain data on eating disorder symptoms.

The EDE measures behavioural symptoms, such as self-induced vomiting, binge-eating, laxative and diuretic misuse, and intense exercise for weight control; as well as cognitive symptoms, such as eating concern, weight concern, shape concern and restraint, within the previous 28-day period.

The sample for the study was 619 parent-youth pairs of children (<13 years) and adolescents (13-18 years) diagnosed with anorexia nervosa, bulimia nervosa or an eating disorder not otherwise specified.

The researchers found differences in agreement between the parents' EDE reporting and that of their child, depending on the youths' age and diagnosis.

"Firstly, children reported less severe eating disorder thoughts and beliefs than reported by parents," Dr Watson says.

"But adolescents reported more severe eating disorder thoughts and beliefs than reported by parents.

"Children may not have insight into their illness and are yet to develop key cognitions such as body dissatisfaction, which tends to onset from puberty.

"Alternatively, some cases of eating disorders may not occur concurrently with eating disordered cognitions, which fits into the new DSM-V eating disorder category of 'avoidant/restrictive food intake disorder'."

In addition, there was poor agreement on frequency of behavioural symptoms between parent-youth reports, with youths reporting more frequent eating disorder behaviours than detected by their parents.

This was particularly the case among youths with bulimia nervosa, who also reported higher severity of cognitive symptoms than their parents.

"Overall, the results support the use of multi-informant assessment, particularly with children, to get a comprehensive assessment and engage the family unit together in treatment," Dr Watson says.

"Treatment services should also incorporate parental education about symptoms to assist parents."

Future research could explore whether certain variables, such as differences in family dynamics, as well as parental psychopathology, predict parent-youth agreement.