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father-daughter relationship and eating psychopathology

Source: British Journal of Clinical Psychology, Volume 45, Number 3, September 2006, pp. 319-330(12)

Objective. The study aimed to establish the relationships between recalled paternal rearing behaviours, core beliefs and eating symptomatology and to test whether core beliefs play a mediating role between the father-daughter relationship and eating psychopathology.

Design. Associations between eating psychopathology, core beliefs and recalled parental rearing behaviours were examined in women with and without eating disorders. Regression analyses were used to test whether core beliefs played a mediating role in the relationship between paternal rearing behaviours and eating psychopathology.

Method. Sixty-six eating-disordered women and fifty female controls completed three self-report questionnaires measuring parental rearing behaviours, core beliefs and eating psychopathology.

Results. In eating-disordered women, paternal rejection and overprotection were found to predict aspects of eating psychopathology via the mediating role of abandonment, defectiveness/shame and vulnerability to harm core beliefs.

Discussion. Core beliefs relating to feelings of abandonment and inherent defectiveness appear to be important in the relationship between unhealthy father-daughter relationships and eating disorder symptoms.

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The significance of the parent-child relationship, and abnormal rearing practices, in the aetiology of disordered eating is well established (e.g. Bruch, 1973; Calam Waller, Slade, & Newton, 1990; Ward, Ramsey, Turnbull, Benedettini, & Treasure, 2000). Whilst much theory and research has concentrated on mother-daughter interactions (e.g. Ehrensing & Weitzman, 1970; Pike & Rodin, 1991), more recent evidence indicates that the father-daughter relationship plays a significant role in eating disorder development and maintenance (e.g. Meyer & Gillings, 2004; Wonderlich, Ukestad, & Perzacki, 1994).

Evidence suggests that fathers and mothers of eating disordered women show quite distinct interpersonal styles. In general, maternal over-protectiveness has been significantly associated with anorexia nervosa (Strober & Humphreys, 1987; Walters & Kendler, 1995), while bulimic women tend to report a rejecting, withdrawn or passive father (Strober & Humphreys, 1987; Stuart, Laraia, Ballenger, & Lydiard, 1990). Both clinical and non-clinical bulimic women have been found to describe their relationships with their father as characterized by insufficient care and high overprotection (Calam et al., 1990; Palmer, Oppenheimer, & Marshall, 1988) and fathers have been described as showing less affection and more control towards their bulimic daughter than towards their siblings (Wonderlich et al., 1994). Furthermore, patterns of parental bonding have been shown to differentiate control from women with anorexia, bulimia with a history of anorexia, and bulimia without a history of anorexia (Calam et al., 1990).

It has been suggested that the investigation of possible mediators in the relationship between family interaction and disordered eating might help enhance the explanatory power of familial models of eating disorder aetiology (Waller & Calam, 1994). Young (1999) postulates that the in order to develop in a healthy manner, children need to develop feelings of autonomy, connectedness and acceptance and that parental practices or social experiences which interfere with the child's ability to achieve these can lead to unhealthy belief systems. The investigation of such maladaptive beliefs in eating disorders have shown that underlying maladaptive core beliefs are associated both with eating disorder symptomatology (Leung, Waller, & Thomas, 1999) and act as mediators in the link between parental relationships and eating psychopathology (e.g. Meyer & Gillings, 2004; Turner, Rose, & Cooper, 2005). Research has also shown that at a symptomatic level, different core beliefs are related to different pathological eating behaviours (Waller, Ohanian, Meyer, & Osman, 2000). Such findings imply that patterns of core beliefs may be related to the development of particular eating related symptomatology - an implication of importance not only to our understanding of eating disorders but also for the identification and treatment of at risk individuals.

The investigation of parent-child interaction in eating disorders is valuable because abnormal family relationships appear to be particularly important for long-term outcome (e.g. Strober, Freeman, & Morrell, 1997). Whilst it is well established that dysfunctional family interactions represent a risk factor in eating disorder aetiology, further investigation of the specific mechanisms by which this effect might take place are needed. The current study intended to examine the role of core beliefs in the relationship between father-daughter relationships and eating psychopathology. The study aimed to explore the relationship between recollections of paternal rearing behaviour and eating psychopathology and to determine whether specific core beliefs would act as mediators between aspects of parenting and eating symptomatology.

The aim of the present study was to examine the associations between paternal rearing behaviours, core beliefs, and eating symptomatology and to establish whether core beliefs act as mediators in specific relationships between paternal rearing and disordered eating. More negative recollections of paternal rearing behaviours, and higher levels of several core beliefs were related to eating symptomatology. Moreover, three core beliefs in particular (abandonment, defectiveness/shame and vulnerability to harm) were found to mediate the influence of aspects of paternal rearing behaviours on eating disorder psychopathology. Overall, these results are compatible with a model whereby perceptions of one's father as rejecting and overprotective, lead to higher levels of specific dysfunctional beliefs and these underlying beliefs have a significant influence on the development of eating disorder symptomatology (Fig. 1).

The present study found that paternal rearing behaviours were predictive of eating psychopathology. These data support previous findings that the role of father is relevant to the development and maintenance of disordered eating (Meyer & Gillings, 2004; Wonderlich et al., 1994) and that paternal rejection is especially important in eating disorder psychopathology (e.g. Castro, Toro, & Cruz, 2000; Dominy, Johnson, & Koch, 2000; Stuart et al., 1990). Previous work has found that paternal overprotection was the only aspect of parental bonding to predict severity of bulimic behaviours (Meyer & Gillings, 2004), the current findings also indicate that perception of paternal overprotection is predictive of drive for thinness. Thus, these results further emphasize the importance of father-daughter relationships in the aetiology of disordered eating.

Three particular core beliefs were important in predicting eating psychopathology. Fears of abandonment, feelings of being fundamentally flawed or inferior and beliefs of vulnerability to harm have been found to be important in eating disorders. Abandonment fears have been linked to binge eating (Patton, 1992) and Waller (2003) found that high levels of abandonment core beliefs distinguished women with bulimia nervosa from women with binge eating disorder. In addition, defectiveness/shame core beliefs have been found to be related to eating-disorders (Meyer, et al., 2001; Waller et al., 2000) and to mediate between parental bonding and eating disorder symptoms (Turner et al., 2005). Finally, eating-disordered women tend to show higher levels of harm avoidance and lower novelty seeking than do normal control women (Bulik, Sullivan, Fear, & Pickering, 2000; Casper, Hedeker, & McClough, 1992). Therefore, whilst the present study supports previous findings regarding the cognitive and emotional background to disordered eating; it also provides evidence that core beliefs may represent key factors that underlie the psychological characteristics of eating disorders. Further research is, however, required to replicate these findings and show that they generalize to formally diagnosed eating-disordered populations.

The present study found that the combination of abandonment and defectiveness/shame beliefs mediated the relationship between paternal rejection and eating symptomatology more significantly than either of the two beliefs taken individually. These results show that perceived paternal rejection can lead to the development of a combination of fear that significant others will not be able to continue providing emotional support and to underlying feelings of shame and inferiority. In turn, it appears that the presence of both of these beliefs predicts eating psychopathology beyond the scope of either belief alone.
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