Parental reflective functioning among mothers with eating disorder symptomatology☆
Introduction
The influence of eating disorders (EDs) and ED symptomatology on parental functioning and attachment remains under-studied. Although it is unclear how many mothers experience these disorders, EDs among women of childbearing age are common (Bulik, 2013).
To our knowledge, there have been few examinations of how ED symptoms impact domains of parent mentalization, that is, the process through which individuals make sense of ourselves and others by understanding and identifying varying emotional and mental states (Fonagy, Steele, Steele, Moran, & Higgitt, 1991). Mentalization can be measured through a person's capacity for reflective functioning (RF). Reflective functioning (RF) is the ability to understand behavior in terms of underlying mental states and to be able to join both a person's intention and their behavior into a meaningful whole (Fonagy et al., 1991). Specifically, it is the ability to understand that people act on the basis of their intentions, desires, and feelings and are able to recognize the separateness and opacity of others' minds (Fonagy and Target, 1997, Slade et al., 2005).
RF is critical in human attachment because it permits both parties to develop rational hypotheses for others' behavior, enabling appropriate and empathetic responses (Fonagy et al., 1991). Similarly, parental RF helps promote the understanding that behaviors are tied to underlying emotions in meaningful, predictable patterns, placing both negative and positive child behaviors into context (Bateman & Fonagy, 2004). RF provides a way for parents to reflect the child's own mental state so that the child can gain insight into their internal reality (Fonagy, Gergely, Jurist, & Target, 2002). In this way, a parent with high RF helps to solidify parent-child attachment by providing the child with a secure base through which to understand their own mental state.
Parental RF is so crucial that its absence or deficiency can be associated with maladaptive attachment in infancy and childhood, as well as personality disorders as children age (Sharp, Fonagy, & Goodyer, 2006). Anorexia nervosa (AN), due to its ego-syntonic nature, has been shown to impair RF (Kuipers and Bekker, 2012, Skårderud, 2007). However, recent studies have found that individuals with bulimia nervosa (BN) have high RF although that increased mentalization does not assist in affect regulation (Pederson et al., 2012, Pederson et al., 2015). Therefore, it is important to define the relationship between eating disorder symptoms and RF since it is currently unclear.
We hypothesized that mothers with clinically significant eating disorder symptomatology might have lower RF. This hypothesis was formed due to the existing literature showing the impairment of RF among patients with AN and the poor emotional regulation despite higher RF among individuals with BN. A thorough understanding of how RF relates to ED symptoms could help inform interventions among mothers with ED symptomatology.
Section snippets
Methods & measures
This study is a secondary analysis of a cohort of women that were involved in a follow-up study to the Yale Study of Stress and Pregnancy's (NICHD 5R01HD045735) original longitudinal cohort of 2783 pregnant women (Yonkers et al., 2011). A total of 60 women were needed – based on a power calculation for the primary analysis – for this follow-up study from that original cohort. Women were recruited into three different groups according to whether they used cigarettes, antidepressants
Statistical analysis
Participants were included if they had complete data for the EDE-Q and PRFQ. T-tests assuming unequal variances were used to assess PRFQ differences between symptoms. The response variable, the PRFQ met the assumptions of normality required for parametric tests. Therefore, linear regressions were used to create the best explanatory model for PRFQ scores with the EDE-Q total as the predictor. Univariate analyses were conducted on EDE-Q subscales against PRFQ subscales. If significant (p < 0.05),
Results
Table 1 presents demographic and clinical characteristics. The majority of women were 35 or older, white, had a self-reported excess weight as measured by the BMI, married or cohabitating, and had completed higher education. Twenty-five percent of mothers had clinically significant eating disorder symptomatology defined by the EDE-Q (N = 14). The mean total EDE-Q score was still relatively low, but with high variance (1.63 ± 1.28). Thirty-three percent (N = 19) of the population had a current Axis I
Discussion
Despite not having an ED diagnosis, 25% of mothers reported clinically significant ED symptoms via the EDE-Q. There was a trend towards higher PRFQ scores, indicating better RF, in mothers with clinically significant ED symptoms, as well as higher PRFQ scores on the EDE-Q ‘weight concerns’ and ‘shape concerns’ subscales. The inconsistency between the bivariate and multivariate analyses for ‘weight concerns’ and ‘shape concerns’ and the Interest and Curiosity subscale could be due to an issue of
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2021, Clinical Psychology ReviewCitation Excerpt :Studying parents of children aged between four and eight years, Claydon et al. (2016) investigated the extent to which mothers understood and were interested in their child's internal world and mental states. Contrary to their hypothesis, Claydon et al. (2016) found that mothers reporting clinically significant symptomatology on the Eating Disorder Examination Questionnaire (EDE-Q; Fairburn & Beglin, 2008) had better parental reflective functioning than mothers reporting less eating disorder psychopathology, although the difference between groups was not statistically significant. Parenting style in parents with and without an eating disorder was reported in only one of the included studies.