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Parental high concern and adolescent-onset anorexia nervosa

A case-control study to investigate direction of causality

North Bristol NHS Trust, Southmead Hospital, Bristol

SIMON G. GOWERS, FRCPsych

University of Liverpool, Liverpool

Declaration of interest P.S. was supported by a training grant from the Wellcome Trust.

Correspondence: Dr P. Shoebridge, Consultant Child, Adolescent and Family Psychiatrist, Southmead Hospital, Westbury-on-Trym, Bristol BS10 5NB

Background Robust evidence that anorexia nervosa is preceded rather than accompanied by high-concern (overprotective) parenting is limited.

Aims To look for evidence of parental high concern occurring before any onset of disorder.

Method Forty consecutive referrals of adolescent girls with DSM-III-R anorexia nervosa were compared with matched controls using obstetric records and maternal interviews.

Results Index mothers reported higher rates of: near-exclusive child care (P=0.02), infant sleep difficulties (P=0.018), severe distress at first regular separation (P=0.048), high maternal trait anxiety levels (P=0.008) and later age for first sleeping away from home (P=0.009). More index families had experienced a severe obstetric loss prior to their daughter's birth (P=0.066).

Conclusions This study lends evidence to the clinical contention that high-concern parenting in infancy is associated with the later development of anorexia nervosa. This may derive, in part, from aspects of unresolved grief.

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