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The British Journal of Psychiatry (2000) 176: 132-137
© 2000 The Royal College of Psychiatrists

Parental high concern and adolescent-onset anorexia nervosa

A case-control study to investigate direction of causality

PHILIP J. SHOEBRIDGE, MRCPsych

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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