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Maternal eating disorder and mother-child conflict

Department of General Psychiatry, St George's Hospital Medical School, London SW17 ORE

Stein et al's study (1999) provides essential reading for clinicians involved in treating anorexia nervosa or bulimia. However, in light of recent research concerning pregnancy and eating disorders (Morgan et al, 1999), three further areas of investigation seem to have been unexplored.

First, we have demonstrated that a third of women with bulimia developed postnatal depression, rising to two-thirds in women with previous anorexia nervosa. Second, Stein et al treat ‘eating disorders’ with unwarranted homogeneity; we found profound differences between pregnant women with bulimia and those with previous anorexia nervosa. The latter predicted postnatal depression, absence of breast-feeding and postpartum relapse into eating disorder. The most striking differences were apparent at a descriptive level, where women with previous anorexia nervosa appeared highly alienated from their infants. Third, the majority of pregnancies described in our study (Morgan et al, 1999) were unplanned due to mistaken beliefs regarding fertility.

It would be interesting if Stein et al were able to re-examine their data with reference to specific eating disorder diagnoses, presence of affective disorder and planning of pregnancy, all of which might generate maladaptive responses to the antecedents of conflict.

EDITED BY LOUISE HOWARD

REFERENCES

Stein, A., Woolley, H. & McPherson, K. (1999) Conflict between mothers with eating disorders and their infants during mealtimes. British Journal of Psychiatry, 175, 455-461.[Abstract/Free Full Text]

Morgan, J. F., Lacey, J. H. & Sedgwick, P. M. (1999) Impact of pregnancy on bulimia nervosa. British Journal of Psychiatry, 174, 135-140.[Abstract/Free Full Text]

Authors' reply

Leopold Muller University Department, Royal Free and University College Medical School, University College London, Royal Free Campus, Rowland Hill Street, London NW3 2PF

K. McPherson

School of Hygiene and Tropical Medicine, Keppel Street, London WCIE 7HT

Dr Morgan makes some interesting points in the light of his own study concerning factors which might influence the nature of the relationship between mothers with eating disorders and their infants. However, the purpose of our paper was to examine the evolution of conflict between mothers with eating disorders and their infants using detailed observations of sequences of interactions. In particular, we wanted to establish whether the way in which mothers and infants responded to different situations during mealtimes influenced development of conflict. We found that whether or not the mothers responded to the infants' cues determined whether or not conflict arose. In addition, the infants' behaviour also contributed to the evolution of conflict in some circumstances. The elucidation of these features of interaction, which was only possible through sequential observations and analyses, offers the potential for intervention irrespective of which background factors influence interaction. In particular, it is critical to help mothers to recognise the positive aspects of their infants' communications and cues during mealtimes in order to facilitate this interaction.

Obviously, we are very interested in the other factors in the mother's history or mental state which might influence the course of these interactions, such as those detailed in the Morgan et al paper cited above. However, in order to carry out the analysis of sequential interactions as we have done, and to determine the relative influence of a variety of other factors on the course of these interactions, a much larger study would be required. This would be valuable but well beyond the scope of our paper.

This article has been cited by other articles:

				J. L. Werth Jr., K. S. Wright, R. J. Archambault, and R. J. Bardash When Does the "Duty to Protect" Apply with a Client Who has Anorexia Nervosa? The Counseling Psychologist, July 1, 2003; 31(4): 427 - 450. [Abstract] [PDF]

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