Parental representation in eating disorder patients with suicide

OBJECTIVE: We examined parental, personality, and symptomatological characteristics in relation to suicide attempts among eating disorder patients. METHODS: Fifty-one eating disorder inpatients, divided into two groups according to lifetime suicide attempts, and 107 non-psychiatric subjects were compared on the following variables: Parental Bonding Instrument (PBI), Global Clinical Score (GCS), Eating Disorder Inventory-91 (EDI-91), Eating Attitudes Test-26 (EAT), clinical and personality characteristics, and family backgrounds. RESULTS: Suicidal patients reported significantly higher overprotection by both parents than non-suicidal patients and non-psychiatric subjects. Suicidal patients had a more prevalent history of child abuse, affective instability, unstable self-image, avoidance of abandonment, maladaptive perfectionism, personality disorder, and mood disorder. There were no differences in symptomatological factors or the severity of the eating disorders. CONCLUSION: The results suggest that high overprotection is associated with suicidal behaviour in eating disorder patients. The association between overprotective parenting and personality characteristics, and methods of suicide prevention are discussed briefly.     

Parental bonding and separation-individuation difficulties among late adolescent eating disordered women

This study is an exploration of both interpersonal and intrapsychic factors associated with eating disorders in late adolescent women. It examines perceived parental bonding characteristics and resolution of the second separation-individuation process for both eating and non-eating disordered subjects. Subjects were 20 late adolescent eating disordered women and 20 symptom-free late adolescent female university students. All subjects received the Eating Disorder Inventory, the Parental Bonding Inventory, and the Separation-Individuation Test of Adolescence. Late adolescent eating disordered women reported significantly higher levels of maternal overprotectiveness during childhood and had significantly higher levels of separation anxiety and lower healthy separation scores than non-eating disordered students.     

Low level of parental bonding might be a risk factor among women with prolonged depression: A preliminary investigation

Aims: The aim of the present study was to determine whether or not the effect of parenting by the father and mother on outcomes for depression may be different between male and female subjects. Methods: A total of 115 patients were involved in this investigation: 74 had states of depression that continued for more than 2 years, and 41 had symptoms that remitted within 4 months. The Parental Bonding Instrument (PBI) was used to test for gender differences in the PBI score, the level of education, and the age at which the depression began, using an unpaired t‐test. Results: It is suggested that female patients with low paternal care and low levels of education have a higher likelihood of showing symptoms of prolonged depression in a primary episode. No relationship was found among prolongation of depression, educational level, and parental care in male patients. Furthermore, comparing the PBI quadrants established by Parker showed that female patients who were exposed to paternal care as ‘Affectionless Control’, had a tendency towards a higher risk of prolonged depression than female patients who received ‘Optimal Parenting’. Conclusion: Especially in female patients, the prolongation of depression is likely a result of low levels of paternal care and low education.     

Nonverbal communication sets the conditions for the relationship between parental bonding and the short-term treatment response in depression

The role of parental bonding and nonverbal communication in the short-term treatment response was investigated in 104 depressed outpatients. At baseline patients completed the Parental Bonding Instrument. We registered the nonverbal involvement behaviour of patients and interviewers from video recordings of baseline clinical interviews and calculated the convergence between patient–interviewer behaviour over the interview. The course of depression was assessed with the Beck Depression Inventory. As hypothesized, low maternal care and high paternal overprotection predicted a poor response to an 8-week treatment. Maternal care was positively correlated with nonverbal convergence. Moreover, convergence moderated the relationship between maternal care and the response to treatment: Lack of convergence between patients and interviewers turned out to annul the positive effects of maternal care on the treatment response. The findings link theories on early parenting to interpersonal theories of depression.     

Image Parentale Lors des Troubles de la Conduite Alimentaire: par l'Instrument de Liaison Parentale

Abstract: Fifty-two single females (ED group) were the subjects who satisfied the diagnostic criteria of DSM-III-R eating disorders. Using the Parental Bonding Instrument (PBI), first, the characteristics of upbringing images displayed by the ED group and, next, the differences in upbringing images between the subclassified clinical type groups in the ED group were studied. Lastly, whether the upbringing image can be changed by the therapeutic approach was pursued along with the course of treatment. The ED group's PBI score was low for "care" and high for "protection" regarding both parents. For the subclassified ED groups, the BN group scored lower for PBI's protectiveness than the AN group. As to the change in PBI scores during the course of treatment of the ED group, the score for "care" rose and that for "protection" declined in the middle and end period of therapy, compared with the beginning period.     

Personal characteristics of adolescent prostitutes and rearing attitudes of their parents: a structural equation model

The aim of this study was to investigate the risk factors of family structure, personality traits, and other variables among adolescent prostitutes. The subjects comprised 158 adolescent prostitutes in a halfway house as the case group and 65 high school girls as the control group. Data were collected by using questionnaires about demographic information, the Junior Eysenck Personality Questionnaire and the Parental Bonding Instrument. A high rate of tobacco, alcohol and drug use was found in the case group. Numerous factors distinguished the cause-effect relationship among adolescent prostitutes. Of all risk factors studied, maternal protection, paternal care, neurotic characteristics, tobacco use, discontinuous schooling and a dysfunctional family had the most direct effect. These results provide useful information for the evaluation of and interventions with adolescent prostitution.     

Parental bonding in pathological gambling disorder

The purpose of this study was to examine the role of perceived parenting behavior in the childhood of patients with pathological gambling disorder (PGD). Thirty-three outpatient subjects with DSM-IV pathological gambling disorder, and no other current Axis I disorders, completed the Parental Bonding Instrument (PBI), which measures subjects' recollections of parenting on dimensions of care and protection. PBI scores of pathological gamblers were compared to normal controls. Subjects with PGD had significantly lower maternal and paternal care scores than the control subjects (22.6 ± 8.9 vs. 26.9 ± 7.3 on maternal care [p = 0.010], and 17.4 ± 9.6 vs. 23.8 ± 7.6 on paternal care [p = 0.001]). In terms of parental bonding patterns based on a combination of care and protection, the pathological gamblers reported low rates of optimal parenting and high rates of neglectful parenting. These preliminary findings suggest that neglectful parenting appears to be associated with pathological gambling disorder.     

Effects of the “affectionless control” parenting style on personality traits in healthy subjects

The effects of the affectionless control (AC) parenting style on personality traits were studied in 414 Japanese healthy subjects. Perceived parental rearing was assessed by the Parental Bonding Instrument, which comprises care and protection factors, and personality traits were assessed by the Temperament and Character Inventory, which has seven dimensions. Parental rearing was classified into four types, i.e., optimal parenting (high care/low protection), affectionate constraint (high care/high protection), neglectful parenting (low care/low protection), and AC (low care/high protection). Males with maternal AC showed significantly higher harm avoidance (HA) scores and lower scores of persistence and cooperativeness than those with maternal optimal parenting. Females with maternal AC showed significantly higher HA scores and lower self-directedness scores than those with maternal optimal parenting. Paternal AC was not significantly related to any personality score. In females, the interaction between paternal rearing and maternal rearing was significant; the effect of maternal AC on HA scores was strongest when combined with paternal neglectful parenting. The present study suggests that the AC type parenting by mothers is associated with specific personality traits, especially high HA, in healthy subjects.     

Influences of parental rearing on the personality traits of healthy Japanese

Influences of parental rearing on the personality traits of healthy subjects were studied in 323 Japanese volunteers. Perceived parental rearing was assessed with the use of the Parental Bonding Instrument, which consists of the factors of care and protection, whereas personality traits were assessed with the use of the Temperament and Character Inventory, which has 7 dimensions. In male subjects, all personality dimensions except for novelty seeking were influenced by parental rearing; in female subjects, only the harm avoidance (HA) and self-directedness (SD) dimensions were affected by parenting. Paternal rearing influenced 3 dimensions in male subjects and 1 dimension in female subjects, whereas maternal rearing influenced 5 dimensions in male subjects and 2 dimensions in female subjects. In male subjects, higher HA was related to higher paternal protection (P < .05), whereas in female subjects, it was related to higher maternal protection (P < .01). In male subjects, lower SD was related to higher paternal protection (P < .05) and lower maternal care (P < .01), whereas in female subjects, it was related to lower paternal care (P < .05) and higher maternal protection (P < .01). These results suggest that parental rearing influences the personality traits of healthy subjects, especially HA and SD, with sex specificity in parents and recipients.     

A comparison of borderline and schizophrenic patients for childhood life events and parent-child relationships

Fifteen patients with DSM-III diagnoses of borderline personality disorder and 14 schizophrenics were administered two questionnaires by an interviewer blind to the diagnoses. The questionnaires were the Childhood Life Events and Family Characteristics Questionnaire and the Parental Bonding Instrument. A scale to monitor denial was also included. Borderlines, when compared with schizophrenics, reported having significantly more childhood sexual and physical abuse, more early separation from their mothers, more paternal criminality, and also more paternal overprotection and less maternal care. When compared with normal population data, they received significantly less care and were significantly more overprotected by both parents.     

The interaction of perceived maternal and paternal parenting styles and their relation with the psychological distress and offending characteristics of incarcerated young offenders.

A shortened form of the Parental Bonding Instrument (PBI) (Pederson, 1994) was used to examine the relationship between parenting styles and the psychological distress and offending patterns of a group of young male offenders held in custody in Scotland. High levels of psychological distress were linked with low parental care, but there was no association between psychological distress and parental control. Parental care was not a distinguishing factor in offending patterns, although high paternal control was linked with a younger age of first arrest. When interactions of paternal and maternal parenting styles were examined, young offenders who perceived poor parenting (i.e. neglectful parenting or affectionless control) from both parents had the highest levels of psychological distress overall.     

Parental Bonding Instrument

The view that those with obsessive compulsive disorder or obsessional personality have been exposed to overcontrolling and overcritical parenting is examined. Two measures of obsessionality (the Maudsley Obsessional-Compulsive Inventory and the Leyton Obsessionality Inventory) were completed by 344 nonclinical subjects. They also scored their parents on the Parental Bonding Instrument (PBI), a measure assessing perceived levels of parental care and overprotection, before and after controlling for levels of state depression, trait anxiety and neuroticism in the analyses. Those scoring as more obsessional returned higher PBI protection scale scores. Links with PBI care scale scores were less clear, essentially restricted to the Maudsley Inventory, and variably influenced by controlling other variables.     

Characteristics of families of women with restricting anorexia nervosa compared with families of normal probands]

This study compares families of women with restricting anorexia nervosa with families of women without any psychiatric history on the following variables: parents' eating problems (Eating Attitudes Test: EAT-26) and psychopathology (Symptom Checklist-90-R: SCL-90-R); family members' perceptions of the parent-daughter relationship (Parental Bonding Instrument: PBI) and the family's overall functioning (Self-Report Family Inventory: SFI). Twenty-eight young women suffering from restricting anorexia nervosa, 27 non-clinical women and their respective parents, completed these questionnaires and also participated in a semi-structured individual interview. Our results demonstrated that parents in the two groups had similar eating attitudes and behaviors. However, parents of women with anorexia nervosa reported more problems with alcohol consumption than non-clinical parents. There were no differences between the two groups on the measure of family functioning (SFI), all scores in the families of anorectics being within normal limits. All the daughters, however, reported less family cohesion and more family conflict than did their parents. On the PBI, all the daughters reported receiving more care from their mothers than their fathers; the anorectic women reported experiencing more maternal control, intrusiveness and overprotection. The relationship between each family member's perception of family functioning and the parent-daughter relationship was examined. Anorectic daughters associate the emotional health of their family with the care received from both parents, whereas control women associate this variable with their father's attitudes and behaviors. However, fathers from both groups do not consider their own care or protection as having contributed to the health of the family.     

Parental representations in drug-dependent patients and their parents

The Parental Bonding Instrument (PBI), a measure of perceived parental care and protection, was administered to drug-dependent patients and their parents with the aim to assess the reliability of the instrument in such samples and to compare the parental representations across generations. Ninety drug-dependent patients and 44 mothers and 35 fathers participated. Reliability indices were calculated, and parental representations of parents and their offspring were compared. Linear regression analyses were performed with the patient's PBI score as the dependent variable and the mother's and father's PBI scores as predictor variables. The reliability indices were highly satisfactory and varied between 0.61 and 0.91. The parental bonding of patients, fathers, and mothers was similar. All three groups reported high maternal and paternal control and low maternal care, a pattern characteristic of an "affectionless control" rearing style. Maternal care received by the fathers and paternal protection received by the mothers predicted the care and protection they themselves gave to their drug-dependent offspring.     

Depression in young adolescents: investigations using 2 and 3 factor versions of the Parental Bonding Instrument

Associations between parenting style and depressive symptomatology in a community sample of young adolescents (N = 2596) were investigated using self-report measures including the Parental Bonding Instrument and the Center for Epidemiologic Studies Depression Scale. Specifically, the 25-item 2-factor and 3-factor models by Parker et al. (1979), Kendler's (1996) 16-item 3-factor model, and Parker's (1983) quadrant model for the Parental Bonding Instrument were compared. Data analysis included analysis of variance and logistic regression. Reanalysis of Parker's original scale indicates that overprotection is composed of separate factors: intrusiveness (at the individual level) and restrictiveness (in the social context). All models reveal significant independent contributions from paternal care, maternal care, and maternal overprotection (2-factor) or intrusiveness (3-factor) to moderate and serious depressive symptomatology, controlling for sex and family living arrangement. Additive rather than multiplicative interactions between care and overprotection were found. Regardless of the level of parental care and affection, clinicians should note that maternal intrusiveness is strongly associated with adverse psychosocial health in young adolescents.     

Eating pathology in East African women: the role of media exposure and globalization

Eating disorder (ED) pathology and its relation to media exposure and globalization were assessed in a sample of young Tanzanian females (N = 214; 19.4 years +/- 3.8 years). Participants completed Kiswahili versions of a DSM-IV ED symptom clinical interview, the Eating Disorder Inventory (EDI), and a media exposure/globalization questionnaire. One third endorsed cognitive ED symptoms; bingeing (10%) and purging (5%) were less common. Four women (1.9%) met modified criteria for anorexia nervosa, one for bulimia nervosa, and 10 (4.7%) reported clinically significant ED pathology consistent with an ED not otherwise specified diagnosis. Media exposure and Western exposure (e.g., travel abroad) were positively associated with ED symptoms. The intended factor structure of the EDI was not supported. Eating pathology is present in this developing nation and is most common in subpopulations with increased exposure to Western culture. Future research should replicate these findings to clarify the role of Western media in the development of ED pathology.     

Symptoms of eating disorders in patients with obsessive-compulsive disorder

OBJECTIVE: This study was designed to explore potential overlap of the symptoms of obsessive-compulsive disorder and eating disorders. METHOD: The authors administered a structured, self-rating scale, the Eating Disorder Inventory, to 59 outpatients at an obsessive-compulsive disorder clinic and to 60 sex-matched normal volunteers. The Eating Disorder Inventory has been previously validated as a reliable measure of the specific cognitive and behavioral dimensions of the psychopathology typical of patients with eating disorders. The scores of the patients with obsessive-compulsive disorder and of the healthy comparison subjects were compared with those of 32 female inpatients with anorexia nervosa (N = 10) or bulimia nervosa (N = 22) who had also been given the inventory. RESULTS: The patients with obsessive-compulsive disorder scored significantly higher than the healthy comparison subjects on all eight subscales of the Eating Disorder Inventory: drive for thinness, bulimia, body dissatisfaction, ineffectiveness, perfectionism, interpersonal distrust, interoceptive awareness, and maturity fears. Relative to the healthy subjects, male patients with obsessive-compulsive disorder had more symptoms than female patients with obsessive-compulsive disorder. The scores of the female patients with obsessive-compulsive disorder were midway between those of the 32 female patients with eating disorders and those of the 35 female normal subjects. CONCLUSIONS: These results suggest that patients with obsessive-compulsive disorder display significantly more disturbed eating attitudes and behavior than healthy comparison subjects and that they share some of the psychopathological eating attitudes and behavior that are common to patients with eating disorders.     

Parents' emotional neglect and overprotection according to the recollections of patients with borderline personality disorder

OBJECTIVE: The purpose of this study was to test clinical hypotheses about the role of emotional neglect and overprotection in the childhood of patients with borderline personality disorder. METHOD: The subjects were male and female borderline (N = 62) and nonborderline (N = 99) patients from a general hospital psychiatric clinic and a university student mental health clinic. Both groups were administered the Parental Bonding Instrument, which measures subjects' recollections of parenting on dimensions of care and protection. RESULTS: The findings showed that the patients with borderline personality disorder remembered both their fathers and their mothers as having been significantly less caring and more controlling than did the nonborderline patients. The results were the same for male and female subjects and for subjects from both sites. CONCLUSIONS: The recollections provide support for psychodynamic theories about the childhood of borderline patients and for a theory of biparental failure in the development of borderline pathology.     

Sub-optimal parenting is associated with schizotypic and anxiety personality traits in adulthood

Part of the variation in personality characteristics has been attributed to the child–parent interaction and sub-optimal parenting has been associated with psychiatric morbidity. In the present study, an extensive battery of personality scales (Trait Anxiety Inventory, Behavioural Inhibition/Activation System questionnaire, Eysenck Personality Questionnaire-Revised, Temperament and Character Inventory, Schizotypal Traits Questionnaire, Toronto Alexithymia Scale) and the Parental Bonding Instrument (PBI) were administered in 324 adult healthy males to elucidate the effects of parenting on personality configuration. Personality variables were analysed using Principal Component Analysis (PCA) and the factors “Schizotypy”, “Anxiety”, “Behavioural activation”, “Novelty seeking” and “Reward dependence” were extracted. Associations between personality factors with PBI “care” and “overprotection” scores were examined with regression analyses. Subjects were divided into “parental style” groups and personality factors were subjected to categorical analyses. “Schizotypy” and “Anxiety” were significantly predicted by high maternal overprotection and low paternal care. In addition, the Affectionless control group (low care/high overprotection) had higher “Schizotypy” and “Anxiety” compared with the Optimal Parenting group (high care/low overprotection). These results further validate sub-optimal parenting as an important environmental exposure and extend our understanding on the mechanisms by which it increases risk for psychiatric morbidity.     

Symptoms of eating disorders in obsessive-compulsive disorder

OBJECTIVE: Despite some empirical evidence suggesting an association between primary OCD and eating disorder (ED) within the 'obsessive-compulsive spectrum', the relationship at a symptomatological level has not been investigated. METHOD: First, comparisons of Eating Disorder Inventory (EDI) scores between 61 patients with primary OCD and 288 control subjects were performed. Secondly, the associations between EDI subscores and Hamburg Obsessive-Compulsive Inventory (HZI) dimensions in OCD patients were investigated by multiple regression analyses, controlling for the impact of general psychopathology. RESULTS: The OCD patients showed significantly higher EDI-scores than controls. However, only distinct OCD symptom dimensions were significantly associated with the core symptoms of ED in females. CONCLUSION: Our results point to a differential gender and symptom-specific relationship between OCD and ED, calling into question a simple dimensional conceptualization of the 'obsessive-compulsive spectrum'.