Goshen Dor, Stein Daniel, Kurman Jenny, Farbstein Dan, Enoch-Levy Adi, Aival-Naveh Erez, Gur Eitan, Yoeli Neta, Bretler Tali, Koren Danny, Rothschild-Yakar Lily
Department of Psychology, School of Psychological Sciences, University of Haifa, Haifa, Israel.
Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
J Eat Disord. 2023 Jul 11;11(1):116. doi: 10.1186/s40337-023-00836-6.
A large theoretical body of knowledge exists emphasizing the importance of parental mentalizing in the context of anorexia-nervosa (AN). However, the empirical support to these assumptions is still scarce. The aim of the present study was to examine whether parents of patients with AN are characterized by a lower mentalizing ability, and whether it is associated with impaired mentalizing, AN symptomatology and eating disorder (ED) related psychological traits in the daughters.
Thirty-two family triads (fathers, mothers, and daughters) of female adolescent and young adult inpatients with AN were compared with thirty-three non-clinical family triads (N = 195). The mentalizing ability of all the participants was assessed using semi-structured interviews and coded using the Reflective Functioning Scale (RFS). Self-report questionnaires were administered to the daughters to evaluate ED symptomatology and ED related psychological traits (e.g., low self-esteem, interpersonal insecurity, emotional dysregulation).
Decreased reflective functioning (RF) levels were found among mothers and fathers of patients with AN compared to their control peers. Examining the entire sample, clinical and non-clinical groups together, showed that both paternal and maternal RF were associated with the daughters' RF and each were found to have a significant and distinct contribution to the daughters' RF. Significant associations were found between lower levels of maternal and paternal RF and increased ED symptoms and ED related psychological traits. The use of a mediation model suggested a serial relationship in which low maternal and paternal RF contributes to the daughters' low RF, which in turn is associated with higher levels of psychological maladjustment, and ultimately contributes to the increased severity of ED symptoms.
The present results provide strong empirical support for theoretical models that suggest that deficits in parental mentalizing may represent important correlates of the presence and severity of ED symptoms in AN. Furthermore, the results highlight the relevance of fathers' mentalizing ability in the context of AN. Finally, clinical and research implications are discussed.
存在大量理论知识强调父母心智化在神经性厌食症（AN）背景下的重要性。然而，对这些假设的实证支持仍然稀缺。本研究的目的是检验AN患者的父母是否具有较低的心智化能力，以及这是否与女儿的心智化受损、AN症状和饮食失调（ED）相关心理特征有关。
将32个AN女性青少年及年轻成年住院患者的家庭三人组（父亲、母亲和女儿）与33个非临床家庭三人组（N = 195）进行比较。使用半结构化访谈评估所有参与者的心智化能力，并使用反思功能量表（RFS）进行编码。向女儿们发放自我报告问卷，以评估ED症状和ED相关心理特征（如低自尊、人际不安全感、情绪失调）。
与对照同龄人相比，AN患者的父母反思功能（RF）水平降低。对整个样本（临床组和非临床组一起）进行检查发现，父亲和母亲的RF均与女儿的RF相关，且各自对女儿的RF有显著且独特的贡献。母亲和父亲较低水平的RF与ED症状增加及ED相关心理特征之间存在显著关联。使用中介模型表明存在一种序列关系，即母亲和父亲的低RF导致女儿的低RF，这反过来又与更高水平的心理适应不良相关，并最终导致ED症状严重程度增加。
本研究结果为理论模型提供了强有力的实证支持，该理论模型表明父母心智化缺陷可能是AN中ED症状存在和严重程度的重要相关因素。此外，结果突出了父亲心智化能力在AN背景下的相关性。最后，讨论了临床和研究意义。
