1. Perceived parenting in patients with major depression, eating disorders, and healthy controls.
Zsolt Unoka1*, Mara J. Richman1,2, 4, Tamás Tölgyes³, Pál Czobor1 1 Semmelweis
1 Semmelweis University, Department of Psychiatry and Psychotherapy, Budapest, Hungary
2J. William Fulbright Program, Washington D.C., United States of America
³ Pázmány Péter Catholic University, Institute of Psychology, , Budapest, Hungary
4Eszterházy Károly College, Eger, Hungary;
Introduction
Literature has suggested that there is an association between perceived problematic parenting in childhood (by either mothers or fathers) and onset of eating disorders (ED). Specifically, this is apparent in restrictive anorexia nervosa (RAN), bulimia anorexia nervosa (BAN), and binge purging anorexia (BPA). Research has evidenced that co-morbidity of EDs and major depression (MD) is of great concern and very common (Hudson et al., 2007). Both MD and EDs are multidimensional and heterogeneous disorders. Much like the ED samples, research has shown inconsistencies in perceived parenting literature in MD samples. Early maladaptive schemas (EMS) or false representations of the world around the self that are developed in childhood are mostly apparent in those with chronic psychological disorders and in extreme mental health cases (Young, 1990) and are a great indicator of how a child may see the world according to their upbringing from their parents.
Results
Demographics
The mean age of the patients was 41.4 (SD= 11.1) for the depressed sample, 23.3 (SD= 4.7) for the RAN sample, 24.9 (SD = 6.1) for the BPA sample, 25.1 (SD= 8.0) for the BN sample, and 28.1 (11.7) for healthy controls. The difference between the 5 subgroups in terms of their age was statistically significant (X2 = 4.48, df= 4, p= .04).
Differences on Rating of Maternal and Paternal Parenting Behavior
Maternal Ratings
Analysis revealed differences between subgroups on the maternal and paternal ratings of the YPI. See table 1.
Paternal Ratings
Analysis showed significant differences. Please see table 2 for further information.
All groups vs. HC (Figure 1 and Figure 2)
Maternal Parenting Behavior
The biggest differences between healthy controls and subgroups were seen on between MD on mistrust/abuse (d= 0.86), BN (d= 0.82), RAN (d= 0.86) on emotional deprivation and BPA (d= 0.78) on shaming; the smallest were seen between healthy controls and RAN on the approval seeking (d= -0.47). Please see Figure 1 for further results.
Paternal Parenting Behavior
The largest differences between perceived paternal rating as compared to healthy controls were in the RA group on vulnerability (d= 0.97), the BUL group on mistrust/abuse (d= 0.90), the BPA group on emotional deprivation (d= 0.76) the MD group on subjugation (d= 0.66). The lowest were seen in the RA group on failure to achieve (d= ).
Current Study
We created the first study that looked at ratings of early maladaptive schemas (maternal vs. paternal) in a comparative study of eating disorders: RAN, BPA, and BN (to differentiate from the aforementioned studies) versus patients with MD as well as HC.
Our study similarly will take the above research into consideration to see the difference among type of eating disorder on the Young Parenting Inventory (YPI).
We hypothesize that the specificity of the eating disorder may show differing results among reported perceived parenting of subject.
Sample and methods
Subjects
449 Females
White/ Caucasian
Diagnosis of an ED (Restrictive Anorexia (RAN); Binge Purging Anorexia (BPA); BN (Bulimia Nervosa) or MD (major depression) as compared to HC
Measures
The Young Parenting Inventory (YPI; Young, 1999) is a is a 72-item self-administered questionnaire, which measures parenting (maternal and paternal) behaviors representing the most likely origins of 17 early maladaptive schemas (EMS). They are the following:
Statistical Methods
Between Groups
Global multivariate differences among the five samples (MD, RAN, BPA, BN, and healthy controls) in terms of the YPI subscale scores were analyzed by a Multivariate Analysis of Variance (MANOVA). If the global MANOVA analysis in each of the five groups yielded statistical difference, post-hoc pair-wise contrasts were computed to understand the pair-wise differences between study groups.
HC vs. MD, RAN, BPA, and BN
We calculated effect sizes based on the variation of two raw means divided by the pooled standard deviation (SD) and were classified as small (d = 0.2), medium (d = 0.5), or large (d ≥ 0.8) (Cohen, 1988).
Table 1. Maternal ratings between subgroups
Table 2. Paternal Ratings between subgroups
Abandonment/ Instability
Entitlement
Insufficient Self-control
Mistrust/Abuse
Subjugation
Emotion Deprivation
Self-sacrifice
Defectiveness/
Approval-seeking
Shame
Negativity/Pessimism
Dependence/ Incompetence
Emotional Inhibition
Unrelenting Standards
Vulnerability
Punitiveness
Enmeshment/ Undeveloped Self
Failure
Figure 1. YPI maternal outcomes as a function of disorder type and
effect size as compared to healthy controls.
Note: *= significant from post-hoc analysis
Figure 2. YPI paternal outcomes as a function of disorder type and effect size as compared to healthy controls.
Note: *= significant from post-hoc analysis
Discussion and conclusion
This study examined perceived parenting (PP) experiences in RAN, BN, BPA and MD patient groups, compared to healthy controls, in order to gain understanding of parental factors that contribute to psychological maladjustment.
Overall, our results showed that there were differences in both the maternal and the paternal perceived parent ratings between HC and patient subgroups and also within patient subgroups.
PP profile give a map to the clinician and the patient about the core needs that were not adequately met in childhood by each parent.
PP profile could contribute to the description of patient specific parenting modes, and to targeted limited reparenting interventions.