Caregivers in anorexia nervosa: is grief underlying parental burden?

ABSTARCT: PURPOSE: Anorexia Nervosa (AN) is a severe chronic disorder and parents' experience of caregiving is usually marked by emotional distress and burden. Severe chronic psychiatric disorders are known to be linked with the concept of grief. Grief has not been investigated in AN. The aim of this study was to explore parents' and adolescents' characteristics that may be related to parental burden and grief in AN, and the link between these two dimensions. METHODS: Eighty mothers, 55 fathers and their adolescents (N = 84) hospitalized for AN participated in this study. Evaluations of clinical characteristics of the adolescent's illness were completed, as well as self-evaluations of adolescent and parental emotional distress (anxiety, depression, alexithymia). Levels of parental burden were evaluated with the Experience of Caregiving Inventory and levels of parental grief with the Mental Illness Version of the Texas Revised Inventory of Grief. RESULTS: Main findings indicated that the burden was higher in parents of adolescents with a more severe AN; fathers' burden was also significantly and positively related to their own level of anxiety. Parental grief was higher when adolescents' clinical state was more severe. Paternal grief was related to higher anxiety and depression, while maternal grief was correlated to higher alexithymia and depression. Paternal burden was explained by the father's anxiety and grief, maternal burden by the mother's grief and her child's clinical state. CONCLUSION: Parents of adolescents suffering from AN showed high levels of burden, emotional distress and grief. These inter-related experiences should be specific targets for intervention aimed at supporting parents. Our results support the extensive literature on the need to assist fathers and mothers in their caregiving role. This in turn may improve both their mental health and their abilities as caregivers of their suffering child. LEVEL OF EVIDENCE: Level III: Evidence obtained from cohort or case-control analytic studies.

Caregiving experience and expressed emotion among parents of adolescents suffering from anorexia nervosa following illness onset.

The aim of this study was to better understand the relationship between parents' experience of caregiving and expressed emotion during the early stage of their child's eating disorder. Fifty mothers and 38 fathers of adolescents suffering from anorexia nervosa and hospitalized for the first time participated in this study. They completed the Experience of Caregiving Inventory, a measure of the negative and positive aspects of the caregiving experience, and the Family Questionnaire, which measured the different dimensions of expressed emotion, namely emotional over-involvement and critical comments. Results showed that caregiving experience is significantly and positively correlated to expressed emotion. Among the negative aspects of caregiving, sense of loss contributed most to emotional over-involvement, while difficult behaviours contributed most to critical comments. The results suggest that parents' perceptions of their child and child's future are strongly related to their tendency to be over-involved. The perception of disruptive behaviours in their child could be one of the principal triggers or exacerbating factors of parents' critical attitudes.