RESUMO
The latest studies and practice guidelines for the treatment of adolescent patients with anorexia nervosa agree in pointing out the key role played by parents in determining the young patients' therapeutic possibilities and outcomes. Still family functioning has usually been studied using only self-reported instruments. The aim of the present study is therefore to investigate the triadic interactions within the families of adolescents with anorexia nervosa using a semi-standardized observational tool based on a recorded play session, the Lausanne Trilogue Play (LTP). Parents and adolescent daughters, consecutively referred to adolescent neuropsychiatric services, participated in the study and underwent the observational procedure (LTP). The 20 families of adolescent girls with anorexia nervosa (restricting type) were compared with 20 families of patients with internalizing disorders (anxiety and depression). The results showed different interactive patterns in the families of adolescents with anorexia nervosa: they had greater difficulties in respecting roles during the play, maintaining the joint attention and in sharing positive affect, especially in the three-together phase (third phase). The majority of these families (12) exhibited collusive alliances. The parental subsystem appeared frequently unable to maintain a structuring role, i.e., providing help, support and guidance to the daughters, while the girls in turn often found it hard to show independent ideas and develop personal projects. Parents experienced difficulty in carving out a couple-specific relational space, from which the ill daughter was at least temporarily excluded also when they were asked to continue to interact with each other, letting the daughter be simply present in a third-part position (fourth phase). The study of the triadic interactions in the families of adolescents with anorexia nervosa may help to shift the attention from the exclusive mother-daughter relation to the involvement of the father, and of the parental couple as a whole. The family functioning is in fact well established as a maintaining factor of anorexia nervosa or vice versa as a facilitating factor in the therapeutic process.
RESUMO
BACKGROUND: Parental relationship dissolutions have repeatedly been linked to negative outcomes for children, but predictors of parental dissolutions have been far less studied. Knowledge about parental dissolutions occurring after the early years of parenthood is especially sparse. The aim of the current study was to investigate whether a broad set of predictors from families of toddlers were associated with relationship dissolutions throughout the next 17 years of parenthood. We specifically investigated whether different predictors were associated with short and long term dissolutions; and whether associations with long term dissolutions were mediated by relationship dissatisfaction or child-rearing conflicts. METHODS: Questionnaire data from 500 married or cohabiting mothers participating in a longitudinal population based study, the Norwegian TOPP study, was used. Child related strains, positive and negative aspects of relationship quality, and other intrinsic, environmental, and socio-demographic factors were assessed when children were 18 months old. Associations between early predictors and early dissolution (before children were 8 years old) and late dissolutions (when children were between 8 and 19 years) were compared using multinomial logistic regression analyses. Indirect paths from early predictors through relationship satisfaction and child-rearing conflicts to late dissolutions were investigated among couples that were still intact when children were 8 years old. RESULTS: Expression of criticism and most socio-demographic variables were associated with early dissolutions only, while temperamental sociability and child related strains were associated with long term dissolutions only in the adjusted regression models. Low levels of emotional support predicted both early and late dissolutions. Associations from low emotional support and child related strains to long term dissolutions were mediated by relationship dissatisfaction, indicating that cascades towards dissolutions may originate in these early predictors. No indirect paths were identified from early predictors through child-rearing conflicts, indicating that low levels of positivity, rather than high conflict levels, are associated with dissolutions in long-term relationships. CONCLUSIONS: Predictors of dissolutions over the next 17 years could be identified among mothers of toddlers. Different predictors were associated with early and late dissolutions, indicating different cascades.