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Purpose: It has been suggested that the intergenerational transmission of anxiety may be an important contributor to the high prevalence of anxiety in adolescents. The objectives of this study are to examine whether and how parental anxiety is related to adolescent's anxiety and to explore the associations of parental anxiety and parent-child communication with adolescents' anxiety across different grades. Methods: The current survey was conducted online from February 8th to February 27th, 2020.The questionnaires were distributed and retrieved through a web-based platform. A total of 6196 Chinese rural adolescents from grade seven to twelve (age ranging from 11 to 18 years old) were included. Results: In this study, parental anxiety was significantly associated with higher adolescent anxiety (ß = 0.14, p < 0.001) and this association was statically strongest at grade twelve. Besides, children with problematic parent-child communication related to COVID-19 reported elevated anxiety (ß = 0.05, p < 0.01). In contrast, effective parent-child communication about COVID-19 mitigated the level of anxiety transmitted from parent to child (ß = -0.04, p < 0.05). Conclusions: During the COVID-19 epidemic, parents' anxiety was related to adolescents' anxiety. In addition, parent-child communication plays a moderating role in the above relationship. These findings emphasize the importance of implementing more psycho-education programs that specifically target parents' emotion regulation and effective communication abilities to ameliorate the psychopathological symptoms of parents and their children. Supplementary Information: The online version contains supplementary material available at 10.1007/s40653-023-00609-y.
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BACKGROUND: Low social support has been identified as a risk factor for perinatal mental health problems. However, previous studies mainly focused on partner support or general social support and neglected the roles of grandparents. Here, we examine whether a lack of grandparental support is related to increased risk of a diagnosis of perinatal depression. In addition, we examine whether poor grandparental support is related to more depressive symptoms in mothers with and without previously diagnosed perinatal depression and whether perceived grandparental support buffers against parenting difficulties in mothers with perinatal depression. METHODS: The sample was drawn from an Australian pregnancy cohort study and consisted of 725 women, including 230 women who met criteria for Major Depression. At 12 months postpartum, women reported on grandparental geographical proximity and hours of grandparental childcare support. Perceived grandparental support was assessed with the Postpartum Social Support Questionnaire and parenting difficulties and depressive symptoms with the Parenting Stress Index and the Edinburgh Postnatal Depression Scale. RESULTS: Perceived grandparental support was related to fewer depressive symptoms among mothers with perinatal depression. In addition, higher levels of perceived grandparental support were related to lower parenting stress in mothers with and without perinatal depression. LIMITATIONS: Intergenerational conflicts and quality of grandparenting were not assessed. CONCLUSIONS: Our findings indicate that supportive grandparents may prevent the development of more severe perinatal depression in mothers experiencing perinatal mental health problems. Future studies should examine whether involving grandparents in treatment may add to the effectiveness of existing perinatal mental health interventions.
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Depressão Pós-Parto , Avós , Poder Familiar , Apoio Social , Humanos , Feminino , Avós/psicologia , Adulto , Gravidez , Depressão Pós-Parto/psicologia , Poder Familiar/psicologia , Austrália , Transtorno Depressivo Maior/psicologia , Relação entre Gerações , Fatores de Risco , Estudos de Coortes , Mães/psicologia , Inquéritos e Questionários , Estresse Psicológico/psicologiaRESUMO
Although cyberbullying is an emerging public health problem, it is unclear how the COVID-19 pandemic affects cyberbullying. This systematic review and meta-analysis aimed to examine the effect of the COVID-19 pandemic on cyberbullying, to estimate the global cyberbullying prevalence and to explore factors related to cyberbullying during the COVID-19 pandemic. We searched the Medline, Embase, PubMed, Scopus, Eric, PsycINFO, Web of Science, Cochrane Library, Wanfang, Chinese CNKI, and EBSCO databases to identify relevant empirical studies published between 2019 and 2022. A total of 36 studies were included. Quality assessment, meta-analyses, and subgroup analyses were conducted. The pooled prevalences were 16% for overall cyberbullying, 18% for victimization and 11% for perpetration during the COVID-19 pandemic, which were lower than before the COVID-19 pandemic. The pooled prevalence of postpandemic cyberbullying perpetration is lower in children than in adults. In addition, both virus- and lockdown-related stressors were the main factors contributing to cyberbullying. The COVID-19 crisis may reduce cyberbullying, and the pooled prevalence of cyberbullying during the pandemic in adults is higher than in children and adolescents. In addition, the transient-enduring factor model of postpandemic cyberbullying built in this review could help identify people at high risk of cyberbullying during public health emergencies.
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Bullying , COVID-19 , Cyberbullying , Humanos , PandemiasRESUMO
Depressive symptoms are common in the postpartum period and can affect mother-infant interaction. To better understand the role of depressive symptoms in the mother-infant interchange, this study examined whether maternal depressive symptoms are associated with self-reported, physiological, and facial expressive responses to infant crying and laughing sounds. A nonclinical sample was used, consisting of 101 mothers (Age M = 30.88 years, 33% scored 7 or higher on the Edinburgh Postnatal Depression Scale) with a young child. Mothers were exposed to standard infant crying and laughing sounds. Affect, perception of crying and laughing, intended caregiving responses, skin conductance level reactivity, and facial expressive responses to infant crying and laughing were measured. Higher levels of depressive symptoms were associated with more self-reported negative affect in general and a more negative perception of infant crying. Depressive symptoms were not associated with intended caregiving responses and physiological responses to infant crying. Infant laughing increased self-reported positive affect and happy facial expressions in mothers with all levels of depressive symptoms. Higher levels of depressive symptoms were associated with higher sad facial expressivity in general. Depressive symptoms were not related to positive perception of infant laughing, intended caregiving responses, and physiological responses to infant laughing. The findings suggest that mothers who score high on depressive symptoms send subtle facial cues showing sadness, which may overshadow happy facial expressions during infant laughing and may affect mother-infant interaction. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Choro , Riso , Feminino , Criança , Lactente , Humanos , Adulto , Choro/fisiologia , Choro/psicologia , Depressão , Mães/psicologia , Riso/fisiologia , Relações Mãe-Filho/psicologiaRESUMO
Support from grandparents plays a role in mothers' perinatal mental health. However, previous research on maternal mental health has mainly focused on influences of partner support or general social support and neglected the roles of grandparents. In this narrative review and meta-analysis, the scientific evidence on the association between grandparental support and maternal perinatal mental health is reviewed. Searches in PubMed, EMBASE, MEDLINE, Scopus, and PsycINFO yielded 11 empirical studies on N = 3381 participants, reporting on 35 effect sizes. A multilevel approach to meta-analysis was applied to test the association between grandparental support and maternal mental health. The results showed a small, statistically significant association (r = .16; 95% CI: 0.09-0.25). A moderator test indicated that the association was stronger for studies reporting on support from the maternal grandmother in particular (r = .23; 95% CI: 0.06-0.29). Our findings suggest that involved grandparents, in particular mother's own mother, constitute a protective factor for the development of maternal postpartum mental health problems. These findings have clear implications for interventions. Future studies should examine whether stimulating high-quality support from grandparents is a fruitful avenue for enhancing maternal postpartum mental health.
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Avós , Saúde Mental , Feminino , Gravidez , Humanos , Avós/psicologia , Mães/psicologia , Período Pós-PartoRESUMO
Parental protection is an important, yet understudied, aspect of parenting behavior. Predictors of the quality of protection and potential underlying neural mechanisms are still unknown. In this study, we examined whether negative caregiving experiences in fathers' own childhood are related to protective behavior and neural reactivity to infant threatening situations. Paternal protective behavior was measured with self- and partner-reported protective behavior and behavioral observations in an experimental set-up (auditory startling task) in 121 first-time fathers (mean age child = 19.35 weeks, SD = 11.27). Neural activation during exposure to videos of infant-threatening (vs. neutral) situations was measured with functional magnetic resonance imaging (fMRI). We found a significant and positive association between negative caregiving experiences and amygdala reactivity to infant-threatening situations. A history of negative caregiving experiences was not significantly related to reported or observed paternal protective behavior. Our findings suggest that fathers with negative caregiving experiences show emotional hyperreactivity to cues of infant threat.
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Pai , Pais , Masculino , Criança , Humanos , Lactente , Pai/psicologia , Pais/psicologia , Comportamento Paterno/fisiologia , Poder Familiar/psicologia , Tonsila do CerebeloRESUMO
BACKGROUND: The impact of the COVID-19 pandemic has been extensive and drastic during the twenty-first century. The increasing phenomenon of child maltreatment during the pandemic is a significant public health concern. OBJECTIVE: This study is the first systematic review to analyze and summarize the prevalence rates, risk factors, and protective factors related to child maltreatment during the COVID-19 pandemic. METHODS: Four electronic databases (PubMed, Web of Science, Scopus, Embase) were systematically searched. Some potential studies were also identified from the reference lists of previously included articles. The quality of the included studies was assessed by the National Institutes of Health (NIH) Quality Assessment Tool and Critical Appraisal Skills Program (CASP) Quality Assessment Tool. RESULTS: A total of 35 articles were included in the analysis, with 16 having prevalence information and 22 having factor information. Sixteen studies were conducted in the US, the other 17 studies were from 12 countries, and only two studies contained mixed countries. The prevalences of child maltreatment during the pandemic varied widely in different types and measurements. The pandemic rates of physical abuse, psychological abuse, neglect, and sexual abuse were 0.1 %-71.2 %, and 4.9 %-61.8 %, 7.3 %-40 % and 1.4 %-19.5 %, respectively. There was a decline in allegations of child maltreatment and an increase in severe cases of child maltreatment during the COVID-19 pandemic. Lockdown measures and their side effects were the main risk factors contributing to child maltreatment. CONCLUSIONS: This review calls for targeted measures to prevent child maltreatment during the COVID-19 pandemic and current and future lockdowns and more future replication studies conducted in countries other than the US.
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COVID-19 , Maus-Tratos Infantis , Criança , Humanos , Prevalência , Pandemias , COVID-19/epidemiologia , Controle de Doenças Transmissíveis , Maus-Tratos Infantis/psicologiaRESUMO
Child maltreatment can negatively impact not only survivors but also survivors' children. However, research on the intergenerational effect of maternal childhood maltreatment on child externalizing behaviour has yielded contradictory results and has not yet been systematically synthesised. The current three-level meta-analysis and systematic review aimed to provide a quantitative estimate of the strength of the association between maternal childhood maltreatment and child externalizing behaviour and to summarise research on potential mediating factors of this association. PsycINFO, PubMed, and Embase were searched and 39 studies with 82 effects sizes were included in the meta-analysis. Results revealed a small significant association between maternal childhood maltreatment and child externalizing behaviour (r = 0.16; 95% CI 0.12-0.19; publication bias-adjusted effect size: r = 0.12, 95% CI 0.08-0.16). Maternal mental health, particularly depressive symptoms, maternal parenting and children's maltreatment exposure were the most frequently examined mediators of this association, with relatively robust mediating effects for children's maltreatment exposure and maternal depressive symptoms, but mixed evidence for the mediating role of maternal parenting. This meta-analysis provides evidence for a small but significant association between maternal childhood maltreatment and children's externalizing behaviour, emphasizing the need to develop effective preventive and intervention strategies to minimise the effects of childhood maltreatment on the next generation.
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BACKGROUND: The COVID-19 pandemic has drastically impacted many aspects of society and has indirectly produced various psychological consequences. This systematic review aimed to estimate the worldwide prevalence of posttraumatic stress disorder (PTSD) in children due to the COVID-19 pandemic, as well as to identify protective or risk factors contributing to child PTSD. METHODS: We conducted a systematic literature search in the PubMed, ProQuest, PsycINFO, Embase, Web of Science, WanFang, CNKI, and VIP databases. We searched for studies published between January 1, 2020 and May 26, 2021, that reported the prevalence of child PTSD due to the COVID-19 pandemic, as well as factors contributing to child PTSD. Eighteen studies were included in our systematic review, of which 10 studies were included in the meta-analysis. RESULTS: The estimated prevalence of child PTSD after the COVID-19 outbreak was 28.15% (95% CI: 19.46-36.84%, I2 = 99.7%). In subgroup analyses for specific regions the estimated prevalence of post-pandemic child PTSD was 19.61% (95% CI: 11.23-27.98%) in China, 50.8% (95% CI: 34.12-67.49%) in the USA, and 50.08% in Italy (95% CI: 47.32-52.84%). CONCLUSIONS: Factors contributing to child PTSD were categorized into four aspects: personal factors, family factors, social factors and infectious diseases related factors. Based on this, we presented a new framework summarizing the occurrence and influence of the COVID-19 related child PTSD, which may contribute to a better understanding, prevention and development of interventions for child PTSD in forthcoming pandemics.
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COVID-19 , Transtornos de Estresse Pós-Traumáticos , COVID-19/epidemiologia , Criança , Surtos de Doenças , Humanos , Pandemias , Prevalência , Transtornos de Estresse Pós-Traumáticos/epidemiologia , Transtornos de Estresse Pós-Traumáticos/psicologiaRESUMO
BACKGROUND: The Covid-19 pandemic has put an unprecedented pressure on families with children. How parents were affected by the first Covid-19 lockdown during the early postpartum period, an already challenging period for many, is unknown. AIM: To investigate the associations between Covid-19 related stress, mental health, and insensitive parenting practices in mothers and fathers with young infants during the first Dutch Covid-19 lockdown. METHODS: The Dutch Covid-19 and Perinatal Experiences (COPE-NL) study included 681 parents of infants between 0 and 6 months (572 mothers and 109 fathers). Parents filled out online questionnaires about Covid-19 related stress, mental health (i.e. anxiety and depressive symptoms), and insensitive parenting. Hierarchical regression models were used to analyze the data. RESULTS: Parents of a young infant reported high rates of Covid-19 related stress, with higher reported stress in mothers compared to fathers. Additionally, the percentages of mothers and fathers experiencing clinically meaningful mental health symptoms during the pandemic were relatively high (mothers: 39.7% anxiety, 14.5% depression; fathers: 37.6% anxiety, 6.4% depression). More Covid-19 related stress was associated with more mental health symptoms in parents and increased insensitive parenting practices in mothers. CONCLUSIONS: The results emphasize the strain of the pandemic on young fathers' and mothers' mental health and its potential negative consequences for parenting. As poor parental mental health and insensitive parenting practices carry risk for worse child outcomes across the lifespan, the mental health burden of the Covid-19 pandemic might not only have affected the parents, but also the next generation.
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COVID-19 , Poder Familiar , COVID-19/epidemiologia , Criança , Controle de Doenças Transmissíveis , Pai/psicologia , Feminino , Humanos , Lactente , Masculino , Saúde Mental , Mães/psicologia , Pandemias , Poder Familiar/psicologia , Pais/psicologia , GravidezRESUMO
In a randomized double-blind within-subject control study we investigated the effects of oxytocin and vasopressin administration on neural reactivity to infant cry sounds in 70 first-time fathers in the first year of fatherhood. Additionally, we examined whether effects of oxytocin and vasopressin administration on neural reactivity were moderated by fathers' early childhood experiences. Neural reactivity to infant cry sounds (versus control sounds) was measured using functional magnetic resonance imaging (fMRI). Furthermore, participants reported on their childhood experiences of parental harsh discipline and parental love withdrawal. Whole brain analyses revealed no significant effect of vasopressin or oxytocin administration on neural activation in response to infant cry sounds. Region of interest analyses showed decreased amygdala activation in both the oxytocin condition and the vasopressin condition as compared to placebo. We found no moderating effects of fathers' early childhood experiences. Our findings suggest that oxytocin administration may decrease feelings of anxiety or aversion to a crying infant. Whether decreased amygdala activation after vasopressin administration might be explained by contextual factors (e.g., absence of high levels of threat, unfamiliarity of the infant) or represents an affiliative response to infant distress warrants further investigation. Findings of the present study showed that oxytocin and vasopressin are important hormones implicated in neural models of infant cry perception in fatherhood.
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Choro , Ocitocina , Administração Intranasal , Encéfalo , Pré-Escolar , Pai , Humanos , Lactente , Imageamento por Ressonância Magnética/métodos , Masculino , Ocitocina/farmacologia , Vasopressinas/farmacologiaRESUMO
Becoming a parent requires new skills and frequent task switching during daily childcare. Little is known about the paternal brain during the transition to fatherhood. The present study examined intrinsic neuronal network connectivity in a group of first-time expectant and new fathers (total N = 131) using amygdala seed-based resting-state functional connectivity analysis. Furthermore, we examined the association between paternal involvement (i.e. hours spent in childcare and real-time push notifications on smartphone) and connectivity within the parental brain network in new fathers. There were no significant differences in functional connectivity between expectant and new fathers. However, results show that in new fathers, time spent in childcare was positively related to amygdala connectivity with the supramarginal gyrus, postcentral gyrus and the superior parietal lobule-all regions within the cognition/mentalizing network that have been associated with empathy and social cognition. Our results suggest that fathers' time investment in childcare is related to connectivity networks in the parental brain.
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Cuidado da Criança , Pai , Tonsila do Cerebelo/diagnóstico por imagem , Encéfalo/fisiologia , Criança , Humanos , Imageamento por Ressonância Magnética , Masculino , PaisRESUMO
Previous studies on the impact of COVID-19 indicate that pandemic-related distress increases risks for child maltreatment, although data on the scope of this problem are still scarce. Here, we assessed whether parents with toddlers (n = 206) more often used harsh discipline during the lockdown in the Netherlands compared to a matched parent sample collected prior to the pandemic (n = 1,030). Parents were matched on background characteristics using propensity score matching. We found that harsh parenting levels were significantly elevated compared to pre-pandemic levels. Harsh parenting behaviors with a low prevalence before COVID-19 increased most strongly: shaking, calling names, and calling the child stupid. These results suggest that parental tolerance for children's disobedience is lower under the adverse circumstances of COVID-19 and, as a result, abusive parenting responses are more difficult to inhibit. Thus, a lockdown seems to increase risks for child maltreatment, underscoring the need for effective support strategies for at-risk families.
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COVID-19 , Maus-Tratos Infantis/estatística & dados numéricos , Poder Familiar , Quarentena , COVID-19/complicações , COVID-19/epidemiologia , COVID-19/psicologia , Estudos de Casos e Controles , Humanos , Lactente , Países Baixos/epidemiologia , Pais , Quarentena/psicologiaRESUMO
Background: The COVID-19 pandemic drastically impacted on family life and may have caused parental distress, which in turn may result in an overreliance on less effective parenting practices. Objective: The aim of the current study was to identify risk and protective factors associated with impaired parenting during the COVID-19 lockdown. Key factors predicting maternal harsh discipline were examined in China, Italy, and the Netherlands, using a cross-validation approach, with a particular focus on the role of allomaternal support from father and grandparents as a protective factor in predicting maternal harshness. Methods: The sample consisted of 900 Dutch, 641 Italian, and 922 Chinese mothers (age M = 36.74, SD = 5.58) who completed an online questionnaire during the lockdown. Results: Although marital conflict and psychopathology were shared risk factors predicting maternal harsh parenting in each of the three countries, cross-validation identified a unique risk factor model for each country. In the Netherlands and China, but not in Italy, work-related stressors were considered risk factors. In China, support from father and grandparents for mothers with a young child were protective factors. Conclusions: Our results indicate that the constellation of factors predicting maternal harshness during COVID-19 is not identical across countries, possibly due to cultural variations in support from fathers and grandparents. This information will be valuable for the identification of at-risk families during pandemics. Our findings show that shared childrearing can buffer against risks for harsh parenting during COVID-19. Hence, adopting approaches to build a pandemic-proof community of care may help at-risk parents during future pandemics.
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New fathers may grow into their parental role through active involvement in childcare. Spending time in physical contact with the child may promote an adaptive transition to fatherhood. In this randomized controlled trial, we tested the effects of a baby carrier intervention on fathers' hormonal and neural functioning. Using functional magnetic resonance imaging (fMRI), we examined whether infant carrying affects neural reactivity to infant crying in first-time fathers, taking into account the role of the hormone oxytocin as a mediating mechanism and fathers' own childhood experiences as a potential moderating factor. Sixty first-time fathers (infant age M = 11.18 weeks, SD = 2.08) were randomly assigned to a baby carrier intervention group (n = 32 fathers) or a control group (n = 28 fathers). Fathers in the intervention group were instructed to use a baby carrier for three weeks, whereas fathers in the control group were instructed to use a baby seat. Before and after the intervention salivary oxytocin was measured and neural reactivity to infant crying was assessed using fMRI. Results showed that the infant carrier intervention increased amygdala reactivity to infant crying compared to the infant seat users. This effect was most pronounced in fathers with experiences of childhood abuse. The carrier intervention did not affect fathers' oxytocin levels. Our findings indicate that spending time in physical contact with the infant may promote attention to and accurate perception of infant signals, in particular in fathers with more adverse childhood experiences. Soft baby carriers may, therefore, facilitate an adaptive transition to fatherhood.
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Choro , Ocitocina , Tonsila do Cerebelo , Criança , Relações Pai-Filho , Pai , Humanos , Lactente , MasculinoRESUMO
We examined internet searches indicative of abusive parental behaviors before and after the World Health Organization's declaration of COVID-19 as a pandemic (March 11, 2020) and subsequent lockdown measures in many countries worldwide. Using Google Trends, we inferred search trends between December 28, 2018, and December 27, 2020, for queries consisting of "mother," "father," or "parents" combined with each of the 11 maltreatment-related verbs used in the Conflict Tactics Scales, Parent-Child version. Raw search counts from the Google Trends data were estimated using Comscore. Of all 33 search terms, 28 terms showed increases in counts after the lockdowns began. These findings indicate a strong increase in internet searches relating to occurrence, causes, or consequences of emotional and physical maltreatment since the lockdowns began and call for the use of maltreatment-related queries to direct parents or children to online information and support.
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BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic had brought negative consequences and new stressors to mothers. The current study aims to compare factors predicting maternal mental health during the COVID-19 lockdown in China, Italy, and the Netherlands. METHODS: The sample consisted of 900 Dutch, 641 Italian, and 922 Chinese mothers (age M = 36.74, s.d. = 5.58) who completed an online questionnaire during the lockdown. Ten-fold cross-validation models were applied to explore the predictive performance of related factors for maternal mental health, and also to test similarities and differences between the countries. RESULTS: COVID-19-related stress and family conflict are risk factors and resilience is a protective factor in association with maternal mental health in each country. Despite these shared factors, unique best models were identified for each of the three countries. In Italy, maternal age and poor physical health were related to more mental health symptoms, while in the Netherlands maternal high education and unemployment were associated with mental health symptoms. In China, having more than one child, being married, and grandparental support for mothers were important protective factors lowering the risk for mental health symptoms. Moreover, high SES (mother's high education, high family income) and poor physical health were found to relate to high levels of mental health symptoms among Chinese mothers. CONCLUSIONS: These findings are important for the identification of at-risk mothers and the development of mental health promotion programs during COVID-19 and future pandemics.
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Neurocognitive symptoms are common in individuals with somatic symptom and related disorders (SSRD), but little is known about the specific impairments in neurocognitive domains in patients with conversion disorder (CD)/functional neurological disorder (FND). This study examines neurocognitive functioning in patients with CD/FND compared to patients with other SSRD. The sample consisted of 318 patients. Twenty-nine patients were diagnosed with CD/FND, mean age 42.4, standard deviation (SD) = 13.8 years, 79.3% women, and 289 patients had other SSRD (mean age 42.1, SD = 13.3, 60.2% women). Patients completed a neuropsychological test battery that addressed a broad range of neurocognitive domains, including information processing speed, attention and executive functioning. Patients with CD/FND had clinically significant neurocognitive deficits in all neurocognitive domains based on normative data comparison. Patients with CD/FND also performed significantly worse than patients with other SSRD on information processing speed (Digit Symbol Substitution Test (V = .115, p = .035), Stroop Color-Word Test (SCWT) card 1 (V = .190, p = .006), and SCWT card 2 (V = .244, p < .001). No CD/FND vs. other SSRD differences were observed in other neurocognitive domains. These findings indicate the patients with CD/FND perform worse on information processing speed tests compared to patients with other SSRD.
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Transtorno Conversivo , Doenças do Sistema Nervoso , Adulto , Cognição , Transtorno Conversivo/complicações , Função Executiva , Feminino , Humanos , Masculino , Doenças do Sistema Nervoso/complicações , Testes NeuropsicológicosRESUMO
Research shows that the Unresolved-disorganized attachment representation (U), resulting from experiences of loss or abuse, is associated with a range of psychiatric conditions. However, clinical implications of U are yet unclear.Objective: To investigate how U is related to symptoms and recovery of eating disorder (ED) patients.Method: First, 38 ED patients starting psychotherapeutic treatment were compared to 20 controls without ED on the prevalence of U, assessed with the Adult Attachment Interview. Second, in the patient group relations between U and ED symptoms, depression, anxiety and subjective experience of symptoms were investigated. Third, we compared, 1 year afterwards, recovery of patients with and without U.Results: The prevalence of U was higher in ED patients than in controls. Symptom severity was not related to U. ED patients with U at the start of treatment improved significantly more regarding anxiety, depression and subjective experience of symptoms than did patients without U.Discussion: The differential recovery of ED patients with or without U confirms the trauma-related heterogeneity of patients found in other diagnostic groups and calls for further investigation into the treatment needs of patients with different attachment representations.