Thinking for healing: The role of mentalization deficits as moderator in the link between complicated grief and suicide ideation among suicide-loss survivors.

Suicide-loss survivors are an at-risk population for complicated grief and suicide ideation. This study examined mentalization deficits as a possible moderator of the association between complicated grief and suicide ideation. Suicide-loss survivors (N = 152) completed questionnaires on complicated grief, suicide ideation, and mentalization deficits. Mentalization deficits facilitated suicide ideation, beyond the contribution of complicated grief. Complicated grief and suicide ideation were more strongly associated at higher mentalization deficit levels. Limitations include the non-representative cross-sectional nature of the sample and the use of a single item for suicide ideation. The findings highlight the critical link between complicated grief and suicide ideation among suicide-loss survivors and mentalization deficits' role as its possible facilitator.

Too healthy for their own good: orthorexia nervosa and compulsive exercise in the community.

BACKGROUND: The similarities and differences between orthorexia nervosa symptoms (ONs) and the symptoms and correlates of eating disorders listed in the DSM-5 need to be elucidated. ONs were examined in a volunteer community sample in conjunction with compulsive exercise, disordered eating, as well as emotional and behavioral correlates of eating disorders. METHODS: Participants were 561 adult volunteers (93 men, 17.09%) aged 19-72 (M = 32.7 ± 11), recruited via social media networks. Participants self-reported on the following measures online: Düsseldorf Orthorexia Scale, Compulsive Exercise Test, Retrospective Child Feeding Questionnaire, Experiences in Close Relationships, Difficulties in Emotional Regulation Scale, Toronto Alexithymia Scale, and Eating Disorder Examination Questionnaire 13. Data were downloaded and analyzed in SPSS26 and Amos26. RESULTS: A theoretical model of the connections between the study variables was tested via SEM and confirmed. The profiles of participants with high, average and low levels of ONs were compared. Participants with the highest levels also scored highest for compulsive exercise, insecure attachment, alexithymia, emotion regulation difficulties, weight and shape concerns, body dissatisfaction, restriction, bingeing, purging and parental feeding practices of concern about child's weight and restricting and monitoring the child's intake of calorie-rich foods. DISCUSSION: High levels of ONs are related to disordered eating attitudes and behaviors, as well as to emotional and behavioral correlates of eating disorders. It is unclear to what extent these ONs are distinguishable from symptoms of other eating disorders listed in the DSM-5. Longitudinal studies may help to elucidate distinct trajectories and risk factors for ON. LEVEL OF EVIDENCE: Level III, case-control analytic study.

Associations between pathological eating, relational attitudes and satisfaction in romantic relationships.

OBJECTIVE: Women with disordered eating report low satisfaction from romantic relationships. We wished to examine whether this may be explained in part by a restricted or inflated sense of relational entitlement, pathological concern and low authenticity levels. METHOD: A community sample of 170 women aged 18-60 (M = 24.89 + 6.22), who had experienced a meaningful romantic relationship, completed questionnaires online. These included measures of disordered eating (EDE-Q), sense of relational entitlement (SRE-R), pathological concern (PCQ), relational authenticity (AIRS) and basic relational needs satisfaction (BNSRS). Structural equation model (SEM) was employed to assess the mediating effect of the SRE-R, PCQ and AIRS on the association between ED symptoms and BNSRS. RESULTS: Participants with high EDE-Q scores tended to score high on inflated and restricted SRE-R, PCQ, AIRS and BNSRS. SRE-R, PCQ and AIRS scores mediated the negative association between EDE-Q and BNSRS scores. CONCLUSIONS: An imbalanced sense of relational entitlement, pathological concern and inauthenticity seem to underlie the dissatisfaction that women with disordered eating experience from romantic relationships. Since these relational characteristics seem to take a high toll on the intimate relationships, it is important to encourage healthy eating attitudes and assertiveness within romantic relationships, in life and in therapy. LEVEL OF EVIDENCE: Level III: evidence obtained from well-designed cohort or case-control analytic studies.

The Eating Disorders Recovery Questionnaire: psychometric properties and validity.

PURPOSE: There is no standardized measurement of recovery from an eating disorder (ED). We examined the psychometric properties and construct validity of the "Eating Disorders Recovery Questionnaire" (EDRQ), which defines recovery beyond symptoms to include self-acceptance, social emotional and physical health. METHODS: Twenty-eight recovery-related items were administered to 978 people (9.5% men) aged 18-76. 172 participants had a current ED diagnosis (AN, BN or BED), 104 had a past ED diagnosis (AN, BN, BED or > one diagnosis), 105 had another past or present ED, and 579 had no lifetime ED. Participants also completed the Eating Disorders Examination Questionnaire, Dresden Body Image Questionnaire-35, Positive and Negative Affect Schedule-Short Form, Patient Health Questionnaire-9, Satisfaction with Life Scale and Positive Eating Scale. RESULTS: Exploratory and confirmatory factor analyses yielded four factors (CFI = 0.93, RMSEA = 0.07): lack of symptomatic behavior, acceptance of self and body, social and emotional connection, and physical health. Group comparisons showed that currently ill women scored lower on EDRQ and positive indices and higher on negative indices than controls and previously ill women. Previously ill women scored similarly to controls on ED symptomatology, positive body experiences, depression, and positive and negative affect but had lower BMI, life satisfaction and positive eating. The EDRQ-EDEQ correlation was r = 0.67, indicating both overlap and distinct variance. CONCLUSION: The EDRQ is a valid, reliable measure of ED recovery, defined more broadly than symptom remission. We recommend its incorporation into a standardized operationalization of recovery and its use by consumers, carers and service providers to monitor ED recovery status. LEVEL OF EVIDENCE: Level III, case-control analytic study.

A longitudinal study of maternal feeding and children's picky eating.

This study aimed to estimate the rate of persistent picky eating (PE) in children 3-8 years of age, and to characterize children with PE and their mothers. From a base sample of 1055 mothers of children 3.4 ± 1.3 years old, we selected those who described their children as picky eaters (PEs; n = 185, 17.5%) for a longitudinal study. 109 PE dyads participated, as well as a matched comparison group of dyads without PE (n = 106). At T1 mothers self-reported on trait anxiety, perfectionism, attachment style; as well as on the child's behavioral problems, their temperament, and their executive function. The participants were re-evaluated twice, at two-year intervals (T2 and T3). At T2 the mothers self-reported on their personality, on their child feeding practices, and reported their child's eating behavior. At T3 the mothers self-reported on their feeding style and the children self-reported on a pictorial frequent food questionnaire. PE persisted throughout T2 and T3 in 22.5% of T1 PE children in the longitudinal study, or in 3.94% of the base sample. The child characteristics that distinguished the PE and non-PE groups at T1 predicted 9-10% of the variance of T3 PE. Maternal feeding practices at T2 contributed 1-2% to the explained variance. It can be concluded that for the overwhelming majority of children, PE is a passing phase. Maternal feeding practices have limited long-term influence on children's PE. Unless PE is persistent and severe, parents would best be advised to relax their feeding efforts.

Is There Anybody Out There? Attachment Style and Interpersonal Facilitators as Protective Factors Against Complicated Grief Among Suicide-Loss Survivors.

Losing a loved one to suicide may have detrimental effects, one of them being suffering from complicated grief (CG). To date, no studies have fully examined the psychological processes that delineate the risk and resilience factors that contribute to CG among suicide-loss survivors (SLSs). We hypothesized that social support and self-disclosure would moderate the relationship between attachment styles and CG for SLS. Questionnaires assessing attachment style, self-disclosure, social support, and CG were completed by 156 SLS participants. A regression model revealed that secure attachment negatively predicted CG, but self-disclosure moderated this association. Secure attachment seems to be a resilient factor for CG. However, SLS with low secure attachment but high in self-disclosure ability use this behavior as a way to impede CG. The capacity to seek out other people, to share experiences with them, and to accept comfort from them may offer a means for SLS to better deal with their tragedy.

Interpersonal theory dimensions facilitate posttraumatic growth among suicide-loss survivors: An attachment perspective.

Many studies have highlighted the deleterious psychological impact of suicide on bereaved individuals. We examined the psychological processes facilitating posttraumatic growth (PTG) among 124 suicide-loss survivors, focusing on attachment styles, perceived burdensomeness, and thwarted belongingness. Securely attached individuals achieved higher PTG than insecurely attached individuals. Perceived burdensomeness and thwarted belongingness both mediated and moderated the associations between attachment and PTG. Anxiously or avoidantly attached individuals who also had a high level of perceived burdensomeness were the least likely to achieve PTG. Thus, these individuals may derive particular benefit from attachment-based therapeutic interventions focusing on interpersonal relationships.

The association between sexual orientation, susceptibility to social messages and disordered eating in men.

OBJECTIVE: Much research points to higher levels of disordered eating and more negative body image in gay and bisexual men than in heterosexual men. The reasons for this difference, however, remain unclear. We hypothesized that disturbed body image and eating attitudes in gay and bisexual men would be partially explained by susceptibility to social messages. METHODS: Two hundred and sixty-two men (203 heterosexual, 46 gay and 13 bisexual) between 18 and 35 years of age participated in the study. They completed measures of disordered eating, body image, internalization of attitudes toward appearance, and concern for appropriateness. In addition, they were asked to what extent they were influenced by ten advertisements, four that emphasized physical appearance, and six that did not. RESULTS: As shown in previous research, gay and bisexual men reported higher levels of disordered eating and dissatisfaction with their bodies than heterosexual men. In addition, the gay and bisexual men were more susceptible than the heterosexual men to social messages, and reported being significantly more influenced than heterosexual men by advertisements focusing on physical appearance, but not by other advertisements. Susceptibility to social messages fully mediated the association between sexual orientation and disordered eating. DISCUSSION: Results provide support for the hypothesis that sensitivity to social messages about appearance explains, at least partially, the link between sexual orientation and disordered eating in men.

My Sister Myself: A Controlled Study of the Relationship Between Women with a Lifetime Diagnosis of Anorexia Nervosa and Their Sisters.

This study focused on the quality of the relationship between women with a lifetime anorexia nervosa (AN) diagnosis and their sisters, in the context of family functioning. Participants were 112 sister pairs including a woman with a lifetime diagnosis of AN, and 356 sister pairs with no history of an eating disorder. Participants completed the Sibling Relationship Questionnaire, Family Environment Scale and Eating Attitudes Test-26. We hypothesised that sister relationships would be less favourably assessed by women with an AN diagnosis than by their sisters, and less favourably assessed overall in the AN sister pairs than in the healthy sib-pair controls. These hypotheses were confirmed. Also, the AN sisters viewed the family as less cohesive and more conflicted than their non-affected sisters. For the AN sisters, there was an inverse relationship between level of current pathology and how favourably they viewed the sister relationship. Sister relationships may suffer during AN and improve as the pathology recedes. This would mean that the quality of sister relationships has clinical significance and may serve as an indicator of recovery. Copyright © 2016 John Wiley & Sons, Ltd and Eating Disorders Association.

Show me your friends, and I shall show you who you are: the way attachment and social comparisons influence body dissatisfaction.

Women with attachment insecurity have greater eating disorder symptoms and poorer prognosis. Socio-cultural agents, such as peers and family, are predictive of the development of body image dissatisfaction (BID). The present study examines the association of insecure attachment styles and direct and indirect social comparisons of body image to women's BID and drive to thinness. Two hundred and eighty three women aged 18-42 years completed online self-reports concerning attachment styles, body mass index (BMI), drive for thinness, body image satisfaction, the Figure Rating Scale (FRS), as well as a modified FRS comparing self to mother, to sister closest in age and to best friend. Hierarchical Linear Models reveal that anxious-ambivalent, but not avoidant attachment style, along with indirect and direct comparisons to best friend and to sister influence drive for thinness and body dissatisfaction, even after controlling for BMI and age. Of all social comparisons, feeling one's best friend is thinner than yourself is the most detrimental to body ideal.

How to enhance nursing students' intention to use information technology: the first step before integrating it in nursing curriculum.

Today, in the 21st century, information technology has an important and critical role in the healthcare delivery system. Nursing educators already know and understand that they should integrate nursing informatics into the nursing curriculum to prepare future nurses for the new world of information technology. However, as of now, the core program of nursing studies in Israel does not put an emphasis on the skills required to properly use nursing informatics. The present research is the first step toward achieving this target by recognizing the importance of the human factor. The main goal is to examine the correlation between nursing students' attitudes and a number of variables: self-efficacy, threat, challenge, and innovativeness. This quantitative study used a convenience sample of nursing students in a bachelor's degree program at a large academic center in central Israel. Results show significant positive correlations between nursing students' attitudes to computer use and self-efficacy, a sense of challenge in using a computer, a sense of threat in using a computer, and previous experience with computers. The insights of these results will benefit nursing educators by helping them find creative ways to expose the students to the world of information technology and to improve the quality of future nurses.

Self-Objectification, Disordered Eating and Sexual Orientation in Men.

The interplay between disordered eating, depressive symptoms and self-objectification differs between genders and sexual orientations, and merits further study in homosexual and heterosexual men. We examined disordered eating, depressive symptoms and self-objectification in a sample of Israeli heterosexual and homosexual men. Participants were 215 men aged 19-65, 108 of whom were classified by the Kinsey scale as being heterosexual and 107 as homosexual. They completed online measures of self-objectification, disordered eating and depressive symptoms. Heterosexual men reported lower levels of disordered eating and self-objectification than homosexual men, however the difference in depressive symptoms was not statistically significant. Correlations between disordered eating, self-objectification and depressive symptoms when controlling for age, BMI and number of children were all significant, with similar patterns of association for heterosexual and homosexual men. Self-objectification partially mediated the association between sexual orientation and disordered eating. However, contrary to our hypothesis, sexual orientation (homosexual/heterosexual) did not moderate the association between disordered eating and self-objectification. The tendency of homosexual men towards self-objectification is linked to unhealthy eating habits. Self-objectification helps explain the propensity of homosexual versus heterosexual men to develop disordered eating and possibly eating disorders. It should therefore be targeted in prevention and in therapy.

The psychometric properties of the Retrospective Child Feeding Questionnaire in Hebrew.

The objective of this study was to develop the Retrospective Child Feeding Questionnaire (RCFQ), and to assess its structural validity. In its original version, the CFQ was constructed to measure current practices of maternal feeding of children. For the present study, the CFQ was translated into Hebrew by translation, independent back-translation, and revision, and was then reworded to assess a retrospective assessment of maternal child feeding practices by adults. A large community sample of volunteers (N=406) was recruited and administered the RCFQ, and self-reported on body satisfaction, disordered eating, and body mass. The structural validity of the RCFQ was established by exploratory and confirmatory factor analysis for men and women. Some measure of construct validity is provided by correlational analysis. The RCFQ is structurally robust, and useful in assessing early influences on adult BMI, eating behavior, and body dissatisfaction.

Nothing gained: an explorative study of the long-term effects of perceived maternal feeding practices on women's and men's adult BMI, body image dissatisfaction, and disordered eating.

The objective of the studies presented here was the prediction of adult body mass index (BMI), body image dissatisfaction, and disordered eating from recalled maternal child feeding practices. Studies 1 and 2 sampled women from the community, and found that recalled childhood feeding practices predicted both current BMI and current disordered eating. Daughters whose mothers pressured them to eat as children had lower BMIs as adults. The more a mother was concerned about her daughter's weight as a child, and the more she restricted fatty food intake, the less the woman was satisfied with her current body image. Disordered eating of adult women was positively related to their mothers' restriction of their fatty food intake as children, and negatively related to the mothers' monitoring of their food intake as children. Combining the samples and subdividing them into four BMI intervals showed that the obese women were higher on all but one of the recalled maternal child feeding practices, as well as on disordered eating and body dissatisfaction. Age was found to be positively related to BMI and drive for thinness, but not to body dissatisfaction or disordered eating, with older women having higher BMI and more drive for thinness. Study 3 sampled adult men from the community and found that recalled maternal child feeding practices predicted adult BMI and disordered eating for men, as well as for women. Considerable sex differences were found for all study variables. Recollection of maternal child feeding practices may have a formative role in the development of body image, disordered eating, and BMI for men and women, even into adulthood.

Relational attitudes in adolescent girls with and without a diagnosis of anorexia nervosa or atypical anorexia nervosa.

BACKGROUND: People with eating disorders experience interpersonal difficulties, but little research explores relational attitudes in this population. We examined sense of relational entitlement towards parents, pathological concern, and psychological distress in adolescent girls with and without anorexia nervosa (AN) or atypical anorexia nervosa (AAN). METHODS: Questionnaires assessing sense of entitlement towards parents, pathological concern, and symptoms of depression and anxiety were completed by 85 girls with and 100 girls without AN/AAN (mean age 15.06 ± 1.41). The AN/AAN group also completed a measure of ED pathology. RESULTS: Eating pathology, pathological concern and symptoms of depression and anxiety were positively associated with both restricted and inflated sense of entitlement towards parents. AN/AAN participants scored significantly higher than controls on restricted and inflated sense of entitlement, pathological concern and symptoms of depression and anxiety. Restricted sense of entitlement and pathological concern partially mediation the association between AN/AAN and symptoms of depression and fully mediated the association between AN/AAN and anxiety. Within the AN/AAN group, pathological concern and symptoms of depression explained a large proportion of the variance in ED pathology. CONCLUSIONS: Adolescent AN/AAN takes a heavy toll on emotional and social health, perhaps in part because crucial aspects of relational mutuality fail to develop. Teens with AN/AAN tend to over-focus on their parents' needs at the expense of their own needs. They also have impaired capacity to realistically appraise expectations from their parents, tending to feel over- and/or under-entitled to need fulfillment. These relational attitudes are associated with symptoms of depression and anxiety and should be addressed in therapy.

In healthy relationships people trust another person to fulfill some but not all their needs. It is maladaptive to expect the fulfillment of all needs (inflated entitlement) or of no needs (restricted entitlement). Restricted entitlement generally masks frustration and an unconscious wish for need fulfillment, so that restricted and inflated entitlement can co-occur. We examined to what degree 85 adolescent girls with a restricting ED and 100 without an ED felt entitled to need fulfillment by their parents, and to what extent they sacrificed their own needs for their parents'. Girls with an ED reported higher levels of both restricted and inflated entitlement from their parents than the other girls, and reported placing their parents' needs before their own more often. The more restricted and/or inflated their entitlement was, the more they tended to place their parents' needs before their own, to have severe ED symptoms and to feel depressed and anxious. Teens with EDs may over-focus on their parents' needs at the expense of their own and feel they deserve to have all or none of their needs fulfilled by their parents. These relational attitudes are associated with symptoms of depression and anxiety and should be addressed in therapy.

Dropout from Mental Health Treatment Among Asylum-Seekers in Israel: A Retrospective Chart Study.

Dropout from psychiatric treatment and psychotherapy is common among asylum-seekers, even though they are at increased risk of emotional distress and psychiatric disorders. We aimed to define the associations between demographic and clinical variables and dropout among asylum-seekers in Israel. In this retrospective chart review we initially examined 271 files from Gesher (Bridge, in Hebrew), a government psychiatric clinic for asylum-seekers. All cases were considered eligible provided data were sufficient and asylum-seeker status could be ascertained. Of the 101 files included in the analysis, comparisons between patients who dropped out and patients who continued treatment were made, and logistic regression for dropout risk was conducted. In the study sample, 27 patients (26.7%) dropped out of treatment. Diagnosis of psychotic spectrum disorder and shorter time in Israel were significantly associated with dropout. Parenthood was significantly associated with dropout for men, but not for women. Defining factors associated with dropout and adherence to therapy for asylum-seekers may help improve ambulatory mental health services and the outcomes of treatment for this population.

Evaluation of the capacity of inpatients with chronic schizophrenia to provide informed consent for participation in clinical trials; use of the Hebrew version of the MacArthur Competence Assessment Tool for Clinical Research (MacCAT-CR).

BACKGROUND: Patient protection requires the provision of informed consent for participation in medical research. The MacArthur Competence Assessment Tool for Clinical Research (MacCAT-CR) is frequently used for screening the capacity of research subjects to consent to participate in research. OBJECTIVES: To evaluate the utility of the Hebrew translation of the MacCAT-CR for assessing the capacity of patients with chronic schizophrenia to provide informed consent to participate in clinical trials. METHODS: We evaluated the translated MacCAT-CR by comparingthe capacity of patients with chronic schizophrenia to provide informed consent to participate in clinical trials. The following standardized neurocognitive assessment tools were used: Addenbrooke's Cognitive Examination (ACE) and Frontal Assessment Battery (FAB), as well as the attending doctor's assessment. RESULTS: Twenty-one patients participated. Mean MacCAT-CR score was 12 +/- 10.57 (range 0-32), mean FAB score 9.9 +/- 4.77 (range 1-18), mean ACE 59.14 +/- 16.6 (range 27-86) and mean doctor's assessment 5.24 +/- 1.18 (range 3-7). CONCLUSIONS: The Hebrew version of the MacCAT-CR helped identify patients with the capacity to provide informed consent for participation in research. Patients with FAB scores > or = 12 tended to score higher on the Hebrew version of the MacCAT-CR, thus confirming the utility of the Hebrew version of the MacCAT-CR. During the screening process for clinical trials it may be practical to administer the concise FAB questionnaire, and then administer the MacCAT-CR only to those who scored > or = 12 on the FAB.

Associations of self-repression with disordered eating and symptoms of other psychopathologies for men and women.

BACKGROUND: Disordered eating has been found to be associated with constructs involving self-repression, such as selflessness (the tendency to relinquish one's needs for others'), and concern for appropriateness (an alertness to information about social comparison and tendency to vary one's behavior in different social situations). This study aimed to examine associations between these self-repression variables and symptoms of general psychopathology for women and men in a community sample. METHODS: Two hundred and thirty-six participants (92 men) aged 18-76 (M = 29.11 ± 10.10) volunteered to complete online measures of disordered eating, concern for appropriateness (cross-situational variability and attention to social comparison information), selflessness, and symptoms of depression, anxiety and somatization. Structural equation models were built to assess pathways between the study variables for men and women separately. RESULTS: A MANOVA 2*7 design showed that women scored significantly higher than men on measures of selflessness, disordered eating and depression. For men, selflessness scores were positively and significantly associated only with depression scores. Cross-situational variability scores were positively associated with depression, somatization and anxiety scores. For women, selflessness scores were positively and significantly associated with depression, disordered eating, somatization and anxiety scores. Cross-situational variability scores were positively and significantly associated with depression, anxiety and somatization scores but not with disordered eating scores. Attention to Social Comparison Information scores were positively and significantly associated only with disordered eating scores. CONCLUSIONS: Self-repression is more closely linked to psychopathology in women than in men. For men, self-suppression seems to be associated with symptoms of internalizing disorders, but not disordered eating. Even for women, it appears that self-repression is not connected exclusively with disordered eating, but with symptoms of psychopathology in general. Future research should explore why self-suppression plays such a central role in women's psychopathology.

The psychometric properties of the Varieties of Inner Speech Questionnaire-Revised in Hebrew.

Introduction: The Varieties of Inner Speech Questionnaire-Revised (VISQ-R) is a self-report questionnaire designed to measure characteristics of inner speech. In the current study, we adapted and validated a Hebrew version of VISQ-R. Our first hypothesis was that Confirmatory Factor Analysis (CFA) of the Hebrew VISQ-R would confirm the five subscales replicating the factor structure of the original questionnaire. In addition, building on previous findings that inner speech is involved in tasks that require the executive functions we examined the relationship between VISQ-R and self-reported executive functions questionnaire (BRIEF-A). We hypothesized that correlations between subscales of the Hebrew VISQ-R would reveal covariance between BRIEF-A and some but not all inner speech subscales. Methods: 406 participants completed the Hebrew VISQ-R and 280 of them also completed the BRIEF-A. Results: As hypothesized, CFA confirmed the factor structure revealing the same 5 subscales reported in the original English version, with acceptable internal reliability. Partial support was found for the hypothesized correlations between VISQ-R and BRIEF-A, with covariance of executive functions with some subscales of inner speech (Evaluative, Other-People and Dialogic), and distinct variance with others (Condensed and Positive). Discussion: These results indicate that the Hebrew version of the VISQ-R has good psychometric properties and that it can be used in future research. The implications concerning the contribution of inner speech for people with difficulties in executive functions are discussed.

Sense of Relationship Entitlement of Aging Parents Toward Their Offspring (SRE-ao)-A New Concept and Measurement Tool.

Our sense of entitlement influences our interactions and attitudes in a range of specific relational contexts, one of them being aging parents' relationships with their adult children. This study aimed to examine the factor structure of the Sense of Relational Entitlement-aging parents toward their offspring (SRE-ao), an 11-item questionnaire that assesses aging people's sense of relational entitlement toward their children, and examine the associations of its subscales with related personality and mental health constructs. One thousand and six participants (24.6% men), aged 65-99, with at least one child, completed the SRE-ao, Brief Symptom Inventory, Loneliness Scale, and General Belongingness scale. The SRE-ao demonstrated good construct structure using confirmatory factor analysis. Both SRE-ao subscales (restricted and inflated sense of entitlement) were significantly and positively associated with anxiety, depression, somatization and sense of loneliness and negatively with sense of belonging. When all variables were entered into a regression model, age, anxiety, and low sense of belonging, but not sense of loneliness, positively predicted both restricted and inflated sense of entitlement. Somatization negatively predicted inflated sense of entitlement. The SRE-ao is a reliable and valid scale that can be used in clinical practice and research to enhance our understanding of parent-child relationships throughout the lifespan.