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Do dysfunctional coping modes mediate the relationship between perceived parenting style and disordered eating behaviours?

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Background: Preliminary studies suggest that both childhood experiences and coping behaviours may be linked to eating disorder symptoms. Methods: In this study maladaptive schema coping modes were investigated as mediators in the relationship between perceived negative parenting and disordered eating. A total of 174 adults with eating and/or body image concerns completed questionnaires measuring parenting experiences, schema modes, and disordered eating behaviours. Results: Perfectionistic Overcontroller, Self-Aggrandiser, Compliant Surrenderer, Detached Protector and Detached SelfSoother coping modes partially explained the variance in the relationships between perceived negative parenting experiences and the behaviours of restricting and compensation (purging and overexercising). Conclusions: Our findings suggest that Overcompensatory, Avoidant and Surrender coping mechanisms all appear to play a role in the maintenance of eating disorder symptoms, and that there are multiple complex relationships between these and Early Maladaptive Schemas that warrant further investigation. Full text available free at: http://rdcu.be/mjFR
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R E S E A R C H A R T I C L E Open Access
Do dysfunctional coping modes mediate
the relationship between perceived
parenting style and disordered eating
behaviours?
Jessica M. Brown
1
, Stephanie Selth
2
, Alexander Stretton
3
and Susan Simpson
2*
Abstract
Background: Preliminary studies suggest that both childhood experiences and coping behaviours may be linked to
eating disorder symptoms.
Methods: In this study maladaptive schema coping modes were investigated as mediators in the relationship between
perceived negative parenting and disordered eating. A total of 174 adults with eating and/or body image concerns
completed questionnaires measuring parenting experiences, schema modes, and disordered eating behaviours.
Results: Perfectionistic Overcontroller, Self-Aggrandiser, Compliant Surrenderer, Detached Protector and Detached Self-
Soother coping modes partially explained the variance in the relationships between perceived negative parenting
experiences and the behaviours of restricting and compensation (purging and overexercising).
Conclusions: Our findings suggest that Overcompensatory, Avoidant and Surrender coping mechanisms all appear to
play a role in the maintenance of eating disorder symptoms, and that there are multiple complex relationships between
these and Early Maladaptive Schemas that warrant further investigation.
Keywords: Eating disorders, Schema modes, Coping, Parenting, Schema Therapy
Plain english summary
In this study, we investigated whether perceived childhood
parenting experiences and coping mechanisms played a
role in the development of eating disorder symptoms in a
group of 174 participants who indicated that they had diffi-
culties with eating and/or body image. The maladaptive
coping mechanisms of perfectionism, avoidance, and com-
pliance partially explained the relationship between per-
ceived negative parenting experiences and restriction/
purging/overexercising. Schema Therapy may therefore be
an appropriate treatment that can address developmental
factors associated with parenting, alongside here-and-now
maintaining factors, including core beliefs and coping style.
Background
Eating disorders are considered one of the most difficult
psychopathologies to treat, due to high levels of complex-
ity, ego-syntonicity, chronicity, and heterogeneity [1, 48].
Comorbidity with other mental health disorders is high,
including anxiety, mood and substance misuse disorders
[5, 11, 34] and personality disorders [8]. Although Cogni-
tive Behavioural Therapy (CBT) is the treatment of choice
for eating disorders (EDs), a significant number of suf-
ferers do not respond [2]. Anorexia Nervosa in particular
remains exceptionally difficult to treat, with Enhanced
CBT outcome trials reporting low remission and high at-
trition rates [9, 10, 18, 19]. Given the limited efficacy of
maintenance models such as CBT in the treatment of
EDs, especially for those with higher comorbidity and se-
verity, deeper level factors are now a focus of the ED lit-
erature [22], and there is a need for new and innovative
therapeutic models to improve our conceptualization and
treatment of the eating disorders [13, 55].
* Correspondence: susan.simpson@unisa.edu.au
2
Psychology Clinic, School of Psychology, Social Work, and Social Policy,
University of South Australia, Magill Campus, GPO Box 2471, Adelaide 5001,
SA, Australia
Full list of author information is available at the end of the article
© The Author(s). 2016 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0
International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and
reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to
the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver
(http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
Brown et al. Journal of Eating Disorders (2016) 4:27
DOI 10.1186/s40337-016-0123-1
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
Schema Therapy encapsulates developmental, mainten-
ance, and deeper level themes and was developed to
conceptualise complex psychopathology with high comor-
bidity, including personality disorders [57]. Early maladap-
tive schemas (EMS) are defined as unconditional, implicit,
and irrefutable cognitive beliefs that result from unmet
core needs and repeated negative experiences with signifi-
cant others during childhood and adolescence [57]. EMS
act as frameworks for understanding interpersonal rela-
tionships and life experiences [28]. Schema modes are de-
fined as the states or parts of the personality and coping
mechanisms that manifest moment-to-moment. Further,
there is preliminary, though limited, empirical support for
the application of the schema model to ED populations
[29, 40, 41]. Specifically, research has linked EMS and
schema processes to ED pathology, and ED populations
have been found to score higher on EMS [22, 25, 52] and
schema modes [45, 49] than non-clinical populations. Pre-
liminary studies suggest that the Compliant Surrenderer,
and two avoidant coping modes, Detached Self-Soother
and Detached Protector, appear to be higher in the ED
population than in non-clinical populations [45] and other
clinical groups [49].
Preliminary studies have also reported a link be-
tween negative parenting experiences particularly
emotional abuse and invalidation and ED pathology
[17, 24, 25, 47, 53]. Further, emerging evidence sug-
gests EMS and schema coping processes may explain
the link between adverse childhood experiences and
the onset of ED pathology [15, 36, 47]. Turner et al.
[47] found high maternal over-protection and low pa-
ternal care were significantly related to the Defectiveness
and Dependenceschemas. In turn, Defectiveness and De-
pendence mediated the relationship between parental
bonding and ED symptoms. Similarly, Deas et al. [15] found
participants with AN had significantly more EMS par-
ticularly perfectionistic schemas - and perceived their
parents as less caring and more controlling than healthy
controls. Sheffield et al. [36] also found the variables of
social control (an over-compensation process) and
behavioural-somatic avoidance (an avoidance process) to
partially mediate correlations between particular negative
parenting experiences and ED pathology. This is the first
studytoourknowledgethathasexploredtheroleofdys-
functional coping modes in explaining the relationship be-
tween parenting and ED behaviours.
The current study aimed to extend the literature by
investigating whether dysfunctional coping modes mediate
the relationship between perceived negative parenting and
the ED behaviours of restricting, binging, and overcom-
pensation (purging and overexercising). Schema coping
modes were selected as a key variable since they amalgam-
ate EMS and schema processes into a unified construct,
both of which have been empirically linked to ED
pathology [22, 25, 27]. The three overarching coping mech-
anisms that encompass the coping modes are Surrender
(Compliant Surrenderer mode), Overcompensation(Perfec-
tionistic Overcontroller mode, Self Aggrandiser Mode, Bully
and Attack Mode), and Avoidance(Detached Protector,
Detached Self-Soother). Based on the aforementioned pre-
liminary research, it is hypothesized that perceived negative
parenting experiences will be positively correlated with both
ED behaviours and dysfunctional coping modes, with
behaviours and coping modes also positively correlated. It is
further hypothesized that dysfunctional coping modes will
mediate the relationship between (a) perceived negative
parenting and (b) ED behaviours.
Method
Participants
Given the high prevalence of ED behaviours (full and
subthreshold) within the general population [20] the
current study recruited participants through advertise-
ments on ED and psychology pages and groups on Lin-
kedIn and Facebook, requesting individuals aged 18 to
65 who held concerns about their eating behaviours, eat-
ing attitudes, and/or body image to take part in an on-
line survey exploring how perceptions of parenting may
impact the development of specific coping modes which
may in turn influence eating and body image. The adver-
tisement included a link to the survey which participants
were invited to complete online through Survey Mon-
key. In all, 187 participants completed the study ques-
tionnaire. Thirteen participants were excluded as they
failed to meet the key selection criteria of eating and/or
body image concerns, as measured by the Eating dis-
order diagnostic scale (EDDS; [44]).
The final sample included 174 participants ranging in
age from 18 to 65 years (m = 28.6, SD = 9.2). Participant
demographics, including diagnoses of EDs, are presented
in Table 1. Diagnoses were made using self-report re-
sponses on the EDDS following the Diagnostic and Statis-
tical Manual of Mental Disorders (5
th
ed.; DSM-5; [3])
criteria. However, eating disorder behaviours rather than
diagnoses were used as outcome variables. 129 partici-
pants met the criteria for an Other Specified Feeding or
Eating Disorder (OSFED), with 14.4 % (25) of these
reporting a BMI of 18.5 or less. Along with the fact that
none of the sample met criteria for full threshold Bulimia
or Binge Eating Disorder, it appears that a high proportion
of the sample were engaging in significant food restriction,
with binge eating being underrepresented.
Instruments
Young Parenting Inventory-Revised (YPI-R; [37])
The YPI-R assesses perceived negative parenting. The YPI-
R is a 37-item questionnaire measuring perceived parent-
ing styles, namely: emotionally depriving; overprotective;
Brown et al. Journal of Eating Disorders (2016) 4:27 Page 2 of 10
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belittling; perfectionist; pessimistic/fearful; controlling;
emotionally inhibited; punitive; and conditional/narcissis-
tic. Items relating to each style were rated using two 6-
point Likert scales one for perceptions of the mother
and one for the father. Scores for each style were deter-
mined by summing the answers of items associated with
each style, with higher scores indicating greater percep-
tions of that parenting style occurring. The YPI-R has been
shown to be a reliable and valid measure of perceived par-
enting [37].
Schema Mode Inventory (SMI, [56])
The SMI is a 124-item self- report measure assessing: child
modes (vulnerable and emotional states), dysfunctional
coping modes (Compliant Surrenderer, Detached Self-
So o t h e r, Detached Pro t e c t o r, Self-aggr a n d izer, and Bully / a t-
tack), parent modes (the Punitive and Demanding modes),
and adaptive modes (the Healthy Adult). In this study only
the dysfunctional coping modes were explored. In addition,
eleven items were added to the SMI to measure the Perfec-
tionistic Overcontroller coping mode. These items had
been removed from the original SMI after analyses showed
it did not emerge as a separate factor. However, as original
analyses were not conducted specifically with an ED popu-
lation, it was considered prudent to re-include it in this
study due to the clinical observation that perfectionism is
typical in this population [15, 39, 50, 51]. Participants rated
how frequently each statement applied to them on a 6-
point Likert scale, ranging from never or almost neverto
all of the time. Scores for each dysfunctional coping mode
were calculated using the mean score of all items related to
that mode. Lobbestael et al. [26]) indicated good internal
consistencies (Cronbachsαranging from .76 to .96), and
test-retest validity (mean ICC =. 84).
Eating Disorder Diagnostic Scale (EDDS; [44])
The EDDS is a 22-item self-report measure of full and
sub-threshold Anorexia Nervosa, Bulimia Nervosa, and
Binge Eating Disorders. Research evidence shows the
EDDS has high internal consistency (α= .89) and test-
retest reliability (0.87) and is a valid measure when used
with both adolescents and adults [43, 44]. In addition, sub-
scales on the Eating Disorder Examination [12] correlate
moderately with total EDDS scores, and concordance be-
tween diagnoses made by these methods is high, ranging
from 93 % for Binge Eating Disorder to 99 % for Anorexia
Nervosa [44]. Participants were asked to estimate over the
past 3 months how often each week on average they had
engaged in binge-eating, excessive exercise, vomiting, fast-
ing and used laxatives or diuretics (range: 014). As the
current study used a general population sample, ED be-
haviours (restriction, binge-eating, compensatory behav-
iours (over-exercise, purging), rather than diagnoses, were
used as outcome variables.
Procedure
Design
The study used a quantitative, cross-sectional survey
design.
Statistical power
As the Schema Mode Inventory (SMI) has not been vali-
dated for use with ED populations, statistical power was
estimated from previous studies using the SMI with per-
sonality disorder samples that reported moderate effects
(d = 0.56: [33]). Given a medium effect size, power of
.80, and an alpha level of .05, G*Power [16] software cal-
culated a minimum of 129 participants were required
for the study.
Ethical considerations
The University of South Australias Human Research
Ethics Committee approved the study.
Table 1 Participant Demographic Information (N= 174)
Frequency Percentage
Nationality
Australian 76 43.7
American 20 11.5
New Zealander 12 6.9
Canadian 11 6.3
Hispanic 5 2.9
Asian 10 5.7
British 34 19.5
Mainland European 6 3.4
Sex
Male 12 7
Female 162 93
Currently Consulting a Mental Health Professional
Yes 53 30.5
No 121 69.5
Consulted a Mental Health Practitioner in the Past
Yes 118 67.8
No 56 32.2
Eating Disorder Diagnostic Scale Diagnosis
No diagnosis 32 18.4
Full threshold AN 9 5.2
OSFED 133 76.4
AN Anorexia Nervosa, OFSED Other Specified Feeding or Eating Disorder
*Note: Eating disorder diagnoses were determined using criteria outlined by
the Diagnostic and Statistical Manual of Mental Disorders, 5
th
Edition [3] using
participant responses to the Eating Disorder Diagnostic Scale [44]
Brown et al. Journal of Eating Disorders (2016) 4:27 Page 3 of 10
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Statistical analyses
Descriptive statistics and correlational analyses were con-
ducted using the Statistical Packages for the Social Sci-
ences (SPSS) version 21. Bootstrap mediation methods
outlined by Preacher and Hayes [31] were used to analyse
the mediating role of dysfunctional coping modes in the
relationship between perceived negative parenting experi-
ences and disordered eating. This involved calculating the
direct effect (c) of perceived negative parenting experi-
ences (a) on disordered eating (b), followed by calculating
the total effect (c) of that same relationship, modelling in
the mediator variable, and finally calculating the indirect
effect (a x b) of the relationship through the mediator
variable (dysfunctional coping mode). The mediation clas-
sification decision tree developed by Zhao et al. [58] was
used to determine the type of mediation and the theoret-
ical implications. Five thousand bootstrap re-samples
using the bias-corrected and accelerated bootstrap
method were applied to all indirect effect analyses, which
were conducted using the AMOS Graphics Software [4],
Version 20. This method affords a number of benefits
when compared to the Sobel test, including increased stat-
istical power, the ability to detect indirect effects when dir-
ect effects are not detected, and the ability to conduct
significance tests on the indirect effect without the need
for normally distributed variables [58]. Complementary
mediation is synonymous with partial mediation [58].
Results
Descriptive statistics
Descriptive statistics including the mean and standard
deviations for each variable and internal consistency
analysis are included in Table 2.
Correlational analyses
Pearson correlational analyses between perceived negative
parenting experiences, specific coping modes, and disor-
dered eating are presented in Table 3. Both restricting and
compensatory behaviour were weakly correlated with a
variety of different perceived negative parenting experi-
ences, however binge eating was not correlated at all and
was thus excluded from the mediation analysis. All dys-
functional coping styles, with the exception of Bully/at-
tack, were weakly to moderately correlated with several
different parenting experiences, with the strongest correla-
tions seen between the Perfectionistic Overcontroller and
both controlling and conditional/narcissistic father, De-
tached Self-soother with belittling, emotionally depriving
and emotionally inhibited mother, and both the Compliant
Surrenderer and Detached Protector with emotionally
inhibited mother. Restriction was weakly to moderately
correlated with all dysfunctional coping modes except
Bully/attack, with the strongest correlation being with Per-
fectionistic Overcontroller. Binge eating was only weakly
correlated with a single mode the Detached Protector.
Finally, compensatory behaviour was strongly correlated
with the Detached Protector, with weak to moderate cor-
relations with all other dysfunctional coping modes.
Model and mediation analyses
In the first instance a model was run to assess the percent-
age of variance explained in disordered eating by the
schema modes in the present study. Together the six
schema modes explained 18 % of the variance in restricting,
23 % of the variance in binging and 23 % of the variance in
purging/overexercising.
All significant correlations between perceived negative
parenting variables and ED behaviours were investigated to
determine whether dysfunctional coping modes mediated
the relationships. Given the large number of correlations
performed a more stringent significance level (p< .01) was
set to determine inclusion of specific perceived negative
parenting styles in the mediation analyses. As Table 4
shows, the relationships between perceived negative par-
enting experiences and restricting were mediated by both
the Perfectionistic Overcontroller and Self-Aggrandiser,
with the former fully mediating four relationships between
perceived parenting styles and restricting. The Perfectionis-
tic Overcontroller and Self-Aggrandiser also mediated the
Table 2 Descriptive statistics for the dysfunctional coping modes
(SMI, [56]), perceptions of negative parenting experiences (YPI-R;
[37]) and eating disorder behaviours (EDDS; [44])
αMean (N= 174) SD
Perfectionistic Overcontroller .80 3.73 .83
Self-Aggrandiser .77 2.80 .75
Bully and Attack .71 1.98 .62
Compliant Surrenderer .84 3.72 .97
Detached Protector .90 2.99 1.05
Detached Self-Soother .75 3.68 1.06
Overprotective father .80 2.46 1.06
Pessimistic/fearful father .79 2.86 1.30
Controlling father .79 2.23 1.27
Conditional/narcissistic father .83 3.14 1.40
Emotionally depriving father .93 3.55 1.48
Belittling mother .94 2.22 1.31
Emotionally inhibited mother .84 3.14 1.50
Punitive mother .83 3.32 1.52
Conditional/narcissistic mother .82 3.27 1.38
Emotionally depriving mother .92 2.92 1.31
Perfectionistic mother .64 3.75 1.20
Restricting - 3.22 4.02
Binging - 2.39 2.90
Compensatory Behaviour - 4.93 6.78
Brown et al. Journal of Eating Disorders (2016) 4:27 Page 4 of 10
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
relationships between perceived negative parenting and
compensatory behaviour, although the Self-Aggrandiser
explained very little variance. The coping mode of Bully/
attack was not correlated with any perceived negative par-
enting variables and was thus excluded from mediational
analysis. The Compliant Surrenderer was found to medi-
ate the relationships between negative parenting and both
restricting and compensatory behaviour. The Detached
Protector and Detached Self-Soother further mediated the
relationships between perceived negative parenting experi-
ences and both restriction and compensatory behaviour.
Discussion
To our knowledge, the current study is the first to explore
the relationship between parenting, dysfunctional coping
modes, and ED behaviours. Findings from this study
highlight the role of the dysfunctional coping modes Perfec-
tionistic Overcontroller, Self-Aggrandiser, Compliant Sur-
renderer, Detached Self-Soother and Detached Protector
which partially explained the variance in the relationship
between perceived negative parenting experiences and both
restriction and compensatory behaviours in this sample.
These findings build on previous research highlighting the
potentially important relationship between coping
processes and eating disordered behaviours [36, 45], and
suggest that negative parenting behaviours that interfere
with meeting the core emotional needs of childhood may
not only be associated with the development of EMS but
may also influence eating behaviours via the coping modes
that the individual adopts.
The association between coping modes and both
restricting and compensatory behaviour suggests that dis-
ordered eating is likely to fulfil a range of functions. Previ-
ous studies have suggested that eating disorder behaviours
may function either as primary or secondary avoidance
strategies, whereby individuals restrict, purge or overexer-
cise in a compulsive or ritualised manner [7, 14, 21, 46]
either as a means to reduce the chances of schema activa-
tion, or as a secondary strategy to block emotional distress
that results from bingeing or other dietary transgressions
[38, 39, 54]. Within the context of the Detached Pro-
tector/Self-Soother modes, restrictive and compensatory
eating behaviours can function as a form of primary or
secondary emotional avoidance whilst generating soothing
feelings of numbness, or in some cases euphoria [23, 42].
In contrast, in Compliant Surrenderer mode, eating disor-
dered behaviours may function as a form of passive com-
pliance in deference to negative self-beliefs (associated
Table 3 Correlations between perceived negative parenting experiences and mediator and outcome variables
Perceived negative
parenting
experience
Correlations between mediation variables
Restricting Compensatory
behaviour
Binging Perfectionistic
overcontroller
Self
aggrandiser
Compliant
surrenderer
Detached
self-soother
Detached
protector
Bully and
attack
Overprotective
father
.281
a
.090 -.026 .196
a
.182
b
.162
b
.293
a
.156
b
.140
Pessimistic/fearful
father
.209
a
.042 .041 .212
a
.151
b
.140 .268
a
.192
b
.129
Controlling father .201
a
.113 -.046 .305
a
.147 .248
a
.260
a
.279
a
.183
b
Conditional/
narcissistic father
.282
a
.205
a
.005 .323
a
.276
a
.196
a
.271
a
.203
a
.181
b
Emotionally
depriving father
.109 .113 .072 .220
a
.082 .278
a
.231
a
.261
a
.120
Belittling mother .197
a
.242
a
-.037 .258
a
.154
b
.280
a
.336
a
.282
a
.185
b
Emotionally
inhibited mother
.250
a
.265
a
-.020 .261
a
.126 .305
a
.307
a
.299
a
.102
Punitive mother .192
b
.216
a
-.155 .256
a
.198
a
.273
a
.238
a
.184
b
.173
b
Conditional/
narcissistic mother
.280
a
.280
a
-.092 .207
a
.220
a
.258
a
.284
a
.172
b
.183
b
Emotionally
depriving mother
.177
b
.191
b
-.090 .249
a
.046 .261
a
.299
a
.276
a
.109
Perfectionistic
mother
.181
b
.226
a
.041 .138 .330
a
.257
a
.207
a
.173
b
.172
b
Restricting - .508
a
-.054 .431
a
.195
a
.347
a
.286
a
.376
a
.026
Compensatory
Behaviour
.508
a
- .139 .429
a
.224
a
.361
a
.368
a
.518
a
.253
a
Binging -.054 .139 - -.104 -.077 -.004 .103 .152
b
.008
a
Significant at the .01 level
b
Significant at the .05 level
Brown et al. Journal of Eating Disorders (2016) 4:27 Page 5 of 10
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Table 4 Perceived negative parenting experiences and disordered eating mediated by schema modes
Direct effect (c) Total effect (c) Indirect effect (a x b) 95 % CI Type of mediation
Perceived negative parenting and restricting mediated by perfectionistic controller
Overprotective father .290
a
.211
a
.079
a
.028 / .148 Complementary
Pessimistic/fearful father .214
a
.127 .087
a
.030 / .157 Full
Controlling father .204
a
.077 .128
a
.070 / .201 Full
Conditional/narcissistic father .284
a
.163
b
.122
a
.065 / .195 Complementary
Belittling mother .205
a
.112 .093
a
.036 / .166 Full
Emotionally inhibited mother .251
a
.144
b
.107
a
.049 / .182 Complementary
Punitive mother .200
a
.096 .104
a
.048 / .177 Full
Conditional/narcissistic mother .285
a
.202
a
.083
a
.029 / .151 Complementary
Perceived negative parenting and compensatory behavior mediated by perfectionistic controller
Emotionally depriving mother .191
b
.090 .101
a
.045 / .175 Full
Conditional/narcissistic mother .280
a
.199
a
.080
a
.026 / .153 Complementary
Punitive mother .216
a
.114 .102
a
.044 / .184 Full
Emotionally inhibited mother .265
a
.165
b
.101
a
.044 / .179 Complementary
Belittling mother .242
a
.141
b
.101
a
.042 / .178 Complementary
Perfectionistic mother .226
a
.170
b
.056
b
.004 / .127 Complementary
Perceived negative parenting experiences and restricting mediated by Self-Aggrandiser
Overprotective father .290
a
.262
a
.028
b
.002 / .083 Complementary
Pessimistic/fearful father .214
a
.188
b
.026
b
.002 / .082 Complementary
Controlling father .204
a
.178
b
.026
b
.001 / .085 Complementary
Conditional/narcissistic father .284
a
.249
a
.035 -.003 / .100 No mediation
Belittling mother .205
a
.175
b
.030
b
.003 / .081 Complementary
Emotionally inhibited mother .251
a
.228
a
.023
b
.000 / .074 Complementary
Punitive mother .200
a
.167
b
.032
b
.004 / .086 Complementary
Conditional/narcissistic mother .285
a
.253
a
.032
b
.001 / .088 Complementary
Perceived negative parenting experiences and compensatory behaviour mediated by Self-Aggrandiser
Emotionally depriving mother .191
b
.181
b
.010 -.018 / .055 No mediation
Conditional/narcissistic mother .280
a
.242
a
.038
b
.006 / .091 Complementary
Punitive mother .216
a
.179
b
.037
b
.006 / .092 Complementary
Emotionally inhibited mother .265
a
.241
a
.024
b
.000 / .075 Complementary
Belittling mother .242
a
.213
a
.030
b
.003 / .078 Complementary
Perfectionistic mother .226
a
.170
b
.056
b
.008 / .122 Complementary
Perceived negative parenting experiences and restricting mediated by Compliant Surrenderer
Overprotective father .290
a
.240
a
.050
b
.002 / .119 Complementary
Pessimistic/fearful father .214
a
.171
b
.043
b
.002 / .105 Complementary
Controlling father .204
a
.122 .082
a
.028 / .161 Full
Conditional/narcissistic father .284
a
.227
a
.058
b
.011 / .132 Complementary
Belittling mother .205
a
.131 .074
a
.022 / .160 Full
Emotionally inhibited mother .251
a
.153
b
.098
a
.042 / .191 Complementary
Punitive mother .200
a
.111 .089
a
.039 / .166 Full
Conditional/narcissistic mother .285
a
.203
a
.081
a
.032 / .161 Complementary
Perceived negative parenting experiences and compensatory behaviour mediated by Compliant Surrenderer
Emotionally depriving mother .191
b
.104 .087
a
.037 / .166 Full
Conditional/narcissistic mother .280
a
.200
a
.080
a
.034 / .146 Complementary
Brown et al. Journal of Eating Disorders (2016) 4:27 Page 6 of 10
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
with EMS) and the ED voice,therebysurrendering control
to the disorder [32, 35].
Further, this study highlights the potential import-
ance of the Perfectionistic Overcontroller mode,
whereby via a focus on controllable behavior (i.e. re-
strictive eating rituals and perfectionism) the individ-
ual may overcompensate for underlying vulnerability
and shame by replacing it with predictability,
certainty, and a pseudo-sense of competence/self-
worth [39, 53]. This supports previous research
asserting the overcompensatory role of eating
disordered behaviours (e.g. [6, 30]). Although the
Self-Aggrandiser mode also functions as a form of
overcompensation, this mode was endorsed at a rela-
tively low level and only weakly correlated with eating
behaviours, consistent with previous findings [45, 49].
Table 4 Perceived negative parenting experiences and disordered eating mediated by schema modes (Continued)
Punitive mother .216
a
.127 .089
a
.043 / .156 Full
Emotionally inhibited mother .265
a
.171
b
.094
a
.047 / .170 Complementary
Belittling mother .242
a
.153
b
.089
a
.040 / .158 Complementary
Perfectionistic mother .226
a
.142 .083
a
.036 / .152 Full
Perceived negative parenting experiences and restricting mediated by Detached Protector
Overprotective father .290
a
.234
a
.056
b
.009 / .123 Complementary
Pessimistic/fearful father .214
a
.146
b
.068
a
.022 / .138 Complementary
Controlling father .204
a
.103 .101
a
.046 / .179 Full
Conditional/narcissistic father .284
a
.218
a
.067
a
.019 / .139 Complementary
Belittling mother .205
a
.095 .110
a
.054 / .186 Full
Emotionally inhibited mother .251
a
.144
b
.107
a
.049 / .190 Complementary
Punitive mother .200
a
.133 .066
a
.016 / .137 Full
Conditional/narcissistic mother .285
a
.220
a
.064
a
.016 / .135 Complementary
Perceived negative parenting experiences and compensatory behaviour mediated by Detached Protector
Emotionally depriving mother .191
b
.052 .139
a
.072 / .226 Full
Conditional/narcissistic mother .280
a
.196
a
.083
b
.017 / .157 Complementary
Punitive mother .216
a
.125 .091
a
.023 / .172 Full
Emotionally inhibited mother .265
a
.121 .144
a
.079 / .224 Full
Belittling mother .242
a
.104 .138
a
.074 / .214 Full
Perfectionistic mother .226
a
.140
b
.085
a
.022 / .157 Complementary
Perceived negative parenting experiences and restricting mediated by Detached Self-Soother
Overprotective father .290
a
.227
a
.066
a
.027 / .132 Complementary
Pessimistic/fearful father .214
a
.147 .068
a
.027 / .130 Full
Controlling father .204
a
.136 .069
a
.028 / .134 Full
Conditional/narcissistic father .284
a
.223
a
.062
a
.023 / .124 Complementary
Belittling mother .205
a
.125 .080
a
.033 / .144 Full
Emotionally inhibited mother .251
a
.178
b
.074
a
.029 / .143 Complementary
Punitive mother .200
a
.141 .058
a
.020 / .118 Full
Conditional/narcissistic mother .285
a
.221
a
.064
a
.026 / .123 Complementary
Perceived negative parenting experiences and compensatory behaviour mediated by Detached Self-Soother
Emotionally depriving mother .191
b
.089 .102
a
.052 / .173 Full
Conditional/narcissistic mother .280
a
.190
a
.089
a
.041 / .153 Complementary
Punitive mother .216
a
.136 .080
a
.033 / .144 Full
Emotionally inhibited mother .265
a
.168
b
.097
a
.048 / .166 Complementary
Belittling mother .242
a
.134 .109
a
.054 / .179 Full
Perfectionistic mother .226
a
.156
b
.069
a
.021 / .133 Complementary
a
Significant at the 0.01 level
b
Significant at the 0.05 level
Brown et al. Journal of Eating Disorders (2016) 4:27 Page 7 of 10
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
Binge-eating was not found to correlate with perceived
negative parenting, although this finding is likely to be a
function of the lack of Bulimia Nervosa/binge eating in
this sample.
These findings support previous theory suggesting the
need to consider developmental factors and the function of
ED behaviours in conjunction with maintenance factors,
when conceptualising and treating EDs [36, 39, 45, 54]. The
study also emphasises that treatment of EDs cannot rely
solely on trait-based factors (i.e. EMS), and intervening with
and understanding state factors (i.e. coping modes) should
inform the conceptualisation of eating disorder symptoms.
A major aspect of the Schema Mode Model is to challenge
unhelpful messages that may be derived from early experi-
ences and to build Healthy Adultcoping through a range
of cognitive, behavioural, interpersonal and experiential
techniques. Those with eating disorders are helped to rec-
ognise [previously unacknowledged] emotional needs, and
to internalise a sense of self-compassion that enables them
to begin to seek healthy relationships and interpersonal pat-
terns, which thereby enables them to get these needs met.
This is accomplished through a range of methods, includ-
ing limited reparenting techniques, imagery rescripting,
chair-work, and empathic confrontation [39].
Future studies in this area should extend the focus on
schema modes to investigate the relationship between par-
enting, eating disorder behaviours and other types of
modes (i.e. Parent and Child modes). Future studies
should also explore the role of other negative experiences
from childhood, including bullying, in the development of
EMS, schema modes, and ED behaviours.
Methodological considerations and limitations
A limitation of the current study is the fact that each of
the behaviours (restriction, binging, purging and overexer-
cising) were only measured with a single question, which
may not adequately capture the complexity of these be-
haviours. In order to minimise participant fatigue, only
the coping mode subscales of the SMI were included in
this study. Moreover, the current study also re-included
the Perfectionistic Overcontroller coping mode, despite it
being excluded from the original SMI. Both of these issues
may affect the reliability of the results. However, the fact
that this emerged as an important mode in this study pro-
vides further support for future research to use the re-
cently designed specialised SMI for EDs (SMI-ED), which
has been validated with this population (Simpson S,
Pietrabissa G, Rossi A, Frahn T, Manzoni M, Munro C,
Nesci J, Castelnuovo G. Factorial Structure of the
Schema Mode Inventory for Eating Disorders in a Clinical
Sample, in preparation). Further, all data was gathered via
self-report, which is subject to bias. While the cross-
sectional nature of the study does not allow for causal at-
tributions to be made, and perceptions of parenting styles
are subjective, the current study nevertheless provides evi-
dence that dysfunctional coping modes play a key role in
the relationship between perceived negative parenting and
ED psychopathology.
Conclusions
Our findings suggest that Overcompensatory, Avoidant
and Surrender coping mechanisms all appear to play a
role in the maintenance of eating disorder symptoms, and
that there are multiple complex relationships between
these and EMS that warrant further investigation. This
highlights the importance of early experiences and the po-
tential role of early interventions for younger clients and
their families as key to circumvent the development of
EMS and dysfunctional coping modes that may lead to
ED symptom development. The multitude of significant
pathways between particular parenting styles, coping
modes and restricting, bingeing and compensatory behav-
iour also highlight the complexity of ED psychopathology,
including the way in which ED behaviours can fulfil mul-
tiple functions. This underlines the need to move beyond
one-size-fits-all treatment approaches to more individua-
lised approaches that can identify and work with the [his-
torical] functional aspect of ED behaviours linked to
coping modes, whilst highlighting their self-sabotaging
role in the present. Schema Therapy facilitates the devel-
opment of more effective and adaptive coping behaviours
that directly focus on meeting emotional needs, whilst re-
ducing reliance on ED coping behaviours. Future research
that replicates the current findings, as well as research
into the efficacy of schema-mode therapy for treating ED
behaviours, is now warranted.
Acknowledgements
Goran Medos contributed to the final formatting of this manuscript.
Funding
Not applicable.
Availability of data and materials
The data that support the findings of this study are available from Susan
Simpson, University of South Australia upon reasonable request and with
permission of University of South Australia ethics committee.
Authorscontributions
JB prepared the final manuscript and performed statistical analyses, SSelth led
in the design and coordination of the study and drafted the first version of the
manuscript. SSimpson conceived the study in collaboration with SSelth,
supervised the coordination of the study and co-authored the final manuscript.
AS performed statistical analyses and prepared the results section of the
manuscript. All authors read and approved the final manuscript.
Competing interests
The authors declare that they have no competing interests.
Consent for publication
Not applicable.
Brown et al. Journal of Eating Disorders (2016) 4:27 Page 8 of 10
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
Ethics approval and consent to participate
Informed assent/consent to participate was obtained from all participants,
and all protocols were approved by The University of South Australia Human
Research Ethics Committee (HREC number) 0000031258.
Author note
This manuscript has not been published elsewhere, has not been
simultaneously submitted for publication elsewhere, and to the best of our
knowledge and belief, contains no material previously published or written
by another person, except where due reference is made.
Author details
1
School of Psychology, University of Adelaide, North Tce, Adelaide 5005, SA,
Australia.
2
Psychology Clinic, School of Psychology, Social Work, and Social
Policy, University of South Australia, Magill Campus, GPO Box 2471, Adelaide
5001, SA, Australia.
3
School of Education, Arts and Social Sciences, University
of South Australia, Adelaide, SA, Australia.
Received: 5 July 2016 Accepted: 25 October 2016
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... 28 Moreover, compliant surrender mode was found to mediate negative parenting and restrictive and compensatory behaviors in an Australian sample with eating disorder. 9 In terms of specific EMS, the most prevalent EMS in the studies were vulnerability, 8,12,20,24,25,27 dependence/ incompetence, 20,24,27 and failure, 20,25,27 from the second domain (impaired autonomy and performance), as well as abandonment 13,14,20,22 and emotional deprivation, 8,20,25 related to the first domain (disconnection/rejection). ...
... Furthermore, half of the studies presented limitations related to the use of self-reporting tools, which may contribute to biased responses and may increase the likelihood of association between the measures used. 8,9,[11][12][13]15,19,21,22,26,27 Use of instruments of retrospective analysis was considered a limitation in 31.8% of the studies, since participants may recall their most recent parenting experiences, be influenced by schemas currently in operation, facilitate distortions and allow inferences about perceived parenting behaviors. 10,11,13,23,25,27,28 One alternative would be to conduct longitudinal studies, which could minimize this effect if they evaluated the present moment -although memory distortions may still occur anyway, considering that the participant would not be answering questions about the present moment. ...
... Other limitations reported were the cross-sectional study designs, 8,9,[21][22][23] since no conclusions can be drawn on cause-effect relations between the variables investigated. An appropriate research study design would ideally include a prospective cohort study or multi-method approach, for example. ...
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Introduction: The present paper aims to identify and characterize studies that assess the repercussions of parental rearing styles on development of psychopathological symptoms and to examine the possible relations between parental rearing behaviors and development of early maladaptive schemas (EMS). Methods: A systematic search was conducted on the PsychNet, BVS, Scopus, Web of Science and PubMed databases for empirical studies published up to 2018 in Portuguese, English, or Spanish that investigated and characterized the effects of parental rearing styles. Results: The electronic search identified 321 articles on the various different databases, only 22 of which met the criteria for inclusion and were read in full. Correlations were found between EMS and maternal rejection, parental rearing styles and depression in the studies. EMS were also found to act as mediators in the relationship between parental rearing styles and/or education and dysfunctional symptoms during personality development. Conclusions: In the studies selected, parental rearing styles stood out from other variables that influence personality development and activation of schematic patterns. It is therefore important to highlight the importance of conducting studies in this area to provide information that can promote care and prevention strategies in early childhood.
... Preliminary conceptualizations of the ED population suggest that all three coping styles (avoidance, surrender and overcompensation) play a significant role in driving and perpetuating ED behaviors (Waller and Kennerley, 2003;Simpson, 2012). Recent evidence supports the notion that maladaptive coping modes mediate the relationship between perceived negative parenting and eating disorder symptoms (Sheffield et al., 2009;Brown et al., 2016). In particular, the "Eating Disorder Overcontroller (Coping) Mode (EDO)" has been proposed as highly relevant to the ED population in recent theoretical conceptualizations (Simpson, 2012(Simpson, , 2016, and supported by findings from a recent study (Brown et al., 2016). ...
... Recent evidence supports the notion that maladaptive coping modes mediate the relationship between perceived negative parenting and eating disorder symptoms (Sheffield et al., 2009;Brown et al., 2016). In particular, the "Eating Disorder Overcontroller (Coping) Mode (EDO)" has been proposed as highly relevant to the ED population in recent theoretical conceptualizations (Simpson, 2012(Simpson, , 2016, and supported by findings from a recent study (Brown et al., 2016). This mode is theoretically linked to the Unrelenting Standards schema, and functions as a form of overcompensation, whereby perfectionism, achievement, and competitiveness, often focused on the body and eating patterns, are utilized to provide distance from underlying feelings of vulnerability and distress by generating a sense of competence, omnipotence and control. ...
... In support of Lobbestael et al.'s (2010) original findings (Lobbestael et al., 2010), Vulnerable, Angry, Enraged, Undisciplined, Impulsive, and Contented Child modes and the two "parent" (or introject) modes retained some items from the original SMI, with the addition of some new items. The ED-Overcontroller Mode (EDO) was found to be differentiated in the SMI-ED, supporting the notion that what was previously identified as a clinically important concept forms a measurable and coherent mode (Simpson, 2012(Simpson, , 2016 and upholding previous findings (Brown et al., 2016). All of these were new items. ...
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Objective: The aim of this study was to examine the psychometric properties and factorial structure of the Schema Mode Inventory for Eating Disorders (SMI-ED) in a disordered eating population. Method: 573 participants with disordered eating patterns as measured by the Eating Disorder Examination Questionnaire (EDE-Q) completed the 190-item adapted version of the Schema Mode Inventory (SMI). The new SMI-ED was developed by clinicians/researchers specializing in the treatment of eating disorders, through combining items from the original SMI with a set of additional questions specifically representative of the eating disorder population. Psychometric testing included Confirmatory Factor Analysis (CFA) and internal consistency (Cronbach's α). Multivariate Analyses of Covariance (MANCOVA) was also run to test statistical differences between the EDE-Q subscales on the SMI-ED modes, while controlling for possible confounding variables. Results: Factorial analysis confirmed an acceptable 16-related-factors solution for the SMI-ED, thus providing preliminary evidence for the adequate validity of the new measure based on internal structure. Concurrent validity was also established through moderate to high correlations on the modes most relevant to eating disorders with EDE-Q subscales. This study represents the first step in creating a psychometrically sound instrument for measuring schema modes in eating disorders, and provides greater insight into the relevant schema modes within this population. Conclusion: This research represents an important preliminary step toward understanding and labeling the schema mode model for this clinical group. Findings from the psychometric evaluation of SMI-ED suggest that this is a useful tool which may further assist in the measurement and conceptualization of schema modes in this population.
... In addition, previous studies have noted the use of dysfunctional coping strategies by individuals with an ED [18,19] that contribute to the aetiology and maintenance of this problem [6,20]. Therefore, the behaviours characteristic of EDs can be employed as dysfunctional coping mechanisms to regain control over stressful circumstances [21]. ...
Article
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Eating disorders are vulnerability factors that increase the likelihood of intimate partner violence. However, the mechanisms underlying this relationship are unclear. Although eating disorders have been associated with increased perception and fear of loneliness, they have also been associated with increased social withdrawal resulting from decreased enjoyment of social situations and poorer social functioning. The purpose of the present study was to examine the mediating role of fear of loneliness in the relationship between the behavioural characteristics of eating disorders and intimate partner violence, as well as to explore the moderating role of social withdrawal in the relationship between fear of loneliness and intimate partner violence. The sample comprised 683 participants (78% female and 22% male) with a mean age of 21.14 years (SD = 2.72). The psychometric scales used were Eating Disorders Inventory (EDI 2), Emotional Dependency Questionnaire (EDQ), Coping Strategies Inventory (CSI) and the Violence Received, Exercised and Perceived in Youth and Adolescent Dating Relationships Scale (VREPS). The hypothesised model was tested by path analysis using maximum likelihood. The path analysis of the hypothesised model showed that inefficacy, fear of maturity, and impulsivity were the behavioural characteristics of eating disorders predominantly related to fear of loneliness. Fear of loneliness had no direct significant effect on any of the received violence variables. However, interaction effects indicated that there was a moderately significant effect of fear of loneliness on physical, psychological, and social violence received as a function of levels of social withdrawal. These findings show the need to take into account and work on fear of loneliness and social withdrawal among individuals with an eating disorder to decrease the likelihood of establishing violent intimate partner relationships. Improving interpersonal functioning and social support is key to recovery from eating disorders.
... In addition, previous studies have noted the use of dysfunctional coping strategies by individuals with an ED (Han et al., 2021;Hernando et al., 2019) that contribute to the aetiology and maintenance of this problem (Aouad et al., 2021;Brown et al., 2016). Therefore, the behaviours characteristic of EDs can be employed as dysfunctional coping mechanisms to regain control over stressful circumstances (Schlegl et al., 2020). ...
Preprint
Eating disorders are vulnerability factors that increase the likelihood of intimate partner violence. However, the mechanisms underlying this relationship are unclear. Although eating disorders have been associated with increased perception and fear of loneliness, they have also been associated with increased social withdrawal resulting from decreased enjoyment of social situations and poorer social functioning. The purpose of the present study was to examine the mediating role of fear of loneliness in the relationship between the behavioural characteristics of eating disorders and intimate partner violence, as well as to explore the moderating role of social withdrawal in the relationship between fear of loneliness and intimate partner violence. The sample comprised 683 participants (78% female and 22% male) with a mean age of 21.14 years ( SD = 2.72). The hypothesized model was tested by path analysis using maximum likelihood. The path analysis of the hypothesized model showed that inefficacy, fear of maturity, and impulsivity were the behavioural characteristics of eating disorders predominantly related to fear of loneliness. Fear of loneliness had no direct significant effect on any of the received violence variables. However, interaction effects indicated that there was a moderately significant effect of fear of loneliness on physical, psychological, and social violence received as a function of levels of social withdrawal. These findings show the need to take into account and work on fear of loneliness and social withdrawal among individuals with an eating disorder to decrease the likelihood of establishing violent intimate partner relationships. Improving interpersonal functioning and social support is key to recovery from eating disorders.
... Indeed, binge-eating episodes are commonly characterized by a feeling of being out of control during the eating episode. According to an emotion regulation explanation, they are not only the effect of dietary restraint but also of an avoidant self-soother coping mode (Luck et al., 2006;Waller et al., 2007;Brown et al., 2016;Simpson and Smith, 2019). The lack of self-control correlated with maternal emotional deprivation, abandonment, and unrelenting standards/ hypercriticism schemas. ...
Article
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Together with socio-cultural components, the family environment and early parent-child interactions play a role in the development of eating disorders. The aim of this study was to explore the nature of early parent-daughter relationships in a sample of 49 female inpatients with an eating disorder. To acquire a detailed image description of the childhood experiences of the patient, we used diagnostic imagery, a schema therapy-derived experiential technique. This procedure allows exploring specific contents within the childhood memory (i.e., emotions and unmet core needs), bypassing rational control, commonly active during direct verbal questioning. Additionally, patients completed self-report measures to assess for eating disorder severity, general psychopathology, and individual and parental schemas pervasiveness. Finally, we explored possible differences in the diagnostic imagery content and self-report measures in two subgroups of patients with anorexia nervosa and bulimia nervosa. The results showed that the most frequently reported unmet needs within the childhood memories of patients were those of safety/protection, care/nurturance, and emotional expression, referred specifically to the maternal figure. Overall, mothers were described as more abandoning, but at the same time particularly enmeshed in the relationship with their daughters. Conversely, patients perceived their fathers as more emotionally inhibited and neglecting. Imagery-based techniques might represent a powerful tool to explore the nature of early life experiences in eating disorders, allowing a more detailed case conceptualization and addressing intervention on early-life vulnerability aspects in disorder treatment.
... In the scope of the current literature on parenting, schema modes, and psychopathology (e.g., Bach & Farrell, 2018;Brown et al., 2016;Roelofs et al., 2016), significant relationships between schema modes and psychological symptoms were expected. Congruent with our expectations, the vulnerable child mode was central in both models. ...
Article
Abstract In this study, we investigated the mediator roles of anger-related schema modes in the relationship between dysfunctional parent modes and psychological symptoms. We focused on specific schema modes (i.e. punitive and demanding parent modes; vulnerable, angry, and enraged child modes; and the angry protector mode). The study included 297 college students (159 women), with the average age of the sample being 19.66 years (SD = 1.53, range = 18 to 29 years). All participants completed self-report questionnaires on schema modes and psychological symptoms, as well as a demographic form. We evaluated two different mediational models to understand two different dysfunctional parenting styles. The results suggest that all variables significantly correlated with each other and almost all the direct paths in the models were significant. However, the mediator analysis revealed that some of the anger-related modes had very low but significant mediator roles in the models (i.e. angry child mode for both models and enraged child mode for demanding parenting model). The vulnerable child mode played a central and key role in the relationship between dysfunctional parenting and psychological symptoms. This study suggested that anger representations might be windows to understand and intervene in the unmet core emotional needs. Keywords: schema modes, schema therapy, psychological symptoms, psychopathology, anger, parenting
... Thirty-two studies appropriately controlled for confounders in their analysis. Regarding the predictor, outcome, and mediator variables, some researchers improved the validity of their findings by using multiple instruments to assess constructs (e.g., Brown, Selth, Stretton, & Simpson, 2016;Carr & Francis, 2009). ...
Article
This is the first review to rigorously examine the mediating role of cognitive factors in the relationship between childhood trauma and subsequent adult psychopathology, and highlight areas for future research. A database search (Child Development & Adolescent Studies, ERIC, Global Health, PsycARTICLES, and PsycINFO) was conducted to identify empirical studies on cognitive factors, explaining the relationship between different types of adverse childhood experiences and adult psychopathology across clinical and nonclinical populations. A narrative synthesis and appraisal of the methodological quality of the studies was conducted. Ninety-eight mediation studies were identified, comprising 4,137 clinical and 28,228 nonclinical participants. Despite great variation in methodological quality of the studies, our narrative synthesis suggests that cognitive factors mediate the relationship between early trauma and later psychopathology. This finding is consistent across different measures of traumatic experiences, psychopathology, and cognitive mediators. Cognitive mediators represent potentially valuable intervention targets for (non)clinical patients who have experienced childhood adversity. Future studies are needed to (a) establish longitudinal causal connections, and (b) assess the effect of interventions that specifically target cognitive change in patients with different levels and types of pathology.
Article
Os transtornos alimentares causam problemas de saúde física e psicológico, prejudicando a qualidade de vida e em alguns casos, podendo levar a morte. Embora a maioria dos modelos de transtornos alimentares não considera as experiências iniciais como causas, as relações entre os eventos iniciais devem ser observadas. A terapia do Esquema é uma terapia cognitivo-comportamental, que vincula características psicológicas e problemas atuais às experiências da infância. Este estudo é uma revisão integrativa da literatura, apoiado por bases de dados internacionais. As buscas foram realizadas na Scopus, Web of Science, Pubmed, CAPES e BVS. Há evidência de que os Esquemas Iniciais Desadaptativos (EID’S) podem estar relacionados à compulsão alimentar e obesidade, sendo os domínios de Desconexão e Rejeição, Autonomia e Desempenho prejudicados e Limites prejudicados, mais evidentes. Portanto a identificação dos EIDs, bem como a terapia do esquema, seria uma alterativa de tratamento. Ainda há poucos estudos sobre o tema.
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Schema Mode Inventory (SMI) is an instrument developed to measure the most frequent Schema Modes that are present in an individual's life. It is an exploratory questionnaire, used for both therapeutic and research purposes and aims to get an overview of the Schema Modes that a particular patient shows most often. The aim of this research was to carry out a review of the literature on SMI, focusing on validation and use. Through two search strategies, the first is a search for the keyword Schema Mode Inventory and the second is a manual search, we found 253 works in the databases (PubMed, PsycInfo, Google Scholar), belonging to the last 11 years, of which 45 met the inclusion criteria. Of these, 36 proposed to use the SMI to evaluate some psychological theme and 09 sought their validation. Among the psychological themes encountered, Personality Disorder stands out as the most targeted analysis of Schema Modes. Finally, it was observed through the review that with the course of the years, there is a growing use and validation of the instrument in several countries, although no empirical studies have been done in Brazil.
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Background: Little research has investigated the use of evidence-based guidelines by eating disorder (ED) therapists, or prescribing of psychotropic medication. Moreover, people with EDs have rarely been surveyed on these topics, and their clinical and demographic features have not been presented. This study investigated perception of psychotherapy, psychotropic medication and the clinical characteristics of a community sample of people with EDs. Method: An online survey methodology was used to recruit 253 people with eating disorders in the community. Where feasible, comparisons were made between four types of eating disorder, anorexia nervosa, bulimia nervosa, and two types of atypical or 'sub-threshold' eating disorder. Results: Unlike medication, reported psychotherapy showed some congruence with evidence based and other guidance. Most participants were currently receiving either psychotherapy, medication or both, and most had a severe and chronic ED. Conclusions: Findings are considered in light of use of evidence-based treatment for EDs, calls for greater dissemination of cognitive behaviour therapy (CBT); indications that much may be poor quality; and the importance of what treatments to offer those who are chronically and severely ill. Development of theory and novel treatments is considered a priority.
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The aim of this study was to examine the association between eating disorders (ED) and schema modes, and identify which specific schema modes are associated with particular eating disorders, including anorexia nervosa (AN), bulimia nervosa (BN) and other specified feeding or eating disorder (OSFED). A total of forty seven women with eating disorders and 89 women from the community participated in this study. Eating disorder diagnosis was determined by a clinician treating the eating disorder and was confirmed on the basis of Body Mass Index (BMI) and the Eating Disorder Examination Questionnaire (EDE-Q). The Schema Mode Inventory (SMI) was used to explore the association between schema modes and eating disorder diagnostic status. A series t-tests revealed that when compared to the community sample, the ED group scored significantly higher on 10 out of 12 maladaptive schema modes, and significantly lower on both adaptive schema modes. A series of planned contrasts revealed that the AN, BN, and OSFED groups each scored significantly higher than the community sample group in the majority of maladaptive schema modes, with slight variations between groups. Further, AN, BN, and OSFED groups each scored significantly lower than the community sample group for the two SMI scores categorized as adaptive. All Cohen’s d that reached significance ranged 0.55-2.24. The current study shows a tendency for females with eating disorders to rely on maladaptive schema modes more frequently, and more adaptive schema modes less frequently compared to a community sample. These findings provide initial empirical support for a schema mode model of eating disorders.
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Background Current literature on Eating Disorders (EDs) is devoid of evidence-based findings providing support to effective treatments, mostly for anorexia nervosa (AN). This lack of successful guidelines may play a role in making these disorders even more resistant. In fact, many individuals do not respond to the available treatments and develop an enduring and disabling illness. With this overview we aimed to highlight and discuss treatment resistance in AN – with an in-depth investigation of resistance-related psychological factors. A literature search was conducted on PubMed and PsychINFO; English-language articles published between 1990 and 2013 investigating the phenomenon of resistance to treatment in AN have been considered. Discussion The selected papers have been then grouped into four main thematic areas: denial of illness; motivation to change; maintaining factors and treatment outcome; and therapeutic relationship. Eating symptomatology was found to only partially explain resistance to treatment. The role of duration of illness has been questioned whilst some maintaining factors seemed promising in providing a useful framework for this phenomenon. Emotive and relational aspects have been investigated on their role in resistance as well as therapists’ countertransference. Summary Remarkably there has been little research done on resistance to treatment in the ED field, in spite of its clinical relevance. Motivation, insight and subjective meaning of the illness can be useful tools to manage the resistance phenomenon when coupled with a wider approach. The latter enables the therapists to be aware of their role in the therapeutic alliance through countertransference aspects and to consider the EDs as disorders of the development of both personality and self, entailing severe impairments as regards identity and relationships.
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Background While self-talk has been argued to play a crucial role in the development and maintenance of eating disorders (EDs), it has received limited research attention. This study aimed to explore the relationship of ED self-talk with ED severity and symptomatology. Methods Analysis of the existing literature, supplemented with a small-scale pilot study, identified 24 distinct categories of ED self-talk. The main study involved the completion of on-line questionnaires by 172 women aged 18–49, recruited through clinical services, ED websites, and the general population. Participants were assigned to clinical (n = 83) and non-clinical (n = 89) samples, using the Eating Disorder Examination Questionnaire to screen for ED psychopathology. Results Substantial differences in the levels of ED self-talk were found between the clinical and non-clinical populations. Principal components analysis, conducted within the clinical sample, revealed ED self-talk to have a two-component structure. Self-talk reflecting an ‘abusive relationship’ between the sufferer and the ED strongly predicted overall severity and several aspects of symptomatology. ‘Ascetic attitudes’ towards thinness were linked with compulsive exercising and lower BMIs but not with overall severity. Conclusions Close examination of the ‘abusive relationship’ component suggests a need to loosen the connection between negative appraisals of the abused self and the abusive voice of the ED so that the former can fulfil their potential as a force for change. Further, in seeking to counter the impact of the ED voice, it is suggested that the seducer and abuser roles require primary clinical focus.
Article
Cognitive-behavioural therapy (CBT) is the recommended treatment for binge eating, yet many individuals do not recover, and innovative new treatments have been called for. The current study compares traditional CBT with two augmented versions of CBT; schema therapy, which focuses on early life experiences as pivotal in the history of the eating disorder; and appetite-focused CBT, which emphasises the role of recognising and responding to appetite in binge eating. 112 women with transdiagnostic DSM-IV binge eating were randomized to the three therapies. Therapy consisted of weekly sessions for six months, followed by monthly sessions for six months. Primary outcome was the frequency of binge eating. Secondary and tertiary outcomes were other behavioural and psychological aspects of the eating disorder, and other areas of functioning. No differences among the three therapy groups were found on primary or other outcomes. Across groups, large effect sizes were found for improvement in binge eating, other eating disorder symptoms and overall functioning. Schema therapy and appetite-focused CBT are likely to be suitable alternative treatments to traditional CBT for binge eating.
Article
Objective: Internal "anorexic voices" are commonly described by individuals with eating disorders. This study examines whether the perceived power and nature of that voice are related to eating pathology in anorexia nervosa. Method: Sixty-three women and one man with an ICD-10 diagnosis of anorexia nervosa participated in this study (mean age = 27.3 years; mean BMI = 16.0). Participants completed questionnaires measuring severity of eating pathology, perceived voice power, and beliefs about voices, either at the start or during treatment. Results: A more powerful anorexic voice was associated with more negative eating attitudes in this clinical group. However, BMI was related to a moderating effect, with the interaction of greater voice power and malevolence being associated with a lower BMI. Discussion: These findings suggest the anorexic voice may function as a maintenance factor in anorexia nervosa. Cognitive models of hearing voices may be applicable to disorders other than psychosis. Further explorations are warranted. © 2016 Wiley Periodicals, Inc. (Int J Eat Disord 2016).
Article
While perfectionism is widely considered to influence risk for eating disorders, results of longitudinal studies are mixed. The goal of the current study was to investigate a more complex model of how baseline perfectionism (both high personal standards and self-critical evaluative concerns) might influence change in risk status for eating disorders in young adolescent girls, through its influence on ineffectiveness. The study was conducted with 926 girls (mean age of 13 years), and involved three waves of data (baseline, 6- and 12-month follow-up). Latent growth curve modelling, incorporating the average rate at which risk changed over time, the intercept (initial status) of ineffectiveness, and baseline perfectionism, was used to explore longitudinal mediation. Personal standards was not supported as contributing to risk but results indicated that the higher mean scores on ineffectiveness over the three waves mediated the relationship between higher baseline self-critical evaluative concerns and both measures of eating disorder risk. The relationship between concern over mistakes and change in risk was small and negative. These results suggest the usefulness of interventions related to self-criticism and ineffectiveness for decreasing risk for developing an eating disorder in young adolescent girls. Copyright © 2015 Elsevier Ltd. All rights reserved.