Study of parental bonding in childhood in children and adolescents with anorexia nervosa

Introduction. - Anorexia nervosa constitutes a severe and complex eating disorder occurring principally in adolescence. It is one of the most deadly psychiatric disorders. Considering the multifactorial nature of anorexia nervosa, the important place of the family and the growing interest in the theory of attachment in eating disorders, parental bonding is questioned in anorexia nervosa. The main study goal is to analyze parental bonding in a population of children and adolescents with anorexia nervosa. The secondary objective is to study differences according to the age group. Method. - We realized an observational pilot study in Bordeaux over a period from June 2015 to April 2017. Twenty five young girls with anorexia nervosa, aged 10 to 17 years, hospitalized in the department of child and adolescent psychiatry and department of eating disorders have been included and divided into two groups: peripubertal for children under 14 and pubertal for children aged 14 to 17 years. We met them individually to complete a series of questionnaires including the Parental Bonding Instrument (for assessing attachment), the Mini International Neuropsychiatry Interview for Children and Adolescent (for detecting the presence of comorbidity) and a structured questionnaire for collecting general information on anorexia nervosa. Results. - Results revealed high parental care, high maternal and paternal overprotection with predominantly "optimal" parenting style followed by "affectionate constraint" style. Significant differences were observed in anorexia nervosa patients with maternal (P= 0.011) and paternal (P= 0.085) overprotection in pubes compared to peripubertal. In correlation analysis, there was a positive correlation between maternal protection and age of diagnosis and a negative correlation between parental care and duration of illness. Furthermore, the maternal overprotection tended to be correlated significantly and positively with the age of the diagnosis and the paternal overprotection with the body mass index. Conclusion. - Our study shows a rating by the parents of warm and understanding parents, an over-protective mother and a father encouraging autonomy. There is maternal and paternal overprotection in pubertal anorexia nervosa compared with peripubertals. Our results suggest the importance of analyzing parenting style in addition to Parental Bonding Instruments results and of supporting the importance of the development of family therapy in the anorexia nervosa. (C) 2018 L'Encephale, Paris.