Family, friends, and feelings: the role of relationships to parents and peers and alexithymia in adolescents with anorexia nervosa

Plain English summary Anorexia nervosa is an eating disorder that affects mostly adolescent and young adult women. Individuals with anorexia nervosa often report problems in their relationships to close persons, e.g., to their parents or peers. Relationships to parents as well as peers undergo major changes during adolescence (with peer relationships gaining major importance), therefore, the present study focused on adolescent girls with anorexia nervosa and assessed the quality of their relationships to parents and peers. As expected, girls with anorexia nervosa reported poorer quality of relationships to their parents and especially to peers compared to healthy girls. Relationship quality was negatively associated with eating disorder symptoms, i.e., the lower relationship quality, the more pronounced were eating disorder symptoms. These results underline that treatment should not only focus on family relationships but also address relationships to peers with therapists encouraging adolescents with anorexia nervosa to establish and maintain friendships. Furthermore, the study revealed that alexithymia (a psychological characteristic involving difficulties in recognising and talking about one's emotions) plays an important role in explaining the interplay between interpersonal relationships and eating disorder symptoms. However, the direction of effects remains unknown and further studies are needed to elucidate the mechanisms through which problems in relationships with close persons exert their influence on eating disorder symptoms and vice versa. Background Anorexia nervosa (AN) is associated with impairments in socio-emotional functioning, including difficulties in interpersonal relationships as well as alexithymia (difficulties identifying and describing one's emotions). Although the onset of the disorder is mostly in adolescence, a developmental period in which interpersonal relationships to parents as well as peers undergo major changes, only few studies have investigated the quality of interpersonal relationships in adolescent AN patients. Furthermore, the mechanisms linking poor relationship quality to eating disorder psychopathology are not yet clarified, albeit some research suggests that alexithymia might play a pivotal role. The aims of the present study were investigating the quality of interpersonal relationships to parents and peers in adolescents with AN compared to healthy adolescents as well as exploring the mediating role of alexithymia in the association between relationship quality and eating disorder symptoms. Methods Self-report questionnaires were used to assess relationship quality (Inventory of Parent and Peer Attachment) and alexithymia (Toronto Alexithymia Scale) in 12-18 year old female adolescents with AN (n = 35) in comparison to healthy adolescents (n = 40). Results Adolescents with AN reported lower relationship quality to both of their parents and to peers compared to healthy controls. Relationship quality scores were negatively correlated to alexithymia as well as eating disorder symptoms. Alexithymia fully meditated the association between eating disorder symptoms and relationship quality to parents and partially mediated the association between eating disorder symptoms and relationship quality to peers. Conclusion The results indicate difficulties in interpersonal relationships among adolescents with AN and emphasize the role of peer relationships for adolescents' eating disorder psychopathology. Alexithymia seems to play an important role in explaining the link between quality of relationships and eating disorder psychopathology. Results suggest that treatment should not only focus on family relationships but also address relationships to peers as well as adolescents' competence in identifying and dealing with their emotions.