Exploring the Multifaceted Burdens and Experiences of Parents With a Child Diagnosed With Anorexia Nervosa: A Psychological Network Analysis.

Objective: Parents of children diagnosed with anorexia nervosa (AN) are facing multiple burdens when caring for their child. This study uses a psychological network approach to identify central factors among parental caregiving burdens and experiences which then can constitute promising targets for caregiver interventions.

Method: A total of 348 parents (247 mothers, 101 fathers) of children diagnosed with AN (96% female, 90% restrictive type) provided data including parental psychopathology, eating-disorder related burden, high-expressed emotion and perceived caregiver skills at baseline and after having participated in a parental skills training, multi-family therapy or systemic family therapy. Regularized partial correlation networks including 14 variables were estimated for baseline and follow-up data were estimated.

Results: High-expressed emotion, particularly parental emotional overinvolvement emerged as the most central variable in the network showing substantial correlations with depression and low self-care behavior. Emotional overinvolvement also functioned as a bridge variable between parental psychopathology, perceived caregiver skills, and eating disorder-related burden. Moreover, parental criticism was strongly associated with burden due to the child's confrontational behavior and low levels of parental frustration tolerance. Network comparison tests neither revealed statistically significant differences in network structure and global network strength between baseline and follow-up, nor between mothers and fathers.

Discussion: This study highlights the importance of parental high-expressed emotion as a promising treatment target. Adding or intensifying intervention components promoting parental emotion regulation strategies as well as intensified training in Motivational Interviewing may be useful therapeutic approaches to decrease overall parental burden.